OBJECTIVES: To determine if unilateral pedicle screw fixation is comparable to bilateral fixation in one-or two-segment lumbar spinal fusion. METHODS: Eighty-eight patients with spinal stenosis or spondylolisthesis were assigned to either unilateral or bilateral pedicle screw instrumentation groups. Demographic variables, preoperative diagnosis, number of fusion segments, and kinds of instrumentation used were similar between the two treatment groups. RESULTS: There were no significant differences between the two groups in terms of blood loss, clinical results, time at which fusion was complete, fusion rate, and complication rate. There were significant differences between the two groups in terms of duration of operating time, duration of hospital stay, medical expenses. The number of fusion segments or kinds of instrumentation did not affect the fusion rate, time at which fusion was complete, or clinical outcomes. Metal failure rate of unilateral fixation was higher in patients with spondylolytic spondylolisthesis than in patients with spinal stenosis. CONCLUSIONS: Unilateral pedicle screw fixation was as effective as bilateral pedicle screw fixation in lumbar spinal fusion independent of the number of fusion segments (one or two segments) or pedicle screw systems. Unilateral pedicle screw fixation is not recommended for spondylolytic spondylolisthesis patients who were treated with Gill' s decompression.
Decompression ; Diagnosis ; Humans ; Length of Stay ; Spinal Fusion* ; Spinal Stenosis ; Spondylolisthesis

Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note.
Acetabulum* ; Debridement ; Humans ; Joints ; Methods

The present study was performed to examine whether acupuncture can regulate the expression of cytokines that play important roles in wound healing and morphological changes in the burn wound healing of rats, such as transforming growth factor (TGF)-beta1, TGF-beta3, epidermal growth factor (EGF), and interleukin-6 (IL-6). Sprague-Dawley rats weighing 250~300 g were divided into two control groups and two experimental groups. Among the control groups, no-treatment group was classified as C and acupuntured group as Ca. Among the experimental groups, burned group (n = 6) was classified as B and acupunctured group after burn (n = 6) as Ba. The lumbar area of rats was burned 15 x 25 mm in size for 15~18 seconds with special small iron adapter and acupunctured at 5~7 mm in diameter and 1 cm in depth using 0.25 mm x 50 mm acupuncture needle for 20 minutes in wound area. Rats in group Ca were acupunctured once. Rats in group Ba were acupunctured every 12 hours 3 times. Rats were sacrificed at days 1, 3, 7, 15 and 20 after burn treatment. Morphological changes were examined by hematoxylin-eosin staining methods. The expression profiles of TGF-beta1, TGF-beta3, EGF and IL-6 were detected by immunohistochemical staining methods. The results we obtained were as follows: 1. In gross observation, the burn wounds were less odorous and cleaner in the acupunctured group (Ba) compared with those of no-acupuncture group (B). 2. Reepithelialization and formation of panniculus carnosus and granulation tissue were more prominent at days 3 and 7 in the acupunctured group Ba than group B. However, this difference was disappear at day 15. 3. In the muscle of group B, TGF-beta1 was observed after day7. However, in group Ba, TGF-beta1 was observed as early as days 1 and 3 and rapidly turnovered at day 7. 4. For TGF-beta3, both B and Ba groups showed similar results. 5. At day 3, EGF was observed in the subcutaneous tissue in both B and Ba groups. However, in day 7, EGF was rapidly decreased in Ba group compared with that of B. 6. For IL-6, both B and Ba groups showed similar results in epidermis, dermis, subcutaneous tissue and muscle. But, at day 3, IL-6 was rapidly decreased in theconnective tissue under the muscle in Ba group compared with that of B. These results suggest that acupuncture may improve the wound healing in the early stage by increasing the TGF-beta1 that is essential for the formation of extracellular matix and by decreasing EGF.
Acupuncture* ; Animals ; Burns* ; Cytokines ; Dermis ; Epidermal Growth Factor* ; Epidermis ; Granulation Tissue ; Interleukin-6* ; Iron ; Needles ; Odors ; Rats* ; Rats, Sprague-Dawley ; Skin ; Subcutaneous Tissue ; Transforming Growth Factor beta1* ; Transforming Growth Factor beta3* ; Transforming Growth Factors ; Wound Healing* ; Wounds and Injuries*

The present study was performed to examine whether acupuncture can regulate the expression of extracellular matrix proteins that play important roles in burn wound healing of rat, such as fibronectin, type I and IV collagens, and laminin. Sprague-Dawley rats weighing 250~300 g were divided into 4 groups such as normal control group (C), only acupuncture treatment group (Ca), burn treatment group (B), and a group for acupuncture treatment after burn (Ba). We burned 15x25 mm in size for 15~18 seconds at lumbar area of rats with special iron adapter and acupunctured at 5~7 mm in diameter and 1 cm in depth using 0.25 mm x 50 mm acupuncture needle for 20 minutes in wound area. Rats in group Ca were acupunctured once, and rats in group Ba were acupunctured every 12 hours 3 times. Rats sacrificed at days 1, 3, 7, 15 and 20 after burn treatment. Histological changes were examined by azan staining methods and expression profiles of fibronectin, type I and IV collagens, and laminin were detected by immunohistochemical staining methods. The results we obtained were as follows: 1. At day 1, fibers in epidermis, dermis and subcutaneous tissue in both groups B and Ba were not observed. However groups B and Ba exhibited fibers stained mildly and moderately, respectively, in muscle and connective tissues. At day 20 , the level of fiber in group B which was comparable to group C was less than that of in B group. 2. At day 3, fibronectin in group Ba was observed in the muscle. At days 15 and 20, fibronectin was increased in epidermis and dermis of group Ba compared with those of group B. 3. Type I collagen in subcutaneous tissue was observed at days 1, 3 and 7 in both groups B and Ba. However type I collagen was observed only in group Ba at day 15. In the epidermis of group Ba, type I collagen was observed at day 3 and maintained until day 20, while observing only at day 20 in group B. 4. For type IV collagen, both groups B and Ba showed similar results. 5. For laminin, both groups B and Ba showed similar results except the 7th day results. However after day 15, laminin was stained moderately and mildly in groups Ba and B, respectively. These results suggest that acupuncture may improve the burn wound healing by increasing fibronectin and type I collagen.
Acupuncture* ; Animals ; Burns* ; Collagen Type I ; Collagen Type IV ; Collagen* ; Connective Tissue ; Dermis ; Epidermis ; Extracellular Matrix Proteins ; Fibronectins* ; Iron ; Laminin* ; Needles ; Rats* ; Rats, Sprague-Dawley ; Skin ; Subcutaneous Tissue ; Wound Healing* ; Wounds and Injuries*

PURPOSE: The purpose of this study is to evaluate the use of plain knee films in assessing the position of tibial component after total knee arthroplasty. MATERIALS AND METHODS: Plain radiological antero-posterior(AP) and lateral view of tibia of 51 adults (mean age: fifty-years old) were taken. On AP view, the medial angles between tibia plateau and mechanical, anatomical and proximal anatomical axis of tibia were measured, and then correlation of each angle and the angle between the tibia plateau and anatomical axis were assessed. On lateral view, the posterior angle formed between the medial tibial plateau and anatomical, proximal anatomical axis, anterior and posterior cortex of proximal tibia were measured, and then correlation of each angle and the angle between the medial tibial plateau and anatomical axis were assessed. RESULTS: On tibial AP view, both axes had significant correlation(p<0.05) with the anatomical axis. The anatomical axis of proximal tibia was closest to it. On lateral view, all three axes had significant correlation(p<0.05) with anatomical axis. Among these, the anterior cortex of proximal tibia was closest to it. CONCLUSION: The position of the tibia component and posterior slope after total knee arthroplasty can be measured on plain knee X-rays using anatomical axis and the anterior cortex line of proximal tibia.
Adult ; Arthroplasty ; Axis, Cervical Vertebra* ; Humans ; Knee* ; Tibia

BACKGROUND/AIMS: Recently, the incidence of nursing home-acquired pneumonia (NHAP) has been increasing and is now the leading cause of death among nursing home residents. This study was performed to identify risk factors associated with NHAP mortality, focusing on facility characteristics. METHODS: Data on all patients > or = 70 years of age admitted with newly diagnosed pneumonia were reviewed. To compare the quality of care in nursing facilities, the following three groups were defined: patients who acquired pneumonia in the community, care homes, and care hospitals. In these patients, 90-day mortality was compared. RESULTS: Survival analyses were performed in 282 patients with pneumonia. In the analyses, 90-day mortality was higher in patients in care homes (12.2%, 40.3%, and 19.6% in community, care homes, and care hospitals, respectively). Among the 118 NHAP patients, residence in a care home, structural lung diseases, treatment with inappropriate antimicrobial agents for accompanying infections, and a high pneumonia severity index score were risk factors associated with higher 90-day mortality. However, infection by potentially drug-resistant pathogens was not important. CONCLUSIONS: Unfavorable institutional factors in care homes are important prognostic factors for NHAP.
Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Cause of Death ; Cross Infection/diagnosis/drug therapy/microbiology/*mortality ; Female ; *Homes for the Aged ; *Hospitals ; Humans ; Inappropriate Prescribing ; Kaplan-Meier Estimate ; Male ; *Nursing Homes ; Pneumonia, Bacterial/diagnosis/drug therapy/microbiology/*mortality ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome

Although the head and neck region is recognized as the most common location for peripheral nerve sheath tumors, central involvement, particularly in the jaw bones, is quite unusual. Neurofibroma is one of the most common nerve sheath tumors occurring in the soft tissue and generally appears in neurofibromatosis 1 (NF1 or von Recklinghausen's disease). Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon sarcomas that almost always arise in the soft tissue. Here, we report four cases of intraosseous peripheral nerve sheath tumors occurring in the jaw bones and compare the clinical, radiologic, and pathologic findings in order to make a differential diagnosis.
X-Rays ; Sarcoma/*diagnosis ; Neurofibromatoses/pathology ; Neurofibroma/*pathology ; Nerve Sheath Neoplasms/*diagnosis ; Male ; Jaw/*radiography ; Humans ; Female ; Diagnosis, Differential ; Child ; Bone Neoplasms/*diagnosis ; Adult ; Adolescent

Endothelin (ET)-1 and its receptors (ETA and ETB receptor) are present in the central nervous system. ET exerts biological effects on gliogenesis and glial cell functions. In order to define a possible mechanism of ETA receptor signaling, the distribution of the ETA receptor in developing oligodendrocytes and the effects of ET-1 on the myelination of oligodendrocytes were examined. ETA receptor immunoreactivity was confined to the perivascular elements of the blood vessels during early postnatal development. However later in development, ETA receptor immunoreactivity was no longer observed in the vessels but became localized to the myelinating oligodendrocytes of the primitive corpus callosum of the white matter, apart from the vessels. ET-1 induced myelin basic protein (MBP) in primary oligodendrocyte precursor cell culture though the ETA receptor and was blocked by an ETA receptor antagonist. In addition, ET-1 evoked the release of Ca2+ which is a central regulator of oligodendrocyte differentiation. Our results provide a link between ET-1 and its ETA receptor and myelination during oligodendrocyte differentiation.
Animals ; Brain/pathology ; Calcium/metabolism ; Calcium Signaling ; Cells, Cultured ; Endothelin-1/metabolism/physiology ; Mice ; Mice, Inbred ICR ; Myelin Basic Proteins/genetics/metabolism ; Myelin Sheath/*physiology ; Oligodendroglia/cytology/*metabolism ; Rats ; Rats, Sprague-Dawley ; Receptor, Endothelin A/metabolism/*physiology

PURPOSE: The aim of this study was to investigate whether vitrification in the cryopreservation of periodontal ligament (PDL) cells could be useful for tooth banking. METHODS: In step 1, primary cultured human PDL cells were cryopreserved in 100% conventional cryopreservation media and 100% vitrification media (ESF40 media) in different temperatures for 2 weeks. In step 2, a series of modified vitrification formulae named T1 (75% vitrification media + 25% F media), T2 (50% vitrification media + 50% F media) and T3 (25% vitrification media + 75% F media) were used to store PDL cells for 2 weeks and 4 weeks in liquid nitrogen. MTT assay was performed to examine the viability of PDL cells. RESULTS: Maximum cell viability was achieved in cells stored in 100% conventional cryopreservation media at -196degrees C (positive control group) in step 1. Compared to the positive control group, viability of the cells stored in 100% vitrification media was very low as 10% in all test conditions. In step 2, as the percentage of vitrification media decreased, the cell viability increased in cells stored for 2 weeks. In 4-week storage of cells in step 2, higher cell viability was observed in the T2 group than the other vitrification formulae while the positive control group had the highest viability. There was no statistically significant difference in the cell viability of 2-week and 4-week stored cells in the T2 group. CONCLUSIONS: These observations indicate 100% vitrification media is not successful in PDL cell cryopreservation. Conventional cryopreservation media is currently the most appropriate media type for this purpose while T2 media would be interesting to test for long-term storage of PDL cells.
Cell Survival ; Cryopreservation ; Humans ; Nitrogen ; Periodontal Ligament ; Tissue Banks ; Tooth ; Vitrification

Purpose: Effectiveness and safety of clofarabine (one of the treatment mainstays in pediatric patients with relapsed/refractory acute lymphoblastic leukemia [ALL]) was assessed in Korean pediatric patients with ALL to facilitate conditional coverage with evidence development. Materials and Methods: In this multicenter, prospective, observational study, patients receiving clofarabine as mono/combination therapy were followed up every 4-6 weeks for 6 months or until hematopoietic stem cell transplantation (HSCT). Response rates, survival outcomes, and adverse events were assessed. Results: Sixty patients (2-26 years old; 65% B-cell ALL, received prior ≥ 2 regimen, 68.3% refractory to previous regimen) were enrolled and treated with at least one dose of clofarabine; of whom 26 (43.3%) completed 6 months of follow-up after the last dose of clofarabine. Fifty-eight patients (96.7%) received clofarabine combination therapy. Overall remission rate (complete remission [CR] or CR without platelet recovery [CRp]) was 45.0% (27/60; 95% confidence interval [CI], 32.4 to 57.6) and the overall response rate (CR, CRp, or partial remission [PR]) was 46.7% (28/60; 95% CI, 34.0 to 59.3), with 11 (18.3%), 16 (26.7%), and one (1.7%) patients achieving CR, CRp, and PR, respectively. The median time to remission was 5.1 weeks (95% CI, 4.7 to 6.1). Median duration of remission was 16.6 weeks (range, 2.0 to 167.6 weeks). Sixteen patients (26.7%) proceeded to HSCT. There were 24 deaths; 14 due to treatment-emergent adverse events. Conclusion Remission with clofarabine was observed in approximately half of the study patients who had overall expected safety profile; however, there was no favorable long-term survival outcome in this study.