A combined anterior and lateral approach to the anterior cervical canal was performed on 2 patients with cervical dumbbell-shaped tumors. The procedure consists of anterior discetomy and ispsilateral uncectomy, and removal of the posterolateral corners and posterior transverse fidges of the upper and lower verterbral bodies at the tumor. In one case of a large tumor in the spinal canal, additional removal of a limited segment from the lateral part of the vertebral body was performed and the bone defect was filled with a T-shaped bone graft. The higest level of the operation was C-2 and the lowes was C-4. The authors believe that any cervical dumbbell-shaped tumor below the C-2 level can be removed via anterolateral approach as long as no more than 3 levels of the spine are involved.
Foraminotomy ; Humans ; Spinal Canal* ; Spine ; Transplants

Two rare cases of intraventricular arachnoid cyst locating in the posterior portion of the third ventricle are presented. A diagnosis was based on the radiological and operative findings and the microscopic features. Cyst wall fenestration by a direct approach resulted in good outcome. The orgin and the management of arachnoid cyst are discussed.
Arachnoid* ; Diagnosis ; Third Ventricle

Two rare cases of intraventricular arachnoid cyst locating in the posterior portion of the third ventricle are presented. A diagnosis was based on the radiological and operative findings and the microscopic features. Cyst wall fenestration by a direct approach resulted in good outcome. The orgin and the management of arachnoid cyst are discussed.
Arachnoid* ; Diagnosis ; Third Ventricle

Functional brain imaging is very important in the diagnosis and evaluation of the various neurologic disorders, In addition to electroencephalography (EEG) and positron emission tomography(PET), single photon emission computed tomography (SPECT)have increasingly gained importance in determination of disturbancesin regional brain functions. Both ictal and interictal Tc-99m hexamethy-propyleneamine oxime single photon emission computed tomography (TC-99m HMPAO SPECT)was done in a patient with the neonatal seizure and right cerebral hemiatrophy. The left parieto-occipital area revealed increased redioactivity during ictal stage and decreased radioactivities during interictal stage on Tc-99m HMPAO Brain SPECT. This brain ares was thought to be a epileptogenic focus. Ictal and interictal Tc-99m HMPAO brain SPECT could be a safe and sensitive diagnostic method in localization of epileptogenic foci.
Brain* ; Diagnosis ; Electroencephalography ; Electrons ; Functional Neuroimaging ; Humans ; Nervous System Diseases ; Radioactivity ; Seizures* ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: Preterm formula used in Korea, theoretically does not supply the recommended mineral intake for optimal bone metabolism in very low birth weight infants(Formula 500-700 mg Ca/L, 300~370mg P/L, and 440IU of vitamin D/L). The purpose of this study is to identify th e possible etiologic factors and clinical course of rickets in these infants. METHODS: We recently identified radiographic rickets or osteopenia in 16 VLBW infants over a 30-month period from January 1990, to July 1992. We performed a retrospective case analysis to evaluate the clinical features, nutritional status, biochemical and radiological findings o f metabolic disease in preterm infants. RESULTS: Mean gestational age and birth weight were 29+/-2.1wks, and 1172+/-245gm. All infants received parenteral nutrition and 11 infants needed assisted ventilation. Enteral feeding w as started at a mean age of 9.4+/-11.0d and mean total calorie intakes were 62+/-16.2kcal/kg /d in the first 2wks and 111+/-26.9kcal/kg/d at 2-4 wks of age. Oral Ca/P intakes were severely restricted during the first month of life, and they were about 20% of recommended intakes of Ca /P for VLBW infants. At diagnosis of active rickets, serum Ca was high in 19% and serum P wa s low in 69% of infants. Serum alkaline phosphatase was increased in 56% and serum 25-hydroxyvitamin D was low in 67%. Active rickets was diagnosed at mean age of 38+/-14.7 d; 12 infants had overt rickets(grade 2), including 3 infants with fractures(grade 3). Healing rickets was diagnosed on follow-up at mean age of 67.3+/-22.0 days. Thus, metabolic bone disease of VLB W infants was associated with low mineral intakes compared to recommended intakes, and signs of P deficiency occurred at about 2 wks of age and persisted to 8 wks of age; hypercalcemia occurred initially, and these biochemical abnormalities precede the radiological abnormalities about 2 or 3 weeks. CONCLUSIONS: Many factors are related to the development of metabolic hone disease of prematurity; one of the most important factor in our study was nutritional deficiency, especially m ineral(phosphorus) and vitamin D. In preterm VLBW infants whose adequate enteral feeding is restricted, mineral(calcium and phosphorus) and vitamin D supplementation would be needed t o reduce the development of metabolic bone disease in preterm infants.
Alkaline Phosphatase ; Birth Weight ; Bone Diseases, Metabolic* ; Diagnosis ; Enteral Nutrition ; Follow-Up Studies ; Gestational Age ; Humans ; Hypercalcemia ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Korea ; Malnutrition ; Metabolic Diseases ; Metabolism ; Nutritional Status ; Parenteral Nutrition ; Retrospective Studies ; Rickets ; Ventilation ; Vitamin D ; Vitamins

A 31-year-old male who had been treated for Churg-Strauss syndrome (CSS) presented with sudden onset of dysarthria. Brain magnetic resonance imaging (MRI) showed acute multifocal bilateral cerebral infarctions suggesting embolic causes. Cardiac MRI showed dilated cardiomyopathy with severe biventricular dysfunction with intracardiac thrombi, and multiple high signal intensity spots in myocardium of the left ventricle with multifocal delayed enhancement suggesting multifocal myocarditis due to small vessel vasculitis associated with CSS. After anticoagulation therapy, treatments for heart failure, and immunosuppressive therapy including parenteral steroids and cyclophosphamide to control CSS, the symptoms and signs of heart failure and cardiac function of the patient were improved. Considering the pathophysiologic mechanism of cardiac involvement in CSS, immunosuppressive therapy to control the disease activity of CSS should be taken into account, besides usual management for heart failure.
Adult ; Brain ; Cardiomyopathy, Dilated* ; Cerebral Infarction ; Churg-Strauss Syndrome* ; Cyclophosphamide ; Dysarthria ; Heart Failure ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Male ; Myocarditis ; Myocardium ; Prognosis ; Steroids ; Vasculitis

OBJECTIVE: This study examined the clinical characteristics of suicide attempters who exposed their suicidal intension to suggest an active intervention strategy for suicide prevention based on the regional emergency medical service system. METHODS: A prospective database of suicide attempters who visited the emergency department of Chungbuk National University Hospital between October 2013 and December 2017 was used. All of the adult patients who provided consent for the initial assessment for suicidal attempters were eligible, excluding cases with unknown exposure of suicidal intension. The primary and secondary endpoints were the risk factors affecting exposure to the suicidal intension and characteristics of the exposure group. The adjusted odds ratios (AORs) of exposure to suicidal attempts after adjusting for potential confounders was calculated. RESULTS: Of a total 1,035 suicidal attempters enrolled, 332 (32.1%) were included in the exposure group. The exposure group was more likely to have an educational level above high school and no religion, and have suicidal characteristics at night time (18:00–08:00), under the influence of alcohol, suicidal plan before 1 week, and suicidal method involving asphyxia (P<0.05). The exposure group was more likely to have no guardian (AORs, 1.46; 95% confidence interval [CI], 1.00–2.12), use methods involving asphyxia (AORs, 2.07; 95% CI, 1.46–2.91), and attempt suicide at night (18:00 to 08:00) (AORs, 1.38; 95% CI, 1.05–1.83) compared to the no exposure group. CONCLUSION: Models need to be established, where regional mental health welfare center, local government, fire headquarter, and tele-communication companies can participate in the implementation of an active intervention strategy.
Adult ; Asphyxia ; Chungcheongbuk-do ; Emergency Medical Services ; Emergency Service, Hospital ; Fires ; Humans ; Local Government ; Mental Health ; Methods ; Odds Ratio ; Prospective Studies ; Risk Factors ; Suicidal Ideation ; Suicide ; Suicide, Attempted

BACKGROUND AND OBJECTIVES: We sought to evaluate the effect of the early use of ezetimibe/simvastatin (Vytorin(R)) on arterial healing and endothelialization after the implantation of a drug-eluting stent (DES) in a porcine model of coronary restenosis. MATERIALS AND METHODS: A total of 20 pigs (40 coronary arteries) were randomly allocated to a pretreatment or no treatment group. The pretreatment group (n=20) received oral ezetimibe/simvastatin (10/20 mg) daily for 7 days before stenting and the no pretreatment group (n=20) did not. All pigs were treated with ezetimibe/simvastatin (10/20 mg) daily after stenting for 4 weeks. Stenting was performed using a bare-metal stent (BMS, n=10) and three types of DES: biolimus A9-eluting stent (BES, n=10), zotarolimus-eluting stent (ZES, n=10), and everolimus-eluting stents (EES, n=10). Four weeks later, pigs underwent a follow-up coronary angiography and were sacrificed for histopathologic analysis. RESULTS: There were no significant differences between the pretreatment and no pretreatment groups in the internal elastic lamina area, lumen area, neointima area, stenotic area, injury score, fibrin score, and inflammation score. In both groups, the fibrin score was higher in pigs with DES than in BMS, particularly in ZES and EES. The inflammatory score was not different between DES and BMS. CONCLUSION: In a porcine model of coronary restenosis, pretreatment with ezetimibe/simvastatin before DES implantation failed to improve arterial healing and endothelialization compared to treatment after stenting.
Coronary Angiography ; Coronary Restenosis* ; Drug-Eluting Stents* ; Fibrin ; Follow-Up Studies ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Neointima ; Stents ; Swine ; Ezetimibe

BACKGROUND AND OBJECTIVES: Circulating endothelial progenitor cells (EPC) with an endothelial phenotype contribute to the regeneration and repair of arteries. The number of circulating EPCs has an inverse correlation with chronic smoking and endothelial dysfunction. Green tea cathechin many improve endothelial dysfunction. The effect of green tea cathechin on the number of circulating EPCs and the endothelial dysfunction in chronic smokers is not known. Subjects and METHODS: In 20 young healthy smokers (27.6+/-3.6 years, all male), the endothelial functions that were defined by flow-mediated endothelium dependent vasodilation (FMD) of the brachial artery, as well as the number of EPC isolated from peripheral blood, were determined at baseline and also at 2 weeks after taking green tea (8 g/day). The circulating EPCs were quantified by flow cytometry as CD45low CD34+ KDR2+ cells and as acyl-LDL and FITC-lectin double positive cells after culture for 7 days. RESULTS: The changes of the clinical characteristics and the laboratory findings were not different between baseline and at 2 weeks after green tea intake. The EPC levels were inversely correlated with the number of smoked cigarettes. Circulating EPCs, as determined-by flow cytometry, and the cultured EPCs increased rapidly at 2 weeks after green tea consumption (78.6+/-72.6/mL vs. 156.1+/-135.8/mL, respectively, p<0.001; 118.2+/-35.7/10 field vs. 169.31+/-58.3/10 field, respectively, p<0.001). The FMD was significantly improved after 2 weeks (7.2+/-2.8 vs. 9.3+/-2.4, respectively, p<0.001). The FMD was correlated with the EPC count before treatment (r=0.67, p=0.003) and after 2 weeks (r=0.60, p=0.013). CONCLUSION: The number of circulating EPCs and the FMD are reduced in chronic smokers. Green tea induces rapid improvements of the EPC levels and the FMD. A short-term of consumption of green tea may be effective for reducing the cardiovascular risk in chronic smokers.
Arteries ; Brachial Artery ; Endothelium ; Flow Cytometry ; Phenotype ; Regeneration ; Smoke ; Smoking ; Stem Cells* ; Tea* ; Tobacco Products ; Vasodilation

Acute myocardial infarction is a rare but potentially lethal complication of systemic lupus erythematosus. There are several proposed mechanisms for acute myocardial infarction in lupus patients: atherosclerosis and endothelial injury leading to plaque rupture, coronary vasculitis and inflammation of the vessel wall causing aneurismal dilatation or spasm, and acute thrombosis and embolism. We report a-37-year-old man with systemic lupus erythematosus who developed myocardial infarction twice. Potential mechanisms for acute myocardial infarction for this patient are discussed in this report.
Atherosclerosis ; Dilatation ; Embolism and Thrombosis ; Humans ; Inflammation ; Lupus Erythematosus, Systemic* ; Male* ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Rupture ; Spasm ; Vasculitis