PURPOSE: The purpose of this study was to evaluate and compare the predictive ability of three mortality scoring systems; Acute Physiology and Chronic Health Evaluation(APACHE) III, Simplified Acute Physiology Score(SAPS) II, and Mortality Probability Model(MPM) II in discriminating in-hospital mortality for intensive care unit(ICU) patients with spontaneous intracerebral hemorrhage. METHODS: Eighty-nine patients admitted to the ICU at a university hospital in Daejeon Korea were recruited for this study. Medical records of the subject were reviewed by a researcher from January 1, 2003 to March 31, 2004, retrospectively. Data were analyzed using SAS 8.1. General characteristic of the subjects were analyzed for frequency and percentage. RESULTS: The results of this study were summarized as follows. The values of the Hosmer-Lemeshow's goodness-of-fit test for the APACHE III, the SAPS II and the MPM II were chi-square H=4.3849 p=0.7345, chi-square H= 15.4491 p=0.0307, and chi-square H=0.3356 p=0.8455, respectively. Thus, The calibration of the MPM II found to be the best scoring system, followed by APACHE III. For ROC curve analysis, the areas under the curves of APACHE III, SAPS II, and MPM II were 0.934, 0.918 and 0.813, respectively. Thus, the discrimination of three scoring systems were satisfactory. For two-by-two decision matrices with a decision criterion of 0.5, the correct classification of three scoring systems were good. CONCLUSION: Both the APACHE III and the MPM II had an excellent power of mortality prediction and discrimination for spontaneous intracerebral hemorrhage patients in ICU.
APACHE ; Calibration ; Cerebral Hemorrhage* ; Classification ; Discrimination (Psychology) ; Hospital Mortality ; Humans ; Critical Care ; Korea ; Medical Records ; Mortality* ; Physiology ; Retrospective Studies ; ROC Curve

In 1910 Purtscher first presented his original report of "angiopathia retinae traumatica" before the German Congress of Ophthalmology in Heidelberg. Since then many varying fundus pictures have been described as "Purtscher's Disease" and many theories have been advanced as to the cause. In 1962 Marr and Marr provided an extensive review of the literature on traumatie retniopathy and pointed out that the cause of Purtscher's retinopathy was an abrupt rise of intravascular pressure in the vessel entering and leaving the orbit, and in most cases the mechanism of the injury was a sudden and violent compression of the chest. Recently we have experienced a case of bilateral Purtscher's traumatic retinal angiopathy leading to optic nerve atrophy and macular degeneraion. Our patient is a 36-year-old previously healthy Korean male. who had his left chest compressed by a truck when he was working in the country farm. Just after the accident he fall into an unconscious state for a short time. Two days after admission he was referred to our ophthalmologic department because of visual impairment. Funduscopic examination revealed Purtscher's retinopathy in both eyes. His chest X-ray examination showed several fractured ribs anterolaterally. Within several days after the accident the whitish retinal exudates and hemorrhages gradually disappeared in the left ocular fundus, but in the right fundus the retinal edema, situated at posterior pole, persisted for about 7 months duration. During this period optic nerve atrophy developed ill the right fundus. As soon as the retinal edema subsided, retinal degeneration of the macular area appeared in the right fundus. Five months after the accident temporal optic nerve atrophy appeared and the patient complained of marked visual impairment in the left eye. We could not find any similar cases in the literature, that is, after the retinopathy and impaired vision recovered, later, the vision was markedly impaired again due to secondary optic nerve atrophy and development of macular Degeneration. In a survey of literature we want to say that the pathogenesis of Purtscher's traumatic retinal angiopathy is due mainly to the result of a sudden and severe increased intravascular pressure. particularly in the upper portion of body. Following points influenced our thought. 1. The ocular fundus changes similar with Purtscher's retinopathy could be seen in hydrostatic pressure syndrome and compression cyanosis syndrome. 2. Purtscher's retinopathy could developed in minor chest compression which is not strong enough to fracture ribs or other banes. 3. Usually Purtscher's retinopathy is developed in both eyes. If unilateral development occurs, it is almost on the right eye. If bilaterally the right eye is more severe than the left. This is postulated due to the shorter venous path to the rijsht eye. In addition, the prognosis of Purtscher's retinopathy seems to be good but poor result such as in our case and other previously reported cases are also possible.
Adult ; Atrophy ; Cyanosis ; Exudates and Transudates ; Hemorrhage ; Humans ; Hydrostatic Pressure ; Macular Degeneration ; Male ; Motor Vehicles ; Ophthalmology ; Optic Nerve ; Orbit ; Papilledema ; Prognosis ; Retina ; Retinal Degeneration ; Retinaldehyde* ; Ribs ; Thorax ; Unconsciousness ; Vision Disorders

Angioimmunoblastic lymphadenopathy (AILD) is a systemic disease clinically characterized by fever, generalized lymphadenopathy, hepatosplenomegaly, polyclonal gamma-globulinemia and Cooms' positive hemolytic anemia. The lymph node in AILD reveals a polymorphic feature consisting of a proliferation of small vessels, immunoblasts and plasma cells and acidophilic interstitial material. Progression into immunoblastic sarcoma is reported as high 35% of the patient with AILD. Nathwani et al have observed not only malignant transformation of AILD in sequential tissue examination, but also the coexistence of AILD and immunoblastic lymphoma in the same lymph node or at different sites in the same patient. Multiple clusters or islands of compactly arranged large lymphoid cells constitute the initial histologic evidence of immunoblastic sarcoma. Immunoblastic sarcoma is a large cell lymphoma conceptually related to transformed T-and B-lymphocytes of the extrafollicular compartment of the immune system, which proignosis is poor. We have recently experienced a case of immuno blastic sarcoma arising in angioimmunoblastic lymphadenopathy in a 24-year-old woman. She had history of multiple enlarged lymph nodes in the inguinal, axilla and supraclavicular areas. Previous lymph node biopsies revealed reactive change. Six month later, right axillary lymph node biopsy reveled AILD with focal clusters of immunoblasts. Subsequent lymph node biopsy at the same site revealed diffuse immunoblasic sarcoma, B-cell type. A case presentation with histologic findings and a brief review of literature were done.
Female ; Humans ; Biopsy

PURPOSE: To report a case of isolated Langerhans cell histiocytosis (LCH) in the palpebral conjunctiva of an adult patient. METHODS: A 39-year-old male presented with a mass of one month's duration on the palpebral conjunctiva of his left upper lid. The lesion had gradually progressed. The mass was non-tender, relatively well circumscribed, yellowish white, flat, firm, and 5 mm x 8 mm in size. Otherwise, the ophthalmic examination was completely normal, including the anterior and posterior segments. Based on the clinical picture, an infiltrative/neoplastic lesion was suspected. Incision biopsy was performed to obtain a diagnosis for proper management. RESULTS: The histopathologic examination of the lesion showed an intensive proliferation of monotonous and histiocytoid cells beneath the epidermis. Immunohistochemical study revealed that the tumor cells were positively stained in the cytoplasm with anti CD1A antibody and anti S-100 antibody. The patient was then referred to the Oncology Department for evaluation. A detailed systemic examination, and the laboratory and radiologic investigations ruled out systemic involvement. The diagnosis of isolated LCH was finally made. Three months later, the lesion underwent remission without any treatment. CONCLUSIONS: This rare disorder may also present as a solitary lesion on the palpebral conjunctiva in adults, and so it should be kept in mind during the differential diagnosis of a conjunctival mass in an adult.
Adult* ; Biopsy ; Conjunctiva* ; Cytoplasm ; Diagnosis ; Diagnosis, Differential ; Epidermis ; Histiocytosis, Langerhans-Cell* ; Humans ; Male

PURPOSE: To report a case of cytomegalovirus (CMV) retinitis in a child who had been managed by immunosuppressive chemotherapy for acute lymphoblastic leukemia (ALL). METHODS: An 8-year-old boy who had been managed by immunosuppressive chemotherapy for ALL was referred to the ophthalmologic clinic because of blurred vision in his right eye. Fundus examination showed hard exudates and white retinal leaion in the macular area of the right eye, white retinal lesion accompanied with retinal hemorrhage and exudates in the midperipheral retina of the left eye. Serologic tests demonstrated a positive response of CMV antibody IgG and a negative response of CMV antibody IgM. CMV was isolated upon the culture of bone marrow and peripheral blood. Immunosuppressive chemotherapy was discontinued and ganciclovir was administered. RESULTS: Administration of ganciclovir led to clinical stabilization of the retinitis lesion that was accompanied by scarring. We were able to discontinue the administration of ganciclovir after the retinal lesions were resolved, and no recurrence of CMV retinitis was noted. CONCLUSIONS: Ganciclovir treatment was clinically effective in improving CMV retinitis in an immunocompromised child with ALL. In addition, the improved systemic immune function achieved by discontinuing immunosuppressive chemotherapy permitted discontinuation of anticytomegalovirus therapy.
Bone Marrow ; Child* ; Cicatrix ; Cytomegalovirus Retinitis* ; Cytomegalovirus* ; Drug Therapy ; Exudates and Transudates ; Ganciclovir ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence ; Retina ; Retinal Hemorrhage ; Retinaldehyde ; Retinitis ; Serologic Tests

PURPOSE: To investigate the characteristics of fluorescein angiograms (FAG) of the optic nerve head and retina according to the presence of optic nerve head swelling (ONHS) in central retinal vein occlusion (CRVO). METHODS: The records of 69 eyes were reviewed, confirmed with the diagnosis of CRVO, and compared for several features according to the presence of ONHS. The best-corrected visual acuities and intraocular pressures were recorded and patterns of retinal hemorrhage were described. The presence of fluorescein filling defects of the optic disc, time till fluorescein started to fill at the optic disc, arteriovenous transit time, and nonperfused areas were assessed using FAG. RESULTS: Forty-one patients without ONHS (group 1) and 28 patients with ONHS (group 2) were included. The mean ages for groups 1 and 2 were 61.4 and 56.9 years, respectively, and there was no significant difference the mean ages between the groups. The fluorescein filling defect of the optic disc was seen more often in group 1 (n=13) than in group 2 (n=2). Marginal irregularity of the foveal avascular zone due to perifoveal capillary drop out was seen significantly more often in group 1 (n=12) than in group 2 (n=2). CONCLUSIONS: Fluorescein filling defects of the optic disc and perifoveal capillary drop out were more frequently seen in CRVO patients without ONHS. However, longitudinal studies are needed to confirm the prognostic value of ONHS and the correlation of filling defects with progressive optic neuropathy in CRVO.
Capillaries ; Diagnosis ; Fluorescein* ; Humans ; Intraocular Pressure ; Optic Disk* ; Optic Nerve Diseases ; Optic Nerve* ; Retina ; Retinal Hemorrhage ; Retinal Vein* ; Visual Acuity

Gartner duct cysts are relatively common congenital cysts in the anterolateral wall of the vagina. Most are small (less than 2 cm) and asymptomatic, but larger cysts may cause problems. We report a rare case of a giant Gartner duct cyst (7 cm) originating from the right lateral portion of the uterine cervix and adjacent myometrium. It appeared as an exophytic multiseptated cystic mass containing different density fluids on CT.
Animals ; Cervix Uteri ; Female ; Mice ; Myometrium ; Vagina

In order to develop questionnaire estimating vinyl chloride monomer(VCM) exposure levels, to reset selection criteria for detailed tests, to measure current VCM exposure levels, to evaluate the mutagenic effects of VCM exposures and to develop multiphasic screening method of PVC- or VCM-handling workers, VCM concentrations of work environments were measured and tentative self-administrative questionnaire, physical examination, sister chromatid exchange(SCE) test and some clinical chemical test were applied to 195 men who had been handling VCM or PVC(Exposed Group) and 37, in the same factories without exposure to VCM or in polyethylene- or polypropylene-related factories(Control Group). Mean VCM concentrations of work environments were 0.268+/-0.183 ppm under PVC synthesis processes, 0.160+/-0.200 ppm under VCM synthesis process, 0.076+/-0.111 ppm under PVC pipe producing processes, 0.090+/-0.108 ppm under PVC wall paper, sheet, or film producing processes, 0.071+/-0.051 ppm under PVC floor producing processes, 0.243+/-0.250 ppm under PVC sash producing processes, and 0.020+/-0.031 ppm under triming process. VCM levels of work environments under manual resin mixing processes (0.209+/-0.168 ppm)were higher than those of the others (0.209+/-0.168 ppm) (p-value<0.05). There was no VCM-related symptoms, the positive response rates of which were higher in the Exposed Group. Overall abnormal rate in clinical chemistry test of the Exposed Group was higher than that of the Control Group, but due to extermely low exposure level of exposure group and to small sample size of the Control Group, no statistical significance was found(p-value>0.05). SCE frequencies of the Exposed Group were significantly higher than those of Contorl Group(p-value<0.05) and those of test-abnormal persons were higher than those of test-normal persons. SCE frequencies linearly increased with not only current but also cumulative VCM exposure levels(p-value<0.05). These results suggest that adverse health effect may ensue from VCM exposure to as low as 1 ppm. But SCE frequencies had no statistically significant correlation with drinking amounts, smoking amoutns, or radiation dose equivalents. Questionnaire was revised by referring to these results and formula estimating cumulative VCM exposure levels based on occupational history in questionnaire were made. In addition, were presented methods evaluating work environments and multiphasic screening test for PVC workers.
Chromatids ; Clinical Chemistry Tests ; Drinking ; Humans ; Male ; Multiphasic Screening* ; Patient Selection ; Physical Examination ; Polyvinyl Chloride* ; Polyvinyls* ; Questionnaires ; Sample Size ; Siblings ; Sister Chromatid Exchange ; Smoke ; Smoking ; Vinyl Chloride*

PURPOSE: The administration of total parenteral nutrition (TPN) has become a standard procedure in the management of nutritionally deprived and critically low birth weight neonates. Sepsis remains the most frequent serious complication during TPN, resulting in increased morbidity, mortality and health care costs. This study was performed to evaluate the clinical efficacy and complications of percutaneous central venous catheterization (PCVC) in very low birth weight infants. METHODS: A total of 56 very low birth weight infants below 1, 500 g during the period from January 1998 to December 2003 were enrolled and their medical records reviewed. Study group (n=32) included the babies who had undergone PCVC and a control group (n=24) included babies who had not undergone PCVC. We compared the study group with the control group for factors such as subject characteristics and catheter-related complications. RESULTS: There was no difference in subject characteristics, such as birth weight, gestational week, respiratory distress syndrome, duration of ventilator therapy, duration from tube to complete oral feeding, days at TPN and its total duration, body weight at discontinuation of TPN and the days taken to reach to 2, 000 g. However, the morbidity rate due to patent ductus arterious, chronic lung disease, necrotizing enterocolitis, osteopenia, cholestasis, and sepsis showed no difference. The study group with infants below 1, 000 g showed a higher incidence of sepsis compared to the control group of the same weight group. The study group with infants between 1, 000 to 1, 500 g showed significantly higher incidences of intraventricular hemorrhage and took longer reach the a body weight of 2, 000 g. CONCLUSION: Considering the high incidence of sepsis in the PCVC group, every attempt should be made to minimize the length of TPN therapy and encourage early enteral feeding. We also recommend the use of PCVC carefully in patients requiring prolonged nutritional support.
Birth Weight ; Body Weight ; Bone Diseases, Metabolic ; Catheterization, Central Venous* ; Central Venous Catheters* ; Cholestasis ; Enteral Nutrition ; Enterocolitis, Necrotizing ; Health Care Costs ; Hemorrhage ; Humans ; Incidence ; Infant* ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Lung Diseases ; Medical Records ; Mortality ; Nutritional Support ; Parenteral Nutrition, Total ; Sepsis ; Ventilators, Mechanical

PURPOSE: To evaluate the long-term results of treatment of epiphyseal fractures of the distal radius in children. MATERIALS AND METHODS: 23 cases of distal radial epiphyseal fracture, treated by two methods: group 1, closed reduction (CR) plus cast (6 cases); group 2, CR and K-wire fixation (under anesthesia due to marked translation of the distal fragment and swelling) plus cast (17 cases), were selected for this study. All patients were followed up for more than 1 year (average: 3.2 years). Postoperatively, epiphyseal displacement and epiphyseal angulation were measured on anteroposterior and lateral radiographs. At follow-up, the affected and normal sides were compared. Final results were classified by radiologic (radial inclination, volar tilting and radial shortening) and clinical (limitation of ROM, wrist pain, grip strength and wrist deformity) criteria. RESULTS: Group 1 had 5 good, 1 fair result; group 2 had 14 good, 2 fair and 1 poor - there was no statistically significant difference between two groups. All cases where the epiphyseal displacement was less than 30% had good results. A poor case showed a radial shortening, wrist deformity and pain due to premature epiphyseal closure. Premature epiphyseal closure was treated by bar resection and free fat, along with corrective osteotomy when necessary and lengthening of radius with or without epiphysiodesis of the ulna. CONCLUSION: Remodeling can be expected in epiphyseal fractures of the distal radius. Repeated forceful attempts to achieve accurate reduction should be avoided to prevent secondary physeal injury.
Anesthesia ; Child ; Congenital Abnormalities ; Displacement (Psychology) ; Follow-Up Studies ; Hand Strength ; Humans ; Osteotomy ; Radius ; Wrist