A 17-year-old man was referred for aborted sudden cardiac death. Ventricular fibrillation (VF) was recorded by automated external defibrillator. Post-resuscitation electrocardiograms showed frequent monomorphic premature ventricular complexes (PVCs), with left bundle branch block configuration and inferior axis. Cardiac arrest due to VF recurred twice within the initial 42 hours. Rhythm monitoring revealed multiple episodes of sustained VF triggered by a triplet of monomorphic PVCs having similar morphology with isolated PVCs. Comprehensive cardiologic workup revealed no structural heart disease and ion-channelopathies. With the impression of idiopathic VF triggered by unifocal PVCs of right ventricular outflow tract (RVOT) origin, radiofrequency catheter ablation was performed to prevent frequent VF recurrence before implantable cardioverter-defibrillator (ICD) implantation. After successful ablation of the origin of unifocal PVCs at anterolateral wall of RVOT, the burden of PVCs decreased remarkably and VF did not recur. The patient was discharged after ICD implantation.
Adolescent ; Axis, Cervical Vertebra ; Bundle-Branch Block ; Catheter Ablation ; Death, Sudden, Cardiac ; Defibrillators ; Defibrillators, Implantable ; Electrocardiography ; Heart ; Heart Arrest ; Heart Diseases ; Humans ; Recurrence ; Triplets ; Ventricular Fibrillation ; Ventricular Premature Complexes

A papillary adeno-carcinoma of the renal pelvis is very rare tumor and mostly diagnosed by histopathologic findings. A 10-years-old female was admitted to Fatima Hospital with Rt. flank pain and intermittent gross hematuria.Herein, we report a case of papillary adeno-carcinoma of the renal pelvis.
Adenocarcinoma ; Female ; Flank Pain ; Humans ; Kidney Pelvis*

Basal cell carcinoma(BCC) and squamous cell carcinoma (SCC) are very prevalent neoplasms of the human skin. Ultraviolet radiation in sunlight is a well-established mutagen of the p53 gene and is one of basal cell carcinoma and squamous cell carcinoma. The newly-formed vascular network is important for neoplasms to grow beyond a size of about 1 mm2. Recent reports have suggested the hypothesis that a mutant p53 protein is closely related with capillary density. Immumohistochemistry for p53 protein and CD34 was performed in 20 cases of BCCs and 14 SCCs to evaluated the relationship between p53 protein and capillary density. The results were as follows:1. The microvessels stained by CD34 were mainly located in the interface of tumor cells and stroma. 2. There was no difference in the microvessel density according to the histologic types and age of the patients, but a higher microvessel density was noted in male patients. 3. The aggressive BCCs and the less-differentiated SCCs showed higher p53 immunostaining. 4. The mean microvessel density of cases showing strong positive immunostaining of the p53 gene(54.73+/-17.75) was higher than that of others(39.75+/-18.30). These results suggested that p53 protein expression and microvessel density are not related to the histologic types and age of the patients, but that differentiation and biologic behavior such as the infiltrating property of tumors and the microvessel density are closely related to p53 protein expression.
Capillaries ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell* ; Genes, p53 ; Humans ; Male ; Microvessels* ; Skin* ; Sunlight

The authors analysed the results of 300 microvascular decompression(MVD) procedures for hemifacial spasm. The follow up period ranged from 6months to 3years. Of these, 70% were women(mean age 54). The vessel most frequently found to compress the facial nerve was the posterior inferior cerebellar artery(43.3%) followed by anterior inferior cerebellar artery(26.7%). For the surgical results, 210 patients(70%) had complete relief of spasm within 3 days after MVD, 65 patients(21.7%) subsequently experienced complete relief, noted in 4 days to 6 months after MVD, ten patients had delayed partial relief and remaining 15 patients showed no improvement. Twelve patients of these 15 unresponsive patients underwent reoperation without beneficial results. Recently the authors have monitored facial elctromyography(EMG) intraoperatively to observe the abnormal late response. There were few cases of permanant major complications, including two cases of ipsilateral hearing loss, ataxia and no operation-related death. These results suggest that MVD is a safe and definite treatment for hemifacial spasm, if performed by experienced surgeon with gentle operative technique, and with intraoperative monitoring such as auditory evoked potential and facial EMG, better surgical results with less complications can be expected.
Ataxia ; Evoked Potentials, Auditory ; Facial Nerve ; Follow-Up Studies ; Hearing Loss ; Hemifacial Spasm* ; Humans ; Microvascular Decompression Surgery* ; Monitoring, Intraoperative ; Reoperation ; Spasm

OBJECTIVES: Glioblastomas, the most common type of primary brain tumors, are highly invasive and cause massive tissue destruction at both the tumor invading edges and in areas that are not in direct contact with glioma cells. As a result, patients with high-grade gliomas are faced with a poor prognosis. Such grim statistics emphasize the need to better understand the mechanisms that underlie glioma invasion, as these may lead to the identification of novel targets in the therapy of high grade gliomas. Protein kinase C(PKC) is a family of serine/threonine kinases and an important signal transduction enzyme that conveys signals generated by ligand-receptor interaction at the cell surface to the nucleus. PKC appears to be critical in regulating many aspects of glioma biology. The purpose of this study was to assess accurately the role of PKC in the invasion regulation of human gliomas based on hypothesis that protein kinase C(PKC) is functional in the process of glial tumor cell invasion. METHOD: To test this hypothesis, U-87 malignant glioma cell line intracellular PKC levels were up and down regulated and their invasiveness was tested. Intracellular PKC level was characterized using PKC activity assays. Invasion assays including barrier migration and spheroid confrontation were used to study the relationship between PKC concentration and invasiveness. RESULT: The cell line which were treated by PKC inhibitor tamoxifen and hypericin exhibited decreased PKC activity and decreased invasive abilities dose dependently both in matrigel invasion assay and tumor spheroid fetal rat brain aggregates(FRBA) confrontation assay. However, the cell line that was treated by PKC activator 12-O-tetradecanylphorbol-13acetate(TPA) did not exhibit increases in either PKC activity or invasive ability. CONCLUSION: These studies suggest that PKC may be a useful molecular target for the chemotherapy of glioblastoma and other malignancies and that a therapeutic approach based on the ability of PKC inhibitors may be helpful in preventing invasion.
Animals ; Biology ; Brain ; Brain Neoplasms ; Cell Line ; Drug Therapy ; Glioblastoma ; Glioma* ; Humans ; Phosphotransferases ; Prognosis ; Protein Kinase C* ; Protein Kinases* ; Rats ; Signal Transduction ; Tamoxifen

Although fibromas are the most common renal medullary tumor identified at autopsy. their small sized and benign course make clinical detection extremely difficult. Only 9 clinical cases of renal medullary fibromas have been reported. Many fibromas of the renal medulla, previously considered as bamahomas. seemed to be composed of tumerous transformation of renomedullary interstitial calls Herein we report on a patient with huge renal medullary fibroma treated by right radical nephrectomy.
Autopsy ; Brain Stem Neoplasms ; Fibroma ; Humans ; Nephrectomy

PURPOSE: This prospective study conducted to estimate mortality and activity of hip fracture among persons over 50 years of age, in Jeju island, Korea during the year 2002. MATERIALS AND METHODS: One hundred forty-nine patients among 150 patients over 50 years of age who lived in Jeju island and sustained a femoral neck or intertrochanteric fracture during the year 2002 were followed-up for average 2 years. Standardized annual mortality ratio was calculated and comparison was made between hip fracture patients and general population in Jeju island. RESULTS: One hundred forty-nine patient were followed-up (35 in men, 114 in women). The mean age of patients was 77.4 years (range 50-98 years). Mortality at 2 years (range, 1.6-2.6 years) was 28.2% (42 patients), mortality at 1 year was 16.8% (25 patients) and mortality at 6 months was 12.1% (18 patients). Patients who were classified as poor (Halpin grade III and IV) increased in number from preoperative 11 patients to postoperative 37 patients. CONCLUSION: Considering 28.2% of high mortality and 25.2% of poor activity who can not do outside activity at average 2 year follow up, the hip fracture is life threatening risk factor of elderly. Prevention falling and hip fracture risk is needed.
Aged ; Femur Neck ; Follow-Up Studies ; Hip* ; Humans ; Korea ; Male ; Mortality* ; Prospective Studies* ; Risk Factors

Increased release of excitatory neurotransmitters leading to activation of signal transduction has been noted after cerebral ischemia. One of the biochemical events in the signaling processes is an alteration of gene expression, that is, increased expression of immediate early genes(IEGs) such as the protooncogenes, c-fos and c-jun. Recent studies have shown that hypothermia has a beneficial protective effect on hippocampal neuronal loss during or after cerebral ischemia. In this study, we investigated the expressions of c-fos and c-jun by immunohistochemical stain at the hippocampal CA1, CA3 and parietal cortex(PC) along the changes of body temperature in a transient global cerebral ischemia model of gerbil in order to check the effect of hypothermia The experimental groups were divided into control(36~36.5 degrees C), normothermic(36~36.5degrees C), hypothermic(32~33 degrees C) and hyperthermic groups(38~39 degrees C)and a transient global cerebral ischemia was made by clipping of both common carotid arteries for 10 minutes, followed by reperfusion for 120 minutes. The results were as follows; 1) In all ischemic groups, the expressions of c-fos and c-jun were increased with the control group. The expression of c-fos was markedly enhanced and that of c-jun was also enhanced in a similar pattern, but lower in count, than that of c-fos. 2) The expression of c-fos at the hippocampal CA1 was enhanced significantly in all three ischemic groups compared with the control group(P<0.01). At the hippocampal CA3 and parietal cortex(PC), the expression was enhanced significantly in the normothermic and hypothermic groups(P<0.01), but not in the hyperthermic group compared with the control group. 3) The expression of c-jun at the hippocampal CA3 was enhanced sighificantly in the hypothermic group compared with all other groups(P<0.01) but there was no significant change in hippocampal CA1 and PC. 4) In the aspect of location in each experimental group, the expressions of both protooncogenes were increased in CA1 Body Temperature ; Brain Ischemia ; Carotid Artery, Common ; Cell Survival ; Gene Expression ; Gerbillinae* ; Hippocampus ; Hypothermia* ; Neurons ; Neuroprotective Agents ; Neurotransmitter Agents ; Rabeprazole ; Reperfusion ; Signal Transduction

Clear cell meningioma is a recently recognized variant of meningiomas. We present a case of a 47-year old man with clear cell meningioma which involved right cerebellar hemisphere. Magnetic resonance imaging revealed a 3(34cm sized well enhanced round nodular lesion with mild mass effect. He underwent suboccipital craniectomy with a successful total removal of the tumor. To our knowledge, this is the first report of clear cell meningioma in our country.
Glycogen ; Humans ; Magnetic Resonance Imaging ; Meningioma ; Middle Aged

Lately, surgical treatment for lumbar disc herniations has advanced markedly with new improvements of neurosurgical procedures using microscope and microinstruments. The following is the authors' report of the surgical outcomes of 3,913 consecutive patients with lumbar disc herniations treated during a 230year period. These patients received treatments of laminectomy, hemilaminectomy or partial laminectomy with or without discectomy. After 1987, we also performed microdiscectomies using microscopes and microinstruments. The ratio of male to female was 71% to 29% and the fourth and fifth decades were most common with respect to age distribution. The causes of herniated discs include lifting, traffic accidents, falls or slipping, and sports Almost all patients had complained of low back pain and leg pain(99%), and 81% had radicular pain or sensory abnormality in a dermatomal distribution. The diagnosis was made by lumbar myelogram, CT scan and/or MRI. Complications were developed in 6.2% of the surgical cases. Several conclusions can be drawn from the above indicated results of this series: 1) male patients predominate in the lumbar disc herniation which are most common the fourth and fifth decades; 2) the incomplete herniation of disc was common; 3) MRI had the highest specificity as a single diagnostic tool, while the combination of myelogram, CT scan and MRI seems to e the best diagnostic method; 4) almost all patients had low back pain and leg pain and 90% of the patients were positive in Laseque test; 5) microdiscectomy is the most recommended treatment for lumbar disc herniations ; 6) The complication rate was 6.2% and the failed back surgery syndrome was most common.
Accidents, Traffic ; Age Distribution ; Diagnosis ; Diskectomy ; Failed Back Surgery Syndrome ; Female ; Humans ; Intervertebral Disc Displacement ; Laminectomy ; Leg ; Lifting ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Neurosurgical Procedures ; Sensitivity and Specificity ; Sports ; Tomography, X-Ray Computed