Subclavian steal syndrome caused by an acute thrombus is very rare. We present a case of cerebellar infarction with proximal subclavian artery thrombosis. A 56-year-old woman was admitted for sudden vertigo. One day prior to admission, she received a shoulder massage comprised of chiropractic manipulation. On examination, her left hand was pale and radial pulses were absent. Blood pressure was weak in the left arm. Downbeat nystagmus and a right falling tendency were observed. Brain MRI showed multiple acute infarctions in the left cerebellum. The findings of Doppler ultrasonography in the left vertebral artery were compatible with a partial subclavian artery steal phenomenon. Digital subtraction angiography demonstrated a large thrombus in the left subclavian artery. After heparin infusion, thrombus size markedly decreased. Cerebellar infarction caused by acute subclavian thrombosis following minor trauma is rare, but the thrombus can be successfully resolved with anticoagulation.
Brain Infarction/*diagnosis/etiology/pathology ; Cerebellar Diseases/diagnosis/etiology ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Thrombosis/*complications

No abstract available.
Duodenal Ulcer* ; Humans ; Recurrence*

Truncus arteriosus is a rare congenital heart disease which is diagnosed in from 1 to 2 percent of congenital cardiac birth. Whithout surgical intervention, survival beyond infancy is unusual. Unoperated patients who survive to adult life have associated pulmonary stenosis or have developed pulmonary arteriolar disease. We report a case of truncus arteriosus in a 17-year-old man with a review of literature.
Adolescent ; Adult ; Heart Defects, Congenital ; Humans ; Parturition ; Pulmonary Valve Stenosis ; Truncus Arteriosus*

No abstract available.

BACKGROUND AND OBJECTIVES: Epidermal characteristics of cholesteatoma such as invasion, migration, uncoordinated proliferation, and altered differentiation may arise as a result of defectiVe wound healing process, induction of preneoplastic transformation or genetic alteration. To date, a number of genes haVe been shown to be differentially regulated in cholesteatoma, which might be responsible for these clinical characteristics. HoweVer, it is still unclear whether these phenomena is only oVert when cholesteatoma is under specific conditions such as inflammation or infection. If these genetic alterations in the deVelopment of cholesteatoma are transient, the pathology of cholesteatoma may be reVersible. We hypothesized that once cholesteatoma is in the normal environment, the cellular or molecular pathology of cholesteatoma can return to normal epidermal characteristics. The aim of this study was to determine whether common molecular characteristics are reVersible or not after removal of inductive factors in aural cholesteatoma induced gerbils. MATERIALS AND METHODS: We induced canal ligation cholesteatoma using Mongolian gerbils. The treated group was untied and managed for 2 weeks. We examined differences between treated cholesteatoma and untreated cholesteatoma by using a TUNEL staining and immunohistochemical technique with proliferation markers (PCNA, cytokeratin 13/16). RESULTS: With PCNA and CK 13/16, untreated group showed positive staining in the suprabasal cells as well as in the basal cells, but the treated group showed weakly positive staining only in the basal cell layer. With TUNEL staining, positive cells increased more in the untreated group than in the treated group. CONCLUSION: These results encourage our belief that some cholesteatomas, especially cholesteatoma in early stages, might be managed with only minimal treatments such as control of inflammation and maintenance of adequate Ventilation.
Cell Differentiation ; Cholesteatoma* ; Cholesteatoma, Middle Ear ; Gerbillinae* ; In Situ Nick-End Labeling ; Inflammation ; Keratins ; Ligation ; Pathology ; Pathology, Molecular ; Proliferating Cell Nuclear Antigen ; Ventilation ; Wound Healing

Purpose: This paper aims to develop a clinical decision support system (CDSS) that can help detect the stone that is most important to the diagnosis of urolithiasis. Among them, especially for the development of artificial intelligence (AI) models that support a final judgment in CDSS, we would like to study the optimal AI model by comparing and evaluating them. Methods: This paper proposes the optimal ureter stone detection model using various AI technologies. The use of AI technology compares and evaluates methods such as machine learning (support vector machine), deep learning (ResNet-50, Fast R-CNN), and image processing (watershed) to find a more effective method for detecting ureter stones. Results: The final value of sensitivity, which is calculated using true positive (TP) and false negative and is a measure of the probability of TP results, showed high recognition accuracy, with an average value of 0.93 for ResNet-50. This finding confirmed that accurate guidance to the stones area was possible when the developed platform was used to support actual surgery. Conclusions The general situation in the most effective way to the detection stone can be found. But a variety of variables may be slightly different the difference through the term could tell. Future works, on urological diseases, are diverse and the research will be expanded by customizing AI models specialized for those diseases.

Technetium-99m methoxyisobutylisonitrile(99m-Tc MIBI), a new myocardial imaging agent, was used in myocardial perfusion scan in 23 patients who had been diagnosed as myocardial infarction to assess its usefulness in elvaluation of coronary artery disease. All patients undertook left ventriculography (LVG) and coronary arteriography (CAG). Gated blood pool scan, plannar scintigraphy and SPECT were also done using 99m-Tc MIBI. After then SPECT image was reconstructed to short axis view of the heart at the level of the base, mid and apex. The data from these studies were compared with the results of EKG, LVG and CAG. Diagnostic sensitivity of myocardial scan using 99m-Tc MIBI was 91.3%. In localization of infarction site and evaluation of its extent, myocardial scan was superior to EKG. CAG revealed significant stenosis at the arteries supplying the area in which the scan showed perfusion defect. In detecting abnormal wall motion, the sensitivity and the specificity were 81.9% and 93.7% respectively. Perfusion defect were found in 75%, 82.5%, and 100% of hypokinetic, akinetic, and dyskinetic segments, respectively. Myocardial perfusion scan using 99m-Tc MIBI was an useful noninvasive test in localizing the site and the extent of infarct and detecting the abnormal left ventricular wall motion.
Angiography ; Arteries ; Axis, Cervical Vertebra ; Constriction, Pathologic ; Coronary Artery Disease ; Electrocardiography ; Heart ; Humans ; Infarction ; Myocardial Infarction* ; Myocardial Perfusion Imaging* ; Perfusion ; Radionuclide Imaging ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

Major known causes of neonatal adrenal insufficiency are prolonged maternalsteroid use, adrenal hemorrhage from the perinatal stress and adrenogenital syndrome. Theoretically adrenal aplasia might be a cause of neonatal adrenal insufficiency but it has not been reported yet. We had experienced a case of adrenal aplasia in a 5 day-old male neonate whose chief complaint was hyperpigmentation. His laboratory findings were compatible with adrenal insufficiency and adrenal gland was not detected by the ultrasonography and thin section abdominal CT. We reported a case of adrenal aplasia with a brief review of the related literature.
Adrenal Glands ; Adrenal Insufficiency ; Adrenogenital Syndrome ; Hemorrhage ; Humans ; Hyperpigmentation ; Infant, Newborn ; Male ; Tomography, X-Ray Computed ; Ultrasonography

Ventricular arrhythmia is known as a major cause of sudden death in patients with heart disease, especially in patients with myocardial infarct. Programmed electrical stimulation (PES) is used in order to identify patients with high risk of ventricular arrhythmia, but it is invasive. So ventricular late potential is studied, which can be performed safely. Ventricular late potential was measured in the 65 normal subjects, 17 patients with in-hospital period acute myocardial infarction and 29 patients with old myocardial infarction using signal-averaged high resolution EKG, Mac-15. The positive criteria of ventricular late potential was one of the following : The duration of TQRS is more than 120 msec, or the amplitude of RMS is less than 25microV, or the duration of LP 40 is more than 40 msec. The results are as follows : 1) Among 65 normal subjects(male ; 33, female ; 32), total QRS duration(TQRS)was 103.9+/-8.3msec(mean S.D), terminal 40msec root mean square amplitude(RMS) 47.8+/-24.3uV and terminal 40msec mean amplitude was 32.5+/-15.4uV. Variables of ventricular late potential showed no significant difference by age. 10 subjects showed positive ventricular late potential. 2) Among 17 patients with in-hospital period myocardial infarction, there was no significant difference in variables of ventricular late potential between patients with ventricular arrhythmia(3 subject) and patients without ventricular arrhythmia(14 subjects). 3) Among 29 subjects with old myocardial infarction, TQRS showed significant differrence between patients with ventricular arrhythmia(3 subjects) and patients without ventricular arrhythmias(26 subjects). All of the patients with ventricular arrhythmia(100%) and 6 subjects(24%) of the patients without ventricular arrhythmia showed positive ventricular late potential, and the difference was significant statistically between groups(p value<0.05). This showed that ventricular late potential is helpful in predicting the risk of ventricular arrhythmia among patients with old myocardial infarction.
Arrhythmias, Cardiac* ; Death, Sudden ; Electric Stimulation ; Electrocardiography ; Female ; Heart Diseases ; Humans ; Myocardial Infarction*

BACKGROUND/AIMS: Advanced hepatocellular carcinoma with portal vein thrombosis has a poor prognosis. This study was undertaken to evaluate the therapeutic effects of concurrent chemo-radiation therapy in advanced hepatocellular carcinoma with portal vein thrombosis. METHODS: A total of 54 patients with advanced hepatocellular carcinoma (TNM stage IVa) were enrolled. Nineteen patients were treated with external beam radiotherapy (4,500 cGy/ 5 weeks) and intrahepatic arterial 5-FU infusion (500 mg on 1-5 day and 30-35 day, respectively) via implanted chemoport. The others were treated with intrahepatic arterial cisplatin infusion (80 mg/m2). RESULTS: In patients treated with concurrent chemo-radiation therapy, response rates at 2nd and 6th months were 42.1% and 26.3%, respectively. In patients treated with intrahepatic arterial cisplatin therapy, response rates at 2nd and 6th months were 2.9% and 0%, respectively. The median survival time was 11.6 months in concurrent chemo-radiation therapy and 4.8 months in intrahepatic arterial cisplatin infusion therapy. Concurrent chemo-radiation therapy produced better response rates and longer survival time than those of intrahepatic arterial cisplatin infusion therapy (p<0.05). CONCLUSIONS: Concurrent chemo-radiation therapy achieved favorable results in advanced hepatocellular carcinoma with portal vein thrombosis and can be considered as a treatment option for the management of advanced hepatocellular carcinoma.
Antineoplastic Agents/*administration & dosage ; Carcinoma, Hepatocellular/complications/radiotherapy/*therapy ; Cisplatin/administration & dosage ; Combined Modality Therapy ; English Abstract ; Female ; Fluorouracil/administration & dosage ; Human ; Infusions, Intra-Arterial ; Liver Neoplasms/complications/radiotherapy/*therapy ; Male ; Middle Aged ; *Portal Vein ; Prognosis ; Venous Thrombosis/*complications