Purpose: Vessel wall imaging (VWI) for carotid plaque is better for detecting unstable carotid plaque such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thin/ruptured fibrous cap. However, the role of VWI before carotid artery stenting (CAS) is unclear. Thus, this study aimed to determine the findings of symptomatic carotid stenosis before CAS on angiography and carotid VWI and to evaluate the imaging findings associated with post-procedural clinical events after CAS. Materials and Methods: This retrospective study included 173 consecutive patients who underwent carotid VWI, CAS, and post-procedural diffusion-weighted imaging (DWI) after CAS. Findings of unstable plaque on carotid VWI and unstable findings on angiography were analyzed. We also analyzed the incidence of post-procedural clinical events, any stroke, myocardial infarction (MI), and death within 30 days of CAS. Results: Of 173 patients, 101 (58.4%) had initial ischemic symptoms and positive findings on DWI. Symptomatic patients were significantly higher in patients with IPH than in patients without IPH (62.4% vs. 45.8%, P=0.031). Degree of stenosis, thrombus of the stenotic lesion, flow delay of internal carotid artery, and flow arrest by filter thrombus had significantly higher prevalence in the symptomatic group. Twenty patients (11.6%) had post-procedural clinical events such as any stroke, clinical symptoms, and/or MI. Hyperlipidemia and intraluminal thrombus on angiography were identified as significant factors influencing post-procedural events after CAS. Conclusion An intraluminal thrombus on angiography was identified as a significant factor influencing post-procedural clinical events after CAS.

OBJECTIVES: The objective of this study was to evaluate an association between posttraumatic stress disorder (PTSD) and altered immunity in North Korean defectors who were more likely to develop medical conditions and other stress-related psychiatric disorders. METHODS: Twenty-four North Korean defectors with PTSD and twenty-two controls without PTSD were recruited from the resettlement and training center for North Korean defectors in South Korea. Peripheral T lymphocyte subsets, natural killer (NK) cells, NK cell activity and plasma hormones (ACTH and cortisol) were obtained from all subjects. We also applied the Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) for all subjects. RESULTS: We found NK cell activity was relatively lower than number of NK cells in North Korean defectors with PTSD. Subjects with PTSD had higher HAM-D and HAM-A scores than controls. However, there were no statistical differences in ACTH, cortisol, CD3, CD4, CD8, CD4/CD8 ratio, CD19 and CD56 between the two groups. CONCLUSION: These findings suggest North Korean defectors with PTSD show higher levels of depression, anxiety and impaired or weak immune function in NK cells.
Adrenocorticotropic Hormone ; Anxiety ; Depression ; Hydrocortisone ; Killer Cells, Natural ; Plasma ; Republic of Korea ; Stress Disorders, Post-Traumatic ; T-Lymphocyte Subsets

Viagra has been prescribed worldwide to treat men with erectile dysfunction. Clinical trials have shown that Viagra may cause various kinds of adverse effects include some central nervous system (CNS) adverse effects. Although extremely rare, toxic encephalopathy also can be one of those effects. This report presents a case of encephalopathy caused by Viagra in correlation with its radiologic findings. Its pharmacologic mechanism and potential effects on the biochemistry of the CNS are reviewed.
Biochemistry ; Brain Diseases ; Central Nervous System ; Erectile Dysfunction ; Humans ; Male ; Neurotoxicity Syndromes* ; Sildenafil Citrate*

BACKGROUND: Observation on the hemodialysis treatment; whether there are any different effects on mortality rate, side effects, or effectiveness of the treatment depending on patients' age. METHODS: Chronic renal failure patients who started hemodialysis treatment between 2002 and 2003 were separated in two groups, 33 patients of 60 and older and 76 patients under 60. We investigated mortality rate difference, A-V shunt re-operation, and total protein and albumin level. Also, comparing and analyzing the urea reduction ratio, we examined whether effectiveness is different depending on the patients' age. RESULTS: The 3 year survivor rate of patients who initially started hemodialysis treatment over 60 was 66.7%, and that of the patients under 60 resulted as 73.1%. The average total protein lefel for over 60 was 6.48g/dL and for under 60 was 6.80g/dL, and albumin for over 60 was 3.15g/dL and under 60 was 3.46g/dL. We identified that the patients who repeated shunt operation in over 60 group was 4(12%) and in under 60 group was 4(5.2%). Effectiveness of the treatment, Urea Reduction Ratio(URR), for both groups was 71%. CONCLUSION: The 3 year survivor rate of patients who initially started hemodialysis treatment over 60 was lower than the control group, but considering the remaining life expectancy, it seems to be no significant difference between the groups; and the treatment effectiveness was same in both groups.
Humans ; Kidney Failure, Chronic ; Life Expectancy ; Prognosis ; Renal Dialysis ; Survivors ; Treatment Outcome ; Urea

PURPOSE: This study was designed to review the results of 2nd and 3rd kidney transplantation at our center. METHODS: Total 1,500 patients who had undergone kidney transplantation from 1968 to Aug 2005 at the Catholic Medical Center were retrospectively analyzed. The graft and patient survival were determined using Kaplan-Meier actuarial survival curves, compared with those of first transplant and assessed for significance using the log rank test. RESULTS: The patient of 2nd transplantation was 77 cases (male 55, female 22, mean age: 48.9+/-2.4 years) and 3rd transplantation was 5 patients (male 4, female 1, mean age 46.8+/-6.0 years). The 82 kidneys included from living donors in 67 patients and from cadaveric donors in 15 patients. The most common cause of renal failure of retransplanted kidney was chronic GN (2nd: 62 cases (80.5%), 3rd: 5 cases (100%)). The immunosuppressive regimen was mainly based on cyclosporine (2nd: 61 cases (79.2%), 3rd: 3 cases (60%)). The mean duration of the second transplantation from the first was 89.0 months and the third transplantation from the second was 32.7 months. There were 16 cases of death patients and the main cause of death was infection and cardiovascular events. The graft survival of 2nd & 3rd transplantation in 1 year were over 80%. CONCLUSION: Renal retransplantation is safe, effective, and the treatment of choice in patients with failed previous kidney transplantation for patient's quality of life and not associated with increased mortality retransplantation. The results of graft survival for retransplantation seem to be excellent for primary transplantation under cyclosporine or tacrolimus-based immunosuppression. The use of the potent and appropriate immunosuppression and surgical technique for retransplantation could help to improve better results.
Cadaver ; Cause of Death ; Cyclosporine ; Female ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation* ; Kidney* ; Living Donors ; Mortality ; Organ Transplantation* ; Quality of Life ; Renal Insufficiency ; Retrospective Studies ; Tissue Donors ; Transplants*

BACKGROUND: Although degree of motor blockade during high thoracic spinal anesthesia is difficult to determine, pulmonary function may reflect the level of motor blockade. So we checked pulmonary function during spinal anesthesia with two different local anesthetic agents. METHODS: 50 patients, ASA PS 1-2, were randomly divided into two groups. After basal pulmonary function test (FVC: forced vital capacity, FEV1: forced expiratory volume in one second, PEFR: peak expiratory flow rate, PEP: peak expiratory pressure, PIP: peak inspiratory pressure.), the patients received spinal anesthesia with either 0.5% hyperbaric bupivacaine or 0.5% hyperbaric tetracaine. Thirty minutes after injection, level of sensory blockade was checked by pinprick test and pulmonary function test was performed. RESULTS: Almost all the values of pulmonary function reduced after spinal anesthesia, but the degrees of reduction were not differ in two groups except PEP, which reduced more profoundly in tetracaine group than bupivacaine group. CONCLUSIONS: It is more desirable that we use bupivacaine rather than tetracaine as spinal anesthetic agent in the patient with poor pulmonary function.
Anesthesia, Spinal* ; Anesthetics ; Bupivacaine* ; Forced Expiratory Volume ; Humans ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Tetracaine* ; Vital Capacity

PURPOSE: To report 2 young female patients with bilateral posterior scleritis and serous retinal detachment. CASE SUMMARY: An 11-year-old girl (Case 1) and a 16-year-old girl (Case 2) visited our clinic with bilateral ocular pain, redness, and blurred vision. Slit lamp examinations revealed severe bilateral scleral injection and mild anterior chamber reactions. Fundus examinations showed bilateral serous retinal detachments in the macular area. In both patients, diffuse multifocal leaking and pooling were found at the macula in the early and late phase fluorescein angiography, respectively. On the B-mode ultrasounds and orbital images (MRI or CT), scleral thickening with retention of subtenons fluid were found. There were no systemic diseases associated with the conditions. We diagnosed the patients with bilateral posterior scleritis and administered systemic steroids. After systemic steroid treatment, all of the symptoms were alleviated. Three months after the regression, bilateral posterior scleritis recurred in patient 2. Oral cyclosporine 100 mg was additionally prescribed in addition to the previous medications that she had taken during her first treatment. CONCLUSIONS: Two young patients diagnosed with posterior scleritis and serous retinal detachment was treated with systemic steroids. With proper examination and treatment, posterior scleritis can be treated with no complications.
Adolescent ; Anterior Chamber ; Child ; Cyclosporine ; Female ; Fluorescein Angiography ; Humans ; Orbit ; Retention (Psychology) ; Retinal Detachment ; Retinaldehyde ; Scleritis ; Steroids ; Vision, Ocular

OBJECTIVES: Glide path preparation is recommended to reduce torsional failure of nickel-titanium (NiTi) rotary instruments and to prevent root canal transportation. This study evaluated whether the repetitive insertions of G-files to the working length maintain the apical size as well as provide sufficient lumen as a glide path for subsequent instrumentation. MATERIALS AND METHODS: The G-file system (Micro-Mega) composed of G1 and G2 files for glide path preparation was used with the J-shaped, simulated resin canals. After inserting a G1 file twice, a G2 file was inserted to the working length 1, 4, 7, or 10 times for four each experimental group, respectively (n = 10). Then the canals were cleaned by copious irrigation, and lubricated with a separating gel medium. Canal replicas were made using silicone impression material, and the diameter of the replicas was measured at working length (D0) and 1 mm level (D1) under a scanning electron microscope. Data was analysed by one-way ANOVA and post-hoc tests (p = 0.05). RESULTS: The diameter at D0 level did not show any significant difference between the 1, 2, 4, and 10 times of repetitive pecking insertions of G2 files at working length. However, 10 times of pecking motion with G2 file resulted in significantly larger canal diameter at D1 (p < 0.05). CONCLUSIONS: Under the limitations of this study, the repetitive insertion of a G2 file up to 10 times at working length created an adequate lumen for subsequent apical shaping with other rotary files bigger than International Organization for Standardization (ISO) size 20, without apical transportation at D0 level.
Dental Pulp Cavity ; Silicones ; Transportation

OBJECTIVES: Glide path preparation is recommended to reduce torsional failure of nickel-titanium (NiTi) rotary instruments and to prevent root canal transportation. This study evaluated whether the repetitive insertions of G-files to the working length maintain the apical size as well as provide sufficient lumen as a glide path for subsequent instrumentation. MATERIALS AND METHODS: The G-file system (Micro-Mega) composed of G1 and G2 files for glide path preparation was used with the J-shaped, simulated resin canals. After inserting a G1 file twice, a G2 file was inserted to the working length 1, 4, 7, or 10 times for four each experimental group, respectively (n = 10). Then the canals were cleaned by copious irrigation, and lubricated with a separating gel medium. Canal replicas were made using silicone impression material, and the diameter of the replicas was measured at working length (D0) and 1 mm level (D1) under a scanning electron microscope. Data was analysed by one-way ANOVA and post-hoc tests (p = 0.05). RESULTS: The diameter at D0 level did not show any significant difference between the 1, 2, 4, and 10 times of repetitive pecking insertions of G2 files at working length. However, 10 times of pecking motion with G2 file resulted in significantly larger canal diameter at D1 (p < 0.05). CONCLUSIONS: Under the limitations of this study, the repetitive insertion of a G2 file up to 10 times at working length created an adequate lumen for subsequent apical shaping with other rotary files bigger than International Organization for Standardization (ISO) size 20, without apical transportation at D0 level.
Dental Pulp Cavity ; Silicones ; Transportation

OBJECTIVES: The purpose of this study was to investigate the prevalence and correlates of major and minor depressive disorders in college students. METHODS: A cross-sectional study was completed on a sample of 906 students (507 men and 399 women) with the self-administered form of Korean version of Mini International Neuropsychiatric Interview (K-MINI). RESULTS: Estimated 12-month prevalence of major depressive disorder was 4.2% in men and 9.5% in women, and that of minor depressive disorder was 15.4% in men and 23.2% in women. The factors, 'female gender' and 'age of 20-21', were significantly associated with major depressive disorder. 'Poor adaptation to school' was significantly associated with major depressive disorder both in men and women, but 'poor interpersonal relationship' and 'history of school withdrawal' were associated only in men. Idea of self-injury and suicidal behaviors (suicidal ideation, plan and attempt) were significantly associated with major depressive disorder in women, but were not associated with minor depressive disorder. CONCLUSION: Major and minor depressive disorders are highly prevalent in the college students. Major depressive disorder was more associated with dysfunctions and suicidal behaviors than minor depressive disorder. Campus-based mental health service is needed for the high-risk students.
Cross-Sectional Studies ; Depressive Disorder* ; Depressive Disorder, Major ; Female ; Humans ; Male ; Mental Health Services ; Prevalence* ; Risk Factors*