No abstract availble

We investigated whether the two variant elements of CRE(TGcCGTCA[5'CRE], TGACcTCA[3'CRE]) in the 5'flanking region of the rat TRH gene, which are different from the CRE consensus sequence(5'-TGACGTCA-3') by one base pair, are responsive to cAMP, and whether the one base pair difference is responsible for the degree of cAMP responsiveness of the gene. When CA 77 cells were stimulated with forskolin and isobutylmethylxanthine for 4 hours, the level of TRH mRNA was increased by only two fold. The transient gene expression study using serial 5'deletion of the TRH gene in PC12 cells showed that the region between-113 and-77, which includes 5'CRE, was crucial for the cAMP resonsiveness. When the plasmid, which contains the 30 bp oligonucleotide including either 5'CRE or 3'CRE ligated to the enhancerless RSV promoter, was transfected into PC12 cells, it did not significantly affect not only the basal transcription but cAMP responsiveness. The 65 bp oligonucleotide including both 5'CRE and 3'CRE, however, increased both of the basal transcription and cAMP-stimulated transcription by 2-3 fold. When the sequence of 5'CRE was converted to that of the CRE consensus by replacing one base pair, the cAMP responsiveness was increased by two fold although the basal transcription was not increased. The one base pair mutant of 3'CRE increased both of the basal and cAMP-stimulated transcription by 3-4 fold. These results suggest that there are the two variant CREs in rat TRH gene, which are relatively weak CRE compared to the CREs of other neuropeptide genes and cooperative for the activation of both the basal and cAMP-stimulated transcription. The one base pair difference of the variant CREs from the CRE consensus sequence is responsible for the weak responsiveness to cAMP.
Animals ; Base Pairing ; Colforsin ; Consensus ; Consensus Sequence ; Cyclic AMP ; Gene Expression ; Neuropeptides ; PC12 Cells ; Plasmids ; Rats ; Response Elements ; RNA, Messenger ; Thyrotropin ; Thyrotropin-Releasing Hormone

OBJECTIVE: Various surgical techniques were developed for control of intracranial pressure such as extraventricular drainage, temporal lobectomy or decompressive craniectomy. We now describe our clinical experience by using the modified decompressive craniotomy. METHODS: Modified decompressive craniotomy was performed in 8 patients with severe cerebral edema from July 2000 to April 2001. The indication of this operation was severe intracranial hypertension and edema in operative field. We analyzed the result(Glasgow coma scale, GCS score, Glasgow outcome scale, GOS score) with the variables(age, sex, mid line shift on brain computed tomography scan) RESULTS: The overall rate of good recovery(GOS score 4 or 5) was 75%(6 of 8 patients), poor recovery(GOS score 2 or 3) was 12.5%(1 of 8 patients), and mortality rate was 12.5%(1 of 8 patients). All of survived patients had improved GCS score(mean: 10.02) compared to preoperative GCS score(mean: 7.82). CONCLUSION: The authors would like to recommend modified decompressive craniotomy for the patient of traumatic brain swelling in appropriate indication. This new operative technique has advantages such as decompressive effect and no need of delayed cranioplasty.
Brain ; Brain Edema ; Coma ; Craniotomy* ; Decompressive Craniectomy ; Drainage ; Edema ; Glasgow Outcome Scale ; Humans ; Intracranial Hypertension ; Intracranial Pressure* ; Mortality

Loss of best corrected visual acuity(BCVA)is a landmark of safety, as one of important complications of refractive surgery. To evaluate causes of 2 lines or more loss of BCVA after laser in situ keratomileusis(LASIK), 206 eyes of 139 patients, who had undergone LASIK and had been followed up for 6 months or more, were included in this study. During the follow-up, nineteen eyes(9.2%, 19/206)showed 2 lines or more loss of BCVA postoperatively. The causes of BCVA were irregular astigmatism(15 eyes, 7.3%), retinal complications(3 eyes, 1.5%), and infectious keratitis(1 eye, 0.5%). All irregular astigmatisms had occured within 1 month postoperatively and 13 eyes of all 15 eyes spontaneously recovered after postoperative 3 months. The persistent loss of BCVA occurred in 5 eyes(2.4%, 5/206). Three cases of all 5 persistent losses of BCVA were due to retinal complications. In conclusion, our results suggest that the most common cause of loss of BCVA after LASIK is irregular astigmatism. Irregular astigmatism is a temporary situation which has a tendancy of spontaneous recovery. Thus careful observation is recommended in irregular astigmatism after LASIK. The retinal complications of LASIK may lead to permanent loss of BCVA. Therefore it is needed to examine preoperative fundus closely and to explain possible postoperative complicaitons to the patients and their family.
Astigmatism ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ* ; Refractive Surgical Procedures ; Retinaldehyde ; Visual Acuity*

Free flaps have been widely used in lower leg reconstruction. However, in cases with extensive injury to the vessels as well as to the bone and soft tissues, and having only one intact major vessel in the lower leg(single vessel leg), careful selection of recipient vessels for the free flap transfer is mandatory for preventing further vascular compromise of the distal lower leg. The sural artery and its vena comitantes are frequently protected form externally harmful forces by the bulky surrounding gastrocnemius muscle and can be used as recipient vessles for free flaps without any detrimental influence on the vascularity of the distal lower leg. In our department, three latissimus dorsi muscle free flap were transferred with sural vessels as recipient vessels in the reconstruction of the single vessel legs. Except for one case of flap failure due to serious infection at the microvascular anastomoses site, all the other cases were successfully reconstructed without any necrosis of the gastrocnemius muscle or the distal leg. In addition, the sural vessels were easily accessed in any patient position and their caliber was similar to that of the vascular pedicles of the donor muscle flaps. In conclusion, the sural vessels can be another useful option in selecting recipient vessels for free flap transfer in the reconstruction of the single vessel leg.
Arteries ; Free Tissue Flaps* ; Humans ; Leg* ; Muscle, Skeletal ; Necrosis ; Superficial Back Muscles ; Tissue Donors

BACKGROUND: The aim of this study was to analyze the questions in the shoulder and elbow section of the Korean Orthopaedic In-Training Examination (KOITE) and compare them with those of the US Orthopaedic In-Training Examination (US OITE). METHODS: Twenty-nine questions in the shoulder and elbow section of the KOITE from 2010 to 2014 were analyzed and compared with those of the US OITE (80 questions) by literature review. A thorough analysis of the contents was performed after categorizing as topics, diagnostic tools, treatment modalities, taxonomic classification, and references. RESULTS: The shoulder and elbow section of the KOITE was 5.8% weight which was similar to the US OITE (5.9%). The most commonly appearing topic was anterior labral injury (17.2%) on the KOITE compared to instability and arthritis (21.3%, each) on the US OITE. Magnetic resonance imaging was most frequently appeared imaging modality on the KOITE (41.0%) compared to the radiograph on the US OITE (43.0%). The Latarjet procedure was the most commonly asked treatment modality (22.2%) on the KOITE, whereas arthroplasty (33.3%) on the US OITE. The KOITE showed an even taxonomic classification distribution compared to the US OITE. Campbell's operative orthopaedics covered 96.6% questions as a reference on the KOITE compared to the Journal of Bone and Joint Surgery, American Volume on the US OITE, which covered 45.0%. CONCLUSIONS: This specific analysis shows us current trends of the shoulder and elbow section of the KOITE and it might be developed for use in the educational curricula for the trainee.
Arthritis ; Arthroplasty ; Classification ; Curriculum ; Elbow* ; Joints ; Magnetic Resonance Imaging ; Orthopedics* ; Shoulder*

Henoch-Schonlein purpura is a condition of unknown origin probably related to an autoimmune phenomenon involving an IgA immune complex disorder. Henoch-Schonlein purpura is a rare cause of intramural hematoma of the duodenum. We herein report a case of intramural hematoma of the duodenum and duodenal obstruction associated with Henoch-Schonlein purpura in a 14-yearold boy. On admission, the patient presented with hematemesis due to duodenal ulcer bleeding. Three days later, he developed both forearm and calf purpurae, fever and severe bile juice vomiting. An endoscopy revealed a luminal obstructing erythematous mass with bulging nature at the third portion of the duodenum. Abdominal CT scan and hypotonic duodenography showed intramural hematoma in the third portion of the duodenum and luminal obstruction. Hematoma removal was performed for the correction of intestinal obstruction. Increased awareness of the gastrointestinal manifestations of Henoch-Schonlein purpura should aid in the recognition of this disorder.
Antigen-Antibody Complex ; Bile ; Duodenal Obstruction ; Duodenal Ulcer ; Duodenum ; Endoscopy ; Fever ; Forearm ; Hematemesis ; Hematoma* ; Hemorrhage ; Humans ; Immunoglobulin A ; Intestinal Obstruction ; Male ; Phenobarbital ; Purpura* ; Purpura, Schoenlein-Henoch ; Tomography, X-Ray Computed ; Vomiting

Authors studied 123 patients with myasthia gravis, who were admitted to the Seoul National University Hospital from 1981 to 1986 to get the incidence of thymoma in myasthenia gravis. 1. Among 66 cases, 23 were said to have the thymoma by radiological studies such as chest CT scan. 2. True thymoma were confirmed by histopathologic study in 10 out of 15 cases of CT-made thymoma. 3. The incidence of the associated thymoma in myasthenia gravis was calculated to be 19.2%. 4. Among 10 cases of thymoma, 7 cases were above 40 year of age, 3 cases below 40. 5. When these were classified by modified Osserman's classification, type IIA was numbered in only one, type IIB in 5, type III in 2, and type IV in 2. Therefore it is concluded that the thymoma plays significant role in myasthenia gravis and it is important to manage it in the diagnosis and treatment of myasthenia gravis.
Classification ; Diagnosis ; Humans ; Incidence ; Myasthenia Gravis ; Seoul ; Thymoma* ; Tomography, X-Ray Computed

BACKGROUND: Local anesthetics depress smooth muscle contractions in the intact bowel and in strips of isolated intestine, and also relax bronchial smooth muscle. Following systemic absorption, local anesthetics act on the cardiovascular system. Their primary site of action is the myocardium, where decreases in electrical excitability, conduction rates, and contraction force occur. In addition, most local anesthetics cause arteriolar dilation. METHODS: The ability of bupivacaine to elicit a direct relaxant effect on vascular smooth muscle was studied using isolated rat thoracic aortic rings contracted by phenylephrine (PE). Each thoracic aorta ring was suspended on wire supports in a 20 ml tissue bath under 2 g of resting tension. All tissues were bathed in Tris Tyrode solution at 37 degrees C and 100% oxygen was supplied. RESULTS: 1. Bupivacaine (10(-5) M) inhibited PE induced contractions of aortic rings significantly (P < 0.05). 2. Relaxation of aortic rings by bupivacaine (10(-5) M) was reversed by L-NAME pretreatment. 3. Relaxation of aortic rings by bupivacaine (10(-5) M) was not recovered by methylene blue. 4. Indomethacine enhanced the contraction of aortic rings by bupivacaine (10(-5) M). 5. Bupivacaine (10(-5) M) inhibited both the influx of extracellular Ca+2 and intracellular Ca+2 release. 6. Relaxation of aortic rings by bupivacaine 10(-5) M was recovered by tetraethylammonium. CONCLUSIONS: From the results obtained, it is concluded that the relaxation effects of bupivacaine are related with endothelium dependent, and that cyclooxygenase and not guanylate cyclase participates in this relaxation. Bupivacaine inhibited both intracellular calcium release and extracelluar calcium influx. In addition, the potassium channel was also found to be related to this relaxation effect.
Absorption ; Anesthetics, Local ; Animals ; Aorta, Thoracic ; Baths ; Bupivacaine* ; Calcium ; Cardiovascular System ; Endothelium ; Guanylate Cyclase ; Indomethacin ; Intestines ; Methylene Blue ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Myocardium ; NG-Nitroarginine Methyl Ester ; Oxygen ; Phenylephrine ; Potassium Channels ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Relaxation ; Tetraethylammonium

OBJECTIVES: Fatigue is a primary human factor for decreased job performance in the workplace. It is well documented that drowsiness is a typical symptom of fatigue and is closely associated with commercial drivers'safety and well-being. However, few studies have been conducted to develop or validate fatigue symptom instruments for a working population. The main purpose of this study was to develop a general fatigue checklist and a driving fatigue checklist for Korean commercial drivers. METHODS: A total of 287 bus drivers in a commercial transportation company participated in a self-administered survey that was designated Study 1. Based on the statistical results of Study 1, a focus meeting with 16 professional consultants was conducted to revise the fatigue symptom instrument for Study 2. In Study 2, 288 commercial drivers (156 bus drivers and 132 truck drivers) participated in the revised questionnaire survey. All collected responses were entered into a SPSS worksheet and the data analysis was conducted using SPSS software 11.1. The exploratory factor analysis used in this study followed the principle component factoring rule and the varimax rotation method for factor extraction. The criteria for item selection were an Eigen value of 1.0 or greater, a communality score of .50 or greater, and no 'fence rider'property over the extracted factors. RESULTS: Through Study 1, the consultant meeting, and Study 2, a general fatigue checklist was developed with a total of 3 factors and 11 items, and a driving fatigue checklist was developed with 2 factors and 10 items. The 3 factors of the general fatigue checklist were physical fatigue, psychological fatigue, and chronic tiredness. The two factors of the driving fatigue checklist were physical fatigue and perceptive and functional fatigue. CONCLUSIONS: The primary contents of general fatigue were different from those of driving fatigue according to the two fatigue instrument factors developed in this study. The primary fatigue symptoms of the commercial driving population were identified as physical fatigue and perceptive and functional fatigue.
Checklist* ; Consultants ; Fatigue* ; Humans ; Motor Vehicles ; Questionnaires ; Sleep Stages ; Statistics as Topic ; Transportation