Epilepsy surgery has been demonstrated to be an effective alternative treatment for intractable partial or localization related epilepsy. Primary intracranial neoplasms and other structural lesions of the brain are important etiological factors in patients with partial seizure disorders. A neuroimaging identified lesion in patients with seizures, not necessarily medically refractory, may also be an indication for surgery in selected patients. Twelve patients operated on under local or general anesthesia for resection surgery underwent intraoperative recording(electrocorticogram) and/or functional mapping by electrical stimulation or somatosensory evoked potentials-(SSEPs) for identification of the secondary epileptogenic area and/or functional area; 2 meningiomas, 5 astrocytomas, 1 gangliocytoma, 1 abscess, 1 small AVM, 1 cysticercosis and one gliosis by previous intracerebral hemorrhage with middle cerebral artery(MCA) aneurysm. Among these, additional corticectomy or anterior temporal lobectomy was performed in eleven patients. All the patients did well after surgery with good outcomes as seizure free in nine(75%) out of 12 patients with 11.9 months of follow-up period, without any neurological deficits. Intraoperative recording and functional mapping of adjacent areas of the structural lesions of the brain are useful in surgery and can guide the extent of further resection.
Adolescent ; Adult ; *Brain Mapping ; Brain Neoplasms/physiopathology/*surgery ; Electroencephalography ; Evoked Potentials, Somatosensory ; Female ; Human ; Intraoperative Period ; Male ; Middle Age ; Seizures/physiopathology/*surgery ; Support, Non-U.S. Gov't

Purpose: This study aimed to analyze the association between fibrotic focus (FF) and tumor-infiltrating lymphocytes (TILs) and to determine the prognostic significance of FF and TILs in the breast according to its molecular subtypes. Methods: The study included patients who underwent surgical treatment for breast cancer, for whom tissue samples were available. FF within the tumor and TILs in breast cancer tissues were evaluated. Clinicopathological characteristics were reviewed from medical records. Results: FF and TILs were present in 31.3% and 81.7% of the patients, respectively. FF and TILs showed a positive correlation. FF were significantly associated with tumor size, lymphovascular invasion, regional lymph node metastasis, and tumor stage. TILs were significantly associated with menopausal status, histologic grade, tubule formation, nuclear grade, mitosis, human epidermal growth factor receptor 2 (HER2) overexpression, molecular subtype of breast cancer, and the number of cluster of differentiation 8+ T cells. In TIL-positive cases, FF were significantly associated with tumor size, regional lymph node metastasis, extranodal extension, lymphovascular invasion, tumor stage, recurrence-free survival, and overall survival (OS). Based on HER2 overexpression status, TILs were significantly associated with tumor size, tumor necrosis, histologic grade, estrogen receptor status, and epidermal growth factor receptor expression in HER2-negative breast cancer. Further, in HER2-negative breast cancer, OS and recurrence-free survival were significantly associated with FF. The OS of FF-positive patients was significantly shorter than that of FF-negative patients. Conclusion Our study showed an association between FF and TIL levels in breast cancer, indicating that FF are associated with poor prognostic factors for breast cancer and poor OS, and that TILs are associated with HER2 overexpression. However, further studies are needed to elucidate the interactions between FF and TILs in breast cancer.

OBJECTIVE: To identify the factors which can delay home discharges or transfers to other hospitals of rehabilitation inpatients in a tertiary hospital and the change of discharge destination during past 6 years. METHOD: This was a retrospective study of patients with a diagnosis of stroke, traumatic brain injury or spinal cord injury who were admitted to our hospital in 1996, 1999, 2001 and 2003. Demographic data, length of stay, discharge destination and functional status by the FIM(TM) instrument were studied by a medical record review. RESULT: Patients who were transferred to other hospitals or discharged with delay showed significantly lower admission and discharge FIM scores, lower FIM efficiencies, longer length of stays and longer intervals between the onset and admission to a rehabilitation ward. CONCLUSION: Lower functional outcome was associated with a longer length of stay and discharge to another hospital. It would be necessary to establish the long term rehabilitation care facilities with extended rehabilitation program for the patients with lower functional gains in a rehabilitation unit of the tertiary hospitals.
Brain Injuries ; Diagnosis ; Humans ; Inpatients* ; Length of Stay ; Medical Records ; Rehabilitation* ; Retrospective Studies ; Spinal Cord Injuries ; Stroke ; Tertiary Care Centers*

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (S-SNHL) has been reported to be associated with hypertension, diabetes mellitus, hyperlipidemia, and stroke in previous studies. The purpose of this study was to confrm whether metabolic syndrome (MS) infuences the hearing outcome of S-SNHL in the Korean population. SUBJECTS AND METHOD: We prospectively investigated the clinical variables of 231 cases of S-SNHL from 2010 March to 2014 February. MS was defned according to the National Cholesterol Education Program Adult Treatment Panel III with Asian modifcations. We analyzed and compared the basic and clinical characteristics, the thresholds of pure tone audiometry (PTA), and the hearing outcomes of patients with MS (MS group) and without MS (NMS group). RESULTS: There were no signifcant differences in the basic characteristics and initial hearing thresholds between the MS and NMS groups; on the other hand, there were signifcant differences in all of the clinical values of MS between the two groups. The average thresholds of final PTA for the MS and NMS groups were 52.9±30.9 dB and 40.5±27.2 dB, respectively, with meaningful diversity (p < 0.01). According to Siegel's criteria, the recovery rate of the NMS group (95/159, 59.7%) was signifcantly higher than those of the MS group (29/72, 40.3%). The proportion of recovery within 5 days after starting the treatment was signifcantly higher of the NMS group (37/95, 39.0%) than those of the MS group (4/29, 13.8%) (p < 0.01). CONCLUSION: The hearing outcome of the NMS group was signifcantly better than those of the MS group.
Adult ; Asian Continental Ancestry Group ; Audiometry ; Cholesterol ; Diabetes Mellitus ; Dyslipidemias ; Education ; Hand ; Hearing Loss, Sensorineural* ; Hearing* ; Humans ; Hyperlipidemias ; Hypertension ; Methods ; Prospective Studies ; Stroke

It is known that antithrombin III is a potent vasodilator and plasmin is a vasoconstrictor, and some patients with a subarachnoid hemorrhage(SAH) develop clinical vasospasm and some patients do not. Under the hypothesis that the development of clinical vasospasm might depend on the difference of the blood level of antithrombin III in each patient with SAH and that the plasmin might have a role in the development of clinical vasospasm, we repeatedly checked the levels of blood antithombin III with a single radial immunodiffusion method and CSF fibrinogen degradation products(FDP : indirect indicator of plasmin activity) with a latex-test(Thrombo-Wellcotest(R)) during the period between 1-4, 5-11 and 12-24 days after a SAH in 29 patients. 10 patients with diseases except those with a SAH were selected as a control group. First, we analyzed the difference of the average of blood antithrombin III and CSF FDP between aneurysmal SAH patients and control patients and then, between patients with clinical vasospasm(8 cases) and patients without clinical vasospasm(21 cases). Secondly, we also analyzed the difference of these data between patients with clinical vasospasm and patients without clinical vasospasm according to the sampling day after a SAH. As a result, there was no statistical difference between the average blood level of antithrombin III in control and in SAH patients(29.06+/-3.04 vs. 25.61+/-6.95, respectively), and in patients with clinical vasospasm and in patients without clinical vasospasm(26.59+/-7.65 vs. 23.67+/-7.40, respectively). The average CSF levels of FDP is higher in SAH patients than in control patients(18.16+/-14.36 vs. 1.00+/-3.16, respectively : p<0.01). It is also higher in patients with clinical vasospasm than in patients without clinical vasospasm. However, there is no statistical significance(28.75+/-9.91 vs. 21.75+/-12.07, respectively : p>0.05). In the analysis of the average CSF levels of the FDP according to the sampling day after a SAH, even though the average levels is higher in patients with clinical vasospasm than in patients without clinical vasospasm(1-4 days : 31.43+/-14.64 vs. 27.33+/-16.24, 5-11 days : 23.75+/-17.68 vs. 18.10+/-16.32, 12-24 days : 32.50+/-13.89 vs. 18.82+/-16.54, respectively), a statistical significant difference was noticed only in levels which were checked between 12 and 24 days after a SAH(p<0.05). This study concludes that the blood level of antithrombin III shows no difference between the control and SAH patients, and patients with clinical vasospasm and patients without clinical vasospasm. Although it suggests a causal relationship between the FDP itself or plasmin in CSF and the development of clinical vasospasm, it does not justify any valid conclusion.
Aneurysm* ; Antithrombin III* ; Cerebrospinal Fluid* ; Fibrinogen ; Fibrinolysin ; Humans ; Immunodiffusion ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial

OBJECTIVES: The authors report experience with patients harboring nonaneurysmal intraventricular hemorrhage treated urokinase thrombolysis and evaluated safety and feasibility of this procedure. METHODS: Fifty-three patients with nonaneurysmal IVH >25 ml without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale (GCS)<5 were excluded. A catheter was directed stereotactically into the IVH under CT guidance. Hematoma aspiration was followed by instillation of urokinase. This was repeated every 6 hours until less than half of its initial volume. For analysis of prognostic factors, we classified two groups ; good (Glasgow Outcome Scale (GOS) > or =3) and bad (GOS<3) prognosis group, and performed comparative analysis between two groups. RESULTS: Mean age was 60.2 years .The baseline hematoma size ranged 16 to 72 ML. IVH volume reduction was done by an average of 74.2%. At 6 months after the procedure, 29 patients had achieved a good recovery, 15 remained vegetative. 9 patients died in hospital. The main good prognostic factors were young age, small IVH volume, high GCS, underlying disease and associated complications. CONCLUSION: The results of this study suggest that this relatively easy and safe method of treatment will improve the prognosis. However, further clinical studies also must assess optimal thrombolytic dosage, frequency, and timing of urokinase instillation for safety and effectiveness and must include controlled comparisons of mortality, disability outcome, quality of life, time until convalescence, and cost of care in treated and untreated patients.
Catheters ; Convalescence ; Glasgow Coma Scale ; Hematoma ; Hemorrhage* ; Humans ; Mortality ; Prognosis ; Quality of Life ; Urokinase-Type Plasminogen Activator*

Sternocostoclavicular hyperostosis is an uncommon disease, characterized by an inflammatory arthrosteitis of the sternocostoclavicular region. Clinically, it manifests as a painful swelling of the upper anterior chest wall, which is associated with occasional pustulosis palmaris and plantaris. A 48-year-old man had suffered from pain in both shoulders and the upper anterior part of the chest for 6 months. On examination, a venous engorgement in the neck with dilated collateral veins in the upper chest and shoulders was observed. Swelling was noticed in his face, neck and both arms. Radiologically, the clavicles, the sternum and the first ribs were enlarged with complete fusion between them. 99Tc scintigraphy showed increased uptake in the clavicles and the sternum. Selective venography resulted in a bilateral subclavian and brachiocephalic vein occulation, which resulted from a subclavian vein thrombosis. All the above suggested a sternocostoclavicular hyperostosis. He underwent a vascular graft interposition between the right jugular vein and the left innomianate vein (using 8mm ringed Gore-Tex graft) and a resection of the bilateral medial half of clavicle and 1st rib. Here, we present a case on sternoclavicular hyperostosis with subclavian and brachiocephalic vein thrombosis, and report this case study with a review of the appropriate literature.
Arm ; Brachiocephalic Veins ; Clavicle ; Humans ; Hyperemia ; Hyperostosis ; Hyperostosis, Sternocostoclavicular* ; Jugular Veins ; Middle Aged ; Neck ; Phlebography ; Polytetrafluoroethylene ; Radionuclide Imaging ; Ribs ; Shoulder ; Sternum ; Subclavian Vein ; Thoracic Wall ; Thorax ; Thrombosis ; Transplants ; Veins ; Venous Thrombosis*

No abstract available.
Female ; Humans ; Infarction* ; Meningitis*

Polyurethane (PU) has been widely examined and used for biomedical applications, such as catheters, blood oxygenators, stents, cardiac valves, drug delivery carriers, dialysis devices, wound dressings, adhesives, pacemaker, tissue engineering, and coatings for breast implants due to its mechanical flexibility, high tear strength, biocompatibility, and tailorable foams although bio-acceptability, biodegradability and controlled drug delivery to achieve the desired properties should be considered. Especially, during the last decade, the development of bio-based PUs has raised public awareness because of the concern with global plastic waste for creating more environmentally friended materials. Therefore, it is desirable to discuss polysaccharide (PS)-contained PU for the wound dressing and bone tissue engineering among biobased PUs because PS has several advantages, such as biocompatibility, reproducibility from the natural resources, degradability, ease of incorporation of bioactive agents, ease of availability and cost-effectiveness, and structural feature of chemical modification to meet the desired needs to overcome the disadvantages of PU itself by containing the PS into the PU.