No abstract available.
Brain Stem Infarctions*

As transplantation for end-stage renal disease has become more common, avascular necrosis has become a major cause of disability after a successful transplantation. We studied the relationship between development of avascular necrosis of bone and the administration and dosage of steroid, cholesterol level and triglyceride level after transplantation in 909 patients who received kidney transplantation from March 1969 until August 1994 at Catholic University, Medical College. These patients were compared against 60 patients who received kidney transplantation and steroid therapy without developing osteonecrosis. Osteonecrosis was observed in 62 of the patients (6.8 per cent) from 3 to 37 months (mean 10) after the transplant operation. The average age was thirty-eight years (range, twenty to sixty-three years). A single bone was involved in 28 patients, while in the rest of the patients there were between two and four different sites. Altogether 109 bones were affected, 102 of them being weight-bearing. The most common sites were the femoral heads, with 32 patients having bilateral involvement. There was no association between the cumulative dosage of prednisone and the development of avascular necrosis. Although the post renal transplant cholesterol and triglyceride level were significantly elevated compared to the pre-renal transplant state, there were no significantly difference between the avascular group and control group.
Cholesterol ; Head ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Necrosis* ; Osteonecrosis ; Prednisone ; Triglycerides ; Weight-Bearing

Digoxin is commonly used in treatment of various heart conditions, such as atrial fibrillation, atrial flutter, and sometimes heart failure. The therapeutic range of digoxin is narrow. Therefore, Digoxin toxicity is common. However, severe digoxin intoxication is uncommon. Many cases involving application of Digoxin immune Fab for digoxin intoxication in other countries have been reported. However, no cases have been reported in Korea. We reported on one case, a 34-year-old male with acute and severe digoxin intoxication who was treated with digibind(R). His chief complaint was gastrointestinal symptoms, including nausea and vomiting. Electrocardiography (ECG) showed third degree atrioventricular (AV) block. After an infusion of digibind(R), third degree AV block rhythm was changed to first degree AV block. Nowadays, we can obtain a digoxin antidote from the national poisoning information center. Therefore, we should actively consider application of Digoxin immune Fab in patients with severe digoxin intoxication.
Adult ; Atrial Fibrillation ; Atrial Flutter ; Atrioventricular Block ; Digoxin* ; Electrocardiography ; Heart ; Heart Failure ; Humans ; Information Centers ; Korea ; Male ; Nausea ; Poisoning ; Vomiting

The occurrence of a trigeminal neuropathy associated with connective tissue disease is rare. Trigeminal neuropathy in connective tissue disease is predominantly sensory and it is characterized by numbness, hypesthesia, slurred speech, and touch pain. Although the pathogenesis of trigeminal neuropathy associated with connective tissue disease remains obscure, the main pathologic findings are vasculitis and neuritis. A case of trigeminal neuropathy associated with mixed connective tissue disease is described, and the incidence, symptoms, pathophysiology, treatment of the disease is discussed.
Connective Tissue Diseases ; Hypesthesia ; Incidence ; Mixed Connective Tissue Disease* ; Neuritis ; Trigeminal Nerve Diseases* ; Vasculitis

Physostigmine has been used to counteract somnolence or coma induced by different types of pharmacological agent, such as anticholinergics, opioids, ketamine, tricyclic antidepressants and inhalational anesthetics. In this study, we have assessed the effect of physostigmine on arousal and respiration after 50% N2O-50% O2-enflurane general anesthesia under controlled condition such as no premedication, no neuromuscular blockade, same operative procedure and duration. Fifty healthy gynecologic patients scheduled for dilatation & curettage and cervical cone biopsy were divided randomly into two groups such as control group and physostigmine group. In physostigmine group, 0.02 mg/kg of physostigmine was administered intravenously at the end of operation. We evaluated the recovery time of pain response, eye opening on verbal command and orientation after the end of operation. We also checked the end-tidal enflurane concentration with SARACAP spectrometry. Blood pressure, pulse rate, respiration rate and tidal volume were checked at the end of operation and at the time of each recovery parameters returned. The results were as follows; first, pain response time was 5.1+/-2.4 min in control group compared with 3.5+/-2.1 min in physostigmine group. Second, on simple order to patients, eye opening time was 8.5+/-2.3 min in control group compared with 6.5+/-2.1 min in physostigmine group. Third, recovery of orientation to time, place and person was 9.7+/-2.8 min in control group compared with 7.5+/-2.1 min in physostigmine group. Fourth, there was no significant difference in respiratory parameters between the two groups. But there was no significant difference in end-tidal enflurane concentration between the two groups inspite of rapid recovery time in physostigmine group. In conclusion, 0.02mg/kg of physostigmine has the effect of early arousal after enflurane anesthesia without specific problems.
Analgesics, Opioid ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Antidepressive Agents, Tricyclic ; Arousal* ; Biopsy ; Blood Pressure ; Cholinergic Antagonists ; Coma ; Dilatation and Curettage ; Enflurane* ; Female ; Heart Rate ; Humans ; Ketamine ; Neuromuscular Blockade ; Physostigmine* ; Premedication ; Reaction Time ; Respiration* ; Respiratory Rate ; Spectrum Analysis ; Surgical Procedures, Operative ; Tidal Volume

PURPOSE: To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. MATERIALS AND METHODS: Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using 192Ir between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. RESULTS: The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT +/- external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (< or =grade 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. CONCLUSION: HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.
Brachytherapy* ; Humans ; Mouth Neoplasms ; Mouth* ; Radiotherapy ; Recurrence ; Retrospective Studies

PURPOSE: To compare the clinical results of an arthroscopic rotator cuff repair with those of a mini-open repair. MATERIALS AND METHODS: Sixty-three patients with a rotator cuff tear were enrolled in this study. Thirty patients had an arthroscopic repair and 33 patients underwent a mini-open repair. The average age was 50 years (range, 23-74) in the arthroscopic group and 50 years (range, 38-69) in the mini-open group. In the arthroscopic group, 8 patients had small-sized tears (<1 cm), 18 patients had medium tears (1-3 cm), and 4 patients had large tears (3-5 cm). In the mini-open group, 12 patients had small tears, 19 patients had medium tears, and 2 patients had large tears. The average follow-up period in the arthroscopic and mini-open groups was 39 (range, 24-77) and 40 months (range, 24-64), respectively. RESULTS: The level of shoulder pain [1.10 vs. 1.45, p>0.05], the range of motion, muscle strength, patient's satisfaction, the ASES score [91.7 vs. 88.6, p>0.05] and the UCLA score [32.4 vs. 31.2, p>0.05] were compared. The size of the tear did not produce different results. In the arthroscopic group, the tendon tore again in one patient, and one anchor-related complication was noted. In the mini-open group, one patient developed a stiff shoulder. CONCLUSION: An arthroscopic and a mini-open repair of rotator cuff tears produced similar clinical results and the size of the tear had little effect. The clinical results depend on the surgical technique and the patient's condition, rather than the method of repair.
Follow-Up Studies ; Humans ; Muscle Strength ; Range of Motion, Articular ; Rotator Cuff* ; Shoulder ; Shoulder Pain ; Tendons

BACKGROUND/AIMS: We evaluated the clinical characteristics and prognostic value of the clinical, laboratory, pathologic features, at time of diagnosis, and the renal survival of patients with ANCA (anti-neutrophil cytoplasmic antibody)-related nephritis. METHOD: We retrospectively analyzed 17 patients who were diagnosed with ANCA-related nephritis at a single center. The risks of progression to ESRD or death according to the clinical parameters, the ANCA pattern and the renal pathologic findings were evaluated. RESULTS: The major symptoms were hematuria (100%), proteinuria (100%), uremic symptoms (41.2%), edema (35.5%), upper respiratory symptoms (29.4%) and oliguria (23.5%), which were not correlated with renal survival. All the patients showed a p-ANCA pattern. The BUN level (p=0.032) and GFR (p=0.023) at the time of diagnosis were different between the improved and the progressed patients in terms of renal function. The pathology indices were not predictive factors of both renal and patient survival. Eight patients (47.1%) were treated with steroid IV pulse, 4 (23.5%) with steroid IV pulse and cyclophosphamide IV pulse, 2 (11.8%) with steroid IV pulse, cyclophosphamide IV pulse and plasma exchange, and 2 (11.8%) with steroid IV pulse and plasma exchange. Fourteen patients (82.4%) needed hemodialysis. There were 3 (17.6%) disease-related deaths, 13 patients (76.5%) reached ESRD and 4 (23.5%) showed recovery of renal function. The mean percent of patients who survived was 80.2% and the mean percent of renal survival was 33.3% at the 1st and 3rd year, respectively. CONCLUSIONS: Poor renal function at presentation was associated with a high risk for disease progression, but age, gender, the clinical patterns of presentation and the pathologic findings were not associated with the prognosis. Early diagnosis and treatment seems to be essential to improve the renal outcomes.
Antibodies, Antineutrophil Cytoplasmic ; Cyclophosphamide ; Cytoplasm ; Disease Progression ; Early Diagnosis ; Edema ; Hematuria ; Humans ; Kidney Failure, Chronic ; Nephritis ; Oliguria ; Plasma Exchange ; Prognosis ; Proteinuria ; Renal Dialysis ; Retrospective Studies

No abstract available.
Antibody Formation* ; Korea* ; Scrub Typhus*

Background/Aims: Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is one of the most fatal complications of hematopoietic cell transplantation (HCT), and defibrotide is the only curative drug. We conducted this study to confirm the survival rate of VOD/SOS patients diagnosed in Korea and assess the efficacy of defibrotide. Methods: Patients diagnosed with VOD/SOS after allogenic HCT between 2003 and 2020 were enrolled. We investigated day +100 survival rates and associated risk factors in patients who satisfied the modified Seattle criteria within 50 days of HCT. Results: A total of 110 patients satisfied the modified Seattle criteria, of which 65.5% satisfied the Baltimore criteria. Thirty-seven patients were treated with defibrotide. The day +100 survival rate of the 110 patients was 65.3%. The survival rates in patients who did not meet the Baltimore criteria and in those who did were 86.8% and 53.7%, respectively (p = 0.001). The day +100 survival rate of patients treated with defibrotide was 50.5%. Among the patients receiving defibrotide, those whose creatinine levels were more than 1.2 times the baseline had a significantly lower survival rate at 26.7% (p = 0.014). On multivariate regression analysis, the hazard ratio of satisfaction of the Baltimore criteria was 4.54 (95% confidence interval [CI], 1.69 to 12.21; p = 0.003). In patients treated with defibrotide, the hazard ratio was 8.70 (95% CI, 2.26 to 33.45; p = 0.002), when creatinine was more than 1.2 times the baseline on administration. Conclusions The day +100 survival rate was significantly lower when the Baltimore criteria were satisfied, and when there was an increase in creatinine at the time of defibrotide administration.