There has been increased attention given to the radial tunnel syndrome since Roles and Maudsley first described it in 1972. The occurance of radial tunnel syndrome is due to the following four anatomical causes: the fibrous bands in front of the "radial head, the radial recurrent fan" of vessels, and the tendinous margins of extensor carpi radialis brevis and of the arcade of Frohse. In these cases, the progressive paralysis of the posterior interosseous nerve was caused by the arcade of Frohse and the radial recurrent artery. The results of splitting the arcade of Frohse and dividing the radial recurrent artery have been sufficiently good in all 3 cases.
Arteries ; Head ; Paralysis

No abstract available.
Humans ; Temporomandibular Joint

PURPOSE: Steatocystoma is a cyst that originates embryologically from hair follicles and usually occurs on the face, chest, back and axillae as multiple lesions and rarely occurs as a solitary lesion. We experienced a case of steatocystoma simplex that developed in the orbit and present our case with a brief review of the literature. CASE SUMMARY: A 44-year-old male presented with a history of palpable mass in the right inferomedial periorbital area that had been slowly growing for a few months. Physical examination revealed a non-tender, soft and round mass. Magnetic resonance imaging of the orbit showed 2.0 x 2.0 x 2.0 cm-sized mass in the right inferomedial orbit. We performed excisional biopsy of the orbital mass using transconjunctival approach. The pathological diagnosis was steatocystoma. There was no local recurrence during the postoperative follow-up. CONCLUSIONS: We experienced a rare case of steatocystoma simplex that developed in the orbit. Base on our results, steatocystoma simplex should be considered when diagnosing an orbital mass.
Adult ; Axilla ; Biopsy ; Diagnosis ; Follow-Up Studies ; Hair Follicle ; Humans ; Magnetic Resonance Imaging ; Male ; Orbit* ; Physical Examination ; Recurrence ; Thorax

BACKGROUND: The purpose of this study was to determine that the assessment of serum neuron specific enolase(NSE) could provide a reliable early predictor of neurologic outcome after cardiac arrest. METHODS: Prospective, observational study was performed from April 1996 to March 1998 at a university teaching hospital ED. Serum NSE concentrations were analysed twice at 24 and 48 hours after return of spontaneous circulation(ROSC). Neurologic outcome was categorized using cerebral performance category(CPC). RESULTS: Twenty-nine patients(16 were men) were enrolled during the study period. The mean age was 50.8 years. Nine(31%) of them showed good outcome defied as CPC 1-3, and 20(69%) patients showed bad outcome defied as CPC 4-5. In the good outcome group, the serum NSE was revealed 33.8+/-9.3 ng/ml at 24 hours, 34.0+/-4.73 ng/ml at 48 hours. While in the bad outcome group, it was 99.5+/-11.7 ng/ml and 114.6+/-15.8 ng/ml. The NSE at 48hr after ROSC was more prescise than that of 24hr. When the cutoff value of 50 ng/ml at 48 hr, the sensitivity was 82%, and specificity was 93%. CONCLUSION: This study suggest that the serum NSE may represent a valuable, noninvasive, and useful clinical tool for prediction of neurologic outcome after cardiac arrest.
Heart Arrest* ; Hospitals, Teaching ; Humans ; Neurons* ; Observational Study ; Phosphopyruvate Hydratase* ; Prospective Studies ; Sensitivity and Specificity

OBJECTIVE: The aim of this study was to describe and evaluate the clinical data and short-term treatment response in patients with obsessive-compulsive disorder (OCD) based on an outpatient setting. METHODS: A group of patients with OCD underwent mean 12-weeks treatment with selective serotonin reuptake inhibitors. The patients were divided into two groups according to treatment response, defined as a reduction of the Yale-Brown Obsessive Compulsive Scale total score >35% and CGI of 1 or 2. RESULTS: 1) Among the 249 patients, 24.1% had checking type and 23.7% washing type. Among these two types, 31.9% had mood disorder, 15.0% had anxiety disorder and 24.5% personality disorder as co-morbidity. One hundred fourteen patients (45.8%) responded to the treatment and 135 (54.2%) did not. The responders decreased Y-BOCS scores from 27.9+/-7.2 at baseline to 21.3+/-6.4 and 19.3+/-3.8 at post-treatment 8 and 12 weeks, respectively (repeated measure ANOVA, p=0.039). There were no differences among the treatment responses to serotonin reuptake inhibitors. CONCLUSION: About half of the OCD patients showed a response to pharmacological treatment using SSRI in the outpatient clinic setting for 12 weeks. Long-term and contrast studies of OCD may elucidate further clinical aspects of this disorder in the future.
Ambulatory Care Facilities ; Anxiety Disorders ; Comorbidity ; Humans ; Mood Disorders ; Obsessive-Compulsive Disorder* ; Outpatients ; Personality Disorders ; Serotonin Uptake Inhibitors

We report a case of reversible encephalopathy syndrome in a 16-year-old girl with acute myelogenous leukemia (AML), who is undergoing during consolidation chemotherapy composed of BH-AC (N4-behenoyl-1-beta-D-arabinofuranosyl cytosine) and idarubicin. On the 6th day of chemotherapy, she was in a drowsy state following generalized tonic clonic seizure lasting 20 minutes. MR images revealed extensive cortical and subcortical white matter brain edema. Alertness returned over the 24 hr following by the discontinuation of BH-AC and intravenous administration of diphenylhydantoin, although she complained of intermittent headaches and visual disturbance. She gradually recovered from these symptoms during subsequent 7 days. Previously noted abnormal signal intensities have nearly disappreared on follow-up MRI obtained on the 22nd day after the first seizure. She was discharged without any neurologic sequela. This case suggests that BH-AC, a derivative of cytosine arabinoside (1-beta-D-arabinofuranosylcytosine) could be a cause of reversible encephalopathy syndrome.
Adolescence ; Antineoplastic Agents/therapeutic use ; Antineoplastic Agents/adverse effects* ; Brain/radiography ; Case Report ; Cytarabine/therapeutic use ; Cytarabine/analogs & derivatives* ; Cytarabine/adverse effects ; Female ; Human ; Leukemia, Myelocytic, Acute/drug therapy ; Leukemia, Myelocytic, Acute/complications* ; Magnetic Resonance Imaging ; Seizures/radiography* ; Seizures/chemically induced

The rapid development of psychotropic drugs and great advancement in psychopharmacology during the past recent years has altered the strategy of pharmacotherapy for major psychiatric disorders, and in turn, an active development of various clinical practice guidelines or algorithm has taken place. However, there could be problems with applying the foreign guidelines directly to our clinical situation, due to the differences in racial characteristics, socioeconomic conditions, government policy, and clinical practices. In addition, the changes of circumstances outside of clinical situation in Korea may distort clinical practices and may go even against the trend of recent psychopharmacology. As a solution to such problems, Korean Medication Algorithm Project for Major Psychiatric Disorders (KMAP) was launched with the support from the Korean Society of Psychopharmacology and Korean Academy of Schizophrenia. However, since clinical practice guidelines and algorithms contain not only the advantages, but also disadvantages and risks, sufficient consideration must precede the development of algorithms. Hence, this review provides a discussion on the definition of clinical guideline and its limitation, its advantages and disadvantages, and the need for the development of clinical guideline in psychiatric field. Also, developing source, dissemination and implementation of clinical practice guidelines were also discussed. We hope that this review can make the purpose of KMAP clear and elicit the productive criticism on Korean algorithm.
Drug Therapy ; Hope ; Korea ; Psychopharmacology ; Psychotropic Drugs ; Schizophrenia

Fascioliasis is a zoonotic disease caused by Fasciola hepatica, a liver fluke, for which human acts as an accidental host. Fascioliasis, while common in some tropical countries, is rare in Korea. Endoscopie retrograde cholangiopancreatography(ERCP) has been described in only a very few cases as a useful technique for the diagnosis of fascioliasis. We report a case of fascioliasis diagnosed by ERCP, after endoscopic sphinchterotomy adult worms were removed by Dormia basket.
Adult ; Biliary Tract* ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis ; Fasciola hepatica ; Fascioliasis* ; Humans ; Korea ; Pancreas* ; Sphincterotomy, Endoscopic ; Zoonoses

BACKGROUND: To the emergency physician, issuing a death certificate is becoming a burden as the DOAs(Deaths on Arrival) have increased in recent years. We analyzed the agreement on the causes of death issued by emergency physicians and attempted to find out whether emergency physicians complied with the guidelines for issuing death certificates. MATERIAL AND METHOD: A survey questionnaire containing twelve pre-selected DOA cases which were supplemented with relevant past medical history and physical examination was used. The cases, with varying causes of death, were chosen from the medical records of DOA patients who presented to the emergency department at Severance Hospital, Yonsei University College of Medicine, from January 1997 to December 2000. The questionnaires were sent to 60 emergency physicians(22 specialists and 38 residents) at 22 university-affiliated teaching hospitals and 2 general hospitals across the nation. They were asked to identify the most probable direct cause of death for each of the 12 cases. The same questionnaire was sent to medical examiners at the National Institute of Scientific Investigation and to a Korean emergency physician at Albert Einstein College of Medicine in New York, USA. We also included an open question about the optimal age for the use of 'senility' as a cause of death. RESULTS: All 60 emergency physicians responded to the survey. The average number of causes of death per case was 9.7(7~14). The range of concordance of causes of death was 23.3% to 66.6%. Out of a total of 720 causes of death given by the emergency physicians, 35(4.9%) failed to adhere to the death certification guidelines. Also, 210 causes of death were not listed in the Korean classification of standard causes of death. Interestingly, the medical examiner answered 'unknown etiology' and the emergency physician in the USA answered 'cardiopulmonary arrest' or 'respiratory arrest' in most cases. Regarding 'senility' as a cause of death, 22 physicians(36.7%) thought the optimal age was over 80 years. CONCLUSION: A significant lack of agreement exists in determining the cause of death for the DOA patients arriving at emergency departments. Therefore, an all-out effort is essential to find ways to improve and resolve this situation. As the death certificate is a legal document and a basis for vital statistics, emergency physician should seek a rational consensus to improve and resolve these inconsistencies.
Cause of Death* ; Certification ; Classification ; Consensus ; Coroners and Medical Examiners ; Death Certificates* ; Emergencies ; Emergency Service, Hospital ; Hospitals, General ; Hospitals, Teaching ; Humans ; Medical Records ; Physical Examination ; Surveys and Questionnaires ; Specialization ; Vital Statistics

Peripheral primitive neuroectodermal tumor (pPNET), a rare, highly aggressive neoplasm of indetermined histogenesis, occurs typically in the soft tissues of the chest wall and the paraspinal region. Comprehensive diagnostic studies including histological, ultrastructural, immunohistochemical and molecular analyses have been stressed to diagnose this entity. We report a case of primary renal PNET which was incidentally found in a 59-year-old man who presented with generalized weakness for 4 months. He was diagnosed as a non-insulin dependent diabetes mellitus 15 years ago and has been made well by oral therapy. An ill-defined mass, measuring 3.5 3 cm, located in the left kidney and perirenal fat, was incidentally found by ultrasonogram during a renal diabetic examination. The mass was resected because of the unresponsiveness against one-year chemotherapy and radiation therapy. Grossly, a homogeneously solid, gray-white mass, measuring 2.8 1.8 cm, was noted in the mid portion of renal cortex. The mass showed severe adhesion to the perirenal fatty tissue. Microscopically, tumor cells were rather uniform, small round with scanty cytoplasm and often showed rosette formation. Ultrastructurally, they showed membrane-bound dense core granules, measuring 125~150 nm, intercellular junctions and microvillous cytoplasmic projections. The tumor cells were uniformly immunoreactive for neuron-specific enolase and were focally immunoreactive for CD99 (013), chromogranin, synaptophysin and cytokeratin. They were not reactive for S-100 protein, vimentin, Leu-7, leukocyte common antigen, desmin and smooth muscle actin. To our knowledge, this is the smallest renal PNET in literature.
Actins ; Adipose Tissue ; Antigens, CD45 ; Cytoplasm ; Desmin ; Diabetes Mellitus ; Drug Therapy ; Humans ; Intercellular Junctions ; Keratins ; Kidney* ; Middle Aged ; Muscle, Smooth ; Neuroectodermal Tumors, Primitive* ; Phosphopyruvate Hydratase ; Rosette Formation ; S100 Proteins ; Sarcoma, Ewing ; Synaptophysin ; Thoracic Wall ; Ultrasonography ; Vimentin