BACKGROUND: The thalamus has multiple connections with areas of the cerebral cortex involved in arousal and cognition. Thalamic damage has been reported to be associated with variable neuropsychological dysfunctions and dementia. This study investigates the changes of regional cerebral blood flow (rCBF) by using SPM analysis of 99mTc-ECD SPECT and examining the neuropsychological abnormalities of 4 patients with anterior thalamic infarctions. METHODS: Four patients with left anterior thalamic infarctions and eleven normal controls were evaluated. K-MMSE and the Seoul Neuropsychological Screening Battery were performed within 2 days after stroke. The normalized SPECT data of 4 patients were compared to those of 11 controls for the detection of areas with decreased rCBF by SPM analysis. RESULTS: All 4 patients showed anterograde amnesia in their verbal memory, which was not improved by recognition. Dysexecutive features were occasionally present, such as decreased word fluency and impaired Stroop test results. SPM analysis revealed decreased rCBF in the left supramarginal gyrus, the superior temporal gyrus, the middle and inferior frontal gyrus, the medial dorsal and anterior nucleus of the left thalamus. CONCLUSIONS: The changes of rCBF in patients with left anterior thalamic infarctions may be due to the remote suppression on metabolism by the interruption of the cortico-subcortial circuit, which connects the anterior thalamic nucleus and various cortical areas. The executive dysfunction and dysnomia may be caused by the left dorsolateral frontal dysfunction of the thalamocortical circuit. Anterograde amnesia with storage deficit may be caused by the disruption of mamillothalamic tract.
Amnesia, Anterograde ; Anomia ; Arousal ; Cerebral Cortex ; Cognition ; Dementia ; Humans ; Infarction* ; Mass Screening ; Memory ; Metabolism ; Seoul ; Stroke ; Stroop Test ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: Raman spectroscopy is a vibrational spectroscopic technique, which is capable of providing details on the chemical composition, molecular structure and molecular interactions in cells and tissues. The primary objective of this study was to explore Raman spectroscopy for the detection of spectral changes between normal and cancer tissue in the stomach. METHODS: Tissue specimens were obtained from the resected stomach of advanced gastric cancer patients. The normal gastric and cancer tissues were harvested from the middle, lower portion of the stomach and from the tumor mass, respectively. 19 sets (antrum, body and cancer) of spectral data, with clearly defined histopathological findings, were selected in this study. FT-Raman spectroscopy (Bruker Inc., Karsruhe, Germany) was used for tissue Raman studies, with excitation at 1, 064 nm. The Raman spectra from the gastric tissue specimens were obtained with a 20 minute signal acquisition time. RESULTS: In the range 700~1, 900 cm-1, the Raman spectra of gastric antral tissue were dominated by a number of vibrational modes of biomolecules, such as proteins, lipids and nucleic acids. The Raman spectrum pattern of gastric body tissue was similar to that of the antrum, suggesting the structure and composition between the gastric antrum and body are much the same. The Raman spectra differed significantly between the normal and malignant cancer tissues, with cancers showing higher percentage signals for protein, lipid and nucleic acid compared to normal tissue (P<0.05). Difference were observed in the shapes of the Raman spectra between the normal and cancer tissues, particularly in the spectral ranges 1, 250~1, 255, 1, 330~1, 340 and 1, 440~1, 450 cm-1, which contain signals relating to protein and lipid conformations and CH2 bending mode of nucleic acids. CONCLUSION: This study demonstrates the ability of Raman spectroscopy to detect biochemical changes in malignant gastric tissue, and may become a useful adjunct to pathological diagnosis allowing guided biopsies and assessment of adequacy of resection margins.
Biopsy ; Diagnosis ; Humans ; Molecular Structure ; Nucleic Acids ; Pyloric Antrum ; Spectrum Analysis ; Spectrum Analysis, Raman* ; Stomach Neoplasms ; Stomach*

The follow-up of patients after performing potentially curative resection for colon cancer is important, yet the ideal surveillance strategy has not been defined. Periodic clinical examinations, laboratory tests, radiographic imaging, colonoscopy and carcinoembryonic antigen (CEA) testing have been utilized for surveillance, and the serial CEA measurement is the most cost-effective test for identifying the recurrence of disease. However, this test also indicates the development of secondary gastrointestinal malignancy such as gastric cancer or duodenal cancer. We report here on a case of metachronous duodenal adenocarcinoma that was revealed by the serial measurement of the serum CEA after we performed curative resection for colon cancer.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Colon* ; Colonic Neoplasms* ; Colonoscopy ; Duodenal Neoplasms ; Follow-Up Studies ; Humans ; Recurrence ; Stomach Neoplasms

BACKGROUND: Radiofrequency catheter ablation (RFCA) becomes an useful treatment for idiopathic ventricular tachycardia, especially right ventricular outflow tract ventricular tachycardia (RVOT VT) typically originates from "superior septal" aspect of right ventricular outflow tract. However, some of the right ventricular outflow tachycardias remain resistant despite repeated attempts of RFCA. This study was focused to search the electrocardiographic characteristics suggesting procedural success of radiofrequency ablation in RVOT VT and ventricular tachycardia that can not be ablated by conventional approach confined to right ventricular outflow tract even though to show similar electrocardiographic morphology. METHODS: The study subjects were 25 patients who underwent RFCA with the diagnosis of RVOT VT. We classified the study subjects into 2 groups and in group 1 (N=17, Age 47.5 +/- 16.8) in those successful RFCA was possible in RVOT. In group 2 (N=8, Age 54.8 +/- 8.0), the removal of VT was not possible with the RFCA confined in RVOT. We analyzed the morphologic characteristics of QRS complex of VT or ventricular premature beats in right precordial leads; V(1-3). The QRS and R wave duration, height of R wave, depth of S wave, R/S ratio and R wave duration index were measured. RESULTS: There was no difference of age and sex between group 1 and 2 (Group 1: N=17, Male 29.4%, Age 49.5 +/- 16.8 vs Group 2: N=8, Age 54.8 +/- 8.0, Male 37.5%). The maximal QRS duration in V(1-3) was 144.2 +/- 23.6 ms in group 1 and 136.3 +/- 25.1 ms in group 2. The R wave duration and R wave duration index were not different either between group 1 and 2. However, the R wave duration of lead V 3 in group 2 was 97.0 +/- 34.4 ms and significantly longer than 65.0 +/- 26.0 msec in Group 1 (p=0.04). R wave duration index also showed significant difference between two groups: 72.0 +/- 23.5% of group 2 vs 45.4 +/- 17.8% of group 1. In comparison of R wave height and depth of S wave in V(1-3) between two groups, the R/S ratio of lead V3 in group 2 showed the ratio of 343.4 +/- 227.7% which was significantly larger than 97.4 +/- 92.2% in group 1. CONCLUSION: For the practice of RFCA for RVOT VT, morphologic characterstics of VT or VPC showing wide R wave and high R/S wave ratio in precordial leads, especially in V3 could be an useful electrocardiographic indicator to suspect the unusual focus of idiopathic VT showing inferior axis and LBBB pattern.
Axis, Cervical Vertebra* ; Bundle-Branch Block* ; Cardiac Complexes, Premature ; Catheter Ablation* ; Diagnosis ; Electrocardiography ; Humans ; Male ; Tachycardia ; Tachycardia, Ventricular*

BACKGROUND: Catenins are the associated protein with E-cadherin in the formation of adhesion complexes in normal and tumor cells related with epithelial differentiation and development of organ formation as well as in the tumor spread. The present study was aimed to find the distribution of alpha- and gamma-catenins in fetal skin development. OBJECTIVE: The purpose of this study was to observe the distribution of above two adhesion related proteins in the fetal skin during development, and to find its relationship by expression and their distribution pattern. METHODS: Skin was obtained from the scalp, chest, and sole of 21 human fetuses, ranging from 13 to 37 weeks of gestational age. Immunohistochemical staining was performed by the avidin biotin peroxidase complex method on paraffin embedded tissue using the anti-human monoclonal antibody against the human alpha- and gamma-catenins. RESULTS: alpha- and gamma-catenins were expressed strongly in basal cells of the epidermis and germ cells of skin adnexa, such as hair and eccrine glands at 13th week, followed by decreased basal cell expression. Increase in the suprabasal epithelium and differentiated adnexal epithelium, such as outer root sheath cells and eccrine ducts and glands at 18th week, and adult pattern in 23th week of gestation. Both showed similar distribution pattern in skin though gamma-catenin appeared two or three weeks later. alpha- and gamma-catenins are expressed not only in the epithelium of the skin, but also in the mesenchymal cells such as endothelial cells and fibroblasts. Though both catenins are more strongly expressed in the membrane portion, cytoplasmic expression is also noted. CONCLUSION: Both alpha- and gamma-catenin showed basically the same expression distribution pattern in the fetal skin developmental stage, suggesting that both adhesion molecules are highly related to each other in function and development of epidermis and adnexae of the skin in fetal stage.
Adult ; Avidin ; Biotin ; Cadherins ; Catenins ; Cytoplasm ; Eccrine Glands ; Endothelial Cells ; Epidermis ; Epithelium ; Fetus ; Fibroblasts ; gamma Catenin* ; Germ Cells ; Gestational Age ; Hair ; Humans ; Membranes ; Paraffin ; Peroxidase ; Pregnancy ; Scalp ; Skin* ; Thorax

Extramammary Paget's disease (EMPD) is a rare intraepithel ial neoplasm arising in apocrine gland-bearing skin. EMPD may be regarded as a skin marker of associated malignancy because it tends to combine a variety of underlying malignancies in up to 50% of cases. Herein a case of gastric cancer diagnosed in a patient with extramammary Paget's disease of the scrotum is reported. The patient was a 65-year-old man whose chief complaint was exanthema of the right scrotum of 3 years duration. Biopsy samples taken from patient showed large, round cells with clear cytoplasm in the epidermis. The final diagnosis was EMPD of the scrotum. The extensive workups, including tumor marker, imaging studies and endoscopy to exclude associated malignancy were performed. Examination of the endoscopic gastric biopsy specimen revealed an adenocarcinoma of the stomach. On the basis of this result, a radical subtotal gastrectomy was successfully performed. This case suggests that, in cases of EMPD, the clinicians should consider the possibility of underlying malignancies and thoroughly examine not only the urogenital tract and lower gastrointestinal tract, but also the visceral organs, such as the stomach, even if there are no clinical symptoms of malignancy.
Adenocarcinoma ; Aged ; Biopsy ; Cytoplasm ; Diagnosis ; Endoscopy ; Epidermis ; Exanthema ; Gastrectomy ; Humans ; Lower Gastrointestinal Tract ; Paget Disease, Extramammary* ; Scrotum ; Skin ; Stomach ; Stomach Neoplasms*

BACKGROUND: Glutathione S-transferases(GST) are a family of multi-functional enzymes involved in cellular detoxification and excretion of a variety of exogenous and endogenous toxic or carcinogenic compounds. The GST family has been divided into three classes, alpha, mu, and pi, based on substrate specificity and sequence homology. GST-pi is an acidic type and predominant in skin, small intestine, breast, lung and prostate. The overexpression of GST-pi associated with skin tumor and tumor-like lesion suggests that GST-pi is a major detoxifying enzyme in skin tumors. OBJECTIVE: The purpose of this study was to observe the expression and the distribution pattern of GST-pi in the human fetal skin. METHODS: Skin was obtained from the scalp, chest, and sole of 49 human fetuses, ranging from 8th to 40th weeks of gestational age. Immunohistochemical staining was performed using avidin biotin peroxidase complex method on paraffin embedded tissue using antirabbit polyclonal antibody against the human GST-pi. RESULTS: GST-pi was expressed in intermediated layer of epidermis at 8th week, and gradually increased in strength of expression stronger in suprabasal layer. In hair unit, GST-pi was expressed in sebaceous gland, bulge, hair matrix cell and outer root sheath cell from 15th week. In eccrine gland, also GST-pi was expressed in central differentiated cells of intradermal eccrine duct from 18th week, and in terminal duct and acini from 26th week of fetal age. CONCLUSION: GST-pi was expressed from the 8th week of gestation suggesting that GST-pi plays an important role in detoxification for the protection of the skin in fetal stage from the various toxic agent.
Avidin ; Biotin ; Breast ; Eccrine Glands ; Epidermis ; Fetus ; Gestational Age ; Glutathione Transferase* ; Glutathione* ; Hair ; Humans ; Intestine, Small ; Lung ; Paraffin ; Peroxidase ; Pregnancy ; Prostate ; Scalp ; Sebaceous Glands ; Sequence Homology ; Skin* ; Substrate Specificity ; Thorax

Soft-tissue lateral neck radiography is important for diagnosing acute supraglottitis. This study aimed to determine the objective criteria for a diagnosis of acute supraglottitis from soft-tissue lateral neck radiographs in Korean adults. The parameters in 30 adult patients with acute supraglottitis were compared with those of age- and sex-matched normal 30 Korean adults. The mean of epiglottis width (EW) and aryepiglottic fold width (AEW) in the control group were 4.37 +/- 0.93 mm, 2.45 +/- 0.71 mm, respectively and in the patient group they were 15.87 +/- 3.60 mm, 6.4 +/- 2.55 mm, respectively. The sensitivity and specificity of an EW greater than 7mm were 100%, and 100% respectively. The sensitivity and specificity of an AEW greater than 4.5 mm were 83%, and 100% respectively.
Acute Disease ; Adult ; Epiglottitis/*radiography ; Female ; Human ; Larynx/*radiography ; Male ; Middle Age

Subcutaneous emphysema often occurs as a result of surgery, trauma of the aerodigestive tract, and increased alveolar pressure. Generally, spontaneous emphysema is rare, because "spontaneous" is only used to describe emphysema that has no obvious etiology. We reviewed six cases of non-traumatic subcutaneous emphysema occurring in the head and neck. Among them, four cases were associated with pneumomediastinum. Two occurred without obvious etiology, another two were due to heavy lifting events, one due to severe vomiting, and the last one due to severe blowing. Most cases occurred in young males. Clinical symptoms, commonly involved sites, treatments and results of these cases of spontaneous emphysema were analysed.
Emphysema ; Head* ; Humans ; Lifting ; Male ; Mediastinal Emphysema ; Neck* ; Subcutaneous Emphysema* ; Vomiting

BACKGROUND: Diabetic nephropathy has long been known as most common culprit of ESRD. In NIDDM, histopathologically intrarenal hemodynamic changes are nonspecific, frequently with global glomerulosclerosis, interstitial fibrosis, tubular atrophy and severe arterosclerosis. Duplex renal Doppler sonography is useful in the noninvasive assessment of intrarenal hemodynamic change and Doppler indices reflect increased renal vascular resistance. So we compared the values of R.I. and P.I., in NIDDM patients, with several clinical parameters to identify that R.I. and P.I. values can reflect increased renal vascular resistance and predict diabetic nephropathy as early markers. METHODS: Renal Doppler US scan was performed on 40 patients with NIDDM to obtain Doppler signals from arcuate artery or interlobar artery and thereby calculate the R.I. and P.I. From every each individual, clinical and laboratory data including age, sex, morbidity period, BMI, mean blood pressure, total cholesterol, serum creatinine, BUN, HbA1c, 24 hr urine protein and creatinine clearance were analyzed. We analyzed the correlation between values of R.I. and P.I. with clinical parameters by using univariate and multiple linear regression analysis. The patients were classified as three groups on the basis of the amount of 24 hour urine protein and value of serum creatinine : Group 1(n=15) was defined as patients with 24 hr urine protein less than 150mg/day and serum creatinine less than 1.5mg/ dL, group 2(n=12) as between 150mg/day and 500mg/ day and serum creatinine less than 1.5mg/dL and group 3(n=13) as more than 500mg/day or serum creatinine above 1.5mg/dL. RESULTS: 1) R.I. values showed correlation with age, morbidity period, mean blood pressure, HbA1c, serum creatinine, BUN, creatinine clearance and 24 hour urine total protein. P.I. values showed correlation with age, morbidity period, mean blood pressure, serum creatinine, BUN, creatinine clearance and 24 hour urine total protein. 2) R.I. and P.I. values were significantly affected by creatinine clearance and age in multiple regression analysis. 3) There were statistically positive correlation between 24 hour urine protein and R.I. and P.I.. But when we divided into three groups based on their amount of 24 hour urine protein. R.I. didn't show statistical correlation but P.I. showed significant correlation in the group of patients with proteinuria over 500mg/day(p<0.05). CONCLUSION: Renal doppler indices reflect increased renal vascular resistance in NIDDM patients and correlate with clinical parameters of diabetic nephropathy. We suggest that the R.I. and P.I. are useful marker for indicating diabetic vascular complication in NIDDM patients. However, further comparative studies should be carried out to elucidate the usefulness of R.I. and P.I. as early markers or advantaging parameters in predicting diabetic nephropathy.
Arteries ; Atrophy ; Blood Pressure ; Cholesterol ; Creatinine ; Diabetes Mellitus, Type 2 ; Diabetic Angiopathies ; Diabetic Nephropathies* ; Fibrosis ; Hemodynamics ; Humans ; Kidney Failure, Chronic ; Linear Models ; Proteinuria ; Vascular Resistance