The diagnostic value of nerve conduction study of spinal stenosis is far limited due to its deeply located lesion and its very short length of diseased nerve compared to the relatively long length of total conduction distance. Recently it became possible to stimulate the deep sited spinal nerve roots non-invasively with magnetic stimulation. The authors made a new method to calculate the motor nerve conduction time of lumbar spinal root using magnetic stimulation and planned to verify the delayed conduction time in patients with spinal stenosis who didn't show any abnormalities in the conventional electrophysiologic studies(peripheral nerve conduction velocity, F-wave and needle EMG). Three steps of magnetic stimulation were applied to vertex(transcortical stimulation), T12 spinous process(thoracic stimulation) and S1 spinous process(sacral stimulation), and three channel recording were performed at rectus abdominis(RA), right and left abductor hallucis(AH) simultaneously. Central motor conduction time(CMCT) was calculated by time difference between vertex and spinal stimulation at RA and AH. Lumbar-segment motor conduction time(LMCT) was defined as conduction time by subtracting CMCT of RA from CMCT of AH. The results as follows; LMCT was delayed in the group of patients with spinal stenosis(5.36+/-2.11 msec) compared to the normal control group(4.05+/-1.23 msec), but the range of LMCT was not quite different individually. Dividing the patients group into multi-level and single-level spinal stenosis group, LMCT in the multi-level spinal stenosis group was 6.12+/-1.95 msec which was significantly different from that of single-level(4.48+/-1.96 msec). The authors conclude that LMCT, the short segmental motor nerve conduction study of lumbosacral nerve root, is useful to confirm the entrapment of spinal nerve root across the lumbosacral spinal canal and is also non- invasive, simple and applicable to any other spinal nerve roots.
Evoked Potentials, Motor ; Humans ; Needles ; Neural Conduction* ; Spinal Canal ; Spinal Nerve Roots ; Spinal Stenosis*

Clinical manifestations of hypothyroidism are very various and these degree are related to the severity and duration of the disease. Pericardial effusions, one of the manifestations of hypothy-roidism, were relatively common in the past. However, recently they may not be so frequent representative of hypothyroid subjects. The higher frequency of Hashimotos thyroiditis in Turners syndrome, especially those with an X-isochromosome, compared with the general population is well known. The pathophysiological process of autoimmunity is thought to be linked with the presence of an abnormal X-chromosome. Recently we experienced a case of X-isochromosome Turners syndrome with hypothyroidism and pericardial effusion and report it with reviews of the literatures.
Autoimmunity ; Hypothyroidism* ; Pericardial Effusion* ; Thyroid Gland ; Thyroiditis ; Turner Syndrome*

BACKGROUND: Numerous studies of safe, long term preservation for lung transplantation have been performed using ex vivo models or in vivo single lung transplantation models. However, a safe preservation time which is applicable for clinical use is difficult to determine. We prepared LPDG solution for lung preservation study. In this study we examined the efficacy of LPDG(low potassium dextran glucose) solution in 24-hour lung preservation by using a sequential bilateral canine lung allotransplant model. MATERIAL AND METHOD: Seven bilateral lung transplant procedures were performed using weight-matched pairs(24 to 25kg) of adult mongrel dogs. The donor lungs were flushed with LPDG solution and maintained hyperinflated with 100% oxygen at 10C degrees for a planned ischemic time of 24 hours for the lung implanted first. After sequential bilateral lung transplantation, dogs were maintained on ventilators for 3 hours: arterial resistance were determined if the recipients hourly after bilateral reperfusion and compared with pretransplant-recipient values, which were used as controls. After 2hours of reperfusion, the chest X-ray, computed tomogram and lung perfusion scan were performed for assessmint of early graft lung function. Pathological examinations for ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery were performed. RESULT: Five of seven experiments successfully finished the whole assessments after bilateral reperfusion for three hours. Arterial oxygen tension in the recipients was markedly decrased in immediate reperfusion period but gradually recovered after reperfusion for three hours. The pulmonary artery and pulmonary vascular resistance showed singificant elevation(p<0.05 versus control values) but also recovered after reperfusion for three hours(p<0.05 versus immediate period value). The ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery showed reversible mild injury in 24 hours of lung perservation and reperfusion. CONCLUSION: This study suggests that LPDG solution provides excellent preservation in a canine model in which the dog is completely dependent on the function of the transplanted lung.
Adult ; Animals ; Dextrans ; Dogs ; Humans ; Lung Transplantation ; Lung* ; Organ Preservation ; Oxygen ; Perfusion ; Potassium ; Pulmonary Artery ; Reperfusion ; Thorax ; Tissue Donors ; Transplants ; Vascular Resistance ; Ventilators, Mechanical

BACKGROUND: In Korea, cerebrovascular accident (CVA) is the most significant cause of death among older people, and the incidence of cerebral hemorrhage is much higher than that of developed countries. There have been many investigations about the risk factors for CVA in both Korea as well as developed countries. A few papers reported various risk factors for cerebral hemorrhage in developed countries:however, well-designed studies of risk factors for the various causes of CVA were rare in Korea. Therefore, the purpose of this study was to compare the risk factors for the various causes of CVA and to evaluate the risk factors compared with age- and sex-matched control groups. In addition, duplex sonographic findings of the carotid artery were evaluated in patients with cerebral infarction. METHODS: One hundred and sixty-four patients admitted to the hospital in 1996 were enrolled. The four groups were divided based on the following states: cerebral infarction (n-63), cerebral hemorrhage (n-64), cerebral infarction with atrial fibrillation (n-19), and lacunar infarction (n-18). Major risk factors were compared with age- and sex-matched control groups and among CVA groups. Duplex sonography of the carotid artery was done in 14 patients with cerebral infarction. RESULTS: In multiple logistic regression analysis, patients with cerebral infarction had higher prevalence of diabetes mellitus and lower high density lipoprotein-cholesterol level than the control group, and hypertension showed borderline significance. Patients with cerebral hemorrhage had higher prevalence of hypertension, higher high density lipoprotein-cholesterol level, and more frequent prevalence of smoking compared with the control group. Patients with cerebral infarction showed lower high density lipoprotein-cholesterol, higher low density lipoprotein-cholesterol levels, more frequent diabetes mellitus, lower prevalence of hypertension and older age than patients with cerebral hemorrhage. Patients with cerebral infarction and atrial fibrillation showed only older age than patients with cerebral infarction only. There were no differences in risk factors between patients with cerebral infarction and lacuna infarction. Atheromatous plaque was found in 71% of patients with cerebral infarction. CONCLUSION: Metabolic abnormalities played more important role in the development of cerebral infarction and hemodynamic abnormalities in cerebral infarction. Sonographic examination of the carotid artery may be useful for predicting the occurrence of cerebrovascular accident in high risk patients.
Atrial Fibrillation ; Carotid Arteries* ; Cause of Death ; Cerebral Hemorrhage ; Cerebral Infarction* ; Developed Countries ; Diabetes Mellitus ; Hemodynamics ; Humans ; Hypertension ; Incidence ; Infarction ; Korea ; Logistic Models ; Prevalence ; Risk Factors* ; Smoke ; Smoking ; Stroke ; Stroke, Lacunar ; Ultrasonography*

Sclerosing mesenteritis is a rare benign disease with a prevalence of 0.16–3.4% and is characterized by chronic nonspecific inflammation and extensive fibrosis in the adipose tissue of the mesentery although the exact pathogenesis is still elusive. A 65-year-old woman was referred with suspicion of an abdominal mass and biliary stones on abdominal ultrasonography and CT. Bile duct stones were confirmed by endoscopic ultrasonography and successfully treated by endoscopic retrograde cholangiography with stone removal. Furthermore, a 4.7 cm conglomerated mass on small intestinal mesentery was suspected as sclerosing mesenteritis based on the features on abdominal MRI. However, because it could not be differentiated from malignancy without histologic examination, laparoscopic excisional biopsy was performed; it showed only inflammatory cells with extensive fibrosis. Therefore, the abdominal mass was confirmed as sclerosing fibrosis and the patient was followed-up without any treatments because no mass-related symptoms accompanied the findings. Six months later, abdominal CT showed no significant change in the mass. Herein, we report a rare case of incidentally found idiopathic sclerosing mesenteritis.
Adipose Tissue ; Aged ; Bile Ducts ; Biopsy ; Cholangiography ; Endosonography ; Female ; Fibrosis ; Humans ; Immunoglobulins* ; Inflammation ; Magnetic Resonance Imaging ; Mesentery ; Panniculitis, Peritoneal ; Prevalence ; Sclerosis* ; Tomography, X-Ray Computed ; Ultrasonography

In this article, the sixth author's affiliation was misprinted unintentionally.

The p16 is a cyclin-dependent kinase inhibitor(CDKI) that inhibits cell cycle progression. In recent studies, homozygous deletions of p16 gene have been noted in some cancer cell lines, which implies the deletion or mutation of p16 gene may contribute to the malignant progression of cells in some ways. This study was to investigate the frequency of p16 gene mutation in breast cancer patients by using polymerase chain reaction-single stranded confromational polymorphysm(PCR-SSCP) analysis. Examination of 24 blood samples and corresponding 16 tissue samples from 24 breast cancer patients were performed by PCR-SSCP method. Four from 24 blood samples(16.7%) disclosed 3 abnormal bands and one band shifting. Among 13 tissue samples revealed three conformational changes(23.1%). In two cases, there were abnormal bands in both blood samples and cancer tissues. One case with no products by PCR in the tissue sample showed a band shifting in the blood sample. Three cases with no PCR products in tissue samples may considered as total allelic deletion of the p16. The cases of abnormal PCR-SSCP results show some abnormalities on direct sequencing by Sanger method as T base insertion, C/T and A/G bases substitution. The results may suggest some of breast cancer patients have germline mutations of the p16 gene and some have somatic mutations. In the carcinogenesis of some breast cancers, p16 gene mutation may dysregulates the cell cycle, that may play an important role in the unlimited tumor cell proliferations.
Breast Neoplasms* ; Breast* ; Carcinogenesis ; Cell Cycle ; Cell Line ; Genes, p16 ; Germ-Line Mutation ; Humans* ; Phosphotransferases ; Polymerase Chain Reaction

BACKGROUNDS: The aim of this retrospective study was to compare patients treated for complicated peptic ulcers with special reference to the morbidity and the mortality rates and its determining factors according to the type of surgery. METHODS: From Jan. 1988 to May 1996, a total of 168 patients with complicated peptic ulcers underwent surgical treatment. Among them, 39 patients were lost during the follow up period and 10 cases were operated on due to pyloric obstruction, so we analyzed 119 cases according to the type of surgery (definitive or minimal). Definitive surgery means acid-decreasing procedures such as a gastrectomy or a truncal vagotomy with drainage procedure. Minimal surgery means life-saving procedures such as primary closure or bleeding vessel ligation. The type of operation was determined according to the preference of the individual consultant surgeons at our institute. RESULTS: There were 70 definitive and 49 minimal operations (6:4). The mean follow-up period was 20.6 months (range: 11-73 months). The risk factors affecting the morbidity and the mortality were comparable for both groups. In spite of little statistical significance, the results of definitive surgery were superior to those of minimal surgery in morbidity (15.7%:20.4%), mortality (0%:6.1%), recurrence (5.5%:12.2%), and Visick grading scale 1 & 2 (92.8%:81.6%). The determining factor affecting morbidity was the presence of combined disease (p=0.001) only; other factors such as age, anemia, leukocytosis, presence of preoperative shock, transfusion amount, and type of operation did not affect the morbidity rate. CONCLUSION: Considering that there were no differences in postoperative morbidity and mortality between definitive and minimal surgery, it is better to perform definitive surgery on patients who have no serious combined disease.
Anemia ; Consultants ; Drainage ; Follow-Up Studies ; Gastrectomy ; Hemorrhage ; Humans ; Leukocytosis ; Ligation ; Mortality ; Peptic Ulcer* ; Recurrence ; Retrospective Studies ; Risk Factors ; Shock ; Vagotomy, Truncal

Carcinoma of the prostate is a common malignancy affecting elderly men. Lung metastasis from prostate cancer occurs frequently, but tumor metastasis to the central bronchi that clinically mimics primary bronchogenic carcinoma are very rare. We report a 73-year old man with endobronchial metastasis from prostatic carcinoma presented with respiratory symptom cough. Diagnosis of issues taken from materials which were used for bronchoscopic biopsy and prostate biopsy and immunohistochemical staining for prostate specific antigen(PSA) confirmed a case of endobronchial metastasis from prostatic carcinoma. Hormonal therapy(LHRH agonist) was applied to this patient.
Aged ; Biopsy ; Bronchi ; Carcinoma, Bronchogenic ; Cough ; Diagnosis ; Humans ; Lung ; Male ; Neoplasm Metastasis* ; Prostate ; Prostatic Neoplasms

Epidermal cysts are benign cysts, which rarely localize in solid organs, but have an unclear pathogenesis. Herein, a case of an intrarenal epidermal cyst, in a 60-year-old woman with right flank pain, is reported. Multiple renal stones in the right kidney were identified by an intravenous pyelogram. A percutaneous nephrolithotomy (PCNL) was performed under the assumption of renal stones. Amorphorous cysts, containing calcification, were identified during the PCNL, which were histologically identical in appearance to an epidermal cyst within the skin. We suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin, due to the patient's history of renal stones, which had been previously treated with an open nephrolithotomy. According to the literature, an intrarenal epidermal cyst was usually treated by nephrectomy, under the assumption of a renal mass. Although the intrarenal epidermal cyst was incidentally found during the PCNL, an additional nephrectomy was not performed as it had almost been removed.
Epidermal Cyst* ; Female ; Flank Pain ; Humans ; Kidney ; Metaplasia ; Middle Aged ; Nephrectomy ; Nephrostomy, Percutaneous ; Skin