No abstract available.

No abstract available.
Emergencies* ; Hematoma, Subdural, Acute* ; Trephining*

STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze the outcomes of conservative management in elderly patients over 65 years of age who were diagnosed with pyogenic spondylitis. SUMMARY OF LITERATURE REVIEW: The surgical treatment of pyogenic spondylitis can lead to complications in elderly patients in a poor general condition or with underlying diseases. MATERIALS AND METHODS: We performed a retrospective review of 32 patients who were diagnosed with pyogenic spondylitis and had a minimum of 12 months of follow-up. Age, sex, comorbidities, clinical symptoms, and the involved segments were analyzed retrospectively. The diagnosis was assessed using clinical, laboratory, and radiologic findings. Antibiotic therapy was either specific (if positive culture results were found) or broad-spectrum cephalosporin (when the pathogenic agent was not isolated). Outcomes were assessed using residual pain and neurologic deficits. RESULTS: The mean onset time was 23.5 days (range, 3-90 days). The mean period of intravenous antibiotic therapy was 36.3 days (range, 10-90 days). All cases underwent conservative management, and 4 patients with progressive neurologic deficits due to epidural abscess underwent posterior laminectomy and abscess drainage. In all cases, the infection was successfully treated, although 12 cases reported residual lower back pain and 2 continued to exhibit minor neurologic deficits. CONCLUSIONS: In elderly patients with pyogenic spondylitis, satisfactory results were obtained with conservative management using antibiotics and orthosis after an early diagnosis, unless progressive neurologic symptom instability or spine deformities were noted.
Abscess ; Aged* ; Anti-Bacterial Agents ; Comorbidity ; Congenital Abnormalities ; Diagnosis ; Drainage ; Early Diagnosis ; Epidural Abscess ; Follow-Up Studies ; Humans ; Laminectomy ; Low Back Pain ; Neurologic Manifestations ; Orthotic Devices ; Retrospective Studies ; Spine ; Spondylitis*

The blood blister-like aneurysm (BBA) of the internal carotid artery (ICA) is a rare but clinically important cause of subarachnoid hemorrhage (SAH), which accounts for 0.5% of incidences of ruptured intracranial aneurysms. BBA is a thin-walled, broad-based aneurysm that lacks an identifiable neck and is one of the most difficult lesions to treat. In this paper, a case is presented of a 57-year-old woman with SAH. Her cerebral angiography demonstrated a small BBA on the dorsal wall of her right ICA. Endovascular treatment that consisted of a stent-within-a-stent was attempted, but the replacement of the second stent failed, and the aneurysm became bigger. Surgery was performed by clipping the BBA with a Sundt slim-line encircling graft clip. The patient completely recovered with no complications. This treatment may be a salvageable option for BBA, especially when endovascular treatment has failed.
Aneurysm ; Carotid Artery, Internal ; Cerebral Angiography ; Endovascular Procedures ; Female ; Humans ; Incidence ; Intracranial Aneurysm ; Middle Aged ; Neck ; Stents ; Subarachnoid Hemorrhage ; Transplants

BACKGROUND AND OBJECTIVES: Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the relation between hypercholesterolemia and plaque composition in patients with coronary artery disease. SUBJECTS AND METHODS: Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercholesterolemic group (> or =200 mg/dL, n=114) and normocholesterolemic group (<200 mg/dL, n=209). RESULTS: Hypercholesterolemic patients were younger (59.7+/-13.3 years vs. 62.6+/-11.5 years, p=0.036), than normocholesterolemic patients, whereas there were no significant differences in other demographics. Hypercholesterolemic patients had higher corrected necrotic core volume (1.23+/-0.85 mm3/mm vs. 1.02+/-0.80 mm3/mm, p=0.029) as well as percent necrotic core volume (20.5+/-8.5% vs. 18.0+/-9.2%, p=0.016) than normocholesterolemic patients. At the minimal lumen area site, percent necrotic core area (21.4+/-10.5% vs. 18.4+/-11.3%, p=0.019) and necrotic core area (1.63+/-1.09 mm2 vs. 1.40+/-1.20 mm2, p=0.088) were also higher than normocholesterolemic patients. Multivariate linear regression analysis showed that total cholesterol level was an independent factor of percent necrotic core volume in the culprit lesion after being adjusted with age, high density lipoprotein-cholesterol , hypertension, diabetes mellitus, smoking and acute coronary syndrome (beta 0.027, 95% confidence interval 0.02-0.053, p=0.037). CONCLUSION: Hypercholesterolemia was associated with increased necrotic core volume in coronary artery plaque. This study suggests that hypercholesterolemia plays a role in making plaque more complex, which is characterized by a large necrotic core, in coronary artery disease.
Acute Coronary Syndrome ; Atherosclerosis ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Demography ; Diabetes Mellitus ; Humans ; Hypercholesterolemia ; Hypertension ; Linear Models ; Smoking

PURPOSE: Spontaneous subarachnoid hemorrhage(S-SAH) is a relatively rare disease with good clinical course and prognosis. The purpose of this study is to evaluate the cisternal blood distribution on CT in patient with S-SAH. MATERIALS AND METHODS: Out of 406 patients with subarachnoid hemorrhage on brain CT scan, 11 patients confirmed to be S-SAH by angiography and clinical follow-up were examined. We analysed the CT findings of these 11 cases retrospectively. RESULTS: Five patients had only perimesencephalic distribution of hemorrhage:the prepontine, the interped- uncular, and the suprasellar cisterns were involved in 4 cases each, the basal sylvian cistern in 3 cases, and the ambient cistern in 2 cases. The quadrigeminal and a portion of the lateral sylvians were also involved in 1 case each. Six patients revealed cisternal hemorrhage extending beyond the perimesencephalic cistern into the ventricles, cortical sulci, and lateral sylvian fissure. Intraventricular hemorrhage was noted in 3 cases of these 6 patients. CONCLUSION: Our study suggests that uncomplicated clinical course and normal anglographic finding are more important than CT distribution of cisternal hemorrhage in diagnosing S-SAH.
Angiography ; Brain ; Follow-Up Studies ; Hemorrhage ; Humans ; Prognosis ; Rare Diseases ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Undiagnosed diabetes mellitus (DM) or impaired glucose tolerance (IGT) is not uncommon in patients with coronary atherosclerosis and is known to be associated with abnormal scores for atherosclerosis surrogates. We sought to determine the prevalence of undiagnosed DM or IGT, and the association between insulin resistance (IR) and atherosclerosis surrogates in patients with coronary atherosclerosis. SUBJECTS AND METHODS: The study population consisted of 187 consecutive patients with angiographically proven coronary atherosclerosis (mean: 61 years old, 94 males). We measured carotid intima-media thickness (IMT) and flow mediated brachial artery dilatation (FMD). We also did oral glucose tolerance tests (OGTT), quantitative insulin-sensitivity check indexes (QUICKI) and homeostasis model assessment-IR (HOMA-IR). RESULTS: Abnormal OGTT was found in 164 patients (87.7%), even though there were only 63 known cases of DM (33.7%). There were 58 patients (31%) with newly diagnosed IGT and 43 patients (23%) with newly diagnosed DM. There were 71 patients (38%) who had IR (defined as measured HOMA-R > or =3.0). HOMA-IR showed a positive correlation with body mass index (BMI) (r=0.275, p<0.001) and triglycerides (r=0.2, p=0.01), whereas QUICKI had a negative correlation with BMI (r=-0.26, p<0.001), total cholesterol (r=-0.15, p=0.04), triglycerides (r=-0.21, p=0.004) and low-density lipoprotein-cholesterol (LDL-C) (r=-0.17, p=0.02). HOMA-IR and QUICKI were not significantly correlated with IMT or FMD. CONCLUSION: This study suggests that there is a high incidence of undiagnosed DM and IGT, but atherosclerosis surrogates are not associated with IR in patients with coronary atherosclerosis.
Atherosclerosis ; Body Mass Index ; Brachial Artery ; Carotid Intima-Media Thickness ; Cholesterol ; Coronary Artery Disease ; Diabetes Mellitus ; Dilatation ; Glucose ; Glucose Tolerance Test ; Homeostasis ; Humans ; Incidence ; Insulin ; Insulin Resistance ; Prevalence ; Triglycerides

Glossopharyngeal neuralgia is a relatively rare condition characterized by severe, paroxysmal episodes of lancinating pain in the tongue, throat, ear, and tonsil. This disorder is assumed to be due to compression of the glossopharyngeal nerve by vascular structures. A 47-year-old woman complaining of sharp and lancinating pain in the right periauricular and submandibular areas visited our hospital. Swallowing, chewing, and lying on her right side triggered the pain. Her neurologic examination revealed no specific abnormalities. The results of routine hematologic and blood chemistry studies were all within normal limits. Carbamazepine and gabapentin were given, but her symptoms persisted. Her pain was temporarily relieved only by narcotic pain medication. MRI showed an arachnoid cyst located in the right cerebellomedullary cistern extending to the cerebellopontine cistern. Cyst removal was performed via a right retrosigmoid approach. Lateral suboccipital craniotomy was performed using the right park-bench position. After opening the dura and cerebellopontine angle, the arachnoid cyst was exposed. The arachnoid cyst was compressing the flattened lower cranial nerves at the right jugular fossa. Her symptoms resolved postoperatively. Two months after the operation, she was completely free from her previous symptoms.
Amines ; Arachnoid ; Carbamazepine ; Cerebellopontine Angle ; Cranial Nerves ; Craniotomy ; Cyclohexanecarboxylic Acids ; Deception ; Deglutition ; Ear ; Female ; gamma-Aminobutyric Acid ; Glossopharyngeal Nerve ; Glossopharyngeal Nerve Diseases ; Humans ; Mastication ; Middle Aged ; Neurologic Examination ; Palatine Tonsil ; Pharynx ; Tongue

OBJECTIVES: This study aimed to explore the persistence and adherence to secondary preventive medication of stroke patients after discharge and to assess the reasons for persistence and nonadherence. METHODS: Four hundred twenty-nine patients with stroke were surveyed to determine their behaviors from discharge. Reasons for stopping medications were ascertained. Persistence was defined as continuation of all secondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribed medications according to health care provider instructions. RESULTS: Of the 429 patients, 86.5% were treatment persistent and 41.2%(non-intentional nonadherence=39.4%, intentional nonadherence=19.4%) were adherent. Independent predictors of persistence included having experience about health education. Independent predictors of non-intentional nonadherence were modified Rankin Scale(mRS) (Exp(B)=2.858, p=0.001) and health education experience (Exp(B)=0.472, p=0.032), and independent predictors of intentional nonadherence were mRS (Exp(B)=2.533, p=0.006), depressive symptoms (Exp(B)=1.113, p=0.016), beliefs about medications questionnaire(necessity, Exp(B)=0.879, p=0.011, concern, Exp(B)=1.098, p=0.019). CONCLUSIONS: Although up to one-ninth of stroke patients continued secondary prevention medications, nonadherence is common. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions. Specially, interventions to improve adherence should target patients' beliefs about their medication.
Depression ; Health Education ; Health Personnel ; Humans ; Secondary Prevention ; Stroke*

BACKGROUND: Hematopoietic stem cells of the human fetal liver prior to 15 weeks gestation have remakable advantages for successful engraftment due to embryological immune immaturity, especially in-utero transplantation. This study was undertaken to obtain objective assessment data about the possibility of fetal liver hematopoietic stem cell transplantation in the future. METHODS: Six cases of the fetal liver tissue were obtained from therapeutic abortions at 12~20 weeks gestation. The fetal liver was collected in RPMI media containing 10% fetal calf serum and the cell suspensions were obtained by centrifugation following physical disruption. The number of nucleated cells in each case was counted and the colony numbers in methyl cellulose media were scored according to incubation period with or without growth factors. Some of the cells were cryopreserved in the liquid nitrogen tank, thereafter cell viability and colony numbers were evaluated according to cryopreservation period. RESULTS: The nucleated cell numbers obtained from each fetal liver increased with gestational age. The colony numbers after incubation increased with gestational age and the erythroid lineage was predominant in 3 cases which are under 15 weeks gestation. The colonogenic activity after incubation with combination of hematopoietic growth factors increased in only one case. The cell viability and the colony numbers after cryopreservation was decreased compare to the value before cryopreservation. CONCLUSION: The number of nucleated cells and hematopoietic stem cell colony formation were increased with gestational age and viability of the cells after cryopreservation was decreased. Further systematic studies using more cases would be needed to obtain objective assessment data for fetal liver transplantation program in the future.
Abortion, Therapeutic ; Cell Count ; Cell Survival ; Centrifugation ; Cryopreservation ; Female ; Gestational Age ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells* ; Humans ; Intercellular Signaling Peptides and Proteins ; Liver Transplantation ; Liver* ; Methylcellulose ; Nitrogen ; Pregnancy ; Suspensions