A Case of Ceruminous Adenoma Arising from the External Auditory Canal / 고신대학교의과대학학술지

Ceruminous adenoma is a benign neoplasm of the ceruminous gland, and its development in human external auditory canal is very rare. Due to the limited number of cases, controversy still exists about nomenclature, classification, diagnosis and its treatment. Recently we experienced a 55 years old woman who was diagnosed with ceruminous adenoma of the external auditory canal, and who was treated with wide excision. So we report this uncommon case in combination with a review of the literature.

Risk Factors of Work-related Musculoskeletal Symptoms Among Motor Engine Assembly Plant Workers / 대한산업의학회지

OBJECTIVES: To determine the synthetic risk factors of musculoskeletal disorders, and to examine effect on musculoskeletal symptoms of physical work intensity and change of work intensity. METHODS: Self-administered questionnaraire survey was conducted on 588 motor engine assembly workers, in Chanwon, Kyungnam provance, Korea, from April 1 to May 31, 2003. The contents of the questionnaire investigation included general characteristic items, workrelated characteristic items, presence of musculoskeletal symptoms, ergonomic risk factors items, job stress items, current physical work intensity and changes of work intensity items. The results underwent statistical analysis with frequency test, t-test, and logistic regression. The statistical significance level was 0.05, and SAS(v8.1) was used. RESULTS: Multiple logistic regression analysis was used to examine the relationship between risk factors and musculoskeletal symptoms. From the results, significant variables were high Quick Exposure Check (QEC) score, high job demand control, physical work intensity, change of work intensity. CONCLUSION: Among the known risk factors of musculoskeletal disorders, the outbreak of musculoskeletal symptoms was confirmed to be correlated with age, tenure, ergonomic risk factors, and job stress. Physical work intensity and the changes of work intensity were also related to musculoskeletal symptoms.

Atrophy of brown adipocytes in the adult mouse causes transformation into white adipocyte-like cells

Adipose tissue is an important endocrine regulator of glucose metabolism and energy homeostasis. Researches have focused on this tissue not only as a target for pharmacotherapy of obesity and insulin resistance but also as an endocrine tissue with leptin secretion and high insulin sensitivity. Brown adipose tissue (BAT) additionally plays a unique role in thermoregulation through the mitochondrial uncoupling protein 1 (UCP1), which uncouples oxidative phosphorylation. As a genetic tissue ablation model of BAT, we made transgenic mice expressing herpes simplex virus thymidine kinase (HSV-TK) driven by the brown adipocyte- specific UCP1 minimal regulatory element. The HSV-TK transgene was expressed specifically in BAT and more than 35% increase of apoptosis was induced by ganciclovir (GCV) treatment. Nevertheless, the expression level was not high enough to induce BAT ablation in GCV-treated adult mice. Importantly, however, we found that brown adipocytes in the periphery of interscapular BAT were transformed into white adipocyte-like unilocular cells. These cells express white adipocyte-specific leptin protein but are different in the ultrastructure of mitochondria from classical white adipocytes. Our data indicates that atrophy of BAT causes transformation into white adipocyte-like cells in the adult mouse and also suggests that further molecular understanding of adipocyte plasticity using our transgenic mouse model might be beneficial for the development of anti-obesity/anti-diabetic therapies.

Effect of stimulation of cerebellar fastigial Nucleus on focal Cerebral Infaretion in Rat

Electrical stimulation of the cerebellar fastigial nucleus(FN) increases cerebral blood flow(CBF) and reduces brain damage after focal cerebral ischemia. The authors studied whether the neuroprotection elicited from electrical stimulation of the cerebellar FN is attibutable to the elevation in regional CBF(rCBF) or reduction in release of excitatory amino acid sprague-Dawley rats were anesthtized with a mixture of halothane(3% for the indurction and 1% for maintenance) and oxygen and artificially ventilated through a tracheal cannula. Arterial pressure, blood gases and body temperature were monitored. The middle cerebral artery(MCA) was occluded distal to the lenticulostriate branches. The FN was then for 2 hours, over the regions corresponding to the ischemic core and penumbra. Postiischemic release of glutamate and aspartate were measured by microdialysis for 2 hours at the same site of measurement of rCBF. Infarct volume was determined 8 hours later in 2,3,5-triphenyl tetrazolium chloride(TTC)-stained sections FN stimulation(n=12) increased mean arterial pressure by 28+/-16mmHg. In nonstimulated control rats(n=12), mean AP was not changed significantly during the experimental procedures. Compared with nonstimulated animal, stimulation of FN for 1 hour following MCA occlusion siginficantly increased rCBF in ischemic core and penumbra by 53.6% and 67.6% respectively. And the volume of infarction decreased by 42% at 8 hours after MCA occlusion. The concentration of glutamate and aspartate in ischemic core after MCA occlusion increased both in the control group(to 12.2+/-3.3 folds and 10.4+/-4.1 folds respectively) and in the stimulation group(10.5+/-2.8 and 11.2+/-4.1 folds, respectively). The concentration of glutamate and aspartate in penumbra did change significantly neither in the control group(to 2.5+/-1.3 folds and 1.8+/-0.6 folds respectively) nor in the stimulation group(1.9+/-0.5 folds and 2.1+/-0.4 folds, respectively). There was no significant difference between the two groups.

A Case of Multiple Meningiomas: Case Report

The neurosurgical frequency of multiple intracranial meningioma is low. The authors report a case of multiple meningiomas of supratentorial region and posterior fossa. The patient was 57-year-old female and presented with severe headache and vomiting. Computerized tomography and magnetic resonance imaging revealed multiple meningiomas in right parasagittal region. right temporal region and posterior fossa. The patient was treated successfully by stage operation and all of these pathological types was meningotheliomatous meningioma.

Problems in the Treatment of Patients with Ankylosing Spondylitis

The characteristic pathological lesions in ankylosing spondylitis are vertebral body osteoporosis, ankylosis of the apophyseal joints, intervertebral disc calcification, and ligamentous ossification. Calcification of the annulus fibrosis reduces the movement and elasticity of the intervertebral disc, causing this point to be the site of least resistance when the spine is subjected to trauma. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. The ligamentous fragility and multiple fused vertebral segments cause the fractured ankylosing spondylitic spine to resemble a long-bone fracture. In ankylosing spondylitis patient who have sustained minor trauma, a complete radiological study of the entire spine and not just the symptomatic region must be performed for an accurate diagnosis, so that any fracture possible along the spine can be detected and thus prevent any medicolegal problems. The authors report 4 cases of ankylosing spondylitis including 2 cases with severe neurological abnormalities that had occurred after minor trauma.

Pain Relief from Dorsal Root Entry Zone(DREZ) Lesions Made with CO2 Laser in Brachial Plexus Injury Patients

Treatment of pain related to various types of deafferentation remains a neurosurgical challenge. Medical therapy and conventional surgical techniques for pain relief have not been effective due to this problem. Six patients with intractable pain following a brachial plexus injury were treated with dorsal root entry zone(DREZ) lesions. These lesions were made with CO2 laser. All patients were followed from 5 months to 5 years after surgery. Two-third of the patients were relieved of more than 50% of their preoperative pain. Post-operative neurosurgical complications were ipsilateral leg weakness and loss of proprioception in 2 cases. The laser technique is exact, makes uniform lesion, shortens the duration of the procedure, lessens cord manipulation and makes shalow penetration into the surrounding spinal cord. Dorsal root entry zone(DREZ) lesions made with CO2 laser appeared to be a satisfactory treatment for brachial plexus injury patients who have failed to respond to more conservative modes of therapy.

Three Cases of Ossification of Ligamentum Flavum Causing Thoracic Myelopathy

The authors report three cases of ossification of ligamentum flavum causing thoracic myelopathy. The symptoms of all cases were numbness in the legs and feet and motor weakness. Preoperative diagnosis were simple spine X-ray, metrizamide CT and magnetic resonance imaging. There was satisfactory improvement in all cases after total laminectomy and medial facetectomy.

Clinical Analysis of Gun Shot and Explosive Injuried Patients of the Brain

A series of 24 cases of gun shot and explosive injuried patients of the brain is analyzed according to causes, types, operability, the relation between Glasgow coma scale(GCS) and operative mortality, associated injuries, complications and sequelae. The authors notice that gun shot and explosive injury of the brain are more worse than blunt head trauma because of injury mechanism by itself.

A Clinical Analysis of Surgically Treated Head Injury on Military Personnel

During the three years from March, 1983 to Feb, 1986, 159 cases of head injury surgically treated in the department of neurosurgery, Capital Armed Forces General Hospital were clinicostatistically analysed and discussed with the review of the literature. The following results were obtained.1) Due to the army distinctiveness, all cases were male and the age incidence was becoming maximal at the third decade. 2) Traffic accidents form by far the largest Group(38.4%), and next are, in order of incidence, accidents due to fall from height, simple fall(19%), exercise(12.6%), gun shot wound or explosive injury(9.4%) and assault(9.4%). 3) Skull fracture were seen in 115 cases(72.3%), and nearly half of those 55 cases, were linear fracture. 4) Of the 133 patients with intracranial hematoma or subdural hygroma, 88 cases(66.7%) were accompanied by skull fracture. 93% of epidural hematomas were associated with skull fracture and the most common wite of hematoma was temporoparietal area. 5) Of all cases of subdural hematoma, acute type was prevalent(59.4%) and its main site involved was temporoparietal area. 6) The associated injuries were found in 22.6% of patients. The frequent ones were facial bone fracture, upper extremity fracture, clavicle fracture, and chest injury, in order. 7) The minor head injury of Glasgow coma scale score(GCS) of 13 to 15 was 68 cases(42.8%). The moderated head injury of 9 to 12 was 28 cases(17.6) and the serve head injury of 3 to 8, 63 cases(39.1%). 8) The operation mortality was 26.8% and the good recovery was achieved 55.4% of patients. The remaining 18.8% resulted in disabled or vegetative state. 9) In the accidents of gun shot wound or explosive injury, operation mortality rate was 60%, but 5 cases(33.3%) were seen good recovery.

A Case of Cystic Cavernous Hemangioma

We experienced a case of cavernous hemangioma suspected to cerebral cysticecosis. The 23-year-old male patient was admitted to our hospital due to sudden severe headache and generalized tonic-clonic seizure. The computerized tomography showed multiple calcification of bilateral cerebral hemisphere, especially right, and cystic mass on right frontal area with mass effect. The mass was diagnosed cavernous hemangioma under the microscopic examination.

A Case of Oligodendroglioma in the Septum Pellucidum

The authors report a case of oligodendroglioma in the septum pellucidum. A 22-year-old male presented with symptoms of headache and decreased visual acuity. Simple skull series showed calcified density near the midline. Brain C-T scan revealed huge calcified mass involving right lateral ventricle, 3rd ventricle and obstructive hydrocephalus. The authors diagnosed oligodendroglioma in operative findings and pathologic examination.

Transoral Fusion of the Odontoid Process Fracture

The Odontoid process fracture has been treated by prolonged external immobilization of by internal fixation and fusion. We reported congential and traumatic odontoid process fracture which were successfully treated by transoral fusion. Operative preparation, technique and postoperative management are described by in detail.

A Case of Thoracic Spinal Canal Stenosis

A compression of spinal cord or nerve roots is commonly seen sequale of acquired or congenital stenosis of the cervical of lumbar portions of the spine. The authors have treated a case of thoracic myelopathy associated with thoracic canal stenosis, which was diagnosed with thoracic myelography and thoracic C-T scan. The pathological findings was thickened ligament flavum, hypertrophied articular processes, narrow spinal canal and compression of spinal cord. It is suggested that the syndrome should be considered in any patient who has a thoracic myelopathy.

The Upper Gastrointestinal Mucosal Lesion / 대한소화기내시경학회지

Clinical and endoscopic features on 86 patients with acute upper gastrointestinal mucosal lesien were evaluated. Males were predaminant about 3 times of female. Most of patients were in 4 th to 6 th decade. The prevalent locations were proximal part of the stomach and dodenal bulb. Most,freqent chief camplaints was epigastric pain. Eeloscopieally aoute ulcers were characterized by shallow in depth, variant size and shape, rather clear ulcer margin without mucosal fold eonvergence and multiple lesions rather than sigle. The inducing factors of the acute mucosal lesiona whiah were noted were alcohol, HCI, analgesics, herb drug, steroid, antibiotlies and orgaaie ipheephorus.

Bleeding Gastric Ulcer - Clinical Observation of 120 Cases of Bleeding Gastric Ulcer) / 대한소화기내시경학회지

Analyses were done on one hudred and twenty caaes of bleeding gastric ulcers diagnosed by emergency endoscopy for the past five years. The reaults are as the following: Much more cases were found in male than female and the most prevalent age group was 6th decade. The body of stomach along the lesser curvature was the most common bleeding site. No age related difference was noted in bleeding sites. Most common type of ulcer was in the round and shallow form. Five of six cases with exposed vessels showed atrophic changes in surrounding mucosa. Among the probable precipitating factors, analgesica, alcohols and certicosteroids were found in such order,

Acute Effect of Methylprednisolone in Experimental Spinal Cord Injury

It is the purpose of this study to determine the benificial effect of treatment with methylprednisolone on the enhancement of Na+, K+-ATPase activity and the increased ATP level during the 4 hours after a 400gm-cm injury to the spinal cord of cat. These results demonstrate that high dose (30mg/kg) of methylprednisolone can benificially enhance the activity of neuronal Na+, K+-ATPase during the first 4 hour after spinal cord injury. But the enhancement of this enzyme activity is not significantly increased with mega dose (60mg/kg) of methylprednisolone. Tissue level of ATP in the high dose-treated cat at 1 hour after trauma was significantly elevated, but those in high dose-treated cat at 4 hour and the 1 and 4 hours with mega dose-treated groups were not significantly increased. The protective effects of methylprednisolone in experimental spinal cord trauma are the enhancement of Na+, K+-ATPase, inhibition of the free-radical reaction and the lipid peroxidation, the increment of neuronal activity and ATP utilization. High dose(30mg/kg) of methylprednisolone is required in order to produce the acute effect in the early phase experimental spinal cord injury.

Systolic Time Intervals in Valvular Heart Disease

Systolic time intervals were studied in a total of 83 patients with pure or predominant isolated valvular heart disease. They consisted of three groups of patients : namely, 38 cases of mitral stenosis, 25 cases of mitral regurgitation and 20 cases of aortic regurgitation. The mean of the electromechanical systole was within normal ranges in all three groups, and threre was no significant difference between the groups. The mean of the left ventriclar ejection time was also within normal limits in all groups, as was that of the electromechanical systole, but it was significantly shorter in patients with mitral regurgitation than in the others, and was significantly longer in patients with aortic regurgitation. The mean of the pre-ejection period and the ratio of the pre-ejection period to the left ventricular ejection time were within normal ranges in patients with aortic regurgitation, whereas both parameters were significantly increased in patients with mitral stenosis or mitral regurgitation, particularly in the latter.