No abstract available.
Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus*

BACKGROUND: Several abnormalities of the autonomic regulation of the heart have been noted after acute myocardial infarction(AMI). Measurement of heart rate(HR) variability has been reported to provide indirect, noninvasive estimate of the cardiac efferent parasympathetic activity. The purposes of this study were to get the information on heart rate variability after AMI and to determine its relation to clinical and hemodynamic data. METHODS: We measured HR variability in 28 patients(23 men and 5 women : mean age, 56.6+/-10.4 years) 3-15days after AMI, in 25 patients with unstable angina and in 21 normal subjects by using triangular interpolation of the frequency distribution histogram om normalto-normal RR intervals from Holter tapes. RESULTS: HR variability was lower in AMI than unstable angina patients(357.9+/-118.6 versus 426.1+/-122.5 msec : p<0.05) and normal subjects(525.1+/-137.4 msec : p<0.025). There was no difference for infarct site, thrombolytic therapy, presence of Q-wave. HR variability was significantly related to mean 24-hour HR, left ventricular ejection fraction(all p<0.0001), left ventricular end diastolic diameter(p<0.05). HR varability was lower in patients belonging to Killip class 2-4 and who reqired the use of diuretics or digitalis(all p<0.05). CONCLUSION: After AMI, HR variabillity was reduced and significantly related to clinical and hemodynamic indexes of severity. Measurement of HR variability early after AMI may offer important clinical information for the early high stratification of patients.
Angina, Unstable ; Autonomic Nervous System ; Diuretics ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Male ; Myocardial Infarction* ; Thrombolytic Therapy

A 79-year-old male patient presented with a continuous transsacral epidural block for the treatment of herpes zoster pain on the right Tll-12 and Ll dermatome levels. However, it was impossible to introduce the Tuohy needle below the subcutaneous tissue. By the C-arm image intensifier, flowing calcifications of the lumbar paravertebral ligaments, except L5-Sl interspace, were observed. Thus, an epidural approach was tried at the L5-Sl interspace, but the Tuohy needle was introduced in the subarachnoid space instead of the epidural space. After an X-ray of the whole spine, diffuse idiopathetic skeletal hyperostosis was diagnosed. The Tuohy needle was introduced into the sacral canal through the second posterior sacral foramen and the epidural catheter was inserted about 15cm in length cephalad through the needle. The pain was controlled by the injection of 1% lidocaine and 0.5% bupivacaine every 3-4 hours continuously After 3 weeks this patient was discharged from hospital without any postherpetic sequelae.
Aged ; Bupivacaine ; Catheters ; Epidural Space ; Herpes Zoster ; Humans ; Hyperostosis ; Hyperostosis, Diffuse Idiopathic Skeletal* ; Lidocaine ; Ligaments ; Male ; Needles ; Spine ; Subarachnoid Space ; Subcutaneous Tissue

OBJECTIVE: Primary intraventricular hemorrhage(PIVH) is uncommon and accounts for only 3.1 % of all non-traumatic intracerebral hemorrhage. The aim of this study is to analyze clinical characteristics, image features, etiology and prognostic factors of outcome in patients with PIVH. METHODS: We identified 25 patients with PIVH during 9-year period between 1994 and 2002 at our institute. The clinical data, complimentary examination, outcome and computed tomographic blood amounts were reviewed. RESULTS: Major symptoms included sudden decreased level of consciousness, headache, nausea/vomiting and neck stiffness. Cerebral angiography was performed in 12 patients(48%) and revealed vascular malformation in 6 patients(24%). The positive result of angiography was more common in young patients and among vascular malformation the incidence of Moyamoya disease was relatively high(4 patients). Other causative factors were coagulation disorder, arterial hypertension, tumor bleeding. Outcome were death in 9 patients(36%): 7 patients(28%) died by direct consequence of bleeding and 2 patients died after other adverse events(sepsis, hepatic failure) but prognosis of survivor was good. Factors correlating with the outcome were the presence of coagulopathy, initial Glasgow Coma Scale(GCS), obstruction of 4th ventricle and ventricular blood amount including hemorrhagic dilatation of temporal horn of lateral ventricle, 3rd and 4th ventricle. CONCLUSION: The poor prognosis factors of PIVH are the presence of coagulopathy, low initial GCS, obstruction of 4th ventricle and large ventricular blood amount. Additionally patients whose initial clinical condition is not serious need an appropriate work up including cerebral angiography, because cause of bleeding is vascular malformation especially in young patients.
Angiography ; Animals ; Cerebral Angiography ; Cerebral Hemorrhage ; Coma ; Consciousness ; Dilatation ; Headache ; Hemorrhage* ; Horns ; Humans ; Hypertension ; Incidence ; Lateral Ventricles ; Moyamoya Disease ; Neck ; Prognosis ; Survivors ; Vascular Malformations

We report a case of extraventricular neurocytoma(left parietal lobe) in a young man presented with hemiparesis. The tumor, a radiologically well-circumscribed, cystic and enhancing mass, was partially removed. The patient, who received postoperative radiotherapy, is living well after 15 months of follow-up. Pathology showed a well-differentiated lesion composed of uniform, round cells with perinuclear halos in a neuropil background, immunohistochemically positive for neuronal markers. This was a cystic extraventricular neurocytoma(glio-neuronal tumor) arising from the left parietal lobe. Its features were consistent with neurocytoma pathologically and were different from those of intraventricular neurocytoma pathophysiologically. We outline the morphological and immunohistochemical evaluations necessary to recognize this rare tumor.
Follow-Up Studies ; Humans ; Neurocytoma* ; Neurons ; Neuropil ; Paresis ; Parietal Lobe ; Pathology ; Rabeprazole ; Radiotherapy ; Synaptophysin

Pituitary adenomas are uncommon in childhood and adolescence. From a series of 94 patients with pituitary adenoma operated by microsurgical technique during the period of June. 1988 to March, 1994, the cases of nine young people whose symptoms had appeared between the ages of 8.3 and 17.3 years are selected and presented. Of these 9 patients, three(33.3%) had prolactin(PRL)-secreting tumors. 3(33.3%) had PRL and adrenocorticotropic hormone(ACTH)-secreting tumors, and among remaining three patients had a tumor secreting both growth hormone(GH) and PRL, one with clinically nonfunctioning tumor, and one with a craniopharyngioma. The average age of patients at the time of surgery was 14.8 years with the youngest patient being 8.5 years old. Presenting symptoms primarily reflected the increased intracranial pressure. All but one underwent operations by the transsphenoidal approach(TSA). There was no death in this patient group. Significant operative morbidity included one incidence of third nerve palsy in one case after transcranial approach and diabetes insipidus in another after TSA. Both incidences were transient and were resolved later. Plurihormonal tumors, broadly defined as tumors producing more than one hormone, were common in this study group. Follow-up study revealed good control of tumors in the majority of cases, however there were two cases of recurrences on 80% of initial remission rate. Based on the observed data, it is concluded that: 1) transsphenoidal surgery is feasible and safe in this age group: 2) plurihormonal tumors occur more frequently in the pediatric and adolescent age group than in adults: 3) Suprasellar extension is more frequent in this age group that in adults: 4) initial remission is high, but recurrence rate seems to be higher in this age group than in adults.
Adolescent* ; Adult ; Craniopharyngioma ; Diabetes Insipidus ; Follow-Up Studies ; Humans ; Incidence ; Intracranial Pressure ; Oculomotor Nerve Diseases ; Pituitary Neoplasms* ; Prolactinoma ; Recurrence

The intestinal immune system maintains oral tolerance to harmless antigens or nutrients. One mechanism of oral tolerance is mediated by regulatory T cell (Treg)s, of which differentiation is regulated by a subset of dendritic cell (DC)s, primarily CD103+ DCs. The aryl hydrocarbon receptor (AhR), a ligand-activated transcription factor, plays an important role in regulating immunity. The intestines are exposed to various AhR ligands, including endogenous metabolites and phytochemicals. It was previously reported that AhR activation induced tolerogenic DCs in mice or in cultures of bone marrow-derived DCs. However, given the variety of tolerogenic DCs, which type of tolerogenic DCs is regulated by AhR remains unknown. In this study, we found that AhR ligand 3,3'-diindolylmethane (DIM) inhibited the development of CD103+ DCs from mouse bone marrow cells stimulated with Flt3L and GM-CSF. DIM interfered with phosphorylation of STAT3 and STAT5 inhibiting the expression of genes, including Id2, E2-2, IDO-1, and Aldh1a2, which are associated with DC differentiation and functions. Finally, DIM suppressed the ability of CD103+ DCs to induce Foxp3+ Tregs.
Animals ; Bone Marrow Cells ; Dendritic Cells* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Immune System ; Intestines ; Ligands ; Mice ; Phosphorylation* ; Phytochemicals ; Receptors, Aryl Hydrocarbon ; Transcription Factors

Osteochondromas make up about 30% to 40% of benign bone tumors. Most are solitary lesions but some are multiple, usually with autosomal dominant inheritance. From 1% to 4% of osteochondromas occur in the spine, where they can cause a variety of signs and symptoms, including those of spinal cord compression. Isolated osteochondromas are usually of little significance. However, if they are located near neural structures, they may cause irritation due to mechanical compression. In patients with hereditary multiple exostoses who present with neck or back pain, and particularly in those who have neurologic symptoms in the upper or lower extremities, a diagnosis of intracanalicular osteochondroma should be presumed until proven otherwise. Computerized tomography(CT) and MRI are the imaging procedures of choice. Prompt surgical excision affords the best prognosis for these patients who have spinal cord compression secondary to intracanalicular osteochondroma.
Back Pain ; Diagnosis ; Exostoses* ; Exostoses, Multiple Hereditary ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Neck ; Neurologic Manifestations ; Osteochondroma* ; Prognosis ; Spinal Cord Compression ; Spine ; Wills

Schwannomas are relatively common, benign tumors that are thought to arise from the nerve sheath cell. Schwannomas of the C1 root are extremely rare and seldom invade lateral masses because they gradually increase in size and can extend through the wide space behind the lateral mass instead of the intervertebral foramen. We present here an unusual case of a benign schwannoma that aggressively invaded the lateral mass of C-1.
Female ; Humans ; Middle Aged ; Neoplasm Invasiveness ; Neurilemmoma/*pathology ; Spinal Neoplasms/*pathology ; Spinal Nerve Roots/*pathology

Aryl hydrocarbon receptor (AhR) regulates both innate and adaptive immune responses by sensing a variety of small synthetic and natural chemicals, which act as its ligands. AhR, which is expressed in dendritic cells (DCs), regulates the differentiation of DCs. However, effects of AhR on the differentiation of DCs are variable due to the heterogeneity of DCs in cell surface marker expression, anatomical location, and functional responses. The plasmacytoid DCs (pDCs), one of DC subsets, not only induce innate as well as adaptive immune responses by secreting type I interferons and pro-inflammatory cytokines, but also induce IL-10 producing regulatory T cell or anergy or deletion of antigen-specific T cells. We showed here that AhR ligands indoxyl 3-sulfate (I3S) and indole-3-carbinol (I3C) inhibited the development of pDCs derived from bone marrow (BM) precursors induced by FMS-like tyrosine kinase 3 ligand (Flt3L). I3S and I3C downregulated the expression of signal transducer and activator of transcription 3 (STAT3) and E2-2 (Tcf4). In mice orally treated with I3S and I3C, oral tolerance to dinitrofluorobenzene was impaired and the proportion of CD11c⁺B220⁺ cells in mesenteric lymph nodes was reduced. These data demonstrate that AhR negatively regulates the development of pDCs from BM precursors induced by Flt3L, probably via repressing the expression of STAT3.
Animals ; Bone Marrow ; Cell Differentiation ; Cytokines ; Dendritic Cells* ; Dinitrofluorobenzene ; fms-Like Tyrosine Kinase 3* ; Immune Tolerance ; Interferon Type I ; Interleukin-10 ; Ligands* ; Lymph Nodes ; Mice ; Population Characteristics ; Receptors, Aryl Hydrocarbon* ; STAT3 Transcription Factor ; T-Lymphocytes ; Vascular Endothelial Growth Factor Receptor-1*