Lexical-semantic Deficit without Semantic Impairment in a Patient with Left Anterior Choroidal Artery Infarction: Neural Correlates Based on Diffusion-tensor Tractography

A 35-year-old male presented with atypical aphasia following left anterior choroidal artery infarction associated with distal internal carotid artery dissection. He presented with 1) lexical-semantic deficit without semantic impairment, 2) frequent surface errors (both surface dyslexia and dysgraphia), and 3) intact non-word reading/repetition (preserved sub-lexical route), suggesting deficit in the phonological output lexicon. Diffusion-tensor tractography analysis revealed disruption in the inferior fronto-occipital fasciculus and inferior longitudinal fasciculus, which might serve as potential subcortical neural correlates for phonological output lexicon.

Sphenoid Sinus Fat Packing in Transsphenoidal Surgery: Long-Term Fate Assessment Using Magnetic Resonance Imaging

Background and Objectives@#Following the transsphenoidal approach (TSA), appropriate sphenoid sinus fat packing has been preferred to prevent postoperative cerebrospinal fluid leakage; however, studies on the behavior of fat tissue transplanted in the sphenoid sinus are lacking. This study aimed to determine the long-term fate of these fat grafts using magnetic resonance imaging (MRI).Subjects and Method: A total of 139 postoperative MRI scans of 41 patients who underwent sphenoid sinus fat packing using the standard TSA were evaluated. Additionally, MRI time series indicating the vital fat volumes were assessed postoperatively. @*Results@#In 82.9% of cases, the fat volumes measured in the final MRI scans declined to 60% of the initial volume. The fat tissue volume decreased significantly with time, with a median half-life of 18 months. Typically, the sphenoid sinus was eventually almost filled with air rather than transplanted fat. In the subgroup analysis, the fat clearance rate was significantly lower in patients with residual tumors than in those without such remnants (p=0.013). @*Conclusion@#Long-term MRI surveillance of fat grafts in the sphenoid sinus revealed that the transplanted fat graft had degraded and was gradually eliminated.

Osteochondroma Arising from Anterior Inferior Iliac Spine as a Cause of Snapping Hip

Snapping hip syndrome is a relatively common problem that can be easily managed with conservative treatment. This syndrome can be divided into external, internal and intra-articular types. Internal snapping hip syndrome is the rarest amongst these and its etiology is not well understood. We report a unique case of osteochondroma arising from the anterior inferior iliac spine (AIIS), which caused the internal snapping hip syndrome with hip pain and restriction of activity. This rare case of snapping hip syndrome from the AIIS was treated surgically and the symptoms completely disappeared after excision of the tumor.

Interictal Motor Cortex Excitability in Migraine and Chronic Tension Type Headache using Transcranial Magnetic Stimulation

BACKGROUND: The pathophysiology of migraine is only partly understood. Transcranial magnetic stimulation has been developed to study cortical physiology noninvasively. Chronic tension-type headache has not been studied with transcranial magnetic stimulation. Among other hypotheses, it has been proposed that interictal hypoexcitability could be partly responsible for the migraine. METHODS: Patients were divided into three groups: normal subjects(n=30), migraine with(n=11) or without aura(n=19) and chronic tension-type headache(n=30) according to the International Headache Society criteria. We studied cortical excitability between normal subjects and patients with migraine with or without aura and between normal and patients with chronic tension-type headache. RESULTS: The mean amplitude of cortex and spinal cord for normal subjects was 3.76 +/-1.74 mV, 2.03 +/-1.54 mV(abductor digiti minimi muscles, respec-tively) and 2.99 +/-2.04 mV, 3.88 +/-3.89 mV(abductor hallucis muscles, respectively). The mean amplitude of cortex and spinal cord for migraine with aura or without aura was 2.16 +/-1.21 mV, 0.90+0.80 mV(abductor digiti minimi muscles, respectively) and 1.88 +/-1.23 mV, 2.31 +/-2.25 mV(abductor hallucis muscles, respectively). The mean amplitude of cor-tex and spinal cord for chronic tension-type headache was 1.61 +/-0.50 mV, 0.72 +/-0.32 mV(abductor digiti minimi mus-cles, respectively) and 1.54 +/-0.55 mV, 1.51 +/-0.59 mV(abductor hallucis muscles, respectively). The amplitude of motor evoked potentials of cortex and spinal cord in migraine and chronic tension-type headache showed significant decreases compared to normal subjects( p < 0.001). CONCLUSIONS: These results are explained by cortical and spinal hypoexcitability in migraine and chronic tension-type headache. We suggest that enhanced serotonergic activity could be some rule for cortical hypoexcitability.

Expression of the Epidermal Growth Factor and Tumor Necrosis Factor-alpha in Lung Cancer / 대한흉부외과학회지

BACKGROUND: Release of Epidermal Growth Factor(EGF) af fects the growth of the lung cancer in various ways and tumor necrosis factor-alpha (TNF-alpha), which is known as acute immune reactants and now used in lung cancer t reatment, supress carcinogenesis of the lung. In this study, expression rates of EGF and TNF-alpha in the lung cancer tissue and the serum of lung cancer patients were measured. MATERIAL AND METHOD: In twenty cases of lung cancer and four cases of benign tumor or granuloma, all patient's peripheral blood was sampled pre, and postopertively, and tumor tissues and tumo r free lung tissues were obtained from resected surgical specimens in all patien ts. Then, all blood samples and tissues were frozen and kept safely in the liqui d nitrogen tank. Human EGF kit(Amersham pharmacia biotech, England) and TNF-alpha I RMA kit (Biosouce, Belgium) were used in quantitation of EGF and TNF-alpha respecti vely. RESULT: 1. Both EGF and TNF-alpha were expressed in all tissues and control tissue, benign tumor or granuloma tis sue, cancer tissue and pre- and postoperatively sampled serum. 2. The amount of EGF and TNF-alpha were significantly higher in cancer tissue than in control and be nign tumor tissues. 3. The expression of TNF-alpha was more potent in adenocarcinom a tissue. 4. The expressed amounts of serum EGF and TNF-alpha were 5.7 times and 1. 3 times higher than in tissue respectively. 5. The expression rates of TNF-alpha in cancer tissue was different according to histologic types of cancer but not dif ferent for EGF. 6. As TNM stages go up the amount of EGF in cancer tissue increa sed but TNF-alpha ecreased. 7. The amount of EGF in serum was increased at immediat e postoprative period but TNF-alpha was decreased. CONCLUSION: The presence of di fference in the expressed amount of EGF and TNF-alpha between cancer tissue and con trol tissue was proven, also the difference was found between tissue and serum r epresenting the concentration of EGF and TNF-alpha which were higher in serum than in tissues. EGF and TNF-alpha are released in all of normal tissue, benign tumor ti ssue and lung cancer tissue and their expression rates were variable according t o cell function. Further research is needed to for the expression of EGF and TN F-alpha in various kinds of cells.

Significance of Ligation of Patent Ductus Arteriosus in Premature Infant / 대한흉부외과학회지

BACKGROUND: Early surgical ligation of patent ductus arteriosus which has a significant hemodynamics and contraindications to the indomethacin therapy is a safe and effective therapeutic modality in premature infants. MATERIAL AND METHOD: From January 1995 to May 2000, 50 premature infants were diagnosed to have patent ductus arteriosus in Kosin University Hospital. There were 22 infants with asymptomatic PDA(Group I) and 28 infants with hemodynamically significant PDA which were treated with indomethacin(Group II, n=5) and surgical ligation(Group III, n=23). Group III had one or more contraindications to indomethacin therapy. Surgical ligation was done in the neonatal intensive care unit. This study is to compare the effects of surgical ligation and indomethacin therapy in premature infant with hemodynamically significant PDA. RESULT: Gestational age(week)and birth weight (g) were shorter and lesser in Group III(29.6 2.1, 1435 431.0) than in Group I(32.1 2.1, 1731 450.9), II(32 1.0, 1830 165.5) significantly(p<0.05), Age at the time of treatment (day) was not different in Group II(8.6 5.5) and III(7.3 4.4)(p<0.05), but body weight at the time of treatment(g) was lesser in Group III(1211 22.4) than Group II (1670 43.6) significantly(p<0.05). Survival rate(%) was higher in Group II(100) than Group III(73.9) significantly(p<0.05). The main causes of deaths were septicemia(5 cases), intracerebral hemorrhage(2), bronchopulmonary dysplasia(2), septic shock(1), and pneumothorax(1), which were not related to the operation. CONCLUSION: Early surgical ligation of hemodynamically significant PDA was a very effective therapeutic modality, and was thought to be safely applicable to the premature infant with contraindication to the indomethacin therapy and the extremely low birth weight.

Expression of Mutant p53 and MAGE-3 Gene Products in Esophageal Squamous Cell Carcinoma / 대한흉부외과학회지

BACKGROUND: Despite recent advances in multimodality therapy, the prognosis for invasive esophageal cancer is poor, with five years survival rate generally below 10%. Therefore, immunotherapy is considered as one of the new therapeutic modality in esophageal cancer. However, expression of tumor specific antigen in tumor tissue should be necessary for immunotherapy of tumor. This study is to clarify that mutant p53 protein and MAGE-3 gene product is expressed in esophageal cancer specifically and they can be played a role of prognostic factors in esophageal cancer. MATERIAL AND METHOD: Expression of mutant p53 protein and MAGE-3 gene products in formalin fixed, paraffin embedded samples of 79 patients with primary squamous cell carcinoma of the esophagus, who undewent esophageal resection, were analyzed immunohistochemically with DO-7 monoclonal antibody and anti- MAGE-3 antibody. Twenty cases of esophageal normal mucosa and 20 cases of leiomyoma which is a benign tumor of esophagus, were used as control groups. Immunoreactivities of mutant p53 and MAGE-3 gene product in esophageal cancer tissues were analyzed and the relationships between immunoreactivity of mutant p53 protein, MAGE-3 gene product and AJCC stage of esophageal cancer were determined by the Chi-square test. RESULT: Positive immunoreactivity of mutant p53 and MAGE-3 gene product were each of 41/79(51.9%), 48/79(60.8%) in esophageal cancer tissue, but 0% in normal mucosa and leiomyoma of esophagus(p<0.001). Both immunoreactivity of mutant p53 and MAGE-3 gene products were not related to AJCC stage of esophageal cancer(p=0.193, p=0.452). There was not correlation between expression of mutant p53 protein and MAGE-3 gene product in esophageal cancer(p=0.697). CONCLUSION: Mutant p53 and MAGE-gene product cannot be a prognostic factor in squamous cell carcinoma of esophagus, but mutant p53 and MAGE-3 gene product is expressed in squamous cell carcinoma of the esophagus specifically, so esophageal cancer can be target for cytotoxic T lymphocyte in anticancer immunotherapy.

A Case of Persistent Left SVC Associated with Tricuspid Regurgitation

A persistent left superior vena cava is the most common anomaly of the superior caval system. Usually the persistent left superior vena cava is connected with the right atrium via the coronary sinus, resulting in no physiologic derangement : however in 7 to 8 percents of the patietns with a persistent left superior vena cava, the anomalous vessel communicates with the left atrim. In the absence of obstruction to the flow from the left atrium to the left ventricle. this anatomic situation usually results in right to left shunting of varying degress. We recently experienced a case of persistent left superior vena cava in a 52-year-old female who complained of chest discomfort, epigastric pain and dyspnea(NYHA functional class II). Cine-angiography showed that the contrast passed from the left SVC through the dilated coronary sinus into right atrium. And right sided SVC was not seen. The patient was treated with conservative measures and discharged with improved condition.