We examined the localization of neurofascin (NF) in the sciatic nerve of rat. In the myelinated fibers, neurofascin localizes strongly in the nodal axolemma except the small central cleft and also expresses in the paranodes, and weakly in the Schmidt-Lanterman incisures. In the paranodes, NF localizes around the axolemma and it expresses in the apposing membrane of paranodal loops. Axoplasm, compact myelin and cytoplasm of Schwann cell do not express NF at all. In the Schmidt-Lanterman incisures, NF is expressed weakly along the Schwann cell membrane. We propose that neurofascin may be a plasmalemmal integral protein of Schwann cell in the paranode and plays some important roles for the maintenance of axo-glial junctions at the paranode. It may also have some roles for maintaining the structure of Schmidt-Lanterman incisure and have some relations with proteins localizing in the node.
Animals ; Cell Adhesion Molecules/*analysis/physiology ; Fluorescent Antibody Technique ; Microscopy, Immunoelectron ; Nerve Growth Factors/*analysis/physiology ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve/*chemistry/ultrastructure

A 68-year-old man presented with a six-month history of painless dysphagia, malnutrition, anorexia and vocal hoarseness. Signs of severe mitral regurgitation and preserved left atrial dimensions were discovered on transthoracic echocardiography. However, electrocardiography and chest radiography were strongly suggestive of left atrial enlargement. Further investigations confirmed extrinsic compression of the oesophagus, which caused the dysphagia. Computed tomography of the throrax revealed a giant left atrium that was not appreciated on echocardiography. Hoarseness was found to be caused by right recurrent laryngeal nerve palsy. Ortner’s syndrome, which describes the occurrence of vocal hoarseness due to a cardiopulmonary disease that results in the compression of the left recurrent laryngeal nerve, is usually associated with severe mitral stenosis. Herein, we report an unusual case of Ortner’s syndrome caused by a giant left atrium, which resulted from severe mitral regurgitation, causing extrinsic oesophageal compression and right recurrent laryngeal nerve palsy. Physicians should remain cognisant of cardiovascular disorders as uncommon causes of painless dysphagia or vocal hoarseness.
Aged ; Cardiovascular Diseases ; diagnosis ; Deglutition Disorders ; diagnosis ; Dysphonia ; diagnosis ; Electrocardiography ; Hoarseness ; diagnosis ; Humans ; Male ; Mitral Valve Insufficiency ; diagnosis ; Radiography, Thoracic ; Syndrome ; Tomography, X-Ray Computed ; Treatment Outcome ; Vocal Cord Paralysis ; diagnosis

Motor posturing in acutely comatose patient is suggestive of an evolving brain herniation. In the presence of a unilateral pupillary abnormality, a metabolic or drug induced coma can be excluded. Neuroimaging studies in such cases will likely reveal underlying mass or acute ventricular obstruction. We recently encountered a patient who presented in stupor with repetitive motor posturing and a transient right oval pupil to light stimulus. Surprisingly, an urgent brain CT revealed only mild global atrophy for age. Further evaluation disclosed cryptococcus meningitis as the underlying cause.

Objective To evaluate the minimally invasive surgery in coronary artery bypass grafting and the feasibility for revascularization of triple vessel coronary artery disease.Methods Nine female patients, aged 49.1 to 81.6 years (mean 64.3), were operated on for triple vessel disease through minimally invasive surgical techniques. The surgeries were performed through limited left parasternal incision under femorofemoral extracorporeal circulation. The myocardium was protected by antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped. Under direct vision, the left saphenous vein grafts were connected sequentially to the diagonal branch, obtuse marginal branch and posterior descending branch, and the left internal thoracic arterial graft was anastomosed to the left anterior descending artery in each patient. Results The number of distal anastomoses was 3 to 4 with a mean of 3.7. The aortic crossclamp time was 52 to 130 minutes (82±25 minutes). The duration of extracorporeal circulation was 78 to 151 minutes (115±29 minutes). The postoperative course was uneventful in all patients. The postoperative length of stay was 4 to 12 days (7.2±2.0 days). Follow-up (4.2 to 8.7 months, mean 6.4) was complete in all patients and there were no late deaths or angina. Coronary angiography of 2 patients showed patent grafts. All patients were satisfied with the good cosmetic healing of the incision.Conclusion Our experience demonstrates that minimally invasive surgery in coronary artery bypass grafting is technically feasible and may be an alternative approach in surgical revascularization of triple vessel coronary artery disease, especially in female patients.

Aged ; Aortic Aneurysm ; diagnostic imaging ; etiology ; Aortic Valve Insufficiency ; diagnostic imaging ; Echocardiography ; Giant Cell Arteritis ; complications ; diagnostic imaging ; Humans ; Male

This is the report of an anterior communicating artery aneurysmal coil as the likely source of septic emboli resulting in bilateral hemispheric abscesses sparing the medial frontal, parietal and occipital lobes and brainstem. Cessation of antegrade anterior cerebral artery flow and resulting turbulent flow into the distal cortical arterial watershed of middle cerebral artery territory bilaterally is the probable mechanism for this unusual pattern.

Purpose: Contemporary treatment strategies for localized prostate cancer (PCa) have been evolved over time. However, there is little data regarding survival outcomes based on initial treatment by risk group in this new era. This study aims to evaluate survival outcomes among men who underwent observation, radiotherapy, or radical prostatectomy for localized PCa using a population-based cohort. Materials and Methods: The Surveillance, Epidemiology, and End Results (SEER) prostate with watchful waiting dataset (2010–2016) was used. We included men diagnosed with localized PCa and clinical stage T1c-2cN0M0. Other inclusion criteria were age 50–79 years, prostate-specific antigen (PSA) ≤50 ng/mL, and initial treatment with observation (active surveillance/watchful waiting), radiotherapy, or radical prostatectomy. PCa risk was assessed using the D’Amico classification. The primary endpoint was overall survival. Secondary endpoints included PCa-specific survival. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression and competing risk analysis were performed to assess outcomes. Results: After IPTW-adjusting, pseudo-population comprised 521,656 men (observation: 170,428, radiotherapy: 175,628, radical prostatectomy: 175,600) at a median 36.5 month follow-up. Observation demonstrated the lowest 5-year overall survival rate (91.6%) after IPTW-adjusting in comparison to radiotherapy (92.4%) and radical prostatectomy (96.1%, p<0.001). Men who underwent radical prostatectomy had the lowest cumulative PCa-specific and all-cause mortality (p<0.001). Compared to observation, radiotherapy (sub-distribution hazard ratio [sHR], 0.89; 95% CI, 0.81–0.97; p=0.012) and radical prostatectomy (sHR, 0.46; 95% CI, 0.41–0.52; p<.001) had a lower risk of PCa-specific mortality in competing risk analysis after adjustment for all other factors and other-cause death. Conclusions Intermediate-term mortality risk in men with localized PCa were lower with active treatments compared to observation-especially for intermediate- and high-risk disease. However, observation represents a safe management strategy in men within the low-risk group.

Gastric hemangioma in the neonatal period is a very rare cause of upper gastrointestinal bleeding. We present a case of hemangioma limited to the gastric cavity in a 10-day-old infant. A huge, erythematous mass with bleeding was observed on the lesser curvature side of the upper part of the stomach. Surgical resection was ruled out because the location of the lesion was too close to the gastroesophageal junction. Medical treatment with intravenous H₂ blockers, octreotide, packed red blood cell infusions, local epinephrine injection at the lesion site, application of hemoclip, and gel-form embolization of the left gastric artery did not significantly alter the transfusion requirement. Hemostasis was achieved with endoscopic argon plasma coagulation (APC). After two sessions of APC, complete removal of the lesion was achieved. APC was a simple, safe and effective tool for hemostasis and the ablation of gastric hemangioma without significant complications.
Argon Plasma Coagulation* ; Argon* ; Arteries ; Epinephrine ; Erythrocytes ; Esophagogastric Junction ; Hemangioma* ; Hemorrhage ; Hemostasis ; Humans ; Infant ; Infant, Newborn* ; Octreotide ; Stomach

Adult ; Anticarcinogenic Agents ; therapeutic use ; Breast Neoplasms ; drug therapy ; pathology ; Disease Progression ; Female ; Humans ; Interdisciplinary Communication ; Neoplasm Staging ; Pregnancy ; Pregnancy Complications, Neoplastic ; drug therapy ; pathology ; Treatment Outcome

Nonaka myopathy (NM) or distal myopathy with rimmed vacuoles was an autosomal recessive muscle disease with preferential involvement of the tibialis anterior and sparing quadriceps muscles in young adulthood. Patients with NM usually showed slightly elevated serum creatine kinase (CK) levels and characteristic rimmed vacuoles in muscle biopsy. Recently, the UDP-N-acetylglucosamine-2-epimerase/N-ace-tylmannosamine kinase (GNE) gene was identified as the identified as the causative gene for NM. Here we reported a NM patient carrying homozygous mutations (V572L) of the GNE gene. To the best of our knowledge, this was the first report of genetically confirmed NM in Korea and NM should be included in the differential diagnosis of slowly progressive weakness of distal legs.
Biopsy ; Creatine Kinase ; Diagnosis, Differential ; Distal Myopathies ; Humans ; Korea ; Leg ; Muscular Diseases* ; Phosphotransferases ; Quadriceps Muscle ; Vacuoles