No abstract available.
Alopecia* ; Mucinosis, Follicular*

On a standpoint of commonly available ESWL for the treatment of urinary stone, percutaneous stone extraction had the role of cooperation to it, and sometimes it could be the first procedure of choice. We have performed percutaneous extraction of the renal and upper ureteral stones in 35 renal unite. The overall success rate was 78.4%, average operation time was 81 minutes, mean fluoroscopic exposure time was 11 minutes, average postoperative hospital stay was 7 days. Causes of failure were as followings ; five inadequate calyceal puncture, one ureteral perforation, one impacted stone, and one downward stone migration. The complications were inappropriate position of the nephrostomy tube, prolonged hematuria through nephrostomy tube, and partial ureteral avulsion. They were not serious but resolved by conservative management.
Hematuria ; Length of Stay ; Punctures ; Ureter ; Urinary Calculi

The ambulatory electrocardiographic examinations were performed in 31 patients (mean age of 59.4+/-9.3 yrs : male 16 cases, female 15 cases) with ischemic heart disease to evaluate the clinical features of ST segment more than 1 mm persisting for 45 seconds or longer. The incidence of associated disease are angina pectoris 14 cases, acute myocardial infarction 3 cases, old myocardial infarction 7 cases, hypertension 19 cases, diabetes mellitus 5 cases, cerebrovascular disease 4 cases, aortic regurgitation 2 cases, ventricular arrhythmia 1 case and chronic renal faliure 1 case. 93.7% of 252 monitored episodes of transient myocardial ischemia were silent. The incidence and duration of transient myocardial ischemia were 8.1+/-6.7 episodes/day (7.6+/-6.5episodes/day for silent myocardial ischemia, 0.5+/-0.9 episodes/day for silent ischemia, 7.6+/-14.1mins/day for symptomatic ischemia). The heart rate at the onset of ST segment depression is higher in symptomatic episode than silent episode (94.6+/-19.7 vs 82.1+/-17.4/min,. p<0.05). But duration of ST segment depression is longer in silent episode than symptomatic episode(32.4+/-97.7 vs 14.8+/-10.2/min,. p<0.01). Maximal ST segment depression was similar between silent and symptomatic episode (1.61+/-0.65 mm, 1.97+/-0.84 mm, repectively). 55.5% of silent episodes occurred during sleep or resting state and 60% of symptomatic episodes occurred during strenuous effort, exercise or eating (p<0.01). Transient myocardial ischemia developed not more frequently in the morning probably because the 24 hour Holter electrocadiographic examination was performed during hospitalization in the majority of cases.
Angina Pectoris ; Aortic Valve Insufficiency ; Arrhythmias, Cardiac ; Depression ; Diabetes Mellitus ; Eating ; Electrocardiography ; Female ; Heart Rate ; Hospitalization ; Humans ; Hypertension ; Incidence ; Ischemia ; Male ; Myocardial Infarction ; Myocardial Ischemia*

No abstract available.
Acne Vulgaris*

The authors experience 3 cases of angiographically occult vascular malformation(AVOM) of the brain during the last 3 months in 1990. All cases were diagnosis of either operative or pathological finding and were associated with intracerebral hemorrhage. The authors recommend that surgery should be considered even to those angiographically negative intracerebral hemorrhage cases, once clinical features are highly suggestive of AOVM. Surgery can be an effective and define therapy for these entities, which are prone to cause recurrent hemorrhage and persistent neural deficits.
Brain* ; Cerebral Hemorrhage ; Diagnosis ; Hemorrhage ; Magnetic Resonance Imaging ; Vascular Malformations*

Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU.
Adult ; Anoxia ; Blood Gas Analysis ; Fatigue ; Humans ; Intubation ; Masks* ; Muscle Fatigue ; Patients' Rooms ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Insufficiency ; Respiratory Muscles ; Vital Signs

PURPOSE: To evaluate and describe the efficacy and side effects of a percutaneous thrombin injection under ultrasonography guidance for the treatment of iatrogenic pseudoaneurysms. MATERIALS AND METHODS: Eighteen consecutive iatrogenic pseudoaneurysm cases were treated with a thrombin injection. The thrombin was injected into the pseudoaneurysm cavity using a 22-gauge needle under ultrasonographic guidance. The causes of the pseudoaneurysms are as follows: post coronary angiography (9 cases), percutaneous coronary balloon angioplasty (5 cases), cerebral angiography (1 case), transhepatic chemoembolization (1 case), percutaneous transfemoral arterial stent insertion (1 case) and bone marrow aspiration for a marrow transplant (1 case). RESULTS: Only one case required a secondary thrombin injection due to recurrent flow in the pseudoaneurysm lumen, which was detected at the follow up Doppler ultrasound. Other seventeen cases were successfully treated on the first trial. There were no technical failures or complication related to the procedure. The average amount of thrombin injected was 733 IU. Nine out of 18 treated patients (50%) showed mild reactions to the thrombin including mild fever (4 cases), chilling sensation (3 cases), a chilling sensation with mild dyspnea (1 case), mild chest discomfort (1 case) after the thrombin injection. All these side effects were transient and improved several hours later. CONCLUSION: All the iatrogenic pseudoaneurysms were treated successfully with an ultrasound-guided percutaneous thrombin injection. There was a high rate of hypersensitivity to the bovine thrombin, which precaution should be taken to prevent more serious side effects.
Aneurysm ; Aneurysm, False* ; Angioplasty, Balloon, Coronary ; Bone Marrow ; Cerebral Angiography ; Coronary Angiography ; Dyspnea ; Fever ; Follow-Up Studies ; Humans ; Hypersensitivity ; Needles ; Sensation ; Stents ; Thorax ; Thrombin* ; Ultrasonography

BACKGROUND: To determine the prognostic value of the initial APACHE II score in the ED compared with the classic APACHE II score in the ICU and to check the usefulness of the MEDS score together for more rapid risk stratification of septic patients admitted to the ICU via the ED. METHODS: We prospectively checked the initial APACHE II and MEDS scores of all the patients who had systemic inflammatory response syndrome in the ED and the classic APACHE II scores after admission to the ICU, as well 6 months later. We enrolled the only sepsis cases in the final diagnosis after reviewing the medical records. We evaluated the predictive abilities of the initial APACHE II and MEDS scores compared with the classic APACHE II score. RESULTS: During 6 months, 58 patients diagnosed with sepsis were enrolled. Twenty-four (41.4%) patients died within 28 days of admission and 34 patients survived. The mortality group had a significantly higher mean classic APACHE II score (19 +/- 6.7 vs. 15 +/- 5.0, p < 0.01) and a higher mean MEDS score (16.67 +/- 2.70 vs. 8.91 +/- 3.11, p < 0.01) than the survivor group. The initial APACHE II score at the ED was not significantly different between the two groups. ROC analysis showed the discriminative power of the MEDS score in predicting mortality was much better than the APACHE II score (areas under the curves of the APACHE II score in the ED and ICU, and the MEDS scores were 0.668, 0.807, and 0.967, respectively; p < 0.01). CONCLUSIONS: The initial APACHE II score in the ED did not predict mortality better than the classic APACHE II score. However, the MEDS score predicted the poor prognosis of septic patients more rapidly and accurately in the ED than the APACHE II model.
APACHE ; Emergencies ; Humans ; Critical Care ; Intensive Care Units ; Medical Records ; Prognosis ; Prospective Studies ; ROC Curve ; Sepsis ; Survivors ; Systemic Inflammatory Response Syndrome

PURPOSE: To identify MR predictors of bone cement leakage in patients receiving percutaneous vertebroplasty. MATERIALS AND METHODS: Percutaneous vertebroplasties were performed in 45 vertebras (T7; one, T8; two, T10; two, T11; two, T12; eight, L1; fifteen, L2; eight, L3; five, L4; two) in 35 patients (age 52-83). The procedure was performed using an 11 G Jamshidi needle, which was inserted into the target by the bipedicular approach. Kyphoplasty, unilateral pedicular approach and extrapedicular approach cases were excluded. Shortly after the procedure, all patients underwent a noncontrast CT covering the vertebroplasty sites. A retrospective study was performed to determine whether cement leakage is related to any of following MR findings: presence of cortical disruption of the vertebral body, severity of body compression (proportion of abnormal to normal vertebral body volumes), bone cement amount, bone cement amount/severity of body compression ratio, proportion of low-signal area in a vertebral body on T1 weighted image, presence of either vacuum or cystic portion below a linear dark signal in a fractured vertebra, and the location of dark signal intensity line in a vertebral body. Logistic discrimination model stepwise method was used in the statistical analysis. RESULTS: On post-vertebroplasty CT scan, bone cement leakage was detected in or around 29 vertebrae (64%), including 11 vertebrae (24%) where leakage was found in the epidural space or radial vein. No patients displayed any neurological symptoms or signs. The most frequent site of bone cement leakage was the anterior external vertebral venous plexus (49%). Endplate cortical bone disruption was related to an increased risk of intervertebral bone cement leakage (p<0.05). Bone cement leakage tended to occur less frequently when there is a vacuum or cystic change below the dark linear signal intensity in a fractured vertebra (p<0.05). No other MR findings showed a statistically significant correlation with bone cement leakage. CONCLUSION: On pre-vertebroplasty MR imaging, vertebral endplate cortical bone disruption and vacuum or cystic change below dark linear signal intensity in fractured vertebra showed a significant correlation with bone cement leakage.
Bone Cements ; Discrimination (Psychology) ; Epidural Space ; Humans ; Kyphoplasty ; Magnetic Resonance Imaging ; Needles ; Retrospective Studies ; Spine ; Tomography, X-Ray Computed ; Vacuum ; Veins ; Vertebroplasty*

Keratinocyte-fibroblast interactions are critical for skin repair after injury. During the proliferative phase of wound healing, proliferation, migration and differentiation of these cells are the major mechanisms leading to tissue remodeling. We have previously reported that glycitin, a major soy isoflavone, stimulates dermal fibroblast proliferation; and the phytochemical, 4′,6,7-trimethoxyisoflavone (TMF), induces migration of HaCaT keratinocyte cells. We therefore investigated whether these compounds display synergistic effects on skin cells during wound healing in vitro and in vivo. Co-treatment with TMF and glycitin synergistically promotes the proliferation and migration of both keratinocytes and dermal fibroblasts, with a 1:1 ratio of these compounds showing the greatest efficacy in our co-culture system. This keratinocyte-fibroblast interaction occurred via the secretion of TGF-β, and the induction of differentiation and proliferation was confirmed in both indirect and direct co-culture assays. In an excisional and burn wound animal model, mice treated with a 1:1 ratio of TMF and glycitin showed faster wound closure, regeneration and scar reduction than even the positive control drug. These data indicate that two isoflavones, TMF and glycitin, act synergistically to promote wound healing and anti-scarring and could potentially be developed together as a bioactive therapeutic for wound treatment.
Animals ; Burns ; Cicatrix ; Coculture Techniques ; Fibroblasts* ; In Vitro Techniques ; Isoflavones ; Keratinocytes* ; Mice ; Models, Animal ; Regeneration ; Skin ; Wound Healing* ; Wounds and Injuries*