This study was carried out to identify synaptic reorganization by mossy fibers of epileptic dentate gyrus by Timm sulphide silver histochemistry and to investigate degree of synaptic reorganization according to both hippocampal sclerosis and epileptiform discharge in human temporal lobe epilepsy(TLE). The control group was composed of two hippocampal tissues obtained from autopsied brain without neurological abnormalities. TLE group was composed of thirteen hippocampal tissues obtained from surgically resected temporal lobe. Among thirteen hippocampal tissues, five specimens were obtained both of two areas of each hippocampus with or without prominent epileptiform discharges on electrocorticogram(ECoG) for tailored hippocampal resection. Hippocampal cell density was quantitatively analyzed in TLE group and compared with that of control group. A portion of hippocampal tissue was observed under light microscopic and transmission electron microscopes after development with Danscher method. The results were as follows : Hippocampal cell loss was noted in all TLE group. Hippocampal cell loss greater than 30% of control values was found in 12 cases and average hippocampal cell loss was 70%(range 39-88%). The remaining 1 case had 13% hippocampal cell loss. The supragranular Timm granules were noted in inner molecular layer of dentate gyrus and tended to significantly increase in proportion as severity of hippocampal sclerosis. Average of hippocampal cell loss in two areas of five hippocampal tissues with or without prominent epileptiform discharge on ECoG was 73.6%(range 53-90%) and 66.4%(range 50-86%), which showed statistically significant (p<0.05) difference between these two areas and the supragranular Timm granules also tended to increase in the hippocampal tissue with epileptiform discharge. On transmission electron microscope, there showed distinct supragranular Timm granules correspond to mossy fiber synaptic terminals. The results of this study demonstrated that mossy fiber synaptic reorganization seems to play a major role in pathogenesis of human TLE and the development of mossy fiber synaptic reorganization is closely related to severity of hippocampal sclerosis. The result also support the rationale for tailoring the extent of hippocampal resection by intraoperative acute recording(ECoG) according to individual pathophysiology.
Brain ; Cell Count ; Dentate Gyrus* ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Presynaptic Terminals ; Sclerosis* ; Silver ; Temporal Lobe*

No abstract available.
Gingival Crevicular Fluid* ; Periodontal Diseases*

In our previous study, we observed that hydrosalpingeal fluid (HSF) adversely effect mouswe embryo development and hatching. The aim of this study was to evaluate the effect of HSF as assessed by the blastocyst development rate (BDR) and by cell counting in vitro HSF was collected from nine patients undergoing salpingoneostomy to correct hydrosalpinx. Two-cell embryos were obtained from superovulated ICR mice. T6 medium and T6+/-0.4% bovine serum albumin were used as control media. T6 medium containing 10% or 50% HSF and 100% HSF from each patient were used as test media. Nine to 15 embryos were cultured in microdrops prepared from each of these media. To assess the total cell number within each blastocyst, the blastocysts were fixed and stained with Hoechst 33342 to facilitate cell counting. The mean BDR in two control media were 88.89% and 85.40%. The mean BDR in media containing 10%, 50%, 100% HSF were 85.87%, 89.58% and 75.57%, respectively (*: p<0.05). The overall mean cell count (+/-SEM) in control media were 87.6+/-9.65 and 90.12+/-11.38. The BDR was affected adversely only by 100% HSF and not in media containing 10% or 50% HSF. Mean cell counts were decreased significantly only in blastocysts cultured 100% HSF (63.8+/-13.66; p<0.01) but not in blastocysts cultured in 10% or 50% HSF (91.3+/-12.44 and 82.9+/-18.27, respectively). Thus, it is concluded that HSF has no embyotoxic effect but has a mildly negatively effect on embryonic growth and development.
Animals ; Blastocyst ; Cell Count ; Embryonic Development ; Embryonic Structures* ; Female ; Growth and Development ; Humans* ; Mice* ; Mice, Inbred ICR ; Pregnancy ; Serum Albumin, Bovine

Jugular bulb diverticulum (JBD) is a rarely reported vascular anomaly, which is an extraluminal outpouching from the jugular bulb. Especially, there exists a lack of reported cases involving JBD encroaching the internal auditory canal (IAC) in Korea. Subjects with JBD may be asymptomatic or have variable symptoms based on its location and size. In this article, we report a unique case of JBD eroding into the IAC that was presented as sudden sensorineural hearing loss with vertigo.
Cytochrome P-450 CYP1A1 ; Diverticulum ; Hearing Loss ; Hearing Loss, Sensorineural ; Korea ; Vertigo

No abstract available.
Female* ; Humans ; Neck* ; Urinary Bladder* ; Urinary Incontinence*

PURPOSE: This study aimed to inquire into the educational implication of peer evaluation in PBL in relation to the evaluation system. METHODS: 89 third and fourth-year medical students in PBL courses participated in this study. Descriptive statistics analysis and correlation analysis were performed. RESULTS: Based on the results of the interviews with all the forth-year students, the feedback method of peer evaluation was modified and the peer evaluation sheet was revised. On the new peer evaluation system, the percentages of indiscriminant scores were significantly lower than those on the previous system. Peer evaluation on the new evaluation system was positively related to tutor evaluation, written examination, and quizzes. Correlations between the peer evaluation scores each units were higher than those of the tutor evaluation scores. All third-year students within the bottom ten percent on the peer evaluation score failed to successfully complete that year. CONCLUSION: The peer evaluation with feedback based on faculty counseling and a user-friendly evaluation sheet can be used as an effective method for assessing student performance in PBL and to screen for maladjusted students.
Counseling ; Humans ; Problem-Based Learning* ; Students, Medical

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is one of the well known complication of conttolled ovarian hyperstimulation. Though there have been numerous protocols for the prevention of OHSS, it has not been completely preventable until now. This study was performed to identify clinical predictors for early and late OHSS. METHODS: A retrospective analysis of all IVF cycles in 1993 up to June 1996 was performed. OHSS was diagnosed using the criteria of Rabau modified by Schenker. All cases of OHSS reported in this study presented with marked ovarian enlargement, ascites, oliguria, hemoconcentration and electrolyte disturbance. Ovarian stimulation was carried out using a combination of gonadotrophin releasing hormone-agonist, follicle-stimulation hormone and human menopausal gonadotrophin. 27 patients has moderate or severe OHSS presenting 3-7 days post-human chorionic gonadotrophin (hCG), and 21 patients had severe OHSS presenting 12-17 days post-hCG. RESULTS: No patient with early OHSS went onto develop late OHSS, and no patient with late OHSS had demonstrated early OHSS. Logistic regression showed that early OHSS was predicted by the number of oocytes retrieved and the estradiol concentration on the day hCG injection (P<0.05). Late OHSS was predicted by the transferred embryos, B-hCG on 14 day after hCG injection (P<0.05). CONCLUSION: Early OHSS was an acute effect of the hCG administered prior to egg retrieval in women with high estradiol and large number of retrieved oocytes. Our analysis of the risk factors for early OHSS indicates that cryopreservation of all embryos will not alter the risk of early OHSS even though it should prevent late OHSS. Late OHSS was induced by the rising serum concentration of hCG produced by the early pregnancy, the number of transferred embryos must be adjusted carefully, since it was associated with multiple gestation.
Ascites ; Chorion ; Cryopreservation ; Embryonic Structures ; Estradiol ; Female ; Humans ; Logistic Models ; Oliguria ; Oocytes ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction ; Ovum ; Pregnancy ; Retrospective Studies ; Risk Factors

In order to obtain more accurate pathological diagosis of the angiographically occult vascular malformations(AOVM) of the brain in the future and to examine the clinical, and radiological characteristics and management outcome of the AOVM, the authors retrospectively reviewed the 30 cases of AOVM in which patients were treated at our instituition during the past 11-year period. The pathological specimens were reexamined, and the lesions were reclassified according to the strict histopathological criteria. The clinical characteristics, radiological features, the difference between the clinical and pathological diagnosis and the management results were studied. There were 15 males and 15 females. The mean age at the time of diagnosis was 31 years, ranging from 3 months to 74 years. The clinical diagnosis were arteriovenous malformation(AVM) in 18 cases, cavernous angioma in 11 and mixed lesion in 1. The pathologic diagnosis was AVM in 14 cases, cavernous angioma in 2, and unclassified lesion in 12. The common presenting symptoms were hemorrhage(53.3%), seizure(20.0%) and mass lesions(20.0%). Twenty four lesions were located at the supratentorial region, 4 at cerebellum and 2 at pons. Most of the lesions were revealed as high density masses with minimal or no contrast enhancement on CT and a core of mixed signal intensity with a peripheral low signal intensity rim on T2-weight MRI. Preoperative clinically significant recurrent hemorrhages were noted in 8 cases and one of them showed marked deterioration of the neurological functions a result of recurrent hemorrhage. Twenty-eight patients underwent surgery and all except one improved neurologically. Six patients initially presented with seizure showed improvement in seizure frequency after operation. One patient who had the lesion at the pons was managed by a radiosurgery and one patient who refused surgery was managed by a conservative method. The conservatively managed patient and another patient who was not found AVM at the hematoma cavity during initial operation rebled about 2 years later following diagnosis and surgery. Thse findings suggest that the complete microsurgical excision, which prevents rebleeding and suppresses seizure activity, represents the treatment of choice for patients with clinically symptomatic AOVM. Avoiding the injury of the vascular mass, obtaining sufficient biopsy specimen during surgery, together with careful histopathological observation of operative specimens through complete clinical-radiological-pathological context are necessary to obtain more accurate pathological diagnosis.
Arteriovenous Malformations ; Biopsy ; Brain ; Cerebellum ; Diagnosis ; Female ; Hemangioma, Cavernous ; Hematoma ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Pathology ; Pons ; Radiosurgery ; Retrospective Studies ; Seizures ; Vascular Malformations*

PURPOSE: This study was aimed to examine whether tutor evaluation in the PBL course assesses different aspects of learning from what written examination assesses. METHODS: 89 medical students were assessed by Self-Directed Learning Readiness Scale (SDLRS) and Learning Orientation Scale (LOS) in March 2004. Their tutor evaluation and written examination scores in the 1st semester of 2004 PBL units were collected in August 2004. Data analyses were conducted using t-test, correlation analysis, and linear regression. RESULTS: SDLRS scores were significantly correlated with tutor evaluation scores, but not with written examination scores. Both schoolwork orientation and academic orientation scores on LOS were significantly associated with tutor evaluation and written examination scores. Tutor evaluation scores were explained significantly by all predictors, such as SDLRS, schoolwork orientation, and academic orientation scores. However, written examination scores were explained significantly by academic orientation only. CONCLUSIONS: Tutor evaluation in the PBL assessed student self-directed learning readiness and academic orientation, but written examination did not. The findings show a crucial possibility that tutor evaluation may overcome shortcomings of the written examination.
Education, Medical, Undergraduate ; Educational Measurement ; Humans ; Learning* ; Linear Models ; Problem-Based Learning ; Psychological Tests ; Regression Analysis ; Statistics as Topic ; Students, Medical

PURPOSE: This study aims to examine how inequalities in suicide by education changed during and after macroeconomic restructuring following the economic crisis of 1997 in South Korea. MATERIALS AND METHODS: Using Korea's 1995, 2000, and 2005 census data aggregately linked to mortality data (1993 - 2006), relative and absolute differentials in suicide mortality by education were calculated by gender and age among Korean population aged 35 and over. RESULTS: Average annual suicide mortality rates have steadily increased from 1993 - 1997 to 2003 - 2006 in almost all sociodemographic groups stratified by gender, age, and education. Based on the relative index of inequality (RII) and slope index of inequality (SII), educational differentials in suicide mortality generally increased over time in men and women aged 45 years +. Although RII did not increase with year among men and women aged 35 - 44 years, SII showed a significantly increasing trend in this age group. CONCLUSION: These worsening absolute inequalities in suicide mortality indicate that the governmental suicide prevention policy should be directed toward socially disadvantaged groups of the Korean population.
Adult ; Age Distribution ; Educational Status ; Female ; Humans ; Korea/epidemiology ; Male ; Mortality/*trends ; Sex Distribution ; Socioeconomic Factors ; Suicide/*statistics & numerical data