OBJECTIVE: This study characterized the neurons in the lumbosacral cord that express phospho ERK (pERK) after distension or irritation of the bladder, and their relation to the vanilloid receptor 1 (VR1) positive primary afferents. METHODS: Mechanical distension and chemical irritation of the bladder were induced by intravesical injection of the saline and mustard oil, respectively. Spinal neurons expressing pERK and the primary afferent fibers were characterized using multiple immunofluorescence for neurokinin 1 (NK1), neuronal nitric oxide synthetase (nNOS) and VR1. RESULTS: Neurons in lamina I, medial dorsal horn (MDH), dorsal gray commissure (DGC) and sacral parasympathetic nucleus (SPN) were immunoreactive for pERK after either mechanical or chemical stimulation. The majority of pERK positive cells were positive for NK1 in lamina I and SPN, but not in the DGC. Most of pERK positive cells are not stained for nNOS except in a small population of the cells in the SPN and DGC. Contacts between perikarya and dendrites of pERK-positive cells and terminals of primary afferents expressing VR1 were identified in lamina I, lateral collateral path (LCP) and SPN. CONCLUSION: In this study, the lumbosacral neurons activated by mechanical and chemical stimulation of the urinary bladder were identified with expression of the pERK, and also provided the evidence that VR1-positive primary afferents may mediate the activation of these neurons.
Administration, Intravesical ; Animals ; Dendrites ; Fluorescent Antibody Technique ; Horns ; Mustard Plant ; Neurons* ; Nitric Oxide Synthase ; Rats* ; Spinal Cord ; Stimulation, Chemical* ; Urinary Bladder*

We report herein an unusual case of tick bite. A 56 year old woman complained of erythematous nodular skin lesion on the left upper chest. An excision biopsy specimen of the lesion showed darkish-red nodule, in which there was a tick. It was identified as an adult female of Ixodes nipponensis by the scanning electron microscopic examination.
Adult ; Biopsy ; Female ; Humans ; Ixodes* ; Middle Aged ; Skin ; Thoracic Wall* ; Thorax* ; Tick Bites ; Tick Infestations* ; Ticks*

PURPOSE: Misdiagnosis is frequent in femoral hernia as inguinal hernia. The aims of this study were to examine the diagnostic concordance and to define the factors having influence on the correct diagnosis of femoral hernia. METHODS: Thirty-two patients who underwent femoral hernia operations were analyzed retrospectively. RESULTS: The mean age of the study subjects was 65.8+/-15.5 (36~97) and the female to male ratio was 5.4:1. The mean body mass index (BMI) was 19.8 kg/m2 (14.6~26.9 kg/m2). Twelve patients (37.5%) showed pre- and post-operative diagnostic concordance and 20 patients (62.5%) did not. Among the 20 misdiagnosed cases, 16 cases were misdiagnosed as inguinal hernia, 2 cases as lipoma, and 1 case as lymphadenopathy. The factors related to the correct diagnosis of femoral hernias were associated with groin mass (96.9%, 31/32: 23 painless and 8 painful), size fluctuation of mass (cyclic wax and wane pattern) (84.4%, 27/32), long duration of mass (over 1 month) (75.0%, 24/32), femoral venous compression CT findings (63.6%, 14/22), and positive ultrasonographic findings (42.1%, 8/19). Emergency operation was done in 12 cases (37.5%). Incarceration was found in 23 cases (71.9%) and most of the incarcerated organs were omental fat (11 cases) and small bowel (10 cases). Bowel resection was done in 4 cases and 2 patients combined inguinal hernia. CONCLUSION: Through the careful taking of medical history and physical examination, physicians can achieve the correct diagnosis and can also decrease the frequency of emergency operations and their related complications.
Body Mass Index ; Diagnostic Errors ; Emergencies ; Female ; Groin ; Hernia, Femoral ; Hernia, Inguinal ; Humans ; Lipoma ; Lymphatic Diseases ; Male ; Physical Examination

OBJECTIVE: In June 28, 2012, a 'Hospitalization guideline for car accident patients' was announced to mediate the clash of opinions about the hospitalization of minor head trauma patients among doctors, patients and insurance companies. The guideline was issued to describe the patients' symptoms and emotions in detail after the injury. In this paper, evaluation for the guideline and suggestions for modifications was done. METHODS: Thirty-two doctors, 96 patients and 60 employees were each given surveys about the hospitalization guidelines, related personnels' attitude and evaluation of patients' emotional problems. The frequency, ratio and chi-square test were performed. RESULTS: Sixty-eight point eight percent of doctors, 79.8% patients and 91.6% insurance company employees agreed to the need for a guideline. Among the 68.8% doctors that supported the need for a guideline, 18.8% knew that the guideline actually existed. Sixty-nine point two percent of doctors said that they would apply the guideline once they were introduced to it. Among the announced guideline provisions, 'Glasgow coma score less than 15' and 'socially not suitable for discharge' required reevaluation since 40.6% all surveyors consented that these two criteria were not suitable. The consensus supporting the need for emotional evaluation came out to be 78.1%, 58.5%, 50.9% in doctors, patients and insurance employees respectively. CONCLUSION: Although a guideline for hospitalization of minor head injury patients is necessary, some part of it seems to be reevaluated and improved, especially for clauses related to the patient's emotional problems. These changes and revisions to the guideline require further speculation and research.
Coma ; Consensus ; Craniocerebral Trauma* ; Hospitalization* ; Humans ; Insurance ; Patient Admission

OBJECTIVE: We compared the effect of decompressive craniectomy between patients < 65 and ≥ 65 years age and investigated prognostics factors that may help predict favorable outcome in acute stroke patients undergoing decompressive surgery. MATERIALS AND METHODS: 52 patients diagnosed with acute middle cerebral artery (MCA) territory infarction that underwent decompressive craniectomy were retrospectively reviewed. The outcome of all patients were evaluated by assessing the Glasgow coma scale, Glasgow outcome scale (GOS), and Modified Rankin scale (mRS) six months after the onset of the disease. 21 patients were preoperatively evaluated with a computed tomography angiography (CTA). Leptomeningeal collateral (LMC) circulation was graded using CTA by experienced neurosurgeons to assess its prognostic value. RESULTS: The thirty day mortality for patients ≥ 65 was 35.0% compared to 37.5% in patients < 65. There was no significant difference in the clinical and function outcome between the two groups (4.8 ± 1.2 vs. 4.5 ± 1.5, p = 0.474). Mortality was lower with early surgery (within 24 hours) group for both age groups (25% vs. 37.5% in ≥ 65, 20% vs. 40.7% in < 65). Longer intensive care units stay time and good collateral supply score were correlated with favorable outcome (p = 0.028, p = 0.018). CONCLUSION: Decompressive craniectomy within 24 hours of stroke symptom onset improved survival in both the < 65 and ≥ 65 age groups. There was no significant difference in the functional outcome of both age groups. Unlike previous reports, old age, delayed operation, and multiple of infarct territories were not predictive of poor functional outcome. The presence of good collateral circulation may be a predictor of positive clinical outcome in acute ischemic stroke patients undergoing decompressive craniectomy.
Aged* ; Angiography ; Brain Edema ; Cerebral Infarction ; Collateral Circulation ; Decompressive Craniectomy* ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Infarction ; Infarction, Middle Cerebral Artery* ; Intensive Care Units ; Middle Cerebral Artery* ; Mortality ; Neurosurgeons ; Retrospective Studies ; Stroke

Arkinson's disease(PD) is a neurodegenerative disease involving mainly the loss of dopaminergic neurons in substantia nigra by several factors. The cause of dopaminergic cell death is unknown. Recently, it has been focused on that Parkinson's disease resulting from mitochondrial dysfunction. In the previous studies, it was found that a 5 kilobase(kb) deletion derived from mtDNA dysfunction. And this result leads to a reduction of ATP production, which ultimately causes result in cell death. Blood samples were collected from 6 positive control(PC) and 9 PD patients. Total DNA was extracted twice with phenol followed by chloroform:isoamylalcohol(24: 1). For the analysis of mtDNA, polymerase chain reaction(PCR) and long and accurate polymerase chain reaction(LA PCR) were performed by mitochondrial specific primers. As a result, a deletions of large quantity was detected within several regions of mtDNA in PD patients. The analysis of the partial sequence of the mitochondrial D-loop gene and restriction fragment length polymorphism(RFLP) technique were performed to investigate the point mutation and nucleotide sequence variations between PC and PD patients. Fragment variations between PC and PD were seen in the fragment digested by Hin d III, Eco R V. These variations are attributed to the presence or absence of recognition site by base substitution. Point mutation was observed in the D-loop region. Patients 1 and 2 had one point mutation. Patient 1 had a transition from T to C at 195, and patient 2 had a transversion from A to T. In addition to point mutation, the deletion of mtDNA occurred complexI, III, IV and V subunits in PD patients.
Adenosine Triphosphate ; Base Sequence ; Cell Death ; DNA ; DNA, Mitochondrial ; Dopaminergic Neurons ; Humans ; Neurodegenerative Diseases ; Parkinson Disease* ; Phenol ; Point Mutation ; Polymorphism, Restriction Fragment Length ; Substantia Nigra

This work describes tamaoxifen, a nonsteroidal antiestrogen compound, which has been used extensively in the treatment of breast cancer on account of its efficacy and relatively low toxicity. It has been reported to inhibit glioma proliferation in all cell line tested, acting by a mechanism independent of estrogen receptor blockade. Tamoxifen causes cytotoxicity at higher concentration(>or=5 micrometer), as compared with control. Our results showed that this compound decreased the rate of cell proliferation in dose-dependent manner. Its treatment against the C6 glioma cells also resulted in enhancement of the antitumor effect. These data suggest that tamoxifen may serve as an useful agent in chemotherapy of glioma.
Breast Neoplasms ; Cell Line ; Cell Proliferation ; Drug Therapy ; Estrogen Receptor Modulators ; Estrogens ; Glioma* ; Tamoxifen*

The effect of mitomycin on the corneal endothelial cell density was evaluated between the mitomycin group of 23 eyes who underwent trabeculectomy with mitomycin and the control group of 20 eyes who underwent trabeculectomy. The mitomycin(0.2 mg/ml) was applied under the scleral flap, Tenon's capsule or conjunctiva during trabeculectomy for 2-5 minutes(average: 4 minutes) and was irrigated with 50ml of balanced salt solution. Average central endothelial cell loss in the mitomycin group was 10.1 +/- 7.1% and 8.4 +/- 8.3% in the control group(P>0.05, t-test). A shallow anterior chamber with iridocorneal touch(Spaeth's grade 1 and 2) was developed in 12(52%) of 23 eyes in the mitomycin group and 9(45%) of 20 eyes in the control group(P>0.05, chi-square). The average central endothelial cell loss was 12.7 +/- 8.3% in 21 eyes with iridocorneal touch and 5.9 +/- 5.4% in 22 eyes that maintained their anterior chamber(P<0.05, t-test). In 21 eyes with iridocorneal touch average central endothelial cell loss was 12.6 +/- 7.8% in the mitomycin group, and 12.8 +/- 9.5% in the control group(P>0.05, t-test). In 22 eyes that maintained their anterior chamber, average loss was 7.1 +/- 5.4% in the mitomycin group, and 4.8 +/- 5.4% in the control group(P>0.05, t-test). These findings suggest that intraoperative use of mitomycin(0.2 mg/ml) during trabeculectomy is unlikely to cause profound corneal endothelial cell loss and iridocorneal touch after the filtering surgery is associated with greater loss of endothelial cells.
Anterior Chamber ; Conjunctiva ; Corneal Endothelial Cell Loss ; Endothelial Cells* ; Filtering Surgery ; Mitomycin* ; Tenon Capsule ; Trabeculectomy*

We present a rare case of 22-year-old man who had a huge aneurysmal bone cyst of the sacrum. Preoperative adjuvant selective arterial embolization of the branches of internal iliac arteries was performed. The next day, the patient received a radical surgical excision and posterolateral screw fixation. The patient was discharged without neurological problems or symptoms. Currently, the patient has been treated without local recurrence and is symptom free. Overall, in similar cases, an aneurysmal bone cyst, chordoma, osteoblastoma and giant cell tumor should be included in a differential diag- nosis based on the imaging studies.
Aneurysm ; Bone Cysts ; Chordoma ; Giant Cell Tumors ; Humans ; Iliac Artery ; Osteoblastoma ; Recurrence ; Sacrum ; Young Adult

OBJECTIVE: Kummell's disease is a rare spinal disorder with delayed post-traumatic osteonecrosis of a vertebral body and the pathophysiology is still unclear. Percutaneous vertebroplasty was found to be an effective procedure as a treatment, but there are not sufficient studies. We evaluated the efficacy and complications of vertebroplasty or kyphoplasty in the treatment of delayed post-traumatic intravertebral osteonecrosis. METHODS: A retrospective review was conducted of 29 patients complicated with delayed post-traumatic intravertebral osteonecrosis among the 393 cases of osteoporotic vertebral compression fracture treated with vertebroplasty or kyphoplasty from January 2001 to June 2005. With 29 cases of intravertebral osteonecrosis, we reviewed the duration from initiation of symptoms to admission and the history of trauma. Also, we analysed the restoration of height of vertebral body, the correction of kyphotic angle, the clinical results with VAS score, the amount of injected polymethylmethacrylate(PMMA), and the complications due to PMMA leakage between the vertebroplasty and kyphoplasty. RESULTS: There were 29 patients(22 females and 7 males) complicated with delayed post-traumatic osteonecrosis of vertebral body(7.3%), and mean age was 73.3 years. The cases with prominent traumatic history were 19 and the mean duration from initiation of symptoms to admission was 5.9 weeks. The whole surgically treated levels were 31 levels; 19 levels with vertebroplasty(group A), 12 levels with kyphoplasty(group B). The leakage of PMMA was occurred in 9 levels; 6 levels in vertebroplasty and 3 levels in kyphoplasy. However, there were no serious complications. In the VAS score, there was 4.9 in group A compared to 5.3 in group B. But there was no significant difference statistically. We measured vertebral body height and kyphotic angle to figure out the degree of restoration after procedures. Both group A and B showed somewhat effective restoration of vertebral height and correction of kyphotic angle. However, there were no stastical differences between two groups. After 14 months, restored vertebral heights and corrected kyphotic angles reaggravated and this suggest that the process of vertebral osteonecrosis is going on even after receiving vertebroplasty and kyphoplasty. CONCLUSION: For the treatment of Kummell's disease, both vertebroplasty and kyphoplasty seemed to be somewhat effective. Although the PMMA leakage occurred more often in vertebroplasty group than kyphoplasty group, there were no statiscal difference in recovery of VAS score. However, the process of intravertebral osteonecrosis can be developed continuously after procedure which may be the cause of serious complications. Therefore, continuous follow-up observation after procedure should be recommended.
Body Height ; Female ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Osteonecrosis ; Polymethyl Methacrylate ; Retrospective Studies ; Vertebroplasty