BACKGROUND: Several biochemical mediators, such as substance P, calcitonin gene-related peptide (CGRP) and prostaglandin E2, have been demonstrated to be involved in herniated or degenerated disc-induced radiculopathy. The authors tested the hypothesis that these mediators would existed in the epidural space of humans. METHODS: Thirty nine patients were divided into two groups; 27 patients, who were diagnosed with spinal stenosis (stenosis group), and 12 scheduled for epidural anesthesia, without a history of back pain (control group). Under fluoroscopic guidance, an epidural catheter was introduced through the caudal space and placed into the anterior and posterior spaces, up to and around the epidural adhesive area, in the stenosis group. In the control group, the catheter was placed into the posterior epidural space through the L3 4 or L4 5 intervertebral space. Epidural irrigation was performed with 10 ml of saline, via an epidural catheter. Aspirated lavage fluid was collected, and the concentrations of biochemical mediators (substance P, CGRP and prostaglandin E2) measured using an enzyme immunoassay kit. RESULTS: Substance P, CGRP and prostaglandin E2 were detected in all the epidural lavage fluids from both groups. The concentrations of substance P and prostaglandin E2 in the stenosis group were higher than those of the control (P < 0.05). However, there was no difference in the CGRP levels between the two groups. In the stenosis group, the concentrations of these three mediators in the anterior epidural space were no different to those in the posterior space. CONCLUSIONS: These results suggest that biochemical mediators, such as substance P and prostaglandin E2, in the epidural space might be partly involved in pain mechanism associated with spinal stenosis.
Adhesives ; Anesthesia, Epidural ; Back Pain ; Calcitonin Gene-Related Peptide* ; Calcitonin* ; Catheters ; Constriction, Pathologic ; Dinoprostone* ; Epidural Space* ; Humans* ; Immunoenzyme Techniques ; Radiculopathy ; Spinal Stenosis ; Substance P* ; Therapeutic Irrigation

BACKGROUND: Amezinium methylsulfate(Risumic) is the useful drug in the treatment of essential hypotension. This drug elevate blood pressure by stimulating sympathetic nervous system and improve symptoms related hypotension. This study was designed to evaluate efficacy and safety of Risumic for patients with essential hypotension. METHODS: This study was performed in patients with systolic blood pressure less than 100mmHg from June, 1999 to December, 1999. Risumic blood pressure response, improvement of symptom and side effect were examined in a double-blind, placebo-controlled, crossover trial. RESULTS: Total of 54 patients participated in this study and only 55.6% of them were finished and the rest of them(44.4%) was stopped. 6 patients of this patients were stopped because of side effects. But there was no difference in side effects in Risumic and placebo periods. In diastolic BP, Risumic group is 5mmHg higher than placebo group. And then there was significant difference in statistics. CONCLUSIONS: In essential hypotensive patients, Risumic is elevater DBP than SBP, side effects frequency was no significance difference in Risumic and placebo group.
Blood Pressure ; Humans ; Hypotension ; Sympathetic Nervous System

OBJECTIVE: The objective is to clarify the long-term functional outcome of NF-2 and to elucidate optimal treatment strategy. METHODS: The authors retrospectively analyzed clinical records and radiological imaging of 32 patients of NF-2 treated at from 1979 to 2000. Age at diagnosis was 30(14-54). Male to female ratio was 14:18. Mean follow-up(F/U) periods were 61(6-240) months. Four patients were lost during F/U periods. Fifty-one tumors of 29 patients were surgically treated including radiosurgery, and three patients rejected any treatment. Eleven tumors of 10 patients with non-schwannomas were managed by craniotomy, and one of them was managed by biopsy only. Among 21 tumors of 19 patients with schwannomas, 16 tumors of 14 patients were vestibular schwannomas(VS), one trigeminal schwannoma, and four spinal schwannomas. Fourteen tumors with 13 patients were managed by radiosurgery. RESULTS: Presenting symptoms were hearing problem(44%, 14/32 patients), motor or sensory change (25%, 8/32 patients), and visual symptoms (15%, 5/32 patients). Long-term functional outcome was poor (KPS; median 46.6). Six patients died during follow periods and the cause of death was aspiration pneumonia related to lower cranial palsy or high cervical cord lesion(except 1 case; suicide). In 17 patients, 7 patients of initial hearing had preserved after any treatment modalities, another 10 patients had deteriorated hearing function. In facial nerve function, 12 patients except one patient deteriorated after surgical resection. Even though facial-hypoglossal anastomosis was performed in two patients, there was no improvement of facial nerve function. CONCLUSION: Long-term results of NF-2 patients were unfavorable. The early detection of the tumor, regular F/U of patients and individually refined management are important for the optimal treatment of NF-2 patients.
Biopsy ; Cause of Death ; Craniotomy ; Diagnosis ; Facial Nerve ; Female ; Hearing ; Humans ; Male ; Neurilemmoma ; Neurofibromatoses* ; Neurofibromatosis 2* ; Paralysis ; Pneumonia, Aspiration ; Radiosurgery ; Retrospective Studies ; Treatment Outcome*

OBJECTIVES: The current study was performed to assess the distribution of intraocular pressure (IOP) and its association with metabolic syndrome (MS) in a community. METHODS: We measured IOP and MS components from 446 adults, age 20 or more years old, who reside in a community in Kyunggi Province, South Korea. We compared the level of IOP according to the number of metabolic abnormalities and between normal and abnormal metabolic components. Linear regression analyses were used to determine the relationship between IOP and metabolic components. RESULTS: No significant difference in IOP (mean +/- SE) was found between men (12.24 +/- 2.42) and women (12.55 +/- 2.41 mmHg, p > 0.1), while IOP of men tended to decrease as age increased (p for trend < 0.01). After adjusting for age, IOP of subjects with abdominal obesity in men and high blood pressure in women were significantly higher than those without abdominal obesity or high blood pressure (p < 0.05). Female subjects with MS showed significantly higher IOP than those without MS. Participants with more metabolic disturbances tended to have a greater IOP elevation with a linear trend after adjusting for age and sex. In the univariate regression analysis, age and waist circumference were significantly associated with IOP in men, but systolic and diastolic blood pressure were associated with IOP in women. In final multiple regression model, age, systolic blood pressure, and triglyceride were associated with IOP in women, and age in men. CONCLUSIONS: These findings suggest that MS and its components may be important determinants of elevated IOP.
Adult ; Age Factors ; Body Mass Index ; Female ; Health Behavior ; Humans ; Hypertension/physiopathology ; Insulin Resistance/physiology ; *Intraocular Pressure ; Linear Models ; Lipids/blood ; Male ; Metabolic Syndrome X/*complications/epidemiology/physiopathology ; Middle Aged ; Republic of Korea/epidemiology ; Sex Factors

BACKGROUND: This study was conducted to survey current status of research and scholarly activity of residency programs and to evaluate quality of education. METHODS: Questionnaire on research and scholarly activity were sent to all residency training programs by regular mail on May 2003. The questionnaire included detailed characteristics of residency programs, current status of conferences, educations for research activities, degree of faculty involvement, and numbers of published papers and presentations for past year. RESULTS: A total of 103 residency programs answered the questionnaire. Most of the programs held journal review, book review, and clinical review in regular bases as scholarly activities. Smaller than 50% of the programs held case review, chart review, and psycho- social conference in regular bases. As research activity, 40 programs offered educations on epidemiology and statistics, and 55 programs held critical review of the literatures. Faculties involve actively in residents' research project in the process of designing research questions and selecting the subjects, but less actively in the process of gathering informations, completing manuscripts, and preparing presentations. Degrees of faculty involvement were smaller in the programs which are connected with medical school, had only 1 faculty, and educational experiences of the faculty were insufficient. CONCLUSION: Current scholarly activities were active in various aspects, but psychosocial conference and chart audit should be encouraged. Special efforts are required in the research activities, especially in programs which were not connected with medical school and had only one faculty.
Congresses as Topic ; Education ; Epidemiology ; Family Practice ; Humans ; Internship and Residency* ; Korea ; Postal Service ; Schools, Medical

Mitochondrial dysfunction in dopaminergic neurons of patients with idiopathic and familial Parkinson's disease (PD) is well known although the underlying mechanism is not clear. We established a homogeneous population of human adipose tissue-derived mesenchymal stromal cells (hAD-MSCs) from human adult patients with early-onset hereditary familial Parkin-defect PD as well as late-onset idiopathic PD by immortalizing cells with the hTERT gene to better understand the underlying mechanism of PD. The hAD-MSCs from patients with idiopathic PD were designated as "PD", from patients with Parkin-defect PD as "Parkin" and from patients with pituitary adenomas as "non-PD" in short. The pGRN145 plasmid containing hTERT was introduced to establish telomerase immortalized cells. The established hTERT-immortalized cell lines showed chromosomal aneuploidy sustained stably over two-years. The morphological study of mitochondria in the primary and immortalized hAD-MSCs showed that the mitochondria of the non-PD were normal; however, those of the PD and Parkin were gradually damaged. A striking decrease in mitochondrial complex I, II, and IV activities was observed in the hTERT-immortalized cells from the patients with idiopathic and Parkin-defect PD. Comparative Western blot analyses were performed to investigate the expressions of PD specific marker proteins in the hTERT-immortalized cell lines. This study suggests that the hTERT-immortalized hAD-MSC cell lines established from patients with idiopathic and familial Parkin-defect PD could be good cellular models to evaluate mitochondrial dysfunction to better understand the pathogenesis of PD and to develop early diagnostic markers and effective therapy targets for the treatment of PD.
Adult ; Aneuploidy ; Blotting, Western ; Cell Line ; Diagnosis ; Dopaminergic Neurons ; Humans* ; Mesenchymal Stromal Cells* ; Mitochondria ; Parkinson Disease* ; Pituitary Neoplasms ; Plasmids ; Strikes, Employee ; Telomerase

The purpose of this study was to investigate the association among nutrient intakes and health-related lifestyles with cardiovascular disease risk assessed by blood lipid profile according to Apolipoprotein E genotypes. Middle-aged industrial male workers who had completed their annual medical examination were recruited and data of 675 subjects who finished the nutrient survey were used in the analysis. Anthropometric parameters, dietary assessment (FFQ), health-related lifestyles and blood profiles were used for statistical analyses. Apo E genotype groups were classified into the following three genotypes: Apo E2 group (including E2/E2, E2/E3, E2/E4), Apo E3 group (including E3/E3), Apo E4 group (including E3/E4, E4/E4). The frequency of Apo E2, E3, and E4 allele were 13.3%, 75.0% and 11.7% respectively. There were no significant differences in the anthropometric parameters depending on different Apo E genotypes. Also, no significant differences in the nutrient intakes were found according to the genotype groups. The nutrient intakes of all subjects were similar to or higher than the level of KDRIs (Dietary Reference Intakes For Koreans) except for intakes of calcium (67.44% of KDRIs), vitamin A (73.83% of KDRIs) and vitamin B2 (78.02% of KDRIs). Also, there were no significant differences of health-related lifestyles according to Apo E genotype groups. As for the lipid profiles, Apo E4 group had significantly higher total and LDL-cholesterol concentrations than the Apo E2 group (p < 0.05). We confirmed that plasma total and LDL-cholesterol concentrations were greatly influenced by Apo E genotypes. However, nutrient intakes and health-related lifestyles were not associated with Apo E genotypes.
Alleles ; Apolipoprotein E2 ; Apolipoprotein E3 ; Apolipoprotein E4 ; Apolipoproteins ; Apolipoproteins E ; Calcium ; Cardiovascular Diseases ; Genotype ; Humans ; Life Style ; Male ; Plasma ; Riboflavin ; Vitamin A

OBJECTIVE: A thorough understanding of the related venous structure is mandatory for successful removal of the petroclival meningiomas. This study was planned to investigate the guideline for safe ligation and incision of transverse or sigmoid sinuses and the importance of drainage pattern of vein of Labb in surgical removal of petroclival meningiomas. MATERIALS AND METHODS: The authors reviewed the venogram of the consecutive 37 cases of petroclival meningiomas and retrospectively analyzed their surgical findings. The drainage pattern of confluence of Herophili was classified as Type A(confluent and equal on both sides), Type B(confluent and non-dominant on tumor side), Type C(confluent and dominant on tumor side) and Type D(unilateral drainage only) as these findings gave the information on safe ligation and resection of the sinus. Usefulness of intraoperative test clamping of sinus for safe ligation was also reviewed. The vein of Labb was analyzed with respect to its draining point and its collaterals to other superficial veins. RESULTS: Contraindications of the sinus ligation and resection according to the drainage pattern at the confluence of Herophili were Type C(n=10, 27%)and Type D(n=4, 11%). Patients with Type A(n=12, 32%)and Type B(n=11, 30%) were tolerable to sinus ligation ipsilateral to tumor, if the test clamping proved to be safe. Identification of no brain swelling, after intraoperative test clamping of the sinus for more than 30 minutes performed in 7 out of 11 cases, was a reliable indicator of safe sinus ligation. The drainage pattern of the vein of Labb, especially low-lying type, could predict the possibility of postoperative hemorrhage and infarction. Its drainage into tentorium or superior petrosal sinus, however, made the transtentorial approach impossible, leading to restricted operative field. CONCLUSION: For a successful removal of the petroclival meningiomas preoperative venogram should be examined carefully. The extent of exposure in a planned approach can be estimated by analyzing the variation of sinuses and the drainage pattern of vein of Labb.
Brain Edema ; Colon, Sigmoid ; Constriction ; Drainage ; Humans ; Infarction ; Ligation ; Meningioma* ; Phlebography* ; Postoperative Hemorrhage ; Retrospective Studies ; Veins

OBJECTIVES: Meningeal hemangiopericytoma is a rare tumor. Clinical and radiological features are similar to those of an ordinary meningioma. But its biological behavior is quite different from those of a meningioma as it brings profuse bleeding in the operation field, frequent recurrence and metastasis to other systemic organs even in the case of gross total resection. In order to find out the prognostic factors and to compare long-term outcome after various treatment modalities, the authors reviewed consecutive 20 operated cases of meningeal hemangiopericytoma to characterize their clinical features, surgical outcomes and effectiveness of the radiation therapy. METHODS: Twenty patients with a hemangiopericytoma were treated between 1982 and 1999 in our department. They are composed of 13 patients of hemangiopericytoma and 7 patients who were initially diagnosed as angioblastic type meningioma and then confirmed as a hemangiopericytoma after review of their previous histopathology slides. The mean follow-up period was 99 months(1-256 months). The long-term outcomes after various treatment modalities were evaluated according to recurrence-free survival and image follow-up. Recurrence-free survival curves are compared between the patient groups according to the extent of removal and radiation therapy. RESULTS: There were 10 cases of recurrence and 4 cases of distant metastases; lung, liver and femur(2 cases) respectively. The 5-year recurrence rate was 37%, while the 10-year recurrence rose to 77%. There was also statistically significant difference of median recurrence-free survival between the completely-resected group(Simpson grade 1 or 2) and partially-resected group(Simpson grade 3 or 4 or 5); 137 months compared to 47 months, respectively(p=0.009). The median recurrence-free period after subtotal resection of tumor and postoperative radiotherapy was 47 months compared to 117 months of the patients who underwent gross total resection of tumor and did not receive radiotherapy. But radiation therapy alone did not show significant difference in recurrence-free survival. Marked tumor volume reduction and easy removal of tumors without bleeding were found in 2 recurred cases. CONCLUSION: The extent of tumor resection and presence of metastasis are the most important factors related to long-term outcome of the patients with hemangiopericytoma. Radiation therapy after the first operation did not have a role in extending the recurrence-free survival, but it affected favorably to decrease the size of residual mass and intraoperative bleeding during the second operation.
Follow-Up Studies ; Hemangiopericytoma* ; Hemorrhage ; Humans ; Liver ; Lung ; Meningioma ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Tumor Burden

No abstract available.
Adult* ; Humans ; Treatment Outcome*