Tetrodotoxin (TTX) cause neurologic dysfunction by blocking the voltage-gated sodium channels located in all of the peripheral nerves and muscles. We experienced two patients presenting with generalized motor weakness after ingestion of pufferfish. The nerve conduction study showed diffuse slowing of motor and sensory nerve conduction velocity, prolonged motor terminal latency and decreased sensory nerve action potentials without temporal dispersion or conduction block. Abnormal findings of nerve conduction study improved rapidly without any deterioration. Clinical symptoms and signs ameliorated in accordance with findings of nerve conduction study without any neurologic sequelae. These imply that tetrodotoxication is reversible and functional neurologic disorder. We suggest that nerve conduction studies can be available in serial monitoring of tetrodotoxication as an objective means.
Action Potentials ; Eating ; Humans ; Muscles ; Nervous System Diseases ; Neural Conduction ; Neurologic Manifestations ; Peripheral Nerves* ; Tetraodontiformes ; Tetrodotoxin ; Voltage-Gated Sodium Channels

Purpose: This study evaluated the usefulness of a silicone ring tourniquet by analyzing the changes in the perioperative hemoglobin (Hb) levels or amount of perioperative bleeding compared to those of a pneumatic tourniquet or no usage during minimally invasive plate fixation for distal femoral fractures. Materials and Methods: From January 2017 to December 2019, 30 patients who underwent minimally invasive plate fixation using a locking compression plate for distal femoral fractures were evaluated and classified as a silicone ring tourniquet (Group 1), a pneumatic tourniquet (Group 2), and no usage (Group 3). The variables for analysis were age, sex, preoperative Hb (preHb), postoperative 72-hour Hb (postHb), differences between preHb and postHb (preHb-postHb), amount of intraoperative and overall transfusion, estimated unit of transfusion corrected by preHb-postHb and total transfusion (Hb-lost), amount of intraoperative and postoperative and total bleeding. One-way ANOVA was used to identify the differences between the groups. Results: The age, sex, operation time, preHb, preHb-postHb, amount of intraoperative and overall transfusion and Hb-lost were similar in the two groups. The amount of intraoperative bleeding was significantly lower in Group 1 than Group 3 (p=0.004), but there was no difference in the amount of postoperative and total bleeding between the two groups. Conclusion The use of a silicone ring tourniquet in the minimally invasive plate fixation for distal femoral fractures decreased the amount of intraoperative bleeding compared to no use of a tourniquet.

The variant of squamous carcinoma of the scrotum known as verrucous carcinoma is very rare, but has a distinct clinical and pathological condition which has a significantly better prognosis than the more common infiltrative type. We report one case of verrucous carcinoma of the scrotum that was treated by wide local excision with placing the bilateral testes subcutaneously in the thigh and a split-thickness skin graft to cover the scrotum. And we tried to detect human Papillomavirus (HPV) type 6, 11, 16 and 18 with DNA in situ hybridization method.
Carcinoma, Squamous Cell ; Carcinoma, Verrucous* ; DNA ; Humans ; In Situ Hybridization ; Prognosis ; Scrotum* ; Skin ; Testis ; Thigh ; Transplants

The authors diagnosed femoral component fracture after total knee arthroplasty (TKA) using an anterior-posterior glide mobile-bearing system in a 78-year-old female patient who visited with severe pain and flexion limitations in the left knee and performed revision TKA. The fracture of the femoral component after TKA is a rare complication, and various factors cause the fracture of the femoral component. This case is reported along with a literature review.

To evaluate oxygenation and metabolic state of the non-brainstem stroke patients after the moderate intensity exercise using arterial blood gas analysis (ABGA). Fifty-two stroke patients were recruited. All the subjects were to follow the instructions for the exercise, not suffered cardiopulmonary diseases before, and not diagnosed with brainstem disorders. They were ordered to maintain 70% heart rate of maximal heart rate during exercise and checked blood pressure, pulse rate, respiratory rate (RR), and ABGA before and after the exercise, respectively. O² saturation, PaO², PaCO², O² content, HCO³⁻, pH, and anion gap were compared between the exercise, and those data changes were performed correlation analysis into age and the time after stroke onset. The data comparison was also done into the subgroup of the severity of stroke using National Institutes of Health Stroke Scale (NIHSS). The statistically significant results were observed in the change of O² saturation, PaO², PaCO², O² content, HCO3⁻, pH, and anion gap after the exercise. The decrease of HCO³⁻ and increase of RR were proportional to age, however the data showed no correlation with the NIHSS. These results suggest relatively preserved respiratory compensation mechanism and homeostatic effect to maintain metabolic balance among the non-brainstem stroke patients.
Acid-Base Equilibrium ; Bicycling ; Blood Gas Analysis ; Blood Pressure ; Brain Stem ; Compensation and Redress ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; National Institutes of Health (U.S.) ; Oxygen ; Oxygen Consumption ; Respiratory Rate ; Stroke*

A 63-year-old man visited outpatient clinic complaining of dysphagia due to left jugular foramen meningioma. The patient underwent conventional dysphagia rehabilitation programs but functional improvement was not enough. A videofluoroscopic swallowing study (VFSS) revealed decreased laryngeal elevation and a lot of residue in pyriform sinus and vallecula. We noticed that enhancing laryngeal elevation like mendelshon maneuver promotes functional compensation, so we developed a therapeutic band for promoting laryngeal elevation. In follow-up VFSS, swallowing function was improved on the band. Persistent dysphagia due to decreased laryngeal elevation is very common and this case showed the possibility of improvement of symptom using therapeutic band we devleoped with conventional dysphagia rehabilitation programs.
Ambulatory Care Facilities ; Compensation and Redress ; Deglutition ; Deglutition Disorders* ; Follow-Up Studies ; Humans ; Meningioma ; Middle Aged ; Pyriform Sinus ; Rehabilitation

Objective: To investigate the differences of spinal curvature, thoracic sagittal mobility, and respiratory strength between patients with chronic neck pain (CNP) and people without cervical pain, and to determine the correlation between respiratory strength and thoracic mobility in CNP patients. Methods: A total of 78 participants were finally included in this study, of whom 30 had no cervical pain and 48 had CNP. The Neck Disability Index (NDI), cervical lordotic curvature, thoracic kyphotic curvature, thoracic sagittal range of motion (ROM), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured and analyzed. Results: In males, thoracic sagittal ROMMEP-MIP and MEP showed a significant difference between the no cervical pain group and the CNP group. In females, thoracic kyphotic curvature, thoracic sagittal ROMMEP-MIP, MIP, and MEP were significantly different between the no cervical pain group and the CNP group. Thoracic kyphotic curvature was significantly correlated with MEP and MIP in all population groups, and significantly correlated with NDI in the female group. Thoracic sagittal ROMMEP-MIP had a significant linear relationship with NDI, MEP, and MIP in all population groups. Conclusion The thoracic mobility during forced respiration was reduced in patients with CNP and was correlated with respiratory strength. Changes in the biomechanics of the cervicothoracic spine and rib cage due to CNP may contribute to impairment of respiratory strength.

PURPOSE: An increased expression of cyclin D1 has been observed in several tumors. Vimentin is known to be present in undifferentiated thyroid cancer. The serum thyroglobulin level can be a useful laboratory parameter to detect tumor recurrence in patients suffering with treated, well-differentiated thyroid carcinoma. We performed immunohistochemical assay for the cyclin D1, vimentin and thyroglobulin (Tg) expression in 97 papillary thyroid cancer tissue specimens to investigate their clinical implication for the prognosis of papillary thyroid carcinoma patients. METHODS: Immunohistochemical assays for cyclin D1, vimentin and Tg were performed on 97 consecutive thyroid carcinoma specimens. The correlation between these factors and the clinicobiological parameters weas analyzed. RESULTS: In 97 papillary thyroid carcinoma specimens, the expression of cyclin D1, vimentin and Tg was seen in 64 cases (66.0%), 36 cases (37.1%) and 55 cases (56.7%), respectively. Only the cyclin D1 expression was significantly increased in the larger tumors (P=0.01). However, there was no evident correlation between these factors and gender, age, tumor size, the lymph node status, the TNM stage and the number of tumors. CONCLUSION: An increased expression of cyclin D1 was present in the larger tumors. Overexpression of cyclin D1 seemed to play a role in carcinogenesis and tumor growth. However, the clinical utility of cyclin D1, vimentin and Tg in thyroid cancer patients has to be further defined by prospective studies with larger sample sizes.
Carcinogenesis ; Cyclin D1* ; Cyclins* ; Humans ; Lymph Nodes ; Prognosis ; Recurrence ; Sample Size ; Thyroglobulin* ; Thyroid Gland* ; Thyroid Neoplasms* ; Vimentin*

Acute cerebellitis is an uncommon neurological complication that may occur following childhood viral infections, and is rarely reported in adults. Imaging studies show no abnormalities in the majority of cases. We experienced three cases of acute cerebellitis, which showed no abnormal findings on MRI, but revealed diffusely increased cerebellar per-fusions on brain perfusion SPECT, which normalized 5~6 months later. Therefore, brain perfusion SPECT is consid-ered to be useful in identifying acute cerebellitis and in monitoring its clinical course.
Adult ; Brain* ; Humans ; Magnetic Resonance Imaging ; Perfusion* ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

We have determined and analyzed the full-length cDNA sequence of a coxsackievirus B3 (CVB3) Korean isolate (CVB3-Korea/97) which has been known as a general human pathogen. The whole genome contains 7,400 nucleotides and has a single large open reading frame with 6,555 nucleotides that encodes a potential polyprotein precursor of 2,185 amino acids. The genome also contains a 5' non-coding region (NCR) of 741 bases and a 3' NCR of 104 bases followed by poly(A) tail. Sequence homologies of nucleotides and deduced amino acids between the CVB3-Korea/97 strain and the prototype (Nancy strain) were 81.7% and 91.5%, respectively. The genes encoding the functional proteins including viral protease and RNA dependent RNA polymerase showed higher homology than those encoding the structural proteins. We have further analyzed the sequences of 5' NCR, VP1 and VP2 of CVB3-Korea/97, which are known as cardiovirulent determining factors at the nucleotide and amino acid levels. Although the CVB 3-Korea/97 strain was isolated from an aseptic meningitis patient without cardiomyopathy, its 234th nucleotide and 165th amino acid were uracil and Asn as same as those of other cardiovirulent strains one. However, the 155th amino acid of VR1, which closely associated with cardiovirulence, was replaced with Arg155 by single nucleoptide substitution from A2916 to T2916. Moreover, additional amino acid substitutions were observed in the flanking region of Asp155. Taken together, aminoacid(s) substitution in VP1 may play a critical role in determining cardiovirulence of the CVB3-Korea/97 strain rather than individual nucleotide replacements in the 5' NCR and/or an amino acid substitution in VP2.
Amino Acid Substitution ; Amino Acids ; Cardiomyopathies ; Clone Cells* ; Cloning, Organism* ; DNA, Complementary* ; Genome ; Humans ; Korea* ; Meningitis, Aseptic ; Nucleotides ; Open Reading Frames ; RNA Replicase ; RNA, Messenger ; Sequence Analysis* ; Sequence Homology ; Uracil