INTRODUCTION: Adult stem cells generate differentiated cells beyond their own tissue boundaries. To prove that stem cells derived from bone marrow is capable of therapeutic application in cerebral ischemic patients, we performed this study. MATERIAL AND METHOD: We transplanted adult stem cells derived from bone marrow of the patient's iliac bone to 5 patients with cerebral infarction. Of 5 patients, two patients had internal carotid artery occlusion, two patients had severe stenosis of the middle cerebral artery, remaining one patient had occlusion of the branch of the middle cerebral artery. At first, we performed extracranial-intracranial bypass surgery in all patients, and then implanted bone marrow stem cell in the infarcted brain and boder zone area directly under the microscopic navigator and also injected bone marrow stem cells through the grafted vessel to the infarcted area. Two weeks after bypass surgery, we confirmed the patency of bypass graft with external carotid angiography. In the same setting, mesenchymal stem cells acquired from autologous bone marrow were superselectively injected into the bypass graft via a microcatheter. Postoperative evaluation of the patients was decided to the neurological status and the degree of reduction of the high signal area on the T2 image of the postoperative MRI. RESULT: All patients who underwent bypass surgery with stem cell implantation had an uneventful postoperative course and showed some improvement of preoperative neurologic dysfunction. Postoperative significant improvement of cerebral vasoreactivity to acetazolamide was showed in all patients. On postoperative 3 months MRI, three patients showed significant reduction of the high signal area on the T2 image, and also improved neurological status on those patients. Other one patient showed moderate degree of the reduction of the high signal area on T2 image of the postoperative MRI, but neurological status of that patient slightly improved. Remaining one patient who showed poor circulation via bypass graft does neither reduction of the high signal area on T2 image of the postoperative MRI nor improvement of the neurological status of that patient. CONCLUSION: In patients of fixed cerebral infarction with major neurologic deficit, EC-IC bypass surgery is not effective, even though infarcted area filled by grafted vessel extensively. In those patients, autologous bone marrow stem cell implantation combined with bypass seems to be expect neuronal regeneration.
Acetazolamide ; Adult Stem Cells ; Angiography ; Bone Marrow* ; Brain ; Carotid Artery, Internal ; Cerebral Infarction* ; Constriction, Pathologic ; Humans ; Magnetic Resonance Imaging ; Mesenchymal Stromal Cells ; Middle Cerebral Artery ; Neurologic Manifestations ; Neurons* ; Regeneration* ; Stem Cell Transplantation* ; Stem Cells* ; Transplants

OBJECTIVE: The authors evaluated the effect of direct bypass (superficial temporal artery-middle cerebral artery bypass) in the prevention of rebleeding episodes in patients suffering from hemorrhagic moyamoya disease by comparing this method with indirect bypass. METHODS: Fifteen patients who had hemorrhagic moyamoya without aneurysm comprised the study group. The mean age of patients was 44.4 years and follow up period ranged from 0.8 to 7.1 years (mean; 3.61 years). Revascularization surgery was performed in 21 sides in 15 patients. Direct bypass was performed in 17 sides and indirect bypass in the other 4 sides. RESULTS: During the follow-up period after the revascularization surgery, three sides (14.3%) of the 21 sides presented with rebleeding episode, one of 17 sides (mean follow-up periods; 2.94 years) treated with direct method and 2 of 4 sides (mean follow-up periods; 6.45 years) treated with indirect method. Kaplan-Meier analysis of rebleedingfree survival showed quite different between direct and indirect method but statistically insignificant (p=0.0541). CONCLUSION: Direct bypass may reduce the risk of hemorrhage more effectively than indirect bypass. However, direct bypass cannot always prevent rebleeding.
Aneurysm ; Cerebral Arteries ; Follow-Up Studies ; Hemorrhage* ; Humans ; Kaplan-Meier Estimate ; Moyamoya Disease*

BACKGROUND AND OBJECTIVES: Vascular endothelial growth factor (VEGF) is a potent endothelial cell-specific mitogen. This study was undertaken to test the hypothesis that the neointima hyperplasia induced by a balloon injury is inhibited by blocking VEGF and VEGF receptor-1 (VEGFR-1) with anti-VEGF peptides. Materials and Methods: Anti-VEGF RRKRRR peptide (dRK6) and anti-VEGFR-1 peptide (anti-flt-1) were synthesized at Pohang University of Science and Technology, Korea. Male Sprague-Dawley rats, weighing 300-350 g, were subcutaneously injected 0.5 mg/kg of dRK6 or 0.5 mg/kg of anti-flt-1, dissolved in phosphate buffer solution, 2 days before induction of a carotid balloon-injury, and then daily in the same manner post carotid balloon injury for 2 weeks. RESULTS: Neointima formation was suppressed in both the dRK6 and anti-flt-1 groups compared to that in the untreated controls at 2 weeks post carotid balloon-injury (neointimal area; control group 0.44+/-0.09 mm2, dRK6 group 0.25+/-0.05 mm2, anti-flt-1 group 0.19+/-0.05 mm2, p<0.01). Anti-flt-1 peptide and dRK6 reduced the numbers of proliferative bromodeoxyuridine-labeled cells in the neointima (control group 16.4+/-10.6%, dRK6 group 3.7+/-2.1%, anti-flt-1 group 5.9+/-3.4%, p<0.05). In addition, an inflammatory response, as determined by monocyte chemoattractant protein-1 and interleukin-6 upregulation, which was evident in the controls, was inhibited by both dRK6 and anti-flt-1. CONCLUSION: This study suggests anti-vascular endothelial growth factor peptides can reduce the inflammation and neointima formation in balloon injured rat carotid arteries.
Animals ; Carotid Arteries* ; Carotid Artery Injuries ; Chemokine CCL2 ; Endothelial Growth Factors* ; Gyeongsangbuk-do ; Humans ; Hyperplasia ; Inflammation ; Interleukin-6 ; Korea ; Male ; Neointima* ; Peptides* ; Rats* ; Rats, Sprague-Dawley ; Up-Regulation ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factor Receptor-1 ; Vascular Endothelial Growth Factors

Bilateral coronary arteriovenous fistula (CAVF), arising from both the right and left coronary arteries, are rare. We experienced a 44 years old male patient with bilateral CAVF, and coronary atherosclerosis, whose diagnosis was confirmed by coronary angiography. The hemodynamic result revealed minimal left-to-right shunt. Therefore, only percutaneous coronary artery intervention of the coronary artery stenosis was performed. Here, this rare case is reported, with a review of the literature.
Adult ; Arteriovenous Fistula* ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels ; Diagnosis ; Hemodynamics ; Humans ; Male

OBJECTIVES: Extracranial-intracranial (EC-IC)bypass procedures have proved useful in selected patients with cerebral ischemia. We have experienced EC-IC bypass procedures in 85 patients with hemodynamic cerebral ischemia, moya moya and complicated aneurysm. In this study, complications after EC-IC bypass procedures was investigated. METHODS: Authors performed EC-IC bypass surgery for augmentation of cerebral blood flow in 85 patients for recent 7 years. Of 85 patients, the pathologic lesions were artherosclerotic hemodynamic cerebral ischemia in 60, moya moya in 14, complicated aneurysm in 9, and traumatic occlusion of the carotid artery in 2. An superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 67 cases and graft bypass with saphenous vein or radial artery in 18 cases. RESULTS: Of 85 patients who underwent bypass surgery, 63 had an uneventful postoperative course. Fifteen patients had hyperperfusion syndrome that included temporary neurologic deficit in 7, reperfusion hemorrhage in 3, seizure in 3, and neusea and vomiting in 2. Five patients had wound problems. Permanant neurologic deficit and complete obstruction of the preoperative stenotic lesion occured in one respectively. All patients except three cases of reperfusion hemorrhage and one case of permanent neurologic deficit recovered completely. Two of three cases of reperfusion hemorrhage and one case of permanent neurologic deficit recovered with minor neurologic deficit, and the remaining one case of reperfusion hemorrhage died. CONCLUSION: EC-IC bypass surgery is a reliable and reasonably safe method for establishing new pathways of collateral circulation to the brain. However, this operation can have potential complications by relative hyperperfusion of chronically hypoperfused and presumably dysautoregulated region, and new flow pattern after bypass. Bypass is deferred to 8 weeks till impaired autoregulation is restored after acute cerebral infarction. And blood pressure should be controlled closely throughout the immediate postoperative period.
Aneurysm ; Blood Pressure ; Brain ; Brain Ischemia ; Carotid Arteries ; Cerebral Arteries ; Cerebral Infarction ; Collateral Circulation ; Hemodynamics ; Hemorrhage ; Homeostasis ; Humans ; Neurologic Manifestations ; Postoperative Period ; Radial Artery ; Reperfusion ; Saphenous Vein ; Seizures ; Transplants ; Vomiting ; Wounds and Injuries

BACKGROUND: Hypertension is an important risk factor for sudden cardiac death, of which the incidence increases with increases in blood pressure. Prolonged QT dispersion has been identified to indicate increased risk of life-threatening ventricular arrhythmia and sudden cardiac death. In this study, QT dispersion was investigated in hypertensive patients during the strain phase of the Valsalva maneuver. METHODS: The study population included 75 subjects: 25 with normal blood pressure (Control), 25 with stage I hypertension (Group A), and 25 with stage II hypertension (Group B). Electrocardiography for QT dispersion was recorded at 25 mm/sec paper speeds before and during the Valsalva maneuver. RESULTS: The patients in Group B were significantly older than the controls (p< 0.05). Differences in sex, smoking, diabetes, angina, and hyperlipidemia were not statistically significant between the three groups. The basal QT dispersion was 25.3 +/- 18.3 ms in the controls, 39.0 +/- 17.8 ms in Group A, and 36.8 +/- 18.8 ms in Group B. The QT dispersion was significantly higher in group A patients than the controls (p< 0.05). In Group B only, a significant increase in QT dispersion was observed during the Valsalva maneuver, compared to conditions prior to the Valsalva maneuver (p< 0.05). CONCLUSION: The conditions that increase intrathoracic pressure may increase QT dispersion and severe hypertensive patients should avoid these conditions.
Blood Pressure/physiology ; Comparative Study ; *Electrocardiography ; Female ; Humans ; Hypertension/diagnosis/*physiopathology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Valsalva Maneuver/*physiology

BACKGROUND: Previous studies showed that increased QT dispersion has been observed during episodes of myocardial ischemia or infarction and identified the patients at risk of arrhythmia or sudden death. The aim of this study was to investigate the relation between QT dispersion and left ventricular (LV) function (systolic and diastolic), dimension and mass as well as to analyze the differences of this relationship according to the extent of angiographic coronary stenosis in patients with coronary artery disease. METHODS: The study population included 262 patients (male 129, female 133;average age 60 years). Echocardiography was done for the measurement of left ventricular function, dimension and mass on admission. Electrocardiography for QT and QTc (corrected QT) dispersion were recorded 25 mm/sec paper speeds before the coronary angiography. Patients were divided into two groups; Group A where angiographic coronary stenosis <50%, and Group B where angiographic coronary stenosis >or =50%. RESULTS: The results were as follows: 1) QT dispersion was higher in those with depressed LV systolic function (EF<55%) than in those with normal LV systolic function among Group A (p<0.05). 2) QT dispersion was higher in those with abnormal IVRT (isovolumic relaxation time) than in those with normal IVRT among Group A (p<0.05). But, there was no correlation between QT dispersion and other diastolic parameters in Group A. 3) QT dispersion was positively correlated with increased LVDd (diastolic left ventricular dimension), LVDs (systolic left ventricular dimension), LAD (left atrial dimension) and IVS (interventricular septum) in those in Group A. But, there found no correlation between QT dispersion and LV dimension parameters in Group B. 4) QT dispersion also had a positive correlation with LV mass in all patients and in those in Group A (all patients p<0.01;Group A p<0.001). But, there found no correlation between QT dispersion and LV mass in Group B. 5) On multiple logistic regression analysis, sex, abnormal IVRT and significant stenosis (> or =50%) of the coronary artery were independent prognostic factors of prolonged QT dispersion (p<0.05). 6) QTc dispersion showed the same result as QT dispersion. CONCLUSION: LV systolic function (EF), some diastolic function (IVRT), dimension (LVDd, LVDs, LAD IVS), and mass are associated with the increased QT dispersion in patients with coronary artery disease, especially minimal angiographic stenosed (<50%) patients. So, we consider echocardiography is an important tool to predict the QT dispersion in patients with coronary artery disease.
Arrhythmias, Cardiac ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Death, Sudden ; Echocardiography* ; Electrocardiography ; Female ; Humans ; Infarction ; Logistic Models ; Myocardial Ischemia ; Relaxation ; Ventricular Function, Left*

BACKGROUND: Diamond Blackfan anemia (DBA), characterized by impaired red cell production, is a rare condition that is usually symptomatic in early infancy. The purpose of this study was to assess nationwide experiences of DBA encountered over a period of 20 years. METHODS: The medical records of 56 patients diagnosed with DBA were retrospectively reviewed from November 1984 to July 2010. Fifteen institutions, including 13 university hospitals, participated in this study. RESULTS: The male-to-female ratio of patients with DBA was 1.67:1. The median age of diagnosis was 4 months, and 74.1% were diagnosed before 1 year of age. From 2000 to 2009, annual incidence was 6.6 cases per million. Excluding growth retardation, 38.2% showed congenital defects: thumb deformities, ptosis, coarctation of aorta, ventricular septal defect, strabismus, etc. The mean hemoglobin concentration was 5.1+/-1.9 g/dL, mean corpuscular volume was 93.4+/-11.6 fL, and mean number of reticulocytes was 19,700/mm3. The mean cellularity of bone marrow was 75%, with myeloid:erythroid ratio of 20.4:1. After remission, 48.9% of patients did not need further steroids. Five patients with DBA who received hematopoietic transplantation have survived. Cancer developed in 2 cases (3.6%). CONCLUSION: The incidence of DBA is similar to data already published, but our study had a male predilection. Although all patients responded to initial treatment with steroids, about half needed further steroids after remission. It is necessary to collect further data, including information regarding management pathways, from nationwide DBA registries, along with data on molecular analyses.
Anemia ; Anemia, Diamond-Blackfan ; Aortic Coarctation ; Bone Marrow ; Congenital Abnormalities ; Diamond ; Erythrocyte Indices ; Heart Septal Defects, Ventricular ; Hemoglobins ; Hospitals, University ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Registries ; Reticulocytes ; Retrospective Studies ; Steroids ; Strabismus ; Thumb ; Transplants

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.