Background: and Purpose The influence of imaging features of brain frailty on outcomes were investigated in acute ischemic stroke patients with minor symptoms and large-vessel occlusion (LVO). Methods: This was a retrospective analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute (within 24 h) minor (National Institutes of Health Stroke Scale score=0–5) ischemic stroke with anterior circulation LVO (acute minor LVO). Brain frailty was stratified according to the presence of an advanced white-matter hyperintensity (WMH) (Fazekas grade 2 or 3), silent/old brain infarct, or cerebral microbleeds. The primary outcome was a composite of stroke, myocardial infarction, and all-cause mortality within 1 year. Results: In total, 1,067 patients (age=67.2±13.1 years [mean±SD], 61.3% males) were analyzed. The proportions of patients according to the numbers of brain frailty burdens were as follows: no burden in 49.2%, one burden in 30.0%, two burdens in 17.3%, and three burdens in 3.5%. In the Cox proportional-hazards analysis, the presence of more brain frailty burdens was associated with a higher risk of 1-year primary outcomes, but after adjusting for clinically relevant variables there were no significant associations between burdens of brain frailty and 1-year vascular outcomes. For individual components of brain frailty, an advanced WMH was independently associated with an increased risk of 1-year primary outcomes (adjusted hazard ratio [aHR]=1.33, 95% confidence interval [CI]=1.03–1.71) and stroke (aHR=1.32, 95% CI=1.00–1.75). Conclusions The baseline imaging markers of brain frailty were common in acute minor ischemic stroke patients with LVO. An advanced WMH was the only frailty marker associated with an increased risk of vascular events. Further research is needed into the association between brain frailty and prognosis in patients with acute minor LVO.

BACKGROUND/AIMS: This nationwide, multicenter prospective randomized controlled trial aimed to compare the efficacy and safety of 10-day concomitant therapy (CT) and 10-day sequential therapy (ST) with 7-day clarithromycin-containing triple therapy (TT) as first-line treatment for Helicobacter pylori infection in the Korean population. METHODS: Patients with H. pylori infection were assigned randomly to 7d-TT (lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg twice daily for 7 days), 10d-ST (lansoprazole 30 mg and amoxicillin 1 g twice daily for the first 5 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 500 mg twice daily for the remaining 5 days), or 10d-CT (lansoprazole 30 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg twice daily for 10 days). The primary endpoint was eradication rate by intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS: A total of 1,141 patients were included. The 10d-CT protocol achieved a markedly higher eradication rate than the 7d-TT protocol in both the ITT (81.2% vs 63.9%) and PP analyses (90.6% vs 71.4%). The eradication rate of the 10d-ST protocol was superior to that of the 7d-TT protocol (76.3% vs 63.9%, ITT analysis; 85.0% vs 71.4%, PP analysis). No significant differences in adherence or serious side effects were found among the three treatment arms. CONCLUSIONS: The 10d-CT and 10d-ST regimens were superior to the 7d-TT regimen as standard first-line treatment in Korea.
Amoxicillin ; Arm ; Clarithromycin ; Disease Eradication ; Helicobacter pylori ; Helicobacter ; Humans ; Korea ; Lansoprazole ; Metronidazole ; Prospective Studies

No abstract available.
Mortality* ; Rhinoplasty* ; Sepsis* ; Transplants*

BACKGROUND: Streptococcus agalactiae (Group B streptococcus, GBS) is known to be the leading cause of neonatal sepsis and meningitis in the United States and Europe. In addition, GBS infection has been increasingly noted in adults, particularly in those with underlying diseases, such as diabetes mellitus, malignancy and liver disease. A few studies reported that resistances to antibiotics, such as erythromycin, clindamycin, tetracycline are increasing. We report clinical and microbiological characteristics of GBS bacteremic patients in Jeju Island. METHODS: We retrospectively analyzed medical records, such as age, sex, underlying disease, mortality, skin defects, laboratory results and antibiotic resistances of GBS in hospitalized adult patients who were diagnosed with GBS bacteremia from 2008 to 2013 in Jeju Island. RESULTS: Twenty two adult patients were diagnosed as GBS bacteremia from 2008 to 2013. The mean age of GBS bacteremic patients was 66.2 years old. Of 22 bacteremic patients, fifteen patients (68%) were older than 60. Twenty patients (91%) of bacteremic patients had underlying diseases such as diabetes mellitus, malignancy and liver disease. Ten (45%) patients had skin defects which were on the lower extremities and buttock, fifteen (68%) patients had fever at the time of admission, twenty one (95%) patients were admitted via the emergency department. Two (9%) patients died. The mean white blood cell (WBC) count, percentile of neutrophil count, and C-reactive protein (CRP) levels were 11,488/microL, 84.3 %, 13.5 mg/dL respectively. All GBS isolates from bacteremia showed sensitivities to penicillin, ampicillin, and vancomycin, and showed resistances to erythromycin (25%), clindamycin (30%), and tetracycline (55%). CONCLUSION: Bacteremia caused by GBS was prevalent in adult patients with underlying diseases. Most of the GBS bacteremic patients were emergency cases, with a high body temperature, WBC, CRP level, and neutrophil count. Half of them had skin defects, which are considered a source of GBS bacteremia.
Adult* ; Ampicillin ; Anti-Bacterial Agents ; Bacteremia* ; Body Temperature ; Buttocks ; C-Reactive Protein ; Clindamycin ; Diabetes Mellitus ; Drug Resistance ; Emergencies ; Emergency Service, Hospital ; Erythromycin ; Europe ; Fever ; Humans ; Leukocytes ; Liver Diseases ; Lower Extremity ; Medical Records ; Meningitis ; Mortality ; Neutrophils ; Penicillins ; Retrospective Studies ; Sepsis ; Skin ; Streptococcus agalactiae* ; Streptococcus* ; Tetracycline ; United States ; Vancomycin

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by cystic dilatation of the pancreatic duct, excessive mucin production, and papillary growth of the tumor. Occasionally, it forms a fistula into other organs. Because of the higher malignant potential of the main duct type IPMN compared to the branch duct type, patients with main duct type IPMN usually undergo surgical treatment and the natural history of the main duct type IPMN is not commonly observed in clinical practice. An 84-year-old woman was diagnosed with main duct type IPMN of pancreas, but she refused operative treatment. Seven years later she was admitted by chance for another disease, and then referred to our gastrointestinal department. We think this case can give us an insight of the natural course of the main duct type IPMN.
Aged, 80 and over ; Dilatation ; Female ; Fistula ; Humans ; Mucins ; Natural History ; Pancreas ; Pancreatic Ducts

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by cystic dilatation of the pancreatic duct, excessive mucin production, and papillary growth of the tumor. Occasionally, it forms a fistula into other organs. Because of the higher malignant potential of the main duct type IPMN compared to the branch duct type, patients with main duct type IPMN usually undergo surgical treatment and the natural history of the main duct type IPMN is not commonly observed in clinical practice. An 84-year-old woman was diagnosed with main duct type IPMN of pancreas, but she refused operative treatment. Seven years later she was admitted by chance for another disease, and then referred to our gastrointestinal department. We think this case can give us an insight of the natural course of the main duct type IPMN.
Aged, 80 and over ; Dilatation ; Female ; Fistula ; Humans ; Mucins ; Natural History ; Pancreas ; Pancreatic Ducts

Gastric duplication cyst is a congenital disease and an uncommon finding in adult patients. Presenting symptoms are often asymptomatic during adulthood. Most cases are discovered incidentally by radiological examination or gastric endoscopy. Preoperative diagnosis of gastric duplication is difficult because definitive diagnosis requires a well-developed coat of smooth muscle with an epithelial lining that represents some portion of the alimentary tract in the lesion. In majority of reported cases, the diagnosis is established by surgical exploration and the treatment is primarily managed by complete excision. We report a case of a gastric duplication cyst in a 40-year-old man.
Adult ; Endoscopy ; Humans ; Muscle, Smooth ; Stomach

Gastric duplication cyst is a congenital disease and an uncommon finding in adult patients. Presenting symptoms are often asymptomatic during adulthood. Most cases are discovered incidentally by radiological examination or gastric endoscopy. Preoperative diagnosis of gastric duplication is difficult because definitive diagnosis requires a well-developed coat of smooth muscle with an epithelial lining that represents some portion of the alimentary tract in the lesion. In majority of reported cases, the diagnosis is established by surgical exploration and the treatment is primarily managed by complete excision. We report a case of a gastric duplication cyst in a 40-year-old man.
Adult ; Endoscopy ; Humans ; Muscle, Smooth ; Stomach

No abstract available.
Chicago

Majocchi's granuloma is well recognized but uncommon infection of dermal and subcutaneous tissue by fungal organisms usually limited to the superficial epidermis. The organism most commonly associated with Majocchi's granuloma is Trichophyton(T.) rubrum, however, other dermatophytes may be the causative agent. A 44-year-old male patient presented with a 6 month history of two well defined erythematous nodular plaques on his right jaw and preauricular area. Histopathologic findings were consistent with the Majocchi's granuloma, showing perifolliculitis and granulomatous inflammation in the dermis. Many fungal elements were noted within the giant cells of the perifollicular dermis of PAS stained section. T. rubrum was cultured from the biopsy specimen and confirmed by slide culture. After 10 weeks of terbinafine (Lamisil(R)) therapy (250 mg/day), lesions were cleared with mild erythematous patches and atrophic scars.
Adult ; Arthrodermataceae ; Biopsy ; Cicatrix ; Dermis ; Epidermis ; Giant Cells ; Granuloma ; Humans ; Inflammation ; Jaw ; Male ; Naphthalenes ; Subcutaneous Tissue ; Trichophyton