Malignant hyperthermia is a potentially fatal genetic and metabolic myopathy that presents with high fever, and muscle rigidity, and it often occurs after administering anesthetic medication. Most cases of malignant hyperthermia occur during anesthesia or surgery, but delayed malignant hyperthermia is very rare, and if it is detected late, it has a high mortality rate. A 39-year-old male with an acute subdural hematoma underwent decompressive craniectomy without any intraoperative medical problems, but a high fever above 40degrees C occurred after 8 hours and he was dead in spite of aggressive management after 48 hours postoperatively. We present here a case of delayed malignant hyperthermia along with a review of the related literature.
Adult ; Anesthesia ; Decompressive Craniectomy ; Fever ; Hematoma, Subdural, Acute ; Humans ; Male ; Malignant Hyperthermia ; Methyl Ethers ; Muscle Rigidity ; Muscular Diseases ; Ryanodine Receptor Calcium Release Channel

Intracranial epithelioid hemangioendothelioma is extremely rare. We report a case of intracranial epithelioid hemangioendothelioma which developed in a 55-year-old man who presented with dysarthria for two weeks. The brain computed tomography scan and magnetic resonance image showed masses which had fat component at the left frontal convexity and at left posterior parietal area. Excisional biopsy at the left frontal convexity confirmed epithelioid hemangioendothelioma which is immunopositive for CD31, supporting endothelial differentiation, and negative for CD68, SMA and HMB-45.
Biopsy ; Brain ; Dysarthria ; Hemangioendothelioma, Epithelioid* ; Humans ; Middle Aged ; Rabeprazole

OBJECTIVE: The incidence of posterior inferior cerebellar artery (PICA) aneurysms is rare, and neurosurgeons have found that the direct open surgical approach for PICA aneurysms is challenging. [0]We analyzed the results of treating posterior inferior cerebellar artery (PICA) aneurysms by embolization or by open surgery. METHODS: 41 patients (1% of all the aneurysms treated; 13 (32%) men, 18 (68%) women; mean age: 55.5 yr) with ruptured or unruptured PICA aneurysms underwent treatment at our hospital. The clinical outcomes of these patients were studied retrospectively by using the medical records and the neuroimaging studies. RESULTS: The sites of PICA aneurysms were at the junction of the vertebral artery and PICA (63%), the lateral medullary segment (7%), the tosillomedullary segment (10%), the telovelotonsillar segment (13%) and the cortical segment (7%). The shapes of the PICA aneurysm were either the saccular type (85%) or the fusiform type (15%). 25 patients with PICA aneurysm underwent surgical treatment and 16 patients with PICA aneurysms underwent endovascular treatment. Open surgery was used more often to treat a distal PICA than an endovascular procedure. Within the open surgery group, 24% of the patients received the Hunt and Hess (HH) grades IV and V, whereas among the endovascular-treated patients, 37.5% of the patient had HH IV and V grades. Twenty eight percent of the patients In the surgery group achieved a Glasgow Outcome Scale (GOS) score of I through III, and 72% patients had gained a GOS score IV or V. For the endovascular-treated patients, 37% of these patients achieved a GOS score of I through III and 63% patients gained a GOS score IV or V. CONCLUSION: We found that the open surgery patients had better clinical outcomes than the endovascular treated patients and they especially achieved higher HH grades. However, Fisher's exact test and Chi-square tests did not show any statistically significant difference between the two groups (p=0.49, which is explained by the selection bias). In the previous literature, the predictors of the outcome for intracranial aneurysms, such as age, the size of the aneurysms, the HH grade and the Fisher grade showed statistical significance for the GOS grade. Yet in our study, we showed that there was no statistical significance between the above mentioned predictors and the GOS grade, while a strong correlation existed between the HH grade and the GOS grade.
Aneurysm ; Arteries ; Endovascular Procedures ; Glasgow Outcome Scale ; Humans ; Incidence ; Intracranial Aneurysm ; Male ; Medical Records ; Neuroimaging ; Pica ; Retrospective Studies ; Vertebral Artery

Helicobacter pylori is a causative agent of type B gastritis and plays a central role in the pathogenesis of gastroduodenal ulcers and gastric cancer. Strategies for the control of H. pylori- induced gastroduodenal diseases based on conventional measures are still of limited utility. Therefore, it seems worthwhile to make a break-through as an alternative strategy by reviewing the host-parasite relationship of H. pylori infection on the basis of genomic structure. In this study, we tried to construct a physical map of H. pylori genome. Chromosomal DNA from a Korean prototype strain, H. pylori 51 was digested with 42 restriction endonucleases to identify restriction patterns suitable for mapping the genome. We identified three enzymes, ApaI, NotI and Sfil, which gave a small number of DNA fragments of higher molecular weight that were well resolved after pulsed-field gel electrophoresis. The H. pylori chromosome contained 7 ApaI fragments ranging from 167 to 311 kb, 7 NotI fragments ranging from 5 to 516 kb and 2 SfiI fragments of 332 and 1,347 kb in size. The genome size of the strain is 1,679 kb. A circular physical map of the H. pylori chromosome was constructed by aligning 3 kinds of restriction fragments by Southern blot analysis of simple ApaI, NotI and SfiI digests or double NotI/ApaI and NotI/SfiI digests with the various probes. When the physical map of H. pylori strain 51 compared with that of strain 26695 of which the cornplete genome sequence was reported, completely different restriction patterns were shown, which suggests the genomic diversity in H. pylori.
Blotting, Southern ; DNA ; DNA Restriction Enzymes ; Electrophoresis, Gel, Pulsed-Field ; Gastritis ; Genome ; Genome Size ; Helicobacter pylori* ; Helicobacter* ; Host-Parasite Interactions ; Molecular Weight ; Peptic Ulcer ; Stomach Neoplasms

To define the genes for production of catalytically active H. pylori urease, we camed out study to elucidate the structure of urease gene transcript, to delineate the genetic region which affected the extent of the expression and the activation of urease structural subunits. UreC and ureD were confirmed not to affect the expression of structural genes and active enzyme production, meaning that these genes are not components of the urease gene cluster of H. pylori. p-independent transcriptional stop signal was found in 12 bp down-stream of ureH stop codon. RNA extension test showed that the transcript starts with 267 bp upstream of ureA start codon. Although accessory genes did not affect the extent of the expression of the structural subunits, they were essential for assembling the active urease in E. coli. E. coli transformants of plasmid clones containing ureAB produced catalytically active urease when they are complemented with the plasmid clones of ureIEFGH or coexisted with ureIEFGH, meaning that accessory gene products could be trans-acting as well as cis-acting. The extent of production of urease structural subunits depended on the region of 241 to 57 bp upstream of ureA start codon. E. coli transformant of pBeloBACII clone containing the urease gene cluster, which is maintained with a single copy in host, did not express the urease. Proteins (60, 38, 30, 29, 27, and 24 kDa) that could hold nickel ions were identified in the cell extract of H. pylori. The results in this study will provide the basis to understand the control mechanism for urease gene expression and formation of the active urease.
Clone Cells ; Codon, Initiator ; Codon, Terminator ; Complement System Proteins ; Gene Expression ; Helicobacter pylori* ; Helicobacter* ; Ions ; Multigene Family ; Nickel ; Plasmids ; RNA ; Urea ; Urease*

This study aims to know cagA and vacA genotypes and the molecular epidemiology of H. pylori strains isolated from patients with gastroduodenal disorders and normal healthy persons of Korea using PCR genotyping, RAPD fingerprinting, and PCR-RFLP. PCR genotyping for cagA genotyping showed that 143 H. pylori isolates tested in this study were cagA positive strains. All the isolates were confirmed as type sla genotype and 13 isolates (9%) among of 143 strains were confirmed as containing the RS2 element. All 143 isolates showed individually unique RAPD profiles. PCR-based RFLP was done to assess the sequence diversity of H. pylori flagella genes. From all H. pylori isolates, 30 distinct patterns were found with HhaI digestion of 1.5 kb flaA segment and 12 distinct patterns were produced with MboI digestion. Among 30 persons, from whom multiple isolates could be obtained, 27 (90%) were confirmed to be colonized with an identical H. pylori strain and 3 (10%) were shown to be infected with the different strains. Among 5 persons attended in follow-up study, 4 were infected with identical strain for 1 year, 1 carried different strains after 1 year. Genotypes of isolates recovered from children were shown to be identical to those of their parents, suggesting that children acquire H. pylori infection from their parents.
Child ; Colon ; Dermatoglyphics ; Digestion ; Flagella ; Follow-Up Studies ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea* ; Molecular Epidemiology* ; Parents ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

Partially purified H. pylori ADH was used to determine the amino acid sequence of ADH N- terminus. The sequence of the ADH N-terminus was determined as MRVQSKGF. The genomic library of H. pylori that has been prepared by pTZ19U plasmid vector was screened with the deduced oligonucleotide probes to select the plasmid clone containing the entire ADH gene. The clone pTZ19U/ADH-6 was selected and its EcoRI-BamHI fragment (1.3 kb) was subcloned into pBluescript II K/S vector to determine nucleotide sequence. The length of H. pylori ADH gene was 1,044 bp. Ribosomal binding site was found in the upstream of start codon and rho- independent transcriptional stop signal was observed in the downstream of stop codon. The ADH gene encodes a protein of 348 amino acids, of which the predicted molecular size and pI value were 38.6 kDa and 7.1, respectively. ADH activity of E. coli transformant of pBluescript/ADH is 10-times greater compared to that of non-transformants. When H. pylori ADH gene was disrupted by pBluescript/ADH-KM whose internal region of 1.3 kb DNA fragment containing ADH gene was replaced by KM resistance sequence, the strain lost the ADH activity completely, despite the normal growth of the strain. This demonstrates that ADH gene is not essential for the viability of H. pylori.
Alcohol Dehydrogenase* ; Amino Acid Sequence ; Amino Acids ; Base Sequence* ; Binding Sites ; Clone Cells ; Cloning, Molecular* ; Codon, Initiator ; Codon, Terminator ; DNA ; Genes, vif* ; Genomic Library ; Helicobacter pylori* ; Helicobacter* ; Oligonucleotide Probes ; Plasmids

The DNA sequence of a plasmid named pHP489 of Helicobacter pylori strain 489 was determined and analyzed to characterize its replication apparatus. The pHP489 plasmid consisted of 1,222 bp and had an overall G+C content of 33.1%. An ORF was predicted to encode the putative protein of 239 amino acid residues (28 kDa). A putative ribosomal binding site and a potential terminator sequence are located upstream and downstream of the ORF, respectively. However, the consensus sequence for a promoter in upstream of ORF was not found. A potential dna A box was found at 317 nt upstream of a start codon and followed by two-57 bp directed repeats and an inverted repeat. The DNA homology was found in the regions of less than 90 bp among pHPK255, pHPM180, and pHel1 of other H. pylori plasmids and Mycoplasma mycoides plasmids. pHP489K that was produced by pHP489 sequence and C. jejuni derived aph(3')-III, was transformed to various H. pylori isolates and were stably maintained in the H. pylori host without the addition of selective antibiotics for the 30-times subcultues. The plasmic vector, in which the ORF region of pHP489 DNA was deleted, could be transformed into H. pylori. However, the plasmid vector, whose the direct repeats region of pHP489 DNA was deleted, failed to be transformed. The direct repeats region of pHP489 DNA was confirmed to be bound with cytosolic factors of H. pylori. These results showed that the direct repeats region of pHP489 DNA is an essential apparatus by which the plasmid could be replicacted in H. pylori. And pHP489 plasmid was supposed to be replicated by host factors rather than plasmic-encoded factors.
Animals ; Anti-Bacterial Agents ; Base Composition ; Base Sequence ; Binding Sites ; Codon, Initiator ; Consensus Sequence ; Cytosol ; DNA ; Ecthyma, Contagious ; Helicobacter pylori* ; Helicobacter* ; Mycoplasma mycoides ; Plasmids* ; Repetitive Sequences, Nucleic Acid ; Sequence Analysis* ; Terminator Regions, Genetic