BACKGROUND AND OBJECTIVES: Pure pontine infarct is defined as an infarct limited to the pons without the evidence of any other brainstem infarct. This study was designed to assess the etiology, lesion topography, and clinical characteristics of pure pontine infarcts. METHODS: Sixty-six patients with pure pontine infarcts, shown on magnetic resonance imaging, were divided into three groups(Group I(n=32) : unilateral lesion reaching the ventral surface of the pons(>1.5cm in size), Group II(n=27) : single or multiple lesions, separated from the surface(<1.5cm), Group III(n=7) : bilateral extensive lesion reaching the ventral surface). Clinical characteristics including the risk factors and the symptomotology were evaluated. Conventional or magnetic resonance angiography was performed in 37 patients(Group I ; 18/32, Group II ; 14/27, Group III ; 5/7). RESULTS: Pontine lesions in Group I(number of lesions = 36) were located longitudinally in the upper (8/36, 22.2%), middle(11/36, 30.6%), and lower(17/36, 47.2%) pons. Thirty-seven patients, in whom angiography was performed, were classified etiologically in each groups. In Group I, fourteen patients had basilar artery branch disease and four had large artery disease. In Group II, all had small artery disease. In Group III, three patients had large artery disease and two had basilar artery branch disease. The most frequent risk factor in pure pontine infarct was hypertension in all three groups. CONCLUSION: The lower region of pons is the most vulnerable site of pure pontine infarct. Basilar artery branch disease was the most common cause of the pure pontine infarct(43.2%). Small artery disease occupied 37.8% and large artery disease(18.9%) was less common.
Angiography ; Arteries ; Basilar Artery ; Brain Stem ; Humans ; Hypertension ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Pons ; Risk Factors

PURPOSE: The purpose of this study was conducted to identify the impact of Symptom Severity and Symptom Interference on Sleep Disturbance among cancer patients. METHODS: This study was conducted from October 8th to October 25th, 2012. One hundred eight cancer patients were recruited from S city in Korea. The instruments used in this study were the Symptom Severity, Symptom Interference and the Sleep Disturbance scales for patients with cancer. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and multiple regression with the SPSS/WIN 20.0 program. RESULTS: The Sleep Disturbance for cancer patients showed a significant relationship with Symptom Interference and cancer stage. The significant factors influencing Sleep Disturbance were Symptom Severity and Symptom Interference. They explained 40.5% of the variance in stage IV. CONCLUSION: Patients with cancer experienced Symptom Severity and Symptom Interference which led to a negative effect on Sleep Disturbance. The results suggest that intervention programs to reduce Symptom Severity, Symptom Interference could improve Sleep Disturbance for cancer patients.
Humans ; Korea ; Sleep Wake Disorders ; Weights and Measures

To study the biology of the endothelium and media under conditions that mimic the architecture of the vascular wall and the effects of low density lipoprotein(LDL) and oxidized lipoprotein(ox-LDL), three dimensional vascular wall model was constructed in vitro. In the vascular wall model, endothelial cells(EC) were grown on a collagen lattice containing multilayer of smooth muscle cells(SMC) and endothelial cell-free portion was made by a cloning ring on the culture disc. The availability of this vascular wall model promptly us to examine the extent LDL and ox-LDL affect ECs and SMCs when these cells were maintained with or without each other in coculture. The results were as follows; 1) Morphologic characteristics of three dimensional vascular wall model Artificial vascular wall was a whitish, non-transparent membrane. Outer boundaries and the zone of no ECs were thicker than that of central portion. By light microscope imaging, luminal surface was EC monolayer, and SMCs and collagen fibers were distributed between the PET membrane and EC monolayer. SMCs and collagen fibers were mainly located near the PET membrane. Venous SMCs were densely infiltrated as compared to arterial SMCs. By scanning electron microscopy, EC monolayer was clearly shown. 2) The effects of LDL and oxidized LDL on ECs and SMCs in artificial vascular wall (1) The effects of LDL Collagen fibers are infiltrated just beneath EC monolayer in venous SMCs-EC coculture model. In the zone of no EC, marked proliferation and synthesis of collagen fibers were noted. (2) The effects of ox-LDL Injured EC monolayer were clearly shown in both venous and arterial SMCs-EC coculture model. On high power field light microscopic examination, collagen fibers were exposed outside to the luminal surface and were pendendicularly arranged, and looked like as ciliary projection. Artificial wall of these experimental model were thicker than that of control, and proliferation of SMCs and collagen synthesis were increased than those of control and LDL experiment groups. On scanning electromicroscopic examination, ECs were more slender and cell-to-cell contact was loosened. As a conclusion, this vascular wall model is to be good experimental model for vascular research. And LDL and ox-LDL have toxic effects on vascular EC layer and stimulate proliferation of SMCs and collagen synthesis in vitro three dimensionally constructed vascular wall model.
Biology ; Clone Cells ; Cloning, Organism ; Coculture Techniques ; Collagen ; Endothelial Cells ; Endothelium ; Lipoproteins ; Membranes ; Microscopy, Electron, Scanning ; Models, Theoretical ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Phenobarbital

BACKGROUND: Ischemic stroke is a complex condition influenced by many factors. Previous studies have demonstrated that inflammatory markers might play a role in such vascular diseases. Therefore the purpose of this study was to compare the expression of inflammatory markers in Korean ischemic stroke patients and to investigate their relationship to APOE polymorphism. METHODS: The patient group consisted of 275 patients with large artery atherosclerosis (LAA, n=169) and small artery occlusion (SAO, n=106). One hundred and nineteen age matched healthy subjects were recruited as the control group. Serum levels of three inflammatory markers (matrix metalloproteinase, MMP-9; tissue inhibitor of metalloproteinase-1, TIMP-1; and high-sensitivity C-reactive protein, hs-CRP) were measured in each patient by using commercially available kits. Comparison of clinical risk factors, inflammatory marker levels, and APOE genotypes between the stroke patient group and control group and between the two patient subgroups was assessed. RESULTS: Comparison of the stroke group to control group showed significantly elevated levels of circulating MMP-9 (P<0.01) and hs-CRP (P=0.01). Comparison between the individual subgroups revealed a significantly higher level of only TIMP-1 in the LAA subgroup compared to the SAO subgroup (P<0.01). There was no significant difference in inflammatory marker levels among each allele carrier. CONCLUSIONS: The present study revealed the obvious tendency of increased circulating inflammatory markers in the patients with acute ischemic attack, especially MMP-9 and hs-CRP. Our observations suggest that measurement of serum MMP-9, TIMP-1, and hs-CRP levels may be useful in the diagnosis of ischemic stroke patients.
Aged ; Apolipoproteins E/*genetics ; Biological Markers/blood ; Brain Ischemia/complications/*diagnosis ; C-Reactive Protein/analysis ; Carotid Artery Diseases/complications ; Female ; Genotype ; Humans ; Inflammation Mediators/*blood ; Korea ; Male ; Matrix Metalloproteinase 9/blood ; Middle Aged ; Polymorphism, Genetic ; Stroke/*diagnosis/etiology/immunology ; Tissue Inhibitor of Metalloproteinase-1/blood

PURPOSE: To compare the accuracy of centration of ablation zones and visual acuity with two different techniques (fixation ring and patient self-fixation) with flying spot laser to maintain immobilization of the globe during laser assisted in situ keratomileusis (LASIK). METHODS: 240 eyes from 124 patients who underwent LASIK by two techniques were studied retrospectively. One technique used a fixation ring to maintain centration of the cornea and the other technique used patient fixation, with no mechanical restraint of the eye. The eyes were treated with the MEL-70 flying spot excimer laser and topographic maps were recorded with the ATLAS(R) (MasterVue(R) software, Zeiss Humphrey, Germany). The amount and direction of decentration were compared between the 2 techniques. The preoperative and postoperative best corrected visual acuity were also compared. RESULTS: Mean amount of decentration in fixation ring using group was 0.59+/-0.39 mm and that of decentration in patient fixation group was 0.61+/-0.42 mm. Between the two groups, no significant difference in amount of decentraion was noted statistically. Most of decentration from the pupil center was located superonasally and inferonasally. Also there was no difference in the mean preoperative best corrected visual acuity, spherical equivalent, 1 year postoperative best corrected visual acuity between the two groups. CONCLUSIONS: The fixation ring during LASIK makes no difference with patient self-fixation in amount of decentration of ablation zone in spite of relatively long time of laser shot in flying spot excimer laser.
Cornea ; Diptera* ; Humans ; Immobilization ; Keratomileusis, Laser In Situ* ; Lasers, Excimer ; Pupil ; Retrospective Studies ; Visual Acuity

PThe numerous options currently available for treatment of aortoiliac occlusive disease have led to considerable controversy in regard to the optional method of revascularization in such patients. Differences of options exist not only with respect to certain technical aspects of direct anatomic aortic reconstruction, which has traditionally been regarded as the "gold standard" treatment, but even more importantly as to whether alternative methods including a variety of catheter-based endoluminal therapies and extraanatomic bypasses may offer nearly equivalent results with less risk. From March 1992 to Dec 2002, 99 aortoiliac occlusive cases were surgically treated at Kyunghee university hospital. Surgical indications, combined diseases, cardiac risk assessment, type of occlusions, surgical methods and cumulative patency rate were reviewed retrospectively. Extensive disease pattern was more common in our experiences. No single option for inflow revascularization is optimal in all instances. Durability must be balanced against the possible advantages of safety and expediency. The availability and results of alternative techniques have improved, but aortofemoral bypass remains the most durable and functionally effective.
Heart Diseases ; Humans ; Iliac Artery* ; Retrospective Studies ; Risk Assessment

PURPOSE: Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system and mostly develops after viral illness or vaccinations. We investigated the clinical differences and neurologic outcomes according to the distribution of the lesions on brain MRI. METHODS: The study group was composed of 21 patients from January 1995 to August 2003 in Kyunghee University hospital. We grouped the patients according to the MRI findings as follows. Group I (14 cases): Multi- or unifocal lesions only in the cerebral white matter. Group II (7 cases): lesions in the gray matter with or without white matter involvement. RESULTS: 1.Preceding events were as follows: no defined prodrome (38.1%), upper respiratory tract infection (28.6%), nonspecific febrile illness (19.0%), gastointestinal disturbance and vaccination. 2.Presenting symptoms were as follows: seizures (76.2%), headache/vomiting (47.6%), altered consciousness (38.1%), hemiparesis, cerebellar ataxia, visual disturbance and facial nerve palsy. 3.Laboratory findings were as follows: CSF pleocytosis (76.2%), leucocytosis (38.1%) and elevated CSF protein (28.6%). 4.Fifteen patients were recovered completely without neurological sequelae. Three patients in group I and 1 patient in group II had intractable seizures. Two patients in group I and 2 patients in group II had motor disturbance. CONCLUSION: There were no statistically significant differences in preceding events, presenting symptoms, and neurological outcomes according to the distribution of the lesions on brain MRI. However, the ADEM have quite diverse clinical manifestations and neuroimage findings. MRI plays an important role in making diagnosis of the patients who are suspected of ADEM.
Brain ; Central Nervous System ; Cerebellar Ataxia ; Consciousness ; Demyelinating Diseases ; Diagnosis ; Encephalomyelitis ; Encephalomyelitis, Acute Disseminated* ; Facial Nerve ; Humans ; Leukocytosis ; Magnetic Resonance Imaging* ; Paralysis ; Paresis ; Prognosis* ; Respiratory Tract Infections ; Seizures ; Vaccination

PURPOSE: This study was done to explore the meaning of joys and sorrows in mothers of children with Mucopolysaccharidosis (MPS). METHODS: The participants were 9 mothers who each had a child with MPS. Data were gathered using in-depth interviews. The interviews were recorded and transcribed verbatim. Data were analyzed using Colaizzi method. RESULTS: The significant results from analyzing the interviews can be grouped into 12 concept descriptions, and 5 theme clusters. The essential theme clusters for the experience of the mothers were 'hopelessness about this rare disease', 'guilt because of the disease being hereditary', 'endless courses of treatment', 'wounds in the relationship', and 'relative composure of mind'. CONCLUSION: The finding of this study offer profound information on joys and sorrows experienced by mothers of children with MPS and provide basic data for developing nursing intervention strategies for the mothers of children with rare diseases.
Child ; Humans ; Mothers ; Mucopolysaccharidoses ; Rare Diseases ; Child Health

Hemophilia A (factor VIII deficiency) and Hemophilia B (factor IX deficiency) are the most common and serious congenital coagulation disorders. Accurate diagnosis is important and essential for effective management. A definitive diagnosis depends on factor assay to demonstrate the presence of factor VIII or factor IX. Bleeding should be treated with factor replacement therapy at the earliest moment possible, preferably within two hours from the onset of symptoms. In spite of improvements in hemophilia therapy, arthropathy remains as a significant clinical problem. Based on numerous recommendations, a major goal of hemophilia therapy is to prevent any joint disease, and prophylaxis is superior to on-demand therapy in delaying or preventing the development of hemophilic arthropathy. Prophylaxis is the administration of clotting factors at regular intervals to prevent bleeding. Currently the most commonly suggested protocol for prophylaxis is the infusion of 25~40 IU/kg of clotting factor concentrates three times a week for those with hemophilia A and twice a week for those with hemophilia B. The management of patients who have inhibitory antibodies against factor VIII or IX remains challenging. About 10~15% of hemophilia A patients and 1~3% of hemophilia B patients may develop persistent inhibitors rendering treatments with factor concentrates difficult. Alternative agents for hemophilia inhibitor patients include bypassing agents, such as recom-binant factor VIIa and prothrombin complex concentrates. Ultimately, immune tolerance induction to eradicate the inhibitor is desired.
Antibodies ; Blood Coagulation Factors ; Factor IX ; Factor VIIa ; Factor VIII ; Hemophilia A ; Hemophilia B ; Hemorrhage ; Humans ; Immune Tolerance ; Joint Diseases ; Prothrombin

Latency within the nervous system is a characteristic feature of herpesviridae infection. It is reactivated by triggering factors such as UV exposure, stress, and trauma. Simultaneous reactivation of herpes simplex and herpes zoster is uncommon, however, an observation provably explained by differences in the trigerring mechanism. Concurrent reactivation of herpes simplex virus (HSV) and varicella zoster virus (VZV) is occasionally encountered in immunosuppressed patients; on the other hand, it is rarely reported in immunocompetent individuals. We present the case of an immunocompetent 8-yr-old female patient with concurrent reactivation of HSV on the face and VZV on the right L2 dermatome.
Buttocks/pathology/virology ; Child ; Face ; Female ; Herpes Simplex/complications/diagnosis/pathology/*virology ; Herpes Zoster/complications/diagnosis/pathology/*virology ; Herpesvirus 3, Human/*physiology ; Humans ; Immunocompetence ; Simplexvirus/*physiology ; Thigh/pathology/virology ; *Virus Activation