PURPOSE: Kidney transplantation is definite treatment in chronic renal failure (CRF). But CRF patients have contracted bladder due to disuse atrophy and fibrosis of bladder mucosa and muscle. Contracted bladder results in CRF itself and failure of transplantation. And this causes many difficulties in ureteroneocystostomy. So many authors suggest that preoperative bladder augmentations of contracted bladder (cystoplasty) using intestine increase success rate in kidney transplantation. But these methods have been usually studied in pediatric transplantation. Preoperative hydrostatic bladder dilatation is nonoperative treatment usually used in interstitial cystitis and hemorrhagic bladder tumor. METHODS: Since January 1996, we newly attempted pretransplant bladder augmentation using hydrostatic pressure in 22 CRF patients who had contracted bladder diagnosed through preoperative voiding cystourethrogram (VCUG). RESULTS: Pre-augmented average bladder volume was 87.7 mL (60~100 mL) and post-augmented bladder volume was 210.5 mL (100~250 mL). There was no complication associated with pretransplant bladder augmentation itself, and there was no transplanted kidney loss. CONCLUSION: These results suggest that pretransplant bladder augmentation using hydrostatic pressure be useful in kidney transplantation of CRF patient who had contracted bladder.
Cystitis, Interstitial ; Dilatation ; Fibrosis ; Humans ; Hydrostatic Pressure* ; Intestines ; Kidney ; Kidney Failure, Chronic* ; Kidney Transplantation ; Mucous Membrane ; Muscular Disorders, Atrophic ; Urinary Bladder Neoplasms ; Urinary Bladder*

OBJECTIVE: The purpose of this study was to investigate a correlation between the muscle strength of trunk and bone mineral density (BMD) in women. METHOD: A total of 218 healthy women participated in the study. Their age ranged from 26 to 72 years. Dual X-ray absorptiometry was used to measure the BMD of lumbar spine and the trunk muscle strength was assessed by a Cybex NORMTM system. Under the standard criteria of World Health Organization for the dual X-ray absorptiometry analysis, we divided spine T-score into three groups(group 1: osteoporosis, group 2: osteopenia, and group 3: normal). RESULTS: The data revealed a siginificant correlation (r= 0.455, p=0.0001) between the age and BMD of lumbar spine. Trunk extensor muscle strength revealed 56.27+/-18.08 Nm (mean+/-SD) in osteoporosis group, 72.84+/-21.69 Nm in osteopenic group, and 77.90+/-22.28 Nm in normal group. Trunk flexor muscle strength was 82.73+/-23.30 Nm in osteoporosis group, 86.00+/-19.77 Nm in osteopenic group, and 98.91+/-18.29 Nm in normal group. CONCLUSION: These results indicated that the trunk extensor muscle was weaker than the flexor muscle in osteoporotic group. As the bone mineral density reduced, the strength of both trunk extensor and flexor decreased. However the weakness of trunk flexor occurred at the earlier stage of osteoporosis than the weakness of trunk extensor.
Absorptiometry, Photon ; Bone Density* ; Bone Diseases, Metabolic ; Female ; Humans ; Muscle Strength* ; Osteoporosis ; Spine ; World Health Organization

OBJECTIVE: To evaluate (1) the effect of chronic low back pain on bone mineral density, and (2) the effect of chronic low back pain on trunk muscle strength in women. METHOD: Subjects were 118 women patients (ages of 28~65 years) suffering from chronic low back pain more than three months and control groups were 218 healthy women (age of 26~72 years). We measured bone mineral density (BMD) at the lumbar spine and proximal femur using Dual X-ray absorptiometry and trunk muscle strength using Cybex 660 dynamometer. RESULTS: There was no significant difference between groups in lumbar spine BMD, in proximal femur BMD, or in trunk flexor muscle strength. However, trunk extensor muscle strength was reduced significantly in patient group. Trunk extensor muscle peak torque was 64.69+/-18.48 Nm in the patient group and 73.84+/-22.50 Nm in the control group in 30 degrees/sec, and 58.65+/-18.59 Nm in the patient group and 65.68+/-20.28 Nm in the control group in 60 degrees/sec. CONCLUSION: The results suggest that chronic low back pain does not affect the BMD. However, it causes trunk extensor muscle weakness; therefore, trunk extension exercise will be help to the patients with chronic low back pain.
Absorptiometry, Photon ; Back Pain ; Bone Density* ; Female ; Femur ; Humans ; Low Back Pain* ; Muscle Strength* ; Muscle Weakness ; Spine ; Torque

OBJECTIVE: To investigate dose-related effects of repeated intraarticular steroid injection on the experimental arthritis. METHOD: Twenty-four adult male rabbits received Zymosan A into their right knee joint for experimental arthritis. After a week, they were injected with 2 mg (group I; n=9), 10 mg (group II; n=7) or 20 mg (group III; n=8) triamcinolone acetonide into their right knee weekly interval for 4 weeks. We measured weekly changes of the weight and the mediolateral diameter of both knees for the calculation of edema index. 99mTechnetium pertechnate (99mTc) uptake measurement were performed before the first steroid injection and a week after the final steroid injection. All rabbits were sacrificed and histologic examinations of their proximal tibia were performed. RESULTS: A progressive weight loss and changes of edema index were evident for all rabbits (p<0.05) and difference among the groups was not found (p<0.05). 99mTc uptake significantly decreased after the steroid injection in group I (p<0.05) but it was not profound in others (p>0.05). In the histological findings, fibrillation-frayings and fissures of the surface were similar in all rabbits, but loss of nuclear stains and cyst formations were increased prominently in group III than group I (p<0.05). CONCLUSION: Low-dose repeated steroid intraarticular injections are safe and effective treatment in arthritis though no definite evidence of chondroprotection, and high-dose steroid injections accelerate degeneration of the arthritic cartilage.
Adult ; Arthritis* ; Cartilage ; Coloring Agents ; Edema ; Humans ; Injections, Intra-Articular ; Knee ; Knee Joint ; Male ; Rabbits* ; Tibia ; Triamcinolone Acetonide ; Weight Loss ; Zymosan

OBJECTIVE: Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complications and assess risk factors associated with lumbar spinal fusion, focusing on geriatric patients at least 70 years of age in the Republic of Korea. METHODS: We retrospectively investigated 489 patients with various lumbar spinal diseases who underwent lumbar spinal fusion surgery between 2003 and 2007 at our institution. Three fusion procedures and the number of fused segments were analyzed in this study. Chronic diseases were also evaluated. Risk factors for complications and their association with age were analyzed. RESULTS: In this study, 74 patients experienced complications (15%). The rate of perioperative complications was significantly higher in patients 70 years of age or older than in other age groups (univariate analysis, p=0.001; multivariate analysis, p=0.004). However, perioperative complications were not significantly associated with the other factors tested (sex, comorbidities, operation procedures, fusion segments involved). CONCLUSION: Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery whereas other factors were not significant. We recommend good clinical judgment and careful selection of geriatric patients undergoing lumbar spinal fusion surgery.
Aged ; Chronic Disease ; Comorbidity ; Humans ; Judgment ; Life Expectancy ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Spinal Diseases ; Spinal Fusion ; Spine ; Stress, Psychological

OBJECTIVE: Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA. METHODS: The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome. RESULTS: Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability. CONCLUSION: Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances.
Aneurysm ; Aneurysm, Dissecting* ; Carotid Artery, Internal* ; Humans ; Hypertension ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Vertebral Artery*

OBJECTIVE: Post-traumatic cerebral infarction (PTCI) is one of the most severe secondary insults after traumatic brain injury (TBI), and is known to be associated with poor outcome and high mortality rate. We assessed the practical incidence and risk factors for the development of PTCI. METHODS: We conducted retrospective study on 986 consecutive patients with TBI from the period May 2005 to November 2012 at our institution. The definition of PTCI was made on non-enhanced CT scan based on a well-demarcated or fairly discernible region of low attenuation following specific vascular territory with normal initial CT. Clinical and radiological findings that related to patients' outcome were reviewed and statistically compared. RESULTS: PTCI was observed in 21 (2.1%) patients. Of various parameters, age (p=0.037), initial Glasgow coma scale score (p<0.01), brain herniation (p=0.044), and decompressive craniectomy (p=0.012) were significantly higher in patients with PTCI than patients who do not have PTCI. Duration between accident and PTCI, patterns of TBI and vascular territory of PTCI were not specific. The mortality rates were significantly higher in patients with PTCI than without PTCI. CONCLUSION: The development of PTCI is rare after TBI, but it usually results in serious outcome and high mortality. Early recognition for risks and aggressive managements is mandatory to prevent PTCI.
Brain ; Brain Injuries* ; Cerebral Infarction* ; Craniocerebral Trauma ; Decompressive Craniectomy ; Glasgow Coma Scale ; Hernia ; Humans ; Incidence* ; Mortality ; Retrospective Studies ; Risk Factors* ; Tomography, X-Ray Computed

A 56-year-old woman was admitted for management of low back pain from compression fracture on L3 vertebral body. Vertebroplasty was performed, and she discharged without any neurologic deficit. She revisited our institute with low back pain with sciatica but without myelopathy after three months. At admission image studies revealed fractured bony particles caused canal encroachment on the same level vertebrae. Surgical management was perfor- med including wide posterior decompression and transpedicular screw fixation on L2, L3, and L4 with posterolateral bony fusion. Authors present a rare case of post-augmentation fracture led to spinal fusion. Additionally, we suggest that filling material for vertebroplasty or kyphoplasty should be, as much as possible, inserted into the posterior half of vertebral body to prevent the refracture or burst fracture.
Decompression ; Female ; Fractures, Compression ; Humans ; Kyphoplasty ; Low Back Pain ; Middle Aged ; Neurologic Manifestations ; Sciatica ; Spinal Cord Diseases ; Spinal Fusion ; Spine ; Vertebroplasty

Parkinson's disease(PD) is characterized clinically by bradykinesia, rigidity, tremor, and disturbance of posture and equilibrium. A higher incidence of fractures in PD patient has been reported, however the studies of musculoskeletal complications in PD have been negligible. The purposes of this study were to investigate the incidence of osteoporosis and spinal compression fracture in PD patients and to evaluate whether the incidence were affected by the severity of PD. Bone mineral density(BMD) in 21 patients(5 males and 16 females) with idiopathic PD was measured by dual energy X-ray absorptiometry(DXA) and compared with an age adjusted control group(32 females). The patients were divided into two groups according to the Hoehn and Yahr(H-Y) stage as mild or severe and the BMD was compared. Simple x-ray studies of thoracolumbar spine were performed to find out the presence of spinal compression fractures. The results showed that the BMD of PD patients was significantly lower than control subjects. The PD patients with high H-Y stage(severe group) had lower BMD scores with no statistical significance. The spinal compression fractures were noted mainly at mid-thoracic area and thoraco-lumbar junction. Spinal t-score in patients with a compression fracture was significantly reduced. No significant correlation exists between back pain and a compression fracture.
Back Pain ; Bone Density ; Fractures, Compression ; Humans ; Hypokinesia ; Incidence ; Male ; Osteoporosis* ; Parkinson Disease* ; Posture ; Spine ; Tremor

SPECT(single photon emission computed tomography) using 99m-Tc-HMPAO is a current method of identifying the relative condition of cerebral blood perfusion in pathologic conditions of the brain such as TIA, complete cerebral infarction, dementia, and psychologically ill states. The purpose of this article is to evaluate the significance of SPECT in head injuries. According to the other previous reports, there are several drawbacks in SPECT to evaluate the victims of head injury such as uncooperability of the patient, long scanning time. poor patient monitoring during the scanning time. poor availability, ete. The authors analyzed 54 cases of head injury patients, studying SPECT and CT in regard to the comparison of CT and SPECT, the relation of SPECT and the severity of the head injury, the duration of admission and the SPECT findings. The results were as follows: 1) In focal lesion, CT was more available for the quick evaluation of the location, size, and rapid decision making, and SPECT was available for the adjuvant method of postoperative follow-up. 2) In diffuse brain lesion, CT showed only the diffuse brain swelling and SPECT was available for more fine localization of the lesion. 3) In mild head injury, CT could not identify the location of the lesion and SPECT showed focal perfusion defects(55%).
Brain ; Brain Edema ; Cerebral Infarction ; Craniocerebral Trauma* ; Decision Making ; Dementia ; Follow-Up Studies ; Head* ; Humans ; Monitoring, Physiologic ; Perfusion ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon*