BACKGROUND:Acute seizures that increase neuronal activity cause a rapid and transient induction of the immmediate early c-fos in specific brain regions. C-fos gene may mediate long-term changes in cell function, such as growth, differeniation, and development, in response to acute extracellular stimulation. This study is designed to compare the expression of Fos protein in hippocampus after single and repeated injections of kainic acid (KA). METHODS:In KA-single injection model, twelve adult male Sprague-Dawley rats were treated with single intraperitoneal injection of convulsive dose(20-30 mg/kg) of KA, and. in KA-multiple injections model, seven rats received KA by repeated daily intraperitoneal injections for 15 days. Eight control rats received normal saline. Expression of Fos protein was tested in hippocampus by immunohistochemical staining, and was scored by the degree of staining intensity and the ratio of stained cells to tested ones. RESULTS:The scores tended to increase in CA3 and dentate gyrus were significantly higher in KA-single injection model than in control (p<0.05). In comparison with scores in KA-model. CONCLUSION:These results show that repeated seizure produces some blockade of c-fos induction in CA2, CA3 and dentate gyrus. This may be a long-term adaptive response by the nervous system to repated neuronal activation
Adult ; Animals ; Brain ; Dentate Gyrus ; Genes, fos ; Hippocampus* ; Humans ; Injections, Intraperitoneal ; Kainic Acid* ; Male ; Nervous System ; Neurons ; Rats* ; Rats, Sprague-Dawley ; Seizures

PURPOSE: The rectoanal reflex is a response of the anal sphincter to rectal distension, reflecting the functional nature of the anal sampling mechanism of rectal discrimination. The role of this reflex in the continence mechanism is believed to be important, but it exact role still remains to be proven, and the stratification of this reflex, along to the degree of functional impairment of the anal sphincter, is rarely performed. The aim of this study was to assess the differences between various parameters of this reflex among healthy volunteers and incontinent and constipated patients. METHODS: The rectoanal contractile and inhibitory reflexes were recorded in 20 normal controls (group A) and 25 constipated (group B) and 19 incontinent patients (group C). The latencies, areas under the reflex curves, amplitudes and recovery times of each reflex were individually estimated, and differences between the groups statistically analyzed. RESULTS: The inhibitory reflex was not detected in 2 cases from group B (8.0%) and 1 from group C (5.26%). The contractile reflex was not detected in 2 cases from group A (10.0%), 8 from group B (32.0%) and 10 from group C (52.63%). There were no significant differences in any of the parameters in a comparison of the three groups. In a two group comparison, the amplitude and area under the reflex curves of the inhibitory reflex differed significantly between groups B and C (P=0.0373, 0.0238), and the latency of the contractile reflex differed significantly between groups A and C (P=0.0476). CONCLUSION: Both the rectoanal reflexes showed significant differences between the three patient groups, although this was not the case with all parameters. An analytical assessment of the various parameters of those reflexes would, therefore, make it possible to stratify the functional impairment of anal continence.
Anal Canal ; Discrimination (Psychology) ; Healthy Volunteers ; Humans ; Reflex*

PURPOSE: Fatigue rate index (FRI) is one of relatively unknown parameters of anal manometry. It was devised to assess sustained voluntary contractibility of external anal sphincter muscle. We designed this study to determine the predictability of FRI in evaluating patients with symptoms of fecal incontinence. METHODS: Consecutive male patients with fecal incontinence, those with prolapsed hemorrhoids but without any kind of incontinence symptom, and male healthy volunteers who have no anal symptom were grouped as A, B, C. Anal manometric parameters including FRI were measured and compared statistically among them. RESULTS: All subjects were 84. Group A 27, Group B 33, and Group C 24. Their ages were 33.33+/-2.91 (mean SE), 39.27+/-2.80, and 50.81+/-4.33, respectively. Mean resting pressures (mmHg) were 78.11 6.56 for group A, 81.18+/-7.19 for group B, and 57.81+/-7.80 for group C. Maximum resting pressures (mmHg) were 98.67+/-9.69, 100.82+/-8.49, 78.13+/-10.26. Mean squeeze pressures (mmHg) were 229.11+/-18.72, 248.18+/-23.03, 156.94+/-17.89. Maximum squeeze pressures (mmHg) were 286.50+/-33.76, 298.59+/-27.83, 187.38+/-21.08. Resting radial asymmetries (%) were 18.85+/-2.81, 19.85+/-2.31, 28.70+/-4.79. Squeeze radial asymmetries were 15.73+/-2.90, 16.29+/-1.96, 16.47+/-2.95. Fatigue rates were 0.90+/-0.21, 1.17+/-0.15, 1.38+/-0.40. Fatigue rate indices (min.) were 3.76+/-0.41, 2.63+/-0.20, 1.94+/-0.26, respectively. Differences between group A and group C were statistically significant in mean squeeze pressure (P=0.0093), maximum squeeze pressure (P= 0.0190) and FRI (P=0.0008). Those between group B and group C were significant also in mean squeeze pressure (P=0.005), maximum squeeze pressure (P=0.0051), and FRI (P=0.0396). Multiple logistic regression analysis revealed that independently significant parameters were age (P= 0.002) and FRI (P=0.007). Cut-off point of FRI for incontinence with maximum sensitivity and specificity was 2.4min. by ROC (receiver operating characteristics) analysis. CONCLUSION: FRI is a meaningful parameter in predicting fecal incontinence, which can be used in assessment of sphincter function and future treatment protocols.
Anal Canal* ; Fatigue* ; Fecal Incontinence ; Healthy Volunteers ; Hemorrhoids ; Humans ; Logistic Models ; Male ; Manometry ; Sensitivity and Specificity

Dislocations or fractures of the limbs can arise from muscle contraction during epileptic seizures. Dislocation complication of the bilateral temporomandibular joint from seizures is reported very rarely. A 36-year-old woman, who had no history of epilepsy, presented recurrent dislocations of the bilateral temporomandibular joint and generalized tonic-clonic seizures. EEG showed intermittent generalized slow activity. We report a case of bilateral temporomandibular joint dislocation that occurred during generalized tonic-clonic seizures, which has not previously been reported in Korea.
Adult ; Dislocations* ; Electroencephalography ; Epilepsy ; Extremities ; Female ; Humans ; Korea ; Muscle Contraction ; Seizures* ; Temporomandibular Joint*

BACKGROUND: Epilepsy and antiepileptic drugs may be associated with cognitive dysfunction. P300 event-related potentials have been used to assess cognitive function. In this study we investigated the effect of antiepileptic drugs on P300 event-related potentials in epileptic patients. METHODS: P300 latency in event-related potentials was recorded during an auditory oddball paradigm in 29 patients, 10 with generalized epilepsy and 19 with partial epilepsy. The relationships between antiepileptic drugs and P300 latency prolongation were analyzed. RESULTS: P300 latency was prolonged in 31% (9/29) patients with epilepsy. There were no significant relationships between etiology of epilepsy, type of seizure, or type of antiepileptic drugs and P300 latency prolongation. The number or serum level of antiepileptic drugs and treatment duration were related to latency prolongation, but these relations were not significant. CONCLUSION: The prolongation of P300 latency in event-related potentials is not significantly related to antiepileptic drug. This finding suggests that P300 may not be a sensitive additional procedure to assess the cognitive status in epileptic patients.
Anticonvulsants* ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Event-Related Potentials, P300 ; Evoked Potentials* ; Humans ; Seizures

The coexistence of multiple sclerosis (MS) and systemic lupus erythematosus (SLE) is very rare. A 31-years old woman with SLE was admitted because of recurrent optic neuritis. She had positive antinuclear antibody and increased anti-Ro, anti-La and anti-RNP antibodies. T2 weighted MRI showed high signal intensity lesions in left anterior midbrain, internal capsule, and centrum semiovale and corpus callosum. We report a case of multiple sclerosis-like attacks in a patient with SLE.
Adult ; Antibodies ; Antibodies, Antinuclear ; Corpus Callosum ; Female ; Humans ; Internal Capsule ; Lupus Erythematosus, Systemic* ; Magnetic Resonance Imaging ; Mesencephalon ; Multiple Sclerosis* ; Optic Neuritis

PURPOSE: Cecal diverticulitis is rare but relatively common in Asians including Koreans. Furthermore, most case of cecal diverticulitis can be diagnosed as an acute appendicitis preoperatively. The purpose of this study was to evaluate antibiotic treatment for cecal diverticulitis, identified during laparotomy under the diagnosis of acute appendicitis. METHODS: From January 1995 to June 2001, we reviewed 52 patients with cecal diverticulitis, who were diagnosed as having acute appendicitis preoperatively and treated by conservative treatment, i.e. appendectomy only and postoperative antibiotics. RESULTS: The results were as follows. The male to female ratio and mean age was 1.2:1 and 33.4 respectively. The mean operative time was 55.4 minutes. The mean hospital stay was 5.9 days. The site of the diverticulitis was mostly located at the cecum (92.3%). Other sites of diverticulitis were the ascending colon in 2 patients, and the cecum and ascending colon in another 2 patients. The number of diverticulitis found was one in 44 patients (84.6%) and multiple in 8 patients (15.4%). Postoperative complications occurred in 6 patients (11.5%). The most common postoperative complication was wound infection, which occurred in 4 patients. There was no recurrence during follow-up. CONCLUSION: When cecal diverticulitis is found incidentally at the time of an emergency operation for acute appendicitis, we conclude that an appendectomy only combined with postoperative antibiotics is a safe, effective, cost-efficient and cosmetic method.
Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Asian Continental Ancestry Group ; Cecum ; Colon, Ascending ; Diagnosis ; Diverticulitis* ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Laparotomy ; Length of Stay ; Male ; Operative Time ; Postoperative Complications ; Recurrence ; Wound Infection

PURPOSE: Anal manometry is one of the most commonly used tests to evaluate fecal continence function. Advanced pressure parameters of the tests, such as fatigue rate index (FRI), resting rectoanal pressure gradient (RPG), cough index (CI), and radial asymmetry (RA) are recently devised to make up the inaccuracy of conventional parameters, but without solid verification. The object of this study is to investigate such parameters including conventional ones in incontinent patients compared with those in controls and to determine the significance of each parameter. METHODS: Forty-four patients with anal incontinence and 42 controls were studied. We examined conventional pressure parameters (mean resting pressure [MRP], maximum squeeze pressure [MXSP]) and advanced parameters (RPG, FRI, CI, RA), and compare those parameters with normal controls. Multiple logistic regression analysis and receiver operating characteristic curve analyses were also performed. RESULTS: No difference was detected in demographic factors between the two groups. Basic manometric parameters were significantly different between the two groups (MRP, 31.1+/-20.7 mmHg vs. 41.4+/-18.6 mmHg, P=0.0170; MXSP, 203.1+/-84.3 mmHg vs. 258.5+/-105.9 mmHg, P=0.0086). Among advanced parameters, RPG and FRI were significantly different (2.83+/-1.54 vs. 4.08+/-1.53, P=0.0003; 9+/-21.6 sec vs. 75.6+/-12.1 sec, P=0.0333), but CI and RA were not so different (0.74+/-0.45 vs. 0.61+/-0.33, P=0.1326; 22.7+/-7.0% vs. 21.1+/-7.6%, P=0.3244). Only RPG was significant in multiple logistic regression analysis (P=0.019). Areas under ROC curves were 0.65 for MRP, 0.65 for MXSP, 0.82 for RPG, and 0.73 for FRI. CONCLUSION: Among anal manometric pressure parameters, RPG and FRI as advanced parameters are more accurate than any other parameters in detecting fecal incontinence.
Cough ; Demography ; Fatigue ; Fecal Incontinence ; Humans ; Logistic Models ; Manometry ; ROC Curve

PURPOSE: Recently, analytical studies of the various parameters of rectoanal inhibitory reflex were reported and revealed that many of the parameters showed significant differences according to the anal continence function. The standardization of these studies is, however, not yet sufficient enough to apply to use those parameters in reflex test for clinical practice. The aim of this study was to check how the parameters react differently to various degrees of rectal distention and to determine the efficacy of each parameter in clinical applications of rectoanal inhibitory reflex. METHODS: Thirty-two subjects underwent repeated manometries for rectoanal inhibitory reflex with different volumes (40, 60, 80 cc) of rectal ballooning. Latencies, amplitudes, slopes, durations, and areas under the reflex curves of the reflexes were measured, and the differences among them according to the ballooning volume in each subject were analyzed statistically. RESULTS: The area under reflex curve, the amplitude, the duration, and the slope did not differ statistically with the ballooning volume (P values were 0.3959, 0.2142, 0.2080, 0.1453, respectively, by repeated measures two way ANOVA). However, the latencies did differ significantly (P=0.0131). CONCLUSIONS: Most of the parameters except latency were stable against different volumes of rectal ballooning. Among the stable parameters, the area under the reflex curve seemed to be the most useful in clinical applications of rectoanal inhibitory reflex.
Manometry ; Reflex*

Arotinolol, a now alpha and beta bloking agent, was administered orally in 32 hypertensive patients for 8 weeks in order to evaluate the antihypertensive effects and side effects. The doses were from 20mg to 30mg a day. The serum chemistries and chest X-ray were taken before and after Arotinolol administration. The results were as follows; 1) Blood pressure which was measured in sitting, supine and standing position was 176.37+/-4.73/116.54+/-4.34, 170.14+/-5.35/103.12+/-3.67, 156.37+/-7.54/104.31+/-3.34mmHg in control and 144.63+/-2.78/94.41+/-2.87, 146.47+/-5.41/89.12+/-4.34, 140.71+/-4.47/89.73+/-3.71mmHg in the treatment group. The differences between both blood pressure were statistically significant(P<0.001). 2) There was no significant change in pulse rate before and after medication. 3) There was no significant change in the laboratory findings such as CTR, GOT, GPT, alkaline phosphatase, CPK, creatinine, BUN, uric acid, cholesterol, fasting blood sugar and triglyceride before and after treatment. 4) The side effects of arotinolol were observed in 6 of 32 cases(18.7%), which were not required discontinuing the medication or decreasing the dose.
Alkaline Phosphatase ; Blood Glucose ; Blood Pressure ; Cholesterol ; Creatinine ; Fasting ; Heart Rate ; Humans ; Hypertension ; Thorax ; Triglycerides ; Uric Acid