OBJECTIVE: This study is to explore the effects on specific bindings between [ 3H]RX821002, alpha-2 adrenergic receptor antagonist and alpha-2 adrenergic receptor in rat brain by G-protein modulation. METHODS: The radioligand binding receptor study was conducted with [ 3H]RX821002, a new alpha-2 adrenergic receptor antagonist, in the presence or absence of Gpp(NH)p and pertussis toxin. RESULTS: The alpha-2 adrenergic receptors were saturated with [ 3H]RX821002 in the fashion of the single binding site. The dissociation constant (Kd) was 0.70+/-0.30 nM, and maximum binding (Bmax) was 599.9+/-283.4 fmol/mg protein. The saturation study showed that the maximum binding (B max ; 668.0+/-50.1 fmol/mg protein) was increased and the dissociation constant (Kd ; 0.61+/-0.14 nM) was decreased significantly in the presence of Gpp (NH)p compared to those (B max ; 559.8+/-81.9 fmol/mg protein, Kd ; 0.87+/-0.14 nM) in the absence of Gpp (NH)p (by paired t-test ; B max, p=0.023, Kd, p=0.005). In the presence of pertussis toxin, the maximum binding (B max ; 617.0+/-58.5 fmol/mg protein) was increased significantly (by paired t-test ; B max, p=0.001) but the issociation constant (Kd ; 0.92+/-0.24 nM) was not decreased compared to those (B max ; 554.1+/-66.1 fmol/mg protein, Kd ; 0.89+/-0.24 nM) in the absence of pertussis toxin. CONCLUSION: These results confirm that the binding profiles between [ 3H]RX821002 and alpha-2 adrenergic receptors be modified by G-protein modulation. This suggests that the drug effects on receptors be influenced by various conditions such as G-protein modulation.
Animals ; Binding Sites ; Brain* ; GTP-Binding Proteins* ; Guanylyl Imidodiphosphate ; Pertussis Toxin ; Rats* ; Receptors, Adrenergic, alpha-2

Fibrohistiocytic tumors are a diverse group of benign and malignant soft tissue lesions, including dermatofibroma, dermatofibrosarcomaprotuberans, and malignant fibrous histiocytoma. On the clinical point of view, the distinction between benign and malignant lesions and malignancy grading is far more important. Therefore, we investigated 23 fibrohistiocytic tumors, using PCNA (PC10) which was a useful marker of proliferating activity, to differentiate the benign lesions from the malignant and correlate with other prognostic factors including tumor necrosis. cellularity, histologic grade, and mitotic counts. The results obtained were as follows 1) Positive tumor cells were clearly identified by the characteristic diffuse or granular nuclear staining. 2) The number of PCNA-positive tumor cells were 2.16+/-2.39% in dermatofibroma, 16.12+/-7.38% in dermatofibrosacoma protuberans, and 28.02+/-17.47% in the malignant fibrous histiocytoma. The numbers of PCNA-positive tumor cells in the malignant lesions higher than in the benign (p<0.001). 3) Deep seated, large size (>5 cm) and recurred or metastatic cases of MFH were more the high PCNA index (more than 20%) than the low index (less than 20%) groups. 4) PCNA index in MFHs had positive correlation with the number of mitotic counts (r=0.7582, p<0.001), cellularity (r=0.5908, p<0.05) and histologic grade (r=0.4164, p<0.05). These results suggested that reactivity on PCNA might assist in the distinction between benign and malignant lesions in fibrohistiocytic tumors, and could be a useful prognostic factor in the patients with malignant fibrous histiocytoma.
Neoplasm Metastasis

CHAP syndorme consists of choreoathetosis, orofacial dyskinesia, affective change, hypotonia, and pseudobulbar signs. CHAP syndrome was firstly des- cribed with onset 1 to 7 days after induced profound hypothermia and complete circulatory arrest for con- genital heart lesion repair. Since then, only a few cases have been reported until now. Case We report a patient who demonstrated all of the elements of the CHAP syndrome in severe cachexic state. Brain SPECT(99mTC-ECD) shows decreased perfusion in left fronto-parieto-temporal lobe. Comments The pathogenesis of CHAP syndrome is obscure. However our case led us to suggest that more essential component pre- disposing to the CHAP syndrome is hypoxia rather than hypothermia. Furthermore, it seems to be related with circulatory insufficiency in extrapyramidal nervous systems.
Anoxia ; Brain ; Heart ; Humans ; Hypothermia ; Movement Disorders ; Muscle Hypotonia ; Nervous System ; Perfusion

Purpose: To compare the contrast sensitivities of type 2 diabetic patients without retinopathy and healthy subjects, and to assess the risk factors associated with a change in contrast sensitivity in diabetes. Methods: A total of 75 (diabetic patients without retinopathy) and 41 (healthy subjects) eyes were reviewed from the medical records. The threshold of contrast sensitivity was measured at 6.3°, 4.0°, 2.5°, 1.6°, 1.0°, and 0.64° under scotopic and photopic states. Optical coherence tomography (OCT) imaging was used to measure the retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GC-IPL) thickness in diabetic patients. Results: Diabetic patients showed a lower threshold of contrast sensitivity at all degree measures than did the controls under both scotopic and photopic states. In subgroup analyses, diabetic patients with abnormal contrast sensitivity showed a longer duration of diabetes, decreased total retinal thickness, and decreased average GC-IPL, superior RNFL, superior GC-IPL, and temporal GC-IPL thicknesses. Multivariate logistic regression analyses showed that the duration of diabetes and total retinal thickness were significant predictive factors of decreased contrast sensitivity (odds ratio = 1.117 and 0.942, respectively). Conclusions As the duration of diabetes increased, the contrast sensitivity decreased in type 2 diabetic patients. Neuroretinal degeneration changes both the inner retinal thickness and total retinal thickness and affects contrast sensitivity. Therefore, for longer-term diabetic patients, it is necessary to consider the changes in contrast sensitivity and retinal thickness on OCT evaluation, even if the patient presents with normal fundus findings.

Recently there has been decreasing trend of high tibial osteotomy in management of the gonarthrotic patients partly due to recurrence of the symptom and, more importantly, due to the relative success of the total knee joint replacement procedure. But there is still room for the high tibial osteotomy, although it may be 'outdated' procedure, in that younger active patients do well postopera- tively for an enough period of time and that even the older have some gain of pain-relief in early postoperative period. The purpose of this study is to detect the affecting factors of the result of the operation. We reviewed 25 valgus high tibial osteotomies in 23 patients who had medial gonarthrosis and could be followed-up more than 1 year among 32 cases between August 1989 and January 1994. The mean length of follow-up was 30 months(ranged twelve to fifty four months). The results were compared according to modified grading of the HSS score. All cases showed the increase of the score from preop. average 65.2 points to postop. 87.8 points, mainly by the decrease of pain and the increase of functional activity. The severity of degenerative change on the radiographs and the degree of varus seemed to be related with the early clinical results of the operation, but the age was not a major affecting factor. These results could be debatable due to some differences from the others', and long term follow-up would be needed.
Follow-Up Studies ; Humans ; Knee Joint ; Knee ; Osteoarthritis ; Osteotomy ; Postoperative Period ; Recurrence

Purpose: To compare the contrast sensitivities of type 2 diabetic patients without retinopathy and healthy subjects, and to assess the risk factors associated with a change in contrast sensitivity in diabetes. Methods: A total of 75 (diabetic patients without retinopathy) and 41 (healthy subjects) eyes were reviewed from the medical records. The threshold of contrast sensitivity was measured at 6.3°, 4.0°, 2.5°, 1.6°, 1.0°, and 0.64° under scotopic and photopic states. Optical coherence tomography (OCT) imaging was used to measure the retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GC-IPL) thickness in diabetic patients. Results: Diabetic patients showed a lower threshold of contrast sensitivity at all degree measures than did the controls under both scotopic and photopic states. In subgroup analyses, diabetic patients with abnormal contrast sensitivity showed a longer duration of diabetes, decreased total retinal thickness, and decreased average GC-IPL, superior RNFL, superior GC-IPL, and temporal GC-IPL thicknesses. Multivariate logistic regression analyses showed that the duration of diabetes and total retinal thickness were significant predictive factors of decreased contrast sensitivity (odds ratio = 1.117 and 0.942, respectively). Conclusions As the duration of diabetes increased, the contrast sensitivity decreased in type 2 diabetic patients. Neuroretinal degeneration changes both the inner retinal thickness and total retinal thickness and affects contrast sensitivity. Therefore, for longer-term diabetic patients, it is necessary to consider the changes in contrast sensitivity and retinal thickness on OCT evaluation, even if the patient presents with normal fundus findings.

Traumatic brain injury (TBI) is an acquired injury to the brain caused by external mechanical forces, which can cause temporary or permanent disability. TBI and its potential long-term consequences are serious public health concerns. This review seeks to provide updated information on the current methods of management of patients with TBI to improve patient care.

Purpose: Necrotizing fasciitis (NF) is one of the most severe healthcare-associated infections. Early diagnosis of NF is difficult because of nonspecific signs and symptoms in the early stage. NF often presents with risks of medicolegal disputes. This study aimed to provide baseline data on the general characteristics of medical accidents involving NF, features of NF, and typical court opinions regarding medical malpractice in Korea. Methods: In this study, 25 cases of medical malpractice litigation involving NF sentenced between 1998 and 2018 were analyzed with respect to 3 variables: medical accident, NF, and breach of duty. Results: The department of colorectal surgery was most frequently involved in litigation cases (40.0%), and colorectal surgery was the most frequent procedure before the diagnosis of NF (40.0%). The most common sites were the upper and lower extremities. The courts agreed that there was typically improper monitoring after treatment, frequently related to NF. Conclusion These litigation cases imply that physicians cannot be blamed for the failure to prevent NF. The timely recognition and management of NF might be considered as one of the main factors for deciding malpractice in court.Therefore, surgeons, especially in the department of colorectal surgery, should pay attention to changes in the patient’s status after surgery. Surgeons need to learn from medical accidents, as it is important for risk management, preventing the occurrence of similar cases, and improving the quality of healthcare services. We report the medicolegal implications from medical lawsuits involving NF.

Intracranial pial arteriovenous fistulas (AVFs) are uncommon, high-flow connection between an artery and a vein without an intervening nidus, vascular lesions treated using endovascular approach with a variety of embolic materials. To our knowledge, hyperperfusion syndrome as a result of embolization of pial AVFs has not been reported before. We report our experience in the treatment of high-flow pial AVF using detachable coils and hyperperfusion syndrome after coil embolization.
Arteries ; Arteriovenous Fistula* ; Embolization, Therapeutic* ; Veins

OBJECTIVE: To investigate the effect of botulinum toxin type A (BTA) injection into the salivary gland and to evaluate the changes of drooling in varied postures in tetraplegic patients with brain injury. METHODS: Eight tetraplegic patients with brain injury were enrolled. BTA was injected into each parotid and submandibular gland of both sides under ultrasonographic guidance. Drooling was measured by a questionnaire-based scoring system for drooling severity and frequency, and the sialorrhea was measured by a modified Schirmer test for the patients before the injection, 3 weeks and 3 months after the injection. Drooling was evaluated in each posture, such as supine, sitting, and tilt table standing, and during involuntary mastication, before and after the injection. RESULTS: The severity and frequency of drooling and the modified Schirmer test improved significantly at 3 weeks and 3 months after the injection (p<0.05). Drooling was more severe and frequent in tilt table standing than in the sitting position and in sitting versus supine position (p<0.05). The severity of drooling was significantly increased in the patients with involuntary mastication (p<0.05). CONCLUSION: Salivary gland injection of BTA in patients with tetraplegia resulting from brain injury who had drooling and sialorrhea could improve the symptoms for 3 months without complications. The severity and frequency of drooling were dependent on posture and involuntary mastication. Proper posture and involuntary mastication of the patients should be taken into account in planning drooling treatment.
Botulinum Toxins* ; Botulinum Toxins, Type A ; Brain Injuries* ; Brain* ; Humans ; Mastication ; Posture ; Quadriplegia ; Salivary Glands ; Sialorrhea* ; Submandibular Gland ; Supine Position ; Ultrasonography