Spinal hematomas are a rare but serious complication that is typically observed in the epidural space. Spinal subdural hematomas are a dangerous clinical situation because of their potential to cause significant compression of the neural elements and can be mistaken easily for spinal epidural hematomas. This paper reports a case of a severe whole lumbar subdural hematoma after a simple epidural injection that was treated with surgical decompression with excellent clinical results.

Objectives: This study was conducted to identify the correlations and usefulness of lateral cervical radiographs compared with wholespine sagittal lateral radiographs for evaluating cervical sagittal alignment.Summary of Literature Review: Few reports have compared cervical lateral radiographs with whole-spine sagittal radiographs. Materials and Methods: We retrospectively analyzed 181 patients with both cervical standing lateral radiographs and whole-spine standing lateral radiographs. The radiographs were evaluated using the following sagittal alignment parameters: C2-7 lordosis, C2-7 sagittal vertical axis (SVA), T1 slope, spino-cranial angle (SCA), and whole-spine SVA. We evaluated the relationships between the two radiographs. The patients were divided into four groups according to age and the measured sagittal parameters were compared across groups. An analysis according to clinical symptoms was also done. Results: C2-7 lordosis was 16.86° and 15.76°, C2-7 SVA was 15.76° and 16.86°, T1 slope was 29.03° and 22.49°, and SCA was 74.74° and 74.5°, respectively, on the cervical and whole spine radiographs. The whole-spine SVA was -2.64 mm. Correlation analysis between the two types of radiographs showed significant relationships for each sagittal parameter. The whole-spine SVA was related with wholespine C2-7 lordosis, T1 slope, and SCA. Cervical C2-7 lordosis and the whole-spine SVA increased with age. A decrease of C2-7 lordosis on whole-spine radiographs was shown in patients with neck pain. Conclusions Cervical SVA and T1 slope were lower on whole-spine standing lateral radiographs than on simple cervical lateral radiographs. The cervical sagittal parameters measured on cervical radiographs were correlated with those measured on whole-spine radiographs. Cervical radiographs can be used to replace whole-spine radiographs with due consideration of these findings.

No abstract available.

OBJECTIVE: Re-implantation of autologous skull bone has been known to be difficult because of its propensity for resorption. Moreover, the structural characteristics of the area of the defect cannot tolerate physiologic loading, which is an important factor for graft healing. This paper describes our experiences and results with cranioplasty following decompressive craniectomy using autologous bone flaps. METHODS: In an institutional review, the authors identified 18 patients (11 male and 7 female) in whom autologous cranioplasty was performed after decompressive craniectomy from January 2008 to December 2011. We examined the age, reasons for craniectomy, size of the skull defect, presence of bony resorption, and postoperative complications. RESULTS: Postoperative bone resorption occurred in eight cases (44.4%). Among them, two experienced symptomatic breakdown of the autologous bone graft that required a second operation to reconstruct the skull contour using porous polyethylene implant (Medpor(R)). The incidence of bone resorption was more common in the pediatric group and in those with large cranial defects (>120 cm2). No significant correlation was found with sex, reasons for craniectomy, and cryopreservation period. CONCLUSION: The use of autologous bone flap for reconstruction of a skull defect after decompressive craniectomy is a quick and cost-effective method. But, the resorption rate was greater in children and in patients with large skull defects. As a result, we suggest compressive force of the tightened scalp, young age, large skull defect, the gap between bone flap and bone edge and heat sterilization of autologous bone as risk factors for bone resorption.
Autografts ; Bone Resorption ; Child ; Cryopreservation ; Decompressive Craniectomy ; Hot Temperature ; Humans ; Incidence ; Male ; Polyethylene ; Postoperative Complications ; Risk Factors ; Scalp ; Skull ; Sterilization ; Transplants*

BACKGROUND: The effect of genistein on different types of cells has been investigated. However, its effect on the nervous system is still unclear. The aim of the present work is to explore the effect of genistein on rat neuroblastoma B35 cells. METHODS: The effect of genistein on the proliferation of B35 cells, its cytotoxicity, the cell-cycle distribution, the ultra-structural changes and the induction of apoptosis were determined using MTT assay, LDH assay, Flow-cytometric analysis, transmission electron microscopy and Hoechst staining, respectively. Furthermore, Real-time quantitative RT-PCR and Western blotting were used to examine the transcriptional and post-translational alterations of the G2/M cell-cycle arrest marker cyclin-dependent kinase inhibitor p21(waf1/cip1) and the apoptosis-related genes after genistein treatment. RESULTS: Genistein significantly inhibits cell survival, slightly elevates the release of lactate dehydrogenase and induced apoptosis in B35 cells. Genistein increased the number of cells at S-phase and induced cells to accumulate at the G2/M phase. These G2/M arrested cells are associated with a marked up-regulation of p21(waf1/cip1) at both the mRNA and protein levels. We observed that genistein up-regulates pro-apoptotic Bax with concurrent down-regulation of the anti-apoptotic Bcl-2 protein. CONCLUSION: These observations suggest that the anticancer effect of genistein on B35 neuroblastoma cells is mediated through multiple cellular pathways including G2/M cell-cycle arrest and the induction of apoptosis.
Animals ; Apoptosis* ; Blotting, Western ; Cell Cycle Checkpoints* ; Cell Cycle* ; Cell Survival ; Down-Regulation ; Genistein* ; L-Lactate Dehydrogenase ; Microscopy, Electron, Transmission ; Nervous System ; Neuroblastoma* ; Phosphotransferases ; Rats* ; RNA, Messenger ; Up-Regulation

Thirty cases of gastric adenocarcinoma were examined immunohistochemically for expression of transforming growth factor-beta(TGF-beta) in order to analyze significant correlation with clinical stage and pathologic grade of gastric adenocarcinoma. Specific immunostaining was clearly detected in the cytoplasm of the neoplastic cells. The TGF-,6 expression in the gastric adenocarcinoma is closely related to the depth of invasion, the degree of invasiveness and the presence of metastasis. Thus, we observed the stronger immunohistochemical. expression of TGF-beta in the deeper portion of invasion and in the invasive gastric adenocarcinomas with the lymph nodal metastasis than in the superficial portion of invasion and in those without the lymph nodal metastasis. There results suggest that the transforming growth factors expression in carcinoma cells may play an important role in the carcinomatous invasion resulting in metastasis.
Adenocarcinoma ; Neoplasm Metastasis

Diagnosing pseudoaneurysms of the popliteal artery is usually straightforward in physical examinations and imaging findings. However, when a pseudoaneurysm shows a soft tissue mass with adjacent osseous change, it can mimic a bone tumor or a soft tissue sarcoma. We present a case of a 65-year-old man who had a pseudoaneurysm of the popliteal artery showing soft tissue mass and insinuating into the intramedullary cavity of the tibia. This presented case emphasizes the importance of considering pseudoaneurysms in the differential diagnosis of an apparent soft tissue mass with pressure erosion in adjacent bone.
Aged ; Aneurysm, False ; Diagnosis, Differential ; Humans ; Hydrazines ; Physical Examination ; Popliteal Artery ; Sarcoma ; Tibia

BACKGROUND: The X gene is the smallest coding region of the hepatitis B virus (HBV) genome. Several studies reported that X gene-encoded protein may be related to viral replication, and possibly used as a new marker indicative of HBV infection. However, its practical application as a diagnostic reagent remains limited. In this study, we developed anti-X monoclonal antibodies using recombinant hepatitis B virus X (HBx) proteins and investigated the humoral immune responses against HBx in sera of HBV-infected patients by enzyme-linked immunosorbent assay (ELISA). METHODS: Sera of 47 HBV-associated patients and 12 normal controls were studied. Using recombinant HBx expressed in Escherichia coli, seven clones of monoclonal anti-HBx antibodies were developed. The binding site and activity of each monoclonal antibody were determined by ELISA and Western blot analysis, and antibodies that gave the best signals in both assays were selected for the detection of HBx antigen. An ELISA to detect anti-X was also constructed by using recombinant HBx proteins. RESULTS: Clinical samples from patients with liver cirrhosis and hepatocellular carcinoma (HCC) were more than 60% positive for anti-HBx antibody. The positive rate of X antigen in patients with liver cirrhosis and HCC was 27% and 33%, respectively. None of acute hepatitis patients and chronic asymptomatic carriers were positive for HBx antigen or anti-X antibody. The present ELISA system detected circulating HBx with a dynamic range from 5 to 1000 ng per milliliter and the specificity of the assay was also acceptable. The analysis of binding site and activity of monoclonal antibodies performed by ELISA were in agreement with Western blotting results. CONCLUSIONS: ELISA using recombinant HBx and monoclonal antibodies showed good sensitivity and corresponded well with immunoblotting results. For the clinical application of this assay, however, further study is needed on the relationship between HBx and the progression of the disease.
Antibodies ; Antibodies, Monoclonal* ; Binding Sites ; Blotting, Western ; Carcinoma, Hepatocellular ; Clinical Coding ; Clone Cells ; Enzyme-Linked Immunosorbent Assay* ; Escherichia coli ; Genome ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunity, Humoral ; Immunoblotting ; Liver Cirrhosis ; Sensitivity and Specificity

BACKGROUND: Recently, epidural anesthesia for elective and emergency cesarean section is increasing in popularity and graudally replacing general anesthesia. However, the complications from the epidural anesthesia such as hypotension, dyspnea, nausea and vomiting have often been reported. This study was designed to estimate the efficacy of crystalloid administration on blood pressure and heart rate change during epidural anesthesia in cesarean section. METHODS: Forty ASAI and II patients scheduled for cesarean section under epidural anesthesia were randomly allocated to receive either only maintained fluid administration(group I) or 15 ml/kg crystalloid solution over 15 minutes(group II). Epidural anesthesia was performed in a lateral decubitus position. According to the patient's height, 20~23 ml of 2% lidocaine was injected through epidural catheter at the L3~4 interspace. RESULTS: Cardiovascular responses and complications after induction of epidural anesthesia were compared and results were as follows. The incidence of hypotension was 14/20 (70%) in the groupI and 4/20(25%) in the group II(p<0.05). Systolic blood pressure after induction of epidural anesthesia in the group I significantly decreased from 6 min to 12 min as compared to the group II. The mean heart rate after induction of epidural anesthesia in the both group was no significant difference to baseline heart rate. CONCLUSIONS: Considering above results, we conclude that a prophylactic crystalloid solution infusion is effective for minimizing and managing hypotension associated with epidural anesthesia in cesarean section.
Anesthesia, Epidural* ; Anesthesia, General ; Blood Pressure* ; Catheters ; Cesarean Section* ; Dyspnea ; Emergencies ; Female ; Heart Rate* ; Heart* ; Humans ; Hypotension ; Incidence ; Lidocaine ; Nausea ; Pregnancy ; Vomiting

OBJECTIVE: Acupuncture has been practiced to treat back pain in the oriental culture for several centuries and still occupies an integral part of traditional oriental medicine. Nowadays, it also comprises one aspect of the so-called alternative medicine, being increasingly practiced in western conturies. However, it has been sometimes practiced less carefully without awareness for adverse effects after acupuncture treatment. This study is performed to stress the concern about the serious complications possibly arising after acupuncture. METHODS: The medical records and radiological datas of 5 patients who suffered from serious complications after acupuncture from 1999 to 2002, were retrospectively reviewed. All 5 patients has treated with acupuncture for pain control before the admission. They did not have any medical problems such as diabetes mellitus, liver diseases, and hematologic problems. RESULTS: Epidural abscess was found in 4 patients and subdural hemorrhage in 1 patient. Among 4 patients with epidural abscess, 3 patients without myelitis had good recovery of neurologic symptoms. However, one patient who was combined with myelitis had poor outcome. One patient who was diagnosed subdural hemorrhage was improved with conservative treatment. CONCLUSION: Acupuncture has been and is being practiced extensively in medical field. However, it has been sometimes abused recklessly for the pain control related with spine, that might result in serious complications such as epidural abscess or subdural hemorrhage as in our cases. These results should raise concern about serious complications that may be developed in practicing the acupuncture.
Acupuncture* ; Back Pain ; Complementary Therapies ; Diabetes Mellitus ; Epidural Abscess ; Hematoma, Subdural ; Humans ; Liver Diseases ; Medical Records ; Medicine, East Asian Traditional ; Myelitis ; Neurologic Manifestations ; Retrospective Studies ; Spine