OBJECTIVES: This study was to assess management outcome of patient undergoing decompressive craniectomy for space-occupying cerebral infarction refractory to medical treatment and to identify risk factors associated with unfavorable outcomes. PATIENTS AND METHODS: Between January 1999 and June 2004, total 20 patients were analyzed. The preoperative consciousness was rated using Glasgow Coma Scale (GCS). The clinical outcome was rated using Glasgow Outcome Scale (GOS) at 3 months follow up and divided into 2 groups;favorable outcome group (GOS> or =3) and unfavorable outcome group (GOS<3). The prognostic factors were analyzed multivariately. RESULTS: Fourteen patients were men and six patients were women (mean age, 58.7 yrs). Seventeen patients had right hemispheric infarction, and three patients had left hemispheric infarction. 16 patients had only middle cerebral artery (MCA) infarction, and 2 patients had combined anterior cerebral artery (ACA) or posterior cerebral artery (PCA) infarction respectively. Eleven patients showed anisocoria preoperatively. The mean time interval between symptom onset of infarction and operation was 61.5 hrs. 8 patients showed favorable outcome, and 12 patients showed unfavorable outcome. CONCLUSIONS: The existence of preoperative anisocoria and low preoperative GCS score were statistically significant prognostic factor related to unfavorable outcome.
Anisocoria ; Anterior Cerebral Artery ; Cerebral Infarction* ; Consciousness ; Decompressive Craniectomy* ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Infarction ; Male ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Risk Factors

Medical education is the process of transforming a layman into a medical professional. Anatomy is a major, primary subject for students entering medical school. How students learn anatomy is important for becoming a doctor. The object of this study is to determine what influences students to get their values and attitudes as an altruistic healer, and to develop professional competence from educational courses in the medical school. We focused on how the lessons and disciplines of the anatomy course guided medical students to become doctors. Interviews of narrative inquiry were conducted in which the students and graduates talked about the experience of learning in their course-work. Anatomy is an important subject for medical students, at both the cognitive and the emotional level. Through learning anatomy, students adapt their emotions and attitudes to the medical profession and become bona fide medical students. They face very stressful condition at first, but they learn how to adapt to their circumstances. They studied with passion, and could develop their own way of studying. Besides, they felt that they were gradually becoming health experts by learning medical terminology, and could enhance their professionalism by practicing anatomy. Indelible experiences in dissection laboratory and rite in memory of cadaver donors evoke deep reflection on thankfulness and altruism. This study addressing the issue of altruistic professionalism in anatomy will have to be continued by following students into the preclinical and clinical years. Public concerns with commercialism in teaching hospitals and schools are also emphasized.
Altruism ; Cadaver ; Education, Medical ; Hospitals, Teaching ; Humans ; Learning ; Memory ; Professional Competence ; Schools, Medical ; Students, Medical ; Tissue Donors

OBJECTIVES: This study was to define the clinical characteristics and formulate the management strategies of the patients with infectious cerebral aneurysms. METHODS: During the past 30 years, among 2,830 patients who were treated with intracranial aneurysms, 11 patients had infectious cerebral aneurysms. The authors reviewed the database and the imaging studies as sources for identification and analysis. RESULTS: Nine patients had ruptured lesions: Five patients presented with subarachnoid hemorrhage (SAH) and 4 patients presented with intracerebral hemorrhage (ICH). Two patients were Hunt and Hess Grade I, 1 Grade II, 2 Grade III, 3 Grade IV, and 1 Grade V. Seven aneurysms were located at middle cerebral artery, 2 at anterior cerebral artery, 1 at internal carotid artery, and 1 at posterior circulation. Ten aneurysms were small ((8 mm). Seven aneurysms were fusiform, and the remaining 4 aneurysms were saccular. Five of the 11 patients (44.4%) had multiple aneurysms. All patient were treated by microsurgery. The obliteration methods of the aneurysms were trapping in 7 patients, and neck clipping in 4 patients. Nine patients showed favorable outcome (good : 7, fair : 2) and 2 patients showed unfavorable outcome (poor : 1, dead : 1). CONCLUSION: Infectious cerebral aneurysms had high frequency of ICH, fusiform-shape, multiple aneurysms, and initial poor clinical grade. Surgery was necessary for ruptured lesion and unruptured lesions which size was increased at follow up angiography. The ultimate management outcome was satisfactory. Co-work with cardiologist and cardiovascular surgeon is necessary.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Cerebral Hemorrhage ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Microsurgery ; Middle Cerebral Artery ; Neck ; Subarachnoid Hemorrhage

OBJECTIVE: Mesenchymal stem cells (MSCs) have shown promise in potentially repairing injured spinal cord. These and similar cell types are being tested clinically, but the understanding about delivering method and subsequent results is lacking. This study was designed to compare the MSCs engraftment results after intralesional, intracisternal, or intravenous injection in a rat with spinal cord injury (SCI). METHODS: A total of 48 male Sprague-Dawley rats (300-350 g in size) were used with 12 in each group. Allogenic MSCs were cultured from human bone marrow aspirates. The SCI was induced using an NYU (New York University) impactor and MSCs were transplanted 1 week after the SCI. Behavioral testing was performed weekly for 6 weeks. The recipients were analyzed histologically to evaluate the extent of cell delivery and survival at the injury site. RESULTS: All three experimental groups showed better behavioral recovery compared with the control group since 6 weeks after stem cell injection (p<0.05). The intracisternal injection group showed the best functional improvement (p<0.05). The intralesional injection group showed the best engraftment until 4 weeks after stem cell injection (p<0.05). A number of the injected MSCs were trapped in the spleen in the intravenous injection group. CONCLUSION: Transplantation of stem cells by a variety of routes can deliver cells with the potential to repair injured spinal cord. Intracisternal injection can easily be translated to patients after some modifications, thus accelerating clinical application of cell therapies.
Animals ; Bone Marrow ; Humans ; Injections, Intralesional ; Injections, Intravenous ; Male ; Mesenchymal Stromal Cells ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; Spinal Cord Injuries ; Spleen ; Stem Cells ; Transplants

BACKGROUND: Behavioral and psychological symptoms (BPS) following acute middle cerebral artery (MCA) infarcts are not uncommon, but these have been considered to be less important than physical disability. The purpose of this study is to evaluate the characteristics of BPS following acute MCA infarcts by using the Korean version of neuropsychiatric inventory (K-NPI). METHODS: Fifty-one patients with acute MCA infarcts were studied using the K-NPI scale. We investigated newly developed BPS after the onset of MCA infarcts by interviewing the primary caregiver of each patient. We then evaluated factors related to the BPS such as lesion laterality and various characteristics of the subjects. RESULTS: The most common BPS following acute MCA infarcts was depression. It was present in 69% of the patients, followed by anxiety (61%), agitation (39%), apathy (29%) and irritability (25%). Depression and anxiety were associated with left MCA lesion, whereas apathy was associated with right lesion. Patients with recurrent MCA infarcts more often had depression and anxiety than those without (p=0.03, p=0.04, respectively). Patients with MCA infarcts caused by cardioembolism more often had irritability and disinhibition than those with other subtypes (p=0.01, p=0.02, respectively). CONCLUSIONS: BPS is frequently observed following acute MCA infarcts. Therefore, early and adequate assessment of post stroke BPS and appropriate therapy may be important in patients with MCA infarcts.
Anxiety ; Apathy ; Caregivers ; Depression ; Dihydroergotamine ; Humans ; Middle Cerebral Artery* ; Stroke

Midgut volvulus is commonly complicated with malrotation, and develops mainly in infants before 1 year old, especially in neonate. Intrauterine midgut volvulus is an extremely rare disease therefore is difficult to diagnose. Furthermore unless the fetus has malrotation, symptoms and results of tests suspicious of fetal midgut volvulus are nonspecific. There are some reports that meconium ileus could be a cause of intrauterine midgut volvulus from foreign countries, however has never been reported in Korea. So we report a case of prematurity born with bowel perforation and gangrene due to intrauterine midgut volvulus caused by meconium ileus.
Fetus ; Gangrene ; Humans ; Ileus ; Infant ; Infant, Newborn ; Intestinal Volvulus ; Korea ; Meconium ; Rare Diseases

No abstract available.
Esophageal Neoplasms* ; Radiotherapy*

PURPOSE: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method. RESULTS: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS. CONCLUSION: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.
Brachytherapy ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Electrons ; Follow-Up Studies ; Glycolysis ; Gynecology ; Humans ; Hysterectomy ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; Pelvis ; Positron-Emission Tomography and Computed Tomography ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; ROC Curve ; Uterine Cervical Neoplasms*

PURPOSE: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method. RESULTS: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS. CONCLUSION: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.
Brachytherapy ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Electrons ; Follow-Up Studies ; Glycolysis ; Gynecology ; Humans ; Hysterectomy ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; Pelvis ; Positron-Emission Tomography and Computed Tomography ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; ROC Curve ; Uterine Cervical Neoplasms*

No abstract available.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy, Combination* ; Etoposide* ; Radiotherapy*