A 50-year-old woman who had chronic headache was admitted to the hospital. Stent-assisted coil embolization of the aneurysm in the right vertebral artery was performed. After the procedure, the patient experienced a transient memory impairment. A microembolic lesion in the right medial temporal lobe and cerebral hemisphere was observed on diffusion-weighted imaging. We report a case of transient global amnesia caused by microembolus in the medial temporal lobe after embolization of an aneurysm.
Amnesia, Transient Global* ; Aneurysm ; Cerebrum ; Embolization, Therapeutic* ; Female ; Headache Disorders ; Humans ; Intracranial Aneurysm* ; Memory ; Middle Aged ; Temporal Lobe ; Vertebral Artery

The authors has investigated the effect of intracisternal urokinase on the multihemorrhage canine model of chronic post-subarachnoid hemorrhage(SAH) hydrocephalus. Each of 16 adult mongrel dogs was assigned to one of two experimental groups. All animals received a total of 13ml of fresh unheparinized autologous blood via three cisternal injections. Eight animals were treated by intracisternal injection of 20,000 IU of Urokinase every 12 hours for 3 days, and the remaining were not treated. The changes in ventricular volumes were measured by computed tomography(CT) before and 3 months after the initial subarachnoid blood injection. To compare the changes of hydrodynamic properties in chronic phases of post-SAH hydrocephalus, the pressure-volume index(PVI) technique of bolus manipulation of cerebrospinal fluid(CSF) was used to measure the volume-buffering capacity of neural axis and the resistance to the absorption of CSF(before SAH, post-SAH 1 month, 3 months). The final ventricular volume at 3 months of control group was 4 times greater than the initial volume, but Urokinase group less than two times. The mean measured PVI values of control group and Urokinase group were 3.98+/-0.76ml(+/- standard deviation(SD)) and 4.01+/-0.82ml in baseline study, 3.09+/-0.96ml and 3.70+/-0.84ml in post-SAH 3 months. The mean resistance of CSF outflow of control group and Urokinase group were 10.30+/-2.24mm Hg/ml/min), and 10.34+/-1.98mm Hg/ml/min in baseline study. At 1 month and 3 months after SAH control group maintained high absorptive resistance(29.54+/-11.50mm Hg/ml/min, 22.43+/-3.82mm Hg/ml/min), whereas the resistances of Urokinase group were slightly increased and then returned to the original levels(16.04+/-4.87mm Hg/ml/min, 12.87+/-3.06mm Hg/ml/min). The results described in this experimental study indicated that if fibrinolysis of the subarachnoid blood clot can be achieved rapidly after SAH, the complicating chronic hydrocephalus might be prevented.
Absorption ; Adult ; Animals ; Axis, Cervical Vertebra ; Dogs ; Fibrinolysis ; Humans ; Hydrocephalus* ; Hydrodynamics ; Subarachnoid Hemorrhage* ; Urokinase-Type Plasminogen Activator*

The peroxisome proliferator activated receptor (PPAR)gamma agonist is used as antidiabetic agent with antihyperglycemic and antihyperinsulinemic actions. Beyond these actions, antifibrotic effects have been reported. We examined antifibrotic effects of PPARgamma agonist and interaction with angiotensin receptor antagonist in the unilateral ureteral obstruction (UUO) model. After UUO, mice were divided to four groups: no treatment (CONT), pioglitazone treatment, L158809 treatment, and L158809+ pioglitazone treatment. On day 14, CONT mice showed severe fibrosis and all treated mice showed decreased fibrosis. The immunohistochmistry of PAI-1, F4/80 and p-Smad2 demonstrated that their expressions were increased in CONT group and decreased in the all treated groups compared to CONT. PAI-1 and p-Smad2 determined from Western blotting, among treated groups, was decreased compared to CONT group. The expression of TGF-beta1 from real time RT PCR showed markedly increased in the CONT group and decreased in all treated groups compared to CONT. These data suggest the pioglitazone inhibited tubulointerstitial fibrosis, however, the synergism between pioglitazone and L158809 is not clear. Considering decreased expression of PAI-1 and TGF-beta/Smad2 in the treated groups, PAI-1 and TGF-beta are likely linked to the decreased renal tubulointerstitial fibrosis. According to these results, the PPARgamma agonist might be used in the treatment of renal fibrotic disease.
*Angiotensin Receptor Antagonists ; Animals ; Antigens, Differentiation/metabolism ; Disease Models, Animal ; Fibrosis ; Hypoglycemic Agents/pharmacology ; Kidney/metabolism/*pathology ; Male ; Mice ; Mice, Inbred C57BL ; PPAR gamma/*agonists ; Plasminogen Activator Inhibitor 1/metabolism ; Smad2 Protein/metabolism ; Thiazolidinediones/pharmacology ; Transforming Growth Factor beta1/genetics/metabolism ; Ureteral Obstruction/metabolism/pathology

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is one of the potentially life-threatening complications for patients with liver cirrhosis, and it has a mortality rate of over 20%. Early diagnosis of SBP and immediate use of an adequate antibiotic therapy are very important for achieving a better prognosis. The aim of our study was to assess the usefulness of reagent strips for making the rapid diagnosis of SBP. METHODS: A diagnostic paracentesis procedure was performed upon hospital admission in 257 cirrhotic patients (187 males, 70 females; mean age: 54 years) with ascites. Each fresh sample of ascitic fluid was tested using a reagent strip, and the result was scored as 0, 1+, 2+ or 3+. The leukocyte count, polymorphonuclear cell count, blood bottle culture, and chemistry of ascites were also done. RESULTS: We diagnosed 79 cases of SBP and 2 cases of secondary bacterial peritonitis by means of the polymorphonuclear cell count and the classical criteria. When a reagent strip result of 3+ was considered positive, the test's sensitivity was 86% (70 of 81), the specificity was 100% (176 of 176), and the positive predictive value was 94%. Furthermore, when a reagent strip result of 2+ or more was considered positive, the test sensitivity was 100% (81 of 81), the specificity was 99% (174 of 176), and negative predictive value was 99%. CONCLUSIONS: The use of reagent strips is a very sensitive and specific tool for the rapid diagnosis of SBP in cirrhotic patients. A positive result should be an indication for empirical antibiotic therapy, and a negative result may be useful as a screening test to exclude SBP.
Aged ; Ascitic Fluid/chemistry/cytology ; Bacterial Infections/*diagnosis/microbiology ; English Abstract ; Female ; Humans ; Liver Cirrhosis/complications ; Male ; Middle Aged ; Peritonitis/*diagnosis/etiology/microbiology ; Predictive Value of Tests ; *Reagent Strips ; Sensitivity and Specificity

BACKGROUND AND AIMS: Zinc is an essential, mostly intracellular, trace element which participates in many oxidative or deoxidative reactions and in a protective action on liver cell activity. Plasma zinc levels are known to decrease in patients with liver disease including chronic viral hepatitis. The aim of this study was to reveal whether hepatic zinc concentrations have a correlation with grades of necroinflammation or stages of fibrosis in the patients with chronic viral hepatitis. METHODS: This study consisted of 50 subjects (43 chronic hepatitis B, 4 chronic hapatitis C, and 3 cirrhosis). Each specimen of liver tissue was classified with the grade of lobular inflammation, portal/periportal inflammation, and stage of fibrosis according to Scheuer's method. Hepatic zinc concentration was determined by ICP-Atomic Emission Spectrometry. RESULTS: The mean hepatic zinc concentration in the 50 chronic viral hepatitis patients was 233.66 g/g dry weight of liver tissue. The hepatic zinc levels were significantly correlated with the grades of portal/periportal inflammation (rs=-0.385, p=0.006), and grades of lobular inflammation(rs=-0.342, p=0.015). The stages of fibrosis were also negatively related (rs=-0.423, p=0.002). The zinc concentrations differed significantly among grades of lobular inflammation (p=0.013) and among stages of fibrosis (p=0.044). CONCLUSIONS: Hepatic zinc concentrations showed negative correlation with grades of portal/periportal inflammation, lobular inflammation, and stage of fibrosis in the patients of chronic viral hepatitis. These results suggest that decreased hepatic zinc concentration might be associated with severe hepatic injury and reflect decreased protective activity on liver cell injury.
Fibrosis ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Inflammation ; Liver ; Liver Diseases ; Plasma ; Spectrum Analysis ; Zinc*

BACKGROUND: Autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC), and autoimmune cholangiopathy (AIC) are major classes of liver diseases currently considered autoimmune. We investigated the clinical, biochemical, and immunologic findings in Korean patients with these disease entities. METHODS: We retrospectively analyzed 47 patients with AIH, 27 with PBC, 3 with Overlap syndrome, 15 with AIC, and 5 with PSC. RESULTS: About 90% of the patients were women, while 40% in PSC. The mean age of onset ranged from 47 to 57 years, while it was 28 years in PSC. Fatigue and jaundice were the most frequent manifestations at diagnosis. In AIH, 13% of patients had an acute onset and 1 died of fulminant hepatic failure. The serum level of IgG was elevated in 67.5%, and antinuclear antibody and anti-smooth muscle antibody were detected in 95.7% and 43.2%. Fifty eight per cent of the patients who received immunosuppressive therapy showed a complete response. In patients with PBC, the level of IgM was elevated in 75% and all of the patients were positive for anti-mitochondrial antibody. Biochemical remission was observed in 37% on ursodeoxycholic acid therapy. Except for the negative anti-mitochondrial antibody, the clinical and biochemical features in AIC were not different from those in PBC. CONCLUSION: Autoimmune liver diseases are not rare in Korea. Considering that these entities are potentially treatable diseases, a high index of suspicion is needed, especially in patients negative for the serologic markers of viral hepatitis.
Age of Onset ; Antibodies, Antinuclear ; Cholangitis ; Cholangitis, Sclerosing ; Diagnosis ; Fatigue ; Female ; Hepatitis ; Hepatitis, Autoimmune ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Jaundice ; Korea* ; Liver Cirrhosis ; Liver Cirrhosis, Biliary ; Liver Diseases* ; Liver Failure, Acute ; Liver* ; Retrospective Studies ; Ursodeoxycholic Acid

BACKGROUND: In Korea, the most common cause of acute viral hepatitis used to be the hepatitis B virus, but now the etiology of acute viral hepatitis seems to be changing. We investigated the etiology of newly developed acute viral hepatitis for the last 3 years. METHODS: We retrospectively reviewed the medical records of patients, who visited Asan Medical Center for jaundice during recent 3 years. Among them, one hundred eighty six patients were diagnosed as acute viral hepatitis by typical clinical feature and positive results in any one of the following tests: IgM anti-HAV, IgM anti-HBc, HCV PCR, and IgM anti-HEV. RESULTS: The proportion of acute viral hepatitis A, B, C, and E were 49.5% (n=92), 45.2% (n=84), 3.8% (n=7), and 1.6% (n=3), respectively. The patients' age of acute hepatitis A (29.1 +/- 1.75 years) was significantly younger than that of acute hepatitis B (38.2 +/- 3.07 years) (p<0.001). There were 10 cases of fulminant hepatic failure, all of which were caused by hepatitis B virus. Of seven patients diagnosed as acute hepatitis C, three patients were treated with interferon-alpha and ribavirin, and all achieved sustained virologic response. Three patients, who were diagnosed as acute hepatitis E, recovered spontaneously. CONCLUSION: Nowadays, the most common causes of acute viral hepatitis in Korea are in the order of the hepatitis A virus and the hepatitis B virus. The most prevalent age of acute hepatitis A is the 20th, while acute hepatitis B is most common in the 30th. Although the acute hepatitis C and E seems to be rare, they do occur sporadically in Korea.
Chungcheongnam-do ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A virus ; Hepatitis B ; Hepatitis B virus ; Hepatitis C ; Hepatitis E ; Hepatitis* ; Humans ; Immunoglobulin M ; Interferon-alpha ; Jaundice ; Korea ; Liver Failure, Acute ; Medical Records ; Polymerase Chain Reaction ; Retrospective Studies ; Ribavirin