Concurrent use of instrumentation has been shown to increase fusion rates and satisfactory results for surgical treatment of the lumbar stenosis. The objectives of the present study were to evaluate clinically and radiologically two groups of lumbar stenosis who were surgically treated with pedicular screw fixation system and posterior lumbar interbody or posterolateral autogenous bone graft following complete posterior decompression. One group was degenerative type and the other group was spondylolisthetic type spinal stenosis. We analyzed the results of 39 cases of lumbar stenosis who underwent pedicular screw and rod fixation system and posterior lumbar interbody or posterolateral autogenous iliac bone fusion following complete posterior decompressive operation during the period from May 1988 to December 1992. There were 27cases of degenerative type and 12 cases of spondylolisthetic type lumbar stenosis. The were 25 women and 14 men. Their age was ranged 20 to 76 years old with an average of 51.7 years old. The follow up period was the interval from 18 months to 6 years with an average of 3.2 years. The radiologic union rate was average 94.9% and 96.3%(26cases) in degenerative spinal stenosis and 91.7%(11 cases) in spondylolisthetic spinal stenosis. The clinical success rate was average 92.3%(36 cases), 88.9%(24 cases) in degenerative spinal stenosis and 100%(12 cases) in spondylolisthetic spinal stenosis. The patients with spondylolytic spinal stenosis showed better result in their life than the patient with degenerative spinal stenosis.
Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Male ; Pedicle Screws ; Spinal Stenosis ; Transplants

BACKGROUND: The appearance of multiple-drug-resistant Mycobacterium tuberculosis strains has been seriously compromising successful control of tuberculosis. Rifampin-resistance, caused by mutations in the rpoB gene, can be indicative of multiple-drug-resistance, and its detection is of great importance. The present study aimed to develop an oligonucleotide chip for accurate and convenient screening of drug-resistance. METHODS: In order to detect point mutations in the rpoB gene, an oligonucleotide chip was prepared by immobilizing specific probe DNA to a microscopic slide glass by a chemical reaction. The probe DNA that was selected from the 81 bp core region of the rpoB gene was designed to have mutation sites at the center. A total of 17 mutant probes related to rifampin-resistance including 8 rifabutin-sensitive mutant probes were used in this study. For accurate determination, wild type probes were prepared for each mutation position with an equal length, which enabled a direct comparison of the hybridization intensities between the mutant and wild type. RESULTS: Mycobacterial genomic DNA from clinical samples was tested with the oligonucleotide chip and the results were compared with those of the drug-susceptibility test in addition to sequencing and INNO-LiPA Rif. TB kit test in some cases. Out of 15 samples, the oligonucleotide chip results of 13 samples showed good agreement with the rifabutin-sensitivity results. The two samples with conflicting result also showed a discrepancy between the other tests, suggesting such possibilities as existence of mixed strains and difference in drug-sensitivity. Further verification of these samples in addition to more case studies are required before the final evaluation of the oligonucleotide chip can be made. CONCLUSION: An oligonucleotide chip was developed for the detection of rpoB gene mutations related to drug-susceptibility. The results to date show the potential for using the oligonucleotide chip for accurate and convenient screening of drug-resistance to provide useful information in antituberculosis drug therapy.
DNA ; Drug Therapy ; Glass ; Mass Screening ; Mycobacterium tuberculosis* ; Mycobacterium* ; Point Mutation* ; Rifabutin ; Rifampin ; Tuberculosis

No abstract available.
Histiocytosis*

The authors analyzed a series of 49 cases of spinal cord tumor confirmed by operation and biopsy at Presbyterian Medical Center, Jeonju, from Jan. 1977 to Dec. 1981. Histologically vertified spinal cord tumors wereneurofibroma(36.7%: 18/49), meningioma(22.5%; 11/49), ependymoma(18.5%; 9/49), metastasis(10.2%; 5/49),astrocytoma(6.1%; 3/49), epidermoid (2.0%;1.49), glioblastoma multiforme(2.0%;1/49), and diffuse non-Hodgkin'slymphoma(2.0%;1.49). The results were as follows; 1. The most frequently encountered tumor was the intraduralextramedulary tumor(55.1%;27/49). The other tumors, in descending order, were intramedullary tumor(26.5%; 13/49),extradural extradural extramedullary tumor(10.2%;5/49), and intra-&extradural extramedullary tumor(8.2%;4/49).The most frequently encoutered tumor was neurofibroma(36.7%; 18/49). Four of the 18 neurofibroma were intra-&extradural extramedullary tumor, and three(3/4) were dumbbell type of neurofibroma. 2. Only 3 cases occurred under20 years of age. They were glioblastoma multiforme, neurofibroma and epidermoid. 3. No sex predominance of spinalcord tumor was seen, but the majority of the meningiomas occurred in females(81.8%). 4. The most frequent site oftumors was the thoracic region(53.1%;26/49). The order sites were the cervical regions(2.0%;1/49) . 5. Thirteencases (26.5%) showed bony changs on preliminary roentgenograms of the spine. None showed bony changes inextradural extramedullary tumor. 6. As a rule, the myelographic deformities produced by intramedullary tumorshowed fairly long fusiform dilatation of the contrast column without displacement of the spinal cord; theextradural extramedullary tumor showed coarse transverse serrated block of the contrast column; and the intraduralextramedullary tumor showed cup defect of the contrast column.
Biopsy ; Congenital Abnormalities ; Dilatation ; Glioblastoma ; Jeollabuk-do ; Meningioma ; Neurofibroma ; Protestantism ; Spinal Cord Neoplasms ; Spinal Cord ; Spine

Spinal dimensions (anterior, mid, and posterior height of the vertebral body) and shape variation (wedge compression, biconcave, and crush ratio) were obtained from plain radiographs of healthy Korean men and women. The purpose of this study was to define vertebral fracture from normal spinal morphometry of Korean men and women and to compare spinal dimension between men and women. Healthy 100 men and 100 women were included in this study. Plain lateral radiographs of thoracic and lumbar vertebrae were taken with standard method. Quantitative morphometry (anterior, mid, and posterior height of the vertebral body) was performed with plain radiographs. Spinal shape variations (wedge compression, biconcave, and crush ratio) were calculated from morphometric data. Spinal dimensions and shape variation of Korean men and women were presented, and morphometric cut-off vaiues for vertebral fracture were evaluated(mean-3xSD). Spinal dimensions of men were greater than women in all level (p<0.01). Wedge compression ratios (T6, 7, 8, 9, 12, L5 level) and biconcave ratios (T12, Ll, 4, 5 level) and crush ratios (Tll, L4, L5 level) were different between men and women (p<0.01). Spinal dimensions and shape variation from quantitative morphometry can be used in objective definition of vertebral fracture which can be used in medicolegal problem, workers compensation and medical insurance.
Female ; Humans ; Insurance ; Lumbar Vertebrae ; Male ; Spine ; Workers' Compensation

We examined the causes of delaying or cancellation of the elective surgery at Seoul National University Children's Hospital. The total numbers of pediatric patient for the elective surgery during September 1, 1994, to November 30, 1994, were 1287 and that of delaying or cancellation of surgery were 135. The fraction of medical causes of delaying of the elective surgery was 62.2%, and that of non-medical causes of the elective surgery was 36.3%, and 1.5% was unknown. The single most frequent cause was upper respiratory infection, 42.2% of total delays, and the second was that patient had not be admitted as 16.3%o of total delays. The third frequent cause was no indication for surgery as 6.7%, the fourths were fever and inadequate preparation for surgery (5.2%), and the sixth was that the patient had refused to give an informed consent (3.7%), etc.
Fever ; Humans ; Informed Consent ; Seoul

As modern society becomes increasingly complex, there has been a steady increase in violence, as well as in automobile and industrial accidents. This has resulted in an increased incidence of facial injuries, including mandibular fractures. Many methods have been advocated to achieve reestablishment of normal feature and function. The choice generally depends upon such factors as location of the fractures, displacements, status of the dentition and favorability of the fracture line. Many cases of mandibular fracture are treated by intermaxillay fixation using an arch bar or bite block(acrylic splint)for rapid bone union and minimal displacement. However, there had been some problems, such as discomfort to patients, limitation to eating and weight loss, poor oral hygiene, and temporomandibular joint ankylosis. As a consequence, we have modified the shape of the acrylic splint and method of fixation for circum-mandibular fixation instead of intermaxillary fixation. Acrylic splints are rigid, strong, easily adjusted and repaired, translucent, lightweight and well tolerated by the oral mucosa. The splints are properly secured to each tooth and bind all the teeth together as a single unit. Authors have used modified acrylic splints as tools of circum-mandibular fixation in 12 cases of mandibular symphysis and body fracture from May 1997 to August 1998, achieving the results of very good occlusal relationship, oral hygiene and comfort to patients.
Accidents, Occupational ; Ankylosis ; Automobiles ; Dentition ; Eating ; Facial Injuries ; Humans ; Incidence ; Mandibular Fractures* ; Mouth Mucosa ; Oral Hygiene ; Splints* ; Temporomandibular Joint ; Tooth ; Violence ; Weight Loss

We presented a case of Ehlers-Danlos syndrome(ED syndrome) in s 21-year- old male, who had hyperextensibility of skin, skin fragility, and cigarette paperlike atrophic scars with no joint problems since infancy. There was a family history which was suggestive of autosomal dominant trait. Microscopic examination of the skin biopsy specimen from the normal appearing skin on the right forearm showed no abnormal appearance. In this case the manifestations of skin including marked hyperextensibility might be in accord with type I (gravis) ED syndrome, but the joint manifestation did not correspond to this type. It might be hard to classify this case according to the eleven types of ED syndrome. Wed rather consider this case as a. mixed form of type I and type Il ED syndrome.
Biopsy ; Cicatrix ; Ehlers-Danlos Syndrome ; Forearm ; Humans ; Joints ; Male ; Skin ; Tobacco Products

A poor prognosis of oral squamous cell carcinoma (SCC) is partly due to the invasiveness and metastasis of the tumor. A key element in tumor invasion and metastasis in the degradation of extracellular matrix is matrix metalloproteinases (MMPs). This study was performed to determine the expression of MMP-2 and MMP-9 of oral SCCs with regard to the histologic invasiveness and differentiation in 5 normal oral mucosa and 36 oral SCCs. The histologic invasiveness of oral SCCs were classified into 4 grades. The differentiation of oral SCCs was divided into 3 grades. The streptavidin-biotin immunohistochemical staining, using MMP-2 and MMP-9 monoclonal antibodies, was performed to determine the expression of MMP-2 and MMP-9. The expression of MMP-2 was positive in 6 of 17 oral SCCs with weak invasiveness and was positive in 7 of 19 oral SCCs with strong invasiveness. The MMP-2 expression did not increase significantly with respect to the invasiveness of oral SCCs (P>0.05). The expression of MMP-9 was strongly positive in 6 out of 17 SCCs with weak invasiveness and was strongly positive in 14 of 19 SCCs with strong invasiveness. The MMP-9 expression increased significantly with respect to the invasiveness of oral SCCs; the stronger the expression, the stronger the invasiveness (P<0.05). The expression of MMP-9 was in 57.9% of well differentiated SCCs, 57.1% of moderately differentiated ones, and 33.3% of poorly differentiated SCCs. The expression of MMP-2 and MMP-9 did not increase significantly with respect to the histologic differentiation. We conclude that with respect to the invasiveness, the MMP-9 expression increases significantly in oral SCCs but the MMP-2 expression does not; and that with respect to the histologic differentiation, their expressions do not increase significantly. These results suggeste that MMP-9 can be used as a tool to evaluate the invasiveness of oral SCCs.
Antibodies, Monoclonal ; Carcinoma, Squamous Cell* ; Extracellular Matrix ; Matrix Metalloproteinase 2* ; Matrix Metalloproteinases ; Mouth Mucosa ; Neoplasm Metastasis ; Prognosis

BACKGROUND: Since the initial report on anesthesia for the renal transplantation from Peter Bent Brighan Hospital in 1962, the anesthesia for kidney transplantation has been reviewed and discussed by many authors. We have performed 200 renal transplantations from August 1990 to October 1996. No cadaveric donor was used and all except two cases was the first graft. METHODS: Anesthetic procedures in the recipients were as follows; 1) The recipient was dialysed within 24 hrs prior to operation. 2) Premedication was done as glycopyrrolate and fentanyl, or glycopyrrolate and diazepam. 3) Thiopental and vecuronium, or thiopental and succinylcholine were used for anesthetic induction. 4) N2O-O2-relaxant (vecuronium) with halothane or isoflurane were used for maintenance. 5) Neostigmine or pyridostigmine were also used to antagonize against the relaxant. 6) CVP was maintained around 10~17 cmH2O. RESULTS: The results were as follows; 1) The mean ages of donors and recipients were 35.3 and 37.4, respectively. The ratio of male to female of donors and recipients was 1.6 : 1 and 1.6 : 1, respectively. 2) One hundred and ten cases (55.0%) were living unrelated donors and 90 cases (45.0%) were living related donors. 3) Overall graft and patient survival rate was 96.9 and 98.0 at 1 year, 94.1 and 95.1 at 3 years. CONCLUSIONS: Most patients with renal failure have several common problems that are of significance to anesthesiologists, including anemia, bleeding tendency, electrolyte imbalance, acidosis, hypertension, hyper- or hypovolemia, and previous therapy with steroids and immunosuppressants, etc. Therefore anesthesiologists should keep in mind the risk factors above mentioned for the anesthetic management of patients with renal failure.
Acidosis ; Anemia ; Anesthesia ; Cadaver ; Diazepam ; Female ; Fentanyl ; Glycopyrrolate ; Halothane ; Hemorrhage ; Humans ; Hypertension ; Hypovolemia ; Immunosuppressive Agents ; Isoflurane ; Kidney Transplantation* ; Male ; Neostigmine ; Premedication ; Pyridostigmine Bromide ; Renal Insufficiency ; Risk Factors ; Steroids ; Succinylcholine ; Survival Rate ; Thiopental ; Tissue Donors ; Transplants ; Unrelated Donors ; Vecuronium Bromide