Degenerative lumbar spondylolisthesis requires fusion of the involved segments and decompression laminectomy because it is mechanically unstahle and usually associated with stenosis of the spinal canal. Transabdominal retroperitoneal approach through small longitudinal pararectal skin incision provides easy and safe access to L3-4 and L4-5 disc spaces with less bleeding. We thought that anterior interbody fusion enable us to restore the disc space and to reduce partially the listhesis with less hleeding and less harvest of graft hone compared to posterolateral fusion, and also without the risk of neural or dural damage which could he occurred in posterior lumbar interbody fusion 4.15.16.17). Thus, authors performed the same-day anterior and posterior spinal surgery (APSS) in 28 patients (30 disc spaces) from 1992 to 1996 and analyzed the clinical and radiological results. The most common site of involvement was L4-5 level (82.1%). The mean follow-up period was 2 years and 2 months (from l2 months to 4 years). Fusion was ohtained at 29 disc spaces (96.7%) within 24 weeks (average, I 6 weeks). The anterior displacement was corrected up to the average of 65.4% (5.8mm) postoperatively and the average of 60.7% (5.2mm) correction remained at last follow-up. The intervertebral disc space was restored up to the average of 96.9% (7.5mm) postoperatively and the average of 86.0% (6.2mm) restoration remained at last follow-up. Twenty-five out of 28 patients (89.2%) showed excellent or good clinical results hy the criteria of Kim, et al6). In conclusion, the same-day procedure of successive anterior interbody fusion, decompression laminectomy and posterior pedicular instrumentation for the degenerative lumbar spondylolisthesis associated with spinal stenosis was thought to be a good method of treatment.
Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Hemorrhage ; Humans ; Intervertebral Disc ; Laminectomy ; Skin ; Spinal Canal ; Spinal Stenosis ; Spondylolisthesis* ; Transplants

BACKGROUND: Hyponatremia in the elderly, one of the most common disorders seen in the emergency room (ER), has been shown to have a poor prognosis if treated improperly. However, it often is a challenge to detect because of its varying symptoms. This study aimed to improve the diagnosis and management of severe hyponatremia in the ER by analyzing clinical characteristics and patterns according to patient age. METHODS: Of the patients who visited the ER at Asan Medical Center in Seoul from May 1 to October 2006, 151 patients whose blood sodium concentration was 120 mEq/L or lower were examined in terms of gender, age, history, major symptoms, history of diuretic uses, and blood tests. RESULTS: The study group included 91 males and 60 females. Of these, 81 (53.6%) were middle-aged and 70 (46.4%) were elderly. For underlying diseases, 58 (38.4%) had liver disease and 79 (52.3%) had cancer. In the elderly group, more patients (21, 30%) visited the ER with neurological disturbances than with gastrointestinal symptoms (13, 18.6%); and more elderly patients (14, 20%) presented with serious hyponatremia (blood sodium concentration 110 or lower) than middle-aged patients (6, 7.4%). CONCLUSION: In the elderly, many patients visiting the ER did not have any underlying disease but were suffering from more severe hyponatremia. The major symptoms observed included neurological disturbances such as impaired consciousness and generalized weakness. The elderly can easily develop serious hyponatremia with accompanying neurologic disturbances. The emergency physician, having a high level of suspicion, should make a quick diagnosis and manage these patients appropriately.
Aged ; Consciousness ; Emergencies ; Female ; Hematologic Tests ; Humans ; Hyponatremia ; Liver Diseases ; Male ; Prognosis ; Sodium ; Stress, Psychological

Mitral regurgitation originating from mitral valve leaflet perforation secondary to blunt chest trauma is a rare condition. The mechanisms related with valvular injury are rapid acceleration- deceleration movements of the thorax, compression of the heart between the sternum and vertebrae during early systole or late diastole, and abrupt increase of the intrathoracic pressure followed by cardiac rupture. Transesophageal echocardiography (TEE) is a recommended diagnostic tool and is superior to transthoracic echocardiography (TTE) for diagnosing valvular lesions. Valvular injury causing sudden and severe mitral regurgitation will lead to congestive heart failure and death without operative correction. A high index of suspicion with appropriate diagnostic methods will provide a diagnosis and allow the possibility of operative correction. We report the case of a 45-year-old man with delayed presentation of traumatic mitral valve perforation and review previous reports of blunt traumatic mitral valve injury.
Deceleration ; Diagnosis ; Diastole ; Echocardiography ; Echocardiography, Transesophageal ; Heart ; Heart Failure ; Heart Rupture ; Humans ; Middle Aged ; Mitral Valve Insufficiency ; Mitral Valve* ; Spine ; Sternum ; Systole ; Thorax*

The purpose of this study was to evaluate new bone formation and healing process in rat calvarial bone defects using BioMesh(R) membrane and DFDB. Forty eight rats divided equally into 4 groups of 1 control group and 3 experimental groups. Standardized transosseous circular calvarial defects (8 mm in diameter) were made midparietally. In the control group, the defect was only covered with the soft tissue flap. In the experimental group 1, it was filled with DFDB only, in the experimental group 2, it was covered BioMesh(R) membrane only, and in the experimental group 3, it was filled DFDB and covered with membrane. At the postoperative 1, 2, 4, 8 weeks, rats were sacrificed and histologic and histomorphometric analysis were performed. These results were as follows. In histomorphometric analysis, It showed the greatest amount of new bone formation through experimental in the experimental group 3 (P < 0.001). The amount of new bone formation at the central portion of the defect was greater in the experimental group 3 than experimental group 2. BioMesh(R) membrane began to resorb at 1 week and resorbed almost completely at 8 weeks after operation. The collapse of membrane into the defect was observed through the experimental periods in the experimental group 2. In the area of collapsed membrane, new bone formation was restricted. These results suggest that maintenance of some space for new bone to grow is required in the use of BioMesh(R) membrane alone in the defect. It is also thought that use of the membrane may promote new bone growth in DFDB graft.
Animals ; Bone Development ; Bone Regeneration* ; Membranes* ; Osteogenesis ; Rats* ; Skull ; Transplants

Background: In response to the disaster of coronavirus disease 2019 (COVID-19) pandemic, Seoul Metropolitan Government (SMG) established a patient facility for mild condition patients other than hospital. This study was conducted to investigate the operation and necessary resources of a community treatment center (CTC) operated in Seoul, a metropolitan city with a population of 10 million. Methods: To respond COVID-19 epidemic, the SMG designated 5 municipal hospitals as dedicated COVID-19 hospitals and implemented one CTC cooperated with the Boramae Municipal Hospital for COVID-19 patients in Seoul. As a retrospective cross-sectional observational study, retrospective medical records review was conducted for patients admitted to the Seoul CTC. The admission and discharge route of CTC patients were investigated. The patient characteristics were compared according to route of discharge whether the patient was discharged to home or transferred to hospital. To report the operation of CTC, the daily mean number of tests (reverse transcription polymerase chain reaction and chest X-ray) and consultations by medical staffs were calculated per week. The list of frequent used medications and who used medication most frequently were investigated. Results: Until May 27 when the Seoul CTC was closed, 26.5% (n = 213) of total 803 COVID-19 patients in Seoul were admitted to the CTC. It was 35.7% (n = 213) of 597 newly diagnosed patients in Seoul during the 11 weeks of operation. The median length of stay was 21 days (interquartile range, 12–29 days). A total of 191 patients (89.7%) were discharged to home after virologic remission and 22 (10.3%) were transferred to hospital for further treatment.Fifty percent of transferred patients were within a week since CTC admission. Daily 2.5–3.6consultations by doctors or nurses and 0.4–0.9 tests were provided to one patient. The most frequently prescribed medication was symptomatic medication for COVID-19 (cough/ sputum and rhinorrhea). The next ranking was psychiatric medication for sleep problem and depression/anxiety, which was prescribed more than digestive drug. Conclusion In the time of an infectious disease disaster, a metropolitan city can operate a temporary patient facility such as CTC to make a surge capacity and appropriately allocate scarce medical resource.

PURPOSE: Recombinant ScFv lym-1 was produced, using pET vector system for large scale production. METHODS: ScFv lym-1 gene inserted pET-22b (+) vector, was expressed in E.coli BL-21 strain. ScFv lym-1 antibody extracted from periplasm, was purified with His-Taq column. To evaluated immunoreactivity with Raji cell, ScFv lym-1 was labeled with I-125 and I-125 ScFv lym-1 was purified with desalting column. Raji cell was injected into the C57BR/cdJ SCID mice. Gamma camera imaging were taken time point at 1, 8, 24, and 48 hr with 8 mm pinhole collimator. RESULTS: An active scFv lym-1 could be produced in E.coli with soluble from using pET vector system. Immunoreactivity and affinity constant of IgG lym-1 were 54% and 1.83 x 10(9) M(-1), respectively, and those of scFv lym-1 were 53.7% and 1.46 x 10(9) M(-1), respectively. Biodistribution of I-125 scFv lym-1 antibody showed faster clearance in blood, spleen, kidney and than I-125 IgG lym-1 antibody. Gamma camera image of I-125 scFv lym-1 antibody showed faster clearance and tumor targeting liver than I-125 IgG lym-1 antibody. CONCLUSIONS: In vitro properties of scFv lym-1 were similar to those of IgG lym-1. ScFv lym-1 showed faster blood clearance than IgG lym-1. These results suggest that scFv lym-1 antibody can be useful for tumor imaging agent.
Animals ; Gamma Cameras ; Immunoglobulin G ; Kidney ; Liver ; Lymphoma* ; Mice ; Mice, SCID ; Periplasm ; Radionuclide Imaging ; Spleen

PURPOSE: In order to evaluate the effects of GAC, which is the combination of active hexose correlated compound (AHCC) and genistein combined polysaccharide (GCP), we investigated the changes in the biochemical profiles and the quality of life of prostate cancer patients with androgen suppression after the administration of GAC. MATERIALS AND METHODS: Thirty two eligible metastatic prostate cancer patients between the ages of 54 and 84 were enrolled in this study, and they were supplemented with 5g GAC per day (n=23) or placebo (n=9) for a 6 months period. Blood and urine sample analysis were taken and the quality of life (QoL) was assessed using the Visual Analogue Scale (VAS) and the Functional Assessment of Cancer Therapy Scale Questionnaire (FACT-G) at baseline and at post intervention (after 3 and 6 months). RESULTS: Twenty six patients (n=18 in the GAC group and n=8 in the placebo group) completed the 6 months intervention. No statistically significant adverse events were reported by the study participants. GAC had no significant effect on the serum biochemical parameters. However, all 7 GAC-treated hypercholesterolemic patients had their cholesterol level decreased after 3 months treatment (p<0.02). Results of Comet assay showed significant decreases in tail moment (p<0.009) and tail length (p<0.004) at 6 months compared to baseline for the GAC group. Although the results of the VAS were inconsistent, the score for physical well-being was increased in GAC group on the FACT-G analysis (p<0.05 between baseline and 3 months, respectively). CONCLUSIONS: Oral administration of GAC 5g per day for 6 months showed a decrease in DNA damage of blood lymphocytes and in the total serum cholesterol level in hypercholesterolemic patients without any significant influences on the serum biochemical parameters of the metastatic prostate cancer patients. Further studies on the role of GAC are necessary to clarify the advantage of GAC supplementation in prostate cancer patients with androgen suppression.
Administration, Oral ; Cholesterol ; Comet Assay ; DNA Damage ; Genistein ; Humans ; Lymphocytes ; Prostate* ; Prostatic Neoplasms* ; Quality of Life* ; Surveys and Questionnaires

BACKGROUND: Percutaneous transluminal coronary angioplasty(PTCA) for long coronary lesion is known to be associated with low success rate,suboptimal outcome,high complication and restenosis rates. Here we report the early clinical and angiographic results of long coronary stent implantations for long coronary lesions. METHOD: We analyzed the clinical,angiographic features and early results after stent implantations in 46 patients who were implanted long coronary stent(> or =20mm in length)among 174 stented patients at Chonnam University Hospital from Jan.through Nov.1996. RESULT: 1) Age was 59+/-7(35-78) years,and sex ratio was 2.5:1(33 male:13 female). clinical diagnosis was as follows; 24 patients with unstable angina, 21 with acute myocardial infarction, 1 with stable angina and 6 with old myocardial infarction. Left ventricular ejection fraction by left venriculogram was 58+/-10(27-87)%. 2) Involved numbers of vessel were single in 27 patients, two in 14 patients, and three in 5 patients. Target stented coronary arteries were 28 left anterior descending arteries, 17 rigtt coronory arteries, and 1 left circumflex artery. Morphologic types of target lesions were type C in 26 patients, type B2 in 20, and diameter stenosis(DS) was 76+/-13%, minimal luminal diameter(MLD) 1.0+/-0.3mm, length 21+/-6(10-38)mm. Indications for stent were 28 denovo lesions, 10 restenoses, 5 suboptimal PTCAs and 3 bailout procedures. Twenty six Microstents 2, 15 Wallstents, 4 Freedom stents, and 1 Wictor stent were used. Stent diameter was 3.2+/-0.3(2.5-5.0)mm and length 30+/-3(20-49)mm, stent diameter/reference diameter(RD) ratio 1.0+/-0.1, and stent minus lesion length 9.0+/-3.7mm. 3) Stents were deployed successfully in all 46 patients. No procedure-related death, myocardial infarction, emergency bypass surgery, and laboratory evidences of acute or subacute stent thrombosis were observed. 4) DS was decreased to 3.5+/-7.5%, MLD was increased to 3.2+/-0.3mm(p<0.0001, respectively). Acute gain was 2.2+/-0.4mm(71.8+/-15.6%,p<0.0001). CONCLUSION: We observed high success rate without major complications in long stent implantations for long coronary arterial lesions. Long-term follow-up should be required to prove long coronary stent as a better treatment modality to reduce acute complications and late restenosis.
Angina, Stable ; Angina, Unstable ; Arteries ; Coronary Vessels ; Diagnosis ; Emergencies ; Follow-Up Studies ; Freedom ; Humans ; Jeollanam-do ; Myocardial Infarction ; Phenobarbital ; Sex Ratio ; Stents* ; Stroke Volume ; Thrombosis

PURPOSE: Current management for patients with differentiated thyroid cancer includes near total thyroidectomy and radioactive iodine therapy followed by administration of supraphysiological doses of levothyroxine (L-T4). Although hyperthyroidism is a well known risk factor for osteoporosis, the effects of L-T4 treatment on bone mineral density (BMD) in patients with thyroid cancer do not appear to be as significant as with endogenous hyperthyroidism. In this study, we evaluated the impact of long-term suppressive therapy with L-T4 on BMD and bone turn over markers in Korean female patients receiving L-T4 suppressive therapy. METHODS: We enrolled 94 female subjects (mean age, 50.84 +/- 11.43 years) receiving L-T4 after total or near total thyroidectomy and radioactive iodine therapy for thyroid cancer (mean follow-up period, 12.17 +/- 4.27 years). The subjects were divided into three groups by thyroid stimulating hormone (TSH) level (group 1 with TSH level < or =0.001 microIU/mL, group 2 with TSH level between 0.001 and 0.17 microIU/mL, group 3 with TSH level >0.17 microIU/mL) and four groups by quartile of free T4 level. L-T4 dosage, BMD (examined by dual-energy x-ray absorptiometry), and bone turnover markers were evaluated according to TSH and free T4 levels. RESULTS: No significant decrease was detected in BMD or bone turnover markers according to TSH level or free T4 level. Also, the prevalence of osteoporosis and osteopenia was not different among groups. CONCLUSION: Long-term L-T4 suppressive therapy after thyroid cancer management did not affect bone density or increase the prevalence of osteoporosis even though TSH levels were supraphysiologically suppressed.
Bone Density* ; Bone Diseases, Metabolic ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism ; Iodine ; Osteoporosis ; Prevalence ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin ; Thyroxine*

BACKGROUND AND OBJECTIVES: We sought to evaluate the effect of the early use of ezetimibe/simvastatin (Vytorin(R)) on arterial healing and endothelialization after the implantation of a drug-eluting stent (DES) in a porcine model of coronary restenosis. MATERIALS AND METHODS: A total of 20 pigs (40 coronary arteries) were randomly allocated to a pretreatment or no treatment group. The pretreatment group (n=20) received oral ezetimibe/simvastatin (10/20 mg) daily for 7 days before stenting and the no pretreatment group (n=20) did not. All pigs were treated with ezetimibe/simvastatin (10/20 mg) daily after stenting for 4 weeks. Stenting was performed using a bare-metal stent (BMS, n=10) and three types of DES: biolimus A9-eluting stent (BES, n=10), zotarolimus-eluting stent (ZES, n=10), and everolimus-eluting stents (EES, n=10). Four weeks later, pigs underwent a follow-up coronary angiography and were sacrificed for histopathologic analysis. RESULTS: There were no significant differences between the pretreatment and no pretreatment groups in the internal elastic lamina area, lumen area, neointima area, stenotic area, injury score, fibrin score, and inflammation score. In both groups, the fibrin score was higher in pigs with DES than in BMS, particularly in ZES and EES. The inflammatory score was not different between DES and BMS. CONCLUSION: In a porcine model of coronary restenosis, pretreatment with ezetimibe/simvastatin before DES implantation failed to improve arterial healing and endothelialization compared to treatment after stenting.
Coronary Angiography ; Coronary Restenosis* ; Drug-Eluting Stents* ; Fibrin ; Follow-Up Studies ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Neointima ; Stents ; Swine ; Ezetimibe