This study was designed to identify expression of calcium-binding proteins and synaptic reorganizations of dentate mossy fibers in hippocampal sclerosis of human temporal lobe epilepsy. Hippocampal neuronal density was quantitively analyzed in temporal lobe epilepsy group (n=50) to investigate the degree of hippocampal sclerosis and it was compared with that of autopsy control (n=3). To verify the distribution of calcium-binding proteins in neurons of epileptic hippocampi, the parvalbumin (PV)-immunoreactive and calbindin-D28K (CB)-immunoreactive neurons were quantitively analyzed in each area of Ammon's horn by immunohistochemical stain. Also, to clarify synaptic reorganizations of the dentate mossy fibers, a part of each hippocampus was examined under light microscopy and transmission electron microscopy using Timm sulphide silver method. In epileptic hippocampi, severity of hippocampal sclerosis (HS) was graded four, which consisted of 3 cases with no HS, 6 mild HS, 12 moderate HS, and 29 severe HS. The hippocampal neuronal loss was most prominent in CA1, followed by CA4 and CA2. Expression of calcium-binding proteins was more prevalent in CA2 of all groups. The proportion of PV-immunoreactive neurons in CA1 and CA4 significantly increased in the moderate and severe HS group, whereas the proportion of CB-immunoreactive neurons did not correlated with the severity of HS. Timm granules were noted in inner molecular supragranular layer of dentate gyrus of epileptic hippocampi and they tended to increase in proportion along with the severity of hippocampal sclerosis. Transmission electron microscopy showed that supragranular Timm granules corresponded to synaptic terminals of mossy fibers. These results suggest that parvalbumin appears to have more protective effect against neuronal loss and that mossy fiber synaptic reorganization seems to play a major role in pathogenesis of hippocampal sclerosis of human temporal lobe epilepsy.
Autopsy ; Calbindin 1 ; Calcium* ; Calcium-Binding Proteins* ; Dentate Gyrus ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Microscopy ; Microscopy, Electron, Transmission ; Nerve Fibers, Myelinated ; Neurons ; Presynaptic Terminals ; Sclerosis* ; Silver ; Temporal Lobe*

To evaluate the status of intestinal protozoan infections in inhabitants of Gangweon-Do, Korea, a total of 1,310 stool specimens (male 669, female 641) was collected from 2 cities and 3 counties. They were examined routinely 1 time by the method of formalin-ether sedimentation technique. The results were as follows: The positive rate for any kind of the intestinal protozoan cysts was 8.9 percent. A total of 6 kinds of the intestinal protozoan cysts were detected. The prevalence rate of each protozoa were; E. histolytica 0.8 percent, E. coli 7.6 percent, E. nana 1.4 percent, I. butschlii 0.2 percent, G. lamblia 0.5 percent and C. mesnili 0.5 percent. Sogcho-city showed the highest positive rate as 15.2 percent, Myeongju county was the next as 11.3 percent and Weonju-city showed the lowest positive rate as low as 3.9 percent. By age, the highest positive rate was found in 20-29 age group(12.4 percent). Female (9.5 percent) showed a slight higher positive rate than male (8.4 percent).
parasitology-protozoa ; Entamoeba histolytica ; Entamoeba coli ; Endolimax nana ; Iodamoeba butschlii ; Giardia lamblia ; Chilomastix mesnili ; epidemiology ; intestine

PURPOSE: Total hip arthroplasty was performed using a direct anterior approach (DAA) on an ordinary operation table and a short femoral stem. The clinical radiographic results were evaluated by a comparison with those performed using the modified hardinge (anterolateral approach, ALA) method. MATERIALS AND METHODS: From January 2013 to November 2015, 102 patients who underwent total hip arthroplasty using DAA (DAA group) and the same number of patients using ALA (ALA group), both performed by a single surgeon, were compared and analyzed retrospectively. The operation time and amounts of bleeding were compared, and the improvement in post-operative pain, ambulatory capacity and functional recovery of the hip joint were checked. The location of insertion of the acetabular cup and femoral stem were evaluated radiologically, and the complications that occurred in the two groups were investigated. RESULTS: The amount of bleeding was significantly smaller in the DAA group (p=0.018). Up to 3 weeks postoperatively, recovery of hip muscle strength was significantly higher in the DAA group (flexion/extension strength p=0.023, abduction strength p=0.031). The Harris hip score was significantly better in the DAA group for up to 3 months (p<0.001) and the Koval score showed significantly better results in the DAA group up to 6 weeks (p≤0.001). The visual analogue scale score improvement was significantly higher in the DAA group by day 7 (p=0.035). The inclination angle (p<0.001) and anteversion angle (p<0.001) of the acetabular cup were located in the safe zone of the DAA group more than in the ALA group, and there was no statistically significant difference in the position of the femur stem and leg length difference. During surgery, two cases of greater trochanter fracture occurred in the DAA group (p=0.155). CONCLUSION: The DAA performed in the ordinary operation table using a short femoral stem showed post-operative early functional recovery. Because a simple to use fluoroscope was used during surgery with an anatomical position familiar to the surgeon, it is considered to be useful for the insertion of implants into the desired position and for an approach that is useful for the prevention of leg length differences.
Acetabulum ; Arthroplasty, Replacement, Hip ; Femur ; Hemorrhage ; Hip ; Hip Joint ; Humans ; Leg ; Methods ; Muscle Strength ; Operating Tables ; Retrospective Studies

Background: Management of periprosthetic femoral fractures (PFFs) is reportedly challenging. Different patterns of PFFs would occur based on whether stem fixation was primarily cemented or cementless and whether these patterns would be associated with clinical outcomes, such as subsidence, fracture union, and complications, after stem revision. Methods: A retrospective comparative study was performed, involving 52 PFF patients treated with tapered fluted modular stems (TFMSs). In the 52 patients with Vancouver B2 or B3, including 21 cemented stems and 31 cementless stems, fracture patterns and bone stock were analyzed. Clinical outcomes after revision surgery using the TFMSs were compared between the two groups. Results: Transverse or short oblique type PFFs occurred around the cemented stem with loosening at the bone-cement interface. The Paprosky type III femoral deficiency and Vancouver type B3 fracture were observed more frequently in the cemented stem group. Otherwise, spiral fractures occurred more frequently in the cementless group (p < 0.001). Excessive subsidence of > 5 mm was observed more frequently in the cemented stem group (p < 0.001). The re-revision rates were higher in the cemented group than in the cementless group (p = 0.047). Conclusions In our study, it was found that the patterns of transverse or oblique PFFs were more frequently produced with cemented stems, while long spiral fractures were more frequent with cementless stems. Stem subsidence and reoperation related to complications were more common in patients with PFFs around cemented stems than those with PFFs around cementless stems.

An aortic aneurysm is described as a permanent localized dilatation of the aorta having a diameter at least 1.5 times that of the expected norrnal diameter of that given aortic segment. Thoracic aortic aneurysms are much less common than are aneurysms of the abdominal aorta. Thoracic aneurysms are classified by the portion of aorta involved, I.e., the ascending, arch, or descending thoracic aorta. We experienced a case of saccular arteriosclerotic aortic aneurysm associated with thrombus in aortic arch in a 78 year-old male who had history of hypertension. He was admitted to Kwangju Veterans Hospital complaining of drowsy mental state and swelling of left foreann. The chest X-ray, chest CT and echocardiogram showed saccular dilatation(maximal diarneter ; 7.67~7.86cm) associated with thrombus in aortic arch. He refused operation because of old age, so he was conservatively rnanaged including propranolol. We report this case of saccular arteriosclerotic aneurysm of aortic arch with a brief review of literature.
Aged ; Aneurysm ; Aorta ; Aorta, Abdominal ; Aorta, Thoracic* ; Aortic Aneurysm* ; Aortic Aneurysm, Thoracic ; Dilatation ; Gwangju ; Hospitals, Veterans ; Humans ; Hypertension ; Male ; Propranolol ; Thorax ; Thrombosis* ; Tomography, X-Ray Computed

A study was carried out to figure the cases and to observe the endemic status of clonorchiasis and metagonimiasis in endemic areas in Korea. Total 13,373 inhabitants living in 40 villages along 7 main rivers and 9 small streams were subjected to stool examination. They were selected randomly among the riverside population. Their specimens were examined both by cellphane thick smear method and Stoll's egg countung technique. This study was performed during the period from May 1979 to April 1980. The results obtained are as follows: The egg positive rate of any kind of helminths was 58.7% out of 13,373 examned cases, and the egg positive rates by each helminth were; Clonorchis sinensis 21.5%, Metagonimus yokogaqai 4.8%, large type Metagonimus eggs 0.4%, Ascaris lumbricoides 22.9%, Trichuris trichiura 35.2%, hookworm 0.2%, Taenia sp. 0.5%, Hymenolepis nana 0.07%, Paragonimus westermani 2 cases, Fasciola sp. 4 cases, Echinostoma sp. 1 case and Hymenolepis diminuta 1 case respectively. Many endemic foci of clonorchiasis were revealed along the 7 major rivers. The egg positive rates of each river basin differed from each other significantly; Nagdonggang 40.2%, Yeongsangang 30.8%, Seomjingang 17.3%, Hangang 15.7%, Tamjingang 15.9%, Geumgang 12.0% and Mangyeonggang 8.0%. The cases of clonorchiasis were estimated in range 830,000 to 890,000 in riverside areas of the 7 rivers. By grading the infection intensity, 64.7% was in Grade I(EPG 0-900), 28.6% in Grade II (EPG 1000-9,900), 5.5% in Grade III (EPG 10,000-29,900) and 1.3% in Grade IV (EPG over 30,000). The proportion of the cases in Grade III and IV was 6.8% among positive cases. Therefore 60,000 cases at least were regarded to suffer from it clinically. Males of 30-60 years of age showed higher positive rate and heavier burden of infection. This makes clonorchiasis more important socially because the patients lose their social productivity. A few endemic foci of metagonimiasis were detected newly by egg detection; Samcheong 28.5% egg positive rate, Uljin 21.3%, Yeuongdeog 46.3%, Milyang 6.7%, Yeongil 9.2% and Geoje 18.2%. The mean EPG values were in range of 320-7, 120 by the focus. The egg positive rate and proportion of EPG Grade varied greatly by the area, and mean proportion of the positive cases were 69.7% in Grade I, 24.1% in Grade II, 5.0% in Grade III and 1.2% in Grade IV. Males of 30-60 years were infected in higher rate also. The large sized eggs of Metagonimus were found also in upper basin of Hangang and Geumgang mainly. They were regarded as eggs of M. takahashii which is mediated by the cyprinid fishes. Its significance should be studied further. Clonorchiasis and metagonimiasis should be realized as important public health problems in Korea by their wide distribution, high prevalence rate and heavy infection intensity. Comprehensive measures against them are needed urgently.
parasitology-helminth-trematoda ; clonorchiasis ; metagonimiasis ; Clonorchisis sinensis ; Metagonimus yokogawai ; epidemiology

A 11-month-old male with severe combined immune deficiency (SCID) received allogeneic bone marrow transplantation (BMT). He had suffered from recurrent infection and chronic diarrhea. Two older brother died of pneumonia 2 months after birth, but his HLA identical sister was healthy. He had very low number of T lymphocyte and NK cell. Although number of B lymphocyte was normal, level of immunoglobulin was extremely low. First BMT was done when he was 11 months old. Eighteen milliliter of bone marrow was simply infused without conditioning or GVHD prophylaxis. T lymphocyte appeared and fever which persisted despite use of antibiotics disappeared at day 7. Grade II GVHD developed, but was well controlled with corticosteroid. T lymphocyte subpopulation became normal at day 42. But pancytopenia developed and persisted despite use of G-CSF. Second BMT was done 4 months after 1st BMT. The conditioning regimen included busulfan (8 mg/kg) and cyclophosphamide (200 mg/kg), and ATG, cyclosporine and short-course MTX were used for GVHD prophylaxis. He achieved ANC> 500/uL at day 20 and platelet> 20,000/uL at day 29. BM examination on day 45 showed that 100% of marrow cells were donor origin. Acute and chronic GVHD did not develop. Since T lymphocyte was observed on day 21, various immunological parameters were normalized sooner or later. Immunological reconstitution was complete on day 280. Vaccination was given after 1 year of BMT and he is healthy now.
Anti-Bacterial Agents ; Bone Marrow ; Bone Marrow Transplantation ; Busulfan ; Cyclophosphamide ; Cyclosporine ; Diarrhea ; Fever ; Granulocyte Colony-Stimulating Factor ; Humans ; Immunoglobulins ; Infant ; Killer Cells, Natural ; Lymphocyte Subsets ; Lymphocytes ; Male ; Pancytopenia ; Parturition ; Pneumonia ; Siblings ; Tissue Donors ; Vaccination

Immunoglobulin G4-related disease is a recently recognized entity characterized by a mass-forming or regional lesion that contains an extensive infiltration of IgG4-producing plasma cells with dense fibrosis. Immunoglobulin G4-related disease can affect any organ system, but solitary hepatic lesion of Immunoglobulin G4-related disease is very rare. This entity mimics primary malignant hepatic tumor, such as hepatocellular carcinoma or intrahepatic cholangiocarcinoma. We experienced a case of hepatic IgG4-related inflammatory pseudotumor in a 50-year-old woman, mimicking hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Cholangiocarcinoma ; Female ; Fibrosis ; Granuloma, Plasma Cell* ; Humans ; Immunoglobulins* ; Middle Aged ; Plasma Cells

Lymphocytic hypophysitis, an inflammatory disease of the pituitary gland that is often associated with pregnancy, is caused by autoimmune destruction of the pituitary gland evidenced by diffuse inflammatory cell infiltration of the pituitary gland and some kinds of detectable autoantibodies. We report a case of lymphocytic hypophysitis in a 31-year-old woman presenting with severe hypoglycemia and hyponatremia after delivery. Hormonal study revealed panhypopituitarism and magnetic resonance imaging with enhancement showed the bulging contour of the right side pituitary gland with an ill-defined mass-like lesion and nodular thickening of the stalk. The patient's symptoms and biochemical data improved greatly with replacement of L-thyroxine and glucocorticoid. Partial recovery of panhypopituitarism was also seen. The follow-up tests revealed dramatic resolution of the pituitary lesion.
Adult ; Autoantibodies ; Female ; Follow-Up Studies ; Humans ; Hypoglycemia* ; Hyponatremia ; Hypopituitarism ; Magnetic Resonance Imaging ; Pituitary Gland ; Pregnancy ; Thyroxine

PURPOSE: This study was performed to evaluate whether age was a factor associated with oncological outcome for colon cancer patients who underwent a curative surgical resection. METHODS: A retrospective study of 2,125 colon cancer patients who underwent surgery between January 1989 to December 2004 was conducted. RESULTS: Of the 2,125 patients, 1,724 patients underwent a curative resection (R0). The patients with R0 were classified into three groups: group I (n=142) under 40 yr of age, group II (n=1,462) between 40 and 75 yr of age, and group III (n=120) over 75 yr of age. There were no significant differences in gender, tumor diameter, or postoperative complications among the groups. A history of hereditary colon cancer, advanced TNM stage (III, IV), and poorly- differentiated histology were more commonly found in group I. Adjuvant chemotherapy was administered less frequently in group III. In the survival analysis, the cancer-specific survival (CSS) and the disease-free survival (DFS) rates were not different between groups I and II. The CSS and the DFS rates of group III were significantly unfavorable compared with those of groups I and II. On the multivariate analysis, old age (group III), TNM stage, and preoperative CEA level were independent risk factors for CSS and DFS. CONCLUSION: In colon cancer patients, tailored approaches according to age, such as early screening in young adults with family history and proper patients selection for adjuvant treatment in old patients, could be needed.
Chemotherapy, Adjuvant ; Colon ; Colonic Neoplasms ; Disease-Free Survival ; Humans ; Mass Screening ; Multivariate Analysis ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Risk Factors ; Young Adult