Temporal lobe epilepsy is characterized by complex partial seizures with either primary intracranial neoplasms or other non-neoplastic lesions. We reviewed 64 cases of surgically resected temporal lobes and amygdalo-hippocampal regions for temporal lobe epilepsy ansed by non-neoplastic lesions to elucidate the incidence and histologic features of each histologic group for a period of 2 years. The patient's age ranged from 12 to 49 years and the ratio of male to female was 42:22. There were 37 cases(57.8%) with single pathology and an additional 20 cases(31.3%) with dual pathology. The emaining 7 cases(10.9%) had no structural alternations. The most common temporal lobe pathology was hippocampal sclerosis in 41 cases(64.1%), diagnosed alone in 21 cases and as dual lesions in 20 cases. The hippocampal neuron loss was most pro,omemt in CA1, followed by CA4, CA3, and CA2. Amygdaloid sclerosis was present in 28 cases(43.8%), lases had 13 dual lesions, 25 cases also had hippocampal sclerosis. The 20 dual lesions showed that 6 cortical dysplasia, 10 microdysgenesis, 1 chronic non-specific inflammatory lesion, and 3 cysticercosis were associated with the various degree of mesial temporal sclerosis. Neuronoglial malformative lesions were identified in 21 cases(32.8%) including 16 dual lesion cases, which composed of 15 microdysgenesis and 6 cortical dysplasia. Neurofilament immunostain for cortical dysplasia revealed abnormally beaded disarray of axons in dysplastic pyramidal cells. The remaining pathologic lesions observed were 1 cysticercosis, 1 chronic non-specific inflammatory lesion, 3 arteriovenous malformation, 2 fibrous nodule, and 1 fibrous adhesions of the arachnoid.
Female ; Male ; Humans ; Incidence

The nuclear accumulation of p53 protein is known to correspond with mutation of p53 tumor supressor gene. To investigate the relationsbip between clinico-pathologic features and expression of p53 mutations, 65 cases of primary cervical carcinoma were analysed by an immunohistochemieal method using monoclonal antibody of p53. Immunostaining demonstrated varioua nuclear stinings of cancer cells in 48.4% of squamous cell carcinoma(51.9% in large cell carcinoma and 25.0% in small cell carcinomas) and 23.5% of adenocarcinoma(p<0.05) No differences in clinical stage and p53 positivity were found. There was no significant correlation between p53 positive cases and status of recurrence. This data suggests that p53 protein is not correlated with the disease progression and prognosis.
Carcinoma, Large Cell ; Cervix Uteri* ; Disease Progression ; Female ; Genes, p53* ; Prognosis ; Recurrence

The revised Mental Health Act, in which the legal status and role of “the committee for the appropriateness of hospitalization” as an administrative committee, which has been launched since June 2017, is discussed. The German and British laws were reviewed in comparison with the Korean laws, focusing on the similarities and differences among the laws and which parts require revision. This study reported that patient care should be considered not only from a constitutional point of view, but also from a health care point of view. Self-determination and medical paternalism are both important but generally incompatible values. In recent days, objective and fair diagnosis from medical experts have been challenging. The current Mental Health Act was inevitably revised to actively accept the decisions of the Constitutional Court and apparently guarantee the basic rights of people in the future. The pros and cons of “the committee for the appropriateness of hospitalization” and which parts need to be revised to perform its role properly as a guardian of the admission procedure are assessed. This should reflect the current reality of the mental health medical community. In addition, a face-to-face examination should be made in principle. Nevertheless, the basic rights of the mentally ill are not guaranteed based on current law because of the shortage of budget and human resources. The final option maybe the introduction of a judicial system on involuntary admission. Legitimacy and professionalism are engagements that should be adhered to when treating psychiatric patients.
Budgets ; Delivery of Health Care ; Diagnosis ; Hospitalization ; Humans ; Illegitimacy ; Jurisprudence ; Mental Health ; Mentally Ill Persons ; Paternalism ; Patient Care ; Professionalism

Purpose: In periprosthetic osteolysis, cytokines, which are secreted from macrophages by the stimulation of particles, up-regulate the signaling for osteoclast activation through RANKL (Receptor activator of Nuclear Factor Kappa-B Ligand). This study compared the reaction to the particles and RANKL in the macrophages by examining the changes in the pro-inflammatory signals. In addition, because erythromycin has an anti-inflammatory effect, the effect of erythromycin on the pro-inflammatory signals by particles and RANKL was also analyzed to clarify the mechanism for the anti-resorptive effect with particles. Materials and Methods: The Raw 264.7 cell line (murine macrophage cell line) was used for these experiments. The particles were made from PMMA (poly-methyl-meth-acrylate) and UHMWPE (ultra high molecular weight polyethylene) to enhance their stimulatory effects. Under the same culture conditions used for macrophages, the cells were treated with either particles or RANKL. The differences in the production of TNF-α, activities of MAP kinase, I-κB and reactive oxygen species (ROS) between the particle and RANKL treated macrophages were examined. The influence of erythromycin on these models was also observed. Results: Erythromycin inhibited ERK and p38 phosphorylation in both models, and suppressed the increase in H2O2 production in the particle-treated macrophages. However, erythromycin inhibited neither the production of TNF- in both models nor the production of H2O2 in the RANKL-treated macrophages. In addition, erythromycin reversed the suppression of I-κB by the particles. Conclusion: For the response of macrophages, erythromycin mainly suppresses the particle induced ROS and NF-κB activation compared with RANKL-induced osteoclastogenesis signaling. Erythromycin might suppress particle-induced osteolysis through these anti-inflammatory effects. Therefore, further studies on the downstream signals of osteoclastogenesis will be needed.
Cell Line ; Cytokines ; Erythromycin* ; Macrophages ; Molecular Weight ; Osteoclasts ; Osteolysis ; Phosphorylation ; Phosphotransferases ; Polymethyl Methacrylate ; Reactive Oxygen Species

Background: The coronavirus disease 2019 pandemic has been challenging the healthcare service, i.e., the vitalization of the point of care accompanying self-testing in vitro diagnostic medical devices (IVDs). This study aims to suggest priority criteria to classify self-testing IVDs using the analytic hierarchy process technique. Methods: Two dimensions of the characteristics embedded in the IVDs and the diseases to be diagnosed with self-testing IVDs were parallelly considered and independently investigated. In addition, three expert panels consisting of laboratory medical doctors (n=11), clinicians (n=10), and citizens (n=11) who have an interest in the selection of self-testing IVDs were asked to answer to questionnaires. Priorities were derived and compared among each expert panel. Results: First of all, ease of specimen collection (0.241), urgency of the situation (0.224), and simplicity of device operation (0.214) were found to be the most important criteria in light of the functional characteristics of self-testing IVDs. Medical doctors valued the ease of specimen collection, but the citizen’s panel valued self-management of the disease more. Second, considering the characteristics of the diseases, the priority criteria were shown in the order of prevalence of diseases (0.421), fatality of disease (0.378), and disease with stigma (0.201). Third, medical doctors responded that self-testing IVDs were more than twice as suitable for non-communicable diseases as compared to communicable diseases (0.688 vs. 0.312), but the citizen’s group responded that self-testing IVDs were slightly more suitable for infectious diseases (0.511 vs. 0.489). Conclusion Our findings suggested that self-testing IVDs could be primarily classified as the items for diagnosis of non-communicable diseases for the purpose of self-management with easy specimen collection and simple operation of devices, taking into account the urgency of the situation as well as prevalence and fatality of the disease.

PURPOSE: As emergency ultrasound (EUS) can improve the management of emergency department patients, education in EUS has become an essential part of emergency medicine resident training. This study examined the efficacy of pediatric EUS education for resident physicians 6 months after training. METHODS: A survey was conducted on emergency medicine resident physicians who participated in the Pediatric Emergency Ultrasound Course in November 2014, which is a training program of pediatric EUS generated by Korean Society of Pediatric Emergency Medicine and Society of Emergency and Critical Care Imaging. The instructor checked the list to evaluate attendee after the course. After the course, resident physicians have been encouraged to use EUS at the patient's bedside, and the same list was checked 6 months after the course. At the same time, a survey of the number of experience of EUS during the 6 months was performed. RESULTS: Ten emergency resident physicians of Seoul National University of Hospital participated in the course and all attendees were re-evaluated 6 months after the course. The mean initial score immediately after the course and that at the 6 months follow-up was 28.6±3.13 and 20.8±3.79, respectively (p < 0.05). No significant relationship was observed between the difference score and the EUS experience number, including the observations of the other physician's EUS (p=0.603) and hands-on by themselves (p=0.771). CONCLUSION: Although a EUS education program could improve the resident physician's ability, the effect decreased with time. Hence, the resident physician's EUS ability cannot be maintained via simple emergency department duty. Therefore, the education program should be repeated regularly.
Critical Care ; Education* ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Seoul ; Ultrasonography*

OBJECTIVE: We analyzed the gene status of p16INK4A, p18INK4C, the expression of cell cycle associated proteins (p16INK4A, p18INK4C, cyclin D1, CDK4, pRb, and p53), and human papillomavirus (HPV) infection to investigate whether the inactivation of these genes participated in carcinogenesis, and to evaluated the expression of cell cycle associated proteins and HPV infections. METHODS: We examined forty-one primary cervical carcinomas (17 adenocarcinomas, 13 keratinizing squamous cell carcinomas, and 11 nonkeratinizing squamous cell carcinomas) using PCR, comparative multiplex PCR, PCR-SSCP, methylation-specific PCR, and immunohistochemistry. RESULTS: Ninety percent of cervical carcinomas showed HPV infection. HPV type 16 was detected in 41% and HPV type 18 was found in 44%. Homozygous deletions at p16INK4A gene were observed in 2 cases, but the mutation of p16INK4A and alterations of p18INK4C gene were not detected. The promoter hypermethylation for p16INK4A in nine cases (31%) of 29 cervical carcinomas was found. Expression of p16INK4A protein was observed in 93% and p18INK4C protein expression was noted in 78%. Positive immunostaining for cyclin D1 was only identified in 5%, whereas positive immunostaining for CDK4 was observed in 95%. Expression of pRb protein was found in 93% and p53 protein in 24% of cervical carcinomas. CONCLUSION: These results suggest that high risk HPV infections and methylation of the p16INK4A promoter region seem to play an important role in the pathogenesis of cervical carcinomas. Alterations of p18INK4C gene and cyclin D1-CDK4 pathway does not contribute significantly in the cervical carcinogenesis.
Adenocarcinoma ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cell Cycle* ; Cyclin D1 ; Cyclin-Dependent Kinase Inhibitor p16 ; Cyclin-Dependent Kinase Inhibitor p18 ; Cyclins ; Genes, p16 ; Humans* ; Immunohistochemistry ; Methylation ; Multiplex Polymerase Chain Reaction ; Papillomavirus Infections* ; Polymerase Chain Reaction ; Promoter Regions, Genetic

BACKGROUND: The clinical characteristics of seizures in adults with localization-related epilepsy have been clearly described and classified. But few researches and data are available in childhood intractable epilepsy. METHODS: We analyzed 334 videotaped seizures from 41 pediatric patients who underwent epilepsy surgery at Dong San Medical Center between 1993 and 1997. Twenty- one of 41 patients had temporal lobe epilepsy, and the remaining 20 patients had extratemporal lobe epilepsy. We divided the patient sample into two groups : (a) those with total cases, (b) those with good outcome (seizure-free or more than 90% reduction of seizures after surgery). We compared temporal lobe epilepsy (TLE) with extratemporal lobe epilepsy (ETE) by clinical symptoms and initial ictal symptoms. In addition, we analyzed the lateralizing value of ictal dystonia, head turning, head deviation and automatism. RESULTS: The aura and head deviation of TLE and the motor arrest, head deviation and dystonic posture of ETE were observed more frequently in total group (P<0.05). In contrast, the vocalization and secondary generalization of TLE and the motor arrest, dystonic posture and dysarthria of ETE were observed more frequently in good outcome group (P<0.05). In cases of the initial ictal symptoms, the aura and hand automatism of TLE and the motor arrest and dystonic posture of ETE were observed more frequently in both groups (P<0.05). Of the ictal motor phenomena, ipsilateral hand automatism and contralateral dystonic posture were useful in lateralizing the seizure focus (P<0.05). CONCLUSION: The clinical ictal manifestations in children are very helpful to localize or lateralize the epileptic focus, like in adults case. Because of the lack of younger age group in our study, however, we suggest more rigorous studies based on more comprehensive data.
Adult ; Automatism ; Child ; Dysarthria ; Dystonia ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Generalization (Psychology) ; Hand ; Head ; Humans ; Posture ; Seizures* ; Temporal Lobe*

OBJECTIVE: This study aimed to measure the disability weights for the Korean Burden of Disease study, and to compare them with those adopted in the Australian study to examine the validity and describe the distinctive features. METHODS: The standardized valuation protocol was developed from the Global Burden of Disease (GBD) study and the Dutch Disability Weights study. Disability weights were measured for 123 diseases of the Korean version of Disease Classification by three panels of 10 medical doctors each. Then, overall distribution, correlation coefficients, difference by each disease, and mean of differences by disease group were analyzed for comparison of disability weights between the Korean and Australian studies. RESULTS: Korean disability weights ranged from 0.037 to 0.927. While the rank correlation coefficient was moderate to high (rs=0.68), Korean disability weights were higher than the corresponding Australian ones in 79.7% of the 118 diseases. Of these, war, leprosy, and most injuries showed the biggest differences. On the contrary, many infectious and parasitic diseases comprised the greater part of diseases of which Korean disability weights were lower. The mean of the differences was the highest in injuries of GBD disease groups, and in cardiovascular disease, injuries, and malignant neoplasm of the Korean disease category. CONCLUSION: Korean disability weights were found to be valid on the basis of overall distribution pattern and correlation, and are expected to be used as basic data for broadening the scope of burden of disease study. However, some distinctive features still remain to be explored in following studies.
Cardiovascular Diseases ; Classification ; Cost of Illness ; Cross-Cultural Comparison ; Korea ; Leprosy ; Parasitic Diseases ; Weights and Measures*

It is difficult to estimate PMI of whom died long times ago, because corpse goes by many decomposition stages. So it makes investigation more difficult. Nowadays many studies about PMI estimation have been performed. In other countries, forensic entomology studies which is possible to estimate not characteristic of death site but also exact death time are actively advanced. So forensic entomology has been more important related not PMI estimation but also many lawsuits in other countries. In Korea, the necessity of Forensic entomology has increased after occuring of the case 'Gaeguri Sonyeon(missing boys who went to catch a flog)'. In this case, regional characteristic is known by insects found on the corpse or clothes. We suggest possibility of applying forensic entomology, consideration, some limitations and the direction of the future study through the analysis, comparison with true facts, and PMI estimation using collected fly larvae in "Hwaseong Case".
Cadaver ; Diptera ; Entomology* ; Female ; Humans ; Insects ; Korea ; Larva