BACKGROUND: The aim of this study was to retrospectively evaluate and analyze the brain magnetic resonance imaging (B-MRI) findings of patients with a favorable neurological outcome following cerebral performance category (CPC) after out-of-hospital cardiac arrest (OHCA) at single university hospital emergency center. METHODS: Patients with return of spontaneous circulation (> 24 h) after OHCA who were older than 16 years of age and who had been admitted to the emergency intensive care unit (EICU) for over a 57-month period between July 2007 and March 2012 and survived with a favorable neurological outcome were enrolled. B-MRI was taken after recovery of their mental status. RESULTS: Fifty-two patients among the 305 admitted patients had a good CPC, and 33 patients' B-MRI were analyzed (CPC 1: 26 patients, CPC 2: 7 patients). Among these, 18 (54.5%) patients had a normal finding on B-MRI. On the other hand, ischemia/infarction/microangiopathy compatible with hypoxic-ischemic encephalopathy (HIE) were found on various brain areas including subcortical white matter (7/13), cerebral cortex, central semiovlae, basal ganglia, putamen, periventricular white matter, and cerebellum. CONCLUSIONS: Survivors with a favorable neurological outcome from OHCA showed HIE on B-MRI, especially all of the patients with a CPC 2. More detail neurologic category including brain imaging would be needed to categorize patients with favorable outcome after OHCA.
Basal Ganglia ; Brain* ; Cerebellum ; Cerebral Cortex ; Emergencies ; Hand ; Humans ; Hypoxia-Ischemia, Brain ; Intensive Care Units ; Magnetic Resonance Imaging* ; Neuroimaging ; Out-of-Hospital Cardiac Arrest* ; Putamen ; Retrospective Studies ; Survivors

The infant kidney is more vulnerable to infections than the adult kidney. It is common that acute pyelonephritis (APN) during infancy and early childhood manifests growth retardation of kidney, ultimately leading to chronic renal failure. However, little is known about the pathogenesis of renal growth retardation in APN in youth. To understand the mechanism underlying the cortical lesions, urinary tract infection was induced in infant rats. To induce ascending APN, saline solution containing Escherichia coli (ATCC No. 25922) 107 bacteria/ml was infused into the bladder through the 16 gage silicone cannula in three-week-old weaning Sprague Dawley rats (weight 50~60 g, n=66). In the normal control group (n=20), saline was infused. Experimental groups were divided according to the treatment into the APN group (APN without any treatment, n=23) and TRX group (APN with ceftriaxone treatment, n=23). After performing the histopathologic examination, including inflammatory score, fibrosis score, and tubular atrophy score, we measured the apoptosis index in the tubular cells of noninflammatory cortical area at post-infection week 1 and 3 by the in situ TUNEL method. Kidney weight was significantly decreased in the APN group compared with the normal group at postinfection week 1 and 3. In the APN group, tubulointerstitial inflammation with heavy neutrophilic infiltration was found mainly in the upper and lower poles of the kidney in both the first and third week groups. Fibrosis was dominant in the third week of the APN group. However, inflammation and fibrosis were not significantly improved by TRX treatment. The apoptotic index of tubular cells was significantly increased in noninflammatory cortical area in the first week of both APN and TRX groups. It decreased near the normal control value in the third week. TGF-beta1 protein expression was localized in the inflammatory area. There was no TGF-beta1 expression in the tubules of the noninflammatory area. These findings suggest that renal growth retardation in experimentally induced APN in infant rats is related not only with the inflammatory reaction itself but also with the increased apoptosis of tubular cells in noninflammatory area. Ceftriaxone alone does not eliminate the inflammation nor prevent growth retardation effectively.
Adolescent ; Adult ; Animals ; Apoptosis* ; Atrophy ; Catheters ; Ceftriaxone ; Escherichia coli ; Fibrosis ; Humans ; In Situ Nick-End Labeling ; Infant* ; Inflammation ; Kidney ; Kidney Failure, Chronic ; Neutrophils ; Pyelonephritis* ; Rats* ; Rats, Sprague-Dawley ; Silicones ; Sodium Chloride ; Transforming Growth Factor beta1 ; Urinary Bladder ; Urinary Tract Infections ; Weaning

No Abstract Available.
Natriuretic Peptides*

A 52-year-old women, suffering from generalized pruritus due to intrahepatic and common hepatic duct stones, was treated with astemizole, 30mg daily. Sixty one days later, convulsions and syncope developed suddenly during hospitalization. She had no history of arrhythmia, heart disease, electrolytes imbalance, or CNS disorders. As another case, a 44-year-old man suffering from pruritus due to liver cirrhosis, was treated with astemizole, 30mg daily. Thirty two days later, palpitations and syncope also developed suddenly during hospitalization. He was diagnosed liver cirrhosis, 3 years ago and there was no history of arrhythmia, heart disease, electrolytes imbalance, or CNS disorders. Administration of astemizole was stopped immediately. The laboratory investigations revealed the normal range of serum potassium, calcium and magnesium in both cases. The ECG finding showed the prolongation of QTc interval, frequent VPCs and intermittent polymorphic drugs. On 1st and 3rd day, after discontinue of astemisole, the ECG abnormalities disappeard. It is suggested that astemizole overdose can induce prolongation of QTc interval and torsade de pointes, especially in the patient with liver disease.
Adult ; Arrhythmias, Cardiac ; Astemizole* ; Calcium ; Electrocardiography ; Electrolytes ; Female ; Heart Diseases ; Hepatic Duct, Common ; Hospitalization ; Humans ; Liver Cirrhosis ; Liver Diseases ; Magnesium ; Middle Aged ; Potassium ; Pruritus ; Reference Values ; Seizures ; Syncope ; Torsades de Pointes*

Blunt trauma to the chest may result in various cardiac injuries. But traumatic myocardial infarction with coronary artery fistula as a complication of chest trauma has been reported in very few cases. The etiology of myocardial infarction is not entirely clear. A 40 years old male was admitted after a traffic accident. He complained of acute retrosternal pain of about one hours duration. There was an area of contusion over the right sternal border. The ECQ showed deep Q wave and elevated ST segments in leads 2, 3 and aVF. There was a considerable increase in creatine kinase(CK) peak level and a CK-MB fraction. Coronary angiography revealed a total proximal occlusion of the right coronary that communicated directly with the right atrium. The left ventridulogram showed hypokinesia of the inferior wall. He was managed with conservative treatments and has remained well sebsequently. We reported a middle aged man who developed an acute transmural inferior wall myocardial infarction associated with coronary artery fistula secondary to blunt cheat trauma in an automobile accident.
Accidents, Traffic ; Adult ; Automobiles ; Contusions ; Coronary Angiography ; Coronary Vessels* ; Creatine ; Fistula* ; Heart Atria ; Humans ; Hypokinesia ; Inferior Wall Myocardial Infarction* ; Male ; Middle Aged ; Myocardial Infarction ; Thorax*

No abstract available.
Niemann-Pick Diseases*

OBJECTIVE: Stent-assisted coiling on intracranial aneurysm has been considered as an effective technique and has made the complex aneurysms amenable to coiling. To achieve reconstruction of intracranial vessels with preservation of parent artery the use of stents has the greatest potential for assisted coiling. We report the results of our experiences in ruptured wide-necked intracranial aneurysms using Y-stent coiling. METHODS: From October 2003 to October 2011, 12 patients (3 men, 9 women; mean age, 62.6) harboring 12 complex ruptured aneurysms (3 middle cerebral artery, 9 basilar tip) were treated by Y-stent coiling by using self-expandable intracranial stents. Procedural complications, clinical outcome, and initial and midterm angiographic results were evaluated. The definition of broad-necked aneurysm is neck diameter over than 4 mm or an aneurysm with a neck diameter smaller than 4 mm in which the dome/neck ratio was less than 2. RESULTS: In all patients, the aneurysm was successfully occluded with no apparent procedure-related complication. There was no evidence of thromboembolic complication, arterial dissection and spasm during procedure. Follow-up studies showed stable and complete occlusion of the aneurysm in all patients with no neurologic deficits. CONCLUSION: The present study did show that the Y-stent coiling seemed to facilitate endovascular treatment of ruptured wide-necked intracranial aneurysms. More clinical data with longer follow-up are needed to establish the role of Y-stent coiling in ruptured aneurysms.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Korea ; Male ; Middle Cerebral Artery ; Neck ; Parents ; Spasm ; Stents ; Subarachnoid Hemorrhage

Immunohistochemical studies of the molecules associated with gastric tumor progression and metastasis were done to evaluate their relationship with known prognostic factors and their usefulness in assessment of the progression of gastric carcinoma in 127 gastric carcinoma tissues. The 4 antibodies used in this study were CD44H, CD44v6, erbB-2, and p53. The CD44H expression was detected in 76 (59.8%), CD44v6 in 63 (49.6%), erbB-2 in 18 (14.2%), and mutant p53 in 98 (77.2%) out of 127 cases of gastric carcinomas. There was no significant correlation between the expression rates of each four proteins. The expression rates of all 4 proteins were not significantly correlated with age and sex of the patients and lymph node metastasis, but the correlation between CD44v6 expression and the depth of tumor invasion and tumor stage was significant (p<0.05). These results suggest that CD44v6 is closely associated with tumor invasion, and high levels of CD44H, erbB-2 and p53 are associated with tumorigenesis of the stomach as they are highly expressed in early as well as in advanced gastric carcinomas. The findings also support the conclusion that the loss of control of alternative CD44 mRNA splicing resulted in production of CD44v6 splicing variant in tumor cell facilitates tissue invasion by increased adherence of the tumor cell to an extracellular matrix or by tumor cell migration. It can be expected that CD44v6 overexpression in tumor cells appears to be an important prognostic indicator for gastric tumor progression.
Neoplasm Metastasis ; Cell Transformation, Neoplastic ; Stomach Neoplasms

Adenoid basal cell tumor of the prostate is a rare tumorous lesion that can be misdiagnosed as adenocarcinoma of the prostate. The malignant potential of adenoid basal cell tumor remains uncertain due to small number of reported cases. This 66-year-old man presented with symptoms of urinary tract obstruction. Under the impression of benign prostatic hyperplasia, a transurethral resection of the prostate (TURP) was performed. The patient was alive with no evidence of recurrence or metastasis 15 months after TURP. Microscopically, most of the lesions were composed of nodular collections of small nests of basaloid cells with peripheral palisading, and clusters of tumor cells forming cribriform pattern. Multiple areas of basal cell hyperplasia and atypical basal cell hyperpalsia were also observed. The coexistence of basal cell hyperplasia, atypical basal cell hyperpalsia, and adenoid basal cell tumor with cribriform pattern in this case supports a morphologic continuum from the benign hyperplastic lesion to malignant neoplasia.
Adenocarcinoma ; Adenoids* ; Aged ; Humans ; Hyperplasia ; Neoplasm Metastasis ; Prostate* ; Prostatic Hyperplasia ; Recurrence ; Transurethral Resection of Prostate ; Urinary Tract

PURPOSE: The purpose of this study was to evaluate the patency, procedure related complications and effectiveness of Wallstent application to the malignant biliary obstruction as a palliative treatment. MATERIALS AND METHODS: We retrospectively reviewed the clinical results, duration of survival, patency rate and complication of the Wallstent application on 33 patients who had had obstructive jaundice by the malignant lesion in recent 3 years. One or two step procedures. were mainly taken with 10mm diameter Wallstents. Grouping according to place the stent at the hilum or not, and grouping according to place the stent through the ampulla or not were done to evaluate the difference of the patency and survival rate between the groups. RESULTS: Biliary endoprosthesis with Wallstent were successfully placed in all patients without difficulty. Procedure related short-term complication rate was about 18.1% (n=6/33). Complications were fever(n=4), cholecystitis(n=1) and sepsis(n=l). Long-term complications were mainly obstruction(n=9/31) of the Wallstent during the follow-up period. Also cholecystitis occurred in one patient 3 months later. Mean survival duration was 139.72 (46-237)days ormong those who expired. Mean patency duration of stents was 139.67 (26-310) days. Survival rates were 93.5% at the second month, 68.8% at the third month, 61.2% at the 4th month, 53.5% at the 5th month, 49.1% at the 7th month and 35.7% at the 9th month. Patency rates were 93.7% at the second month, 84.2% at the 4th month, 66.9% at the 5th month, 59.5% at the 7th month and 39.6% at the 10th month. The application was repeated in the 6 patients with stent occlusion. Significant statistical difference could not be found between the groups according to placing the stent at the hilum and according to placing the stent through the ampulla. Patency rates were higher than survival rates in the follow-up period. CONCLUSION: Wallstent application provides good palliation with little discomfort and few complications in the patients with malignant obstructive jaundice.
Cholecystitis ; Follow-Up Studies ; Humans ; Jaundice, Obstructive ; Palliative Care ; Retrospective Studies ; Stents ; Survival Rate