Two cases of subdural tension pneumocephalus were introduced after posterior fossa surgery in the sitting position. The possible mechanism for entry of air into the subdural space is explained as the fluid pours out air bubbles to the top of the container. All of two cases manifested generalized seizure at recovery room and were diagnosed with plain skull series and computed tomogram. Subdural air evacuated patient fail to recover as expected, following posterior fossa surgery in sitting position.
Humans ; Pneumocephalus* ; Recovery Room ; Seizures ; Skull ; Subdural Space

Retraction of any part of the brain may damage the cortex as well as the parenchyma, so it is advisable to retract the brain with the least force necessary and for the shortest time as possible. The purpose of this study was to examine in cats the damage caused by retraction of the brain by measuring the regional blood flow and brain edema, and to determine which of two methods, continuous or intermittent brain retraction, is less harmful to the brain. Twenty five adult cats weighting 2.5 to 4.0Kg, were used in this study. The twenty five cats were divided into three groups ; control (n=5), continuous retraction (n=10) and intermittent retraction groups (n=10) respectively. The brain retraction was produced by applying the lead weight with the stainless retractor on the right frontal lobe through a craniectomy at the right frontal bone. The weight (20g) was supported throught the pulley so that its long axis was perpendicular to the cortical surface. In the continuous retraction group, the brain was retracted for 180 min with a retraction force of 20g and in the intermittent retraction group, a 15 min period of retraction was applied, followed by a 5 min release, repeated nine times. The regional cerebral blood flow (rCBF) and brain specific gravity measurements were carried out in each animal before and immediately after brain retraction, at the 30th min, 60th min, 90th min, 120th min, 150th min and 180th min after retraction. The rCBF was measured by hydrogen clearance method and the brain edema was measured by gravimetric technique. The results were as follows : 1) After the brain retraction, there were rise in blood pressure and bradycardia in 60 min. 2) Normal control cerebral blood flow (rCBF, ml/100g/min) were 38.7+/-1.9 in right frontal, 38.7+/-1.7 in left frontal, 38.6+/-2.3 in right parietal and 38.2+/-2,3 in left parietal lobes. 3) A considerable reduction in rCBF at the retraction site, has been demonstrated with continuous brain retraction in 60 min after retraction. A reduction in rCBF to 30% of control (RF ; 28.2+/-2.1ml/100g/min) in 180 min after continuous retraction of the right frontal lobe, however, intermittent retraction resulted in a reduction of flow to 12% of control(RF ; 37.5+/-2.9ml/100g/min) at retraction site in 180 min after retraction. 4) The changes of brain specific gravity relatively began to notice at rCBF less than 23.0ml/100g/min. It might be inferred from these that intermittent retraction was less harmful to the brain, which indicate adequate arterial blood flow under the retractor was vital for the preservation and return of the neuronal function following brain retraction.
Adult ; Animals ; Axis, Cervical Vertebra ; Blood Pressure ; Bradycardia ; Brain Edema* ; Brain* ; Cats ; Frontal Bone ; Frontal Lobe ; Humans ; Hydrogen ; Neurons ; Parietal Lobe ; Rabeprazole ; Regional Blood Flow ; Specific Gravity

Mycoplasma pneumoniae is a common cause of respiratory tract infections and typically causes mild disease. Extrapulmonary manifestations of M. pneumoniae infection are also common, but rhabdomyolysis is a rare complication. Here, we describe the case of a previously healthy 23-year-old male who displayed the simultaneous onset of rhabdomyolysis and severe pneumonia requiring mechanical ventilation. Both conditions were resolved by a 10-day course of antimicrobial treatment and the patient was discharged without complication.
Humans ; Male ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Respiration, Artificial ; Respiratory Tract Infections ; Rhabdomyolysis ; Young Adult

The term MYH9-related disorders indicates a group of autosomal dominant illnesses, formerly known as May-Hegglin anomaly, Sebastian syndrome, Fechtner syndrome and Epstein syndrome, caused by mutations of MYH9, the gene encoding for the heavy chain of non-muscle myosin IIA (NMMHC-IIA). We experienced a family with macrothrombocytopenia without leukocyte inclusion. A 5-year-old girl was found to have macrothrombocytopenia incidentally. Her father also had macrothromtocytopenia, but had been suffering from hearing loss and chronic renal failure. Meticulous search by light and electron microscopy failed to detect leukocyte inclusions. To our knowledge, these cases seem to be the first description of autosomal dominant Epstein giant platelet syndrome in Korea.
Bernard-Soulier Syndrome* ; Child, Preschool ; Fathers ; Female ; Hearing Loss ; Humans ; Kidney Failure, Chronic ; Korea ; Leukocytes ; Microscopy, Electron ; Nonmuscle Myosin Type IIA

BACKGROUND: The natural course of sarcoidosis is variable from spontaneous remission to significant morbidity or death. So the assessment of disease activity is important but no single parameter was generally accepted as a good marker. Recently several studies suggested that adhesion molecules, especially ICAM-1 can be a marker, but there are some controversies. And only few data are available about the relationship of ICAM-1 with clinical follow-up course. METHOD: We measured the expression of adhesion molecules on BAL cells by flow cytometry and the level of soluble ICAM-1 (sICAM-1) in serum and BALF at the time of diagnosis in 12 patients with active disease and 7 inactive sarcoidosis(5 male, 14 female, mean age : 39.4+/-10.7 years, mean follpw-up 20+/-15 months). Follow-up clinical course were compared with the changes in serum sICAMA-1 level and the adhesion molecule on BAL cells. RESULTS: In the patients with active disease, the ICAM-1 on AM(RMFI 3.68+/-1.71) and sICAM-1 level in serum(582+/-193 ng/ml) and BAL fluid(47.8+/-16.5 ng/ml) were all higher than those of 7 inactive disease(RMFI :1.89+/-0.75, p=0.0298, serum : 294+/-117 ng/ml, p=0.0049, BALF : 20.9+/-8.3ng/ml). In the active sarcoidosis, ICAM-1 on AM(RMFI:1.51+/-0.84) and serum sICAM-1 were decreased after the therapy(250+/-147 ng/ml) but no significant change was noted in inactive disease. Also we found the initial ICAM-1 on AM and serum sICAM-1 had a significant correlation with the degree of improvement in PFT after the therapy. During the follow-up, the disease relapsed in 4 patients after the discontinuation of steroid and the serum sICAM-1 level went-up again at the time of relapse. CONCLUSION: Our data suggest that the serum sICAM-1 level and the JCAM-1 expression on AM can be a good marker of disease activity and also a predictor of outcome in sarcoidosis.
Diagnosis ; Female ; Flow Cytometry ; Follow-Up Studies ; Humans ; Intercellular Adhesion Molecule-1* ; Male ; Recurrence ; Remission, Spontaneous ; Sarcoidosis*

PURPOSE: The prevalence rate of the BRAF mutation in papillary thyroid cancer (PTC) is as high as about 52 to 83% in Korea. Preoperative detection of BRAF mutation on fine needle aspiration cytology (FNAC) slides may help the surgeon make better therapeutic decisions. The present study aims to assess the feasibility of the mutant allele specific amplification (MASA) and restriction fragment length polymorphism (RFLP) method with using conventional FNAC slides and we also wanted to evaluate the clinical role of preoperatively detecting BRAF mutation. METHODS: We extracted the genomic DNA from 59 FNAC slides and performed direct sequencing (DS) for detecting BRAF mutation. We could use only 17 slides for the MASA method and 6 slides for the RFLP method due to the shortage of extracted DNA. Additionally, we retrospectively analyzed the cases for which a histological diagnosis could be made. RESULTS: Genomic DNA was extracted from 23 out of the 59 FNAC slides. The BRAF mutation status could be assessed via DS in 33 out of the 59 FNAC slides. The concordance between the MASA method and DS and the RFLP method and DS was 36.3% and 66.7% respectively. The positive and negative predictive value of the 13 indeterminate nodules was 87.5% and 20%, respectively. We could not find any association between the BRAF mutations and the alleged risk factors of PTC. CONCLUSION: We believe that the purity and the amount of the DNA template must be increased to detect BRAF mutation with using a FNAC slide. Preoperative detection of the BRAF mutation on a FNAC slide may refine the cytological diagnosis, but the application of assessing BRAF mutation as a prognostic marker is debatable.
Alleles ; Biopsy, Fine-Needle* ; Diagnosis* ; DNA ; Korea ; Methods ; Polymorphism, Restriction Fragment Length ; Prevalence ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms*

Cases of hospital acquired pneumonia occurring during the 1st 12 months of Medico-Surgical ICU (Intensive care unit, MSICU) in operation were evaluated retrospectively to determine its incidence, common causative pathogens, outcome and radiological patterns with the new hospital setting providing a unique relatively aseptic environment. Among the 920 admitted patients, 73 episodes of nosocomial pneumonia on 63 patients were identified and the incidence rate was 7%. The most common pathogens were Pseudomonas. Staphylococcus, Serratia, and Enterobacter in the order of frequency of occurrence, and the gram-negative pathogens comprised 70%. Nosocomial pneumonia was more common after use of antibiotics due to such pathogens as Enterobacter, Acinetobacter, and Candida which caused poor outcome. Enterobacter had the greatest tendency to be related with poor outcome and Serratia the least. Overall mortality was 25%. Bronchopneumonia was the most common type of pneumonia caused by any pathogen except Acinetobacter which caused a mixed type of nosocomial pneumonia.
Cross Infection/epidemiology/*etiology/radiography ; Enterobacter/isolation & purification ; Humans ; Incidence ; *Intensive Care Units ; Outcome Assessment (Health Care) ; Pneumonia/epidemiology/*etiology/radiography ; Pseudomonas/isolation & purification ; Retrospective Studies ; Staphylococcus/isolation & purification

Background/Aims: Functional dyspepsia is a disease involving a range of upper gastrointestinal symptoms derived from various pathophysiologies. Tablets containing a combination of rabeprazole and controlled-release (CR) mosapride were recently developed.To investigate a more effective treatment, this trial evaluated the efficacy and safety of UIC201609/UIC201610 as a preliminary study. Methods: A multicenter, double-blind, randomized study was performed on 30 subjects. UIC201609/UIC201610 (combination of rabeprazole and CR mosapride) was the case group, and the two control groups were rabeprazole 10 mg once a day and mosapride 15 mg CR tablet once a day. As a primary efficacy endpoint of the study, the changes in the total score of eight items of the Nepean Dyspepsia Index-Korean version were analyzed at 2 weeks and 4 weeks. The outcomes regarding safety were collected. Results: The total symptom score of Nepean Dyspepsia Index-Korean decreased in the rabeprazole single group (29.4±17.1), mosapride CR single group (33.4±15.6), and UIC201609/UIC201610 group (33.4±11.8) at 4 weeks without significant differences. On the other hand, the UIC201609/UIC201610 combination group showed more score reduction of pain in the upper abdomen, burning in the upper abdomen compared to each control group, but it did not reach statistical significance. No difference was found in safety analysis. Conclusions UIC201609/UIC201610 once daily showed some improvement in epigastric pain and dyspepsia in patients with functional dyspepsia, but there was no significance. Further study based on the advanced clinical trial design will be needed to confirm the efficacy of UIC201609/UIC201610 combination therapy in the future.

Background/Aims: Functional dyspepsia is a disease involving a range of upper gastrointestinal symptoms derived from various pathophysiologies. Tablets containing a combination of rabeprazole and controlled-release (CR) mosapride were recently developed.To investigate a more effective treatment, this trial evaluated the efficacy and safety of UIC201609/UIC201610 as a preliminary study. Methods: A multicenter, double-blind, randomized study was performed on 30 subjects. UIC201609/UIC201610 (combination of rabeprazole and CR mosapride) was the case group, and the two control groups were rabeprazole 10 mg once a day and mosapride 15 mg CR tablet once a day. As a primary efficacy endpoint of the study, the changes in the total score of eight items of the Nepean Dyspepsia Index-Korean version were analyzed at 2 weeks and 4 weeks. The outcomes regarding safety were collected. Results: The total symptom score of Nepean Dyspepsia Index-Korean decreased in the rabeprazole single group (29.4±17.1), mosapride CR single group (33.4±15.6), and UIC201609/UIC201610 group (33.4±11.8) at 4 weeks without significant differences. On the other hand, the UIC201609/UIC201610 combination group showed more score reduction of pain in the upper abdomen, burning in the upper abdomen compared to each control group, but it did not reach statistical significance. No difference was found in safety analysis. Conclusions UIC201609/UIC201610 once daily showed some improvement in epigastric pain and dyspepsia in patients with functional dyspepsia, but there was no significance. Further study based on the advanced clinical trial design will be needed to confirm the efficacy of UIC201609/UIC201610 combination therapy in the future.

PURPOSE: To investigate the role of induction chemotherapy in relation to the treatment results and toxicities of concurrent chemoradiotherapy (CCRT) for locally advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Patients with unresectable and pathologically confirmed Stage III NSCLC were eligible. According to the stage and pathological subgroup, the patients were randomized into two arms. Arm A received two cycles of the induction chemotherapy composed of gemcitabine, 1,000 mg/m2 (D1 and D8), and cisplatin, 70 mg/m2 (D1), followed by CCRT with weekly paclitaxel, 50 mg/m2, and cisplatin, 20 mg/m2. Arm B received immediate CCRT without the induction chemotherapy. A daily 2.2 Gy radiation dose was delivered to the isodose line covering the planned target volume, which was defined as the gross tumor volume plus a 1.0 cm margin from the planning CT, using a 3-D conformal radiation therapy technique. RESULTS: Between May 2003 and 2004, 63 patients were enrolled. Forty four patients (Arm A 23, Arm B 21) were evaluable, with follow-up periods exceeded 1 month after the end of the assigned treatment. The median follow-up periods were 6 and 7 months for Arms A and B, respectively. The patients' characteristics, including gender, age, weight loss, performance status, pulmonary function and stage, were well balanced between the two arms. The median largest tumor diameters were 4.8 cm (3.0~15 cm) and 5.0 cm (2.5~10 cm) for Arms A and B, respectively. The one-year survival rates were 58 and 63% for Arms A and B respectively, which showed no statistical significance (p=0.6667). The compliance of the induction chemotherapy was 96% (22/23 patients), and those of the CCRT were 86% for both arms (18/21 patients). The response rate of the induction chemotherapy was 64% (14/22 patients) and those of the CCRT were 83 (15/18 patients) and 89% (16/18 patients) for Arms A and B, respectively, which showed no statistical significance (p=0.630). In the 23 patients of Arm A, 8 (35%) suffered grade 3~4 neutropenia during the induction chemotherapy and 1 expired due to sepsis. CCRT caused grade 3~4 neutropenia in 6 and 1 patients of Arms A (29%) and B (5%), respectively, showing statistical significance (p=0.038). Grade 3~4 radiation pneumonitis developed in 2 and patients from Arms A (10%) and B (5%), respectively, (p=0.464) and grade 3~4 acute esophagitis developed in 7 (Arm A) and 5 patients (Arm B) (p=0.495). CONCLUSION: Both treatment schemes showed acceptable treatment compliance and toxicities. However, the induction chemotherapy resulted in a higher incidence of severe neutropenia. The treatment outcomes, as yet, have shown no statistical significance. To evaluate the role of induction chemotherapy on the survival prolongation in CCRT for locally advanced NSCLC, more patients and a longer follow-up are mandatory
Arm ; Carcinoma, Non-Small-Cell Lung* ; Chemoradiotherapy* ; Cisplatin ; Compliance ; Esophagitis ; Follow-Up Studies ; Humans ; Incidence ; Induction Chemotherapy* ; Neutropenia ; Paclitaxel ; Prospective Studies* ; Radiation Dosage ; Radiation Pneumonitis ; Sepsis ; Survival Rate ; Tumor Burden ; Weight Loss