Chronic progressive radiation myelopathy(CPRM) is a rare but serious complication of radiation therapy. It's exact cause is unknown and the diagnosis is usually made based on the exclusion of other causes of myelopathy. Magnetic resonance imaging(MRI) with gadolinium- diethylenetriamine pentaacetic acid(DTPA) enhancement seems to be useful for the diagnosis of CPRM. There is no known effective treatment and the complication is irreversible. We report a case of CPRM after radiation therapy for subglottic cancer which was not respond to high-dose steroid therapy with review of literature.
Diagnosis ; Spinal Cord Diseases*

Prader-Willi syndrome(PWS) was first described by Prader et al in 1956. This syndrome is characterized by diminished fetal activity, low birth weight, infantile hypotonia with feeding problem, temperature instability, early onset of childhood hyperphagia with consequent obesity, short stature, hypogonadism and mental retardation. The deletion of chromosome 15(del 15(qll-13)) was reported by Ledbetter in 1981, which was thought to be of paternal origin. Recently, such micro- deletion may be diagnosed by fluorescence in situ hybridization(FISH) that recognizes specific DNA base sequence. We experienced a Prader-Willi syndrome confirmed by FISH in an infant that had hypotonia, growth retardation, feeding difficulty and FUO since 1 month of age. We report this case with a brief review and related literature.
Base Sequence ; DNA ; Fetal Movement ; Fluorescence ; Humans ; Hyperphagia ; Hypogonadism ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intellectual Disability ; Muscle Hypotonia ; Obesity ; Prader-Willi Syndrome*

Cyclins are proteins that activate different cyclin-dependent kinases(CDKs) and promote the cell cycles. Their correlations with several human cancers have been identified. Cyclin E, as one of G1 cylins, produces DNA replication through the progression of cell cycle G1 --> S phase. In contrast, cyclin-dependent kinase inhibitors(CDKI) bound with cyclin E-cdk2 complex control the cell cycle and inhibit the cell proliferation. P21(WAF1) proteins, which are CDKIs, are transcripted by a p53 gene and participate in the cell cycle inhibition. Variant p53 proteins produced by a mutated p53 gene lose the ability to control of the cell cycle resulting in cell proliferation. This study is aimed to reveal the expressions of cyclin E, p21(WAF1) protein, p53 variant protein in colorectal adenomas and carcinomas, and also reveal their correlations in the process of carcinogenesis. Twenty-one colorectal adenomas or adenomatous polyps, and thirty colorectal carcinoma tissues were obtained by operative resections or endoscopic polypectomies. Immuno histochemical stains of the above-mentioned three proteins and a statistical analysis of their correlations were made. The results were as follows: 1. P21 proteins were expressed in the upper-one third layer of all normal colonic mucosa, but cyclin E and variant p53 protein were not identified. 2. Cyclin E was expressed in 23.8% of adenomas and 76.7% of carcinomas. Variant p53 protein was expressed in 71.4% of adenomas and 83.3% in carcinomas. The degree of positivity of variant p53 expression was correlated with cancer staging. P21 protein was expressed in all adenomas, similar to normal mucosa, but was not expressed in 43.3% of carcinomas. 3. Expression of cyclin E was increased as to the positivity of variant p53 proteins but the correlations of p21 proteins and cyclin E, and p21 proteins and variant p53 proteins were not identified. Cancer staging was not correlated with the expressions of the three proteins. In conclusion, it can be thought that the overexpression of cyclin E and variant p53 proteins, and the loss of p21 proteins are related with the colorectal carcinogenesis. We can also identify the relationship of cyclin E and variant p53 proteins.
Adenoma* ; Adenomatous Polyps ; Carcinogenesis ; Cell Cycle ; Cell Proliferation ; Colon ; Colorectal Neoplasms ; Coloring Agents ; Cyclin E* ; Cyclins* ; DNA Replication ; Genes, p53 ; Humans ; Mucous Membrane ; Neoplasm Staging ; Phosphotransferases ; S Phase

Fryns syndrome is a lethal syndrome of multiple congenital anomalies first described by Fryns et al in 1979. A recently developed major diagnostic criteria includes abnormal face, small thorax with widely spaced hypoplastic nipples, distal limb and nail hypoplasia, lung hypoplasia with diaphragmatic hernia, central nervous system anomalies and congenital heart disease. The pathogenesis of Fryns syndrome is not clear. Of the major immediate life-threatening abnormalities of this syndrome, lung hypoplasia associated with diaphragmatic hemia has usually proven to be fatal. We report a case of Fryns syndrome, which has the prenatal ultrasonographic findings of Dandy-Walker malformation and renal hypoplasia.
Central Nervous System ; Dandy-Walker Syndrome ; Extremities ; Heart Defects, Congenital ; Hernia, Diaphragmatic ; Lung ; Nipples ; Thorax

OBJECTIVE: The purpose of this study was to determine the efficacy of short segment fixation following postural reduction for the re-expansion and stabilization of unstable burst fractures in patients with osteoporosis. METHODS: Twenty patients underwent short segment fixation following postural reduction using a soft roll at the involved vertebra in cases of severely collapsed vertebrae of more than half their original height. All patients had unstable burst fracture with canal compromise, but their motor power was intact. The surgical procedure included postural reduction for 2 days and bone cement-augmented pedicle screw fixations at one level above, one level below and the fractured level itself. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. RESULTS: The mean follow-up period was 15 months. The mean pain score (visual analogue scale) prior to surgery was 8.1, which decreased to 2.8 at 7 days after surgery. The kyphotic angle improved significantly from 21.6+/-5.8degrees before surgery to 5.2+/-3.7degrees after surgery. The fraction of the height of the vertebra increased from 35% and 40% to 70% in the anterior and middle portion. There were no signs of hardware pull-out, cement leakage into the spinal canal or aggravation of kyphotic deformities. CONCLUSION: In the management of unstable burst fracture in patients with severe osteoporosis, short segment pedicle screw fixation with bone cement augmentation following postural reduction can be used to reduce the total levels of pedicle screw fixation and to correct kyphotic deformities.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Osteoporosis ; Spinal Canal ; Spine

OBJECTIVE: To investigate the effect of taping therapy on hemiplegic shoulder subluxation. METHOD: Sixty patients were randomly assigned to three groups. In study group, two parts of the first tape was shaped as letter Y and were attached from humeral insertion of deltoid muscle to extension line of the clavicle midline, following anterior and middle deltoid line, respectively, with 125% elasticity. And two parts of the second tape as same as the first tape were attached horizontally from head of greater tubercle to medial border of scapular, following supraspinatus and infraspinatus muscles, respectively, with 125% elasticity. The placebo group was applied by the tape with 100% and 150% elasticity and control group was not applied. The effects of strapping were evaluated by using visual analogue scale (VAS), passive range of movement (ROM), vertical distance (VD) and horizontal distance (HD) on radiologic findings of plain anteroposterior (AP) view and lateral distance (LD) on shoulder ultrasonography at entry (day 0), 1 and 2 days later. RESULTS: Repeated measured analysis of variances indicated that the study group showed corrective effect in the VAS (p<0.05). The control and placebo groups showed no significant change in any parameters of distance measurements and clinical findings. In every group, spasticity, MMT and Brunnstrom stage were not changed during study. CONCLUSION: The taping therapy with 125% elasticity may be helpful for patients with hemiplegic shoulder to reduce pain.

OBJECTIVE: To evaluate the autonomic nervous function in post-stroke patients. METHOD: A total of 58 subjects, 34 post-stroke patients (mean age of 61.35 years) and 24 healthy subjects (mean age of 34.42 years) were included. The sympathetic skin response (SSR), the R-R interval variation (RRIV) and orthostatic hypotension (OH) were evaluated. Bilateral sympathetic skin responses were recorded on the palm and sole with stimulation of both median and tibial nerves. The obtained SSRs were divided into normal response and abnormal response including no response. The R-R interval variations were estimated during rest, deep breathing and Valsalva maneuver respectively. RESULTS: In all healthy subjects, obtained SSRs were of normal response. Although the rate of abnormal SSR was 75.4% (205 of 272 waves) in stroke patients, the rate of abnormal SSR on affected side (81.6%, 111 of 136 waves) was significantly higher than unaffected side (69.1%, 94 of 136 waves) (p<0.05). The rate of abnormal SSR according to OH was not significantly different (with OH 75.0%, without OH 75.6%) (p>0.05). The RRIV of stroke patients with OH (1.09+/-0.06) was significantly lower than in control (1.14+/-0.05) during rest (p<0.01), and in stroke patients without OH, the RRIV (1.13+/-0.06) was also significantly lower than in control (1.27+/-0.22) during Valsalva maneuver (p<0.01). CONCLUSION: Evaluation of SSR and RRIV could be helpful in detecting dysfunction of autonomic nervous system in post-stroke patients.
Autonomic Nervous System ; Humans ; Hypotension, Orthostatic ; Respiration ; Skin ; Stroke ; Tibial Nerve ; Valsalva Maneuver

The purpose of this study was to describe the CT findings of focal organizing pneumonia and to compare the findings with pathology. CT findings of histologically proven focal organizing pneumonias in 26 consecutive patients were analyzed. In 17 patients who had undergone surgical resections, the findings were correlated with pathology. Focal organizing pneumonias appeared as a nodule (n= 13) or a mass (n=13), ranging from 9 mm to 66 mm in diameter. Ground-glass opacity was seen in 6/13 (46%) nodules and 6.5/13 (50%) masses (k=.48) with an extent ranging from 5% to 75% (mean, 16%). In 4/26 (15%) patients, the extent was more than 50% of the lesion. They showed smooth (n=4), lobulated (n=8), spiculated (n=1), or lobulated and spiculated margin (n=13). On correlative analysis, nodule or mass on CT consisted histologically of intraalveolar exudate or microabscess, chronic inflammatory cell infiltration, fibrotic nodules, and polypoid granulation tissue in the alveolar or bronchiolar spaces. Ground-glass opacity consisted of interstitial fibrosis and chronic inflammatory cell infiltration and intraalveolar polypoid granulation tissue. Focal organizing pneumonia may simulate a lung cancer with variable appearances on CT and the findings reflect underlying histopathology of the disease.
Adult ; Aged ; Aged, 80 and over ; Female ; Human ; Male ; Middle Age ; Pneumonia/pathology/*radiography ; *Tomography, X-Ray Computed

PURPOSE: The significant drastic complications of performing laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients are gastric staple line leakage and bleeding. The aim of our study is to evaluate the efficacy of the clinical data for detecting postoperative complications after LSG. METHODS: The study enrolled 150 consecutive patients who underwent LSG from January 2003 to July 2006. When abnormal data (heart rate > or = 10/min, or temperature > or = 7.5degrees C) was detected on postoperative day 1, then laboratory tests (blood, urine, chest X-ray and abdominal sonogram) and water soluble gastrografin UGIS were performed to detect the postoperative complications after LSG (group A). The patients who had normal postoperative clinical data (group B) were compared with group A. RESULTS: Of the 150 patients who underwent LSG, 9 patients (6%) had postoperative complications. Two patients had major complications: 1 case of leakage (0.6%) and 1 case of delayed bleeding (0.6%), and 4 patients had minor complications in group A. But no major complications were detected in group B (P<0.01). The heart rate and body temperature in group A were significantly faster and higher than those in group B (P<0.01). Especially, 2 patients who had major complications had severe tachycardia over 120 beats per minute (bpm). However, when the body temperature of a patient was elevated, there was no high grade fever in all the cases ( > 39degrees C). CONCLUSION: Evidence of tachycardia or a high body temperature may be useful to detect major complications after LSG. We also recommend performing laboratory test and UGIS when clinically indicated.
Body Temperature ; Diatrizoate Meglumine ; Fever ; Gastrectomy ; Heart Rate ; Hemorrhage ; Humans ; Obesity, Morbid ; Postoperative Complications ; Tachycardia ; Thorax

Epinephrine is frequently used to control local bleeding during surgery. However, it may be associated with complications, such as pulmonary edema, reversible cardiomyopathy, and cardiac arrest. We encountered a case of stress induced cardiomyopathy (SIC) after local epinephrine instillation. The SIC is manifested with typical left ventricular apical ballooning and clinical symptoms of a myocardial infarction without coronary stenosis. Although its prognosis is more favorable than a myocardial infarction, anesthesiologists need to be aware of the possible adverse effects of local epinephrine infiltration.
Cardiomyopathies ; Coronary Stenosis ; Epinephrine ; Heart Arrest ; Hemorrhage ; Myocardial Infarction ; Prognosis ; Pulmonary Edema