Rigid posterior fixation of the atlas to the third and fourth cervical spine was achieved in a patient in whom axis pedicle fracture and dislocation of axis on the third cervical spine. Althouth there was no evidence of neurologic disorder, marked instability of axis on the third cervical spine should inevitably be fused in any procedures. An anatomically contoured loop was secured to the posterior arch of the atlas and the laminae of the third and the fourth cervical spine by sublaminar wirings. The technique has the advantage over bone graft, either alone or with cement, in that it affords rigid stabilization, allows early mobilization and some flexion movement of atlanto-occipital joint.
Atlanto-Occipital Joint ; Dislocations ; Early Ambulation ; Humans ; Nervous System Diseases ; Spine ; Spondylolisthesis ; Transplants

No abstract available.
Capillaries* ; DNA* ; Vacuum*

PURPOSE: Vascular endothelial growth factor (VEGF) is a potent angiogenic factor in a number of cancers. The aim of this study was to evaluate the clinical significance of the serum level of VEGF in hepatocellular carcinoma (HCC) patients. METHODS: Serum VEGF was measured by an enzyme linked immunosorbent assay (ELISA) method. The correlation between serum VEGF level and clinico-pathological data of HCC patients were evaluated. RESULTS: The serum VEGF levels significantly increased with increasing tumor size and platelets count. The mean serum VEGF level in HCC patients with microvessel tumor invasion was higher than in those without microvessel tumor invasion. CONCLUSION: A high serum VEGF level may be an indicator of tumor progression and an important predictor of microvessel tumor invasion.
Angiogenesis Inducing Agents ; Carcinoma, Hepatocellular* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Microvessels* ; Vascular Endothelial Growth Factor A*

PURPOSE: To evaluate the temporal evolution of the ischemic area and trace ratio, and to define ischemic penumbra within the hyperacute experimental focal cerebral ischemia model. MATERIALS AND METHODS: A focal cerebral ischemia model of middle cerebral artery occlusion (MCAO) was constructed in twelve Korean cats weighing 2 -3 Kg. T2-weighted images (T2WI) and diffusion-weighted images(DWI) were obtained using a 1.5T MR imager. Trace images were reconstructed after post-image processing with IDL 5.0. The trace ratio (ipsilateral trace value/contralateral trace value) was calculated in the ischemic core and periphery, and MR images were obtained at 1, 3, 6, and 24 hrs after MCAO. The twelve cats were divided into three groups, and 4, 5, and 3 cats were sacrified after obtaining MR images at 3, 6, and 24 hrs after MCAO, respectively. After 2% triphenyl tetrazolium chloride (TTC) solution and formalin preparation, the infarction area of the brain slice and T2WI and DWI trace images of the same slice were compared. The trace ratio was calculated at the peripheral portion of the ischemic core, which was the presumed ischemic penumbra in images obtained 1hr after MCAO. Changes in trace ratio in the ischemic core and infarction territory were also evaluated according to time. RESULTS: The trace ratio in the peripheral portion of the ischemic core was 0.71 +/- 0.03. The region where the trace ratio was 0.83 +/- 0.06 in images obtained 1 hour after MCAO was presumed to be ischemic penumbra; the region progressed to infarction in images taken during the next time period. In all cases the abnormal area of trace images was larger than that seen on DWI. The trace ratio was lower, by 6.2 %, 3 -6hrs after MCAO than at any other time. In cat number 3, the trace radio decreased rapidly and progressively, by 21%, during the first six hours. For 3 -6hrs after MCAO, the area of infarction showed progressive enlargement. CONCLUSION: Within six hours of MCAO, ischemic penumbra is progressively incorporated into the ischemic core. In the experimental focal cerebral ischemia model, an area of trace ratio larger than 0.71 and less than 1may be defined as ischemic penumbra.
Animals ; Brain ; Brain Ischemia* ; Cats* ; Formaldehyde ; Infarction ; Infarction, Middle Cerebral Artery ; Magnetic Resonance Imaging* ; Stroke*

BACKGROUND/AIMS: Vascular endothelial growth factor (VEGF) is a potent angiogenic factor. Hepatocellular carcinoma (HCC) is a typical hypervascular tumor and VEGF may play a important role in its carcinogensis and progression. Transcatheter arterial chemoembolization (TACE) which is one of the therapeutic modalities of HCC induces hypoxia to the tumor. VEGF is known to be up-regulated by hypoxia. In this study, we examined the level of VEGF in the course of TACE. METHODS: Twenty-two HCC patients were enrolled in this study. Serum VEGF level was investigated before and 1, 5 and 10 days after TACE. The correlation of clinical factors of patients and the level of serum VEGF before TACE was evaluated. Platelet count was also measured with VEGF. RESULTS: Mean serum VEGF level increased significantly 1 and 5 days after TACE. Platelet count decreased significantly 1 day after TACE. Serum VEGF level was positively correlated with platelet count before and 1 day after TACE. CONCLUSION: TACE may increase the serum level of VEGF induced by hypoxia.
Angiogenesis Inducing Agents ; Anoxia ; Carcinoma, Hepatocellular* ; Humans ; Platelet Count ; Vascular Endothelial Growth Factor A*

Quadricuspid aortic valve is a rare congenital abnormality but it is well recognized as the cause of significant aortic regurgitation. We describe 5 patients who underwent surgery for severe aortic regurgitation associated with quadricuspid valve. In all patients, this abnormality had been incidentally detected during surgery. Two of the patients had infective endocarditis. In accordance with the Hurwitz and Roberts classification, two valves were type d, two were type a, and one was type c.
Aortic Valve Insufficiency ; Aortic Valve* ; Classification ; Congenital Abnormalities ; Endocarditis ; Humans

BACKGROUND: Reduction aortoplasty has been advocated for dilatation of the ascending aorta associated with aortic valve disease in older, high-risk patients. We report our results with modification of reduction aortoplasty and aortic valve replacement. MATERIAL AND METHOD: Between July 2001 and December 2002, 14 consecutive patients who underwent modification of reduction aortoplasty, suture plication technique without excision of the dilated aortic wall, were reviewed. The mean age was 63.7+/-6.7 (50 to 75) years. Ten patients had congenital bicuspid aortic valve. Twelve patients had severe aortic valve stenosis and 6 had regurgitation of grade III~IV. The diameter of the ascending aorta was measured before and immediately after surgery and 6 and 12 months postoperatively using echocardiography or computed tomography. Follow-up was complete in an average of 14.7+/-5.4 (7 to 24) months. RESULT: There were no early postoperative deaths and no bleeding complications. Reduction aortoplasty with suture plication technique decreased the diameter of ascending aorta from 49.4+/-3.5 mm preoperatively to 33.2+/-3.4 mm postoperatively (p<0.001). During follow-up, there were no late deaths and no aneurysm recurrence on the ascending aorta. CONCLUSION: Suture plication technique of reduction aortoplasty without excision of the dilated aortic wall offers good early and short-term results in older, high-risk patients with dilatation of the ascending aorta associated with aortic valve disease. Surgical long-term results of our technique should be evaluated in further studies.
Aneurysm ; Aorta* ; Aortic Valve Stenosis ; Aortic Valve* ; Bicuspid ; Dilatation* ; Echocardiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Recurrence ; Sutures*

BACKGROUND AND OBJECTIVES: The measurement of the coronary flow velocity reserve (CFR) using transthoracic Doppler echocardiography (TTDE) has been reported to be useful for assessing the physiological significance of left anterior descending coronary artery (LAD) stenosis. This study was performed to evaluate the usefulness of CFR by TTDE for diagnosis of restenosis following revascularization procedures. SUBJECTS AND METHODS:Patients who were scheduled for follow-up coronary angiography following percutaneous intervention, or coronary bypass, surgery for a LAD lesion were enrolled. Prior to the follow-up coronary angiography, flow velocities in the distal LAD were measured by TTDE, both at rest and during the intravenous infusion of adenosine. CFR was defined as the ratio of the hyperemic to the basal peak diastolic velocities. Angiographic restenosis was defined as a diameter stenosis of more than 50% of the normal value by a quantitative coronary angiography. Of 142 consecutive patients, measurement of the CFR was possible in 95% (n=135), with 39 patients having a myocardial infarction in the LAD territory. The remaining 96 patients were used as the subjects ofin this study. RESULTS: The diameter stenosis was 41+/-26%, with angiographic restenosis found in 33 patients (34%). The mean CFR by TTDE was 2.5+/-1.1. CFR <2.0 was used to diagnose restenosis, with a sensitivity and specificity of 79% (26/33) and 89% (56/63), respectively. CONCLUSION: The noninvasive measurement of the CFR with TTDE is highly feasible, and can be a useful diagnostic modality for restenosis of a LAD following a revascularization procedure.
Adenosine ; Blood Flow Velocity ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Echocardiography, Doppler* ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Myocardial Infarction ; Reference Values ; Sensitivity and Specificity