Implications of Mechanical Endovascular Thrombectomy for Acute Basilar and Posterior Cerebral Artery Occlusion

OBJECTIVE: Protocols for posterior circulation ischemic stroke have not been established by randomized clinical trials. Mechanical endovascular thrombectomy (MET) devices are evolving, and many of these devices already developed or in development are suitable for posterior circulation MET. MATERIALS AND METHODS: We investigated the medical records of patients who underwent MET for posterior circulation ischemic stroke from January 2012 to August 2016. Fifteen patients were included. MET was performed in patients with or without injected intravenous tissue plasminogen activator. MET was considered in patients with a National Institute of Health Stroke Scale score of 4 or more, older than 18 years, with definite occlusion of the basilar artery or posterior cerebral artery (PCA), and who arrived at the hospital within 24 hours from onset. RESULTS: The direct catheter aspiration technique was used in five cases, and the stent retrieval technique was used in seven cases. The stent retrieval technique with the direct aspiration technique was used in three cases. Recanalization failed in two cases. Basilar occlusion without PCA involvement is the only effective factor of successful recanalization (p = 0.03). Successful recanalization (p = 0.005) and the presence of a posterior communicating artery (p = 0.005) affected the good outcome at discharge. CONCLUSION: An early diagnosis and active MET may improve the patient outcome. MET may help recanalization and good flow restoration and the potential for a good outcome.

Intraventricular Hemorrhage Long after Successful Encephaloduroarterio Synangiosis in Moyamoya Patient

Intraventricular hemorrhage long after successful encephaloduroarterio synangiosis (EDAS) is very rare. The effect of revascularization surgery for preventing hemorrhagic event of moyamoya disease remains controversial. We report a 17-year-old female with intracerebral hemorrhage and intraventricular hemorrahge 10 years after successful EDAS. Even though cerebral vessels angiography showed good collateral circulations without specific weak points, a cerebral hemorrhage could occur in patient with ischemic type of moyamoya disease long after successful indirect bypass operations. Good collateralization of cerebral angiography or magnetic resonance perfusion image after indirect bypass surgery would ensure against ischemic symptoms, not a hemorrhage. And, thus a life-time follow-up strategy might be necessary even if a good collateral circulation has been established.

Analysis of clinical characteristics of cornual pregnancy / 대한산부인과학회지

OBJECTIVE: To determine the efficacy of ultrasonogram in the detection of cornual pregnancy and the factors that might be affected on early diagnosis. METHOD: We studied 26 cases which were diagnosed as a cornual pregnancy from Jan, 1, 2000 to Dec, 31, 2004 at department of Obstetrics and Gynecology, St. Vincent's Hospital, the Catholic University of Korea. We compared two groups about clinical characteristics and outcomes. One group (A group) was diagnosed as cornual pregnancy before beginning of treatment, another group (B group) was not diagnosed as cornual pregnancy until operation. RESULTS: A group was 8 cases (30.8%) and B group was 18 cases (69.2%). There were no significant differences in age (33.0+/-6.21 years : 31.0+/-5.82 years), duration of amenorrhea (7.32+/-1.07 weeks : 8.90+/-5.44 weeks), previous cesarian section history (25.0% : 27.8%), present myoma (12.5% : 11.1%) and abdominal pain (50% : 77.78%), vaginal bleeding (50% : 55.6%), shock (0% : 27.8%) between two groups. There were significant differences in parity (1.63+/-0.74 : 1.0+/-0.77, p=0.032), number of abortions (2.25+/-1.16 : 1.11+/-1.18, p=0.016), previous history of ectopic pregnancy (37.5% : 0%, p=0.022). Of the method of treatments, only cornual resection (50% : 94.4%) showed significant differences between two groups. CONCLUSION: 30.8% of cornual pregnancy was early diagnosed by ultrasonogram. The important early detective factors for cornual pregnancy might be parity, previous ectopic pregnancy history and abortion history. Therefore if the patient has the previous ectopic pregnancy and abortion history, she can visit early to the hospital and the doctors do pay attention to the possibility of cornual pregnancy.

Comparison of Cotinine Excretion in Schizophrenics and Normal Controls / 대한정신약물학회지

OBJECTIVES: The prevalence of smoking in schizophrenic patients (74-92%) is higher than that of all psychiatric patients (34-54%) or general population (30-35%). This higher smoking Prevalence is demonstrated even after controlling for known confounders, such as marital status, alcohol use, and socioeconomic status. This study was conducted to determine whether there would be any difference in nicotine intake and metabolism between schizophrenics and normal controls. METHODS: Sixteen schizophrenic patients and sixteen normal controls were collected. All subjects were supplied with a pack of cigarette a day. Urinary cotinine excretion was measured by using gas chromatographic mass spectrometric method. RESULTS: Cotinine excretion was significantly increased in schizophrenic patients compared to normal controls (p<0.05). None of variables such as age at initial smoking, the average number of cigarettes at initial smoking, pack year (packs daily smoked x smoking year), abstinence history were found to influence cotinine levels when examined via the ANOVA, even when the interaction with diagnosis was considered. CONCLUSION: This result suggests that nicotine intake and consumption are increased in schizophrenic patients compared to normal controls, which can be an attempt to improve sensory inhibition and counteract neuronal effect of antipsychotic medications.