No abstract available.
Base Sequence* ; DNA* ; Internet* ; Sequence Analysis, DNA*

No abstract available.
Multiple Myeloma* ; Oncogene Proteins* ; Oncogenes* ; Proliferating Cell Nuclear Antigen*

BACKGROUND: In epidermolysis bullosa acquisita, it has been recognized that there exists heterogeneity in the clinical and serologic/immunopathologic features. OBJECTIVE: We examined patients with epidermolysis bullosa acquisita to see if there were any associated clinical and serological features which may predict disease activity or prognosis in the disease. METHODS: Clinical and some serologic features were compared. between 2 groups of patients with epidermolysis bullosa acquisita; one with complete remission of the symptoms and signs of the disease for more than 2 years and the other group with persistent disease activities of longer than 5 years.
Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Humans ; Population Characteristics ; Prognosis

No abstract available.
Multiple Myeloma* ; Osteosclerosis*

After the introduction of the surgical microscope, microsurgical direct intracranial approach became a standard technique for the treatment of ruptured intracranial aneurysms with satisfactory results. Nevertheless, aneurysms of the anterior communicating artery present particular difficulties, because of their critical location, prevalence of local vascular anomalies, serious circulatory disturbances of the perforating vessels after the rupture of the aneurysm or vasospasm, and their marked tendency to fatal recurrent hemorrhage. The authors analyzed 102 cases of anterior communicating artery aneurysms surgically treated in the Department of Neurosurgery, Yonsei University Hospital from 1971 throught August 1981. Of the 102 cases, 84 operations were performed by microsurgical pterional approach. The analysis and evaluation was made with particular emphasis on the microsurgical treatment. The results of analysis were summarized as follows. 1) The anterior communicating artery aneurysms ruptured most frequently in the 5th decade(37.2%), and 81.7% of the patients were in their 30s to 50s. Anterior communicating artery aneurysms were more common in men than women(60:42). 2) Presenting symptoms and signs of rupture of the anterior communicating artery aneurysms were headache(98.6%), stiff neck(95.1%), brief lapse of consciousness(83.4%), vomiting(81.8%), hypertension(41.6%), and impaired conscious level(34.3%). 3) The prechiasmatic projection of the anterior communicating artery was slightly mjore frequent than the interhemispheric projection(43:39) in our series. The aneurysms were fed by the left anterior cerebral artery in 55.9% and by the right in 33.3%. Angiographic vasospasm was noted in 45.1% and the incidence of the multiple aneurysm was 8.8%. 4) The brain CT scan showed subarachnoid hemorrhage in 47.3%, hydrocephalus in 43.7%, and cerebral infarction in 27.3%. The aneurysms appeared as enhancing small lesions when the diameter of the aneurysm was larger was larger than 10mm. The actual size of the giant aneurysm was measured more precisely with the CT scan than by the angiogram. 5) Patients in Botterell's Grade I and II occupied 70.2% of the microsurgically treated cases. Majority of cases(82.1%) were operated in the second to fourth weeks after the last bleeding. 6) All of the 84 microsurgically treated cases were operated by pterional approach, and the gyrus rectus resection was frequently performed. Clipping of the aneurismal neck was possible in 82.1% of the series. 7) Fourteen cases of postoperative vasospasm, 4 cases of intracranial hematoma, and 7 cases of serious electrolyte imbalance were found as the major postoperative complications. Four patients died of these major complications. 8) Operative mortality of the microsurgical pterional approach was 4.8% and the morbidity 5.9%. Mortality rate of 9 premature rupture cases was 11.1%. Among the 18 cases which were operated on without the aid of microscope before 1975, the mortality rate was 16.7%, and the morbidity, 44.4%.
Aneurysm ; Anterior Cerebral Artery ; Arteries ; Brain ; Cerebral Infarction ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Neck ; Neurosurgery ; Postoperative Complications ; Prevalence ; Rupture ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

Two major factors, delayed hypoperfusion and membrane failure influence the sequelae of cerebral ischemic injury. Calcium ions play a major role in both pathophysiological mechanisms. Calcium channel blockers are a logical choice for investigation as possible therapeutic agents for the treatment of cerebral ischemia. Nimodipine, a dihydropyridine derivative, is one of the most potent calcium channel blocking agent with a selective action on the intracranial vessels. The present study was designed to test the effects of nimodipine on focal cerebral ischemia in rats. At 1,2 or 6 hours after occlusion of the middle cerebral artery(MCA), rats were treated with either nimodipine or saline. Neurological and pathological evaluation was performed at 24 hours after occlusion. Neurological outcome was better in nimodipine-treated rats and the size of the infarcted area was statistically smaller in rats treated with nimodipine 1,2 or 6 hours after occlusion(P<0.001, P<0.001, P<0.001, respectively) when compared with control rats(MCA occlusion only) or saline-treated rats. The results show that nimodipine improves neurological outcome and decreases the size of infarction after ischemic insult. The mechanism of action of nimodipine is not fully understood but nimodipine could influence cerebral postischemic changes by improving blood flow and/or by a direct action on neurons.
Animals ; Brain Ischemia* ; Calcium ; Calcium Channel Blockers ; Calcium Channels ; Infarction ; Ions ; Logic ; Membranes ; Neurons ; Nimodipine* ; Rats

The authors report their experience with 73 cases of unruptured cerebral aneurysms in a consecutive series of intracranial microsurgery for 380 cerebral aneurysms in 307 patients from September, 1975 through March, 1984. Multiple, symptomatic, and incidental aneurysms are included in this group of 73 unruptured aneurysms. There was no mortality among fifty nine of these cases who had surgery. The only morbidity was due to massive postoperative vasospasm in a patient with multiple aneurysms, that developed on the site of ruptured aneurysm. Discussed in this report are characteristics of three categories of unruptured cerebral aneurysm patients and the principles of the management of unruptured aneurysms. In conclusion, all symptomatic unruptured aneurysms should be clipped immediately upon definite diagnosis, while decision for the operation of multiple unruptured aneurysms and aneurysms detected incidentally should be made with discretion by the surgeon.
Aneurysm ; Aneurysm, Ruptured ; Diagnosis ; Humans ; Intracranial Aneurysm* ; Microsurgery ; Mortality

The authors have reviewed and analyzed 105 cases of unruptured cerebral aneurysms in 94 patients from the medical records of 407 patients who had aneurysm sugery consecutively since the advent of microsurgery at the Department of Neurosurgery of Yonsei University. This study was done to define the clinical characteristics of intact intracranial aneurysms and to determine the principles of their management. There was no surgical mortality among 75 cases of intact intracranial aneurysms in 68 patients. Two cases of morbidity were not directly related to the surgery of intact aneurysms. As a result of the analysis of the cases, it was concluded that all symptomatic aneurysms should be treated immediately after the diagnosis, because they tend to be large in size and prone to rupture. If asymptomatic multiple unruptured aneurysms are accessible during surgery for a ruptured aneurysm, they should be treated at the same time. The decision for the treatment of unruptured aneurysms located opposite to ruptured ones or detected incidentally, should be made at the surgeon's discretion. The authors' belief is that intact intracranial aneurysms should be corrected regardless of their size when detected in young patients, in hypertensive patients, in hypertensive patients, or in patients with such high flow lesions as arteriovenous malformation.
Adult ; Aged ; Female ; Human ; Intracranial Aneurysm/surgery* ; Male ; Middle Age ; Postoperative Complications/etiology ; Prognosis ; Subarachnoid Hemorrhage/surgery

Forty-three patients with aneurysmal subarachnoid hemorrhage entered and thirth-three of them completed the Nimodipine trial at the Yonsei University Hospital, under the Study Protocol provided by the Bayer AG, to determine the efficacy of preventing vasospasm as well as to evaluate the tolerability of this calcium channel blocker. Treatment was started within four days of initial bleeding and continued for two weeks. Fixed neurological deficits developed in seven of the 33 patients - four from vasospasm, two from raised intracranial pressure, and one from rebleeding. The incidence of symptomatic vasospasm in the patients treated with Nimodipine was 12.1%, which accounts for about one third of the rate experienced before the Nimodipine treatment at our hospital during the past five years(33.2%). Twenty-five patients were operated on without surgical mortality, and the morbidity rate was 8%. Management outcome became worse in proportion to increasing amount of blood in the basal cistern on initial CT scan. Side effects from the Nimodipine treatment was reversible and insignificant. These results suggest that the calcium antagonist administered to the patients with aneurysmal subarachnoid hemorrhage may reduce the incidence of delayed ischemic deficits.
Aneurysm* ; Calcium ; Calcium Channels ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Intracranial Pressure ; Mortality ; Nimodipine* ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

Pemphgus vulgaris (PV), Bullus pemphigoid (BP), and Epidermolysis bullous acqusita (EBA) are autoimmune bullous dermatoses, characterized by circulating IgG autoantibodies. These antibodies react with antigens located at the intercellular substance (ICS) of epidermis, basement membrane zone (BMZ), and subepidermal anchoring fibril zone (AFZ), respectively. The subclass distribution of IgG autoantibodies, and the properties and degrees of complement fixing activities of these autoantibodies in each of the above diseases have not been well understood. Indirect immunofluorescence and in vitro complement stainings were performed for the titration of subclasses of IgG antibodies and for the immunofluorescence staining reactivities of complement components C3, C4, C5b-9, H, C4bp, and S. Each serum specimen from five cases of PV, five cases of BP. and three cases of EBA was tested. The findings of multistep technique with monoclonal and polyclonal antibodies are as follows : All four subclasses of IgG antibodies were identified at the antigenic sites in these group, however there were some differences in the antibodies titers. In PV and BP the dominant subclass of highest antibody titer was IgG1 and/or IgG4. In EBA only IgG4 was dominant in all three cases. The results of complement component stainings, in most of the cases of PV, showed positive for C3 and C4 but were negative for the other components or inhibitor proteins at the ICS of epidermis. In BP most of the cases revealed positive staining reactivities at the BMZ for C3, C4, C5b-9, H, and C4bp-9 with no staining reactivities for the inhibitor proteins No significant relevancy was found between the titers of complement fixing IgG subclasses and the numbers of positive complement staining reactivities for complement components. The results suggest that the complement system may contribute more strongly to the formation of bullous lesions in BP and EBA than in PV.
Antibodies ; Autoantibodies ; Basement Membrane ; Blister ; Complement Membrane Attack Complex ; Complement System Proteins ; Epidermis ; Epidermolysis Bullosa Acquisita* ; Epidermolysis Bullosa* ; Fluorescent Antibody Technique ; Fluorescent Antibody Technique, Indirect ; Immunoglobulin G ; Pemphigoid, Bullous* ; Pemphigus* ; Skin Diseases, Vesiculobullous