No abstract available.
Child* ; Humans ; Interleukin-6* ; Nephritis* ; Purpura, Schoenlein-Henoch*

Posterior lumbar fusion is a safe and effective surgical method for diseases, such as lumbar stenosis, spondylolisthesis, lumbar instability, spinal deformity, and tumor. Pedicle screw (PS) fixation was first introduced by Bouche and has been adopted as the gold standard for posterior lumbar fusion. Santoni and colleagues introduced a new methodological screw insertion technique that uses a cortical bone trajectory (CBT), described as that from a medial to lateral path in the transverse axial plane and caudal to the cephalad path in the sagittal plane through the pedicle for maximum contact of the screw with the cortical bone. Owing to the lower invasiveness, superior cortical bone contact, and reduced neurovascular injury incidence, the CBT technique has been widely used in posterior lumbar fusion; however, these advantages have not been proven in clinical/radiological and biomechanical studies. We designed the present study to review the existing evidence and evaluate the merit of CBT screw fixation. Six electronic databases were searched for relevant articles published in August 2020 using the search terms “cortical bone trajectory,” “CBT spine,” “CBT fixation,” “cortical pedicle screws,” and “cortical screws.” Studies were analyzed and divided into the following groups: “biomechanics investigation,” “surgical technique,” and “clinical/radiological studies.” Most studies compared CBT and PS fixation, and the CBT screw fixation method showed better or similar outcomes.

In order to control the pain after hemorrhoidectomy and snal fistulectomy, 6 mg of 0.5% hyperbaric tetracaine without (control, group l) or with 0.3mg(group ll) or 0.5 mg(group lll) of 0.1% morphine was injected with a 22 gauge spinal needle into the subarachnoid space through L3-4 interspace of patients in lateral position. About 30 minutes in Fowler' sposition after injection, operation was performed in lithotomy position. All the patients who had morphine showed remarkable relief of postoperative pain for an average of 27 hours. However, the dosage(0.3 or 0.5 mg) or morphine administered did not affect the duration of pain relief. Blood pressure, pulse rate and pulpil size were unchanged in all patients. Dysuria after block developed for on average of 5.6, 13.2 and 14.6 hours in group l, ll, and lll respectively. Most of these cases required urethral catheterization. Minor complications such as nausea, vomiting, itching, fever, burning sensation and paresthesia were observed 16.7, 20 and 20% of cases in group l, ll and lll respectively; however, no treatment was required.
Blood Pressure ; Burns ; Dysuria ; Fever ; Heart Rate ; Hemorrhoidectomy ; Humans ; Morphine* ; Nausea ; Needles ; Pain, Postoperative* ; Paresthesia ; Pruritus ; Sensation ; Subarachnoid Space ; Tetracaine ; Urinary Catheterization ; Urinary Catheters ; Vomiting

PURPOSE: An experimental study was carried out to evaluate the morphological changes in the blood brain barrier and neighbouring brain tissue caused by Gd-DTPA in uremia-induced rabbits. MATERIALS AND METHODS: Bilateral renal arteries and veins of ten rabbits were ligated. Gd-DTPA(0.2 mmol/kg) was intravenously injectedinto seven rabbits immediately after ligation. After MRI, they were sacrificed 2 or 3 days after ligation in orderto observe light and electron microscopic changes in the blood brain barrier and brain tissue. RESULTS: MRIfindings were normal, except for enhancement of the superior and inferior sagittal sinuses on T1 weighted imagesin uremia-induced rabbits injected with Gd-DTPA. On light microscopic examination, these rabbits showed perivascular edema and glial fibrillary acidic protein expression ; electron microscopic examination showed separation of tight junctions of endothelial cells, duplication/rarefaction of basal lamina, increased lysosomes of neurons with neuronal death, demyelination of myelin, and extravasation of red blood cells. Uremia-induced rabbits injected with Gd-DTPA showed more severe changes than those without Gd-DTPA injection. CONCLUSION: Injuries to the blood brain barrier and neighbouring brain tissue were aggravated by Gd-DTPA administration inuremia-induced rabbits. These findings appear to be associated with the neurotoxicity of Gd-DTPA.
Animals ; Basement Membrane ; Blood-Brain Barrier* ; Brain Injuries ; Brain* ; Demyelinating Diseases ; Edema ; Endothelial Cells ; Erythrocytes ; Gadolinium DTPA* ; Glial Fibrillary Acidic Protein ; Ligation ; Magnetic Resonance Imaging ; Myelin Sheath ; Neurons ; Rabbits* ; Renal Artery ; Tight Junctions ; Veins

PURPOSE: The determine the chest CT findings in breast cancer patients who have undergone postoperative irradiation. MATERIALS AND METHODS: The chest CT findings in 36 female patients who underwent breast surgery and radiotherapy between May 1996 and March 2000 were retrospectively analysed. Prior to radiotherapy, baseline chest CT depicted normal parenchyma in all cases. In 11 patients, the ipsilateral breast and chest wall were irradiated using opposed tangential fields, while 25 were treated by the four fields method (opposed tangential fields plus anterior and posterior supraclavicular/high axillary fields), with a total dose of 5040-5400 cGy for 5-9 weeks. RESULTS: CT after radiotherapy demonstrated reticular opacity (n=24), perpendicular linear opacity (n=15), traction bronchiectasis (n=7), consolidation (n=6), ground glass attenuation (n=3), pathologic rib fractures (n=3), pleural effusion (n=2), and pleural thickening (n=1), while in five patients no abnormality was observed. In addition, in the anterolateral lung area of 23 (64%) of 36 patients who underwent tangential beam irradiation, CT demonstrated peripheral opacities. When supraclavicular and axillary portals were used, radiation-induced lung changes mostly occurred at the apex of the lung (n=24). Chest radiographs were abnormal in 26 patients and normal in ten; in five of these ten, CT demonstrated reticular opacity. CONCLUSION: Depending on the irradiation CT findings of radiation-induced lung injury in breast cancer include areas of increased opacity with or without fibrosis, in apical and/or anterior subpleural regions. CT may help differentiate radiation-induced parenchymal change from superimposed or combined lung disease.
Breast Neoplasms* ; Breast* ; Bronchiectasis ; Female ; Fibrosis ; Glass ; Humans ; Lung ; Lung Diseases ; Lung Injury ; Pleural Effusion ; Radiography, Thoracic ; Radiotherapy ; Retrospective Studies ; Rib Fractures ; Thoracic Wall ; Thorax* ; Tomography, X-Ray Computed* ; Traction

BACKGROUND: Traumatic spinal cord injury (SCI) is a tragic event that has a major impact on individuals and society as well as the healthcare system. The purpose of this study was to investigate the strength of association between surgical treatment timing and neurological improvement. METHODS: Fifty-six patients with neurological impairment due to traumatic SCI were included in this study. From January 2013 to June 2017, all their medical records were reviewed. Initially, to identify the factors affecting the recovery of neurological deficit after an acute SCI, we performed univariate logistic regression analyses for various variables. Then, we performed a multivariate logistic regression analysis for variables that showed a p-value of < 0.2 in the univariate analyses. The Hosmer-Lemeshow test was used to determine the goodness of fit for the multivariate logistic regression model. RESULTS: In the univariate analysis on the strength of associations between various factors and neurological improvement, the following factors had a p-value of < 0.2: surgical timing (early, < 8 hours; late, 8–24 hours; p = 0.033), completeness of SCI (complete/incomplete; p = 0.033), and smoking (p = 0.095). In the multivariate analysis, only two variables were significant: surgical timing (odds ratio [OR], 0.128; p = 0.004) and completeness of SCI (OR, 9.611; p = 0.009). CONCLUSIONS: Early surgical decompression within 8 hours after traumatic SCI appeared to improve neurological recovery. Furthermore, incomplete SCI was more closely related to favorable neurological improvement than complete SCI. Therefore, we recommend early decompression as an effective treatment for traumatic SCI.
Decompression ; Decompression, Surgical* ; Delivery of Health Care ; Humans ; Logistic Models ; Medical Records ; Multivariate Analysis ; Smoke ; Smoking ; Spinal Cord Injuries* ; Spinal Cord* ; Spine

OBJECTIVE: Little is known about the natural course of pre-mild cognitive impairment (pre-MCI) and predictors to MCI. We followed-up individuals with pre-MCI and cognitively normal (CN) elders to identify neuropsychological predictors for rapid conversion to MCI. METHODS: Seventy-seven individuals with pre-MCI and 180 CN elders were recruited from the pool of individuals registered at the National Research Center for Dementia in Gwangju, Korea. We followed-up with them after a mean of 14±2.29 months. All participants underwent comprehensive clinical and neuropsychological assessment. Logistic regression analysis examined the ability of neuropsychological tests to predict conversions to MCI. RESULTS: Of 257 participants, 142 (55.3%) were eligible for the follow-up study (102 CN, 40 pre-MCI). Logistic regression revealed that spatial delayed recall significantly predicted the conversion from pre-MCI to MCI. In CN, copy for a complex figure significantly predicted the conversion to pre-MCI or MCI. CONCLUSION: Our findings indicated that spatial delayed recall was associated with rapid conversion from pre-MCI to MCI. Spatial organization and planning, measured by complex figure reproduction, were associated with rapid conversion from CN to pre-MCI or MCI. Our study suggests that inclusion of visuospatial reproduction and memory using a complex figure further facilitates early detection of MCI.
Alzheimer Disease ; Cognition Disorders* ; Dementia ; Early Diagnosis ; Follow-Up Studies ; Gwangju ; Korea ; Logistic Models ; Memory* ; Mild Cognitive Impairment* ; Neuropsychological Tests ; Reproduction ; Spatial Memory

Background and Objectives: PET/CT is widely used to determine whether metastasis or recurrence will occur following initial treatment of thyroid cancer. However, there are not much research on diagnostic usefulness of preoperative PET/CT imaging for papillary thyroid cancer (PTC). We analyzed the correlation between the preoperative maximum standard uptake value (SUVmax) of PET/CT and prognostic factors of PTC to evaluate the diagnostic usefulness of PET/CT. Materials and Methods: Of the 133 patients who underwent surgery for PTC, 88 patients who had an increased uptake in thyroid mass in preoperative PET/CT were enrolled. They were divided into two groups according to B-RAF gene mutation, extrathyroidal extension (ETE), lymph node metastasis, and recurrence. The average of the SUVmax for each group was analyzed through multiple regression analysis. Correlation analysis were performed on changes in SUVmax according to the size of the thyroid tumor. Statistical analysis was performed to determine whether there were stage differences between the 47 patients who had no increased uptake in PET/CT and the others who had. Results: There were no statistical correlation between recurrence, the presence of central/lateral lymph node metastasis, ETE, stage and the SUVmax in PET/CT (p=0.513, p=0.8, p=0.73, p=0.01, p=0.9). There were statistical correlations between the size of tumor (p=0.001), the presence of the B-RAF mutation (p=0.024) and SUVmax. Statistical correlations between the presence of the hypermetabolic uptake and high stage were found by the chi-square test (p=0.012). Conclusion The size of tumor, B-RAF are major factors in determining prognosis of PTC. There is a possibility that there is a correlation between preoperative SUVmax and prognosis of PTC.

PURPOSE: To assess therapeutic effects of percutaneous polymethylmethacrylate(PMMA) vertebroplasty on the pain caused by osteoporotic thoracic and lumbar vertebral body compression fractures in a large scale of a prospective clinical design, and to determine clinical factors influencing its therapeutic effects. METHODS: A prospective clinical study was carried out in 349 vertebral levels of 159 patients between April 1998 and July 1999. The compression fractures were confirmed with bone scan and spine CT, and bone marrow density was measured. Visual analogue scale(VAS) score was used for pre- and post-operative assessments of the pain. All 159 patients were assessed immediately after surgery, and 140 patients of them were followed-up for about 6 months in average. RESULTS: Partial and complete pain relief was sustained immediately after operation in 73%, through follow-up period in 88% of the patients. Pain relief was not proportional to the amount of PMMA or the rate of increase in the height of the compressed vertebral body. It appears that 3 to 6cc of PMMA was proper enough to sustain pain relief. Better clinical improvement was achieved in the patients treated within 6 months after occurrence of vertebral body fracture. The most frequent surgical complication was epidural leakage of PMMA, and the most serious complication was extravertebral leakage into the paravertebral muscles, which appeared to exert the worst influence on the outcome. However, surgery was not required in these patients. CONCLUSION: Therapeutic effects of PMMA percutaneous vertebroplasty on osteoporotic vertebral body compression fractures were confirmed in a relatively large scale of prospective clinical study. It appears that good outcome can be achieved in patients treated within 6 months after fracture, treated each level with 3 to 6cc of PMMA in amount. without serious complications.
Bone Marrow ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Muscles ; Osteoporosis ; Polymethyl Methacrylate* ; Prospective Studies ; Spine ; Vertebroplasty*

OBJECTIVE: To discover the risk factor of postpartum depression and whether this is different from the induced factor of prepartum depression and to clarify what is the recovery factor from prepartum depression. METHODS: In the first test stage, 310 pregnant women were examined and with their postpartum follow-up survey, materials from 85 people in total were retrieved. In order to predict the postpartum depression and find out the recovery factor from prepartum depression, longitudinal study was carried out. For the statistical analysis hierarchical regression analysis and MANOVA were used. RESULTS: Postpartum depression (Beck Depression Inventory; BDI score of 16 or greater) was prevalent amongst 22.4% of pregnant women and prepartum depression was experienced by 10.5% in pregnant women. There were no significant on psychological variable factor of prepartum and postpartum depression. Only preatum depression redicted 33% for postaprtum depression. In the case of depressed during pregnancy but not depressed after pregnancy, recovery factor is related to increase in self-esteem, husband support and improvement in marital satisfaction. Postpartum depression showed twice higher depression ration than prepartum depression and it was serious in terms of degree of depression. CONCLUSION: Postpartum depression is related with lack of husband support that is recovery factor from prepartum depression. Also, unstable attachment is vulnerable to depression but even people with unstable attachment can be recovered from depression with better marriage relationship. Even people without unstable attachment if husband support is reduced then it is suggested that can be subject to vulnerability in depression.
Depression* ; Depression, Postpartum* ; Female ; Fibrinogen ; Follow-Up Studies ; Humans ; Longitudinal Studies ; Marriage ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Risk Factors ; Spouses