OBJECTIVE: The use of decompressive craniectomy for treating massive cerebral infarction is attracting much attention because conventional medical treatment is associated with high mortality. The aim of this retrospective study was to evaluate the surgical treatment results and prognostic factors for patients suffering with malignant cerebral infarction. METHODS: We analyzed 9 consecutive patients who underwent decompressive craniectomy with or without temporal lobectomy after malignant cerebral infarction from 2000 to 2008. We reviewed the medical records, the radiological finding and the pre-operative clinical assessment using the Glasgow Coma scale (GCS). The postoperative functional outcome was assessed as the Barthel-Index (BI) and the modified Rankin scale (mRS). RESULTS: The male to female ratio was 3.5:1. The mean age was 50 years (range: 36-68). Eight patients (89%) showed involvement of the entire middle cerebral artery (MCA) territory and the concomitant anterior cerebral artery (ACA) or posterior cerebral artery (PCA) territory. The preoperative mean GCS was 8.3 (range: 5-12) and the mean time to surgery after the onset of symptoms was 47.7 hours (range: 4-168 hours). All the patients underwent decompressive craniectomy and duroplasty. Among them, four patients (45%) underwent temporal lobectomy. The mean followup period was 7.3 months (range: 1-26 months) and five patients died within this period. CONCLUSION: Decompressive craniectomy with or without lobectomy for patients with malignant cerebral infarction decreases the mortality rate and it improves the functional outcome. In the survived group, comparison of the two surgical modalities didn't show any statistically significant difference. However, the decompressive craniectomy with lobectomy group demonstrated a high survival rate (75%). Future studies are needed to investigate the proper treatment modalities for malignant cerebral infarction.
Anterior Cerebral Artery ; Cerebral Infarction ; Decompressive Craniectomy ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Male ; Medical Records ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Retrospective Studies ; Stress, Psychological ; Survival Rate

No abstract available.
Adenoma* ; Common Bile Duct*

Cytomegalovirus(CMV) infections are common in immune compromised situations such as human immunodeficiency virus infection and organ transplantation. However CMV colitis had been rarely found in immunocompetent individuals. We experienced a case of an 83-year-old female patient, initially immune competent, who developed a massive lower gastrointestinal bleeding caused by CMV colitis. Previously, multiple antibiotics were used for nontuberculous Myco- bacterium and other bacterial infections after total knee arthroplasty. Colonoscopy revealed multiple ulcerations and mucosal congestion with hemorrhage. In spite of ganciclovir therapy, our patient did not recover.
Aged, 80 and over ; Anti-Bacterial Agents ; Arthroplasty ; Bacterial Infections ; Colitis ; Colonoscopy ; Cytomegalovirus ; Estrogens, Conjugated (USP) ; Female ; Ganciclovir ; Hemorrhage ; HIV ; Humans ; Knee ; Mycobacterium Infections, Nontuberculous ; Nontuberculous Mycobacteria ; Organ Transplantation ; Transplants ; Ulcer

OBJECTIVE: To establish the normal range of the fetal cerebral artery pulsatility index (PI) throughout pregnancy and to determine if there are any gender differences. METHODS: Doppler ultrasonographic examination was performed to measure the fetal middle cerebral artery (MCA) and anterior cerebral artery (ACA) PI in 71 normal pregnancies between 25 and 39 weeks gestation. Gender determination was possible in 44 fetuses by either a postnatal examination or genetic amniocentesis. The gestational weeks were grouped into 4-week sections. Group I ranged from 28 to 31 gestational weeks. Group II and III ranged from 32 to 35 and from 36 to 39 weeks, respectively. RESULTS: The ACA PI of the male fetuses decreased with increasing gestational time (group I, II and III: 1.79+/-0.35, 1.57+/-0.67 and 1.30+/-0.35; P<0.05). The ACA PI of the female fetuses also decreased significantly (group I, II and III: 1.97+/-0.59, 1.68+/-0.41 and 1.33+/-0.21; P<0.05). The MCA PI of the male fetuses decreased (group I, II and III: 2.02+/-0.58, 1.88+/-0.43 and 1.53+/-0.47; P<0.05). However, there was no significant decrease in the MCA PI of female fetuses (group I, II and III: 2.14+/-0.60, 1.87+/-0.56 and 1.88+/-0.40; P=0.83). CONCLUSION: These data demonstrate that female fetuses show a relatively constant middle cerebral artery PI regardless of the gestational time.
Amniocentesis ; Anterior Cerebral Artery ; Cerebral Arteries* ; Female ; Fetus ; Humans ; Male ; Middle Cerebral Artery ; Pregnancy ; Reference Values

PURPOSE: We investigate the impact of tumor multifocality on the biochemical recurrence rate after radical prostatectomy. MATERIALS AND METHODS: Data was collected from 525 patients who underwent radical prostatectomy for clinically localized prostate cancer from 2003 to 2007. We evaluated the potential associations of multifocality with various clinical and pathologic factors. The ability to predict extra-capsular extension(ECE) was tested by logistic regression models, whereas biochemical recurrence(BCR) was assessed via Kaplan-Meier analyses and Cox-hazard regression models. The BCR was defined as a level of serum prostate-specific antigen(PSA) of 0.2ng/ml or greater on consecutive evaluations. RESULTS: Multifocality was observed to be significantly associated with the presence of a high grade Gleason pattern(p=0.014), the pT stage(p< 0.001), ECE(p=0.005) and a positive surgical margin(PSM)(p=0.019). Moreover, it was the independent predictor of ECE on multivariate logistic regression analyses(p=0.039). However, although multifocality had a significant influence on biochemical recurrence on the Kaplan-Meier analyses (log rank test, p=0.019), only the PSA level and the Gleason score were significant predictors of BCR on the multivariated Cox-hazard analyses. CONCLUSIONS: Although multifocality was associated with adverse pathologic features, it had no significant effect on biochemical recurrence on the multivariated cox-hazard analyses.
Humans ; Logistic Models ; Neoplasm Grading ; Prostatectomy ; Prostatic Neoplasms ; Recurrence

OBJECTIVES: Helicobacter pylori infection induces selective reduction of the number of antral D-cells and results in abnormal regulation of serum gastrin secretion. The purpose of this study was to investigate the relationship between H. pylori infection and the numbers of G-cells and D-cells. METHODS: The numbers of antral G-cells and D-cells, the ratio of G-cells to D-cells and fasting serum gastrin concentrations were compared between 37 patients with (29 with duodenal ulcers and 8 with gastric ulcers) and 33 without H. pylori infection (22 with duodenal ulcers and 11 with gastric ulcers). Serum gastrin concentrations were measured using the radioimmunoassay technique. Antral mucosal biopsy specimens were examined using immunohistochemical staining with antibodies specific for gastrin and somatostatin and the numbers of G-cells and D-cells per gastric gland were counted. RESULTS: Fasting serum gastrin concentrations were significantly higher in patients with H. pylori infection compared to patients without infection (80.3 +/- 23.5 vs 47.6 +/- 14.1 pg/ml, p < 0.001). The number of G-cells per gastric gland was similar in infected and uninfected patients (7.1 +/- 3.1 vs 7.3 +/- 3.9, respectively, p > 0.5). The number of D-cells was significantly lower in patients with H. pylori infection than in uninfected patients in both duodenal and gastric ulcer patients (1.3 +/- 0.4 vs 2.5 +/- 1.6, respectively, p < 0.001). The ratio of G-cells to D-cells was also significantly higher in infected patients compared with uninfected patients for both gastric and duodenal ulcers (5.7 +/- 2.7 vs 3.5 +/- 1.9, respectively, p < 0.001). CONCLUSIONS: These results strongly suggest that Helicobacter pylori infection induces reduction of the number of antral D-cells. The resulting relative hypofunction of the inhibitory action of D-cells against G-cells may be responsible for increased serum gastrin secretion.
Case-Control Studies ; D Cells/pathology ; D Cells/metabolism ; G Cells/pathology ; G Cells/metabolism ; Gastrins/metabolism ; Gastrins/blood ; Gastritis/pathology ; Gastritis/metabolism* ; Helicobacter Infections/pathology ; Helicobacter Infections/metabolism* ; Helicobacter pylori* ; Human ; Somatostatin/metabolism

Stent thromboses due to multifactorial causes including hypercoagulable conditions and high on treatment platelet reactivity (HTPR), which means a low response to anti-platelet therapy, especially clopidogrel. Prasugrel is a third generation thienopyridine and inactive pro-drug requiring metabolic activation in vivo, which improves the rate of HTPR with clopidogrel. This drug is mostly effective, with a potent, fast, and consistent anti-platelet action, but rare cases of inadequate platelet inhibition with prasugrel have been reported. Here we describe the case of a 47-year-old man who presented with a recurrent acute myocardial infarction and ST during an intravascular ultrasound pullback and was resistant to prasugrel, was successfully treated with ticagrelor.
Activation, Metabolic ; Blood Platelets ; Humans ; Middle Aged ; Myocardial Infarction ; Prasugrel Hydrochloride* ; Stents* ; Thrombosis* ; Ultrasonography

PURPOSE: The factors related to early-onset tumor recurrence in patients with spontaneously ruptured hepatocellular carcinoma (HCC) after hepatectomy remain unclear. The aims of the present study were to compare characteristics between early and late recurrence groups in spontaneously ruptured HCC patients who received curative hepatectomy and to identify risk factors for mortality. METHODS: We selected 19 patients who had been diagnosed with spontaneously ruptured HCC and who were treated with curative liver resection between 1998 and 2013. The 19 patients were divided into 2 groups: the early recurrence group of patients who experienced tumor recurrence within 12 months after hepatectomy, and the late recurrence group of patients who experienced recurrence after 12 months or who did not experience recurrence. RESULTS: The median tumor size was 7.4 cm, and there were no cases of postoperative mortality. Patient survival rates at 1, 3, and 5 years were 78.9%, 58.6%, and 58.6%, respectively. The incidence of tumor protrusion in the early recurrence group was higher than that in the late recurrence group (100% vs. 30%, respectively, P = 0.003). There were no statistically significant differences in other factors between the 2 groups. Multivariate analysis showed that greater than 30% protrusion of the tumor was a predictor of patient survival. CONCLUSION: The results from the present study suggests that spontaneously ruptured HCC patients with protrusion should be frequently monitored after hepatectomy in order to achieve early detection of tumor recurrence and improve survival.
Carcinoma, Hepatocellular* ; Hepatectomy* ; Humans ; Incidence ; Liver ; Mortality ; Multivariate Analysis ; Recurrence* ; Risk Factors ; Rupture ; Rupture, Spontaneous* ; Survival Rate