OBJECTIVE: The use of decompressive craniectomy for treating massive cerebral infarction is attracting much attention because conventional medical treatment is associated with high mortality. The aim of this retrospective study was to evaluate the surgical treatment results and prognostic factors for patients suffering with malignant cerebral infarction. METHODS: We analyzed 9 consecutive patients who underwent decompressive craniectomy with or without temporal lobectomy after malignant cerebral infarction from 2000 to 2008. We reviewed the medical records, the radiological finding and the pre-operative clinical assessment using the Glasgow Coma scale (GCS). The postoperative functional outcome was assessed as the Barthel-Index (BI) and the modified Rankin scale (mRS). RESULTS: The male to female ratio was 3.5:1. The mean age was 50 years (range: 36-68). Eight patients (89%) showed involvement of the entire middle cerebral artery (MCA) territory and the concomitant anterior cerebral artery (ACA) or posterior cerebral artery (PCA) territory. The preoperative mean GCS was 8.3 (range: 5-12) and the mean time to surgery after the onset of symptoms was 47.7 hours (range: 4-168 hours). All the patients underwent decompressive craniectomy and duroplasty. Among them, four patients (45%) underwent temporal lobectomy. The mean followup period was 7.3 months (range: 1-26 months) and five patients died within this period. CONCLUSION: Decompressive craniectomy with or without lobectomy for patients with malignant cerebral infarction decreases the mortality rate and it improves the functional outcome. In the survived group, comparison of the two surgical modalities didn't show any statistically significant difference. However, the decompressive craniectomy with lobectomy group demonstrated a high survival rate (75%). Future studies are needed to investigate the proper treatment modalities for malignant cerebral infarction.
Anterior Cerebral Artery ; Cerebral Infarction ; Decompressive Craniectomy ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Male ; Medical Records ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Retrospective Studies ; Stress, Psychological ; Survival Rate

PURPOSE: To evaluate the radiologic and clinical results of treatment of the Shatzker type 6 tibia plateau fracture using the lateral and posteromedial dual incision approach and dual plating. MATERIALS AND METHODS: Twelve cases in eleven patients of Shatzker type 6 tibia plateau fracture which has been treated using the lateral and posteromedial dual incision approach and dual plating were analyzed with an average follow-up of 16 months. Times to union, alignment and reduction loss on radiograph and postoperative clinical outcome with checking the range of motion of the knee joint, Knee Society Score and UCLA activity scale were analyzed and evaluated. RESULTS: In all cases, bony union was obtained in an average fifteen weeks after the operation, and there was no reduction loss. The arc of motion of the knee joint at the latest follow-up was 132 degrees on average. Average of Knee Society Score was 85 and UCLA activity scale was decreased from 9.6 points preoperatively to 5.7 points postoperatively. CONCLUSION: The treatment of Shatzker type 6 tibia plateau fracture using the lateral and posteromedial dual approach and dual plating have shown clinically preferable results of excellent recovery of joint motion and good knee society score by early range of motion exercise after firm fixation. However, it was high energy injury, so the sports activity of patients was significantly decreased.
Follow-Up Studies ; Humans ; Joints ; Knee ; Knee Joint ; Range of Motion, Articular ; Sports ; Tibia

In the previous studies, we found that lumbrokinase an, extract from Korean earthworm, had a strong in vitro thrombolytic effect, and that when added to thrombin had a significant effect in reducing fatality rate in thrombin-induced lung infarction mice model. To determine whether it also has in vivo thrombolytic effect in cerebral embolism model using 9 Spraw Dawly male rats of 200 to 300gm, we cannulated the extemal carotid artery lene tubes and occluded the pterygopalatine arteries. Via the extemal carotid artery, we injected 1 mm3 of human blood clots which were previously mixed with Tc-99m sulfur colloid. After confirming the intracranially situated clot by camera, we injected 3cc of following fiuids to each group of three rats: saline, urokinase, lumbrokinase fraction m Then using Gamma camera of 64*64 m obtained for 1 minute in every 30 minutes. After 150 minutes radioactivities of the clots in the brain were 3.02%, 21 02% urokinase, and lumbrokinase treated animals respectively. In the liver, the uptake of radioactivities was accordingly increased. Brain sections showed no Significant intracranial bleeding in any of the treated animals. Therefore, we conclude that lumbrokinase has in vivo thromboembolism model without producing significant intracranial bleeding. However, compared with its in vitro effects the in vivo effects appear to be less potent. Futher experiments with better designed animal models are warranted.
Animals ; Arteries ; Brain ; Carotid Arteries ; Gamma Cameras ; Hemorrhage ; Humans ; Infarction ; Intracranial Embolism ; Liver ; Lung ; Male ; Mice ; Models, Animal ; Oligochaeta ; Radioactivity ; Rats* ; Technetium Tc 99m Sulfur Colloid ; Thrombin ; Thromboembolism* ; Urokinase-Type Plasminogen Activator

Sudden sensorineural hearing loss due to the initial manifestation of hematologic disease is very rare. Chronic myelogenous leukemia has been implicated as a causative factor of sudden sensorineural hearing loss. Leukemic infiltration, hemorrhage, infection, and hyperviscosity have been suggested as possible mechanisms in patients with chronic myelogenous leukemia. A 49-year-old male presented unilateral sudden sensorineural hearing loss. The patient was found to have chronic myelogenous leukemia during the work-up for the hearing loss. The WBC count upon admission was 485,100/mm(3). Hemoglobin, hematocrit, and platelet count were within the normal limits. The patient underwent three cycles of leukapheresis and chemotherapy with interferon alpha and hydroxyurea for the treatment of leukemia. The hearing threshold level was 75 dB on admission. It improved to 35 dB when the WBC count fell to 294,000/mm(3), and finally settled at 32 dB two weeks after the termination of chemotherapy when the WBC count was 125,900/mm(3). We present a case of a chronic myelogenous leukemia patient who initially presented with sudden sensorineural hearing loss. We presume that cochlear vessel occlusion as a result of elevated blood viscosity was responsible for this patient's hearing loss. Early onset of sudden deafness in a chronic myelogenous leukemia patient may be due to the hyperviscosity syndrome and be possible to reverse hearing loss through early leukapheresis.
Blood Viscosity ; Drug Therapy ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Hematocrit ; Hematologic Diseases ; Hemorrhage ; Humans ; Hydroxyurea ; Interferon-alpha ; Leukapheresis ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukemic Infiltration ; Male ; Middle Aged ; Platelet Count

Background/Aims: CD40 agonists are thought to generate antitumor effects on pancreatic cancer via macrophages and T cells. We aimed to investigate the role of CD40 agonists in the differentiation of macrophages and treatment of human pancreatic adenocarcinoma. Methods: Immunohistochemistry was performed on paraffin-embedded surgical blocks from patients with pancreatic cancers to evaluate macrophage phenotypes and their relationship with survival. The effects of CD40 agonists on macrophage phenotypes and human pancreatic cancer were evaluated utilizing cell cocultures and organotypic slice cultures. Results: CD163 + (predominant in M2 macrophages) and FOXP3 + (predominant in regulatory T cells) expression levels in the tumors were significantly lower in patients with stage IB pancreatic cancer than in those with stage II or III disease (p=0.002 and p=0.003, respectively). Patients with high CD163 + expression had shorter overall survival than those with low CD163 + expression (p=0.002). In vitro treatment of THP-1 macrophages with a CD40 agonist led to an increase in HLA-DR + (predominant in M1 macrophages) and a decrease in CD163 + expression in THP-1 cells. Cell cocultures showed that CD40 agonists facilitate the suppression of PANC-1 human pancreatic cancer cells by THP-1 macrophages. Organotypic slice cultures showed that CD40 agonists alter the pancreatic cancer microenvironment by shifting the macrophage phenotype toward M1 (increase HLA-DR + and decrease CD163 + expression), decreasing the abundance of regulatory T cells, and increasing tumor cell apoptosis. Conclusions CD163 is related to advanced human pancreatic cancer stages and shorter overall survival. CD40 agonists alter macrophage phenotype polarization to favor the M1 phenotype and suppress human pancreatic cancer.

Background: Although electrocardiography and cardiac troponin play important roles in the diagnosis of acute coronary syndrome (ACS), there remain unmet clinical needs. Heart-type fatty acid-binding protein (H-FABP) has been identified as an early diagnostic marker of acute myocardial infarction (AMI). In this study, we examined the diagnostic and prognostic value of H-FABP in patients suspected with ACS. Methods: We conducted an observational single-center cohort study, including 89 adults aged 30 years or older, who presented to the emergency room (ER) within 24 hours after the onset of chest pain and/or dyspnea. We performed laboratory analysis and point-of-care testing (POCT) for cardiac markers, including H-FABP, troponin I, and creatine kinasemyocardial band. We also evaluated the correlation between cardiac markers and left ventricular (LV) dysfunction and extent of coronary artery disease (CAD). Results: In patients presented to ER within 4 hours after symptom onset (n = 49), the diagnostic accuracy of H-FABP for AMI, as quantified by the area under the receiver operating characteristic curve, was higher (0.738; 95% confidence interval [CI], 0.591–0.885) than other cardiac markers. In POCT, the diagnostic accuracy of H-FABP (56%; 95% CI, 45–67) was significantly higher than other cardiac markers. H-FABP was correlated with not extent of CAD but post-AMI LV dysfunction. Conclusion H-FABP is a useful cardiac marker for the early diagnosis of AMI and prediction of myocardia injury. Difference in the circulatory release timeline of cardiac markers could explain its utility in early-stage of myocardial injury.

Background: Although electrocardiography and cardiac troponin play important roles in the diagnosis of acute coronary syndrome (ACS), there remain unmet clinical needs. Heart-type fatty acid-binding protein (H-FABP) has been identified as an early diagnostic marker of acute myocardial infarction (AMI). In this study, we examined the diagnostic and prognostic value of H-FABP in patients suspected with ACS. Methods: We conducted an observational single-center cohort study, including 89 adults aged 30 years or older, who presented to the emergency room (ER) within 24 hours after the onset of chest pain and/or dyspnea. We performed laboratory analysis and point-of-care testing (POCT) for cardiac markers, including H-FABP, troponin I, and creatine kinasemyocardial band. We also evaluated the correlation between cardiac markers and left ventricular (LV) dysfunction and extent of coronary artery disease (CAD). Results: In patients presented to ER within 4 hours after symptom onset (n = 49), the diagnostic accuracy of H-FABP for AMI, as quantified by the area under the receiver operating characteristic curve, was higher (0.738; 95% confidence interval [CI], 0.591–0.885) than other cardiac markers. In POCT, the diagnostic accuracy of H-FABP (56%; 95% CI, 45–67) was significantly higher than other cardiac markers. H-FABP was correlated with not extent of CAD but post-AMI LV dysfunction. Conclusion H-FABP is a useful cardiac marker for the early diagnosis of AMI and prediction of myocardia injury. Difference in the circulatory release timeline of cardiac markers could explain its utility in early-stage of myocardial injury.

PURPOSE: The purpose of this study is to clarify the degree of corneal neovascularization and its expression of MMP-2. 9(matrix metalloproteinase) and TIMP-1, 2(tissue inhibitor of metalloproteinases) according to the different concentrations of VEGF(vascular endothelial growth factor). METHODS: After the pellets with different amounts of VEGF(VEGF 125, 250 ng) were inserted into the corneal stroma of rat model, their degree of corneal neovascularization and the expression of MMP-2, 9 and TIMP-1, 2 were compared with those of control group where pellets were filled with phosphate-buffered saline. RESULTS: At the 7th day after the pellet insertion, degree of neovascularization was most highly scored in the group with pellet which contained the largest amount of VEGF, 250 ng, and there was statistically noticeable increase of eovascularization with the increase of VEGF amount(P<0.05). On immunohistochemical staining, as the amount of VEGF increases, not only MMP-2, 9 and flk-1, but also TIMP-1, 2 were expressed more. CONCLUSIONS: In conclusion, when it comes to neovascularization, MMP-2, 9, which induces angiogenesis, as well as its inhibitor TIMP-1, 2 are increased to maintain the homeostasis of the cornea.
Cornea ; Corneal Neovascularization* ; Corneal Stroma ; Homeostasis ; Models, Animal ; Tissue Inhibitor of Metalloproteinase-1* ; Vascular Endothelial Growth Factor A

BACKGROUND AND OBJECTIVES: The Korean phonetically balanced (PB) word list (Ham's Korean PB Word List) is currently the most commonly used word list for speech discrimination test. The aim of this study was to investigate the frequency characteristics of the Ham's Korean PB word list and to compare frequency characteristics of the Ham's Korean PB word list with that of the 21st Century Sejong words, which represent characteristics of the contemporary spoken Korean language. SUBJECTS AND METHOD: The 300 syllables most commonly used were collected from the words in 21st Century Sejong project. The 21st Century Sejong words were weighted according to the frequency of usage. The 21st Century Sejong words and words from the Ham's Korean PB word list were analyzed using an acoustic analysis program that has the MATLAB function. RESULTS: Syllables with frequencies above 2,000 Hz comprise 34% of the 21st Century Sejong words and 16% of the Ham's Korean PB word list. The Ham's Korean PB word list does not represent the high frequency characteristics of the contemporary spoken Korean language. The 21st Century Sejong words have more 'eu', 'i' and open syllables than the Ham's Korean PB word list. CONCLUSION: The Ham's Korean PB word list does not reflect the high frequency characteristics of the contemporary spoken Korean language included in the 21st Century Sejong words. Therefore, a new PB word list that incorporates a greater number of syllables with high frequency characteristics is required.
Acoustics* ; Audiometry, Speech ; Speech Acoustics ; Speech Discrimination Tests

Background: Detection of arrhythmias is crucial for the treatment of cardiovascular diseases.However, conventional devices do not provide sufficient diagnostic accuracy while patients should suffer from bothersome diagnostic process. We sought to evaluate diagnostic capability and safety of the new adhesive electrocardiogram (ECG) monitoring device in patients who need ECG monitoring during admission. Methods: We enrolled 10 patients who admitted to Seoul National University Bundang Hospital and required continuous ECG monitoring between October 31, 2019 and December 18, 2019. New adhesive ECG monitoring device and conventional ECG monitoring device were simultaneously applied to the patients and maintained for 48 hours. From each patient, 48 pairs of ECG signal were collected and analyzed by two cardiologists independently.Discrepancy of diagnosis and frequency of noise or signal loss were compared between the two devices. Results: From analyzable ECG data, discrepancy of arrhythmia diagnosis was not observed between the two devices. Noise rate was higher in conventional ECG monitoring device (2.5% vs. 17.3%, P < 0.001) and signal loss was not observed in new adhesive device while there was 9.4% of signal losses in conventional Holter recorder group. The new device was well-tolerated among 48 hours of monitoring period and no adverse event was observed. Conclusion A newer adhesive ECG monitoring device demonstrated similar diagnostic accuracy compared to conventional ECG monitoring device.