We report a case of basilar artery dissection presenting with subarachnoid hemorrhage, which was successfully treated with self-expandable stent placement and coil embolization, achieving excellent clinical and anatomical outcome. This method can provide protection of the rupture point, collapse of dissected space within the vessel wall, and prevention of further dissection although long-term outcome needs to be seen.
Basilar Artery* ; Embolization, Therapeutic* ; Rupture* ; Stents* ; Subarachnoid Hemorrhage

Two cases of blood blisterlike aneurysm or dorsal bleb of the internal carotid artery (ICA) underwent segmental occlusion of the aneurysmal segment and trapping of the ICA. With this procedure, the causative lesions were successfully excluded from the circulation and moderate to good clinical outcome could be attained. We describe these cases with review of the literature.
Aneurysm ; Blister* ; Carotid Artery, Internal* ; Subarachnoid Hemorrhage

Azithromycin* ; Doxycycline* ; Scrub Typhus*

Pseudomembranous colitis (PMC) is a frequent cause of morbidity and mortality among hospitalized patients. Although diarrhea is the most common manifestation, PMC may be associated with intraperitoneal fluid accumulation in the severe cases. And a few cases showing both ascites and pleural effusion have been reported in patients with PMC. We report a case of PMC who showed elevated serum and ascites levels of carcinoembryonic antigen (CEA) with a normal CEA level in pleural effusion and who successfully recovered after oral administration of metronidazole. After treatment, the serum CEA level returned to the reference range.
Administration, Oral ; Ascites ; Carcinoembryonic Antigen* ; Diarrhea ; Enterocolitis, Pseudomembranous* ; Humans ; Metronidazole ; Mortality ; Pleural Effusion ; Reference Values

BACKGROUND: Many strategies to reduce pain during propofol injection have been investigated. Inhibitors of cyclooxygenase are frequently used to provide post operative pain relief in patients undergoing minor gynecologic surgery. Therefore, in this study, we have investigated whether ketorolac injected intravenously reduces pain during propofol injection. METHODS: Fifty healthy female patients scheduled for minor gynecological surgery were randomly allocated to one of four groups. All patients were inserted 20 G Angiocatheter into the veins on the dorsum of the hands. After applying an arm tourniquet at an inflation pressure of 40-45 mmHg, the control group received 2 ml of 0.9% saline, and those in groups I, II, and III received ketorolac 0.5, 0.75, and 1.0 mg/kg mixed with 2 ml of 0.9% saline respectively. The tourniquet was released 2 minutes later. 2 mg/kg of 1% propofol bolus was then injected with an infusion pump intravenously. After 50 mg of propofol were injected, patients were assessed for visual analogue scale (VAS) scores and pain grades. RESULTS: VAS scores during propofol injection diminished significantly in group II (0.75 mg/kg ketorolac) and group III (1 mg/kg ketorolac) compared with the control (saline) group. CONCLUSIONS: Pretreatment with intravenous ketorolac more than 0.75 mg/kg during the 2 minutes tourniquet time can reduce pain elicited by profofol injection.
Arm ; Female ; Gynecologic Surgical Procedures ; Hand ; Humans ; Inflation, Economic ; Infusion Pumps ; Ketorolac* ; Propofol* ; Prostaglandin-Endoperoxide Synthases ; Tourniquets ; Veins

OBJECTIVE: To evaluate the usefulness of time-resolved contrast enhanced magnetic resonance angiography (4D MRA) after stent-assisted coil embolization by comparing it with time of flight (TOF)-MRA. MATERIALS AND METHODS: TOF-MRA and 4D MRA were obtained by 3T MRI in 26 patients treated with stent-assisted coil embolization (Enterprise:Neuroform = 7:19). The qualities of the MRA were rated on a graded scale of 0 to 4. We classified completeness of endovascular treatment into three categories. The degree of quality of visualization of the stented artery was compared between TOF and 4D MRA by the Wilcoxon signed rank test. We used the Mann-Whitney U test for comparing the quality of the visualization of the stented artery according to the stent type in each MRA method. RESULTS: The quality in terms of the visualization of the stented arteries in 4D MRA was significantly superior to that in 3D TOF-MRA, regardless of type of the stent (p < 0.001). The quality of the arteries which were stented with Neuroform was superior to that of the arteries stented with Enterprise in 3D TOF (p < 0.001) and 4D MRA (p = 0.008), respectively. CONCLUSION: 4D MRA provides a higher quality view of the stented parent arteries when compared with TOF.
Adult ; Aged ; Cerebral Arteries/pathology ; *Contrast Media ; *Embolization, Therapeutic ; Female ; Humans ; *Imaging, Three-Dimensional ; Intracranial Aneurysm/*diagnosis/therapy ; *Magnetic Resonance Angiography/methods ; Male ; Middle Aged ; Sensitivity and Specificity ; *Stents ; Young Adult

T cell mediated immunity amlifies macrophage capacities to kill and digest the bacilli through production of interferon-gamma (IFN-gamma). The secreted cytokines of Th1 and Th2 cells can mutually regulate and inhibit each other's function. Therefore, the fine balance between the secreted cytokines is important for the resulting nature of tuberculosis. In this study, activation marker and cytokine production profiles were compared in patients with active tuberculosis and healthy control, and according to degree of radiographic extent and pleural involvement. METHOD:Forty-four patients with active pulmonary tuberculosis and 25 normal controls were recruited. We measuerd soluble interleukin-2 receptor(sIL-2R), IFN-r, IL-4 and IL-5 produced from blood mononuclear cells in vitro stimulation with phytohemagglutinin by ELISA. RESULTS: The sIL-2R and IFN-gamma from patients with active pulmonary tuberculosis were significantly lower than normal control, while IL-4 and IL-5 were not different between two group. The sIL-2R and IFN-r decreased in proportion to the extent of pulmonary involvement, and the sIL-2R and IFN-r from pulmonary tuberculosis with pleural effusion were significantly lower than those without pleural effusion. CONCLUSION: At the level of systemic T cells, development of tuberculosis is associated with diminished Th1 but not enhanced Th2 response.
Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunity, Cellular ; Interferon-gamma ; Interleukin-2 ; Interleukin-4 ; Interleukin-5 ; Macrophages ; Pleural Effusion ; T-Lymphocytes ; Th2 Cells ; Tuberculosis ; Tuberculosis, Pulmonary

OBJECTIVE: This study was designed to evaluate the feasibility and clinical implications of CT angiography (CTA) in patients with acute ischemic stroke. METHODS: From August 2004 to July 2005, 24 cases of acute ischemic stroke were prospectively included in this study. We checked location of ischemic parenchymal lesion, location of vascular occlusion, degree of collateral supply, and presence of other accompanying vascular lesions on CT and CTA, and assessed the usefulness of CTA by comparing the findings with those of diffusionweighted MR imaging and digital subtraction angiography. RESULTS: Average time required for performing CT and CTA and getting reconstructed images was 30 minutes. Location of the parenchymal lesions and the corresponding occluded or stenosed artery could be clarified in 16 cases (67%) and 20 cases (83%), respectively. There were 13 cases of severe stenosis and 7 cases of occlusion. In 7 cases of major arterial occlusion, degree of collateral circulation could be assessed as good in 5, and moderate in 2. Incidental unruptured intracranial aneurysms were identified in 5 cases. CONCLUSION: CTA could provide valuable information regarding locations of parenchymal lesion and vascular occlusion, degree of collateral supply, and presence of accompanying intracranial aneurysm in cases of acute ischemic stroke without significant time delay, thereby guiding therapeutic plan.
Angiography* ; Angiography, Digital Subtraction ; Arteries ; Collateral Circulation ; Constriction, Pathologic ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Prospective Studies ; Stroke*

OBJECTIVE: To investigate the incidence of non-responder to hormone replacement therapy (HRT) and to evaluate the bone response to HRT according to basal bone mineral density(BMD) in postmenopausal women. METHODS: A total of 211 postmenopausal women received either continuous combined estrogen-progestogen replacement (n=112) or estrogen replacement (n=99) for 1 years. BMD at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry (DEXA) before and 1 year after HRT. RESULTS: The incidence of non-responder (women with > 3% bone loss per year) to HRT was 9.2% in the lumbar spine, and 23.8% in femoral neck. Estrogen replacement group had a higher incidence of non-responder than combined replacement group. Non-responder group had a higher basal BMD at the lumbar spine than responder group, and showed bone loss rate of 7.6% per year. After 1 year of HRT, postmenopausal women with osteoporosis showed a higher rate of increase in BMD at the lumbar sine and femoral neck than women with normal BMD or osteopenia. CONCLUSION: The non-responders to HRT have a higher basal lumbar BMD, compared with responders. The higher basal BMD at the lumbar spine is, the less bone conservation effect of HRT is.
Absorptiometry, Photon ; Bone Density* ; Bone Diseases, Metabolic ; Estrogen Replacement Therapy ; Female ; Femur Neck ; Hormone Replacement Therapy* ; Humans ; Incidence ; Osteoporosis ; Spine

The incidence of gastric band erosion has decreased to 1%. Gastric band erosion can manifest with various clinical symptoms, although some patients remain asymptomatic. We present a case of a mostly asymptomatic patient who was diagnosed with gastric band erosion during a routine health check-up. A 32-year-old man without any underlying diseases except for non-alcoholic fatty liver underwent laparoscopic adjustable gastric band surgery in 2010. He had no significant complications postoperatively. He underwent routine health check-ups with near-normal gastroduodenoscopic findings through 2014. However, in 2015, routine gastroduodenoscopy showed that the gastric band had eroded into the stomach. His gastric band was removed laparoscopically, and the remaining gastric ulcer perforation was repaired using an omental patch. Due to the early diagnosis, the infection was not serious. The patient was discharged on postoperative day 3 with oral antibiotics. This patient was fortunately diagnosed early by virtue of a routine health check-up; thus, eliminating the possibility of serious complications.
Adult ; Anti-Bacterial Agents ; Bariatric Surgery ; Cytochrome P-450 CYP1A1 ; Early Diagnosis ; Fatty Liver ; Humans ; Incidence ; Obesity, Morbid ; Stomach ; Stomach Ulcer ; Virtues