In early thrombolytic therapy for acute focal ischemic stroke, the start of treatment within therapeutic time window is one of the most important thing. Recently, new imaging modalities such as SPECT, transcranial doppler, diffusion/ perfusion-weighted MRI, and MR anglography have been implicated to avoid time consumption and delayed therapy. Of these, MR angiography is nomnvasi and rapid technique to visualize large and medium-sized arteries. We explored the usefulness of MR angiography in early thrombolytic therapy. Arterial occlusion of three patients with severe ischemic stroke were demonstrated on MR anglography and wluch were treated with Urokmase (10, 000-20, 000 units/kg) by intravenous infusion within 2-4 hours after symptom onset. Recanalization and brain lesion was assessed by repeated MR angiography and MRI or CT 24 hours later. Clinical improvement was observed in two patients 5-24 hours after initiation of treatment. In one patient hemorrhagic infarction without clinical deterioration was detected by follow-up computed tomography. Recanalization was documented on repeated MR angiography of three patients. MR angiography can document occlusion of stroke-related vasculature without delay of thrombolytic therapy and repeated MR anglography can reveal whether recanalization has occurred.
Angiography ; Arteries ; Brain ; Follow-Up Studies ; Humans ; Infarction ; Infusions, Intravenous ; Magnetic Resonance Angiography* ; Magnetic Resonance Imaging ; Stroke ; Thrombolytic Therapy ; Tomography, Emission-Computed, Single-Photon

PURPOSE: Esophageal cancer patients have a difficulty in the intake of meals through the blocked esophageal lumen, which is caused by an ingrowth of cancer cells and largely influences on the prognosis. It is reported that esophageal cancer has a very low survival rate due to the lack of nourishment and immunity as the result of this. In this study a new radioactive stent, which prevents tumor ingrowth and restenosis by additional radiation treatment, has been developed. MATERIALS AND METHODS: Using HANARO research reactor, the radioactive stent assembly (166Ho-SA) was prepared by covering the metallic stent with a radioactive sleeve by means of a post-irradiation and pre-irradiation methods. RESULTS: Scanning electron microscopy and autoradiography exhibited that the distribution of 165/166Ho (NO3) compounds in polyurethane matrix was homogeneous. A geometrical model of the esophagus considering its structural properties, was developed for the computer simulation of energy deposition to the esophageal wall. The dose distributions of 166Ho-stent were calculated by means of the EGS4 code system. The sources are considered to be distributed uniformly on the surface in the form of a cylinder with a diameter of 20 mm and length of 40 mm. As an animal experiment, when radioactive stent developed in this study was inserted into the esophagus of a Mongrel dog, tissue destruction and widening of the esophageal lumen were observed. CONCLUSION: We have developed a new radioactive stent comprising of a radioactive tubular sleeve covering the metallic stent, which emits homogeneous radiation. If it is inserted into the blocked or narrowed lumen, it can lead to local destruction of the tumor due to irradiation effect with dilatation resulting from self-expansion of the metallic property. Accordingly, it is expected that restenosis esophageal lumen by the continuous ingrowth and infiltration of cancer after insertion of our radioactive stent will be decreased remarkably.
Animal Experimentation ; Animals ; Autoradiography ; Computer Simulation ; Dilatation ; Dogs ; Esophageal Neoplasms* ; Esophagus ; Humans ; Meals ; Microscopy, Electron, Scanning ; Polyurethanes ; Prognosis ; Stents ; Survival Rate

Giant cell arteritis (GCA) is an autoimmune vasculitic disorder of unknown origin. Systemic GCA causing cerebral infarction due to intracranial arteritis is rare. Early diagnosis and anti-inflammatory treatment of the GCA are necessary to prevent systemic involvement. A 66-year-old woman presented with dysarthria and left hemiparesis. A brain MRI showed ischemic lesions in the right temporoparietal area. We report a pathological case of GCA with clinical and neuroradiological evidence of cerebral infarction.
Aged ; Arteritis ; Brain ; Cerebral Infarction* ; Dysarthria ; Early Diagnosis ; Female ; Giant Cell Arteritis* ; Giant Cells* ; Humans ; Magnetic Resonance Imaging ; Paresis ; Pathology

We reviewed 27 patients wlth cerebellar infarction which was demonstrated by brain CT and/or MRI. Infarction occurred in the territory of posterior inferior cerebellar artery (PICAj in 16 patients, and the territory of the superior cerebellar artery(SCA) was involved in 5 patients. Antenor inferior cerebellar artery(AICA) infarcts occurred in 3 patients. Both PICA and SCA temtories were involved in 2 patients. In the remaining 1 patient, the infarct encompassed the borderzone between the SCA and PICA territories. The main symptoms and signs were sudden onset of vertigo, dizziness, nausea, vomiting, dysmetria, ataxia, nystagmus, and headache. There were signs of associated brain stem infarction or occipitotemporal infarction; rostral basilar artery syndrome, classic SCA syndrome, Wallenberg syndrome, internuclear ophthalmoplegia, facial palsy, hearing impairment. Presumed cerebral embolism was the main stroke mechanism in the SCA terntories. Six patients with brainstem compression or brainstem involvement showed consciousness deterioration, and only one of them died as a result of extensive cerebellar infarctions involving both SCA and PICA territories Cerebellar infarction may run a more benign course than previously thought.
Arteries ; Ataxia ; Basilar Artery ; Brain ; Brain Stem ; Brain Stem Infarctions ; Cerebellar Ataxia ; Consciousness ; Dizziness ; Facial Paralysis ; Headache ; Hearing Loss ; Humans ; Infarction* ; Intracranial Embolism ; Lateral Medullary Syndrome ; Magnetic Resonance Imaging ; Nausea ; Ocular Motility Disorders ; Pica ; Stroke ; Vertigo ; Vomiting

BACKGROUND: To clarify the clinicoradiological correlation and prognosis of acute ischemic stroke involving para-median territory of pons. METHODS: We studied 37 patients with first-ever ischemic stroke involving paramedian terri-tory of pons and divided them based on the shape and level of lesion shown in their MRI. The clinical features, MRI findings, and prognosis were assessed. RESULTS: The paramedian infarctions extending to the basal surface were found in 28 patients (76%), and small infarctions separated from the basal surface were found in 9 patients (24%). In patients with infarction extending to the basal surface, 23 patients (82%) had progressive or fluctuating onset, whereas all patients with small infarction separated from the basal surface had non-progressive onset. In the group with upper pon-tine lesion (14 patients), dysarthria-clumsy hand syndrome was found in 4 patients, ataxic hemiparesis (AH) in 3, pure motor hemiparesis (PMH) in 2, and pure sensory stroke in 1. In the group with middle and lower pontine lesion (22 patients), PMH was found in 9, AH in 3, and sensory motor stroke in 2. The mean Modified Rankin Disability Scale scores on admission and after follow-up (mean 29 months) of the group with upper pontine lesion were 2.36 +/-0.50 and 1 . 0 0 +/-0.55, those with mid-lower pontine lesions, 3.48 +/-0.51 and 1.17 +/-0.49 (P<0.01 and P>0.05 respectively). CONCLUSIONS: Paramedian pontine infarction extending to the basal surface usually presents with progressive onset. Paramedian pontine infarction most often produces classic lacune syndrome of which PMH is the most common. In our study, patients with mid-lower paramedian pontine infarction had more severe initial neurological deficits than those with upper paramedian pontine infarction. However, a late outcome was found to be favorable in both groups.
Follow-Up Studies ; Hand ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Paresis ; Pons ; Prognosis* ; Stroke

Marchiafava-Bignami disease(MBD), characterized by the primary degeneration of the corpus callosum, is a rare complication of chronic alcoholism. Recently, a few cases of MBD with reversible neuro-imaging abnormalities were reported. A 58-year-old, chronic alcoholic man was admitted with mental change, dysarthria, and a seizure attack. A T2-weighted Brain magnetic resonance imaging demonstrated high signal intensities in the body and splenium of the corpus callosum, multiple white matter, and cortical gray matter. Treatment with a multiple vitamin complex resulted in a near complete recovery of neurological manifestation. A brain MRI obtained four weeks after admission revealed a dramatic resolution of previous imaging abnormalities. We report a case of Marchiafava-Bignami disease with reversible neuro-imaging abnormalities.
Alcoholics ; Alcoholism ; Brain* ; Corpus Callosum ; Dysarthria ; Humans ; Magnetic Resonance Imaging* ; Marchiafava-Bignami Disease* ; Middle Aged ; Neurologic Manifestations ; Seizures ; Vitamins

Symptoms of compressive cervical myelopathy classically include spasticity and weakness, predominantly involving the lower extremities. Sensory abnormalities are reportedly common in the upper extremities, but are often vague or misleading. The sensory findings are usually localized 2-3 spinal segments below the actual spinal cord compression. In our current series, 3 patients presented with progressive symptoms of weakness and hyperreflexia involving the lower extremities without upper extremity symptoms and with a distant thoracic sensory level ranging from T10 to T12. All 3 patients were eventually found to have a cervical herniated intervertebral disc. The direct physical effects of compression and vascular compromise in the central cervical cord compression may be responsible for the reported abnormality at a distinct thoracic sensory level. Failure to diagnose cervical myelopathy because of the presence of a thoracic sensory level can delay appropriate treatment or lead to incorrect therapy.
Humans ; Intervertebral Disc* ; Lower Extremity ; Muscle Spasticity ; Reflex, Abnormal ; Spinal Cord Compression ; Spinal Cord Diseases ; Upper Extremity

We report a case of paronychia induced by cetuximab in a 43-year-old woman. Cetuximab is an antibody to the epidermal growth factor receptor, and has previously been shown to block the proliferation of various cancer cells. The patient had taken cetuximab for the treatment of metastatic rectal cancer. One month after the injection of cetuximab, the patient visited our clinic with painful periungal edema and erythema. The lesions partially improved after treatment with systemic and topical antibiotics. But, after discontinuing cetuximab, there was a significant decrease in the erythematous and edematous plaques. Three weeks later, she was asymptomatic and the lesions had resolved completely.
Adult ; Anti-Bacterial Agents ; Edema ; Erythema ; Female ; Humans ; Paronychia* ; Receptor, Epidermal Growth Factor ; Rectal Neoplasms ; Cetuximab

Background and Objectives: Many preclinical studies have been conducted using animal disease models to determine the effectiveness of human mesenchymal stem cells (hMSCs) for treating immune and inflammatory diseases based on the belief that hMSCs are not immunogenic across species. However, several researchers have suggested xenogeneic immune responses to hMSCs in animals, still without detailed features. This study aimed to investigate a xenogeneic humoral immune response to hMSCs in mice in detail. Methods: and Results: Balb/c mice were intraperitoneally injected with adipose tissue-derived or Wharton’s jelly-derived hMSCs. Sera from these mice were titrated for each isotype. To confirm specificity of the antibodies, hMSCs were stained with the sera and subjected to a flow cytometic analysis. Spleens were immunostained for proliferating cell nuclear antigen to verify the germinal center formation. Additionally, splenocytes were subjected to a flow cytometric analysis for surface markers including GL-7, B220, CD4, CD8, CD44, and CD62L. Similar experiments were repeated in C57BL/6 mice. The results showed increased IgG 1 and IgG 2a titers in the sera from Balb/c mice injected with hMSCs, and the titers were much higher in the secondary sera than in the primary sera. These antibodies were specifically stained the hMSCs. Germinal centers were observed in the spleen, and flow cytometric analysis of the splenocytes showed higher frequencies of centroblasts (B220 ＋ GL7 ＋ ) and memory T cells (CD62L ＋ CD44 ＋ ) both in CD4 ＋ and CD8 ＋ subsets. Similar results were obtained for C57BL/6 mice. Conclusions hMSCs induced a humoral immune response in mice, with characters of T cell-dependent immunity

PURPOSE: The present study was designed to examine the distribution of dorsal root ganglion(DRG) cells innervating the anterior and posterior cruciate ligaments of the Sprague-Dawley rat knee joint. MATERIALS AND METHODS: Fluoro-gold(FG) was used to identify the distribution of DRG cells innervating the ligaments, and horseradish peroxidase(HRP) was used to measure the DRG cell size innervating the ligaments. RESULTS: Neural tracers-labelled DRG cells were found ipsilaterally only in the lumbosacra1 DRGs. FG-labelled DRG cells innervating the anterior and posterior cruciate ligaments were found from the 1st lumbar DRG to the 1st sacral DOR(L1-Sl). The majority of FG-labelled DRG cells innervating the poste-rior cruciate ligaments were located in the L4, and the majority innervating the anterior cruciate ligaments were found in the L3, The size of HRP-labelled DRG cells innervating the cruciate ligaments was below 800 micromiter (c), showing that these cells were small. CONCLUSION: This study indicates that the DRG origin of sensory nerves is different in each cruciate ligament of the knee joint. But the size and the type innervating each ligament is similar.
Animals ; Anterior Cruciate Ligament ; Armoracia ; Cell Size ; Diagnosis-Related Groups ; Horseradish Peroxidase ; Knee Joint* ; Knee* ; Ligaments ; Posterior Cruciate Ligament* ; Rats* ; Rats, Sprague-Dawley ; Spinal Nerve Roots*