We report a case of delayed rupture of an anterior communicating artery (Acom) pseudoaneurysm following mechanical thrombectomy (MT) of a distal artery occlusion using a stent retriever. An elderly patient with right hemiparesis showed left proximal internal cerebral artery and middle cerebral artery occlusions. During MT, a fragmented thrombus moved to the anterior cerebral artery (ACA). A stent retriever was deployed to the occluded ACA, and the Acom and proximal ACA segment were significantly straightened. Additionally, we attempted a blind exchange mini-pinning (BEMP) technique, but a subarachnoid hemorrhage (SAH) occurred. Bleeding was almost entirely absorbed 9 days after the procedure, but the SAH recurred at 20 days, and computed tomography angiography revealed a new pseudoaneurysm formation in the Acom. We suggest that the proposed mechanism of pseudoaneurysm formation was likely due to the dislocation and avulsion of the Acom perforators when the ipsilateral ACA was pushed and pulled during MT.

Chronic obstructive pulmonary disease (COPD) is a chronic progressive disease, characterized by irreversible airflow limitation, with a partially reversible component. The pathological abnormalities of COPD are associated with lung inflammation, imbalances of proteinase and antiproteinase, and oxidative stress, which are induced by noxious particles and gases in susceptible individuals. The physiological changes of COPD are mucus hyper-secretion, ciliary dysfunction, airflow limitation, pulmonary hyperinflation, gas exchange abnormalities, pulmonary hypertension, cor pulmonale and systemic effects. The airflow limitation principally results from an increase in the resistance of the small conducting airways and a decrease in pulmonary elastic recoil due to emphysematous lung destruction. This article provides a general overview of the pathophysiology of COPD.
Emphysema ; Gases ; Hypertension, Pulmonary ; Lung ; Mucus ; Oxidative Stress ; Pneumonia ; Pulmonary Disease, Chronic Obstructive* ; Pulmonary Heart Disease

A 63-year-old Korean man presented with generalized, asymptomatic, discrete papules and coalescent annular plaques for one year. Interestingly, the patient complained of conjunctival congestion, concurrently with aggravation of the skin lesion. Histopathologic findings of the skin lesion and conjunctiva revealed giant cells engulfing fragmented elastic fibers, and a diagnosis of actinic granuloma with ocular involvement was made. Ten months later, the patient revisited with a two-week history of bilateral temporal headache, neck pain, intermittent jaw claudication, and blurred vision. Biopsy of the temporal artery confirmed the clinical diagnosis of temporal arteritis. Both actinic granuloma and temporal arteritis show similar pathologic process, and this case supports the hypothesis that actinically degenerated elastic tissue is likely to be the antigenic basis of actinic granuloma of the skin and temporal arteritis.
Actins* ; Biopsy ; Conjunctiva ; Diagnosis ; Elastic Tissue ; Estrogens, Conjugated (USP) ; Giant Cell Arteritis* ; Giant Cells ; Granuloma* ; Headache ; Humans ; Jaw ; Middle Aged ; Neck Pain ; Skin ; Temporal Arteries

PURPOSE: It has been customary to perform brain ultrasonogram (brain US) for the early detection of intraventricular hemorrhage (IVH) during intensive care of neonates. On the other hand magnetic resonance imaging (MRI) has been greatly restrictioned due to its complicated procedures. This study was conducted to identify changes in neonates' brain structure and to gain basic data for the long-term follow-up of neurologic sequelae in the future. For this purpose, the findings obtained from both brain US performed within one postnatal week and MRI at the time of discharge were compared and analysed. METHODS: Brain US within one postnatal week and MRI at discharge were carried out on 67 neonates who were discharged from the neonatal intensive care unit of Fatima Hospital from July 01, 1996 to June 30, 1998. We compared and analysed IVH found in the brain US, and focal parenchymal hemorrhage, periventricular leukomalacia (PVL), basal ganglia hemorrhage, and encephalomalacia revealed the MRI performed at discharge. RESULTS: It was found that out of 67 cases from the brain US, there were 13 with IVH of Grade l & ll, 11 with IVH of Grade lll or higher, one with focal parenchymal hemorrhage, and three with PVL. Also the MRI found seven with focal parenchymal hemorrhage, one with basal ganglia hemorrhage, six with PVL, three with encephalomalacia, and one with ventricular dilatation. CONCLUSION: For infants with IVH of Grade lll or higher, MRI performed at discharge is considered to be very useful in identifying structural parenchymal abnormality and the presence or absence of its associated lesions as well as in carrying out long-term follow-up.
Basal Ganglia Hemorrhage ; Brain* ; Dilatation ; Encephalomalacia ; Follow-Up Studies ; Hand ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Critical Care ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging* ; Ultrasonography*

BACKGROUND: 1-8D gene is a member of human 1-8 interferon inducible gene family and was shown to be overexpressed in fresh colon cancer tissues. Three peptides 1-6, 3-5 and 3-7 derived from human 1-8D gene were shown to have immunogenicity against colon cancer. METHODS: To study tumor immunotherapy of three peptides we established an active immunization model using HHD mice. D(b-/-) x beta2 microglobulin (beta2 m) null mice transgenic for a chimeric HLA-A2.1/D(b-)beta2 m single chain (HHD mice) were challenged with B16/HHD/1-8D tumor cells and were immunized with irradiated peptide-loaded RMA- S/HHD/B7.1 transfectants. In therapy model tumor growth was retarded in HHD mice that were injected with 3-5 peptide-loaded RMA-S/HHD/B7.1. In survival test vaccination with 1-8D-derived peptide protects HHD mice from tumor progression after tumor challenge. RESULTS: These studies show that peptide 3-5 derived from 1-8D gene can be the most effective candidate for the vaccine of immunotherapy against colon cancer and highlight 1-8D gene as putative colon carcinoma associated antigens. CONCLUSION: We demonstrated that RMA-S/HHD/ B7.1 loaded with 1-8D peptides, especially 3-5, immunization generates potent antitumor immunity against tumor cells in HHD mice and designed active immunization as proper immunotherapeutic protocols.
Animals ; Antigens, Tumor-Associated, Carbohydrate ; Colon* ; Colonic Neoplasms* ; Humans ; Immunization ; Immunotherapy ; Interferons ; Mice* ; Peptides ; Vaccination*

Acute coronary closure occurs 2-10% during the procedure of PTCA, 50-80% of those events are in the catheterization room. The causes of acute coronary closure are mainly due to dissection, thrombosis or spasm. We recently experienced a case of acute left main coronary artery closure due to guiding catheter induced embolization in the 56 year-old female, unstable angina patient complicated by diabetes mellitus and chronic renal failure. The patient received cardiopulmonary resuscitation shortly after acute closure because of cardiac arrest. During the resuscitation, we performed PTCA at the site of acute closure. The blood pressure maintained normaly after successful recanalization. And then we inserted IABP(intraaortic balloon pump) balloon and did PTCA of original stenosis sites. The patient removed IABP 24 hours later and discharged a month later without complication.
Angina, Unstable ; Blood Pressure ; Cardiopulmonary Resuscitation* ; Catheterization ; Catheters* ; Constriction, Pathologic ; Coronary Vessels ; Diabetes Mellitus ; Female ; Heart Arrest ; Humans ; Kidney Failure, Chronic ; Middle Aged ; Resuscitation ; Spasm ; Thrombosis

Contrary to ventricular mural thrombi, left atrial appendage thrombi are extremely rare in cerebral infarction correlated with acute myocardial infarction but they can be easily detected by transesophageal echocardiography(TEE). We expierienced a case of cerebral infarction which was suspected to be caused from the thrombi in left atrial appendage in a patient with acute myocardial infarction. The cerebral infarction was developed 2 days after myocardial infarction had been occurred and any source of the thrombi could not be detected except in left atrial appendage. The diagnosis was established by TEE and also aided by transthoracic echocardiography, brain computed tomography.
Atrial Appendage* ; Brain ; Cerebral Infarction* ; Diagnosis ; Echocardiography ; Humans ; Myocardial Infarction*

BACKGROUND: In this study, the quality of life of patients with chronic and episodic migraine was compared using quality of life assessments tools, which included the MIDAS (migraine disability assessment) questionnaire and MSQoL (migraine-specific quality of life) questionnaire. METHODS: The investigation occurred from November 2005 to April 2006 for patients who visited the neurology department of hospital in because of headache. The patients for the question investigation consisted of 34 patients with chronic migraine (CM) and 48 patients with episodic migraine (EM). The diagnosis of migraines was obtained by the migraine criteria of the International Headache Society (IHS). RESULTS: In the comparisons of the MIDAS score in patients with CM and EM, the second question (reduced effectiveness at work/school), the fourth question (reduced effectiveness in housework), total scores (28+/-19.7 versus 12.0+/-10.1, p<.01), and the question A were higher in CM patients (51.2+/-20.1 versus 15.5+/-13.1, p<.01). MIDAS grade of CM patients were also higher than EM patients. In MSQoL score comparisons of CM and EM patients, three parts of life qualities, which are role-function restrictive, role-function preventive, and emotional function due to headache, and total score (61.9+/-11.7 versus 73.7+/-13.9, p<.01) was less in CM patients than EM patients. CONCLUSIONS: The study shows that life qualities of the patients with CM were significantly lower than of the patients with EM.
Diagnosis ; Headache ; Humans ; Migraine Disorders* ; Neurology ; Quality of Life* ; Surveys and Questionnaires

BACKGROUND: Hybrid coronary revascularization (HCR) was developed to combine the advantages of coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI). However, it is still controversial whether it is more optimal to perform CABG or PCI first. The purpose of this study was to compare the clinical outcomes of these 2 approaches. METHODS: Eighty patients who underwent HCR from May 2010 to December 2015 were enrolled in this retrospective analysis. The CABG-first group comprised 12 patients and the PCI-first group comprised 68 patients. Outcomes of interest included in-hospital perioperative factors, major adverse cardiac and cerebrovascular events (MACCEs), and the incidence of repeated revascularization, especially for the target vessel lesion. RESULTS: No significant difference was found in the amount of postoperative bleeding (p=0.239). The incidence of MACCEs was similar between the CABG-first and PCI-first groups (1 of 12 [8.3%] vs. 5 of 68 [7.4%], p>0.999). Repeated revascularization was performed on 3 patients (25%) in the CABG-first and 9 patients (13.2%) in the PCI-first group (p=0.376). CONCLUSION: There were no significant differences in postoperative and medium-term outcomes between the CABG-first and PCI-first groups. Based on these results, it can be inferred that it is safe to opt for either CABG or PCI as the primary procedure in 2-stage HCR.
Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Hemorrhage ; Humans ; Incidence ; Percutaneous Coronary Intervention ; Retrospective Studies ; Transplants

Coronary artery spasm plays an important role for evoking myocardial ischemia and infarction as well as sudden cardiac death in patients with variant angina. The coronary anatomy in patients with variant angina has been defined both at autopsy and during coronary arteriography. Severe porximal coronary atherosclerosis of at least one major vessel occurs in 3/4 of patients and the remainder have normal coronary arteries. Coronary angiography is a relatively insensitive diagnostic tool especially in the early stages of coronary artery disease. Due to arterial remodelling, angiographic luminogram may show little or no narrowing even though a large part of the total vessel area is occupied by plaque. Intravascular ultrasonography(IVUS) enables accurate determination of vessel dimensions and wall characteristics and is more sensitive in delineating early intimal changes than angiography. We experienced 2 cases that IVUS showed focal or diffuse atherosclerosis in spastic segments of the coronary arteries, even though they appeared angiographically normal.
Angiography ; Atherosclerosis ; Autopsy ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Death, Sudden, Cardiac ; Humans ; Infarction ; Muscle Spasticity* ; Myocardial Ischemia ; Spasm