Described here is a case of accidental intrathecal administration of vincristine with pathologic findings in the central nervous system. A 3-year-old boy with acute lymphoblastic leukemia, was given his ninth course chemotherapy. Vincristine was accidentally injected intrathecally. The clinical course was rapidly progressive (6-day course) and resulted in death. An autopsy was done. The brain and spinal cord was grossly edematous and congested without any specific feature. Histologically, profound loss of neuron was noted in the spinal cord. Remaining neurons in the spinal cord, particularly anterior horn cells were markedly swollen. The spinal nerves show diffuse axonal degeneration and myelin loss. The upstream portion of the spinal cord (brain stem, cerebellum, cerebrum) showed patchy loss of neurons, especially Purkinje cells and granular cells of the cerebellar cortex. Many neurons showed axonal reaction (chromatolysis) with swelling. Several neurons show intracytoplasmic eosinophilic inclusion body. Myelin loss, axonal swelling and enlargement of perivascular spaces were seen throughout the white matter of central nervous system.
Antineoplastic Agents/therapeutic use* ; Brain/pathology ; Brain/drug effects ; Case Report ; Central Nervous System/pathology ; Central Nervous System/drug effects* ; Child, Preschool ; Fatal Outcome ; Histocytochemistry ; Human ; Injections, Spinal ; Leukemia, Lymphocytic, Acute/drug therapy* ; Male ; Medication Errors* ; Spinal Cord/pathology ; Spinal Cord/drug effects ; Spinal Nerves/pathology ; Spinal Nerves/drug effects ; Vincristine/therapeutic use* ; Vincristine/administration & dosage

It was learned in 1960 that pregnancy could cause respiratory and circulatory changes, and that severe labor pain could cause tachycardia and cardiac arrythmias. We have experienced successful anesthetic management for cessarean section of a full term pregnant woman with multiple premature ventricular contractions under spinal anesthesia. PVC's could be caused by systemic hyposia, hypokalemia, acidosis hypercapnia, hypocalcemia, regional myocardial ischemia, etc. We could not confirm the cause of this woman's PVCs, but we assume that either deterioration of the respiratory and cardiac changes or severe labor pain could be implicated.
Acidosis ; Anesthesia, Spinal* ; Arrhythmias, Cardiac ; Female ; Humans ; Hypercapnia ; Hypocalcemia ; Hypokalemia ; Labor Pain ; Myocardial Ischemia ; Pregnancy ; Pregnant Women ; Tachycardia ; Ventricular Premature Complexes

BACKGROUND: Recently, the number of people interested in health in South Korea has increased, and the rate of dietary supplement use is rising. Researchers have hypothesized that the rate of practicing healthy habits is higher among those who use dietary supplements than those who do not. Therefore, this study aimed to discover the association between taking dietary supplements and practicing various healthy habits in the Korean, adult population. METHODS: The sample included 15,789 adults over 19 years old who participated in the fifth Korea National Health and Nutrition Examination Survey. The user group was defined as those taking dietary supplements for more than 2 weeks during the previous year or once during the past month. Measures for the seven healthy habits were based on those included in the Alameda study and were analyzed accounting for the complex sampling design. RESULTS: The rate of taking dietary supplements was significantly higher in women, middle aged participants, urban residents, those with a higher income, those with a higher education level, and nonsmokers as well as among women with a moderate subjective health status, women who limited their alcohol content, and women with dyslipidemia. In the adjusted analysis, the rate of performing three of the 'Alameda 7' habits-eating breakfast regularly, restricting snacking, and limiting drinking-was higher in the female dietary supplement user group than in the other groups. Women practiced more healthy habits and had a higher dietary supplement intake rate than men. CONCLUSION: We found that taking dietary supplements in Korean adults is highly associated with demographic and social factors. Taking dietary supplements had a relationship with dietary habits, and there was no significant association between dietary supplement and other healthy habits. Thus in the health clinic, we suggest that taking dietary supplements complements a patient's healthy habits, with the exception of dietary habits, for health promotion.
Adult* ; Breakfast ; Complement System Proteins ; Diagnostic Self Evaluation ; Dietary Supplements* ; Dyslipidemias ; Education ; Female ; Food Habits ; Health Behavior ; Health Promotion ; Humans ; Korea* ; Male ; Middle Aged ; Nutrition Surveys ; Snacks

The purpose of our study was to analyze the incidence of incidental thyroid cancers which were detected by simultaneous sonographic examination of breast and thyroid glands. Between January 2001 and March 2004, 518 patients were diagnosed with breast cancer after modified radical mastectomy (n=369) or breast conserving surgery (n=149). We screened thyroid glands when we examined breast for diagnosis and follow-up after surgery. If we found the sonographic finding of suspicious for malignancy in thyroid, we immediately performed ultrasound-guided fine needle aspiration biopsy (FNAB). Forty-two cases showed suspicious sonographic findings and of those, 18 cases (42.9%) were determined to have suspicious malignant cytology by ultrasound guided FNAB. Among 518 breast cancers, total 13 cases (2.5%) were diagnosed with papillary carcinoma after thyroidectomy. The mean longest diameter of the thyroid masses was 9.9mm (range 1-30mm). Six cases (6/13, 46.2%) were diagnosed as simultaneous breast and thyroid cancers, and the rest of the thyroid cancers were detected after 6 to 33 months (mean 16.5 months) after surgery. In conclusion, the patients with breast cancer had a high incidence (2.5%) of thyroid cancer. Sonographic screening is useful for the early detection of thyroid cancer.

STUDY DESIGN: A prospective study OBJECTIVES: We wanted to assess the clinical outcomes of posterior dynamic stabilization with selective wide decompression for treating multilevel lumbar stenosis in old age. SUMMARY OF THE LITERATURE REVIEW: Deciding on the segments to be operated on is challenging problem for old age patients with multilevel lumbar stenosis. There have been no reports on posterior dynamic stabilization with selective wide decompression for treating multilevel lumbar stenosis. MATERIALS AND METHODS: We evaluated 18 patients who underwent posterior dynamic stabilization with selective decompression for multilevel disc degeneration and spinal stenosis. The mean age was 70.2 years and mean follow-up was 15.1 months. We evaluated the segmental angle, the range of motion (ROM) and pedicle screw loosening. The clinical results were evaluated according to the operative time, blood loss, the visual analogue scale (VAS) for the back pain and leg pain and and the Oswestry disability index (ODI). RESULTS: The mean number of operated segments was 2.16. The lordosis of the lumbar and operated segments showed no significant difference. However, the ROM of the total lumbar spine and the operation segment was significantly decreased from 36.8 to 24.3 and 22.9 to 13.1, respectively. The ROM for the adjacent segment did not show a significant difference. A radiolucent line around the pedicle screw appeared at 22 screws (19.3%) out of a total 114 screws. The VAS for back and leg pain were improved from 7.5 and 8.6 to 2.3 and 2.1, respectively. The ODI was improved from 41.5 to 13.4. CONCLUSIONS: The initial clinical outcomes were favorable after posterior dynamic stabilization with selective decompression. This procedure could be considered to be a useful option for treating multilevel stenosis in old age patients.
Animals ; Back Pain ; Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Leg ; Lordosis ; Operative Time ; Prospective Studies ; Range of Motion, Articular ; Spinal Stenosis ; Spine

Idiopathic granulomatous lobular mastitis (IGLM), also known as idiopathic granulomatous mastitis, is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The aim of this study was to describe the radiological imaging and clinical features of IGLM in order to better differentiate this disorder from breast cancer. We performed a retrospective analysis of the clinical and radiographic features of 11 women with a total of 12 IGLM lesions. The ages of these women ranged between 29 and 42 years, with a mean age of 34.8 years. Ten patients were examined by both mammography and sonography and one by sonography alone. The sites that were the most frequently involved were the peripheral (6/12), diffuse, (3/12), and subareolar (3/12) regions of the breast. The patient mammograms showed irregular ill-defined masses (7/11), diffuse increased densities (3/11), and one oval obscured mass. In addition, patient sonograms showed irregular tubular lesions (7/12) or lobulated masses with minimal parenchymal distortion (2/12), parenchymal distortion without definite mass lesions (2/12), and one oval mass. Subcutaneous fat obliteration (12/12) and skin thickening (11/12) were also observed in these patients. Contrary to previous reports, skin changes and subareolar involvement were not rare occurrences in IGLM. In conclusion, the sonographic features of IGLM show irregular or tubular hypoechoic masses with minimal parenchymal distortion. Both clinical information and the description of radiographic features of IGLM may aid in the differentiation between IGLM and breast cancer, however histological confirmation is still required for the proper diagnosis and treatment of the disorder.
Ultrasonography, Mammary ; Retrospective Studies ; Mastitis/*radiography/ultrasonography ; Mammography ; Humans ; Female ; Diagnosis, Differential ; Carcinoma/radiography/ultrasonography ; Breast Neoplasms/radiography/ultrasonography ; Adult

STUDY DESIGN: Comparative study. OBJECTIVES: To compare the outcomes of unilateral TLIF, bilateral TLIF using Wiltse approach and bilateral TLIF using conventional midline approach. SUMMARY OF LITERATURE REVIEW: There are many studies about outcomes of Unilateral TLIF, but few have compared the 3 different fusion procedures. MATERIALS AND METHODS: 60 patients were divided into 3 groups. Each group has enrolled 20 patients (Study group: unilateral TLIF, Control group 1: bilateral TLIF using Wiltse approach, Control group 2: bilateral TLIF using conventional midline approach). For clinical outcomes, we compared operative time, blood loss, time for ambulation and discharge, VAS for back pain and leg pain and ODI among three groups. For radiologic evaluation, disc height and segmental lordosis were examined. RESULTS: The mean operative time was 147 minutes in study group(SG), 172 minutes in control group 1(CG1), 167 minutes in control group 2(CG2). The mean total blood loss was 466ml in SG, 569ml in CG1, 1140ml in CG2 respectively. VAS for back pain at the third postoperative day significantly decreased in SG and CG1 compared with CG2. There was no significant difference in ODI, disc height and segmental lordosis among the groups. CONCLUSION: Using Wiltse approach, there were several advantages in decreasing blood loss, immediate postoperative back pain, hospital stay and early ambulation. Clinical and radiological results of unilateral TLIF were comparable with bilateral TLIF.
Animals ; Back Pain ; Early Ambulation ; Humans ; Leg ; Length of Stay ; Lordosis ; Operative Time ; Walking

BACKGROUND AND OBJECTIVES: Reverse redistribution pattern (RRP), that is defined as the worsening of the perfusion defect at rest image, can be observed in 99mTC-sestamibi (methoxy isobutyl isonitrile) myocardial scan with standard stress-rest protocol. This study was prepared to evaluate the prevalence and clinical characteristics of RRP in stress 99mTc-sestamibi myocardial scan. MATERIALS AND METHODS: We retrospectively reviewed 1304 images of 99mTC-sestamibi myocardial perfusion scan performed between January 1995 and June 1997, and scintigraphic findings were compared with clinical and angiographic data. RESULTS: The prevalence of RRP was 5.2%(68 of 1,304). RRP was noted in 6.0% (41 of 679) of the adenosine study and 4.3% (27 of 625) of the exercise study. The mean coronary artery stenosis at RRP territory was 51.5+/-38.9%. However, normal coronary artery at RRP territory was noted in 45.8% (11 of 24). There was no significant differences in luminal narrowing of coronary arteries, TIMI flow grade and LV wall motion between the patient with RRP positive and RRP negative at the infarct related artery territory. CONCLUSION: Reverse redistribution pattern on 99mTC-sestamibi myocardial SPECT does not seem to indicate the presence of significant coronary artery disease or patency of the infarct related arteries in the patients with acute MI.
Adenosine ; Arteries ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Humans ; Perfusion* ; Phenobarbital ; Prevalence ; Retrospective Studies ; Technetium Tc 99m Sestamibi* ; Tomography, Emission-Computed, Single-Photon

Inflammatory myopathy is characterized by symmetrical proximal muscle weakness, elevated muscle enzyme levels and favorable response to glucocorticoids therapy. Although periorbital edema is a common manifestation of inflammatory myopathy, generalized subcutaneous edema is very rare. We report here a case of a 47-year-old female patient with acute polymyositis/systemic lupus erythematosus overlap syndrome with generalized subcutaneous edema and interstitial lung disease. We aggressively treated the disease with high-dose glucocorticoids, intravenous immunoglobulin, and immunosuppressive agents.
Edema* ; Female ; Glucocorticoids ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Lung Diseases, Interstitial* ; Middle Aged ; Muscle Weakness ; Muscles ; Myositis

OBJECTIVE: Autophagy plays a vital role in homeostasis by combining organelles and cellular proteins with lysosome under starvation conditions. In addition, autophagy provides tumor cells with a source of energy. Continued autophagy will induce cells death. Here we aim to see if autophagic induction has an effect on conventional chemotherapeutic agents. METHODS: Rapamycin, or mammalian target of rapamycin and paclitaxel, apoptosis-inducing agents were used autophagy in HeLa cervical cancer cells. RESULTS: Growth inhibition of cells was not observed after the application of 0, 10, 20 nM of paclitaxel with or without rapamycin. Using a 5 nM concentration of paclitaxel, rapamycin administration inhibited cell growth significantly compared to no treatment. This implies the synergic antitumor effect of paclitaxel and rapamycin. Paclitaxel itself did not show any autophagic effect on cells but did show cell apoptosis by flow cytometry. Light chain 3, a microtubule-associated protein, which reflect autophagy, was increased with 5 nM of paclitaxel after pretreatment with 10 nM of rapamycin. CONCLUSION: These findings suggest that the autophagic inducer, rapamycin, can potentiate autophagic cell death when added as an apoptosis-inducing chemotherapeutic agent. In conclusion, the control of autophagy may be a future target for chemotherapy.
Apoptosis ; Autophagy ; Cell Death ; Flow Cytometry ; Homeostasis ; Light ; Lysosomes ; Organelles ; Paclitaxel ; Proteins ; Sirolimus ; Starvation ; TOR Serine-Threonine Kinases ; Uterine Cervical Neoplasms