BACKGROUND: To assess the effects of mDOT implementation on sputum smear conversion for AFB (Acid fast bacilli) positive pulmonary tuberculosis patients, modified Directly Observed Treatment (mDOT) was started on October 8th 2001 at a health center in Seoul. mDOT was defined through weekly interviewing and supervising of a patient by a supervisor (doctor, nurse, or lay health worker). The sputum smear conversion of a mDOT group was compared with that of a self-medication (self) group. METHODS: This study included 52 AFB positive pulmonary tuberculosis patients registered at a health center in Seoul between October 8th 2001 and April 23rd 2002. 24 and 28 patients were enrolled in the mDOT and self medication groups, respectively. Paired (1:1) individual matching, by gender, extent of disease, relapse and age-matching variables, was performed between the two groups, resulting in 20 paired matches. This prospective study was planned as an unblinded, non-randomized quasi- experimental pilot project. Outcomes were identified from results of sputum smear examinations for AFB in both groups at 2 weeks, and 1 and 2 months. The paired matching data were analyzed using the SAS program version 8.1 by McNemar test. RESULTS: At the end of 2 weeks of treatment, the sputum smear conversion of the mDOT group was somewhat higher than that of the self medication group (78.57 vs. 50%, p-value=0.289), and after 1 month of treatment no statistically significant difference was shown between the two groups (83.33 vs. 50, p-value=0.125). At the end of 2 months of treatment (initial intensive phase), the sputum smear conversions of the mDOT and self groups were 95 and 75%, respectively (p-value=0.219). CONCLUSIONS: The implementation of mDOT did not result in clinically significant increases in the sputum smear conversion at 2 weeks, and 1 and 2 months compared with that of the self medication group. However, the increases experienced might contribute to diminishing the infectious period of AFB positive patients, and this approach may act as a guide for a specific group of patients. In this study, mDOT was performed for one hundred percent of the intensive treatment phase. It can also be an effective treatment for pulmonary tuberculosis patients, and may be useful for some high risk tuberculosis patients.
Humans ; Pilot Projects ; Prospective Studies ; Recurrence ; Self Medication ; Seoul ; Sputum* ; Tuberculosis ; Tuberculosis, Pulmonary

Intramural hematoma of the aorta (IMH) is the precursor or a variant of a classic aortic dissection where hemorrhage occurs within the aorta wall in the absence of an initial intimal tear. IMH has a high rate of mortality and morbidity. The optimal therapy for IMH is uncertain, yet the involvement of the ascending aorta is usually considered as an indication for surgery due to the associated risk of rupture or cardiac tamponade. We report here on a case of a 71-year-old man who presented with syncope. Because of misdiagnosis, he underwent computed tomography (CT) after 5 hrs from arriving to the ER. Computed tomography of the aorta revealed intramural hematoma of the ascending aorta with cardiac tamponade. He also had vascular complications such as acute renal failure and visceral ischemia. We performed emergency graft replacement of the total arch and ascending aorta. He was discharged without complication on postoperative day 14.
Acute Kidney Injury ; Aged ; Aorta ; Cardiac Tamponade ; Delayed Diagnosis ; Diagnostic Errors ; Emergencies ; Hematoma ; Hemorrhage ; Humans ; Ischemia ; Rupture ; Syncope ; Transplants

BACKGROUND: Constrictive pericarditis after coronary artery bypass surgery has been known to affect cardiac output by limiting diastolic ventricular filling. We aimed to assess the influence of postoperative constrictive physiology on the early outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCAB). MATERIALS AND METHODS: Between January 2008 and July 2011, 903 patients underwent an isolated OPCAB and postoperative transthoracic-echocardiography. The patient cohort was classified into two groups: group A, constrictive physiology and group B, control group without constrictive physiology. Early outcomes were analyzed between the two groups. RESULTS: Of the total 903 patients, group A consisted of 153 patients (16.9%). The amount of blood loss in group A during the postoperative 24 hours was greater than that of group B, but this was not statistically significant (p=0.20). No significant differences were found in the mortality rates (group A, 0.6%; group B, 1.4%; p=0.40) and 30-day major adverse cardiac and cerebrovascular events (MACCEs; group A, 3.3%; group B, 6.1%; p=0.42). CONCLUSION: Postoperative constrictive physiology does not affect 30-day MACCEs or other major complications after OPCAB. The results of this study suggest that patients with early postoperative constrictive physiology do not need medical or surgical treatment, and that conservative care is sufficient.
Cardiac Output ; Cohort Studies ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Humans ; Pericarditis, Constrictive ; Transplants

Calcifying fibrous pseudotumors (CFP) are rare soft tissue tumors that have unique histopathologic features characterized by a dense hyalinized collagenous tissue interspersed with benign spindle cells, lymphoplasmacytic infiltrate, and psammomatous or dystrophic calcifications. We report here on a case of calcifying fibrous pseudotumors in the pleura and provide a literature review.
Collagen ; Hyalin ; Pleura ; Pleural Diseases

Forty two patients were diagnosed as having subcortical(lobar) intracerebral hemorrhage among 407 consecutive patients presenting with spontaneous intracerebral hemorrhage. Brain CT and MRI or angiography were performed in 39 patients. The authors analyzed clinical features, brain CT, etiological factors, and outcome. Headache(69%) and vomiting(55%) were most common symptoms. The incidence of seizure was 14%. The volume of hematoma on CT was below 20cc in 21 patients, between 20cc and 40cc in 16 patients, and aove 40cc in 5 patients. The most common site of hemorrhage was parietal lobe in 32 of 42 patients. The mortality rate was 9.5% and the functional outcome of the patients was generally better than in other forms of intracerebral hemorrhage. Thirty one patients had arterial hypertension which was the leading cause. Two patients had AVMs and two patients had blood dyscrasias. Unknown etiology occurred in 7 patients. Neither brain MRI nor cerebral angiography showed abnormal vascular lesion in all of the pa tients who had arterial hypertension. We conclude that no further evaluation if recommended in patients with subcortical hemorrhage who were definitely diagnosed as having arterial hypertension.
Angiography ; Brain ; Cerebral Angiography ; Cerebral Hemorrhage ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Magnetic Resonance Imaging ; Mortality ; Parietal Lobe ; Seizures

The purpose of this study is to assess the usefulness of digital infrared thermographic image(DITI) in patients with surgically treated lumbar disc disease. A series of 480 patients with lumbar herniated disc was studied. The mean age of the patients was 37 years, with a range of 18 to 64 years. Of which 126 cases of chemonucleolysis. 18 cases of percutaneous endoscopic laser discectomy, and 336 cases of laminectomy with discectomy were performed. Among these patients, 336 cases of laminectomy were assessed by DITI preoperatively. The thermal differences(delta T) between the symptomatic and asymptomatic limbs were evaluated. We have categorized the types of herniations into 3 classes: 200 protruded, 99 extruded, and 37 sequestered. The thermal differences were classified into 3 groups: 177 patients had delta T < 0.5 degrees C, 74 patients had 0.5 degrees C < or = delta T < 0.8 degrees C and 85 patients had delta T > or = 0.8 degrees C. Among the group of patients with the sequestered disc, 30(i.e. 80%) had delta T > or = 0.8 degrees C. Among the surgically treated 336 patients, non-visualization of a part of the sciatic limb on preoperative DITI was the condition used to coin the term amputation sign by the authors. In the sequestered group, the "amputation sign" was observed in 28 cases(75%). We conclude that DITI can predict a sequestered disc disease, and it allows more precise indication regarding open surgery.
Amputation ; Diskectomy ; Extremities ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc Displacement ; Laminectomy ; Numismatics

A case of rare symptomatic cerebellopontine angle lipoma treated by surgical decompression is described. In this 28-year-old male with intermittent facial pain 17 years, a mass was noted in the right cerebellopontine angle on C-T and MRI. Partial removal of the mass was made for decompression of the lesion from the trigeminal nerve root entry zone. The surgical biopsy results was lipoma. This represents, to our knowledge, the first lipoma in the cerebellopontine angle reportes in the Korean literature.
Adult ; Biopsy ; Cerebellopontine Angle* ; Decompression ; Decompression, Surgical ; Facial Pain ; Humans ; Lipoma* ; Magnetic Resonance Imaging ; Male ; Neuroma, Acoustic ; Trigeminal Nerve ; Trigeminal Neuralgia*

BACKGROUND: Although human parasitic infestations have decreased generally in Korea, Clonorchis sinensis, Paragonimus westermani, Cysticercus and Sparganum are still a serious concern due to their relatively high prevalence and severe complications. A definitive diagnosis, however cumbersome and occasionally invasive, is required in order to detect adult worms, eggs, or cysts. The parasite-specific IgG antibody (PSA) test using the ELISA method has been recently developed to diagnose and monitor the infestations of those four parasites. We analysed PSA positive patients for Clonorchis sinensis, Paragonimus westermani, Cysticercus and Sparganum. METHODS: The serum samples referred to the Neodin Medical Institute for PSA were tested by the ELISA method using crude extracts of C. sinensis, P. westermani, Sparganum and cystic fluid of Cysticercus. The PSA results during the 7-month period from January to July 2001 were retrospectively analysed. The medical records of the patients at Asan Medical Center (AMC) with positive PSA were reviewed with stool examinations for parasites, skin tests for C. sinensis and P. west-ermani, radiological findings and antiparasitic management. RESULTS: A total of 865 specimens were tested for PSA and 84 samples (9.7%) of 76 patients were positive; C. sinensis, Cysticercus, Sparganum, and P. westermani were positive in 26 patients (3.0%), 26 (3.0%), 14 (1.6%) and 10 (1.2%), respectively. 26 specimens from 18 AMC patients were positive for one or more PSA; 6 Cysticercus. 4 C. sinensis, 5 Sparganum and 3 P. westermani. All PSA-positive cases for Cysticercus, C. sinensis and P. westermani were compatible with the clinical diagnosis; however, it was difficult to elucidate in the clinical correlation of 3 out of 5 Sparganum-positive cases. CONCLUSION: Cysticercus, C. sinensis and P. westermani are currently prevalent in Korea. Positive PSA ELISA tests for Cysticercus, C. sinensis and P. westermani are reliable indicators in diagnosing present infestations among the clinically suspected patients.
Adult ; Chungcheongnam-do ; Clonorchis sinensis* ; Complex Mixtures ; Cysticercus* ; Diagnosis ; Eggs ; Enzyme-Linked Immunosorbent Assay* ; Humans ; Immunoglobulin G ; Korea ; Medical Records ; Ovum ; Paragonimus westermani* ; Parasites ; Prevalence ; Retrospective Studies ; Skin Tests ; Sparganum*

PURPOSE: This is to examine the neurodevelopmental outcomes of very low birth weight (VLBW) infants by Korean infant developmental screening test. METHODS: 29 VLBW infants and 39 normal term infants, at their corrected age of 1 to 3 years, were included for the study. Risk factors which influence neurodevelopmental outcomes were analyzed. RESULT: The mean levels of developmental quotients for VLBW infants were lower than those of term infants (P<0.001); gross motor 99.3+/-27.28 vs. 121.3+/-19.08, fine motor 95.9+/-27.22 vs. 118.3+/-17.77, social-personality 100.2+/-28.01 vs. 126.3+/-21.31, language 99.5+/-27.34 vs. 120.1+/-18.82, cognitive-adaptive 101.4+/-28.60 vs. 122.7+/-19.59, and total developmental quotient is 99.3+/-27 vs. 121.7+/-19.18. Nevertheless, the mean levels of the individual developmental quotients for VLBW infants were in normal range. There were five VLBW infants (17%) those who scored lower than 80, also showed neurologic sequelae. The infants who had the more risk factors during hospitalization scored the less developmental quotient (R(2)=0.35, P=0.01). CONCLUSION: Although the mean levels of the individual developmental quotient for VLBW infants, assessed by Korean infant developmental screening test, were lower than those of term infants, they are in normal range.
Child ; Child Development* ; Hospitalization ; Humans ; Infant* ; Infant, Very Low Birth Weight* ; Mass Screening* ; Reference Values ; Risk Factors

The growth or rebleeding of the spontaneous ICH is catastrophic so that prevention of them is critical in management. We reviewed 233 cases of spontaneous ICH from Jan. 1990 to Dec. 1994 to evaluate the factors associated with the hematoma enlargement. The relationship among the admission time from hematoma onset, the systolic BP at admission, hemostatic parameter, liver dysfunction with rebleeding incidence were assessed. Also, hematoma shape, density, site, volume, and operation tiem from hematoma onset were evaluated. Hematoma growth was oserved at 26 patients(11.6%). Incidence of rebleeding was significantly associated in patients with shorter admission time from hematoma onset, high systoic BP at admission, inhomogenous, irregular-shaped hematoma at CT and liver dysfunction. The incidence of hematoma growth was higher in the early operation group but there was no significant relationship in statistic analysis. Patients admitted within 6 hours of hematoma onset, with irregular-shaped, inhomogenous hematoma on CT, and liver dysfunction should be observed closely for the enlargement of hematoma. The operation time might be delayed at least 6 hours after hematoma onset.
Cerebral Hemorrhage* ; Hematoma ; Humans ; Incidence ; Liver Diseases