Diffuse neonatal hemangiomatosis is a fatal disorder characterired by multiple cutaneous and visceral hemangiomas. The organs most commonly affected are the gastrointestinal tract, brain, liver and lung. The complications are high output cardiac failure, gastrointestinal bleeding and hydrocephalus. We present a patient with diHuse neonatal hemangiomatosis associated with massive hepatic involvement and high output cardiac failure, which was successfully treated with high dose corticosteroid.
Brain ; Gastrointestinal Tract ; Heart Failure ; Hemangioma ; Hemorrhage ; Humans ; Hydrocephalus ; Liver ; Lung

PURPOSE: To evaluate the outcomes and complications of cataract surgery, using phacoemulsification in patients with Behcet's disease. METHODS: Twenty eyes of fourteen patients with Behcet's disease, who underwent extracapsular cataract extraction using phacoemulsification and intraocular lens implantation between July 2001 and March 2004, were included in this study. Their postoperative visual acuity and complications were reviewed. RESULTS: Ocular attacks after cataract surgery occurred in 10 eyes (50%). Uveitis developed in 10 of 12 eyes (83.3%) that had a uveitis-free interval of less than six months. On the other hand, in eight eyes that lasted more than 12 months with no uveitis, no postoperative ocular attack was found (p<0.01, Chi-square test). The incidence and severity of uveitis did not appear to increase upon surgery. Visual acuity improved in 17 eyes (85%). However, after 1 year postoperatively, a statistically significant decrease in visual acuity was observed in the recurrent uveitis group (p=0.05, t-test). CONCLUSIONS: Cataract surgery, using phacoemulsification and intraocular lens implantation, is tolerable in patients with Behcet's disease. The most predictive factor of ocular attacks and prognosis after cataract surgery was the 'uveitis free' duration before surgery. A uveitis-free interval of more than 12 months in duration was predictive of the best prognosis.
Behcet Syndrome ; Cataract Extraction ; Cataract* ; Hand ; Humans ; Incidence ; Lens Implantation, Intraocular ; Phacoemulsification* ; Prognosis ; Uveitis ; Visual Acuity

PURPOSE: Although carotid endarterectomy (CEA) is recommended as a treatment for carotid stenosis rather than carotid artery stenting (CAS), CAS has been preferred in Korea. The aim of this study was to analyze long-term outcomes after CAS compared with CEA using Korean nationwide insurance data. MATERIALS AND METHODS: We obtained all data from the nationwide database of the Health Insurance Review & Assessment Service (HIRA) during the study period using several codes regarding the procedure or operation. We included the HIRA data, which included at least one-year follow-up after the procedures. The outcomes associated with both procedures were death, recurrence of ischemic stroke, and admission for cerebral hemorrhage. RESULTS: A total of 16,065 eligible patients who were treated with CAS or CEA between 1 January 2007 and 31 December 2016 were analyzed. The number of patients with CAS and CEA was 12,173 (75.8%) and 3,892 (24.2%), respectively. 8,976 patients (55.9%) were classified as symptomatic patients. CAS was associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.282; 95% confidence interval [CI], 1.173–1.400). The adjusted rates for recurrent ischemic stroke and cerebral hemorrhage between CAS versus CEA were 24.9% versus 15.9% (HR, 1.474; 95% CI, 1.325–1.639) and 1.5% versus 0.9% (HR, 2.026; 95% CI, 1.322–3.106), respectively. In young symptomatic patients, there was no statistically significant difference in all-cause mortality and cardiovascular death between CAS and CEA. CONCLUSION: Our study using Korean nationwide insurance data demonstrated similar results to previous studies. Until further evidence of CAS is established through prospective studies, CAS should be performed in selected patients according to current guidelines.
Carotid Arteries ; Carotid Stenosis ; Cerebral Hemorrhage ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Insurance ; Insurance, Health ; Korea ; Mortality ; Prognosis ; Prospective Studies ; Recurrence ; Stents ; Stroke

Hyperintense vessels are frequently observed on fluid-attenuated inversion recovery imaging in acute ischemic stroke patients. Some investigators suggest that a hyperintense vessel sign in patients with middle cerebral arterial occlusion results from collateral blood flow originating in neighboring arterial territories, especially via pial collaterals. We report two cases of acute proximal middle cerebral arterial infarction that exhibited hyperintense vessels signs on fluid-attenuated inversion recovery imaging accompanying pial collaterals as confirmed by cerebral angiography.
Cerebral Angiography ; Cerebral Infarction ; Collateral Circulation ; Glycosaminoglycans ; Humans ; Infarction ; Infarction, Middle Cerebral Artery ; Middle Cerebral Artery ; Research Personnel ; Stroke

PURPOSE: To determine whether sleep-related erections(SREs) occur during chronic vegetative state and if so, to investigate what factors are involved. MATERIALS AND METHODS: Twenty-six men in a vegetative state aged 16~65 were selected. Exclusion criteria were the lack of informed consent, mean blood pressure under 90/60 mmHg during last 3 days, erectile dysfunction before brain injury, and a history of any anti-androgen treatment. Serum testosterone, albumin, sex hormone binding globulin(SHBG), and dehydroepiandrosterone sulfate(DHEAS) were assayed, and bioavailable testosterone(cBT) and free testosterone(cFT) were calculated. Nocturnal penile erections were counted and evaluated using the Rigiscan device for72 hours. Data on the number of erections, erection duration, minimal and maximal base tumescence, minimal and maximal tip tumescence, and base and tip rigidity were taken. RESULTS: SREs were noted in 25 patients. The mean erection number was 4.65+/-3.93(1~15), and the mean erection duration was 128.85+/-46.86 minutes(0~478.5). SREs were negatively correlated with age(r=-0.445, p<0.05), systolic BP(r=-0.394, p<0.05) and diastolic BP(r=-0.403, p<0.05), but positively correlated with DHEAS(r=0.395, p<0.05). SREs were not correlated with total testosterone, cBT or cFT. CONCLUSIONS: These preliminary findings suggest that SREs are a normal occurrence in vegetative patients. They contribute to penile blood perfusion if the supraspinal erection control center is intact and serum testosterone level is above the minimum required for SREs.
Blood Pressure ; Brain Injuries ; Dehydroepiandrosterone ; Dehydroepiandrosterone Sulfate ; Erectile Dysfunction ; Humans ; Informed Consent ; Male ; Perfusion ; Persistent Vegetative State* ; Testosterone

No abstract available.
Cerebral Infarction ; Constriction, Pathologic* ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery*

PURPOSE: To evaluate the changes in corneal keratometry (K) readings after corneal collagen cross- linking (CXL) using 20% alcohol in primary keratoconus and keratectasia after refractive surgery. METHODS: Twelve eyes of 10 patients with primary keratoconus and 3 eyes of 3 patients with keratectasia after refractive surgery were included in the present study. Best-corrected visual acuity (BCVA) and mean K, corneal astigmatism by corneal topography, and mean K, corneal astigmatism, and spherical equivalent (SE) by auto refractometer were evaluated at baseline, and 6 months postoperatively. Eight eyes of 7 patients were also evaluated 1 year postoperatively. RESULTS: Mean BCVA improved from log MAR 0.66 +/- 0.50 to log MAR 0.55 +/- 0.58 (p = 0.100) at 6 month after CXL. In corneal topography, mean K significantly decreased from 50.04 +/- 5.88 D to 49.18 +/- 6.15 D (p = 0.019), and corneal astigmatism slightly decreased from 5.33 +/- 4.47 D to 5.29 +/- 4.88 D (p = 0.755) at 6 months after CXL. According to the auto refractometer, mean K significantly decreased from 48.53 +/- 5.94 D to 47.95 +/- 5.79 D (p = 0.038), corneal astigmatism significantly decreased from 3.95 +/- 2.54 D to 3.52 +/- 2.40 D (p = 0.010), and SE significantly decreased from -6.25 +/- 3.45 D to -5.40 +/- 2.91 D (p = 0.037) at 6 months after CXL. Significant mean K and corneal astigmatism decreases in topography were also observed at 1 year after CXL. Complications related to CXL were not observed. CONCLUSIONS: CXL using 20% alcohol appears to be a safe and promising treatment modality with less corneal stromal damage in progressive primary keratoconus and keratectasia after refractive surgery.
Astigmatism ; Collagen ; Corneal Topography ; Eye ; Humans ; Keratoconus ; Reading ; Refractive Surgical Procedures ; Visual Acuity

Several new antithrombotic drugs have been developed and approved to use in clinical practice recently. Dabigatran, a direct thrombin inhibitor, and rivaroxaban, a factor Xa inhibitor, have been approved in many countries including Korea to prevent stroke in patient with atrial fibrillation. Apixaban, another factor Xa inhibitor, showed good results in clinical trial and is waiting for approval for clinical use. New antiplatelet agent, terutroban, selective thromboxane A2 receptor inhibitor, failed to prove the efficacy over the aspirin in secondary stroke prevention. Vorapaxar, a new antiplatelet agent that inhibits thrombin through PAR-1 antagonism, showed a high incidence of intracranial hemorrhage in patient with a history of stroke.
Aspirin ; Atrial Fibrillation ; Benzimidazoles ; beta-Alanine ; Factor Xa ; Humans ; Incidence ; Intracranial Hemorrhages ; Korea ; Lactones ; Morpholines ; Naphthalenes ; Propionates ; Pyrazoles ; Pyridines ; Pyridones ; Receptors, Thromboxane A2, Prostaglandin H2 ; Stroke ; Thiophenes ; Thrombin ; Dabigatran ; Rivaroxaban

OBJECTIVE: There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. MATERIALS AND METHODS: A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. RESULTS: CEA or CAS is indicated when the patient has a symptomatic stenosis > or = 50%, or when the patient has an asymptomatic stenosis > or = 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. CONCLUSION: We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis.
Carotid Arteries ; Carotid Stenosis* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Humans ; Stents

Carotid artery stenting is widely performed for extracranial carotid artery stenosis. In-stent thrombosis is a rare but potentially devastating complication. We present a case of acute in-stent thrombosis immediately following stent insertion and post-balloon dilatation in a 64-year-old male. Thrombosis was successfully treated by intravenous tirofiban, a glycoprotein IIb/IIIa receptor inhibitor.
Acute-Phase Reaction/*drug therapy/*pathology ; Angiography ; Carotid Artery Diseases/*drug therapy/*pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Stents ; Thrombosis/*drug therapy/*pathology ; Tyrosine/*analogs & derivatives/therapeutic use