OBJECTIVE: This study was performed to elucidate the technical and patient-specific risk factors for postoperative ischemia in patients undergoing temporary arterial occlusion (TAO) during the surgical repair of their aneurysms. METHODS: Eighty-nine consecutive patients in whom TAO was performed during surgical repair of an aneurysm were retrospectively analyzed. The demographics of the patients were analyzed with respect to age, Hunt and Hess grade on admission, Fisher grade of hemorrhage, aneurysm characteristics, timing of surgery, duration of temporary occlusion, and number of temporary occlusive episodes. Outcome was analyzed at the 3-month follow-up, along with the occurrence of symptomatic and radiological stroke. RESULTS: In overall, twenty-seven patients (29.3%) had radiologic ischemia attributable to TAO and fifteen patients (16.3%) had symptomatic ischemia attributable to TAO. Older age and poor clinical grade were associated with poor clinical outcome. There was a significantly higher rate of symptomatic ischemia in patients who underwent early surgery (p = 0.007). The incidence of ischemia was significantly higher in patients with TAO longer than 10 minutes (p = 0.01). In addition, patients who underwent repeated TAO, which allowed reperfusion, had a lower incidence of ischemia than those who underwent single TAO lasting for more than 10 minutes (p = 0.011). CONCLUSION: Duration of occlusion is the only variable that needs to be considered when assessing the risk of postoperative ischemic complication in patients who undergo temporary vascular occlusion. Attention must be paid to the patient's age, grade of hemorrhage, and the timing of surgery. In addition, patients undergoing dissection when brief periods of temporary occlusion are performed may benefit more from intermittent reperfusion than continuous clip application. With careful planning, the use of TAO is a safe technique when used for periods of less than 10 minutes.
Aneurysm ; Brain Ischemia ; Craniotomy ; Demography ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Ischemia ; Reperfusion ; Retrospective Studies ; Risk Factors ; Stroke ; Troleandomycin

BACKGROUND: Morphological changes that accompany aging, such as wrinkles and skin laxity, are particularly prominent on facial skin. Recently, facial rejuvenation using the hydrofilling effect of hyaluronic acid (HA) filler has been employed for improvement of skin texture. In this study, we studied rejuvenating effects of stabilized HA (Restylane Vital) through direct intradermal injections. METHODS: A total of 30 female patients underwent a series of procedures on face, including three sessions at intervals of four weeks. A total of 2 mL of Restylane Vital was injected along the whole face using an automatic injector. Improvement of skin surface roughness, elasticity, brightness, moisture, and fine wrinkles was evaluated. Patient satisfaction was evaluated, and pictures of patients were taken at each visit and 6 months after last treatment session. Scoring for each patient was performed by three doctors according in five subjects. Moisture, oil and elasticity were measured before the procedure and before the last treatment in 10 patients. RESULTS: The majority of patients (77%) were satisfied with the therapeutic outcomes. Approximately 66% of patients responded that the effects of this procedure persisted for longer than four months, and the majority of patients (77%) wanted to undergo this procedure again and would recommend this procedure to acquaintances. Regarding doctors' evaluation, scores for improvement of skin surface roughness, elasticity, and brightness were significantly higher than those for improvement of moisture and fine wrinkle. CONCLUSIONS: Intradermal injection of HA can have a rejuvenating effect on dry and tired facial skin, especially in improvement of skin surface roughness.
Aging ; Elasticity ; Female ; Friends ; Humans ; Hyaluronic Acid ; Injections, Intradermal ; Patient Satisfaction ; Rejuvenation ; Skin

BACKGROUND: Clinicians who perform radiation therapy (RT) are exposed to radiation, which may negatively affect their health. The present study reports a case of acute lymphoblastic leukemia in a healthcare provider who was exposed to radiation at work; we also present a literature review of this topic. CASE PRESENTATION: A 45-year-old patient, who had been a radiation oncologist and had been exposed to radiation while performing brachytherapy 10 years ago, complained of chest pain and was suspected of having leukemia based on the results of a blood test in an outpatient clinic. He was diagnosed with acute lymphoblastic leukemia, and subsequently underwent chemotherapy. However, the case died during treatment. Through epidemiological investigation, it was found that the case's cumulative exposure dose based on personal exposure and spatial dose measured during the work period was in the range of 6.08–12.15 mSv. CONCLUSIONS: Based on the following considerations, acute lymphoblastic leukemia was highly correlated with the level of radiation to which the case was exposed while performing brachytherapy on patients with cancer. Firstly, the latent period of acute lymphoblastic leukemia in the case closely matched the latency time reported in previous published studies (5–10 years). In addition, numerous studies have reported significantly higher relative risks of cancer among clinicians who perform RT compared with the general population. The case was also atypically exposed to radiation through his hands, despite wearing protective equipment. Lastly, the case's coworkers were also found to have been exposed to high levels of radiation. Investigation into the influence of radiation exposure through atypical routes during RT on the health of clinicians is recommended.
Ambulatory Care Facilities ; Brachytherapy ; Cesium ; Chest Pain ; Drug Therapy ; Hand ; Health Personnel ; Hematologic Tests ; Humans ; Leukemia ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Radiation Exposure

Components of silk including silk fibroin have long been used as anti-diabetic remedies in oriental medicine. However, detailed mechanisms underlying these anti-diabetic effects remain unclear. In this study, we examined the anti-diabetic activity of silk fibroin hydrolysate (SFH) in C57BL/KsJ-db/db (db/db) mice, a well-known animal model of non-insulin dependent diabetes mellitus. When the db/db mice were administered SFH in drinking water for 6 weeks, hyperglycemia in the animals gradually disappeared and the level of glycosylated hemoglobin decreased, indicating that SFH plays important role in reducing the symptoms of diabetes. In addition, SFH-treated db/db mice exhibited improved glucose tolerance with increased plasma insulin levels. Immunohistochemical and morphological analyses showed that SFH up-regulated insulin production by increasing pancreatic beta cell mass in the mice. In summary, our results suggest that SFH exerts anti-diabetic effects by increasing pancreatic beta cell mass in a non-insulin dependent diabetes mellitus mouse model.
Animals ; Diabetes Mellitus ; Drinking Water ; Fibroins ; Glucose ; Hemoglobin A, Glycosylated ; Hyperglycemia ; Insulin ; Insulin-Secreting Cells ; Medicine, East Asian Traditional ; Mice ; Models, Animal ; Plasma ; Silk

Here we report a case in a 41-year-old woman histologically proven cystic embryonal sarcoma of the kidney, with emphasis on the imaging findings and pathological features. A large lobulated solid mass in the cystically dilated pelvocalyceal region was accompanied with hydroureter as depicted on both ultrasound and contrast-enhanced CT images.
Adult ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Imaging, Three-Dimensional/methods ; Kidney/radiography/surgery/ultrasonography ; Kidney Neoplasms/*radiography/surgery/*ultrasonography ; Neoplasms, Germ Cell and Embryonal/*radiography/surgery/*ultrasonography ; Sarcoma/*radiography/surgery/*ultrasonography ; Tomography, X-Ray Computed/methods

BACKGROUND AND OBJECTIVES: There have been very few pathophysiologic studies on isolated diastolic dysfunction. We hypothesized that the characteristics of isolated diastolic dysfunction would be located, on the clinical continuum, between those of a normal heart and diastolic heart failure. SUBJECTS AND METHODS: We enrolled 102 subjects who had no history of overt symptoms of heart failure and who had a left ventricular ejection fraction of more than 50%. They were examined for myocardial deformation and rotation using the two-dimensional speckle tracking image (2D-STI) technique. RESULTS: The circumferential strains and radial strain at the apical level (RS(apex)) were related to the ratio of the transmitral early peak velocity over the early diastolic mitral annulus velocity (E/E'). After adjustment for age, the RS(apex) showed a positive relationship with the E/E' ratio; whereas, the circumferential strains did not. Instead, the circumferential strains demonstrated a significant correlation with age. Basal rotation and left ventricular (LV) torsion were also related to age, but had no relationship with the E/E' ratio. However, as the E/E' ratio value increased, systolic mitral annular velocity decreased. CONCLUSION: Except for the RS(apex), LV myocardial deformation and rotation did not vary with the degree of E/E' ratio elevation when there was no associated diastolic heart failure. Additionally, in clinical situations such as isolated diastolic dysfunction, the advancement of age has a relatively greater influence on characteristics of LV myocardial deformation and rotation rather than on the E/E' ratio.
Echocardiography, Doppler ; Heart ; Heart Failure ; Heart Failure, Diastolic ; Sprains and Strains ; Stroke Volume ; Track and Field

BACKGROUND/AIMS: Few studies have assessed left ventricular (LV) dyssynchrony in cases of diastolic dysfunction that do not include overt symptoms of heart failure. We hypothesized that systolic or diastolic dyssynchrony involves unique features with respect to the degree of diastolic impairment in isolated diastolic dysfunction. METHODS: We examined 105 subjects with no history of overt symptoms of heart failure and a left ventricular ejection fraction > 50% for mechanical dyssynchrony using tissue Doppler imaging. RESULTS: In terms of longitudinal dyssynchrony, four cases showed (6.3%) LV intraventricular systolic dyssynchrony (SDS(LV)), whereas none had LV intraventricular diastolic dyssynchrony (DDS(LV)) or co-existing systolic dyssynchrony. Radial dyssynchrony (RD) was found in six cases (9.4%). After adjusting for age, SDS(LV) and DDS(LV) were found to be significantly related to increases in the E/E' ratio (r = 0.405 and p < 0.001 vs. r = 0.216 and p = 0.045, respectively). RD at the base and apex was also significantly related to increases in E/E' (r = 0.298 and p = 0.002 vs. r = 0.196 and p = 0.045, respectively). CONCLUSIONS: Systolic and diastolic dyssynchrony in subjects with isolated diastolic dysfunction but without overt symptoms of heart failure was not as common as in patients with diastolic heart failure; however, the systolic and diastolic intraventricular time delay increased with increases in the E/E' ratio, an indicator of diastolic dysfunction.
Adult ; Aged ; Case-Control Studies ; Diastole ; Echocardiography, Doppler ; Female ; Heart Failure, Diastolic/*physiopathology/ultrasonography ; Humans ; Male ; Middle Aged ; Systole ; Ventricular Dysfunction, Left/*physiopathology/ultrasonography

Laparoscopic cholecystectomy has now rapidly replaced open cholecystectomy. Rarely a calculus may arise from a metallic surgical clip migrated into the common bile duct (CBD) after this surgical procedure was performed. We report a 50-year-old man with CBD stone formed around a surgical clip, who had undergone a laparoscopic cholecystectomy because of acute calculous cholecystitis 14 months before. Abdominal CT revealed a single stone in mildly dilated CBD. A high density core within the CBD stone, was suspected to be a surgical clip. The stone was removed using a retrieval balloon catheter and basket after endoscopic sphincterotomy.
Cholecystectomy, Laparoscopic/adverse effects/*instrumentation ; Choledocholithiasis/*etiology ; *Foreign-Body Migration ; Humans ; Male ; Middle Aged ; Surgical Instruments/*adverse effects

BACKGROUND AND OBJECTIVES: Left ventricular (LV) dyssynchrony has been commonly detected among hypertensive patients with normal LV systolic function and no evidence of congestive heart failure. The purpose of our study was to assess the changes in LV systolic dyssynchrony (SDSLV) among hypertensive patients after antihypertensive treatment, and to determine the relationship between SDSLV and other conventional echocardiographic parameters. SUBJECTS AND METHODS: Forty one hypertensive patients with normal LV ejection fraction were enrolled. By performing a conventional echocardiographic study, the SDSLV was measured as the time difference between the shortest and longest time of the peak myocardial systolic velocities among 12 segments of the basal and mid-levels of the 3 apical views, and radial dyssynchrony of the basal (RDSbase) and mid-levels (RDSmid) measured as the time difference between the earliest and latest peak values on the radial strain curves of each level of the parasternal short-axis views. RESULTS: Compared to baseline after six months of antihypertensive treatment, the SDSLV improved significantly (48.7+/-37.9 ms vs. 29.5+/-34.1 ms, p=0.020). Also the RDSbase and RDSmid improved significantly in respect to the baseline values (129.9+/-136.3 ms vs. 38.8+/-45.4 ms, p=0.002 and 75.2+/-63.8 ms vs. 28.2+/-37.7 ms, respectively, p<0.001). CONCLUSION: The severity of SDSLV improved with antihypertensive treatment, and was associated with the regression of LV mass. Furthermore, it might precede improvement in the mitral inflow pattern, as assessed by conventional echocardiography, so that early detection of the benefit of antihypertensive treatment may be possible.
Echocardiography ; Heart Failure ; Humans ; Hypertension ; Sprains and Strains

Purpose: Managing patients with hemorrhagic shock is mainly dependent on stopping the bleeding as fast as possible. Emergency Department laparotomy (EDL) is considered one of the approaches to control intra-abdominal bleeding rapidly. This study aims to evaluate the outcomes of EDL in a regional trauma center of Pusan National University Hospital in a 4-year period. Methods: The medical records and data of patients who underwent EDL from January 2016 to December 2019 were analyzed. Patients who underwent preperitoneal pelvic packing only or did not receive surgery immediately after EDL were excluded. Results: Twenty-four patients who underwent EDL were included in the study. 18 patients had sustained blunt trauma, and 6 suffered from penetrating injuries. Small bowel mesentery and liver injuries were the most frequent. Increase of median systolic blood pressure (SBP) after EDL was 55.5 mmHg. Four (16.7%) out of the 24 survived; one of the four survivors received cardiopulmonary resuscitation (CPR). In the nonsurvivor group, Injury Severity Score was significantly higher (p = 0.013), initial pH was lower (p = 0.035) and the amount of packed red blood cells transfusion after EDL was significantly higher (p = 0.013) than those in the survivor group. Conclusion The mortality rate was very high in trauma patients who were required EDL. Although EDL was not proved to be an effective procedure for resuscitation in trauma patients, it could be considered as one of the treatment options for trauma patients in extremis. Further studies are required to examine the effects of EDL.