An effect of D-phenylalanine on the pain inhibitory mechanism of prolonged electrical stimulation of the peripheral nerve was studied in decerebrate cats and spinal cats. The response of spinal neurons was elicited either by electrical stimulation of the ipsilateral common peroneal nerve and tibial nerve. The single-unit activity of motor neurons which represent the flexion reflex was recorded from a filament of ventral rootlet divided from either the L7, S1 or S2 ventral root, and activity of dorsal horns cells was recorded with a microelectrode at the lumbosacral cord The conditioning stimuli which provocate the pain inhibitory mechanism of the common peroneal or tibial nerve was applied with repetitive, low frequency (2Hz), at a suprathreshold intensity for C fiber, for 30-45 minutes. The results of the experiment are summarized as follows: 1. Applying conditioning stimuli produced a powerful inhibition of the responses which was provocated by noxious stimuli in either the decerebrate or the spinal cat without any statistical difference, and this effect can be observed for 15 minutes after the cessation of the conditioning stlmuli 2. This response was reversed completely by systemic injection of a specific opiate antagonist, naloxone. It suggests that the conditioning stimulus of the peripheral nerve can produce the endogenous opiate related pain inhibitory effect as the spinal mechanism. 3. The conditioning stimuli can produce the analgesic effect by means of supression of the activity of the dorsal horn cell which was related to the pain response in the decerebrate cat. The same result could be observed in flexion reflex. 4. D-phenylalanine, a putative inhibitor of carboxypeptidase which degradates the endogenous opiate-enkephalin, was studied in this experiment under the hypothesis that D-phenylalanine will emphasize or prolongate the action of enkephalin. But, intravenously injected D-phenylalanine did not potentiate the inhibitory effect of the conditioning stimuli of the peripheral nerve. From the above result, it is speculated that the electrical stimulation of the peripheral nerve is directly mediated by an endogenous opiate related analgesia, and the site of the analgesic action resides mainly in spinal cord level. But these data could not support the gypothesis that antinociceptive effect of D-phenylalanine results frm the potentiation of endogenously released enkephalin.
Analgesia* ; Animals ; Cats* ; Electric Stimulation ; Enkephalins ; Horns ; Microelectrodes ; Motor Neurons ; Naloxone ; Nerve Fibers, Unmyelinated ; Neurons ; Peripheral Nerves* ; Peroneal Nerve ; Posterior Horn Cells ; Reflex ; Spinal Cord ; Spinal Nerve Roots ; Tibial Nerve

We experienced a case of anterior mediastinal teratoma in 26 month old boy with 2 month history of cough and dyspnea. The diagnosis was easily established by chest CAT which revealed calcific densities, while plane radiographs of chest revealed no evidence of calcification. Operation was done with good result and remained in good condition thereafter. A brief review of the related literature was made on this subject.
Anemia ; Animals ; Cats ; Child, Preschool ; Cough ; Diagnosis ; Dyspnea ; Hemangioma ; Humans ; Kasabach-Merritt Syndrome* ; Male ; Teratoma ; Thorax ; Thrombocytopenia

We experienced a case of anterior mediastinal teratoma in 26 month old boy with 2 month history of cough and dyspnea. The diagnosis was easily established by chest CAT which revealed calcific densities, while plane radiographs of chest revealed no evidence of calcification. Operation was done with good result and remained in good condition thereafter. A brief of the related literature was made on this subject.
Animals ; Cats ; Child, Preschool ; Cough ; Diagnosis ; Dyspnea ; Humans ; Male ; Teratoma* ; Thorax

Transcutaneous electrical nerve stimulation (TENS), acupuncture-needling, and electroacu! Puncture are useful non-ablative methods in medical practice for relief of acute and chronic r pain These procedures appear to work by causing an increased discharge in afferent nerve fibers which in turn modifies the transmission of impulses in pain pathways. The present study was performed to evaluate the analgesic effects of peripheral nerve stimulation with different stimulatory parameters in decerebrated cats and spinalized cats. And we studied the effects of naloxone, a specific opiate antagonist, on analgesia produced by 50 Hz, C intensity conditioning stimulation. The electrical response of.spinal neurons was elicited either by electrical stimulation of the ipsilateral common peroneal nerve or tibial nerve, and then the single unit activity of the dorsal horn cell was recorded with a carbon filament-filled glass microelectrode at the lumbosacral spinal cord. The conditioning stimuli which provoke the pain inhibitory mechanism were applied to the cornmon peroneal nerve or tibial nerve with a relatively high frequency (25, 50, 200Hz) for 15, 30, and 60 seconds at suprathreshold intensity for A delta or C fiber. The results of the experiment are summarized as follows: 1. Peripheral conditioning stimulation at C strength showed larger analgesic effects than those produced by stimulation at A delta strength. And analgesic effects produced by conditioning stimulation for 30sec were greater than those produced by stimulation for 15sec, but showed no statistically significant difference from those produced by stimulation for 60 sec. 2. Analgesic effects produced by 50Hz conditioning stimulation were greater than thoseproduced by 25Hz stimulation. But 200Hz stimulation showed a lesser analgesic effect than 50 or 25Hz conditioning stimulation. 3. The analgesic effect produced by 50Hz conditioning stimulation was only slightly affected by naloxone, a specific opiate antagonist, indicating that involvement of an endogenous opiate system was minimal. 4. The analgesic effect produced by conditioning stimulation in decerebrated cats was nearly the same as in spinal cats suggesting that the neural circuitry responsible for the analgesic action seems to reside mostly within the spinal cord. From the above results, it is concluded that 1) frequency of stimulation is important for an efficient analgesia, i.e., stimulation with excessively high frequency decreases the analgesic effect, 2) the analgesic effect produced by high frequency conditioning stimulation may be minimally mediated by an endogenous opiate system, and 3) the site of analgesic action resides mainly in the spinal cord.
Analgesia ; Animals ; Carbon ; Cats ; Electric Stimulation* ; Glass ; Microelectrodes ; Naloxone ; Nerve Fibers ; Nerve Fibers, Unmyelinated ; Neurons ; Peripheral Nerves* ; Peroneal Nerve ; Posterior Horn Cells* ; Punctures ; Spinal Cord ; Tibial Nerve ; Transcutaneous Electric Nerve Stimulation

Condyloma acuminata, an uncommon disease in the pediatric patients, is being reported with increasing frequency in both adults and children. During the last 10 years, we had the opportunity to treat 11 children with condyloma acuminata in anogenital area. Patient age at presentation varied from 9 months to 11 years, and boys were outnumbered girls by a ratio of 2 : 1. The lesions were found in the perianal area in 9 patients, while the remaining had lesions localized to the genitalia. No history of sexual contact or abuse could be elicited. Although the exact mode of transmission of human papillomavirus (HPV) couldn't be defined, maternal-infant transmission at birth and close nonsexual family contact were the main possible causes of HPV infection in our patients. Our experience suggest that fulguration of the warts and concomitant scissors excision for the larger ones are the satisfactory method of treatment in children. However, based on our data we feel that condyloma acuminata has a high recurrence rate despite treatment. Viral typing and careful epidemiological investigation on a larger series of patients may further clarify the causal factors and effective modalities of treatment in childhood anogenital condyloma acuminata.
Adult ; Child* ; Female ; Genitalia ; Humans ; Parturition ; Recurrence ; Warts

OBJECTIVE: This prospective study evaluated the ability of indirect 16-row multidetector CT venography, in comparison with Doppler sonography, to detect deep vein thrombosis after total hip or knee replacement. MATERIALS AND METHODS: Sixty-two patients had undergone orthopedic replacement surgery on a total of 30 hip joints and 54 knee joints. The CT venography (scan delay time: 180 seconds; slice thickness/increment: 2/1.5 mm) and Doppler sonography were performed 8 to 40 days after surgery. We measured the z-axis length of the beam hardening artifact that degraded the image quality so that the presence of deep vein thrombosis couldn't be evaluated on the axial CT images. The incidence and location of deep vein thrombosis was analyzed. The diagnostic performance of the CT venograms was evaluated and compared with that of Doppler sonography as a standard of reference. RESULTS: The z-axis length (mean +/- standard deviation) of the beam hardening artifact was 4.5 +/- 0.8 cm in the arthroplastic knees and 3.9 +/- 2.9 cm in the arthroplastic hips. Deep vein thrombosis (DVT) was found in the popliteal or calf veins on Doppler sonography in 30 (48%) of the 62 patients. The CT venography has a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 90%, 97%, 96%, 91% and 94%, respectively. CONCLUSION: The ability of CT venography to detect DVT was comparable to that of Doppler sonography despite of beam hardening artifact. Therefore, CT venography is feasible to use as an alternative modality for evaluating post-arthroplasty patients.
Adult ; Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Hip ; *Arthroplasty, Replacement, Knee ; Artifacts ; Female ; Humans ; Leg/*blood supply ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Venous Thrombosis/etiology/*radiography/*ultrasonography

PURPOSE: In order to expand and improve community-based medical education (CBME), we attempted to delineate the characters of the primary care physicians interested in medical education and their opinions on the new medical teaching method for ambulatory care settings, Wave model. METHODS: Through mailed questionnaires, we asked the Seoul members of the family physician association and the internal medicine physician association about their interest and opinions of CBME and the Wave model. RESULTS: We received 186 replies from the total 1088 questionnaires (17.1%) sent out. Many of the primary care physicians (141/186; 75.8%) had no experience with CBME. However, 127 (68.7%) were interested in CBME and 121 (65.4%) answered that they were interested in teaching students in their clinic. There were 128 (69.2%) affirmative responses to the Wave model, which was much higher than that to the observation-centered method, 53 (30.3%) (p < 0.0001). Primary care physicians who have affirmative attitudes to adopting the Wave model would select this model as their CBME program (p < 0.0001). Primary care physicians willing to teach students tend to be males (p=0.0085) and younger in age (p=0.0003), have examination rooms for student-patient contact (p < 0.0001), and possess positive attitude to adopting the Wave model (p= 0.0018). CONCLUSION: There are many primary care physicians eager to participate in CBME. They view the Wave model as an effective teaching method. Factors associated with the desire to work as a preceptor include being male and younger in age. having examination rooms for student-patient contact, and possessing a positive attitude to adopting the Wave model.
Ambulatory Care* ; Community Health Services ; Education, Medical* ; Humans ; Internal Medicine ; Male ; Physicians, Family ; Physicians, Primary Care ; Postal Service ; Primary Health Care* ; Seoul ; Teaching* ; Surveys and Questionnaires

BACKGROUND/OBJECTIVES: The relationship between folate and colorectal neoplasia remains controversial. We examined the association between serum folate concentrations and colorectal adenomas in a case-control study of Korean adults and conducted a meta-analysis. SUBJECTS/METHODS: Our case-control study included 113 pairs of case and control who underwent colonoscopy and provided blood samples. We used multivariable conditional logistic regression models to obtain the odds ratios and 95% confidence interval (CIs). For meta-analysis, we identified the relevant studies by searching the PubMed database up to February 2017, included our case-control study and combined the study-specific relative risks (RRs) using a random-effects model. RESULTS: In this case-control study, we included 58 men and 55 women with colorectal adenomas and sex and fasting status matched the controls. We did not find any significant association between the serum folate levels and colorectal adenomas in either men or women. For meta-analysis, a total of eleven studies were included in our analysis and classified into two groups; polyp clearance group (PC) for the studies that included participants who underwent endoscopies and had their polyps removed at baseline; and no polyp clearance group (NPC) for the studies that included participants whose histories of endoscopies were unknown or who underwent their first endoscopies. Four PC (1,311 cases and 1,672 non-cases) and eight NPC studies (3,501 cases and 11,347 non-cases) were included. The combined RRs (95% CIs) comparing the bottom with the top categories of circulating folate levels were 1.07 (0.97-1.18) for the NPC group but 1.45 (1.16-1.74) for the PC group. CONCLUSIONS: Low circulating folate levels were associated with new adenoma formation.
Adenoma* ; Adult ; Case-Control Studies* ; Colonoscopy ; Fasting ; Female ; Folic Acid* ; Humans ; Logistic Models ; Male ; Odds Ratio ; Polyps

PURPOSE: The determination of HER-2/neu gene amplification has become necessary for the selection of breast cancer patients to undergo anti-HER-2/neu therapy, using a humanized monoclonal antibody. Chromogenic in situ hybridization (CISH) detection of the HER-2/neu gene, a newly developed method, utilizes a robust and unique-sequence DNA probe labeled with digoxygenin, which is sequentially incubated with antidigoxygenin fluorescein, antifluorescein peroxidase and diaminobenzidine. The aim of this study was to establish a CISH assay for the detection of HER-2/neu amplification. The results were compared with those of the immunohistochemistry (IHC) methods, most frequently used for detecting HER-2/neu alteration. METHODS: CISH was performed in 4 groups of infiltrating breast carcinomas. Each group was comprised of 20 cases in which the HER-2/neu stati had previously been scored on a four value scale: 0, 1+, 2+ and 3+ by IHC. The results of CISH and IHC were compared for each tumor group. The HER-2/neu gene amplification detected by CISH was thpically visualized as large DAB-stained clusters or by many dots in the nucleus. RESULTS: The concordance between the CISH and IHC was 95% (kappa=0.901). Three IHC-positive cases (score 2+) showed no gene amplification and one IHC-negative case (score 1+) showed gene amplification by CISH. CONCLUSION: The current study showed excellent agreement between the CISH and IHC methods. CISH is an accurate, practical and economical approach for determining the HER-2/neu stati in breast carcinomas. It is also a useful methodology for confirming the IHC results in paraffin- embedded tumor samples, so offers a promising alternative to IHC in a routine diagnostic setting.
Breast Neoplasms* ; Breast* ; DNA ; Fluorescein ; Gene Amplification ; Genes, vif ; Humans ; Immunohistochemistry ; In Situ Hybridization* ; Peroxidase