This experiment was designed for the evaluation of the usefulness of enzyme histochemistry in the determination of the lapse of time in brain wound, and also for the establishment of medicolegal 'biological time table' on brain wound. Brain injury was made by contusion and laceration of meninges and brain itself in rats. The results were as follows; 1) By routine histological technique, estimation of the lapse of time in brain wound could be possible 4 hours after the infliction of wound. 2) The earliest change of enzyme activities was recognizable by the decreased activities of ATPase and succinic dehydrogenase 30 minutes after the injury. These decreased enzyme activities were not recovered up to the 4th day after the brain injury. 3) Increased acid phosphatase activity was noticed 1 hour, and beta-glucuronidase, 2 hours after the injury in a mild degree. Both increased activities were pronounced following the lapse of time in brain wound. 4) No significant change was seen in alkaline phosphatase, monoamine oxidase, non-specific esterase and leucine aminopeptidase activities throughout the experimental period up to the 4th day. So the enzyme histochemistry of these enzymes seemed to be little valuable for the study on the timing of wound in brain injury. In the light of these results it appeared that the enzyme histochemistry, in particular of ATPase, succinic dehydrogenase, and acid phosphatase, for the estimation of timing of brain wound not only shortened the histological "lag period" up to 30 minutes after the injury, but also provided a useful information in determining the biological time table following the brain injury.
Acid Phosphatase ; Adenosine Triphosphatases ; Alkaline Phosphatase ; Animals ; Brain Injuries* ; Brain* ; Carboxylesterase ; Contusions ; Glucuronidase ; Histological Techniques ; Lacerations ; Leucyl Aminopeptidase ; Meninges ; Monoamine Oxidase ; Rats ; Succinate Dehydrogenase ; Wounds and Injuries

BACKGROUND: Coughing during emergence from general anesthesia is a common clinical problem and results in a number of undesirable side effects. Remifentanil stimulate micron-opioid peptide receptor known to be related to antitussive effect. The goal of this study was to evaluate the effect of remifentanil on coughing after general anesthesia with desflurane. METHODS: Fifty one ASA physical status I and II patients undergoing elective oral and maxillofacial surgery were randomly assigned to receive either remifentanil with 1 ng/ml effect site concentration or normal saline until extubation. The number and intensity of coughs were monitored during emergence and the recovery time was recorded. RESULTS: The incidence and number of coughing during emergence was significant less frequent in the remifentanil group (P < 0.05). The intensity of coughing was significant milder in the remifentanil group (P < 0.05). There was no significant difference between two groups in the recovery time. CONCLUSIONS: Continuous remifentanil infusion with 1 ng/ml effect site concentration during emergence from general anesthesia with desflurane decrease the incidence of coughing without delaying the recovery time.
Anesthesia, General ; Cough ; Humans ; Incidence ; Isoflurane ; Piperidines ; Receptors, Peptide ; Surgery, Oral

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the significance of the intraoperative postural reduction for kyphotic deformity in unstable burst fracture and confirm the relations of postural reduction and the final correction after loss of correction by posterior instrumentation. SUMMARY OF LITERATURE REVIEW: The loss of kyphotic correction after instrumentation in unstable burst fracture is found. Some methods have been developed to reduce the loss of correction. MATERIALS AND METHODS: 24 short-segment pedicle screw instrumentations in the patients with a unstable burst fracture were performed. We measured sagittal index, wedge angle of vertebral body and anterior vertebral height preoperatively, intraoperatively, postoperatively and at final follow-up. RESULTS: Sagittal index was 20.2 degrees preoperatively, 7.5 degrees intraoperatively, 0.9 degrees postoperatively and 7.2 degrees at final follow-up, so the loss of correction was 32.6%. Wedge angle of vertebral body was 20.3 degrees preoperatively, 10.1 degrees intraoperatively, 6.8 degrees postopera-tively and 9.4 degrees at final follow-up, so the loss of correction was 19.3%. Anterior vertebral height was 57.0%, 79.3%, 85.0%, and 78.8% respectively, so the loss of correction was 22.1%. The loss of correction occurred more in the disc space and less in the vertebral body itself. Postural reduction corrected 63% of sagittal index, 50% of wedge angle of vertebral body and 52% of anterior vertebral height. CONCLUSIONS: Postural reduction corrected kyphotic deformity appropriately. The correction by posterior instrumentation in unstable burst fracture was lost in some amount. The final correction was similar to the one by postural reduction. It is important to obtain the maximum postural reduction intraoperatively to prevent kyphotic deformity caused by loss of correction after surgery.
Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Retrospective Studies

No abstract available.
Head Injuries, Penetrating*

Background: and Purpose Spinocerebellar ataxias (SCAs) are the most common form of hereditary ataxias. Extracerebellar signs have been well described and are helpful in differentiating the SCA subtypes. However, there are few reports on the early-stage extracerebellar signs in various SCA subtypes. This study explored the clinical and magnetic resonance imaging (MRI) characteristics of early-stage SCAs in the Korean population. Methods: We retrospectively reviewed the medical records of genetically confirmed SCA patients with a disease duration of <5 years. Data on baseline characteristics, extracerebellar signs, and initial MRI findings were organized based on SCA subtypes. Results: This study included 117 SCA patients with a median age at onset of 40.6 years. The family history was positive in 71.8% of the patients, and the median disease duration and the score on the Scale for the Assessment and Rating of Ataxia at the initial visit were 2.6 years and 5.0, respectively. SCA3 was the most prevalent subtype, and oculomotor abnormalities were the most frequent extracerebellar signs in early-stage SCAs. Saccadic slowing was characteristic of SCA2 and SCA7, and gaze-evoked nystagmus was prominent in SCA6. Parkinsonism was relatively frequent in SCA8 and SCA3. Decreased visual acuity was specific for SCA7. Dementia was not an early manifestation of SCAs. Brain MRI revealed a pattern of pontocerebellar atrophy in SCA2 and SCA7, while SCA6 demonstrated only cerebellar cortical atrophy. Conclusions SCA patients exhibited diverse extracerebellar signs even in the early stage.Specific extracerebellar signs were characteristic of specific subtypes, which could facilitate differential diagnoses of early-stage SCAs.

Background: and Purpose Spinocerebellar ataxias (SCAs) are the most common form of hereditary ataxias. Extracerebellar signs have been well described and are helpful in differentiating the SCA subtypes. However, there are few reports on the early-stage extracerebellar signs in various SCA subtypes. This study explored the clinical and magnetic resonance imaging (MRI) characteristics of early-stage SCAs in the Korean population. Methods: We retrospectively reviewed the medical records of genetically confirmed SCA patients with a disease duration of <5 years. Data on baseline characteristics, extracerebellar signs, and initial MRI findings were organized based on SCA subtypes. Results: This study included 117 SCA patients with a median age at onset of 40.6 years. The family history was positive in 71.8% of the patients, and the median disease duration and the score on the Scale for the Assessment and Rating of Ataxia at the initial visit were 2.6 years and 5.0, respectively. SCA3 was the most prevalent subtype, and oculomotor abnormalities were the most frequent extracerebellar signs in early-stage SCAs. Saccadic slowing was characteristic of SCA2 and SCA7, and gaze-evoked nystagmus was prominent in SCA6. Parkinsonism was relatively frequent in SCA8 and SCA3. Decreased visual acuity was specific for SCA7. Dementia was not an early manifestation of SCAs. Brain MRI revealed a pattern of pontocerebellar atrophy in SCA2 and SCA7, while SCA6 demonstrated only cerebellar cortical atrophy. Conclusions SCA patients exhibited diverse extracerebellar signs even in the early stage.Specific extracerebellar signs were characteristic of specific subtypes, which could facilitate differential diagnoses of early-stage SCAs.

PURPOSE: To assess the prevalence of KRAS, BRAF, and TP53 mutations in cases of low-grade and high-grade serous carcinomas and to evaluate the clinical outcomes of these morphologically distinct carcinomas. MATERIALS AND METHODS: Patients with primary invasive serous carcinomas were classified according to the universal grading system. Grade 2 serous tumors were excluded. A total of 100 patients were included for clinical evaluation. Thirty-seven patients, including 20 with low-grade and 17 with high-grade carcinomas, were selected for mutational analysis. RESULTS: The low-grade carcinoma group was characterized by young age and premenopausal period compared with the high-grade carcinoma group, but there were no statistically significant differences in stage, metastasis of lymph node and residual disease. There were no statistically significant differences in survival rates, however, the low-grade carcinoma group showed a trend for improved progression-free survival compared with the high-grade carcinoma group of early stage (p = 0.064). Mutations in KRAS and BRAF were found in 6 (30%) and 2 (10%) patients in the low-grade carcinoma group, respectively, however, they were not found in the high-grade carcinoma group. KRAS and BRAF mutations were mutually exclusive, and both mutations were observed in 40% (8/20). The frequency of TP53 mutations in low-grade and high-grade carcinoma groups were found in 20% (4/20) and 70.6% (12/17), respectively (p = 0.009). CONCLUSION: Low-grade serous carcinoma shows mutation pattern different from that with high-grade carcinoma. As there were no significant differences in stage distribution and survival, especially in advanced stage, we suggest that more studies are needed to segregate these patients into distinct disease entities.
Adult ; Cystadenocarcinoma, Serous/*genetics ; DNA Mutational Analysis ; Female ; Humans ; Middle Aged ; Ovarian Neoplasms/*genetics ; Proto-Oncogene Proteins/*genetics ; Proto-Oncogene Proteins B-raf/*genetics ; ras Proteins/*genetics

The funding acknowledgment in this article was omitted as published.

OBJECTIVE: The importance of central blood pressure evaluation for cardiovascular risk stratification has been emphasized. The aim of this study is to evaluate whether brachial blood pressure obtained by the oscillometric method accurately reflects central blood pressure. METHODS: The subjects consisted of 84 consecutive patients with suspected coronary artery disease who underwent cardiac catheterization. Central blood pressure was invasively measured in the origin of the left subclavian artery by using the fluid-filled system, and at the same time, brachial blood pressure in the left upper arm was measured by the oscillometric method. RESULTS: No significant difference was found between central systolic pressure and brachial systolic pressure (144.49+/-18.84 mmHg vs. 142.44+/-14.96 mmHg, P=0.063). Bland-Altman analysis accounted for only a small bias of +2.25 mmHg, and the limits of agreement were 24.15 mmHg and -19.65 mmHg. Central diastolic pressure was significantly lower than brachial diastolic pressure (75.80+/-8.74 mmHg vs. 86.70+/-10.48 mmHg, P<0.001). Bland-Altman analysis showed a significant bias of -5.45 mmHg, and the limits of agreement were 2.83 mmHg and -13.73 mmHg. CONCLUSION: These results indicate that central systolic pressure can be directly estimated from brachial systolic pressure using the noninvasive oscillometric method and observed biases seem to remain within the practical range. However, use of the brachial diastolic pressure and pulse pressure measured by the noninvasive oscillometric method is doubtful in clinical practice because of their large biases.
Arm ; Bias (Epidemiology) ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Artery Disease ; Humans ; Oscillometry ; Subclavian Artery

OBJECTIVES: Busan is reported to have the highest mortality rate among 16 provinces in Korea, as well as considerable health inequality across its districts. This study sought to examine overall and cause-specific mortality and deprivation at the town level in Busan, thereby identifying towns and causes of deaths to be targeted for improving overall health and alleviating health inequality. METHODS: Standardized mortality ratios (SMRs) for all-cause and four specific leading causes of death were calculated at the town level in Busan for the years 2005 through 2008. To construct a deprivation index, principal components and factor analysis were adopted, using 10% sample data from the 2005 census. Geographic information system (GIS) mapping techniques were applied to compare spatial distributions between the deprivation index and SMRs. We fitted the Gaussian conditional autoregressive model (CAR) to estimate the relative risks of mortality by deprivation level, controlling for both the heterogeneity effect and spatial autocorrelation. RESULTS: The SMRs of towns in Busan averaged 100.3, ranging from 70.7 to 139.8. In old inner cities and towns reclaimed for replaced households, the deprivation index and SMRs were relatively high. CAR modeling showed that gaps in SMRs for heart disease, cerebrovascular disease, and physical injury were particularly high. CONCLUSIONS: Our findings indicate that more deprived towns are likely to have higher mortality, in particular from cardiovascular disease and physical injury. To improve overall health status and address health inequality, such deprived towns should be targeted.
Cause of Death ; Confidence Intervals ; Geographic Information Systems ; Health Services Accessibility ; *Health Status Disparities ; Humans ; Korea/epidemiology ; Life Expectancy ; Mortality/*trends ; Normal Distribution ; Poverty/*statistics & numerical data ; Regression Analysis ; Risk ; Socioeconomic Factors