No abstract available.
Pancreas*

STUDY DESIGN: Experimental investigation in vitro. OBJECTIVES: To evaluate the relationship between the degeneration of intervertebral disc cells, and low back pain induced by degeneration of intervertebral disc cells and increases in use of proinflammatory mediators via nicotine stimulation. SUMMARY OF LITERATURE REVIEW: Smoking is a leading cause of degeneration of intervertebral disc cells and low back pain. According to the existing literature, nicotine, one of the main ingredients in cigarettes, causes the degeneration of intervertebral disk cells including decrease of glycoprotein through generation of carboxy-hemoglobin, vasoconstriction, and disability of fibrinolysis and changes of metabolism of nucleus pulposus cells. MATERIALS AND METHODS: Annulus fibrosus of intervertebral disc and knee joint cartilage were collected from pigs; these cells were acquired by gradual enzyme decomposition. Using Trypan blue, concentration and survival rate of cells were examined; cells were inserted on alginate beads for tertiary cultivation. Nicotine was then applied at 0, 50, 100, 200 and 300 nM, respectively, and the samples were cultivated for three, six and nine days, respectively. After collecting culture fluid, it was measured for interleukin(IL)-1beta, IL-6 and IL-8 with the ELISA Test. DNA of cells used for cultivation was quantitated and the amount of the resulting proinflammatory mediator was normalized. The results were then compared with the result of same study on cartilage of porcine knee joints. RESULTS: For changes of the inflammatory mediator based on the concentration of nicotine, in nicotine stimulation with low concentration of 50 nM and the control group, there was no significant change, while transient increases of inflammatory mediator showed in nicotine stimulation with concentrations of 100, 200 nM, respectively. There was not a significant increase of IL-1beta observed in all nicotine stimulation groups; these were the same results in porcine cartilage study. The level of IL-6 in 200, 300 nM nicotine concentration showed significant increases, respectively. The level of IL-8 in high dose nicotine stimulation groups also showed significant increases of DNA on the sixth day. And in porcine cartilage study group, significant changes were observed in 200, 300 nM, but the absolute value was lower than that of annulus fibrous cells group. CONCLUSION: Inflammatory mediators such as IL-6 and IL-8 increased as the result of tertiary cultivation of annulus fibrosus cells of porcine intervertebral disk and nicotine stimulation. It is believed that the cells of the disc annulus are more sensitive than articular chondrocytes to nicotine stimulation. This may be the focus of future long-term studies effects of nicotine other inflammatory cytokines.
Cartilage ; Chondrocytes ; Cytokines ; DNA ; Enzyme-Linked Immunosorbent Assay ; Fibrinolysis ; Glycoproteins ; Interleukin-6 ; Interleukin-8 ; Intervertebral Disc* ; Knee Joint ; Low Back Pain ; Metabolism ; Nicotine* ; Smoke ; Smoking ; Survival Rate ; Swine ; Tobacco Products ; Trypan Blue ; Vasoconstriction

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system, characterized by repeatedly invading the brain, optic nerve, or spinal cord. In 2004, when a disease-specific antibody (aquaporin-4-immunoglobulin G) was discovered in the serum of an optic neuromyelitis patient, it was thought to be a separated disease from multiple sclerosis. Since 2004, however, the concept of the disease has been expanded to include NMO spectrum disorder (NMOSD). We experienced a rare case of NMOSD in a patient who presented with left visual disturbance and underwent endoscopic sinus surgery because of acute fungal sinusitis. We report this case with a review of the literature.

BACKGROUND: This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. METHODS: Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. RESULTS: No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. CONCLUSIONS: The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps strength and walking ability. However, adductor canal block was inferior to femoral nerve block in maintaining the exact location of the catheter.
Anesthesia, Spinal ; Arthroplasty, Replacement, Knee* ; Catheters ; Data Collection ; Femoral Nerve* ; Humans ; Knee ; Nerve Block ; Pain, Postoperative ; Peripheral Nerves ; Walking

PURPOSE: The purpose of this study was to analyze patient factors including smoking, body mass index, correction angle, graft material, presence of lateral cortex fracture, and age for the effect on bone union after open-wedge high tibial osteotomy and the effect of graft material used for lateral cortex fractures. MATERIALS AND METHODS: This retrospective study was conducted on 54 patients and 58 cases with osteoarthritic change Kallgren-Lawrence grade 2 or less from May 2012 to June 2014. Average follow-up period was 22 months (14–38 months). The patients were divided into two groups according to patient related factors and graft materials (allograft, n=6; beta-tricalcium phosphate [β-TCP], n=6) used for lateral cortex fractures and were analyzed for the relationship with bone union after open-wedge high tibial osteotomy. Radiographic and clinic analyses were performed, and van Hemert grading was used for grading bone union at 6 weeks, 3 months, 6 months, and 1 year postoperatively. RESULTS: The non-smoking group and the group without lateral cortex fracture showed significantly higher bone union rates than the control group. No significant clinical or radiological difference was observed between the two groups in 12 cases and the allograft group showed significantly higher rates of union at 6 months and 1 year postoperatively according to the van Hemert grading. CONCLUSION: Smoking and the presence of a lateral cortex fracture is a risk factor for nonunion in medial open-wedge high tibial osteotomy. The use of allograft material rather than β-TCP for lateral cortex fractures is thought to result in better bone union.
Allografts ; Body Mass Index ; Follow-Up Studies ; Humans ; Knee ; Osteoarthritis ; Osteotomy* ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Transplants*

BACKGROUND: Recently, body composition analyzer has been used widely clinically. Various indirectly measured values of body are calculated without direct measuring. The abdominal circumference that is presented by such instrument may be used for diagnosing abdominal obesity, but the reliable evidence of the accuracy and the validity may be not be enough for application to general population. For this reason, the author investigated the usefulness of automatically produced abdominal circumference for diagnosing abdominal obesity. METHODS: The medical records of 5,555 outpatients who had undergone body composition analysis in a tertiary hospital was collected. The usefulness of the automatically presented abdominal circumference for diagnosing abdominal obesity among general population was investigated. RESULTS: There was a significant positive correlation between abdominal circumference measured by body composition analyzer and measuring tape in the normal, the overweight, and the obese groups of both gender. But, the results were the same only in females in the underweight group. The most significant difference between the two values were 4.8+/-5.0 cm in normal male group and -5.7+/-5.5 cm in female obese group. The difference of the male obese group was lesser than that of the overweight, the normal and the underweight groups. The difference of the male overweight group was lesser than that of the normal group. The difference of the female obese group was lesser than that of the overweight, the normal and the underweight groups. The sensitivity and specificity to detect abdominal obese person among the total subjects was 76.3% and 79.1%, respectively. The specificity was higher in all male and the normal female groups, wheras the sensitivity was higher in the obese and the overweight female groups. CONCLUSION: Physicians should confirm the accuracy of abdominal circumference, especially in normal males and obese female group, although the automatically presented value is convenient and reflects the manually measured one very well which is useful to diagnose abdominal obesity.
Body Composition* ; Body Mass Index* ; Female ; Humans ; Male ; Medical Records ; Obesity, Abdominal ; Outpatients ; Overweight ; Sensitivity and Specificity ; Tertiary Care Centers ; Thinness ; Waist Circumference

PURPOSE: Laparoscopic procedures for the treatment of patients with a rectal prolapse have gained increasing worldwide acceptance because they have lower recurrence and better functional outcome than perineal procedures. Nevertheless, ideal surgical methods are still not available. We propose a new surgical technique, laparoscopic vaginal suspension and rectopexy, for correcting a full-thickness rectal prolapse and/or middle-compartment prolapse. This study assessed the short-term outcomes for patients who underwent laparoscopic vaginal suspension and rectopexy. METHODS: Between April 2014 and April 2016, 69 female patients underwent laparoscopic vaginal suspension and rectopexy to correct a rectal prolapse. Demographics, medical histories, and surgical and follow-up details were collected from their medical records. In addition to the clinical outcome, we repeated defecation proctography and a questionnaire regarding functional results three months after surgery. RESULTS: No major morbidities or no mortalities occurred. The defecation proctography confirmed excellent anatomical result in all cases. Of 7 patients with combined middle-compartment prolapses, we observed good anatomical correction. During follow-up, full-thickness recurrence occurred in one patient. Preoperative fecal incontinence was improved significantly at 3 months (mean Wexner score: 12.35 vs. 7.71; mean FISI: 33.29 vs. 21.07; P < 0.001). Analysis of responses to the fecal incontinence quality of life (FIQOL) questionnaire showed overall improvement at 3 months compared to the preoperative baseline (mean pre- and postoperative FIQOL scores: 12.11 vs. 14.39; P < 0.004). CONCLUSION: Laparoscopic vaginal suspension and rectopexy is a new combined procedure for the treatment of patients with rectal prolapses. It has excellent functional outcomes and minimal morbidity and can correct and prevent middlecompartment prolapses.
Defecation ; Demography ; Fecal Incontinence ; Female ; Follow-Up Studies ; Humans ; Medical Records ; Mortality ; Prolapse ; Quality of Life ; Rectal Prolapse* ; Recurrence

No abstract available.

PURPOSE: To analyze the CT findings of aortic intramural hematoma (IMH) with or without associated penetrating aortic ulcer (PAUH), as seen on initial and follow-up CT scans. MATERIALS AND METHODS: We retrospectively analyzed the CT findings of 36 cases diagnosed clinically and radiologically as IMH (n=7) and PAUH (n=29) after initial and follow-up CT scanning. The period between initial and follow-up scanning-which was performed between two and four times-ranged from 1 week to 91 months (mean: IMH, 18.4 months;PAUH, 16.2 months). RESULTS: With regard to maximal thickness and extension of IMH, maximal diameter of the involved aorta, inward displacement of intimal calcification, Stanford type of IMH, and pleural and pericardial effusion between IMH & PAUH, the results were not statistically significant, but PAUH tends to develop in older patients and shows a more frequent incidence of aortic atherosclerosis. Only PAUH involved abdominal aortic a-neurysm and focal right renal infarction, each in one case. Penetrating aortic ulcers (PAU) were more frequently found in the proximal descending thoracic aorta (n=24) than in the mid(n=11) to distal(n=10) descending thoracic aorta. Among 53 cases of PAU, seven could not be detected on initial CT scans; this was due to excessive scan thickness (n=4) and masking of the aortic ulcer by IMH(n=3), circumstances which were visualized after resolution of IMH. Follow-up CT scanning showed that PAU progressed to fusiform or saccular aortic dilatation (n=15) or localized aortic dissection (n=4), and that in 34 cases, there was no interval change. Follow-up CT findings of IMH in cases of PAUH were as follows: Type A (n=8), with four resolutions after surgery and four after conservative treatment; Type B (n=21), with 21 resolutions after conservative treatment. Follow-up CT findings of IMH were as follows: Type A (n=2), with one resolution after surgery and one after conservative treatment; Type B (n=5), with progression of typical aortic dissection in two cases, and three resolutions after conservative treatment. CONCLUSION: PAUH is characterized by its occurrence in older patients, a more frequent incidence of aortic atherosclerosis and abdominal aortic aneurysm, but no difference in the extension of IMH and other CT findings between PAUH and IMH. Branch vessel involvement was noted in one case of PAUH but not in cases of IMH. Follow-up CT scanning showed that in the absence of surgery, IMH progressed to aortic dissection or resolution. In all patients who did not undergo surgery, PAU progressed to saccular or fusiform aortic dilatation, localized aortic dissection and no interval change, with resolution of IMH after conservative treatment. Initial and follow-up thin-slice spiral CT scanning can provide correct diagnosis and treatment planning (especially ascending aorta is involved), and permit differentiation between PAUH and IMH.
Aorta ; Aorta, Thoracic ; Aortic Aneurysm, Abdominal ; Atherosclerosis ; Diagnosis ; Dilatation ; Follow-Up Studies ; Hematoma* ; Humans ; Incidence ; Infarction ; Masks ; Pericardial Effusion ; Retrospective Studies ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Ulcer*

A 34-year old woman visited the hospital complaining severe general pain which had onset on the way of improvement of sore throat, cough with sputum as symptoms of acute upper respiratory infection for 3 days. The facts that her younger sister also had a history of porphyria and the color of the patient's urine changed to dark black after it had exposed to sunlight made us to rule out porphyria strongly. Therefore, we measured the level of delta-ALA and porphobilinogen in the collected urine during 24 hours, and confirmed her diagnosis as acute intermittent porphyria. The SIADH was complicated and the sleep disturbance, disorientation and hallucination onset during the hospital days. She had taken high dose dextrose IV and hematin IV therapy for porphyria and improved gradually. Therefore, authors et al. report a case of acute intermittent porphyria with various clinical symptoms on the way of treatment of upper respiratory infection as well as review the previous literatures.
Cough ; Diagnosis ; Female ; Glucose ; Hallucinations ; Hemin ; Humans ; Inappropriate ADH Syndrome ; Pharyngitis ; Porphobilinogen ; Porphyria, Acute Intermittent ; Porphyrias* ; Siblings ; Sputum ; Sunlight