Objective: High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. Methods: We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. Results: Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. Conclusion The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

BACKGROUND: Selective antegrade perfusion via axillary artery cannulation along with circulatory arrest under deep hypothermia has became a recent trend for performing surgery on the ascending aorta and aortic arch and when direct aortic cannulation is not feasible. The authors of this study tried using moderate hypothermia with right brachial and femoral artery perfusion to complement the pitfalls of single axillary artery cannulation and deep hypothermia. MATERIALS AND METHODS: A retrospective analysis was performed on 36 patients who received ascending aorta or aortic arch replacement between July 2005 and May 2010. The adverse outcomes included operative mortality, permanent neurologic dysfunction and temporary neurologic dysfunction. RESULTS: Of these 36 patients, 32 (88%) were treated as emergencies. The mean age of the patients was 61.9 years (ranging from 29 to 79 years) and there were 19 males and 17 females. The principal diagnoses for the operation were acute type A aortic dissection (31, 86%) and aneurysmal disease without aortic dissection (5, 14%). The performed operations were ascending aorta replacement (9, 25%), ascending aorta and hemiarch replacement (13, 36%), ascending aorta and total arch replacement (13, 36%) and total arch replacement only (1, 3%). The mean cardiopulmonary bypass time was 209.4+/-85.1 minutes, and the circulatory arrest with selective antegrade perfusion time was 36.1+/-24.2 minutes. The lowest core temperature was 24+/-2.1degrees C. There were five deaths within 30 post-op days (mortality: 13.8%). Two patients (5.5%) had minor neurologic dysfunction and six patients, including three patients who had preoperative cerebral infarction or unconsciousness, had major neurologic dysfunction (16.6%). CONCLUSION: When direct aortic cannulation is not feasible for ascending aorta and aortic arch replacement, the right brachial and femoral artery can be used as arterial perfusion routes with the patient under moderate hypothermia. This technique resulted in acceptable outcomes.
Aneurysm ; Aorta ; Aorta, Thoracic ; Axillary Artery ; Cardiopulmonary Bypass ; Catheterization ; Cerebral Infarction ; Complement System Proteins ; Emergencies ; Female ; Femoral Artery ; Humans ; Hypothermia ; Male ; Neurologic Manifestations ; Perfusion ; Retrospective Studies ; Unconsciousness

BACKGROUND: K-cells function as targets for insulin gene therapy. In a previous study, we constructed EBV-based plasmids expressing rat preproinsulin controlled by glucose-dependent insulinotropic polypeptide promoters. In the present study, we attempted to correct hyperglycemia in vivo using genetically engineered K-cells in a mouse model of type 1 diabetes. METHODS: K-cells expressing insulin were transplanted under the kidney capsules of STZ-induced diabetic mice. The blood glucose levels and body weights of the experimental animals were measured daily. After four weeks, the mice were injected intra-peritoneally with 2 g/kg glucose following a 6 hr fast. Blood glucose levels were measured immediately following glucose injections. All animals were sacrificed at the end of the glucose tolerance study, and pancreas and graft-bearing kidney tissue samples were stained with antibodies against insulin, glucagon, and C-peptide. RESULTS: The body weights of K-cell-transplanted diabetic mice increased after transplantation, whereas those of untreated diabetic control mice continued to decline. The blood glucose levels of K-cell-transplanted diabetic mice decreased gradually during the two weeks following transplantation. After intra-peritoneal injection of glucose into K-cell-transplanted diabetic mice, blood glucose levels increased at 30 minutes, and were restored to the normal range between 60 and 90 minutes, while untreated control diabetic mice continued to experience hyperglycemia. Kidney capsules containing transplanted K-cells were removed, and sections were stained with anti-insulin antibodies. We detected insulin-positive cells in the kidney capsules of K-cell-transplanted diabetic mice, but not in untreated control mice. CONCLUSION: We detected glucose-dependent insulin secretion in genetically engineered K-cells in a mouse model of type 1 diabetes. Our results suggest that genetically modified insulin producing K-cells may act as surrogate beta-cells to effectively treat type 1 diabetes.
Animals ; Antibodies ; Blood Glucose ; Body Weight ; C-Peptide ; Capsules ; Gastric Inhibitory Polypeptide ; Genetic Therapy ; Glucagon ; Glucose ; Herpesvirus 4, Human ; Hyperglycemia ; Insulin ; Kidney ; Mice ; Pancreas ; Plasmids ; Protein Precursors ; Rats ; Reference Values ; Transplants

Interferon alpha is an immunomodulator that is used as an antiviral agent to treat chronic active viral hepatitis C. However, interferon can induce or exacerbate sarcoidosis. We report a case of 42-year-old man with an exacerbation of pulmonary sarcoidosis after the cessation of interferon and ribavirin therapy for chronic hepatitis C. The patient's sarcoidosis improved spontaneously and he continues to be monitored regularly without steroid therapy.
Adult ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis, Chronic* ; Humans ; Interferon-alpha* ; Interferons ; Ribavirin ; Sarcoidosis* ; Sarcoidosis, Pulmonary

PURPOSE: To know whether the changes in the risk factors of nosocomial sepsis had an impact on the occurrence of nosocomial sepsis (NS) in extremely low birth weight infants (ELBW I). METHODS: ELBW I who were admitted to the NICU at Samsung Medical Center from October 1994 to December 2000 were devided into three groups according to periods (period I:1994.10-1996.9, period II:1996.10-1998.12, period III:1999.1-2000.12), and charts were reviewed retrospectively for demographic profile, incidence of NS, and changing patterns of risk factors of NS. RESULTS: Gestational age and birth weight of ELBW I decreased and the incidence of NS increased significantly during third period. However, cumulative incidence of NS corrected by hospital days was not changed irrespective of periods. Among the risk factors of NS in 3rd period, use of antibiotics in the 1st day, postnatal dexamethasone and use and duration of indwelling umbilical catheters decreased significantly and the use of nasal continuous positive airway pressure increased significantly especially, in ELBW I under 800 g of birth weight. In the ELBW I under 800 g of birth weight, cumulative incidence of NS and mortality among the infants who suffered from NS decreased significantly in 3rd period. CONCLUSION: Efforts to decrease the risk factors of NS can prevent the increase in incidence of NS in ELBW I.
Anti-Bacterial Agents ; Birth Weight ; Catheters ; Continuous Positive Airway Pressure ; Dexamethasone ; Gestational Age ; Humans ; Incidence* ; Infant* ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight* ; Infant, Newborn ; Mortality ; Retrospective Studies ; Risk Factors* ; Sepsis*

The authors have studied six patients with histologically proven primary malignant lymphoma of the brain which is still a rare primary brain tumor. The clinical, radiological and pathological findings with results of the treatment are presented. All cases showed a good response to radiation therapy. Therefore, the early diagnosis by computerized tomography scan followed by biopsy or excision is considered to be very important for the BEST results in the treatment. Related reports are discussed briefly.
Biopsy ; Brain Neoplasms ; Brain* ; Drug Therapy ; Early Diagnosis ; Humans ; Lymphoma*

Authors report 10 cases of intracranial inflammatory granulomatous lesions which were identified on CT scan and proven pathologically after surgical excision. They were composed of three cases of tuberculoma, three cases of degenerated cysticercus, two cases of healed abscess and two cases of non-specific inflammatory lesions. Most patients were children or young adults. Seizure was the most frequent presenting symptom. All cases had characteristic CT findings in common : a small nodular or ring-like lesion with strong enhancement surrounded by irregular-shaped low density area. Surgical exploration is of value in that specific diagnosis would not be possible with clinical and radiological findings only.
Abscess ; Child ; Cysticercus ; Diagnosis ; Granuloma* ; Humans ; Seizures ; Tomography, X-Ray Computed* ; Tuberculoma ; Young Adult

The authors reviewed 37 consecutive cases of histologically proven oligodendroglioma who were treated at the Seoul National University Hospital, between 1979 and 1986. There was a 1.5 : 1 male to female ratio. The age of patients at the time of diagnosis varied between 6 and 64 years(mean 38 years), with 51% in the fourth and fifth decades. The incidence of oligodendrogliomas represented 5% of all brain tumors and 15.5% of all gliomas. All but one were located supratentorially and 54% of them involved the frontal lobe. The mean duration of symptoms prior to the surgery was 27.2 months, but seizures had a considerably longer duration of 6.4 years. The common symptoms were headache(62%), seizures(38%), and motor weakness(22%). The common neurological findings were papilledema(51%), motor dificit(24%), and change in cognition(19%). Six out of 37 cases(16%) presented as the spontaneous intracranial hemorrhage. Calcifications were detected on plain X-ray films of the skull in 19% of patients and fine vascular stains were found on carotid angiograms in 30% of the cases. Brain CT revealed calcification(57%), cyst formation(43%), low density(35%) and heterogenous contrast enhancement(35%). The important factors affecting the prognosis and the recurrence rate were (1) the extent of surgical excision, (2) postoperative radiation therapy, and (3) the pathologic grading. There was a significant difference in the recurrence rate between patients treated with postoperative irradiation and patients treated with surgery alone.
Brain ; Brain Neoplasms ; Coloring Agents ; Diagnosis ; Female ; Frontal Lobe ; Glioma ; Humans ; Incidence ; Intracranial Hemorrhages ; Male ; Oligodendroglioma* ; Prognosis ; Recurrence ; Seizures ; Seoul ; Skull ; X-Ray Film

The authors report 3 cases of primary intramedullary glioblastoma multiforme which is relatively rare among spinal cord tumors. They were located at the thoracolumbar, cervical and conus medullaris region respectively. Clinical, radiographic and pathological material are presented and the literature is discussed.
Conus Snail ; Glioblastoma* ; Prognosis ; Spinal Cord Neoplasms

One case of craniopharyngioma confined to the third ventricle is reported. His symptom was only headache without visual disturbance or endocrine dysfunction. The CT scan showed isodense round mass in the anterior portion of the third ventricle with strong homogeneous enhancement. There was no calcification.
Craniopharyngioma* ; Headache ; Third Ventricle ; Tomography, X-Ray Computed