Hemifacial spasm is a relatively uncommon but distressing condition characterized by insiduous development of paroxysmal, involuntary, unilateral hyperkinetic facial movement. In patients with hemifacial spasm, there is an abnormality in the facial nerve or its nucleus which allows the stimulus applied to one branch of the facial nerve to spread to other branches of that same nerve. This lateral spread response is presumed to be due to cross transmission of the antidromic activity in the branch of the facial nerve, and intraoperative monitoring of lateral spread responses provides a useful way of confirming complete facial nerve decompression. In 17 consecutive patients, intraoperative electromyographic(EMG) recordings were made from facial muscles during microvascular decompression for hemifacial spasm. At the beginning of the operation, electrical stimulation of the temporal or zygomatic branch of the facial nerve gave rise to electrically recordable activity in the mentalis muscle(lateral spread), with a latency of about 10msec, that in ten patients, lasted until the facial nerve was decompressed; In seven patients, however, it disappeared when the arachnoid membrane was opened. Early disappearance of lateral spread was frequently occurred in single offending vessel or cases where there was loose compression. Postsurgically the 16 patients in whom the lateral spread response disappeared totally were free from spasm after the operation and in the remaining patient, there was much improvement. These results support the use of lateral spread response monitoring during decompression surgery for hemifacial spasm, and provide strong circumstantial evidence that vascular cross-compression is an important etiologic factor in hemifacial spasm. During a decompression operation for hemifacial spasm, the authors now routinely monitor facial EMG response.
Arachnoid ; Decompression* ; Electric Stimulation ; Facial Muscles ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Membranes ; Microvascular Decompression Surgery ; Monitoring, Intraoperative ; Spasm

PURPOSE: It is unknown whether cilostazol pretreatment reduces postprocedural myonecrosis (PPMN). Cilostazol pretreatment reduces PPMN after percutaneous coronary intervention (PCI). MATERIALS AND METHODS: A total of 120 patients with stable angina scheduled for elective PCI were randomly assigned to a 7-day pretreatment with Cilostazol (200 mg/day) or to a control group. Creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) levels were measured at baseline and at 6 and 24 hours after PCI. The primary end-point was the occurrence of PPMN, defined as any CK-MB elevation above the upper normal limit (UNL). Aspirin and clopidogrel were co-administered for 7 days before PCI, and resistance to these agents was then assayed using the VerifyNow System. RESULTS: There was no difference in baseline characteristics between the final analyzable cilostazol (n=54) and the control group (n=56). Despite a significantly greater % inhibition of clopidogrel in the cilostazol group (39+/-23% versus 25+/-22%, p=0.003), the incidence of PPMN was similar between the cilostazol group (24%) and the control group (25%, p=1.000). The rate of CK-MB elevation at > or =3 times UNL was also similar between the two groups (6% versus 5%, p=0.583). The incidence of cTnI increase over the UNL or to 3 times the UNL was not different between the two groups. There was no significant difference in terms of the rate of adverse events during follow-up, although the cilostazol group showed a tendency to have a slightly higher incidence of entry site hematoma. CONCLUSION: This trial demonstrated that adjunctive cilostazol pretreatment might not significantly reduce PPMN after elective PCI in patients with stable angina.
Aged ; Angina, Stable/drug therapy/enzymology/therapy ; Angioplasty, Balloon, Coronary/*adverse effects ; Creatine Kinase, MB Form/blood ; Female ; Heart Injuries/etiology/prevention & control ; Humans ; Male ; Middle Aged ; Myocardium/pathology ; Necrosis ; Phosphodiesterase 3 Inhibitors/*administration & dosage ; Prospective Studies ; Tetrazoles/*administration & dosage

PURPOSE: Cerebral ischemia leads to neuronal cell death, and eventually causes neurological impairments. Tadalafil is a long-acting phosphodiesterase type-5 (PDE-5) inhibitor, and it has been used for the treatment of erectile dysfunction. In the present study, we investigated whether tadalafil has the protective effect on apoptotic neuronal cell death in the motor cortex following transient global ischemia in gerbils. MATERIALS AND METHODS: For this study, Mongolian gerbils were used for the experimental animals, and transient global ischemia was induced to the gerbils by occlusion of both common carotid arteries for 7 min. Gerbils were randomly divided into five groups (n=8 in each group): the sham-operation group, the cerebral ischemia-induced group, the cerebral ischemia-induced and 0.1 mg/kg tadalafil-treated group, the cerebral ischemia-induced and 1 mg/kg tadalafil-treated group, the cerebral ischemia-induced and 10 mg/kg tadalafil-treated group. Tadalafil-treated groups received tadalafil orally once a day for a 7 consecutive days, starting one day after surgery. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay and immunohistochemistry for caspase-3 were performed for the detection of apoptotic neuronal cell death in the motor cortex. RESULTS: The number of TUNEL-positive cells was 21.45+/-3.69/section in the sham-operation group, 771.66+/-97.25/section in the cerebral ischemia-induced group, 688.44+/-81.35/section in the cerebral ischemia-induced and 0.1 mg/kg tadalafil-treated group, 295.66+/-36.34/section in the cerebral ischemia-induced and 1 mg/kg tadalafil-treated group, and 198.47+/-25.25/section in the cerebral ischemia-induced and 10 mg/kg tadalafil-treated group. In the present results, induction of ischemic injury increased apoptotic neuronal cell death in the motor cortex of gerbils. However, tadalafil treatment suppressed the cerebral ischemia-induced apoptotic neuronal cell death in the motor cortex as dose-dependently. CONCLUSIONS: Here in this study, we showed that tadalafil has protective effect on the cerebral ischemia-induced apoptotic neuronal cell death, and thus this drug may facilitate the recovery following ischemic cerebral injury.
Animals ; Apoptosis ; Brain Ischemia ; Carbolines ; Carotid Artery, Common ; Caspase 3 ; Cell Death ; Erectile Dysfunction ; Gerbillinae ; Immunohistochemistry ; Ischemia ; Male ; Motor Cortex ; Neurons ; Polyenes ; Tadalafil

Eosinophilic granulomatosis with polyangiitis (EGPA), previously called Churg-Strauss syndrome, is an anti-neutrophil cytoplasmic antibody associated vasculitis, accompanied by asthma, hypereosinophilia, nonfixed pulmonary infiltrates, and sinusitis. Peripheral neuropathy is common in patients with EGPA; however, a few cases of EGPA with central nervous system (CNS) involvement have been reported. A 45-year-old female referred for right side weakness and posterior neck pain was diagnosed as EGPA with subarachnoid hemorrhage and mononeuritis multiplex. She was effectively treated with a high dose glucocorticoid, cyclophosphamide, and intravenous immunoglobulin. EGPA with CNS involvement is uncommon and causes significant morbidity and mortality. Therefore more rapid and accurate diagnostic evaluation may be required. EGPA should be considered in patients with neurological symptoms and hypereosinophilia.
Antibodies, Antineutrophil Cytoplasmic ; Asthma ; Central Nervous System ; Churg-Strauss Syndrome ; Cyclophosphamide ; Eosinophils* ; Female ; Humans ; Immunoglobulins ; Middle Aged ; Mononeuropathies* ; Mortality ; Neck Pain ; Peripheral Nervous System Diseases ; Sinusitis ; Subarachnoid Hemorrhage* ; Vasculitis

Nephrogenic systemic fibrosis (NSF) is a progressive systemic fibrosing disease that may occur after gadolinium contrast exposure. It can lead to severe complications and even death.NSF is highly prevalent among patients with advanced chronic kidney disease (CKD). In this report, however, we describe the case of a patient with NSF that occurred during early CKD. A 65-year-old man with stage 3a CKD was transferred to our hospital because of lower extremity edema. The medical history revealed that he was exposed to gadolinium 185 days earlier, and the result of his tibial skin biopsy was consistent with NSF. The patient underwent a combined therapy with ultraviolet-A1 phototherapy and methotrexate and steroid therapy for 6 months. The combined therapy stopped the systemic progression of NSF.

Pedicle ossification is a rare but significant complication following mandibular reconstruction using a fibular free flap (FFF), a technique widely employed in maxillofacial surgery due to its reliable vascularized bone supply and low donor site morbidity. The FFF supports dental implantation and prosthetic rehabilitation, with its vascularized periosteum enhancing osteogenic potential. Despite these advantages, unexpected ossification of the flap’s vascular pedicle may occur, potentially mimicking tumor recurrence and causing diagnostic uncertainty. This case report describes a 38-year-old male with left buccal squamous cell carcinoma treated by wide excision, modified radical neck dissection, and reconstruction using a radial forearm free flap. Postoperative radiotherapy led to complications including trismus and alveolar bone exposure, culminating in a pathological mandibular fracture. Mandibular reconstruction was performed using an FFF. Over 4 years of follow-up, computed tomography revealed ossification within the vascular pedicle. Notably, the patient remained asymptomatic, maintaining normal speech and swallowing without functional impairment. Pedicle ossification may present radiographically as a suspicious bony change misinterpreted as tumor recurrence. Routine follow-up imaging such as computed tomography is essential for differentiation. Although trismus, bony swelling, or pain may occur, surgical intervention is typically deferred unless symptoms develop. Therefore, careful clinical assessment and monitoring remain crucial.

Pedicle ossification is a rare but significant complication following mandibular reconstruction using a fibular free flap (FFF), a technique widely employed in maxillofacial surgery due to its reliable vascularized bone supply and low donor site morbidity. The FFF supports dental implantation and prosthetic rehabilitation, with its vascularized periosteum enhancing osteogenic potential. Despite these advantages, unexpected ossification of the flap’s vascular pedicle may occur, potentially mimicking tumor recurrence and causing diagnostic uncertainty. This case report describes a 38-year-old male with left buccal squamous cell carcinoma treated by wide excision, modified radical neck dissection, and reconstruction using a radial forearm free flap. Postoperative radiotherapy led to complications including trismus and alveolar bone exposure, culminating in a pathological mandibular fracture. Mandibular reconstruction was performed using an FFF. Over 4 years of follow-up, computed tomography revealed ossification within the vascular pedicle. Notably, the patient remained asymptomatic, maintaining normal speech and swallowing without functional impairment. Pedicle ossification may present radiographically as a suspicious bony change misinterpreted as tumor recurrence. Routine follow-up imaging such as computed tomography is essential for differentiation. Although trismus, bony swelling, or pain may occur, surgical intervention is typically deferred unless symptoms develop. Therefore, careful clinical assessment and monitoring remain crucial.

Pedicle ossification is a rare but significant complication following mandibular reconstruction using a fibular free flap (FFF), a technique widely employed in maxillofacial surgery due to its reliable vascularized bone supply and low donor site morbidity. The FFF supports dental implantation and prosthetic rehabilitation, with its vascularized periosteum enhancing osteogenic potential. Despite these advantages, unexpected ossification of the flap’s vascular pedicle may occur, potentially mimicking tumor recurrence and causing diagnostic uncertainty. This case report describes a 38-year-old male with left buccal squamous cell carcinoma treated by wide excision, modified radical neck dissection, and reconstruction using a radial forearm free flap. Postoperative radiotherapy led to complications including trismus and alveolar bone exposure, culminating in a pathological mandibular fracture. Mandibular reconstruction was performed using an FFF. Over 4 years of follow-up, computed tomography revealed ossification within the vascular pedicle. Notably, the patient remained asymptomatic, maintaining normal speech and swallowing without functional impairment. Pedicle ossification may present radiographically as a suspicious bony change misinterpreted as tumor recurrence. Routine follow-up imaging such as computed tomography is essential for differentiation. Although trismus, bony swelling, or pain may occur, surgical intervention is typically deferred unless symptoms develop. Therefore, careful clinical assessment and monitoring remain crucial.

BACKGROUND/AIMS: Serum alpha-fetoprotein (AFP) measurement is commonly included in a health check-up program in Korea. However, its benefits remain uncertain. We analyzed whether AFP measurement should be included in a general health check-up program to screen for hepatocellular carcinoma (HCC). METHODS: A total of 36,552 adults aged 18 years or older—who participated in a routine health examination including AFP determination between January 2009 and December 2009 at the Health Promotion Center, Samsung Medical Center, South Korea—were analyzed. High risk of HCC was defined as positivity for hepatitis B surface antigen, anti-hepatitis C virus antibody or having liver cirrhosis. RESULTS: AFP level >10 ng/mL was observed in 27 participants (0.1%) and primary liver cancer was diagnosed in 9 patients (6 HCC and 3 cholangiocarcinoma). Among 1,619 participants with high risk factors of HCC, AFP level >10 ng/mL was observed in 16 participants, of which, 4 diagnoses were made. Sensitivity, specificity, positive predictive value, and negative predictive value of AFP for HCC was 0.66, 0.99, 0.25 and 0.99, respectively, for high risk participants. Among 34,933 participants without risk factors for HCC, 11 patients (<0.1%) showed elevated AFP levels above 10 ng/mL, and no case was diagnosed with primary liver cancer during a median follow-up period of 36 months (range: 0-48 months). CONCLUSIONS: AFP elevation was rare in participants without risk factors for HCC, and was unable to screen for HCC in this population. We discourage routine AFP measurements for asymptomatic adults without risk factors of HCC.
Adult ; alpha-Fetoproteins* ; Carcinoma, Hepatocellular* ; Diagnosis ; Follow-Up Studies ; Health Promotion ; Hepatitis B Surface Antigens ; Humans ; Korea ; Liver Cirrhosis ; Liver Neoplasms ; Mass Screening* ; Risk Factors ; Sensitivity and Specificity

PURPOSE: Previous studies suggested that asymmetric stent expansion did not affect suppression of neointimal hyperplasia (NIH) after sirolimus-eluting stents (SES) implantation. The aim of this study was to evaluate the effects of stent eccentricity (SE) on NIH between SES versus paclitaxel-eluting stents (PES) using an intravascular ultrasound (IVUS) analysis from the randomized trial. MATERIALS AND METHODS: Serial IVUS data were obtained from Post-stent Optimal Expansion (POET) trial, allocated randomly to SES or PES. Three different SE (minimum stent diameter divided by maximum stent diameter) were evaluated; SE at the lesion site with maximal %NIH area (SE-NIH), SE at the minimal stent CSA [SE-minimal stent area (SE-MSA)], and averaged SE through the entire stent (SE-mean). We classified each drug-eluting stents (DES) into the concentric (> or = mean SE) and eccentric groups (< mean SE) based on the mean value of SE. RESULTS: Among 301 enrolled patients, 233 patients [SES (n = 108), PES (n = 125)] underwent a follow-up IVUS. There was no significant correlation between %NIH area and SE-NIH (r = - 0.083, p = 0.391) or SE-MSA (r = - 0.109, p = 0.259) of SES. However, SE-NIH of PES showed a weak but significant correlation with %NIH area (r = 0.269, p < 0.01). As to the associations between SE-mean and NIH volume index, SES revealed no significant correlation (r = - 0.001, p = 0.990), but PES showed a weak but significant correlation (r = 0.320, p < 0.01). However, there was no difference in the restenosis rate between the eccentric versus concentric groups of both DES. CONCLUSION: This study suggests that lower SE of both SES and PES, which means asymmetric stent expansion, may not be associated with increased NIH.
Aged ; Angiography/methods ; Coronary Restenosis/pathology/ultrasonography ; *Drug-Eluting Stents ; Female ; Humans ; Hyperplasia/*drug therapy/pathology ; Immunosuppressive Agents/administration & dosage ; Male ; Middle Aged ; Paclitaxel/*administration & dosage ; Sirolimus/*administration & dosage ; Tunica Intima ; Ultrasonography, Interventional/methods