OBJECTIVE: This study is performed to evaluate the risk factors, clinical manifestations, treatments, and prognostic factors among patients with postoperative wound infection after spinal instrumentation. METHODS: The records and radiologic data of 28 patients diagnosed as postoperative wound infection from Jan. 1991 to Oct. 2002 who had underwent spinal instrumentation initially were retrospectively evaluated. RESULTS: All patients(mean age, 50.4 yrs) diagnosed as postoperative wound infection and subsequently received IV antibiotics and continuous irrigation system. The 13 among 28 cases had significant preoperative risk factors(for example, diabetes mellitus, obesity, alcoholism, long-term corticosteroid usage, and chronic renal failure). Infection was diagnosed at an average of 15.9 days after operation. The most common presenting features were local heating, fever, and wound discharge. All patients could be discharged after infection control. At follow up evaluation, 21 case(75%) have not shown recurrence but, the recurrence was developed among 7 cases. The C-reactive protein(CRP) was more correlated with clinical outcomes than other laboratory findings and the recurred group exhibited significant(p<0.05) higher CRP level, compared with the non-recurred group, from 7 days to 21 days after operation. CONCLUSION: Without removal of instruments, surgical removal of infective tissues and continuous irrigation with susceptible antibiotics can be effective in the treatment of postoperative wound infection after spinal instrumentation. CRP level can be an effective parameter of infection treatment and prognosis.
Alcoholism ; Anti-Bacterial Agents ; Diabetes Mellitus ; Fever ; Follow-Up Studies ; Heating ; Hot Temperature ; Humans ; Infection Control ; Obesity ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Spine* ; Surgical Instruments ; Surgical Wound Infection ; Wound Infection* ; Wounds and Injuries*

Giant cell tumor which is arisen at vertebra is rare and this tumor of the cervical vertebra has been very rarely reported tumor which is less than 1% of all giant cell tumor. When the treatment option is considered, the curretage is often selected rather than total resection because the anatomic relationship of adjacent structures is complicated and there are major vessels and organs around the cervical vertebra. The prognosis of this tumor is decided by degree of resection so, total sponylectomy should be considered as primary surgical option. We report a case of cervical giant cell tumor in which the total spondylectomy was performed successfully and discuss the feasibility of this procedure at cervical region.
Giant Cell Tumors* ; Giant Cells* ; Prognosis ; Spine*

Transient cortical blindness is a rare but well-recognized complication of cerebral angiography. A 62-year-old woman with unruptured cerebral aneurysm and a 16-year-old boy with cerebellar hemangioblastoma experienced blindness after diagnostic cerebral angiography and tumor embolization, and the symptom resolved after 1 hour and 36 hours later, respectively. We report two cases of this complication.
Adolescent ; Blindness ; Blindness, Cortical* ; Cerebral Angiography* ; Female ; Hemangioblastoma ; Humans ; Intracranial Aneurysm ; Male ; Middle Aged

Neurogenic pulmonary edema (NPE) leading to cardiopulmonary dysfunction is a potentially life-threatening complication in patients with central nervous system lesions. This case report describes a 28-yr woman with life-threatening fulminant NPE, which was refractory to conventional respiratory treatment, following the rupture of an aneurysm. She was treated successfully with extracorporeal membrane oxygenation (ECMO), although ECMO therapy is generally contraindicated in neurological injuries such as brain trauma and diseases that are likely to require surgical intervention. The success of this treatment suggests that ECMO therapy should not be withheld from patients with life-threatening fulminant NPE after subarachnoid hemorrhage.
Adult ; Brain/radiography ; Decompressive Craniectomy ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Intracranial Aneurysm/complications/*diagnosis ; Pulmonary Edema/*diagnosis/etiology/therapy ; Subarachnoid Hemorrhage/etiology ; Tomography, X-Ray Computed

In an effort to investigate the molecular basis of growth discordance in embryos that experience the same uterine environment, we compared telomerase activity and apoptosis in placental trophoblasts obtained from growth discordant twins. Between January 2003 and February 2005, placental tissue from twenty pairs of twins was obtained within thirty minutes of delivery. Eleven cases were classified as growth discordant, with birth weight discordance greater than 20%. Nine cases comprised the control group, with less than 20% discordance. Telomerase and apoptotic activities in placental trophoblasts were analyzed by ELISA and immunoblot. Statistical significance was analyzed by a paired t-test, chi- squared test, and ANOVA (SPSS ver 11.0). The average growth discordance was 26.8% in the growth discordant group and 14.4% in the control group. There were no significant differences in maternal age, week of gestation at delivery, parity, or chorionisity between the two groups. In the growth discordant group, the larger twin showed significantly higher telomerase activity (p < 0.01), whereas no significant difference was observed in the control group (p = 0.36). In addition, there was no definitive correlation between telomerase activity and the degree of growth discordance in the larger or smaller twins (R = -0.521 and -0.399, p = 0.15 and 0.25, respectively). The apoptosis proteins Bax and Bcl 2 were detected in both the larger and smaller twins in the growth discordant and control groups. There was no statistically significant difference in Bax expression between the larger and smaller twins (p = 0.25 and 0.92, respectively) for either the growth discordant or the control groups. Bcl 2 expression also showed no significant difference between groups. In Conclusion, A tendency toward reduced telomerase activity and increased apoptosis was discovered in placental trophoblasts of the smaller growth- discordant twin, possibility resulting in delayed fetal growth.
bcl-2-Associated X Protein/metabolism ; Trophoblasts/*enzymology/pathology ; Telomerase/*metabolism ; Proto-Oncogene Proteins c-bcl-2/metabolism ; Immunoblotting ; Humans ; Fetal Growth Retardation/*enzymology/metabolism/*pathology ; Fetal Development/physiology ; Enzyme-Linked Immunosorbent Assay ; Diseases in Twins/*enzymology/metabolism/*pathology ; *Apoptosis

PURPOSE: The aim of this study was to analyze anatomical popliteal artery entrapment syndrome (PAES) and to individualize the treatment of this condition according to the anatomical status of the artery and the adjacent structure. METHODS: A total of 35 anatomical PAES legs in 23 consecutive patients treated within the Asan Medical Center, Seoul, Korea between 1995 and 2011 were analyzed retrospectively. Anatomical PAES was diagnosed by MRI and/or CT scans of the knee joint, and CT or conventional transfemoral arteriography of the lower extremities. RESULTS: We noted a type II gastrocnemius medial head (GNM) anomaly, a type III GNM anomaly, or an aberrant plantaris muscle in 51.4%, 20%, and 28.6% of PAES legs, respectively. In assessments of the arterial lesions, popliteal or tibial artery occlusion was noted in 19 of 26 symptomatic PAES legs. For cases without popliteal artery lesions, myotomy of the anatomically deranged muscle was performed in 5 of 7 symptomatic and 4 of 9 asymptomatic PAES legs. For occluded popliteal arteries, we performed ten direct repairs of the pathological popliteal artery and 4 femoro-below the knee popliteal bypass surgeries. As a result of the arterial Surgery, 9 direct procedures with myotomy yielded a patent artery, while 3 graft failures were noted in the bypass group. The median follow-up period was 84 months (range, 12–206 months). CONCLUSION: We recommend that treatment of PAES should be individualized based on pathology, symptoms, and various imaging studies.
Angiography ; Arteries ; Chungcheongnam-do ; Follow-Up Studies ; Head ; Humans ; Knee ; Knee Joint ; Korea ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Pathology ; Popliteal Artery* ; Retrospective Studies ; Seoul ; Tibial Arteries ; Tomography, X-Ray Computed ; Transplants

OBJECT: Transforming growth factor-beta (TGF-beta) is involved in many physiological and pathophysiological processes, such as cell growth, differentiation, inflammation, and tissue repair. It is not yet clear whether the presence of this cytokine has deleterious or protective effects for neurons in a given pathophysiological condition. Several authors have demonstrated that TGF-beta has been shown to rescue cultured neurons from excitotoxic and hypoxic cell death and to reduce infarct size after focal cerebral ischemia in mice and rabbits. The present study investigated the effect of diazepam on the expression of TGF-beta in rat brain tissue after inducing transient cerebral ischemia. METHODS: Ten male rats were killed after a mild and reversible ischemic damage produced by a 15-minutes occlusion of both carotid arteries without occlusion of the vertebral arteries. Five ischemia-treated and 5 sham-operated rats were injected with 10 mg/kg diazepam and vehicle, respectively at 30 minutes, and again 90 minutes following the onset of reperfusion. After 1, 2 and 7 days following the reperfusion, brains were removed from control, sham-operated, and ischemia-treated with or without diazepam-injected groups, then immunohistochemistry and Western blotting for TGF-beta were performed. Cerebral cortices and hippocampi were sectioned from ischemia-treated, shamoperated and control group rats, and stained using cresyl violet. RESULTS: When the immunoblot-results of TGF-beta expression were analyzed using a image analysis system, TGF-beta expression were increased in ischemia-treated without diazepam-injected rats, and decreased in ischemia-treated with diazepam-injected rats at 2 and 7 days after reperfusion compared to control and sham-operated groups. Cresyl violet staining became intense in ischemia-treated without diazepam-injected group and became unclear in ischemia-treated with diazepam-injected group compared to sham-operated and control groups, respectively. CONCLUSION: Diazepam influenced the TGF-beta expression in the brain of ischemia-treated rats.
Animals ; Blotting, Western ; Brain Ischemia ; Brain* ; Carotid Arteries ; Cell Death ; Cerebral Cortex ; Diazepam* ; Humans ; Immunohistochemistry ; Inflammation ; Ischemic Attack, Transient* ; Male ; Mice ; Neurons ; Rabbits ; Rats* ; Reperfusion ; Transforming Growth Factor beta ; Vertebral Artery ; Viola

The purpose of this study was to investigate the anti-hyperlipidemic effect of soy bean extract solution fermented by Bacillus subtilis MORI (BTD-1E) in obese db/db mice. Eight-week-old male db/db mice were administered 33.3 mg/kg BTD-1E solution orally once a day for four weeks. The BTD-1E group showed significantly lower body weight compared with the db control group (P<0.05). The BTD-1E group showed significantly lower serum total cholesterol and LDL cholesterol levels compared with the db control group, respectively (P<0.05, P<0.01). The BTD-1E group showed significantly decreased liver weight relative to final body weight compared with the db control group (P<0.01). After four weeks of BTD-1E administration, lipid droplets in the liver were apparently decreased in the BTD-1E group compared to the db control group. In summary, our results suggest that BTD-1E has an anti-hyperlipidemic effect in the obese mouse model.
1-Deoxynojirimycin ; Animals ; Bacillus ; Bacillus subtilis ; Body Weight ; Cholesterol ; Cholesterol, LDL ; Humans ; Liver ; Male ; Mice ; Mice, Obese ; Soybeans

OBJECTIVE: To optimize the recanalization of acute cerebral stroke that were not effectively resolved by conventional intraarterial thrombolysis (IAT), we designed a double device technique to allow for rapid and effective reopening. In this article, we describe the feasibility and efficacy of this technique. METHODS: From January 2008 to September 2009, twenty patients with acute cerebral arterial occlusion (middle cerebral artery : n=12; internal carotid artery terminus : n=5; basilar artery : n=3) were treated by the double device technique. This technique was applied when conventional thrombolytic methods using drug, microwires, microcatheters and balloons did not result in recanalization. In the double device technique, two devices are simultaneously placed at the lesion (for example, one microcatheter and one balloon or two microcatheters). Chemicomechanical or mechanicomechanical thrombolysis was performed simultaneously using various combinations of two devices. Recanalization rates, procedural time, complications, and clinical outcomes were analyzed. RESULTS: The initial median National Institute of Health Stroke Scale (NIHSS) was 16 (range 5-26). The double device technique was applied after conventional IAT methods failed. Recanalization was achieved in 18 patients (90%). Among them, 55% (11 cases) were complete (thrombolysis in cerebral infarction 2B, 3). The median thrombolytic procedural time including the conventional technique was 135+/-83.7 minutes (range 75-427). Major symptomatic hemorrhages (neurological deterioration > or =4 points in NIHSS) developed in two patients (10%). Good long term outcomes (modified Rankin Scale < or =2 at 90 days) occurred in 25% (n=5) of the cases. Mortality within 90 days developed in two cases (10%). CONCLUSION: The double device technique is a feasible and effective technical option for large vessel occlusion refractory to conventional thrombolysis.
Basilar Artery ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebral Infarction ; Glycosaminoglycans ; Hemorrhage ; Humans ; Stroke

A young woman who had a delivery history 3 months previously presented with dyspnea and orthopnea. Initial findings of physical examination, chest radiography, and echocardiogram showed typical congestive heart failure with severe left ventricular (LV) dysfunction. At first, we considered peripartum cardiomyopathy because she had given birth to a baby 3 months previously. However, even though we massively tried conventional drug therapy for 10 days, the patient still remained with refractory heart failure. We performed additional laboratory studies such as complement level and autoantibodies, of which the results supported systemic lupus erythematosus. We could make the diagnosis of acute lupus myocarditis and treated her with corticosteroid. The symptoms were dramatically disappeared and LV function also improved.
Acute Disease ; Administration, Oral ; Adult ; Echocardiography ; Female ; Glucocorticoids/administration & dosage ; Heart Failure/*diagnosis ; Humans ; Lupus Erythematosus, Systemic/complications/*diagnosis/radiography ; Methylprednisolone/administration & dosage ; Myocarditis/*diagnosis/etiology/radiography ; Prednisolone/administration & dosage