In this study, the feasibility of identification and genotypic differentiation of enteroviruses was investigated by using nested reverse transcription-polymerase chain reaction (nested RT-PCR), single-stranded conformation polymorphism (SSCP), and restriction fragment length polymorphism (RFLP) techniques. Two hundred seventy-four clinical samples were assayed by both nested RT-PCR and tube culture method using MRC-5 and MK cells; 58 (86.6%) out of 67 enterovirus culture-positive samples contained enteroviral RNA. In addition, 114 (55.1%) of 207 samples from patients with suspected enteroviral CNS disease with negative viral cultures were positive by the nested RT-PCR. The nested RT-PCR products were genotyped by the SSCP method and the results were compared with serotypes. We could differentiate 6 subtypes, 3 of which are similar to coxsackievirus B3, B5, echovirus 11, plus 3 other subtypes. RFLP cleaved with Sty I, Bgl I, and Xmn I yielded characteristic patterns for each laboratory strains. This study demonstrates the usefulness of the RT-PCR for the rapid diagnosis of enterovirus infection and the potentials of the SSCP method for differentiation of enterovirus strains.
Central Nervous System Diseases ; Diagnosis ; Enterovirus B, Human ; Enterovirus Infections ; Enterovirus* ; Genotype* ; Humans ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single-Stranded Conformational ; RNA

OBJECTIVES: The purpose of this study is to evaluate the incidence of complications accompanying tracheostomy, and in addition, to suggest ways to prevent serious complications. MATERIALS AND METHODS: We performed tracheostomy in 168 patients and their data were analyzed retrospectively. RESULTS: Twenty one patients (12.5%) had complications directly related to tracheostomy. The most common complication was postoperative bleeding which accounted for 11 cases (6.7%). Others complications included pneumothorax which claimed 3 cases (1.8%) with reduced morbidity, cannula dislodgment claimed 3 cases (1.8%), cannula obstruction 2, wound infection 2 and tracheal stenosis 2. Among them, two patients died of tracheostomy complications. Decannulation was tried in 44 patients, but it fell short since only 11 patients were decannulated without difficulty. The rest of patients could not be decannulated because of various reasons including death, underlying disease, subglottic stenosis, tracheal stenosis or vocal cord palsy. CONCLUSION: In order to avoid complications of tracheostomy, it is important to treat preoperatively the tendency to bleeding, and meticulously control it during the operation as well. Also, the use of longer cannulas and tracheal fenestration technique is helpful for patients with short and stocky neck. Positive pressure applied through the cannula can make serious complications such as pneumothorax when cannula-obstruction or cannuladislodgment is suspected and the high volume-low pressure cuff is useful to prevent the decannulation difficulties by longterm cannulation, especially in patients using ventilator.
Catheterization ; Catheters ; Constriction, Pathologic ; Hemorrhage ; Humans ; Incidence ; Neck ; Pneumothorax ; Retrospective Studies ; Tracheal Stenosis ; Tracheostomy* ; Ventilators, Mechanical ; Vocal Cord Paralysis ; Wound Infection

PURPOSE: Extracorporeal shock wave lithotripsy(SWL) is currently prorposed for the first line treatment of most renal and ureteral stones. In general, SWL is very effective and non-invasive method than open surgery or endoscopic lithotripsy. We experienced 350 cases of SWL for 46 months and announced it. MATERIALS AND METHODS: We retrospectively reviewed the data of 324 patients(350 stones) who had been diagnosed as renal or ureteral stones and underwent SWL using Tripter Compact(R) lithotriptor from September 1994 to July 1998. Male to female ratio was 1.9:1 and patient`s ages ranged from 18 to 82 years(mean 43.7 years). We underwent SWL only with parenteral analgesics for pain control. RESULTS: In 350 stones, renal stones were 90 cases(25.7%) and ureteral stones were 260 cases(74.3%). In 90 renal stones, calyceal stones(include 1 staghorn stone) were 62 cases(68.9%) and renal pelvic stones were 28 cases(31.1%). In 260 ureteral stones, upper ureteral stones were 209 cases(80.4%), mid ureteral stones were 10 cases(3.8%), and lower ureteral stones were 41 cases(15.8%). The stones from 10 to 19mm in diameter were the majority of renal stones(53.3%), whereas in ureter, the stones smaller than 10mm in diameter were most common(41.5%). Less than 3 treatment sessions were needed for 147 cases(93.0%) of stones smaller than 10mm and for 146cases(76.0%) stones larger than 10mm. Less than 3 sessions were needed for 68 cases(75.6%) of renal stones and for 225 cases(86.5%) of ureteral stones. All renal stones were fragmented and the success rate for upper ureteral stones was 93.3%(195/209), for mid ureteral stones was 80.0%(8/10), and for lower ureteral stones was 80.5%(33/41). According to the size of stone, the success rate for the stones smaller than 10mm in diameter was 96.2%(152/158) and for the stones larger than 10mm was 90.6%(174/192). Total success rate was 93.1%(326/350). The complications after SWL were gross hematuria over 24hours(64 cases, 18.3%), flank pain(52 cases, 14.9%), gastrointestinal disturbances(7 cases, 2%), and Steinstrasse(31 cases, 8.9%). The causes of failure were incomplete fragmentation(21 cases, 87.5%) and mucosal impact(3 cases, 12.5%) of stones. Re-treatment rate was 59.7% and auxiliary procedure rate was 8.0%(efficiency quotient was 0.56). CONCLUSIONS: Our experiences shows extracorporeal shock wave lithotripsy is a safe and effective method for the treatment of renal and ureteral stones, and we expect the better outcome by development of techniques and equipments.
Analgesics ; Female ; Hematuria ; Humans ; Lithotripsy* ; Male ; Retrospective Studies ; Shock* ; Ureter ; Urinary Calculi

No abstract available.
Retroperitoneal Fibrosis*

The advent of computerized cranial tomography represents a great advance in the diagnosis of very wide variety of intracranial lesions. The CT findings of acoustic neuroma have been reported by many authors, especially by Hatam in early contrast enhancement and evaluation of the internal auditory meatus. We have analysed 22pathologically proven cases of acoustic neuroma examined at the Kyung Hee University Hospital from Oct. 1977 to June 1981 and the results were as follows. 1. The sex ratio was 12 females to 10 males and the greatest number of cases (27%) were seen in fourth decade. 2. The precontrast CT scan of the tumor appeared as isodensity in 10 cases (46%), low density in 8 cases (36%) and high density in 4 cases (18%). The shape of tumor was round in 10 cases (46%), irregular amorphous in 9 cases (41%) and ovoid in 3 cases (13%). 3. The tumor was located at both anteriorand posterior sides of porus acousticus in 17 cases (77%), and only posterior side in 5 cases (23%), Associated hydrocephalus and intratumoral calcification were found in 18 cases (82%) and 1 case (4%), respectively. Bilateral involvement of the tumor was not seen. 4. In postcontrast CT scan, all of the acoustic neuromas but one, were enhanced and well defined. The most frequent enhancement pattern was heterogenous enhancement, seen in 10 cases (46%), but there was no specific enhancement.
Acoustics ; Diagnosis ; Female ; Humans ; Hydrocephalus ; Male ; Neuroma, Acoustic ; Sex Ratio ; Tomography, X-Ray Computed

Although cystic neoplasms of the pancreas are an uncommon disease, it occures often enough that proper sugicalmanagement depends on accurate preoperative diagnosis. It is very difficult to diagnose accurately by conventionalradiological methods alone. Angiographic findings are fairly characteristic for these tumors, but they are in noway specific. The imaging characteristics of ultrasonography and CT are particularly useful in the diagnosis ofthis particular tumors. This report presents an analysis of 2 cases of cystadenoma and 3 cases cystadenocarcinomaexamined by ultrasonography and CT. Ultrasonography findings are complelx multicytic mass in the pancreas withthick irregular wall, daughter cyst, septa and solid component. These septa and solid component are highlyechogenic if the tumor is mucin producing. Computed tomographic findings are large cyst possessing irregular thickwall, solid component and septa which are enhanced by contrast infusion. Punctate or curvilinear calcification isseen occasionally. Tortuous or beaded vascular collaterals are seen around the cyst. On the other hand, pseudocystis usually a single cyst possessing thin smooth wall, and solid component or septa are unusual in pseudocyst.
Cystadenocarcinoma ; Cystadenoma ; Diagnosis ; Hand ; Mucins ; Nuclear Family ; Pancreas ; Ultrasonography

No abstract available.
Hyperlipidemias* ; Tarsal Tunnel Syndrome*

Left ventricular free wall rupture following acute myocardial infarction (AMI) is the second most common cause of death and has been reported to be responsible for 4 to 24% of all infarction deaths. The rupture occurs anywhere from a few hours to several days after AMI. The common findings of ventricular rupture are persistent chest pain bradycardia and shock. This may be often mistaken for the ruptured dissection of the ascending aorta. The different points from dissection are 1) persistent chest pain 2)persistent ST segment elevation and 3) only intramural hematoma in ascending aorta. We have sucessfully managed two patients with postinfarction myocardial rupture. Surgical management consisted of infarctectomy repairi of the ventricular rupture and coronay artery bypass grafting. We conclude that successful surgical management of ventricular free wall rupture should require prompt diagnosis and emergency operation.
Aorta ; Arteries ; Bradycardia ; Cause of Death ; Chest Pain ; Diagnosis ; Emergencies ; Heart Rupture* ; Hematoma ; Humans ; Infarction ; Myocardial Infarction ; Rupture ; Shock ; Transplants

BACKGROUND: Angioleiomyoma of the skin is a rare smooth muscle tumor and may develop anywhere in the body. Comprehensive clinicopathological analysis of angioleiomyomas developed in Korean has not been reported in domestic dermatological journals. OBJECTIVE: The purpose of this study was to evaluate the clinical and pathological characteristics of angioleiomyoma and the relationship between the tumor and the nerve with immunohistochemical stains. METHODS: Fifty nine cases of angioleiomyoma were reappraised from the files of the pathology of Seoul National University, Green Cross Reference Laboratory Center and Korea Veterans Hospital. Brief clinical histories of all cases were examined and microscopic findings in 35 cases were classified according to subtypes. Paraffin blocks were recut and stained in 16 cases for desmin, smooth muscle actin and S-100 protein. RESULTS AND CONCLUSION: 1. Male to female ratio was 1:1.27. 2. The age of the patients was mostly over 20 years and the mean age was 51 years in men and 40 years in women. 3. Tumors occurred most frequently in the lower extremity(38 cases), and followed by upper extremity(18 cases), head(2 cases), and trunk(1 case). Women had predominance of the legs in location site and men showed equal distribution in the lower and upper extremities.
Actins ; Angiomyoma* ; Coloring Agents ; Desmin ; Female ; Hospitals, Veterans ; Humans ; Korea ; Leg ; Male ; Muscle, Smooth ; Paraffin ; Pathology ; S100 Proteins ; Seoul ; Skin ; Smooth Muscle Tumor ; Upper Extremity

Pheochromocytoma is one of the surgically curable hypertensive diseases and can arise wherever chromaffin cells are located. Herein, a case of extra-adrenal pheochromocytoma developed in a 51 year-old male is presented with brief review of literatures.
Chromaffin Cells ; Humans ; Male ; Middle Aged ; Pheochromocytoma*