Acute peripheral facial palsy usually manifests Bell's palsy of unknown cause, and rarely lacunar infarct which located in facial nucleus can mimic peripheral facial palsy. A 73 year-old man with isolated facial asymmetry diagnosed with lacunar infarction which selectively involve the facial fascicles which lie in inferolateral aspect of pons. Clinicians should take into account the possibility of central lesion and brain stem infarction, even when patients present with isolated peripheral type facial palsy.
Bell Palsy ; Brain Stem Infarctions ; Facial Asymmetry ; Facial Nucleus ; Facial Paralysis* ; Humans ; Pons ; Stroke, Lacunar

TGF-beta-induced tolerogenic-antigen presenting cells (Tol-APCs) could induce suppression of autoimmune diseases such as collagen-induced arthritis (CIA) and allergic asthma. In contrast, many studies have shown that NKT cells are involved in the pathogenesis of Th1-mediated autoimmune joint inflammation and Th2-mediated allergic pulmonary inflammation. In this study, we investigated the effect of CD1d-restricted NKT cells in the Tol-APCs-mediated suppression of autoimmune disease using a murine CIA model. When CIA-induced mice were treated with Tol-APCs obtained from CD1d+/- or CD1d-/- mice, unlike CD1d+/- APCs, CD1d-/- Tol-APCs failed to suppress CIA. More specifically, CD1d-/- Tol-APCs failed to suppress the production of inflammatory cytokines and the induction of Th2 responses by antigen-specific CD4 T cells both in vitro and in vivo. Our results demonstrate that the presence of CD1d-restricted NKT cells is critical for the induction of Tol-APCs-mediated suppression of CIA.
Animals ; Antibodies/blood ; Antibody Formation/immunology ; Antibody Specificity/immunology ; Antigen-Presenting Cells/*immunology ; Antigens, CD1d/immunology ; Arthritis, Experimental/blood/*immunology/*prevention & control ; Collagen Type II/immunology ; Cytokines/blood ; Immune Tolerance/*immunology ; Inflammation Mediators/blood ; Mice ; Natural Killer T-Cells/*immunology ; Th1 Cells/immunology

Collagen-induced arthritis (CIA) is mediated by self-reactive CD4+ T cells that produce inflammatory cytokines. TGF-beta2-treated tolerogenic antigen-presenting cells (Tol-APCs) are known to induce tolerance in various autoimmune diseases. In this study, we investigated whether collagen-specific Tol-APCs could induce suppression of CIA. We observed that Tol-APCs could suppress the development and severity of CIA and delay the onset of CIA. Treatment of Tol-APCs reduced the number of IFN-gamma- and IL-17-producing CD4+ T cells and increased IL-4- and IL-5-producing CD4+ T cells upon collagen antigen stimulation in vitro. The suppression of CIA conferred by Tol-APCs correlated with their ability to selectively induce IL-10 production. We also observed that treatment of Tol-APCs inhibited not only cellular immune responses but also humoral immune responses in the process of CIA. Our results suggest that in vitro-generated Tol-APCs have potential therapeutic value for the treatment of rheumatoid arthritis as well as other autoimmune diseases.
Animals ; Antigen-Presenting Cells/*drug effects/*immunology ; Arthritis, Experimental/*immunology ; Chickens ; Collagen Type II/immunology ; Immune Tolerance/drug effects ; Mice ; Mice, Inbred BALB C ; Ovalbumin/immunology ; Th1 Cells/drug effects/immunology ; Th2 Cells/*drug effects/*immunology ; Transforming Growth Factor beta2/*pharmacology

Hypopharyngeal perforation associated with traffic accident is a rare occurrence, which can cause serious morbidity and mortality if not diagnosed and treated early. We report an autopsy case of hypopharyngeal perforation following a traffic accident. A 32-year-old man hits his chin when his car hits highway guardrail. He complained continuous neck pain and died 5 days after the accident. Autopsy was performed, and death was due to undiagnosed retropharyngeal abscess with sepsis.
Accidents, Traffic ; Adult ; Autopsy ; Chin ; Humans ; Hypopharynx ; Neck Pain ; Retropharyngeal Abscess ; Sepsis

A seaman died after a jet of compressed air directed to his anus while working with his colleagues in deck of the ship. He suffered from abdominal pain and distension, and died 5 hours later in the ship. Autopsy was performed and revealed rupture of the splenic flexure of the colon and partial seromuscular tearing in the rectosigmoidal region. We concluded that the cause of death was tension pneumoperitoneum by the pneumatic colonic rupture. The need for education of the workers handling compressed air appliances is emphasized.
Abdominal Pain ; Anal Canal ; Autopsy ; Cause of Death ; Colon ; Colon, Transverse ; Compressed Air ; Handling (Psychology) ; Pneumoperitoneum ; Rupture ; Ships

Endoscopic thoracoscopic sympathicotomy (ETS) for treatment of hyperhidrosis is usually considered as a simple and safe procedure. The complication of ETS is low and no death following ETS has ever been reported in the literature without anecdotal fatal cases. Recently, we experienced two cases of intraoperative cardiac arrest and death. Two patients are suffered from sudden cardiac arrest after transection of the left sympathetic nerve trunk by the thoracoscopic method. Vigorous cardiopulmonary resuscitations were performed but both patients are not recovered. Autopsy examinations are performed and there are no remarkable pathology.

This study was performed to investigate the effect of insight on the readiness to change in alcoholism. The subjects were 131 Korean male patients with alcohol dependence who were being hospitalized in a community-based alcohol treatment center. The patients' readiness to change was classified into precontemplation, contemplation, and action stage through the readiness to change questionnaire. The state of the patients' insight was measured through the Hanil alcohol insight scale. Fourteen patients (10.7%) were in the stage of precontemplation, 65 (49.6%) in contemplation and 52 (39.7%) in action stage. The insight score of the patients in precontemplation stage was significantly lower (p<0.001) than that of others. On the basis of the precontemplation stage, multinomial logistic regression analysis for the control of the differences in the patients' characteristics among each stage of the readiness to change showed that the possibility of contemplation and action stage went up 1.231 (p<0.01) and 1.249 (p<0.01) times higher as the insight score increased.
Adaptation, Psychological ; Adult ; Alcohol Drinking ; Alcoholism/*psychology/*therapy ; Awareness ; Health Behavior ; Humans ; Korea ; Male ; Middle Aged ; Motivation ; Psychometrics ; Questionnaires ; Regression Analysis ; Self Care

This study describes the histochemical characteristics and ultrastructure of mast cells from tongue, proventriculus, ileum and fabricius bursa, in pheasant (Phasianus colchicus) by light and electron microscopy. We compared the stainability of 4 different methods, toluidine blue, alcian blue, congo red and alkaline Giemsa, to stain mast cell granules from fixed pheasant organs in three different fixatives, 10% neutral buffered formalin, Carnoy's solution or half-strength Karnovsky's solution. Mast cells in all experimental organs were not stained with 4 different staining methods after fixation in 10% neutral buffered formalin but well stained in fixed organs with half-strength Karnovsky's solution. The mast cells had many metachromatic granules stained with toluidine blue or alkaline Giemsa and orthochromatic granules stained with alcian blue or congo red in tissues fixed in half-strength Karnovsky's solution. In electron microscopy, pheasant mast cells were oval, triangular, spindle-like or irregular and had a few finger-like cytoplasmic processes. There were the membrane-bounded secretory granules and the well-developed organelles in mast cells. Internal large granules were oval or irregular, and had variable shape; some higher or lower electron density with homogeneous appearance; some had a particular appearance, and a few showed reticular or spongy-like structure. This indicates that 10% neutral buffered formalin or Carnoy's fixation may be inadequate for detection of mast cells in pheasant, whereas the half-strength Karnovsky's fixation provides metachromatic or orthochromatic staining of mast cell granules.
Alcian Blue ; Animals ; Bursa of Fabricius ; Congo Red ; Cytoplasm ; Fixatives ; Formaldehyde ; Ileum ; Mast Cells* ; Microscopy, Electron ; Organelles ; Proventriculus ; Secretory Vesicles ; Tolonium Chloride ; Tongue

OBJECTIVE: Primary intraventricular hemorrhage(PIVH) is uncommon and accounts for only 3.1 % of all non-traumatic intracerebral hemorrhage. The aim of this study is to analyze clinical characteristics, image features, etiology and prognostic factors of outcome in patients with PIVH. METHODS: We identified 25 patients with PIVH during 9-year period between 1994 and 2002 at our institute. The clinical data, complimentary examination, outcome and computed tomographic blood amounts were reviewed. RESULTS: Major symptoms included sudden decreased level of consciousness, headache, nausea/vomiting and neck stiffness. Cerebral angiography was performed in 12 patients(48%) and revealed vascular malformation in 6 patients(24%). The positive result of angiography was more common in young patients and among vascular malformation the incidence of Moyamoya disease was relatively high(4 patients). Other causative factors were coagulation disorder, arterial hypertension, tumor bleeding. Outcome were death in 9 patients(36%): 7 patients(28%) died by direct consequence of bleeding and 2 patients died after other adverse events(sepsis, hepatic failure) but prognosis of survivor was good. Factors correlating with the outcome were the presence of coagulopathy, initial Glasgow Coma Scale(GCS), obstruction of 4th ventricle and ventricular blood amount including hemorrhagic dilatation of temporal horn of lateral ventricle, 3rd and 4th ventricle. CONCLUSION: The poor prognosis factors of PIVH are the presence of coagulopathy, low initial GCS, obstruction of 4th ventricle and large ventricular blood amount. Additionally patients whose initial clinical condition is not serious need an appropriate work up including cerebral angiography, because cause of bleeding is vascular malformation especially in young patients.
Angiography ; Animals ; Cerebral Angiography ; Cerebral Hemorrhage ; Coma ; Consciousness ; Dilatation ; Headache ; Hemorrhage* ; Horns ; Humans ; Hypertension ; Incidence ; Lateral Ventricles ; Moyamoya Disease ; Neck ; Prognosis ; Survivors ; Vascular Malformations

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has been more and more often regarded as a serious disorder, because nonalcoholic steatohepatitis (NASH), a part of NAFLD, may progress to the end stage of liver disease. Though an advanced age, obesity, diabetes mellitus (DM) etc. being not infrequent conditions in Korea, are known to exacerbate the severity of this disease, there are only a few Korean reports on this subject. The purpose of this study is to identify possible factors that might add up to the pathological severity of this disorder in Korean patients. METHODS: Of 60 patients with steatosis found at liver biopsy, 43 NAFLD patients were reviewed retrospectively after exclusion of other liver diseases. RESULTS: The cases of steatosis were mild, moderate, and severe in 9, 10, and 24 patients, respectively. The degree of necroinflammatory activity was mild, moderate, and severe in 33, 9, and 1 patients, respectively. There were no established factors directly related to these classes. As to fibrosis, the cases were classified as none, mild, moderate, severe, and cirrhotic in 9, 11, 16, 7, and 0 patients, respectively. The stage of fibrosis correlated with the age (p< 0.001), BMI (body mass index) (p=0.032), and the platelet count (p=0.009), but the presence of NASH was associated only with BMI (p=0.002) and obesity (p=0.001). CONCLUSION: It seems that there are no factors that are directly related to the degree of steatosis or necroinflammatory activity. BMI seems to be a unique factor directly related to both the severity of fibrosis and the presence of NASH. The age and the platelet count are factors that are directly related to the degree of fibrosis but not to the presence of NASH.
Adult ; Analysis of Variance ; Body Mass Index ; Fatty Liver/blood/classification/*pathology ; Female ; Human ; Korea ; Male ; Platelet Count ; Prognosis ; ROC Curve ; Retrospective Studies ; Risk Factors ; Severity of Illness Index