Neonatal tension pneumothorax is life-threatening. A tension pneumothorax on the right side was detected on a newborn boy weighing 2,380 g, who was born at 35 weeks of gestation. Given the unavailability of an on-duty thoracic surgeon and appropriately sized chest tubes in the neonatal intensive care unit, an emergency physician performed closed thoracostomy using two 7-French latex catheters. Immediately after the re-expansion of the right lung, left tension pneumothorax was newly detected. Two more 7-French latex catheters were inserted, relieving the left lesion. We consider that the right pneumothorax occurred due to the mixture of spontaneous rupture of the subpleural blebs and barotrauma during the initial positive pressure ventilation, while the left lesion did due to the high-flow oscillatory ventilation. Despite the limited availability of devices in the present case, a favorable outcome was achieved by the use of alternative catheters, which were chosen by the emergency physician.

BACKGROUND: Soluble IL-2R, soluble CD8 and TNF-alpha are elevated in sera of some patients with hematological malignancies, and a marked elevation of these cytokines could be used to assess disease activity and prognosis in this malignancy group. METHODS: The serum levels of sIL-2R, sCD8 and TNF-alpha were assessed in 28 patients with myelodysplastic syndrome (MDS) and 32 patients with acute myeloid leukemia (AML), and 39 cases of healthy control subjects to define clinical usefulness as prognostic markers by sandwich enzyme immunoassay. RESULTS: In MDS patients, serum sIL-2R levels were significantly higher as compared with controls, and a more pronounced increase of serum sIL-2R levels was found in patients with RAEB RAEB-t and CMML as compared with RA and RARS. Serum sCD8 levels were higher as compared with controls, but not related with FAB classification. In patients with leukemic conversion. sCD8 levels tended to be higher as compared with patients with non-conversion. The sIL-2R levels of AML patients were significantly higher than controls, and a significant correlation was detected between the levels of sIL-2R and WBC counts. Higher sIL-2R levels( >2000 U/ml) tended to affect both complete remission rate and survival. Serum sCD8 levels were higher than controls, but not related to FAB classification. No differences of serum TNF-alpha levels were detected as compared with healthy controls. CONCLUSIONS: From these results, this study indicates that serum sIL-2R and sCD8 are significantly increased in some patients with MDS and AML, and increased levels of serum sIL-2R and sCD8 may be useful for predicting prognosis of these patients.
Anemia, Refractory, with Excess of Blasts ; Classification ; Cytokines ; Hematologic Neoplasms ; Humans ; Immunoenzyme Techniques ; Leukemia, Myeloid, Acute* ; Myelodysplastic Syndromes* ; Prognosis ; Tumor Necrosis Factor-alpha*

Parenteral reserpine was given intramuscularly to 32 hospitalized hypertensive patients: 10 hypertensive patients without renal insufficiency, 3 hypertensive patients with heart failure, 10 hypertensive patients of malignant phase or with uremia, and 9 hypertensive patients with cerebrovascular accident. Follwoings were the result. 1. In the majority of patients, the effective dose of reserpine was 2 to 3 mg. 2. Reserpine given intramuscularly lowered blood pressure in 2 to 4 hours, had its maximum effect in 3 to 6 hours and had a duration of 3 to more than 24 hours (average 9 hours). 3. When effective dose of reserpine was given, blood pressure was lowered significantly (more than 30mmHg in mean blood pressure) in 18 patients (81.7%) of 22 hypertensive patients without renal insufficiency, and in 4 patients (40%) of 10 hypertensive patients with renal insufficiency. 4. Major side effect was drowsiness which was more evident in the patients with renal insufficiency. 5. Reserpine administered parenterally is an effective and safe agent for the treatment of hypertensive emergencies on a short term basis especially in the patient without renal insufficiency.
Blood Pressure ; Emergencies ; Heart Failure ; Humans ; Renal Insufficiency ; Reserpine* ; Sleep Stages ; Stroke ; Uremia

Recently, several reports of extrahepatic hepatocellular carcinoma metastasis demonstrated by technetium-99mTc-IDAs scan have shown that 99mTc-IDAs can be used to detect extrahepatic metastasis in hepatocellular carcinoma. We report here a case of hepatocellular carcinoma with pulmonary nodules that were demonstrated as metastasis in nature by the use of the 99mTc-DISIDA. The findings in this case and several reports reviewed here suggest that the 99mTc-DISIDA scan may be a useful diagnostic agent that can detect the extrahepatic metastasis of hepatocellular carcinoma and stage the disease. But more clinical study in needed to establish the position of 99mTc-DISIDA in the field of diagnosis of extrahepatic hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Clinical Study ; Diagnosis ; Lung* ; Neoplasm Metastasis ; Technetium Tc 99m Disofenin

PURPOSE: Sentinel lymph node (SLNB) is the first confronted lymph node from primary lesion of tumor through lymphatic drainage, which is important for determining early metastasis and setting guidelines for treatment. We reported significant of sentinel lymph node biopsy in malignant melanoma (MM) and squamous cell carcinoma (SCC) of lower extremities. MATERIALS AND METHODS: Twenty-five cases of surgically treatment and being possible for follow up more than 1 year among the patients who were diagnosed as MM and SCC in this institution from Sep. 2005 to Jan. 2009, and 10 cases of them were performed SLNB. Average age was 64 years old, and 15 cases of male and 10 cases of female were in this group. RESULTS: 3 years overall survival rate was 100% and 3 years disease-free survival rate was 76%. Metastasis occurred in total 6 patients, 4 cases of inguinal lymph nodes, 1 case of soft tissue around knee, 1 case of left achilles tendon. In 15 cases of not performing SLNB, overall survival rate was 93.3% and disease-free survival rate was 73.3%. In 10 cases of performing SLNB, overall survival rate was 100% and disease-free survival rate was 90%. And only 1 case showed positive finding in the biopsy, and none of the 10 cases showed metastasis in follow-up. CONCLUSION: SLNB leads simpler and less complications compared to prior elective lymph node dissection, and shows high degree of accuracy. Throughout the SLNB, setting guidelines for treatment by accurate staging is thought to be helpful for increasing the survival rate in the patient with MM and SCC.
Achilles Tendon ; Biopsy ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Drainage ; Female ; Follow-Up Studies ; Humans ; Knee ; Lower Extremity ; Lymph Node Excision ; Lymph Nodes ; Male ; Melanoma ; Neoplasm Metastasis ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy ; Survival Rate

Clinical study was carried out on the 64 hemodialysis patients(HD) with chronic renal failure who had been treated from December 1992 to July 1993 in Yeungnam University Hospital. The following results were obitained. In hematologic parameters, MCH was 28.8±2.0pg, and MCV was 92.4±4.7fl. Result revealed normochromic and normocytic anemia. Mean values of serum ferritin were 657.4±292.0ng/ml in men and 511.5±370g in women. Mean values of serum iron were 145.5±63.7µg/dl. Mean values of transferrin saturation was 61.6±28.4%. Serum frerritin, serum iron and transferrin saturation were higher in HD group than normal reference. In erythropoeitin treatment group, Hb and Hct were significantly higher than non-erythropoietin treatment group. Amount of transfusion was significantly higher in non-erythropoietin treatment group than erythropoeitin treatment group(p<0.05). Values of iron, transferrin saturation were significantly higher in abnormal liver function test(LFT0 hemodialysis group than normal LFT group(p<0.05). Transfusion amounts revealed positive correlation with ferritin(r=0.4675), transferrin satruation (r=0.3823) and iron(r=0.3386) (p<0.05).
Anemia* ; Clinical Study ; Erythropoietin* ; Female ; Ferritins ; Humans ; Iron ; Kidney Failure, Chronic ; Liver ; Male ; Renal Dialysis ; Transferrin

To evaluate the prevalence and the role of mutation of p53 gene in the transitional ceI1 carcinoma of the urinary bladder with special attention to the clinicopathologic features, we examined p53 expression in paraffin-embedded tissues from 95 transitional cell carcinomas with various stages and grades and 5 specimens of morphologically normal bladder. Nuclear expression of p53 protein was detected by immunohistochemical analysis with avidin -alkaline phosphatase method, using the monoclonal antibody DO-7. And to evaluate the correlation of p53 expression with cell proliferation, expression of proliferating cell nuclear antigen(PCNA) was also assessed immunohistochemically in 43 specimens, using the monoclonal antibody PC1O. Median follow-up duration was 36 months(12-117 months). Immunohistochemical staining with p53 in 5 normal bladder specimens showed that 4 specimens exhibited absence of nuclear staining in urothelial and stromal cells and 1 specimen exhibited nuclear staining less than 5% of urothelial cells in the basal layer. Forty six(48%) of 95 specimens with transitional cell carcinoma of the bladder showed positive nuclear staining. Nuclear expression of p53 was observed with significantly higher frequency and stronger intensity(p<0.01 and p<0.005, respectively) in cases with invasive tumors(17,27, 70%) than superficial tumors(27/68, 40%). Nuclear expression of p53 was observed with signi6cantly higher frequency and stronger intensity(p<0.005 and p<0.005, respectively) in. cases with high grade tumors(32,43, 74%) than in cases with low grade tumors(14/52, 27%). Patients with bladder tumors were stratified into two groups with different patterns of staining for p53 protein (group A: <20%, group B: >20%). Recurrence rates of patients with superficial tumors were 2.2% per month for group A and 4.2% for group B, and patients in group B had a significantly 1ower disease-free interval(P<0.005). Disease progression rates of patients with T1 tumors were 4% per year and 21.2% for group B, and patients in group B had a significantly lower progression- free interval(P<0.025). Difference of survivorship of patients with invasive tumors between group A and B was not statistically significant(p>O.1). Mean value of PCNA expression rates of 43 transitional cell carcinomas of the bladder was 12.1+8.34%(mean + SD). Mean value of PCNA expression rates was slightly higher in p53 positive-stained group(13.2+/-7.81%) than negative stained group(10.8+/-8.89%), but difference was not statistically significant(p>0.1). These results suggest that p53 mutations play an important role in the acquisition of aggressive biological natures in invasive bladder transitional cell carcinomas rather than in the genesis of tumors of low malignant potentials. This study also suggests that immunohistochemical examination of p53 in superficial bladder transitional cell carcinomas (especially, T1 tumors) offers significant information, and the degree of p53 expression might be a useful prognostic indicator which can be considered in treatment planning.
Avidin ; Carcinoma, Transitional Cell* ; Cell Proliferation ; Disease Progression ; Follow-Up Studies ; Genes, p53 ; Humans ; Immunohistochemistry ; Prevalence ; Proliferating Cell Nuclear Antigen ; Recurrence ; Stromal Cells ; Survival Rate ; Urinary Bladder Neoplasms ; Urinary Bladder*

Primary progressive aphasia(PPA) can be classified into nonfluent and fluent types. The fluent PPA usually manifests as Wernicke's or transcortical sensory aphasia. We report a 61-year-old right-handed woman who presented with a fluent PPA. An aphasia test revealed fluent speech and intact comprehension but decreased repetition and naming, consistent with conduction aphasia. Other cognitive functions and activities of daily living were preserved. Brain MRI and SPECT respectively showed a focal atrophy and a hypoperfusion in the left temporal lobe.
Activities of Daily Living ; Aphasia, Conduction* ; Aphasia, Primary Progressive* ; Aphasia, Wernicke ; Atrophy ; Brain ; Comprehension ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neuropsychological Tests ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon

Background & Objectives: To determine the prevalence and characteristics of radiculopathy in Parkinson’s disease (PD) patients through electrodiagnostic tests, to assess associated radicular pain characteristics,and to investigate the relationship between pain and other clinical manifestations of PD. Methods: Electrodiagnostic testing including nerve conduction studies and needle electromyographywas performed to investigate comorbid peripheral neuropathy or radiculopathy. All patients were asked to complete aquality of life (QOL) measurement related to pain. Results: Thirty-two (39%) of 82 PD patients had radiculopathy based on electrodiagnostic testing. 46.9% with radiculopathy patients had involvement of multiple roots level. The most commonly involved root was L5 (83.3%). Patients with radiculopathy had longer PD durations (p=0.011) and higher posture-related axial scores on the UPDRS scale (p=0.017).There was a trend for pain in the leg and low back to occur more frequently in PD patients with radiculopathy. QOL is not significantly different according to the presence of radiculopathy in PD. Conclusions: This study demonstrates a high prevalence of radiculopathy, particularly multiple root involvement, and is correlated with pain complaints and with axial motor scores on UPDRS. These findings might be related to increased shear force at the intervertebral disc by axial rigidity and flexed posture in PD along with the duration and severity of PD disease course.
Parkinson Disease ; Radiculopathy

Horizontal tear of the meniscus occurs most commonly in older patients. The tear begins initially with a simple horizontal cleavage which divides the meniscus into superior and inferior leaves resembling a fish mouth and which may become a flap or more complex tear with time if subjected to repeated injury. Thirty-four patients(36knees/40menisci) with horizontal tear of the meniscus, treated with arthroscopic partial meniscectomy except in 3 extensive tears at Ulsan University Hospital from Jan. 1993 to Jun. 1996, were analyzed to investigate the factors that may be associated with this type of meniscal tear, and the results were as follows; 1. The tears commonly occurred in labor workers(61.7%) and without obvious trauma history(67.6%), and the average age at the time of surgery was 44 years. 2. The most common site of the tear was posterior horn of the medial meniscus (62.5%). 3. The 40 horizontal tears consisted of 12 horizontaVcleavage(30%), 3 horizontaVflap(7.5%), and 25 horizontaUdegenerative complex tears(62.5%). 4. Degenerative changes were frequently noted in both arthroscopy(69.5%) and roentgenography (72.2%).
Animals ; Horns ; Humans ; Menisci, Tibial ; Mouth ; Radiography ; Ulsan