OBJECTIVE : The sperm acrosome reaction is a Ca2+ -dependent exocytotic event that is triggered by adhesion to the mammalian egg's zona pellucida. Previous studies suggested a role of Ca2+ channels in acrosome reactions. This study was conducted to investigate the T-type calcium channel is operated in acrosome reaction of human spermatozoa. METHOD : Human semen samples were obtained from healthy donors with nomal criteria. The spermatozoa were divided into five groups: Group 1 were non-treated as a control; Group 2 where spermatozoa were exposed to 5 micrometer Ca2+ A23187 (Ca2+i); Group 3 where spermatozoa were exposed 5 micrometer Ca2+i and mibefradil; Group 4 where spermatozoa were exposed 5 micrometer Ca2+i and nifedipine, and Group 5 where spermatozoa were treated with 5 micrometer Ca2+i and both of mibefradil and nifedipine. Spermatozoa in all groups were retrieved after incubation for 15 and 30 minutes at 37degrees C. After staining with PSA-FITC, fluorescence was observed under a fluorescence microscope, and AR was evaluated on a total >100 spermatozoa/side. RESULT AND CONCLUSION : We observed on acrosome reaction inhibition rate in human spermatozoa the various of concentration of mibefradil, nifedipine. Maximum response was noted with 1.0 micrometer mibefradil and the decrease of acrosome reaction inhibition rate 45%. Nifedipine in acrosome reaction inhibition rate was only about 25%. The Ca2+i-induced AR of spermatozoa was significantly suppressed by mibefradil. Incidence of the suppression was depending on concentration of mibefradil. Results from the present study suggest that the human spermatozoa possess T-type channel. The observation that reversible inhibitor of T channels in male germ cells provides a new mechanism of contraceptive action.
Acrosome Reaction* ; Acrosome* ; Calcimycin ; Calcium Channels, T-Type ; Fluorescence ; Germ Cells ; Humans* ; Incidence* ; Male ; Mibefradil* ; Nifedipine ; Semen ; Spermatozoa* ; Tissue Donors ; Zona Pellucida

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the radiological and clinical results of three different methods in the deformity correction of a degenerative flat back. OVERVIEW OF LITERATURE: There are no comparative studies about different procedures in the treatment of degenerative flat back. METHODS: Sixty-four patients who consecutively underwent corrective surgery for degenerative flat back were reviewed. The operations were performed by three different methods: posterior-only (group P, n=20), one-stage anterior-posterior (group AP, n=12), and two-stage anterior-posterior with iliac screw fixation (group AP-I, n=32). Medical and surgical complications were examined and radiological and clinical results were compared. RESULTS: The majority of medical and surgical complications were found in group AP (5/12) and group P (7/20). The sagittal vertical axes were within normal range immediately postoperatively in all groups, but only group AP-I showed normal sagittal alignment at the final follow-up. Postoperative lumbar lordosis was also significantly higher in group AP-I than in group P or group AP and the finding did not change through the last follow-up. The Oswestry disability index was significantly lower in groups AP and AP-I than in group P at the final follow-up. Meanwhile, the operating time was the longest in group AP-I, and total amount of blood loss was larger in group AP-I and group AP than in group P. CONCLUSIONS: Anterior-posterior correction showed better clinical results than posterior-only correction. Two-staged anterior-posterior correction with iliac screw fixation showed better radiological results than posterior-only or one-staged anterior-posterior correction. Two-staged anterior-posterior correction with iliac screw fixation also showed a lower complication rate than one-staged anterior-posterior correction.
Animals ; Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Lumbar Vertebrae ; Reference Values ; Retrospective Studies ; Treatment Outcome

OBJECTIVES: Cerebral infarction as a macrovascular complication in patients with diabetes mellitus is frequent. However, mechanisms for the development of cerebral infarction were not well known until today. The aims of this study were 1) to determine the relationship between the fibrinogen B beta 448 polymorphism and fibrinogen levels in patients with cerebral infarction, and 2) to assess usefulness of fibrinogen B beta 448 polymorphism as a marker of cerebral infarction in patients with diabetes mellitus. METHODS: We studied 60 diabetes mellitus patients, 26 diabetes mellitus patients with cerebral infarction, 17 cerebral infarction patients, and 121 normal controls. Fibrinogen B beta 448 genotype was determined by the PCR-RFLP method using restriction enzyme Mnl I. RESULTS: Fibrinogen levels in each patient group were not significantly different from one another. Fibrinogen B beta 448 genotype frequencies of the patient groups did not significantly differ from those of the normal controls. CONCLUSION: This study didn't show the relationship between the fibrinogen B beta 448 polymorphism and fibrinogen levels in patients with cerebral infarction. Moreover, these data didn't suggest the fibrinogen B beta 448 polymorphism as a marker of cerebral infarction in patients with diabetes mellitus. Further studies are needed to find the other polymorphic sites of fibrinogen gene which can affect the levels of fibrinogen.
Cerebral Infarction* ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Fibrinogen* ; Genotype ; Humans

Purpose: Surgery to create a stoma for decompression might be required for unresectable stage IV cancer patients with complete colonic obstruction. The aim of this study was to compare the results of blowhole colostomy with those of loop ostomy. Methods: Palliative ileostomy or colostomy procedures performed at a single center between January 2011 and October 2020, were analyzed retrospectively. Fifty-nine patients were identified during this period. The demographic characteristics and outcomes between the blowhole colostomy group (n=24) and the loop ostomy group (n=35) were compared. Results: The median operative time tended to be shorter in the blowhole colostomy group (52.5 minutes; interquartile range [IQR], 43–65) than in the loop ostomy group (60 minutes; IQR, 40–107), but the difference did not reach statistical significance (P=0.162). The median length of hospital stay was significantly shorter with blowhole colostomy (blowhole, 13 days [IQR, 9–23]; loop, 21 days [IQR, 14–37]; P=0.013). Mean cecum diameter was significantly larger in the blowhole group than in the loop group (8.83±1.91 cm vs. 6.78±2.36 cm, P=0.001), and the emergency operation rate was higher in the blowhole group than in the loop group (22 of 24 [91.7%] vs. 23 of 35 [65.7%], P=0.021). Conclusion In surgical emergencies, diverting a blowhole colostomy can be safe and effective for palliative management of colonic obstruction in patients with end-stage cancer and might reduce the operative time in emergent situations.

Purpose: Choosing the appropriate antibiotic is important for treatment of complicated appendicitis. However, increasing multidrug resistant bacteria have been a serious problem for successful treatment. This study was designed to identify bacteria isolated from patients with complicated appendicitis and reveal their susceptibilities for antibiotics and their relationship with patient clinical course. Methods: This study included patients diagnosed with complicated appendicitis and examined the bacterial cultures and antimicrobial susceptibilities of the isolates. Data were retrospectively collected from medical records of Kangbuk Samsung Hospital from January 2008 to February 2018. Results: The common bacterial species cultured in complicated appendicitis were as follows: Escherichia coli (n=113, 48.9%), Streptococcus spp. (n=29, 12.6%), Pseudomonas spp. (n=23, 10.0%), Bacteriodes spp. (n=22, 9.5%), Klebsiella (n=11, 4.8%), and Enterococcus spp. (n=8, 3.5%). In antibiotics susceptibility testing, the positive rate of extended-spectrum beta lactamase (ESBL) was 9.1% (21 of 231). The resistance rate to carbapenem was 1.7% (4 of 231), while that to vancomycin was 0.4% (1 of 231). E. coli was 16.8% ESBL positive (19 of 113) and had 22.1% and 19.5% resistance rates to cefotaxime and ceftazidime, respectively. Inappropriate empirical antibiotic treatment (IEAT) occurred in 55 cases (31.8%) and was significantly related with organ/space surgical site infection (SSI) (7 of 55, P=0.005). Conclusion The rate of antibiotic resistance organisms was high in community-acquired complicated appendicitis in Koreans. Additionally, IEAT in complicated appendicitis may lead to increased rates of SSI. Routine intraoperative culture in patients with complicated appendicitis may be an effective strategy for appropriate antibiotic regimen.

STUDY DESIGN: Comparative study. OBJECTIVES: To compare the outcomes of unilateral TLIF, bilateral TLIF using Wiltse approach and bilateral TLIF using conventional midline approach. SUMMARY OF LITERATURE REVIEW: There are many studies about outcomes of Unilateral TLIF, but few have compared the 3 different fusion procedures. MATERIALS AND METHODS: 60 patients were divided into 3 groups. Each group has enrolled 20 patients (Study group: unilateral TLIF, Control group 1: bilateral TLIF using Wiltse approach, Control group 2: bilateral TLIF using conventional midline approach). For clinical outcomes, we compared operative time, blood loss, time for ambulation and discharge, VAS for back pain and leg pain and ODI among three groups. For radiologic evaluation, disc height and segmental lordosis were examined. RESULTS: The mean operative time was 147 minutes in study group(SG), 172 minutes in control group 1(CG1), 167 minutes in control group 2(CG2). The mean total blood loss was 466ml in SG, 569ml in CG1, 1140ml in CG2 respectively. VAS for back pain at the third postoperative day significantly decreased in SG and CG1 compared with CG2. There was no significant difference in ODI, disc height and segmental lordosis among the groups. CONCLUSION: Using Wiltse approach, there were several advantages in decreasing blood loss, immediate postoperative back pain, hospital stay and early ambulation. Clinical and radiological results of unilateral TLIF were comparable with bilateral TLIF.
Animals ; Back Pain ; Early Ambulation ; Humans ; Leg ; Length of Stay ; Lordosis ; Operative Time ; Walking

PURPOSE: The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis. MATERIALS AND METHODS: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter. RESULTS: A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis. CONCLUSION: Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses.
Catheters ; Central Venous Catheters ; Humans ; Retrospective Studies ; Risk Factors ; Thrombolytic Therapy* ; Thrombosis ; Upper Extremity Deep Vein Thrombosis* ; Urokinase-Type Plasminogen Activator* ; Vena Cava, Superior

PURPOSE: : Skin-sparing mastectomy with immediate reconstruction provides psychological satisfaction and a good cosmetic effect for patients with breast cancer. However, this procedure takes longer operation time than mastectomy, and the risk of pulmonary thromboembolism (PTE) and deep vein thrombosis may be increased. The purpose of this study was to evaluate the incidence of PTE. METHODS: Between January and May in 2005, 54 breast cancer patients who underwent skin-sparing mastectomy with immediate transverse rectus abdominalis myocutaneous flap (TRAM) at Asan Medical Center were prospectively investigated according to the clinicopathologic data. Patients were placed in compression stockings on the day of operation, and lung perfusion, inhalation scans,and serum D-dimer assays were performed on the first three postoperative days. If findings were suspicious, we performed embolism computed tomography. We compared patient age, body mass index (BMI), clinical risk factors, operative findings, pathologic results, and the clinical course between PTE patients and non-PTE patients. RESULTS: There were 9 cases of intermediate probability and 6 cases of high probability for PTE according to lung perfusion and inhalation scans, and they underwent embolism CT. Eleven patients (20.4%) were diagnosed with embolism CT or with lung perfusion and inhalation scans;2 patients were symptomatic and 9 patients were asymptomatic. There was significant difference between PTE and non-PTE patients for age, but none for BMI, clinical risk factors, operation time, serum D-dimer, or stage. CONCLUSION: The incidence of PTE after mastectomy with immediate TRAM is relatively high, and a strategy for the prevention and treatment of PTE is required. Although age is a risk factor for PTE on this study, future studies are needed to determine the risk factors for and to confirm proper treatment and prevention of PTE.
Body Mass Index ; Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Embolism ; Humans ; Incidence ; Inhalation ; Lung ; Mastectomy* ; Myocutaneous Flap ; Perfusion ; Prospective Studies* ; Pulmonary Embolism* ; Risk Factors ; Stockings, Compression ; Venous Thrombosis

PURPOSE: Performance of a skin-sparing mastectomy with immediate reconstruction provides psychological satisfaction and good cosmetic outcome for patients with breast cancer. However, this is a lengthy procedure to perform, and there is increased risk of pulmonary thromboembolism (PTE). The purpose of this study was to evaluate the efficiency of the use of low molecular weight heparins (enoxaparin) for prophylaxis against a pulmomary thromboembolism followed by mastectomy with an immediate transverse rectus abdominis myocutaneous flap (TRAM) in breast cancer. METHODS: A total of 123 patients underwent a skin-sparing mastectomy with an immediate TRAM. The "non-enoxaparin group" wore compression stockings for PTE prophylaxis and the "enoxaparin group" received enoxaparin (40 mg SC injection, once daily starting 2 hr before surgery and continuing for 6 days postoperatively) in conjunction with the use of compression stockings. Lung perfusion, inhalation scans, and serum D-dimer assays were performed on postoperative day 3. If findings were clinically suspicious or intermediate to high probability of a PTE in a lungs scan, embolism computed tomography was performed. Patients were prospectively investigated according to the clinicopathological data. We compared the incidence of PTE and hemorrhagic complications between the two groups. RESULTS: There were no significant clinicopathological differences between the two groups. Eleven patients developed a PTE (nine patients in the non-enoxaparin group and two patients in the enoxaparin group). The prevalence rate of a PTE was 17.3% and 3.2% for each group, respectively (p=0.01). One patient in the non-enoxaparin group required a second operation for bleeding control and three patients in the enoxaparin group needed transfusions. There were minor hemorrhagic complications in the enoxaparin group that improved after supportive management. CONCLUSION: Although there were minor hemorrhagic complications, enoxaparin is safe and effective in a preventing PTE in patients that undergo immediate reconstruction after a skin-sparing mastectomy.
Breast ; Breast Neoplasms ; Cosmetics ; Embolism ; Enoxaparin ; Fibrin Fibrinogen Degradation Products ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Humans ; Incidence ; Inhalation ; Lung ; Mastectomy ; Perfusion ; Prevalence ; Prospective Studies ; Pulmonary Embolism ; Rectus Abdominis ; Stockings, Compression ; Thromboembolism