Infective endocarditis (IE) is not a common cause of stroke. Considering the high mortality rates, however, IE should always be considered as a possible cause of stroke even when the chances are low. Atrioesophageal fistula is a life-threatening condition that can cause IE and subsequent stroke, but the diagnosis is often delayed due to its rarity. We report a case of multiple embolic infarcts caused by infective endocarditis associated with atrioesophageal fistula after radiofrequency catheter ablation for atrial fibrillation.
Atrial Fibrillation ; Catheter Ablation ; Diagnosis ; Endocarditis ; Esophageal Fistula ; Fistula ; Mortality ; Stroke

PURPOSE: Lung Cancer Subcommittee of Korean Radiation Oncology Group (KROG) has recently launched a prospective clinical trial (KROG 17-06) of hippocampus-sparing whole brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in treating multiple brain metastases from non-small cell lung cancer. In order to improve trial quality, dummy run studies among the participating institutions were designed. This work reported the results of two-step dummy run procedures of the KROG 17-06 study. MATERIALS AND METHODS: Two steps tested hippocampus contouring variability and radiation therapy planning compliance. In the first step, the variation of the hippocampus delineation was investigated for two representative cases using the Dice similarity coefficients. In the second step, the participating institutions were requested to generate a HS-WBRT with SIB treatment plan for another representative case. The compliance of the treatment plans to the planning protocol was evaluated. RESULTS: In the first step, the median Dice similarity coefficients of the hippocampus contours for two other dummy run cases changed from 0.669 (range, 0.073 to 0.712) to 0.690 (range, 0.522 to 0.750) and from 0.291 (range, 0.219 to 0.522) to 0.412 (range, 0.264 to 0.598) after providing the hippocampus contouring feedback. In the second step, with providing additional plan priority and extended dose constraints to the target volumes and normal structures, we observed the improved compliance of the treatment plans to the planning protocol. CONCLUSION: The dummy run studies demonstrated the notable inter-institutional variability in delineating the hippocampus and treatment plan generation, which could be decreased through feedback from the trial center.
Brain ; Carcinoma, Non-Small-Cell Lung ; Compliance ; Hippocampus ; Lung Neoplasms ; Neoplasm Metastasis ; Prospective Studies ; Radiation Oncology ; Radiotherapy

We experienced anaphylaxis during general anesthesia twice in the same patient. After the first incidence of anaphylaxis at the induction of anesthesia, we speculated that the allergen was rocuronium. Thus, we administered sugammadex as well as a vasopressor to treat the anaphylaxis and the vital signs gradually recovered to nearly normal. Thereafter, we could not avoid the administration of another muscle relaxant, cisatracurium, since the patient moved uncontrollably after the surgery was restarted. A second anaphylactic event then occurred. We speculated that the second allergen was cisatracurium and stopped using it. The results of the investigation after the surgery showed that the allergens were indeed rocuronium and cisatracurium. When we encounter anaphylaxis during general anesthesia, it is necessary to suspect all administered medicines as the cause, with the potential of two or more causes, especially with muscle relaxants.
Allergens ; Anaphylaxis* ; Anesthesia ; Anesthesia, General* ; Humans ; Incidence ; Intradermal Tests ; Vital Signs

OBJECTIVE: To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in stroke patients, and to assess the difference in swallowing function between stroke patients with COPD (COPD group) and stroke patients without COPD (control group). METHODS: The subjects included 103 stroke patients. They underwent the pulmonary function test and were assigned to either the COPD group or the control group. Their penetration-aspiration scale (PAS) scores and functional dysphagia scale scores were compared by performing a videofluoroscopic swallowing study. The intergroup differences in lip closure, bolus formation, mastication, and the oral transit time, laryngeal elevation, cricopharyngeal dysfunction, oronasal regurgitation, residue in pyriform sinus and vallecula, pharyngeal transit time, aspiration, and esophageal relaxation were also compared. RESULTS: Thirty patients were diagnosed with COPD. The COPD group showed statistically higher PAS scores (4.67+/-2.15) compared to the control group (2.89+/-1.71). Moreover, aspiration occurred more frequently in the COPD group with statistical significance (p<0.05). The COPD group also showed higher occurrence of cricopharyngeal dysfunction, albeit without statistical significance. CONCLUSION: This study shows that a considerable number of stroke patients had COPD, and stroke patients with COPD had higher risk of aspiration than stroke patients without COPD.
Deglutition Disorders ; Deglutition* ; Humans ; Lip ; Mastication ; Prevalence ; Pulmonary Disease, Chronic Obstructive* ; Pyriform Sinus ; Relaxation ; Respiratory Aspiration ; Respiratory Function Tests ; Stroke*

OBJECTIVE: The purpose of this study was to examine the symmetry and parallelism of the skeletal and soft-tissue poria by three-dimensional (3D) computed tomographic (CT) imaging. METHODS: The locations of the bilateral skeletal and soft-tissue poria in 29 patients with facial asymmetry (asymmetric group) and 29 patients without facial asymmetry (symmetric group) were measured in 3D reconstructed models of CT images by using a 3D coordinate system. The mean intergroup differences in the anteroposterior and vertical angular deviations of the poria and their anteroposterior and vertical parallelism were statistically analyzed. RESULTS: The symmetric and asymmetric groups showed significant anteroposterior angular differences in both the skeletal and the soft-tissue poria (p = 0.007 and 0.037, respectively; Mann-Whitney U-test). No significant differences in the anteroposterior and vertical parallelism of the poria were noted (p < or = 0.05; Wilcoxon signed-rank test). CONCLUSIONS: In general, the skeletal poria are parallel to the soft-tissue poria. However, patients with facial asymmetry tend to have asymmetric poria.
Facial Asymmetry* ; Humans ; Poria*

BK virus nephropathy has emerged as an important cause of renal allograft dysfunction. It affects 1-10% of renal transplant patients and results in significant graft dysfunction in more than 50% of cases. A reduction in the amount of immunosuppressants is not an appropriate treatment option for advanced stage BK nephropathy; therefore, other treatment strategies need to be considered such as cidofovir, leflunomide, and intravenous immunoglobulin (IVIG) in combination with reduced immunosuppression. The use of IVIG may be a valuable treatment option in patients with BK virus nephropathy. We report our experience with IVIG rescue therapy in a patient and the progression of BK nephropathy despite leflunomide therapy.
BK Virus ; Cytosine ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Immunosuppression ; Immunosuppressive Agents ; Isoxazoles ; Kidney Transplantation ; Organophosphonates ; Transplantation, Homologous ; Transplants

PURPOSE: Hypertension is a common problem in maintenance hemodialysis (HD) patients. We assessed the effects of low sodium dialysate on changes of blood pressure in maintenance HD patients. METHODS: Forty HD patients were enrolled in this cross-over study. All the patients underwent nine consecutive HD sessions with the dialysate contained 138 mEq/L sodium (conventional sodium HD), then concentrations of sodium were switched to match the patients average pre-HD plasma sodium measured during the conventional sodium phase (135 mEq/L for patients with sodium levels less than 137, 137 for patients with sodium levels over 137). Dry weight and dialysis prescription were not modified during the six weeks of the study. RESULTS: There was a significant decrease in the interdialytic weight gain (2.4+/-0.9 kg vs. 2.0+/-0.7 kg, p<0.001) and the interdialytic thirsty in low sodium HD sessions compare to conventional sodium HD sessions. Pre-HD systolic and diastolic blood pressure (BP), post-dialysis systolic BP was similar in both periods of the study. The use of low sodium dialysate is associated with significantly lower systolic BP in patients with uncontrolled hypertension (n=10,157.1+/-3.6 mmHg vs. 148.0+/-9.4 mmHg, p=0.011), but not in those with controlled hypertension. Cardio-thoracic ratio was significant decrease in low sodium dialysate HD (0.53+/-0.08 vs. 0.51+/-0.07, p=0.002). The episodes of intradialytic hypotension and related symptoms were not more frequent in low sodium dialysate HD. CONCLUSION: Low dialysate sodium concentration based on predialysis sodium levels of patients could reduce the pre-HD systolic BP, interdialytic thirsty and interdialytic weight gain in maintenance HD patients.
Blood Pressure ; Cross-Over Studies ; Dialysis ; Humans ; Hypertension ; Hypotension ; Plasma ; Prescriptions ; Renal Dialysis ; Sodium ; Thirst ; Weight Gain

PURPOSE: The diagnosis of clinically early-stage (T1) renal cell carcinoma (RCC) has increased. The present study evaluated the association of B7-H4 expression on the pathological outcome and recurrence of carcinoma in the T1 stage of RCC. MATERIALS AND METHODS: Among patients who underwent partial or radical nephrectomy after diagnosis of T1 stage RCC during the period of January 2000 to March 2007, 102 pathologically confirmed cases of clear cell carcinoma were included in this study. The patients' medical records were reviewed retrospectively. For the immunohistochemical staining tests, the B7-H4 antibody (Abbiotec 1:500) was used, and clinicopathological characteristics were analyzed. RESULTS: The mean age of the patients (39 males: 38.2%, 63 females: 61.8%) was 53.0+/-12.0 years (range, 31-74 years), and the mean follow-up time was 33.4+/-21.0 months (range, 6-84 months). B7-H4 expression was positive in 18 cases and negative in 84 cases. Recurrence during the follow-up period occurred in 5 cases in the group with positive B7-H4 expression and in 7 cases in the group with negative B7-H4 expression, respectively (p=0.035). In the univariate analysis, a statistically significant relationship was observed only for the presence of B7-H4 expression (p=0.0019). In the multivariate analysis, other than the expression of B7-H4, cancer size and TNM stage had effects on the recurrence of cancer. CONCLUSIONS: For clear cell RCC, B7-H4 expression had a critical impact on the prognosis of the patients, particularly on the recurrence of the carcinoma in patients with clinical stage T1 RCC.
Carcinoma, Renal Cell ; Follow-Up Studies ; Humans ; Medical Records ; Multivariate Analysis ; Nephrectomy ; Prognosis ; Recurrence ; Retrospective Studies

The rare 'burned out' phenomenon in germ cell tumors is known as the presence of an extragonadal germ cell tumor with a spontaneously regressed testicular tumor found in common metastatic sites, including the retroperitoneal, mediastinal, supraclavicular, cervical, and axillary lymph nodes; lung; and liver. We report a patient who presented with a retroperitoneal extragonadal germ cell tumor with a spontaneously regressed testicular tumor.
Humans ; Liver ; Neoplasms, Germ Cell and Embryonal ; Retroperitoneal Neoplasms ; Seminoma ; Testicular Neoplasms ; Testis

The rare 'burned out' phenomenon in germ cell tumors is known as the presence of an extragonadal germ cell tumor with a spontaneously regressed testicular tumor found in common metastatic sites, including the retroperitoneal, mediastinal, supraclavicular, cervical, and axillary lymph nodes; lung; and liver. We report a patient who presented with a retroperitoneal extragonadal germ cell tumor with a spontaneously regressed testicular tumor.
Humans ; Liver ; Neoplasms, Germ Cell and Embryonal ; Retroperitoneal Neoplasms ; Seminoma ; Testicular Neoplasms ; Testis