STUDY DESIGN: This is a retrospective study. OBJECTIVE: We wanted to evaluate the efficacy of epidural steroid injection (ESI) for treating lumbar spinal stenosis (LSS) SUMMARY OF LITERATURE REVIEW: Treatment for lumbar spinal stenosis has generally consisted of some form of conservative treatment or surgery. Surgery may be contraindicated in many stenotic patients because of their significant comorbidities. Therefore, conservative management is necessary for those who cannot or do not want to undergo surgery. MATERIALS AND METHODS: From January 2002 to June 2003, we retrospectively analyzed 128 patients, 55 years or older, who received ESI (s). The average age of the men and women was 47 and 81, respectively. Their mean age was 76 (age range: 55~84). The injection materials were 2 ml methylprodnisolone acetate (40 mg/cc) in combination with 3 cc normal saline and 3 cc lidocaine. The follow up period was 12 months to 30 months. We measured the outcomes by the duration and amount of pain relief, the change in functional status and the rate of performing surgery; patient satisfaction was assessed by a 5-item questionnaire. RESULT: Of the 128 participants, 31% reported more than 2 months of pain relief, 41% reported less than 2 months of pain relief and 27% reported no relief from the injection (s). Sixteen percent subsequently had surgery. Sixty-nine percent reported improvement in their functional abilities. Seventy-two percent were at least somewhat satisfied with ESI as a form of treatment. CONCLUSION: ESI is a reasonable treatment for LSS as it provided one third of our patient population with sustained relief and more than half with sustained improvement in function.
Comorbidity ; Female ; Follow-Up Studies ; Humans ; Lidocaine ; Male ; Patient Satisfaction ; Surveys and Questionnaires ; Retrospective Studies ; Spinal Stenosis* ; Spine

Spontaneous hemarthrosis of the knee after a total knee arthroplasty is a rare complication, and thereis no report is available in Korea. We report a case that was cured with an open synovectomy in the spontaneous hemarthrosis, which developed 10 months after the total knee arthroplasty for degenerative osteoarthritis in a 60-year-old woman.
Arthroplasty* ; Female ; Hemarthrosis* ; Humans ; Knee* ; Korea ; Middle Aged ; Osteoarthritis

Antiphospholipid antibodies may be produced in cases involving autoimmune diseases and can sometimes be caused by infections, such as Mycoplasma pneumoniae infection. However, antiphospholipid antibodies causing thrombosis associated with M. pneumoniae pneumonia in children have rarely been reported. We report a case of an 8-year-old boy with M. pneumoniae pneumonia with antiphospholipid antibodies, complicated by brachial artery thrombosis. He was found to have antiphospholipid antibodies and low protein S levels. The brachial artery thrombus was removed via thrombectomy. The titers of antiphospholipid antibodies turned normal within 5 months. This is a rare case of M. pneumoniae infection with brachial artery thrombosis associated with transient antiphospholipid antibodies.
Antibodies, Antiphospholipid ; Autoimmune Diseases ; Brachial Artery ; Child ; Humans ; Male ; Mycoplasma pneumoniae ; Mycoplasma ; Pneumonia ; Pneumonia, Mycoplasma ; Protein S ; Thrombectomy ; Thrombosis

PURPOSE: Purpose: To compare the diagnostic accuracy of ferumoxides-enhanced MR with that of combined CT during arterial portography (CTAP) and CT hepatic arteriography (CTHA) in the preoperative detection of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: For preoperative evaluation, 20 patients with HCC underwent ferumoxides-enhanced MR and combined CTAP and CTHA. The MR protocol included fat-suppressed respiratory-triggered fast spin echo, T2*-weighted fast multiplanar gradient-recalled acquisition in the steady state, proton density-weighted fast multiplanar spoiled gradient-recalled echo, and breath-hold in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo. In all patients, laparotomy was performed. The presence or absence of HCC was confirmed by pathologic examination in the resected liver and by intraoperative ultrasonography of remaining liver, or by follow up. Images were reviewed by three radiologists working independently; regarding the presence or absence of HCC in each segment, each observer assigned one of five confidence levels. A receiver operating characteristic (ROC) curve was fitted to these confidence ratings, and the diagnostic accuracy of each modality was evaluated by calculating the Az value (area under the ROC curve) and compared with that of other modalities. The sensitivity and specificity of each modality in the detection of HCC were also calculated and compared, and using a κstatistic, inter-observer agreement for each modality was assessed. RESULTS: In 28 of 160 liver segments, 30 HCCs were present. For ferumoxide-enhanced MR the mean Az value was 0.958, and for combined CTAP and CTHA this value was 0.948. The difference was not statistically significant. The mean sensitivities of ferumoxide-enhanced MR and combined CTAP and CTHA were 92.9% and 90.9%, respectively, the difference being statistically insignificant. The mean specificities of these modalities were, respectively, 98.9% and 93.6%. The difference was statistically significant. For both ferumoxide-enhanced MR and combined CTAP and CTHA, interobserver agreement was excellent. CONCLUSION: In the preoperative detection of HCC, ferumoxide-enhanced MR imaging of the liver showed a diagnostic accuracy similar to that of combined CTAP and CTHA. Its specificity, however, was higher.
Angiography* ; Carcinoma, Hepatocellular* ; Follow-Up Studies ; Humans ; Iron ; Laparotomy ; Liver ; Liver Neoplasms ; Magnetic Resonance Imaging ; Portography* ; Protons ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: Bacillus Calmette-Guerin (BCG) is known to suppress the asthmatic responses in a murine model of asthma and to induce dendritic cells (DCs) maturation. Mature DCs play a crucial role in the differentiation of regulatory T cells (Tregs), which are known to regulate allergic inflammatory responses. To investigate whether BCG regulates Tregs in a DCs-mediated manner, we analyzed in a murine model of asthma. METHODS: BALB/c mice were injected intraperitoneally with BCG or intravenously with BCG-stimulated DCs and then sensitized and challenged with ovalbumin (OVA). Mice were analysed for bronchial hyperresponsiveness (BHR), the influx of inflammatory cells in the bronchoalveolar lavage (BAL) fluid, and histopathological changes in the lung. To identify the mechanisms, IgE, IgG1 and IgG2a in the serum were analysed and the CD25+ Tregs in the mice were depleted with anti-CD25 monoclonal antibody (mAb). RESULTS: BCG and the transfer of BCG-stimulated DCs both suppressed all aspects of the asthmatic responses, namely, BHR, the production of total IgE and OVA-specific IgE and IgGs, and pulmonary eosinophilic inflammation. Anti-CD25mAb treatment reversed these effects. CONCLUSIONS: BCG can attenuate the allergic inflammation in a mouse model of asthma by a Tregs-related mechanism that is mediated by DCs.
Animals ; Asthma ; Bacillus* ; Bronchoalveolar Lavage ; Dendritic Cells* ; Eosinophils ; Immunoglobulin E ; Immunoglobulin G ; Inflammation ; Lung ; Mice ; Mycobacterium bovis ; Ovalbumin ; T-Lymphocytes, Regulatory*

Bilateral adrenal neoplasms are associated with metastatic cancer, pheochromocytoma and lymphoma. The coexistence of a unilateral functioning adrenocortical adenoma with contralateral pheochromocytoma is extremely rare. A 52-year-old woman complained of fatigue, headache, palpitation, and progressive weight gain. Hormonal assessment demonstrated high 24 hours urine epinephrine, norepinephrine, and free cortisol. A dexamethasone suppression test (overnight 1 mg, low dose 2 mg) showed insuppressible cortisol. Computerized tomographic scanning revealed a bilateral adrenal tumor. To preserve adrenal function, right adrenalectomy along with left adrenal tumorectomy was performed. Histological finding of the right adrenal tumor was pheochromocytoma and the left adrenal tumor was adrenocortical adenoma. This patient was the first case of a functional adrenocortical adenoma with contralateral cystic pheochromocytoma in Korea. We report the case with a review of the literature.
Adrenal Gland Neoplasms ; Adrenalectomy ; Adrenocortical Adenoma ; Cushing Syndrome ; Dexamethasone ; Epinephrine ; Fatigue ; Female ; Headache ; Humans ; Hydrocortisone ; Korea ; Lymphoma ; Middle Aged ; Norepinephrine ; Pheochromocytoma ; Weight Gain

BACKGROUND: Introduction of automation instruments for the blood bank is essential in order to reduce inspection error and minimize workload. We compared the results of ABO-RhD blood type and antibody screening tests using the manual method and those using the automation instruments AutoVue Innova (Ortho-Clinical Diagnostics, Raritan, NJ, USA) and QWALYS-3 (DIAGAST, Loos Cedex, France). METHODS: ABO-RhD blood type tests using the slide method, the tube method, and the instruments were performed with 200 selected samples. Antibody screening tests using the Ortho BioVue system (Ortho-Clinical Diagnostics, Raritan, NJ, USA), which is used in our laboratory, and the two instruments were performed with 188 specimens and 12 antibody positive samples that were kept in the laboratory. We evaluated the concordance rate of the results, applying CLSI guideline EP12-A2. RESULTS: The concordance rate of ABO-RhD blood type results between the manual methods and the two instruments was 100%. On antibody screening tests, a concordance rate of 100% was observed between the manual method and AutoVue Innova, which uses the gel card manufactured by the company making the gel card used for the manual method. However, using QWALYS-3 in performance of antibody screening tests, the concordance rate was 97.5%, because of discordance in five specimens. CONCLUSION: The concordance rate of ABO-RhD blood type by use of two automation instruments was 100%, however, that of the antibody screening test was 97.5%. Thus, there was a difference in positive rate on the antibody screening test, depending on the instrument. Therefore, introduction of an instrument, considering the pros and cons for each instrument, is necessary. In addition, further discussion of standardized guidelines for quality control is needed.
Automation ; Blood Banks ; Cephalosporins ; Mass Screening ; Quality Control

Clinical features, laboratory and operative findings were reviewed in 17 cases adult Ebstein's anomaly admitted to Seoul National University Hospital from Feburary,1979 to October, 1987. 1) Mean age of first diagnosis was 28.6 tears old(range ; 14-57 years old). 2) Exertional duspnea(88.2%) and palpitation(64.7%) were the predominant symptoms, and PSVT was documented in 4 cases among 11 patoents with palpitation. 3) Echocardiogram showed displacement or delayed closure of the tricuspid valve in 13 cases. 4) On similtaneous recording of the intracardiac ECG and pressure, right ventricular electrogram with atrial pressure in atrialized right ventricle was observed in all cases. 5) Right ventriculogram revealed displacement of the tricuspid valve in 9 cases and tricuspid regurgitation in 10 cases. 6) Interatrial communication via ASD(8) and PFO(3) was present in 11 cases(64.7%). 7) Operative finding of 9 cases showed abnormalities of septal leaflet in 9(100%), posterior leaflet in 8(88.8%), and anterior leaflet in 2 cases(22.2%).
Adult* ; Atrial Pressure ; Diagnosis ; Ebstein Anomaly* ; Electrocardiography ; Heart Ventricles ; Humans ; Seoul ; Tricuspid Valve ; Tricuspid Valve Insufficiency

Kimura's Disease is a very rare, chronic inflammatory disorder with an unknown etiology, and this illness is primarily seen in young Asian males. The typical clinical features consist of painless subcutaneous masses in the head or neck region, and especially in the salivary gland and submandibular region. It is often accompanied with a regional lymphadenopathy, peripheral blood eosinophilia and elevated serum IgE levels. Histologically, it is characterized by prominent germinal centers in the involved lymph nodes, together with eosinophilic infiltration in these lymph nodes. The treatment modalities for this disease are steroid therapy, radiation therapy and surgical excision. Its clinical course is of a benign nature. We report here on a case of a 28 year old man who had a soft tissue mass in his left arm. We excised this mass and the microscopy confirmed that he suffered from Kimura's disease on microscopic examination in his left distal arm.
Arm ; Asian Continental Ancestry Group ; Eosinophilia ; Eosinophils ; Germinal Center ; Head ; Humans ; Immunoglobulin E ; Lymph Nodes ; Lymphatic Diseases ; Male ; Microscopy ; Neck ; Salivary Glands

PURPOSE: We wanted to analyze the effects of tourniquet pressure on the postoperative thigh pain and blood loss of patients who undergo total knee arthroplasty. MATERIALS AND METHODS: This prospective randomized study focused on one-hundred sixty-one unilateral total knee arthroplasties that were done with using a tourniquet. The tourniquet pressures were 300 mmHg in group I (seventy-four cases) and 100 mmHg higher than the systolic blood pressure in group II (eighty-seven cases). We analyzed the postoperative thigh pain with using a visual analog scale (VAS), and we assessed the hemoglobin levels and the hematocrits. RESULTS: The incidence of postoperative thigh pain in group II was statistically lower than that of group I. The intensity of the postoperative thigh pain of group II was lower than that of group I at both 6 hours and 72 hours after surgery. There were no statistical differences in blood loss between the two groups. CONCLUSION: Using a tourniquet pressure of 100 mmHg above the systolic blood pressure during total knee arthroplasty can reduce the postoperative thigh pain. When comparing the above technique with a TKA using 300 mmHg of tourniquet pressure, there was no statistically significant difference of the postoperative blood loss.
Arthroplasty ; Blood Pressure ; Hemoglobins ; Humans ; Incidence ; Knee ; Prospective Studies ; Thigh ; Tourniquets