No abstract available.
Multiple Organ Failure* ; Sepsis*

Transpubic approach provides ease and accuracy of anastomosis under direct vision for posterior urethroplasty. It is greatly helpful especially for stricture greater than 3 cm in length or obliterated complex posterior urethral stricture. 9 patients underwent transpubic posterior urethroplasty at the Department of urology. Kyungpook National University Hospital during the period from January. 1979 to May, 1982. Of these 9 patients, 7 underwent by Waterhouse's and 2 by Allen's. Postoperatively. 6 had satisfactory results without orthopedic disability. voiding problem or impaired sexual potency. One needed periodic urethral dilatation for anterior urethral stricture. The results in 2 cases were regarded failed, with development of restricture at the anastomotic site and urinary incontinence, respectively.
Constriction, Pathologic ; Dilatation ; Gyeongsangbuk-do ; Humans ; Orthopedics ; Urethral Stricture* ; Urinary Incontinence ; Urology

Pineal cysts (PCs) are often encountered as incidental findings in intracranial images. The vast majorityof cysts are normally asymptomatic and clinically benign. Bleeding into the cysts, which leads to neurologicalsymptoms and signs, is considered to be quite rare. The authors illustrate a newly identifiedcomplication of PC in a 56-year-old woman who characterized by headache of sudden onset and vomiting.MRI disclosed a small hemorrhagic PC without narrowing of the cerebral aqueduct. The patientwas managed conservatively without any surgical interventions, and she remained symptom-free overa period of 15-year follow-up. The description of this case adds to the limited literature on the series inwhich nonsurgical treatments had a role in the care for patients with PC complicated by intracystichemorrhage.

Objective: : To evaluate the stent apposition of a low-profile visualized intraluminal support (LVIS) device in distal internal carotid artery (ICA) aneurysms, examine its correlation with clinical and angiographic outcomes, and determine the predictive factors of ischemic adverse events (IAEs) related to stent-assisted coiling. Methods: : We retrospectively analyzed a prospectively maintained database of 183 patients between January 2017 and February 2020. The carotid siphon from the cavernous ICA to the ICA terminus was divided into posterior, anterior, and superior bends. The anterior bends were categorized into angled (V) and non-angled (C, U, and S) types depending on the morphology and measured angles. Complete stent apposition (CSA) and incomplete stent apposition (ISA) were evaluated using unsubtracted angiography and flat-panel detector computed tomography. Dual antiplatelet therapy with aspirin 200 mg and clopidogrel 75 mg was administered. Clopidogrel resistance was defined as fewer responders (≥10%, <40%) and non-responders (<10%) based on the percent inhibition (%INH) of the VerifyNow system. These were counteracted by a dose escalation to 150 mg for fewer responders or substitution with cilostazol 200 mg for non-responders. IAEs included intraoperative in-stent thrombosis, transient ischemic attack, cerebral infarction, and delayed in-stent stenosis. A multivariate logistic regression analysis was used to determine the predictive factors for ISA and IAEs. Results: : There were 33 ISAs (18.0%) and 27 IAEs (14.8%). The anterior bend angle was narrower in ISA (-4.16°±25.18°) than in CSA (23.52°±23.13°) (p<0.001). The V- and S-types were independently correlated with the ISA (p<0.001). However, treatment outcomes, including IAEs (15.3% vs. 12.1%), aneurysmal complete occlusion (91.3% vs. 88.6%), and recanalization (none of them), did not differ between CSA and ISA (p>0.05). The %INH of 27 IAEs (13.78%±14.78%) was significantly lower than that of 156 non-IAEs (26.82%±20.23%) (p<0.001). Non-responders to clopidogrel were the only significant predictive factor for IAEs (p=0.001). Conclusion : The angled and tortuous anatomical peculiarity of the carotid siphon caused ISA of the LVIS device; however, it did not affect clinical and angiographic outcomes, while the non-responders to clopidogrel affected the IAEs related to stent-assisted coiling.

The sinking skin flap syndrome is a rare complication after a large craniectomy. It consists of a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. In patient with sinking skin flap syndrome, cerebral blood flow and cerebral metabolism are decreased by sinking skin flap syndrome, and it may cause the deterioration of autoregulation of brain. We report a case of a patient with sinking skin flap syndrome who suffered from reperfusion injury after cranioplasty with review of pertinent literature.
Brain ; Headache ; Homeostasis ; Humans ; Reperfusion ; Reperfusion Injury ; Seizures ; Skin

OBJECTIVE: The introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events. METHODS: A total of 35 consecutive patients who underwent CAS between January 2009 and March 2012 were included in this study. Patients were divided into two groups including those with small emboli (group A; grade 1, 2) and those with large emboli (group B; grade 3, 4). The size and number of emboli were assigned one of four grades (1=no clots, 2=1 or 2 small clots, 3=more than 3 small clots, 4=large clots) by microscopic observation of the EPD after CAS. We compared demographic characteristics, medical history, and angiographic findings of each group. RESULTS: Thirty-five patients underwent CAS, and technical success was achieved in all cases. Twenty-three patients were included in group A and 12 patients in group B. Our results demonstrated that advanced age [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.52; p=0.044] and smoking (OR 42.06; CI 2.828-625.65, p=0.006) were independent risk factors for developing large emboli after CAS. CONCLUSION: In patients with carotid artery stenosis treated with CAS, advanced age and smoking increased the number and size of emboli. Although use of an EPD is controversial, it may be useful in CAS in patients with risk factors for large emboli in order to reduce the risk of ischemic events.
Carotid Arteries ; Carotid Stenosis ; Embolic Protection Devices ; Humans ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stents ; Stroke

Objective: : To confirm the usefulness of the extradural anterior clinoidectomy during the clipping of a lower riding posterior communicating artery (PCoA) aneurysm through cadaver dissection. Methods: : Anatomic measurements of 12 adult cadaveric heads (24 sides total) were performed to compare the microsurgical exposure of the PCoA and internal carotid artery (ICA) before and after clinoidectomy. A standard pterional craniotomy and transsylvian approach were performed in all cadavers. The distance from the ICA bifurcation to the origin of PCoA (D1), pre-anterior clinoidectomy distance from the ICA bifurcation to tentorium (D2), post-anterior clinoidectomy distance from the ICA bifurcation to tentorium (D3), pre-anterior clinoidectomy distance from the tentorium to the origin of PCoA (D4) and post-anterior clinoidectomy distance from the tentorium to the origin of PCoA (D5) and the distance of the ICA obtained after anterior clinoidectomy (D6) were measured. We measured the precise thickness of the blade for the Yasargil clip with a digital precision ruler to confirm the usefulness of the extradural anterior clinoidectomy. Results: : Twenty-four sites were dissected from 12 cadavers. The age of the cadavers was 79.83±6.25 years. The number of males was the same as the females. The space from the proximal origin of the PCoA to the preclinoid-tentorium (D4) was 1.45±1.08 mm (max, 4.01; min, 0.56). After the clinoidectomy, the space from the proximal origin of the PCoA to the postclinoid-tentorium (D5) was 3.612±1.15 mm (max, 6.14; min, 1.83). The length (D6) of the exposed proximal ICA after the extradural clinoididectomy was 2.17±1.04 mm on the lateral side and 2.16±0.89 mm on the medial side. The thickness of the Yasargil clip blade used during the clipping surgery was 1.35 mm measured with a digital precision ruler. Conclusion : The proximal length obtained by performing an external anterior clinoidectomy is about 2 mm, sufficient for proximal control during PCoA aneurysm surgery, considering the thickness of the aneurysm clips. In a subarachnoid hemorrhage, performing an extradural anterior clinoidectomy could prevent a devastating situation during PCoA aneurysm clipping.

PURPOSE: To compare anterior segment parameters in angle-closure glaucoma (ACG), primary open angle glaucoma (POAG), and normal subjects (N) using a Schiempflug camera. METHODS: Central corneal thickness (CCT), lens thickness (LT), axial length (AL), anterior chamber angle (ACA), anterior chamber depth (ACD), and anterior chamber volume (ACV) were measured in ACG (93 eyes of 92 patients), POAG (90 eyes of 87 patients), and normal (91 eyes of 88 subjects) with Pentacam(R) and A-scan. All of the results and measurements were then compared. RESULTS: Compared to normal and POAG patients, ACG patients presented with significantly different measurements of CCT, LT, AL, and ACA, ACD, and ACV (p<0.05). Further, correlations were high between three measurements (ACA, ACD, ACV) in ACG, and the best correlations were found in acute angle-closure glaucoma (P<0.05). CONCLUSIONS: By using a Schiempflug camera it was possible to assess the correlation between anterior segment parameters (ACA, ACD, ACV) in glaucoma patients. The best correlations were found in acute angle-closure glaucoma, and thus anterior segment parameters can offer reciprocally complementary information.
Anterior Chamber ; Eye ; Glaucoma ; Glaucoma, Angle-Closure ; Glaucoma, Open-Angle ; Growth Hormone ; Humans ; Peptide Fragments

Renal arteriovenous fistula is a relatively rare disease, which was first described by Varela in 1923. Most of these have been diagnosed in recent years because of the increasing use of both percutaneous needle biopsy of the kidney and renal arteriography as diagnostic tools. We report one case of intrarenal arteriovenous fistula after stabbing, diagnosed by selective renalarteriography, with the review of literatures.
Angiography ; Arteriovenous Fistula* ; Biopsy, Needle ; Kidney ; Rare Diseases

We report a first case of meningitis due to listeria monocytogenes after cardiac transplantation in Korea. This patient is a 40-year-old man with Dilated cardiomyopathy, he presented with intermittent dyspnea and abdominal distension for about 1 year. After cardiac transplantation, he was treated with azathioprine, cyclosporine and prednisolone for graft rejection. He was presented with intermittent fever, headache and lethargy for about 10days after cardiac transplantation. Listeria monocytogenes was isolated from blood culture and CSF culture. He was treated with intravenous penicillin G for 10days successfully and changed with ampicillin for 10days, took oral ampicillin for 10days without any complication after discharge.
Adult ; Ampicillin ; Azathioprine ; Cardiomyopathy, Dilated ; Cyclosporine ; Dyspnea ; Fever ; Graft Rejection ; Headache ; Heart Transplantation* ; Heart* ; Humans ; Korea ; Lethargy ; Listeria monocytogenes* ; Listeria* ; Meningitis* ; Penicillin G ; Prednisolone