Immune enhancement effect of an herb complex extract through the activation of natural killer cells and the regulation of cytokine levels in a cyclophosphamide-induced immunosuppression rat model

Objective:To investigate the effects of a herb complex extract (HCE) prepared from Cornus officinalis Sieb. Et Zucc., Eriobotrya japonica Lindley, and olive leaves on immune response of mouse spleen NK cells in vitro and in vivo analysis.Methods:The activity of natural killer (NK) cells was measured in splenocytes and YAC-1 cells. Mice were immunosuppressed using cyclophosphamide (5 mg/kg body weight). Three different doses of HCE (200, 400, and 800 mg/kg body weight) and red ginseng extract (800 mg/kg body weight) which was used as standard immunomodulatory herb were administered orally for 4 weeks. The body weight, dietary, water intake, organs (liver, thymus, and spleen) weight, completed blood count, and cytokines (tumor necrosis factor alpha, interferon gamma, and interleukin-2) production was measured.Results:At the maximum concentration of HCE, the activity of NK cells was increased by 48.5%. HCE increased liver, spleen, and thymus weights without altering numbers of white blood cells, lymphocytes, and neutrophils in a cyclophosphamide-induced immunosuppression rat model. However, HCE recovered the inhibited cytokine expression; HCE (800 mg/kg) increased cytokines levels. The results indicate the immune enhancement potential of this HCE.Conclusion:The HCE enhances immunity by increasing NK cell activity, regulating cytokine levels, and maintaining spleen weight. Therefore, it may be used as a potential immunity enhancer.

Importance of total radiation dose and overall treatment time in T1 early glottic cancer

Background: In this study, we retrospectively reviewed the treatment outcome of 63 patients with T1 early glottic cancer treated with RT alone to determine the treatment outcome and the prognostic factors affecting local control

Materials and Methods: All patients were treated by 6 MV photons with conventional bilateral fields up to a median dose of 66 Gy in 33 fractions

Results: The 5-year local control rate and overall survival were 77.7% and 93.1%, respectively. The total radiation dose with a cut-off value of 66 Gy was a significant prognostic factor for local control. The 5-year local control rate was 54.5% in patients treated with less than 66 Gy compared to 85.7% in patients treated with 66 Gy or higher dose [p = 0.014]. In subgroup analysis, in patients who received 66 Gy or higher doses, all recurrences developed in whose overall treatment time was 49 days or longer, although the statistical significance was marginal [p = 0.066]

Conclusion: This study showed that a total dose of 66 Gy or higher is required for the treatment of T1 glottic cancer, and delivering the total dose within 49 days seems important for local control

Are pregnant women adequately equipped for autonomy in pregnancy screening?

<p><b>INTRODUCTION</b>Aneuploidy screening is widely practised in the field of obstetrics in current times. This study thus aims to gain an insight on pregnant women's knowledge and risk perception of Down syndrome and first trimester screening (FTS), as well as their views on various potential pregnancy outcomes and how these may affect their decision-making processes.</p><p><b>MATERIALS AND METHODS</b>A cross-sectional questionnaire-based qualitative study of consecutive 50 women choosing to undergo FTS at KK Women's and Children's Hospital (KKH), Singapore was conducted. The women completed a questionnaire after their FTS pretest counselling session. Basic knowledge of Down syndrome and FTS as well as participants' risk perception with regards to various cut-off values used in FTS were examined. Patients' views of various potential pregnancy outcomes were also studied.</p><p><b>RESULTS</b>Most patients had good retention and comprehension of what FTS entailed after a FTS counselling session at the KKH Antenatal Monitoring Clinic. However, knowledge of the risks of invasive diagnostic testing was poor. Patients also did not possess an adequate understanding of FTS risk values. With regards to risk perception, patients had very different views on acceptable pregnancy outcomes and what constituted a high-risk FTS value to them personally. A significant number of women were concerned even at medically low-risk values of 1:500 and 1:1000 in FTS. The majority of patients viewed highest detection rate followed by a lowest false positive rate as the more important factors impacting their choice of a Down syndrome screening test.</p><p><b>CONCLUSION</b>This study demonstrates the diversity of pregnant women's risk perception, risk aversion and participation in decision processes when there are 2 different values in competition. The study also highlights our patients' gaps in knowledge and lack of understanding of risk values used in FTS.</p>

Cognitive Intervention in a Patient with Carbon Monoxide Intoxication

BACKGROUND: Cognitive intervention (CI) is a nonpharmacological approach used to compensate for cognitive impairment. It is categorized into cognitive training, cognitive stimulation and cognitive rehabilitation. Several studies showed that CI could induce cognitive enhancement and reduction of risk for future cognitive decline in patients with brain injury. We investigated effects of CI on cognitive functions and brain glucose metabolism based on serial cognitive assessments and [18F]-Fluorodexoxyglucose positron emission tomography (FDG-PET) in a patient with carbon monoxide (CO) intoxication. METHODS: A 40-year-old man presented with memory impairment and abnormal behaviors such as apathy, indifference, and perseveration 2-month after CO intoxication. Brain magnetic resonance image (MRI) demonstrated high signal changes in the bilateral basal ganglia, hippocampus and the subcortical white matter on T2 weighted images. FDG-PET also showed glucose hypometabolism in the bilateral hippocampus, basal ganglia, and the subcortical white matter. A detailed neuropsychological evaluation revealed multiple cognitive impairments in memory, language and frontal functions. He received twice a week sessions of 60-minute group-based cognitive intervention for 12 weeks. Several neuropsychological examinations and FDG-PETs were conducted at baseline and after CI. RESULTS: After CI, he showed improvements in memory and frontal functions compared with baseline performances. These cognitive improvements persisted by the 7-month follow-up. The extent of glucose hypometabolism was decreased 1-month after CI, however increased 8-month after CI. CONCLUSIONS: This case study suggested that CI could enhance cognitive functions and improve glucose metabolism in a patient with CO intoxication. Also, the effects of CI on cognitive functions seem to be last at least 7-month after training.

The Classification of Congenital Color Vision Deficiency by SNU Computerized Color Test

PURPOSE: This study was designed to investigate the characteristics and classification of congenital color vision deficiency (CVD) by the SNU computerized color test (SCCT) that was developed to sufficiently utilize the advantages of a computer. METHODS: Hardy-Rand-Rittler test (HRR test), Nagel anomaloscope and SCCT were performed on 60 eyes of 30 CVD patients and 30 normal subjects and the results were compared. RESULTS: In normal subjects, the error scores were all zero at all colors by SCCT. By SCCT protan color defectives showed a peak at hue 0 red in 7 eyes (29.2%), at hue 150 green in 3 eyes (12.5%), at hue 180 green in 18 eyes (75%), and at hue 330 red in 2 eyes (8.3%). By SCCT, deutan color defectives showed a peak at hue 0 red in 2 eyes (5.6%), at hue 150 green in 24 eyes (66.7%), at hue 180 green in 2 eyes (5.6%), and at hue 330 red in 23 eyes (63.9%). CONCLUSIONS: SCCT showed specific axes in CVD patients, with accuracy and high sensitivity to diagnosis. SCCT appears to be useful clinically as a color vision test to diagnose and classify CVD patients.

A retrospective comparison of four different procedures for extracting dermoid cyst by laparoscopy / 대한산부인과학회잡지

OBJECTIVES: To compare results of 4 different extraction methods in laparoscopic management of dermoid cyst. STUDY DESIGN: This article is a retrospective, multicenter study for 247 patients with benign dermoid cyst in period of 1995-1998. Dermoid cyst was extracted by Endopouch (99 cases), puncture-irrigation-extraction (69 cases), colpotomy (35 cases), and dermoid cyst as a "pouch bag" (44 cases). RESULTS: We analyzed irrigation amount, operative time, postoperative hospital stay and complications by four different extraction methods. Endopouch extraction method needed less amount of irrigation fluid for cleaning the abdominal cavity and had a shorter postoperative hospital stay (ANOVA, p=0.0001). There were no significant differences in operative times among groups. There were four cases of morbidity in puncture-irrigation-extraction method (6%), three had fever (> 38degrees C) and one intraabdominal abscess. One incisional hernia was noted in "pouch bag" method (2%). CONCLUSIONS: We recommend minimal spillage method for extraction of dermoid and careful irrigation of abdominal cavity to prevent potential risk of chemical peritonitis such as Endopouch, "pouch bag", and colpotomy with the exception of puncture-irrigation-extraction method.

MR Imaging Findings of Orbitofacial Infarction Secondary to Rhinoorbital Mucormycosis: A Case Report

Rhino-orbital mucormycosis is the most frequently fatal fungal infection commonly occurring in patients with poorly controlled diabetes mellitus and and those who are immunocompromised, and requires prompt treatment. We describe a case of rhino-or-bital mucormycosis with orbital cellulitis and paranasal sinusitis, as seen on initial MR images, which on follow-up images had evol ved to orbitofacial infarction. MR imaging was useful for the demonstration of orbitofacial infarction, seen as areas of lack of enhancement and thus suggesting vascular invo l vement by mucor hyphae.

Assessments of myocardial perfusion in human using stress intravenous PESDA myocardial contrast echocardiography and Pulse Inversion Harmonic Imaging: A Comparison study with Tc-99m sestamibi SPECT

OBJECTIVE: The object of this study was to assess the accuracy of dipyridamole stress intravenous (IV) myocardial contrast echocardiography (MCE) using pulse inversion harmonic imaging and PESDA in the detection of perfusion defect in the patients with coronary artery disease in comparison with dipyridamole stress Tc-99m sestamibi SPECT. METHODS: Total 46 patients (29 males, mean age 64 years old) were consecutively enrolled. Patients with prior myocardial infarction were excluded. MCE and Tc-99m sestamibi SPECT were performed at the same day during rest and after 0.56 or 0.84mg/Kg dipyridamole infusion. Continuous IV infusion of PESDA (2-5 mL/min) was administered while obtaining triggered (1:1) end-systolic apical 2, 4 chamber and long axis views. Tc-99m sestamibi was injected 3 minutes after dipyridamole. Tc-99m sestamibi SPECT images were obtained one hour later. Coronary angiography was followed within two days in all patients. Tc-99m sestamibi SPECT images were matched to the sixteen segments of left ventricle according to American Society of Echocardiography for segmental comparison. Both images were analyzed visually. Results Using coronary angiography as the standard, MCE showed overall sensitivity of 70.7%, specificity of 95.8%, positive predictive value (PPV) of 87.8% and negative predictive value (NPV) of 88.5% in the detection of coronary atherosclerosis (70% stenosis). Tc-99m sestamibi SPECT showed sensitivity of 75.6%, specificity of 98.9%, PPV of 96.8% and NPV of 90.6%. The overall concordance rate between MCE and Tc-99m sestamibi SPECT for the detection of perfusion defects was 86.9% (Cohen's kappa value 0.63) according to the coronary territory and 86.8% (Cohen's kappa value 0.55) according to segmental analysis. CONCLUSION: Dipyridamole stress IV MCE using pulse inversion harmonic imaging and PESDA is feasible and comparable to Tc-99m sestamibi SPECT in identifying significant coronary stenosis and inducible myocardial perfusion defects in the patients with coronary artery disease. MCE using pulse inversion harmonic imaging seems to be a promising modality for assessing myocardial perfusion in the patients with suspected coronary artery disease.

Gene Analysis in Huntington Disease

BACKGROUND & OBJECTIVE: Huntington disease(HD) is clinically diagnosed by the triad of autosomal dominant inheritance, involuntary movements mainly chorea and dementia. The phenotype of HD is variable and other diseases can have same phenocopy. Therefore gene diagnosis of HD becomes essential for confirmatory diagnosis. Recent discovery of an expanded CAG trinucleotide repeat at the telomeric position of chromosome 4p made the gene diagnosis possible even in sporadic cases. We examined the length of CAG repeat in Huntington gene locus by PCR method in clinically diagnosed HB patients to make a confirmatory diagnosis. METHODS: Three patients with chorea, dementia and family history were tested. All laboratory tests including MRI had been normal so far. Genomic DNA was extracted from their WBC, and PCR was done on Huntington gene locus using primers modified from HD Collaboratory Group. Agarose gel electrophoresis to examine the rough degree of expansion, polyacrylamide gel electrophoresis to determine repeat length, and sequencing of the expanded allele were done. As a second step, three choreic patients without family history, one patient with tardive dyskinesia and one whole HD family were tested. RESULTS: Three choreic patients with family history showed expansion of CAG repeats in the amplified site. Two sporadic choreic patients, and one asymptomatic member in a HD family had increased CAG repeats. CONCLUSION: We confirmed expansion of CAG repeats in Huntington gene locus in clinically diagnosed HD. None of the patients had caudate atrophy, which has been considered an early finding. Sporadic choreic patients could be diagnosed as HD by gene study. Presymptomatic case was found in a family screening, and will need to be followed. Gene analysis offers a critical tool to make a confirmatory diagnosis of HD, and will be a powerful tool in genetic counseling.

The Findings of MRI and Transcranial Doppler Sonography in Three Cases of Moyamoya Disease

The confirmatory diagnosis of Moyamoya disease has been obtained by invasive angiographic examination. We report the results of MRI and transcranial doppler sonography of three cases ol Moyamoya disease, which ws disgnosed by clinical and angiography. We think that the diagnosis of Moyamoya disease can be made by noninvasive MRI and transcranial doppler sonography without conventional invasive angiography.

Clinical Report of 46 Intracranial Tumors with LINAC Based Stereotactic Radiosurgery / 대한치료방사선과학회지

Between July 1988 and December 1992, we treated 45 patients who had deep seated inoperable or residual and/or recurrent intracranial tumors using LINAC based stereotactic radiosurgery at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College. Treated intracranial tumors included pituitary tumors(n=15), acoustic neurinomas(n=8), meningiomas(n=7), gliomas(n=6), craniopharyngiomas(n=4), pinealomas(n=3), hemangioblastomas(n=2), and solitary metastatic tumor from lung cancer (n=1). The dimension of treatment field varied from 0.23 to 42.88 cm3(mean ; 7.26 cm3). The maximum tumor doses ranging from 5 to 35.5 Gy (mean; 29.9 Gy) were given, and depended on patients' age, target volume, location of lesion and previous history of irradiation. There were 22 male and 23 female patients. The age was varied from 5 to 74 years of age(a median age; 43 years). The mean duration of follow-up was 35 months (2~55 months). To date, 18(35.1%) of 46 intracranial tumors treated with SRS showed absent or decrease of the tumor by serial follow-up CT and/or MRI and 16(34.8%) were stationary, e.g. growth arrest. From the view point of the clinical aspects, 34(73.9%) of 46 tumors were considered improved status, that is, alive with no evidence of active tumor and 8(17.4%) of them were stable, alive with disease but no deterioration as compared with before SRS. Although there showed slight increase of the tumor in size according to follow-up imagings of 4 cases(pituitary tumor 1, acoustic neurinomas 2, pinealoma 1), they still represented clinically stable status. Clinically, two(4.4%) patients who were anaplastic astrocytoma(n=1) and metastatic brain tumor(n=1) were worsened following SRS treatment. So far, no serious complications were found after treatment. The minor degree headache which could be relieved by steroid or analgesics and transient focal hair loss were observed in a few cases. There should be meticulous long term follow-up in all cases.

Thracia and Lumbar Fracture: Classification According to Three Column Theory and its Relationship to Paralysis / 대한정형외과학회잡지

We reviewed 217 patients (270 cases) of thoracic and lumbar fractures and fracture-dislocations, who were treated at Hanyang University Hospital from January, 1977 to December, 1985. We classified spinal injuries according to three column theory and then analyzed the cause of injury, sex-age distribution, treatment and neurological injuries. The results were as follows: 1. The cases were classified into 4 different categories according to the three column theory; compression fractures (191 cases, 70.7%), burst fractures (54 cases, 20.0%), fracture-dislocations(22 cases, 8.2%), and seat belt type injuries (3 cases, 1.1%). And each of these 4 different categories was then subdivided into subtypes. 2. The most common cause of injury was fall from a height (45.2 %). 3. The neurological injuries were occurred in 21 patients (9.7%). The 16 patients with neural deficit in fracture-dislocation, 15 patients were flexion rotation type. The 5 patients with neural deficit in burst fracture, all were incomplete neural deficits. 4. The greatest advantage of Luque instrumentation was an early rehabilitation without external surport.