PURPOSE: Lumbar degenerative kyphosis (LDK) is a subgroup of the flatback syndrome, which is a condition caused by spinal degeneration. LDK is reported to be the most frequent cause of lumbar spine deformity in the farming districts of the 'Oriental' countries. We investigated the relationship between the cross-sectional area (CSA) and the moment arm length (MAL) of the erector spinae muscle and the thickness of the psoas major muscle (PT) and the body mass index (BMI) by performing statistical analysis, and we tried to show the crucial role of these variables for diagnosing LDK. MATERIALS AND METHODS: From July 2004 to April 2005, we retrospectively reviewed 17 LDK patients who had undergone anterior lumbar interbody fusion (ALIF) with posterior stabilization. We measured both the CSA & MAL on the transverse cross-sectional MR image of the trunk at the fourth to fifth vertebrae (L4/5). The MAL was defined as the anterior-posterior distance between the center of the erector spinae muscle and that of the vertebral body. A comparative study was undertaken between the LDK group and the matched (according to age & gender) control group with regard to the CSA, MAL, PT and BMI. RESULTS: The 17 LDK patients were all females [age: 62.5+/-4.93 years, height: 157+/-6.19 cm, weight: 55.59+/-4.7 kg, and BMI: 22.58+/-2.08 kg/m2]. The control group patients were all females [age: 63.6+/-2.27 years, height: 156+/-5.05 cm, weight: 59.65+/-7.39 kg and BMI: 24.38+/-2.94 kg/m2]. Spearman's rho indicated a positive association between the CSA & BMI (rho=0.49, p=0.046), between the MAL & BMI (rho=0.808, p=0.000) and between the CSA & PT (rho=0.566, p=0.018) in the LDK patients. In terms of the CSA versus MAL, there was a positive association in both groups (rho=0.67, p=0.000, MAL=0.023CSA+5.454 in the LDK group; rho=0.564, p=0.018, MAL=0.02CSA+5.832 in the control group with using linear regression analysis). Independent t-tests revealed that both groups had statistically different mean values (p=0.000) in terms of the CSA & MAL. CONCLUSION: This study showed that the patients with LDK not only had atrophied erector spinae muscles, but also atrophied psoas major muscles and short MALs, which is harmful because of the increased lower back load in the aged patients. Along with BMI, measurement of the CSA, MAL & PT on the MR images provides an objective assessment of the dimension & severity of the muscle atrophy in the LDK patients.
Arm* ; Body Mass Index* ; Congenital Abnormalities ; Female ; Humans ; Kyphosis* ; Linear Models ; Magnetic Resonance Imaging* ; Muscles ; Muscular Atrophy ; Retrospective Studies ; Spine

Inflammatory pseudotumor is a benign lesion mainly developed in respiratory system. It is difficult to distinguish from malignant lesions, so surgical biopsy is necessary. Of the extrarespiratory system, the inflammatory pseusotumor is rarely developed in the spleen, and first reported by Cotelingam and Jaffe in 1984. We report a case of the inflammatory pseudotumor in the spleen. A 59-years old woman has visited with a splenic mass detected on routine check. She denied the history of abdominal trauma or other diseases except urinary stone and had no subjective symptoms. Tumor markers were all within normal limits. For the differential diagnosis of the splenic mass, splenectomy was done. Grossly, 6x5x4.5 cm sized yellow, hard, well-demarcated mass was seen, and microscopically, prominent fibrosis and collagenation and partial infiltration of plasma cells and neutrophils were found. And the postoperative course was uneventable.
Biopsy ; Collagen ; Diagnosis, Differential ; Female ; Fibrosis ; Granuloma, Plasma Cell* ; Humans ; Middle Aged ; Neutrophils ; Plasma Cells ; Respiratory System ; Spleen* ; Splenectomy ; Biomarkers, Tumor ; Urinary Calculi

Cell-penetrating peptides (CPPs) are short amino acids that have been widely used to deliver macromolecules such as proteins, peptides, DNA, or RNA, to control cellular behavior for therapeutic purposes. CPPs have been used to treat immunological diseases through the delivery of immune modulatory molecules in vivo. Their intracellular delivery efficiency is highly synergistic with the cellular characteristics of the dendritic cells (DCs), which actively uptake foreign antigens. DC-based vaccines are primarily generated by pulsing DCs ex vivo with various immunomodulatory antigens. CPP conjugation to antigens would increase DC uptake as well as antigen processing and presentation on both MHC class II and MHC class I molecules, leading to antigen specific CD4+ and CD8+ T cell responses. CPP-antigen based DC vaccination is considered a promising tool for cancer immunotherapy due to the enhanced CTL response. In this review, we discuss the various applications of CPPs in immune modulation and DC vaccination, and highlight the advantages and limitations of the current CPP-based DC vaccination.
Amino Acids ; Antigen Presentation ; Cell-Penetrating Peptides* ; Dendritic Cells ; DNA ; Immune System Diseases ; Immunotherapy ; Peptides ; RNA ; Vaccination* ; Vaccines

German cockroaches are major household allergens that can trigger allergic airway inflammatory diseases with sensitive T-cell responses. Although the use of immune modulatory biologics, such as antibodies, to mediate allergic responses has recently been examined, only systemic administration is available because of the size limitations on intranasal administration. Here we utilized a cell-permeable peptide, dNP2, to deliver the cytoplasmic domain of cytotoxic T-lymphocyte antigen-4 (ctCTLA-4) through the airway epithelium to modulate Th2 responses in a German cockroach extract (GCE)-induced allergic airway inflammation model. The intranasal delivery efficiency of the dNP2-dTomato protein to the lungs was higher in GCE-induced asthmatic lung parenchymal cells compared to the sham cells. Intranasal administration of the dNP2-ctCTLA-4 protein inhibited airway hyper-responsiveness and reduced airway inflammation and remodeling, including goblet cell metaplasia and collagen deposition around the bronchi. The number of infiltrated cells, including eosinophils, and the levels of IL-4, IL-5, IL-13 and IFN-γ in the lungs were significantly reduced, presumably owing to inhibition of Th2 differentiation. However, intranasal administration of CTLA4-Ig did not inhibit airway inflammation. These results collectively suggest that dNP2-ctCTLA-4 is an efficient intranasally applicable candidate biologic for treating allergic asthma.
Abatacept ; Administration, Intranasal ; Allergens ; Antibodies ; Asthma ; Biological Products ; Blattellidae* ; Bronchi ; Collagen ; Cytoplasm ; Eosinophils ; Epithelium ; Family Characteristics ; Goblet Cells ; Inflammation* ; Interleukin-13 ; Interleukin-4 ; Interleukin-5 ; Lung ; Metaplasia ; Respiratory Hypersensitivity ; T-Lymphocytes ; T-Lymphocytes, Cytotoxic

Brain abscesses can be highly lethal if appropriate treatment is not administered, and reports of such an abscess caused by Enterococcus avium are very rare. Here,we report a case of a 48-year-old man presenting with chronic otitis media. He initially presented with a headache and right otalgia. An otoscopic evaluation performed on the day of admission showed exudation of fresh pus from the right ear. Brain magnetic resonance imaging demonstrated a hypodense area in the right temporoparietal lobe, suggestive of a brain abscess. A culturing of the ear discharge and brain abscess aspirate proved of E. avium infection. Following stereotactic aspiration of the brain abscess and proper antimicrobial treatment, the patient recovered completely. In this report, we also review and discuss the available medical literature on previous cases of E. avium infection associated with brain abscess.
Abscess ; Brain ; Brain Abscess ; Ear ; Earache ; Enterococcus ; Headache ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Otitis Media ; Suppuration

Background: Excessive citrate load during therapeutic plasma exchange (TPE) can cause metabolic alkalosis with compensatory hypercarbia and electrolyte disturbances. If TPE is required immediately before ABO-incompatible (ABOi) liver transplant (LT) surgery, metabolic derangement and severe electrolyte disturbance could worsen during LT anesthesia.Case: We report two ABOi LT cases who received TPE on the day of surgery because isoagglutinin titers did not be dropped below 1:8. One case had a surprisingly high metabolic alkalosis with a pH of 7.73 immediately after tracheal intubation because of hyperventilation during mask bagging. The other experienced sudden ventricular tachycardia and blood pressure drop after surgical incision accompanied with severe hypokalemia of 1.8 mmol/L despite supplementation with potassium. Conclusions Special attention should be paid to patients who just completed TPE the operative day morning as they are vulnerable to severe acid-base disturbances and life-threatening ventricular arrhythmias in ABOi LT.

An 81-year-old male patient presented with complaint of a pulsating neck mass. The patient had a previous history of cervical lymphadenopathy by non-tuberculous mycobacterium infection. Rapid growth of the mass on admission and contrast enhanced computed tomography of the neck resulted in a diagnosis of non-tuberculous mycobacterium induced pseudoaneurysm. The patient underwent emergency open repair of the pseudoaneurysm. Pseudoaneurysm of the common carotid artery is regularly reported, but here we report a rare case of non-tuberculous mycobacterium induced pseudoaneurysm of the common carotid artery.
Aged, 80 and over ; Aneurysm, False* ; Carotid Arteries ; Carotid Artery, Common* ; Diagnosis ; Emergencies ; Humans ; Lymphatic Diseases ; Male ; Mycobacterium Infections ; Mycobacterium* ; Neck ; Nontuberculous Mycobacteria ; Vascular Diseases

Many herbs have been used as therapeutics in Korean traditional medicine. In view of their clinical indications, anti-oxidant activity may contribute to their pharmacological effects. However, anti-oxidant information on these plants has not been available. In this study, seventy herbs which have been used in Korean traditional medicine were selected and screened for anti-oxidant activity using their water extracts. The anti-oxidant activity was assessed by their ability to inhibit three oxidation reactions; luminol/Fenton reagent, 2, 7-dichlorodihydrofluorescein (DCHF)/Fenton reagent and DCHF/peroxynitrite. In each assay, 70 herbs were divided into two groups; anti-oxidant group which inhibited the respective oxidation reaction and was majority (about 60 herbs), and pro-oxidant group which enhanced the oxidation reaction but was minority (more or less 10 herbs). When the herbs were listed in the order of their anti-oxidant strength, the orders obtained from each assay were found to be quite similar. The upper top rankers (more or less 10 herbs) in each assay showed strong activity compared to the others. The uppermost rankers in each assay were Rubus coreanus Miquel/ Rubus schizostylus, Schisandra chinensis Baillon/ Schizandra chinensis and Terminalia chebula Retzius/ Terminalia chebula. Of the pro-oxidant herbs, about 4-5 herbs were strongly pro-oxidant, which enhanced the control oxidation reactions to 150-300%. But the meaning of this observation is not known since few of them in one assay were also anti-oxidant in other assays. The results obtained in the present study may serve as information for understanding pharmacological effects of these herbs and developing new drugs from them.
Hydrogen Peroxide ; Iron ; Luminescence ; Medicine, Korean Traditional ; Peroxynitrous Acid ; Schisandra ; Terminalia ; Water

Vertebral osteomyelitis is primarily seen in middle-aged individuals, with a mean age of presentation of ~60 years. Recent trends suggest an increase in the incidence of vertebral osteomyelitis due to longer life expectancy of patients with chronic debilitating diseases. Haemophilus influenzae is a small, fastidious, gram-negative bacillus, which is known to cause infections in young children. While invasive H. influenzae infections have become increasingly common in adult populations, bone infections caused by this organism remain extremely rare. The existing medical literature includes only 11 reports of vertebral osteomyelitis caused by H. influenzae since 1978, with no reports of H. influenzae-associated vertebral osteomyelitis observed in Korea. Here, we present the case of a 72-year old patient with hematogenous vertebral osteomyelitis and psoas abscess caused by non-typeable H. influenzae.
Adult ; Bacillus ; Bacteremia* ; Child ; Haemophilus ; Haemophilus influenzae* ; Humans ; Incidence ; Influenza, Human ; Korea ; Life Expectancy ; Osteomyelitis* ; Psoas Abscess*

Vertebral osteomyelitis is primarily seen in middle-aged individuals, with a mean age of presentation of ~60 years. Recent trends suggest an increase in the incidence of vertebral osteomyelitis due to longer life expectancy of patients with chronic debilitating diseases. Haemophilus influenzae is a small, fastidious, gram-negative bacillus, which is known to cause infections in young children. While invasive H. influenzae infections have become increasingly common in adult populations, bone infections caused by this organism remain extremely rare. The existing medical literature includes only 11 reports of vertebral osteomyelitis caused by H. influenzae since 1978, with no reports of H. influenzae-associated vertebral osteomyelitis observed in Korea. Here, we present the case of a 72-year old patient with hematogenous vertebral osteomyelitis and psoas abscess caused by non-typeable H. influenzae.
Adult ; Bacillus ; Bacteremia* ; Child ; Haemophilus ; Haemophilus influenzae* ; Humans ; Incidence ; Influenza, Human ; Korea ; Life Expectancy ; Osteomyelitis* ; Psoas Abscess*