STUDY DESIGN: In a prospective study of 38 patients undergoing lumbar pedicle screw instrumentation 200 pedicle hole were tested intraoperatively using electrical stimulation. OBJECTIVES: To evaluate the searching stimulus intensity at pedicle in Korean and to identify the most vulnerable root in transpedicular screw fixation of lumbosacral spine. MATERIALS AND METHOD: Electromyelogram(EMG) was monitored from eight lower extremity muscles bilaterally. Constant current stimulation pulses(0.2msec duration) were delivered through a ball-tipped nasopharyngeal probe used to evaluate each pedicle hole, and evaluated for searching stimulus intensity, the current necessary to evoked EMG RESULTS: The searching stimulus intensity above 5 mA were 194 cases(97.0%), above 7mA 151cases(75.5%), above 10 mA 107 cases(53.5%) and below 5 mA were 6 cases(3.0%). The vastus medialis muscle is most sensitive in L2(100%), L3(83.3%), tibialis anterior is in L4(68.4%), peroneus longus is in L5(44.2%) and gastrocnemious is in S1(64.5%). CONCLUSIONS: Stimulus-evoked EMG monitoring is a valuable and efficacious adjunct to lumbar pedicle screw instrumentation. A stimulation threshold greater than 5 mA reliably indicates adequate screw position and the root located at infero-medial side of pedicle is most vulnerab18 in transpedicular screw fixation.
Electric Stimulation ; Humans ; Lower Extremity ; Muscles ; Prospective Studies ; Quadriceps Muscle ; Spine

PURPOSE: The modification of radiation-induced apoptosis by EGCG, known as antioxidants or oxidants, was studied in mice spleens irradiated with a lethal dose. MATERIALS AND METHODS: Male C57BL/6 mice were divided into control, irradiation-only, and EGCG (100 mg/kg i.p. 1 h before irradiation) pretreatment groups. The mice were irradiated with a single whole-body dose of 7 Gy. The apoptosis in the spleens after irradiation of the lethal dose were analyzed by TUNEL assay. In addition, the expression levels of the Bax and Bcl-2 proteins were quantified using a Western blotting method. RESULTS: The induction of apoptosis was detected in the splenic white pulp. The highest level of apoptosis was detected at 8 hours after irradiation. No significant difference was identified by the apoptotic index (53.9% vs. 52.1%, p=0.328) and relative Bax protein expression (0.86 vs. 0.81, p=0.335), between the irradiation-only and EGCG pretreatment group, respectively. However, a lower Bax/Bcl-2 ratio (1.64 vs. 0.97, p=0.037) and higher relative expression level of Bcl-2 protein (0.57 vs. 0.82, p=0.037) was measured in the EGCG pretreatment group. CONCLUSION: The EGCG pretreatment neither decreased the radiation-induced apoptosis in mice splenocytes, nor induced additional apoptosis.
Male ; Humans ; Oxidants

The purposes of this study were to verify the effect of selective nerve root injection for sciatica caused by lumbosacral radiculopathy and to compare the difference of the therapeutic effects with the various clinical parameters and the morphologic types of herniated intervertebral disc on MRI finding. Forty-two patients, 14 males and 28 females, with an average age of 51 years (range, 26~71) and an average duration of symptoms of 17.8 months (range, 1~120) presenting with sciatica thought to be due to lumbosacral nerve root compromise were admitted to the study. All of the patients underwent clinical examination and lumbosacral MRI. Epiradicular infiltration of corticosteroids and local anesthetics by the transforaminal route under the image intensifier was done as a treatment. All the patients were followed up at 2 weeks and 3 months after the injection. A high proportion of patients made a satisfactory relief of sciatica with a selective nerve root injection at 2 weeks (85.7%) and 3 months (76.2%) follow-up. Among the patients who showed a significant symptom relief at 3 months, 12 patients were followed up and the relieved symptoms lasted for 6 months to 1 year in majority of those patients. In a few patients with clinical improvements at 2 weeks after the injection, the symptoms recurred at 3 months (9/36, 25%) and between 6 months to 1 year (3/12, 25%). There were no differences of the therapeutic effects according to the duration of the disease, neurologic findings on physical examination and the MRI findings of herniated intervertebral discs. The selective nerve root injection can be an effective therapeutic modality for the treatment of sciatica in lumbosacral radiculopathy.
Adrenal Cortex Hormones ; Anesthetics, Local ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Physical Examination ; Radiculopathy* ; Sciatica*

BACKGROUND: Menopause is an independent risk factor in metabolic syndrome which induced an alteration of the lipid metabolism by hormonal changes. Apolipoprotein A5 gene (APOA5) was related to the regulation of triglyceride and high density lipoprotein cholesterol (HDL-C) level with biosynthesis and decomposition. This study was conducted to investigate the relationship between APOA5 polymorphism and metabolic syndrome in Korean postmenopausal women. METHODS: This study included 307 postmenopausal women with anthropometric and biochemical measurement in 2010-2011. The polymorphism of APOA5 was analyzed by polymerase chain reaction-restriction fragment length polymorphism method with MseI restriction enzyme. RESULTS: The metabolic syndrome prevalence with TT genotype was significantly lower than the frequency in those with TC/CC (27.09%, 38.46%, and 45.71% for TT, TC, and CC, respectively; P < 0.05). Multiple regression analysis of metabolic syndrome risk factors indicated that postmenopausal women with CC genotype had a higher risk with 3 times than that in TT genotype (P < 0.05). APOA5 C carriers showed an increased risk of triglyceride level (odd ratio, 2.93 and 1.85 for CC and TC+CC, respectively; P < 0.05). Interestingly, HDL-C was related to triglyceride directly in comparison to APOA5. CONCLUSION: The results of this study indicate that APOA5 has an influence on serum triglyceride and HDL-C, which contribute to metabolic syndrome in Korean postmenopausal women.
Apolipoproteins ; Apolipoproteins A ; Cholesterol ; Cholesterol, HDL ; Female ; Genotype ; Humans ; Lipid Metabolism ; Lipoproteins ; Menopause ; Metabolic Syndrome X ; Polymorphism, Single Nucleotide ; Prevalence ; Risk Factors ; Triglycerides

OBJECTIVE: The aim of this study is to elucidate the effects of transforming growth factor-beta (TGF-beta)1 and L-ascorbic acid on proteoglycan synthesis, and the relationship between Sox9, proteoglycan, and TGF-beta1 in intervertebral disc cells. METHODS: Human intervertebral disc tissue was sequentially digested to 0.2% pronase and 0.025% collagenase in DMEM/F-12 media and extracted cells were cultured in 37degrees C, 5% CO2 incubator. When intervertebral disc cells were cultured with TGF-beta1 or L-ascorbic acid, the production level of sulfated glycosaminoglycan (sGAG) was estimated by dimethyl methyleneblue (DMMB) assay. The changes of Sox9 mRNA and protein levels via TGF-beta1 were detected by RT-PCR and Western blot analysis in each. RESULTS: The amount of sGAG was increased with the lapse of time during incubation, and sGAG content of pellet cultured cells was much larger than monolayer culture. When primary cultured intervertebral disc cells in monolayer and pellet cultures were treated by TGF-beta1 20 ng, sGAG content of experimental group was increased significantly compared to control group in both cultures. L-Ascorbic acid of serial concentrations (50-300 ug/ml) increased sGAG content of mono layer cultured intervertebral disc cells significantly in statistics. The co-treatment of TGF-beta1 and L-ascorbic acid increased more sGAG production than respective treatment. After treating with TGF-beta1, Sox9 mRNA and protein expression rates were significantly increased in disc cells compared with the control group. CONCLUSION: This study suggests that TGF-beta1 would increase sulfated glycosaminoglycan (sGAG) and other proteoglycans such as versican by elevating Sox9 mRNA and protein expressions in order.
Ascorbic Acid ; Blotting, Western ; Cells, Cultured ; Collagenases ; Glycosaminoglycans ; Humans ; Incubators ; Intervertebral Disc ; Pronase ; Proteoglycans ; RNA, Messenger ; Transforming Growth Factor beta1 ; Versicans

PURPOSE: We analyzed the incidence and related factors of radiation dermatitis; at first, to recognize whether a decrease in radiation dermatitis is possible or not in breast cancer patients who received radiation therapy. MATERIALS AND METHODS: Of 338 patients, 284 with invasive breast cancer who received breast conservation surgery with radiotherapy at Chonbuk National University Hospital from January 2007 to June 2009 were evaluated. Patients who also underwent bolus, previous contralateral breast irradiation and irradiation on both breasts were excluded. For patients who appeared to have greater than moderate radiation dermatitis, the incidence and relating factors for radiation dermatitis were analyzed retrospectively. RESULTS: A total of 207 and 77 patients appeared to have RTOG grade 0/1 or above RTOG grade 2 radiation dermatitis, respectively. The factors found to be statistically significant for the 77 patients who appeared to have greater than moderate radiation dermatitis include the presence of lymphocele due to the stasis of lymph and lymph edema which affect the healing disturbance of radiation dermatitis (p=0.003, p=0.001). Moreover, an allergic reaction to plaster due to the immune cells of skin and the activation of cytokine and concomitant hormonal therapy were also statistically significant factors (p=0.001, p=0.025). CONCLUSION: Most of the breast cancer patients who received radiation therapy appeared to have a greater than mild case of radiation dermatitis. Lymphocele, lymphedema, an allergy to plaster and concomitant hormonal therapy which affect radiation dermatitis were found to be significant factors. Consequently, we should eliminate lymphocele prior to radiation treatment for patients who appear to have an allergic reaction to plaster. We should also instruct patients of methods to maintain skin moisture if they appear to have a greater than moderate case of radiation dermatitis.
Breast ; Breast Neoplasms ; Dermatitis ; Edema ; Humans ; Hypersensitivity ; Incidence ; Lymphedema ; Lymphocele ; Skin

PURPOSE: We evaluated the failure pattern of the celiac axis, gastric lymph node, and treatment outcome in the upper and mid-esophageal region of cancer patients treated by definitive radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, retrospectively. MATERIALS AND METHODS: The study constituted the evaluation 108 patients with locally advanced esophageal cancer receiving radiotherapy or a combination of radiotherapy and chemotherapy at Chonbuk National University Hospital from January 1986 to December 2006. In total, 82 patients treated by planned radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, were analysed retrospectively. The study population consisted of 78 men and 2 women (mean age of 63.2 years). In addition, 51 patients received radiotherapy alone, whereas 31 patients received a combination of radiation therapy and chemotherapy. The primary cancer sites were located in the upper portion (17 patients), and mid portion (65 patients), respectively. Further, the patients were in various clinical stages including T1N0-1M0 (7 patients), T2N0-1M0 (18 patients), T3N0-1M0 (44 patients) and T4N0-1M0 (13 patients). The mean follow up period was 15 months. RESULTS: The various treatment outcomes included complete response (48 patients), partial response (31 patients) and no response (3 patients). The failure patterns of the lymph node were comprised of the regional lymph node (23 patients) and the distance lymph node which included celiac axis and gastric lymph node (13 patients). However, metastasis was not observed in the regional and distant lymph node in 10 patients, whereas 36 patients were not evaluated. Furthermore, of the 13 patients who developed celiac axis and gastric lymph node metastases, 3 were in stage T1N0-1M0 and 10 were in stage T2-4N0-1M0. A complete response appeared in 12 patients, whereas a partial response appeared in 1 patient. The mean survival time of the patients who appeared for regional and distant lymph node metastasis was 14.4 and 7.0 months, respectively. CONCLUSION: In locally advanced esophageal cancer patients, who were treated by definitive radiotherapy without celiac axis and gastric lymph node irradiation, the distant lymph node metastasis rate was high and the overall survival rate was lower compared to the regional lymph node metastasis. The incidence of regional and distant lymph node metastasis was high in patients who appeared beyond clinical stage T2 and received radiotherapy alone.
Axis, Cervical Vertebra ; Esophageal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Retrospective Studies ; Survival Rate ; Treatment Outcome

PURPOSE: We evaluated retrospectively the outcome of locally advanced non-small cell lung cancer patients treated with definitive radiotherapy to find out prognostic factros affecting survival. MATERIALS AND METHODS: 216 cases of stage IIIB non-small cell lung cancer were with treated radiotherapy at our Hospital between 1991 to 2002 and reviewed retrospectively. Cases were classified by mode of treatment and response to treatment. Patients showing complete response or partial response to treatment were included in the "response group", while those showing stable or progressive cancer were included in the "non-response group". RESULTS: 30 patients completed the planned radiotherapy treatments and 39 patients completed combined treatments or chemoradiotherapy. Median survival was 4.6 months for patients treated with radiotherapy and 9.9 months for those undergoing combined radiotherapy and chemotherapy. Survival rates for the first year were 13.3% with radiotherapy and 35.9% with chemoradiotherapy. In the second year, 3.3% of the radiotherapy patients survived and 20.5% of the patients receiving chemoradiotherapy survived. By the third year, 15.4% of the patients receiving the combined treatments survived. None of the patients treated with radiotherapy alone lived to the third year, however. Overall survival was significantly different between the radiotherapy patients and the combined chemoradiotherapy patients (p<0.001). In the response group, median survival was 7.2 months with radiotherapy and 16.5 months with combined therapy. In the non-response group, median survival was 4.4 months with radiotherapy and 6.7 months with combined treatments. Severe acute complications (grade 3) occurred in 2 cases using radiotherapy, and in 7 cases using combined therapy. CONCLUSION: When the patients with stage IIIB non-small cell lung cancer received chemoradiotherapy, treatment response rate and overall survival was greater than with radiation alone.
Carcinoma, Non-Small-Cell Lung* ; Chemoradiotherapy ; Drug Therapy ; Humans ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Treatment Outcome*

Anisakis is an accidental parasitic infection caused by the larvae of marine mammals. An individual becomes infected with a larval form of the nematode Anisakis by consuming raw or undercooked fish containing the parasite. Generally, the clincal symptoms are characterized by severe cramping abdomianl pain, nausea, vomiting, and an epigastric full sensation. A case was recently experienced by a patient who suffered acute esophageal anisakiasis, and had a history of eating raw sea fish. His symptoms included substernal chest pain and odynophagia. Early endoscopic examination revealed a whitish linear worm in the mid-esophagus, which was removed by biopsy forceps.
Anisakiasis* ; Anisakis ; Biopsy ; Chest Pain ; Eating ; Esophagus ; Humans ; Larva ; Mammals ; Muscle Cramp ; Nausea ; Parasites ; Sensation ; Surgical Instruments ; Vomiting

Ankle disorders are a relatively common pathological condition, and ankle injuries account for approximately 14% of sports-related orthopedic emergency visits. Various imaging modalities can be used to make a diagnosis in cases of ankle pain; however, ultrasound (US) has several benefits for the evaluation of ankle pain, especially in the tendons, ligaments, and nerves of the ankle. The purpose of this article is to review the common causes of ankle pathology, with particular reference to US features. In addition, the importance of a dynamic evaluation and a stress test with US is emphasized.
Ankle Injuries ; Ankle Joint* ; Ankle* ; Diagnosis ; Emergencies ; Exercise Test ; Ligaments ; Orthopedics ; Pathology ; Tendons ; Ultrasonography*