Deposition of monosodium urate crystal in joints and periarticular soft tissue is regarded as one of the characteristics of chronic gouty arthritis. In spine, however, only nineteen cases of tophaceous deposits have been reported to date suggesting the rarity of clinical symptoms secondary to involvement of spine. Authors report a case of spinal stenosis due to hypertrophy of ligament flavum with monosodium urate deposits. The patient was 65 years of age with chronic gouty arthritis who underwent a decompressive laminectomy at L4-5. At surgery, hypertrophied ligament flavum that was covered with chalky amorphous materials was noted without any evidence of radiologic features. Microscopically, a portion of ligament flavum had been focally destoryed by amorphous material deposits that were surrounded by a thin layer of mononuclear and giant cells along with occasional sprinkling of chronic inflammatory cells and negative birefringence on polarizing microscopy.
Arthritis, Gouty ; Birefringence ; Giant Cells ; Humans ; Hypertrophy* ; Joints ; Laminectomy ; Ligaments* ; Microscopy ; Spinal Stenosis* ; Spine ; Uric Acid*

BACKGROUND: The lateral radiograph-based system described by Tsuyama is used widely to classify ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. However, OPLL is a complex 3-dimensional (3-D) lesion, not a simple and uniplanar one, which is often difficult to identify on a lateral radiograph. Furthermore, its reliability among spine surgeons has not been investigated. Given the popularity of a reconstructed computed tomography (CT), this study examined the inter- and intra-observer reliability of lateral radiograph-based OPLL classification using that modality. METHODS: Five spine surgeons independently reviewed the lateral radiograph, axial CT, 2-D (sagittal) and 3-D reconstructed CT images of 108 OPLL patients on 2 separate occasions. Based on these images, the reviewers classified each OPLL case according to the Tsuyama's system. The kappa values were used to assess the statistical reliability. RESULTS: The inter- and intra-observer kappa values were only 0.51 and 0.67 for the lateral radiograph, even in combination with the axial CT images, 0.70 and 0.85 for 2-D CT images, and 0.76 and 0.86 for 3-D CT images, respectively. These kappa values showed a good-to-excellent range for the 2-D and 3-D reconstructed CT images while those of the lateral radiograph indicated a fair range. According to the OPLL types, the inter- and intra-observer reliability was low in the continuous type and high in the circumscribed type on the lateral radiograph. However, the low reliability of the continuous type on lateral radiograph was overcome somewhat using 2-D and 3-D reconstructed CT images. CONCLUSIONS: The inter- and intra-observer kappa values were only 0.51 and 0.67 for the lateral radiograph, even in combination with the axial CT images, 0.70 and 0.85 for 2-D CT images, and 0.76 and 0.86 for 3-D CT images, respectively. These kappa values showed a good-to-excellent range for the 2-D and 3-D reconstructed CT images while those of the lateral radiograph indicated a fair range. According to the OPLL types, the inter- and intra-observer reliability was low in the continuous type and high in the circumscribed type on the lateral radiograph. However, the low reliability of the continuous type on lateral radiograph was overcome somewhat using 2-D and 3-D reconstructed CT images.
Adult ; Aged ; Cervical Vertebrae/radiography ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; Observer Variation ; Ossification of Posterior Longitudinal Ligament/*classification/*radiography ; *Tomography, X-Ray Computed

A reduced retroversion angle of humeral head may predispose to recurrent anterior shoulder dislocation and may also be a factor in persistent instability after soft tissue procedures. Rotation osteotomy of proximal humerus is one of many surgical modalities proposed for recurrent anterior shoulder dislocation. To support such an operation, fundamental knowledge of shoulder anatomy is essential. The semi-axial view by Soderlund have been regarded as simple and reliable method for measuring humeral head retroversion angle. The purpose of this study was to evaluate validity of the semi-axial view and to assess reference values for humeral head retroversion angle in Korean. Humeral head retroversion angle was determined from 80 healthy subjects, 48 men and 32 women. Radiographs which shown less than 10degrees between humeral shaft axis and epicondylar axis were defined as acceptable radiographs by Soderlund. Acceptable radiographs were selected and two orthopedic surgeons measured retroversion angle, separately. Acceptable radiographs were obtained in only 70 shoulders (43.8%). The mean angle was 35.2+/-8.24degrees for dominant hand and 32+/-6.27degrees for nondominant in Korean. The mean angle was 35.3+/- 7.78degrees for right side and 31.9+/-6.8degrees for left. The interobserver difference was 2.9degrees. The semi-axial view by Soderlund was not reproducible solely. But if correct arm position is considered, the method presented is easy to use daily.
Arm ; Axis, Cervical Vertebra ; Female ; Hand ; Humans ; Humeral Head* ; Humerus ; Male ; Orthopedics ; Osteotomy ; Reference Values ; Shoulder ; Shoulder Dislocation

Methods: Rats were allocated randomly into one of three groups: control, STZ, and STZ-insulin. Diabetes was induced by a single intraperitoneal injection of STZ (65 mg/kg) in the STZ and STZ-insulin groups. The blood glucose level was consistently above 400 mg/ dL in the STZ and STZ-insulin groups 2 weeks after STZ injection. After 2 weeks of STZ injection, the STZ-insulin group was administered insulin treatment (1.5 unit/100 g) daily for up to 4 weeks. Blood glucose of the STZ-insulin rats significantly decreased to normal levels 4 weeks after insulin treatment. The rats were sacrificed 6 weeks after STZ injection, and disc cells and tissues were harvested to investigate the expression of apoptosis markers and matrix metalloproteinases (MMPs). Results: Fas and caspase-8, -9, and -3 expressions were significantly increased in the STZ group, along with increased expressions of MMP-2 and -3. On the contrary, insulin treatment significantly decreased the expressions of Fas, caspase-8, -9, and -3 as well as MMP-2 and -3 in the STZ-insulin group. Conclusions The results of the current study demonstrated that insulin treatment attenuates excessive apoptosis of disc cells and matrix degradation in the diabetic rat model. Accordingly, strict blood glucose control should be recommended to prevent disc degeneration in diabetic patients.

STUDY DESIGN: Radiological analysis. PURPOSE: To investigate sacralization of L5 on radiological studies of degenerative spondylolisthesis at L4-L5. OVERVIEW OF LITERATURE: Degenerative spondylolisthesis commonly develops at L4-L5. Sacralization of L5 is thought to cause stress concentration at this level, which accentuates degenerative changes and promotes development of degenerative spondylolisthesis. However, there has been no study dedicated to determining whether the presence of sacralization at L5 influences the radiological findings in degenerative spondylolisthesis at L4-L5. METHODS: Seventy-eight patients with degenerative spondylolisthesis at L4-L5 were classified into two groups according to the presence of L5 sacralization: with (n=54) and without (n=24). Four radiographic parameters were measured and compared between the two groups: anterior slippage of L4 on L5 (% slip), facet orientation of L4-L5 (degrees), facet osteoarthritis of L4-L5 by Fujiwara's criteria (1~4 grades), and disc degeneration of L4-L5 by Frymoyer's criteria (grades 1~5). RESULTS: There was no significant difference in the degree of anterior slippage of L4 on L5 (17.02+/-6.21 versus 16.65+/-4.87, p=0.809), facet orientation (54.99+/-12.18 versus 56.23+/-4.35, p=0.642), facet osteoarthritis (3.43+/-0.59 versus 3.53+/-0.37, p=0.527), or disc degeneration (4.50+/-0.51 versus 4.35+/-0.61, p=0.340) between the two groups. CONCLUSIONS: Our study shows that the influence of sacralization of L5 on radiological findings in degenerative spondylolisthesis at L4-L5 may be less significant than previously expected. Further studies in large patient groups are needed to clarify the role of L5 sacralization on the development of degenerative spondylolisthesis at L4-L5.
Humans ; Intervertebral Disc Degeneration ; Orientation ; Osteoarthritis ; Spondylolisthesis

INTRODUCTION: The current study examined the morphological characteristics of maxillary sinus septum by computed tomography (CT). MATERIALS AND METHODS: Two hundred and four patients (408 maxillary sinuses) who visited dental clinic were evaluated. CT were examined. The height of the septum measured from the sinus floor to the apex of the septum more than 3 mm was defined as "sinus septum". RESULTS: The prevalence of sinus septa was 21.3% (87/408), and 31.4% (64/204) of patients had more than 1 sinus septum. Females showed higher and thinner sinus septa than males. The anatomic location of the septa were distributed in the 2nd molar region (43.7%), 1st molar region (31.0%), 2nd premolar region (21.8%) and 1st premolar region (3.5%). In 57 patients with chronic disease, there was no significant difference between sinus disease and the presence of sinus septa. The loss of remaining teeth and teeth adjacent to the sinus septum area was not related to the presence of sinus septa. Older subjects showed a reduced height and length of the septum, and a thicker septum. CONCLUSION: These results show that the maxillary sinus septum undergoes atrophy with age.
Atrophy ; Bicuspid ; Chronic Disease ; Dental Clinics ; Female ; Floors and Floorcoverings ; Humans ; Male ; Maxillary Sinus ; Molar ; Prevalence ; Tooth

OBJECTIVE: To evaluate correlation of preoperative anemia with clinical outcomes in patients with early stage cervical cancer who were treated with radical hysterectomy and lymph node dissection. METHODS: Patients who underwent radical hysterectomy and lymph node dissection for cervical cancer from January 2001 to February 2012 were included in this study. Clinicopatholgoical factors included in univariate and multivariate analysis were age, tumor histology, FIGO (International Federation of Gyneocology and Obstetrics) stage, preoperative hemoglobin, depth of invasion, tumor size, parametrial involvement, resection margin, and lymph node status. RESULTS: A total of 387 patients were retrospectively analyzed in this study; 141 patients (36.4%) had preoperative anemia (hemoglobin <12 g/dL) and 16 out of 141 patients (11.3%) received blood transfusion for correction of preoperative anemia. Patients with preoperative anemia showed significant association with age <50 years, more advanced stage, non-squamous cell carcinoma histology, larger tumor size, deeper stromal invasion, and lymph node metastasis (P<0.05). Both relapse-free survival and overall survival were worse in patients with preoperative anemia in univariate analysis. In multivariate analysis, overall survival was worse in patients with preoperative anemia, but relapse-free survival was not associated with preoperative anemia. In the intergroup analysis of anemic patients for the effect of preoperative blood transfusion, preoperative anemia correction did not affect survival. CONCLUSION: Preoperative anemia was not an independent prognostic factor for survival in patients with early cervical cancer. However, it was associated with poor prognostic factors. Further study in large population is needed.
Anemia* ; Blood Transfusion ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Retrospective Studies ; Uterine Cervical Neoplasms*

STUDY DESIGN: In vitro cell culture. PURPOSE: The purpose of this study was to investigate the effect of high glucose on autophagy in adult rat intervertebral disc cells. OVERVIEW OF LITERATURE: Diabetes mellitus is considered to be an important etiologic factor for intervertebral disc degeneration, resulting in degenerative disc diseases. A glucose-mediated increase of autophagy is a major causative factor for the development of diseases associated with diabetes mellitus. However, no information is available for the effect of high glucose on autophagy in adult intervertebral disc cells. METHODS: Nucleus pulposus and annulus fibrosus cells were isolated from 24-week-old adult rats, cultured and placed in either 10% fetal bovine serum (normal control) or 10% fetal bovine serum plus two different high glucose concentrations (0.1 M and 0.2 M) (experimental conditions) for one and three days, respectively. The expressions of autophagy markers, such as beclin-1, light chain 3-I (LC3-I) and LC3-II, autophagy-related gene (Atg) 3, 5, 7 and 12, were identified and quantified. RESULTS: Two high glucoses significantly increased the expressions of beclin-1, LC3-II, Atg3, 5, 7, and 12 in adult rat nucleus pulposus and annulus fibrosus cells in a dose- and time-dependent manner. The ratio of LC3-II/LC3-I expression was also increased in a dose-respectively time-dependent manner. CONCLUSIONS: The results suggest that autophagy of adult nucleus pulposus and annulus fibrosus cells might be a potential mechanism for the intervertebral disc degeneration in adult patients with diabetes mellitus. Thus, the prevention of autophagy in adult intervertebral disc cells might be considered as a novel therapeutic target to prevent or to delay the intervertebral disc degeneration in adult patients with diabetes mellitus.
Adult* ; Animals ; Autophagy* ; Cell Culture Techniques ; Diabetes Mellitus ; Glucose* ; Humans ; Intervertebral Disc Degeneration ; Intervertebral Disc* ; Rats*

BACKGROUND: Thoracoscopic sympathicotomy was thought to be a simple and safe method for hyperhidrosis. There is a significant decrease in heart rate during the procedure. Also it has been suggested that the effect of the degree of sympathetic block on cardiac function was affected by the preoperative level of sympathetic activity. Our hypothesis was that the higher heart rate before sympathicotomy the more heart rate change during the procedure because heart rate is one of the indicators of sympathetic activity. METHODS: Sixty two patients with essential hyperhidrosis undergoing thoracoscopic sympathicotomy were studied. During the procedure, we recorded blood pressure at left arm and heart rate after anesthetic induction as baseline values, immediately after left side sympathicotomy, and after right side sympathicotomy. Patients were divided by median value of preoperative heart rate (83 beats/min) into group I (n = 32), preoperative heart rate below 83 beats/min, and group II (n = 30), above 83 beats/min. RESULTS: The preoperative mean heart rates of group I and II were 72 +/- 7.9 beats/min and 100 +/- 12.5 beats/min respectively. After sympathicotomy, the decrease of heart rate compared to the preoperative value in Group I was 6.6%, which was significantly lower than that of Group II, 17.6%. After left sympathicotomy, the number of cases of heart rate decreasing more than 10% was higher in Group II (20/30 cases) than Group I (13/32 cases). CONCLUSIONS: The main result of this study showed that the higher heart rate before sympathicotomy the more heart rate change during procedure.
Arm ; Blood Pressure ; Heart Rate* ; Heart* ; Humans ; Hyperhidrosis

STUDY DESIGN: Prospective study. PURPOSE: We investigated normative temporal levels of white blood cell (WBC) and absolute neutrophil count (ANC) in uncomplicated anterior cervical discectomy and fusion (ACDF) using allograft and demineralized bone matrix (DBM). OVERVIEW OF LITERATURE: No study has investigated the diagnostic usefulness of WBC and ANC for postoperative infection following ACDF using allograft and DBM. METHODS: Blood samples of 85 patients, who underwent one or two-level ACDF, were obtained and evaluated before surgery and on the first, third, fifth, seventh, fourteenth, thirtieth, and ninetieth postoperative days. No infection was found in all patients for at least one year follow-up period. RESULTS: Mean WBC and ANC values increased significantly and reached peak levels on the first postoperative day. The peaked levels rapidly decreased but still remained elevated above the preoperative levels on the third postoperative day. The levels returned close to the preoperative levels on the fifth postoperative day. The mean WBC and ANC values did not get out of their normal reference ranges throughout the follow-up periods. One-level and two-level ACDF exhibited a similar course of postoperative changes in WBC and ANC values and no significant difference in mean levels of WBC and ANC throughout the follow-up periods. CONCLUSIONS: Uncomplicated ACDF using allograft and DBM showed normal values of WBC and ANC during the early postoperative period. Therefore, significant abnormal values of WBC and ANC at an early postoperative period suggest the possibility of the development of acute postoperative infection after ACDF using allograft and DBM.
Bone Matrix ; Diskectomy ; Follow-Up Studies ; Humans ; Leukocytes ; Neutrophils ; Postoperative Period ; Prospective Studies ; Transplantation, Homologous