STUDY DESIGN: Prospective study. PURPOSE: We investigated normative temporal levels of white blood cell (WBC) and absolute neutrophil count (ANC) in uncomplicated anterior cervical discectomy and fusion (ACDF) using allograft and demineralized bone matrix (DBM). OVERVIEW OF LITERATURE: No study has investigated the diagnostic usefulness of WBC and ANC for postoperative infection following ACDF using allograft and DBM. METHODS: Blood samples of 85 patients, who underwent one or two-level ACDF, were obtained and evaluated before surgery and on the first, third, fifth, seventh, fourteenth, thirtieth, and ninetieth postoperative days. No infection was found in all patients for at least one year follow-up period. RESULTS: Mean WBC and ANC values increased significantly and reached peak levels on the first postoperative day. The peaked levels rapidly decreased but still remained elevated above the preoperative levels on the third postoperative day. The levels returned close to the preoperative levels on the fifth postoperative day. The mean WBC and ANC values did not get out of their normal reference ranges throughout the follow-up periods. One-level and two-level ACDF exhibited a similar course of postoperative changes in WBC and ANC values and no significant difference in mean levels of WBC and ANC throughout the follow-up periods. CONCLUSIONS: Uncomplicated ACDF using allograft and DBM showed normal values of WBC and ANC during the early postoperative period. Therefore, significant abnormal values of WBC and ANC at an early postoperative period suggest the possibility of the development of acute postoperative infection after ACDF using allograft and DBM.
Bone Matrix ; Diskectomy ; Follow-Up Studies ; Humans ; Leukocytes ; Neutrophils ; Postoperative Period ; Prospective Studies ; Transplantation, Homologous

Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.
*Hepatectomy/statistics & numerical data ; Humans ; *Laparoscopy/statistics & numerical data ; Liver/*surgery ; Liver Diseases/pathology/surgery ; Liver Neoplasms/pathology/surgery ; Postoperative Complications/epidemiology ; Questionnaires ; Republic of Korea

BACKGROUND: The aim of this study was to investigate sarcopenia and its association with cardiometabolic risk factors in a community-based elderly cohort in Korea. METHODS: We recruited 287 men and 278 women aged 65 years or older and without physical disability. Appendicular skeletal muscle mass (ASM) was measured with dual energy X-ray absorptiometry. We used two definitions for sarcopenia-ASM divided by height2 (kg/m2) or by weight (%) <1 SD below the sex-specific mean for young adults. We compared RBP-4, adiponectin, hsCRP, lipid profiles, and insulin resistance between the sarcopenic and normal groups using ASM/Ht2 and ASM/Wt. RESULTS: The prevalence of sarcopenia was 35.3% in men and 13.4% in women with sarcopenia defined by ASM/Ht2. However, it was 38.3% in men and 62.6% in women by ASM/Wt. In correlation analysis, body mass index was positively correlated with ASM/Ht2 and negatively correlated with ASM/Wt. The sarcopenic group, when defined as ASM/Ht2, showed lower RBP4, fasting plasma glucose, and HOMA-IR and higher adiponectin than the normal group but not significantly different lipid profiles. The sarcopenic group defined by ASM/Wt had higher RBP4, fasting plasma glucose, and HOMA-IR, and lower adiponectin than the normal group in both sexes. Only in the males did the sarcopenic group defined by ASM/Wt reveal higher total cholesterol, triglycerides, and LDL cholesterol, and lower HDL cholesterol than the normal group. CONCLUSION: In conclusion, the sarcopenic group defined by ASM/Wt was more closely associated with cardiometabolic risk factors than the normal group in a community-based elderly cohort.
Absorptiometry, Photon ; Adiponectin ; Aged ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Cohort Studies ; Fasting ; Female ; Glucose ; Humans ; Insulin Resistance ; Korea ; Male ; Muscle, Skeletal ; Plasma ; Prevalence ; Risk Factors ; Sarcopenia ; Triglycerides ; Young Adult

Esophageal hematoma is a rare form of esophageal injury. It may occur spontaneously, or in association with direct esophageal damage or a bleeding diathesis. Endoscopy and computed tomography are generally necessary for the establishment of a diagnosis. In this report, we present a case of esophageal hematoma that was discovered via a bedside transthoracic echocardiography. The echocardiography was conducted to evaluate an unexplained shock in a critically ill-patient. After conservative treatment, complete resolution of the esophageal hematoma was documented by a 7-day short-term follow-up of bedside transthoracic echocardiography. To the best of our knowledge, this is the first case report regarding transthoracic echocardiographic detection, differential diagnosis, and follow-up for esophageal hematoma.
Diagnosis ; Diagnosis, Differential* ; Disease Susceptibility ; Echocardiography* ; Endoscopy ; Follow-Up Studies* ; Hematoma* ; Hemorrhage ; Shock

PURPOSE: Tourette's disorder (TD), which is characterized by multiple waxing and waning motor tics and one or more vocal tics, is known to be associated with abnormalities in the dopaminergic system. To testify our hypothesis that risperidone would improve tic symptoms of TD patients through the change of the dopaminergic system, we measured the dopamine transporter (DAT) densities between drug-naive children with TD and normal children, and investigated the DAT density before and after treatment with risperidone in drug-naive children with TD, using iodine-123 labelled N- (3-iodopropen-2-yl) -2beta-carbomethoxy -3beta- (4-chlorophenyl) tropane ([123I]IPT) single photon emission computed tomography (SPECT). MATERIALS AND METHODS: [123I]IPT SPECT imaging and Yale Global Tic Severity Scale-Korean version (YGTSS-K) for assessing the tic symptom severity were carried out before and after treatment with risperidone for 8 weeks in nine drug-naive children with TD. Eleven normal children also underwent SPECT imaging 2 hours after an intravenous administration of [123I]IPT. RESULTS: Drug-naive children with TD had a significantly greater increase in the specific/nonspecific DAT binding ratio of both basal ganglia compared with the normal children. However, no significant difference in the specific/nonspecific DAT binding ratio of the basal ganglia before and after treatment with risperidone in children with TD was found, although tic symptoms were significantly improved with risperidone. CONCLUSION: These findings suggest that DAT densities are directly associated with the pathophysiology of TD, however, that the effect of risperidone on tic symptoms in children with TD is not attributed to the change of dopaminergic system.
Administration, Intravenous ; Basal Ganglia ; Child* ; Dopamine Plasma Membrane Transport Proteins* ; Dopamine* ; Humans ; Risperidone* ; Tics ; Tomography, Emission-Computed, Single-Photon* ; Tourette Syndrome*

OBJECTIVES: This study was carried out to explore the relationship between major depressive disorder and CTLA-4 which is related to the immunologic function such as T cell regulation. METHODS: Among the Korean patients diagnosed as major depressive disorder according to DSM-IV, 77 patients without neurological illness, hormonal disorder, or comorbid mental illness were selected. The stored data of 149 normal Koreans from the Catholic Hemopoietic Stem Cell Bank of Korea, were used as a normal control group. The data of Korean control group were compared with those of the studies of different ethnics. DNA was extracted from whole blood and the exon 1 region of CTLA-4 gene was amplified by polymerase chain reaction. Gene typing was performed by using SSCP and then, the results were assessed. RESULTS: There were no significant differences in genotype frequencies of CTLA-4*G/G, CTLA-4*G/A, and CTLA-4*A/A between the patients with major depressive disorder and the control group in Korean population(48.1% vs 46.3%, 41.6% vs 39.6%, 10.3% vs 14.1%, respectively).There were no significant differences in allelic frequencies of CTLA-4*G and CTLA-4*A between the patients with major depressive disorder and the control group in Korean population(68.8% vs 66.1%, 31.2% vs 33.9%, respectively). CONCLUSION: Considering negative result for the association of the exon 1 polymorphism of CTLA-4 gene with major depressive disorder in this study, the exon 1 polymorphism does not appear to be possible candidate gene for major depressive disorder. Moreover, further systematic researches including diverse clinical variables would be required.
Depressive Disorder, Major* ; Diagnostic and Statistical Manual of Mental Disorders ; DNA ; Exons ; Genotype ; Humans ; Korea ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational ; Stem Cells

A 56 year-old female patient with major depressive disorder, single episode with unremarkable findings on past medical and psychiatric history visited due to various depressive symptoms. Mirtazapine of 15 mg/day at evening was administered for the control of her depressive symptoms along with alprazolam of 0.5 mg/day at morning and evening for the control of anxiety. On fifth hospitalized day, she complained of creeping and crawling sensation on both legs which was aggravated at night after about one hour of mirtazapine intake and improved with movement. She also had a difficulty in falling a sleep as well as onset of discomfort on both legs. We rendered her discomfort as restless legs syndrome (RLS) due to mirtazapine disposition. Therefore, we maintained mirtazapine of 15 mg/day at evening and added clonazepam of 1 mg/day at morning and evening for the control of RLS. After 7 days observation, the patient complained of aggravated natures of RLS and wanted to stop the drug. Though the effectiveness of mirtazapine for control of depressive symptoms, the drug was switched to paroxetine of 20 mg/day at 16th hospitalized day and 4 days later the RLS was completely terminated.
Alprazolam ; Anxiety ; Clonazepam ; Depression ; Depressive Disorder, Major ; Female ; Humans ; Leg ; Middle Aged ; Paroxetine ; Restless Legs Syndrome* ; Sensation

BACKGROUND: The purpose of this study was to evaluate the toxicity and efficacy of high-dose chemotherapy with busulfan, thiotepa and melphalan (BTM) as a myeloablative regimen in allogeneic bone marrow transplantation (allo-BMT) for patients with acute myelogenous leukemia (AML). METHODS: Twenty-seven patients with AML were enrolled; Sixteen patients had standard risk (SR) diseases (first complete remission (CR1) and de novo AML) and eleven patients had high risk (HR) diseases (second, or subsequent remission, secondary AML, relapsed, or refractory AML, CR marrow with persisting extramedullary manifestation (chloroma), or hypoplastic acute leukemia). The conditioning regimen included busulfan 4 mg/kg/day for a total dose of 12 mg/kg; thiotepa 250 mg/m2/day for a total dose of 500 mg/m2; and melphalan 50 mg/m2/day for a total dose of 100 mg/m2. Cyclosporine A and short-course methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. RESULTS: The median time to recovery a granulocyte count of 0.5 x 109/L was 14 days (range 10~25 days) and platelet transfusion independence was 30 days (range 12~49 days). The major regimen-related toxicities were gastrointestinal-related symptoms including oral mucositis, nausea, vomiting, and diarrhea. All patients experienced oral mucositis (> or = grade 1) and the patients with oral mucositis of equal and greater than grade 3 were 44% in SR and 45% in HR. The toxicities associated with lung, skin, heart and brain were minimal. Three (11%) patients had severe or fatal veno-occlusive disease (VOD). There were five treatment-related death (19%) (hepatic VOD with multiorgan failure (n=3), pneumonia and ARDS (n=2)) within the first 100 days after allo-BMT. There was not a significant difference between SR and HR group (p=0.167). The incidence of acute GVHD equal or greater than grade II was less than 10%. The actual survival at 2 year was 70.4%(95% confidence interval (CI), 54.7%~86.1%)(SR; 81.3% (95% CI; 63.4~99.1%) vs HR; 54.6% (95% CI; 28.7~80.4%), p=0.154). After a median follow-up of 630 days, 18 of 27 (67%, 355~1062 days) patients are alive without evidence of disease. Three of the 27 patients relapsed (SR; 0% vs HR; 55.6% (95% CI; 19.6~71.3%), p=0.004). CONCLUSION: The BTM regimen followed by allo-BMT is associated with acceptable toxicity and appears to have significant activity in patients with AML. It should be used with caution in patients with prior hepatopathy or refractory state who have an increased risk of severe VOD. Busulfan, thiotepa, and melphalan is an effective and alternative myeloablative regimen for patients with AML.
Bone Marrow Transplantation* ; Bone Marrow* ; Brain ; Busulfan* ; Cyclosporine ; Diarrhea ; Drug Therapy ; Follow-Up Studies ; Graft vs Host Disease ; Granulocytes ; Heart ; Humans ; Incidence ; Leukemia, Myeloid, Acute* ; Lung ; Melphalan* ; Methotrexate ; Nausea ; Platelet Transfusion ; Pneumonia ; Skin ; Stomatitis ; Thiotepa* ; Transplantation, Homologous ; Vomiting

OBJECTIVES: This study was conducted to evaluate the prescription patterns, overall efficacy, and safety of atypical antipsychotics for inpatients with bipolar I disorder. METHODS: Inpatients with bipolar I disorder, who had received adjunctive treatment with olanzapine or risperidone, beyond 1 month, along with mood stabilizers were selected for a retrospective study. The charts of those patients(N=56) were reviewed for the details of efficacy, safety, and other pharmacological variables of the two drugs. RESULTS: Olanzapine and risperidone showed equivalent efficacy by the evaluation in accordance with clinical global impression scale (CGI) and global assessment of functioning scale(GAF) score. Different side effect profiles were noted between two drugs. CONCLUSION: These limited results suggested that the efficacy and safety of risperidone and olanzapine were similar for the treatment of inpatients with bipolar I disorder. Prospective controlled study for efficacy and safety of risperidone and olanzapine in the treatment of bipolar I disorder should be conducted in future.
Antipsychotic Agents ; Humans ; Inpatients* ; Prescriptions ; Retrospective Studies ; Risperidone

There had been few reports of arachnoid cyst accompanying psychiaric disturbance and no report treated with low-dose resperidone administration. We report a patient, developed first-transient psychotic episode considered to be provoked by an arachnoid cyst, responsive to risperidone, which was found in the middle cranial fossa as follows. A 57-year-old man was admitted by suddenly developed headache, auditory hallucination, delusion of persecution and, an arachnoid cyst in the anteromedial aspect of middle cranial fossa was found on MRI after admission. The psychotic episode was first to him and he was also negative to other clinical evaluation including endocrine abnormality, his psychotic symptom was suspected to be induced by arachnoid cyst and was well controlled to low-dose risperidone administration. He left hospital free from psychotic symptoms on 14 hospital days.
Arachnoid* ; Cranial Fossa, Middle ; Delusions ; Hallucinations ; Headache ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Psychotic Disorders* ; Risperidone*