Retroperitoneal duodenal rupture is rare and is often difficult to diagnose on the plain abdominal x-ray. From a review of the plain abdomen films of 21 cases with retroperitoneal duodenal rupture, confirmed by operation, pneumoretroperitoneum was revealed in 16 cases; Air in the peritoneum was manifested as a bubbly shadow in 12 cases, a renal halo in 9 cases, air shadow along the right psoas margin in 2 cases, air along the diaphragmatic crus in 2 cases and air in the right properitoneal fat in 2 cases, US and CT also revealed air bubbles and fluid collection around the right kidney. We recommend the plain abdomen as a useful diagnostic method for detection of pneumoretroperitoneum.
Abdomen* ; Kidney ; Methods ; Peritoneum ; Retropneumoperitoneum ; Rupture*

No abstract available.
Gastrointestinal Tract* ; Radionuclide Imaging*

No abstract available.
Arteries* ; Humans ; Quadriplegia*

Asterixis is an abrupt, brief, arrhythmic lapse of tonically contracting muscles. A 64-year old woman with a left thala-mic infarction showed asymmetric bilateral asterixis after taking phenytoin for the control of thalamic pain. Though thalamic lesion can cause asterixis, her asterixis may have been induced by phenytoin, because it was bilateral and sub-sided after stopping phenytoin. We report an unusual case of asymmetric asterixis induced by phenytoin in a patient with a left thalamic infarction.
Dyskinesias* ; Female ; Humans ; Infarction* ; Middle Aged ; Muscles ; Phenytoin*

Medical education and research require various forms of information, which form multimedia data. While traditional computer can only deal with numeric and coded data, modern computer technology enabl es intergrated management of multimedia data. The present system was designed to perform convenient, acquisition, processing and analysis, and efficient presentation of medical multimedia data. APC-486 DX2 system epuipped with 8MB DRAM and 250 MB HDD provided fast enough computation speed, and image quality guaranteed by 17-inch SVGA color monitor. Both sound and image data are simultaneously acquired through a condenser microphone and audiocard, and respectively, in a video signal format. Printed pictures are digitized by a color scanner. Data transmission is also possible through a local area network (LAN). Acquired media data are structured in a hierarchy with the image data as apex. A variety of image processing and analysis algorithms were implemented and the media data can be reproduced simultaneously. Furthermore, simple and dynamic image animation can be performed to enhance data editing and authoring capability. Selected data sets can be reproduced in a user defined sequence, enabling "multimedia slide presentation". User interface was made in Windows format and all application programs were written in Borland C++ for future flexibility and extension. The present system will be of convenient use to acquire, manage, and present multimedia data for medical education and research.
Dataset ; Education, Medical ; Local Area Networks ; Multimedia* ; Pliability

Acute gastric anisakiasis with multiple anisakid larvae infection is reported. A 68-year-old woman residing in Busan, Korea, had epigastric pain with severe vomiting about 5 hours after eating raw anchovies. Four nematode larvae penetrating the gastric mucosae in the great curvature of the middle body and fundus were found and removed during gasteroendoscopic examination. Another one thread-like moving larva was found in the great curvature of upper body on the following day. On the basis of their morphology, the worms were identified as the 3rd stage larvae of Anisakis simplex. This case is acute gastric anisakiasis provoking severe clinical problems by the multiple infection and the greatest number of anisakid larvae found in a patient in Korea.
Acute Disease ; Aged ; Animals ; Anisakiasis/*parasitology/surgery ; Anisakis/*growth & development ; Female ; Gastric Mucosa/parasitology/pathology/surgery ; Gastroscopy ; Human ; Stomach Diseases/*parasitology/pathology/surgery

Familial idiopathic striopallidodentate calcification is a disorder radiologically characterized by bilateral calcifications of the brain without abnormalities in the serum calcium level and related endocrinological parameters. We report a 70-year-old woman presented with slowly progressive gait disturbance, dementia and Parkinsonism. She had bilateral and symmetric calcifications of the basal ganglia, thalamus, dentate nucleus, and subcortical white matter on the brain CT. One son and two granddaughters also showed calcifications of the basal ganglia, suggesting an autosomal dominant inheritance.
Aged ; Basal Ganglia ; Brain ; Calcium ; Cerebellar Nuclei ; Dementia ; Female ; Gait ; Humans ; Parkinsonian Disorders ; Thalamus ; Wills

OBJECTIVE: Heart rate variability(HRV) is helpful to diagnosis autonomic disturbance and sympathetic-parasympathetic imbalance in patients with myocardial infarction and diabetes mellitus. Patients with liver cirrhosis demonstrate reduced blood pressure despite increased heart rate and increased cardiac output, indicating a fall in peripheral vascular resistance. Autonomic disturbance may contribute to this phenomenon. The aim of the present study is to evaluate the degree of autonomic disturbance and the circadian rhythm of autonomic nervous system by estimating HRV with 24 hour-Holter recorder, METHODS: 24 hour-HRV with Del Mar Avionics 563 Holter recorder and cardiovascular reflex tests were carried out on 32 patients with liver cirrhosis and 20 control subjects. We evaluated the presence of autonomic disturbance, and assessed quantitatively the autonomic disturbance. RESULTS: 1) Among cardiovascular reflex tests, Valsalva test, standing test and deep breathing test were showed a significantly decreased response in liver cirrhosis compared with control groups. 2) The standard deviation of 24hours average R-R intervals were showed a significantly decrease in liver cirrhosis than control groups(P<0.0001). The HRV of low frequency(LF. P<.D.001), high frequency(HF, P<0.0001) and total power spectral density (P<0.0001) in liver cirrhosis were statistically lower than control. 3) The LF/HF ratio of patients with liver cirrhosis was showed higher than control at night CONCLUSION: Non-invasive assessment of 24 hour-HRV has a few advantages in the diagnosis and degree of autonomic disturbance, evaluation of diurnal variation of autonomic tone.
Autonomic Nervous System ; Blood Pressure ; Cardiac Output ; Circadian Rhythm ; Diabetes Mellitus ; Diagnosis ; Heart Rate* ; Heart* ; Humans ; Liver Cirrhosis* ; Liver* ; Myocardial Infarction ; Reflex ; Respiration ; Vascular Resistance

BACKGROUND: During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients. METHODS: This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors. RESULTS: Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026). CONCLUSIONS: In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.
Adult ; APACHE ; Critical Illness ; Health Facility Size ; Humans ; Influenza, Human ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Pandemics ; Retrospective Studies ; Risk Factors

BACKGROUND: Continuous epidural catheterization is a popular and effective procedure for postoperative analgesia. However, continuous epidural catheterization has associated complications such as venous puncture, dural puncture, subarachnoid cannulation, suboptimal catheter placement, and paresthesia because the tip of the epidural catheter touches thenerves of the dura in the epidural space. In this study, we compared the incidence of paresthesia in two different lengths of epidural catheter insertion. METHODS: One hundred women undergoing gynecologic or orthopedic surgery were enrolled in this prospective, double-blinded, randomized study. All patients were randomly divided into two groups based on the insertion length of the epidural catheter 2 cm (group A) or 4 cm (group B). A Tuohy needle was inserted in the lumbarspinal region with a bevel directed cephalad by use of the median approach, and then the epidural space was confirmed by the loss of resistance technique with air. While the practitioner inserted an epidural catheter into the epidural space, a blind observer checked for paresthesia or withdrawal movement. RESULTS: In 97 included patients, 30.6% of the patients in group A (n = 49) had paresthesia, versus 31.3% in group B (n = 48). Withdrawal movements were represented in 2% and 6% of the patients in group A and group B, respectively. There was no difference in the incidence of paresthesia and withdrawal movement between the two groups. CONCLUSIONS: There is no clear relationship for the incidence of catheter-related paresthesia according to the catheter length inserted into the epidural space for epidural analgesia.
Analgesia ; Analgesia, Epidural ; Catheterization* ; Catheters* ; Epidural Space ; Female ; Humans ; Incidence* ; Needles ; Orthopedics ; Paresthesia* ; Prospective Studies ; Punctures