There are several EKG changes in cerebrovascular disease(CVD). The wide prominent of inverted T wave is frequently developed in patients with CVD. There were case reports for CVD in patient with ST-segment elevation without myocardial infarction, but the exact mechanism is unknown. EKG abnormalities associated with subarachnoid hemorrhage were first described by Byer et al, in 1947.1 We report the case of 72 years old female patient who developed subarachnoid hemorrhage and intraventricular hemorrhage with ST-segment elevation.
Aged ; Electrocardiography ; Female ; Hemorrhage ; Humans ; Myocardial Infarction ; Subarachnoid Hemorrhage*

BACKGROUND: Granulocyte colony stimulating factor (G-CSF) is known as a cytokine central to the hematopoiesis of blood cells and to modulate their cellular functions. Besides granulocytes and their precursors, monocytes/macrophages and endothelial cells are direct target cells of G-CSF action. G-CSF influences immune cells in an anti-inflammatory way. METHODS: To evaluate whether G-CSF has a potential for preventing or ameliorating diseases characterized by mucosal inflammation, we used a mouse model with trinitrobenzene sulfonic acid (TNBS)-induced inflammatory colitis. To the mice model G-CSF was administrated daily by intraperitoneal injection. Macroscopic evaluation and immunohistochemical analysis of colonic tissues were performed. RESULTS: Recombinant human G-CSF significantly inhibited LPS-induced TNF-alpha mRNA expression in THP-1 cells. As for in vivo relevance, G-CSF dramatically reduced the weight loss of mice, colonic damage, and mucosal ulceration that characterize TNBS colitis. Moreover, G-CSF suppressed the expression of tumor necrosis factor-alpha, interleukin-1beta, and intercellular adhesion molecule-1 in TNBS colitis. CONCLUSION: Current results demonstrate that G-CSF may be an effective agent for the treatment of diseases characterized by mucosal inflammation.
Animals ; Blood Cells ; Colitis* ; Colon ; Colony-Stimulating Factors* ; Endothelial Cells ; Granulocyte Colony-Stimulating Factor ; Granulocytes* ; Hematopoiesis ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Injections, Intraperitoneal ; Intercellular Adhesion Molecule-1 ; Interleukin-1beta ; Mice* ; RNA, Messenger ; Tumor Necrosis Factor-alpha ; Ulcer ; Weight Loss

BACKGROUND/OBJECTIVES: This study was conducted to examine disparities in food and nutrient intakes based on family types identified among 1,856 participants who were the Korean elderly people in the 6th Korea National Health and Nutrition Examination Survey (KNHNES) excluding those who were currently practicing the diet therapy. SUBJECTS/METHODS: We separated the subjects into two groups: living alone (LA, n = 638) and living with a spouse (LS, n = 1,218). We also examined the disparities of dietary quantity and quality of those two groups using complex sampling design general linear regression analyses (CS GLM). RESULTS: In the LA group, there was a higher percentage of females and average age in LA group was higher than the participants in the LS group. Household income and education level were significantly lower in LA compared to those of LS. The frequencies of skipping meals were higher in LA. LA's food and nutrient intakes showed lower consumption of vegetables, fruits, seaweeds, and of most nutrients. Even after adjusting for the confounding factors, the consumption of vegetables, seaweeds, carbohydrates, potassium, riboflavin, and vitamin C showed lower in LA than LS. Moreover, LA's nutrient intake ratios compared to the KDRIs were lower which turned out to be similar to their nutrient intakes. CONCLUSIONS These results show that dietary behavior and food intake of the elderly are associated with family types. Frequently skipping meals and less dietary variety are more common with elderly persons who were living alone. Therefore, it is necessary to integrate the supplementary food programs and nutrition education programs for the elderly living alone.

Autonomic dysfunction is a common manifestation in Guillain-Barre syndrome (GBS), but it rarely persists. We report a case involving a 22-year-old man who presented with glove-and-stocking type sensory loss, symmetric weakness, urinary distension, orthostatic hypotension, decreased perspiration, and the syndrome of inappropriate secretion of antidiuretic hormone. He was subsequently diagnosed as having GBS with autonomic failure that persisted for more than six months, despite regaining muscle strength. Orthostatic hypotension progressively improved after rehabilitation and administration of midodrine and fludrocortisone. Extensive evaluation and management should be performed in patients with GBS because severe autonomic dysfunction is a major source of disability.
Fludrocortisone ; Guillain-Barre Syndrome ; Humans ; Hypotension, Orthostatic ; Midodrine ; Muscle Strength ; Young Adult

Background: Accurate measurement of glycated hemoglobin (HbA1c) is crucial for a diabetes diagnosis and subsequent patient management. The detection method and presence of variant Hb can interfere with HbA1c measurements. We evaluated the HbA1c-measuring performance of the DxC 700 AU (Beckman Coulter, Brea, CA, USA) immunoassay-based device in comparison with another immunoassay device and the reference method. Methods: A total of 120 normal and 14 variant Hb samples were analyzed using the Cobas c 513 (Roche Diagnostics, Mannheim, Germany) and DxC 700 AU analyzers. Variant Hb samples were also analyzed using the reference method, along with 20 normal samples. The accuracy, precision, linearity, and carryover were determined. Results: DxC 700 AU results strongly correlated with those of Cobas c 513 and exhibited accuracy in comparison with the reference method. The within-run, between-run, between-day, and total imprecision (%CV) values for the low- and high-concentration control materials were below 2%. The results of DxC 700 AU were linear over a wide HbA1c range (3.39%–18.30%). Although DxC 700 AU performed well in the presence of variant Hb, the HbA1c concentration was underestimated in the presence of fetal Hb. The possibility of interference from a high HbH proportion could not be ruled out. Conclusions The overall analytical performance of DxC 700 AU was acceptable. The device is accurate, precise, and linear over a wide HbA1c concentration range. Although DxC 700 AU results highly correlated with those of Cobas c 513, caution should be exercised in cases of high HbF and HbH concentrations.

Purpose: The purpose of this study was to compare the clinical and radiographic outcomes with use of short-curved stems versus standard-length single wedged stems over a minimum follow-up period of five years. Materials and Methods: A retrospective study of primary total hip arthroplasties performed using the Fitmore® stem (127 hips, 122 patients) and the M/L taper® stem (195 hips, 187 patients) between October 2012 and June 2014 was conducted. The clinical and radiographic outcomes were obtained for evaluation over a minimum follow-up period of five years. Results: In both the Fitmore® and M/L taper® groups, the mean Harris hip score improved from 52.4 and 48.9 preoperatively to 93.3 and 94.5 at the final follow-up, respectively (P=0.980). The mean Western Ontario and McMaster Universities Osteoarthritis Index scores also improved from 73.3 and 76.8 preoperatively to 22.9 and 25.6 at the final follow-up, respectively (P=0.465). Fifteen hips (Fitmore®: 14 hips; M/L taper®: one hip, P<0.001) developed intraoperative cracks and were treated simultaneously with cerclage wiring. Radiography showed a radiolucent line in 24 hips in the Fitmore® group and 12 hips in the M/L taper® group (P=0.125). Cortical hypertrophy was detected in 29 hips (Fitmore® group: 28 hips; M/L taper® group: one hip, P<0.001). Conclusion Similarly favorable clinical and radiographic outcomes were achieved with use of both short-curved stems and standard-length single wedged stems. However, higher cortical hypertrophy and a higher rate of femoral crack were observed with use of Fitmore® stems.

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon, acute, and aggressive fungal infection occurring in several immunocompromised states including poorly controlled diabetes. ROCM causes a very high residual morbidity and mortality due to the angioinvasion property of the fungus. Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone, generally from pituitary adenoma. Although it has been demonstrated that acromegalic patients have an increased risk of neoplasm, gastric cancer with acromegaly is very rare. We experienced a case of pituitary mucormycosis in the diabetic patient with acromegaly and gastric cancer. The patient was treated successfully with subtotal gastrectomy for early gastric cancer, transsphenoidal surgery for pituitary adenoma, and a systemic application of amphotericin B for the mucormycosis.
Acromegaly* ; Amphotericin B ; Fungi ; Gastrectomy ; Growth Hormone ; Humans ; Mortality ; Mucormycosis* ; Pituitary Neoplasms ; Stomach Neoplasms*

OBJECTIVE: To evaluate flow pattern characteristics in the ascending aorta (AA) with four-dimensional (4D)-flow MRI and to determine predictors of aortic dilatation late after tetralogy of Fallot (TOF) repair. MATERIALS AND METHODS: This study included 44 patients with repaired TOF (25 males and 19 females; mean age, 28.9 ± 8.4 years) and 11 volunteers (10 males and 1 female, mean age, 33.7 ± 8.8 years) who had undergone 4D-flow MRI. The aortic diameters, velocity, wall shear stress (WSS), flow jet angle (FJA), and flow displacement (FD) at the level of the sinotubular junction (STJ) and mid-AA were compared between the repaired TOF and volunteer groups. The hemodynamic and clinical parameters were also compared between the aortic dilatation and non-dilatation subgroups in the repaired TOF group. RESULTS: The diameters of the sinus of Valsalva, STJ, and AA were significantly higher in the repaired TOF group than in the volunteer group (p = 0.002, p < 0.001, and p = 0.013, respectively). The FJAs at the STJ and AA were significantly greater in the repaired TOF group (p < 0.001 and p = 0.003, respectively), while velocities and WSS parameters were significantly lower. FD showed no statistically significant difference (p = 0.817). In subgroup analysis, age at TOF repair was significantly higher (p = 0.039) and FJA at the level of the AA significantly greater (p = 0.003) and mean WSS were significantly lower (p = 0.039) in the aortic dilatation group. FD were higher in the aortic dilatation group without statistical significance (p = 0.217). CONCLUSION: Patients with repaired TOF have an increased FJA, dilated AA, and secondarily decreased WSS. In addition to known risk factors, flow eccentricity may affect aortic dilatation in patients with repaired TOF.
Aorta ; Dilatation ; Female ; Hemodynamics ; Humans ; Magnetic Resonance Imaging ; Male ; Risk Factors ; Sinus of Valsalva ; Tetralogy of Fallot ; Volunteers

Background: Over the last decade, extracorporeal membrane oxygenation (ECMO) use in critically ill children has increased and is associated with favorable outcomes. Our study aims to evaluate the current status of pediatric ECMO in Korea, with a specific focus on its volume and changes in survival rates based on diagnostic indications. Methods: This multicenter study retrospectively analyzed the indications and outcomes of pediatric ECMO over 10 years in patients at 14 hospitals in Korea from January 2012 to December 2021. Four diagnostic categories (neonatal respiratory, pediatric respiratory, postcardiotomy, and cardiac-medical) and trends were compared between periods 1 (2012–2016) and 2 (2017–2021). Results: Overall, 1065 ECMO runs were performed on 1032 patients, with the annual number of cases remaining unchanged over the 10 years. ECMO was most frequently used for post-cardiotomy (42.4%), cardiac-medical (31.8%), pediatric respiratory (17.5%), and neonatal respiratory (8.2%) cases. A 3.7% increase and 6.1% decrease in pediatric respiratory and post-cardiotomy cases, respectively, were noted between periods 1 and 2.Among the four groups, the cardiac-medical group had the highest survival rate (51.2%), followed by the pediatric respiratory (46.4%), post-cardiotomy (36.5%), and neonatal respiratory (29.4%) groups. A consistent improvement was noted in patient survival over the 10 years, with a significant increase between the two periods from 38.2% to 47.1% (P = 0.004). Improvement in survival was evident in post-cardiotomy cases (30–45%, P = 0.002).Significant associations with mortality were observed in neonates, patients requiring dialysis, and those treated with extracorporeal cardiopulmonary resuscitation (P < 0.001). In pediatric respiratory ECMO, immunocompromised patients also showed a significant correlation with mortality (P < 0.001). Conclusion Pediatric ECMO demonstrated a steady increase in overall survival in Korea;however, further efforts are needed since the outcomes remain suboptimal compared with global outcomes.

The association between nephrotic syndrome and intravascular coagulation has been known for more than a century, but it was not until 1948 that a thrombotic diathesis in nephrotic patients was proposed. The prevalence of thrmbo-embolic complications is much higher in adult patients. Deep vein thrombosis of the leg is the most common complications in nephrotic adult and was responsible for one-third of the thrombo-embolic complications of nephrotic children. Arterial thrombosis occurs less frequently and is seen primarily in childern. We present a case of acute anterior myocardial infarction in a young man with nephrotic syndrome, secondary to minimal change glomerulonephritis, in which thrombosis of the proximal left anterior descanding artery was the actual cause of acute myocardial infarction.
Adult ; Arteries ; Child ; Disease Susceptibility ; Humans ; Leg ; Myocardial Infarction* ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Prevalence ; Thrombosis ; Venous Thrombosis