Compliance of epileptic patients is one of the most important factors for adequate therapy. Recently, it had been shown that the variability of three serial measurement of the serum levels of antiepileptic drug(AED) may be used as an indication of the degree of compliance. Coefficient variation(CV) of serum drug levels calculated by only one AED had been used to determine the compliance in epileptic patients who took multiple AEDs. We attempted to evaluate the CV of AEDs and then find the objective clue of compliance and the compatible therapeutic planing according to CV. Ninety seven epileptic patients of outpatients department of the Gyengsang National University Hospital were entered to this study. All patients were taking medication at least for 6 months without any changes of drug regimen. Patient's information was acquired by reviewing the chart and interview with questionnaire. With these informations, we determined the compliance of the patients. Antiepileptic serum levels were measured three times at intervals of at least two to four weeks apart, and their CV was calculated. We compared the CV between the compliant and non-compliant group in each AED(phenytoin, carbamazepine , valproic acid) and three drugs in the compliant group. The mean CVs of phenytoin, carbamazepine and valproic acid in the compliant group were 18.3+/-13.0, 15.2+/-10.2 and 23.8+/-8.9, respectively(mean+/-SD). The mean of CV in the compliant and the non-compliant group were 17.9+/-10.9 and 38.8+/-27.2, respectively. The CVs of the compliant group were significantly lower than those of the non-compliant group(p<0.05). However, CVs had no significant difference between three antiepileptic drugs. This study showed that CVs of AEDs were not different between each AEDs, even though they possess different pharmacokinetic properties. Therefore, the CV of one AED can be used in determining the compliance of the epileptics who are taking multiple AEDs.
Anticonvulsants ; Carbamazepine* ; Compliance ; Humans ; Outpatients ; Phenytoin* ; Surveys and Questionnaires ; Valproic Acid*

PURPOSE: The mechanisms, which alter urinary bladder muscle function during infectious cystitis, are poorly understood. The objective of this study was to identify potential resident targets for endotoxin lipopolysaccharide(LPS) within normal bladder smooth muscle and test the hypothesis that LPS induces an inflammatory response within the bladder muscle and that this is associated with a decrease in muscle contractility. MATERIALS AND METHODS: Male rats were studied 24 hours after a single bolus i.p. injection of LPS(15mg/kg). Whole-mount preparations of the bladder muscle were immunohistochemically stained for neutrophils(myeloperoxidase), macrophages(ED2), activated leukocytes(LFA-1) and mast cells(FITC-Avidin). Contractile activity was assessed from muscle strips of the bladder in response to bethanechol(0.3-300microM). Voiding frequency and urine volume for 24 hours were measured using metabolic cage. Cystometry was performed to measure the intravesical bladder pressure. RESULTS: Using the resident macrophage marker ED2, dense network of macrophages were observed within the bladder muscle of control and LPS treated rats. Few neutrophils(myeloperoxidase-positive cells, 2.3 +/- 0.38 cells, x200) were detected in whole-mounts of bladder muscle of control rats, while LPS pretreatment resulted in a significant increase in the number of neutrophils which demonstrate inflammatory response(10.8 +/- 1.70 cells, x200, p<0.001). LFA-1 immunohistochemistry demonstrated an increased presence of LFA-1 positive cells in bladder muscle of LPS treated rats, which had a morphology similar to both neutrophils and resident macrophages. The expression of LFA-1 is known as a marker of cells that are in an activated state. LPS pretreatment resulted in a significant reduction in bladder muscle contractions in response to bethanechol(i.e. control = 0.049 +/- 0.010 vs. LPS= 0.029 +/- 0.003 gr/mm2/sec, 100microM, p<0.05). Voiding frequency of LPS treated rats was significantly increased compared to that of control rats. In LPS treated rats, voiding phase representing bladder contractility in cystometry was observed. CONCLUSIONS: These data demonstrate that a single intraperitoneal injection of LPS initiates an inflammatory response within the bladder muscle that is associated with a decrease in the functional activity of the bladder. We hypothesize that secretions from the resident macrophages and extravasated leukocytes within the muscle cause the observed suppression in bladder muscle activity in vitro.
Animals ; Cystitis ; Humans ; Immunohistochemistry ; Inflammation* ; Injections, Intraperitoneal ; Leukocytes ; Lymphocyte Function-Associated Antigen-1 ; Macrophages ; Male ; Muscle Contraction ; Muscle, Smooth ; Neutrophils ; Rats* ; Urinary Bladder*

Central diabetes insipidus (CDI) is a clinical syndrome that result from a failure of the neurohypophyseal axis to produce or release a sufficient quantity of arginine vasopressin (AVP) to permit normal function of the urinary concentrating mechanism. Polyuria and polydipsia are the symptoms associated with CDI. The most common cause of CDI is idiopathic variety and head trauma, neurohypophyseal surgery, primary or metastatic brain tumors acount for most of the remaining cases. CDI in Langerhans cell histiocytosis (LCH) is thought to be to infiltration of the hypothalamus-neurohypophyseal system. We report a patient with CDI and LCH underwent water depriviation test, MR imaging of the pituitary-hypothalamic region, and VATS associated open lung biopsy.
Arginine Vasopressin ; Axis, Cervical Vertebra ; Biopsy ; Brain Neoplasms ; Craniocerebral Trauma ; Diabetes Insipidus* ; Diabetes Insipidus, Neurogenic ; Histiocytosis* ; Histiocytosis, Langerhans-Cell ; Humans ; Lung ; Magnetic Resonance Imaging ; Polydipsia ; Polyuria ; Thoracic Surgery, Video-Assisted

Etretinate(Ro 10-9359), an aromatic analogue of vitamin A acid, has been known to be effective in the treatment of psoriasis, Darier's disease, pityriasis rubra pilaris, ichthyosis, and palmoplantar keratoderma when administered orally. In this experiment, we compared the therapeutic and side effects between a group with high dose therapy(initially 75mg of etretinate a day) and an another group with low dose therapy(initially 40mg of etretinate a day). We also observed whether the pretreatment followed by combined treatment with vitamin E could potentiate the therapeutic effect as well as reduce the side effects of oral etretinate. This experiment comprised 102 moderate to severe psoriatic patients. The following results were obtained from this experiment. 1. Fifty-six among 92 patients(61%) who were treated with etretinate for more than 4 weeks showed good to excellent therapeutic effect. 2 The high dose therapy was more effective, but showed more side effects than low dose therapy. 3 Vitamin E did not potentiate the effect of etretinate. In low dose therapy, the pretreatment followed by combined treatment with vitamin E showed a tendency to reduce the side effects of etretinate.
Acitretin* ; Darier Disease ; Etretinate* ; Humans ; Ichthyosis ; Keratoderma, Palmoplantar ; Pityriasis Rubra Pilaris ; Psoriasis* ; Tretinoin ; Vitamin E* ; Vitamins*

The purpose of this study was to evaluate the sequential signal intensity changes in post-traumatic vertebral compression fractures of varying ages. Sixty-six patients with 115 post-traumatic vertebral compression fractures underwent MR imaging. The ages of fractures at the time of MR images ranged from 1 day to 6 years. Sequential follow-up MR imagings were obtained in 4 patients for 2 years after initial MR examination. The fracture sites in all 52 fractures with traumatic events less than 3 months prior were hypointense on T1-weighted images and hyperintense on T2-weighted images (type I). A type I fracture could be subdivided into 3 patterns depending on its morphologic appearance: diffuse (type Ia); patchy (type Ib); and bandlike (type Ic). In 12 fractures of 3 to 5 months after trauma, six showed focal hypointensity (type II) in all pulse sequences, and six showed isointensity (type IV). Four of 51 fractures with trauma over 5 months showed focal hyperintensity on T1-weighted images and isointensity on T2-weighted images (type III); and the remaining 47 fractures showed isointensity on all sequences (type IV). In conclusion, MR imaging is useful in predicting the age of known traumatic compression fractures, so familiarity with these sequential MR findings would be helpful in distinguishing benign from malignant fractures.
Adult ; Aged ; Female ; Human ; Lumbar Vertebrae/*injuries ; *Magnetic Resonance Imaging ; Male ; Middle Age ; Spinal Fractures/*diagnosis ; Time Factors

PURPOSE: Most studies on immune tolerance of mesenchymal stem cells (MSCs) have been performed using MSCs derived from bone marrow, cord blood, or adipose tissue. MSCs also exist in the craniofacial area, specifically in teeth. The purpose of this study was to evaluate the mechanisms of immune tolerance of dental pulp-derived MSC (DP-MSC) in vitro and in vivo. MATERIALS AND METHODS: We isolated DP-MSCs from human dental pulp and co-cultured them with CD4⁺ T-cells. To evaluate the role of cytokines, we blocked TGF-β and IL-10, separately and together, in co-cultured DP-MSCs and CD4⁺ T-cells. We analyzed CD25 and FoxP3 to identify regulatory T-cells (Tregs) by fluorescence-activated cell sorting (FACS) and real-time PCR. We performed alloskin grafts with and without DP-MSC injection in mice. We performed mixed lymphocyte reactions (MLRs) to check immune tolerance. RESULTS: Co-culture of CD4⁺ T-cells with DP-MSCs increased the number of CD4⁺CD25⁺FoxP3⁺ Tregs (p<0.01). TGF-β or/and IL-10 blocking suppressed Treg induction in co-cultured cells (p<0.05). TGF-β1 mRNA levels were higher in co-cultured DP-MSCs and in co-cultured CD4⁺ T-cells than in the respective monocultured cells. However, IL-10 mRNA levels were not different. There was no difference in alloskin graft survival rate and area between the DP-MSC injection group and the non-injection group. Nonetheless, MLR was reduced in the DP-MSC injected group (p<0.05). CONCLUSION: DP-MSCs can modulate immune tolerance by increasing CD4⁺CD25⁺FoxP3⁺ Tregs. TGF-β1 and IL-10 are factors in the immune-tolerance mechanism. Pure DP-MSC therapy may not be an effective treatment for rejection, although it may module immune tolerance in vivo.
Adipose Tissue ; Animals ; Bone Marrow ; Coculture Techniques ; Cytokines ; Dental Pulp ; Fetal Blood ; Flow Cytometry ; Graft Survival ; Humans* ; Immune Tolerance* ; In Vitro Techniques ; Interleukin-10* ; Lymphocyte Culture Test, Mixed ; Mesenchymal Stromal Cells* ; Mice ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; T-Lymphocytes ; T-Lymphocytes, Regulatory* ; Tooth ; Transplants

Wall-eyed monocular internuclear ophthalmoplegia (WEMINO) with contraversive ocular tilt reaction has not been previously reported. A 71-year-old woman suddenly developed blurred vision. Examination revealed left internuclear ophthalmoplegia, left exotropia, right hypotropia, and rightward head tilt. Magnetic resonance imaging showed a tiny infarction at the area of the left medial longitudinal fasciculus in the upper pons. WEMINO with contraversive ocular tilt reaction may be caused by a paramedian pontine tegmental infarction that selectively involves the medial longitudinal fasciculus.
Aged ; Exotropia ; Female ; Head ; Humans ; Infarction ; Magnetic Resonance Imaging ; Ocular Motility Disorders* ; Pons

BACKGROUND/AIMS: Although it is generally known that the risk for all types of cancer increases with adult height, combined and for several common site-specific cancers (including colon and rectal), evidence is limited for adenomas, which are precursors to colorectal cancer. We evaluated the association between height and risk of colorectal adenoma at various stages of the adenoma-carcinoma pathway. METHODS: We conducted a retrospective study using data from patients who had undergone a complete colonoscopy as part of a health examination at the Health Promotion Center of Samsung Medical Center between October 13, 2009 and December 31, 2011. A total of 1,347 male subjects were included in our study. Multivariate logistic regression analysis was used to evaluate the association between height and colorectal adenoma. RESULTS: Each 5-cm increase in height was associated with 1.6% and 5.3% higher risks of advanced colorectal adenoma and high-risk colorectal adenoma, respectively, but associations were not significant after adjusting for age, body mass index, metabolic syndrome, alcohol intake, smoking, family history of colorectal cancer, and regular aspirin use (p = 0.840 and p = 0.472, respectively). CONCLUSIONS: No clear association was found between colorectal adenoma risk and height. Unlike other site-specific tumors reported to have a consistent relationship with height, the association between colorectal tumor and height remains controversial.
Adenoma* ; Adult ; Aspirin ; Body Height ; Body Mass Index ; Body Weight ; Colon ; Colonoscopy ; Colorectal Neoplasms ; Health Promotion ; Humans ; Logistic Models ; Male ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking

BACKGROUND/AIMS: A diagnosis of acute diverticulitis is based on computed tomography (CT). Colonoscopy is commonly performed after the acute event to exclude other diagnoses. This study aimed to determine whether colonoscopy is necessary and what additional information is gained from a colonoscopy after acute diverticulitis. METHODS: Acute diverticulitis was diagnosed by clinical criteria and characteristic CT findings. We analyzed the number of patients in whom colorectal cancers were diagnosed and other incidental findings of polyps and other diseases. RESULTS: A total of 177 patients were analyzed retrospectively. The mean age was 43.3+/-15.3 years (range, 13-82 years) and 97 patients (54.8%) were male. Sixty-one patients had undergone a colonoscopy within 1 year of the acute attack. Advanced adenomatous lesions and colonic malignancy were not detected. Nineteen patients (31.1%) had > or =1 polyp and 11 patients (18.0%) had an adenomatous polyp. No new or different diagnosis was made after colonoscopy. None of the 116 patients who did not undergo colonoscopy within a year after acute diverticulitis had a diagnosis of colorectal cancer registered with the Korea Central Cancer Registry. CONCLUSIONS: Routine colonoscopy yields little benefit in patients with acute diverticulitis diagnosed by typical clinical symptoms and CT. The current practice of a colonoscopy after acute diverticulitis needs to be reevaluated.
Adenomatous Polyps ; Colon ; Colonoscopy* ; Colorectal Neoplasms ; Diagnosis* ; Diverticulitis* ; Humans ; Incidental Findings ; Korea ; Male ; Polyps ; Retrospective Studies

Neuroendocrine carcinoma of the colon is a very rare entity. However, this type of tumor is known to have aggressive progression and poor prognosis. A case of a 72-year-old male is presented in this report. A 3 cm sized tumor was found on the rectum with multiple liver metastases. The pathological findings including a positive immunohistochemical staining for synaptophysin and cytokeratin done with colonoscopic biopsy and liver biopsy confirmed the tumor as a neuroendocrine carcinoma. The nomenclature and definition of this disease still remains somewhat unclear, and not a small population of this disease may thus have been misdiagnosed and treated as other less aggressive entities, such as carcinoid tumor. The necessity to make an accurate differential diagnosis in such cases is thus emphasized because of different treatments and clinical courses. For its rarity and clinical significance, we report this case with a review of the literatures.
Aged ; Biopsy ; Carcinoid Tumor ; Carcinoma, Neuroendocrine* ; Colon ; Diagnosis, Differential ; Humans ; Keratins ; Liver ; Male ; Neoplasm Metastasis ; Prognosis ; Rectum* ; Synaptophysin