To define if the signs of sacral cord involvement have any predictive values in the behavior of bladder and sphincter function after spinal cord injury, we analysed results of neurologic signs and urodynamic studies from 45 patients with spinal cord injuries. Patients were classified based on the anatomical level (suprasacral vs. infrasacral), and the presence or absence of sacral cord sign (SCS) (bulbocavemous reflex latency time, perineal sense, anal sphincter tone). Urodynamic findings were classified as either detrusor hyperreflexia (DH), detrusor sphincter dyssynergia (DSD), detrusor areflexia (DA) or normal. Results were as follows; 1) Of the 15 suprasacral cord lesioned patients 6 (40%) had DA, of the 30 infrasacral cord lesioned patients 9 (20%) had either DA or DH with DSD. 2) SCS was positive in 16 out of 30 infrasacral, and in 3 out of 15 suprasacral cord lesioned patients. Of the 26 SCS negative patients, suprasacral cord lesioned patients comprised 46%. 3) Of the 30 infrasacral lesioned patients, 21 had DA and 16 had positive SCS. Incidence of positive SCS in the patients with DA was 72%. 4) Incidence of negative SCS with DH or DH+DSD was 100% in suprasacral lesion. But of the 15 suprasacral lesioned patients, 6 had DA and 3 had positive SCS. 5) In all levels of the injury, positive predictive value for the DA in positive SCS was 95%. However, negative predictive value for DA or DA+DSD in negative SCS was only 62%. These results indicate that there were poor correlation between the level of the cord injury and types of urodynamic abnormalities. Also, the correlation of the SCS with anatomical level of the injury was relatively poor. Correlation of the Positive SCS with DA was very significant for both levels of the cord injury; whereas there were poor correlation of the negative SCS with DH or DH+DSD. In conclusion, the positive SCS in itself are thought to be valuable tool in predicting infrasacral lesion and/or detrusor areflexia However, the results of negative SCS may not exclude infrasacral lesion or detrusor areflexia completely. Thus, combination of the sacral cord sign and results of urodynamic evaluation will provide a more precise diagnosis and treatment plan for the patients of spinal cord lesions.
Anal Canal ; Ataxia ; Diagnosis ; Humans ; Incidence ; Neurologic Manifestations ; Reflex ; Reflex, Abnormal ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urodynamics*

No abstract available.
Lasers, Dye* ; Melanosis*

BACKGROUND: Although steroid is one of the most widely used therapeutic measures for brain edema, its effect on brain edema after intracerebral hemorrhage (ICH) remains to be clarified. We performed this study to evaluate the efficacy of high dose methylprednisolone and conventional dose dexamethasone on the development of brain edema after experimental ICH. METHODS: Fifty-four male Sprague-Dawley rats, weighing 350-450 g, were used. ICH was made by stereotaxic injection of autologous arterial blood (0.13ml) into the right caudatoputamen. The animals were divided into three groups (n = 18 each). Group A received intraperitoneal(IP) injection of normal saline at 8-hour interval. Group B received dexamethasone (0.2mg/kg IP 30minutes after blood injection and 0.1mg/kg IP every 8h thereafter). Group C received methylprednisolone (30 mg/kg IP 30 minutes after ICH, 15mg/kg IP at 2 h after initial dose, and every 8h thereafter). We sacrificed the rat after 3 days and the development of brain edema was determined by measuring brain water content. We compared brain water content in each group. RESULTS: Water content of the right hemisphere was slightly lower in the methylprednisolone-treated rats than other groups; mean + S.D. in group A, B, and C was 80.94 + 0.66%, 80.56 + 0.70%, and 80.42 + 0.91%, respectively. However, there was no statistical significance ( p > 0.1) by the ANOVA test. The difference of the mean water contents between the two hemispheres was slightly higher in the saline-treated group than other groups, but without statistical significance ( p > 0.1). CONCLUSION: We could not find any significant reduction of the brain water content in the groups treated with steroid regardless of the doses. Our results do not warrant the popular steroid therapy in patients with ICH.
Animals ; Brain ; Brain Edema* ; Cerebral Hemorrhage* ; Dexamethasone ; Humans ; Male ; Methylprednisolone ; Rats ; Rats, Sprague-Dawley

The Acknowledgements was published incorrectly. The authors apologize for any inconvenience that it may have caused.

The synovium is lined by a layer of intimal cells which have been classified on ultrastructural criteria into type A and B synoviocytes. The functionally important lining cells of the synovium(type A and B synoviocytes) are the subjects of many study but have presented problems with their characterization and microscopical identification. Synovial sarcoma is a distinct and generally recognized soft tissue tumor that its origin still raises controversy. In this study, 12 cases of nonspecifically proliferative and resting human synoviocytes have been obtained from the synovium of knee and hip joints, and 3 cases of synovial sarcoma which have arisen in the left thigh, left buttock and right inguinal region were examined with light microscopy, immunohistochemical observation, and electron microscopy. In light microscopic level, it was difficult to differentiate the type A synoviocytes from type B synoviocytes morphologically. The reactive type B synoviocytes were positive for the protein of cytoskeleton such as pancytokeratin, CK1, CK8, CEA, and vimentin. The resting type B synoviocytes showed positive reactions for pancytokeratin, CK1, and CK8. The markers for the monocytes/histiocytes(CD15, CD68, lysozyme, Al-AT, Al-ACT) were reactive in resting and reactive type A synoviocytes. Also, MHC class II antigen was reactive in type A synoviocytes. Three cases of primary synovial sarcoma were 2 fibrous monophasic and 1 biphasic. Spindle-shaped cell in fibrous monophasic synovial sarcoma showed reactivity for CK7 and pancytokeratin, and epithelial cells (lining the glands) in biphasic synovial sarcoma were reactive for CK 7, pancytokeratin, EMA, and focally CEA, but only spindle cells reactive for vimentin, By electron microscopy, fibrous monophasic synovial sarcoma showed pseudogland formation with intercellular junctions of paired subplasmalemmal density and discontinuous basal lamina. These results suggest that the reactive type B synoviocytes and synovial sarcoma show an aberrant expression of the vimentin and CEA. The expression of CK on the resting and reactive type B synoviocytes and fibrous monophasic and biphasic synovial sarcomas are different. Type A synoviocytes expressing the MHC class II molecule and monocyte/histiocyte markers suggest a member of the mononuclear phagocytic system. The reasons of the aberrant expression of the intermediate filament, vimentin and oncofetal antigen, and CEA in reactively proliferative type B synoviocytes and synovial sarcoma and the different expression of cytokeratin on the resting, reactive type B synoviocyte and synovial sarcoma should be further evaluated.
Basement Membrane ; Buttocks ; Cytoskeleton ; Epithelial Cells ; Hip Joint ; Histocompatibility Antigens Class II ; Humans* ; Immunohistochemistry ; Intercellular Junctions ; Intermediate Filaments ; Keratins ; Knee ; Microscopy ; Microscopy, Electron ; Muramidase ; Sarcoma, Synovial* ; Synovial Membrane ; Thigh ; Vimentin

No abstract available.
Ovarian Neoplasms* ; Survival Analysis*

One hunderd and ten patients who had undergone surgery for lumbar spinal stenosis between March, 1988 and March, 1991 were evaluated in terms of radiological findings, classification, clinical features, coexisting disease and postoperative results. The overall mean age was 60 years, and patients with lateral stenosis were, an average, 11years younger than those with central canal stenosis. There was a high incidence of coexisting disease but its effect on symptoms and disease progression was statistically not significant. Characteristic radiological features were disc height decrease, facet joint hypertrophy, facet joint arthrosis, diffuse bulging disc, and ligamentum flavum hypertrophy, but no significant difference between the sexes was seen Nor were there differences between the symptoms of patients with lateral and central stenosis, though claudication was found mainly in patients with multiple level stenosis. The relief of symptoms by decompressive surgery more significantly successful in lateral than in central stenosis, and the surgical success rate was 74%.
Classification ; Constriction, Pathologic ; Disease Progression ; Humans ; Hypertrophy ; Incidence ; Ligamentum Flavum ; Spinal Stenosis* ; Zygapophyseal Joint

OBJECTIVE: Pregnancy is a major risk factor of thromboembolism, and the patients with preeclampsia (PE) are known to have higher risk of thromboembolic complications than normal pregnant women. D-dimer is a well-established laboratory marker for the screening of venous thromboembolism (VTE), but the concentrations of d-dimer tend to increase physiologically in pregnant women throughout the gestational age. We performed this study to evaluate the clinical significance of d-dimer concentrations in patients with gestational hypertensive disorders (GHD) according to the severity. METHODS: Retrospective cohort study was performed in one institution. Singleton pregnant women with GHD were enrolled, and their antepartum concentrations of d-dimer were measured as a part of routine evaluation for patients suspected with PE. Patients with multiple gestations, rheumatic diseases, autoimmune diseases, or suspected VTE were excluded. A categorization of severity about PE was based on the general criteria. RESULTS: In 73.3% of study population, their d-dimer concentrations exceeded the normal range (>0.55 mg/L). A significantly greater proportion of pregnant women had excessive concentrations of d-dimer in the severe GHD than in the non-severe GHD (89.8% vs. 53.7%; P<0.01). Patients with severe GHD had significantly higher median concentrations of d-dimer than those with non-severe GHD (median [range], 2.00 mg/L [0.11 to 7.49] vs. 0.71 mg/L [0.09 to 5.39]; P<0.01) although their earlier gestational ages of sampling. CONCLUSION: Maternal concentrations of d-dimer were significantly elevated in patients with severe features than those without severe features among those with GHD. Some pregnant women with GHD can have markedly elevated concentrations of d-dimer without any evidence of current VTE.
Autoimmune Diseases ; Biomarkers ; Cohort Studies ; Female ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Mass Screening ; Pre-Eclampsia ; Pregnancy ; Pregnant Women ; Reference Values ; Retrospective Studies ; Rheumatic Diseases ; Risk Factors ; Thromboembolism ; Venous Thromboembolism

No abstract available.
Endometrial Neoplasms* ; Female ; Prognosis*

Pregnancy is rare in women with Cushing's syndrome, as the associated infertility is related to excess cortisol and/or androgen. However, approximately 100 such cases have been reported, with 50% due to an adrenal cortical adenoma. Establishing a diagnosis and cause can be difficult. Clinically, striae, hypertension and gestational diabetes are common features in pregnancy, with hypertension and diabetes being the most common signs of Cushing's syndrome in pregnant women. Furthermore, biochemically, a normal pregnancy is associated with a several fold increase in plasma cortisol, as the increased cortisol production rate also increases the cortisol binding protein. Untreated, the condition results in high maternal and fetal morbidity and mortality. An adrenal or pituitary adenoma should be excised, but a metyrapone, which is not teratogenic, has been effective in controlling many cases of excess cortisol. Here, a case of Cushing's syndrome, complicating a pregnancy due to an adrenal cortical adenoma, with thorough obstetric and medical management, including a metyrapone, which was adrenalectomized after delivery, is reported.
Adrenocortical Adenoma ; Carrier Proteins ; Cushing Syndrome* ; Diabetes, Gestational ; Diagnosis ; Female ; Humans ; Hydrocortisone ; Hypertension ; Infertility ; Metyrapone ; Mortality ; Pituitary Neoplasms ; Plasma ; Pregnancy* ; Pregnant Women