Sphenoid sinus aspergillosis is notorious for its serious complications, such as permanent cranial nerve deficits and possible death. The most common associated symptoms are headache, followed by visual changes, and cranial nerve palsies. Because of an insidious onset, frequently resulting in missed and delayed diagnosis, sphenoid sinus aspergillosis is a potentially lethal medical condition. We report a case of visual loss secondary to isolated sphenoid sinus aspergillosis. A 69-year-old man presented to our hospital with the complaint of headache. The headache started one year previously and was described as severe dull pain localized bilaterally to the temporo-orbital region. The patient took daily NSAIDs for the pain. The neurological examination was normal. The MRI of the brain showed a left sphenoid sinusitis. A transnasal endoscopic superior meatal sphenoidotomy was performed. Aspergillosis was confirmed after a surgical biopsy was obtained. The patient was discharged from hospital without antifungal therapy. One month later, the patient complained of headache and loss of vision bilaterally. The orbital MRI showed a left cavernous sinus and bilateral optic nerve invasion. The loss of visions was permanent. In our case, the diagnosis was delayed; antifungal agents were not administered after surgery and the patient lost his vision as a result. Therefore, early diagnosis and proper treatment are important. Although the treatment of an invasive type of aspergillus has not been established, surgical removal of a nidus and aggressive antifungal therapy are recommended.
Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Antifungal Agents ; Aspergillosis* ; Aspergillus ; Biopsy ; Blindness* ; Brain ; Cavernous Sinus ; Cranial Nerve Diseases ; Cranial Nerves ; Delayed Diagnosis ; Diagnosis ; Early Diagnosis ; Headache* ; Humans ; Magnetic Resonance Imaging ; Neurologic Examination ; Optic Nerve ; Orbit ; Sphenoid Sinus* ; Sphenoid Sinusitis

Although the sternalis muscle has been well known to anatomists, it is quite unfamiliar to clinicians. During routine educational dissection, we came across a well-defined bilateral double sternalis muscle innervated by the intercostal nerve, respectively. The right sternalis muscle 1) became tendinous to insert into the sternum and 2) crossed midline and then intermingled with the left pectoralis major muscle, which could be classified into a double with single cross based on Snosek et al.'s criteria. The left sternalis muscle was composed of two bellies, which were combined at the midway, and became tendinous to insert into the contralateral manubrium, which could be classified into a bicipital diverging with double cross based on Snosek et al.'s criteria. The detailed knowledge on the sternalisis is important for clinicians as well as for anatomists, since the clinical importance of the sternalis muscle has been highlighted in recent years.
Anatomists ; Cadaver* ; Humans ; Intercostal Nerves ; Manubrium ; Sternum

Dentatorubropallidoluysian atrophy (DRPLA) is a rare neurodegenerative disorder usually inherited in an autosomal dominant pattern. DRPLA has been shown to be associated with expansion of an unstable cytosine-adenine-guanine (CAG) trinucleotide repeat in a gene on chromosome 12p. We evaluated a family with DRPLA that affected three members; A 35-year-old female presented with seven year history of gait ataxia, dysarthria and mild cognitive impairment. The MRI of the brain revealed diffuse cerebellar atrophy with an incidental lipoma in the midbrain. Her 30-year-old brother presented with progressive cerebellar ataxia that developed at the age of 20. Her grandmother and mother were reported to have developed ataxia during the late period of their life, and died at the age of 60 and 55, respectively. The demonstration of an expanded CAG repeat in the gene for DRPLA was used to confirm the diagnosis.
Adult ; Ataxia ; Atrophy* ; Brain ; Cerebellar Ataxia ; Diagnosis ; Dysarthria ; Female ; Gait Ataxia ; Genes, vif ; Humans ; Lipoma ; Magnetic Resonance Imaging ; Mesencephalon ; Mild Cognitive Impairment ; Mothers ; Neurodegenerative Diseases ; Siblings ; Trinucleotide Repeats

Calcium-binding proteins play an important role in the protection, differentiation, and reorganization of the central nervous system. The effects of neonatal retinal deafferentiation on calretinin, and tracing of retinotectal pathway were examined immunohistochemically in the superficial layer of the rat superior colliculus. Tracing with cholera toxin was revealed on the superior colliculus contralateral to the ocular injection. On the contralateral side of superior colliculus, the calretinin-immunoreactive (IR) cells were dramatically increased, calretinin-IR fibers were markedly decreased in the superficial layer. These results show that retinal deafferentation results in an increase of calretinin-immunoreactive cells within the superficial layers of the superior colliculus, which suggest reorganization of neurons in superior colliculus.
Animals ; Calbindin 2 ; Calcium-Binding Proteins ; Central Nervous System ; Cholera Toxin ; Eye Enucleation* ; Neurons ; Rats* ; Retinaldehyde ; Superior Colliculi

This study aimed to analyze the epidemiologic characteristics of patients who underwent hip arthroplasty using the Korean nationwide database and investigate the recent trends in implant fixation methods and bearing surface selection. We aimed to compare clinical characteristics and differences with the results from the registry of other western countries. We analyzed the data collected by the Health Insurance Review and Assessment Service database of Korea from 2007 to 2011 and the Main Surgery Statistical Yearbook from 2014 to 2018, published by the National Health Insurance Service. The number and rate of patients who underwent hip joint arthroplasty per 10,000 persons have been steadily increasing since 2007. There was a big difference in mean age and preoperative diagnosis of patients between the bipolar hemiarthroplasty and total hip arthroplasty groups. Most patients underwent surgery using a cementless biological fixation method, and the cemented fixation method was selectively used for a small portion of old aged osteoporotic patients. In relation to the use of bearing surfaces, the registry data showed that ceramic-ceramic bearings were used at an overwhelmingly high rate (81%) in Korea compared to other countries. The reason was attributable to various factors, such as patient’s age or economic status, differences in the health insurance system between countries, and recently reported complications, such as ceramic fracture or noise.

A 59 year-old woman who had suffered daily headaches was diagnosed with leptomeningeal metastasis. Leptomeningeal metastasis is uncommon but devastating form of metastatic spread. Cerebral venous thrombosis is a disease sometimes associated with systemic cancer. Rarely, cerebral sinus occlusion accompanies leptomeningeal cancer. We report a patient who had cerebral sinus thrombosis and leptomeningeal metastasis.
Female ; Headache ; Humans ; Middle Aged ; Neoplasm Metastasis* ; Sinus Thrombosis, Intracranial ; Venous Thrombosis*

OBJECTIVE: There have been no clinical studies regarding the epidemiology and treatment outcome for unruptured intracranial aneurysm (UIA) in South Korea yet. Thus, The Korean Society of Cerebrovascular Surgery (KSCVS) decided to evaluate the clinical and epidemiological characteristics, and outcome of the treatment of UIA in 2006, using the nationwide multicenter survey in South Korea. METHODS: A total of 1,696 cases were enrolled retrospectively over one year at 48 hospitals. The following data were obtained from all patients : age, sex, presence of symptoms, location and size of the aneurysm, treatment modality, presence of risk factors for stroke, and the postoperative 30-day morbidity and mortality. RESULTS: The demographic data showed female predominance and peak age of seventh and sixth decades. Supraclinoid internal carotid artery was the most common site of aneurysms with a mean size of 5.6 mm. Eight-hundred-forty-six patients (49.9%) were treated with clipping, 824 (48.6%) with coiling, and 26 with combined method. The choice of the treatment modalities was related to hospital (p = 0.000), age (p = 0.000), presence of symptom (p = 0.003), and location of aneurysm (p = 0.000). The overall 30-day morbidity and mortality were 7.4% and 0.3%, respectively. The 30-day mortality was 0.4% for clipping and 0.2% for coiling, and morbidity was 8.4% for clipping and 6.3% for coiling. Age (p = 0.010), presence of symptoms (p = 0.034), size (p = 0.000) of aneurysm, and diabetes mellitus (p = 0.000) were significant prognostic factors, while treatment modality was not. CONCLUSION: This first nation-wide multicenter survey on UIAs demonstrates the epidemiological and clinical characteristics, outcome and the prognostic factors of the treatment of UIAs in South Korea. The 30-day postoperative outcome for UIAs seems to be reasonable morbidity and mortality in South Korea.
Aneurysm ; Carotid Artery, Internal ; Diabetes Mellitus ; Female ; Humans ; Intracranial Aneurysm ; Korea ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Stroke ; Treatment Outcome

Transverse rectus abdominis musculocutaneous (TRAM) flap is one of the best flap in breast reconstruction. Even though many trials have been attempted to increase the rate of the flap survival, the necrosis of distal flap area due to vascular compromise is troublesome. The aim of this study was to evaluate the effect of prostaglandin E1(PGE1), surgical delay and the combined procedure on TRAM flap survival rate in vascular compromised rat by diabetes. Left inferior epigastric vessel pedicled TRAM flaps(5.0 x 2.5 cm) were elevated in 40 Sprague-Dawley rats. In control group(N=10), there was no procedure before the flap elevation. In surgical delay group(N=10), the left superior epigastric vessels and the contralateral rectus perforators were ligated 2 weeks before the flap elevation. In PGE1 injection group(N=10), PGE1(0.5microgram) was given intraperitoneally for 2 weeks before the flap elevation daily. In combined procedure group(N=10), the same surgical delay and injection of PGE1 were done simultaneously. On the seventh postoperative day, we evaluated and compared the flap survival rates, the vessel distribution status through Microfil casts, the vessel area rates by histomorphometric analysis in each group. The results were as follows 1) The mean percentages of surviving flap areas of surgical delay group(73.41+/- 10.43%), PGE1 injection group(68.95 +/- 7.13%) and combined procedure group(79.39 +/- 13.44%) were greater than that of control group(44.85 +/- 18.08%) with a statistical significance(p< 0.05). 2) The vessel distributions of each procedure group were more abundant than those of control group in Microfil casts. 3) The mean percentages of vessel areas of surgical delay group(2.74 +/- 0.23%), PGE1 injection group(2.58 +/- 0.49%) and combined procedure group(3.15+/- 0.25) were greater than that of control group(1.24 +/- 0.40%) with a statistical significance(p< 0.05). The results indicated that PGE1 injection or surgical delay procedure could be used to increase the TRAM flap survival area in diabetic condition and the effect of PGE1 was comparable to that of surgical delay procedure. But, the synergistic effect of surgical delay and PGE1 injection was not observed statistically.
Alprostadil* ; Animals ; Female ; Mammaplasty ; Myocutaneous Flap* ; Necrosis ; Rats* ; Rats, Sprague-Dawley ; Rectus Abdominis* ; Silicone Elastomers ; Survival Rate

In addition to the central and the peripheral nervous system, calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) has been identified throughout the enteric nervous system. Several functions of the CGRP in gastrointestinal (G-I) tract has been identified, but the effect of CGRP on G-I motility is unclear. The distribution of calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) in the murine small bowel were studied by using immunohistochemistry, also analyzed functionally by using electrophysiological method. Immunohistochemical studies demonstrated that CGRP-LI is localized in both nerve fibers and myenteric ganglion cells in the whole-mount preparation of murine small intestine. Double labelling with CGRP and c-kit investigated by confocal microscope was shown that CGRP-LI enteric nerve fiber surrounded the c-kit positive interstitial cells of Cajal (ICC). Electrophysiological finding revealed that treatment of CGRP inhibited electrical activity on culture ICC. Our results suggest a CGRP innervation of murine small bowel ICC. The released CGRP from enteric nerve terminals may induce relaxation of small bowel through the inhibition of ICC.
Animals ; Calcitonin Gene-Related Peptide* ; Calcitonin* ; Enteric Nervous System ; Ganglion Cysts ; Immunohistochemistry ; Interstitial Cells of Cajal ; Intestine, Small* ; Mice ; Nerve Fibers ; Peripheral Nervous System ; Relaxation

No abstract available.