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

Loeffler's endocarditis, a rare cardiac manifestation of hypereosinophilic syndrome (HES), is characterized by fibrous thickening of the endocardium of both ventricles, leading to apical obliteration and heart failure. We report a case of a 41-year-old male with slowly progressive right-sided heart failure symptoms. The complete blood count showed hypereosinophilia and the echocardiogram revealed that the both ventricles were filled with large amount of thrombus. His symptoms and typical echocardiographic findings markedly improved within several weeks after steroid and anticoagulation therapy.
Adult ; Blood Cell Count ; Endocardium ; Heart Failure ; Humans ; Hypereosinophilic Syndrome ; Male ; Thrombosis

PURPOSE: The National Cancer Institute(NCI)'s Hollow Fiber Assay(HFA) is currently used as an in vivo screening model to quantitatively define anticancer activity. To investigate the use of HFA in a bladder cancer model, we conducted in vitro and in vivo experiments with several anticancer drugs in nude mice. MATERIALS AND METHODS: The human bladder cancer cell lines(CRL2742, 253JP, SW1710, HTB9) were cultured both in vitro and in vivo in polyvinylidene fluoride(PVDF) hollow fibers. The fibers were implanted intraperitoneally(ip) and subcutaneously(sc) into female athymic nude mice(C57BL/6), and the mice were then treated with gemcitabine 120 mg/kg(bolus), cisplatin(3mg/kg), paclitaxel(15mg/kg) or vehicle only (control) for 4-consecutive days. After 6 days, the fibers were retrieved and the viable cell density was analyzed by MTT assay. RESULTS: The difference between in vitro and in vivo growth was not significant for the CRL2742, 253J-P and SW1710 cell lines; the difference between the ip and sc fibers was also not significant in the CRL2742, SW1710 and HTB9 cell lines. After drug treatment, the percent of growth inhibition revealed constant and effective anticancer activities for the 3 individual drugs. CONCLUSIONS: This study demonstrates the possibility of measuring and quantifying the anticancer effect with using in vivo hollow fiber assay in a bladder cancer model.
Female ; Humans ; Mice ; Animals

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

BACKGROUND: A management protocol for hepatitis C virus (HCV) after liver transplantation (LT) has not been established in Korea. We therefore investigated HCV transplant protocols and post-transplant results from liver transplant centers in Korea. METHODS: The HCV protocol and medical data of individual cases from eight major liver transplant centers were compiled and analyzed. RESULTS: A post-transplant protocol biopsy was performed in only three centers. In these centers, HCV treatment was considered when pathological abnormalities were confirmed on the protocol biopsy (irrespective of liver function). In the other five centers, biopsies were performed when biochemical parameters were aggravated. Only two out of the eight centers performed preemptive or prophylactic therapy. A total of 5,663 adult LTs were performed between 2000 and 2010. HCV-related liver disease was responsible for 277 LTs (4.9%). Pre-transplant data were not available in many patients, including HCV genotype and serum HCV RNA level. Tacrolimus was more frequently used for initial maintenance immunosuppression than cyclosporine A (61.7% vs. 36.8%). Post-transplant HCV treatment was performed in 135 patients (48.7%). Sixty-seven recipients (24.2%) died during follow-up after LT and 11 HCV-related graft loss (4.0%) developed. The cumulative patient survival rate was 74.7% at 5 years and 67.9% at 10 years after LT. CONCLUSIONS: The HCV management protocol after LT varied markedly between the eight Korean transplant centers and a standard protocol did not exist. A nationwide multicenter study is required to investigate the most effective treatment for HCV after LT, with the goal of establishing the most effective standard protocol.
Adult ; Biopsy ; Cyclosporine ; Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis ; Hepatitis C ; Humans ; Immunosuppression ; Korea ; Liver ; Liver Diseases ; Liver Transplantation ; RNA ; Survival Rate ; Tacrolimus ; Transplants