Bone or bone substitute has been widely used for the reconstruction of bony defect developed by trauma, infecton, cyst, tumor, congenital abnormality, etc. Owing to its variety in quality and quantity, the use of alloplasts is increased rapidly. Among the various graft materials, HA has been studied and applied in clinic most exensively. When HA applied to bony defect, it is considered to help the bone healing by osteoconduction but tends to be encapsulated with fibrous tissue and floated in the applied area by the lack of consolidation. Bioglass is considered as a subsitute which can cover such weak point of HA. Bone defect were artificially prepared in the calvaria of the rats followed by grafts of HA and bioglass into defects. Sequential sacrifice was peformed at the 3rd, 7th, 14th and 28th day of experiment. The staining of the obtained specimen was performed with H&E, MT, immunohistochemical stain and then histological examinaions were carried out under the light and scanning electron microscope. 1. In the features of H&E stain, infiltration of chronic inflammatory cell were present in all group at the 3rd and 7th day of experiment with decrease at the 14th day in bioglass group. The infiltration of inflammatory cells was more active in control and HA group whereas the formation of granulation tissue was more active in bioglass group was larger and more irregular than in HA group. 2. The features of MT stain showed new bone formation from the 7th day in all groups and the evidence of advanced calcification was observed at the 28th day. 3. In the features of immunohistochemical stain, bioglass group showed more PCNA positive response in the osteoblasts at the site of new bone formation and the lower activity of undifferentiated mesenchymal cells than HA group. 4. In scanning electron microscopic features, fibrous tissue formation and osteoid attached to HA was observed in the HA group after the 7th day. In bioglass group, osteoid formation was observed between the absorbed bioglass. Generally in HA group, bone formation progressed with characteristic of the fibrous and osteoid tissue mainly attached to the surface and the high activity of undifferented mesenchymal cells was seen at the graft site. In bioglass group, osteoid tissue formation was seen between the irregulary absorbed bioglass and the increased PCNA positive response was observed in the osteoblast at the new bone formation site.
Animals ; Bone Regeneration ; Bone Substitutes ; Congenital Abnormalities ; Durapatite* ; Granulation Tissue ; Osteoblasts ; Osteogenesis ; Proliferating Cell Nuclear Antigen ; Rats* ; Skull ; Transplants

BACKGROUND AND PURPOSE: We investigated subsequent vascular events in patients with transient ischemic attack (TIA) and determined the predictors of such events among vascular risk factors including large-artery disease, TIA-symptom duration, and acute ischemic lesions on diffusion-weighted imaging (DWI). METHODS: We identified 98 consecutive patients with TIA who visited a tertiary university hospital and underwent DWI and brain magnetic resonance angiography within 48 hours of symptom onset. We reviewed the medical records to assess the clinical characteristics of TIA, demographics, and the subsequent vascular events including acute ischemic stroke, TIA, and myocardial infarction. RESULTS: Large-artery disease was detected in 55 patients (56%). Ten patients (10%) experienced TIA symptoms for longer than 1 hour, and acute infarctions on DWI were identified in 30 patients (31%). During the mean follow-up period of 19 months, seven patients (7%) had an acute ischemic stroke and 20 patients (20%) had TIA. Retinal artery occlusion in two patients, spinal cord infarction in one patient, and peripheral vascular claudication in one patient were also recorded. Cox proportional-hazards multivariate analysis revealed that large-artery disease was an independent predictor of subsequent cerebral ischemia (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.1-7.1; p=0.02) and subsequent vascular events (HR, 2.9; 95% CI, 1.2-6.7; p=0.01). CONCLUSIONS: In patients with TIA, large-artery disease is an independent predictor of subsequent vascular events. Acute infarction on DWI and a symptom duration of more than 1 hour are not significantly correlated with a higher risk of subsequent vascular events. These findings suggest that the underlying vascular status is more important than symptom duration or acute ischemic lesion on DWI.
Brain ; Brain Ischemia ; Constriction, Pathologic* ; Demography ; Follow-Up Studies ; Humans ; Infarction ; Ischemic Attack, Transient* ; Magnetic Resonance Angiography ; Medical Records ; Multivariate Analysis ; Myocardial Infarction ; Prognosis ; Retinal Artery Occlusion ; Risk Factors ; Spinal Cord ; Stroke

INTRODUCTION: The location of parotid gland tumors in the superficial or deep lobes can affect the time and difficulty of operations. Therefore, accurate preoperative evaluation of the tumor location is important for surgical outcomes. MATERIALS AND METHODS: A total of 16 patients with parotid gland tumors and who underwent a parotidectomy between April 2003 and March 2011 were retrospectively reviewed in terms of demographic background, tumor location, surgical treatment, and treatment outcomes. Tumor location was estimated by four landmarks on contrast enhanced computerized tomography scans, which were Conn's arc, the facial nerve (FN) line, the Utrecht line, and the retromandibular vein. Tumor location was confirmed by relative position depending on the facial nerve during surgery. It was assumed positive since the tumor lies in the superficial lobe of the parotid gland, the sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of each landmark were evaluated. RESULTS: Our result revealed that the facial nerve line had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 71.4%, and efficiency of 87.5%. Some would be more efficient preoperative evaluation methods of the relationship of parotid gland tumors to the facial nerve than others. CONCLUSION: In our study, the FN line was found to be the most reliable analysis method.
Facial Nerve ; Humans ; Parotid Diseases ; Parotid Gland ; Parotid Neoplasms ; Retrospective Studies ; Sensitivity and Specificity ; Veins

Vernet syndrome involves the IX, X, and XI cranial nerves and is most often attributable to malignancy, aneurysm or skull base fracture. Although there have been several reports on Vernet's syndrome caused by fracture and inflammation, cases related to varicella-zoster virus are rare and have not yet been reported in South Korea. A 32-year-old man, who complained of left ear pain, hoarse voice and swallowing difficulty for 5 days, presented at the emergency room. He showed vesicular skin lesions on the left auricle. On neurologic examination, his uvula was deviated to the right side, and weakness was detected in his left shoulder. Left vocal cord palsy was noted on laryngoscopy. Antibody levels to varicella-zoster virus were elevated in the serum. Electrodiagnostic studies showed findings compatible with left spinal accessory neuropathy. Based on these findings, he was diagnosed with Vernet syndrome, involving left cranial nerves, attributable to varicella-zoster virus.
Aneurysm ; Cranial Nerves ; Deglutition ; Ear ; Emergencies ; Herpesvirus 3, Human ; Inflammation ; Laryngoscopy ; Neurologic Examination ; Republic of Korea ; Shoulder ; Skin ; Skull Base ; Uvula ; Vocal Cord Paralysis ; Voice

Iron deficiency anemia has been rarely reported as a cause of cerebral venous thrombosis but its pathogenic relationship with cerebral venous thrombosis is still unknown. A previously healthy 25-year old woman presented with headache, nausea, vomiting, and slight confusion. A magnetic resonance imaging and venogram revealed an infarction involving the right frontal subcortical white matter and left thalamus, with thrombosis in the internal cerebral vein, the vein of Galen. Etiological investigations for cerebral venous thrombosis disclosed no precipitating factors other than iron deficiency anemia. The patient's symptoms rapidly improved with anticoagulation and no neurologic deficits remained. We report a rare case of deep cerebral vein thrombosis associated with iron deficiency anemia without reactive thrombocytosis.
Adult ; Anemia, Iron-Deficiency* ; Cerebral Veins ; Female ; Headache ; Humans ; Infarction ; Iron* ; Magnetic Resonance Imaging ; Nausea ; Neurologic Manifestations ; Precipitating Factors ; Thalamus ; Thrombocytosis ; Thrombosis ; Venous Thrombosis* ; Vomiting

Congenital muscular torticollis (CMT) is called 'pseudotumor of infancy' because it is commonly discovered and diagnosed within 14~28 days after birth as a sternomastoid tumor. We report two cases of CMT which presented as head tilt without any palpable neck mass immediately after birth but later developed into sternomastoid tumors. Serial ultrasonography confirmed increased echogenicities of the sternocleidomastoid muscles. We think that these findings are prodromal signs of sternomastoid tumors. Close physical examination by a neonatologist is crucial for an early diagnosis of CMT. Neonates with head tilt and increased ecogenicity of the sternocleidomastoid muscle on ultrasonography should be carefully followed up to see whether neck mass develops later. The authors suggest that CMT is not a static entity but rather one that progress to mass alteration after birth.
Early Diagnosis ; Head ; Humans ; Infant, Newborn ; Muscles ; Neck ; Parturition ; Physical Examination ; Prodromal Symptoms ; Torticollis

Treatment of choice for cervical dystonia is botulinum toxin (BTX) injection and surgical interventions can be tried in refractory cases. Success of BTX injection depends on precise muscle selection and adequate dosage of BTX. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) can evaluate the metabolism of the superficial and deep cervical muscles with high resolution and may be useful for identifying dystonic muscles in CD. We report a satisfactory result of BTX injection using 18F-FDG PET/CT for identification of dystonic muscles in a patient with cervical dystonia who previously failed to respond to botulinum toxin injection and denervation operation.
Botulinum Toxins ; Denervation ; Electrons ; Fluorodeoxyglucose F18 ; Humans ; Muscles ; Positron-Emission Tomography ; Torticollis

PURPOSE: Congenital pseudarthrosis of the tibia, which is recalcitrant to treatments and prone to recur, is frequently associated with neurofibromatosis. The causative gene for neurofibromatosis, NF1, has been identified, but the pathomechanism of congenital pseudarthrosis has not been elucidated. The purposes of this study were to establish primary cell culture from the fibrous hamartoma tissue of pseudoarthrosis, and to compare the gene expression patterns of the fibrous hamartoma and normal bone. MATERIALS AND METHODS: Incubation of the enzymatically treated fibrous hamartoma tissue resulted in growth of the adherent fibroblast-like spindle cells. Expression of hundreds of genes including bone morphogenetic protein-2 and -4, and NF1 were screened by reverse transcription-polymerase chain reaction and cDNA array hydridization methods. RESULTS: Bone morphogenetic protein-2 and -4, and, NF1 were found to express in normal bone, normal periosteum as well as fibrous hamartoma and adjacent hypotrophic bone. Twenty-four genes were found to express exclusively in the fibrous hamartoma, and fifty genes only in the normal bone. CONCLUSION: These findings suggest that the causative gene of neurofibromatosis, NF1, may be associated with pathogenesis of the congenital pseudoarthrosis of the tibia in neurofibromatosis patients.
Gene Expression ; Hamartoma ; Humans ; Neurofibromatoses* ; Oligonucleotide Array Sequence Analysis ; Periosteum ; Primary Cell Culture ; Pseudarthrosis* ; Tibia*

PURPOSE: We have used a hybrid fixation, in which DynaExtor(R) and Ilizarov rings are connected each other with special connectors. Here, we report upon the technical tips learned and the clinical outcomes of the first twenty five consecutive cases treated using this method. MATERIALS AND METHODS: Between May 1997 and December 1999, 25 patients were treated using hybrid fixation aimed at simple lengthening (8 patients), concomitant deformity correction and lengthening (12), deformity correction alone (3), and fracture fixation (2). RESULTS: In the group requiring simple lengthening, the healing index (H.I.) was 38.3 day/cm (23.6-66.8 day/cm). For concomitant deformity correction and lengthening, the mean amount of angular correction was 33.8degrees (15-75degrees) and the length gain, 4.7 cm (2.2-8.9 cm). For deformity correction alone, the amount of angular correction was 50.1degrees (15-120degrees). For fracture fixation, the mean external fixation time was 59.5 days (26-93 days). Complications included mild pin-tract infection in 8 patients, a temporary stiff joint in 5, and equinus of the foot and delayed union in one patient each. CONCLUSION: The DynaExtor(R) hybrid-fixation system is an effective and convenient method that can be selectively applied to cases that need deformity correction, lengthening, or fixation of the long bone.
Bone Lengthening ; Congenital Abnormalities ; Foot ; Fracture Fixation ; Humans ; Joints

Bone Resorption ; Follow-Up Studies ; Humans ; Mandible ; Surgery, Oral ; Tissue Donors ; Transplants