BACKGROUND: This study aimed to evaluate the abilities of transcranial magnetic stimulations(TMS) and electrical stimulations(ES) in predicting clinical recovery in patients with Bell's palsy and to contribute to the understanding of the relations observed between the clinical and electrophysiological time courses of the disease. METHOD: We serially studied 22 patients(9 males, mean age 42) with Bell's palsy. Facial nerve function was graded according to the House-Brackmann grading system. RESULTS: A side-to-side comparison(amplitude ratio) of the amplitude of evoked responses between the initial and follow up studies showed a significant change except for the TMS on the stylomastoid foramen. With the TMS over the parieto-occipital area, the absence of a compound muscle action potential(CMAP) was observed in 19 patients during the early course of the disease. The reappearance(n=14) of evoked muscle potentials after an initial absence was observed in 14 patients with satisfactory recoveries at the last follow-up study. The amplitude ratio of ES and TMS during the early course of the disease correlated with the clinical outcome. CONCLUSIONS: Our findings indicate that TMS and ES can provide an early prediction for the outcome of the palsy. The presence of CMAP at the acute phase or the reappearance of CMAP after an initial absence with TMS suggests a rather good prognosis. Both TMS and ES were found to be useful methods for the assessment of facial palsy and as early predictors for the outcome in patients with Bell's palsy. Serial neurophysiologic studies were also important for evaluation of the prognosis of facial palsy.
Bell Palsy* ; Electric Stimulation ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Male ; Paralysis ; Prognosis* ; Transcranial Magnetic Stimulation

The existence of NMDA receptor and a new organizer protein, Shank, in the postsynaptic density was studied with the cultured hippocampal neurons using by double immunofluorescence method. The hippocampi from embryonic 18 days were dissected and hippocampal neurons were obtained from dissociated hippocampi with 0.25% trypsin and 0.1% DNase in PBS. The hippocampal neurons were plated with density 3,600/cm2 on the poly-L-lysine coated coverglass and cultured 37degrees C, 5% CO2 incubator for 5 weeks. The N2 supplemented MEM was used as a culture medium. Following results are obtained from experiments: 1. The 3~5 minor processes from the cell body of hippocampal neurons were observed at 20 hr in vitro. One of the minor processes was elongated and looked like an axon, and another minor processes showed dendritic branching pattern with slender in thickness. 2. The excitatory NMDA receptor colocalized with PSD-95 which is the postsynaptic density protein. The presynaptic protein, synapsin 1, was closely apposed with PSD-95. 3. Shank which is an organizer protein colocalize with NMDA receptor/PSD-95 complex in the postsynaptic density. Shank proteins may be concerned with the cluster formation of NMDA receptor/PSD-95 in the postsynaptic membrane.
Axons ; Deoxyribonucleases ; Fluorescent Antibody Technique ; Immunohistochemistry ; Incubators ; Membranes ; N-Methylaspartate* ; Neurons* ; Post-Synaptic Density ; Trypsin

Polaris, which is encoded by Tg737 gene, has been associated with cilia formation. Recently pheno-types of ventral neural tube in mice who have abnormal cilia formation have been reported to be similar with those of sonic hedgehog (Shh)signaling mutants. These interesting findings lead us to further examine the patterning of ventral neural tube in Tg737(oprk) mice. In this study, we found that motor neuron and V2 interneuron were preserved whereas P3 progenitor domain and floor plate were missing in Tg737(oprk) mutant. V2 and motor neurons in Tg737(oprk) were ventralized and ixed with each other. Nkx6.1 and Olig2 expressions were preserved and the Olig2 expression was ventralized in Tg737(oprk). These penotypes are quite similar with those in Shh(-/-); Gli3(-/-) or Gli2(-/-) ; Gli3(-/-) mutants, suggesting that the function of Polaris might be involved in Shh signaling.
Animals ; Cilia ; Hedgehogs ; Interneurons ; Mice ; Motor Neurons ; Neural Tube*

University Sonic hedgehog (Shh) signaling has been shown to play instructive roles in developing spinal cord. Depending on the Shh concentration gradient, different progenitor domains and ventral neurons are induced. However, the way how the Shh gradient is translated into different progenitor domains, is not clear. To investigate the translation of the Shh gradient, we studied expressions of homeoproteins which are critical for establishment of progenitor domains, in the ventral neural tube of Shh(-/-)and Shh(-/-);Gli3(-/-) mutants, using in situ hybridization. In Shh(-/-) mutant, the expressions of class II homeoproteins (Nkx6.1, Nkx6.2, Olig2, Nkx2.2 were totally repressed. The expressions of class I homeoproteins (Dbx1, Dbx2, Irx3, Pax6 were ventralized. In Shh(-/-);Gli3(-/-) mutant, the expressions of class II homeoproteins except Nkx2.2 were restored. The expressions of class I home-oproteins were restored to its original position although their restoration is not complete. From above results, we conclude that Gli3 can regulate the expressions of class II homeoproteins, which suggests that the Shh gradient will be translated into Gli activity in the developing spinal cord.
Hedgehogs ; Homeodomain Proteins ; In Situ Hybridization ; Neural Tube ; Neurons ; Spinal Cord*

Essential roles of Gli3 in ventral neural tube have been stressed from studies of Shh(-/-) and Shh(-/-); Gli3(-/-) mutants. However, roles of Gli3 in dorsal neural tube have not been fully appreciated despite of its high expression. To find out roles of Gli3 in dorsal neural tube, we studied cell proliferation and neuronal differentiation in dorsal neural tube of Gli3(-/-) mutant. In Gli3(-/-) mutant, proliferation of progenitor cells in dorsal neural tube is increased compared to wild type embryos based on phosphohistone 3 immunohistochemistry and BrdU experiment. The appearances of HuC/D positive and Isl1 postive cells which represent postmitotic neurons and dI3 interneurons were delayed in Gli3(-/-) mutant compared to wild type embryo. The appearance of a proneural gene, Ngn2 was also delayed in Gli3(-/-) mutant compared to wild type embryo. Neuronal differentiation of progenitor cells in dorsal neural tube was delayed in Gli3(-/-) mutant compared to wild type embryos based on HuC/D, Isl1 and Ngn2 expressions. These results suggest that Gli3 plays important roles in cell proliferation and neuronal differentiation in dorsal neural tube. Thus our data shed a new light on the role of Gli3 in the development of neural tube.
Bromodeoxyuridine ; Cell Proliferation ; Embryonic Structures ; Immunohistochemistry ; Interneurons ; Neural Tube* ; Neurons ; Stem Cells

BACKGROUND: Focal or segmental dystonic syndromes affecting cranial or upper limb muscles are well recognized. Restricted dystonic movements affecting axial muscle group are less common. Restricted involuntary movements of body parts such as ear and trunk which are not normally affected in isolation by movement disorders have been reported. Despite their unusual locations, the clinical and neurophysiologic characteristics of the movements were similar to dystonia and they were classified as focal dystonia. CASE: We report four patients who have focal dyskinesia affecting ear and abdomen. In two patients, dyskinesia affecting the ear developed after head or facial trauma and in the other two cases, dyskinesia affecting the abdomen occurred after surgical operation. The unusual locations and appearance distinguish these dyskinesias from recognized movement disorder syndromes. CONCLUSION: The characteristic features of these dyskinesia led us to classify it as dystonia. We'd like to underline that dystonia can affect any part of the body and peripheral factors may play a role in pathogenesis of the dystonia.
Abdomen* ; Dyskinesias* ; Dystonia ; Dystonic Disorders ; Ear* ; Head ; Human Body ; Humans ; Movement Disorders ; Muscles ; Upper Extremity

No abstract available.
Hepatocyte Growth Factor* ; Hepatocytes* ; Placenta* ; Pre-Eclampsia*

Primary hyperparathyroidism is rarely encountered during pregnancy but its prompt diagnosis and treatment if encountered during pregnancy is important because it can carry considerable morbidity not only for the mother but also for the fetus. It tends to remain undiagnosed because 50~80% of the patients are asymptomatic. Even if they do demonstrate symptoms, those are often nonspecific. The other reason for non-diagnosis is masking of hypercalcemia due to the change of calcium homeostasis during pregnancy. Neonatal tetany can be a clue for the presence and diagnosis maternal hyperparathyroidism. The asymptomatic patient who is diagnosed postpartum when her newborn is symptomatic should undergo elective parathyroidectomy to avoid future complication. We experienced a woman with undiagnosed primary hyperparathyroidism during pregnancy whose two children suffered neonatal tetany. We report this case along with a review of literature on primary hyperparathyroidism in pregnancy and calcium homeostasis during pregnancy.
Calcium ; Child ; Diagnosis ; Female ; Fetus ; Homeostasis ; Humans ; Hypercalcemia ; Hyperparathyroidism* ; Hyperparathyroidism, Primary ; Infant, Newborn ; Masks ; Mothers ; Parathyroidectomy ; Postpartum Period ; Pregnancy* ; Tetany*

PURPOSE: We analyzed the clinical and radiologic results after arthroscopic reconstruction of the posterior cruciate ligament and posterolateral rotatory instability using fresh frozen Achilles tendon allograft. MATERIALS AND METHODS: Nine patients (10 cases) were evaluated. Male was 8 and female 1. Mean age was 38.4 years (23~59) and interval after trauma was 12.4 months (3~25 mo). Mean follow-up period was 14 months (12~21 mo). Posterior cruciate ligament was reconstructed with arthroscopic transtibial, single bundle technique and posterolateral rotatory instability with figure of "8" method using fibular tunnel. Clinical evaluation was done using posterior drawer test, posterolateral drawer test, varus stress test, prone external rotation (dial) test and range of motion. Functional evaluation was done by Lysholm knee score and Tegner activity scale. RESULTS: 90% of cases showed improvement to grade I by posterior drawer and to normal by posterolateral drawer, varus stress and dial test. One case showed flexion limitation more than 10degrees compared to opposite knee. Lysholm knee score and Tegner activity scale have been improved from mean 48.5 and 2.1 preoperatively to mean 80.2 and 4.5 postoperatively (p<0.05). Posterior drawer stress radiographs showed the improvement from mean 17 mm to 4.2 mm(p<0.05). CONCLUSION: Successful results were obtained by combined reconstruction of the posterior cruciate ligament and posterolateral rotatory instability with fresh frozen Achilles allograft.
Achilles Tendon* ; Allografts* ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Knee ; Male ; Posterior Cruciate Ligament* ; Range of Motion, Articular

Objectives: This study evaluates soft tissue changes of the upper lip and nose after maxillary setback with orthognathic surgery such as Le Fort I or anterior segmental osteotomy. Materials and Methods: All 50 patients with bimaxillary protrusion and skeletal Class II malocclusion underwent Le Fort I or anterior segmental osteotomy with backward movement. Soft and hard tissue changes were analyzed using cephalograms collected preoperatively and 6 months postoperatively. Results: Cluster analysis on the ratios shows that 2 lines intersected at 4 mm point. Based on this point, we divided the subjects into 2 groups: Group A (less than 4 mm, 27 subjects) and Group B (more than 4 mm, 23 subjects). Also, each group was divided according to changes of upper incisor angle (≥4°=A1, B1 or <4°=A2, B2). The correlation between A and B groups for Aʼ/ANS and Ls/Is (P<0.001) was significant; Aʼ/A (P=0.002), PRN/A (P=0.043), PRN/ANS (P=0.032), and St/Is (P=0.010). Variation of nasolabial angle between the two groups was not significant. There was no significant correlation of vertical movement and angle variation. Conclusion The ratio of soft tissue to hard tissue movement depends on the amount of posterior movement in the maxilla, showing approximately two times higher rates in most of the midface when posterior movement was greater than 4 mm. The soft tissue changes caused by posterior movement of the maxilla were little affected by angular changes of upper incisors. Interestingly, nasolabial angle showed a different tendency between A and B groups and was more affected by incisal angular changes when horizontal posterior movement was less than 4 mm.