We report the case of a patient with a hemiparetic stroke whose metatarsalgia was successfully managed by reducing the spasticity of plantar flexor using neurolysis with 20% ethyl alcohol. A 57-year-old female patient with left hemiparesis following an infarct of the right corona radiata and basal ganglia one year previously presented with pain (numeric rating scale: 7) in the forefoot under the second to fourth metatarsal heads for six months. We diagnosed her with metatarsalgia and considered that the forefoot pain was associated with mechanical stress around the metatarsal head due to the spasticity (Modified Ashworth Scale: 1+) of the ankle plantar flexor. We performed neurolysis of the medial and lateral motor branches of the tibial nerve to the gastrocnemius muscle with 20% ethyl alcohol. After the alcohol block, foot pain and spasticity significantly reduced (numeric rating scale: 1; Modified Ashworth Scale: 0). Moreover, this effect persisted for at least three months. Clinicians should consider the possibility that spasticity can contribute to the development of foot pain in a patient with stroke.
Metatarsalgia

No abstract available.
Anxiety* ; Depression* ; Humans ; Inpatients* ; Schizophrenia*

Patients with thalamic lesions can experience ataxia on the contralesional side. We report here a 24 year old female patient who presented with a left thalamic tumor and experienced bilateral ataxia of the upper and lower extremities after a left thalamic resection. Her right-sided ataxia was more severe than that of the left side. The bilateral ataxia was likely to be from cerebellar ataxia. The right-sided ataxia may have been caused by injury of the dentatorubrothalamic tract originating from the dentate nucleus of the right cerebellum and terminating in the contralateral ventrolateral nucleus of the left thalamus. We believe that the left sided ataxia in this patient was due to an uncrossed dentatorubrothalamic tract, which control the movement of the ipsilateral side of the human body.
Ataxia

Objective: : We investigated the effect of hypnotics on sleep quality, cognitive function, and depressive mood in patients with insomnia following brain tumor resection. Methods: : From patients who underwent brain tumor resection, we recruited 10 patients with insomnia who received hypnotics for more than 1 week during a 3-week follow-up period (insomnia group). We also recruited 12 control patients with brain tumors but without insomnia (control group). We evaluated sleep quality at baseline and 3 weeks later using the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), the Stanford Sleepiness Scale (SSS), and the Epworth Sleepiness Scale (ESS) and investigated cognitive function and depression using the Computerized Neuropsychological Test and the Beck Depression Inventory (BDI). Results: : At baseline, SSS, ISI, PSQI, and BDI scores were significantly higher and visual continuous performance test (VCPT) and auditory continuous performance test (ACPT) scores were significantly lower in the insomnia than in the control group. Three weeks later, the patients who had received hypnotics had significantly higher ISI, PSQI, ESS, VCPT, ACPT, visual span forward and backward, and visual recognition test scores, and significantly lower BDI scores. Conclusion : Quality of sleep in patients with insomnia following brain tumor resection was initially poor but improved significantly after taking hypnotic medication. Further, the hypnotic medications appeared to contribute to the amelioration of cognitive impairments and depressive moods in patients who previously underwent brain tumor resection. We thus recommend the use of hypnotics for patients with brain tumors with insomnia.

DNA aneuploid cells are poorly characterized in both biochemical and morphological terms. This study was performed to see the relationship between DNA ploidy and morphometric and photometric nuclear features. DNA contents of tumor cells were measured by image cytometry in 46 cases of micro- or early invasive squamous cell carcinoma of the uterine cervix. Also measured were nuclear area, perimeter, maximum diameter, chromatin pattern index, and staining intensity. Among the 46 cases, 20 cases which had both DNA diploid and aneuploid cell subpopulations were selected, and the two subpopulations were discriminated statistically. Multivariate discriminant analysis seperated clearly the two subpopulations, whereas univariate analysis failed. For canonical discriminant function, nuclear area was selected first, followed by staining intensity in each case. Other variables selected afterwards were nuclear perimeter, maximum diameter, and/or chromatin pattern index in random fashion. Correlation coefficient between the canoncial discriminant function and the variables were 0.20~0.40 for nuclear area and 0.25 or less for the others. The above results suggest that DNA ploidy is a parameter more or less independent on individual morphometric and photometric parameters.

The amniotic membrane has some characteristics. First, it does not express the human leukocyte antigens, and therefore immunologic rejection is not a concern. Second, it can be obtained easily and sufficiently. Third, because it has antimicrobial properties, transplantation of the amniotic membrane has fewer risks of post-operative infection. So it is under research for the amniotic membrane transplantation in cases of sterile corneal ulcer, pterygium excision,severe chemical and thermal corneal burns, ocular surface defects, conjunctival surface reconstruction after removal of large conjunctival lesions. We have experienced a good result of amniotic membrane transplantation for the conjunctival defect resulting from conjunctival necrosis, in enucleated eye having undergone scleral graft for scleral necrosis. Therefore, we report this case with a review of the literature.
Amnion* ; Burns ; Corneal Ulcer ; HLA Antigens ; Necrosis* ; Pterygium ; Transplants

PURPOSE: To evaluate the MR appearance of the accessory hepatic veins. MATERIALS AND METHODS: The study included 87 consecutive patients for whom abdominal MR images were obtained. The subjects who had liver lesion or hepatic vascular abnormalities were excluded. Couinaud classified accessory hepatic veins into inferior and middle right hepatic veins. Our major interests were evaluation of the incidence, morphology, and location of the accessory hepatic vein. RESULTS: Inferior right hepatic vein was demonstrated in 43 out of 87 patients(49%). The morphology was linear in 35 patients(80.5%), and V-shaped in 8 patients(19.5%). In 40 patients(93%), the inferior right hepatic vein was located in the posteroinferior aspect of the right lobe. Middle right hepatic vein was demonstrated in 7 out of 87 patients(8%). All were single linear in morphology, combined with the inferior right hepatic vein, and located between the right hepatic vein and inferior right hepatic vein. CONCLUSION: The accessory hepatic vein was demonstrated in 49% among the Korean adult population, and was located in posteroinferior portion of the liver, in 93%.
Adult ; Hepatic Veins* ; Humans ; Incidence ; Liver ; Magnetic Resonance Imaging*

Papillary and solid epithelial neoplasm of the pancreas from five patients were studied using immunohistochemistry and electron microscopy to define the cellular origin of this type of tumor. The tumors ranged in diameter form 5.5 to 15 cm Grossly, these were well circumscribed by a firm, gray-white, fibrous capsule and their cut-surface showed mainly area containing mucinous substance with necrotic and hemorrhagic material, with some solid portion. Microscopically, there was a solid and papillary pattern, with uniform cells typically having round to ovoid nuclei containing indistinct nucleoli and eosinophilic, granular cytoplasm. Within the cytoplasm of the tumor cells, numerous PAS-positive granules were found. Immunostaining was positive for neuron-specific enolase(three of five cases), alpha1-antitrypsin and alpha1-antichymotrypsin(three of five cases) in the solid and papillary portion of the tumor. But no polypeptide hormone immunoreactive cells were present in all cases except for gastrin which showed focally weak positivity in the papillary area. Ultrastructurally, the papillary and solid epithelial neopasm of the pancreas showed evidence of acinar cell differentiation, because in the cell of one observed some zymogen-like granules and presence of annulate lamellae. But also, abundant typical neurosecretory granules were detected in the tumor cells ultrastructurally. Both facts suggested acinar and islet cell differentiation of the tumor. From the these findings, it concluded that papillary and solid epithelial neoplasm of the pancreas may be originated from a primordial cell which will be able to render both endocrine and exocine component.

PURPOSE: The differentiation between renal cell carcinoma(RCC) and transitional cell carcinoma(TCC) is important due to the different methods of treatment and prognosis. But occasionally it is difficult to draw a distinction between the two diseases when renal parenchyme and renal collecting systems are invaded simultaneously. MATERIAL AND METHOD: We reviewed CT scans of 37 cases of renal cell carcinoma and 12 cases of transitional cell carcinoma which showed involvement of renal parenchyma and renal sinus fat on CT. Retrospective analysis was performed by 3 abdominal radiologists. Check points were renalcontour bulging or reniform shape, location of mass center, intact parenchyme overlying the tumor, cystic change, calcification, LN metastasis, vessel invasion, and perirenal extention. RESULT:There were renal contour bulging due to the tumor mass in 33 out of 37 cases of renal cellcarcinima, wherea and nine of 12 cases of transitional cell carcinoma maintained the reniform appearance. This is significant statiscal difference between the two(p<0.005). Center of all TCCs were located in the renal sinus, and 24 out of 35 cases of RCC were located in the cortex(p<0.005). Thirty-six out of 37 cases of RCC lost the overlying parenchyma, whereas 4 out of 9 cases of well enhanced TCC had intact overlying parenchyma(p<0.005) RCC showed uptic change within the tumor mags in 31 cases which was significanity higher than the 4 cases in TCC(p<0.05). CONCLUSION: CT findings of renal cell carcinoma are contour bulging, peripheral location, obliteration of parenchyma, and cystic change. Findings of transitional cell carcinoma are reniform appearance, central location within the kidney, intact overlying parenchyma, and rare cystic change.
Carcinoma, Renal Cell* ; Carcinoma, Transitional Cell* ; Kidney ; Neoplasm Metastasis ; Pelvis* ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed

The epidermal growth factor receptor (EGFR) is a transmembrane glycoprotein whose expression is a possible cause of increased tumor cell proliferation and has recently been proposed as a prognostic parameter in some tumors. Expression of EGFR was studied immunohistochemically in 62 cases of human renal cell carcinomas to evaluate their possible prognostic roles. We also examined the correlation between EGFR expression and cell proliferation by immunohistochemical staining for proliferating cell nuclear antigen (PCNA). Fifty-six cases (90.3%) expressed EGFR, with staining largely confined to the cell membrane and cytoplasm. Staining intensity of EGFR was directly correlated with nuclear grade (p=0.000) and TNM stage (p=0.015). PCNA index was significantly higher in EGFR-positive tumors than in EGFR- negative tumors. There was a statistically significant positive correlation between PCNA index and increasing staining intensity of EGFR (p=0.000). In univariate survival analysis, EGFR expression was significantly associated with shortened survival. However, EGFR expression was not an independent prognostic factor by multivariate analysis. These findings suggest that EGFR expression may be an important cause of tumor cell proliferation in renal cell carcinoma and further studies are needed to evaluate whether EGFR expression analysis provides independent prognostic information.
Carcinoma, Renal Cell* ; Cell Membrane ; Cell Proliferation* ; Cytoplasm ; Epidermal Growth Factor* ; Glycoproteins ; Humans ; Multivariate Analysis ; Proliferating Cell Nuclear Antigen ; Receptor, Epidermal Growth Factor*