With the increased use of implantable cardiac devices, the incidence of hardware problems has also increased. Some of the hardware problems might be induced by patient factors. We experienced recurrent pacemaker lead fracture and dislocation after permanent pacemaker implantation. The patient was a bus driver who used his left arm vigorously when he turned the steering wheel. After a new lead was inserted via an axillary vein approach and the patient changed his occupation, no more lead problems have occurred. When a recurrent hardware problem with an implantable pacemaker or defibrillator occurs, patient factors related to anatomy or behavior must be considered.
Arm ; Atrioventricular Block ; Axillary Vein ; Defibrillators ; Dislocations ; Humans ; Incidence ; Occupations

OBJECTIVES: Recently, it was reported that microsurgical fenestration of the lamina terminalis (LT) may reduce the incidence of shunt-dependent hydrocephalus in aneurysmal SAH. The authors investigated the efficacy of the LT opening on the incidence of shunt-dependent hydrocephalus especially in the ruptured anterior communicating artery (ACoA) aneurysms. METHODS: The data of 71 ruptured ACoA aneurysm patients who underwent aneurysmal clipping in acute stage were reviewed retrospectively. The patients were divided into two groups according to the use of intraoperative microsurgical opening of the LT. Group I (n=36) included the patients with microsurgical fenestration of LT during routine pterional approach, Group II (n=35) consisted of patients in whom microsurgical fenestration of LT was not feasible. The rate of shunt-dependent hydrocephalus was compared between two groups by logistic regression to control for confounding factor. RESULTS: Ventriculo-peritoneal shunts were performed after aneurysmal obliteration in 18 (25.4%) patients. Overall conversion rates from acute hydrocephalus on admission to chronic hydrocephalus in each group were 29.6% (Group I) and 58.8% (Group II), respectively. There was no significant correlation between the microsurgical fenestration and the rate of occurrence of shunt-dependent hydrocephalus (p>0.05). CONCLUSION: Although this study cannot provide a definitive answer, the microsurgical fenestration of LT can play a negative role for reducing the incidence of chronic hydrocephalus. Surgeons should carefully decide the concomitant use of LT fenestration during surgery for the ruptured ACoA aneurysms.
Aneurysm ; Arteries ; Humans ; Hydrocephalus* ; Hypothalamus* ; Incidence ; Intracranial Aneurysm* ; Logistic Models ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Ventriculoperitoneal Shunt

No abstract available.
Endoscopy* ; Esophageal Motility Disorders*

OBJECTIVE: The direct repair of the pars interarticularis defect using a lag screw with bone grafting(Buck operation) is an anatomical, less invasive surgical treatment preserving motion segment. This paper reports the methods and long-term results of the direct screw repair of the pars interarticularis defect and fusion in symptomatic lumbar spondylolysis using a cannulated lag screw. METHODS: Ten patients with symptomatic spondylolysis nonresponsive to medical treatment more than 6 months underwent this operation. Eight patients(6 men and 2 women) were followed for longer than 24 months after surgery. Mean age at the time of surgery was 28.3(18-43) years. The involved lumbar vertebra were L5 in 6 cases, L3 in 1 case and L4 in 1 case. All patients except 1 case had bilateral lesion. All patients underwent preoperative magnetic resonance(MR) image and plain radiographs including functional view. Patients with slippage, instability, moderate to severe intervertebral disc degeneration on preoperative MR image at the affected segment and isthmus defect more than 4mm in length were contraindications to this procedure. Surgical outcome was evaluated with visual analogue scale(VAS), Macnab classification, and functional rating index(FRI). Postoperative plain radiographs were taken 4 weeks, 3 months. 6 months, 12 months, 18 months, 24 months after surgery and postoperative computed tomography scan was performed between 12-24 months after surgery. RESULTS: The average length of inserted screws were 42mm(35-45mm). Three cases experienced Excellent outcome, Good in 5 cases according to Macnab classification 6months after operation. Preoperative mean FRI scrore is 86.0%(34.4points) and postoperative 24months is 32.8%(13.1points). DeltaFRI is 0.62. There was no operation related complication including implant related complication(eg. screw fracture, screw malposition). One case with unilateral pars defect showed fusion as early as 6 months. CONCLUSION: These results indicate that Buck operation is a reliable and safe operation for symptomatic lumbar spondylolysis. Long-term data are needed for further evaluation for fusion.
Classification ; Humans ; Intervertebral Disc Degeneration ; Male ; Spine ; Spondylolysis*

BACKGROUNDS/AIMS: Stem cell therapies for liver disease are being studied by many researchers worldwide, but scientific evidence to demonstrate the endocrinologic effects of implanted cells is insufficient, and it is unknown whether implanted cells can function as liver cells. Achieving angiogenesis, arguably the most important characteristic of the liver, is known to be quite difficult, and no practical attempts have been made to achieve this outcome. We carried out this study to observe the possibility of angiogenesis of implanted bio-artificial liver using scaffolds. METHODS: This study used adipose tissue-derived stem cells that were collected from adult patients with liver diseases with conditions similar to the liver parenchyma. Specifically, microfilaments were used to create an artificial membrane and maintain the structure of an artificial organ. After scratching the stomach surface of severe combined immunocompromised (SCID) mice (n=4), artificial scaffolds with adipose tissue-derived stem cells and type I collagen were implanted. Expression levels of angiogenesis markers including vascular endothelial growth factor (VEGF), CD34, and CD105 were immunohistochemically assessed after 30 days. RESULTS: Grossly, the artificial scaffolds showed adhesion to the stomach and surrounding organs; however, there was no evidence of angiogenesis within the scaffolds; and VEGF, CD34, and CD105 expressions were not detected after 30 days. CONCLUSIONS: Although implantation of cells into artificial scaffolds did not facilitate angiogenesis, the artificial scaffolds made with type I collagen helped maintain implanted cells, and surrounding tissue reactions were rare. Our findings indicate that type I collagen artificial scaffolds can be considered as a possible implantable biomaterial.
Actin Cytoskeleton ; Adult ; Animals ; Artificial Organs ; Biocompatible Materials ; Collagen Type I* ; Humans ; Liver Diseases ; Liver* ; Membranes, Artificial ; Mice ; Stem Cells* ; Stomach ; Tissue Scaffolds ; Vascular Endothelial Growth Factor A

Shiitake mushrooms (Lentinula edodes) containing beta-glucans may be beneficial for human health; they have been used in the treatment of cancer, hypertension, and high cholesterol levels. The objective of this study was to determine the beta-glucan content in different sections of the fruiting bodies and mycelia of ten shiitake mushroom cultivars. The measured beta-glucan content ranged from 20.06 +/- 1.76% to 44.21 +/- 0.13% in the pileus sections, and from 29.74 +/- 1.40% to 56.47 +/- 4.72% in the stipe sections. The results of this study indicate that the variance in beta-glucan content dependent on the shiitake cultivar, and that the beta-glucan content is higher in the stipe than in the pileus.
beta-Glucans ; Cholesterol ; Fruit* ; Humans ; Hypertension ; Shiitake Mushrooms*

PURPOSE: It is well known that serum S-100 beta protein levels increased in adults after brain injury. However, there is no definite clinical data in children with isolated minor head trauma. The present study was conducted to validate S-100 beta protein levels as a screening test for brain damage in children with minor head trauma. METHODS: Serum S-100 beta protein levels were measured in 48 pediatric patients with minor head trauma. All patients had brain computed tomography (CT) scan to confirm brain injury. Data were analyzed using a contingency table and a receiver operating characteristic (ROC) curve to determine the diagnostic value of S-100 beta protein levels. RESULTS: Twelve (25%) patients had abnormal brain CT findings. Using a concentration cutoff value of 0.12 ug/L, patients with abnormal brain CT findings were identified by S-100 beta protein levels measurement with a sensitivity level of 100% and a specificity 38.9%. The area under the ROC curve for S-100 beta protein levels was 0.758 (95% CI, 0.606- 0.910). The number of high risk factors were 2.35+/-1.23 in the positive group and 1.53+/-0.76 in the negative group (p=0.011). CONCLUSION: Serum S-100 beta protein levels in children with minor head trauma were similar to those of adults. Our study supports the contention that rapid assessment of serum S-100 beta protein levels may reduce the use of brain CT in children with minor head trauma.
Adult ; Brain ; Brain Injuries ; Child ; Craniocerebral Trauma ; Head ; Humans ; Mass Screening ; Pediatrics ; Risk Factors ; ROC Curve ; S100 Proteins ; Sensitivity and Specificity

Small bowel tumors are very rare and generally malignant. As a result of the anatomical location and nonspecific manifestations of small bowel tumors, they are very difficult to diagnose. Balloon-assisted enteroscopy is a relatively noninvasive method compared to surgical resection, and allows for real-time observation, tissue confirmation with biopsy, and interventional procedures. Here, we report the case of a 69-year-old woman with a small bowel metastatic carcinoma observed with double balloon enteroscopy (DBE). She had a history of multiple cancers including ovarian cancer, bladder cancer, and breast cancer. The antegrade DBE procedure was performed before surgery for biopsy tissue confirmation. The patient underwent small bowel resection, and the final diagnosis was the same as that determined by preoperative biopsy. The final diagnosis was metastatic small bowel cancer originating from a cancer of the breast. This is the first detailed report of the preoperative diagnosis of small intestinal metastatic breast cancer by DBE.
Aged ; Biopsy ; Breast Neoplasms ; Diagnosis ; Double-Balloon Enteroscopy* ; Female ; Humans ; Ovarian Neoplasms ; Urinary Bladder Neoplasms

Although stress-induced cardiomyopathy (SCMP) is a reversible disease and the prognosis is usually excellent, several complications can occur and can result in fatal adverse events. The formation of left ventricular (LV) thrombus is one of these critical complications of SCMP. This report describes a case of SCMP complicated by formation of a LV thrombus that became increasingly mobile as LV contractility recovered, and for which surgical removal was performed. Here, we report a case of SCMP complicated by LV thrombus and review the literature regarding this topic.
Cardiomyopathies* ; Echocardiography ; Humans ; Prognosis ; Takotsubo Cardiomyopathy ; Thrombosis*

Nephrotic syndrome is associated with a hypercoagulable state, which results in thromboembolism as one of its main complications. Various pathogenetic factors that cause the hypercoagulable state in nephrotic syndrome have been recognized. We report on a 19-year-old female with a minimal-change disease who developed pulmonary thromboembolism combined with intracardiac thrombus while on tapering steroid. Our patient showed hypoalbuminemia with an episode of shock, and was successfully treated with thrombolysis and anticoagulation therapy.
Female ; Humans ; Hypoalbuminemia ; Nephrotic Syndrome* ; Pulmonary Embolism* ; Shock ; Thromboembolism ; Thrombosis* ; Young Adult