No abstract available.
Erythropoietin* ; Humans* ; Renal Dialysis*

PURPOSE: Many articles have proposed that osteonecrosis of the femoral head (ONFH) is caused by fat embolism or intravascular coagulation linked to hyperlipidemia. To determine whether hyperlipidemia is an associated factor for ONFH, serum lipid levels were measured. MATERIALS AND METHODS: Nighty-eight patients presenting with ONFH and 110 controls were investigated. We compared the average value of serum lipid levels and the incidence of hyperlipidemia of the two groups. RESULTS: ONFH group showed generalized increase in lipid level and statistically significant difference in the average value of total cholesterol (P=0.0001), HDL-cholesterol (P=0.0261) and phospholipid (P=0.0465) compared with the control. The incidence of hyperlipidemia of the two groups showed statistically significant difference in HDL-cholesterol (P=0.019) and triglyceride (P=0.024). CONCLUSION: Hyperlipidemia seems to be associated with pathogenesis of ONFH. We speculated that hyperlipidemia might be a contributing factor of ONFH. Hyperlipidemia may play a role as a triggering factor in the pathogenetic process that results in osteonecrosis. However, it can not be ruled out that secondary hyperlipidemia might be a finding following ONFH.
Cholesterol ; Embolism, Fat ; Head* ; Humans ; Hyperlipidemias ; Incidence ; Osteonecrosis* ; Triglycerides

In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.
Autoantibodies ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia* ; Dermatomyositis* ; Dyspnea ; Fibrosis ; Humans ; Immunoglobulins* ; Immunosuppressive Agents ; Inflammation ; Lung Diseases, Interstitial ; Middle Aged ; Pneumonia ; Prognosis ; Respiratory Insufficiency ; Steroids

Benign tumors of the trachea are rare and are usually misdiagnosed as bronchial asthma because of the similarity of the symptoms and signs. Although the prognosis of neurofibroma which originats from Schwann cells is good, it may recur or undergo malignant change, so segmental resection of the trachea is recommended. Recently, we experienced a case of primary neurofibroma of the trachea treated successfully by segmental resection of the trachea and end-to-end anastomosis. We report it with a brief review of literatures.
Asthma ; Neurofibroma* ; Prognosis ; Schwann Cells ; Trachea* ; Tracheal Neoplasms

BACKGROUND/AIMS: To investigate the use of measurements of liver stiffness (LS) by two-dimensional real-time shear wave elastography (SWE) for predicting the development of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). METHODS: We retrospectively collected data on 291 enrolled patients with CHB whose LS had been measured using SWE. RESULTS: The mean age of the patients was 46.8 years; males predominated (67%), and 40 of the patients (14%) had clinical cirrhosis. Among the patients, 165 (56.7%) received antiviral treatment. The median LS value was 7.4 kPa, and the median follow-up period was 35.8 months (range, 3.0 to 52.8 months). During follow-up, HCC developed in 13 patients (4.5%), and the cumulative incidence rates of HCC at 1, 2, and 4 years were 1.1%, 3.6%, and 8.4%, respectively. Based on a multivariate analysis, older age (≥50 years) and higher LS value (≥10 kPa) were independently associated with the risk of developing HCC (hazard ratio [HR], 4.53, p=0.023; and HR, 4.08, p=0.022). The cumulative incidence rate of HCC was significantly higher in patients with higher LS values (≥10 kPa) than in those with lower LS values ( < 10 kPa) (p=0.001). CONCLUSIONS: Increased LS measured by SWE at any time point regardless of antiviral treatment is associated with an increased risk of HCC in patients with CHB.
Carcinoma, Hepatocellular* ; Elasticity Imaging Techniques* ; Fibrosis ; Follow-Up Studies ; Hepatitis B ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Incidence ; Liver ; Male ; Multivariate Analysis ; Retrospective Studies

PURPOSE: The purpose of this study was to find out what clinicopathologic or immunohistochemical parameter that may affect FDG uptake of primary tumor in PET/CT scan of the gastric carcinoma patient. MATERIALS AND METHODS: Eighty-nine patients with stomach cancer who underwent pre-operative FDG PET/CT scans were included. In cases with perceptible FDG uptake in primary tumor, the maximum standardized uptake value (SUVmax) was calculated. The clinicopathologic results such as depth of invasion (T stage), tumor size, lymph node metastasis, tumor differentiation and Lauren's classification and immunohistochemical markers such as Ki-67 index, expression of p53, EGFR, Cathepsin D, c-erb-B2 and COX-2 were reviewed. RESULTS: Nineteen out of 89 gastric carcinomas showed imperceptible FDG uptake on PET/CT images. In cases with perceptible FDG uptake in primary tumor, SUVmax was significantly higher in T2, T3 and T4 tumors than T1 tumors (5.8+/-3.1 vs. 3.7+/-2.1, p=0.002). SUVmax of large tumors (above or equal to 3 cm) was also significantly higher than SUVmax of small ones (less than 3 cm) (5.7+/-3.2 vs. 3.7+/-2.0, p=0.002). The intestinal types of gastric carcinomas according to Lauren showed higher FDG uptake compared to the non-intestinal types (5.4+/-2.8 vs. 3.7+/-1.3, p=0.003). SUVmax between p53 positive group and negative group was significantly different (6.0+/-2.8 vs. 4.4+/-3.0, p=0.035). No significant difference was found in presence of LN metastasis, tumor differentiation, Ki-67 index, and expression of EGFR, Cathepsin D, c-erb-B2 and COX-2. CONCLUSION: T stage of gastric carcinoma influenced the detectability of gastric cancer on FDG PET/CT scan. When gastric carcinoma was perceptible on PET/CT scan, T stage, size of primary tumor, Lauren's classification and p53 expression were related to degree of FDG uptake in primary tumor.
Cathepsin D ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms

Herein, we present a case of a successful catheter ablation of ventricular tachycardia (VT) using a radial artery approach in a post-myocardial infarction patient, who had an implantable cardioverter-defibrillator and peripheral artery disease. Although the patient did not use antiarrhythmic drugs, the patient experienced no recurrence of VT during the following 3-year period.
Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Catheter Ablation ; Catheters ; Defibrillators, Implantable ; Humans ; Infarction ; Myocardial Infarction ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Radial Artery ; Recurrence ; Tachycardia, Ventricular ; Ventricular Premature Complexes

OBJECTIVE: The use of decompressive craniectomy for treating massive cerebral infarction is attracting much attention because conventional medical treatment is associated with high mortality. The aim of this retrospective study was to evaluate the surgical treatment results and prognostic factors for patients suffering with malignant cerebral infarction. METHODS: We analyzed 9 consecutive patients who underwent decompressive craniectomy with or without temporal lobectomy after malignant cerebral infarction from 2000 to 2008. We reviewed the medical records, the radiological finding and the pre-operative clinical assessment using the Glasgow Coma scale (GCS). The postoperative functional outcome was assessed as the Barthel-Index (BI) and the modified Rankin scale (mRS). RESULTS: The male to female ratio was 3.5:1. The mean age was 50 years (range: 36-68). Eight patients (89%) showed involvement of the entire middle cerebral artery (MCA) territory and the concomitant anterior cerebral artery (ACA) or posterior cerebral artery (PCA) territory. The preoperative mean GCS was 8.3 (range: 5-12) and the mean time to surgery after the onset of symptoms was 47.7 hours (range: 4-168 hours). All the patients underwent decompressive craniectomy and duroplasty. Among them, four patients (45%) underwent temporal lobectomy. The mean followup period was 7.3 months (range: 1-26 months) and five patients died within this period. CONCLUSION: Decompressive craniectomy with or without lobectomy for patients with malignant cerebral infarction decreases the mortality rate and it improves the functional outcome. In the survived group, comparison of the two surgical modalities didn't show any statistically significant difference. However, the decompressive craniectomy with lobectomy group demonstrated a high survival rate (75%). Future studies are needed to investigate the proper treatment modalities for malignant cerebral infarction.
Anterior Cerebral Artery ; Cerebral Infarction ; Decompressive Craniectomy ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Male ; Medical Records ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Retrospective Studies ; Stress, Psychological ; Survival Rate

A 45-year old man, who had tuberculosis five years ago presented with paresthesia, decreased proprioception, and gait disturbance in the lower extremity which were aggravated for a month. Magnetic resonance imaging revealed the T3-7 intradural extramedullary fibrotic mass with dark signal intensity on T2-weighted images. The yellowish material in the thick fibrous mass was confirmed as caseous necrosis. Two days after the operation, the symptoms improved. Although quite rare, intradural extramedullary tuberculoma should be considered as a chronic sequel of the previous medical history of pulmonary tuberculosis or tuberculous meningitis.
Gait ; Lower Extremity ; Magnetic Resonance Imaging ; Necrosis ; Paresthesia ; Proprioception ; Tuberculoma ; Tuberculosis ; Tuberculosis, Meningeal ; Tuberculosis, Pulmonary

PURPOSE: To evaluate the technical feasibility and clinical efficacy of the use of local thrombolysis for below-knee deep vein thrombosis (DVT). MATERIALS AND METHODS: From a population of 41 patients with a lower extremity DVT, the prospective clinical trial included 11 patients (7 female, 4 male, average age 61.4 years) treated with catheter-directed thrombolysis with urokinase for below-knee DVT. After removal of the proximal ilofemoral DVT, additional interventional procedures to remove the residual thrombus and restore the venous flow from the below-knee vein were performed in cases of continuous occlusion of venous flow from the popliteal and tibial veins. Under ultrasound (US) guidance, catheter-directed thrombolysis with urokinase was performed through the ipsilateral popliteal vein. After administration of oral anticoagulation therapy, CT and venography were performed to identify patency and the presence of a recurrent thrombosis. RESULTS: Successful removal of the thrombus and restoration of venous flow were achieved in all of the patients (100%). Restoration of flow with a residual thrombus occurred in one case. Focal venous stenosis was discovered in four cases. The duration of urokinase infusion was 1-4 days (average 2.36 days), which was considered long. For 15.2 months, the venous lumen of all cases was preserved without a recurrent thrombosis. CONCLUSION: Catheter-directed thrombolysis is an effective procedure for recanalization of below-knee DVT in patients with a lower extremity DVT.
Constriction, Pathologic ; Female ; Humans ; Lower Extremity ; Male ; Phlebography ; Popliteal Vein ; Prospective Studies ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins ; Venous Thrombosis