This is a report of 23 year old soldier who developed sudden onset of flaccid paraplegia and loss of all sensory modalited below the level of T4. The clinical entities of hematomyelia were sudden onset of pain, repidly developing pyramidal signs and paraplegia. The mainly involving sites of this disease were cervical and thoracic regions. The causative factors were hemorrhagic diasthesis, vascular malformation and inflammatory process as well as trauma and neoplasms affecting the spinal cord. We experienced a case of hematomyelia which did not combine with vascular anomaly, inflammatory process, hemophilia or trauma history.
Hemophilia A ; Humans ; Military Personnel ; Paraplegia ; Spinal Cord ; Spinal Cord Vascular Diseases* ; Vascular Malformations ; Vascular Neoplasms ; Young Adult

BACKGROUND AND PURPOSE: Recent randomized clinical trials (RCTs) have demonstrated benefits of endovascular recanalization therapy (ERT) contrary to earlier trials. We aimed to estimate the benefits of ERT added to standard therapy in acute ischemic stroke. METHODS: From a literature search of RCTs testing ERT, we performed a meta-analysis to estimate an overall efficacy and safety of ERT for all trials, stent-retriever trials, and RCTs comparing ERT and intravenous tissue plasminogen activator (IV-TPA). RESULTS: We identified 15 relevant RCTs including 2,899 patients. For all trials, ERT was associated with increased good outcomes (odds ratio [OR] 1.79; 95% confidence interval [CI] 1.34, 2.40; P<0.001) compared to the control. ERT also increased no or minimal disability outcomes, good neurological recovery, good activity of daily living, and recanalization. ERT did not significantly increase symptomatic intracranial hemorrhage (SICH) (OR 1.19; 95% CI 0.83, 1.69; P=0.345) or death (OR 0.87; 95% CI 0.71, 1.05; P=0.151). In contrast, ERT significantly reduced extreme disability or death (OR 0.77; 95% CI 0.61, 0.97; P=0.025). Restricting to five stent-retriever trials comparing ERT plus IV-TPA vs. IV-TPA alone, the benefit was even greater for good outcome (OR 2.39; 95% CI 1.88, 3.04; P<0.001) and extreme disability or death (OR 0.57; 95% CI 0.41, 0.78; P=0.001). Restricting to eight RCTs comparing ERT (plus IV-TPA in six trials) with IV-TPA alone showed similar efficacy and safety. CONCLUSIONS: This updated meta-analysis shows that ERT substantially improves clinical outcomes and reduces extreme disability or death without significantly increasing SICH compared to standard therapy.
Humans ; Intracranial Hemorrhages ; Stroke* ; Thrombectomy ; Tissue Plasminogen Activator

The source of hemangioblastoma in the hindbrain was considered to be avascular analoge in or adjacent to the posterior medullary velum. In hemangioblastoma of the brain stem, the area postrema has been known as the most common site. Operative and autopsy findings were confirmed by Okawara that the solid lesions are more likely to involve the brain stem. The solid hemangioblastoma is much more difficult to treat and the mortality is higher than the cystic type due to involvement of the brain stem, massive postoperative edema, and intraoperative or postoperative bleeding from the tumor mass. Operative and histopathologic findings of our case are confirmed with solid hemangioblastoma which involves the posterior medullary oblongata and was regarded as arising at the postrema.
Area Postrema ; Autopsy ; Brain Stem ; Edema ; Hemangioblastoma* ; Hemorrhage ; Mortality ; Rhombencephalon

In this study, the effects of verapamil on growth rate, apoptosis, production of transforming growth factor (TGF-beta) and fibronectin were evaluated in keloid and normal human dermal fibroblasts. Both fibroblasts were primarily cultured from earlobe keloids of three female patients and treated with various concentrations of verapamil. Cell toxicity was assessed by MTT assay, growth rate and apoptosis by FACS, and the production of TGF-beta and fibronectin by ELISA and Western blot, respectively. In the MTT50, the cell growth was more suppressed in keloid fibroblasts. In the MTT90, cell growth was more stimulated in normal fibroblasts. No significant effect appeared on TGF-beta expression but an increase in extracellular fibronectin secretion was found in keloid fibroblasts. Keloid fibroblasts responded to verapamil more sensitively, and the percentage of apoptosis was higher at the MTT50l. In brief, verapamil had growth-inhibitory effect with inducing apoptosis at the MTT50, but rather growth-stimulatory effect at the MTT90. The biphasic effect of verapamil depending on the dose might explain one of the reasons of relapse after keloid treatment with verapamil. Clinical application with high concentration (2.5mg/ml) is advised unless excessive dosage is used.
Apoptosis* ; Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibroblasts* ; Fibronectins ; Humans ; Keloid* ; Recurrence ; Transforming Growth Factor beta ; Transforming Growth Factors ; Verapamil*

Major neurological features of achondroplasia are attributed to premature synostoses of the pedicles of the vertebrae and of the base of the skull producing obstruction of the ventricular fluid circulation or compression of the medulla and spinal cord. Significant hydrocephalus is due to the obstruction of the cerebrosspinal fluid pathways at the level of the foramen magnum or the disturbance of CSF absorption caused by increased superior sagittal sinus pressure. In generally, the hydrocephalus in achondroplasia is of the communicating type in the pattern, so the CSF diversionary shunt may not be indicate. But, shunting procedures may be needed in patients who showed signs of severe IICP such as bulging fontanels and enlarged lateral ventricle. In this case, we experienced that the hydrocephalus in achondroplasia is prosorption following the stenosis of the foramen magnum and increased superior sagittal sinus pressure.
Absorption ; Achondroplasia* ; Constriction, Pathologic ; Foramen Magnum ; Humans ; Hydrocephalus* ; Lateral Ventricles ; Skull ; Spinal Cord ; Spine ; Superior Sagittal Sinus ; Synostosis

The aim of this update of Korean clinical practice guidelines for stroke is to provide timely evidence-based recommendations on the antiplatelet therapy in secondary prevention of stroke. Evidence-based recommendations are included for the use of antiplatelet agents for noncardioembolic stroke. Changes in the guidelines necessitated by new evidence will be continuously reflected in the new guideline.
Aspirin ; Platelet Aggregation Inhibitors ; Secondary Prevention ; Stroke ; Ticlopidine

Bleomycin, the generic name for a group of sulfur- containing polypeptide antibiotics derived from Streptomyces verticillus, has been used as a single agent and in combination for treatment of various neoplasms and viral diseases. Recently, intradermal bleomycin injections have been shown to bring about significant improvements in keloid and hypertrophic scar. However, the mechanism by which this drug acts on keloid is not entirely clear. In this study, the effects of bleomycin on growth rate, apoptosis, production of transforming growth factor(TGF-beta) and expression of its receptor, secretion of fibronectin were evaluated in keloid and normal human dermal fibroblasts. Human keloid and normal fibroblasts were primarily cultured from earlobe keloids of three female patients and treated with various concentration of bleomycin. Cell toxicity was assessed by MTT assay, growth rate and apoptosis was assessed by FACS, production of fibronectin by immunoprecipitation and western blot, TGF-beta secretion by ELISA, and expression of TGF-beta receptor by western blot, respectively. The obtained results are follows : Bleomycin induced cell toxicity dose-dependently in keloid fibroblasts in the range of 0.0012-0.075mg/ml, and the MTT90 and MTT50 values of bleomycin were 0.0081mg/ml and 0.0352mg/ml, respectively. Even in lower concentration (MTT90) of bleomycin, the cell growth was significantly suppressed in both normal and keloid fibroblasts, with the latter more suppressed than the former. Keloid fibroblasts secreted more TGF-beta than normal fibroblasts, but there was no significant difference of TGF-beta secretion between the group with bleomycin treatment and the untreated control group. There was no significant effect of bleomycin on the suppression of the expression of TGF-beta receptor and the production of fibronection in fibroblast. Keloid fibroblasts responded to bleomycin more sensitively than normal fibroblasts, and the percentage of apoptosis was higher in keloid fibroblasts than in normal fibroblast at the MTT50 concentration of bleomycin. Bleomycin had growth-inhibitory effect with inducing the apoptosis directly in lower concentration(MTT90). Therefore, clinical application with lower concentration than 1.0 mg/ml is adviced. Further studies, including clinical demonstration, will be required to better elucidate the anti-keloid effect of bleomycin depending on the dosage and the additive effect of different anti-keloid action by other agents. In summary, bleomycin may be a drug of promise in the treatment of keloid and hypertrophic scar.
Anti-Bacterial Agents ; Apoptosis* ; Bleomycin* ; Blotting, Western ; Cicatrix, Hypertrophic ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibroblasts* ; Fibronectins ; Humans ; Immunoprecipitation ; Keloid* ; Receptors, Transforming Growth Factor beta ; Streptomyces ; Transforming Growth Factor beta ; Virus Diseases

Keloids represent a dysregulated response to cutaneous wounding that results in an excessive deposition of extracellular matrix. However, the molecular mechanisms underlying this pathologic deposition of extracellular matrix still remain to be elucidated. In this study, the effects of anti-keloid drugs (triamcinolone(R), 5-FU(R), bleomycin(R), verapamil(R)) on the expression of fibronectin and TGF-beta and its receptor in keloid fibroblasts were evaluated in vitro. Human keloid fibroblasts(KFs) and normal human dermal fibroblasts(NHDFs) were isolated from earlobe keloids. Immunoprecipitation and Western blot of fibronectin, ELISA of TGF-beta secretion and Western blot of TGF-beta receptor were performed using the primary cultured fibroblasts treated with various drugs. TGF-beta secretion was increased in keloid fibroblasts compared to NHDFs. TGF-beta promoted fibronectin synthesis in keloid fibroblasts. These results substantiate the hypothesis that the elevated levels of TGF-beta play a potential role in keloid pathogenesis. 5-FU suppressed profoundly TGF-beta secretion. Triamcinolone and verapamil inhibited significantly fibronectin synthesis and secretion, and also suppressed TGF-beta receptor expression in keloid fibroblasts. In conclusion, it is postulated that the combination of low dose of 5-FU and triamcinolone or verapamil may be useful in keloid treatment by the additive effect of different anti-keloid action.
Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Fibroblasts* ; Fibronectins* ; Fluorouracil ; Humans ; Immunoprecipitation ; Keloid* ; Receptors, Transforming Growth Factor beta ; Transforming Growth Factor beta ; Triamcinolone ; Verapamil ; Wounds and Injuries

Antithrombotic therapy is a cornerstone of acute ischemic stroke (AIS) management and secondary stroke prevention. Since the first version of the Korean Clinical Practice Guideline (CPG) for stroke was issued in 2009, significant progress has been made in antithrombotic therapy for patients with AIS, including dual antiplatelet therapy in acute minor ischemic stroke or high-risk transient ischemic stroke and early oral anticoagulation in AIS with atrial fibrillation. The evidence is widely accepted by stroke experts and has changed clinical practice. Accordingly, the CPG Committee of the Korean Stroke Society (KSS) decided to update the Korean Stroke CPG for antithrombotic therapy for AIS. The writing members of the CPG committee of the KSS reviewed recent evidence, including clinical trials and relevant literature, and revised recommendations. A total of 35 experts were invited from the KSS to reach a consensus on the revised recommendations. The current guideline update aims to assist healthcare providers in making well-informed decisions and improving the quality of acute stroke care. However, the ultimate treatment decision should be made using a holistic approach, considering the specific medical conditions of individual patients.

Cardioembolic stroke related to atrial fibrillation is problematic due to high recurrence, mortality, and morbidity rates. The optimal anticoagulant therapy therefore needs to be applied to prevent the occurrence of a second stroke in patients with nonvalvular atrial fibrillation. The oral anticoagulant warfarin has traditionally been used, but it is limited by its narrow efficacy window, complex pharmacokinetics, and multiple drug interactions, thus requiring frequent blood monitoring. New oral anticoagulants have recently been developed that target a specific coagulation component. Dabigatran (a direct thrombin inhibitor) and rivaroxaban, apixaban, and edoxaban (inhibitors of factor Xa) have advantages of rapid action time, short half-life, stable plasma concentration, and few drug interactions. Large randomized clinical trials and meta-analyses have recently been published on the efficacy and safety of these new oral anticoagulants. Based on the results obtained in recent clinical trials, we have revised the recommendations for selecting optimal anticoagulant therapy in patients with nonvalvular atrial fibrillation.
Anticoagulants ; Atrial Fibrillation* ; Dabigatran ; Drug Interactions ; Half-Life ; Humans ; Ischemic Attack, Transient* ; Mortality ; Pharmacokinetics ; Plasma ; Recurrence ; Rivaroxaban ; Secondary Prevention ; Stroke* ; Thrombin ; Warfarin