Expression of TIMP1, TIMP2 Genes by Ionizing Radiation / 대한방사선종양학회지

PURPOSE: Expression of TIMP, intrinsic inhibitor of MMP, is regulated by signal transduction in response to genotoxins and is likely to be an important step in metastasis, angiogenesis and wound healing after ionizing radiation. Therefore, we studied radiation mediated TIMP expression and its mechanism in head and neck cancer cell lines. MATERIALS AND METHODS: Human head and neck cancer cell lines established at Asan Medical Center were used and radiosensitivity (D0), radiation cytotoxicity and metastatic potential were measured by clonogenic assay, MTT assay and invasion assay, respectively. The conditioned medium was prepared at 24 hours and 48 hours after 2 Gy and 10 Gy irradiation and expression of TIMP protein was measured by Elisa assay with specific antibodies against human TIMP. hTIMP1 promotor region was cloned and TIMP1 luciferase reporter vector was constructed. The reporter vector was transfected to AMC-HN-1 and -HN-9 cells with or without expression vector Ras, then the cells were exposed to radiation or PMA, PKC activator. EMSA was performed with oligonucleotide (-59/-53 element and SP1) of TIMP1 promotor. RESULTS: D0 of HN-1, -2, -3, -5 and -9 cell lines were 1.55 Gy, 1.8 Gy, 1.5 Gt, 1.55 Gy and 2.45 Gy respectively. MTT assay confirmed cell viability, over 94% at 24hrs, 48hrs after 2 Gy irradiation and over 73% after 10 Gy irradiation. Elisa assay confirmed that cells secreted TIMP1, 2 proteins continuously. After 2 Gy irradiation, TIMP2 secretion was decreased at 24hrs in HN-1 and HN-9 cell lines but after 10 Gy irradiation, it was increased in all cell lines. At 48hrs after irradiation, it was increased in HN-1 but decreased in HN-9 cells. But the change in TIMP secretion by RT was mild. The transcription of TIMP1 gene in HN-1 was induced by PMA but in HN-9 cell lines, it was suppressed. Wild type Ras induced the TIMP-1 transcription by 20 fold and 4 fold in HN-1 and HN-9 respectively. The binding activity to -59/-53, AP1 motif was increased by RT, but not to SP1 motif in both cell lines. CONCLUSIONS: We observed the difference of expresson and activity of TIMPs between radiosensitive and radioresistant cell line and the different signal transduction pathway between in these cell lines may contribute the different radiosensitivity. Further research to investigate the radiation response and its signal pathway of TIMPs is needed.

Acute Pulmonary Edema Occurred During the Cesarean Section in a Patient with Ritodrine Pretreatment: A case report / 대한마취과학회지

The mechanism of development of pulmonary edema associated with -sympathomimetic agent is still not fully understood. 2-sympathomimetic drugs such as ritodrine, terbutaline, and fenoterol are widely used for the treatment of premature uterine contraction. We describe a case of pulmonary edema that occurred suddenly during Cesarean section in a previously healthy parturient, associated with ritodrine pretreatment for 5 days in an attempt to arrest preterm labor. Pulmonary edema was completely treated with mechanical ventilation and diuretic therapy.

Oral Ketamine Premedication for Pediatric Outpatient Anesthesia / 대한마취과학회지

BACKGROUND: In children, fear of venipuncture and seperation from parents may produce stormy induction of anesthesia. Premedication administered by nontraumatic methods helps to decrease anxiety and minimize psychological trauma. METHODS: To define a dose of oral ketamine that would facilitate smooth induction of anesthesia for pediatric outpatient surgery without causing significant side effects, sixty children(ASA Physical Status 1; aged 1-7 years) undergoing inguinal herniorrhaphy were assigned randomly to four separate groups that received 5 mg/kg, 7 mg/kg, 10 mg/kg, or no ketamine(control group) mixed in 0.2 ml/kg cola. They were evaluated preoperatively and postoperatively for acceptance of oral ketamine, reaction to separation from their parents, acceptance of facial mask for inhalation induction, emergence delirium and postanesthetic complications. RESULTS: The 7 mg/kg and 10 mg/kg doses were well accepted; provided predictable sedation within 22-25 minutes; allowed calm seperation from parents and good induction conditions. However, the 10 mg/kg dose prolonged discharge time from recovery room, probably due to delayed recovery. Emergence deliriums were observed in two of all ketamine administered children(4.4%). And the incidences of postanesthetic complications such as vomiting, decreased appetite, lethargy, nausea, nightmare, behavioral change were slightly higher in ketamine administered groups, compared to the control group. CONCLUSION: The authors conclude that an oral dose of 7 mg/kg ketamine is well accepted in young children undergoing outpatient surgery for inguinal hernia and provides relatively predictable and satisfactory sedation without prolongation of discharge time and significant side effects.

Posterior Lower Cervical fixation with the AME Haid Universal Bone Plate System

During posterior cervical stabilization, lateral mass fixation with plate-screw has been found to be a simple and safe application, without the dependence on intact posterior element and immediate rigid fixation. We applied the AME Haid Universal Bone Plate System to six cases of traumatic lower cervical instability with favorable results. Drilling direction was 30 degrees lateral and 15-20 degrees rostral to the vertebral plane, and we have not noticed any complication. Screw loosening, the pitfall of the procedure is described.

Two Operative Cases of Moya Moya Disease in Children

The treatment of moya moya disease, a chronic occlusive cerebrovascular disease of unknown etiology, isn't settled ut various operative methods to maximize cerebral revascularization have been reported. Two cases in children treated surgically are presented, one with cerebroarteriosynangiosis and the other with encephalo-duro-arterio-synangiosis(EDAS). The methods of cerebral revascularization are discussed in detail.

Effect of Focal Brain Retraction on the Regional Cerebral Blood Flow and the Electroencephalographic Activity in the Cat

The use of brain retractors, unavoidable method in operation of deep intracranial lesions, may lead to focal cerebral ischemia and thereby cause brain infarction. In such operation, the surgical microscope is commonly used to get good surgical field. However, as the time of operation becomes lengthened, it results in longer retraction of the brain and probable greater ischemic infarction. To estimate the risk of ischemic damage, the authors investigated the regional cerebral blood flow(rCBF) and the electroencephalographic(EEG) activity at different forces and durations of the brain retraction in the cat models simulating the frontal approach of the pituitary surgery. Twenty-six adult cats weighing from 2.4 to 4.5 kg were used in this study. The animals were divided into 3 groups : control(n=6), 20g-retraction(n=10), and 30g-retraction groups(n=10) respectively. The brain retraction was produced by applying the lead weight with the stainless steel retractor on the right frontal lobe through a craniectomy over the right frontal bone. The weight(20g or 30g) was supported with the pulley so that its long axis was perpendicular to the cortical surface, The measurements of rCBF activity were carried out in each animal before and immediately after brain retraction at 30 min, 60 min, 90 min, 120 min and 180 min after retraction. The results were as follows ; 1) After brain retraction, there were rise in intracranial pressure, bradycardia, elevation in blood pressure and alteration in respiration at 60 min after brain retraction. 2) Normal control flows(rCBF, ml/100g/min) were 39.7+/-6.1 in the right frontal, 37.8+/-2.6 in the left frontal, 37.5+/-3.6 in the right parietal and 38.8+/-4.1 in the left parietal lobes. 3) A considerable reduction in rCBF was demonstrated at 60 min after brain retraction. A reduction of rCBF to 40% of control flow(19.5+/-7.5ml/100g/min) was found at 60 min after retraction in the right frontal with the 20g-retractor. With the 30g-retractor, rCBF were reduced to 64% of control flow(13.3+/-6.8ml/100g/min) at 60 min and 90% of control flow(4.0+/-2.1 ml/100g/min) at 180 min after retraction in the right frontal lobe. 4) A close correlation was found between EEG activity and rCBF changes, suggesting a threshold relationship. The changes of EEG activity began to be noted at the rCBF value of less than 20.0 ml/100g/min. A 50% suppression of the EEG activity appeared at the rCBF value of 4.0+/-1.2 ml/100g/min. It is concluded that EEG activity is secondarily is secondarily suppressed by reduction in local blood flow which is caused by local compression. It is advisable to retract the brain with the least force necessary and for the shortest time possible. It is also suggested to resect the brain partially before retraction to avoid irreversible ischemic infarction of the brain in consequence of forceful, longtime retraction in exploration of deep intracranial lesions.

A Case of Cerebral Candidal Granuloma

Candidosis, the most common fungal infection involving the central nervous system, is rarely diagnosed during life. The authors present a case of candidal granuloma of the caudate area in a 31-year-old, otherwise healthy man with episode of intermittent antibiotic therapy. There was no extracranial fungal lesions, Ventriculoperitoneal shunt and biopsy followed by treatment with Amphotericin-B resulted in a favorable outcome.

A Case of Traumatic Spinal Epidural Hematoma in Ankylosing Spondylitis

A case of traumatic thoracolumbar epidural hemorrhage is presented in a 37-year-old man with ankylosing spondylitis. The patient complained neck and back pain right after the accident but paralegia and difficult urination followed 2 days later. Spine CT showed thoracolumbar epidural mass, which was confirmed to be hemorrhage associated with spine fracture and was solely responsible for paraplegia.

A Case of Oligodendroglioma of the Cerebellar Vermis

In the posterior fossa rarely develops oligodendroglioma and a review of the literature yields reports of two cases in the 4th ventricle in Korea. The authors present a case of 65-year-old woman patient with only the symptoms of increased intracranial pressure such as headache, dizziness and vomiting in spite of a large, irregular calcified mass occupying the cerebellar vermis on the brain CT scan. The caudal portion of the tumor attached firmly to the floor of the 4th ventricle and the complete removal of the mass, associated with a good long-term prognosis, was not feasible.

CO2 Laser in Microneurosurgery

The laser is a new surgical modality that utilizes high intensity beams radiant energy to vaporize of coagulate tissue. Radiant energy is generated by stimulated emission of photons resulting in a unidirectional monochromatic beam that is temporary coherent small diameter beams of great power density are achievable by this means. The author reviewed 24 months experience with a CO2 laser involving neurosurgical operations to 45 neurosurgical lesion, i, e. brain tumor 25, intracerebral hemorrhage 15, cerebral paragonimiasis 1, cysticercosis 1, brain abscess 1, and arteriovenous malformation of brain 1 and spine 1 were removed with the use of Shaplan CO2 laser since 1981. We have conclude that there had been a significant reduction in blood loss and neurological morbidity though it was readily conceded that the number of operations were relatively small. The particular advantages of the combination of CO2 laser and microscope were felt to be precision reduction of mechanical trauma good hemostasis and low cost. Especially the blood loss and replacement during operation have been reduced.

Histiocytosis X Case Report

Eosinophilic granuloma, Hand-Schuller-Christian and Abt-Letterer-Siewe syndrome are known to be the same disease entity involving the reticulohistiocytic system of the body, although their clinical manifestations are different. So they were included under the term of Histiocytosis X and this concept has been generally accepted. The authors have experienced one case of Hand-Schuller-Christian disease and that of eosinophilic granuloma. The former was a 23 years old man with complaints of exophthalmos, polyuria and a tender palpable mass on the right parietal area and in the latter a soft pulastile mase located on the left parietal area in a 3 year old boy. There was no neurological deficits on their admission. We managed them with radiation and steroid therapy following surgical curettage.

A Case of Carotico-Cavernous Fistula Treated by Intraluminal Occlusion

A case of carotico-cavernous fistula was managed by intravascular occlusion using a Fogarty catheter and ligation of the carotid artery. The fistula was obliterated by the procedure and neurologic deficits improved progressively without further recurrence. The radiological feature, symptomatology and surgical management were discussed.

A Case of Spontaneous Cerebellar Hemorrhage

Spontaneous cerebellar hemorrhage is classically considered a rare and fatal disease because the early diagnosis is very rarely made during the life, and there is scant mention of the problems of spontaneous hemorrhage into the cerebellar hemisphere. However our opinions indicate that its frequency is greater than is generally thought although it is considered a rare lesion. The purpose of this paper is to record our present opinions concerning the possible early diagnosis and surgical management of the spontaneous cerebellar hemorrhage. We believe that it is possible by clinical examination alone to make or strongly suspect the diagnosis in life during the early stage before irreversible damage occurs and that emergency surgical intervention is strongly indicated. The patients is a 38 year old man admitted to the Department of Neurosurgery, Catholic Medical Center on Nov 3, 1976 with severe headache, vomiting, dysarthria and mental confusion. On examination, he was disclosed mental confusion, repeated vomiting, constricred pupil, horizontal nystagmus, inability to stand, dysarthria and neck stiffness. We confirmed the diagnosis under the cerebellar hemorrhage involving the cerebellar vermis and both cerebellar hemispheres by means of vertebral and carotid angiography, conray ventriculography, and cerebrospinal fluid examination. We underwent suboccipital craniectomy with the evacuation of hematoma at the vermis and both cerebellar hemispheres after 48 hours of onset of illness and his postoperative course was good except for mild cerebellar dysfunction signs and he was discharged on 45th hospital days.

A Case of Intracranial Arachnoid Cyst

The intracranial arachnoid cyst is distinctly uncommon and they have unusual clinical course. The plain skull series were usually shown bulging of the overlying skull due to progressive collection of cerebrospinal fluid in cystic cavity. Pre-operative diagnosis is unlikely to be made. The predilection sites of this lesion are usually convexity of hemisphere, cisterna chiasmaticus, especiaily forebrain along the axis of main cerebral artery. The authors report a case of intracranial arachnoid cyst arisen along the Sylvian fissure combined chronic subdural hematoma follwoing sustained mild head injury. The pathologic diagnosis was arachnoid cyst, since the removed cyst wall was normal arachnoid tissue.

Analysis on the Result of Treatment of Hypertensive Intracerebral Hemorrhage

We have experienced 109 cases of hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery of Catholic Medical Center from January 1973 to August 1976. We analized the result of treatment of hypertensive intracerebral hemorrhage and assessed prognostic factors affecting the results of surgical treatment of hypertensive intracerebral hemorrhage. 1. The age of the patients did not significantly influence on the mortality of operative or non-operative cases provided the age is below sixty. 2. The amount of hematoma did not directly related to the outcome of operated cases if the hematoma is less than 50ml, while the mortality was considerably increased if the clot was more than 50ml. 3. There was no specific difference in operative mortality between total evacuation and partial evacuation of hematoma in surgery of the hypertensive intracerebral hemorrhage, but total evacuation had better result than that of partial evacuation in the functional recovery. 4. The operative mortality of the hypertensive intracerebral hemorrhage was 43.6% and 55.7% in non-operative cases. Thalamic hemorrhage carried the highest mortality either operated or conservatively treated. 5. The surgical treatment carried better result than non-operative treatment in the case showing progressive change in consciousness following intracerebral hemorrhage. Conservative treatment obtained good result in the cases showed progressive improvement of conscious level following intracerebral hemorrhage. 6. The interval from the ictus to surgical intervention did not constantly influence on the result of surgery and it might be wise to decide the time of surgical intervention according to the progressive changes in conscious level and neurological status after bleeding. 7. The operative result was favorable in the patients who has shown progressive worsening of conscious level and neurologic status following clear conscious at hemorrhage (class II). We also noted that the patients were unconscious at ictus then became progressively stupor with increasing neurologic deficit showed better result with surgical treatment than non-operative care.