Pleomorphic xanthoastrocytoma(PXA) is a benign brain tumor with favorable prognosis in spite of its marked pleomorphism. We report a case with review of the literature. An eight-year-old boy presented with headache and vomiting. Plain skull X-ray showed findings of increased intracranial pressure. The MR imaging demonstrated superficially located large cystic mass with a Iobulated mural nodule in the left frontal lobe. The mural nodule abutting leptomeninges showed intense enhancement on postcontrast Tl-weighted images, but the cyst wall was not enhanced. Preoperative diagnosis of PXA with the MRI findings could lead to avoidance of more aggressive brain resection and therefore more favorable neurological outcome
Brain ; Brain Neoplasms ; Child* ; Diagnosis ; Frontal Lobe ; Headache ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Male ; Prognosis ; Skull ; Vomiting

OBJECTIVE: The goal of this study was to determine the efficacy of caudal epidural injection in relieving pseudoclaudication of patients with lumbar spinal stenosis. METHOD: Fifteen patients with a spinal stenosis which was confirmed by the magnetic resonance imaging(MRI) studies, received a caudal epidural steroid injection of triamcinolone acetate 120 mg, in a solution mixed with 2 ml of 1% lidocaine, and 15 ml of normal saline. RESULTS: The visual analogue scales checked at 1 hour prior to injection, 1 hour postinjection, and 1 month postinjection were 8.1+/-0.8, 3.7+/-1.7, and 6.4+/-1.9, respectively. The exercise tolerance on the treadmill with 0o ramp inclination and 1.8 km/h speed was measured at 1 hour prior to injection, 1 hour postinjection, and 1 month postinjection. The time intervals to the first symptom of the pseudoclaudication were 2.3+/-0.8 minutes, 6.5+/-0.7 minutes, and 4.6+/-1.9 minutes, respectively. CONCLUSION: In our study, the caudal epidural injection offered a significant short-term relief for the pseudoclaudication. Also it appeared to be a reasonable therapeutic option among patients with lumbar spinal stenosis after 1 month postinjection.
Architectural Accessibility ; Exercise Tolerance ; Humans ; Injections, Epidural* ; Lidocaine ; Spinal Stenosis* ; Triamcinolone ; Weights and Measures

PURPOSE: Combined chemoradiotherapy is standard management for locally advanced non-small cell lung cancer (LA-NSCLC), but standard treatment for elderly patients with LA-NSCLC has not been confirmed yet. We evaluated the feasibility and efficacy of concurrent chemoradiotherapy (CCRT) for elderly patients with LA-NSCLC. MATERIALS AND METHODS: Among patients older than 65 years with LA-NSCLC, 36 patients, who underwent CCRT were retrospectively analyzed. Chemotherapy was administered 3-5 times with 4 weeks interval during radiotherapy. Thoracic radiotherapy was delivered to the primary mass and regional lymph nodes. Total dose of 54-59.4 Gy (median, 59.4 Gy) in daily 1.8 Gy fractions and 5 fractions per week. RESULTS: Regarding the response to treatment, complete response, partial response, and no response were shown in 16.7%, 66.7%, and 13.9%, respectively. The 1- and 2-year overall survival (OS) rates were 58.2% and 31.2%, respectively, and the median survival was 15 months. The 1- and 2-year progression-free survivals (PFS) were 41.2% and 19.5%, respectively, and the median PFS was 10 months. Regarding to the toxicity developed after CCRT, pneumonitis and esophagitis with grade 3 or higher were observed in 13.9% (5 patients) and 11.1% (4 patients), respectively. Treatment-related death was not observed. CONCLUSION: The treatment-related toxicity as esophagitis and pneumonitis were noticeably lower when was compared with the previously reported results, and the survival rate was higher than radiotherapy alone. The results indicate that CCRT is an effective in terms of survival and treatment related toxicity for elderly patients over 65 years old with LA-NSCLC.
Aged ; Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy ; Disease-Free Survival ; Esophagitis ; Humans ; Lymph Nodes ; Pneumonia ; Retrospective Studies ; Survival Rate

No abstract available.
Echocardiography, Transesophageal*

BACKGROUND: Recently, a lower incidence of late potentials has been reported in patients with acute myocardial infarction after successful thrombolysis when compared with conventionally treated patients. In another recent study, however, no significant effect of thrombolytic therapy on any abnormal signal average electrocardiography was found at 13 days after acute myocardial infarction. The present study was designed to determine the prognostic significance of the signal average electrocardiography and to evaluate the possible value of this technique as a noninvasive tool for monitoring of coronary occlusion and reperfusion. METHODS: Signal averaging was performed by using a signal average electrocardiography with bidirectional filterings before coronary artery occlusion, at 5 minutes after coronary occlusion and on reperfusion in 20 cats. Three of them died due to malignant ventricular arrhythmia during reperfusion. In all cats, approximately 250 beats were averaged. All data were analysed at filter frequency 25 to 250Hz, 40 to 250Hz and 80 to 250Hz. The following quantitative high resolutional electrocardiographic variables were calculated by computer : 1) filtered total QRS duration, 2) duration of HFLA(high frequency low amplitude) signals under 40uV, 3) RMS voltage of terminal 40ms, 4) mean Voltage of terminal 40ms, 5) average noise voltage. RESULTS: At the filter frequency of 40 to 250Hz and 80 to 250Hz, the filtered QRS duration and duration of HFLA signals 40uV were significantly prolonged at 5 minutes after coronary artery occlusion than before coronary occlusion(p<0.01). At the filter frequency of 40 to 250Hz and 80 to 250Hz, the RMS voltage(terminal 40ms) and mean voltage(terminal 40ms) were significantly prolonged at 5 minutes after coronary artery occlusion than before coronary occlusion(p<0.01, p<0.01 respectively). At the filter frequency of 80 to 250Hz, the filtered QRS duration and at the filter frequency of 25-250Hz, the duration of HFLA signals at 40uV were significantly shortened during reperfusion than at 5 minutes after coronary artery occlusion(p<0.01, p<0.05 respectively). At the filter frequency of 40 to 250Hz and 80 to 250Hz, the RMS voltage(terminal 40ms) and mean Voltage(terminal 40ms) were significantly shortened during reperfusion than at 5 minutes after coronary artery occlusion(p<0.01, p<0.01 respectively). There was no significant change of the filtered QRS duration, duration of HFLA signals 40uV,RMS voltage(terminal 40ms) and mean Voltage(terminal 40ms) after reperfusion compared with those of control at the filter frequency of 25 to 250Hz, 40 to 250Hz and 80 to 250Hz respectively. CONCLUSION: These results suggest that the signal average electrocardiography could be a valuable tool for monitoring the state of coronary artery occlusion and reperfusion.
Animals ; Arrhythmias, Cardiac ; Cats* ; Coronary Occlusion ; Coronary Vessels* ; Electrocardiography* ; Humans ; Incidence ; Myocardial Infarction ; Noise ; Reperfusion* ; Thrombolytic Therapy

STUDY DESIGN: Retrospective study OBJECTIVES: To investigate the type of postsurgical spinal stenosis in patients who had undergone a primary laminectomy and discectomy for a herniated lumbar disc, and to evaluate the clinical outcomes of the revision operation. SUMMARY AND LITERATURE REVIEW: Spinal stenosis occurs frequently after a laminectomy and discectomy. Facet joint arthritis, hypertrophy of the ligamentum flavum, iatrogenic instability, postsurgical scarring or any combination of these conditions can cause spinal stenosis. MATERIALS AND METHODS: Twenty-four patients, who had postsurgical spinal stenosis were reviewed. Patients with a simple recurrent disc herniation without a spinal stenosis were excluded. The mean age was 52.5 years (range 31~70). There were 19 males and 5 females. The primary discectomy were performed at L4-5 in 21 patients, L5-1 in 2 patients, and both L4-5 and L5-1 in 1 patient. The mean interval between the first discectomy and revision surgery was 11.6 years (range 2.7~40). The anatomical site of the spinal stenosis, combined herniated disc, height of the disc space, segmental instability, hypertrophy of facet joint and thickening of the ligamentum flavum in radiographs was evaluated. The clinical outcome was measured using the Oswestry disability index. RESULTS: Lateral spinal stenosis was observed in all patients. Eight patients showed both central and lateral stenosis. The lateral stenosis was caused by hypertrophy of the facet joint in 20 patients and a thickening of the ligamentum flavum in 8 patients. Nineteen patients showed herniated lumbar disc, including disc protrusion in 8 patients, disc extrusion in 9 patients, and disc sequestration in 2 patients. A loss of disc height was observed in 12 patients, segmental instability in 5 patients, and spondylolisthesis in 3 patients. All the patients received posterior decompression and posterolateral fusion with pedice screw instrumentation. Eighteen patients received a discectomy simultaneously. The average Oswestry score at the last visit was 24.4. CONCLUSIONS: Postlaminectomy spinal stenosis resulted from a lateral spinal stenosis associated with facet joint hypertrophy. Recurrent disc herniation also contributed to the novel development of symptoms. A wide decompression and fusion provided good clinical outcomes.
Arthritis ; Cicatrix ; Constriction, Pathologic ; Decompression ; Diskectomy* ; Female ; Humans ; Hypertrophy ; Intervertebral Disc Displacement ; Laminectomy ; Ligamentum Flavum ; Male ; Retrospective Studies ; Spinal Stenosis* ; Spondylolisthesis ; Zygapophyseal Joint

OBJECTIVE: Recently, a fixed combination of grazoprevir and elbasvir (GE) has been introduced to the arsenal of chemotherapeutics to fight against this virus. The study aimed to provide information on the efficacy and safety of GE for the treatment of HCV infection by performing a meta-analysis of literature data. METHODS: PubMed and EMBASE database searches were conducted. Among the literature retrieved, pivotal Phase III clinical studies were analyzed. Statistical analysis of the data was performed by RevMan. RESULTS: Four pivotal Phase III clinical studies compared the efficacy and safety of GE. When HCV patients were treated with GE for 12 weeks, the sustained virologic response, defined as the viral RNA level below the lower limit of quantification at 12 weeks after the cessation of therapy (SVR12), was 94.7%. The clinical advantage of GE involves its use by patients with cirrhosis and/or renal failure without dose adjustment. If the genotype (GT) of the causative virus was GT1a with NS5A polymorphism or GT4 with resistance to peginterferon/ribavirin, treatment with GE plus ribavirin for 16 weeks resulted in a better outcome compared to treatment with GE alone for 12 weeks. Adverse events reported during the four clinical studies were 71.09% in the GE arms and it was 76.61% in the non-GE arms, with the most frequent events being mild central nervous system symptoms. CONCLUSION: GE was generally safe and effective for the treatment of HCV infection. However, since HCV mutates very rapidly and becomes resistant to antiviral agents, long-term monitoring should be mandatory.
Antiviral Agents ; Arm ; Central Nervous System ; Fibrosis ; Genotype ; Hepacivirus ; Hepatitis C ; Hepatitis ; Humans ; Renal Insufficiency ; Ribavirin ; RNA, Viral

A free-floating ball thrombus in the left atrium is a rare complication of the mitral valvular disease. A 53-year-old man was admitted for pain and paresthesia on both legs. On admission he had auscultatory sign of mitral stenosis and mitral regurgitation, and the roentgenogram of his chest revealed a slight pulmonary ve..ous congestion, enlargement of the pulmonary conus and cardiomegaly. Laboratory findings including complete blood counts, coagulation studies and blood chemistry were normal. An echocardiographic examination revealed a mitral stenosis and a free-floating ball thrombus in the left atrium. We performed the emergent open heart surgery for removal of the ball thrombus and mitral replacement successfuly with Duromedics 29 mm valve. The size of thrombus was 39 X 32 X 30 mm.
Blood Cell Count ; Cardiomegaly ; Chemistry ; Conus Snail ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart Atria ; Humans ; Leg ; Middle Aged ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Paresthesia ; Thoracic Surgery ; Thorax ; Thrombosis*

It has recently become possible to record electrical activity originationg from abnormally conducting myocardium from the body surface with high-gain amplification and averaging technique. These signals, which result from delayed ventricular activation(late potentials), have been recorded in patients with documented ventricular tachyarrythmia. Several electrode lead system for detecting ventricular late potential were introduced. Pyramidal electrode lead system(PLS) is useful. Also interpretation of SAECG in the young could be of value in detecting those at risk for episodic ventricular tachycardia, but suffer from a lack of data in normal young people. There was no difference between normal values, determined by FLS and PLS at high pass filtering of 25 Hz and 80 Hz, but significant, difference was found in HFLAD and RMS-40 of 40 Hz (p<0.05). These results will provide a basis for interpretations of SAECG, determined by FLS and PLS in healthy young adults with normal QRS duration. SELECTION OF SUBJECTS: For this study, normal healthy young adult volunteers (age : mean 24 years) were recruited from the medical students at Yeungnam University Hospital, Internal Medicine. Twenty fourths male and seventeenths female subjects were selected. All subjects had normal resting ECGs as judged from both the standard 12 channel lead and echocardiography, and none had a history of cardiovascular disease. All subjects were considered to be in good general physical condition. SIGNAL-AVERAGED ELECTROCARDIOGRAPHY: In order to obtain low noise recordings with a small number of averaging cycles, all subject ware asked to relax completely in the supine position. Silver/silver chloride electrodes were attached after the skin was cleaned with alcohol, to constitute classic flank lead system(FLS) and pyramidal lead system(PLS). Signals were recorded and processed using a commercially available microprocessor-augmented ECG cart(Marquette Electronics, USA) suitable for portable bedside recording.
Cardiovascular Diseases ; Echocardiography ; Electrocardiography* ; Electrodes ; Female ; Humans ; Internal Medicine ; Male ; Myocardium ; Noise ; Patient Selection ; Reference Values ; Skin ; Students, Medical ; Supine Position ; Tachycardia, Ventricular ; Volunteers ; Young Adult*

OBJECTIVES: It is widely accepted that estrogen has favorable effects on cardiovascular diseases, especially in the postmenopausal women. Endothelin-1(ET-I), released from the vascular endothelium, is a 21-amino acid peptide with strong vasoconstrictor activity. However, the effect of estrogen on the vasoconstriction to ET-1 has not been extensively studied. METHODS: To investigate the effect of estrogen (175beta-estradiol) on the vascular contraction to ET-1, porcine coronary artery(PCA) rings were suspended in organ chambers(37 degrees C, 95% O2/5% CO2) for measurement of isometric tension change. Endothelium was removed mechanically if necessary. In acute experiments, vascular rings were preincubated for 15minutes with 3different concentrations of 170beta-estradiol(10(-6), 10(-5), 10(-4)M) and concentration-contraction curves to cumulative doses of ET-1 were constructed. In the experiments after a longer exposure to 17beta-estradiol, the vessels with endothelium were exposed in the 5% CO2 incubator to 3different concentrations of 17beta-estradiol(10(-9), 10(-8), 10(-7)M) for 44-50 hours, and then concentrationcontraction curves to ET-1 were obtained. RESULTS: Incubation for 15minutes with 170beta-estradiol(10(-4)M) inhibited ET-1-induced contraction in the vessels with endothelium(area under the curve and maximal contraction, p<0.05 compared with control). This effect persisted regardless of the sex and the presence or absence of the endotheliurn. Incubation of the vessels far a longer time with 170beta-estradiol(44-50 hours) resulted in the inhibition of maximal contraction to ET-1(p<0.05) by a lower concentration of 175beta-estradiol(10(-7)M) than in acute experiments in male PCA rings, but an enhanced contraction to ET-1(area under the curve; p<0.05) by 10M of 175beta-estradiol was observed in female PCA rings. CONCLUSION: Short-time incubation with 17Pbeta-estradiol has an inhibitory effect on the contraction to ET-1 in PCA rings. This effect is independent of the presence of the endothelium and the sex of the pigs. A longer incubation with 17beta-estradiol results in a similar inhibitory effect on male(but not female) PCA rings, suggesting that a sex-related difference may exist concerning the effect of 17beta-estradiol on ET-1-induced contraction.
Cardiovascular Diseases ; Coronary Vessels* ; Endothelin-1* ; Endothelins ; Endothelium ; Endothelium, Vascular ; Estrogens ; Female ; Humans ; Incubators ; Male ; Passive Cutaneous Anaphylaxis ; Swine ; Vasoconstriction