The present in vitro experiments were performed to investigate the contractile activity and action sites of various vasoactive agents on isolated porcine internal carotid artery as a preliminary study on cerebral arterial spasm. The cumulative dose-response curves were obtained for most vasoactive agents such as serotonin and adrenergic drugs including agonists and these effects were investigated under antagonists in isolated arterial rings. The results of this study suggest that serotonin is the most potent agent for the cerebral arterial spasm, and there are alpha-adrenoceptor and serotonin receptor mediating vasoconstriction and beta-adrenoceptors mediating vasodilation in porcine internal carotid artery. The cross reactivity between alpha-adrenoceptor and serotonin receptor suggests that the two types of receptors have common features which will be further investigated.
Adrenergic Agents ; Carotid Artery, Internal ; Cerebral Arteries* ; Epinephrine ; Negotiating ; Norepinephrine ; Serotonin ; Spasm ; Vasoconstriction ; Vasodilation

Radiotherapy (RT) is a fundamental modality in treatment of cervical cancer. With advancement of technology, conventional RT used for external beam radiotherapy (EBRT) for over half a century has been rapidly replaced with intensity-modulated radiation therapy (IMRT) especially during the last decade. This newer technique is able to differentiate the intensity of radiation within the same field, thus reduces the inevitable exposure of radiation to normal organs and enables better dose delivery to tumors. Recently, the American Society for Radiation Oncology has released a guideline for RT in cervical cancer. Although a section of the guideline recommends IMRT for the purpose of toxicity reduction, a thorough review of the literature is necessary to understand the current status of IMRT in cervical cancer. This narrative review updates the recent high-level evidences regarding the efficacy and toxicity of IMRT and provides a better understanding of the most innovative techniques currently available for EBRT enabled by IMRT.

PURPOSE: Recent development of diffusion tensor imaging enables the evaluation of the microstructural characteristics of the brain white matter. However, optimal imaging parameters for diffusion tensor imaging, particularly concerning the number of diffusion gradient direction, have not been studied thoroughly yet. The purpose of this study was to evaluate the influence of the number of diffusion gradient direction on the fiber tracking of the white matter. MATERIALS AND METHODS: 13 healthy volunteers (ten men and three women, mean age 30 years, age range 23-37 years) were included in this study. Diffusion tensor imaging was performed with different numbers of diffusion gradient direction as 6, 15, and 32, keeping the other imaging parameters constant. The imaging field ranged from 1 cm below the pons to 2-3 cm above the lateral ventricle, parallel to the anterior commissure-posterior commissure line. FA (fractional anisotropy) maps were created via image post-processing, and then FA and its standard deviation were calculated in the genu and the splenium of the corpus callosum on each of FA maps. Fiber tracking of the corticospinal tract in the brain was performed and the number of the reconstructed fibers of the tract was measured. FA, standard deviation of FA and the number of the reconstructed fibers were compared statistically between the different diffusion gradient directions. RESULTS: FA is not statistically significantly different between the different diffusion gradient directions. By increasing the number of diffusion gradient direction, standard deviation of FA decreased significantly, and the number of the reconstructed fibers increased significantly. CONCLUSION: The higher number of diffusion gradient direction provided better quality of fiber tracking.
Anisotropy* ; Brain ; Corpus Callosum ; Diffusion Tensor Imaging ; Diffusion* ; Female ; Healthy Volunteers ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging* ; Male ; Pons ; Pyramidal Tracts

The lips are essential in maintaining oral competence and assist in mastication, deglutition, and articulation. The lips are also important aesthetically, contributing to appearance and facial expression. Defects of up to one third of the lower lip can be closed primarily, but larger defects require more complex techniques. Successful lip reconstruction require careful meticulous planning to achieve the optimum functional and cosmetic result. When planning a reconstruction of a large defect of the lower lip, the following points should be taken into consideration: 1) maintain the sphincter function, 2) retain the sensation, 3) acquire a large enough opening for the mouth, 4) strive for an acceptable cosmetic appearance. It is not possible to satisfy all these criteria in every instance, and careful preoperative evaluation is essential. We describe here a successful technique to reconstruct a large lower lip defect using a depressor anguli oris musculocutaneous flap and a mucosal flap for elderly patients.

We describe here a 57-year-old woman with a chronic-contained rupture of an internal iliac arterial aneurysm, and this was eroding the sacral neural foramen. Although an isolated internal iliac arterial aneurysm is known to be rare, the ruptured internal iliac arterial aneurysm was diagnosed based on the characteristic radiolgic findings with performing color Doppler ultrasound, MRI and multi-slice computed tomography. The ruptured aneurysm was successfully treated by coil embolization. Color Doppler US, MRI and multi-slice CT are useful for evaluating a mass of a vascular origin that involves the neural foramen.
Aneurysm ; Aneurysm, Ruptured ; Cytochrome P-450 CYP1A1 ; Embolization, Therapeutic ; Female ; Humans ; Middle Aged ; Rupture ; Spine

Neurilemmomas are benign tumors that arise from the nerve sheath. Facial nerve neurilemmomas are uncommon, slow-growing neoplasms that occur anywhere along the course of the facial nerve. The majority of facial nerve neurilemmomas are intratemporal, with a few cases arising from the intraparotid portion. The clinical presentations are generally insidious and the nature of the disease depends on the location and extent of the tumor. They are difficult to diagnose preoperatively and are frequently misdiagnosed because of the variety of their clinical manifestations. Therefore, early and correct diagnosis and evaluation are necessary. Recently, we experienced two cases of facial nerve neurilemmoma with relatively good surgical result, involving the mastoid segment of the facial nerve and the main trunk of the facial nerve in the parotid gland. We reviewed the diagnosis, pathology, and treatement of this case, and report the cases with reviews of literature.
Diagnosis ; Facial Nerve* ; Mastoid ; Neurilemmoma* ; Parotid Gland ; Pathology

In general, causes of conductive hearing loss with the intact tympanic membrane and external auditory canal are known as congenital anomaly of the ossicular chain, otosclerosis, and head trauma-induced ossicular discontinuity. But it may also occur due to fibrotic change by potential inflammation of the ossicular chain as a result of otitis media in the infancy or childhood. We report two cases of fibrous change of the ossicles by probable middle ear inflammation with a review of the related literature.
Ear Canal ; Ear Ossicles ; Head ; Hearing Loss, Conductive* ; Inflammation ; Otitis Media ; Otosclerosis ; Tympanic Membrane*

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) production in the respiratory epithelium and the demonstration of inducible nitric oxide synthase in ciliated epithelium of the upper airway have recently been reported. The aim of this study was to investigate the expression of inducible nitric oxide synthase in the nasal epithelium after capsaicin treatment, which stimulates the substance P innervation. MATERIALS AND METHODS: In vivo treatment -Capsaicin (112 nM) was applied to the nasal cavities of the rat and guinea pig, and 30 nl of normal saline was applied for the control groups. After 2 hours, animals were sacrificed with cardiac perfusion of 4% paraformaldehyde and septal mucosa were removed. The 8 nm serial frozen tissue sections were made, and the expression of inducible nitric oxide synthase was determined using nicotinamide adenine diphosphate-diaphorase histochemistry. In vitro treatment- The nasal septum of the rats and the trachea of the guinea pigs were incubated in DMEM culture media with or without 112 nM capsaicin for experimental or control groups. After 0, 30 or 120 minutes of incubation, the tissues were fixed and processed for nicotinamide adenine diphosphate-diaphorase histochemistry. RESULTS: Both in vivo and in vitro studies demonstrated that the strong positive histochemical reactivity were observed in the respiratory epithelium of the rats and guinea pigs after capsaicin treatment compared to control groups. CONCLUSION: These data imply that capsaicin induces the expression of inducible nitric oxide synthase and that the substance P innervation of the nasal mucosa may have a protective role in the airway defense mechanism through nitric oxide production.
Adenine ; Animals ; Capsaicin* ; Culture Media ; Epithelium* ; Guinea Pigs ; Guinea* ; Mucous Membrane ; Nasal Cavity ; Nasal Mucosa ; Nasal Septum ; Niacinamide ; Nitric Oxide ; Nitric Oxide Synthase Type II* ; Perfusion ; Rats* ; Respiratory Mucosa ; Substance P ; Trachea

BACKGROUND AND PURPOSE: Variant alleles of CYP2C9 and VKORC1 account for differences in anticoagulation response. We sought to establish a warfarin dosing formula for individualized target International Normalization Ratio of Prothrombin Times (INRs) using data from single nucleotide polymorphisms (SNPs) in VKORC1 and CYP2C9 in Korean patients. METHODS: Ischemic stroke patients displaying stable target INR for at least 3 months before enrollment were analyzed. Warfarin and vitamin K levels were measured to adjust for confounders. Phenotypes were defined using the 'warfarin response index' (WRI) defined as INR divided by the daily maintenance warfarin dose. We tested SNPs in CYP2C9 (3 sites: 430C>T (rs1799853), 1075A>C (rs1057910), 1076T>C) and VKORC1 (14 sites: 381C>T, 861C>A (rs17880887), 2653G>C, 3673A>G, 5496G>T, 5808T>G (r17882154), 6009C>T, 6484T>C (rs9934438), 6853C>T (rs17886369), 7566T>C, 8767G>C, 8814T>C, 9041G>A (rs17880624), and 9071G>T) using a standard sequencing method. Multivariate linear regression analysis was applied to establish the formula for warfarin dosage. RESULTS: All 204 patients had excellent drug compliance. The mean INR was 2.22 (+0.56) and mean daily maintenance dose of warfarin was 3.92 mg (+1.54). Patients with low WRI were younger (P<0.001) with high body mass index (P=0.003), high prevalence of wild-type CYP2C9 polymorphism (1075A>C, P<0.001), and six heterozygote SNPs in VRORC1 (P<0.001), which were tightly interlinked (381T>C, 3673G>A, 6484T>C, 6853C>G. 7566C>T, 9041G>A) (r2=1). Based on these data, a warfarin dosing formula was established. CONCLUSIONS: WRI is influenced by age, body mass index and SNPs in VKORC1 and CYP2C9 in Korean stroke patients. The obtained warfarin dosing formula may be clinically applicable.
Alleles ; Body Mass Index ; Compliance ; Genotype ; Heterozygote ; Humans ; International Normalized Ratio ; Linear Models ; Phenotype ; Polymorphism, Single Nucleotide ; Prevalence ; Prothrombin Time ; Stroke ; Vitamin K ; Warfarin

Suicide, the fourth leading cause of death in Korea, is a serious national problem. The Korea National Suicide Survey (KNSS) is the result of the first legislation to address this issue, "Article 11 of THE ACT FOR THE PREVENTION OF SUICIDE AND THE CREATION OF A CULTURE OF RESPECT FOR LIFE" (the "Act for the Prevention of Suicide"). To overcome the limitations of previous studies, the KNSS was designed by collaborators from a variety of fields : psychology, epidemiology, social welfare, and psychiatry. The KNSS was composed of four substudies that addressed the multifaceted process involved in suicide-related behavior over time, exploring general attitudes toward suicide and suicidal ideation, suicide planning, suicide attempts, and completed suicides. Study 1 examined the risk factors for suicide based on data regarding completed suicides ; Study 2 adopted the approach of a psychological autopsy ; Study 3 focused on suicide attempters ; and Study 4 explored attitudes toward suicide in the general population. The KNSS was designed to provide a comprehensive understanding of suicide from a longitudinal, multifaceted perspective to serve as a basis for policies aimed at suicide prevention.
Autopsy ; Cause of Death ; Epidemiology ; Korea ; Psychology ; Risk Factors ; Social Welfare ; Suicidal Ideation ; Suicide*