Serial Magnetic Resonance Imaging Findings in Hyperglycemia-Related Osmotic Demyelination Syndrome: A Case Report

We report a rare case of hyperglycemia-related osmotic demyelination syndrome (ODS) with focus on the imaging findings. A 61-year-old man with diabetes was admitted for general weakness and severe thirst. A few days later, he complained of dysarthria, dysphasia, and dysmetria. Laboratory examinations showed significant hyperglycemia, but normal electrolyte levels. Brain MRI revealed T2-signal abnormalities that were symmetrical, non-space occupying, and located in the central pons with a peripheral sparing pattern, which were suggestive of ODS. In addition, subsequent MRI revealed progression of signal hyperintensity; however, the patient's symptoms improved.

Serial Magnetic Resonance Imaging Findings in Hyperglycemia-Related Osmotic Demyelination Syndrome: A Case Report

We report a rare case of hyperglycemia-related osmotic demyelination syndrome (ODS) with focus on the imaging findings. A 61-year-old man with diabetes was admitted for general weakness and severe thirst. A few days later, he complained of dysarthria, dysphasia, and dysmetria. Laboratory examinations showed significant hyperglycemia, but normal electrolyte levels. Brain MRI revealed T2-signal abnormalities that were symmetrical, non-space occupying, and located in the central pons with a peripheral sparing pattern, which were suggestive of ODS. In addition, subsequent MRI revealed progression of signal hyperintensity; however, the patient's symptoms improved.

Magnetic Resonance Imaging and Clinical Features of Chlorfenapyr-Induced Toxic Leukoencephalopathy: A Case Report

Chlorfenapyr is widely used as an insecticide, despite it being fatal to humans. However, chlorfenapyr- induced central nervous system toxicity has rarely been reported. We report the magnetic resonance imaging (MRI) findings in a rare case of chlorfenapyr-induced toxic leukoencephalopathy. A 71-year-old man who had ingested chlorfenapyr approximately two weeks prior visited our hospital and presented with bilateral lower motor weakness and voiding dysfunction that had developed two days before admission. Brain MRI revealed extensive bilateral white matter abnormalities involving the corpus callosum, internal capsule, brain stem, and bilateral middle cerebellar peduncle. Furthermore, spine MRI revealed diffuse swelling and hyperintensity on the T2-weighted images.

Pro- and anti-inflammatory cytokine expression and histopathological characteristics in canine brain with traumatic brain injury

We analyzed the expression level and cellular localization of pro- and anti-inflammatory cytokines and histopathologically characterized canine traumatic brain injury (TBI). Canine TBI brains revealed subarachnoid and cerebral cortical hemorrhage, neutrophilic infiltration, neuronal necrosis, astrocytosis, and vasogenic edema. Immunohistochemical evaluations suggested that both pro-inflammatory cytokines [interleukin (IL)-1beta, IL-6, and tumor necrosis factor-alpha] and anti-inflammatory cytokines [IL-10 and transforming growth factor-beta (TGF-beta)] were highly expressed in neurons and neutrophils. In particular, the highest magnitude of expression was identified for IL-1beta and TGF-beta. This data helps describe the pathologic characteristics of canine TBI, and may help in the design of potential therapeutic approaches to control secondary damage by inflammatory cytokines.

Characterization of canine oral papillomavirus by histopathological and genetic analysis in Korea

In August 2008, forty dogs out of 400 developed oral warts in a breeding farm in Korea. Canine oral papilloma infection is a common disease in dogs. However, there has been no report of an outbreak of canine oral papillomavirus (COPV) in a group of dogs or in dog breeding farms in Korea, and the genetic analysis of COPV in Korea has yet to be performed. This study diagnosed canine oral papilloma from the oral samples of these dogs based on histopathological examination and immunohistochemistry. Polymerase chain reaction was applied to amplify the corresponding products using pre-existing primer sets for COPV and a universal human papillomavirus targeting L1 gene. Further genetic analysis of the major viral capsid gene L1 confirms the sequences of Korean COPV, which shows a close relationship to previously reported COPV. This study describes the histopathological and immunohistochemical characteristics of canine oral papilloma in a group of breeding dogs in Korea and discloses the complete L1 gene sequences of Korean COPV.

Histopathological retrospective study of canine renal disease in Korea, 2003~2008

Renal disease includes conditions affecting the glomeruli, tubules, interstitium, pelvis, and vasculature. Diseases of the kidney include glomerular diseases, diseases of the tubules and interstitium, diseases of renal pelvis, and developmental abnormalities. Renal tissue samples (n = 70) submitted to the Department of Veterinary Pathology of Konkuk University from 2003 to 2008 were included in this study. Tissue histopathology was performed using light microscopy with hematoxylin and eosin stains. Masson's trichrome, Congo Red, and Warthin starry silver staining were applied in several individual cases. Glomerular diseases (22.9%), tubulointerstitial diseases (8.6%), neoplastic diseases (8.6%), conditions secondary to urinary obstruction (24.3%), and other diseases (35.7%) were identified. Glomerulonephritis (GN) cases were classified as acute proliferative GN (5.7%), membranous GN (4.3%), membranoproliferative GN (4.3%), focal segmental GN (2.9%), and other GN (4.2%). The proportion of canine GN cases presently identified was not as high as the proportions identified in human studies. Conversely, urinary obstruction and end-stage renal disease cases were relatively higher in dogs than in human populations.

Comparative immunohistochemical characterization of canine seminomas and Sertoli cell tumors

Primary testicular tumors are the most common causes of cancer in male dogs. Overall, the majority of canine patients should be cured by testicular surgery. However, tumor markers are not well-known in veterinary medicine. We sought to determine using immunohistochemistry whether the combined human testicular tumor markers (placental alkaline phosphatase, OCT3/4, CD30, alpha-fetoprotein, inhibin-alpha, vimentin, c-KIT, and desmin) are expressed in canine seminomas and Sertoli cell tumors (SCTs). We examined 35 canine testicular tumors, 20 seminomas and 15 SCTs. c-KIT was expressed markedly in canine seminomas. Both inhibin-alpha and vimentin were expressed significantly in canine SCTs. The results of this study demonstrate differences and similarities between tumor marker expression of testicular tumors in dogs and humans. All the main markers in current routine use are discussed as well as potential useful markers for benign and malignant tumors, and tumor progression.

Maternal and Perinatal Outcomes of Early- and Late-onset Preeclampsia / 대한주산의학회잡지

PURPOSE: Early-onset preeclampsia is thought to be associated with fetal mortality and maternal complications. We compared maternal clinical characteristics, complications, and perinatal outcome between early- and late-onset preeclampsia. METHODS: We analysed retrospectively 212 pregnant women with preeclampsia between 2004 and 2008 at a tertiary university hospital. We divided preeclamptic women as early-onset (n=58), with an onset before 32 weeks gestation, and late-onset (n=154), with an onset after 32 weeks gestation. We compared maternal characteristics, maternal complications, and neonatal outcomes between the two groups. RESULTS: There were no significant differences in maternal age, parity, BMI, previous history of preeclampsia, hypertension, and DM between early- and late-onset preeclampsia. Among the maternal complications, maternal blood pressure was higher in early-onset preeclampsia without any statistical significance, but the amount of 24 hours urine protein was significantly higher in early-onset preeclampsia than late-onset (P=0.003). There were significantly higher rate of visual disturbance, elevated liver enzyme, pulmonary edema and severe disease in early-onset preeclampsia (all P<0.05). Comparing neonatal outcome, there were higher rate of fetal death in uterus (FDIU) (P=0.0001), low Apgar score (P<0.0001), and perinatal death (P<0.0001) in early-onset preeclampsia. Fetal birth weight and onset of preeclampsia were significant covariate factors for perinatal mortality. CONCLUSION: Early-onset preeclampsia was related to poor perinatal and materanl outcomes, but there was no difference in maternal characteristics. Further studies are necessary for prediction, pathogenesis, and therapy of early-onset preeclampsia.

Analysis of residual tumor based on pathologic severity and site of positive margin after cold-knife conization of the uterine cervix / 대한산부인과학회지

OBJECTIVE: To evaluate correlation of sites of positive margin and residual tumor and to establish management after conization. METHODS: Of 599 cold-knife conizations [15 (2.6%) with cervical intraepithelial neoplasia (CIN) I, 37 (6.1%) with CIN II, 450 (75.1%) with CIN III, 97 (16.2%) with microinvasion] performed at our institution from January, 1993 to June, 2006, 144 patients (24.0%) had positive margins and 113 patients were included in the retrospective study excluding 31 cases that were not followed more than 12 months. Correlation of conization pathology and residual tumor according to sites of positive margin were evaluated. RESULTS: The prevalence rates of positive margins were 6.7% (1/15) in CIN I, 21.6% (8/37) in CIN II, 21.1% (95/450) in CIN III, and 41.2% (40/97) in microinvasion. The prevalence rate of positive margin increased with severity of conization pathology (P=0.0001). Of 113 patients followed more than 12 months, 27.4% (31/113) had residual tumor [0.0% (0/1) in CIN I, 12.5% (1/8) in CIN II, 18.9% (14/74) in CIN III, and 53.3% (16/30) in microinvasion]. The prevalence rate of residual tumor increased with severity of conization pathology (P=0.0028). Residual tumor was more common in patients in whom both endocervical and exocervical margins or in whom only the endocervical margin were involved than in those in whom only exocervical margin was involved [87.5% (7/8) or 35.3% (24/68) versus 0% (0/37), respectively]. CONCLUSIONS: Expectant management is reasonable for patients with positive margin after conization. However, careful follow-up of these patients is essential, particularly in endocervical involvement.

The Effect of Combined Ephedrine and Lidocaine Pretreatment on Tracheal Intubation Condition and Maximum Neuromuscular Block after Rocuronium Administration / 대한마취과학회지

BACKGROUND: Rocuronium is a nondepolarizing muscle relaxants used for trying rapid-sequence intubation due to its relatively rapid onset of action and low side effects. Methods to further reduce the onset time of a muscle relaxant include increasing the dose of muscle relaxant, pretreatment for potentiating neuromuscular block of the muscle relaxants or increasing the cardiac output and muscle blood flow. The purpose of this study was to examine the pretreatment effect of combined lidocaine and ephedrine, as a pretreatment, on the onset time and intubation conditions of rocuronium-induced neuromuscular block in adults. METHODS: Sixty ASA physical stati 1 and 2 patients were randomly allocated to four groups. Normal saline 10 ml was administered to Group NS prior to induction, lidocaine (1.5 mg/kg) to Group L, ephedrine (70microgram/kg) to Group E, and combined lidocaine (1.5 mg/kg) and ephedrine (70microgram/kg) to Group LE. Anesthesia was induced with propofol (2.0 mg/kg) and rocuronium (0.6 mg/kg). Intubation was performed 45 seconds after the administration of rocuronium and the intubation conditions then evaluated. The change in the mean arterial pressure and heart rate were checked and compared during the peri-induction periods. RESULTS: There were no differences in the hemodynamics between the four groups. The intubation conditions were graded as good to excellent in 33.3, 53.3, 66.7 and 93.3% of patients in NS, L, E and LE groups, respectively. The intubation conditions in group LE were significantly better than those in group NS (P < 0.05). CONCLUSIONS: The above results demonstrated that pretreatment with a combination of ephedrine and lidocaine, following rocuronium, improves the tracheal intubation conditions.

Effects of Preincisional Ketamine on Postoperative Pain after Laparoscopic Assisted Vaginal Hysterectomy

BACKGROUND: We evaluated the effect of preincisional injection of a small dose of ketamine on postoperative pain after laparoscopic assisted vaginal hysterectomy (LAVH). METHODS: Fourty patients undergoing LAVH were randomly allocated to one of two groups. Group K received ketamine 0.5 mg/kg IV. Group N received normal saline IV as a control group. Postoperative pain was rated at 1, 3, 6, 12, and 24 hr postoperatively by visual analog scale (VAS). The incidence of patients requiring analgesics in the PACU and on the ward, the time to the first analgesic request and side effects were recorded. RESULTS: At 1, 3, 6, 12, 24 hr after surgery, patients in the group K had significantly lower VAS than those in the group N (P < 0.05). The incidence of patients requiring analgesics in the postanesthetic care unit (PACU) and on the ward was not significantly different in the group K compared with group N. There were no significant differences in the first analgesic request time and the incidence of side effects in both group. CONCLUSIONS: Preincisional treatment with ketamine 0.5 mg/kg IV reduces postoperative pain after LAVH.

Sudden Cardiac Arrest Following Cervical Facet Joint Injection: A case report / 대한마취과학회지

The common disorder called facet syndrome exhibits back pain, with or without referred or radiating pain due to facet joint arthropathy. Facet joint injection using local anesthetics is a reliable method for the diagnosis and treatment for facet syndrome. Because the complications secondary to facet block have usually been temporary and infrequent, facet block has been known as a simple and safe procedure. But spinal anesthesia is a serious complication of facet block and can lead to a life threatening conditions. The authors report a patient who developed un-explainable cardiac arrest following facet joint injection. A 64 year-old woman with 4-year history of cervical facet syndrome was admitted for the fourth facet block. Cardiac arrest followed with unconsciousness and apnea occurred 4 minutes after cervical facet joint injection with 2 ml of 2% lidocaine. The patient was immediately resuscitated and recovered without any sequelae. Sudden cardiac arrest can be unexpectedly developed during facet block, and we recommend close monitoring during cervical facet joint block.

Tension Pneumothorax during One-Lung Ventilation in Patient with Bronchiectasis: A case report / 대한마취과학회지

One-lung ventilation is very rarely associated with tension pneumothorax which can progress rapidly to become a life threatening situation when it develop in the ventilated dependent lung during one-lung ventilation. A 59-year-old female patient with bronchiectasis underwent double-lumen endotracheal tube intubation for left lower lobectomy. Our patient's presenting signs were decreased tidal volume, increased airway pressure, decreased oxygen saturation and bronchoscopic finding of collapsed bronchus during one-lung ventilation. In our case, hypotension was transiently noticed but recovered without any treatment. Resumption of two-lung ventilation did not relieved these signs. A diagnosis of tension pneumothorax in the ventilated dependent lung was confirmed by chest X-ray.

A Case of Adult-Onset Minimal Change Nephrotic Syndrome Relapsed after 15-year of Complete Remission / 대한신장학회잡지

We report an unusual case of adult minimal change nephrotic syndrome relapsed after 15-year of complete remission. In this case, the disease had occurred to the patient for the first time when he was 52 years old; relatively high age, and had been remitted with steroid therapy. After 15 years of complete remission, he visited our hospital with the symptoms of the generalized edema and the pitting edema of both lower extremities that occurred 15 days ago. Massive proteinuria(15, 865 mg/day) and hypoalbuminemia(1.7 g/dL) were detected. The pathologic evaluation of the biopsied specimen of the kidney showed the global sclerosis in 19% of glomeruli in light microscopic finding and the fusion of epithelial foot processes in electron microscopic finding. He was treated with pulse steroid therapy (methylprednisolone 500 mg/day iv for 3 days) and then, with oral prednisolone (60 mg/day). Generalized edema and proteinuria disappeared after 14 days of treatment, and there has been no relapse ever since. Adult-onset minimal change nephrotic syndrome relapses within 4 years after complete remission in 90 % of relapsed patients. The relapse after more than 5 years of complete remission, like this case, is very rare, especially in the case of late-onset disease. However, the possibility of relapse of the minimal change nephrotic syndrome after several years of its remission should be considered constantly and the long-term follow-up more than 10 years may be needed.

Correlation Analysis of KT 2000 arthrometer, Cybex Isokinetic Test and Lysholm Knee Score in ACL deficient knees

PURPOSE: The authors performed correlation analysis among the values of KT 2000 arthrometer, Cybex isokinetic test, and Lysholm knee score to reveal the clinical significance and their role in functional evaluation of ACL insufficiency. MATERIALS AND METHODS: Fifty-one patients with isolated ACL insufficiency were evaluated with KT 2000 arthrometer (15, 20, 30 lb, max.manual), Cybex isokinetic test (60 & 180 degrees/sec), and Lysholm knee score. Correlation analysis was performed between the values of the tests. RESULTS: The Lysholm knee scores had significant linear correlation with the values of KT 2000 of maximal manual difference (r=0.587, P<0.05). The Lysholm knee score had significant linear correlation with all the values of Cybex test of hamstring & quadriceps muscle weakness (r=0.585, 0.635, 0.656, 0.720, p<0.05). The degree of muscle weakness and maximum manual difference in KT 2000 did not show any linear correlation. The time lap between injury and evaluation did not show any correlation with any of the above parameters. CONCLUSION: Lysholm knee score appears to be mostly influenced by the degree of muscle weakness than anterior displacement. The values of KT 2000 of maximal manual difference revealed to be best correlated with Lysholm knee score. The time interval after injury cannot be clinically correlated with muscle weakness or Lysholm knee score.

Analysis of 1058 Patients with Uterine Cervical Cancer / 대한산부인과학회잡지

OBJECTIVES: This study was undertaken to analyze the demographic profile and to identify the clinicopathologic prognostic factors affecting survival rate in patients with cervical cancer. METHODS: Records of 1058 patients with cervical cancer treated in Asan Medical Center(AMC) from June 1989 to March 1999 were reviewed. All patients were diagnosed and treated initially in AMC, and the patients who transferred after initial treatment from other hospital or who visited AMC after recurrence were excluded. Demographic profile, findings in preoperative work-up, treatment modality, and post-treatment clinical course were evaluated. Of the 1058 patients, 863 patients were primarily treated with surgery, and their operation records were reviewed. 5-year disease free survival rate(DFSR) was calculated according to histopathologic risk factors such as clinical stage, clinical tumor size, depth of cervical wall invasion, histologic type, LN involvement, lympho-vascular space invasion(LVSI), and involvement of resection margin. And their clinical significance as prognostic factors were assessed using multivariate analysis. RESULS & CONCLUSION: The age at diagnosis ranged from 22 to 85 years old, and the mean age was 50.5 years(SD: 12.5). Of the 1058 patients, the number of patients with FIGO stage I disease were 665(62.8%), those with stage II were 318(30.1%), and those with stage III and stage IV were 58(5.5%) and 17(1.6%), respectively. According to pathologic report, 88.1% of the patients had squamous cell carcinoma, 4.8% had adenosquamous cell carcinoma, 4.1% had adenocarcinoma, 1.3% had undifferentiated malignancy, and 1.7% had the other histologic type of malignancy. Of surgically treated 863 patients, LN involvement was present in 8.6% of patients with stage Ia, 15.1% with Ib, 25.0% with IIa and 26.5% with IIb. External iliac LN was the most frequently involved among regional pelvic LN. Bladder dysfunction was the most common complication after surgery, occupying 11.4%. Other surgical complications included lymphocyst formation(8.9%), fistula formation(2.0%), wound disruption(1.8%), intestinal injury(1.1%), vessel injury(0.8%), and ureteral injury(0.5%). 5-year DFSR according to FIGO stage was as follows: Ia 95.7%, Ib 88.9%, IIa 81.8%, IIb 61.8%, III 45.0%, and IV 25.0%. While FIGO stage, histologic type, LN involvement, and involvement of resection margin had prognostic significance in multivariate analysis, clinical tumor size, depth of cervical wall invasion, and LVSI did not.

Bone tunnel enlargement after anterior cruciate ligament reconstruction / 대한정형외과학회잡지

PURPOSE: To evaluate the bone tunnel enlargement after an anterior cruciate ligament reconstruction (ACLR), We compared the results between a group that had a bone-patellar tendon-bone (BPTB) autograft (group 1) that included the nubbin and one that had a hamstring double looped autograft (group 2). MATERIALS AND METHODS: We evaluated 120 knees over a one year follow-up period. In group 1, the tibial tunnel was completely filled with nubbin. The clinical results were evaluated using the IKDC knee rating system and a KT-2000 arthrometer. Changes in the bone tunnel width on ordinary radiographs were measured periodically. RESULTS: Clinically, there was no significant difference between the two groups. In group 2, more tunnel enlargement occured (p<0.05). ACLR that included the nubbin in the BPTB autograft showed better results in the tunnel enlargement than the others. CONCLUSION: ACLR using the nubbin at the BPTB autograft is one of the solutions available for prevention of bone tunnel enlargement after ACLR.

Molecular Genetic Assessment of Benign and Borderline Tumors as Precursor Lesions of Epithelial Ovarian Carcinoma / 대한산부인과학회잡지

No abstract available.

A Clinico-Histopathological Study of Malignant Melanoma / 대한피부과학회지

BACKGROUND: Cutaneous malignant melanoma represents a tumor arising within the melanocytic systems of the skin. Once considered an uncommon cancer, melanoma is now rising in incidence at a rate faster than any other cancer. OBJECTIVE: The purpose of this study was to investigate the clinico-pathological characteristics of malignant melanoma. METHODS: A total of 61 patients with malignant melanoma were enrolled in this retrospective study. We classified malignant melanoma as follows; ALMM, acral lentigious malignant melanoma, NMM, nodular malignant melanoma, SSMM, superficial spreading malignant melanoma, MM, mucosal melanoma, LMM, lentigo maligna melanoma. We used the staging system of American Joint Committee on Cancer to evaluate the clinical status in our subjects. The hospital charts and histopathological slides of patients with malignant melanoma diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. Immunohistochemical study was performed for S-100 and HMB-45 in 10 cases and for Ki-67 in 5 cases. RESULTS: 1. The male to female ratio was 1.3. The mean age at diagnosis was 52.6 years. ALMM was the most common type(52.5%) in this study. ALMM and NMM developed in elderly persons, while SSMM developed in younger persons. Malignant melanomas arising from pre-existing mole were 10 cases(16.4%). 2. In forty two cases(68.9%), malignant lesions were limited to skin, but 19 cases(31.1%) were disseminated to lymph nodes, skin or internal organ at the initial examination. Sole and heel were the favored sites in ALMM. Lower extremities and back were the favored sites in NMM and SSMM. Four patients were initially presented with metastatic symptoms such as dyspnea, abdominal mass, headache, or axillary mass, and cutaneous malignant melanoma eventually were diagnosed as their origin. 3. Histopathologically, 6 cases were categorized into amelanotic type and 1 case was into desmoplastic type. 4. More than a half cases developed metastases to other organs. Common metastatic sites were lymph nodes, lung, brain, skin, liver, bone, and bladder in decreasing order of frequency. 5. The five-year survival rate was 100% in stage IA, IB, and IIA but 0% in stage IV. Face, chest and lower extremities showed worse prognosis. Men had worse prognosis than women. NMM revealed the lowest 5-year survival rate(30%). CONCLUSION: Among the prognostic factors such as locations, clinical types, ages, and gender, the stages at the initial presentation was the most important predictable value in our study. Therefore, the early recognition of malignant melanoma is the key to possible cure.

Clinical efficacy of thymomodulin on neutropenia induced by chemotherapy in the patients with gynecologic cancer / 대한암학회지

No abstract available.