We report the case of a patient with a hemiparetic stroke whose metatarsalgia was successfully managed by reducing the spasticity of plantar flexor using neurolysis with 20% ethyl alcohol. A 57-year-old female patient with left hemiparesis following an infarct of the right corona radiata and basal ganglia one year previously presented with pain (numeric rating scale: 7) in the forefoot under the second to fourth metatarsal heads for six months. We diagnosed her with metatarsalgia and considered that the forefoot pain was associated with mechanical stress around the metatarsal head due to the spasticity (Modified Ashworth Scale: 1+) of the ankle plantar flexor. We performed neurolysis of the medial and lateral motor branches of the tibial nerve to the gastrocnemius muscle with 20% ethyl alcohol. After the alcohol block, foot pain and spasticity significantly reduced (numeric rating scale: 1; Modified Ashworth Scale: 0). Moreover, this effect persisted for at least three months. Clinicians should consider the possibility that spasticity can contribute to the development of foot pain in a patient with stroke.
Metatarsalgia

No abstract available.
Anxiety* ; Depression* ; Humans ; Inpatients* ; Schizophrenia*

Patients with thalamic lesions can experience ataxia on the contralesional side. We report here a 24 year old female patient who presented with a left thalamic tumor and experienced bilateral ataxia of the upper and lower extremities after a left thalamic resection. Her right-sided ataxia was more severe than that of the left side. The bilateral ataxia was likely to be from cerebellar ataxia. The right-sided ataxia may have been caused by injury of the dentatorubrothalamic tract originating from the dentate nucleus of the right cerebellum and terminating in the contralateral ventrolateral nucleus of the left thalamus. We believe that the left sided ataxia in this patient was due to an uncrossed dentatorubrothalamic tract, which control the movement of the ipsilateral side of the human body.
Ataxia

Objective: : We investigated the effect of hypnotics on sleep quality, cognitive function, and depressive mood in patients with insomnia following brain tumor resection. Methods: : From patients who underwent brain tumor resection, we recruited 10 patients with insomnia who received hypnotics for more than 1 week during a 3-week follow-up period (insomnia group). We also recruited 12 control patients with brain tumors but without insomnia (control group). We evaluated sleep quality at baseline and 3 weeks later using the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), the Stanford Sleepiness Scale (SSS), and the Epworth Sleepiness Scale (ESS) and investigated cognitive function and depression using the Computerized Neuropsychological Test and the Beck Depression Inventory (BDI). Results: : At baseline, SSS, ISI, PSQI, and BDI scores were significantly higher and visual continuous performance test (VCPT) and auditory continuous performance test (ACPT) scores were significantly lower in the insomnia than in the control group. Three weeks later, the patients who had received hypnotics had significantly higher ISI, PSQI, ESS, VCPT, ACPT, visual span forward and backward, and visual recognition test scores, and significantly lower BDI scores. Conclusion : Quality of sleep in patients with insomnia following brain tumor resection was initially poor but improved significantly after taking hypnotic medication. Further, the hypnotic medications appeared to contribute to the amelioration of cognitive impairments and depressive moods in patients who previously underwent brain tumor resection. We thus recommend the use of hypnotics for patients with brain tumors with insomnia.

No abstract available.
Cryptococcosis*

Papillary and solid epithelial neoplasm of the pancreas from five patients were studied using immunohistochemistry and electron microscopy to define the cellular origin of this type of tumor. The tumors ranged in diameter form 5.5 to 15 cm Grossly, these were well circumscribed by a firm, gray-white, fibrous capsule and their cut-surface showed mainly area containing mucinous substance with necrotic and hemorrhagic material, with some solid portion. Microscopically, there was a solid and papillary pattern, with uniform cells typically having round to ovoid nuclei containing indistinct nucleoli and eosinophilic, granular cytoplasm. Within the cytoplasm of the tumor cells, numerous PAS-positive granules were found. Immunostaining was positive for neuron-specific enolase(three of five cases), alpha1-antitrypsin and alpha1-antichymotrypsin(three of five cases) in the solid and papillary portion of the tumor. But no polypeptide hormone immunoreactive cells were present in all cases except for gastrin which showed focally weak positivity in the papillary area. Ultrastructurally, the papillary and solid epithelial neopasm of the pancreas showed evidence of acinar cell differentiation, because in the cell of one observed some zymogen-like granules and presence of annulate lamellae. But also, abundant typical neurosecretory granules were detected in the tumor cells ultrastructurally. Both facts suggested acinar and islet cell differentiation of the tumor. From the these findings, it concluded that papillary and solid epithelial neoplasm of the pancreas may be originated from a primordial cell which will be able to render both endocrine and exocine component.

PURPOSE: To evaluate the MR appearance of the accessory hepatic veins. MATERIALS AND METHODS: The study included 87 consecutive patients for whom abdominal MR images were obtained. The subjects who had liver lesion or hepatic vascular abnormalities were excluded. Couinaud classified accessory hepatic veins into inferior and middle right hepatic veins. Our major interests were evaluation of the incidence, morphology, and location of the accessory hepatic vein. RESULTS: Inferior right hepatic vein was demonstrated in 43 out of 87 patients(49%). The morphology was linear in 35 patients(80.5%), and V-shaped in 8 patients(19.5%). In 40 patients(93%), the inferior right hepatic vein was located in the posteroinferior aspect of the right lobe. Middle right hepatic vein was demonstrated in 7 out of 87 patients(8%). All were single linear in morphology, combined with the inferior right hepatic vein, and located between the right hepatic vein and inferior right hepatic vein. CONCLUSION: The accessory hepatic vein was demonstrated in 49% among the Korean adult population, and was located in posteroinferior portion of the liver, in 93%.
Adult ; Hepatic Veins* ; Humans ; Incidence ; Liver ; Magnetic Resonance Imaging*

The amniotic membrane has some characteristics. First, it does not express the human leukocyte antigens, and therefore immunologic rejection is not a concern. Second, it can be obtained easily and sufficiently. Third, because it has antimicrobial properties, transplantation of the amniotic membrane has fewer risks of post-operative infection. So it is under research for the amniotic membrane transplantation in cases of sterile corneal ulcer, pterygium excision,severe chemical and thermal corneal burns, ocular surface defects, conjunctival surface reconstruction after removal of large conjunctival lesions. We have experienced a good result of amniotic membrane transplantation for the conjunctival defect resulting from conjunctival necrosis, in enucleated eye having undergone scleral graft for scleral necrosis. Therefore, we report this case with a review of the literature.
Amnion* ; Burns ; Corneal Ulcer ; HLA Antigens ; Necrosis* ; Pterygium ; Transplants

Mutation of the p53 tumor-suppressor gene in exons 4 through 9 was examined in 34 cases of primary advanced gastric cancer using PCR-SSCP (polymerase chain reaction-single strand conformation polymorphism) and the results were compared with p53 protein expression as determined by immunohistochemistry (IHC) using a monoclonal antibody(DO-1). p53 protein detected by IHC was observed in 14 cases (41.2%) and genotypic mutation detected by PCR-SSCP in exons 4-9 was observed in 13 cases (38.2%) One case showed an aberrant band on PCR-SSCP both in Exon 7 and Exon 8/9. p53 alteration detected by either IHC or PCR-SSCP was observed in 19 cases (55.9%), but only 8 cases (23.5%) showed both p53 mutation and protein expression. We also tried to obtain the correlation between relative intensity of the shifted bands on PCR-SSCP and percentage of positive cells by IHC, but a significant correlation was not seen between relative intensity of shifted bands on PCR-SSCP and positve cell ratio. A discrepancy between p53 protein expression and p53 mutation is observed in primary gastric carcinomas. The reason for this discrepancy are not apparent. However, examination of gastric carcinomas for mutations in other exons may identify a better correlation with protein overexpression. The results obtained in this study suggest that the negative reaction for p53 immunohistochemistry may not necessarily mean no genetic alteration of the p53 locus.
Exons ; Immunohistochemistry* ; Stomach Neoplasms

OBJECTIVES: We compared the characteristics of the pain threshold and pain experience between demented group and non-demented group. METHODS: This study was part of Gangwon projects for early detection of dementia in 2010. We recruited 8302 local resident ages over 65 years old. Of theses, 1259 people who scored low MMSE were selected and 365 of them completed CERAD-K(Consortium to Establish a Registry for Alzheimer's disease). Finally, 90 in non-demented group and 57 in demented group(mild to moderate Alzheimer's disease) were analyzed. Pain threshold was experimentally measured by pressure algometer and we investigated the pain experience, by Brief pain inventory (BPI), a self-report test. RESULTS: In the demographic characteristics, there are more female, higher ages, lower education in the demented group. There was no significant difference between the two groups in the pain threshold. On the BPI results, 'shoulder pain', 'the number of pain' and 'interference of working' were significantly more prevalent in non-demented group. However, there are no significant differences between the groups in the 'pain severity', 'prevalence of pain' and 'pain treatment'. CONCLUSIONS: Demented group report less pain experience but, still perceived pain. It support previous studies that patient with dementia have increased pain tolerance but preserved pain threshold. Thus, active pain assessment and treatment for patients with dementia is needed.
Aged* ; Dementia* ; Education ; Female ; Gangwon-do ; Humans ; Pain Measurement ; Pain Threshold*