BACKGROUND: Despite improvement of mortality in acute myocardial infarcrtion, high mortality rate associated with cardiogenic shock remains essentially unchanged. We have reviewed our result of coronary intervention in 15 patients and found relative survival advantage. METHODS: Between Sep. 1992 and Aug. 1995, 15 consecutive patients(M. 10, F. 5) with cardiogenic shock in acute myocardial infarction were treated with coronary intervention using ballon PTCA. IABP was inserted in all patients prior to PTCA. RESULTS: 1) Most commonly found infarct related artery was left anterior descending artery(11) followed by right coronary artery(3) and left main coronary artery(1). 2) Successful reperfusion rate was 86.7%(13/15), and in-hospital mortality rate was 26.7%(4/15). 3) In-hospital mortality was higher in elderly patients compared with less than 70yaer old patients(0%(0/11)vs. 75.0%(3/4)(P < 0.05). 4) Mortality rate was lower in single vessel disease than multivessel disease(11.1%(1/9) vs. 50%(3/6) p<0.05). CONCLUSION: Although this study is uncontrolled, the date suggest that urgent coronary intervention for improving coronary perfusion may reduce mortality of acute myocardial infarction complicated by cardiogenic shock, particularly with single vessel disease and young age group.
Aged ; Arteries ; Hospital Mortality ; Humans ; Mortality ; Myocardial Infarction* ; Perfusion ; Reperfusion ; Shock, Cardiogenic*

PURPOSE: This study was undertaken to correlate the CT and histopathologic findings of abscess wall. MATERIALS AND METHODS: The CT findings of 12 patients with pathologically proven brain abscess were retrospectively analyzed with particular attention to the thickness, smoothness and uniformity of enhancing abscess wall, and the results were correlated with histopathologic findings. RESULTS: Two patients with acute cerebritis showed an isodense ring on non-contrast CT(NCCT), but a true capsule formation could not be identified at pathologic examination. Six other patients with isodense ring on NCCT consisted of early to late cerebritis(3 cases), late cerebritis to early capsule(1 case), early capsule(1 case), and late capsule(1 case). These 6 cases showed ring enhancement on contrast enhanced CT(CECT) and true capsule formation pathologically. There was no isodense ring on NCCT in the remaining four patients. They consisted of early to late cerebritis(2 cases), late cerebritis(1 case), and late cerebritis to early capsule formation(1 case). These also showed ring enhancement on CECT and true capsule formation pathologically. CONCLUSION: We found that it is difficult to predict the exact stage of brain abscess on preoperative CT findings. It is suggested that clinical findings and sequential dynamic CT may provide more detailed informations for evaluation of abscess staging.
Abscess ; Brain Abscess* ; Brain* ; Humans ; Retrospective Studies

Despite advances in surgical techniques and instrumentation, current intra-operative estimations of acetabular version in total hip arthroplasty are of limited accuracy. In the present study, two experienced orthopedic surgeons compared intra-operatively measured (using portable imaging) anteversions and vertical inclinations of acetabular components with those measured using standardized radiographs post-operatively in 40 patients. Of the all vertical inclinations measured from intra-operative radiographs, 72.5% (n=29) were within +/-2degrees, and 97.5% (n=39) were within +/-5degrees of those determined using post-operative radiographs, and for anteversion, 52.5% (n=21) were within +/-2degrees, and 97.5% (n=39) were within +/-5degrees. Post-operative radiographs demonstrated that 90.0% (n=36) of vertical inclinations and anteversions were within the adequate zone. Obviously, our method has its limitations, but the authors conclude that the method described in this article better allows surgeons to verify acetabular version intra-operatively. In particular, the described method is suitable in cases with a deformed acetabular anatomy and difficult revision surgery.
Acetabulum/radiography/*surgery ; Adult ; Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Hip ; Female ; Hip Joint/*radiography/surgery ; Hip Prosthesis ; Humans ; Imaging, Three-Dimensional/methods ; Intraoperative Care/*instrumentation/methods ; Male ; Middle Aged ; Prosthesis Fitting

Brain-derived neurotrophic factor (BDNF) rapidly enhances synaptic transmission among the hippocampal neurons in the resting state. This mechanism may be due to the phosphorylation of NMDA receptors through its Trkb receptors on the postsynaptic neuron. In contrast, BDNF also has a suppressing effect on the synaptic transmission via non-NMDA receptors. The activities of non-NMDA receptors are known to modulate the NMDA receptors activities. This study was to investigate, using patch clamp technique, whether the BDNF increases or decreases the glutamate-induced synaptic transmission in which glutamate acts on both NMDA- and non-NMDA receptors. When a postsynaptic neuron was previously excited by a large amount of glutamate, BDNF decreased the synaptic transmission induced by subsequently-applied glutamate. However, when the signal entered into a postsynaptic neuron was blocked by the application of tetrodotoxin, BDNF increased the glutamate-induced responses. These results show that BDNF plays a role in a protection of the neurons against hazardous or uncontrolled activation of glutamate receptors and in an accentuation of the synaptic response when the signal is inevitably diminished.
Brain-Derived Neurotrophic Factor* ; Glutamic Acid ; Neurons* ; Phosphorylation ; Receptor, trkB ; Receptors, Glutamate ; Receptors, N-Methyl-D-Aspartate ; Synaptic Transmission* ; Tetrodotoxin

Hallervorden-Spatz disease is a rare, autosomal recessive disorder of mainly early childhood which is characterized by pigmentary degeneration of the globus pallidus, substantia nigra, and red nucleus. Clinically it manifests various symptoms and signs of extrapyramidal and pyramidal involvement. Authors report a 28-year-old female patient with suspected Hallervorden-Spatz disease in the aspects of clinical and MRI findings suggesting metal deposition in the globus pallidus, substantia nigra, and red nucleus on both side.
Adult ; Female ; Globus Pallidus ; Humans ; Magnetic Resonance Imaging ; Pantothenate Kinase-Associated Neurodegeneration* ; Red Nucleus ; Substantia Nigra

Polyarteritis nodosa(PAN) has been depicted as a necrotizing arteritis of small and medium-sized muscular arteries, affecting multiple organ systems throughout the body. The etiology of PAN remains unknown, but the histopathologic resemblance to chronic serim sickness has suggested an immune complex pathogenesis. The peripheral nervous system(PNS) is more frequently affected (in about 20-50% of patients) than the central nervous system(in about 10-20% of patients). Although multiple mononeuritis multiplex is generally considered to be the typical PNS manifestation of PAN, distal symmetrical polyneuropathy may occur more frequently than previous recognized. We report a case of polyarteritis nodosa with mononeuritis multiplex and distal symmetrical polyneuropathy, which was diagnosed by electrophysiological study and biopsies of muscle and sural nerve.
Antigen-Antibody Complex ; Arteries ; Biopsy ; Mononeuropathies* ; Polyarteritis Nodosa* ; Polyneuropathies ; Sural Nerve

Vascular leiomyoma or angioleiomyoma is a uncommon benign solitary tumor that arises from the tunica muscularis of blood vessels. It is usually located in the wall of the uterus. It may present with a confusing picture of hand pain and paresthesia or be asymptomatic. We describe a 49-year-old man who presented with a slowly growing mass in the volar region of wrist which, on histological examination, was shown to be a vascular leiomyoma. It is not usually included in the differential diagnosis of anterior wrist mass or median nerve tumors.
Angiomyoma* ; Blood Vessels ; Diagnosis, Differential ; Hand ; Humans ; Leiomyoma ; Median Nerve* ; Middle Aged ; Paresthesia ; Uterus ; Wrist

PURPOSE: To evaluate implant survivorship and clinical outcomes after acetabular revision using cementless acetabular cups. MATERIALS AND METHODS: We evaluated 27 cementless acetabular revision cases performed between January 1998 and October 2005. All patients were followed up for more than 2 years, and the mean follow-up period was 54.1 months (range: 24~120 months). In all cases, morselized allografting was performed. Five cases needed structural allografting to achieve stability of the acetabular cup. The clinical results were analyzed using the Harris hip score, and radiological analysis was performed for evaluation of radiolucent lines, osteolysis, loosening, and changes in the hip center. RESULTS: At the time of latest follow-up, no cups showed failure requiring re-revision. The average Harris hip score improved from 67.1 points preoperatively to 91.4 points postoperatively. Radiologically, 7 cases (25.9%) showed radiolucent lines around the acetabular cup, but there was no loosening or osteolysis. CONCLUSION: Cementless acetabular revision showed satisfactory radiological and clinical results on short-term follow-up analysis. Even in cases with considerable amounts of acetabular bone loss, stable fixation could be obtained with structural bone grafting.
Bone Transplantation ; Follow-Up Studies ; Hip ; Humans ; Osteolysis ; Survival Rate ; Transplantation, Homologous

PURPOSE: This study was performed to evaluate the factors associated with dissociation of the polyethylene liner with using a Harris-Galante I or II acetabular component in a stably positioned acetabular cup. MATERIALS AND METHODS: Between January 1998 and February 2007, 32 cases underwent revision of the acetabular component due to osteolysis, wear of the polyethylene liner or locking mechanism failure around the acetabulum in spite of stable positioning. 5 cases were primarily operated on using the type I Harris-Galante Hip Prosthesis and 27 cases used the type II. We divided the 32 cases into the two groups: Group I (18 cases) was composed of cases with the existence of polyethylene liner (PE) dissociation and Group II (14 cases) had no dissociation. The analyzed factors were age, gender, body weight, the type and the size of the acetabular cup, the thickness of the polyethylene liner, the duration of the time interval from the primary surgery, the inclination and ante-version of the acetabular cup, the wear rate of the PE liner, the degree of the osteolysis around the acetabulum and the existence of failure of the locking mechanism in the acetabular component. Statistical analysis was performed using the Mann-Whitney test (SPSS 12.0). RESULTS: Statistical significance was noted only for the wear rate of the PE liner (Group I: 0.40+/-0.19 mm/year, Group II: 0.19+/-0.08 mm, p=0.002) and the existence of failure of the locking mechanism (Group I: 16 cases (88.9%), Group II: 6 cases (42.9%), p=0.006). CONCLUSION: According to this study, the dissociation of the PE liner was influenced by the wear rate of the PE liner and the existence of failure of the locking mechanism in the acetabular component. In order to prevent PE liner dissociation, improvement of the locking mechanism and the PE liner system are essential.
Acetabulum* ; Body Weight ; Hip Prosthesis ; Osteolysis ; Polyethylene*

Restoring the microbiota via fecal microbiota transplantation (FMT) can be an effective treatment for steroid-refractory acute graft-versus-host disease (GVHD) of the gut. Here, we report two adult patients who underwent FMT to treat steroid-refractory acute GVHD of the gut. The first patient was a 43-year-old man who underwent allogeneic hematopoietic stem cell transplantation (HSCT) with cells from a matched sibling donor. The second patient was a 70-year-old woman who underwent haplo-identical HSCT with cells from her son. Gut GVHD developed at 7 and 4 weeks after HSCT, respectively. After undergoing FMT, the clinical symptoms improved; the first patient had a complete response and the second patient had a partial response. Microbial analyses using RNA gene sequencing showed that a diverse fecal microbiome was recovered by 4 weeks after FMT. FMT should be considered an effective therapeutic option for managing steroid-refractory acute GVHD of the gut.