MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) is one of the mitochondrial encephalomyopathy, A rare disease caused by a disturbance of the mitochondrial chain of respiration. MELAS is confirmed by typical light and electron microscopic findings : "ragged red fibers" by modified Gomori trichrome stain on light microscope and numerous abormal mitochondria on electron microscope. We experienced a boy with the characteristic clinical and pathologic findings of MELAS. Our patient demonstrated bilateral basal ganglia calcifications and infarction at right parieto-occipital and thalamic areas on CT and MR We found that MRI was more sensitive and represented the infarcted lesions better than CT. Detection of cerebral insults of MELAS by MRI is important in making decision on patient treatment and also in predicion of the patient prognosis.
Acidosis, Lactic ; Basal Ganglia ; Brain Diseases ; Child* ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; MELAS Syndrome* ; Mitochondria ; Mitochondrial Encephalomyopathies ; Muscular Diseases ; Rare Diseases ; Respiration

In the study of 142 psoriatic patients who visited psoriasis clinic in Seoul Nstional University Hospital during recent five years, psoriasis was classified according to the severity based on the activity. The guideline of activity was as follows : 1. Mild: skin lesions stationary for the last one month. 2. Moderate : peripherally spreading plaque lesions with only occasionally small papules. 3. Severe : rapidly developing new lesions from the periphery of plaques or normal skin, or newly developing pustules. This study was done to evaluate the distribution and clinical features of psoriasis according to the activity. Among 142 patients of psoriasis, 84(59.2%) patients had mild psoriasis, 39(27. 4%) patients had moderate psoriasis, and 19(13.4%) patients were presented as severe psoriasis.
Classification* ; Humans ; Psoriasis* ; Seoul ; Skin

Atherosclerotic carotid stenosis, as a major cause of stroke, increases in Korea due to westernized eating habit and increasing proportion of elderly people. Since carotid endarterectomy (CEA) has been proven to be beneficial to the medical treatment only, carotid artery stenting (CAS) revealed the results not inferior to CEA. Currently, the advent of Anti-Embolic devices (or protection devices) and accumulating evidence supports the safety and efficacy of these strategies in minimizing the risk of embolization during the procedure. Particularly important are the recent reports of two randomized trials (CAVATAS and SAPPHIRE) that demonstrated favorable outcomes of stenting as compared to CEA. Growing evidence also supports the late efficacy of CAS in preventing stroke resulting from obstructive extracranial carotid artery disease. This review summarized the results of published randomized trials and the directions of ongoing trials of revascularization treatment of atherosclerotic carotid artery stenosis. And the appropriate patient selection, current procedural technique and complications of CAS are also reviewed.
Aged ; Angioplasty ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Stenosis* ; Eating ; Endarterectomy, Carotid ; Humans ; Korea ; Patient Selection ; Stents* ; Stroke

Contemporary cementing techniques improved the longevity of the cemented total hip replacement. The mechanical strength of acrylic bone cement can be changed by different handling techniques with reduction of the porosity of acrylic bone cement. The greatest improvement of the mechanical properties with reducing the porosity is that of the fatigue strength. We investigated the mechanical properties of the specimens of high viscosity, Palacos R(Merk, Darmstadt, FRG) bone cement with two mixing methods, hand and vacuum mixing. Vacuum mixing improved the ultimate tensile strength by 22.4% compared to hand mixing in previous study. For the uniaxial tension fatigue test, the specimens were cyclically loaded at a maximum stress of 25 MPa at a frequency of 2.5 Hz and to investigate the porosity, scanning electromicroscopic examination was taken in each hand mixed and vacuum mixed specimens. Scanning electromicrogram showed the vacuum mixed specimens to be the more uniform and free of small voids compared with the hand mixed specimens. The results of the fatigue test were analized using Weibull distribution of survival probability, the average number of cycles to failure was 1459±924 cycles in hand mixed specimens, in vacuum mixed specimens, 21491±14956 cycles. The average fatigue life of the vacuum mixed specimens was 15 times loanger than that of the hand mixed specimens by Weibull mean, this differene exists stastically within 95% confidence interval. We could suggest vacuum mixing technique as a method eliminating porosity in a chilled acrylic bone cement and thereby markedly improving the mechanical properties. In cemented joint replacement surgery, a vacuum mixing technique are recommended as a method of preparation of acrylic bone cement
Arthroplasty, Replacement, Hip ; Clothing ; Fatigue ; Hand ; Joints ; Longevity ; Methods ; Polymethyl Methacrylate ; Porosity ; Tensile Strength ; Vacuum ; Viscosity

Carotid artery angioplasty with stenting (CAS) is being performed in many hospitals in Korea. Most of the guidelines which are being used are similar, but the practical aspects such as techniques are different between hospitals. For example, usage of various protective devices, the oral antiplatelet regimen prior to procedure and placing of temporary pacemaker to prevent bradycardia are different between hospitals. In this article, we summarize and propose the guidelines for CAS which is currently being accepted in Korea. These guidelines may be helpful in providing protocol to neurointerventionalist who perform CAS and to standardize the process including reporting of CAS in the future comparative trials in Korea.
Angioplasty ; Bradycardia ; Carotid Arteries ; Korea ; Protective Devices ; Stents*

Rapid and continuous progression in the field of interventional neuroradiology (INR) has allowed many surgically difficult cranial vascular lesions to be treated effectively and less invasively. Development of high-resolution fluoroscopy and digital subtraction angiography also contributed to expansion of the role of the INR. The spectrum of INR application includes intracranial and extracranial stenosis, aneurysms, arteriovenous malformations, hypervascular tumors, and bleeding. Introduction of new devices and materials is so rapid that it is difficult to get outcome evaluation and reimbursement by the insurance which requires a long period of process. Role changes of the physicians and the hospitals seem to be considered for the patients who had required difficult surgery and perioperative surgical management.
Aneurysm ; Angiography, Digital Subtraction ; Arteriovenous Malformations ; Atherosclerosis ; Constriction, Pathologic ; Fluoroscopy ; Hemorrhage ; Humans ; Insurance ; International Normalized Ratio ; Vascular Malformations

Cystic hypersecretory carcinoma of the breast is a rare variant of ductal carcinoma of breast, first described in 1984 by Rosen and Scott. Histologically, it is characterized by the formation of dilated ducts and cysts containing an eosinophilic secretory product resembling thyroid colloid. Cytologic findings show a few clusters of atypical ductal epithelial cells in amorphous proteinaceous material with cracking artifact. Differential diagnosis include mucinous carcinoma and benign mucocele-like tumor. We present two cases of fine needle aspiration cytology of cystic hypersecretory intraductal carcinoma of the breast with a review of the literature.
Adenocarcinoma, Mucinous ; Artifacts ; Biopsy, Fine-Needle* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating* ; Colloids ; Diagnosis, Differential ; Eosinophils ; Epithelial Cells ; Thyroid Gland

Objective: Extramammary Paget’s disease (EMPD) of the vulva is a rare disease which predominantly presents in postmenopausal Caucasian women. As yet, no studies on Asian female patients with EMPD have been performed. This study aimed to identify the clinical features of patients with vulvar EMPD in Korea, and to evaluate the risk factors of recurrence and postoperative complications in surgically treated EMPD. Methods: We retrospectively reviewed 47 patients with vulvar EMPD who underwent wide local excision or radical vulvectomy. The clinical data and surgical and oncological outcomes following surgery were extracted from medical records and analyzed. Univariate and multivariate analyses for predicting recurrence and postoperative complications were performed. Results: 21.3% of patients had complications after surgery, and wound dehiscence was the most common. 14.9% of patients experienced recurrence, and the median interval to recurrence from initial treatment was 69 (range 33–169) months. Vulvar lesions larger than 40 mm was the independent risk factor of postoperative complications (odds ratio [OR]=7.259; 95% confidence interval [CI]=1.545–34.100; p=0.012). Surgical margin status was not associated with recurrence in surgically treated vulvar EMPD patients (OR=0.83; 95% CI=0.16–4.19; p=1.000). Conclusion Positive surgical margin is a frequent finding in the patients with vulvar EMPD, but disease recurrence is not related with surgical margin status. Since EMPD is a slow growing tumor, a surveillance period longer than 5 years is required.

BACKGROUND: It has been demonstrated that the expression of tumor necrosis factor-alpha (TNF-alpha) and apoptotic cell death in the dorsal root ganglion (DRG) following spinal nerve constriction injury play a role in the initiation and continuation of hyperalgesia and allodynia. The present study was designed to investigate the effects of ethyl pyruvate (EP) on mechanical and cold allodynia, TNF-alpha expression, and apoptosis in DRG after spinal nerve ligation injury. METHODS: Rats were divided into 3 groups: control, pre-EP, and post-EP. EP (50 mg/kg) was intraperitoneally injected 30 minutes before (pre-EP) or after (post-EP) surgery. Behavioral tests to determine mechanical and cold allodynia were conducted before surgery and 4 and 7 days after surgery. Seven days after surgery, TNF-alpha protein levels in DRG were evaluated by enzyme-linked immunosorbent assay, and DRG apoptosis was determined by immunohistochemical detection of activated caspase-3. RESULTS: Treatment with EP significantly reduced mechanical and cold allodynia following spinal nerve ligation injury. TNF-alpha protein levels in the pre-EP (4.7 +/- 1.2 pg/200 microg; P < 0.001) and post-EP (6.4 +/- 1.8 pg/200 microg; P < 0.001) groups were 2-3 times lower than the control group (14.4 +/- 1.2 pg/200 microg). The percentages of neurons and satellite cells that co-localized with caspase-3 were also significantly lower in the pre-EP and post-EP groups than the control group. CONCLUSIONS: These results demonstrate that EP has a strong anti-allodynic effect that acts through the inhibition of TNF-alpha expression and apoptosis in DRG after spinal nerve ligation injury.
Animals ; Apoptosis ; Caspase 3 ; Cell Death ; Cold Temperature ; Constriction ; Diagnosis-Related Groups ; Enzyme-Linked Immunosorbent Assay ; Ganglia, Spinal ; Hyperalgesia ; Ligation ; Neurons ; Pyruvates ; Pyruvic Acid ; Rats ; Spinal Nerve Roots ; Spinal Nerves ; Tumor Necrosis Factor-alpha

Objectives: ：This study was aimed to investigate whether 1) sexual dimorphism in subcortical gray matter volumes (GMV) and the length ratio between the second and fourth digits (2D:4D) would be found and 2) 2D:4D would have associated with subcortical GMV in healthy elderly people. Methods: ：Sixty-two females aged 70.3±6.3 (mean±SD) years and 23 males aged 70.4±4.9 years were recruited from the Dementia Clinic in the Pusan National University Hospital. The subjects with the clinical dementia rating scale-sum of boxes (CDR-SB) total score greater than 2.0, any psychiatric or neurological disease, or any pathologic lesion on brain MRI other than micro-angiopathy were excluded. The 2D:4D of the left and right hands were measured 3 times each. Volumetric segmentation of T1-weighted MRI scans was done by Freesurfer software (v7.1.1.1). Results: ：2D:4Ds of males were smaller than those of females significantly on repeated measures ANOVA. The males’ thalamus, putamen, hippocampus in both hemispheres and the right amygdala were larger than females’. These differences were not significant after controlling for age, education and total intracranial volume (ICV). In the females, the left 2D:4D was negatively correlated with the left hippocampal volume. In the males, 2D:4D was positively correlated with the volumes of ipsilateral or contralateral thalamus, hippocampus, amygdala and accumbens. These correlations were not significant after Bonferroni’s correction, except for the right accumbens. Conclusions ：Sexual dimorphism of 2D:4D is preserved in healthy elderly people. There is a significant correlation between the right 2D:4D and GMV of the accumbens in males.