BACKGROUND: Bronchial asthma is an inflammatory disease of the airways that is associated with airway remodeling. The vascular endothelial growth factor (VEGF) is a potent, multifunctional cytokine that contributes to angiogenesis and inflammation. Matrix metalloproteinase-9 (MMP-9) is a major proteolytic enzyme that induces bronchial remodeling in asthma. However, there is no data available on the possible role of the VEGF or on the potential relationship between the VEGF and MMP-9 in acute asthma. Therefore, the VEGF was studied to determine whether or not it participates in airway inflammation during acute asthma. An additional aim of this study was to determine whether or not the VEGF levels correlated with the MMP-9 levels in the sputum of acute asthma patients. METHODS: Both the VEGF and MMP-9 levels were measured by an enzyme immunoassay and zymographic analysis in the sputum of patients with either stable asthma or with acute asthma. The VEGF and MMP-9 levels were also evaluated during a spontaneous asthma attack. RESULTS: The VEGF levels were significantly higher in the sputum of acute asthmatic patients than in either the stable patients the control subjects. The VEGF levels in the sputum during asthma exacerbation were significantly higher than those on the remission days, and those levels decreased after decreased after asthma therapy. In acute asthmatic patients, the VEGF levels in the sputum correlated with the number of neutrophils and eosinophils. In addition, a significant correlation was established between the VEGF and MMP-9 levels in the sputum. CONCLUSION: These results suggest that VEGF overproduction is associated with airway inflammation during acute asthma and is related to the MMP-9 function.
Airway Remodeling ; Asthma* ; Eosinophils ; Extracellular Matrix ; Humans ; Immunoenzyme Techniques ; Inflammation ; Matrix Metalloproteinase 9* ; Neutrophils ; Sputum ; Vascular Endothelial Growth Factor A*

BACKGROUND: Epidural steroid injections (ESIs) have been widely used in managing spinal pain. Dexamethasone has recently emerged as a useful drug in this setting, relative to particulate steroids, although the associated systemic effects have not been fully elucidated. This study aimed to investigate the incidences and types of systemic effects after fluoroscopically guided ESI with dexamethasone. METHODS: This retrospective study included 888 ESIs with dexamethasone (fluoroscopically guided at the cervical and lumbosacral levels) performed on 825 patients during January to June 2017. Data regarding systemic effects were collected via telephone interviews using a standardized questionnaire at 2 weeks after the procedure. Data on patient demographic, clinical, and procedural characteristics were collected and analyzed to identify factors that were associated with systemic effects. All statistical analyses were performed using the chi-squared test. RESULTS: Among the 825 patients, 40 patients (4.8%) experienced systemic effects during the 2-week follow-up period. The most common systemic effect was facial flushing (12 patients, 1.5%), which was followed by urticaria (7 patients, 0.8%) and insomnia (7 patients, 0.8%). A history of spine surgery was significantly associated with the occurrence of systemic effects (P = 0.036). Systemic effects were significantly more common for injections at the cervical level than at the lumbar level (P = 0.019). CONCLUSIONS: Approximately 4.8% of the patients who underwent ESI with dexamethasone experienced minor and transient systemic effects. These effects were more common in patients who had undergone a previous spine surgery or received a cervical ESI.
Dexamethasone ; Drug-Related Side Effects and Adverse Reactions ; Epidural Space ; Fluoroscopy ; Flushing ; Follow-Up Studies ; Humans ; Incidence ; Interviews as Topic ; Low Back Pain ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders ; Spine ; Steroids ; Urticaria

STUDY DESIGN: A retrograde study, using Computerized Tomography (CT), to evaluate a safer approaching angle and distance for a percutaneous endoscopic discectomy. OBJECTIVES: To measure the safest approaching angle and distance in a percutaneous endoscopic discectomy at each vertebra level in Koreans. LITERATURE REVIEW SUMMARY: Some authors have shown an approaching angle of between 25 to 30 degrees, but reports on Koreans patients are very rare. MATERIALS AND METHODS: 200 cases of abdomino-pelvic CT were investigated. The minimal angle of safe approach was composed of two lines, one horizontal line passing through the mid point in the posterior cortex of upper vertebra, with the other extending passed the mid point of posterior cortex in the upper vertebra to the dorsal margin of the retroperitoneal fat or peritoneum. The maximal distance for a safe approach was measured from the end of spinous process to the point where the extended former second line crosses the skin. The minimal angles and maximal distances for safe approaches in males and females, from the right and left sides, at each level of the intervertebral space and in groups according to the BMI were compared. RESULTS: Females had a larger mean minimal angle for a safe approach (14.7 degrees) than that for males (9.6 degrees). However, no differences were observed between the right (12.0 degrees) and left sides (12.4 degrees). At each vertebral level, L2-3(16.4 degrees), L3-4(11.3 degrees) and L4-5(8.8 degrees), significant differences were observed. However, obesity had no influence on the different angles for a safe approach. The maximal distances for safe approaches were 12.9 and 12,6cm in males and female, 12.8 cm in for both of the right and left sides, and 11.8, 13.0 and 13.6cm in L2-3, L3-4 and L4-5, respectively. No differences were observed in any of the above group, but the more obese group had a longer distance. CONCLUSIONS: Females and the upper level of the intervertebral space had larger minimal angles for a safe approach, but there were no differences in relation to gender, direction and obesity. All the maximal distances for safe approaches were the same in males, females, right and left, and at each level of the intervertebral space, but the more obese group had a longer distance. A safer zone for the approach in a percutaneous endoscopic lumbar discectomy can be taken, considering the gender, vertebra level and obesity.
Diskectomy* ; Female ; Humans ; Intra-Abdominal Fat ; Male ; Obesity ; Peritoneum ; Skin ; Spine

STUDY DESIGN: A retrograde study, using Computerized Tomography (CT), to evaluate a safer approaching angle and distance for a percutaneous endoscopic discectomy. OBJECTIVES: To measure the safest approaching angle and distance in a percutaneous endoscopic discectomy at each vertebra level in Koreans. LITERATURE REVIEW SUMMARY: Some authors have shown an approaching angle of between 25 to 30 degrees, but reports on Koreans patients are very rare. MATERIALS AND METHODS: 200 cases of abdomino-pelvic CT were investigated. The minimal angle of safe approach was composed of two lines, one horizontal line passing through the mid point in the posterior cortex of upper vertebra, with the other extending passed the mid point of posterior cortex in the upper vertebra to the dorsal margin of the retroperitoneal fat or peritoneum. The maximal distance for a safe approach was measured from the end of spinous process to the point where the extended former second line crosses the skin. The minimal angles and maximal distances for safe approaches in males and females, from the right and left sides, at each level of the intervertebral space and in groups according to the BMI were compared. RESULTS: Females had a larger mean minimal angle for a safe approach (14.7 degrees) than that for males (9.6 degrees). However, no differences were observed between the right (12.0 degrees) and left sides (12.4 degrees). At each vertebral level, L2-3(16.4 degrees), L3-4(11.3 degrees) and L4-5(8.8 degrees), significant differences were observed. However, obesity had no influence on the different angles for a safe approach. The maximal distances for safe approaches were 12.9 and 12,6cm in males and female, 12.8 cm in for both of the right and left sides, and 11.8, 13.0 and 13.6cm in L2-3, L3-4 and L4-5, respectively. No differences were observed in any of the above group, but the more obese group had a longer distance. CONCLUSIONS: Females and the upper level of the intervertebral space had larger minimal angles for a safe approach, but there were no differences in relation to gender, direction and obesity. All the maximal distances for safe approaches were the same in males, females, right and left, and at each level of the intervertebral space, but the more obese group had a longer distance. A safer zone for the approach in a percutaneous endoscopic lumbar discectomy can be taken, considering the gender, vertebra level and obesity.
Diskectomy* ; Female ; Humans ; Intra-Abdominal Fat ; Male ; Obesity ; Peritoneum ; Skin ; Spine

OBJECTIVE: To compare the T1-weighted spectral presaturation with inversion-recovery sequences (T1 SPIR) with T2-weighted turbo spin-echo sequences (T2 TSE) on 3T magnetic resonance arthrography (MRA) in the evaluation of the subscapularis (SSC) tendon tear with arthroscopic findings as the reference standard. MATERIALS AND METHODS: This retrospective study included 120 consecutive patients who had undergone MRA within 3 months between April and December 2015. Two musculoskeletal radiologists blinded to the arthroscopic results evaluated T1 SPIR and T2 TSE images in separate sessions for the integrity of the SSC tendon, examining normal/articular-surface partial-thickness tear (PTTa)/full-thickness tear (FTT). Diagnostic performance of T1 SPIR and T2 TSE was calculated with arthroscopic results as the reference standard, and sensitivity, specificity, and accuracy were compared using the McNemar test. Interobserver agreement was measured with kappa (κ) statistics. RESULTS: There were 74 SSC tendon tears (36 PTTa and 38 FTT) confirmed by arthroscopy. Significant differences were found in the sensitivity and accuracy between T1 SPIR and T2 TSE using the McNemar test, with respective rates of 95.9–94.6% vs. 71.6–75.7% and 90.8–91.7% vs. 79.2–83.3% for detecting tear; 55.3% vs. 31.6–34.2% and 85.8% vs. 78.3–79.2%, respectively, for FTT; and 91.7–97.2% vs. 58.3–61.1% and 89% vs. 78–79.3%, respectively, for PTTa. Interobserver agreement for T1 SPIR was almost perfect for T1 SPIR (κ = 0.839) and substantial for T2 TSE (κ = 0.769). CONCLUSION: T1-weighted spectral presaturation with inversion-recovery sequences is more sensitive and accurate compared to T2 TSE in detecting SSC tendon tear on 3T MRA.
Arthrography* ; Arthroscopy ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Sensitivity and Specificity ; Tears* ; Tendons*

PURPOSE: To evaluate the efficacy of a fluoroscopy-guided epidural blood patch (EBP) in the treatment of a post-dural puncture headache (PDPH). MATERIALS AND METHODS: From November 2013 to April 2017, a total of 164 patients (76 males, 88 females, mean age 40.7 years, age range 12 to 87 years) underwent a fluoroscopy guided EBP for the treatment of PDPH in the department of radiology. The treatment outcomes were classified as follows: complete relief, incomplete relief, failure, and recurrence. In the case of recurrence, the duration between the date of the first EBP and the date of recurrence was described. The effectiveness of the second EBP was also evaluated. RESULTS: In 164 PDPH patients, complete relief was achieved in 157 patients (95.8%), incomplete relief was achieved in 1 patient (0.6%), failure in 2 patients (1.2%) and recurrence in 4 patients after the first EBP. All 4 recurrence patients and the 2 failure patients were discharged with complete relief after receiving one additional EBP. CONCLUSION In patients with PDPH, a fluoroscopy-guided EBP is an effective treatment. Moreover, an additional EBP can be considered in the clinical failure or recurrence of PDPH after the first EBP.

Purpose: To evaluate the ultrasonographic characteristics of steatocystomas focusing on the features that aid in differentiating them from epidermal inclusion cysts and lipomas. Materials and Methods: The ultrasonographic findings of 14 histologically proven steatocystomas in 10 patients were retrospectively reviewed. The following features were assessed: the layer of involvement, shape, margin, echogenicity, posterior acoustic features, and the presence of a visible wall or intralesional striations. The findings were compared with those of subcutaneous lipomas and epidermal inclusion cysts to identify those findings that aid in the differential diagnosis of steatocystomas. Results: The majority of steatocystomas appeared as a subcutaneous mass (n = 6, 42.9%) or a mass involving both the dermal and subcutaneous layers (n = 6, 42.9%). Steatocystomas exhibited a well-defined smooth margin (n = 12, 85.7%) and homogeneous echogenicity (n = 9, 64.3%), and showed no specific posterior acoustic features (n = 9, 64.3%). The most important features that differentiated steatocystomas from epidermal inclusion cysts were a homogeneous internal echotexture (p = 0.009) and absent or less prominent posterior acoustic enhancement (p < 0.001). The features that distinguished steatocystomas from lipomas were the margin (p < 0.001), echogenicity (p = 0.034), internal echotexture (p = 0.004), and the absence of intralesional striations (p < 0.001). Conclusion Steatocystomas appeared as well-defined homogeneous masses with mild or absent posterior acoustic enhancement.

Hemangioblastomas are low-grade, highly vascular tumors that are usually associated with von Hippel-Lindau syndrome. Hemangioblastomas most commonly occur in the cerebellum, and intradural extramedullary hemangioblastoma of the cauda equina is very rare, especially in patients without von Hippel-Lindau syndrome. Herein, we report a case of intradural extramedullary hemangioblastoma of the cauda equina that was not associated with von HippelLindau syndrome, with a focus on its imaging characteristics and differential diagnoses. We compared the clinical presentation and imaging features of our case with those of previously reported cases in the review of the literature.

Hibernoma is a rare benign tumor that arises from vestiges of brown fat. Spinal intraosseous hibernoma has only recently been described in the literature, and only 12 cases have been reported to date due to its extreme rarity. Here, we report the case of a patient who was incidentally diagnosed with an intraosseous hibernoma in the thoracic spine, following a diverse imaging work-up and pathologic confirmation. We correlate the clinical presentation and imaging features of our case with those of previously reported cases during our review of the literature.

Purpose: To evaluate the ultrasonographic characteristics of steatocystomas focusing on the features that aid in differentiating them from epidermal inclusion cysts and lipomas. Materials and Methods: The ultrasonographic findings of 14 histologically proven steatocystomas in 10 patients were retrospectively reviewed. The following features were assessed: the layer of involvement, shape, margin, echogenicity, posterior acoustic features, and the presence of a visible wall or intralesional striations. The findings were compared with those of subcutaneous lipomas and epidermal inclusion cysts to identify those findings that aid in the differential diagnosis of steatocystomas. Results: The majority of steatocystomas appeared as a subcutaneous mass (n = 6, 42.9%) or a mass involving both the dermal and subcutaneous layers (n = 6, 42.9%). Steatocystomas exhibited a well-defined smooth margin (n = 12, 85.7%) and homogeneous echogenicity (n = 9, 64.3%), and showed no specific posterior acoustic features (n = 9, 64.3%). The most important features that differentiated steatocystomas from epidermal inclusion cysts were a homogeneous internal echotexture (p = 0.009) and absent or less prominent posterior acoustic enhancement (p < 0.001). The features that distinguished steatocystomas from lipomas were the margin (p < 0.001), echogenicity (p = 0.034), internal echotexture (p = 0.004), and the absence of intralesional striations (p < 0.001). Conclusion Steatocystomas appeared as well-defined homogeneous masses with mild or absent posterior acoustic enhancement.