The time course of recovery in vestibular neuritis varies between individuals. The aim of this study was to identify the predictors for the early or late recovery of vestibular neuritis. The inclusion criteria were patients 1) who had an acute onset of vertigo lasting at least 24 hours, 2) with a horizontal-torsional unidirectional spontaneous nystagmus, and 3) with a canal paresis of 20% or more on the bithermal caloric tests. The primary endpoint for this study was an early or late recovery of vestibular neuritis as a dependent variable. A functional level scale was used to define the late recovery (5 or more points) at seven days after the symptom onset. The secondary endpoint was the duration of hospitalization. One hundred twenty eight patients met the inclusion criteria for this study, and among them, 71 patients had an early recovery. Multiple logistic regression analysis showed that diabetes mellitus was the only independent significant variable for the prediction of a late recovery of vestibular neuritis. In addition, the diabetes mellitus was a predicting variable for long duration of hospitalization. Diabetes mellitus was a predictor for a late recovery of vestibular neuritis.

Anterior cervical microforaminotomy is the one of surgical options for treating cervical spondylotic lesions manifested by radiculopathy or myelopathy. This minimally invasive surgical procedure is gaining popularity due to the recent trends of avoidance of spinal fusion resulting in loss of the physiologic spinal motion and developing a future adjacent segment syndrome. Although the spinal fusion still remains a gold standard procedure for degenerative cervical spinal diseases, the eager for maintaining the function of the motion segment is another issue for contemporary spinal surgeons. Anterior cervical microforaminotomy is a target-oriented operation that decompresses the nerve root or spinal cord without destruction of the spinal anatomical functional unit. Unlike to other procedures including total or partial resection of the intervertebral disc, this surgical procedure removes only a small part of the uncovertebral joint or vertebral body. Through this narrow corridor, adequate decompression of the nerve root or spinal cord can be achieved while preserving functional motion. Technical variations of the original anterior cervical microforaminotomy have been continuously developed to minimize the concerns for the postoperative disc height loss and instability. As of now, the anterior cervical microforaminotomy and its technical variations have been proved to be an excellent procedure for treating the cervical spondylotic radiculopathy from literatures review. But the long-term clinical results and the efficacy of the procedure for cervical myelopathy still remain to be seen.
Decompression ; Intervertebral Disc ; Joints ; Radiculopathy ; Spinal Cord ; Spinal Cord Diseases ; Spinal Diseases ; Spinal Fusion

We report a case of an erythrodermic form of mycosis fungoides in a 68-year-old male, who showed generalized erythroderma with scales for 3 months. Lymphadenopathies in the inguinal and neck areas were present. Histopathological findings showed epidermotropism, perivascular atypical lymphocyte infilteration in the upper dermis, and dermatopathic lymphadenopathy in the inguinal lymph node. T cell markers were positively stained in the immunohistochemical study. These clinicopathological features were consistent with an erythrodermic form of mycosis fungoides(TNM IIl). The patient was treated with PUVA therapy and low dose chemotherapy.
Aged ; Dermatitis, Exfoliative ; Dermis ; Drug Therapy ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Lymphocytes ; Male ; Mycosis Fungoides* ; Neck ; PUVA Therapy ; Weights and Measures

PURPOSE: The tumor suppressor gene p53 has been shown to be a factor in the carcinogenesis or progression of gastric cancer. The mutant p53 has been reported to cause a higher risk of lymph-node metastasis. Futhermore, mutation of the p53 has been linked to a poor prognosis for gastric cancer. The heat shock protein-27 (HSP27), a stress protein, has also been reported to be a poor prognostic factor in ovarian and breast cancers. However, in gastric-cancer patients, controversies exist as to its influence on the prognosis. In the present study, we used an immunohistochemical stain to observe the effects of p53 and HSP27 on the clinicopathological factors and on the prognosis for gastric-cancer patients. MATERIALS AND METHODS: To evaluate the significance of p53 and HSP27 in gastric cancer patients, we analyzed 212 cases of gastric cancer (stage I~IV). Tissue samples of 212 patients were stained immunohistochemically for the mutant p53 protein and for HSP27. The correlations between protein expression and the clinicopathological factors were investigated. RESULTS: The overall expression rates for p53 and HSP27 were 36.9% and 27.8%, respectively. p53 and HSP27 were correlated to each other because the HSP27 expression rate was higher in the p53-positive group (P=0.046). Statistically, the p53 and the HSP27 expression rates were significantly increased in the case of tumor invasiveness, lymphatic metastasis and vessel involvement. Therefore, they play a role in cancer progression. The 5-year survival rates of the p53-positive and the p53-negative groups were 62.8% and 60.1%, respectively (P=0.793) while the 5-year survival rates for the HSP27-positive and HSP27-negative groups were 54.2% and 63.1%, respectively (P=0.090). CONCLUSION: p53 and HSP27 were correlated to each other in our immunohistochemical study of gastric carcinomas and they were not independent prognostic factors in gastric- cancer patients. However, further studies are needed to determine their prognostic values for gastric-cancer patients.
Breast ; Carcinogenesis ; Genes, Tumor Suppressor ; Hot Temperature ; HSP27 Heat-Shock Proteins ; Humans ; Lymphatic Metastasis ; Neoplasm Metastasis ; Prognosis ; Shock ; Stomach Neoplasms ; Survival Rate

PURPOSE: Mechanical thrombectomy using a Solitaire stent has been associated with a high recanalization rate and favorable clinical outcome in intra-arterial thrombolysis. To achieve a higher recanalization rate for mechanical Solitaire thrombectomy, we used an intra-arterial low-dose booster tirofiban injection into the occluded segment after stent deployment. We report the safety and recanalization rates for mechanical Solitaire thrombectomy with a low-dose booster tirofiban injection. MATERIALS AND METHODS: Between February and March 2013, 13 consecutive patients underwent mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. The occlusion sites included the proximal middle cerebral artery (5 patients), the internal carotid artery (5 patients), the top of the basilar artery (2 patients) and the distal middle cerebral artery (M2 segment, 1 patient). Six patients underwent bridge treatment, including intravenous tissue plasminogen activator. Tirofiban of 250 µg was used in all patients except one (500 µg). All occluded vessels were recanalized after 3 attempts at stent retrieval (1 time, n=9; 2 times, n=2; 3 times, n=2). RESULTS: Successful recanalization was achieved in all patients (TICI 3, n=8; TICI 2b, n=5). Procedural complications developed in 3 patients (subarachnoid hemorrhage, n=2; hemorrhagic transformation, n=1). Mortality occurred in one patient with a basilar artery occlusion due to reperfusion brain swelling after mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. Favorable clinical outcome (mRS≤2) was observed in 8 patients (61.5%). CONCLUSION: Our modified mechanical Solitaire thrombectomy method using a low-dose booster tirofiban injection might enhance the recanalization rate with no additive hemorrhagic complications.
Basilar Artery ; Brain Edema ; Carotid Artery, Internal ; Hemorrhage ; Humans ; Methods ; Middle Cerebral Artery ; Mortality ; Reperfusion ; Stents ; Thrombectomy* ; Tissue Plasminogen Activator

OBJECTIVE: Unexpected Solitaire stent detachment can occur during mechanical Solitaire thrombectomy. The purpose of this study was to retrospectively evaluate the influencing factors causing unexpected Solitaire stent detachment and the clinical outcomes. METHODS: Between October 2011 to December 2013, 232 cases of mechanical Solitaire thrombectomy for acute ischemic stroke were performed in 3 stroke centers. During this period, we encountered unexpected Solitaire stent detachments during mechanical Solitaire thrombectomies in 9 cases. RESULTS: Solitaire stents unexpectedly detached in 9 cases (3.9%) during the retrieval of Solitaire stents. The median patient age was 76 years. The occlusion sites of the unexpected stent detachment were the proximal middle cerebral artery (MCA) in 7 cases and the internal carotid artery in 2 cases. The sizes of the stents that unexpectedly detached were 6x30 mm in 7 cases, 5x30 mm in 1 case, and 4x20 mm in 1 case. Four patients had unexpected detachment at the first retrieval, 1 patient at the second, 3 patients at the third, and 1 patient at the fifth. In all of the cases of unexpected detachment at the first retrieval, the stent deployment site was the proximal MCA. After detachment, a proximal marker of the Solitaire stent was observed in 3 patients. However, no marker was visible in the remaining 6 patients. CONCLUSION: Unexpected Solitaire stent detachment should be considered in the first instance of stent retrieval for a relatively large-diameter stent, especially in elderly patients with MCA occlusions.
Aged ; Carotid Artery, Internal ; Humans ; Middle Cerebral Artery ; Retrospective Studies ; Stents* ; Stroke ; Thrombectomy*

We present a case of an athetoid cerebral palsy with quadriparesis caused by kyphotic deformity of the cervical spine, severe spinal stenosis at the cervicomedullary junction, and atlantoaxial instability. The patient improved after the first surgery, which included a C1 total laminectomy and C-arm guided righ side unilateral C1-2 transarticular screw fixation. C1-2 fixation was not performed on the other side because of an aberrant and dominant vertebral artery (VA). Eight months after the first operation, the patient required revision surgery for persistent neck pain and screw malposition. We used intraoperative VA angiography with simultaneous fluoroscopy for precise image guidance during bilateral C1-2 transarticular screw fixation. Intraoperative VA angiography allowed the accurate insertion of screws, and can therefore be used to avoid VA injury during C1-2 transarticular screw fixation in comorbid patients with atlantoaxial deformities.
Angiography ; Cerebral Palsy ; Congenital Abnormalities ; Fluoroscopy ; Humans ; Laminectomy ; Neck Pain ; Quadriplegia ; Spinal Stenosis ; Spine ; Vertebral Artery

Acromegaly and hyperprolactinemia have been described in association with polyostotic fibrous dysplasia. The pathogenic mechanisms of this endocrinopathy are not clear. We experienced a 19-year-old male with hypersecretion of GH, hyperprolactinemia and fibrous dysplasia. He was referred for evaluation of suspected acromegaly. He had no skin pigmentation. Plasma GH, PRL, somatomedin-C, LH, FSH, testosterone, estradiol, progesterone, T3, T4, TSH and cortisol were measured. Among those, the levels of plasma GH, PRL and somatomedin-C were high. Serum alkaline phosphatase was increased. OGTT did not suppress plasma OH concentration and GH showed paradoxical response to TRH and LHRH. GH was suppressed after a test-dose of somatastatin and bromocriptine. Brain MRI demonstrated a mass lesion in sella turcica and another mass lesions in nasal cavity and posterior occipital bone. Whole body bone scan revealed increased uptake in skull, nasal bone, both 9th posterior rib, both femurs, both tibias, left scapular and pelvic bone. These fmdings were consistent with bone tumor such as fibrous dysplasia. We report a case with incomplete MeCune-Albright syndrome including acromegaly, hyperprolactinemia and polyostotic fibrous dysplasia.
Acromegaly ; Alkaline Phosphatase ; Brain ; Bromocriptine ; Estradiol ; Femur ; Fibrous Dysplasia, Polyostotic ; Glucose Tolerance Test ; Gonadotropin-Releasing Hormone ; Humans ; Hydrocortisone ; Hyperprolactinemia ; Magnetic Resonance Imaging ; Male ; Nasal Bone ; Nasal Cavity ; Occipital Bone ; Pelvic Bones ; Plasma ; Progesterone ; Ribs ; Sella Turcica ; Skin Pigmentation ; Skull ; Testosterone ; Tibia ; Young Adult

A cerebral infarction involving the nodulus usually produce contralateral lateropulsion and ipsilateral spontaneous nystagmus to the lesion. Here, we report a case of atypical isolated nodular infarction showed ipsilateral lateropulsion and contralateral spontaneous nystagmus to the lesion with a normal head impulse test. A right-handed 70-year-old man developed sudden vertigo with an unsteady gait. Neurologic examination revealed spontaneous left-beating nystagmus with a torsional component. He also displayed imbalance of walking and axial lateropulsion to the right side. Head impulse test was normal. Magnetic resonance imaging indicated acute infarction in the right nodulus on diffusion-weighted images.
Cerebral Infarction ; Gait Disorders, Neurologic ; Head ; Infarction ; Magnetic Resonance Imaging ; Neurologic Examination ; Vertigo ; Vestibular Neuronitis ; Walking

PURPOSE: To evaluate the function of Trp-Lys-Tyr-Met-Val-D-Met (WKYMVm) in human neonatal monocytes. METHODS: The peptide, Trp-Lys-Tyr-Met-Val-D-Met (WKYMVm), was synthesized, purified, and prepared in the Peptide Library Support Facility at Pohang University of Science and Technology. Female Sprague-Dawley rats (200+/-10 g) were preinfected with S. aureus and treated with WKYMVm through femoral vein. At various time points, blood samples were obtained by puncture of femoral artery and the serum was plated on the nutrient agar plate. The number of viable bacteria was determined by counting the number of bacterial colonies. In addition, using S. aureus and C. albicans, we evaluated the bactericidal and fungicidal activities of neonatal monocytes, which were separated from umbilical cord blood by Ficoll gradient. RESULTS: The numbers of bacteria in the blood of WKYMVm-treated rats were rapidly decreased with time, as compared with those of the untreated rats. The peptide treatment enhanced the bactericidal activity in vivo within 10 minutes. In neonatal monocytes, WKYMVm stimulated the intracellular killing of S. aureus in a dose dependent manner, showing the maximum effect at 100 nM. WKYMVm stimulated the phagocytic and fungicidal activities against C. albicans in a dose dependent manner, with the maximum effect at the 100 nM. CONCLUSION: These results suggest that WKYMVm may be an effective agent against the neonatal infections.
Agar ; Animals ; Bacteria ; Female ; Femoral Artery ; Femoral Vein ; Fetal Blood ; Ficoll ; Gyeongsangbuk-do ; Homicide ; Humans ; Monocytes* ; Peptide Library ; Punctures ; Rats ; Rats, Sprague-Dawley