Although obstruction of the carotid artery after head trauma or non-penetrating injuries of the neck had been well known, reports of occlusion of middle cerebral artery following closed head trauma are rare. Up to now Jacque, et al, have found only 22 cases of posttraumatic middle cerebral artery occlusion including their own one case in the world literatures since DeVeer and Browder reported the first case in 1942. We report a case of posttraumatic middle cerebral artery occlusion. The patient developed right hemiplegia, aphasia and mental confusion 2 days following closed head trauma. Left cerotid angiograms revealed complete occlusion of the horizontal portion of the left middle cerebral artery distal to the origin of the lenticulostriate branches. Previously reported cases are review and possible pathophysiological mechanisms discussed.
Aphasia ; Carotid Arteries ; Craniocerebral Trauma ; Head Injuries, Closed ; Hemiplegia ; Humans ; Infarction, Middle Cerebral Artery* ; Middle Cerebral Artery* ; Neck

Surgical effects were evaluated in 37 cases of mono-canalicular laceration following canaliculoplasty using Mini-Monoka from April, 1993 through SEptember, 1997 in the Department of Ophthalomology, Yeungnam University, College of Medicine. Lower canalicular laceration was included in 33 cases and upper canalicular laceration was found in 4 cases. Distance from the punctum to the lacerated canaliculus was noted to be 1 to 9mm(mean 4.6mm) and age ranged from 3 to 57 years(mean29.3 years). Thirty-four patients were men and three were women. Punctal portion of Mini-Monoka was fixated at the punctum with 6-0 black silk suture. End to end anastomosis was performed with 9-0 Ethylone(spatula needle) or 6-0 Vicryl(round needle). Steroid and antibiotics eye drops were used for 6 months after surgery. Mini-Monoka was removed 4 months postoperatively. After the follow-up period of 6-49 months(mean 11.3 months), 36 cases became recanalized well but 1 case showed obstruction because the laceration site was distant, 9mm from the punctum. Postoperative complications included loss of tube(3 cases), granuloma of the punctum(3 cases) and corneal abrasion(2 cases). Canaliculoplasty using Mini-Monoka is a procedure of choice for repair of mono-canalicular laceration with prevention of loss of the tube by punctal fixation suture without damage of the intact another canaliculi and the inferior meatus.
Anti-Bacterial Agents ; Female ; Follow-Up Studies ; Granuloma ; Humans ; Lacerations ; Male ; Ophthalmic Solutions ; Postoperative Complications ; Silk ; Sutures

The cerebral vasospasm which often accompanies a subarachnoid hemorrhage from a ruptured intracranial aneurysm is one the chief reasons for morbidity and motarlity. Although the phenomenon still needs clarification, experimental evidence has indicated that alpha-blocking agents can modify this blood-induced spasm. A disappointing experience with these agents led to a clinical trial of the beta-adrenergic drug isoproterenol. In 1975 Sundt reported a good final result with the use of isoproterenol and lidocaine hydrochloride in the treatment of cerebral ischemia attributed to progressive vasospasm after a subarachnoid hemorrhage in human beings. We have reported our experience with the use of isoproterenol and lidocaine hydrochloride in 5 such cases. 3 were treated preoperatively and 2 postoperatively. Experience suggests that the drug regimen reported is useful when institute early after the onset of symptoms and is safe with proper monitoring techniques. The symptomatology of cerebral vasospasm, the reationable for this form of therapy, and the pharmacology of the drugs were discussed.
Brain Ischemia ; Humans ; Intracranial Aneurysm* ; Isoproterenol* ; Lidocaine* ; Pharmacology ; Spasm ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial*

PURPOSE: Aspirin(acetylsalicylic acid) has been used to treat unstable angina and acute myocardial infarction in adults and Kawasaki disease in children. The antithrombotic effect of aspirin was attributed to its ability to inhibit platelet aggregation by inhibiting platelet cyclooxygenase, which leads to decreased thromboxane synthesis. The purpose of this study was to evaluate the effect on the platelet aggregation by low dose aspirin in Kawasaki patients and to learn the side effects of low-dose aspirin. METHODS: Fifty patients with Kawasaki disease who were treated with low-dose aspirin, and 22 normal children were studied from Jan. 1996 to Dec. 1997. The platelet count, bleeding time, clotting time, platelet aggregation test(induced by ADP, epinephrine, collagen and ristocetin) and blood aspirin level by colorimetric method were checked. RESULTS: The platelet count, bleeding time, and clotting time in the patient group were not significantly different from the control group. The mean maximum platelet aggregation was 54.4+/-12.8% induced by ADP, 15.9+/-11.7% by epinephrine, 55.5+/-23.8% by collagen, 52.6+/-32.2% by ristocetin in the patient group. It was significantly lower than the control group(P<0.05). The mean blood aspirin level in the patient group was 5.4+/-3.7mg/dl. Side effects of low-dose aspirin were bruise, epistaxis and hematuria. CONCLUSION: Low-dose aspirin therapy in patients with Kawasaki disease inhibited platelet aggregation, but attention would be needed because of the tendency to bleed in these patients. Further investigations should be focused on the subject such as the onset of the maximal antiplatelet effect and time needed for the recovery of platelet function.
Adenosine Diphosphate ; Adult ; Angina, Unstable ; Aspirin* ; Bleeding Time ; Blood Platelets* ; Child ; Collagen ; Contusions ; Epinephrine ; Epistaxis ; Hematuria ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction ; Platelet Aggregation* ; Platelet Count ; Prostaglandin-Endoperoxide Synthases ; Ristocetin

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant inherited disorder characterized by recurrent pressure palsies. Most HNPP patients have a 1.5 mb deletion in chromosome 17p11.2-p12. The present study aimed at evaluating the deletion of the 17p11.2-p12 region in Korean subjects with families exhibiting HNPP phenotype, and to determine the clinical, electrophysiological and morphological aspects specifically associated with this deletion in HNPP patients. By genotyping six microsatellite markers (D17S921, D17S955, D17S1358, D17S839, D17S122 and D17S261), HNPP with the deletion was observed in 79% (19 of 24) of HNPP families. Nerve conduction studies were performed in 35 HNPP patients from these 19 families. The observed HNPP deletion frequency in Koreans is consistent with findings in other populations. Disease onset occurred at a significantly earlier age in patients with recurrent pressure palsies than in those with a single attack (P<0.01). Nerve conduction studies demonstrated diffuse mild to moderate slowing of nerve conduction velocities that were worse over the common entrapment sites, regardless of the clinical manifestations. A long duration of compound muscle action potentials without a conduction block or a temporal dispersion is a characteristic of this disease. A sural nerve biopsy with teasing was performed in four patients, and tomacula of the myelin sheath was found in 56.4%. Our findings appear to support the existence of a phenotype/genotype correlation in HNPP patients of Korean ancestry with the deletion, and suggest that HNPP patients with earlier symptom onset face an increased chance of having recurrent attacks.
Adolescent ; Adult ; Age of Onset ; Aged ; Charcot-Marie-Tooth Disease/genetics ; Child ; Child, Preschool ; *Chromosome Deletion ; *Chromosomes, Human, Pair 17 ; DNA Mutational Analysis ; Electrophysiology ; Female ; Genotype ; Hereditary Motor and Sensory Neuropathies/*genetics/pathology/physiopathology ; Humans ; Korea ; Male ; Microsatellite Repeats ; Middle Aged ; Paralysis/*genetics/pathology/physiopathology ; Pedigree ; Phenotype ; Research Support, Non-U.S. Gov't ; Sural Nerve/pathology/physiopathology

BACKGROUDN: The ratio of mitral inflow (E) and annular velocity (E') to stroke volume (E/E'/SV) has been used as an index of diastolic elastance (Ed). However, its change during exercise has not been evaluated. We hypothesized that Ed values obtained during exercise would be abnormal in patients with apical hypertrophic cardiomyopathy (ApHCM). METHODS: Ed was measured at rest and during graded supine bicycle exercise (25 Watts, 3 minute increments) in 15 patients with ApHCM (12 male; mean age, 57 years) and in 15 age- and gender-matched control subjects. RESULTS: Ed was not significantly different at rest and during 25 W of exercise. However, Ed was significantly higher at 50 W of exercise in patients with ApHCM compared to control subjects (0.21+/-0.05 vs. 0.15+/-0.04 cm/s, p=0.0059). There was significant positive correlation between the magnitude of change in proBNP levels during exercise and the change of Ed from rest to 50 W of exercise (r2=0.69, p<0.0001). CONCLUSION: Noninvasively-determined Ed was similar at rest and during mild exercise between patients with ApHCM and control subjects. However, Ed was significantly higher during moderate exercise in ApHCM patients, suggesting a dynamic change in LV stiffness during exercise in these patients.
Cardiomyopathy, Hypertrophic* ; Humans ; Male ; Stroke Volume

BACKGROUDN: The ratio of mitral inflow (E) and annular velocity (E') to stroke volume (E/E'/SV) has been used as an index of diastolic elastance (Ed). However, its change during exercise has not been evaluated. We hypothesized that Ed values obtained during exercise would be abnormal in patients with apical hypertrophic cardiomyopathy (ApHCM). METHODS: Ed was measured at rest and during graded supine bicycle exercise (25 Watts, 3 minute increments) in 15 patients with ApHCM (12 male; mean age, 57 years) and in 15 age- and gender-matched control subjects. RESULTS: Ed was not significantly different at rest and during 25 W of exercise. However, Ed was significantly higher at 50 W of exercise in patients with ApHCM compared to control subjects (0.21+/-0.05 vs. 0.15+/-0.04 cm/s, p=0.0059). There was significant positive correlation between the magnitude of change in proBNP levels during exercise and the change of Ed from rest to 50 W of exercise (r2=0.69, p<0.0001). CONCLUSION: Noninvasively-determined Ed was similar at rest and during mild exercise between patients with ApHCM and control subjects. However, Ed was significantly higher during moderate exercise in ApHCM patients, suggesting a dynamic change in LV stiffness during exercise in these patients.
Cardiomyopathy, Hypertrophic* ; Humans ; Male ; Stroke Volume

The aims of our study were to identify the risk factors for an increased aortic pulse wave velocity (AoPWV) and to assess the impact of the AoPWV on the cerebro-cardiovascular (CV) outcomes of hemodialysis (HD) patients. Seventy two HD patients were included, and the AoPWV, the echocardiography and the biochemical parameters were measured. After dividing the patients into tertiles according to the AoPWV values, we defined the low, the middle and the high AoPWV groups. The patients in the high AoPWV group showed a significantly higher age and high-sensitivity C-reactive protein level, a greater prevalence of diabetes and statin use, left ventricular hypertrophy, average pulse pressure (PP), AoPWV and left ventricular mass index and a lower serum albumin level than those in the low AoPWV group (p<0.05). On multivariate regression analysis of the AoPWV, age and the average PP were independently related to the AoPWV (p<0.05). On the multivariate Cox analysis for CV outcomes, the AoPWV and the average PP remained significant independent predictors of CV events. Our data suggest that an increased AoPWV is an independent predictor for the CV outcomes of HD patients.
Adult ; Aged ; Albumins/metabolism ; Aorta/*pathology ; C-Reactive Protein/metabolism ; Echocardiography/methods ; Female ; Heart Rate ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Kidney Failure, Chronic/*complications/*therapy ; Male ; Middle Aged ; *Pulse ; Renal Dialysis/methods