BACKGROUND: Vestibular schwannomas (VS) are common tumors that can be cured; they are reported to comprise 6 approximately 8% of all intracranial tumors. The primary objective in the surgery of extralarge VS is total removal of the tumor mass while preserving the facial nerve. In extralarge tumors, complete excision of the tumor carries a significant risk of injuring the facial nerve and adjacent vital brain structures. The authors are reporting the techniques and results of operation on extralarge VS. METHODS: The material consisted of 30 patients during the last 6 years with surgically treated VS that had a maximal extrameatal diameter exceeding 4 cm. Suboccipital craniotomy and tumor removal was performed with patients in the lateral position. Results and complications of the surgical technique will be reviewed. RESULTS: Average age of patients was 45.2 years; there was a slight female predominance (1.5:1). Size of the mass ranged from 41 to 70 mm; all were removed by the retrosigmoid transmeatal approach. Peritumoral edema on MRI was seen in 50% (15/30). Total removal was achieved in 73.3% (22/30) with no significant relationship to peritumoral edema. In the cases of total removal, the facial nerve preservation rate was 86.4% (19/22). There was no mortality. Surgical complications were hemorrhage and CSF leakage in 1 case (3%) and 8 cases (26.7%), respectively, but in most of these cases, conservative treatment was adequate. In patients in whom anatomic preservation of the facial nerve was achieved, facial nerve function improved progressively within a year. In all cases except for one with gait disturbance, a good outcome was achieved. CONCLUSIONS: Our surgical techniques, including the prediction of facial nerve displacement, not using retractors, and replacement of bone, contributed to good surgical results in a series of extralarge VS.

Adolescent↗

PubMed2000

Resection of a posterior pubic symphyseal protuberance using the electrocautery device.

A posterior protuberance of the pubic symphysis can make a radical retropubic prostatectomy difficult. We describe a technique using electrocautery to remove this protuberance, which can be safely and easily performed.

Electrosurgery↗

PubMed2000

Characterization and cDNA cloning of two glycine- and histidine-rich antimicrobial peptides from the roots of shepherd's purse, Capsella bursa-pastoris.

Two novel antimicrobial peptides were isolated and characterized from the roots of shepherd's purse, Capsella bursa-pastoris. These antimicrobial peptides, named shepherin I and shepherin II, consist of 28 and 38 amino acids, respectively, and are glycine- and histidine-rich peptides. Shepherin I and shepherin II have 67.9% and 65.8% (mol/mol) glycine, respectively, and 28.6% and 21.1% (mol/mol) histidine, respectively. Both shepherins have a Gly-Gly-His motif. These antimicrobial peptides exhibit antimicrobial activity against Gram-negative bacteria and fungi. Circular dichroism spectra of shepherin I and shepherin II showed that shepherin I and shepherin II in 50% trifluoroethanol have 66.7% and 75% random coils, respectively, without any alpha-helices. cDNA sequence analysis revealed that shepherin I and shepherin II are produced from a single polypeptide, designated shep-GRP, consisting of 120 amino acids; shep-GRP has five distinct domains, an amino-terminal putative signal peptide, a shepherin I, a linker dipeptide, a shepherin II and a carboxy-terminal peptide. Southern blot analysis indicates that the gene encoding shepherins belongs to a low-complexity gene family. Northern blot analysis revealed that transcripts of shep-GRP are present in roots but not in leaves and stems.

Amino Acid Sequence↗

PubMed2000

Glomerulonephritis is the major cause of proteinuria in renal transplant recipients: histopathologic findings of renal allografts with proteinuria.

The proteinuria in renal allograft recipients has been regarded as a sign of poor prognosis. The causes of post-transplant proteinuria include chronic rejection, chronic transplant glomerulopathy, glomerulonephritis (GN), acute rejection, and cyclosporine nephrotoxicity. Among them, chronic rejection is known to be most frequent. We analyzed the histopathologic findings of renal allograft biopsies in 197 Korean recipients with proteinuria. Among them, 26 patients developed proteinuria over 500 mg/d. All patients received baseline immunosuppression with cyclosporine. From 26 patients with post-transplant proteinuria, 29 biopsies were performed and their histologic diagnoses were immunoglobulin A nephropathy (IgAN) in 17, IgAN combined with chronic allograft nephropathy in 1, focal segmental glomerulosclerosis in 2, crescentic GN in 1, membranous GN in 1, diabetic nephropathy in 1, acute tubulointerstitial nephritis in 1, and chronic rejection in 3 biopsies. The remaining two biopsies showed nonspecific findings. The most common cause of post-transplant proteinuria was IgAN (62% of biopsies). The incidence of chronic rejection was relatively low and predominant cyclosporine-associated changes were not observed. In conclusion, our data suggest that the main causes of post-transplant proteinuria in Korea are primary glomerulonephritides rather than chronic rejection or cyclosporine nephrotoxicity, and the kidney allograft biopsies from patients with proteinuria should be handled as native kidney.

Adult↗

PubMed2000

Multicenter study of the treatment of erectile dysfunction with transurethral alprostadil (MUSE) in Korea.

A Korean multicenter study was conducted to assess the effectiveness of transurethral alprostadil with MUSE in 334 subjects with chronic erectile dysfunction (ED) who were enrolled in 21 clinical centers. Patients with psychogenic impotence comprised about 30% of subjects. Intraurethral alprostadil was titrated in a stepwise fashion in the clinics from 250 to 500 or 1000 mcg based on erectile response and tolerability. The erectile responses were evaluated using an erection assessment scale (score of 1-5). The dose that produced a maximal penile response of score 5 (full rigid erection) or 4 (full tumescence, partial rigidity) was selected for home treatment. Patients who showed partial erection (score of 3) with 1000 mcg were also included in the home-treatment group. In-clinic phase: 198 men (59.3%) had maximal penile responses of score 4 or 5. The rate of maximal responses was not related to patient age, etiology or duration of the ED. A total of 228 (68.3%) men progressed to home treatment. The overall level of comfort of the transurethral alprostadil was rated as uncomfortable or very uncomfortable in 12%. Home phase: During the two-month period of home treatment, 178 (78.1%) men had successful sexual intercourse at least once, and 78.2% of administrations (1976) resulted in successful intercourse. The main causes of drop-out were insufficient erectile response in 27 men (11.8%), adverse reactions (mostly penile or urethral pain) in 7 (3.1%) or both in 7 (3.1%). In conclusion, transurethral alprostadil could be a suitable treatment option for patients with ED regardless of age and etiology of ED. Efficacy in an Asian population (Korea) is comparable to that reported previously in Caucasians.

Adult↗

PubMed2000

Generalized atrophic benign epidermolysis bullosa--poor prognosis associated with chronic renal failure.

Generalized atrophic benign epidermolysis bullosa (GABEB) is an autosomal recessive form of junctional epidermolysis bullosa, with milder clinical features than the Herlitz subtype. A 25-year-old man presented with the clinical and histological findings of GABEB. At the initial visit, laboratory tests revealed that he also had chronic renal failure (CRF). Usually, GABEB has a good prognosis. However, in this case, the patient had CRF as an associated complication. He died of an intracranial haemorrhage combined with sepsis after 3 weeks of hospitalization. This case suggests that renal complications can occur in this relatively mild form of epidermolysis bullosa, and may contribute to morbidity and premature mortality.

Adult↗

PubMed2000

The effects of isolated lipoproteins and triglyceride, combined oxidized low density lipoprotein (LDL) plus triglyceride, and combined oxidized LDL plus high density lipoprotein on the contractile and relaxation response of rabbit cavernous smooth muscle.

The aim of this study was to investigate the effects of isolated lipoproteins and triglyceride (TG), and the effects of combined oxidized low density lipoprotein (LDL) plus TG and the combined oxidized LDL plus high density lipoprotein (HDL) on the contractility and relaxation response of rabbit cavernous smooth muscle. Cavernous muscle strips from New Zealand White rabbits were studied in organ chambers for isometric tension measurement. The strips were exposed to HDL, LDL, oxidized LDL, TG, combined oxidized LDL plus TG and combined oxidized LDL plus HDL for 30 min. Both HDL and LDL did not affect contraction and relaxation responses of the cavernous muscles. The oxidized LDL did not affect norepinephrine (NE)-induced contractility of the strips, but significantly (p < 0.05) decreased the relaxation response to endothelium-dependent agonist, acetylcholine (Ach). Non-specific NO synthase inhibitor (L-NAME) completely inhibited the relaxation response to Ach, and L-arginine partially improved the diminished relaxation. TG did not significantly change the relaxation responses to Ach, but decreased the contractility of cavernous muscle to NE. Neither the combined oxidized LDL plus TG nor oxidized LDL plus HDL had significant synergistic or detoxication effects on the contractility and relaxation responses. In conclusion, oxidized LDL may have acute toxic effects on the endothelium-dependent, NO-mediated relaxation, but not on the contractility, of rabbit cavernous smooth muscle. TG may decrease contractility of the cavernous muscle. There may be neither synergistic nor detoxication effects on the contractility and relaxation response when TG or HDL is added to the oxidized LDL.

Animals↗

PubMed2000

Drug eruption due to low molecular weight heparin.

Explore the source record for details and available documents.

Adult↗

PubMed2000

Nephroenteric fistula treated with fulguration of the fistulous tract.

We report the management of a nephroenteric fistula with percutaneous fulguration in a patient with recurrent pyelonephritis and urolithiasis. A nephrostogram at 6 weeks and retrograde pyelogram at 18 weeks after fulguration showed no evidence of a recurrent fistula. We believe this to be the first reported case of a nephroenteric fistula treated successfully with fulguration.

Digestive System Fistula↗

PubMed2000

Prevention of postoperative nausea and vomiting by continuous infusion of subhypnotic propofol in female patients receiving intravenous patient-controlled analgesia.

In this prospective, randomized, double-blind, placebo-controlled study, the use of continuous subhypnotic propofol infusion as an antiemetic in fentanyl intravenous patient-controlled analgesia (i.v. PCA) was investigated during the first 24 h after surgery. One hundred female patients, ASA I-II, aged 20-71 yr, undergoing major gynaecological or orthopaedic surgery, were included. Either propofol 10 mg or placebo (1 ml of Intralipid) was given and one of the following five regimens was maintained for 24 h: propofol 5, 10, 15 or 20 microg kg(-1) min(-1) or Intralipid 1 ml h(-1) as a placebo. Fentanyl i.v. PCA was started in the postanaesthesia care unit for postoperative analgesia. Significantly more of the patients given propofol 15 and 20 microg kg(-1) min(-1) experienced no nausea or vomiting compared with those given placebo (65% and 70% versus 25%; P<0.05). Patients given propofol 20 microg kg(-1) min(-1) reported more sedation than those in the other groups 4 h after surgery (P<0.05).

Adult↗

PubMed2000

A case of acinic cell adenocarcinoma on the left hemifacial area.

Acinic cell adenocarcinoma is a rare salivary gland tumor which predominantly occurs in the parotid gland. A 46-year-old man presented with a left preauricular mass of one month duration; the pathologic report showed acinic cell adenocarcinoma. He was transferred to the oral and maxillofacial surgery department, and a total parotidectomy was performed. We present this interesting case of acinic cell adenocarcinoma from the parotid gland with cutaneous involvement.

Biopsy, Needle↗

PubMed2000

Risk factors for an early increase in dose of vasoactive agents for intracavernous pharmacotherapy.

AIMS: This study was to identify factors that influence the early increase in the dose of intracavernous vasoactive agents to maintain erection for satisfactory intercourse and to elucidate when the dose increase would begin. METHODS: Seventy-nine patients using intracavernous pharmacotherapy with tri-mix (PGE(1), papaverine, and phentolamine) over a 3- to 4-year period were enrolled. At 3-month intervals, patients were questioned about changes in dose to maintain erection for satisfactory intercourse and frequency of injection, and underwent examination of the penis. The patients were divided into 2 groups: group A, dose increase of > or = 20% after initiating home therapy, and group B, no change or an increase in dose < 20%. RESULTS: A significant increase (p < 0.01) in dose was started 2-3 years after initiating pharmacotherapy. The initial doses of group A at 2-3 and 3-4 years were significantly higher than those of group B (p < 0.01). There were no significant differences in the age of the patients, duration of erectile dysfunction, incidence of accompanying vascular risk factors, frequency of injection, or incidence of fibrous plaques between group A and group B, both at 2-3 and 3-4 years. CONCLUSION: The initial dose of intracavernous vasoactive agents (tri-mix) may be a unique risk factor for the early increase in dose to maintain erection for satisfactory intercourse.

Adult↗

PubMed2000

The in vitro blood compatibility of poly(ethylene oxide)-grafted polyurethane/polystyrene interpenetrating polymer networks.

Poly(ethylene oxide) (PEO)-grafted polyurethane (PU)/polystyrene (PS) interpenetrating polymer networks (IPNs) were synthesized. The effects of the mobile pendant PEO chains with their microphase separated structure on blood-compatibility were investigated. The morphology of both the fracture surface as well as the top surface indicate that the size of the dispersed domains of the PS-rich phase decreased as the grafting with the PEO was increased. The swelling ratio also decreased as the grafting with the PEO was increased. However, the dynamic contact angle and the interfacial energy between IPN surface and water decreased, due to the structural reorganization of the pendant PEO chains. PU/PS IPNs have an excellent mechanical property as compared with PU homopolymers. The adsorption of bovine plasma fibrinogen (BPF) onto the PU/PS IPNs and PU homopolymers was effectively suppressed by the PEO-grafting. In the platelet adhesion test, the amount of platelets adsorbed, activated, and/or coagulated upon the PEO-grafted PU/PS IPNs were reduced when compared to the ungrafted PU homopolymers.

Animals↗

PubMed2000

Preparation of monoclonal antibody against ginsenoside Rf and its enzyme immunoassay.

A rapid and sensitive indirect competitive enzyme immunoassay method has been developed for quantitating ginsenoside Rf (Rf) in crude total Panax ginseng saponins and in rat plasma using high titer mouse monoclonal antibody (mAb) raised against a conjugate of Rf and bovine serum albumin (BSA). The isotype of mAb against Rf was IgG3 with a K chain. The presence of Rf inhibited the binding of the mouse anti-Rf mAb to a Rf-BSA solid phase coating antigen. The working range was 0.01-10 ng/assay and detection limits were 20 pg in various ginseng extract fractions or 34 pg in rat plasma per assay. The anti-Rf mAb cross-reacted with ginsenoside Rg2 by 57.5%, but not with other ginsenosides. However, this anti-Rf mAb did not cross-react with BSA or cellubiose, which is a carbohydrate component of Rf. Using this standard curve, we could measure the amount of Rf in ginseng total extract, ginseng total saponins, protopanaxadiol saponins, and propanaxatriol saponins. We could also measure the amount of Rf in rat plasma after the oral administration of Rf and found that Rf reached a maximum level in rat plasma after 16 h. These results indicate that the anti-Rf mAb could be useful for the quantitation of Rf in crude ginseng fractions and in body fluids.

Administration, Oral↗