Transient visual loss after lung surgery in a healthy patient: posterior reversible encephalopathy syndrome: A case report

Postoperative visual loss is a rare complication of general anesthesia in patients undergoing lung surgery. If the visual complication is permanent, it can greatly affect the patient's quality of life. Posterior reversible encephalopathy syndrome (PRES) leads to visual disturbances and may be associated with hypertension, renal disease, eclampsia, and chemotherapy. Although PRES is usually reversible, delayed diagnosis and treatment can result in permanent damage. We herein report a case of PRES in a patient with no medical history. The patient's symptoms included somnolence, visual loss, and headache. He was treated with conservative therapy, and his vision abruptly recovered three days after surgery. He was discharged from the hospital without neurologic complications 13 days after surgery.

Immunostimulatory Activity of Apios Tuber Extract on RAW264.7 Macrophage Cells

Apios americana Medik tubers are medicinal foods with anti-cancer and anti-inflammatory activities. However, mechanisms of immunostimulatory action of the Apios tuber extract (ATE) on macrophages have not been elucidated. In the present study, we investigated whether ATE could modulate immune responses, such as production of nitric oxide (NO), proinflammatory cytokines, and transcription factors, in RAW264.7 macrophage cells. ATE significantly increased the production of NO and proinflammatory cytokines such as interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α), and induced the mRNA and protein levels of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) and proinflammatory cytokines in a dose-dependent manner. Furthermore, Western blot analysis revealed that ATE activated the transcription factor Nuclear Factor-κB and mitogen-activated protein kinases signaling cascades, including extracellular signal-regulated kinase, c-Jun N-terminal kinase, and p38 kinase. In addition, we found that ATE induced the activation of macrophages through upregulation of toll-like receptor 4 (TLR4) and TLR2. Taken together, these findings indicate that ATE possesses a potential as a functional food with immunostimulatory activity.

Posterior Interspinous Fusion Device for One-Level Fusion in Degenerative Lumbar Spine Disease : Comparison with Pedicle Screw Fixation - Preliminary Report of at Least One Year Follow Up

OBJECTIVE: Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw. METHODS: From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups. RESULTS: The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively 7.16+/-2.1 and 8.03+/-2.3 in the IFD and pedicle screw groups, respectively, and improved postoperatively to 1.3+/-2.9 and 1.2+/-3.2 in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029). CONCLUSION: Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.

A Study of the 18 Deaths Due to Multiple Gunshot Wounds with Korean Military Rifles (K-1 and K-2) / 대한법의학회지

Forensic interpretation of whether the manner of death is suicide or homicide is very important in death cases due to multiple gunshot wounds. We analyzed 18 death cases from multiple gunshot wounds with Korean military rifles (K-1 and K-2) in the Republic of Korea Army from 2000 to 2011. In cases of the suicide, distance of gun from the body was all contact or near-contact range, except for 1 case of near range. When the selector was set to single shot, the initial entrance wounds were formed on the typical suicidal areas. The bullet tracks, however, did not involve the anatomical regions that would cause immediate incapacitation. The following entrance wounds also were sustained on the typical suicidal areas while the bullet tracks were made in the immediate incapacitation regions. When the selector was set to precision shot or multiple shot, the initial entrance wounds were located on typical suicidal areas, and the entrance wounds resulting from following bullets were gradually moving away form the initial entrance wound due to pop-up effect of the rifle. In cases of the homicide, distance of gun from the body was all distant range and the location of entrance wounds were not significantly related to typical suicidal areas.

The Relationship between Suicide by Hanging and Lunar Phase in ROK Army / 대한법의학회지

The authors investigated the death days of 246 people who committed suicide and converted them into their respective days in lunar calendar in order to see if there are any correlations with the cycle of months. The cycle of the months was divided into the first quarter, full moon, last quarter, and the new moon. The death days were investigated by daily statistics each, and they were investigated in relation with the cycle of the months regarding the occurrence of suicide, holidays, and weekends. There were twice as many people committing suicide when the moon is dark than when it is full moon, but there weren't much significance when judging from the big context. There were three times as many people committing suicide in a short period of time when the moon is dark than when it is full moon, but there wasn't much significance when judging from the big context. There wasn't anything special about suicide in daily basis. There wasn't a big inclination in the number of people committing suicide over holidays or weekends despite common belief. If we find the correlation between the psychological factors and the actions of those who commit suicide in the military, we could contribute to adjusting to some extent the actions of those who have the potential of committing a suicide. Out of such expectation was proceeded this research.

The Investigation for Damage Patterns by Experimental Detonations of a Hand Grenade / 대한법의학회지

Deaths caused by grenades hardly occur except for during wartime, and can be seen as a particular incident that can be observed only within the military or by acts of terrorism. However, there has never been any data which tried to analyze the damage patterns through mock grenade explosions. So far, the processes leading to deaths were merely inferred by reconstructing the situation with limited intelligence after the incidents have already occurred. Therefore, the authors believe that having mock grenade explosions in order to compare and study the observances with those of the actual incident will be helpful for a more precise and objective medical jurisprudence, and thus have summarized the damage patterned obtained on 8 butchered pigs, that were 6~8 months old, about 100 cm in length and 70~100 kg in weight by photographing with radioactive rays and running autopsies after detonating grenades on them. In conclusion, if there was extensive loss of body parts, the grenade probably exploded when in contact with the lost body parts. If fractures were found the grenade is likely to have detonated contacting or within 25 cm of distance with the body, and if there were no lacerations or loss of body parts the grenade probably exploded at a distance of at least 50 cm. If soot was prevalent on the deceased's body, the grenade is likely to have exploded within a distance of 25 cm from the body at a free floating state, in which it was not in contact with the ground or the body. Lastly, if no soot was found, the grenade most probably detonated at a distance of 50 cm or more. The posture or the direction of the body cannot give precise clues of the victim's state before theexplosion, and a hasty presupposition could be very dangerous in case of contact explosions especially.

Primary Intramedullary Spinal Sarcoma : A Case Report and Review of the Current Literatures

Primary central nervous system (CNS) sarcomas are exceedingly rare, and, to the best of our knowledge, there has not yet been a report of intramedullary sarcoma. Here, we report a primary intradural intramedullary sarcoma of the spinal cord in a four-year-old boy who presented with low back pain and a radiculopathy involving both lower extremities. The tumor showed significant enhancement on magnetic resonance (MR) images due to its extreme vascularity. Gross total tumor removal was performed with microelectrical pulse recording, and the patient also received adjuvant radiotherapy and chemotherapy. After the operation, the patient's sensory deficits were improved. Because CNS dissemination is common, entire neuraxis evaluation is essential, although there was no evidence of dissemination in this case. The prognosis of primary CNS sarcoma is poor due to infiltrative nature and early CNS dissemination is common, and the treatment of choice is radical surgical resection. Adjuvant therapy is also beneficial with radiotherapy and chemotherapy.

Rod Migration into the Posterior Fossa after Harms Operation : Case Report and Review of Literatures

C1 lateral mass and C2 pedicle (C1LM-C2P) fixation is a relatively new technique for atlantoaxial stabilization. Complications from C1LM-C2P fixation have been rarely reported. The authors report unilateral rod migration into the posterior fossa as a rare complication after this posterior C1-C2 stabilization technique. A 23-year-old man suffered severe head trauma and cervical spine injury after vehicle accident. He was unconscious for 2 months and regained consciousness. He underwent C1LM-C2P fixation for stabilization of type II odontoid process fracture described by Harms. The patient recovered without a major complication. Twenty months after operation, brain computed tomogram performed at psychology department for disability evaluation showed rod migration into the right cerebellar hemisphere. The patient had mild occipital headache and dizziness only regarding the misplaced rod. He refused further operation for rod removal. To our knowledge, this complication is the first report regarding rod migration after Harms method. We should be kept in mind the possibility of rod migration, and C1LM-C2P fixation should be performed with meticulous technique and long-term follow-up.

Intranodal Palisaded Myofibroblastoma with Desmin Expression : A Brief Case Report

Intranodal palisaded myofibroblastoma is a rare benign mesenchymal neoplasm of the lymph node. It is characterized by intranodal spindle cell proliferation along with amianthoid fibers and prominent hemorrhage. It has been rarely reported in South Korea. We report here on a case of palisaded myofibroblastoma that arose in the left inguinal lymph node. The tumor mass was well demarcated, and it was composed of a proliferation of benign-looking spindle cells. It showed focal hemorrhage and a fibrous pseudocapsule. The tumor cells displayed little pleomorphism, no mitotic count, and characteristic palisading nuclei and amianthoid fibers. The tumor cells were positive for smooth muscle actin, vimentin, and also for desmin, but they were negative for S-100 protein, supporting the diagnosis of myofibroblastoma.

The Prognostic Significance of Neuroendocrine Differentiation for Treating Prostatic Carcinoma in 699 Cases of Radical Prostatectomy

BACKGROUND: Neuroendocrine differentiation of prostatic carcinoma is known to be associated with a poor prognosis, tumor progression and androgen-independency, and there is currently no successful therapy for this type of tumor. The purpose of this study is to evaluate the prognostic implications of neuroendocrine differentiation in prostatic carcinoma in Korean men. METHODS: Six hundreds and ninety nine consecutive cases of radical prostatectomy specimens were systematically processed for topographic mapping. Neuroendocrine differentiation was detected by immunohistochemistry by using antibody to chromogranin. We analyzed the relationship between neuroendocrine differentiation and the clinicopathological prognostic factors, as well as biochemical failure. The neuroendocrine differentiation was evaluated according to the presence of chromogranin-positive cells, the pattern of neuroendocrine cells and the number of neuroendocrine cells, respectively. RESULTS: Neuroendocrine differentiation was detected in 150 out of 699 cases (21.5%). The presence of neuroendocrine differentiation as well as the pattern of neuroendocrine cells was correlated with biochemical failure and the other clinicopathological prognostic factors such as the Gleason score, the pathologic stage, the tumor volume, angiolymphatic invasion, perineural invasion, and the Ki-67 proliferative index (p<0.05). CONCLUSIONS: We suggest that neuroendocrine differentiation of prostatic carcinoma is a prognostic factor even in radical prostatectomy specimens for localized prostate cancer. Evaluation of the presence of neuroendocrine differentiation as well as the pattern of neuroendocrine cells is recommended in radical prostatectomy specimens.

The Prognostic Implications of the Histologic Subtype and the Expression of Phosphorylated ERK 1/2 in Papillary Renal Cell Carcinoma

BACKGROUND: The authors of this study wanted to confirm the prognostic implication of the histologic subtype; further, we wanted to explore the expression of phosphorylated extracellular signal-regulated kinase 1/2 (pERK) in papillary renal cell carcinoma (PRCC) and determine its clinicopathologic and prognostic significance. METHODS: A total of 45 patients who underwent nephrectomy for PRCC were enrolled in this study. The hematoxylin and eosin slides were reviewed and pERK immunohistochemistry was performed. RESULTS: Type 2 PRCC was significantly correlated with a larger tumor size (p=0.030), a higher nuclear grade (p<0.001), a more advanced tumor stage (p=0.041) and more frequent distant metastasis (p=0.019). The tumors were pERK-low (0 and 1+) in 30 cases (66.7%) and pERK-high (2+) in 15 cases (33.3%). The pERK-high PRCC was significantly associated with a smaller tumor size (p=0.001) and an earlier tumor stage (p=0.004). On the univariate analysis, the histologic subtype, the TNM stage and the pERK status were significantly associated with progression-free survival (PFS). Multivariate analysis showed that the histologic subtype (hazard ratio 22.81, p=0.042) and the TNM stage (hazard ratio 23.48, p=0.009) were independent prognostic factors for PFS. CONCLUSIONS: Type 2 PRCC, together with the TNM stage, was identified as one of independent poor prognostic factors for PFS. The pERK status was a prognostic factor for PFS on the univariate analysis, but not on the multivariate analysis.

Expression of Substance P in the Experimental Diabetic Rat Retina / 대한해부학회지

Substance P (Sub P) being composed of 11 amino acids sequence is a kind of tachykinin family peptides. It has been known that this substance plays a role of neurotransmitter and/or neuromodulator and is a very potent vascular growth factor in the nervous system. This study has been investigated expression pattern of Sub P in the rat retina at normal and alteration of Sub P expression following diabetic injury using immunohistochemistry. Diabetic condition was induced by a single injection of streptozotocin in Sprague-Dawley rats aged 8 weeks. The animals showing high blood glucose levels (above 300 mg/dL) were cared for 1, 4, 8 and 12 weeks, respectively. The whole-mounted or sectional preparations of the retinas were used for Sub P immunohistochemistry. Sub P immunoreactivity has been localized in subsets of amacrine cells in the inner nuclear layer (INL) and displaced amacrine cells in the ganglion cell layer (GCL) in the normal retina. The dendrites from amacrine cells in the INL were ramified with strata 1 and 3, and those from displaced amacrine cells in the GCL with strata 5 of the inner plexiform layer. Sub P immunoreactive neurons in both the INL and the GCL were more densely populated in the superior half of the retina. During diabetes, the cell number of Sub P immunoreactive neurons was decreased to one third of the normal value at 4 weeks of diabetes and then slightly increased to half of the normal value at 12 weeks of diabetes. In addition, Sub P mRNA levels were reduced at 4 weeks but reincreased at 12 weeks. These results suggest that Sub P in the rat retina at normal state may function differentially in the superior or the inferior halves and Sub P synthetic pathway in the retinal neurons maybe irradiated in earlier stages of diabetic retinopathy.

Apoptotic Neuronal Death in the Mouse Brain Induced by Experimental Japanese Encephalitis Virus Infection / 대한해부학회지

Japanese encephalitis virus (JEV)may cause acute encephalitis in humans and induce severe cytopathic effects in various types of cultured cells. To investigate whether JEV infection induces apoptosis, we examined DNA fragmentation and apoptosis in the specific region of the JEV infected mouse brain by DNA oligonucleosomal laddering and in situ terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL)technique and immunohistochemical study. JEV infections in the mouse brain were detected in the telencephalon, the diencephalons, and the brain stem, but not in the cerebellum and the hippocampus. Fragmentation of cellular DNA into oligonucleosome-length ladders was only observed in tissue samples prepared from the cerebral cortex. In addition, the large number of TUNEL-positive cells was observed in the cerebral cortex. Double-labeling experiment with TUNEL staining and immunostaining for the JEV showed that TUNEL-positive neurons containing JEV immunoreactivity. These results suggest that JEV infection may evoke apoptotic neuronal death in the mouse brain, which plays an important role in the pathogenesis of Japanese encephalitis.

Maturation of the Neurokinin 1 (NK1) Receptor Immunoreactive Amacrine Cells in the Rat Retina during Postnatal Development / 대한해부학회지

We examined the morphological maturation of amacrine cells expressing neurokinin 1 (NK1) receptor, whose ligand is substance P, in the rat retina, focusing on the period from postnatal day 5 (P5) when the outer plexiform layer is formed, to postnatal day 13 (P13) when the eyes open, with immunohistochemistry using a specific antiserum against NK1 receptor, and we compared maturing NK1 receptor-immunoreactive (NK1 receptor-IR) amacrine cells with adult one. In the adult retina, numerous NK1 receptor-IR amacrine cells were located in the inner part of the inner nuclear layer (INL) adjacent to the inner plexiform layer (IPL), and their processes emerging from the somata branched and stratified at 1, 2, and 5 strata of within the IPL. NK1 receptor-IR amacrine cells were already observed at P5. The cell bodies were located in the inner INL away from the IPL and their processes branched and formed two distinct bands in the IPL. Afterwards, somata of NK1 receptor-IR amacrine cells moved toward the inner part of the INL, and thus, were located in the INL adjacent to the IPL. Their processes formed three distinct bands at P10 and then, at P13, three bands occupied the same strata as those of the adult, which were posed at 1, 2, and 5 strata of the IPL. During the postnatal development, most of NK1 receptor-IR amacrine cells directly extended one or a few primary dendrites toward the IPL and formed the strata. However, some of the labeled cells located at the outermost row had horizontal processes emerging from their primary dendrites, and these horizontal processes branched and formed plexuses in the INL. The NK1 receptor-IR amacrine cells with horizontal processes were frequently observed at P7, rarely at P10, and not at P13 and in the adult. These results indicate that the NK1 receptor-IR amacrine cells of the rat retina morphologically mature by way of migration of their somata within the INL and formation of distinct processes during postnatal development, and suggest that they morphologically and functionally complete the maturation process about the time of P13.

Morphology and Distribution of the Vasoactive Intestinal Polypeptide (VIP)-Immunoreactive Amacrine Cells in the Mouse Retina / 대한해부학회지

Vasoactive intestinal polypeptide (VIP) is a neuroactive substance that is widely expressed in both non-mammalian and mammalian retinas. In this study, we immunocytochemically identified and investigated the VIP-containing neurons in the mouse retina, which has become an important model for the study of the structure and function of the mammalian retina, mainly because of the wide availability of transgenic animals. VIP immunoreactivity was observed in the somata of the amacrine cells in the inner nuclear layer (INL) and their varicose processes ramifying in strata 1 and 3 of the inner plexifrom layer (IPL). The distribution of VIP-immunoreactive (IR) amacrine cells showed a peak of 430 cells/mm2 in the central retina and minimum values of 50 cells/mm2 in the peripheral one. Double-label experiments demonstrated that all VIP-IR amacrine cells possessed GABA immunoreactivity. These results demonstrate that VIP-IR amacrine cells of the mouse retina make up a neurochemically and morphologically distinct subpopulation of the GABAergic amacrine cell population.

Surgical Treatment of Distal Anterior Cerebral Artery Aneurysms

The incidence of the distal anterior cerebral artery(DACA) aneurysm comprises about 2-6% of all intracerebral aneurysms. Because of the low incidence, unique anatomies of the distal anterior cerebral arteries and some technical difficulties in surgery, these aneurysms present such challenge to neurosurgeons. Presently, early surgery using interhemispheric approach is preferred. The auhtors experienced six patients with DACA aneurysms in 130 consecutive intracerebral aneurysms surgically treated between May. 1994 and Dec. 1997. The patients received operations within five days from the ictus, except one patient because of symptomatic vasospasm. The surgical approaches were all unilateral interhemispheric approaches. During the operations, infusion of large amount of mannitol and CSF volume removal were applied, although there were few difficulties in the interhemispheric dissections, the outcomes of the patients were excellent in three, good in three. The authors suggest that early operative interventions using unilateral interhemispheric approach without generous craniotomy can improve the outcomes of the patients with ruptured DACA aneurysm.

One Case of Congenital Complete Atrioventricular Block Diagnosed by Fetal Echocardiography

Congenital complete atrioventicular block is uncommon which has a heterogenous etiology. According to recent studies, about one-third of the mothers of the patients who were diagnosed as congenital complete atrioventricular block, had symptoms or signs of connective tissue disease. Even though the outlook is usually regarded as favorable, the mortality is highest in the neonatal period, much lower during childhood and adolescence and increases slowly later in life. In the neonatal period the predominant indication for pacing was heart failure. It is difficult to make a prognosis in the individual patient. A slow, fixed or decreasing venticular rate neonatally and a prolonged QT interval seem to be bad prognostic sign. We report a case of congenital complete atrioventricular block who was diagnosed by fetal echocardiography. Her mother was asymptomatic, but had positive serologic test to anti-Ro antibody and anti-La antibody. We report a case of congenital complete atrioventricular block with a brief review of related literatures.

GDC(Guglielmi Detachable Coil) Embolization Used in Carotid-Cavernous Fistula Incompletely Occluded by Detachable Balloon

For the treatment of carotid-cavernous fistula, detachable balloon occlusion(DBO) is the method of choice. When it fails, or when the fistula is incompletely occluded, alternative treatment methods include direct surgery and internal carotid artery occlusion at the proximal and distal portion of the fistula. Before ligation or occlusion of the internal carotid artery, however, coil embolization should be considered, as this preserves patent internal carotid artery. The authors used DBO in a 22-year-old male patient with carotid-cavernous fistula which developed after head injury. During the procedures the fistula was partially obstructed by one detachable balloon. In spite of several attempted occlusions with a second balloon, this could not be introduced into the small remnant fistula hole. The second stage of intervention involved embolization with a Guglielmi detachable coil(GDC) ; this was successfully introduced into the partially obstructed fistula, which was thus completely occluded, and the patient's clinical symptoms improved. In this case, GDC emboization was an effective tool for the treatment of carotid-cavernous fistula incompletely occluded by a detachable balloon.

GDC(Guglielmi Detachable Coil) Embolization Used in Carotid-Cavernous Fistula Incompletely Occluded by Detachable Balloon

For the treatment of carotid-cavernous fistula, detachable balloon occlusion(DBO) is the method of choice. When it fails, or when the fistula is incompletely occluded, alternative treatment methods include direct surgery and internal carotid artery occlusion at the proximal and distal portion of the fistula. Before ligation or occlusion of the internal carotid artery, however, coil embolization should be considered, as this preserves patent internal carotid artery. The authors used DBO in a 22-year-old male patient with carotid-cavernous fistula which developed after head injury. During the procedures the fistula was partially obstructed by one detachable balloon. In spite of several attempted occlusions with a second balloon, this could not be introduced into the small remnant fistula hole. The second stage of intervention involved embolization with a Guglielmi detachable coil(GDC) ; this was successfully introduced into the partially obstructed fistula, which was thus completely occluded, and the patient's clinical symptoms improved. In this case, GDC emboization was an effective tool for the treatment of carotid-cavernous fistula incompletely occluded by a detachable balloon.

Cerebellar Botryomycosis: Case Report

A 60 year old male patient with a medical history of pulmonary tuberculosis presented with severe headaches and general weakness. Radiological studies revealed mass lesions both in the right using and the right cerebellar hemisphere. Clinically metastatic brain tumor and tuberculoma were highly suspected. The cerebella mass was totally excised and an unusual pathologic result was reported as botryomycosis. According to literatures reviewed, botryomycosis is a chronic bacterial infectious lesion resembling actinomycosis and mycotic abscess and it has been frequently reported in the skin, subcutaneous lesions and other visceral organs, but the cases of brain involvement were extremely rare. This article is a case report of a cerebellar botryomycosis. The pathologic characteristics and the differential diagnosis of botryomycosis are discussed.