Objective: : Endovascular treatment of intracranial aneurysms is challenging in case of wide-necked aneurysms because coils are prone to herniate into the parent artery, causing thromboembolic events or vessel occlusion. This study aims to compare long-term angiographic results of wide-necked aneurysms treated by stent-assisted, double-microcatheter, or single-microcatheter groups. Methods: : Between January 2003 and October 2016, 108 aneurysms that were treated with endovascular coil embolization with a neck size wider than 4 mm and a follow-up period of more than 3 years were selected. We performed coil embolization with singlemicrocatheter, double-microcatheter, and stent-assisted techniques. Angiographic results were evaluated using the Raymond-Roy occlusion classification (RROC). All medical and angiographic records were reviewed retrospectively. Results: : Clinical and angiographic analyses were conducted in 108 wide-necked aneurysms. The immediate post-procedural results revealed RROC class I (complete occlusion) in 66 cases (61.1%), class II (residual neck) in 36 cases (33.3%), and class III (residual sac) in six cases (5.6%). The final follow-up results revealed class I in 48 cases (44.4%), class II in 49 cases (45.4%), and class III in 11 cases (10.2%). Of a total of 45 (41.6%) radiologic recurrences, there were 21 cases (19.4%) of major recurrence that required additional treatment, and 24 cases (22.2%) of minor recurrence. The final follow-up angiographic results showed statistically significant differences between the stent-assisted group and the others (p<0.01). Conclusion : Long-term follow-up angiography demonstrated that the stent-assisted technique had a better complete occlusion rate than the other two techniques.

Objective: : Endovascular treatment of intracranial aneurysms is challenging in case of wide-necked aneurysms because coils are prone to herniate into the parent artery, causing thromboembolic events or vessel occlusion. This study aims to compare long-term angiographic results of wide-necked aneurysms treated by stent-assisted, double-microcatheter, or single-microcatheter groups. Methods: : Between January 2003 and October 2016, 108 aneurysms that were treated with endovascular coil embolization with a neck size wider than 4 mm and a follow-up period of more than 3 years were selected. We performed coil embolization with singlemicrocatheter, double-microcatheter, and stent-assisted techniques. Angiographic results were evaluated using the Raymond-Roy occlusion classification (RROC). All medical and angiographic records were reviewed retrospectively. Results: : Clinical and angiographic analyses were conducted in 108 wide-necked aneurysms. The immediate post-procedural results revealed RROC class I (complete occlusion) in 66 cases (61.1%), class II (residual neck) in 36 cases (33.3%), and class III (residual sac) in six cases (5.6%). The final follow-up results revealed class I in 48 cases (44.4%), class II in 49 cases (45.4%), and class III in 11 cases (10.2%). Of a total of 45 (41.6%) radiologic recurrences, there were 21 cases (19.4%) of major recurrence that required additional treatment, and 24 cases (22.2%) of minor recurrence. The final follow-up angiographic results showed statistically significant differences between the stent-assisted group and the others (p<0.01). Conclusion : Long-term follow-up angiography demonstrated that the stent-assisted technique had a better complete occlusion rate than the other two techniques.

Cardiac arrest (CA) is sudden loss of heart function and abrupt stop in effective blood flow to the body. The patients who initially achieve return of spontaneous circulation (RoSC) after CA have low survival rate. It has been known that multiorgan dysfunctions after RoSC are associated with high morbidity and mortality. Most previous studies have focused on the heart and brain in RoSC after CA. Therefore, the aim of this research was to perform serological, physiological, and histopathology study in the lung and to determine whether or how pulmonary dysfunction is associated with low survival rate after CA. Experimental animals were divided into sham-operated group (n=14 at each point in time), which was not subjected to CA operation, and CA-operated group (n=14 at each point in time), which was subjected to CA. The rats in each group were sacrificed at 6 hours, 12 hours, 24 hours, and 2 days, respectively, after RoSC. Then, pathological changes of the lungs were analyzed by hematoxylin and eosin staining, Western blot and immunohistochemistry for tumor necrosis factor α (TNF-α). The survival rate after CA was decreased with time past. We found that histopathological score and TNF-α immunoreactivity were significantly increased in the lung after CA. These results indicate that inflammation triggered by ischemia-reperfusion damage after CA leads to pulmonary injury/dysfunctions and contributes to low survival rate. In addition, the finding of increase in TNF-α via inflammation in the lung after CA would be able to utilize therapeutic or diagnostic measures in the future.
Animals ; Blotting, Western ; Brain ; Eosine Yellowish-(YS) ; Heart ; Heart Arrest* ; Hematoxylin ; Humans ; Immunohistochemistry ; Inflammation ; Lung* ; Models, Animal* ; Mortality ; Rats* ; Survival Rate ; Tumor Necrosis Factor-alpha*

There have been no long-term complications or life-threatening adverse effects related to botulinum toxin treatment for any cosmetic indications. Nevertheless, there are well-known, mild side effects of botulinum toxin treatment on the upper face, though most of them are self limited with time. However, excluding brow ptosis, reports about site specific side effects are few and anecdotal. We experienced cases of exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines, and report them here. In our cases, new appearance of a noticeable glabellar protrusion following botulinum toxin injection on the forehead was observed in 2 patients. Also, a new deep wrinkle on one side of the forehead just above the eyebrow appeared in another 2 patients. The exaggerated wrinkles nearly disappeared without treatment by week 4 in all subjects. These exaggerations of wrinkles may be caused by hyperactivity and overcompensation of untreated muscles. With the increasing availability of diverse botulinum toxin for cosmetic purposes, physicians and patients should be aware of this temporary change after therapeutic injections. We recommend explaining this possible effect prior to injection, for better understanding of treatment for cosmetic indications.
Botulinum Toxins ; Cosmetics ; Eyebrows ; Forehead ; Humans ; Muscles

BACKGROUND: Recent research demonstrates a strong association between smoking-related behaviors and genetic variation. We investigated the clinical features and genetic effects of dopamine receptors and a serotonin transporter on smoking cessation in Koreans. METHODS: Smokers (n=51) wanting to quit smoking were included as the study population. They were genotyped for polymorphisms in dopamine D2 receptor (DRD2) (TaqI and -141C), dopamine D4 receptor (DRD4), and a serotonin transporter (5-HTT). We defined abstinence as stopping smoking at six months after enrollment. RESULTS: Eighteen patients (35.3%) stopped smoking at six months. The abstinence group had a higher rate of alcohol use whereas the non-abstinence group had more coughing. However, there were no significant differences in average smoking rate, starting age of smoking, gender, nicotine dependence, and forced expiratory volume in one second between the two groups. As for the genes in the dopamine pathway, the polymorphisms of DRD2 TaqI (A1 allele) and DRD2 -141C (Ins C allele) were not genotypically different between the two groups (P=0.245 and 0.409, respectively). The genetic variation in the DRD4 variable number of tandem repeats (VNTR) also showed a similar distribution in the two groups. Regarding the polymorphisms of 5-HTT, there was no difference in the long allele between the two groups (P=0.852). CONCLUSIONS: This study suggests that the genetic variations of DRD2 TaqI, DRD2 -141C, DRD4 VNTR, and 5-HTT might have little influence on smoking cessation in Korean smokers.
Alleles ; Cough ; DNA ; Dopamine ; Forced Expiratory Volume ; Genetic Variation ; Humans ; Minisatellite Repeats ; Polymorphism, Genetic ; Receptors, Dopamine ; Receptors, Dopamine D2 ; Receptors, Dopamine D4 ; Serotonin Plasma Membrane Transport Proteins ; Smoke ; Smoking ; Smoking Cessation ; Tobacco Use Disorder

Traffic accident leaves various traces on vehicle, road or pedestrians and these can be viewed as the failure mechanism of relatively moving obstacles. This paper introduces tribology and fractography, which are the parts of failure mechanics, as a means of theoretical analysis and approaching methods on the traffic accident. Actual specific traces are introduced as illustrations of tribology and fractogrphy. A verified traffic accident is also introduced as a case report.
Accidents, Traffic ; Mechanics

PURPOSE: To study the characteristics of the accompanying amblyopia and strabismus in patients with anisometropia. METHODS: We retrospectively reviewed the medical records of 193 patients, who had either spherical or cylindrical anisometropia of more than 1.00D. Patients were divided into four groups: spherical hyperopic anisometropia, spherical myopic anisometropia, cylindrical hyperopic anisometropia, and cylindrical myopic anisometropia. We investigated the accompanying amblyopia and strabismus. Amblyopia was treated with lens correction and patch therapy and we analyzed the results for 78 patients who fulfilled six-month follow-up examinations. RESULTS: There was no significant difference in the frequency of amblyopia between spherical and cylindrical anisometropia. Spherical myopic anisometropia of more than 3.00D showed a significant increase in the incidence of amblyopia (p=0.001). Spherical hyperopic anisometropia of more than 1.00D, cylindrical hyperopic anisometropia of more than 2.00D, and cylindrical myopic anisometropia of more than 2.00D showed an increased tendency for amblyopia. Between spherical and cylindrical anisometropia, there were no significant differences in the results and duration of amblyopia treatment, and type and frequency of strabismus. CONCLUSIONS: In spherical anisometropia, hyperopic anisometropia has a higher risk for developing amblyopia. We could find the threshold for the development of amblyopia.
Amblyopia* ; Anisometropia* ; Follow-Up Studies ; Humans ; Incidence ; Medical Records ; Retrospective Studies ; Strabismus*

PURPOSE: This study analyzes the factors influencing anatomical failure of the primary operation for simple rhegmatogenous retinal detachment. METHODS: The patients in this study were diagnosed with simple rhegmatogenous retinal detachment and operated on by a single physician. The success group comprised 251 eyes and the failure group comprised 29 eyes. The factors analyzed between the two groups were the type of primary procedure, the type of retinal defect; the numbers of retinal defects; the extent of retinal detachment; the duration of retinal detachment; the existence of peripheral degeneration; carrying out of subretinal fluid drainage; the type of tamponade material used and the position of retinal defects. RESULTS: The anatomical success rate of the primary operation for simple rhegmatogenous retinal detachment was 89.64%. Patient sex, the type of tamponade material used and the position of the retinal defect showed significant differences between the success and failure groups. There was a higher percentage of male patients in the failure group than in success group (p=0.034). Silicone oil used as the tamponade material resulted in a greater chance of failure than success (p=0.017). Analysis of the position of the retinal defect showed that, defects distributed in the inferior retina or through multiple area led to a greater likelihood of anatomical failure (p=0.036). CONCLUSIONS: Due ti the greater possibility of anatomical failure of the primary operation when retinal defects are distributed in the inferior retina or through multiple area, clinicians should consider intensive treatment for such cases.
Drainage ; Humans ; Male ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Silicone Oils ; Subretinal Fluid

BACKGROUND: Adrenocortical carcinoma (ACC) is an extremely rare tumor. Its early detection is difficult and its prognosis is poor. METHOD: We retrospectively analyzed the medical records of 13 patients with ACC between 1995 and 2005 at Samsung Medical Center. Their clinical features and prognosis were evaluated. RESULTS: The average age of the patients with ACC was 40 years (2~75 years). Eight patients were men and five were women. On the first visit, eight of 13 patients (62%) complained abdominal pain, and abdominal mass was palpable in five of 13 patients (38%). Urinary concentration of 17-ketosteroid collected for 24 hours was increased in two of eight patients (25%). Three out of 13 patients were identified as having functioning adrenal tumors (1 Cushing's syndrome and 2 androgen-producing tumors), and the other 10 patients had hormonally inactive adrenal tumors. Ten patients had tumors in left adrenal gland, and three had in right adrenal gland. At the time of diagnosis, four patients were classified as having stage II, seven as stage III, and two as stage IV. Twelve patients underwent adrenalectomy. One of them received additional chemotherapy, and two patients were treated with external radiation therapy after surgery. The other one patient was treated only with chemotherapy due to the presence of liver metastasis. It was possible to continue the regular follow-up in eight of 13 patients. The median duration of follow-up was 39 months (7~114 months). Six of them are still alive (three have no evidence of disease, one had persistence of disease, and two had recurrence of disease during follow-up period). Two patients died of multiple metastases and lung metastasis, respectively. CONCLUSION: Radical surgery is the only curative approach and is recommended for all patients with resectable tumors, even though in those patients with recurrent disease. There is no consensus concerning adjuvant therapy.
Abdominal Pain ; Adrenal Glands ; Adrenalectomy ; Adrenocortical Carcinoma* ; Consensus ; Cushing Syndrome ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Liver ; Lung ; Male ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies

BACKGROUND: Octreotide(OC)-LAR is a long-acting preparation of octreotide which has been effectively used to suppress GH/IGF-1 hypersecretion in acromegalic patients. The clinical response, biochemical outcomes, and safety of OC-LAR were evaluated in 27 active acromegalic patients. METHOD: 27patients with an active disease status (according to the clinical picture, GH >5microgram/L and elevated age-matched IGF-1), and previously treated with bromocriptine after surgery, comprised the study population. OC-LAR was given(20mg, i.m., every 4 week for 3 injections, then the doses were titrated individually) and the acromegalic symptoms and adverse reactions recorded. The serum levels of GH and IGF-1 were evaluated every 12 week. The acromegalic symptoms including headache, fatigue and arthralgia, improved in all patients. RESULTS: Gastrointestinal side effects were transient and mild. The levels of GH significantly decreased, from 8.9+/-3.5 to 2.9+/-2.2 microgram/L at 12 weeks(P<0.001, vs. baseline), to 2.9+/-2.1microgram/L after 24 weeks(P<0.001) and to 2.5 +/-1.3microgram/L at 48 weeks(P<0.001). The levels of IGF-1 significantly decreased, from 753.7+/-213.6 to 429.7+/-253.4 microgram/L at 12 weeks(P<0.001, vs. at baseline), to 405.7+/-213.3microgram/L at 24 weeks(P <0.001) and to 348.9+/-144.7microgram/L at 48 weeks(P<0.001). The safelevel of GH is less than 2.5microgram/L and normal age-matched IGF-1 levels were achieved in 63 and 52% of the patients, respectively. CONCLUSION: Octreotide-LAR was well tolerated and effective as an adjuvant treatment in lowering the levels of GH and IGF-1 in active acromegalic patients.
Acromegaly ; Arthralgia ; Bromocriptine ; Fatigue ; Headache ; Humans ; Insulin-Like Growth Factor I ; Octreotide*