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: 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

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*

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

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

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

BACKGROUND: The major risk factors such as hypercholesterolemia, hypertension, diabetes melitus and cigarrete smoking have not been studied in an attempt to provide a composition of major risk factors in Korea. Also we have met with some patients without major risk factors. METHODS: A Retrospective Study was done on 160 patients of acute myocardial infarction who had been admitted to National Medical Center within 48 hours from onset, from January 1948 to December 1992 and studied on major risk factors of acute myocardial infarction. RESULTS: 1) Among major risk factors, smoking was found in 50%, hypertension in 49%, diabetes in 25% and hypercholesterolemia in 21%. 2) The percentage of patients without major risk factors was 19%. 3) Among major risk factors, hypertension, hypercholesterolemia and diabetes were increasing tendencies, recentely. CONCLUSION: Some patients with acute myocardial infarction don't have any major risk factors. Also hypertension, hypercholesterolemia and diabetes were increasing tendencies. So further study for other risk factors is needed and preventive management should require a commitment to behavior modification and alteration in life-style.
Behavior Therapy ; Humans ; Hypercholesterolemia ; Hypertension ; Korea ; Myocardial Infarction* ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking

C-fos protein is a gene regulatory third messenger involved in long-term responses of cells to various stimuli. Kainic acid(KA), a powerful excitatory analogue, induces seizures and damages the hippocampus and other limbic regions in rats. KA treatment induces c-fos protein production in the hippocampus. This study was undertaken to investigate the expression of c-fos protein in the hippocampus according to seizure stage induced by systemic injection of KA. Twenty-three adult male Sprague-Dawley rats experienced convulsions by a single intraperitoneal injection of convulsive dose (20-40 mg/Kg) of KA. Seven control rats received normal saline. Animals were sacrificed 3 hr after KA treatment. The expression of c-fos protein was tested in the hippocampus by immunohistochemical staining using polyclonal anti-Fos. Most of the rats exhibited limbic motor epileptic activity. C-fos protein immunoreactivity increased in the CA1, CA3 and dentate gyrus at stage 1-2, and not only in the CA1, CA3 and dentate gyrus but also in the CA4 at stage 3-4. At stage 5, c-fos protein immunoreactivity increased in all areas of the hippocampus. C-fos protein immunoreactivity increased progressively with increasing severity of convulsions. These results show that KA produces limbic motor seizure associated with a rise in the c-fos protein in the hippocampus, and that the expression of c-fos protein may has some relevance to the progressive and permanent brain changes occurring during epilepsy.
Adult ; Animals ; Brain ; Dentate Gyrus ; Epilepsy ; Genes, vif ; Hippocampus* ; Humans ; Injections, Intraperitoneal ; Male ; Rats* ; Rats, Sprague-Dawley ; Seizures*

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*