The salient pathological findings following acute blunt cord trauma, now documented by a number of investigators, are hemorrhagic necrosis of central gray matter and increased catecholamine, especially dopamine concentration of the traumatized cord level, which have progressive and, according to some authors, reversible nature. But paraplegia and disappearence of sensory evoked potential (SEP) are the obvious clinical conditions appeared immediately after blunt cord trauma which are sudden events not progressive ones. These phenomena are clearly results of neuronal conduction block of white matter at the traumatized cord level. Dohrmann et al. demonstrated in their electron microscopic studies that the myelinated nerve fibers of the traumatized cord level with 300 gm-cm force are resemble those of a control animal until 15 to 20 minutes after impact. At this point, we can imagine 2 phase of pathophysiological process of acute blunt cord trauma, ie ; 1. Initial alterations of normal cord physiology. 2. Secondary or aggrevating processes to the initial alterations of normal physiology. There are a number of reports and arguements about so called secondary aggrevating processes but neither explanations nor experimental studies about those immediate pathologic clinical phenomena. As the initiation of the investigations about the immediate physiological alterations, we planned this experiment to observe radioactive potassium uptake of the white matter of the blunty traumatized spinal cord. At first, we carried dorsal laminectomy out on the T2 and T6 level of adult Mongoreal dogs and injected K42 Cl, 500 micro Ci into the right atrium via catheterized antecubital vein. At 6 seconds after injection of K42, 5cc bolus of saturated KCI was shot intravenously via same route to produce instant cardiac arrest. As rapidly as possible, the cord of T2 and T6 were excised and dissection of white matter was done which was facilitated by use of loupe. After tissue weighing, tissue indicator was counted with Well-type Scintillating Counter. As a result, the radioactivity of T6 white matter (cpm/mg) was 77% (SD=2.04) of that of T2, which was essentially same as the regional blood flow rates measured by Bingham et al. with fractional indicator technique. Secondly, we elicited seizures on the animals by electrical stimuli delivered to the electrode attached on the bifrontal scalp. Seizure duration was 3 minutes and at the time of termination of tonic phase 500 micro Ci of K42 Cl was injected. 6 seconds later cardiac arrest was produced and radioactivity of the white matter T2 and T6 were measured with same way described above. Radioactivity of the white matter of T2 and T6 were measured with same way described above. Radioactive potassium uptake of the white matter of T2 and T6 were 57.82% (SD=2.62) and 61.38% (SD=3.69) to those of control animal. This result can be explained as a greatly increased K+ ion concentration in the interstitial space of white matter during the convulsive seizure. Next time, the animals were laminectomized on the level of T2 and T6, and 500 gm-cm force was impacted on the T6 exposed cord while T2 segment served as non-traumatized control. 15 minutes after impact, 500 micro Ci of K42 was injected and at 6 seconds after injection cardiac arrest was produced. And radioactivity of white matter was measured. The K42 uptake of the T6 white matter was 171%(SD=24) to that of T2, which was thought as a reflextion of increases regional blood flow. Alteration of blood-brain barrier resistance must be influenced upon the K+ ion uptake but they may be masked by increased blood flow, which was supported by a biphasic curve obtained from time-lag experiments, ie; decreased uptake in 1 1/2 hour group, increased uptake in 2 1/2 hour group and approach to the base line in the 4 hour group. Another experimental study to discover so called immediate physiological changes will be presented in the next report.
Adult ; Animals ; Blood-Brain Barrier ; Catheters ; Dogs ; Dopamine ; Electrodes ; Evoked Potentials ; Heart Arrest ; Heart Atria ; Humans ; Laminectomy ; Masks ; Necrosis ; Nerve Fibers, Myelinated ; Neurons ; Paraplegia ; Physiology ; Potassium ; Radioactivity ; Regional Blood Flow ; Research Personnel ; Scalp ; Seizures ; Spinal Cord Injuries* ; Spinal Cord* ; Veins

The purpose of this study is to identificate root canal system including ideal access placement, root curvature, canal configuration, incidence of isthmus in mandibular incisors for success of endodontic treatment. 200 mandibular incisors were selected. The ideal access placement was determimed as follows. The teeth were radiographed from mesiodistal and buccolingual views using intraoral dental film. The image was divided into coronal, middle and apical third using the proximal film. Straight line access was determined by measuring the faciolingual canal width and placing points at midway point between the buccal and lingual wall at the junction of the middle and apical third and at the juntion of coronal and middle third of the root canal. A line was drawn connecting these two points extending through the crown of the tooth. The point at which the line crossed the external crown surface was recorded as facial, incisal, lingual. Degree of root curvature was determined by Schneider Protractor Method. Both section method and clearing method were used in this study. By section method, 100 mandibular incisors were embedded in clear resin and transeverse serial sectioned at 0.5, 1.0, 2.0, 3.0, 4.0, 5.0mm level from root apex. The resected surfaces were stained by methylene blue and examined under x40 magnification with a stereomicroscope. By clearing method, 100 mandibular incisors were cleared in methysalicylate after decalcification with 10% nitric acid and evaluated under x18 magnification with a stereomicroscope. The results were as follows ; 1. 29% had the center of the plotted straight-line access facial to incisal edge, whereas 71% had straight-line access at the incisal edge. When incisal wear classified as extensive, the straight-line access was plotted on the incisal edge 95.5%. When incisal wear classified as slight/none, the straight-line access was plotted on the facial 65.9%. 2. Degree of curvature of main canal was straight or almost straight, and only 10% in buccolingual direction had a degree of curvature greater than 20 degrees and 5.5% in mesiodistal direction had. 3. In section method, canal configuration analysis showed that 51% of the specimen classified as type I, 27% as type II, 12% as type III, 10% as type IV. For thoses setions with two canals, the incidence of an isthmus was 26.7%, 64.3%, 79.2%, 96.3%, 97.4%, 97.6% at each level and highest in 3~5mm sections. 4. In clearing method, canal configuration analysis showed that 74% of the specimen classified as type I, 11% as type II, 6% as type III, 9% as type IV. These results suggested that traditional access from lingual should be moved as far toward the incisal as possible to locate and debride the lingual canal and root canal system should be cleaned, shaped completely and obturated three dimensionally for successful endodontic treatment.
Crowns ; Dental Pulp Cavity ; Incidence ; Incisor ; Methylene Blue ; Nitric Acid ; Tooth

Clinical observation and analysis were performed on 481 cases of craniocerebral injuries under 15 years of age those were treated at Chung-ang University hospital during the period from January, 1972 to August, 1975. Following results were obtained: 1. There were 302 males and 179 females and sex ratio was 1.7:1. 2. Age incidence of the accidents was greatest at 5 years of age and mostly distributed to the age group between 5 to 7. 3. Seasonal peak of the accidents was at June. 4. The most frequent cause of the craniocerebral injuries was traffic accident(277 cases, 57.59%), and the next was fall from height(159 cases, 33.06%). 5. No deterioration of consciousness before and after the admission was observed in 176 cases(3.6%). 6. Pupillary change was observed in 28 cases in which unilateral were 21 and bilateral were 7. Babinski sign was elicitable in 91 cases. 7. Early convulsion and vomiting were frequent symptoms in childhood. 8. Skull fracture was observed in 204 cases(40.33%) in which linear fracture was most frequent. The location of the linear fracture was parietal and the predilection sites of the depressed fractures were frontal and parietal. 9. The accompanying rate of skull fracture in intracranial hemorrhage was;epidural 75%, subdural 50% and subarachnoid 17.3%. 10. The overall mortality was 8.32%. In non-surgical group(442 cases), the mortality rate was 7.47% but in surgical group(39 cases), operation mortality was 17.95%.
Consciousness ; Craniocerebral Trauma* ; Female ; Humans ; Incidence ; Infant* ; Intracranial Hemorrhages ; Male ; Mortality ; Rabeprazole ; Reflex, Babinski ; Seasons ; Seizures ; Sex Ratio ; Skull Fractures ; Vomiting

To provide a guideline of accurate diagnosis and proper methods of treatment of meningioma, the most common benign intracranial tumor, the authors studied 94 cases of intra & extracranial meningioma who had been diagnosed and operated at the Department of Neurosugery, Yonsei University College of Medicine from November, 1966 to October, 1982. The results were as followings. 1) The ratio of male to female was 1 to 1.4 and 30.8% of the 94 patients were in the 4th decade of age and another 30.8% in the 5th decade. 2) The predilection sites were parasagittal and falx(37.2%), sphenoid ridge(15.9%), convexity(14.9%), and suprasellar(10.6%) area. 3) The common initial clinical features were headache(55.5%), visual disturbance (16.0%) and seizure (14.9%). In radiologic diagnostic tests, there were abnormal findings in over a half on plain skull X-ray, and brain CT scan was regarded as the most accurate and safe method. Cerebral angiography provided the informations such as vascularity, venous drainage and relationship with the venous sinus. 4) Among the 6 cases of basal posterior fossa meningioma, the surgical excision of the tumor could be performed totally in 2 cases and subtotally in 4. 5) In 8 recurrent cases, all the tumors except one were located at parasagittal area and they were 3 hemangiopericytic, 2 hemangioblastic, 2 angiomatous and 1 meningotheliomatous type. 6) The Laser was thought to be very effective surgical tool to remove vascular tumor, such as meningioma, with its unique properties of non-mechanical bloodless evaporation of tumor and minimizing of brain edema.
Brain ; Brain Edema ; Cerebral Angiography ; Diagnosis ; Diagnostic Tests, Routine ; Drainage ; Female ; Hemangioblasts ; Humans ; Male ; Meningioma* ; Recurrence ; Seizures ; Skull ; Tomography, X-Ray Computed

Four cases of delayed post-traumatic epidural hematoma which had not been present on initial CT scan were found on repeated CT scan. The delayed epidural hematoma was developed after evacuation of a hematoma in all cases. And a skull fracture was present at the site of the delayed hematoma in two cases. The neurologic deterioration heralded the onset of delayed epidural hematoma after decompressive therapy by either surgical or medical means. Repeated CT scan is indicated if anticapated improvement from does not occur after decompression by either surgical or medical means, recovery from shock, or whenever there is evidence of even minimal bleeding under a skull fracture on the initial CT scan.
Decompression ; Hematoma* ; Hemorrhage ; Shock ; Skull Fractures ; Tomography, X-Ray Computed

OBJECTIVES: In the present study, three kinds of tissues cells (pulp, gingiva, and periodontal ligament) were investigated if those cells express MMP and TIMP when they were stimulated with neuropeptides (substance P, CGRP) or proinflammatory cytokine, TNF-alpha. MATERIALS AND METHODS: The cells cultured from human dental pulp (PF), gingiva (GF) and periodontal ligament were (PDLF) stimulated with Mock, SP, TNF-alpha, and CGRP for 24 hrs and 48 hrs. for an RNase protection assay and Enzyme Linked Immunosorbent Assay. Cells (PF, GF and PDLF) seeded in 100 mm culture dish were stimulated with SP (10(-5), 10(-8) M) or only with medium (Mock stimulation) for 4hrs and for 24 hrs for RNase Protection Assay, and they were stimulated with CGRP (10(-5) M) and TNF-alpha (2 ng/mL) for 24 hrs and with various concentraion of TNF-alpha (2, 10, and 100 ng/mL) for Rnase Protection Assay with a human MMP-1 probe set including MMP 1, 2, 8, 7, 8, 9, 12, and TIMP 2, 3. In addition, cells (PF, GF and PDLF) were stimulated with Mock and various concentraion of TNF-alpha(2, 10, and 100 ng/mL) for 24 hrs and with TNF-alpha(10 ng/mL) for 48 hrs, and the supernatents from the cells were collected for Enzyme Linked Immunosorbent Assay (ELISA) for MMP-1 and MMP-13. RESULTS: The expression of MMPs in PF, GF, PDLF after stimulation with SP and CGRP were not changed compared with Mock stimulation for 4 hrs and 24 hrs. The expression of MMP-1, -12, -13 24 hrs after stimulation with TNF-alpha were upregulated, however the expression of TIMP-3 in PF, GF, PDLF after stimulation with TNF-alpha were downregulated. TNF-alpha (2 ng/mL, 10 ng/mL, 100 ng/mL) increased MMP-1 and MMP-12 expression in PF dose dependently for 24 hrs. CONCLUSIONS: TNF-alpha in the area of inflammation may play an important role in regulating the remodeling of dentin, cementum, and alveolar bone.
Dental Cementum ; Dental Pulp ; Dentin ; Enzyme-Linked Immunosorbent Assay ; Gingiva ; Humans ; Inflammation ; Matrix Metalloproteinases ; Neuropeptides ; Periodontal Ligament ; Ribonucleases ; Seeds ; Substance P ; Tissue Inhibitor of Metalloproteinase-3 ; Tumor Necrosis Factor-alpha

BACKGROUND AND OBJECTIVES: Several echocardiographic methods, such as ejection fraction, fractional shortening, and Doppler tissue imaging (DTI), have been developed to quantify systolic function but all had several important limitations. The purpose of this study was to quantify the regional wall motion abnormality, using strain, in an acute myocardial infarction, compared with a visual estimation. SUBJECTS AND MEHTODS: Forty-five patients, with acute anterior (n=28) and inferior myocardial (n=17) infarctions, who underwent color DTI, were examined using longitudinal strain and standard echocardiography, and the results were compared with 54 normal controls. A total of 594 segments [3 segments (apical, mid and basal portion) of septum and inferior wallx99 patients] were evaluated. RESULTS: In the normal control group, the strain was uniformly distributed in all segments (-20%~-23%). In the infarction groups, the strain was negatively related with the wall motion score. The strain of the apical segments and mid-septum was decreased in the anterior wall infarctions, and the strain of basal septum and mid to basal inferior wall was decreased in the inferior wall infarctions. The dyskinetic segments showed positive strain. CONCLUSION: This study validates strain as a superior method for the quantification of the regional wall motion abnormality in an acute myocardial infarction than visual estimation.
Echocardiography ; Humans ; Infarction ; Myocardial Infarction*

BACKGROUND AND OBJECTIVES: Although cardiac troponin I is widely used as a marker for myocardial infarction (MI), minor elevations of cardiac troponin I are also observed in other clinical situations. The prognostic factors for patients with these clinical features are not well established. The aim of this study was to discover the predictors of mortality for the patients who had minor troponin elevations without acute MI. SUBJECTS AND METHODS: We enrolled consecutive 154 patients from the emergency department or inpatient units who had a peak troponin I level greater than the lower limit of detectability (0.04 ng/mL), and the level was also less than the suggestive value of MI (0.6 ng/mL). They were with chest pain or nonspecific symptoms of circulatory abnormality, but they lacked the traditional features of acute MI. The endpoint was defined as death from all causes. The Cox proportional hazard model was used to test the relationship between the clinical and biochemical variables and the outcomes. RESULTS: During the follow-up period of 7.9+/-7.3 months, mortality occurred in 15 patients. Age, the creatine kinase myocardial isoform (CK-MB) level and the C-reactive protein (CRP) level as continuous variables had significant correlations with the occurrence of death. After adjusting for any possible confounders in the multivariate model, these variables remained as independent predictors of mortality: age (HR 1.07, CI 1.02-1.14, p=0.012), CK-MB level (HR 1.61, CI 1.16-2.24, p=0.005), and CRP level (HR 1.01, CI 1.00-1.01, p=0.025). CONCLUSION: Integration of the CK-MB and CRP levels, as well as age, can be used for risk-stratification in the patients showing minor troponin I elevation for reasons other than acute MI.
C-Reactive Protein ; Chest Pain ; Creatine Kinase ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Inpatients ; Mortality ; Myocardial Infarction* ; Prognosis ; Proportional Hazards Models ; Troponin ; Troponin I*

OBJECTIVE: The objective of this study was to evaluate the safety and therapeutic efficacy of percutaneous radiofrequency (RF) ablation for the treatment of hepatocellular carcinomas (HCCs) adjacent to the gallbladder with the use of internally cooled electrodes. MATERIALS AND METHODS:We retrospectively assessed 45 patients with 46 HCCs (mean size, 2.2 cm) adjacent to the gallbladder (< or =1.0 cm) treated with RF ablation using an internally cooled electrode system. An electrode was inserted into the tumor either parallel (n = 38) or perpendicular (n = 8) to the gallbladder wall. The safety and therapeutic efficacy of the procedures were assessed with clinical and imaging follow-up examinations. Follow-up with the use of CT ranged from four to 45 months (mean, 19 months). The association between variables (electrode direction, electrode type, tumor size, tumor location, lobar location) and the presence of a residual tumor or local tumor progression was also analyzed. RESULTS: There were no major complications and minor complications were noted in three patients (7%) including one case of vasovagal syncope and two cases of bilomas. Wall thickening of the gallbladder adjacent to the RF ablation zone was noted in 14 patients (41%) as determined on immediate follow-up CT imaging. Wall thickening showed complete disappearance on subsequent follow-up CT imaging. The primary technique effectiveness rate was 96% (44/46) based on one-month follow-up CT imaging. Local tumor progression was noted in six (14%) of 44 completely ablated tumors during the follow-up period. The direction of electrode insertion (perpendicular), tumor size (> or =3 cm) and tumor location (a tumor that abutted the gallbladder) were associated with an increased risk of early incomplete treatment. No variable was significantly associated with local tumor progression. CONCLUSION: Percutaneous RF ablation of HCCs adjacent to the gallbladder using an internally cooled electrode is a safe and effective treatment. Significant risk factors that lead to early incomplete treatment include tumor size, tumor location and electrode direction.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*surgery ; Catheter Ablation/instrumentation/*methods ; Cholecystography ; *Electrodes ; Female ; Follow-Up Studies ; *Gallbladder ; Humans ; Liver Neoplasms/*surgery ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Tomography, X-Ray Computed

Rolandic epilepsy(or benign epilepsy with centrotemporal spikes) and childhood absence epilepsy are idiopathic epilepsies and are the most common forms of age-related epilepsies, occurring in previously neurologically normal children. Benign epilepsy with centrotemporal spikes is the most common partial childhood epilepsy, beginning between 2 and 13 years of age and characterized by typical EEG focal discharges and a self- limited course with recovery in or before puberty. Childhood absence epilepsy is one of generalized epilepsies with bilateral synchronous and symmetrical spike-wave paroxysms of 3 Hz and it has a good prognosis under a correct antiepilepsy treatment. These two epilepsies share some common features : similar age at onset, overall good prognosis and marked hereditary predisposition. A coincidence of these two epilepsies in a patient is very rare. We experienced a case of a coincidence of rolandic and childhood absence epilepsy in a 6 year-old female. The presence of an absence focus in rolandic epilepy, however, makes the coincidence of these entirely distinct phenomena, even if very rare, not excluded. We present the case with a review of related literature.
Adolescent ; Child ; Electroencephalography ; Epilepsy ; Epilepsy, Absence* ; Epilepsy, Generalized ; Epilepsy, Rolandic ; Female ; Humans ; Prognosis ; Puberty