No abstract available.
Hyperlipidemias* ; Hypertension* ; Mass Screening*

OBJECTIVE: The aim of this study is to evaluate the clinical course of intracranial aneurysm in patients aged 65 years and older and the immediate outcome after its aggressive management. MATERIALS AND METHODS: We performed a retrospective analysis using the medical records of 159 elderly patients managed at our institute from September 2008 to December 2013. Obtained clinical information included age, sex, Hunt and Hess grade (HHG), aneurysm location, Fisher grade (FG) and the treatment modality. Concomitant clinical data aside from cerebrovascular condition (hypertension, diabetes, previous medication) were evaluated to determine risk factors that might affect the functional outcomes. RESULTS: A total of 108 patients (67.9%) presented with subarachnoid hemorrhage (SAH), and 51 (32.1%) with unruptured intracranial aneurysms (UIAs). Coiling was performed in 101 patients and 58 patients underwent clipping. In the SAH population, 62 patients (57.4%) showed favorable outcomes, with a mortality rate of 11.3% (n = 18). In the UIAs population, 50 (98%) patients achieved 'excellent' and one (2%) achieved 'good' outcome. Factors including high-grade HHG (p < 0.001), advanced age (p = 0.014), and the presence of intraventricular hematoma (IVH) (p = 0.017) were significant predictors of poor outcome. CONCLUSION: SAH patients with high grade HHG and IVH are associated with poor outcome with statistical significance, all the more prominent the older the patient is. Therefore, the indication for aggressive therapy should be considered more carefully in these patients. However, as the outcomes for elderly patients with UIAs were excellent regardless of the treatment modality, aggressive treatment could always be considered in UIAs cases.
Aged* ; Aneurysm ; Hematoma ; Humans ; Intracranial Aneurysm* ; Medical Records ; Mortality ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage

We experienced a case of non-Hodgkin's lymphoma presented only as right side pleural effusion, that is primary effusion lymphoma (PEL), in a 75 year-old male patient in Korea where is the endemic area of tuberculosis. He visited our hospital complaining of exertional dyspnea. He did not have B symptoms. The breathing sound was decreased on the right side chest, but we could not find external lymphadenopathy or hepatosplenomegaly on physical examination. Simple chest radiograph showed right side pleural effusion. The cells of pleural fluid were lymphocyte-predominant and the pH, protein, lactate dehydrogenase, adenosine deaminase of the fluid was 7.31, 38 g/L, 381 U/L, 31 U/L, respectively. The biopsy specimen of the parietal pleura was diagnosed as non-Hodgkin's lymphoma of small lymphocytic type. Computed tomograph of the chest, abdomen and pelvis, and the biopsy of bone marrow were negative for disease. We tried up to 3 cycles of chemotherapy with adriamycin, vincristine, cyclophosphamide and prednisolone and there was a marked decrease in the amount of the pleural effusion.
Abdomen ; Adenosine Deaminase ; Aged ; Biopsy ; Bone Marrow ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Dyspnea ; Humans ; Hydrogen-Ion Concentration ; Korea ; L-Lactate Dehydrogenase ; Lymphatic Diseases ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Lymphoma, Primary Effusion ; Male ; Pelvis ; Physical Examination ; Pleura ; Pleural Effusion* ; Prednisolone ; Radiography, Thoracic ; Respiratory Sounds ; Thorax ; Tuberculosis ; Vincristine

No abstract available.
Rho(D) Immune Globulin*

Actinomycosis is a chronic suppurative and granulomatous disease caused by Actinomyces species and characterized by sulfur granule formation. Depending on the site of primary infection, it is generally classified as cervicofacial, thoracic and abdominal type. Abdominal actinomycosis is often difficult to diagnose before operation because of low frequency and no characteristic clinical features of the disease. As it progresses chronically, it can be misdiagnosed such as cancer, inflammatory bowel disease or other abscess. The diagnosis is usually based on histologic demonstration of sulfur granules in pus or surgically resected specimen. In vast majority of cases, treatment has consisted of long-term antibiotic therapy coupled with surgical resection. We experienced a case of colonic actinomycosis initially diagnosed as Dieulafoy's ulcer and confirmed by colonoscopic biopsy. Treatment with intravenous penicillin for 4 weeks was successful independently, and we report this case with a brief review of literatures.
Abscess ; Actinomyces ; Actinomycosis* ; Biopsy ; Colon ; Colonoscopy ; Diagnosis ; Inflammatory Bowel Diseases ; Penicillins ; Sulfur ; Suppuration ; Ulcer*

No abstract available.
Education*

In this study, we evaluated the effects of fentanyl, midazolam, and fentanyl-midazolam on cardiovascular system and blood glucose during endotracheal intubation in forty normotensive patients scheduled for elective surgery under general anesthesia. The patients were randomly classified into four groups; Group I (control) received tracheal intubation with thiopental 5 mg/kg (n=10), group II received tracheal intubation with fentanyl 6 ug/kg followed by thiopental 2 mg/ kg (n=10), group III received tracheal intubation with midazolam 0.3 mg/kg (n=10), group IV received tracheal intubation with fentanyl 4 ug/kg followed by midazolam 1 mg/kg (n=10). The changes of systolic blood pressure, diastolic blood pressure, mean arterial blood pressurie, heart rate, and blood glucose were compared in each group. The results were as follows; 1) In group I, endotracheal intubation caused a significant rise in SBP, HR and blood glucose. 2) In group II, endotracheal intubation caused little changes in SBP, DBP,MAP and blood glucose but HR was rised. 3) In group III, endotracheal intubation caused little changes in SBP, DBP, MAP, HR and blood glucose. 4) In group IV, endotracheal intubation caused little changes in SBP, DBP, MAP, HR and blood glucose.
Anesthesia, General ; Blood Glucose* ; Blood Pressure ; Cardiovascular System* ; Fentanyl* ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal ; Midazolam* ; Thiopental

No abstract available.
Humans

Mycophenolate mofetil (MMF) is a immunosuppressive agent increasingly used in organ transplantation and autoimmune disease. We report a case about use of MMF in SLE patient with rapidly worsening renal function. A 24-year old female was admitted due to 1-week history of generalized edema. Despite use of diuretics and conventional supported care, generalized edema was more aggravated and serum creatinine was elevated up to 5.2 mg/dL. Ten days after the initial admission, we started hemodialysis. After hemodialysis, improvement of generalized edema was achieved. Eighteen days after initial hemodialysis, we started corticosteroids and MMF because she shows persistent heavy proteinuria and oliguria. After use of corticosteroids and MMF, clinical improvement of renal complication was achieved in this patient. About 6 weeks later, we could discontinue hemodialysis. On two year follow up duration, she shows good renal function and no evidence of lupus flare-up signs. We suggest MMF is one of therapeutic options for patients with severe lupus nephritis, especially those refractory or intolerant to conventional cytotoxic agents.
Acute Kidney Injury* ; Adrenal Cortex Hormones ; Autoimmune Diseases ; Creatinine ; Cytotoxins ; Diuretics ; Edema ; Female ; Follow-Up Studies ; Humans ; Lupus Nephritis* ; Oliguria ; Organ Transplantation ; Proteinuria ; Renal Dialysis ; Transplants ; Young Adult

No abstract available.
Lutein* ; Lymphangioma, Cystic*