BACKGROUND AND PURPOSE: Following the positive results from recent trials on endovascular therapy (EVT), bridging therapy (intravenous alteplase plus EVT) is increasingly being used for the treatment of acute ischemic stroke. However, the optimal dose of intravenous alteplase remains unknown in centers where bridging therapy is actively performed. The optimal dose for eventual recanalization and positive clinical outcomes in patients receiving bridging therapy also remains unknown. METHODS: In this prospective Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) sub-study, we explored the outcomes following treatment with two different doses (low- [0.6 mg/kg] or standard-dose [0.9 mg/kg]) of intravenous alteplase across 12 Korean centers where EVT is actively performed. The primary endpoint was a favorable outcome at 90 days (modified Rankin Scale scores 0 to 1). Secondary endpoints included symptomatic intracerebral hemorrhage (ICH) in all patients, and the recanalization rate and favorable outcome in patients who underwent cerebral angiography for EVT (ClinicalTrials.gov, number NCT01422616). RESULTS: Of 351 patients, the primary outcome occurred in 46% of patients in both the standard-(80/173) and low-dose (81/178) groups (odds ratio [OR], 1.14; 95% confidence interval [CI], 0.72 to 1.81; P=0.582), although ICHs tended to occur more frequently in the standard-dose group (8% vs. 3%, P=0.056). Of the 67 patients who underwent cerebral angiography, there was no significant difference in favorable functional outcome between the standard- and low-dose groups (39% vs. 21%; OR, 2.39; 95% CI, 0.73 to 7.78; P=0.149). CONCLUSIONS: There was no difference in functional outcome between the patients receiving different doses of alteplase in centers actively performing bridging therapy.
Cerebral Angiography ; Cerebral Hemorrhage ; Cerebral Infarction ; Humans ; Hypertension ; Intracranial Hemorrhages ; Prospective Studies ; Stroke ; Thrombectomy ; Tissue Plasminogen Activator

Maxillary enlargement is a rare complication of secondary hyperparathyroidism (SHPT). A 35-year-old Korean man undergoing chronic hemodialysis presented with a painless enlargement involving the maxilla and mandible. Plain radiography and CT scan showed bony expansion at the maxilla and mandible with multiple radiolucency. Serum intact parathyroid hormone (iPTH) was >1,600 pg/mL. Tc-99m sestamibi (MIBI) parathyroid scan and neck sonogram were compatible with SHPT. He underwent limited parathyroidectomy and commenced a course of paricalcitol. Fifteen months after surgery, maxillary enlargement and bony resorptions involving both hands markedly improved. Thirty-six months after the surgery, the serum iPTH level was 109.3 pg/mL. This is the first report in Korea documenting a patient with maxillary enlargement in SHPT who was successfully treated with limited parathyroidectomy and paricalcitol.
Adult ; Ergocalciferols ; Hand ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Korea ; Mandible ; Maxilla ; Neck ; Parathyroid Hormone ; Parathyroidectomy ; Renal Dialysis ; Renal Osteodystrophy

Secondary hyperparathyroidism is one of the most common complications of patients with chronic kidney disease (CKD). Mandibular enlargement, metastatic pulmonary calcification, and gastric mucosal calcinosis are rare complications in these patients. The defect of calcium and phosphorus metabolism may precipitate pathologic calcification at diverse organs and soft tissue, and change bone architecture. In case of involving periarticular area, patients usually present with localized swelling, pain, and reduced mobility in affected sites. However, in case of organ involvement, except in an advanced stage of disease, there are no specific symptoms. Among these patients, treatment strategies include tight control of calcium and phosphate levels, parathyroidectomy for hyperparathyroidism, renal transplantation, and local excision of calcific lesions. We report a case of mandibular enlargement, metastatic pulmonary calcification, and gastric mucosal calcinosis due to CKD with improvement 3 months after medical and surgical treatment.
Calcinosis ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Kidney ; Kidney Transplantation ; Parathyroidectomy ; Phosphorus ; Renal Insufficiency, Chronic

We report four cases of toxic hepatitis that occurred after taking a decoction made by boiling down the root of Dictamnus dasycarpus. The four patients had a median age of 60 years, common symptoms of jaundice and general weakness, and stated that they had not consumed alcohol for at least 5 years. The markers of hepatitis A, B, and C were all negative in the patients. Abdominal ultrasonography revealed common bile ducts with normal diameters. Two of the cases were a mother and daughter, and the other two were sporadic. All of them had consumed a decoction made by boiling down the root of Dictamnus dasycarpus five or six times daily until several days before admission. Dictamnus dasycarpus induced liver injury presenting with a benign course lasting less than 1 month after cessation of the causative agent. We suggest that this natural product can cause acute hepatitis in rural areas.
Acute Disease ; Aged ; Dictamnus/*adverse effects ; Female ; Hepatitis, Toxic/*diagnosis/etiology/ultrasonography ; Humans ; Liver Function Tests ; Male ; Middle Aged ; Plant Roots/*adverse effects

PURPOSE: To evaluate the risk factors associated with enucleation or evisceration in endophthalmitis patients. METHODS: The medical records of endophthalmitis cases from January 1995 to July 2006 were reviewed retrospectively. The cases were divided into 2 groups, the enucleation/evisceration group (36 eyes of 36 patients) who underwent enucleation or evisceration and the intraocular procedures group (61 eyes of 60 patients) who received intravitreal antibiotics injection and/or vitrectomy. We analyzed these cases with respect to age, sex, initial visual acuity, causes of endophthalmitis, systemic disease, and causative organisms. RESULTS: Older age (p=0.002), women (17/32, p=0.027), no light perception at presentation (33/37, p<0.001), endophthalmitis associated with corneal ulcer (25/25, p<0.001), and diabetes mellitus (14/20, p=0.001) were significantly associated with enucleation or evisceration. CONCLUSIONS: Older age, poor initial visual acuity, endophthalmitis associated with corneal ulcer, and diabetes mellitus were strongly associated with enucleation or evisceration. If any of these factors are present, more intensive treatments are warranted to prevent loss of the eye.
Anti-Bacterial Agents ; Corneal Ulcer ; Diabetes Mellitus ; Endophthalmitis* ; Female ; Humans ; Medical Records ; Retrospective Studies ; Risk Factors* ; Visual Acuity ; Vitrectomy

BACKGROUND: Despite the advent of molecular biology and immunogenetics, the biologic behaviors and disease entities of primary cutaneous B-cell lymphomas(pCBCL) have been undetermined. Moreover, rarity of pCBCL cases and the conflicting datas of current issues have contributed to the dilemmas in understanding of the biology of pCBCL. Until now, a study of the overall features of pCBCL in Korea has been rarely presented. OBJECTIVE: We performed this study in order to identify the histopathologic and immunogenetic characteristics of pCBCL in Korea. METHODS: The histopathologic, immunophenotypic and molecular analysis of preserved specimens of 15 cases with pCBCL were conducted. RESULTS: 1. Of the 15 patients with pCBCL, most common types are follicle center cell lymphomas(73.3%). In REAL classification, diffuse large B-cell lymphoma is most common(66.6%). 2. In bcl-2 immunohistochemical staining, 3 cases(20%) were positive. 3. Only one of 15 cases of pCBCL denoted bcl-2 gene rearrangement by t(14;18) in minor cluster region. 4. Immunohistochemical staining demonstrated overexpression of p53 protein in 3(20%) of 15 cases. 5. 2 cases(13.3%) with point mutations(one for exon 5; the other for exon 8) in p53 DNA sequencing analysis. CONCLUSION: t(14;18) translocation may be rare in pCBCL in Korea. This finding indicates that bcl-2 expression by tumor cells in pCBCL without t(14;18) may occur by different genetic dysregulation. It seems to be that overexpression of p53 protein might not correspond with p53 mutations in pCBCL.
B-Lymphocytes* ; Biology ; Classification ; Exons ; Genes, bcl-2 ; Humans ; Immunogenetics* ; Korea* ; Lymphoma, B-Cell* ; Molecular Biology ; Sequence Analysis, DNA

BACKGROUND: Recently, resistance to activated protein C(APC) is known to be an important risk factor for venous leg ulcers. Leiden mutation in clotting factor V is the most common genetic defect leading to APC resistance in western countries. Until now, the prevalence of APC resistance and Leiden mutation in Korean patients with venous ulcers has been ill defined. OBJECTIVE: We performed this study in order to investigate the prevalence of APC resistance and Leiden mutation in Korean patients with venous ulcers. METHODS: The functional analysis for APC resistance(APC resistance ratio) and genetic study for Leiden mutation were conducted in 40 patients with venous ulcers. RESULTS: 1. Of the 40 patients with venous ulcers, resistance to APC was documented in 11 individuals (27.5%). 2. We could not find factor V Leiden mutation in 40 patients. 3. Patients with APC resistance more frequently represented recurrence of venous ulcers and venous thrombosis than in their non-APC resistant counterparts. CONCLUSION: APC resistance may be one of the thrombophilic defects in relation with venous ulcers in Korea. However, Leiden mutation may be rare in Korean patients with venous ulcers than in Caucasians. These findings suggested that the other genetic or non-genetic factors may be involved in the pathogenesis of APC resistance in Korea.
Activated Protein C Resistance* ; Factor V ; Humans ; Korea ; Leg Ulcer ; Prevalence* ; Recurrence ; Risk Factors ; Varicose Ulcer* ; Venous Thrombosis

Double pylorus is either a congenital abnormality or an acquired complication of peptic ulcer disease. An accessory channel normally connects the lesser or greater curvatore of the prepyloric antrum with the duodenal bulb. Three cases of double pylorus, an unusual complication of peptic ulcer disease is herein reported. A peptic ulcer lay in the accessory channel in all cases. In one of the cases, the fistula closed spontaneously after Helicobacter pylori eradication. The remaining 2 patients became asympto-matic despite the persistence of the accessory channel.
Congenital Abnormalities ; Fistula* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Peptic Ulcer* ; Pylorus*

BACKGROUND AND OBJECTIVES: Some objective and quantitative diagnositc methods are introduced to evaluate vocal cord paralysis, such as electro glottography (EGG) and laryngeal electromyography (LEMG). LEMG is an invasive and highly technical method requiring patient's cooperation. It records action potential generated when intrinsic laryngeal musculature contracts. EGG, on the other hand, records changes of impedence between both vocal cords when theses vibrate and represents many information of vocal cord movements. This method is non-invasive and very simple offering some valuable information about voice function of laryngeal diseases. MATERIALS AND METHODS: From January 1998 through May 2000, we evaluated 15 vocal cord paralysis patients by LEMG and EGG and compared the usefulness of these two methods by determining the lesions of vagal nerve injury. RESULTS: For patients who had severe recurrent laryngeal nerve injuries, EGG and dEGG showed no plateau phase but a loss of two-mass movements. Some showed very irregular saw-tooth shaped wave patterns. Patients with vagal nerve injury, EGG and dEGG showed relatively well maintained plateau phases because they had paralyzed cricothyroid muscles which are counteract to abductor of vocal cord. CONCLUSION: Although EGG did not provide information about such diseases as laryngeal myopathy and arthropathy, it is simple and non-invasive, and may he much valuable as a topodiagnostic method of vocal cord paralysis.
Action Potentials ; Diagnosis* ; Electromyography ; Hand ; Humans ; Laryngeal Diseases ; Laryngeal Muscles ; Muscular Diseases ; Ovum ; Recurrent Laryngeal Nerve Injuries ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

The technique of in situ hybridization using synthetic oligonucleotides labelled by non-radioactive method was developed to localize vasoactive intestinal polypeptide, arginine-vasopressin and oxytocin mRNAs in the rat brain. Also double in situ hybridization technique where combination of non-radioactive and radioactive probes were applied was developed to localize 2 neuropeptide mRNAs in single tissue section. The results were as follows; In non-radioactive in situ hybridization methods using digoxigenin-labelled oligonucleotide probe, alkaline-phosphates method using NBT and BCIP as substrates gave the best result that specific hybridization signals were observed. In radioactive in situ hybridization methods using 35S-labelled oligonucleotide probe, specific hybridization signals were observed in both nuclear track emulsion and X-ray film autoradiography. In double in situ hybridization methods using combination of 35S-labelled and digoxigenin-labelled oligonucleotide probes, specific hybridization signals were observed in the group where K5 emulsion was applied as nuclear track emulsion. The technique of in situ hybridization using digoxigenin-labelled oligonucleotide applied in this study will be useful as alternative for radioactive in situ hybridization technique. Moreover, combination of non-radioactive and radioactive labelled probes in double in situ hybridization technique will be a useful tool for the simultaneous localization of various mRNAs in single section for the study of various neurotransmitters, neuropeptides, receptors and signal transduction molecules.
Aging ; Animals ; Autoradiography ; Brain* ; Corpus Callosum ; Digoxigenin ; In Situ Hybridization* ; Magnetic Resonance Imaging ; Mesencephalon ; Neuropeptides ; Neurotransmitter Agents ; Oligonucleotide Probes ; Oligonucleotides ; Oxytocin* ; Pons ; Rats* ; RNA, Messenger* ; Signal Transduction ; Vasoactive Intestinal Peptide* ; Vasopressins* ; X-Ray Film