No abstract available.
Anencephaly* ; Autopsy*

No abstract available.
Molecular Biology* ; Shigella*

Succinylcholine(SCC) is well known to elevate the serum potassium level and to threaten life in some cases. In order to minimize the elevation of serum potassium following SCC, several attempts have been made such as SCC tamming and pretreatment with pancuronium or lidocaine or diazepam. Our study was undertaken to evaluate the change of serum potassium following induction in 60 patients divided into 7 different groups; group l. SCC 1mg/kg; group ll. SCC 2 mg/kg, grouplll, SCC 1mg/kg after SCC 10mg; group IV, SCC 1mg/kg after pancuronium 0.015mg/kg, group V. Pnacuronium 0.1mg/kg; group VI, SCC 1mg/kg after Lidocaine 1mg/kg; grou VII, SCC 1mg/kg after Diazepam 0.2mg/kg. The results were as follows: 1) Serum potassium were increased 0.14mEq/L in group l and 0.17 mEq/L in group ll. 2) Serum potassium were decreased in group lll, VI and VII than their control values but they were not statistically significant. 3) The decrease in serum potassium was most significant in group IV and V.
Calcium ; Diazepam ; Humans ; Lidocaine ; Pancuronium ; Potassium ; Succinylcholine

Spontaneous regression of an intracranial lesion, as seen in sequential CT or MRI images, does not necessarily indicate a self-limiting process such as trauma or vascular disease. This report describes two cases of intracranial enhancing lesions which, on follow-up, showed complete resolution of the changes seen on MRI, without any treatment other than the administration of corticosteroid for a short period. We review several reports of "disappearing CT lesions", and discuss the possible mechanism of disappearance of intracranial lesions.
Follow-Up Studies ; Magnetic Resonance Imaging ; Vascular Diseases

Brain abscess commonly occurs secondary to an adjacent infection (mostly in the middle ear or paranasal sinuses) or due to hematogenous spread from a distant infection or trauma. Pulmonary arteriovenous fistulas (AVFs) are abnormal direct communications between the pulmonary artery and vein. We present two cases of brain abscess associated with asymptomatic pulmonary AVF. A 65-year-old woman was admitted with a headache and cognitive impairment that aggravated 10 days prior. An magnetic resonance (MR) imaging revealed a brain abscess with severe edema in the right frontal lobe. We performed a craniotomy and abscess removal. Bacteriological culture proved negative. Her chest computed tomography (CT) showed multiple AVFs. Therapeutic embolization of multiple pulmonary AVFs was performed and antibiotics were administered for 8 weeks. A 45-year-old woman presented with a 7-day history of progressive left hemiparesis. She had no remarkable past medical history or family history. On admission, blood examination showed a white blood cell count of 6290 cells/uL and a high sensitive C-reactive protein of 2.62 mg/L. CT and MR imaging with MR spectroscopy revealed an enhancing lesion involving the right motor and sensory cortex with marked perilesional edema that suggested a brain abscess. A chest CT revealed a pulmonary AVF in the right upper lung. The pulmonary AVF was obliterated with embolization. There needs to consider pulmonary AVF as an etiology of cerebral abscess when routine investigations fail to detect a source.
Abscess ; Aged ; Anti-Bacterial Agents ; Arteriovenous Fistula* ; Arteriovenous Malformations ; Brain Abscess* ; Brain* ; C-Reactive Protein ; Cognition Disorders ; Craniotomy ; Ear, Middle ; Edema ; Embolization, Therapeutic ; Female ; Frontal Lobe ; Headache ; Humans ; Leukocyte Count ; Lung ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Middle Aged ; Paresis ; Pulmonary Artery ; Thorax ; Tomography, X-Ray Computed ; Veins

PURPOSE: There is a controversy about whether the use of polymethylmethacrylate (PMMA) in orthopedic reconstructive surgery can increase the possibility of cardiovascular dysfunction. This study was undertaken to determine if cemented hemiarthroplasty is safe for treating femoral neck fracture in patients with ischemic heart disease. MATERIAL AND METHODS: Between March 1999 and February 2004, we performed cemented hemiarthroplasties for displaced femoral neck fractures in 158 consecutive patients. This retrospective study consisted of 44 patients with ischemic heart disease (group 1) and 58 age matched control patients (group 2). We compared the mortality rate, the incidence of deep vein thrombosis (DVT), pulmonary embolism, cerebrovascular disease, dislocation and deep infection, the amount of postoperative blood loss and the grade of cementation according to the schema of Barrack on the radiograph between the two groups. RESULTS: No difference was found in the perioperative mortality rate, the deep infection rate, the incidence of DVT or pulmonary embolism, the newly developed heart ischemic events or brain hemorrhagic lesions between the two groups. But there was a greater incidence of dislocation related to weakness from past brain ischemic lesion and the newly developed brain ischemia in group 1 than in group 2 (p<0.05). More importantly, six patients in group 1 had transient symptoms of dyspnea, signs of hypotension and bradycardia within two days postoperatively, which raises suspicions of embolic phenomenon, even though this was not confirmed. CONCLUSION: Close and careful observations should be done for the occurrence of dislocation related to previous brain ischemia, or newly developed brain ischemic lesion or embolic phenomenon. Appropriate thromboprophylaxis is necessary in patients with ischemic heart disease after cemented hemiarthroplasty for the treatment of femoral neck fracture.
Bradycardia ; Brain ; Brain Ischemia ; Cementation ; Dislocations ; Dyspnea ; Femoral Neck Fractures* ; Femur Neck* ; Heart ; Hemiarthroplasty* ; Humans ; Hypotension ; Incidence ; Mortality ; Myocardial Ischemia* ; Orthopedics ; Polymethyl Methacrylate ; Postoperative Hemorrhage ; Pulmonary Embolism ; Retrospective Studies ; Venous Thrombosis

No abstract available.
R Factors* ; Shigella*

Somatosensory evoked potential (SSEP) changes during cerebral aneurysm surgery and their relationship to postoperative neurologic complications have been studied on many occasions. However, it is still a matter of debate whether SSEP monitoring is really helpful in detecting or preventing neurologic complications. We studied 87 patients undergoing aneurysm surgery of the anterior cerebral circulation and SSEPs were monitored in 60 of these patients. All patients were grade 2 by the subarachnoid hemorrhage (SAH) grading system. Median nerve SSEP was monitored for middle cerebral or internal carotid artery aneurysms and posterior tibial nerve SSEP for anterior cerebral artery aneurysms. A decrease in the cortical amplitude of more than 50%, compared with control, was considered significant and interventions were then taken to reverse the SSEP. The pre- and postoperative neurologic deficits of each patient were evaluated immediately before and after surgery. No significant difference was found in the incidence of postoperative neurologic complications in the SSEP monitored (15% [9/60]) and unmonitored patients (22% [6/27]). In the SSEP monitored patients, the amplitudes of SSEPs decreased significantly in 14 patients and 4 of these showed neurologic complications. However, SSEP amplitudes were not significantly changed in 46 patients, and 5 of these showed neurologic complications. Significant changes in the amplitude of SSEP might represent neuronal injury, but the absence of change in the SSEP cannot guarantee patient safety. Our results suggest that SSEP monitoring may be useful for detecting the danger of neuronal injury, but that it does not reduce the incidence of neurologic complications in aneurysm surgery.
Adult ; Evoked Potentials, Somatosensory/physiology* ; Female ; Human ; Intracranial Aneurysm/surgery* ; Male ; Middle Age ; Monitoring, Physiologic* ; Nervous System Diseases/physiopathology ; Nervous System Diseases/etiology* ; Nervous System Diseases/diagnosis* ; Surgical Procedures, Operative/adverse effects*

PURPOSE: Colorectal cancer (CRC) has a high risk for postoperative thromboembolic complications such as venous thromboembolism (VTE) compared to other surgical diseases, but the relationship between VTE and CRC in Asian patients remains poorly understood. The present study examined the incidence of symptomatic VTE in Korean patients who underwent surgery for CRC. We also identified risk factors, incidence and survival rate for VTE in these patients. MATERIALS AND METHODS: The patients were identified from the CRC database treated from January 2011 to December 2012 in a single institution. These patients were classified into VTE and non-VTE groups, their demographic features were compared, and the factors which had significant effects on VTE and mortality between the two groups were analyzed. RESULTS: We analyzed retrospectively a total of 840 patients and the incidence of VTE was 3.7% (31 patients) during the follow-up period (mean, 17.2 months). Histologic subtype (mucinous adenocarcinoma) and previous history of VTE affected the incidence of VTE on multivariate analysis. There was a statistically significant difference in survival rate between the VTE and non-VTE group, but VTE wasn't the factor affecting survival rate on multivariate analysis. Comparing differences in survival rate for each pathologic stage, there was only a significant difference in stage II patients. CONCLUSION: Among CRC patients after surgery, the incidence of VTE was approximately 3% within 1 year and development of VTE wasn't a significant risk factor for death in our study but these findings are not conclusive due to our small sample size.
Asian Continental Ancestry Group ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Prognosis* ; Retrospective Studies ; Risk Factors ; Sample Size ; Survival Rate ; Venous Thromboembolism*

BACKGROUND/AIMS: A single gene mutation alone cannot explain the poor prognosis of colorectal cancer. This study aimed to establish a correlation between the expression of six proteins and the prognosis of colorectal cancer patients. METHODS: Tissue samples were collected from 266 patients who underwent surgery for colorectal cancer at our institution from January 2006 to December 2007. The expression of six proteins were determined using immunohistochemical staining of specimens. RESULTS: Cathepsin D, p53, COX-2, epidermal growth factor receptor, c-erbB-2, and Ki-67 expression were detected in 38.7%, 60.9%, 37.6%, 35.7%, 30.1%, and 74.4% of the samples, respectively. The expression of cathepsin D was significantly correlated with reduced cancer-free survival (p=0.036) and colorectal cancer-specific survival (p=0.003), but the other expression levels were not. In a multivariate analysis, cathepsin D expression was found to be an independent prognostic factor for poorer colorectal cancer-specific survival (hazard ratio, 8.55; 95% confidence interval, 1.07 to 68.49). Furthermore, patients with tumors expressing four or more of the proteins had a significantly decreased cancer-free survival rate (p=0.006) and colorectal cancer-specific survival rate (p=0.002). CONCLUSIONS: Patients with cathepsin D positivity had a poorer outcome than patients who were cathepsin D-negative. Thus, cathepsin D may provide an indicator for appropriate intensive follow-up and adjuvant chemotherapy.
Adenocarcinoma/*pathology ; Adenocarcinoma, Mucinous/pathology ; Adult ; Aged ; Cathepsin D/analysis ; Colorectal Neoplasms/*pathology ; Cyclooxygenase 2/analysis ; Female ; Humans ; Ki-67 Antigen/analysis ; Male ; Middle Aged ; Prognosis ; Receptor, Epidermal Growth Factor/analysis ; Receptor, ErbB-2/analysis ; Survival Analysis ; Tumor Markers, Biological/*analysis ; Tumor Suppressor Protein p53/analysis