Traumatic common carotid artery dissection (CCAD) is rare. To our knowledge, only 14 case reports have described traumatic CCAD previously. Here, we report a case of CCAD in a patient with severe trauma. A 50-year-old man was lying on the road after drinking alcohol when a car drove over him. Computed tomography (CT) revealed multiple rib fractures with hemopneumothorax, lung contusion, flail chest, large amount of hematoma with bladder rupture, and fractures on the C6 spinous process, sacral ala, iliac bone, and pubic ramus. Repair of the bladder rupture, exploratory thoracotomy, and open reduction of multiple rib fractures were performed. Right side hemiparesis was observed on hospital day 4. Brain CT showed a large acute left middle cerebral artery infarction. CT angiography showed focal carotid dissection at the left common carotid artery with intimal flap. The CCAD was located at the C6 level. Clexane (enoxaparin sodium) treatment was initiated. An abdominal CT scan revealed a huge retroperitoneal hematoma and increased amount of hematoma in the prevesical and perivesical space, 10 days later. The patient died two days later. Although traumatic CCAD is rare, this case report provides useful information for trauma surgeons regarding the treatment and diagnosis of similar cases.
Angiography ; Brain ; Carotid Artery, Common* ; Contusions ; Deception ; Diagnosis ; Drinking ; Enoxaparin ; Flail Chest ; Hematoma ; Hemopneumothorax ; Humans ; Infarction, Middle Cerebral Artery ; Lung ; Middle Aged ; Paresis ; Rib Fractures ; Rupture ; Surgeons ; Thoracotomy ; Tomography, X-Ray Computed ; Urinary Bladder

Marchiafava-Bignami disease (MBD), Wernicke encephalopathy (WE) and alcoholic polyneuropathy (AP) are distinct diseases and all have strong relationship with chronic alcoholism. A 70-year-old male who had altered mentality and ataxia of both lower limbs and had past history of WE 3 years previously admitted with 6 months history of impaired walking. He also had a symptom of altered sensorium by impaired consciousness for 2 days. In brain magnetic resonance imaging, the body, splenium of corpus callosum and bilateral frontal cortex were involved. The patient was diagnosed with MBD on the basis of the clinical features and the brain imaging findings. The electrodiagnostic findings implied demyelinating neuropathy in all extremities. He failed to recover his mentality and the function of the limbs remained poor finishing several treatment options including medications and physical therapy. The poor prognosis of this patient is thought to be associated with cortical involvement of MBD. We reported this very rare case who was affected by 3 distinct diseases of MBD, AP, and WE as complications of chronic alcohol abuse. Moreover, the case was relevant to a rare clinical presentation of MBD with cortical involvement which was associated with poor prognosis.

PURPOSE: Recent studies using human and mice reported that apolipoprotein A-V (APOA5) gene plays an important role in controlling triglyceride (TG) concentrations. The purpose of the present study was to investigate the correlation between single nucleotide polymorphisms (SNPs) and haplotypes in the APOA5 gene and TG in subjects and to search for possible associations of the APOA5 gene variants and common haplotypes with hypertriglyceridemia (HTG). MATERIALS AND METHODS: We examined the case-control subjects including 100 HTG patients and 243 unrelated healthy control. The genes were screened for SNPs by direct sequencing in 48 genetically unrelated individuals. Six SNPs (-1390C>T, -1020G>A, -3A>G, V150M, G182C and 1259T>C) were genotyped in case and control populations. RESULTS: In this study, our results indicated a strong association between APOA5 SNP -3A>G and G182C and elevated TG levels (p<0.001). Analysis of the SNPs from APOA5 gene has identified major haplotype showing very strong association with HTG, CGGGTT (p<0.001). Likelihood ratio test (LRT) of these six SNPs revealed that haplotypes were strong independent predictors of HTG (p<0.001). Haplotype-trend logistic regression (HTR) analysis revealed a significant association between the CGGGGC (haplotype 2) and CGGGTT (haplotype 4) and HTG (OR=2.48, 95% CI=1.06-5.76 and OR=8.54, 95% CI=2.66-27.42, respectively). CONCLUSION: We confirm that the APOA5 variants are associated with triglyceride levels and the haplotype may be strong independent predictors of HTG among Koreans.
Apolipoproteins A/*genetics ; Case-Control Studies ; Female ; Genetic Predisposition to Disease ; *Haplotypes ; Humans ; Hypertriglyceridemia/genetics ; Korea ; Linkage Disequilibrium ; Male ; Middle Aged ; *Polymorphism, Single Nucleotide ; Triglycerides/*blood

BACKGROUND AND OBJECTIVES: Cardiovascular disease (CVD) is a complex multigenic disorder, with significant inheritable elements having important roles relating to environmental factors. Recently, the alpha 2 adrenoceptor (alpha(2)-AR) gene has been reported to be involved in the development of coronary artery disease (CAD). The aim of this study was to investigate the relationships between an insertion/deletion (I/D) in alpha(2B)-AR and CAD in Korean subjects. SUBJECTS AND METHODS: The alpha(2B)-AR I/D polymorphism, which was located in the third intracellular loop of the receptor polypeptide, was examined in 292 patients (M:F=219:73) with CAD and 151 healthy control subjects (M:F=70:81) who visited the Cardiovascular Genome Center in Yonsei Cardiovascular Hospital. RESULTS: In the patient group, 77 men (35.1%) and 26 women (35.6%) had the I/I genotype; 105 men (47.9%) and 39 women (53.4%) a heterozygous genotype and 37 (17.0%) and 8 (11.0%) the D/D genotype. In the controls, 23 men (32.8%) and 29 women (35.8%) had the I/I genotype; 38 (54.3%) and 39 (48.1%) the I/D genotype and 9 (12.9%) and 13 (16.1%) the D/D genotype. There were no differences in the genotype frequencies between the patient and control groups, either in men or women. From a logistical regression analysis, the alpha(2B)-AR genotype was not significantly associated with CAD in our study group. CONCLUSION: The alpha(2B)-AR I/D polymorphism is not a risk factor for CAD in the Korean population.
Cardiovascular Diseases ; Coronary Artery Disease* ; Coronary Vessels* ; Female ; Genome ; Genotype ; Humans ; Male ; Polymorphism, Genetic ; Risk Factors*

PURPOSE: The purpose of this study was to investigate the usefulness of heart-type fatty acid binding protein (H-FABP) and ischemia modified albumin (IMA) to differentiate the causes of cardiac arrest. METHODS: From May 2007 to November 2007, we prospectively studied 27 patients who presented to the emergency department with sudden collapse. The blood samples collected during cardiopulmonary resuscitation (CPR) were centrifuged at 3000 rpm for 10 min, and the obtained serum was stored at -70degrees C. RESULTS: Cardiac arrest were caused by cardiac disease (N=7, 26%), trauma (N=7, 26%) and other disease (N=13, 48%). The patients with cardiac cause showed significantly increased H-FABP levels compared to the patients with noncardiac causes (39.7+/-19.3 ng/mL vs 24.6+/-16.9 ng/mL, respectively, p=0.048). The cut-off value of H-FABP was 29.05 ng/mL (sensitivity 85%, specificity 75%). The IMA showed no statistical difference between the patients with cardiac causes and those with non-cardiac causes (86.6+/-29.9 U/mL vs 107.4+/-39.4 U/mL, respectively, p=0.219). There were no significant differences of the H-FABP and IMA levels between the return of spontaneous circulation (ROSC) group and the non-ROSC group, and also between the survival and death groups. A higher H-FABP concentration was correlated with a longer arrest time, and mortality was correlated with a longer CPR time. CONCLUSION: The IMA is not changed according the cause of arrest, but the H-FABP is useful to diagnose the cardiac causes of arrest.
Biomarkers ; Cardiopulmonary Resuscitation ; Carrier Proteins ; Emergencies ; Heart Arrest ; Heart Diseases ; Humans ; Ischemia ; Prospective Studies ; Sensitivity and Specificity ; Serum Albumin

BACKGROUND: The demand for Rh-related and other specific antigen negative donations has increased recently, and in response, we need to improve work efficiency while decreasing reagent consumption. Thus, we desire to create a ‘table of Nambu Blood Laboratory Center's own Rh-related and other antigen negative rate’. METHODS: We analyzed the results of Rh-related specific antigen test for 2,806,330 donors using ‘PK-7300’ and the results of manual test for 10,024 other blood type antigen-related specific and compound antigens. We made a table summarizing the results using two cases. RESULTS: The negative rate of Rh-related specific antigens was approximately 12.9% for C, 41.7% for c, 49.5% for E, and 9.2% for e antigens. The negative rate of compound antigens was increased when compared with the number of inspections. The negative rate for C and e antigens was increased from 90.1% to 97.3%, and that for E, c, and JKa was increased from 7.6% to 31.6%. CONCLUSION: The negative rate table made in July 2016 has been determined to be very effective in screening for specific and compound antigen negative blood. Also it was very efficient in terms of examining and supplying the compound antigen negative blood. It would be helpful to improve the supply of specific antigen negative blood to better meet the unique needs of each medical institution.
Hepatitis B e Antigens ; Humans ; Mass Screening ; Tissue Donors

Cryptococcus spp. other than Cryptococcus neoformans or Cryptococcus gattii were previously considered saprophytes and thought to be non-pathogenic to humans. However, opportunistic infections associated with non-neoformans and non-gattii species, such as Cryptococcus laurentii and Cryptococcus albidus, have increased over the past four decades. We experienced a case of cryptococcosis caused by non-neoformans and non-gattii spp. in a 47-year-old female with refractory acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation. The patient underwent salvage chemotherapy with fluconazole prophylaxis and subsequently developed neutropenic fever with multiple erythematous umbilicated papules. A skin biopsy revealed fungal hyphae and repetitive blood cultures showed yeast microorganisms that were identified later as C. laurentii by Vitek-II®. Skin lesions and fever began to improve with conventional amphotericin B therapy. The treatment regimen was continued for 21 days until the disseminated cryptococcosis was completely controlled.
Amphotericin B ; Biopsy ; Cryptococcosis ; Cryptococcus gattii ; Cryptococcus neoformans ; Cryptococcus* ; Drug Therapy ; Female ; Fever ; Fluconazole ; Hematopoietic Stem Cell Transplantation ; Humans ; Hyphae ; Leukemia, Myeloid, Acute* ; Middle Aged ; Opportunistic Infections ; Skin Manifestations* ; Skin* ; Yeasts

PURPOSE: An altered mental state is a common chief complain at the emergency departments (EDs). But it is difficult to find out the reason for this mental change. Serum biomarkers are an alternative way to diagnose the reason for mental change. We determined the values of four biomarker for diagnosing the mental changes of the patients seen at the ED: BNP, d-dimer, MMP-9 and S100beta. METHODS: From September 2007 to March 2008, we prospectively enrolled 42 adult patients who visited the ED of Hospital because of an altered mental status. We categorized the patient's mental state into 5 steps (alert to coma), and we took samples of blood at the time of visiting the ED. We then measured the 4 serum markers. The clinical records were reviewed to analyze the usefulness of these 4 serum markers. RESULTS: We enrolled 42 patients (24 females and 18 males). Thirty-three people were diagnosed with stroke and 7 people were diagnosed to not have stroke. The measurements of BNP, d-dimer and MMP-9 were on average 136.5+/-231.7 pg/mL, 2052.2+/-2071.8 ng/mL and 294.9+/-311.7 ng/mL, respectively, and S100beta was mostly measured below 100 pg/mL. After statistic analysis, only MMP-9 had diagnostic value for stroke, and BNP & d-dimer had a negative relation to making the diagnosis of stroke. CONCLUSION: MMP-9 is useful for making the different diagnosis of acute stroke in patients with an altered mental status at the ER. There is the probability of metabolic causes for ED patients' depressed mentality when the BNP and ddimer levels are highly elevated, but further study is needed to confirm this.
Adult ; Biomarkers ; Consciousness Disorders ; Emergencies ; Female ; Fibrin Fibrinogen Degradation Products ; Humans ; Prospective Studies ; Stroke

PURPOSE: The purpose of this research was to describe how nurses in intensive care units (ICU) work. METHOD: A total of 18 ICU nurses participated in the research. The data was collected through individual in-depth interviews and analyzed by grounded theory method using NUDIST 4.0 software program. RESULTS: Three different patterns regarding nursing performance among ICU nurses were identified. These are 1) nursing performance of nurses who perform excellently, 2) nursing performance of nurses who do not perform well because of their lack of experience, and 3) nursing performance of nurses who do not perform well in spite of their good years of experience. These three different nursing performances were described in terms of seven different categories; 1) assessing and monitoring nursing problems, 2) clinical decision making, 3) interpersonal relationships, 4) holistic care, 5) technical skills, 6) problem solving, 7) working independently and creatively. This study also identified two intervening factors that influenced the advancement of their expertise. CONCLUSION: The results of this study might help nurse managers in developing continuing educational programs for inexperienced nurses or those nurses not performing well to become experts by a deeper understanding of the nature of nursing performance and the factors that influence nursing performance in ICU settings.
Clinical Competence ; Decision Making ; Humans ; Intensive Care Units ; Nurse Administrators ; Nursing* ; Problem Solving

Donor lymphocyte infusion (DLI) followed by hematopoietic stem cell transplantation has served as an effective prevention/treatment modality against the relapse of some hematologic tumors, such as chronic myeloid leukemia (CML). However, the therapeutic efficacies of DLI for other types of leukemia, including acute lymphocytic leukemia (ALL), have been limited thus far. Therefore, we examined whether increasing the reactivity of donor T cells by gene modification could enhance the therapeutic efficacy of DLI in a murine model of ALL. When a CTLA4-CD28 chimera gene (CTC28) in which the intracellular signaling domain of CTLA4 was replaced with the CD28 signaling domain was introduced into CD4 and CD8 T cells in DLI, the graft-versus-tumor (GVT) effect was significantly increased. This effect was correlated with an increased expansion of donor CD8 T cells in vivo, and the depletion of CD8 T cells abolished this effect. The CD8 T cell expansion and the enhanced GVT effect were dependent on the transduction of both CD4 and CD8 T cells with CTC28, which emphasizes the role of dual modification in this therapeutic effect. The CTC28-transduced T cells that expanded in vivo also exhibited enhanced functionality. Although the potentiation of the GVT effect mediated by the CTC28 gene modification of T cells was accompanied by an increase of graft-versus-host disease (GVHD), the GVHD was not lethal and was mitigated by treatment with IL-10 gene-modified third-party mesenchymal stem cells. Thus, the combined genetic modification of CD4 and CD8 donor T cells with CTC28 could be a promising strategy for enhancing the therapeutic efficacy of DLI.
Chimera* ; Graft vs Host Disease ; Hematologic Neoplasms* ; Hematopoietic Stem Cell Transplantation ; Humans ; Interleukin-10 ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Lymphocytes* ; Mesenchymal Stromal Cells ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Recurrence ; T-Lymphocytes* ; Tissue Donors*