No abstract available.
Syringomyelia*

No abstract available.
Hemispherectomy*

A series of 4 patients with aneurysm of distal anterior cerebral artery(DACA), operated with microtechniques, is reviewed. Because the incidence of aneurysms in this location was only 2 to 4% of that of total aneurysm, little expericences on surgical management of this aneurysm have been reported. An aneurysm in this location is difficult to approach surgically because of their multiplicity, characteristically broad and sclerotic base, with small subarachnoid space in the interhemispheric fissure. We surgically treated DACA aneurysms of 4 cases through the interhemispheric approach via the unilateral frontal paramedian craniotomy on the nondominant side.
Aneurysm ; Anterior Cerebral Artery* ; Craniotomy ; Humans ; Incidence ; Intracranial Aneurysm* ; Subarachnoid Space

BACKGROUND AND OBJECTIVES: The aim of the study was to evaluate the difference of temporal lability in myocardial repolarization between acute non-Q (NQMI) and Q-wave myocardial infarction (QMI), and to discern whether the locations of myocardial infarction influence such temporal lability. SUBJECTS AND METHODS: Twelve patients with NQMI and 28 with QMI, including 16 anterior (AMI) and 12 inferior MI (IMI) patients were enrolled. Twenty four-hour ambulatory ECG recordings of each patient were analyzed, and the digitized data was partitioned into 30-min sections. The QT intervals were measured using a template matching strategy. We then calculated the low (LF:0.03 - 0.15 Hz) and high frequency (HF:0.15 - 0.4 Hz) power of the QT interval variability using an algorithm capable of removing the influence of the RR-interval on QT interval variability (Normalized Idioventricular QT variability Index:IV-QT). RESULTS: For patients with QMI, the low frequency IV QT (LF IV-QT) was higher than that of NQMI (1.941+/-0.101 and 1.556+/-0.114 respectively, p<0.05). No difference was seen in the high frequency IV QT (HF IV-QT) of the two groups. For QMI patients, both the LF IV-QT and HF IV-QT were higher in day time (6AM-6PM) than in night time (6PM-6AM). Comparing the differences of these indices by the location of QMI, both the LF IV-QT and HF IV-QT of AMI were higher than those of IMI patients (2.231+/-0.135 vs 1.355+/-0.131 and 2.341+/-0.161 vs 1.346+/-0.145 respectively, p<0.0005). Both indices of each group also demonstrated a circadian change. CONCLUSION: In cases of QMI, the temporal lability in myocardial repolarization is larger than that seen in NQMI. Moreover, it was worse in AMI than IMI. Finally, such temporal repolarization lability tends to have a circadian pattern in QMI.
Electrocardiography ; Electrocardiography, Ambulatory ; Humans ; Myocardial Infarction*

PURPOSE: Re-188-Hydroxyethylidene diphosphonate (HEDP) is a new cost-effective agent for systemic radioisotope therapy of metastatic bone pain. We investigated the influence of carrier for labeling and biodistribution of Re-188-HEDP using HEDP kit with or without carrier (KReO4). MATERALS AND METHODS: The kits (HEDP 15 mg, gentisic acid 4 mg and SnCl2.2H2O 4.5 mg) with or without carrier (KReO4 0.1 mg) were labeled with Re-188 solution, made available from an in-house generator by boiling for 15 min. We compared the labeling efficiency and stability of carrier-added and carrier-free preparations of Re-188-HEDP. Biodistribution and imaging studies of each preparation were performed in ICR mice (1.85~3.7 MBq/0.1 ml) and SD rats (74.1~85.2 MBq/0.5 ml). RESULTS: The carrier-added preparation showed high labeling efficiency (95% at pH 5) and high stability in serum (88%, 3 hr). However, the carrier-free preparation showed low labeling efficiency (59% at pH 5) and low stability (43%, 3 hr). The carrier-added preparation showed high uptake in bone and low uptake in stomach and kidneys. However, the carrier-free preparation showed lower uptake in bone and higher uptake in both stomach and kidneys, which is supposed to be due to released perrhenate. The carrier-added preparation also showed better images with higher skeletal accumulation, lower uptake in other organs and lower soft tissue uptake than the carrier-free preparation. CONCLUSION: The results of these studies clearly demonstrate that addition of carrier perrhenate is required for high labeling efficiency, stability, bone uptake and good image quality of Re-188-HEDP.
Animals ; Etidronic Acid ; Hydrogen-Ion Concentration ; Kidney ; Mice ; Mice, Inbred ICR ; Rats ; Stomach

BACKGROUND/AIMS: Transforming growth factor beta1 (TGF-beta1) is a key cytokine in the production of extracellular matrix. A genetic polymorphism at codon 10 of the TGF-beta1 gene is associated with liver fibrosis. We investigated the effect of genetic polymorphisms at codon 10 on the development of alcoholic liver cirrhosis (ALC). METHODS: In total, 119 controls and 182 patients with ALC, were enrolled in the study. Clinical and laboratory data including total lifetime alcohol intake were collected at enrollment. The genotype at codon 10 was determined for each patient by single-strand conformation polymorphism. RESULTS: There were three types of genetic polymorphism at codon 10: homozygous proline (P/P), heterozygous proline/leucine (P/L), and homozygous leucine (L/L). Among the controls, the proportions of P/P, P/L, and L/L were 26.1%, 44.5%, and 29.4%, respectively in the ALC group, these proportions were 23.1%, 43.4%, and 33.5%, respectively. The genotype distribution did not differ between the controls and the ALC group. In the ALC group, age, total lifetime alcohol intake, and distribution of Child-Pugh class did not differ with the genotype. Of the male patients with ALC (n=164), the proportions of P/P, P/L, and L/L were 20.1%, 44.5%, and 35.4%, respectively the genotype distribution did not differ between the male controls and the male ALC patients. CONCLUSIONS: The genotype at codon 10 in TGF-beta1 does not appear to influence the development of ALC. Further study is needed to investigate other genetic factors that influence the development of ALC in patients with chronic alcohol intake.
Aged ; Alcohol Drinking ; Codon ; Female ; Genotype ; Heterozygote ; Homozygote ; Humans ; Liver Cirrhosis, Alcoholic/*genetics/pathology ; Male ; Middle Aged ; *Polymorphism, Genetic ; Transforming Growth Factor beta1/*genetics/metabolism

BACKGROUND/AIMS: Recently, the prognosis for spontaneous bacterial peritonitis (SBP) has improved; however, the causative microorganisms and antibiotic resistance rates are changing. We evaluated the changing pattern of causative agents and antibiotic resistance rates of SBP over a 12-year period. METHODS: We retrospectively analyzed 113 patients who were diagnosed with SBP and in whom ascites cultures were positive between 1996 and 2007. The 12-year period was subdivided into 6-year terms (period A, 1996~2001; and period B, 2002~2007). RESULTS: One hundred thirteen of 410 cases of SPB had positive ascites cultures. Thirty-seven cases were from period A and 76 cases were from period B. Hospital-acquired SBP was more common during period B. Gram negative microorganisms were isolated from 78% of SBP cases, and the most common microorganism was E.coli (60%). The resistance rates for ampicillin and ciprofloxacin were similar between the two periods, but resistance to cefotaxime was more frequent in period B (3% vs. 26%, p=0.002), and ESBL-producing E.coli was only cultured in period B (0% vs. 32%, p=0.002). Most of the initial antibiotics used were cefotaxime; carbapenem was used as a secondary antibiotic only in period B (0% vs. 55%, p=0.007). ESBL-producing microorganisms were the only predictor of in-hospital mortality based multivariate analysis (OR: 4.14, 95% CI: 1.09-15.07, p=0.037). CONCLUSIONS: No change in pattern of microorganisms in the ascites of patients with SBP was noted during the 12-year period under study, but there was a significant increase in the incidence of hospital-acquired SBP, resistance to cefotaxime, and ESBL-producing E.coli when comparing the outcomes of periods A and B. ESBL-producing microorganisms were the only predictor of in-hospital mortality.
Ampicillin ; Anti-Bacterial Agents ; Ascites ; Cefotaxime ; Ciprofloxacin ; Drug Resistance, Microbial ; Hospital Mortality ; Humans ; Incidence ; Liver Cirrhosis ; Multivariate Analysis ; Peritonitis ; Prognosis ; Retrospective Studies

Tenofovir disoproxil fumarate (TDF) is one of the most widely used treatment options for human immunodeficiency virus (HIV) and HBV infections. Despite its efficacy and safety, some cases of nephrotoxicity have been reported in the treatment of HIV patients. Even more recently, very few cases of Fanconi syndrome associated with tenofovir therapy in HBV monoinfection have been reported. Herein, we report a case of a 47-year-old male with an HBV monoinfection, who developed Fanconi syndrome and a secondary osteomalacia with multiple bone pain. After TDF withdrawal and supplementation of calcitriol, his renal function was reverted. Although the overall risk of TDF-associated nephrotoxicity is very low, both glomerular and tubular function should be monitored in patients undergoing TDF treatment.
Calcitriol ; Fanconi Syndrome* ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; HIV ; Humans ; Kidney Tubules ; Male ; Middle Aged ; Osteomalacia ; Tenofovir

Sorafenib is a multi-targeted tyrosine kinase inhibitor that inhibits Raf kinase and the vascular endothelial growth factor receptor intracellular kinase pathway and is the first agent to demonstrate a statistically significant improvement in overall survival for patients with advanced hepatocellular carcinoma (HCC). However, there were few cases of partial or complete response reported in the previous studies. We herein report a case of dramatic partial response in a patient who had advanced HCC with multiple lung metastasis and portal vein thrombosis treated with sorafenib.
Carcinoma, Hepatocellular* ; Drug Therapy ; Humans ; Lung* ; Neoplasm Metastasis* ; Phosphotransferases ; Protein-Tyrosine Kinases ; Receptors, Vascular Endothelial Growth Factor ; Treatment Outcome ; Venous Thrombosis

BACKGROUND/AIMS: Various clinical scoring systems, including the Glasgow-Blatchford score (GBS), Rockall risk score (RS), and AIMS65 score (AIMS65), have been validated to predict the clinical outcomes in patients with upper gastrointestinal bleeding (UGIB). We compared the performance of these three scoring systems in predicting clinical outcomes in patients with UGIB in Korea. METHODS: We retrospectively evaluated 286 patients with UGIB who visited emergency department. The primary outcome was the need for clinical intervention (endoscopic, radiologic, or surgical) and blood transfusion. RESULTS: The causes of UGIB were esophageal/gastric varices in 64 patients, peptic ulcer in 168, Mallory-Weiss tear in 32, malignancy of UGI tract in eight, and unknown in 14. One hundred seventy-four (61%) patients required blood transfusion, 166 (58%) required endoscopic intervention, and 10 (3.5%) required surgical intervention. The GBS outperformed the RS and AIMS65 in predicting the need for endoscopic intervention. CONCLUSIONS: The GBS and RS were more accurate than AIMS65 in predicting the need for clinical interventions and transfusion patients with UGIB, regardless of variceal or nonvariceal bleeding. The AIMS65 may not be optimal for predicting clinical outcomes of UGIB in Korea.
Blood Transfusion ; Emergency Service, Hospital ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Korea ; Mallory-Weiss Syndrome ; Mortality ; Peptic Ulcer ; Retrospective Studies ; Risk Assessment ; Varicose Veins