Many previous studies have shown reduced glucose uptake in the ischemic brain. In contrast, in a permanent unilateral common carotid artery occlusion (UCCAO) mouse model, our pilot experiments using 18F-fluorodeoxyglucose positron emission tomography (FDG PET) revealed that a subset of mice exhibited conspicuously high uptake of glucose in the ipsilateral hemisphere at 1 week post-occlusion (asymmetric group), whereas other mice showed symmetric uptake in both hemispheres (symmetric group). Thus, we aimed to understand the discrepancy between the two groups. Cerebral blood flow and histological/metabolic changes were analyzed using laser Doppler flowmetry and immunohistochemistry/Western blotting, respectively. Contrary to the increased glucose uptake observed in the ischemic cerebral hemisphere on FDG PET (p<0.001), cerebral blood flow tended to be lower in the asymmetric group than in the symmetric group (right to left ratio [%], 36.4±21.8 vs. 58.0±24.8, p=0.059). Neuronal death was observed only in the ischemic hemisphere of the asymmetric group. In contrast, astrocytes were more activated in the asymmetric group than in the symmetric group (p<0.05). Glucose transporter-1, and monocarboxylate transporter-1 were also upregulated in the asymmetric group, compared with the symmetric group (p<0.05, respectively). These results suggest that the increased FDG uptake was associated with relatively severe ischemia, and glucose transporter-1 upregulation and astrocyte activation. Glucose metabolism may thus be a compensatory mechanism in the moderately severe ischemic brain.

Female phenotype of a 46,XY male may originates from male pseudohermaphroditism due to 17alpha-hydroxylase deficiency. Lack of cortisol increases adrenocorticotropic hormone (ACTH) and mineralocorticoid production, leading to low renin hypertention and hypokalemia. A 41-year-old phenotypic female presented primary amenorrhea and hypertension. In the hormonal profile, the levels of serum estradiol, testosterone, rennin, and cortisol were decreased and ACTH and deoxycorticosterone were increased. Laparoscopic bilateral gonadectomy was performed, and corticosteroid, antihypertensive drugs, and estrogen were administered. We report this case with a brief review of the literatures.
46, XY Disorders of Sex Development* ; Adrenal Hyperplasia, Congenital ; Adrenocorticotropic Hormone ; Adult ; Amenorrhea ; Antihypertensive Agents ; Chymosin ; Desoxycorticosterone ; Estradiol ; Estrogens ; Female ; Humans ; Hydrocortisone ; Hypertension ; Hypokalemia ; Male* ; Phenotype ; Renin ; Testosterone

OBJECTIVE: The purpose of this study was to compare the survival of patients with pseudomyxoma peritonei (PMP) according to the modalities of treatment and find out the prognostic factors by evaluating clinical variables. METHODS: Thirty one patients were treated at Seoul National University Hospital between May 1995 and May 2005. The clinical data were collected retrospectively and all charts were reviewed. Kaplan-Meier survival analyses with low-rank test were performed for the comparison of survival according to clinical variables, and univariate and multivariate Cox regression analyses were performed for finding out the prognostic factors of PMP. RESULTS: The mean age at diagnosis was 60.9 years and the mean survival (MS) was 25 months. The recurrence rate was 46.7 % and the disease free survival (DFS) till recurrence was 22.6 months. The prognostic factors affecting DFS were histology, FIGO stage, ascites, CA 125, residual disease in 1st and last operations by univariate analyses, but only FIGO stage was the statistically significant prognostic factor by multivariate analysis. Surgical treatment combined with chemotherapy (intraperitoneal or adjuvant) improved MS more than surgical treatment alone by univariate analysis. CONCLUSION: FIGO stage is a prognostic factor that can predict the DFS in patients with PMP. Histology, CA 125, ascites, residual disease may be probably prognostic factors associated with DFS. Surgical treatment combined with chemotherapy is more effective than surgical treatment alone for the treatment of PMP.
Ascites ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Humans ; Multivariate Analysis ; Pseudomyxoma Peritonei* ; Recurrence ; Retrospective Studies ; Seoul

OBJECTIVE: The purpose of this study was to compare the survival of patients with pseudomyxoma peritonei (PMP) according to the modalities of treatment and find out the prognostic factors by evaluating clinical variables. METHODS: Thirty one patients were treated at Seoul National University Hospital between May 1995 and May 2005. The clinical data were collected retrospectively and all charts were reviewed. Kaplan-Meier survival analyses with low-rank test were performed for the comparison of survival according to clinical variables, and univariate and multivariate Cox regression analyses were performed for finding out the prognostic factors of PMP. RESULTS: The mean age at diagnosis was 60.9 years and the mean survival (MS) was 25 months. The recurrence rate was 46.7 % and the disease free survival (DFS) till recurrence was 22.6 months. The prognostic factors affecting DFS were histology, FIGO stage, ascites, CA 125, residual disease in 1st and last operations by univariate analyses, but only FIGO stage was the statistically significant prognostic factor by multivariate analysis. Surgical treatment combined with chemotherapy (intraperitoneal or adjuvant) improved MS more than surgical treatment alone by univariate analysis. CONCLUSION: FIGO stage is a prognostic factor that can predict the DFS in patients with PMP. Histology, CA 125, ascites, residual disease may be probably prognostic factors associated with DFS. Surgical treatment combined with chemotherapy is more effective than surgical treatment alone for the treatment of PMP.
Ascites ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Humans ; Multivariate Analysis ; Pseudomyxoma Peritonei* ; Recurrence ; Retrospective Studies ; Seoul

Liposarcoma is the most common soft tissue sarcoma in adults and accounts for 9.8% to 16% in all soft tissue sarcomas. The common sites include limbs, buttocks, and retroperitoneum, et al. The early diagnosis of retroperitoneal liposarcoma may be difficult because of due to the late onset of symptoms and the tumors are frequently noted in a large size with the involvement of adjacent structures. Surgical therapy remains the most effective modality for the treatment of retroperitoneal liposarcoma. But, complete surgical resection of these tumors is often challenging and, at times, may be impossible. So, adjuvant radiation therapy is necessary for the improvement of prognosis in many cases. We report a case of retroperitoneal liposarcoma which was treated with complete surgical resection followed by adjuvant radiation therapy.
Adult ; Buttocks ; Early Diagnosis ; Extremities ; Humans ; Liposarcoma* ; Prognosis ; Sarcoma

Central venous cannulation via an internal jugular vein has become a common procedure in the management and monitoring of severely ill patients. Although complications such as carotid artery puncture or pneumothorax have been reported, hemothorax is relatively uncommon. We describe a case of hydrohemothorax and subclavian artery laceration which occurred during right internal jugular vein cannulation. A 44-year-old female patient was admitted for laparoscopic adrenalectomy under general anesthesia. For central venous pressure monitoring, central venous cannulation performed. However, dilator overinsertion injured the right subclavian artery. This led to a massive ipsilateral hydrohemothorax requiring thoracotomy for subclavian artery repair. This case suggests that central venous cannulation should be done carefully and improves awareness of the potential for dilator induced injury.
Adrenalectomy ; Adult ; Anesthesia, General ; Carotid Arteries ; Catheterization* ; Central Venous Pressure ; Female ; Hemothorax ; Humans ; Jugular Veins* ; Lacerations* ; Pneumothorax ; Punctures ; Subclavian Artery* ; Thoracotomy

Ewing sarcoma is an uncommon bone malignancy of childhood. Although Ewing sarcoma is mostly a tumor of bone, it may also arise from soft tissues (extraskeletal Ewing sarcoma). We report a case of extraskeletal Ewing sarcoma that arose in the retroperitoneum of a 18-month-old girl and presented with right leg pain and gait disturbance. A brief review of related literatures was also made.
Female ; Gait ; Humans ; Infant ; Leg ; Sarcoma, Ewing*

BACKGROUND: The aim of the present study was to detect and quantify auto-positive end-expiratory pressure (auto-PEEP) in anesthetized patients using a Laser-Flex endotracheal tube (Mallincrodt, ID, 6.0 mm), by comparing the effects of changes in tidal volume and respiratory rate. METHODS: All patients (n = 30) undergoing elective surgery were anesthetized, paralyzed and intubated with a ID 8.0 mm endotracheal tube (n = 10, control), ID 6.0 mm endotracheal tube (n = 10, group S), or ID 6.0 mm Laser-Flex endotracheal tube (n = 10, group L), respectively. After anesthetic induction, ventilator settings using a Siemens Servo 900C were changed for a tidal volume of 8, 10 ml/kg, respiratory rates of 10, 12 or 14 breaths/min. Peak airway pressure was measured and auto-PEEP was quantified using an end-expiratory occlusion method. Data recorded on the Bicore CP-100 pulmonary monitor was transfered to a PC and analyzed by processing software (ANADAT). RESULTS: In group S and L, peak airway pressure and auto-PEEP were higher than control group and increased during an increase in tidal volume (P < 0.05). But they were increased significantly during an increase of respiratory rate, only when the tidal volume was 10 ml/kg (P < 0.05). CONCLUSIONS: There was an increase of auto-PEEP in anesthetized patients using a Laser-Flex endotracheal tube during incremental changes of tidal volume and respiratory rates.
Humans ; Positive-Pressure Respiration, Intrinsic* ; Respiratory Rate* ; Tidal Volume* ; Ventilators, Mechanical

The purpose of this paper is to introduce standardization activities of nursing documentation for special nursing units following standardization efforts for general nursing units last year. Modified Delphi approach with expert panel was used to identify essential nursing documents and data set for each units. Expert panel was consisted of head nurses or charge nurses of each special nursing unit from 8 tertiary hospitals with more than 500 beds in Seoul. the secretary-general of Clinical Nurses Association and a faculty of College of Nursing. The exiting nursing forms of seven special nursing units, which include Emergency room, Intensive care unit, Operating room, Respiratory intensive care unit. Delivery floor. Nursery and Dialysis room, were analyzed and prototypes of the standard nursing forms and guidelines were developed. The clinical field test was done with the help of Clinical Nurses Association. At the field test 3.744 clinical staff nurses from 20 tertiary hospitals with more than 500 beds in Korea were involved and provided feedback. Finally public hearing was held and more than 600 nurses from 116 hospitals attended and provided feedback. Through these process consensus of nursing community was attained for standard documents and data items. The result is available at http://nursing.snu.ac.kr/standard/ through internet.
Consensus ; Dataset ; Dialysis ; Emergency Service, Hospital ; Hearing ; Intensive Care Units ; Internet ; Korea ; Nurseries ; Nursing* ; Nursing, Supervisory ; Operating Rooms ; Seoul ; Tertiary Care Centers

This paper reflects on the standardization activities of nursing documentation. Even though nurses are the most important manpower in terms of collecting patients' data, nursing documentation have been overlooked in the process of developing electronic patients records. It is impossible to complete a computerized patient record system without including nursing documentation. Standardization of nursing documentation is the first step toward a computerized documentation system. In this study nursing documentation forms were gathered from 11 tertiary hospital with more than 500 beds in Seoul. Out of various nursing documentation, 9 essential forms were chosen to standardize. They are admission assessment, form, nursing treatment record, nursing care plan, discharge planning record, patient transfer record, clinical observation record, nursing treatment record, nursing progress notes, critical care flow sheet, and preoperative checklist Forms and data elements were reviewed and analyzed. It was learned that there is no one perfect from that could be used in any agency. Data elements were analyzed and standardized. Data elements to be included in each form were selected. Standardized forms were developed with the selected data element. Guideline outlining how to use each nursing form were developed. Now it is in the process of validating the forms and the guidelines at 240 nursing units at 8 tertiary hospitals. The results of the validation study will be incorporated in the final version of nursing forms and they will be introduced to general nursing population at an open forum to be held by Korean Nurses Association at the end of this year. This standardization activities will have a great impact on nursing practice, education, administration and research.
Checklist ; Critical Care ; Education ; Health Records, Personal ; Humans ; Nursing Informatics* ; Nursing Records* ; Nursing* ; Patient Discharge ; Patient Transfer ; Seoul ; Tertiary Care Centers