PURPOSE: Dopamine plays a critical role in promoting sexual drive and penile erection through dopamine receptors. This study was performed to investigate whether the cavernousal nerve controls the expression of peripheral dopamine D1 receptors in rat penile tissues after cavernousal nerve injury. MATERIALS AND METHODS: Male rats (n=20) were divided into two groups: a control group consisting of sham-operated rats (n=10) and an experimental group consisting of rats that underwent incision of the bilateral cavernous nerve (n=10). Three months later, the intracavernous pressure response was monitored using an intracavernous papaverine injection of 300 microgram. The expression of dopamine D1 receptor mRNA were studied using an RT-PCR method, and dopamine D1 receptor protein expression by Western blot analysis and immuno-histochemical staining in each group. The expressed band density of the RT-PCR and Western blot were measured by a densitometer. RESULTS: Erectile functions, as studied by intracavernosal papaverine injection at three months, were similar in both groups. The dopamine D1 receptor mRNA and protein expressions were significantly lower in the neurotomy group. The immuno-histochemical staining also showed a reduction in the dopamine D1 receptor expression in the neurotomy group compared with the control group. CONCLUSIONS: Our results show that dopamine D1 receptors in penile tissues were down-regulated following cavernousal nerve injury. These findings suggest that cavernousal nerve injury affects directly the reduction of dopamine D1 receptor expression, and that the action of dopamine on the cavernousal dopamine receptor will be affected in cavernousal nerve injured rats.
Animals ; Blotting, Western ; Dopamine* ; Down-Regulation* ; Humans ; Male ; Papaverine ; Penile Erection ; Penis ; Rats* ; Receptors, Dopamine ; Receptors, Dopamine D1* ; RNA, Messenger ; Wounds and Injuries

OBJECTIVE: The purpose of this study is to evaluate the types of aphasia and the clinicoanatomic correlation in aphasic patients with subcortical lesions, and to investigate the change in the types of aphasia during the recovery stage. METHOD: Twenty-three stroke patients (16 men and 7 women) with left subcortical lesion was investigated. On the basis of the brain CT or MRI findings, the patients were divided into the 4 groups. Language dysfuntion was evaluated using the modified Western Aphasia Battery (WAB) and the type of aphasia and aphasia quotient were determined. Initial examination was performed within 2 months post-onset in all of the patients and the follow-up examination was done after 6 months post-onset in 9 patients. RESULTS: The most common type was anomic aphasia (39%). The type of subcortical aphasia was variable regardless of the sites of left subcortical lesion. Aphasia quotient was significantly related with the lesion size (gamma = 0.05, p<0.05) and the initial Barthel index (gamma = 0.65, p<0.05). The scores of all the subtests of the modified WAB and aphasia quotient were significantly decreased in the group with the cortical involvement or the history of operation. On the follow-up examination, the scores of fluency, information and naming subtests were significantly increased. CONCLUSION: The most common type of aphasia was anomic aphasia and the type of subcortical aphasia was not correlated to the anatomic lesion. Severity of subcortical aphasia would be related with the lesion size, the history of operation or the cortical involvement. The prognosis of subcortical aphasia was generally good.
Anomia ; Aphasia* ; Brain ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Prognosis ; Stroke

BACKGROUND: Retrograde interlaminar ventral epidural injection (RIVEI) may hypothetically be more effective if the catheter is placed at the ventrocaudal aspect of the exiting nerve. We tested that hypothesis by measuring ventral and dorsal epidural contrast flow during RIVEI. METHODS: To perform RIVEI, a 17 G Tuohy needle was inserted to access the epidural space. A 19 G epidural catheter was inserted and advanced through the needle, passing in a caudal direction to the lower aspect of the contralateral pedicle. Fluoroscopic images were recorded at 1.5 ml increments of contrast. Based on the images of contrast dispersal, the extent of contrast spreading was assessed in 82 patients. RESULTS: All 82 patients (100%) injected with 3.0 ml contrast medium demonstrated ventral epidural spreading. Mean spreading level from the catheter tip was 2.21 +/- 0.93 with 3.0 ml of contrast. Spreading to the superior aspect of the supra-adjacent intervertebral disc was observed in 67/82 (81.7%) of RIVEIs with 3.0 ml of contrast injected into the ventral epidural space. We found that 3.0 ml of contrast reached the inferior aspect of the infra-adjacent intervertebral disc in 95.1% (78/82) of RIVEIs performed. CONCLUSIONS: Our findings imply that a one-level RIVEI may be sufficient in situations where a two-level injection would currently be used.
Catheters ; Contrast Media ; Epidural Space ; Humans ; Injections, Epidural* ; Intervertebral Disc ; Needles ; Organic Chemicals ; Quaternary Ammonium Compounds

Nocardiosis is a rare infection seen most commonly in immunocompromized patients. Most patients have pulmonary involvement, but some develop disseminated infection. A 52-year-old man, treated with immunosuppressive drugs for 3 months after kidney transplantation, developed pulmonary nocardiosis and disseminated infection involving brain, skin, and both uvea. The diagnosis was made by open lung biopsy specimens showing characteristic weak acid fastness with modified Ziel-Neelsen stainig and histologic examination. Immunosuppressive therapy was continued and combination of surgical drainage of brain abscess and chemotherapy with Minocycline were successful. With the increasing number of allograft recipients and concomitant immunosuppression, the possibility of an increase in Nocardia opportunistic infections exists.
Allografts ; Biopsy ; Brain ; Brain Abscess ; Diagnosis ; Drainage ; Drug Therapy ; Humans ; Immunosuppression ; Kidney Transplantation ; Kidney* ; Lung ; Middle Aged ; Minocycline ; Nocardia ; Nocardia Infections* ; Opportunistic Infections ; Skin ; Transplantation* ; Uvea

A Schwannoma is a tumor originating from the neural sheath of Schwann cells, and is also known as a neurilemmoma, neurinoma or fibroblastoma. It can be either a benign or malignant tumor arising from the associated nerve sheath. Here, a case of a Schwannoma, originated from the obturator nerve of the pelvic cavity, in a patient with urinary frequency is reported, with a brief review of the literature.
Humans ; Neurilemmoma* ; Obturator Nerve* ; Pelvis ; Schwann Cells

BACKGROUND: We performed a prospective, randomized, controlled trial to compare the quality, hemodynamic response, and recovery index of laryngeal mask airway (LMA) insertion after either propofol alone or co-administration of alfentanil-propofol anesthesia. METHODS: Sixty patients (ASA 1 or 2, 17-63 years) were randomly allocated to control and experimental group. Control group(Group I) was received placebo (saline), experimental groups were received alfentanil 10microgram/kg (Group II), 20microgram/kg (Group III), 30microgram/kg (Group IV). RESULTS: Loss of consciousness and LMA insertion were more rapid in patients with alfentanil 30 microgram/kg group than control group (P<0.05). In alfentanil 20microgram/kg group, loss of consciousness was more rapid than control group. Also, there were significant differences in propofol induction dose, effect site concentration on induction, and propofol maintenance dose between control and experimental group (P<0.05). CONCLUSIONS: We conclude that co-adminstration of alfentanil-propofol, especially 30microgram/kg group, compares favorably with propofol alone, although LMA removal time is prolonged.
Alfentanil ; Anesthesia ; Hemodynamics ; Humans ; Laryngeal Masks* ; Propofol* ; Prospective Studies ; Unconsciousness

BACKGROUND: Morphine has a direct action on morphine receptors in the brain and spinal cord. Intrathecally administered L-NAME, a nitric oxide synthase inhibitor, is known to have an antinociceptive effect on formalin-induced pain in animal studies. Efficacy of intrathecally administered ketorolac, a cyclooxygenase inhibitor, is somewhat controversial. The interactions of intrathecally administered morphine, ketorolac and L-NAME on formalin-induced nociception was studied. METHODS: Male Sprague-Dawley rats were implanted with chronic lumbar intrathecal catheters and were tested for paw flinch by a formalin injection. Drugs were intrathecally administered 15 min before the formalin injection, and biphasic painful behaviors were observed. We obtained the ED50 for each agent (ketorolac, L-NAME and morphine). ED50 fractions (1, 1/2 and 1/4) of drug combinations of L-NAME-ketorolac, morphine-L-NAME and ketorolac-morphine were administered. The ED50 of each combined drug was established and isobolographic analysis of the drug interactions was carried out. RESULTS: Intrathecal administration of ketorolac, L-NAME and morphine produced a dose-dependent suppression of pain behaviors in phase 2. ED50 values were 297.04micro gram for ketorolac, 207.46micro gram for L-NAME and 0.17micro gram for morphine in phase 2. Isobolographic analysis showed that the combination of intrathecal morphine and L-NAME synergistically reduced pain behaviors in phase 2. CONCLUSIONS: Intrathecally administered morphine, L-NAME and ketorolac produced a dose-dependent decrease in the number of paw flinches in both phase 1 and phase 2 on the formalin test. Morphine with L-NAME showed synergistic analgesic effects on formalin-induced pain in phase 2.
Animals ; Brain ; Catheters ; Drug Combinations ; Drug Interactions ; Formaldehyde ; Humans ; Ketorolac* ; Male ; Morphine* ; NG-Nitroarginine Methyl Ester* ; Nitric Oxide Synthase ; Nociception ; Pain Measurement ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Rats, Sprague-Dawley ; Receptors, Opioid, mu ; Spinal Cord

Hemangioblastoma is an uncommon tumor of the central nervous system, accounting for only 1 % to 2.5% of all intracranial neoplasms. Hemangioblastoma can occur either sporadically or as a manifestation of von Hippel-Lindau diseasean inherited disorder of the autosomal dominant trait-characterized by tumors or tumor-like lesions developing in several organs including angioma of retina, pheochromocytoma, cyst or carcinoma in kidney and pancreas. We have encountered a family in which two male members were histologically diagnosed as suffering from von Hippel-Lindau disease and another male member was clinically suspected of suffering from spinal hemangioblastoma. The pathophysiology and genetic aspect of von Hippel-Lindau disease are discussed with review of literatures.
Brain Neoplasms ; Central Nervous System ; Hemangioblastoma ; Hemangioma ; Humans ; Kidney ; Male ; Pancreas ; Pheochromocytoma ; Retina ; von Hippel-Lindau Disease*

Post-traumatic seizure is a known consequence of head trauma and a major public problem. But the surveillance study of this problem in our country is very rate. The purpose of the current study was to determine the incidence, clinical patterns and the outcome of the post-traumatic seizure in our institute. A retrospective review of management in 5053 patients with head injury was performed in our department between 1983 and 1992. In our series, the frequency of post-traumatic epilepsy was 254 patients, giving 1 5.0% incidence rate(early seizure occurred in 2.2% and late seizure occurred in 2.8% of patients). Of these, the records of 203 patients who received follow-up care for at least 2 years was reviewed. The first early epileptic attack occurred within 24 hours of injury in one third of the cases(33.3%), and the first late epileptic attack occurred within 1 year was about two thirds of the cases(64.6%). On CT scan findings, the early epilepsy had a higher incidence in scans that showed diffuse brain swelli ng and the late epilepsy had a higher incidence in subdural and intracerebral hematoma. 57.5% of early seizure were focal type, and 55.2% of late seizure were generalized convulsive seizure. The outcome of severe head injury patients with early seizure was better than that of late seizure group. The severity of head injury was related to the occurrence of late post-traumatic seizure.Development of new antiepileptic drugs, increasing knowledge of preventing post-traumatic sequelae and demand for surgical treatments have allowed the reduction of the incidence of the post-traumatic seizures. But further survey or study is recommanded in order to achieve more improvement in the management of post-traumatic seizures.
Anticonvulsants ; Brain ; Craniocerebral Trauma* ; Electroencephalography ; Epilepsy ; Epilepsy, Post-Traumatic ; Follow-Up Studies ; Head* ; Hematoma ; Humans ; Incidence* ; Retrospective Studies ; Seizures* ; Tomography, X-Ray Computed

Laryngeal cysts, including epiglottic cysts, are rare lesions which are clinically asymptomatic in many cases. Rarely laryngeal cysts cause unexpected airway management difficultties perioperatively. We report up on a case of laryngeal cyst that caused postextubation airway obstruction and negative-pressure pulmonary edema. A 25-year-old man was admitted for brain surgery with neurofibromatosis. He did not have any specific airway problem preoperatively, and anesthesia was done uneventfully. But when he was extubated after surgery, he revealed symptoms of upper airway obstruction in the recovery room. We reintubated him easily, and then we found a laryngeal cyst. Though negative-pressure pulmonary edema occurred after reintubation, he responded to conservative treatment and was discharged without specific problems. We present a review of postextubation airway obstruction and negative-pressure pulmonary edema due to a laryngeal cyst.
Adult ; Airway Management ; Airway Obstruction* ; Anesthesia ; Brain ; Humans ; Neurofibromatoses ; Pulmonary Edema* ; Recovery Room