BACKGROUND: The improved technique for cardiopulmonary resuscitation(CPR) has resulted in the survival of many patient who experienced cardiac arrest. However, mortality in resuscitated patients is high, and the survival rate without brain damage is very low. Various neurological examination models, neuro-imaging techniques, electrophysiological procedures, and biochemical tests have been studied with respect to the detection of cerebral damage and outcome, but an early, reliable prediction of individual outcomes is still uncertain. METHODS: We studied twenty patient who had been in a coma for more than 24 hours after CPR, Somatosensory evoked potentials(SEP) were measured within the first three days after CPR. RESULTS: Of the twenty patients, seven patients(35%) had a good outcome, and thirteen patients(65%) had a bad outcome. Of the eleven patients with loss of the cortical evoked potential's N20 peak, all had a bad outcome. CONCLUSION: SEPs are of great benefit in prognostic evaluation after CPR.
Brain ; Cardiopulmonary Resuscitation* ; Coma* ; Evoked Potentials, Somatosensory* ; Heart Arrest ; Humans ; Mortality ; Neurologic Examination ; Survival Rate

Hughes-Stovin syndrome is an extremely rare entity. We present a case of a 42-year-old man, who developed deep vein and inferior vena cava (IVC) thrombosis, repeated internal bleeding and pulmonary artery aneurysms (PAAs). The patient presented with massive hemoptysis and with PAAs of a 2.5 cm maximum diameter. We describe the successful percutaneous transhepatic venous embolization of the PAAs due to occluded common vascular pathways to the pulmonary artery.
Adult ; Aneurysm* ; Hemoptysis ; Hemorrhage ; Humans ; Pulmonary Artery* ; Thrombosis ; Veins ; Vena Cava, Inferior

PURPOSE: Kidney transplantation from elderly donors is controversial because of decline of received renal function and increased risk of perioperative complication. METHODS: We retrospectively reviewed the records of the 676 patients from 1985 to 2006 in our center. 42 (6.2%) donors were > or =60 years old, and constitue the group 1, and 634 donors (93.8%) were <60 years old (group 2). We analysis graft survival, preoperative and postoperative creatinine, creatinine clearance, acute rejection rate, infection rate, delayed graft fucntion rate, HLA matching between groups. RESULTS: The average donor age in group 1 is 62.8 yr (60~73) and 39.3 yr (16~59) in group 2. Graft survival rate at 1, 5 and 10 years were 92%, 71%, 56% in group 1 vs 92%, 77%, 62% in group 2 (P=0.0831). There was no difference of graft survival between groups. In preoperative serum creatinine or postoperative days 3, 30 creatinine there was not difference between groups. Infection rate was 9.5% (4 patients) in group 1 vs. 7.3% (46 patients) in group 2. Acute rejection rate was 28.6% (12 patients) vs. 30.9% (196 patients). Delayed graft function (DGF) rate was 7.1% (3 patients) vs. 9.0% (57 patients). HLA-AB matching was 1.86 vs. 1.78 and HLA-DR matching was 1.12 vs. 1.06. All were not significantly different between groups. But the elderly donor group has a lower creatinine clearance at postoperative 3, 30 days (P=0.0422, 0.0231). CONCLUSION: The short and long-term survival of kidney transplantation from elderly donors (> or =60) are similar to younger donors (<60). We suggest that use of elderly donors may help to expand the donor pool in kidney transplantation.
Aged ; Creatinine ; Delayed Graft Function ; Graft Survival ; HLA-DR Antigens ; Humans ; Kidney ; Kidney Transplantation ; Rejection (Psychology) ; Retrospective Studies ; Tissue Donors ; Transplants

Progressive multifocal leukoencephalopathy (PML) is a fatal disease that is characterized by progressive demyelination of the cerebral white matter due to JC viral infection. We report serial magnetic resonance spectroscopy (MRS) and tractography changes in a patient with PML. After a three-cycle treatment with cidofovir and cytarabine, the patient exhibited remarkable improvements in motor and cognitive functions. Follow-up MRS and tractography revealed regeneration of the white-matter fibers. This is the first consecutive neuroimaging study showing improvements in neurological symptoms using MRS and tractography.
Cytarabine ; Cytosine ; Demyelinating Diseases ; Follow-Up Studies ; Humans ; Leukoencephalopathy, Progressive Multifocal ; Magnetic Resonance Spectroscopy ; Neuroimaging ; Organophosphonates ; Regeneration

OBJECTIVE: To evaluate whether twin discordancy is a risk factor for adverse perinatal and neonatal outcomes. METHODS: Three hundred and seventy-five twin gestations over 28 weeks of gestation were included in this retrospective study. Medical records of mothers and infants were reviewed. Pregnancies were divided into 2 groups according to the birth weight discordancy(%) between twin neonates(group I;less than 25%, group II;25% or more). Birth weight discordancy was calculated from following formula; (birth weight of larger twin-birth weight of smaller twin)/birth weight of larger twin x 100. Perinatal and neonatal outcomes in group I and II were compared with each other. Also, difference in the outcomes between the smaller and larger twins of group II was evaluated. To evaluate whether birth weight discordancy is an independent variable in predicting poor perinatal and neonatal outcomes, multiple logistic regression analysis was used. RESULTS: Thirty-seven gestations(9.9%) were documented to belong to group II. Group II showed significantly higher incidence of preeclampsia, placenta previa, and small for gestational age infants(p<0.01, p<0.05 and p<0.001, respectively). The group also showed higher incidence of adverse neonatal outcomes(admission to neonatal intensive care unit, respiratory distress syndrome, pneumonia, bronchopulmonary dysplasia, patent ductus arteriosus, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, sepsis, congenital anomaly, neonatal death, p<0.01). Outcomes of the larger and smaller twins of group II were not significantly different with each other except small for gestational age infants(p<0.005). However, birth weight discordancy was not an independent variable in predicting adverse perinatal and neonatal outcomes. CONCLUSION: Fetal growth discordancy of 25% or more should be regarded as a risk factor for adverse perinatal and neonatal outcomes in twin gestations. However it is not an independent factor in predicting adverse perinatal and neonatal outcomes.
Birth Weight ; Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Fetal Development* ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Logistic Models ; Medical Records ; Mothers ; Placenta Previa ; Pneumonia ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Retinopathy of Prematurity ; Retrospective Studies ; Risk Factors* ; Sepsis

PURPOSE: Amiodarone (AD) is a potent and effective anti-dysrhythmic drug, but some literature reports that it 's long-term use is associated with the development of potentially life-threatening amiodarone-induced pulmonary toxicity (AIPT). Until now, oxygen free radical theory has been the most probable hypothesis for the development of AIPT. We investigated the protective effect of two potent antioxidants, N-acetylcysteine(NAC) and vitamin E, against AIPT. METHODS: Twenty-six (26) Hamsters were divided into a sham-operation group(n=2) and the following 4 groups: AD-induced effects without antioxidants (group 1, n=6), with NAC (group 2, n=6), with vitamin E (group 3, n=6), and with both NAC and vitamin E (group 4, n=6). Vitamin E (100 mg/kg) was injected intramuscularly into the hind leg once a day. At day 21, amiodarone (1.83 umol) was administered by transoral intratracheal instillation. NAC (300 mg/kg) was injected intraperitoneally just after amiodarone instillation. At day 28, amiodarone and NAC were administered again. Twenty-one (21) days after instillation of the second dose of amiodarone, the hamsters were sacrificed, and the lung fibrosis index and the hydroxyproline content were assessed. RESULTS: In the NAC-treated group (group 2), there was no significant decrease in either the lung fibrosis index, as determined by microscopic evaluation, or the lung hydrox-yproline content (p > 0.05). But there were significant decreases in the fibrosis index and the lung hydroxyproline content in the vitamin E-treated groups (group 3 and 4 ) (p < 0.05). CONCLUSION: Although vitamin E and NAC are both potent antioxidants, we found that AD-induced lung fibrosis was significantly decreased by only vitamin E and that there was no synergistic effect between vitamin E and NAC. It is possible that AIPT is developed by some other mechanisms rather than oxygen free radical injury. Vitamin E may have some other path for decreasing lung fibrosis. Further studies are warranted.
Acetylcysteine ; Amiodarone ; Animals ; Antioxidants ; Cricetinae* ; Fibrosis ; Hydroxyproline ; Leg ; Lung ; Oxygen ; Pulmonary Fibrosis* ; Vitamin E* ; Vitamins*

Midpalatal suture expansion if often used for patients having narrow maxillary arch, cleft palate, respiratory handicap with narrow nasal cavity. CGRP has been known as a modulator of pain transmission in central nervous system and a local effector to peripheral tissue causing vasodilation, increase of blood flow, modulation of immunesystem, regulation of macrophagic function and stimulation of bone formation. To investigate changes of CGRP-immunoreactive nerve fibers in midpalatal suture during the expansion, immunohistochemical study was performed by using rats. Experimental rats (10 weeks, 250 gm) were divided into five groups (control, 1, 4, 7, 14 days group (each n=4) and applied orthodontic force (approximately 200gm) to upper anterior incisors. Frozen sections of midpalatal suture area were immunostained by using rabbit antisera. The results were as follows: The CGRP-immunoreactive nerve fibers were hardly observed in control group. In 1 day group, the CGRP-immunoreactive nerve fibers were more increased around the vessels than control group. In 4 days group, the CGRP-immunoreactive nerve fibers were more increased than control group, but nor more increased than 1 day group. Vascular diameter was more enlarged. In 7 days group, especially, hematoxilin affinity of cells was remarkable and cells were arranged along the bone margin. The CGRP-immunoreactive nerve fibers were more reduced than 4 days group and vascular diameter was also reduced. In 14 days group. the CGRP-immunoreactive nerve fibers were similar to those of 7 days group and the irregularity of bone margin was almost recoverd. In Conclusion, the CGRP-immunoreactive nerve fibers may be related to intial neurogenic inflammatory reaction in expanding mid-palatal suture.
Animals ; Central Nervous System ; Cleft Palate ; Frozen Sections ; Humans ; Immune Sera ; Incisor ; Nasal Cavity ; Nerve Fibers* ; Osteogenesis ; Rats* ; Sutures* ; Vasodilation

Diffuse leukoencephalopathy is a well-known complication of methotrexate in intrathecal or high dose intravenous administration, especially when it is combined with cranial radiation therapy. However, low dose intravenous methotrexate induced leukoencephalopathy has not been reported previously. A 46-year-old female was administered intravenous methotrexate and 5-fluorouracil with oral cyclophosphamide after a modified radical mastectomy for breast cancer. After six cycles of chemotherapy, she developed rapidly progressing dementia and upper motor neuron signs. Brain MRI showed bilaterally symmetric white matter lesion without gadolinium enhancement. Laboratory investiga-tion showed no evidence of brain metastasis. This case suggests that low dose intravenous methotrexate can induce dif-fuse leukoencephalopathy.
Administration, Intravenous ; Brain ; Breast Neoplasms ; Cyclophosphamide ; Dementia ; Drug Therapy ; Female ; Fluorouracil ; Gadolinium ; Humans ; Leukoencephalopathies* ; Magnetic Resonance Imaging ; Mastectomy, Modified Radical ; Methotrexate* ; Middle Aged ; Motor Neurons ; Neoplasm Metastasis

PURPOSE: To assess the usefulness of Gd-DTPA MRI in the evaluation of the characteristics of intracranial meningiomas and in the correlation with their histopathologic pattern. MATERIALS AND METHODS: We retrospectively analyzed the Gd-DTPA MRI findings in 22 cases of histologicalty-proven intracranial meningiomas. The images were assessed for signal intensity, internal texture, peritumoral edema, and enhancement characteristics. Computed tomograms were obtained in 18 cases and compared with MRI findings. RESULTS: Tl-weighted images were not particularly useful for discriminating pathologic subtype, but signal intensity on T2-weighted images were relatively well correlated with histopathologic findings. A heterogeneous texture produced by tumor vascularity, calcification, cystic foci, hemorrhagic necrosis, or psammoma body was relatively well shown on Gd-DTPA Tl-weighted image compared with that on T1- or T2-weighted image. Gd-DTPA Tl-weighted images revealed a dural tail sign in 19 cases(83%). Angioblastic type was slightly hypointense on Tl-weighted image and markedly hyperintense on T2-weighted image. Psammomatous type and firboblastic type were isointense on both T1- and T2-weighted image. Fibroblastic type was more densely enhanced than the other. The transitional, atypical, and papillary types showed tendency of heterogeneous enhancement. CONCLUSION: Gd-DTPA MRI was a useful imaging modality in evaluation of the characteristics of meningiomas and correlated well with the pathologic patterns.
Edema ; Fibroblasts ; Gadolinium DTPA* ; Magnetic Resonance Imaging* ; Meningioma ; Necrosis ; Retrospective Studies

PURPOSE: No proven neuroprotective treatment exists for ischemic brain damage after cardiac arrest (CA). Although several animal studies have shown that mild to moderate hypothermia markedly mitigates ischemic brain damage after CA, the clinical safety and efficacy of mild hypothermia remain unproven. We conducted this preliminary study to evaluate the clinical feasibility and safety of mild resuscitative hypothermia (RH) for comatose patients of out-of-hospital CA. METHODS: We performed prospectively a preliminary, non-randomized, uncontrolled, clinical feasibility trial over four years in a university-based hospital. Consecutive patients admitted or transferred to the emergency medical center after out-of-hospital CA who met inclusion and exclusion criteria were enrolled. Hypothermia was induced as soon as possible after return of spontaneous circulation (ROSC) by using external surface cooling methods and cold saline gastric lavage at the target temperature (34 degrees C) and was maintained for 24 hours by using external surface cooling methods, which was followed by passive rewarming. RESULTS: Twelve patients were enrolled. Mean arrest time was 20+/-12 minutes (range 2 to 40); the mean advanced cardiac life support (ACLS) time was 12+/-8 minutes (range 4 to 27) and the mean time from start of ACLS to initiation of RH was 129 +/-113 minutes (range 40 to 420). Achieving the target temperature took 160+/-79 minutes (range 80 to 330) and the mean rewarming time was 605+/-190 minutes (range 360 to 960). One patient developed transient atrial fibrillation and premature ventricular complex during the induction period. Hypotension developed in six patients during hypothermia, pneumonia associated with induced hypothermia developed in four patients. Other complications, such as myoclonus (n=4), increased serum amylase (n=7), increased serum creatinine (n=2), and potassium abnormalities (n=2), also occurred. These complications occurred more frequently in patients with poor cardiac function after ROSC. No serious complications, such as ventricular fibrillation, bleeding, or sepsis, occurred. CONCLUSION: Mild RH after CA appears clinically feasible. However, induction with surface external cooling methods is slow, and maintenance of mild hypothermia was difficult. Future efforts to shorten the induction time and to develop more effective maintenance methods and more cautious applications to patients with poor cardiac function after ROSC are needed. Furthermore, well-designed, prospective, randomized, and controlled, multi-center efficacy trials are needed to evaluate the effect of mild RH.
Advanced Cardiac Life Support ; Amylases ; Animals ; Atrial Fibrillation ; Brain ; Coma* ; Creatinine ; Emergencies ; Gastric Lavage ; Heart Arrest ; Hemorrhage ; Humans ; Hypotension ; Hypothermia* ; Hypothermia, Induced ; Myoclonus ; Out-of-Hospital Cardiac Arrest* ; Pneumonia ; Potassium ; Prospective Studies ; Rewarming ; Sepsis ; Ventricular Fibrillation ; Ventricular Premature Complexes