BACKGROUND AND PURPOSE: Thrombectomy within 24 hours can improve outcomes in selected patients with a clinical-infarct mismatch. We devised an easy-to-use visual estimation tool that allows infarct volume estimation in centers with limited resources. METHODS: We identified 1,031 patients with cardioembolic or large-artery atherosclerosis infarction on diffusion-weighted images (DWIs) obtained before recanalization therapy and within 24 hours of onset, and occlusion of the internal carotid or middle cerebral artery. Acute DWIs were mapped onto a standard template and used to create visual reference maps with known lesion volumes, which were then used in a validation study (with 130 cases) against software estimates of infarct volume. RESULTS: The DWI reference map chart comprises 144 maps corresponding to 12 different infarct volumes (0.5, 1, 2, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mL) in each of 12 template slices (Montreal Neurological Institute z-axis –15 to 51 mm). Infarct volume in a patient is estimated by selecting a slice with a similar infarct size at the corresponding z-axis level on the reference maps and then adding up over all slices. The method yielded good correlations to software volumetrics and was easily learned by both experienced and junior physicians, with approximately 1 to 2 minutes spent per case. The sensitivity, specificity, and accuracy for detecting threshold infarct volumes ( < 21, < 31, and < 51 mL) were very high (all about >90%). CONCLUSIONS: We developed easy-to-use reference maps that allow prompt and reliable visual estimation of infarct volumes for triaging patients to thrombectomy in acute stroke.
Atherosclerosis ; Cerebral Infarction ; Decision Making ; Diffusion Magnetic Resonance Imaging ; Humans ; Infarction ; Medical Staff, Hospital ; Methods ; Middle Cerebral Artery ; Sensitivity and Specificity ; Stroke ; Thrombectomy

Ginseng gintonin is an exogenous ligand of lysophosphatidic acid (LPA) receptors. Accumulating evidence shows LPA helps in rapid recovery of corneal damage. The aim of this study was to evaluate the therapeutic efficacy of gintonin in a rabbit model of corneal damage. We investigated the signal transduction pathway of gintonin in human corneal epithelium (HCE) cells to elucidate the underlying molecular mechanism. We next evaluated the therapeutic effects of gintonin, using a rabbit model of corneal damage, by undertaking histochemical analysis. Treatment of gintonin to HCE cells induced transient increases of [Ca²⁺](i) in concentration-dependent and reversible manners. Gintonin-mediated mobilization of [Ca²⁺](i) was attenuated by LPA1/3 receptor antagonist Ki16425, phospholipase C inhibitor U73122, inositol 1,4,5-triphosphate receptor antagonist 2-APB, and intracellular Ca²⁺ chelator BAPTA-AM. Gintonin facilitated in vitro wound healing in a concentration-dependent manner. When applied as an eye-drop to rabbits with corneal damage, gintonin rapidly promoted recovery. Histochemical analysis showed gintonin decreased corneal apoptosis and increased corneal cell proliferation. We demonstrated that LPA receptor activation by gintonin is linked to in vitro and in vivo therapeutic effects against corneal damage. Gintonin can be applied as a clinical agent for the rapid healing of corneal damage.
Apoptosis ; Cell Proliferation ; Corneal Injuries ; Epithelium, Corneal ; Humans ; In Vitro Techniques ; Inositol 1,4,5-Trisphosphate ; Mortuary Practice ; Panax ; Rabbits ; Receptors, Lysophosphatidic Acid ; Signal Transduction ; Therapeutic Uses ; Type C Phospholipases ; Wound Healing* ; Wounds and Injuries*

BACKGROUND: Effective chest compression may improve the return of spontaneous circulation and neurologic outcome in arrest victims. For fear of rescuer's fatigue, guidelines for cardiopulmonary resuscitation (CPR) recommended that chest compression (CC) should be switched every 2 minutes, but there is little evidence. We investigated whether health personnel could provide consistent quality of CC for 2 minutes. METHODS: We recruited prospectively health personnel working on one university hospital. On the day assigned randomly, CPR performance data was collected with use of CPR recording technology. Quality of CPR was calculated every 30 seconds interval. To identify the quality decay, we used repeated measure analysis of variance with SPSS 17.0 for analysis. RESULTS: We analyzed 8,485 CCs performed by 41 subjects. Total number of CC decayed between 90 to 120 seconds (51.6 +/- 3.3 to 50.8 +/- 3.5, p = 0.020) within recommended range. The ratio of correct depth CC decayed between 90 to 120 seconds, falling from 83.4 +/- 24.9% to 68.3 +/- 38.4% (p = 0.002). The ratio of low depth CC increased significantly over time (10.2 +/- 20.7% to 31.3 +/- 38.5%, p < 0.001). CONCLUSIONS: Health personnel may provide adequate number of CC for 2 minutes. But, the number of correct depth CC may decay between 90 to 120 seconds. Also the number of low depth CC may increase over time.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Humans ; Manikins ; Prospective Studies ; Quality of Health Care ; Thorax

PURPOSE: Gastric epithelial dysplasia (GED) was defined as "unequivocally neoplastic epithelium that may be associated with or give rise to invasive adenocarcinoma" and GED also represents a direct precursor of intestinal type adenocarcinoma of the stomach. The recommended treatment guidelines for GED in the medical literature are endoscopic mucosal resection (EMR) or surgery for high grade dysplasia (HGD) and annual endoscopic surveillance with biopsy for low grade dysplasia (LGD) The aim of this study was to determine the treatment plan for GED that is diagnosed by endoscopic biopsy. MATERIALS AND METHODS: We enrolled 148 patients who were treated by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for GED: there were 63 patients with HGD and 85 patients with LGD and all of them were diagnosed by endoscopic biopsy from January 2006 to December 2008. The results of the final histopathologic reports after EMR or ESD were compared with the results of the endoscopic biopsies. RESULTS: The final histopathologic results of the 148 patients with GED showed 49 (33.1%) patients with adenocarcinoma, 40 (27.0%) patients with HGD and 59 (39.9%) patients with LGD. Among the 63 patients with HGD, 34 (54.0%) patients had adenocarcinoma, 20 (31.7%) patients had HGD and 9 (14.3%) patients had LGD. For the 85 patients with LGD, 15 (17.6%) patients had adenocarcinoma, 20 (23.5%) patients had HGD and 50 (58.8%) patients had LGD. CONCLUSION: Complete resection, including EMR or ESD, is needed for patients with GED diagnosed by endoscopic biopsy and they have HGD. For patients with LGD, EMR or ESD may be needed in addition to endoscopic surveillance with biopsy for making the correct diagnosis and proper treatment because of the possibility of adenocarcinoma.
Adenocarcinoma ; Biopsy ; Epithelium ; Humans ; Stomach

ST-segment elevation myocardial infarction (STEMI) is a disease decribed by typical chest pain, ST-segment elevation on eletrocardiogram, elevated cardiac enzymes, along with wall motion abnormality under echocardiographic findings, and it is caused by vulnerable plaques. However, stress induced cardiomyopathy (SICM) may show similar clinical symptoms, but specific echocardiographic findings (i.e. transient left ventricular regional wall motion abnormalities with peculiar apical ballooning appearance) and normal coronary angiography may differentiate it from STEMI. Therefore, one may mistake STEMI for SICM, and lead to serious error in diagnosis and treatment of the disease. We report a case of STEMI mimicking SICM, and suggest an idea to approach the patient with SICM.
Cardiomyopathies ; Chest Pain ; Coronary Angiography ; Humans ; Myocardial Infarction

Although malignant melanoma involving the stomach is commonly mentioned in association with autopsies, endoscopic experience in this gastric malignancy is still limited, and few cases have been illustrated in the literature. This clinical condition is even rarer in Asians who are much less vulnerable to malignant melanoma than Caucasians. We experienced two cases of gastric metastases of malignant melanoma which presented as indigestion and epigastric pain. In the first case, a 75-year-old man visited because of indigestion persisting for 2 months. He had a history of multiple gastric ulcer and was treated at a local medical center, but symptoms did not improved. Endoscopic finding revealed multiple and elevated lesions with central black pigmented bases. In the second case, a 47-year-old man visited because of epigastric soreness and intermittent pain for 1 month. Metastatic melanoma in the stomach was noticed by endoscopic examination. Both patients had multiple metastatic lesions in the liver, thyroid, and brain. These two cases were diagnosed as having metastatic malignant melanoma in the stomach of unknown origin. Therefore, we report these cases with a brief review of the related literature.
Aged ; Asian Continental Ancestry Group ; Autopsy ; Brain ; Dyspepsia ; Humans ; Liver ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Stomach ; Stomach Ulcer ; Thyroid Gland

BACKGROUND: Argatroban, a direct thrombin inhibitor, has been suggested to be beneficial in acute ischemic stroke by preventing microthrombi formation. The aim of this multicenter, aspirin-controlled, randomized trial is to determine the safety and the efficacy of argatroban compared with aspirin in acute ischemic stroke. METHODS: The patients within 48 hours of noncardioembolic ischemic stroke were recruited from 8 centers. Argatroban was infused continuously at 2.5 mg/hr for the first 48 h, and then 10mg of argatroban was infused over 3 h twice a day on days 3-7. Control group received aspirin 300 mg/day for 7 days. The primary outcome was the NIHSS at 30 days and the secondary outcome was Barthel index (BI) and modified Rankin scale (mRS) at 90 days. The safety was evaluated by the incidence of bleeding complication. RESULTS: A total of 236 patients (123 for argatroban and 113 for aspirin) were included. NIHSS at 30 days, BI at 90 days and mRS at 90 days did not show significant difference between the argatroban and the aspirin group (3.1 +/- 3.1 vs 3.5 +/- 3.0, 88.9 +/- 22.5 vs 86.2 +/- 23.8, 1.4 +/- 1.1 vs 1.6 +/- 1.3, p>0.3, respectively). Post hoc analysis revealed that as for the patients who were treated within 24 hours after onset, numbers of patients with NIHSS=1 at 30 days were larger in the argatroban group (23 of 49) than in the aspirin group (10 of 40) (p=0.03). Bleeding complication was not different between the two groups (2 of 123 vs 0 of 113: p>0.4). CONCLUSIONS: Argatroban treatment is relatively safe in acute ischemic stroke. The efficacy of argatroban is not superior to aspirin. However, argatroban may be more beneficial in some subgroup of stroke patients than aspirin.
Aspirin ; Hemorrhage ; Humans ; Incidence ; Stroke* ; Thrombin

A seven months old, tiger shovelnose catfish was referred to the veterinary medical teaching hospital of the college of veterinary medicine, Konkuk university because of suspecting a foreign body in the stomach. By physical and radiologic examinations, the catfish revealed abdominal enlargement, vomiting, inactivity and radiopaque foreign bodies in the stomach. Under general anesthesia with dilute isoflurane solution, celiotomy was performed. Stomach was atonic, and three foreign bodies were palpated in the stomach. In this process, three stones came out through mouth. Abdominal muscles were closed with a simple continuous suture pattern, and skin was closed with a simple mattress suture pattern. Sutured site was covered with glue and mucous taken from allogenic skin. On the second day after surgery, the patient recovered to normal condition, showing increased appetite and activity.
Animals ; Catfishes/*surgery ; Foreign Bodies/pathology/*surgery ; Gastroscopy/veterinary ; Stomach/*surgery

BACKGROUND AND OBJECTIVES: Dual blood supply to the anterior interventricular septum (IVS), derived from the septal branches of the left anterior descending artery (LAD) and the conal branch of the right coronary artery (RCA), may prevent ST segment elevation in lead V1 during an anterior acute myocardial infarction (AMI), and predict a favorable in-hospital clinical course. SUBJECTS AND METHODS: The admission 12-lead electrocardiogram (ECG), and the coronary angiograms performed within 10 days of hospital admission, were evaluated in 67 patients with anterior wall AMI, as defined by a ST segment elevation > or =2mm in at least 2 of the V1 to 4 leads. The patients were divided into two groups according to the magnitude of the ST segment elevation in V1 lead: group 1 (ST <1.5 mm, n=22) and group 2 (ST > or =1.5 mm, n=45). The conal branch types were classified into small (a diameter <0.5 mm), not reaching the IVS, and large (a diameter >0.5 mm), reaching the IVS. RESULTS: A large conal branch was found in 11 patients of each group 50 and 24%, respectively (p=0.04). There was no significant relation between the sites of the LAD lesion, whether proximal or distal to the first septal branch, and the presence of ST segment elevation in lead V1. The serum cardiac enzymes, Killip class and the incidence of in-hospital congestive heart failure, were not significantly different. CONCLUSION: The absence of ST segment elevation in lead V1 during an anterior AMI suggested that the IVS is protected by a large conal branch, in addition to the septal branch of the LAD, but this did not influence the in-hospital clinical course.
Anterior Wall Myocardial Infarction* ; Arteries ; Coronary Vessels* ; Electrocardiography ; Heart Failure ; Humans ; Incidence ; Myocardial Infarction ; Prognosis

Actinomycosis is a chronic, granulomatous suppurative disease caused by Actinomyces species. Actinomyces is an anaerobic, gram positive organism that requires special techniques for culture and isolation. Actinomycosis is characterized by formation of multiple abscesses, draining sinuses, abundant granulations (sulfur granule) and dense fibrous tissue. The three major clinical presentations include the cervicofacial, thoracic, and abdominal regions. Since A. israelii is a normal inhabitant of the oral cavity, to make a definitive diagnosis it must be recovered from closed tissue spaces, draining sinuses, or abscesses, or it must be shown to be invasive in histopathologic sections. The drug of choice is penicillin. Because of the dense fibrous tissue surrounding the colonies of organisms and the concentration of organisms in clusters, high doses of pharmacologic agents must be used for long periods, and radical surgical excision should accompany antibiotic therapy if possible. We report three cases of abdominal actinomycosis, preoperatively impressed as appendicitis and pelvic abscess, which was diagnosed by a histological study of operative specimens. The possible pathogenic mechanisms causing clinical symptoms are discussed.
Abscess ; Actinomyces ; Actinomycosis* ; Appendicitis ; Diagnosis ; Mouth ; Penicillins