OBJECTIVE: Bilateral C1 lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (AAI). However, the inevitable situation of vertebral artery injury or unfavorable bone structure may necessitate the use of unilateral C1LM-C2P. This study compares the fusion rates of the C1 lateral mass and C2 pedicle screw in the unilateral and bilateral methods. METHODS: Over five years, C1LM-C2P was performed in 25 patients with AAI in our institute. Preoperative studies including cervical X-ray, three-dimensional computed tomography (CT), CT angiogram, and magnetic resonance imaging were performed. To evaluate bony fusion, measurements of the atlanto-dental interval (ADI) and CT scans were performed in the preoperative period, immediate postoperative period, and postoperatively at 1, 3, 6, and 12 months. RESULTS: Unilateral C1LM-C2P was performed in 11 patients (44%). The need to perform unilateral C1LM-C2P was due to anomalous course of the vertebral artery in eight patients (73%) and severe degenerative arthritis in three patients (27%). The mean ADI in the bilateral group was 2.09 mm in the immediate postoperative period and 1.75 mm in 12-months postoperatively. The mean ADI in the unilateral group was 1.82 mm in the immediate postoperative period and 1.91 mm in 12-months postoperatively. Comparison of ADI measurements showed no significant differences in either group (p=0.893), and the fusion rate was 100% in both groups. CONCLUSION: Although bilateral C1LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.
Arthritis, Rheumatoid* ; Humans ; Magnetic Resonance Imaging ; Osteoarthritis ; Postoperative Period ; Preoperative Period ; Tomography, X-Ray Computed ; Vertebral Artery

BACKGROUND: Hypopituitarism is associated with osteoporosis and osteopenia especially when hypogonadotropic hypogonadism is present. Despite hypopituitarism being an important cause of secondary osteoporosis, osteoporosis in patients receiving surgery for pituitary tumors in Korea has not been studied. In this study, we evaluated the effects of testosterone replacement therapy (TRT) on bone mineral density (BMD) in postoperative hypogonadal patients with pituitary tumors. METHODS: To examine the effect of TRT on BMD, we performed a retrospective observational study in 21 postoperative male patients who underwent pituitary tumor surgery between 2003 and 2012 at the Ajou University Hospital. Testosterone was replaced in postoperative hypogonadal patients by regular intramuscular injection, daily oral medication, or application of transdermal gel. BMD (g/cm2) measurements of central skeletal sites (lumbar spine, femoral neck, and total femur) were obtained using dual-energy X-ray absorptiometry (GE Lunar). For lumbar spine BMD, L1 to L4 values were chosen for analysis. Femur neck and total femur were also analyzed. RESULTS: During the follow-up period (mean, 56 months; range, 12 to 99 months) serum testosterone levels increased with the administration of TRT (P=0.007). There was significant improvement (4.56%+/-9.81%) in the lumbar spine BMD compared to baseline BMD. There were no significant changes in the femur neck BMD or total femur BMD. We did not find any statistically significant relationships between changes in testosterone levels and BMD using Spearman correlation analysis. CONCLUSION: Our results indicated that TRT used in the postoperative period for hypogonadal pituitary tumor surgery patients may have beneficial effects on the BMD of the spine.
Absorptiometry, Photon ; Bone Density* ; Bone Diseases, Metabolic ; Femur ; Femur Neck ; Follow-Up Studies ; Humans ; Hypogonadism ; Hypopituitarism ; Injections, Intramuscular ; Korea ; Male* ; Observational Study ; Osteoporosis ; Pituitary Neoplasms* ; Postoperative Period ; Retrospective Studies ; Spine ; Testosterone*

Immunohistochemical staining was used to evaluate the presence of nitricoxide synthase (NOS) family enzymes in the rat penis and major pelvic ganglion.We used three kinds of antisera which are brain(neuronal), endothelial cell andmacrophge(inducible) enzymes of NOS. Many brain NOS positive neurons wereobserved in the major pelvic ganglion, especially in the initial portion of thecavenous nerve. In the penile erectile tissue, many delicate, beaded or linearbrain NOS-positive fibers were observed on the bundle of smooth muscles,adventitia of helicine artery and wall of cavernous space. Brain NOS-positiveimmunoreactivity were also seen on the encapsulated nerve ending and adventitiaof dorsal vessels of penis. Endothelial cell NOS immunoreactivity was exclusivelyin the urethral epithelium of corpus spongiosum. There was no inducible NOSimmunoreactivity in rat penis and major pelvic ganglion. These results suggestthat NO related to penile erection in rat was made from brain NOS rather thanendothelia1 cell or inducible NOS.
Animals ; Arteries ; Brain ; Endothelial Cells ; Epithelium ; Ganglion Cysts* ; Humans ; Immune Sera ; Male ; Nerve Endings ; Neurons ; Nitric Oxide Synthase* ; Nitric Oxide* ; Penile Erection ; Penis* ; Protein Isoforms* ; Rats*

Objective: The purpose of this study is to identify the types of pain changes that affect older Koreans, as well as their effects on depressive symptom. Methods: We analyzed the Korean Longitudinal Study of Aging data collected from 2010 to 2018. A data of total of 1,359 participants, aged 65 or older were used to estimate the change in pain. A latent growth model and growth mixture modeling were performed to estimate the overall change in pain and to categorize the types of pain changes. Results: The pain changes of older adults were classified into two categories: low-stable and high increasing. The depressive symptom showed a stronger relationship among the high-increasing type of pain than the low-stable type. The high-increasing type had a higher percentage of females, lower income, relatively low educational attainment, and a higher percentage of rural residents than the low-stable type. Conclusion The significance of this study is that it reiterated the importance of early pain diagnosis and intervention by identifying the types of pain changes in older adults and analyzing their effects on depressive symptoms. Therefore, it is especially important to pay attention to interventions that are designed to help vulnerable groups with a high risk of pain obtain effective pain management.

Objective: The purpose of this study is to identify the types of pain changes that affect older Koreans, as well as their effects on depressive symptom. Methods: We analyzed the Korean Longitudinal Study of Aging data collected from 2010 to 2018. A data of total of 1,359 participants, aged 65 or older were used to estimate the change in pain. A latent growth model and growth mixture modeling were performed to estimate the overall change in pain and to categorize the types of pain changes. Results: The pain changes of older adults were classified into two categories: low-stable and high increasing. The depressive symptom showed a stronger relationship among the high-increasing type of pain than the low-stable type. The high-increasing type had a higher percentage of females, lower income, relatively low educational attainment, and a higher percentage of rural residents than the low-stable type. Conclusion The significance of this study is that it reiterated the importance of early pain diagnosis and intervention by identifying the types of pain changes in older adults and analyzing their effects on depressive symptoms. Therefore, it is especially important to pay attention to interventions that are designed to help vulnerable groups with a high risk of pain obtain effective pain management.

Objective: The purpose of this study is to identify the types of pain changes that affect older Koreans, as well as their effects on depressive symptom. Methods: We analyzed the Korean Longitudinal Study of Aging data collected from 2010 to 2018. A data of total of 1,359 participants, aged 65 or older were used to estimate the change in pain. A latent growth model and growth mixture modeling were performed to estimate the overall change in pain and to categorize the types of pain changes. Results: The pain changes of older adults were classified into two categories: low-stable and high increasing. The depressive symptom showed a stronger relationship among the high-increasing type of pain than the low-stable type. The high-increasing type had a higher percentage of females, lower income, relatively low educational attainment, and a higher percentage of rural residents than the low-stable type. Conclusion The significance of this study is that it reiterated the importance of early pain diagnosis and intervention by identifying the types of pain changes in older adults and analyzing their effects on depressive symptoms. Therefore, it is especially important to pay attention to interventions that are designed to help vulnerable groups with a high risk of pain obtain effective pain management.

Objective: The purpose of this study is to identify the types of pain changes that affect older Koreans, as well as their effects on depressive symptom. Methods: We analyzed the Korean Longitudinal Study of Aging data collected from 2010 to 2018. A data of total of 1,359 participants, aged 65 or older were used to estimate the change in pain. A latent growth model and growth mixture modeling were performed to estimate the overall change in pain and to categorize the types of pain changes. Results: The pain changes of older adults were classified into two categories: low-stable and high increasing. The depressive symptom showed a stronger relationship among the high-increasing type of pain than the low-stable type. The high-increasing type had a higher percentage of females, lower income, relatively low educational attainment, and a higher percentage of rural residents than the low-stable type. Conclusion The significance of this study is that it reiterated the importance of early pain diagnosis and intervention by identifying the types of pain changes in older adults and analyzing their effects on depressive symptoms. Therefore, it is especially important to pay attention to interventions that are designed to help vulnerable groups with a high risk of pain obtain effective pain management.

Objective: The purpose of this study is to identify the types of pain changes that affect older Koreans, as well as their effects on depressive symptom. Methods: We analyzed the Korean Longitudinal Study of Aging data collected from 2010 to 2018. A data of total of 1,359 participants, aged 65 or older were used to estimate the change in pain. A latent growth model and growth mixture modeling were performed to estimate the overall change in pain and to categorize the types of pain changes. Results: The pain changes of older adults were classified into two categories: low-stable and high increasing. The depressive symptom showed a stronger relationship among the high-increasing type of pain than the low-stable type. The high-increasing type had a higher percentage of females, lower income, relatively low educational attainment, and a higher percentage of rural residents than the low-stable type. Conclusion The significance of this study is that it reiterated the importance of early pain diagnosis and intervention by identifying the types of pain changes in older adults and analyzing their effects on depressive symptoms. Therefore, it is especially important to pay attention to interventions that are designed to help vulnerable groups with a high risk of pain obtain effective pain management.

Myocardial involvement with clinical symptoms is a rare manifestation of systemic lupus erythematosus (SLE), despite the relatively high prevalence of myocarditis at autopsies of SLE patients. In this review, we report the case of a 19-year-old male SLE patient who initially presented with myopericarditis and was successfully treated with high dose of glucocorticoids.
Autopsy ; Glucocorticoids ; Humans ; Lupus Erythematosus, Systemic ; Male ; Myocarditis ; Pericarditis ; Prevalence ; Young Adult

A 65-year-old woman was referred for management of chest pain and ST segment elevation on electrocardiography. Emergency coronary angiography revealed a well demarcated thrombus that near totally occluded the mid portion of the left anterior descending artery, with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 1, and a fusiform aneurysm on the left main coronary artery. No significant stenosis was observed after aspiration of the thrombus; however, complete coronary reperfusion by urgent aspiration did not improve her dyspnea and tachypnea. Echocardiography revealed a D-shaped left ventricle; thus, we performed a chest computed tomography scan and diagnosed a pulmonary embolism. The patient's coagulation studies were normal. She was prescribed chronic anticoagulation, and we carried out transthoracic echocardiography using second harmonic imaging with agitated saline. Second harmonic imaging with the Valsalva maneuver revealed no right-to-left shunt. We report here a case of concurrent coronary embolism and pulmonary embolism without right-to-left shunt.
Aged ; Aneurysm ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Aneurysm ; Coronary Angiography ; Coronary Vessels ; Dihydroergotamine ; Dyspnea ; Echocardiography ; Electrocardiography ; Embolism ; Emergencies ; Female ; Humans ; Myocardial Infarction ; Myocardial Reperfusion ; Pulmonary Embolism ; Tachypnea ; Thorax ; Thromboembolism ; Thrombosis ; Valsalva Maneuver