Embryonal rhabdomyosarcoma in the abdominal cavity of an aged Sprague-Dawley rat / 대한수의학회지

We report a spontaneous embryonal rhabdomyosarcoma in the abdominal cavity of an aged (88-week-old) Sprague-Dawley rat. The animal had a firm lobulated 5 x 5 x 4.5 cm mass in the abdominal cavity that was whitish to tan with necrotic and hemorrhagic plaques. Microscopically, the mass contained nodules with spindle or globoid shaped neoplastic cells with abundant eosinophilic cytoplasm and round or elongated nuclei mixed with other spindle cells with a filamentous appearance and scanty cytoplasm. Multinucleated cells and cross-striations were also observed. The neoplastic cells were positive for vimentin, desmin, and alpha-smooth muscle actin, especially the small spindle cells.

Preoperative Erythropoietin Administration in Patients With Prostate Cancer Undergoing Radical Prostatectomy Without Transfusion

PURPOSE: In this study, we administered erythropoietin preoperatively to patients who underwent open radical prostatectomy without transfusion to increase their hemoglobin levels and investigated the efficacy of this procedure. MATERIALS AND METHODS: We evaluated 62 patients who underwent open radical prostatectomy performed by the same surgeon between June 2005 and January 2011. The 22 patients who refused transfusion were assigned to group 1; the patients who accepted transfusion were assigned to group 2. Before surgery, we administered erythropoietin beta to group 1 patients whose hemoglobin levels were <12 g/dL and retrospectively compared the clinical data of the two groups. We used the t-test and the chi-square test for statistical analysis. RESULTS: Mean preoperative hemoglobin levels in group 1 after erythropoietin administration (14.5 g/dL) were significantly higher than those in group 2 (13.59 g/dL, p=0.003). Moreover, the difference in the mean hemoglobin levels before and after surgery for group 1 patients (3.55 g/dL) significantly exceeded that for group 2 patients (2.08 g/dL, p=0.000). Additional analysis revealed no statistically significant differences in perioperative complications between the groups. CONCLUSIONS: Preoperative erythropoietin administration increased the safety margin of hemoglobin levels, and this strategy worked sufficiently well in our experience.

Aluminum Nanoparticles Induce ERK and p38MAPK Activation in Rat Brain

Aluminum nanoparticles (Al-NPs) are one of the most widely used nanomaterial in cosmetics and medical materials. For this reason, Al-NP exposure is very likely to occur via inhalation in the environment and the workplace. Nevertheless, little is known about the mechanism of Al-NP neurotoxicity via inhalation exposure. In this study, we investigated the effect AL-NPs on the brain. Rats were exposed to Al-NPs by nasal instillation at 1 mg/kg body weight (low exposure group), 20 mg/kg body weight (moderate exposure group), and 40 mg/kg body weight (high exposure group), for a total of 3 times, with a 24-hr interval after each exposure. Inductively coupled plasma mass spectrometry (ICP-MS) analysis indicated that the presence of aluminum was increased in a dose-dependent manner in the olfactory bulb (OFB) and the brain. In microarray analysis, the regulation of mitogen-activated protein kinases (MAPK) activity (GO: 0043405), including Ptprc, P2rx7, Map2k4, Trib3, Trib1, and Fgd4 was significantly over-expressed in the treated mice than in the controls (p = 0.0027). Moreover, Al-NPs induced the activation of ERK1 and p38 MAPK protein expression in the brain, but did not alter the protein expression of JNK, when compared to the control. These data demonstrate that the nasal exposure of Al-NPs can permeate the brain via the olfactory bulb and modulate the gene and protein expression of MAPK and its activity.

Primary Adenocarcinoma of the Rete Testis With Preceding Detection of Unilateral Hydronephrosis

Primary adenocarcinoma of the rete testis is a rare malignant testicular tumor with a poor prognosis. Here we report the case of a 54-year-old man with right hydronephrosis that was detected before the diagnosis of the primary testicular lesion. During the evaluation of the right hydronephrosis by use of abdominopelvic computed tomography, a painless, hard, solid lesion was found on the right testis. The patient underwent radical orchiectomy, and the pathologic examination revealed an adenocarcinoma of the rete testis. Multiple metastases were present at the time of diagnosis. The patient received combined chemotherapy after the surgery but lived only 8 months after the initial diagnosis.

Primary Adenocarcinoma of the Rete Testis With Preceding Detection of Unilateral Hydronephrosis

Primary adenocarcinoma of the rete testis is a rare malignant testicular tumor with a poor prognosis. Here we report the case of a 54-year-old man with right hydronephrosis that was detected before the diagnosis of the primary testicular lesion. During the evaluation of the right hydronephrosis by use of abdominopelvic computed tomography, a painless, hard, solid lesion was found on the right testis. The patient underwent radical orchiectomy, and the pathologic examination revealed an adenocarcinoma of the rete testis. Multiple metastases were present at the time of diagnosis. The patient received combined chemotherapy after the surgery but lived only 8 months after the initial diagnosis.

Uterine leiomyosarcoma in a wild rat (Rattus norvegicus): usefulness of Ki-67 labeling index for diagnosis / 한국실험동물학회지

Uterine smooth muscle tumor is very rare in laboratory rats and, there has been no report in the wild rodents. Among a total of 400 wild rats captured in Gyeonggi, Gangwon, and Chungbuk provinces of Korea in 2007, 2010, and 2011, we found a uterine spindle cell tumor, diagnosed as smooth muscle cell origin based on differential features of histology and immunohistochemistry. Its incidence was very low, like in the laboratory rats, as under 0.5% for female. Considering generally applied histological and cellular criteria, this case was difficult in differential diagnosis between benign and malignant. Ki-67 labeling index was therefore further investigated, and it ranged from 26.4 to 37.6% in the 10 different areas, representing an average of 32.9+/-0.05%. The Ki-67 labeling index of neoplastic cells near the necrotic area was recorded as 83.5%. According to such high Ki-67 labeling index, it was more likely a malignant leiomyosarcoma, assenting to the previous proposal that Ki-67 labeling index is a significant criterion to differentiate between malignant and benign in the smooth muscle tumors.

Expression of ErbB receptors in the pre-pubertal and pubertal virgin mammary glands of dairy cows / 대한수의학회지

In the present study, we investigated the expression patterns of ErbB family proteins in the pre-pubertal and pubertal mammary glands of dairy cows in association with gland development. For this study, we performed immunohistochemistry for ErbB-1-4 and Ki-67 cell proliferation marker. We found that the pre-pubertal and pubertal mammary glands had typical structures, including ducts and terminal end buds embedded in the stroma, and no development of lobuloalveolar structures. On immunohistochemistry, ErbB-2 and ErbB-3 were strongly expressed in the cytoplasm and nuclei in the epithelial cells of mammary ducts and terminal end buds, and stromal cells, whereas ErbB-1 and ErbB-4 were weakly expressed only in the cytoplasm of gland epithelium and stromal cells, irrespective of the developmental stage. Cell proliferation was inactive in the mammary gland cell compartments in both phases. Thus, expression of the ErbB family in the developing mammary glands was not associated with their functional effects, such as cell proliferation and lobuloalveolar development. In conclusion, ErbB receptors were differentially expressed in the epithelial and stromal cells of virgin mammary glands of dairy cows. Compared with rodent mammary glands, ErbB-3 and ErbB-4 were found to be highly expressed in bovine mammary glands.

Evaluation of Anterior Knee Pain

Anterior knee pain is an enigmatic entity with multiple causes, and so the patients, who present with diverse symptoms, require different treatments. A combination of variables, including abnormal lower limb biomechanics, soft-tissue tightness, muscle weakness and excessive exercise, may result in increased cartilage and subchondral bone stress, patellofemoral pain and subtle or more overt patellar maltracking. Because of the multiple forces affecting the patellofemoral joint, the clinical evaluation and treatment of this disorder is quite a challenge. Our extensive search of the literature revealed no single gold-standard test/maneuver to diagnose this disorder, and the reliability of the maneuvers described was generally low or untested. Making a specific and accurate diagnosis of the etiology, based on a thorough physical exam and imaging studies, is essential to create an effective therapeutic approach for the patient's successful return to proper knee function.

An analysis of failure mode of teeth restored with fiber-reinforced posts under the condition of bony resorption / 대한치과보철학회지

STATEMENT OF PROBLEM: Fiber-reinforced posts have lower modulus of elasticity than titanium post or cast post-core. With this similar elasticity to that of dentin, fiber-reinforced posts have been known to have a tendency to reduce the risk of root fracture. However, there were few studies on the teeth restored with fiber-reinforced posts under the condition of reduced periodontal support. PURPOSE: The purpose of this study was to evaluate the fracture strength and failure mode of endodontically treated teeth restored with fiber-reinforced posts and titanium posts under the condition of reduced periodontal support. MATERIAL AND METHOD: Extracted human maxillary incisor roots were divided into 3 groups (group 1 : carbon fiber post, group 2 : glass fiber post, and group 3 : titanium alloy post). After coronectomy and endodontic treatment, teeth were restored with each post systems and resin core according to the manufacturer's recommendation. Then, teeth with simulated periodontal ligament were embedded in the acrylic resin blocks at the level of 4 mm below the cemento-enamel junction. Each specimen was exposed to 105 load cycles with average 30 N force in 36.5 degrees C water using a computer-controlled chewing simulator. Loads were applied at 45.angle to the long axis of the teeth. After cyclic loading, teeth were subjected to a compressive load until failure at a crosshead speed of 0.5 mm/min. Fracture strength (N) and failure mode were examined. The fracture strength was analyzed with one-way ANOVA and the Sch ffe adjustment at the 95% significance level. RESULTS AND CONCLUSION: The results were as follows. 1. There was no statistically significant difference in the mean fracture strength among the groups ( P>0.05). 2. Carbon fiber post and glass fiber post group showed less root fracture tendency than control group. 3. All specimens with root fractures showed fracture lines above the level of acrylic resin block, except for only one specimen in group 3.

Clinical Pictures of Stroke Patients

OBJECTIVE: The present study evaluated the characteristics and natural history of stroke patients. METHOD: Seven hundred and sixty seven consecutive patients admitted through acute care facility were reviewed. All medical records including age, case fatality, risk factors and radiological findings including CT or MRI were reviewed. To investigate the activities of daily living (ADL) of stroke patients, follow-up study was done in 303 patients through telephone interview or direct contact. Stroke was subdivided into cerebral infarct, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). RESULTS: The proportion of stroke subtypes were infarct (45.9%), ICH (34.7%) and SAH (19.4%). The recurrence rate of stroke was higher in the infarct patient. Higher percentage of fatality was noted in the SAH patient. Higher incidence of hemorrhage was still observed compared to western country. Hypertension is the major risk factors for all stroke subtypes. But among hypertensive individuals, only 29% patients controlled the hypertension. Fifty-eight percent of stroke patients regained independent ADL. CONCLUSION: The result of this study shows the clinical pictures of stroke patients. Further research was needed to investigate the trends of stroke and control of risk factors and attention must be paid to the patients who is dependent in ADL.

A Correlation of Bulbocavernosus Reflex Test and Urodynamic Investigation in the Spinal Cord Injury Patients

OBJECTIVE: To investigate the correlations of neurological level, BCR and urodynamic study (UDS) in the spinal cord injury(SCI) patients, we analyzed the results of BCR and UDS fundings. METHOD: The sujects were twenty-four patients with SCI who were beyond 3 months following the SCI. According to the level of injury, the patients were divided into 3 groups: above T10 level, 7; T10 to L2 level, 8; below L2 level, 9. Electrophysiological BCR test and UDS were performed in all patients. RESULTS: The results showed a significant correlation between the BCR test and level of injury, however there was no correlation between the UDS and level of injury, nor between the detrusor function and BCR test. The results might be from a differential recovery of the somatic and autonomic nervous system. CONCLUSION: As a part of comprehensive evaluation for the bladder function in the SCI patients, we recommend both the bulbocavernosus reflex test and urodynamic study. Further neurophysiological research would be needed to understand the urodynamic findings which did not correlate with the level of SCI.

Visual Evoked Potentials in Premature Infants

Visual evoked potentials(VEPs) are the cerebral electrical activities recorded from the occipital scalp following a flash or pattern stimulation and can detect the lesions of sensory visual pathways. Although the VEPs change with the maturation of CNS in children, a few studies have documented the maturational changes in premature infants. Using the light- emitting diode goggles, VEPs were studied in 131 neurologically intact infants of 28~41 weeks gestational age or 34~59 weeks postmenstrual age. The VEPs were analysed by three waveforms; normal, abnormal, and flat, and four patterns; N300, P200-N300, P100-N155-P200-N300, and P100 pattern. Normal waveforms were 63 of 131 VEPs(48.1%). Of the normal waveforms, N300 patterns were 38.1%, P200-N300 36.5%, P100-N155-P200-N300 19.0%, and P100 6.4%. Each pattern correlated with the postmenstrual age. These findings support the hypothesis of VEP pattern changes according to the maturation of the visual system with age.

Clinical Features of Tuberculous Spondylitis

Tuberculous spondylitis occurs commonly by the hematogenous spread of infectious organism, Mycobacterium tuberculosis, from the primary foci of the pulmonary and genitourinary systems. Spinal involvement is the most common among tuberculosis of the musculoskeletal system. Tuberculous spondylitis is not easily diagnosed in its early stages and furthermore it is hard to know whether or not the vertebrae are involved by simple X-ray study. The incidence of neurologic deficits varies from 4 to 50%. If the disease is not diagnosed and treated promptly, paraplegia may occur from vertebral collapse. A retrospective study was performed to evaluate the clinical features of tuberculous spondylitis in 51 patients (male 25, female 26), age range of 4-79 years (mean, 36.2?18.7). Clinical symptoms, signs, radiological findings and laboratory findings were reviewed. The latest follow ups were done with telephone interviews to evaluate their general improvement and neurological recoveries. Back pain was the most frequent symptom, followed by sensory disturbance and gait difficulty. Twenty one patients had kyphotic deformity, 7 had lower extremity paralysis, and 29 patients were accompanied by pulmonary tuberculosis. The involved spinal segments were C2 through S1 with the most common site of thoracolumbar spines. The average erythrocyte sedimentation rate (ESR) was 42.1?23.5 mm/hour before medical or surgical treatment and 19.6?12.6 mm/hour after treatment. The acid-fast bacillus test was positive in only 6 patients. Electrodiagnostic studies and bone scans showed positive findings in 75% and 86%, respectively. Back pain was relieved in 90% of the patients with medical or surgical treatment. In patients with paralysis, initial kyphotic angle and degree of vertebral body loss were significantly greater than in patient without paralysis. When treated surgically early after the leg paralysis, patients with paralysis improved their neurologic deficits and gait better than when treated after 2 months.

Shoulder Pain in the Hemiplegia: Causative Factors and Radiologic Finding

Shoulder pain is the one of the most frequent and serious complicatsion in hemiplegia, which impedes effective rehabilitation. A prospective study was performed to evaluate the shoulder pain, related causative factors and radiologic findings in 35 stroke patients. Triphasic bone scan and simple radiologic evaluation of shoulder were performed at the beginning of rehabilitation treatment. The degree of shoulder pain, spasticity, passive range of motion (ROM) and subluxation were evaluated weekly and followed up for at least 3 months. The incidence of shoulder pain was 62.9%(22/35). It developed in 5.7+/-.7 weeks after the onset of stroke. The muscle tone was increased slightly and mean modified Ashworth scale was 0.77+/-.69 at the onset of shoulder pain. The duration of flaccid stage was longer in patients with shoulder pain than in patients without shoulder pain. The degree of spasticity was inversely correlated well with shoulder pain(r=-0.43, P<0.05). The shoulder pain was also correlated well with the degree of uptake in triphasic bone scan(r=0.61, P<0.05). The more limited ROM of shoulder presented, the more severe pain was. However, there was no relationship between shoulder pain and the degree of subluxation. Therefore, a special precaution is needed to prevent shoulder pain in flaccid stage and the triphasic bone is a useful study in predicting shoulder pain in hemiplegic patients.

The Outcome of Head Injured Patients in Relation to Glasgow Coma Scale and Secondary Systemic Insults

A prospective analysis of 106 patients with head injury whose initial Glasgow Coma Scale was 3 to 10, who were managed in a uniform way was analyzed to relate out come to initial Glasgow Coma Scale, combined injuries and secondary systemic insults characterized by serum electrolytes imbalance, arterial gas study, blood pressure, and hemoglobin and hematocrit. The good recovery or moderate disability were achieved by 37% of the patients. The remaining 63% resulted in severe disability, vegetable and death. The poor out come group in comparing with the good outcome group showed lower initial Glasgow Coma Scale and more combined injuries. The five week follow up of secondary systemic insults mean flow showed higher serum Na flow and lower arterial PaO2 flow in poor outcome group.

Clinical Features of Craniocerebral Injury in Children

The present study involves 667 patients of craniocerebral injury under 15 year old who were admitted to the Department of Neurosurgery, Yonsei Medical College and Wonju Christian Hospital from January, 1982 to December, 1983. The results of which were analyzed and evaluated as follows. 1) The proportion of male to female was 2 to 1, and one third of patients was from 2 to 7 years of age. 2) The most frequent cause of injury was traffic accident : crash injury by truck and taxi and the next was fall from height and which were the causes of three quaters of all the craniocerebral injury of children. 3) Accidents were most frequent in May, and their frequent hour was from 3 P.M. to 4 P.M. 4) In 546 cases(81.9%), the consciousness was lost at the moment of the accident, and the duration was considered to be correlated with the clinical severity. Vomiting was observed in 353 cases(52.9%), and the early seizure attack accured in 31 cases(4.6%). 5) On admission, 631 patients were G.C.S. 8 and over, 25 patients were G.C.S. between 5 and 7,11 patients were G.C.S. 3 or 4. Two thirds of mortality cases were observed in G.C.S. under 7. 6) On plain skull films, skull fracture was observed in 292(43.8%) cases. Among those, depressed skull fracture was observed in 57 cases, and compound comminuted depressed fracture in 21 cases. By brain CT scan, abnormal hemorrhagic density was observed in 126 cases(18.9%), which involves 65 cases of epidural hematoma and 14 cases of subdural hematoma. In 47 cases, the hemorrhagic density was observed in intracerebral, intraventricular or intracerebellar region. 7) Associated injury accompanied by head injury was observed in 102(15.3%) cases, and mandible fracture, with or without tooth fracture, clavicle fracture, femur fracture, tibia fracture in order of frequency. It is considered that associated injury was one of the major causes of long term hospitalization and complication. 8) Total mortality rate was 3.1%, and the postoperative mortality was 6.9%.

Treatment of Hypertensive Intracerebral Hematoma

212 cases of hypertensive intracerebral hematoma were treated and followed for more than 3 months. The outcome was analysed in point of comparison between conservative treatment and operative treatment. The precipitating factors on prognosis depend on size and site of hematoma, level of mental deterioration, and blood pressure on admisson. Operative treatment showed better outcome than conservative treatment in cases of severly mentally deteriorated patients, large hematoma, and pontine hematoma.

The Early Diagnosis and Treatment in Cerebellar Infarction

Cerebellar infarction may be rapidly fatal when the patient is not diagnosed and treated promptly. Since 1980, we have encountered five patients of cerebellar infarction and here we analysed the cases and reviewed the literature. All patients were treated by means of the posterior fossa decompression with mortality rate of 20%. By the mode of onset and progression of symptoms and signs, the patient of cerebellar infarction could be divided into two groups;The patients who took the benign course showed the initial symptoms of headache, nausea, vomiting, dizziness and lack of balance, and were usually recovered spontaneously with the conservative treatment. On the contrary, the patients who took the progressive course showed rapidly progressive deterioration of the initial symptoms and signs and mental state. They could be recovered by the early posterior fossa decompression. The emphasis should be given to the early diagnosis and treatment for the purpose of recover in the patient of cerebellar infarction.

A Case of Multiple Huge Brain Abscesses Caused by Paragonimiasis

Cerebral paragonimiasis, occurring as an extrapulmonary infestation, is one of the important intracranial lesions in Korea. We have experienced a case of multiple huge brain abscesses caused by cerebral paragonimiasis. The patient, 17 year old boy, had chief complaints of headache and vomiting followed by mental deterioration. Neurologically, the patient presented mental change, papilledema, left abducense palsy and right hemiparesis. The treatment included the closed drainage followed by total removal of abscess capsules which was confirmed histopathologically. This paper is concerned with the description of the clinical features of cerebral paragonimiasis and review of literatures.