The Clinical Efficacy of Decompressive Craniectomy in Patients with an Internal Carotid Artery Territory Infarction

OBJECTIVE: To evaluate the surgical efficacy of and factors associated with decompressive craniectomy in patients with an internal carotid artery (ICA) territory infarction. METHODS: Seventeen patients (8 men and 9 women, average age 61.53 years, range 53-77 years) were treated by decompressive craniectomy for an ICA territory infarction at our institute. We retrospectively reviewed medical records, radiological findings, and National Institutes of Health Stroke Scale (NIHSS) at presentation and before surgery. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS). RESULTS: Of the 17 patients, 15 (88.24%) achieved a poor outcome (Group A, GOS 1-3) and 2 (11.76%) a good outcome (Group B, GOS 4-5). The mortality rate at one month after surgery was 52.9%. Average preoperative NIHSS was 27.6+/-10.88% in group A and 10+/-4.24% in group B. Mean cerebral infarction fraction at the septum pellucidum level before surgery in group A and B were 33.67% and 23.72%, respectively. Mean preoperative NIHSS (p=0.019) and cerebral infarction fraction at the septum pellucidum level (p=0.017) were found to be significantly associated with a better outcome. However, no preexisting prognostic factor was found to be of statistical significance. CONCLUSION: The rate of mortality after ICA territory infarction treatment is relatively high, despite positive evidence for surgical decompression, and most survivors experience severe disabilities. Our findings caution that careful consideration of prognostic factors is required when considering surgical treatment.

Intraventricular Hemorrhage and Ischemic Heart Disease as Initial Presentation of Polycythemia Vera: Case Report / 대한뇌혈관외과학회지

Polycythemia vera (PV) is a myeloproliferative disorder characterized by clonal proliferation of hematopoietic stem cells leading to an accumulation of erythrocytes, leukocytes and platelets within the circulation. Thrombosis and hemorrhage are the most common serious complications of PV, and occur in 30-50% of patients. We report an unusual case of PV initially presenting with intraventricular hemorrhage, with concomitant ischemic heart disease.

A Case of Acute Lithium Intoxication Treated with Continuous Venovenous Hemodiafiltration / 대한신장학회지

Lithium is commonly used for the treatment of bipolar affective disorders. Lithium therapy has a narrow therapeutic window, which can lead to various neurologic, cardiovascular, and renal side effects. Dialysis is recommended for the treatment of severe lithium toxicity, but conventional hemodialysis can cause post-dialysis rebound of serum lithium level. We report a case of lithium intoxication in which continuous venovenous hemodiafiltration (CVVHDF) was successfully used in reducing toxicity. CVVHDF provides excellent lithium clearance, and prevents post-therapy lithium rebound by allowing a progressive removal of intracellular lithium. It could become a modality of choice for lithium intoxication.

Actinobacillus actinomycetemcomitans Indeces Apoptosis of Jurkat Cell Line Through the Cleavage of Poly (ADP-ribose) Polymerase

No abstract available.

Identification of a Lymphocyte Mitogenic Factor Produced by Actinobacillus actinomycetemcomitans

Actinobacillus actinomycetemcomitans, a gram-negative, capnophiTic bacterium, is associated with several human diseases including periodontal disease. Products of A. actinomycetemcomitans exert immunomodulatory effects on various lymphoid populations, some of which may be implicated in the pathogenesis of periodontitis. It has been recently suggested that some of periodontopathic bacterial products might possess superantigenic (SAg) activities. In order to examine SAg activity of A. actinomycetemcomitans, we tried to purify immunomodulating factor (IMF) which can induce proliferation of mouse splenocytes and human PBMC. IMF fraction was obtained from the culture supernatant of A. actinomycetemcomitans by alcohol precipitation, ultrafiltration, size exclusion chromatography, and dye ligand affinity chromatography which has been widely used for the puri5cation of known SAgs. SDS-PAGE analysis showed that the factor migrated to a molecular mass of 40 kDa. The concentration of IMF which elicited maximal proliferative response of mouse splenocytes was ranged 1-10 ug/ml of protein on day 3 in culture. Human PBMC gave a similar response profile to IMF, but their maximal response was obtained by lower concentraion of IMF on day 2 in culture. This activity of IMF was heat and proteinase K sensitive and was not blocked by co-incubation with polymyxin B, a ligand for the lipid A region of lipopolysaccharide. T cell-enriched fraction of mouse splenocytes obtained by nylon wool column lost the response to IMF. Even though mitomycin C-treated antigen presenting cells were added to T cell-enriched fraction, the response to IMF was feeble as compared to unfractionated cells. Splenocytes depleted of T cells by anti-Thy 1.2 and complement also did not respond to IMF. These findings demonstrated that T cells are responsible for a minor proportion of the observed proliferation induced by IMF and the help of these cells are essential to the most of the proliferating cells which may be B cells. This observation was confirmed by flow cytometric analysis of responding lymphocyte subpopulations. These results indicate that IMF of A. actinomycetemcomitans does not act in a manner consistent with known SAgs but is more relevant to the explanation of pathologic findings of periodontal lesions.