Twelve patient with fracture of the neural arch of the axis (hangman's fracture or traumatic spondylolisthesis of the axis) were treated at Kangnam St. Mary's Hospital between 1980 and 1986. There were three type I fractures, seven type II fractures, and two type III fracture. Non of these patients had neurological damage. Seven patients (five in type II and two in type III) in this series, underwent anterior interbody fusion operation between axis and third cervical vertebra following 6 weeks of cervical traction. The remaining five patients were treated conservatively by cervicel traction in the bed. Average follow up period was 24 months. The mean duration of fracture union was 10 weeks after trauma in 3 cases of type I and twelve weeks after trauma in 2 cases of type II which were treated conservatively. Otherwise in 5 cases of type II and two cases of type III which were taken anterior interbody fu sion, the mean duration of fracture union was 8 weeks in type II and 10 weeks in type III after surgery. All regained a stability of the cervical spines. Because the fracture healing of the neural arch invariably occurred through this study, it is felt that anterior interbody fusion between axis and third cervical vertebra is necessary surgical.procedure to gain the early stability if there is an evidence of persistant instability between axis and third cervical verbebrae even after 6 weeks of conservative traction treatment.
Follow-Up Studies ; Fracture Healing ; Humans ; Spine ; Spondylolisthesis ; Traction

Syphilitic aortitis, passing out of our mind, is the most common systemic manifestation of late syphilis and is more typically manifestated 10 to 30 years afterward. This diagnosis has been made less frequently in recent decades than in the past, because of public awareness of syphilis and screening program. Treponema pallidum lodge within vasa vasorum, especially ascending aorta cause the histologic changes, which are responsible for the three major forms of symptomatic cardiovascular syphilis, including aortic insufficiency, coronary ostial stenosis, and aortic aneurysm. We experienced a case of syphilitic aortitis with aortic insufficiency and aortic aneurysm in a 48-year-old man presented with progressive dyspnea. Echocardiography, chest CT, and later surgical correction were performed and surgical specimen revealed the histologic finding consistent with syphilitic aortitis. We report this case with a review of the literature.
Aorta ; Aortic Aneurysm* ; Aortitis ; Constriction, Pathologic ; Diagnosis ; Dyspnea ; Echocardiography ; Humans ; Mass Screening ; Middle Aged ; Syphilis ; Syphilis, Cardiovascular* ; Tomography, X-Ray Computed ; Treponema pallidum ; Vasa Vasorum

The aim of this study was to evaluate endodontic irrigation methods with EndoVac(R) and EndoActivator(R) in the elimination of Enterococcus faecalis from the root canals. Extracted 70 human single-rooted teeth were used. The canals were instrumented by a crown-down technique with .04 taper ProFile to ISO size 40. After the teeth were autoclaved, the canals were inoculated with E. faecalis and incubated for 48 h. The teeth were randomly divided into three experimental groups of 20 teeth each according to canal irrigation methods and two control groups as follows: group 1 - EndoVac(R) group 2 - EndoActivator(R) ; group 3 - Conventional needle irrigation method. After canal irrigation using 2.5% NaOCl, first samples (S1) were taken using sterile paper point. And the canals were filled with sterile brain heart infusion (BHI) broth and incubated for 24 h, then second samples (S2) were taken. The samples were cultured on BHI agar plate to determine the numbers of colony forming units (CFU). In first sampling (S1), only one canal of conventional method among the all experimental groups was positive cultured. In second sampling (S2), EndoVac(R) group showed the least positive culture numbers of E. faecalis. There was statistically significant difference between the EndoVac(R) and conventional needle irrigation methods in the mean value of Log CFU. According to the results of this study, EndoVac(R) showed better efficacy than conventional needle irrigation method in the elimination of E. faecalis from the root canal.
Agar ; Brain ; Dental Pulp Cavity ; Enterococcus ; Enterococcus faecalis ; Heart ; Humans ; Needles ; Stem Cells ; Tooth

Adult ; Aneurysm ; Arteries ; Carotid Artery, Internal ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Angiography ; Parents ; Prospective Studies ; Recurrence ; Retinal Artery ; Retreatment ; Stents ; Stroke, Lacunar ; Thromboembolism

BACKGROUND/AIMS: A prospective study was performed to evaluate the efficacy of low dose administration of cisplatin (CDDP) and 5-fluorouracil (5-FU) by repeated arterial infusion via a percutaneously implantable port system (PIPS) for advanced hepatocellular carcinoma (phase II trial). METHODS: Ten patients with hepatocellular carcinoma belonging to TNM stage IV, but without extrahepatic spread, were enrolled. Nine patients had main portal vein thrombosis. All the patients were positive for HBsAg. Patients were repeatedly treated with an arterial infusion of CDDP and 5-FU (10 mg and 250 mg, respectively, for 5 hours on days 1-5) via a PIPS at four week intervals. The response was assessed by dynamic CT after two courses of chemotherapy. RESULTS: Insertion of PIPS was successful in 8 of 10 patients. Two patients could not receive a second course of chemotherapy because one died of progressive hepatic failure and the other developed local infection and pseudoaneurysm formation. All the remaining 6 patients exhibited tumor progression after two courses of chemotherapy. The median survival time was 89 days (range, 59-204). The causes of death were progressive hepatic failure in one patient and uncontrolled esophageal variceal bleeding in one patient. CONCLUSIONS: Arterial infusion chemotherapy with CDDP and 5-FU via a PIPS was not an effective treatment for patients with advanced hepatocellular carcinoma.
Aneurysm, False ; Carcinoma, Hepatocellular* ; Cause of Death ; Cisplatin* ; Drug Therapy ; Esophageal and Gastric Varices ; Fluorouracil* ; Hepatitis B Surface Antigens ; Humans ; Liver Failure ; Prospective Studies ; Venous Thrombosis

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BACKGROUND/AIMS: TRAIL-induced apoptosis was believed to occur in tumor cell lines, while not in normal cells, which suggested that TRAIL might be safe as an antitumor therapy. Some authors advocate that this exclusive TRAIL-induced apoptosis depended on whether or not TRAIL-R3 mRNA was expressed. In this study we investigated the difference in the expression of TRAIL and its receptors mRNA between human hepatocellular carcinoma (HCC) and surrounding liver tissues. METHODS: Intra-operative sampling of HCC and paired surrounding liver tissue was performed in 12 patients who underwent hepatic resection due to HCC. After RT-PCR, using total RNA extracts from the tissues, amplified RT-PCR, products were analyzed qualitatively for the expression of TRAIL and its receptors mRNA. Both tissues were compared semi-quantitatively for the expression of TRAIL-R3 mRNA with beta-actin using the method of Nicoletti et al. RESULTS: 1) TRAIL mRNA was expressed in HCC and surrounding liver tissues in all cases. 2) TRAIL-R1, -R2, and -R3 mRNA were also expressed in HCC and surrounding liver tissues in all cases. 3) The ratio of the expression of TRAIL-R3 mRNA to beta-actin mRNA was 0.22+/-0.15 in HCC and 0.34+/-0.21 in surrounding liver tissues (p=0.124, paired t-test). 4) TRAIL, TRAIL-R1, -R2 and -R3 mRNA were expressed in all HCC cases irrespective of the degree of tumor cell differentiation. CONCLUSIONS: TRAIL, TRAIL-R1, -R2, and TRAIL-R3 mRNA were expressed in all of the HCC and surrounding liver tissues. There was no quantitative difference in the expression of TRAIL-R3 mRNA between both tissues.
Actins ; Apoptosis ; Carcinoma, Hepatocellular* ; Cell Differentiation ; Cell Line, Tumor ; Humans ; Liver* ; Necrosis* ; RNA ; RNA, Messenger* ; TNF-Related Apoptosis-Inducing Ligand

Talc pleurodesis is a safe and effective treatment for a recurrent malignant pleural effusion. However, acute hypoxemia, pulmonary edema or acute respiratory failure can develop in a small number of patients. We report 2 patients who developed fatal hypoxemia after talc pleurodesis which was necessary the control recurrent pleural effusion. The first case was an 18-year old male diagnosed with Ewing's sarcoma with bilateral lung metastases and pleural effusion. The performance status was ECOG (Eastern Cooperative Foncology Group) grade 3. Fever along with hypoxemia and leukocytosis developed 10 hours after the second talc pleurodesis on the right side for an uncontrolled pleural effusion, The patient died from respiratory failure after 13 days. The second case was a 66-year old female diagnosed with non-small cell lung cancer with a bone metastasis. Two weeks after systemic chemotherapy, she complained of dyspnea, and a pleural effusion was observed on the right side. Her performance status was ECOG grade 3. Talc pleurodesis was performed for recurrent pleural effusion, but hypoxemia developed 6 days after pleurodesis and she died from respiratory failure 10 days after pleurodesis. In conclusion, talc pleurodesis should be performed very carefully in patients with a poor performance status, in cases with repeated pleurodesis, bilateral pleural effusion, recent chemotherapy, radiotherapy and when there are parenchymal metastatic lesions present.
Adolescent ; Aged ; Anoxia* ; Carcinoma, Non-Small-Cell Lung ; Drug Therapy ; Dyspnea ; Female ; Fever ; Humans ; Leukocytosis ; Lung ; Male ; Neoplasm Metastasis ; Pleural Effusion ; Pleural Effusion, Malignant* ; Pleurodesis* ; Pulmonary Edema ; Radiotherapy ; Respiratory Insufficiency ; Sarcoma, Ewing ; Talc*

BACKGROUND AND PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) has potential as a noninvasive neuromodulation treatment method for various neuropsychiatric disorders, and repeated sessions of rTMS are more likely to enhance the therapeutic efficacy. This study investigated neurophysiologic and spatiodynamic changes induced by repeated 1-Hz rTMS of the temporal cortex using transcranial magnetic stimulation (TMS) indices and fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS: Twenty-seven healthy subjects underwent daily 1-Hz active or sham rTMS of the right temporal cortex for 5 consecutive days. TMS indices of motor cortical excitability were measured in both hemispheres daily before and after each rTMS session, and 2 weeks after the last stimulation. FDG-PET was performed at baseline and after the 5 days of rTMS sessions. RESULTS: All subjects tolerated all of the sessions well, with only three of them (11.1%) reporting mild transient side effects (i.e., headache, tinnitus, or local irritation). One-Hz rTMS decreased motor evoked potential amplitudes and delayed cortical silent periods in the stimulated hemisphere. Statistical parametric mapping of FDG-PET data revealed a focal reduction of glucose metabolism in the stimulated temporal area and an increase in the bilateral precentral, ipsilateral superior and middle frontal, prefrontal and cingulate gyri. CONCLUSIONS: Repeated rTMS sessions for 5 consecutive days were tolerated in all subjects, with only occasional minor side effects. Focal 1-Hz rTMS of the temporal cortex induces cortico-cortical modulation with widespread functional changes in brain neural networks via long-range neural connections.
Brain ; Evoked Potentials, Motor ; Glucose ; Headache ; Positron-Emission Tomography ; Salicylamides ; Tinnitus ; Transcranial Magnetic Stimulation

BACKGROUND/AIMS: Gastric variceal bleeding is a severe complication of liver cirrhosis with a high mortality. The purpose of this study was to determine the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with gastric variceal bleedings and predictive factors for survival. METHODS: We retrospectively analyzed the medical records of 30 consecutive patients with gastric variceal bleedings from January 1998 to March 2001. The causes of cirrhosis were viral hepatitis in 17, alcohol in 12, and biliary cirrhosis in 1. Eighteen patients were in Child-Pugh class B and 9 in class C at the time of TIPS. The median follow-up period was 403 days (3-1,215 days). RESULTS: TIPS insertion was successful in all 30 patients. The portal pressure gradient (PPG) was significantly reduced from 23+/-8 mmHg to 11+/-5 mmHg (p<0.05). Hepatic encephalopathy, which developed in 3 patients and was aggravated in 1, was improved with medical therapy. Patients with non-alcoholic etiology experienced deterioration of liver function after TIPS. Those with alcoholic etiology did not. The 6-month and 1-year rebleeding rates were 22% and 41%, respectively. 56% of bleeding episodes were associated with stent dysfunction. The degree of PPG reduction and the development of stent dysfunction were independent predictive factors for rebleeding. The 6-month and 1-year survival rates were 83% and 79%. The causes of death were hepatic failure in 3 (37.5%), recurrent variceal bleeding in 3, and others in 2. Child-Pugh class C was the only prognostic factor for survival. CONCLUSIONS: TIPS was effective in acute hemostasis and the prevention of rebleeding in patients with gastric variceal bleeding. Especially, it can be safely applied to patients with alcoholic etiology and in Child-Pugh class A or B.
Adult ; English Abstract ; Esophageal and Gastric Varices/complications/*surgery ; Female ; Gastrointestinal Hemorrhage/*etiology ; Human ; Liver Cirrhosis/complications ; Male ; Middle Aged ; *Portasystemic Shunt, Transjugular Intrahepatic ; Recurrence