A Stable Secondary Gliosarcoma with Extensive Systemic Metastases: A Case Report

A 63-year-old man complained of intermittent motor weakness of his arm. The magnetic resonance image (MRI) of his brain displayed a high signal lesion in right cingulate gyrus on T2 weighted image. One year later, he showed a stuporous mental status with repeated seizures, and the follow-up brain MRI showed heterogeneously enhanced mass associated with bleeding. He was treated with surgery and radiotherapy for secondary glioblastomas in right cingulate gyrus. One year more later, a mass recurred on the left frontal base, and gliosarcoma was diagnosed. After tumor resection, ventriculoperitoneal shunt, chemotherapy, and re-radiation therapy, all brain lesions were stable. Fourteen months after the diagnosis of gliosarcoma, he complained of dyspnea and back pain. Torso positron emission tomography/computed tomography revealed multiple metastatic lesions in both lungs, pericardium, pleura, liver, lymph nodes, and bones, and metastatic gliosarcoma was diagnosed. One month later, the patient died because of the systemic metastases. We present an unusual case of secondary gliosarcoma with stable brain lesions and extensive systemic metastases.

Proteomic Analysis of a Rat Cerebral Ischemic Injury Model after Human Cerebral Endothelial Cell Transplantation

OBJECTIVE: Cerebral endothelial cells have unique biological features and are fascinating candidate cells for stroke therapy. METHODS: In order to understand the molecular mechanisms of human cerebral endothelial cell (hCMEC/D3) transplantation in a rat stroke model, we performed proteomic analysis using 2-dimensional electrophoresis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Protein expression was confirmed by quantitative real-time PCR and Western blot. RESULTS: Several protein spots were identified by gel electrophoresis in the sham, cerebral ischemia (CI), and CI with hCMEC/D3 treatment cerebral ischemia with cell transplantation (CT) groups, and we identified 14 differentially expressed proteins in the CT group. Proteins involved in mitochondrial dysfunction (paraplegin matrix AAA peptidase subunit, SPG7), neuroinflammation (peroxiredoxin 6, PRDX6), and neuronal death (zinc finger protein 90, ZFP90) were markedly reduced in the CT group compared with the CI group. The expression of chloride intracellular channel 4 proteins involved in post-ischemic vasculogenesis was significantly decreased in the CI group but comparable to sham in the CT group. CONCLUSION: These results contribute to our understanding of the early phase processes that follow cerebral endothelial cell treatment in CI. Moreover, some of the identified proteins may present promising new targets for stroke therapy.

Multiple Intracranial High Density Foci after Brain Parenchymal Catheterization / 대한신경손상학회지

OBJECTIVE: To report an observational investigation of small high attenuated foci in computed tomography (CT) scan followed by brain parenchymal catheterization. METHODS: From January 2011 to March 2015, we retrospectively reviewed the 381 patients who had undergone brain catheterization in our clinic and enrolled the patients who had newly developed high attenuation foci in the postoperative CT scans. The brain CT scans were reviewed about the lesion location, Hounsfield Unit (HU) and the time of appearance. RESULTS: Twenty seven of 381 patients had high attenuation foci in CT scans after the procedure. The location of high density lesions was as follows: parenchyma in 9 (33.3%) cases, ventricle in 5 (18.5%), combined in parenchyma and ventricle in 13 (48.1%). The lesions were identified in the catheter tract in parenchymal type, and catheter-lodged frontal horn or choroid plexus in ventricular type. We could not find the calcific foci before the catheter removal, and those were found after removal in all cases. The time of appearance after the removal was variable from 0 to 14 days (mean 4.2, median 3). The regular rules of HU change in CT scans were not found as times go on. CONCLUSION: The high attenuation foci in CT scans were bone dust originated from skull during operation. Although these lesions did not make troubles, we should clean the operation field before the insertion of brain catheter and we may use another material, like Surgicel to seal up the burr hole instead of bone dust in the end of operation.

Problems of Trauma Care and Rate of Preventable Trauma Death in Jeju, South Korea

PURPOSE: This study was undertaken to investigate preventable trauma death and trauma care errors contributing to death on Jeju Island. METHODS: A retrospective study was conducted on all trauma deaths between January 2008 and May 2010 at five emergency departments (ED) in Jeju. Of the 165 deaths, 101 patients included for study after excluding death within one hour or after one week. Injury severity was scored according to the Injury Severity Score (ISS) and survival probability (Ps) was calculated. Trauma care errors were coded to six categories: pre-hospital, ED, operating room, intensive care unit, general ward, and inter-hospital transfer. In addition, system inadequacy, problems in treatment, diagnosis, and procedures were analyzed. Patient records were reviewed independently and preventability was determined by agreement. RESULTS: The preventable death rate was 35.6%, and the mean ISS was 25.25+/-10.78. Of all 149 inappropriate cares, 66.4% contributed to death. Of the 121 treatment-related problems, 88 problems occurred in the ED. Of the 18 system-related problems, 12 were in the pre-hospital phase. Seventy of the 96 problems associated with deaths occurred in the ED, and 12 of 29 problems in the pre-hospital phase. CONCLUSION: The preventable death rate was high. Inappropriate care rendered in the treatment process in the ED and system-related errors in the pre-hospital phase were major contributors to preventable trauma deaths. To reduce preventable deaths, more efforts are required on organizing trauma team management and improving care errors during the pre-hospital and inter-hospital transfer.

Effects of Appropriate Sputum Expectoration on Culture Studies in Emergency Department

PURPOSE: In clinical situations requiring the use or the sputum Gram stain test, the adequacy of specimens is often compromised by improper sample generation by patients. We designed a study to evaluate the effect of good written instruction for sputum expectoration on the outcome of sample adequacy. METHODS: Data were collected from adult patients over age 15 at a tertiary teaching hospital emergency department who had the sputum Gram stain test from October 1 to October 31, 2006. Patients were given carefully written instruction cards for sputum expectoration, together with a bottle of mineral water to gargle before expectoration. Patients' data were compared to a group of patients who visited the same ED during the same month in 2005. RESULTS: The total numbers of sputum tests were 164 in 2006 and 151 in 2005. The number and percentage of adequate specimens increased from 62(44%) in the 2005 patient group to 114(69.5%) in the 2006 patient group (p=0.000). CONCLUSION: By the simple use of properly written instructions for expectoration and of mineral water for oral gargling before sputum expectoration, the adequacy of sputum specimens for testing can be significantly improved.