Since the turn of the century surgeons were proposed many procedures for exposure of the hypophysis cerebri of the operations proposed, two pricipal routes have been selected to reach the sella, first the intracranial, and second, the extracranial transsphenoidal. A variety of transnasal approaches have been used to gain access to the sella turcica. Each of these approaches requires crossing the sphenoid sinus, hence the transsphenoidal designation of these methods. Since the growth and refinement of microsurgery as a distinct surgical discipline there has been a coincidental maturation of transsphenoidal microsurgical techniques for the management of the hormone secreting microadenoma. The present paper reviews the historical events leading to the current methods of transsphenoidal pituitary surgery. Detailed descriptions of each method are given, with advantages and disadvantages of each. The author's experience in the management of 2 acromegalic patients with the transethmoidal approach are presented. The purpose of this paper is to focus recount the historical events leading to author's present method of pituitary surgery and to present the advantages and disadvantages as well as a procedural description for the transethmoidal approach to the sella turcicaz.
Acromegaly ; Growth Hormone ; Humans ; Microsurgery ; Pituitary Gland ; Sella Turcica ; Sphenoid Sinus

The stem barks, heartwoods, and leaves of Acer tegmentosum (Aceraceae) are widely used in Korea to treat hepatic or cerebral disorders mainly due to alcohol poisoning. This study was aimed to analyze phenolic substances in A. tegmentosum. Quantitative analysis of the three phenolic substances (salidroside, (+)-catechin and scopoletin) was performed by HPLC and the identification of volatile phenolic substances were done by GC-MS. The contents of the three compounds in the three MeOH extracts were higher in the stem bark (salidroside: 80.22 mg/g, (+)-catechin: 23.31 mg/g, and scopoletin: 9.45 mg/g) compared to the heartwoods and leaves. And GC-MS analysis of the stem bark extract demonstrated that p-tyrosol is a main substance of twenty-one compounds identified.
Acer* ; Aceraceae ; Catechin ; Chromatography, High Pressure Liquid* ; Korea ; Phenol* ; Poisoning ; Scopoletin

PURPOSE: The safety and the feasibility of performing laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy (CRT) have not yet been established. Thus, the aim of this study was to evaluate the efficacy and the safety of laparoscopic rectal cancer surgery performed after preoperative CRT. METHODS: We enrolled 124 consecutive patients who underwent laparoscopic surgery for rectal cancer. Of these patients, 56 received preoperative CRT (CRT group), whereas 68 did not (non-CRT group). The patients who were found to have distant metastasis and open conversion during surgery were excluded. The clinicopathologic parameters were evaluated and the short-term outcomes were compared between the CRT and non-CRT groups. RESULTS: The mean operation time was longer in the CRT group (294 minutes; range, 140 to 485 minutes; P = 0.004). In the non-CRT group, the tumor sizes were larger (mean, 4.0 cm; range, 1.2 to 8.0 cm; P < 0.001) and more lymph nodes were harvested (mean, 12.9; range, 0 to 35; P < 0.001). However, there was no significant difference between the two groups in time to first bowel movement, tolerance of a soft diet, length of hospital stay, and postoperative complication rate. CONCLUSION: Performing laparoscopic surgery for rectal cancer after preoperative CRT may be safe and feasible if performed by a highly skilled laparoscopic surgeon. Randomized controlled trials and long-term follow-up studies are necessary to support our results.
Chemoradiotherapy ; Diet ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Neoplasm Metastasis ; Postoperative Complications ; Rectal Neoplasms

The three flavone glycosides, 4′-O-methylisoscutellarein 7-O-(6‴-O-acetyl)-β-D-allopyranosyl(1→2)-β-D-glucopyranoside (1), isoscutellarein 7-O-(6‴-O-acetyl)-β-D-allopyranosyl(1→2)-β-D-glucopyranoside (3), and isoscutellarein 7-O-β-D-allopyranosyl(1→2)-β-D-glucopyranoside (4) in addition to a flavonol glycoside, kaempferol 3-O-β-D-glucopyranoside (astragalin, 2), were isolated from Stachys japonica (Lamiaceae). In cholinesterase inhibition assay, compound 1 significantly inhibited aceylcholinesterase (AChE) and butyrylcholinesterase (BChE) activities (IC₅₀s, 39.94 µg/ml for AChE and 86.98 µg/ml for BChE). The content of isolated compounds were evaluated in this plant extract by HPLC analysis. Our experimental results suggest that the flavonoid glycosides of S. japonica could prevent the memory impairment of Alzheimer's disease.
Alzheimer Disease ; Butyrylcholinesterase ; Cholinesterases ; Chromatography, High Pressure Liquid ; Glycosides ; Lamiaceae ; Memory ; Plants ; Stachys

Behcet disease is a chronic systemic inflammatory disease involving mucous membranes, skin, eyes, gastrointestinal tract, joints, vessels, and neurologic systems. The disease usually manifests in early adulthood. Childhood onset is rare. We experienced a case of Behcet disease in a 11-year-old boy. He suffered from recurrent arthritis of the left knee joint which was managed under the impression of septic arthritis since he was seven years old. Behcet disease should be considered in case of recurrent arthritis mimicing septic arthritis in children.
Arthritis* ; Arthritis, Infectious ; Behcet Syndrome* ; Child ; Gastrointestinal Tract ; Humans ; Joints ; Knee Joint ; Male ; Mucous Membrane ; Skin

This study aimed to establish the quantitative method to analyze the content of peroxynitrite-scavengers belonging to polyphenols in six Korean Quercus species (Quercus mongolica, Q. dentata, Q. acutissima, Q. alienta, Q. serrata, and Q. variabilis) by HPLC. The twelve peroxynitrite-scavengers, flavanols (catechins: (+)-catechin, (−)-epicatechin, and (−)-epigallocatechin), flavonols (kaempferol and quercetin), flavonol glycosides (astragalin, quercitrin, and isoquercitrin), flavonol acylated glycosides (astragalin 6″-gallate and isoquercitrin 6″-gallate), gallic acid and its dimer (ellagic acid) were analyzed by HPLC. Further, anti-Alzheimer's activity was assayed in a passive avoidance testusing mice by measuring the retention latency (sec), the concentration of acetylcholine (ACh), and acetylcholinesterase (AChE) activity. Simultaneous analysis of the extracts of the six Quercus leaves was achieved on a Capcell C18 column (5 µm, 250 mm × 4.6 mm i.d.) with a gradient elution of 0.05% HAc and 0.05% HAc in CH₃CN. In the extract of Q. mongolica leaves, the content of gallic acid (32.53 mg/g), (+)-catechin (28.78 mg/g), (−)-epicatehin (22.03 mg/g), astragalin 6″-gallate (20.94 mg/g), and isoquercitrin 6″-gallate (44.11 mg/g) and peroxynitrite-scavenging activity (IC₅₀, 0.831 µg/ml) were high. This extract delayed the retention latency and inhibited acetylcholinesterase activity in scopolamine-induced memory impairment of mice, suggesting that it has anti-Alzheimer's activity.
Acetylcholine ; Acetylcholinesterase ; Animals ; Catechin ; Chromatography, High Pressure Liquid* ; Fagaceae ; Flavonols ; Gallic Acid ; Glycosides ; Memory ; Methods ; Mice ; Phenol* ; Polyphenols ; Quercus*

Caryopteris incana (Verbenaceae) has been used to treat cough, arthritis, and eczema in Oriental medicine. The two fractions (CHCl₃- and BuOH fractions) and the essential oil of the plant material were subjected to the inducible nitric oxide synthase (iNOS) assay. The IC₅₀ of the CHCl₃ fraction and the essential oil on LPS-induced macrophage RAW 264.7 cells were 16.4 µg/mL and 23.08 µg/mL, respectively. On gas chromatography (GC)-mass spectroscopy (MS) analysis, twenty-five components representing 85.5% amount of total essential oil were identified. On the chromatogram, three main substances, trans-pinocarveol, cis-citral, and pinocarvone, occupied 18.8%, 13.5% and 18.37% of total peak area. Furthermore, by HPLC-UV analysis, six compounds including one iridoid (8-O-acetylharpagide)- and five phenylethanoid glycosides (caryopteroside, acteoside, phlinoside A, 6-O-caffeoylphlinoside, and leucosceptoside A) isolated from the BuOH fraction were quantified. The content of six compounds were shown as the following order: caryopteroside (162.35 mg/g) > 8-O-acetylharpagide (93.28 mg/g) > 6-O-caffeoylphlinoside (28.15mg/g) > phlinoside (22.60mg/g) > leucosceptoside A (16.87 mg) > acteoside (7.05 mg/g).
Arthritis ; Chromatography, Gas ; Chromatography, High Pressure Liquid ; Cough ; Eczema ; Glycosides ; Macrophages ; Medicine, East Asian Traditional ; Nitric Oxide Synthase Type II ; Nitric Oxide Synthase ; Nitric Oxide ; Plants ; RAW 264.7 Cells ; Spectrum Analysis ; Verbenaceae

Skeletal muscle atrophy is a common phenomenon during the prolonged muscle disuse caused by cast immobilization, extended aging states, bed rest, space flight, or other factors. However, the cellular mechanisms of the atrophic process are poorly understood. In this study, we investigated the involvement of mitogen-activated protein kinase (MAPK) in the expression of muscle-specific RING finger 1 (MuRF1) during atrophy of the rat gastrocnemius muscle. Histological analysis revealed that cast immobilization induced the atrophy of the gastrocnemius muscle, with diminution of muscle weight and cross-sectional area after 14 days. Cast immobilization significantly elevated the expression of MuRF1 and the phosphorylation of p38 MAPK. The starvation of L6 rat skeletal myoblasts under serum-free conditions induced the phosphorylation of p38 MAPK and the characteristics typical of cast-immobilized gastrocnemius muscle. The expression of MuRF1 was also elevated in serum-starved L6 myoblasts, but was significantly attenuated by SB203580, an inhibitor of p38 MAPK. Changes in the sizes of L6 myoblasts in response to starvation were also reversed by their transfection with MuRF1 small interfering RNA or treatment with SB203580. From these results, we suggest that the expression of MuRF1 in cast-immobilized atrophy is regulated by p38 MAPK in rat gastrocnemius muscles.
Aging ; Animals ; Atrophy ; Bed Rest ; Fingers ; Imidazoles ; Immobilization ; Muscle, Skeletal ; Muscles ; Myoblasts ; Myoblasts, Skeletal ; p38 Mitogen-Activated Protein Kinases ; Phosphorylation ; Protein Kinases ; Pyridines ; Rats ; RNA, Small Interfering ; Space Flight ; Starvation ; Transfection

Bone Marrow Cells ; Dexamethasone ; Mandible ; Osteoblasts ; Osteogenesis ; Platelet-Rich Plasma ; Rabbits ; Silver Nitrate

BACKGROUND: To maximize the histological advantage and minimize the physiological disadvantage, we have been using the skeletonized gastroepiploic artey (GEA) as a free graft for total arterial revascularization. The aims of the current study was to assess the efficacy of the skeletonized GEA as a composite or extended graft for total arterial revascularization. MATERIAL AND METHOD: Between January 2000 and Feburary 2005, 133 patients (43 female, mean age=61.8 yrs) undergoing coronary artery bypass grafting (CABG) with a skeletonized GEA as free graft (22 extended, 107 composite and 4 others) were enrolled in this study. Coronary angiograms were performed in the immediate (median 14 days, n=86), early (median 366 days, n=56) and midterm (median 984 days, n=29) postoperative periods. RESULT: There were 3 (2.2%) early and 4 (3.3%) late cardiac-related deaths. The mean number of distal anastomoses per patient was 3.34 for total graft and 1.92 for GEA graft. The immediate, early, and midterm GEA patency were 157/159 (98.7%), 106/112 (94.6%), and 53/56 (94.6%), respectively. During follow-up, four patients required percutaneous intracoronary intervention because of GEA and target coronary artery stenosis or competitive flow. CONCLUSION: These data demonstrate satisfactory clinical and angiographic results in the skeletonized GEA as free graft for total arterial revascularization. Although we need a careful longer follow-up, the skeletonized GEA as a free graft will be a valuable option 'to be' for CABG.
Coronary Artery Bypass* ; Coronary Stenosis ; Coronary Vessels* ; Female ; Follow-Up Studies ; Gastroepiploic Artery* ; Humans ; Postoperative Period ; Skeleton* ; Transplants*