PubMed Health⌕ Search

Biomedical subjects

S Kwak

Publications and source records attributed to S Kwak.

At least 19 recordsLinked to original sources

Hemiparkinsonism associated with a mesencephalic tumor.

A 66-year-old woman presented with a 3-year history of progressive right-sided hemiparkinsonism manifested by a right-hand resting tremor and right-sided bradykinesia. Magnetic resonance imaging (MRI) of the brain revealed a non-enhanced polycystic mass in the left midbrain. (11)C-methylspiperone ((11)C-NMSP) and (18)F-fluorodopa ((18)F-DOPA) positron emission tomography (PET) revealed a striatal hypometabolism that was restricted to the left side. These findings are consistent with a dysfunction in the left nigrostriatal dopaminergic pathway that is presumably induced by the cystic mass in the left midbrain. This case is significant due to the paucity of reports regarding the occurrence of a relatively pure parkinsonism that is associated with a mesencephalic space-occupying lesion.

Brain Stem Neoplasms↗

Reduction of GluR2 RNA editing, a molecular change that increases calcium influx through AMPA receptors, selective in the spinal ventral gray of patients with amyotrophic lateral sclerosis.

Enhancement of calcium influx through the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA)/kainate receptor is a plausible mechanism underlying selective neuronal death in amyotrophic lateral sclerosis (ALS). The calcium conductance of the AMPA receptor is regulated by the GluR2 subunit that is edited at the glutamine/arginine residue site in the subunit assembly. We investigated the molecular changes of GluR2 mRNA in the spinal cord of ALS cases, those of cases with other neurological diseases, and those of normal cases using reverse transcription-polymerase chain reaction combined with restriction enzyme cleavage. We found that the editing efficiency was significantly lower only in the ventral gray of ALS cases (virtually 0% in 2 cases) than in any spinal region of the disease controls and normal controls. In addition, expression of GluR2 mRNA is lower in the ventral gray of the ALS cases and disease controls than in that of the normal controls. The above molecular changes of GluR2 mRNA in the ventral gray of ALS cases may enhance calcium influx through AMPA receptors, thereby promoting neuronal vulnerability. The decrement of GluR2 mRNA editing efficiency is unique to the ventral gray of ALS cases and may be closely linked to the etiology of ALS.

Adult↗

Intracapsular origin of the long head of the biceps tendon.

A developmental anomaly of the long head of the biceps tendon was found in a cadaveric shoulder. Findings on arthroscopy, routine MR imaging, and MR arthrography were compared and correlated with results of anatomic dissection. MR arthrography appears to be a very good diagnostic imaging method for depicting this anomaly prior to arthroscopy.

Aged↗

Characterization of bone quality using computer-extracted radiographic features.

Both bone mineral density (BMD) and trabecular structure are important determinates of bone mechanical properties. However, neither BMD or trabecular structural features can completely explain the variations in bone mechanical properties. In this study, we combine BMD and bone structural features to characterize bone mechanical behavior. Radiographs were obtained from 34 femoral neck specimens excised during total hip arthroplasties. Each neck radiograph was digitized and a region of interest (ROI) was selected from the medial side of the femoral neck. Textural features, the global Minkoswski dimension and trabecular orientation, were extracted from each ROI image using Minkowski dimension analysis. The BMD of each specimen was measured using dual-energy x-ray absorptiometry (DXA) and subsequently normalized by bone size as measured from a standard pelvis radiograph. Mechanical testing was performed on the trabecular bone cubes machined from each femoral neck to yield bone mechanical properties. Multiple regression was performed to select the best features to predict bone mechanical properties. The results suggest that, using multiple predictors including normalized BMD structural features, and patient age, the coefficients of determination (R2) improved over the use of BMD alone. For bone strength, the R2 was improved from 0.24 using conventional BMD to 0.48 using a four-predictor model. Similar results were obtained in the prediction of Young's modulus, i.e., the R2 was improved from 0.25 to 0.55 in going from the model using conventional BMD to a four-predictor model. This study demonstrates the contributions of normalized BMD, structural features, and age to bone mechanical properties, and suggests a potential method for the noninvasive evaluation of bone mechanical properties.

Absorptiometry, Photon↗

Risk of subarachnoid hemorrhage after surgical treatment of unruptured cerebral aneurysms.

BACKGROUND AND PURPOSE: Recent progress in noninvasive imaging techniques has resulted in increased detection of unruptured aneurysms. Although many neurosurgeons advocate surgical intervention for such unruptured aneurysms, the long-term results of surgery for unruptured aneurysms have not been carefully investigated. METHODS: We analyzed 173 consecutive patients who had unruptured intracranial saccular aneurysm(s) detected by angiography that was performed for reasons other than subarachnoid hemorrhage (SAH). Of those, 115 cases were surgically treated and studied. All patients were followed up for either SAH, repeat treatment of aneurysms, or death. The median follow-up period was 8.8 years. RESULTS: Four of the 115 patients suffered SAH either from a de novo aneurysm (2) or from regrowth of clipped aneurysm (1), or from regrowth after wrapping (1). Additionally, 1 patient also suffered SAH from an unstudied basilar aneurysm. One patient was incidentally found to have de novo aneurysm and underwent reoperation 14 years after the first operation. The cumulative risk for SAH for the 114 cases excluding the basilar aneurysm case was 1.4% in 10 years and 12.4% in 20 years. CONCLUSIONS: Although this study confirmed the long-term efficacy of clipping unruptured aneurysms, the risk of SAH was high compared with that in the general population, even after treatment. Considering the high mortality rate of SAH, long-term follow-up by angiography may be warranted for patients with surgically treated unruptured aneurysms.

Adult↗

Evaluation of articular cartilage thickness of the humeral head and the glenoid fossa by MR arthrography: anatomic correlation in cadavers.

OBJECTIVE: To evaluate the accuracy of MR arthrography in determining the thickness of articular cartilage of the humeral head and glenoid fossa. DESIGN AND PATIENTS: MR arthrography of the glenohumeral joint was performed in 17 cadaveric shoulders. Articular cartilage thickness was measured on the MR arthrographic images and corresponding anatomic sections. RESULTS: The correlation coefficients for MR arthrographic measurement versus anatomic measurement of the cartilage thickness were 0.7324 and 0.8757 for humeral head and glenoid fossa, respectively. With regard to the humeral head, there was a tendency to overestimate regions of thin cartilage and underestimate regions of thick cartilage. This tendency was not found in the assessment of glenoid cartilage. The mean of the absolute value of MR-anatomic differences was similar on the glenoid side (0.27 mm) and the humeral side (0.29 mm). The accuracy of measurement was significantly better on the glenoid side (Fisher's r-to-Z transformation: Z=5.21, P=0.000001). CONCLUSION: MR arthrography causes a moderate degree of error in the naked-eye measurement of the cartilage of the glenohumeral joint. The accuracy is higher on the glenoid side than on the humeral side.

Aged↗

Metastatic adenocarcinoma arising in a congenital foregut cyst of the esophagus: a case report with review of the literature.

Benign tumors and cysts of the esophagus are rare, and malignant transformation of esophageal cysts is even more rare. In this article, we report on the first case to our knowledge of a patient presenting with metastatic adenocarcinoma arising in a congenital foregut cyst of the esophagus. A 37-year-old woman had multiple cysts along the aerodigestive tract and diffuse soft tissue metastases. Endoscopic biopsies of a mediastinal mass revealed an enteric cyst with a spectrum of columnar epithelium ranging from benign through adenomatous to frankly malignant. There was only transient response to radiotherapy and chemotherapy. Only three other cases of carcinoma arising from esophageal duplication foregut cysts have been reported, and none of these were metastatic. Given the rarity of malignant transformation within an esophageal cyst, prophylactic excision of known esophageal cysts is not warranted. However, biopsy of the cyst may be useful to exclude the possibility of malignancy, particularly if the onset of symptoms has been recent.

Adenocarcinoma↗

Risk of recurrent subarachnoid hemorrhage after complete obliteration of cerebral aneurysms.

BACKGROUND AND PURPOSE: The neck clipping of cerebral aneurysms is a well-established treatment for subarachnoid hemorrhage (SAH) caused by aneurysmal rupture. However, it is still unclear how great a risk of recurrence patients with a successfully treated aneurysm carry over a long-term period. METHODS: Of 425 patients with SAH surgically treated in Aizu Chuou Hospital from 1976 to 1994, 220 cases meeting the following criteria were studied: (1) all aneurysms detected by 3- or 4-vessel cerebral angiography were clipped, (2) complete obliteration of aneurysm(s) was confirmed by postoperative angiography, and (3) the patient survived >3 years. All patients were traced until January 1998 for recurrent SAH or death. The mean follow-up period was 9.9 (range, 3 to 21) years. RESULTS: Six patients (2.7%) had recurrent SAH, each with an interval ranging from 3 to 17 years (mean, 11 years) since the original treatment. In addition, 2 patients were found to have regrowth of the originally operated aneurysms. The cumulative recurrence rate of SAH, calculated using the Kaplan-Meier method, was 2.2% at 10 years and 9. 0% at 20 years after the original treatment. CONCLUSIONS: The recurrence rate was considerably higher than the previously reported risk of SAH in the normal population, and the rate increased with time. These data indicate that patients with ruptured cerebral aneurysms still carry higher risks for SAH in a long-term period, even after complete obliteration of the aneurysm, and that periodic examination to detect recurrent aneurysms may be indicated for such patients.

Adult↗

Anterior labroligamentous structures of the glenohumeral joint: correlation of MR arthrography and anatomic dissection in cadavers.

OBJECTIVE: The purpose of this study was to establish the accuracy of MR arthrography in depicting the morphology of the glenohumeral ligaments and the superior portion of the glenoid labrum. MATERIALS AND METHODS: Findings on MR arthrography and those derived from careful dissection of gross specimens were compared in 15 cadaver shoulders, focusing on the morphology and size of the superior and middle glenohumeral ligaments and the morphology of the inferior glenohumeral ligament. The frequencies of sublabral recess and sublabral foramen seen on MR arthrography and at anatomic dissection were also compared. RESULTS: For the superior and middle glenohumeral ligaments, moderate correlation of size was found between measurements made on MR arthrograms and at anatomic dissection, with the Spearman's rank correlation coefficient calculated as .69990 and .71133, respectively. Morphologic descriptions of the inferior glenohumeral ligament based on MR arthrography and on anatomic dissection also showed good association (Cohen's kappa = .8936). Dissection revealed that the sublabral recess was present in 11 specimens. Of these, 10 recesses were identified on MR arthrograms. MR arthrography also revealed a sublabral recess that was not found at dissection. Four sublabral foramina were identified by both MR arthrography and dissection, and two were revealed only by MR arthrography. CONCLUSION: MR arthrography is useful in the evaluation of the glenohumeral ligaments and the superior portion of the labrum. Anatomic variations of these anterior intraarticular structures can be accurately shown by MR arthrography. In addition, estimation of the size of glenohumeral ligaments can be achieved with acceptable accuracy on MR arthrograms.

Aged↗

AMPA receptor-mediated slow neuronal death in the rat spinal cord induced by long-term blockade of glutamate transporters with THA.

Excitotoxicity secondary to the loss of glutamate transporters (GluT) has been proposed as a possible pathogenetic mechanism for neuronal degeneration in amyotrophic lateral sclerosis. We therefore investigated whether prolonged in vivo pharmacologic inhibition of GluT would result in neuronal damage in the rat. DL-Threo-beta-hydroxyaspartate (THA), a potent GluT inhibitor, and glutamate were continuously infused into the rat spinal subarachnoid space by using a mini-osmotic pump. Animals that received both THA and glutamate, but not those received either singly, displayed tail paralysis with or without hind-limb paralysis and urinary incontinence after the third postoperative day. Pathologically, symptomatic animals exhibited neuronal loss with a variable extent of gliosis preferentially involving the dorsal horn of the lumbosacral cord. In the rostral spinal segments adjacent to those regions of intense pathologic changes, small neurons in the dorsal horn were selectively destroyed, a pattern similar to the late-onset neuronal damage induced by continuous intrathecal administration of 1-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) [R. Nakamura et al., Brain Res. 654 (1994) 279-285]. These behavioral and pathologic changes were blocked by 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX), suggesting that pharmacologic blockade of GluT causes selective neuronal damage in vivo by AMPA receptor activation.

6-Cyano-7-nitroquinoxaline-2,3-dione↗

Expression of the copper-zinc superoxide dismutase gene in amyotrophic lateral sclerosis.

The demonstration of a genetic linkage between the copper-zinc superoxide dismutase (SOD1) gene and familial amyotrophic lateral sclerosis has aroused interest in the role of SOD1 in motoneuronal death. We investigated the expression of the human SOD1 gene at a cellular level in the motoneurons of patients with sporadic amyotrophic lateral sclerosis, patients with familial amyotrophic lateral sclerosis, and normal control subjects, using a quantitative in situ hybridization technique. There were no significant differences between the amounts of SOD1 messenger RNA observed in patients with sporadic disease, patients with familial disease, and normal control subjects. However, many of the atrophic motoneurons from patients with sporadic or familial disease had significantly lower levels of SOD1 messenger RNA, compared to morphologically intact motoneurons. Moreover, motoneurons in the normal spinal ventral horn and precentral motor cortex exhibited significantly higher levels of SOD1 messenger RNA than did other neurons. Our study indicated that vulnerable neurons in amyotrophic lateral sclerosis exhibit high levels of SOD1 messenger RNA, suggesting a close relationship between the SOD1 gene and the pathogenesis of amyotrophic lateral sclerosis.

Aged↗

EAAT4, a glutamate transporter with properties of a chloride channel, is predominantly localized in Purkinje cell dendrites, and forms parasagittal compartments in rat cerebellum.

Glutamate transporters play a pivotal role in terminating glutamatergic transmission by eliminating glutamate from the synaptic cleft. Four different glutamate transporter cDNAs have been isolated thus far, and their tissue distribution has been investigated using northern blot and immunohistochemical analysis. We raised site-directed antisera against a synthetic oligopeptide corresponding to the C-terminal of EAAT4, a recently cloned human glutamate transporter, and investigated the distribution of EAAT4 in rat cerebellum. Western blot analysis demonstrated that the affinity-purified antiserum SAE4 recognized specifically a single band (about 62 kDa) in the rat cerebellum, cerebrum and spinal cord. The SAE4-immunoreactivity was localized predominantly in the dendritic spines and distal dendrites of Purkinje cells. The intensity of the immunoreactivity was uneven among Purkinje cells, forming parasagittal compartments. Since EAAT4 also has the properties of a glutamate-gated chloride channel, it should be able to modulate the transmission at the parallel fiber-Purkinje cell synapses.

Amino Acid Transport System X-AG↗

Concentration-dependent changes in motor behavior produced by continuous intrathecal infusion of excitatory amino acids in the rat spinal cord.

A growing body of evidence has suggested that glutamate receptors mediate selective degeneration of neurons in the central nervous system during the development of neurodegenerative diseases. Glutamate receptors are divided into N-methyl-D-aspartate (NMDA)-type and non-NMDA-type. Neurotoxicity mediated by the latter has attracted much interest as a possible causative mechanism underlying amyotrophic lateral sclerosis (ALS). As the clinical course of ALS is chronic and progressive, investigation of chronic effects of non-NMDA receptor agonists on neuronal function would be useful for evaluating the role of glutamate receptor-mediated neurotoxicity in ALS. However, chronic non-NMDA receptor-mediated neurotoxicity has been investigated less thoroughly than acute neurotoxicity. We infused an aqueous solution of R,S-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) intrathecally and continuously by an osmotic minipump in rats. This method of continuous infusion enabled us to keep the drug concentration relatively constant in the cerebrospinal fluid surrounding the spinal cord. The present method of AMPA administration is more suitable for investigating ALS pathogenesis than acute injections, in view of the gradual progression of the disease and the selectivity of lesions produced.

6-Cyano-7-nitroquinoxaline-2,3-dione↗

Frontal small craniostomy and irrigation for treatment of chronic subdural haematoma.

A new surgical method for the treatment of chronic subdural haematoma is presented. A small craniostomy is made on the superior lateral angle of the forehead just beneath the hair line without hair removal using a high-speed drill. Through this aperture, evacuation and irrigation of the haematoma can be carried out safely. No infections occurred in a series of patients treated in this way, and the recurrence rate was 10% (2/20). The surgical wound was negligible. Because of its simplicity, and the lack of a need for hair removal, the procedure appears to be acceptable as an optional therapeutic modality.

Aged↗

In situ nick end-labeling detects necrosis of hippocampal pyramidal cells induced by kainic acid.

It is believed that in situ nick end-labeling (ISNEL) is an easy and selective method for detecting apoptosis in situ. To test whether ISNEL selectively detects apoptosis but not necrosis, we investigated the kainic acid (KA)-induced neuronal death with ISNEL, comparing with the results of gel electrophoresis and electron microscopy. Many degenerating neurons (ca. 50%) in the hippocampal CA1 area and amygdaloid complex were intensely stained with ISNEL 1-3 days after intraperitoneal injection of KA. Although most of the ISNEL-positive neurons displayed a pathological feature of necrosis, a small number of them displayed apoptosis-like changes when examined by electron microscopic observation. It should be noteworthy that ISNEL recognizes at least a certain form of necrosis and is not selective for apoptosis.

Animals↗

Neurotoxicity of (2S,1'R,2'R,3'R)-2-(2,3-dicarboxycyclopropyl)glycine, a potent agonist for class II metabotropic glutamate receptors, in the rat.

Neurotoxicity of (2S,1'R,2'R,3'R)-2-(2,3-dicarboxycyclopropyl)glycine (DCG-IV), a potent agonist for metabotropic glutamate receptors negatively coupled to adenylyl cyclase, was investigated in vivo by the intraventricular administration in the rat, compared with that of (2S,1'S,2'S)-2-(carboxycyclopropyl)glycine (L-CCG-I) and (1S,3R)-1-aminocyclopentane-1,3-dicarboxylic acid [(1S,3R)-ACPD]. Neither L-CCG-I nor (1S,3R)-ACPD caused any apparent pathological change in the brain at an intraventricular dose of 1 mumol, whereas DCG-IV induced selective neuronal damage in some rats at higher doses than 3 nmol. The neurotoxicity was intensified in a dose-dependent manner, and at a dose of 50 nmol DCG-IV caused repetitive seizures and selective neuronal damage in all cases. Neuronal damage was pronounced in the cingulate cortex, lateral septum and hippocampus, and a few degenerating neurons were observed also in other brain areas, such as the striatum, thalamus or neocortex. Since DCG-IV activates N-methyl-D-aspartate-type receptors as well at relatively high concentrations, the protective effect of a competitive antagonist for N-methyl-D-aspartate receptors, 3-[(RS)-2-carboxypiperazin-4-yl]propyl-1-phosphonic acid (CPP), was examined on the neurotoxicity of DCG-IV. Although a combined treatment with CPP (0.1 nmol) completely blocked the neurotoxicity of N-methyl-D-aspartate (100 nmol), at least 3 nmol of CPP was necessary to decrease the neurotoxicity of DCG-IV (50 nmol) to a considerable extent. The synergistic activation of metabotropic glutamate receptors and N-methyl-D-aspartate receptors is suggested as a possible mechanism underlying the selective neuronal damage induced by DCG-IV, although a direct participation of metabotropic glutamate receptors in glutamate neurotoxicity is not deniable.

Animals↗

Effects of aging and musical experience on the representation of tonal hierarchies.

Two experiments explored the representation of the tonal hierarchy in Western music among older (aged 60 to 80) and younger (aged 15 to 22) musicians and nonmusicians. A probe tone technique was used: 4 notes from the major triad were presented, followed by 1 note chosen from the 12 notes of the chromatic scale. Whereas musicians had a better sense of the tonal hierarchy than nonmusicians, older adults were no worse than younger adults in differentiating the notes according to musical principles. However, older adults were more prone than younger adults to classify the notes by frequency proximity (pitch height) when proximity was made more salient, as were nonmusicians compared with musicians. With notes having ambiguous pitch height, pitch height effects disappeared among older adults but not nonmusicians. Older adults seem to have internalized tonal structure, but they sometimes fail to inhibit less musically relevant information.

Adolescent↗

[Involuntary movements observed in a patient with Russian spring summer encephalitis].

A 38-year-old woman had an episode of headache, fever and convulsion in October, 1993. She became alert in two weeks, though weakness and atrophy remained in the upper limb muscles. She was diagnosed as Russian spring summer encephalitis (RSSE) based on several serological studies. Three kinds of involuntary movements were noted after recovery. These were spontaneous muscle jerks in the left arm, action tremor in the right arm and pathological associated-movement in the right leg. The movements were studied physiologically by electroencephalogram (EEG)-electromyogram (EMG) polygraphic recordings, jerk-locked averaging (JLA), magnetencephalography (MEG), and sensory evoked potentials (SEPs). The jerky movements in her left arm were observed at rest and aggravated by emotional stress. EEG-EMG polygraph showed that the jerks were sometimes associated with small spikes thus were considered to be due to epilepsia partialis continua (EPC). JLA analysis revealed a pre-myoclonus spike on the right hemisphere which preceded the onset of the jerk in the left first dorsal interosseous muscle by 25.2ms, which was equal to the magnetic cortical latency of that muscle. Jerk-locked magnetic field, obtained by averaging neuromagnetic activities with respect to the onset of myoclonus, showed that the spike preceding the jerk, originated from the right motor cortex. The spontaneous spikes were localized mainly on the right motor cortex. Sensory evoked potentials (SEPs) were normal in both size and latency. No hyperexcitability of the sensory cortex was demonstrated even by using paired stimulation SEPs. Based on these results, we conclude that the jerky movements in this patient were produced by abnormal spontaneous discharges in the motor cortex. The action tremor had a frequency of 4-5 Hz and its clinical features were compatible with cerebellar tremor. This is thought to result from a lesion in the left thalamus, affecting the cerebellothalamic pathways. Her right leg unintentionally moved whenever she began to move the hands. This was considered to be a pathological associated-movement due to dysfunction of the pyramidal tracts.

Adult↗