PURPOSE: We report a case of ophthalmic artery occlusion with third nerve paresis in the left eye due to acute occlusion of the left ICA. CASE SUMMARY: A 37-year-old man visited our emergency room with "black out" in the left eye, headache, and nausea. The corrected visual acuity was 20/25 in the right eye, and hand motion in the left eye. In the left eye, a relative afferent papillary defect was noted, with an intraocular pressure of six mmHg. Twenty prisms of exotropia in the primary position was observed, and ocular motor examination revealed limitations of supraduction, infraduction, and adduction in the left eye, suggesting third nerve palsy of the left eye. Fundus examination revealed a pale retina in the macula of the left eye. Brain MRI demonstrated multifocal faint low densities in the left caudate nucleus as well as the frontal and parietal lobes. CT angiography and four-vessel angiography demonstrated complete occlusion in the proximal part of the left internal carotid artery ICA.
Adult ; Angiography ; Brain ; Carotid Artery, Internal ; Caudate Nucleus ; Emergencies ; Exotropia ; Eye ; Hand ; Headache ; Humans ; Intraocular Pressure ; Nausea ; Oculomotor Nerve ; Oculomotor Nerve Diseases ; Ophthalmic Artery ; Paresis ; Parietal Lobe ; Retina ; Visual Acuity

PURPOSE: The aim of this study was to identify gene- gene and gene-environmental factor on cervical carcinogenesis in Korean women. MATERIALS AND METHODS: We evaluated 185 women patients who had cervical cancer with 345 normal control healthy women. The single nucleotide polymorphisms (SNPs) of the p53 codon 72, the p21 codon 31 and the IRF-1 intron 6 were evaluated from extracted DNA of peripheral blood with an automatic DNA sequencer. The difference of each SNP, gene-gene and gene-environmental interaction between normal controls and patients, were evaluated in an adjusted environmental background. RESULTS: With regard to environmental factors, the cervical cancer increased in the women with a lower level of education, a younger age at first sexual intercourse and with the increased number of children borne. The women who had p53 (Arg/Arg), IRF-1 (T/T) and an education of less than 6 years showed a 14.7 fold increased risk of cervical cancer than those women who had p53 (~Pro), IRF-1 (~C) and an education of more than 15 years. The women who had p53 (Arg/Arg), p21 (Ser/Ser) and more than 3 children showed a 6.4 fold increased risk of cervical cancer than those women who had p53 (~Pro), p21 (~Arg) and had borne no child. The women who had p53 (Arg/Arg), IRF-1 (T/T) and had experience of first sexual intercourse before the age of 22-years showed a 5.5 fold increased risk of cervical cancer than those women who had p53 (~Pro), IRF-1 (~C) and had experience of first sexual intercourse after the age of 26-years. CONCLUSION: We found that the level of education, the age at first intercourse, and the number of children borne, were independent risk factors in cervical carcinogenesis. The specific combination of p53, p21 and IRF-1 gene-gene and gene-environmental interactions were significantly noted in the cervical carcinogenesis of Korean women.
Carcinogenesis ; Child ; Codon ; Coitus ; DNA ; Education ; Female ; Genes, p53 ; Humans ; Introns ; Polymorphism, Single Nucleotide ; Risk Factors ; Uterine Cervical Neoplasms*

STUDY DESIGN: In vitro experimental study OBJECTIVES: To examine the effect of a synovial supernatant on the cell viability, osteogenic phenotype, mRNA expression of the types collagen and various transcriptional factors on osteogenesis in ligamentum flavum (LF) cells stimulated with synovial fluid from a degenerated facet joint. LITERATURE REVIEW: In degenerative lumbar spinal stenosis, hypertrophied LF or osteoarthritic hypertrophy of a facet joint often causes neurogenic claudication. The facet joint is a synovial joint with hyaline cartilage on each side. Therefore, osteoarthritis of a facet joint eventually occurs with aging and other degenerative conditions of the spine. In lumbar spinal degeneration, inflammatory mediators or cytokines are released from the facet joint tissue, which consequently affects the adjacent LF because the LF covers posterolateral aspect of the spinal canal near facet joints. However, there are no reports on the relationship between a degenerated facet joint fluid and the LF in the lumbar spine. MATERIALS AND METHODS: LF surgical specimens were obtained from patients with a lumbar spine stenosis, and the cells were isolated by enzymatic digestion. Each of the synovium tissues were weighed and recorded. Each tissue was cut into small pieces with a pair of scissors and then washed 3 times with PBS. The washed tissue pieces were then cultured for 96 hr at 37degrees C, 5% CO2 in DMEM/F-12-0.1% FBS with a density of 200 mg/ml medium. The supernatant was collected after 96 hr. In order to measure quantitatively the proliferation of cells, the AlamarBlue assay was used. The total cellular RNA was extracted from the cells and amplification reactions specific to the following types of cDNA were performed: the osteogenic master transcription factors, Dlx5, Runx2, osterix, and types collagen and osteocalcin. Alkaline phosphatase staining for the biochemical assay and western blotting for osteocalcin protein expression were performed. RESULTS: Human LF cells cultured with the supernatant from the facet synovium showed a slightly stronger AlamarBlue staining than the intensity of the control culture. RT-PCR revealed the upregulation of the osteogenic master transcription factors, Dlx5, Runx2, and osterix in the synovium supernatant group from one hour to 72 hours, and an increase in osteocalcin, types collagen I, III, V, XI levels from one hour to one week. LF cells cultured with the supernatant from the facet synovium showed positive staining for alkaline phosphatase. The level of the osteocalcin protein in the LF cells cultured with the supernatant from the facet synovium was higher than the control group. Conclusions: The supernatant of the facet joint from patients with degenerative spinal stenosis affects LF cells by increasing the level of cellular proliferation, upregulating the mRNA expression of osteocalcin, types of collagen, osteogenic transcription factors, positive alkaline phosphatase staining, and osteocalcin protein expression. Therefore, degenerated synovial fluid from the facet joint is an important mechanism of LF hypertrophy and ossification.
Aging ; Alkaline Phosphatase ; Blotting, Western ; Cell Proliferation ; Cell Survival ; Collagen ; Constriction, Pathologic ; Cytokines ; Digestion ; DNA, Complementary ; Humans ; Hyaline Cartilage ; Hypertrophy* ; Joints ; Ligamentum Flavum* ; Osteoarthritis ; Osteocalcin ; Osteogenesis ; Phenotype ; RNA ; RNA, Messenger ; Spinal Canal ; Spinal Stenosis ; Spine ; Synovial Fluid* ; Synovial Membrane ; Transcription Factors ; Up-Regulation ; Zygapophyseal Joint

PURPOSE: We studied the voiding dysfunction after surgical treatment of female stress urinary incontinence and diagnosis and treatment. MATERIALS AND METHODS: Three hundred women with stress urinary incontinence underwent surgical procedure between January 1998 and December 2004. Ninety two patients(30.6%) experienced the postoperative voiding dysfunction. As the primary procedure for the management of postoperative voiding dysfunction alpha-blockers medication and clean intermittent catheterization(CIC) were performed. Then, hegar dilation and urethral pull-down procedure were performed as a secondary measure. For the patients who showed persistent obstructed symptoms, cutting of mesh or sling materials were performed. RESULTS: In 57 patients, symptoms improved by alpha-blockers medication and CIC. The others were received hegar dilation and urethral pull-down procedure, and 29 patients were improved. 6 patients were not controlled by conservative treatment, of which 3 patients underwent cutting of mesh or sling. De novo urgency was developed in 12 patients. Anticholinergics were taken, symptoms were diminished in 10 patients after 5 months of medication. CONCLUSION: Most voiding dysfunction after surgery may be effectively managed by conservative treatment. In cases of failure, hegar dilation and urethral pull-down procedure may be useful within postoperative first weak. Finally, cutting of mesh or sling must be considered in patient whose the secondary measure is failed.
Cholinergic Antagonists ; Diagnosis ; Female* ; Humans ; Urinary Incontinence*

PURPOSE: N-acetylcysteine (NAC) is a potent antioxidant, and a free radical scavenger. We investigated the possible effects of NAC after ischemia/reperfusion (I/R) of rat bladder. MATERIALS AND METHODS: I/R injury was induced by abdominal aorta clamping and ischemia for 60minutes, followed by 120minutes reperfusion. Twenty rats were divided into four groups: sham operation + saline group (S+S), sham operation + NAC group (S+NAC), I/R + saline group (I/R+S), I/R + NAC group (I/R+NAC). Blood levels of reactive oxygen species (ROS) were determined using the free oxygen radical tests (FORT). Superoxide generation was measured based on lucigenin-enhanced chemiluminescence. The level of malondialdehyde (MDA) was analyzed in order to measure lipid peroxidation. RESULTS: In I/R+S group, the isometric contractile responses to carbachol were significant lower than other groups and were reversed by the pretreatment with NAC. The level of FORT and MDA showed a marked increase in I/R+S group compared with S+S group. NADPH-stimulated superoxide production was also significantly increased. I/R+NAC decreased these parameters compared with I/R+S group. CONCLUSION: Our results suggest that treatment with NAC reversed the low contractile responses of rat bladder and prevented oxidative stress following I/R.
Acetylcysteine ; Animals ; Aorta, Abdominal ; Carbachol ; Constriction ; Ischemia ; Lipid Peroxidation ; Luminescence ; Malondialdehyde ; Oxidative Stress ; Oxygen ; Panax* ; Rats* ; Reactive Oxygen Species ; Reperfusion ; Superoxides ; Urinary Bladder*

PROPOSE: Ureteral stents are commonly placed after routine ureteroscopic procedures to prevent acute obstruction. However, stents can cause significant symptoms and they can require a secondary procedure for removal; further, they may possibly be forgotten. In order to overcome these problems, a temporary ureteral drainage stent capable of dissolving spontaneously was developed to evaluate the tissue reaction and toxicity. MATERIALS AND METHODS: We developed a dissolvable ureteral catheter composed of polydioxanone (PDO). We evaluated the toxicity and tissue reaction by hematologic (CBC, aminotransferase/alanine transaminase (AST/ALT), blood urea nitrogen, creatinine (BUN, Cr), alkaline phosphatase) and histologic examination (ureter, kidney and liver tissue). Twelve rabbits were placed into groups of four rabbits each: the uninserted control group, group I that had a dissolvable ureteral catheter inserted with harvest at four weeks, group II that had a dissolvable ureteral catheter inserted with harvest at eight weeks, and group III that had a dissolvable ureteral catheter inserted with harvest at twelve weeks. RESULTS: On histologic examination, the ureter had a normal appearance of transitional cells and it contained the dissolvable ureteral catheter in the ureteral lumen without any inflammatory change. The ureteral surface cells appeared normal after contact with the dissolvable ureteral catheter during the 12 weeks. Liver and kidney tissue showed mild focal inflammatory change, but no definitive difference was noted between the control and groups I, II and III. On the hematologic examination, there was no significant change of the value of CBC, AST/ALT, BUN, Cr and alkaline phosphatase due to the inserted dissolvable ureteral catheter during the 12 weeks. CONCLUSIONS: A dissolvable ureteral catheter appeared to have no toxic effect, as evidenced by histological and hematological examination. However, further study is warranted in order to overcome the catheter's limitations like for its flexibility.
Alkaline Phosphatase ; Blood Urea Nitrogen ; Creatinine ; Drainage ; Kidney ; Liver ; Pliability ; Polydioxanone ; Rabbits ; Stents ; Ureter* ; Urinary Catheterization ; Urinary Catheters*