Proper classification of the causative mechanism of stroke is important for optimizing stroke treatment and assessing prognosis. The primary etiology of stroke differs according to race and ethnicity: emboli originating from the heart or extracranial large arteries are common in Western populations, whereas small-vessel occlusion or intracranial atherosclerosis is more prevalent in Asians. Intracranial atherosclerosis frequently leads to stroke by branch-artery occlusion, and the degree of stenosis in these cases is often <50%. Mild intracranial atherosclerotic stenosis may cause distal embolization, if the atherosclerotic plaque is sufficiently vulnerable. Moreover, high-resolution magnetic resonance imaging studies have identified small plaques causing infarction, even in patients with normal-appearing vascular findings. Such cases, which are prevalent in Asia, could not be classified as large-artery atherosclerosis by previous classification systems. Additionally, single subcortical infarctions, which are usually attributed to lipohyalinotic small-vessel disease, can have other causes, including microatheroma of perforators and atherothrombotic lesions at the parental artery. Single subcortical infarctions associated with parental artery disease or those bordering on the main vessel more often have atherosclerotic characteristics than do those associated with lipohyalinosis of the penetrating artery. In countries where intracranial atherosclerosis is common, such atherosclerotic single subcortical infarctions are predicted to be prevalent. These cases, however, could not be appropriately classified in previous systems. Further effort should be devoted to formulate ischemic stroke classification systems that adequately incorporate results of recent studies and reflect the underling pathologic mechanisms, especially in patients with single subcortical infarction and intracranial atherosclerosis.
Arteries ; Asia ; Asian Continental Ancestry Group* ; Atherosclerosis ; Cerebral Infarction ; Classification* ; Constriction, Pathologic ; Continental Population Groups ; Heart ; Humans ; Infarction ; Intracranial Arteriosclerosis ; Magnetic Resonance Imaging ; Parents ; Plaque, Atherosclerotic ; Prognosis ; Stroke*

No abstract available.

STUDY DESIGN: The authors retrospectively analysed the difference of clinical natures in contained vs. ruptured HIVD. OBJECTIVE: To compare contained HIVD with ruptured HIVD in respect of clinical symptoms, signs and the result after surgery. SUMMARY OF LITERATURE REVIEW: In contained disc herniation, the disc material remains beneath tile intact outer annulus. But, once disc material penetrates through the limit of posterior annulus, it is a ruptured herniation or disc extrusion/sequestration. There is few report concerning the clinical characteristics related to type of herniation. MATERIALS AND METHODS: Forty-six patients, treated by open discectomy from March 1990 to December 1994, were followed up for minimum two years. The clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR, and severity of radiating pain were periodically followed up on the predesigned protocol. Result: Twenty patients had contained disc and remaining 26 had ruptured disc. The mean age of contained disc was 31.4 years and that of ruptured disc was 43.3 years. In preoperative examination, 18/26 cases of patients with ruptured discs, developed pain in less than 3 months, compared with 7/20 cases of does with contained ones. Motor deficit was positive in 25/26 cases (96.2%) of ruptured discs and 12/20 cases (60%) of contained ones. 23/26 cases (80.8%) of patients with ruptured discs, had sensory deficit compared with 12/20 cases (60%) of those with contained ones. There was no significant difference in SLR and DTR change between ruptured and contained disc. CONCLUSIONS: Factors such as age, motor and sensory deficits and duration of symptoms had correlation with the type of herniation, but SLR and DTR change showed no statistical difference in this study. Clinical outcome showed no significant difference between two groups, but in ruptured group, the results were getting worse with the time goes. On the basis of this study, we concluded that the clinical symptoms and signs were different between the two groups, but surgical results showed no statistical difference.
Diskectomy ; Humans ; Retrospective Studies

Intradural lipomatosis is a rare clinical entity characterized by excessive fat deposition in the intradural space. And they occur slightly more frequently in males. It may lead compression of the spinl cord or lumbargo, radiating pain, paresthesia, intermittent claudication and if they involve the cervical and thoracic region, the patients with tumours in these regions most frequently present with a slow ascending monoparesis or paraparesis, cutaneous sensory loss and defective deep sensation. Only 3% of tumours have been reported in the thoraco-lumbar region. The diagnosis should be based on a combination of clinical, imaging, surgical, and histological findings, and especially the diagnostic procedure of choice in patients with progressive myelopathy is MRI scan as it produces accurate imaging without exposure to ionizing radiation. He was treated surgically-removal of excessive fat tissue and decompressive laminectomy. We report a case of intradural lipomatosis that we had removed by surgically.
Diagnosis ; Humans ; Intermittent Claudication ; Laminectomy ; Lipomatosis* ; Magnetic Resonance Imaging ; Male ; Paraparesis ; Paresis ; Paresthesia ; Radiation, Ionizing ; Sensation ; Spinal Cord Diseases

BACKGROUND: Vascular endothelial growth factor (VEGF) plays a role in the development of cancer and the progression of liquid tumors such as chronic lymphatic leukemia, non-Hodgkin lymphomas, and multiple myeloma. VEGF also triggers endothelial cells to secrete hematopoietic growth factors such as interleukin-6 (IL-6); this in turn promotes further leukemia growth, thereby contributing to a paracrine loop between the leukemia and the endothelial cells. METHODS: We transfected a small interfering RNA (siRNA) targeting VEGF into K562 cells in order to investigate the role of VEGF in the development of leukemic cancer. After the conditioned media (CM) of the K562 was cells added to the human umbilical endothelial cell (HUVEC) culture media, we compared the proliferation and tube formation of the HUVECs. Recombinant human prothrombin kringle2 (K2), which is a known angiogenic inhibitor, was also treated onto the HUVECs, and we then examined the level of IL-6 to determine the paracrine interaction between the leukemic and endothelial cells. RESULTS: RT-PCR and western blot analysis demonstrated that the siRNA efficiently down regulated the expression of VEGF in the K562 cells. When the CM of the K562 cells was added to the HUVEC culture, the proliferation of the HUVECs was stimulated. The proliferation of the HUVEC induced by the CM from the siRNA-VEGF K562 cells was diminished, compared with that of the vector control K562 cells. K2 reduced not only the proliferation of the HUVECs, but also the secretion of IL-6 by the HUVEC. CONCLUSION: The siRNA strategy is an alternative tool for inhibiting leukemia-induced angiogenesis. A combinated therapy with angiogenesis inhibitor K2 increases the efficiency. K2 modulates the production of IL-6, which may affect the paracrine interaction between leukemia and endothelial cells.
Blotting, Western ; Culture Media ; Culture Media, Conditioned ; Endothelial Cells ; Humans* ; Intercellular Signaling Peptides and Proteins ; Interleukin-6 ; K562 Cells ; Kringles* ; Leukemia ; Lymphoma, Non-Hodgkin ; Multiple Myeloma ; Prothrombin* ; RNA, Small Interfering* ; Vascular Endothelial Growth Factor A*

No abstract available.
Mycobacterium chelonae* ; Mycobacterium* ; Skin*

The search for a new flap with minimal donor morbidity has been pursued by many plastic surgeons. Numerous donor sites available for microsurgical composite tissue transplantation have been described owing to the tremendous advances made in the field of microsurgery. To be suifable for use as a free flap, a sizable vessel must be included within the tissue, leading to significant donor morbidity. There have been studies for prefabrication of an axial pattern flap in an effort to create a new flap, but most of these methods relied solely on revascularization of a preexisting composite tissue. Our experiment, using an isolated femoral artery and vein as the main pedicle, led to formation of a capsule flap through a normal foreign body reaction between 2 silastic sheet implants. On this induced capsule flap, a skin graft was performed and a total of 40 axial pattern capsulo-cutaneous flaps from 20 Sprague-Dawley rats were successfully obtained after nearly 12 weeks through 4 stages of experiment, including a delay procedure at the second stage. Pathology revealed neovascularization, and abundantly impregnated vascular structures near the pedicle were observed along with random pattern collagen fibers. The skin graft took 100% on this newlyformed axial pattern capsular flap and thus implied that the capsule structure was able to survive on it`s own and was able to support skin grafts. This new flap using only the isolated artery and vein structure can be induced according to various needs with minimal donor morbidity.
Arteries ; Collagen ; Femoral Artery ; Foreign-Body Reaction ; Free Tissue Flaps ; Humans ; Microsurgery ; Pathology ; Rats, Sprague-Dawley ; Skin ; Tissue Donors ; Tissue Transplantation ; Transplants ; Veins

The cumulative incidence of breast cancer in Korea is low, being about one-fifth of that in the United States. This low incidence has been mainly explained by environmental factors, and recently, however, racial variations in the disease-causing genes should also be considered. The BRCA1 is one of the common genes involved in early-onset breast cancer and/or ovarian cancer in the United States and Northern Europe. However, the involvement of BRCA1 in Korean'breast cancer patients are still unclear. We performed germline mutation screening of the BRCA1 gene by DNA single strand conformation polymorphism (SSCP) analysis. We examined 27 breast cancer patients who were diagnosed less than 35 years by age including two cases with family history of breast cancer. Our study showed no germline mutation at the exons 2, 11 and 20, which were known as the supreme susceptible regions of BRCA1 mutations. Even though our cases did not fulfilled the criteria of familial breast/ovarian cancer, the proprotion of families who inherit the mutated BRCA1 allele seems to be very small and might be negligible among Korean population. Therefore, it is considered that the BRCA1 itself cannot be a major susceptibility gene and the contributions of other genes might be important for the breast cancer.
Alleles ; Breast Neoplasms* ; Breast* ; DNA ; Europe ; Exons ; Genes, BRCA1 ; Germ-Line Mutation* ; Humans ; Incidence ; Korea ; Mass Screening ; Ovarian Neoplasms ; United States

OBJECTIVES: The aim of this study was to evaluate the differences in patients with positional dependent sleep apnea according to their non-supine apnea-hypopnea index (AHI, > or =5 vs. <5). METHODS: 92 patients with positional sleep apnea were evaluated. The patients were divided into two groups : group I was non-supine AHI having > or =5 ; group II was non-supine AHI having less than 5. Statistical analysis was performed to find the difference between two groups. RESULTS: In 92 patients, the number of group I patients was 11 (12%) and the number of group II patients was 81 (88%). In the severe AHI group, percentage of group I was dominated (70%) and showing a significant difference compared with the mild and moderate AHI groups (p<.05). In the severe body mass index (BMI) group, percentage of group I was dominated (54.5%) and showing a significant difference compared with of the mild and moderate BMI groups (p<.05). The percentage of group I was significantly higher than group II (p<.05) in the AHI, supine AHI, non-supine AHI and snore time. CONCLUSIONS: In patients with positional sleep apnea, severe OSA and high BMI are more common in patients with non-supine AHI> or =5 than non-supine AHI<5.
Body Mass Index ; Humans ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive

BACKGROUND: The aim of this study was to analyze the questions in the shoulder and elbow section of the Korean Orthopaedic In-Training Examination (KOITE) and compare them with those of the US Orthopaedic In-Training Examination (US OITE). METHODS: Twenty-nine questions in the shoulder and elbow section of the KOITE from 2010 to 2014 were analyzed and compared with those of the US OITE (80 questions) by literature review. A thorough analysis of the contents was performed after categorizing as topics, diagnostic tools, treatment modalities, taxonomic classification, and references. RESULTS: The shoulder and elbow section of the KOITE was 5.8% weight which was similar to the US OITE (5.9%). The most commonly appearing topic was anterior labral injury (17.2%) on the KOITE compared to instability and arthritis (21.3%, each) on the US OITE. Magnetic resonance imaging was most frequently appeared imaging modality on the KOITE (41.0%) compared to the radiograph on the US OITE (43.0%). The Latarjet procedure was the most commonly asked treatment modality (22.2%) on the KOITE, whereas arthroplasty (33.3%) on the US OITE. The KOITE showed an even taxonomic classification distribution compared to the US OITE. Campbell's operative orthopaedics covered 96.6% questions as a reference on the KOITE compared to the Journal of Bone and Joint Surgery, American Volume on the US OITE, which covered 45.0%. CONCLUSIONS: This specific analysis shows us current trends of the shoulder and elbow section of the KOITE and it might be developed for use in the educational curricula for the trainee.
Arthritis ; Arthroplasty ; Classification ; Curriculum ; Elbow* ; Joints ; Magnetic Resonance Imaging ; Orthopedics* ; Shoulder*