No abstract available.
Leptospirosis*

Far Eastern countries including Korea show the high prevalence of hepatitis B virus carriers, so that the incidence of liver cirrhosis is higher than in western countries. But pregnancies with liver cirrhosis are rarely encountered in clinical settings, since liver cirrhosis usually develops after childbearing ages and often causes the disturbance of estrogen metabolism, resulting in severe menstrual irregularity and infertility. Therefore, little is known about the interactions between liver cirrhosis and pregnancy. Liver cirrhosis and portal hypertension are not contraindications to pregnancy but necessitate intensive monitoring throughout pregnancy because the complications of liver cirrhosis, which pose additional risks during pregnancy, are numerous and unpredictable. We report 3 cases of pregnancies in patients with liver cirrhosis with brief review of the literature.
Estrogens ; Hepatitis B virus ; Humans ; Hypertension, Portal ; Incidence ; Infertility ; Korea ; Liver Cirrhosis* ; Liver* ; Metabolism ; Pregnancy* ; Prevalence

OBJECTIVE: The aim of this prospective study was to evaluate the efficacy of bone cement-augmented percutaneous short segment fixation for treating Kummell's disease accompanied by severe osteoporosis. METHODS: From 2009 to 2013, ten patients with single-level Kummell's disease accompanied by severe osteoporosis were enrolled in this study. After postural reduction for 1-2 days, bone cement-augmented percutaneous short segment fixation was performed at one level above, one level below, and at the collapsed vertebra. Clinical results, radiological parameters, and related complications were assessed preoperatively and at 1 month and 12 months after surgery. RESULTS: Prior to surgery, the mean pain score on the visual analogue scale was 8.5+/-1.5. One month after the procedure, this score improved to 2.2+/-2.0 and the improvement was maintained at 12 months after surgery. The mean preoperative vertebral height loss was 48.2+/-10.5%, and the surgical procedure reduced this loss to 22.5+/-12.4%. In spite of some recurrent height loss, significant improvement was achieved at 12 months after surgery compared to preoperative values. The kyphotic angle improved significantly from 22.4+/-4.9degrees before the procedure to 10.1+/-3.8degrees after surgery and the improved angle was maintained at 12 months after surgery despite a slight correction loss. No patient sustained adjacent fractures after bone cement-augmented percutaneous short segment fixation during the follow-up period. Asymptomatic cement leakage into the paravertebral area was observed in one patient, but no major complications were seen. CONCLUSION: Bone cement-augmented percutaneous short segment fixation can be an effective and safe procedure for Kummell's disease.
Follow-Up Studies ; Humans ; Osteonecrosis ; Osteoporosis ; Prospective Studies ; Spine

A Schmorl's node is defined as a simple endplate intravertebral herniation resulting from trauma or idiopathic causes. Although Schmorl's nodes have been considered clinically insignificant, they might indicate an active symptomatic process or cause serious complications. In this study, we report an interesting case of complete separation of a vertebral body caused by an untreated Schmorl's node accompanying severe osteoporosis. To our knowledge, this is the first clinical report in the published literature to evaluate the complete separation of a vertebral body associated with a Schmorl's node.
Osteoporosis*

PURPOSE: To analyze the stress distribution of the implant and its supporting structures through 3D finite elements analysis for implants with different hexagon heights and to make the assessment of the mechanical stability and the effect of the elements. MATERIALS AND METHODS: Infinite elements modeling with CAD data was designed. The modeling was done as follows; an external connection type Phi 4.0 mm x11.5 mm Osste(R) USII (Osstem Co., Pusan, Korea) implant system was used, the implant was planted in the mandibular first molar region with appropriate prosthetic restoration, the hexagon (implant fixture's external connection) height of 0.0, 0.7, 1.2, and 1.5 mm were applied. ABAQUS 6.4 (ABAQUS, Inc., Providence, USA) was used to calculate the stress value. The force distribution via color distribution on each experimental group's implant fixture and titanium screw was studied based on the equivalent stress (von Mises stress). The maximum stress level of each element (crown, implant screw, implant fixture, cortical bone and cancellous bone) was compared. RESULTS: The hexagonal height of the implant with external connection had an influence on the stress distribution of the fixture, screw and upper prosthesis and the surrounding supporting bone. As the hexagon height increased, the stress was well distributed and there was a decrease in the maximum stress value. If the height of the hexagon reached over 1.2 mm, there was no significant influence on the stress distribution. CONCLUSION: For implants with external connections, a hexagon is vital for stress distribution. As the height of the hexagon increased, the more effective stress distribution was observed.
Dental Implants ; Molar ; Plants ; Prostheses and Implants ; Titanium

PURPOSE: This study was performed to determine the natural history of histologically confirmed IgA nephropathy in pediatric patients who presented with hematuria and proteinuria. PATIENTS AND METHODS: We reviewed the clinical course of 57 patients diagnosed with IgA nephropathy at the age of 15 years or younger from 1981 to 2000. All patients presented with hematuria or minimal proteinuria(<40 mg/m2/day) and had normal renal function and blood pressure at the time of renal biopsy. Based on the clinical and pathological findings at the time of diagnosis, we sought for complications of IgA nephropathy such as heavy proteinuria(> or =40 mg/m2/day), hypertension, and chronic renal failure. RESULTS: The mean age at presentation was 9.5+/-2.8 years(4 to 15 years) and 42(74%) were male. Isolated gross hematuria was observed in 20 patients(35%), microscopic hematuria in 3(5%), minimal proteinuria in 4(7%), both gross hematuria and minimal proteinuria in 15(26 %), and both microscopic hematuria and minimal proteinuria in 15(26%). During a median follow-up of 7.0+/-3.5 years, 38(67%) had complete resolution of hematuria and proteinuria, 12(21%) had persistently abnormal urinalysis without development of adverse events. Only 7(12%) developed adverse events:4(7%) developed severe proteinuria, 1(2%) became hypertensive, and 2(3%) developed impaired renal function. By univariate analysis using the chi-square test, the age at presentation(>10 years)(P<0.01) and poor histological classes of the Lee or Haas classification at onset(P<0.05) were significantly correlated with adverse events, whereas sex and clinical signs at onset were less concordant. CONCLUSION: We can conclude that the prognosis of IgA nephropathy diagnosed in early childhood is better and a good correlation exists between the clinical manifestations of this disease and the histological classes.
Biopsy ; Blood Pressure ; Child* ; Classification ; Diagnosis ; Follow-Up Studies ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Hypertension ; Immunoglobulin A* ; Kidney Failure, Chronic ; Male ; Natural History ; Prognosis* ; Proteinuria ; Urinalysis

Hemifacial spasm is a relatively uncommon but distressing condition characterized by insiduous development of paroxysmal, involuntary, unilateral hyperkinetic facial movement. In patients with hemifacial spasm, there is an abnormality in the facial nerve or its nucleus which allows the stimulus applied to one branch of the facial nerve to spread to other branches of that same nerve. This lateral spread response is presumed to be due to cross transmission of the antidromic activity in the branch of the facial nerve, and intraoperative monitoring of lateral spread responses provides a useful way of confirming complete facial nerve decompression. In 17 consecutive patients, intraoperative electromyographic(EMG) recordings were made from facial muscles during microvascular decompression for hemifacial spasm. At the beginning of the operation, electrical stimulation of the temporal or zygomatic branch of the facial nerve gave rise to electrically recordable activity in the mentalis muscle(lateral spread), with a latency of about 10msec, that in ten patients, lasted until the facial nerve was decompressed; In seven patients, however, it disappeared when the arachnoid membrane was opened. Early disappearance of lateral spread was frequently occurred in single offending vessel or cases where there was loose compression. Postsurgically the 16 patients in whom the lateral spread response disappeared totally were free from spasm after the operation and in the remaining patient, there was much improvement. These results support the use of lateral spread response monitoring during decompression surgery for hemifacial spasm, and provide strong circumstantial evidence that vascular cross-compression is an important etiologic factor in hemifacial spasm. During a decompression operation for hemifacial spasm, the authors now routinely monitor facial EMG response.
Arachnoid ; Decompression* ; Electric Stimulation ; Facial Muscles ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Membranes ; Microvascular Decompression Surgery ; Monitoring, Intraoperative ; Spasm

PURPOSE: The purpose of this study was to evaluate the surface characteristics and response of osteoblast-like cell at SLA surface treated with NaOH. MATERIALS AND METHODS: Three kinds of specimens were fabricated for the experiment groups. Control group was a machined surface, SLA group was a conventionally SLA treated surface, and SLA/NaOH gorup was SLA surface treated with NaOH. To evaluate the surface characteristics, the surface elemental composition (XPS), surface roughness and surface contact angle were evaluated in each group. And the cytotoxicity, cell adhesion, cell proliferation and ATP activity of osteoblast-like cells (MG-63 cells) were compared in each group for evaluatation of the cell responses. Statistical comparisons between groups were carried out via one-way ANOVA using the SPSS software (SPSS Inc., Chicago, USA), and then performed multiple comparisons. The differences were considered statistically significant at P<.05. RESULTS: SLA surface treated with NaOH (SLA / NaOH group) was changed to hydrophilic surface. All groups did not show the cytotoxicity to the MG-63. In cell adhesion studies, SLA / NaOH group showed the higher degree of adhesion than anothers (P<.05), Up to 7 days of incubation, the proliferation was showed the increasing tendency in all groups but SLA / NaOH group showed the highest cell proliferation between the three groups (P<.05). At 7 days of incubation, there was no difference in ALP activities between the three groups, but at 14 days, SLA / NaOH group showed significant increase in ALP activities (P<.05). CONCLUSION: In this study, SLA surface treated with NaOH promoted cell adhesion, proliferation and differentiation. It means that SLA/NaOH group is possible to promote osseointegration of implants.
Adenosine Triphosphate ; Cell Adhesion ; Cell Culture Techniques ; Cell Proliferation ; Osseointegration

A 35-year-old man, previously hepatitis B surface antigen (HBsAg) carrier, presented with gross hematuria and heavy proteinuria that he had been suffering from for 1 month. Serum creatinine was 4.4 mg/dL. Renal biopsy showed pauci-immune crescentic glomerulonephritis. He received plasmapheresis and was treated with high-dose steroids and cyclophosphamide. Lamivudine was started for the prevention of hepatitis B virus (HBV) activation. Serum creatinine and proteinuria were ameliorated one week after the treatment. There was no sign of HBV activation after six months of treatment. We report a case of rapidly progressive glomerulonephritis in a HBV carrier successfully treated with high dose immunosuppressive therapy and prophylactic lamivudine.
Adult ; Biopsy ; Creatinine ; Cyclophosphamide ; Glomerulonephritis ; Hematuria ; Hepatitis ; Hepatitis B ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Lamivudine ; Plasmapheresis ; Proteinuria ; Steroids ; Stress, Psychological

Polycythemia vera (PV) is a chronic myeloproliferative disease characterized by an increase in the total mass of red cells. Leukocyte and platelet counts are often elevated as well. The most common complication is thrombosis, which usually involves brain, heart, gastrointestinal tract, and kidneys, but rarely involves spleen. The cornerstone of therapy for this disease is phlebotomy and it is associated with an increased risk of thrombosis, especially for patients older than 70 years, those with a history of thrombosis, and those requiring an increased frequency of phlebotomy. Concurrent treatment with myelosuppressive agents decreases the risk of thrombotic complications.Recently we experienced a case of multiple splenic infarction in PV treated phlebotomy alone in a 42-year old woman who had complained of massive splenomegaly, left upper quadrant abdominal pain and fever. CT scan of abdomen showed multiple hypodense areas suggesting splenic infarction. She was managed with hydroxyurea and salicylate instead of phlebotomy and showed a clinical improvement with lowering the platelet count and reducing splenomegaly. PV with a assive splenomegaly is prone to thrombosis and phlebotomy in such patients may contribute to the thrombotic complications by increasing platelet counts. When it is necessary to lower the platelet count or reduce splenomegaly, hydroxyurea may be more useful than phlebotomy.
Abdomen ; Abdominal Pain ; Adult ; Brain ; Female ; Fever ; Gastrointestinal Tract ; Heart ; Humans ; Hydroxyurea ; Kidney ; Leukocytes ; Phlebotomy* ; Platelet Count ; Polycythemia Vera* ; Polycythemia* ; Spleen ; Splenic Infarction* ; Splenomegaly ; Thrombosis ; Tomography, X-Ray Computed