Cerebrospinal fluid (CSF) leakage is a rare complication that can occur due to dural defects during spinal surgery, hindering the improvement of the surgical site and increasing the possibility of infection. DuraSeal® is a dural sealing adhesive that prevents CSF leakage and is used as an adjunct to enable the watertight repair of dural defects when the dura is damaged during spinal surgery. In the present case, DuraSeal® was applied to repair a dural defect in the surgical area after thoracic spine surgery, and no neurological problems occurred immediately after surgery. However, a day later, the patient’s paraparesis worsened; therefore, reoperation was performed and the symptoms improved.

OBJECTIVE: Symptoms of posterior reversible encephalopathy syndrome (PRES) include headache, altered mental status, visual disturbances, and seizures. Typical radiological features include edema of the parieto-occipital lobes. The purpose of this study is to review the clinical and radiological findings in patients diagnosed with PRES. METHODS: All patients diagnosed with PRES between January 2006 and December 2012 were retrospectively included in this study. We reviewed demographic and clinical characteristics, and radiological findings. RESULTS: We identified 16 patients with PRES. The most common clinical presentation was seizure (n = 12, 75%). Clinical recovery occurred in all patients within days (mean, 5.7 +/- 4.6 days). Comorbid conditions included hypertension (n = 4, 25%), cytotoxic medications (n = 3, 18.8%), sepsis (n = 4, 25%), malignancy (n = 4, 25%), subarachnoid hemorrhage (n = 1, 6.3%), autoimmune disorders (n = 1, 6.3%) and eclampsia (n = 1, 6.3%). The most commonly involved location was the parieto-occipital lobe (n = 13, 81.3%). Atypical radiological findings included significant basal ganglia involvement in 4 episodes; brainstem in 3, cerebellum in 2, and thalamus in 3. Eleven patients (68.8%) underwent diffusion-weighted imaging and apparent diffusion coefficient mapping. Of those, 9 patients (81.8%) had hypo- or isointensity on diffusion-weighted imaging. On the apparent diffusion coefficient map, 10 patients (90.9%) had hyperintensity, and the other had normal values. CONCLUSION: We suggest that PRES may occur in patients with complex systemic conditions. The prognosis of PRES is usually benign. Physicians should be aware of certain atypical radiological findings to avoid a delayed diagnosis of PRES, as delayed diagnosis and treatment can result in permanent neurological sequlae.
Basal Ganglia ; Brain Stem ; Cerebellum ; Delayed Diagnosis ; Diffusion ; Eclampsia ; Edema ; Female ; Headache ; Humans ; Hypertension ; Pregnancy ; Prognosis ; Retrospective Studies ; Seizures ; Sepsis ; Subarachnoid Hemorrhage ; Thalamus

OBJECTIVE: Symptoms of posterior reversible encephalopathy syndrome (PRES) include headache, altered mental status, visual disturbances, and seizures. Typical radiological features include edema of the parieto-occipital lobes. The purpose of this study is to review the clinical and radiological findings in patients diagnosed with PRES. METHODS: All patients diagnosed with PRES between January 2006 and December 2012 were retrospectively included in this study. We reviewed demographic and clinical characteristics, and radiological findings. RESULTS: We identified 16 patients with PRES. The most common clinical presentation was seizure (n = 12, 75%). Clinical recovery occurred in all patients within days (mean, 5.7 +/- 4.6 days). Comorbid conditions included hypertension (n = 4, 25%), cytotoxic medications (n = 3, 18.8%), sepsis (n = 4, 25%), malignancy (n = 4, 25%), subarachnoid hemorrhage (n = 1, 6.3%), autoimmune disorders (n = 1, 6.3%) and eclampsia (n = 1, 6.3%). The most commonly involved location was the parieto-occipital lobe (n = 13, 81.3%). Atypical radiological findings included significant basal ganglia involvement in 4 episodes; brainstem in 3, cerebellum in 2, and thalamus in 3. Eleven patients (68.8%) underwent diffusion-weighted imaging and apparent diffusion coefficient mapping. Of those, 9 patients (81.8%) had hypo- or isointensity on diffusion-weighted imaging. On the apparent diffusion coefficient map, 10 patients (90.9%) had hyperintensity, and the other had normal values. CONCLUSION: We suggest that PRES may occur in patients with complex systemic conditions. The prognosis of PRES is usually benign. Physicians should be aware of certain atypical radiological findings to avoid a delayed diagnosis of PRES, as delayed diagnosis and treatment can result in permanent neurological sequlae.
Basal Ganglia ; Brain Stem ; Cerebellum ; Delayed Diagnosis ; Diffusion ; Eclampsia ; Edema ; Female ; Headache ; Humans ; Hypertension ; Pregnancy ; Prognosis ; Retrospective Studies ; Seizures ; Sepsis ; Subarachnoid Hemorrhage ; Thalamus

PURPOSE: This study was performed in order to determine the changes over time in preventable and potentially preventable traumatic death rates, and to assess the factors that affected the deaths of trauma patients which occurred in Korean pre-hospital and hospital settings. METHODS: All trauma deaths occurring either in the emergency department (ED) or after admission at twenty Korean hospitals between August 2009 and July 2010 were retrospectively analyzed. The deaths were initially reviewed by a team of multidisciplinary specialists and classified into non-preventable, potentially preventable, and preventable deaths. Only preventable and potentially preventable deaths were the subject of our analysis. Structured data extraction included patient demographics, vital signs, injury severity, probability of survival, preventability of mortality, reported errors in the evaluation and management of the patient, and classification of error types (system, judgment, knowledge). RESULTS: During the study period, 446 trauma victims died in the ED or within 7 days after admission. The mean age was 52 years, 74.1% were men and the mean time from injury to death was 35.6 hours. The most common cause of death was head injury (44.7%) followed by hemorrhage (30.8%) and multi-organ failure (8.0%). The rates of preventable/potentially preventable deaths were 35.2% overall and 29.8% when limited to patients surviving to admission. Of all death classifications, 31.2% were potentially preventable and 4.0% were preventable. Errors leading to preventable death occurred in the emergency department (51.2%), pre-hospital setting (30.3%) and during inter-hospital transfer (60.8%). Most errors were related to clinical management (48.4%) and structural problems in the emergency medical system (36.5%). CONCLUSION: The preventable death rates for Korean trauma victims were higher than those found in other developed countries, possibly due to poorly established emergency medical systems for trauma victims in pre-hospital and hospital settings. A system wide approach based on the emergency medical system and well-developed in-hospital trauma teams should be adopted in order to improve the quality of care of trauma victims in Korea.
Cause of Death ; Craniocerebral Trauma ; Demography ; Developed Countries ; Emergencies ; Emergency Medical Services ; Hemorrhage ; Humans ; Judgment ; Korea ; Male ; Retrospective Studies ; Specialization ; Vital Signs

OBJECTIVES: This study examined the effect of 2% chlorhexidine on the microTBS of a direct composite restoration using one-step self-etch adhesives on human dentin. MATERIALS AND METHODS: Twenty-four extracted permanent molars were used. The teeth were assigned randomly to six groups (n = 10), according to the adhesive system and application of chlorhexidine. With or without the application of chlorhexidine, each adhesive system was applied to the dentin surface. After the bonding procedure, light-cure composite resin buildups were produced. The restored teeth were stored in distilled water at room temperature for 24 hours, and then cut and glued to the jig of the microtensile testing machine. A tensile load was applied until the specimen failed. The failure mode was examined using an operating microscope. The data was analyzed statistically using one-way ANOVA, Student's t-test (p < 0.05) and Scheffe's test. RESULTS: Regardless of the application of chlorhexidine, the Clearfil S3 Bond showed the highest microTBS, followed by G-Bond and Xeno V. Adhesive failure was the main failure mode of the dentin bonding agents tested with some samples showing cohesive failure. CONCLUSIONS: The application of 2% chlorhexidine did not affect the microTBS of the resin composite to the dentin using a one-step self-etch adhesive.
Adhesives ; Chlorhexidine ; Dental Cements ; Dentin ; Dentin-Bonding Agents ; Humans ; Methacrylates ; Molar ; Resin Cements ; Tooth ; Water

OBJECTIVE: The aim of this study is to evaluate the acceleration of the center of mass (COM) of the body in stroke patients. METHOD: Seventeen stroke patients and 9 normal subjects were participated. Three dimensional gait analysis was used to classify gait phases for the reference. The accelerometer held over the COM were used to record vertical and medio- lateral accelerations of the COM of the body. Modified Ashworth scale and Brunnstrom stage were used to evaluate the clinical status of stroke patients. RESULTS: In normal subjects, the acceleration showed symmetric pattern. The maximum peak of vertical acceleration occurred in loading response. In stroke patients, the acceleration wave was characterized by asymmetry and polyphasicity. Maximum peak in affected side was higher than that in unaffected side (p<0.05). There were significant correlations between several elements of hemiplegic gait and the correspondent acceleration values; interval of successive peak I in vertical acceleration vs. step time, walking velocity and swing symmetry ratio vs. mean peak I, swing symmetry ratio vs. affected side peak I, step length symmetry ratio vs. peak I symmetry ratio. CONCLUSION: The accelerometer can be an easy and useful way to evaluate gait characteristics in stroke patients.
Acceleration ; Gait Disorders, Neurologic ; Gait* ; Humans ; Stroke* ; Walking

PURPOSE: Surgery remains the treatment of choice for a hepatocellular carcinoma (HCC) confined within the liver. When there is no underlying liver disease, resection is the preferred option. In cases of HCC with cirrhosis, impaired hepatic reserve often precludes safe resection. Recently, acceptable transplantation outcomes have been shown in selected HCC patients. The aim of this study was to review the results of liver transplantation for HCC at the Asan Medical Center. METHODS: 73 HCC patients were treated by liver transplantation between August 1992 and April 2001. There were 7 in-hospital mortalities. The mean age of the patients was 51 years. The period of the median follow-up was 22 months. By reviewing the patients' medical records, we investigated tumor size, and number, TNM stage, survival rates, and recurrences. Statistical analysis was performed using Statistica 5.1 and SPSS 9.0. RESULTS: Among 67 patients, 8 (12%) developed a tumor recurrence or distant metastasis following the liver transplantation. The 3 year and 5 year survival rate were 88 and 57%, respectively. There were 12 incidentalomas. The 1 year and 3 year disease free survival rates of 54 cases, with the exception of the incidentalomas, were 80 and 50%, respectively. There were no statistically significant differences in the survival rates between the groups, with and without preoperative TACE (P=0.70). Also, there were no statistically significant differences in the survival rates between cadaveric donor liver transplantations (CDLT) and living donor liver transplantations (LDLT). CONCLUSION: We assume that transplantation for HCC, in carefully selected patients, may be the solution to HCC in cirrhotic livers. If the donor safety with a LDLT can be ensured, its application to patients with cirrhosis and early HCC may be a solution to the donor shortage, which could improve the survival of this group of patients.
Cadaver ; Carcinoma, Hepatocellular* ; Chungcheongnam-do ; Disease-Free Survival ; Fibrosis ; Follow-Up Studies ; Hospital Mortality ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Survival Rate ; Tissue Donors

BACKGROUND: Bronchial anthracofibrosis (BAF) is a dark black or brown pigmentation of multiple large bronchi associated with a fibrotic stenosis or obliteration that is incidentally found during a diagnostic bronchoscopy. Some reporters have suggested endobronchial tuberculosis or tuberculous lymphadenitis as a possible cause of BAF. However, some BAF patients do not have any medical history of tuberculosis. The aim of this study was to elucidate the clinical features of simple BAF patients, which were not associated with tuberculosis. METHODS: We reviewed the patients' charts retrospectively and interviewed all BAF patients who were followed up for 1 year or more. Among the 114 BAF patients, 43 patents (38 %) had no associated tuberculosis, cancer and pneumoconiosis. The clinical characteristics, radiological findings and associated pulmonary diseases of these patients were evaluated. RESULTS: Most patients were non-smokers, old aged, housewifes who resided in a farming village. The common respiratory symptoms were dyspnea, cough and hemoptysis. The predominant X-ray findings were a multiple bronchial wall thickening(89%), bronchial narrowing or atelectasis (76%) and a mediastinal lymph node enlargement with/without calcification (78%). Pulmonary function test usually showed mild obstructive ventilatory abnormalities but no patient showed a restrictive ventilatory pattern and the patients were frequently affected with chronic bronchitis(51%), post-obstructive pneumonia(40%) and chronic asthma(4%). CONCLUSION: Because BAF is frequently associated with chronic bronchitis and obstructive pneumonia as well as tuberculosis, a careful clinical evaluation and accurate differential diagnosis is more essential than empirical anti-tuberculous medication.
Diagnosis, Differential ; Pneumoconiosis

The Complete testicular feminization syndrome is a hereditary syndrome characterized clinically by female phenotype with 46, XY karyotype and bilateral testes. There is a congenital insensitivity to androgens, transmitted by means of a maternal X-linked recessive gene responsible for the androgen intracellular receptor. Therefore, androgen induction of Wolffian duct development does not occur. However, anti-mullerian hormone activity is present and the individual does not have mullerian development. Principle of treatment is reinforced to live normal female life. This is a case report of testicular feminization syndrome with rudimentary salpinx with the brief review of literatures.
Androgen-Insensitivity Syndrome* ; Androgens ; Anti-Mullerian Hormone ; Fallopian Tubes* ; Female ; Genes, Recessive ; Humans ; Karyotype ; Male ; Phenotype ; Testis ; Wolffian Ducts

The lingual thyroid is the most common manilestation of benign ectopic thyroid tissue, but is still a rare clinical entity. As a result, attempts at management may prove to be rather confusing. It may present with symptoms of dysphagia, upper airway obstruction or even hemorrhage at any time from infancy through adulthood. Therefore, clinical findings, laboratory tests, and radiographic imaging studies should be employed in confirming the diagnosis and appropriate planning treatment, keeing in mind that the primary therapeutic goal is to restore the thyroid function. We report two cases of lingual thyroid gland with the review otliterature.
Airway Obstruction ; Deglutition Disorders ; Diagnosis ; Hemorrhage ; Lingual Thyroid* ; Thyroid Dysgenesis ; Thyroid Gland ; Tongue Diseases