Acute Cerebral Infarction Associated With Polycythemia Vera

No abstract available.

A Case of Late Postpartum Eclampsia 14 Days after Delivery / 대한간질학회지

Eclampsia is a syndrome characterized by pregnancy-induced hypertension, edema, proteinuria, and generalized tonic-clonic convulsions, occurring between 20 and 40 weeks of gestation or within 48 hours of postpartum. A convulsion that shows up more than 48 hours after delivery is late postpartum eclampsia. A 40-year-old woman was admitted due to a headache and generalized tonic-clonic seizures in 14 days of postpartum. Two months prior to the admission, she had been admitted to the hospital because of mild proteinuria. Her blood pressure on arrival was 160/100 mmHg. There were no focal neurologic signs. She was given lorazepam and valproate sodium intravenously and her convulsion was stopped. A brain MRI showed multiple bilateral high signal intensities in the both deep white matter and the parieto-occipital cortex. Cerebral angiography showed a diffuse vasospasm. We report a patient with late postpartum eclampsia occurring 14 days after parturition whose seizures was accompanied by preceding headache and proteinuria as a pre-eclamptic sign.

A Case of Lateral Medullary Infraction Presenting with Thoracic Sensory Level

Loss of pain and temperature sensation due to lateral medullary infarction are well known and classically involve the ipsilateral side of the face and the lower part of the body on the controlateral side. This pattern of sensory loss below a certain level on the trunk, usually a sign of spinal cord disease, may also appear following a lesion in the lateral medullar, due to damage to the spinothalamic tract. A 72-year-old hypertensive man developed sudden dizziness, headache, and gait ataxia. On neurologic examination, he had left limb and gait ataxia. Five days later he noted loss of pain and temperature sensation on the right leg and trunk with a sensory level at T4 with preservation of touch, vibration, and joint position sense in all limbs. Brain MRI showed a small infarct in the left lower lateral medulla. Brain MR angiography showed stenosis of the right proximal carotid artery, left distal vertebral artery, and mid-basilar artery. We report a case of sensory defects with a sensory level on the trunk that occured as the result of lesion of the lower lateral medulla.

Electrophysiological Abnormalities in a Patient with Acute Methyl Bromide Poisoning

No abstract available.

Fibromuscular Dysplasia Associated with Recurrent Cerebral Hemorrhage: Case Report / 대한뇌혈관외과학회지

Fibromuscular dysplasia (FMD) is a rare, segmental nonatheromatous angiopathy of unknown etiology affecting small to medium-sized arteries. The most common angiographic pattern is the classic string-of-beads appearance. But the tubular stenosis type of the FMD is a rare finding and has not been reported previously. We report a case who presented with recurrent intracerebral hemorrhages, whose angiographic features were long tubular stenosis type of FMD affecting the both internal carotid arteries associated with terminal carotid occlusions.

Predicting Factors of Long-term Surgical Outcome for Mesial Temporal Lobe Epilepsy with Unilateral Hippocampal Atrophy on MRI / 대한간질학회지

PURPOSE: To identify the clinical and electroencephalographic factors which are independently predictive of a postoperative seizure-free outcome for 4 years. We compared the outcomes of the first 2 years with the subsequent 2 years one after anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (MTLE) with unilateral hippocampal atrophy (HA) on MRI. METHODS: We studied 51 consecutive operated patients who had above 4 years of follow-up and had MTLE with definite unilateral HA on MRI. The surgical outcome was classified as either seizure-free or not seizure-free in the first postoperative 2 years and the subsequent 2 years. Several clinical variables were included. The scalp EEG parameters included the lateralization of interictal epileptiform discharges, ictal onset location, ictal onset frequency, ictal EEG lateralization, and ictal scalp EEG propagation (bitemporal asynchrony or switch of lateralization). Variable factors were subjected to univariate analysis. RESULTS: Overall, 36 patients (71%) became seizure-free during the postoperative 4 years. On univariate analysis, only one factor was significantly associated with poor outcome (p<0.05): ictal scalp EEG propagation pattern such as bitemporal asynchrony or switch of lateralization. The seizure-free outcome was seen in 88.9% of patients without bitemporal asynchroncy, or switch of lateralization while only 54.5% of patients with those patterns (p=0.007) during the postoperative third and fourth year. However, those propagation patterns did not show the prognostic value during the first 2 years (p=0.449). Other variable factors were found not to be predictive of prognosis on early or late recurrence. CONCLUSIONS: Bitemporal asynchrony or a switch of lateralization in the ictal scalp EEG might be a highly predictive factor for an undesirable surgical outcome, late recurrence of seizure during a follow-up period after ATL, and probably an index of bitemporal epileptogenicity in MTLE.

Two Cases of Methyl Bromide Intoxication with Seizures and Altered Mental State / 대한간질학회지

Methyl bromide is presently used as a fumigant for insects in soil, grains or fruit in storage or transport. It is a neurotoxic agent and has been responsible a number of deaths or acute poisonings among occupationally exposed persons. We report 2 patients, who had worked fumigation warehouse, presented with seizures and altered mental state. The serum concentrations of bromide were elevated 32.9 and 42.5 mg/l, respectively. Brain MRI showed bilateral symmetric high signal intensities in the splenium of corpus callosum, the globus pallidus, the quadrigeminal plate, the periaqueductal gray matter, the red nucleus, the substantia nigra, the medial lemniscus, the pontine tegmentum, the dentate nucleus, and the medulla. There was no brain lesion in the other patient. Appropriate and supervised handling of the chemical and regular education to workers are important to avoid the risk of methyl bromide poisoning.

Clinical Significance of HPV DNA Chip Test in the Management of Atypical Squamous Cells of Undetermined Significance / 대한산부인과학회잡지

OBJECTIVE: Cervical intraepithelial neoplasia (CIN) and invasive cervix cancer were detected in some cases of atypical squamous cells of undetermined significance (ASCUS) PAP smear. So it is reasonable to evaluate and manage ASCUS PAP smear. In this study, we attempted to assess the clinical significance of a cytologic diagnosis of ASCUS and determine the usefulness of HPV DNA chip test (which is a new diagnostic method for HPV) in management and evaluation of ASCUS patients. METHODS: This study was performed from November 2001 to June 2002 and included 48 cases of ASCUS. They were evaluated by HPV DNA chip test and the pathology was evaluated by punch biopsy, cone biopsy or hysterectomy. The result of type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 and 69 in HPV DNA chip test were categorized as high risk. RESULTS: The rate of CIN II or above in ASCUS was 18.8% (9/48). The detection rate of high risk HPV DNA in ASCUS was 41.7% (20/48). The detection rate of high risk HPV DNA was 30.6% (11/36) in normal or reactive, 33.3% (1/3) in CIN I, 80% (4/5) in CIN II, 100% (2/2) in CIN III, 100% (2/2) in invasive cervix cancer. Higher the grade of pathology, more the detection rate of high risk HPV DNA chip test. The sensitivity for the prediction of CIN II or above by HPV DNA chip test was 88.9% and specificity was 69.2%, respectively. CONCLUSION: The use of HPV DNA chip test in patients with ASCUS may provide usefulness in detection of CIN II, CIN III and invasive cervix cancer.

A Case Of Acute Misoprostol Toxicity / 대한산부인과학회잡지

Misoprostol (Cytotec) is a prostaglandin E1 analog used in prevention of nonsteroidal anti-inflammatory drugs induced gastric ulcer and has a uterotonic effect. It has been used to terminate pregnancy at any stage by promoting uterine contractions and for ripening the cervix before induced labor or abortion. Recently, it is known to reduce postpartum hemorrhage. Very little experience has been reported acute misoprostol toxicity in contrast with its usages. We have experienced a case of acute toxicity of misoprostol used for management of postpartum hemorrhage. We report this case with a review of literatures.

A Case Of Acute Misoprostol Toxicity / 대한산부인과학회잡지

Misoprostol (Cytotec) is a prostaglandin E1 analog used in prevention of nonsteroidal anti-inflammatory drugs induced gastric ulcer and has a uterotonic effect. It has been used to terminate pregnancy at any stage by promoting uterine contractions and for ripening the cervix before induced labor or abortion. Recently, it is known to reduce postpartum hemorrhage. Very little experience has been reported acute misoprostol toxicity in contrast with its usages. We have experienced a case of acute toxicity of misoprostol used for management of postpartum hemorrhage. We report this case with a review of literatures.

Left Ventricular Rhabdomyoma with Tuberous Sclerosis: A Report of one case / 대한흉부외과학회지

The most common primary heart tumor in infants is the rhabdomyoma.It is known that tuberous sclerosis is found in half of the patients with cardiac rhabdomyoma. Because the prognosis of this tumor associated with subaortic stenosis is poor,the surgical intervention is indicated.We report one case of left ventricular rhabdomyoma with tuberous sclerosis.

Aortobronchial Fistula After Chest Trauma / 대한흉부외과학회지

Few patients with traumatic aortic laceration remain undiagnosed and survive long enough to develop a chronic aneurysm. Such aneurysms are frequently asymptomatic: alternatively, they may manifest chest pain, dysphagia, bronchial irritation, or sudden death. A case of aortobronchial fistula secondary to a chronic post-traumatic aneurysm of the aortic isthmus is presented. Hemoptysis was the main sign. The affected segment of the thoracic aorta was repaired with a Hemashield patch and a left upper lobectomy was performed.

Dural Arteriovenous Fistula of the Cavernous Sinus Presenting with Progressive Venous Congestion of the Pons and Cerebrum: Report of one case

A 61-year-old woman with a left cavernous sinus dural arteriovenous fistula presented with left 6th nerve palsy. Initial brain MRI showed findings consistent with left-sided pontine infarction. Follow-up MRIs revealed an enlarged pontine lesion, and additional lesions in the right hippocampus, both basal ganglia and centrum semiovale mimicking a brain tumor or a demyelinating disease. We suggest that the MRI lesions are venous congestions caused by the shunting of blood flow from the left carotid artery into the venous system. (J Korean Neurol Assoc 19(5):520~525, 2001)

Neuropsychological Characteristics of Mesial Temporal Lobe Epilepsy:Lesion Laterality-Sex Interaction

BACKGROUND: We investigated the neuropsychological features of laterality-sex interactions in mesial temporal lobe epilepsy (MTLE), using a broad and comprehensive neuropsychological test battery. METHODS: Eighty-nine consecutive patients (female 46) with MTLE (left 46) were included in the study. They underwent anterior temporal lobectomy and became seizure-free for at least one year postoperatively. All patients had a language dominancy in the left hemisphere. The following neuropsychological tests including : Korean Wechsler Intelligence Scale (KWIS), Wechsler Memory Scale-Revised (WMS-R), Wisconsin Card Sorting Test (WCST), and Color Trails Test (CTT), were performed preoperatively. Each variable of the neuropsychological tests were analyzed with regard to laterality-sex interactions. RESULTS: General memory, verbal memory, and delayed recall of WMS-R and a executive function measured by WCST were significantly decreased in patients with left MTLE compared to those with right MTLE. However, this laterality effect especially on verbal memory and some variables of WCST including the number of category completed was observed only in female patients. Interference index of CTT had a tendency to be increased in the male patients with right MTLE. The intelligence scale of KWIS was not correlated with lesion laterality or sex. CONCLUSIONS: Laterality-sex interactions were evident for verbal memory and an executive function in female patients with MTLE. Further studies need to be done on these neuropsychological features. (J Korean Neurol Assoc 19(2):132~138, 2001)

Neuropsychological Characteristics of Mesial Temporal Lobe Epilepsy:Lesion Laterality-Sex Interaction

BACKGROUND: We investigated the neuropsychological features of laterality-sex interactions in mesial temporal lobe epilepsy (MTLE), using a broad and comprehensive neuropsychological test battery. METHODS: Eighty-nine consecutive patients (female 46) with MTLE (left 46) were included in the study. They underwent anterior temporal lobectomy and became seizure-free for at least one year postoperatively. All patients had a language dominancy in the left hemisphere. The following neuropsychological tests including : Korean Wechsler Intelligence Scale (KWIS), Wechsler Memory Scale-Revised (WMS-R), Wisconsin Card Sorting Test (WCST), and Color Trails Test (CTT), were performed preoperatively. Each variable of the neuropsychological tests were analyzed with regard to laterality-sex interactions. RESULTS: General memory, verbal memory, and delayed recall of WMS-R and a executive function measured by WCST were significantly decreased in patients with left MTLE compared to those with right MTLE. However, this laterality effect especially on verbal memory and some variables of WCST including the number of category completed was observed only in female patients. Interference index of CTT had a tendency to be increased in the male patients with right MTLE. The intelligence scale of KWIS was not correlated with lesion laterality or sex. CONCLUSIONS: Laterality-sex interactions were evident for verbal memory and an executive function in female patients with MTLE. Further studies need to be done on these neuropsychological features. (J Korean Neurol Assoc 19(2):132~138, 2001)

Recurrent Gastrobronchial Fistula after Esophagectomy: one case report / 대한흉부외과학회지

Gastrobronchial fistula is an extremely rare condition. It is usually associated with trauma, esophagogastric surgery, subphrenic abscess, gastric ulcer, and neoplasm. A case of recurrent gastrobronchial fistula secondary to a benign gastric ulcer 2 and 3 years after Ivor Lewis procedure for treatment of esophageal carcinoma is described. The literature of this subject is reviewed and discussed.

Long-Term Resultof Surgical Treatmentfor Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: From 1987 to 1997, a total of 500 patients underwent surgery for esophageal cancer in our department. To determine the lon g-term results, recurrence patterns and prognostic factors, we reviewed the 11 y ears experiences. MATERIAL AND METHOD: Double pr imary tumors, cancers of the pharyngoesophageal and esophagogastric junction, pa lliative bypass surgery or esophageal prosthesis and exploration only were exclu ded in this study. Resection was usually performed through right thoracotomy(Ivo r Lewis operation) and anastomosis was made with staplers. Extended lymph node d issection was performed from August 1994 but not before. The stomach was used as a substitute for the esophagus in 96.8%. All reconstruction was done through po steromediastinal route except cervical reconstruction. RESULT: 474(94.8%) had confirm ed squamous cell carcinoma. Most(58.2%) of the tumors were located in the middle third of the esophagus, 47.4% of patients had operative pathologic stage III di sease, and 25% had stage IIA disease. Of the resections, 392 were classified as curative and 74 palliative, blunt dissection(transhiatal esophagectomy) and jeju nal free graft(34) were excluded in these classifications. The overall morbidity rate was 38.4%. The operative mortality rate was 5.8%, mainly due to respirator y complications and anastomosis leakages. The follow-up rate of these patients w as 99.8%. Overall actuarial 1, 2, and 5-year survival rates were 63.5%, 38.9%, a nd 19.4% including operative mortality. In standard lymph node dissection group, the actuarial 1, 2, and 5-year survival rates were 60.7%, 35.9%, and 16.9%(oper ative mortality rate: 4.3%), but in extended lymph node dissection group, the ac tuarial 1, 2, and 4-year survival rates were 70.2%, 46.5% and 30.9%(operative mo rtality rate: 6.5%), respectively. In curative resection group, the actuarial 1, 2, and 5-year survival rates were 69.4%, 43.9%, and 21.9%, but in palliative re section group, these were 37.8%, 17.6%, and 7.3%, respectively. The 4-year survi val rate was 35.6% in curative resection with extended lymph node dissection gro up. Postoperative recurrence was found in 226 patients. Site of recurrence were mainly lymph nodes(69%; neck, paratracheal and abdominal) and other systemic rec urrence was detected at liver, lung, bone, brain etc. CONCLUSION: We think that cura tive resection with extensive lymph node dissection is necessary for long term s urvival, but adequate postoperative care is a prerequisite. In advanced esophage al cancer, more effective multimodal adjuvant regimens remain to be established.

Primary Repair of Boerhaave's Syndrome / 대한흉부외과학회지

Boerhaave's syndrome has the worst prognosis of the esophageal perforation, despite the advancement in the treatment of esophageal perforation due to the development of ICU care and antibiotics. There were controversies in the treatment of esophageal perforation when diagnosed after 24hrs. From 1995 to 2000, we performed a buttressed primary repair and mediastinal drainage in 6 Boerhaave's syndrome patients among 13 esophageal perforation patients. Two patients died(33%). They died because of pneumonia, ARDS and sepsis on 38th, 39th post-operative day respectively. Two patients had leak at the site of repair which was treated completely with conservative treatment. We report on the result of a buttressed primary repair and mediastinal drainage for 6 Boerhavve's syndrome patients.

Result of Complete Resection of T3 Non-Small Cell Lung Cancer Invading the Chest Wall / 대한흉부외과학회지

BACKGROUND: The long-term survival after operation of patients with lung cancer invading the chest wall is known to be related to regional nodal involvement, completeness of resection and depth of chest wall involvement. In this study results of complete resection are reviewed to determine survival charateristics. MATERIAL AND METHOD: Of 680 consecutive patients who were operated on for primary non-small cell carcinoma between 1988 and 1998, we retrospectively reviewed 55 patients(8.0%) who had complete resection for lung cancer invading the chest wall or parietal pleura. RESULT: Resection of the chest wall was en bloc in 29 patients(47.3%), and extrapleural in 26(52.7%). In the patients undergoing extrapleural resection, the depth of chest wall invasion was confined to the parietal pleura in all patients(100%). In the patients underging en bloc resection, the pathologic depth of invasion was into the parietal pleura alone in 9(31.0%) and into the chest wall in 20(69.0%). The follow-up rate of these patients was 100%. Hospital mortality was 5.4%(n=3). The actuarial 5-year survival rate was 26% for all hospital survivors(n=52). The actuarial 5-year survival rate of patients with T3N0M0 disease(29%) was better than that of T3N2M0 disease(18%), however, there was no significant(p=0.30) difference. The depth of chest wall invasion had no statistically significant effect on survival in our series, neither for patients with involved lymphatic metastasis nor for those without(p=0.99). CONCLUSION: These observations indicate that the good five year survival in patients with T3 NSCLC invading the chest wall resulted from complete resection. Survival of patients with lung cancer invading the chest wall after complete resection is dependent on the extent of nodal involvement and much less so on the depth of chest wall invasion.

Treatment of Stomach Cancer Involving Esophagogastric Junction / 대한흉부외과학회지

BACKGROUND: The origin site of carcinoma invading esophagogastric junction is variable. It may arise from squamous cell carcinoma of low esophagus, adenocarcinoma arising from Barrett's esophagus, adenocarcinoma of gastric cardia, or extension from proximal stomach cancer. In Korea, the majority of adenocarcinoma invading esophago-gastric junction seems to arise from proximal gastric carcinoma. MATERIAL AND METHOD: We reviewed the data of surgically-resected gastric adenocarcinoma involving esophagogastric junction in KCCH between 1988 and 1999. RESULT: There were 212 cases. Male to female ratio was 156 to 56. Age distribution was between 22 and 78. Variable surgical approaches including median laparotomy, laparotomy with left or right thoracotomy, left thoracotomy, and thoracoabdominal approach were used. Postoperative pathologic stages were : Stage IA-7, IB-11, II-25, IIIA-73, IIIB-34, and IV-57. Curative resection was performed in 199 patients, and total gastrectomy was performed in 200 patients. There were 77.4%(164 cases) with esophageal involvement, 74.1%(157 cases) with tumor involvement in the abdominal LN, and 8%(17 cases) with mediastinal LN metastasis. Operative mortality was 3.3%, and over-all 5 year survival rate was 35%. CONCLUSION: There are various surgical approaches and many things to consider for surgical resection, thoracic and abdominal approach may need for obtain proper resection margin and adequate lymph node dissection in stomach cancer invading esophagogastric junction.