Association Between a Polymorphism in CASP3 and CASP9 Genes and Ischemic Stroke

OBJECTIVE: To investigate whether the polymorphisms of CASP3 gene (rs4647602, intron A/C and rs1049216, UTR C/T) and CASP9 gene (rs1052576, Gln/Arg G/A and rs1052571, Ser/Val T/C) were associated with the development, and clinical severity of ischemic stroke and functional consequences after stroke. METHODS: Genomic DNA from 121 ischemic stroke patients and 201 healthy control subjects were extracted, and polymerase chain reaction products were sequenced. To investigate the association of polymorphisms and the development, and National Institutes of Health Stroke Scale (K-NIHSS), logistic regression models were analyzed. RESULTS: Polymorphism of the untranslational region of CASP3 (rs1049216, UTR C/T) has been associated with the development of ischemic stroke—in codominant1 model (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.29–0.88; p=0.017), in dominant model (OR, 0.57; 95% CI, 0.34–0.97; p=0.034), and in the overdominant model (OR, 0.50; 95% CI, 0.29–0.87; p=0.011). A missense SNP of CASP9 gene (rs1052571, Ser/Val T/C) was associated with the development of ischemic stroke (OR, 1.93; 95% CI, 1.05–3.55; p=0.034 in recessive model). CONCLUSION: These results indicate the possibility that CASP3 and CASP9 genes are markers for the development of ischemic stroke.

The Association Between Fall History and Physical Performance Tests in the Community-Dwelling Elderly: A Cross-Sectional Analysis

OBJECTIVE: To evaluate the association between baseline characteristics, three physical performance tests and fall history in a sample of the elderly from Korean population. METHODS: A total of 307 participants (mean age, 76.70±4.85 years) were categorized into one of two groups, i.e., fallers and non-fallers. Fifty-two participants who had reported falling unexpectedly at least once in the previous 12 months were assigned to the fallers group. Physical performance tests included Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Timed Up and Go test. The differences between the two study groups were compared and we analyzed the correlations between fall histories and physical performance tests. RESULTS: SPPB demonstrated a significant association with fall history. Although the BBS total scores did not show statistical significance, two dynamic balance test items of BBS (B12 and B13) showed a significant association among fallers. CONCLUSION: This study suggests that SPPB and two dynamic balance test items of the BBS can be used in screening for risk of falls in an ambulatory elderly population.

The Relationship Between Tongue Pressure and Oral Dysphagia in Stroke Patients

OBJECTIVE: To evaluate the relationships between tongue pressure and different aspects of the oral-phase swallowing function. METHODS: We included 96 stroke patients with dysphagia, ranging in age from 40 to 88 years (mean, 63.7 years). Measurements of tongue pressure were obtained with the Iowa Oral Performance Instrument, a device with established normative data. Three trials of maximum performance were performed for lip closure pressure (LP), anterior hard palate-to-tongue pressure (AP), and posterior hard palate-to-tongue pressure (PP); buccal-to-tongue pressures on both sides were also recorded (buccal-to-tongue pressure, on the weak side [BW]; buccal-to-tongue pressure, on the healthy side [BH]). The average pressure in each result was compared between the groups. Clinical evaluation of the swallowing function was performed with a videofluoroscopic swallowing study. RESULTS: The average maximum AP and PP values in the intact LC group were significantly higher than those in the inadequate lip closure group (AP, p=0.003; PP, p<0.001). AP and PP showed significant relationships with bolus formation (BF), mastication, premature bolus loss (PBL), tongue to palate contact (TP), and oral transit time (OTT). Furthermore, LP, BW, and BH values were significantly higher in the groups with intact mastication, without PBL and intact TP. CONCLUSION: These findings indicate that the tongue pressure appears to be closely related to the oral-phase swallowing function in post-stroke patients, especially BF, mastication, PBL, TP and OTT.

A Case of Psoas Abscess Caused by Staphylococcus lugdunensis / 대한내과학회지

Staphylococcus lugdunensis is a member of coagulase-negative staphylococci (CoNS), an uncommon microbial culture isolate with virulent potency. Although CoNS are common skin commensals, and often regarded as contaminants or colonizers when isolated from clinical specimen cultures, the clinical course and microbiological characteristics of Staphylococcus lugdunensis may resemble those of Staphylococcus aureus rather than other CoNS. Invasive infectious diseases such as infective endocarditis, peritonitis, skin and soft tissue infection, vascular prosthetic infection, septicemia, and osteomyelitis have been found to be associated with Staphylococcus lugdunensis. Here we report the first case of psoas abscess caused by methicillin-sensitive Staphylococcus lugdunensis in Korea.

Acute Myocardial Infarction with Simultaneous Occlusions of Left Anterior Descending Artery and Right Coronary Artery

Acute myocardial infarctions involving multiple coronary arteries simultaneously are infrequent and causative risk factors of the occlusions are unclear. However, severe complications arise, such as congestive heart failure or death. We report a case of two simultaneously occluded coronary arteries. A 39-year-old Korean man with simultaneous total occlusion of the left anterior descending artery and the right coronary artery presented with chest discomfort and cardiogenic shock. Immediate percutaneous coronary intervention was performed and a transvenous temporary pacemaker and intra-aortic balloon counterpulsation catheter were inserted. Through continuous effort he was discharged 8 days post intervention without any complaints.

Transient J-Wave Appearance in the Inferior-Lateral Leads during Electrical Storm in a Patient with Brugada Syndrome

A 67-year-old male patient was admitted with an abrupt sudden cardiac death. He represented with an extreme electrical storm of 30 times of ventricular fibrillation (VF) episodes on one day. External shocks were performed to terminate VF. Transient J-wave in the inferior-lateral leads and Brugada electrocardiography pattern on the right precordial leads appeared during the electrical storm. And J-wave disappeared after the termination of electrical storm. We report a case of the appearance of J-wave during electrical storm in a patient with Brugada syndrome.

Clinical Characteristics of Patients with Neonicotinoid Insecticide Poisoning

PURPOSE: Neonicotinoid insecticides are widely used as they have been proven by experimental studies to have low toxicity to mammals, including humans. As the use of neonicotioids increases, the number of patients with neonicotinoid poisoning has also increased. We conducted a study to investigate the clinical manifestations of neonicotinid poisoning. METHODS: We retrospectively analyzed the patients who ingested neonicotinids and who visited the emergency department located in Korea from March 2002 to February 2010. We reviewed the patients' age, gender, the amount of exposure, the elapsed time to presentation, the treatment and the outcome. According to the poisoning severity score, we divided the patients with a Poisoning severity score (PSS) of 0 or 1 into the mild/moderate toxicity group and the patients with a PSS of 2 or 3 into the severe/fatal toxicity group. RESULTS: A total of 24 patients were analyzed. The most common clinical manifestations of neonicotinoid insecticide toxicity were gastrointestinal symptoms (66.7%) such as nausea, vomiting and abdominal pain and the others are respiratory symptoms (16.7%), cardiovascular symptoms (12.5%), metabolic imbalance (12.5%), renal dysfunction (8.3%), CNS symptoms (8.3%), and asymptomatic (29.2%). Twenty patients (83.3%) showed mild/moderate toxicity and 4 patients (16.7%) showed fatal conditions such as shock and mutiorgan failure. The mortality rate was 4.2%. In these fatal cases, the patients developed respiratory failure, hypotension, altered mentality and renal failure at the acute stage and they deteriorated to a more serious condition. This severe toxicity was caused by decreased renal excretion of neonicotinid metabolite, and this was improved after hemodialysis. CONCLUSION: Most patients with neonicotinoid poisoning and who showed mild toxicity usually improved after symptomatic treatment. However, some patients showed significant toxicity with respiratory failure and renal function deterioration, and intensive care needed, including mechanical ventilation and hemodialysis.

Clinical Characteristics and Treatments of Intermediate Uveitis

PURPOSE: To investigate the clinical characteristics and treatment of intermediate uveitis under new diagnostic standards. METHODS: Medical records of patients diagnosed with pars planitis or intermediate uveitis were followed for more than 6 months, and retrospectively reviewed. RESULTS: A total of 90 patients and 117 eyes were enrolled in the study. The mean age was 40.1 years, and the mean follow-up period was 43.0 months. Thirty percent of cases were bilateral. The most common initial symptom was decreased visual acuity. Snowbank was detected in 39.3%, snowballs in 15.4%, vitritis in 96.6%, and vasculitis in 56.4%. Common complications includedcystoid macular edema (57.3%), cataracts (43.6%), and epiretinal membrane (36.8%). Therapies included topical steroids (82.9% of cases), posterior sub-Tenon steroid injection (45.3% of cases), systemic steroid administration (67.8% of cases), and immunosuppressants (28.7% of cases). Vitrectomy was performed in 11.1% of patients due to complications such as epiretinal membrane and traction retinal detachment. The mean initial and final visual acuities were 0.67 and 0.74, respectively. CONCLUSIONS: The patients in this study experienced various courses of symptoms that required different treatment plans. Future investigations may corroborate these results.

Comparison of Laparoscopic Adrenalectomy with Open Adrenalectomy for Adrenal Tumor / 대한내시경복강경외과학회지

PURPOSE: The definite indications of laparoscopic adrenalectomy (LA) and the limitations of minimally invasive surgery have yet to be determined. To verify the benefit and safety of LA, we compared the results of LA with those of open adrenalectomy (OA) and we further analyzed the clinical results of LA in accordance with the time period of performing this surgery. METHODS: We retrospectively reviewed 69 patients who received adrenalectomy between 1997 and 2008. We compared LA with OA. The LA was divided into subsets of the early and late groups, and the transperitoneal approach and retroperitoneal approach groups, and we compared and analyzed the results of each group, along with the results of the OA and LA groups. For each of the groups, we analyzed the following factors; age, gender, tumor size, tumor location, the operative time, the time under anesthesia, the amounts of blood loss and transfusion, the time to first oral intake, the length of the postoperative hospital stay and the complications. RESULTS: LA (25 cases), as compared to OA (20 cases), showed better results for the amount of transfusion, the time to first oral intake, the length of the postoperative hospital stay and the complication rates (p=0.032; p=0.017; p=0.02). As for CA (4 cases), the time to first oral intake and the length of the postoperative hospital stay were significantly longer than that of LA (p=0.001; p=0.021). LA done in the late period demonstrated less blood loss and a shorter time to first oral intake as compared to the LA of the early period (p=0.032; p=0.019). There were no significant statistical differences between the results of the peritoneal or retroperitoneal approaches. CONCLUSION: LA has the merits of a shortening hospital stay and decreased complication. Furthermore, as the experience with this type of surgery accumulates, these merits are likely to become stronger. Thus, surgeons are expected to carefully decide on choosing the surgical methods by fully understanding the benefits and indications of LA.

A Wide Discrepancy between Intraocular Pressure by Applanation and Non-contact Tonometry after LASIK

PURPOSE: To report the case of a glaucoma patient with a history of LASIK surgery who presented with a wide discrepancy in intraocular pressure between the Goldmann applanation tonometry and non-contact tonometry. METHODS: A 20-year-old male glaucoma patient was referred to our clinic with a chief complaint of blurred vision in his right eye. The patient had a history of uneventful bilateral LASIK surgery. Upon our initial examination, his best-corrected visual acuity in the right eye was 0.04 and his right eye IOP was 14 mmHg by Goldmann applanation tonometry and 40 mmHg by non-contact tonometry. A slit lamp examination showed corneal epithelial edema with diffuse interface opacities. The central corneal thickness in the right eye was 587 micrometer. An ultrabiomicroscopy demonstrated an interface fluid accumulation between the LASIK flap and the stromal bed. The patient was diagnosed with juvenile open-angle glaucoma and was scheduled for a trabeculectomy. RESULTS: Seven days after trabeculectomy, the patient's vision in the right eye improved to 0.7 and his IOP was 12 mmHg by Goldmann applanation tonometry and 14 mmHg by non-contact tonometry. In addition, the corneal epithelial edema, interface opacities, and fluids had all resolved and the central corneal thickness was reduced to 489 micrometer. CONCLUSIONS: In eyes that have undergone LASIK surgery, the IOP measured by Goldmann applanation tonometry may underestimate the true pressure due to fluid accumulation under the LASIK flap. In such cases, non-contact tonometry can be a convenient and a reliable method for determining treatment plan.

A case report about correction of implant position at horizontal plane after corticotomy

A Development of Intelligent Picture Archiving Communication System that Embedded Computer-Aided Diagnosis and Speech Recognition / 대한의료정보학회지

The rapid technological progress in the fields of computer and engineering has accelerated the medical society to introduce a new advanced paradigm in handling medical information. This paper describes a fully integrated Computer Aided Diagnosis, Speech Recognition/PACS system running on a single platform. We feel that the combination of Computer Aided Diagnosis, Speech Recognition and PACS in a fully integrated single platform has created a tremendous synergy, with process improvements that maximize the advantage s of three systems. The Computer Aided Diagnosis and the Speech Recognition included marked improvement in experiments turnaround time and cost saving for departments because of decreased transcription costs. Proposed system should help others complete the task of digitalizing a hospital information system and may be adaptable to other systems as well.

Stool Cultures and Antibiotic Therapy in Cases of Acute Diarrhea

BACKGROUND: Most episodes of acute diarrhea are self-limiting. Most patients require neither a stool culture nor antibiotic therapy. This study was designed to investigate the predictors of a stool-culture positivity and indicators for antibiotic therapy in acute infectious diarrheal patients. METHODS: Medical records of 139 adult cases were retrospectively reviewed during the 12 months between January 1999 and December 1999. We used the Chisquare-test to analyze the data for statistical significance. RESULTS: Fecal leukocytes were examined in 104 cases; 30 tested positive (28.8%). Eighty-five stool cultures were taken, and 24 yielded enteric pathogens, such as Salmonella, Shigella, V. Cholera and V. Parahaemolyticus. Cultures from patients treated between August and October, with fever above 37.6degrees C, or with symptoms of abdominal pain had higher yields(44.2% vs 11.9%, p=0.001, correlation coefficient=0.359; 36.8% vs 10.7%, p=0.012, correlation coefficient=0.273;, 38.1% vs 18.6%, p=0.046, correlation coefficient=0.216 ; respectively) and when combined with fecal leukocytes had a sensitivity of 100% and a specificity of 90.1-95.1%. CONCLUSION: The primary variables (season, fever, and abdominal pain) were excellent predictors of stool culture positivity and indicators for antibiotic therapy, especially when combined with fecal leukocytes

A case of early gastric cancer with IgA nephropathy and minimal change nephrotic syndrome / 대한내과학회지

The nephrotic syndrome has been reported in association with a wide variety of neoplastic disease. The relationship between early gastric cancer and glomerulonephritis has not been well elucidated. Only 6 cases (5 cases in Korea and 1 case in Japan) have been reported associated with glomerulonephritis by this time. 5 cases in Korea included three cases of membranous glomerulonephritis, one case of IgA nephropathy and membranoproliferative glomerulonephritis. Four out of six cases including presented case were mucin secreting adenocarcinomas of stomach. Minimal change disease associated with solid tumors has been reported very rarely. Three cases of colon adenocarcinoma have been reported in association with minimal change disease by this time. Complete remission of nephrotic syndrome with tumor resection without corticosteroid therapy was reported in one of three cases, but two of them had to be on corticosteroid therapy in addition to tumor resection to get complete remissions. We report a 44-year-old man case with nephrotic syndrome associated with early gastric cancer. Renal biopsy findings were indicative of minimal change disease but with scanty IgA deposition. Low grade IgA nephropathy was suggested. Endoscopic biopsy on stomach demonstrated the adenocarcinoma with signet ring cells. Serum IgA concentration was 543 mg/dL, and decreased to 336 mg/dL after tumor resection. But, owing to persistent proteinuria and acute renal failure complicated, corticosteroid therapy was applied on the 30th day after operation. So we could not prove definite relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease. But, it is regarded that normalized serum IgAlevel and the complete remission of nephrotic syndrome with tumor resection and corticosteroid therapy can be indirect evidences for the relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease.

The Influence of Choice of Pain Control Method on Analgesic effect and Postoperative Progress after Cesarean Section / 대한산부인과학회잡지

OBJECTIVE: We investigated influence of choice of pain control method on analgesic effect and postoperative course after cesarean section. METHODS: Ninety parturients were randomly allocated to three groups and each group had 30 women. The postoperative pain was controlled with classical intramuscular injection in IM group and PCA (patient-controlled analgesia)device in meperidine (D) and meperidine+diclofenac (DV) group for up to 48 hours after Cesarean section when the parturients awoke and complained pain. The parturients received intramuscular diclofenac 75 mg every 12 hours in DV group. We evaluated usefulness and safety of each pain control method on postoperative opioid requirement, numerical rating score of pain, side effect and first ambulation time for 48 hours after operation. RESULTS: Total opioid requirement was decreased almost 40-50% in DV group. Pain score lowered significantly at 6, 12 and 24 hours in DV group(p<0.05). Nausea,Vomiting and Dizziness were increased in IM group than PCA group(p<0.05). There was no difference in laboratory data including hemoglobin, hematocrit, platelet count and bleeding time in diclofenac used group. Ambulation was started earlier significalty in DV group after Cesarean section(p<0.05). CONCLUSION: We concluded that diclofenac combined PCA is the most effective and safe method in pain control after cesarean section. But it is necessary to try further evaluation of hemostatic effect of diclofenac.

A Case of RPGN associated with toxic epidermal necrolysis / 대한내과학회지

RPGN is a catastrophic form of acute glomerulonephritis characterized by an abrupt onset and rapid deterioration of renal function resulting in oliguria within weeks or months. RPGN is seen in a variety of systemic disorders, including systemic lupus erythematosus, poly arteritis nodosa, Wegener's granulomatosis and subacute bacterial endocarditis. In addition, RPGN is seen in association with a variety of primary renal diseases such as poststreptococcal glomerulonephritis, membranoproliferative glomerulonephritis, and IgA nephropathy, Goodpasture's syndrome. Toxic epidermal necrolysis(TEN) is a drug induced life threatening disease characterized by extensive epidermal detachment, necrosis, and mucosal erosion. TEN may involve liver, lung, intestine, and kidney. But renal involvement has seldom been reported. We report on a 63-year-old patient who developed a RPGN with a TEN. Renal biopsy showed pauci-immune crescentric glomerulonephritis and skin biopsy showed edematous change with extravasated erythrocytes in upper dermis and several individually necrotic keratinocytes. ANCA and FANA test was negative. Our patient recovered renal function with steroid pulse therapy. The pathophysiology of TEN is unresolved but abnormal cytokine release(e.g., tumor necrosis factor) has been implicated in pathogenesis of TEN. Because various cytokines have direct toxic effect on kidney structure, the tubular and glomerular damage may be related to the cytokines involved in TEN. To our knowledge, this is the first case documenting the presence of RPGN in patients with TEN. And there maybe some relations between PRGN and TEN which require further study.

Surgical Treatment of the Craniofacial Dysostoses-Crouzon's Disease

Craniofacial dysostoses(Crouzon's disease) are characterized by cranial and facial deformities but the relationship between the craniosynostosis and facial deformities has not been clearly established. However, we believe that certain facial hypoplasias are comparable in nature with craniostenosis. Our objective in treatment of the Crouzon's disease is to achieve a postero-anterior movement of the whole facial mass, with the double aim of establishing normal dental occlusion and of increasing orbital capacity. The method we describe uses Tessier's basic procedures for surgical correction of the Crouzon's diseases patient who was 16 year-old boy. It would appear that the best treatment of these requires a radical and total osteostomy of the middle third of the face, to permit complete repositioning of the involved segment. These total osteotomies frequently include the creation of a line of separation between the anterior cranial base above and the facial bone below and also between the pterygoid processes behind and the maxilla anteriorly. Thus one is detaching the face from the cranial base. The authors described the surgical management of the Crouzon's disease and discussed the warning points of intraoperative technique in correction of the craniofacial dysostosis.

Giant Vaginal Stone due to Prolonged Urethrovaginal fistula: Report of a case / 대한비뇨기과학회지

No abstract available.

Studies on the Arteries of the Korean Human Kidney / 대한비뇨기과학회지

Followings are the results obtained from the observation on the microangiograms and Geon D11 Alatex molding casts in the rabbit, canine and Korean human Kidneys. 1. The findings of microangiograms in the rabbit and canine Kidneys are uniform interlobar arteries run toward lateral border of Kidney in radiating form without branching, divide the Kidney into similar sized segments and segmental distribution is evident. The arcuate arteries arising from the interlobar arteries run toward lateral border to form numerous interlobular arteries, make angle nearly horizontal with av. 152.8 degree in rabbit and with av. 151.6 degree in canine. In Korean human Kidney, it is difficult to confirm the interlobar arteries and arcuate arteries because of ununiform size and length of these. And the angle between arcuate arteries is sharp with av. 40.6 degree. 2. The findings of the molding casts in rabbit and canine Kidneys are that interlobar arteries running toward lateral border of Kidney with radiating form are evident, which are 6-9 branches from anterior division and 5-7 from posterior in rabbit and 7-9 from anterior and 5-7 from posterior in canine. The angle between arcuate arteries dividing from interlobar arteries with right angle is nearly horizontal with av. 162.3 degree in rabbit and with av. 159.8 degree in canine. The numerous interlobular arteries arise from arcuate artery with right angle. In Korean human Kidneys it is difficult to confirm interlobar arteries which are 2-4 branches originating from anterior because of ununiform size and length of these. And the angle between arcuate arteries in sharp degree with av. 43.7 degree. 3. The renal collecting system which has close relation to are pathway of interlobar arteries by molding casts shows that calyces are symmetrical, 2 rows and regular in rabbit and canine Kidneys while irregular in human. 4. Nephrotomy line, that is, junction of anterior and posterior division blood supply in the Kidney by molding casts is different between canine and human. Nephrotomy line in human is in posterior aspect of lateral border of Kidney almost 2/3 but there is no avascular area in the lateral borden of Kidney, the so called Brodels line as advocated by Brodel because interlobular arteries branching from arcuate arteries are interdigitated together as end arteries. 5. Gross anatomic differences of renal vasculature among rabbit, canine and human on the basis of microangiograms and molding casts suggest that rabbit and canine may not be suitable subjects for surgical experimentation.

Orchiopexy and Its Operative Results / 대한비뇨기과학회지

The authors outline the method of orchiopexy and report the results of orchiopexy performed on 79 cases (113 testes) of cryptorchism. A. Method of orchiopexy 1) In inguinal oblique skin incision, while noting frequent keloid formation, no keloid formation was noted as the lower abdominal transverse incision. 2) It was easy to descend testes to the base of the scrotal sac by performing orchidofuniculolysis sufficiently. 3) Of the several methods of orchiopexy, dartos pouch method was most ideal. B. Operative results on the 79 cases (113 testes) of cryptorchism are as follows. 1) Of the 113 testes, there were noted sufficient descent to the scrotal base in 108 testes, and somewhat insufficient descent in 5 testes. 2) In the consideration that 5 case of unsufficient descent in the group of type IV which was not detectable on manual palpation, sufficient orchidofuniculolysis should be carried out preoperatively regarding difficulties in sufficient descent. C. While operation time of cryptorchism being 4-5 years old as a rule, 25% or so are performed at 1-5 years old in authors' cases. So more active instruction should be considered.