Spinal fixation using pedicle screws has recently been the focus of increased attention, but the adequate size of pedicle screw and maximum percentage fill as related to the pedicle diameter and are not well known. The objects of this study were to determine the ideal ratio among pedicle, drill and screw diameter, and to determine the maximum percentage fill of the screw without significant decrease of pull-out strength. The materials used for the experiments were 376 thoracic pedicles obtained from the 38 young pigs, and the diameters of pedicles ranged from 3.0 to 8.5mm. After 40% to 100% drilling as compared to pedicle diameter, screws were inserted carefully, and measurements were taken of the outer pedicle changes and pull-out strengths, and adequate drill and screw sizes as related to the diameters of given pedicles were determined. It was found that pull-out strength was the strongest after 60% drill, and the larger the drill diameter, the smaller the holding power, and the larger the screw diameter, the greater the holding power. Maximum pull-out strength was seen at 80-90% fill with 60% drill. After sequentially drilling each pedicle with increasingly larger drill bits, larger screws could be inserted with pedicle changes such as expansion, cutout, split fracture, and comminuted fracture. after larger drilling up to 100%, pedicle screws with diameters smaller than 115% of measured pedicle diameters could be safly inserted without fracture and significant decrease of pull-out strength. It is concluded that effective percentages of drill and screw diameters to the pedicle diameter are 60% and 80-90% respectively, and pedicle screw up to 115% of measured pedicle diameter can be safely inserted into pedicle without significant decrease of pull-out strength. It is thought that fresh pedicle has elasticity and larger screw can be inserted to the pedicle with strong holding after larger drilling.
Elasticity ; Fractures, Comminuted ; Pedicle Screws ; Swine

Stroke is a rare but serious complication of acute myocardial infarction (AMI). Currently, glycoprotein (GP) IIb/IIIa inhibitor is used in clinical practice for acute coronary syndromes and percutaneous coronary interventions (PCIs). The incidence of stroke in patients receiving GP IIb/IIIa inhibitor during PCIs is very low. We report the case of a 47-year-old man who presented with AMI and suffered an acute cerebral infarction after infusion of a GP IIb/IIIa inhibitor following primary PCI.
Acute Coronary Syndrome ; Cerebral Infarction ; Glycoproteins ; Humans ; Incidence ; Middle Aged ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stroke

Rubinstein-Taybi syndrome (RTS) is a congenital disorder characterized by typical facial features, broad thumbs and toes, with mental retardation. Additionally, tumors, keloids and various congenital anomalies including congenital heart defects have been reported in RTS patients. In about 50% of the patients, mutations in the CREB binding protein (CREBBP) have been found, which are understood to be associated with cell growth and proliferation. Here, we describe a typical RTS patient with Arnold-Chiari malformation. A mutation in the CREBBP gene, c.4944_4945insC, was identified by mutational analysis.
Arnold-Chiari Malformation ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; CREB-Binding Protein ; Heart Defects, Congenital ; Humans ; Intellectual Disability ; Keloid ; Rubinstein-Taybi Syndrome ; Thumb ; Toes

PURPOSE: The poor prognosis of advanced bladder cancer requires the investigation of novel treatment modalities. In this study, we investigated the suicide gene therapy for bladder cancer, using the adenovirus-mediated expression of Escherichia coli cytosine deaminase (CD) in conjunction with the prodrug 5-fluorocytosine (5-FC). MATERIALS AND METHODS: A replication-deficient recombinant adenovirus, which contains the Rous sarcoma virus (RSV) promoter driving the expression of CD, (Ad-RSV-CD) was constructed. In vitro cell-killing assay, using Ad-RSV-CD (20 MOI) plus 5-FC (500muM), was performed in bladder cancer cell lines, HT-1376, UM-UC-3 and NBT-II. The CD enzymatic activity was measured in the Ad-RSV-CD (20 MOI) infected cells, and the concentrations of 5-fluorouracil (5-FU) yielding an IC50 were calculated for those cells. RESULTS: 5-FU dose response curve showed that IC50 of NBT-II was 0.8muM, HT-1376 1.0muM and UM-UC-3 5.1muM at day 6. The CD enzymatic activities of the Ad-RSV-CD infected UM-UC-3, HT-1376 and NBT-II cells were 5696, 4655, 1766 pmole/1x10(6) cells, respectively. Whereas the administration of 5-FC (500muM) or Ad-RSV-CD (20 MOI) alone demonstrated no cytotoxicity to cells, Ad-RSV-CD/5-FC exhibited a significant cytotoxic effect in the cells, especially the UM-UC-3 and HT-1376. CONCLUSIONS: Ad-RSV-CD/5-FC suicide gene therapy is effective for bladder cancer cells in cell cultures, suggesting this approach may have potential as a strategy for the treatment of bladder cancer.
Adenoviridae* ; Cell Culture Techniques ; Cell Line ; Cytosine Deaminase* ; Cytosine* ; Escherichia coli* ; Escherichia* ; Flucytosine ; Fluorouracil ; Genetic Therapy* ; Inhibitory Concentration 50 ; Prognosis ; Rous sarcoma virus ; Suicide* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

BACKGROUND: In patients with coronary artery disease, dysfunctional hypoperfused myocardium at rest may represent either nonviable or viable hibernating myocardium. Two-dimensional echocardiography can detect regional wall motion abnormalities resulting from myocardial ischemia by dobutamine infusion. The purpose of the present study was to identify the prediction of improvement of regional left ventricular (LV) function after surgical revascularization. MATERIALS AND METHODS: Sixteen patients with chronic regional LV dysfunction underwent dobutamine stress echocardiography (DSE) (dobutamine: baseline, 5, 10, 20microgram/kg/min) before coronary artery bypass grafting (CABG) and underwent echocardiography at least 2 months after CABG. RESULTS: All patients were male with mean age of 58 years ranging from 42 to 73 years. The mean LV ejection fraction was 41.8% with a range from 19% to 55%. During DSE, there were no complications, also, there were no operative morbidities or mortalities. Improvement of wall motion within the dysfunctional myocardium was found in 8 (50%) of 16 patients in DSE. Among them, 6 patients (75%) showed functional recovery after CABG. Another 8 patients did not show improvement of wall motion in DSE. But among them, 3 patients (38%) showed functional recovery after CABG. 84 dysfunctional segments were found in 256 segments of 16 patients. Improvement of wall motion was found in 34 of 84 segments in DSE. Among them, 23 segments (74%) showed functional recovery after CABG. Another 53 segments did not show improvement of wall motion in DSE. But among them, 12 segments (23%) showed functional recovery after CABG. The sensitivity and specificity of DSE for the prediction of postoperative improvement of segmental wall motion were 66% and 84%, respectively. The positive and negative predictive value of DSE were 74% and 77%, respectively. In patients with chronic regional LV dysfunction, think that DSE is a good predictor of the improvement of dysfunctional segments after CABG.
Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Humans ; Male ; Mortality ; Myocardial Ischemia ; Myocardium* ; Sensitivity and Specificity

PURPOSE: We prospectively evaluated the diagnostic efficacy of the BTA TRAK assay according to the stage, grade and hematuria in detecting primary and recurrent bladder cancer, and compared results with voided urine cytology. MATERIALS AND MTHODS: Urinalysis, cytology and BTA TRAK assay were performed simultaneously with the single voided fresh urine samples from 130 subjects. The sensitivity and specificity of the BTA TRAK assay were compared to those of urine cytology and analyzed according to the stage or grade. The subjects were also divided into 4 groups according to the degree of hematuria and the influence of hematuria on the result of the BTA TRAK assay was evaluated. RESULTS: The overall sensitivity and specificity of the BTA TRAK assay for detecting bladder cancer were 82.8% and 65.3%, respectively and those of urine cytology were 44.8% and 100%. The sensitivity of the BTA TRAK assay was significantly higher than that of urine cytology in bladder cancer with lower stage and grade. On univariate and multivariate analysis, gross hematuria and the presence of bladder cancer affected the results of the BTA TRAK assay significantly. In cases following after transurethral resection of bladder tumor (TURB), the sensitivity and specificity of the BTA TRAK assay for detecting recurrent bladder cancer were 100% and 79.5%, respectively. CONCLUSIONS: The BTA TRAK assay was more sensitive but less specific than voided urine cytology. Because gross hematuria affected the result of the BTA TRAK assay independently, it appears reasonable to delay the BTA TRAK assay until gross hematuria subsides in cases with gross hematuria. In cases following after TURB, the BTA TRAK assay appears to be useful for detecting recurrent bladder cancer.
Diagnosis ; Hematuria ; Multivariate Analysis ; Prospective Studies ; Sensitivity and Specificity ; Urinalysis ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: We prospectively evaluated the diagnostic efficacy of the BTA TRAK assay according to the stage, grade and hematuria in detecting primary and recurrent bladder cancer, and compared results with voided urine cytology. MATERIALS AND MTHODS: Urinalysis, cytology and BTA TRAK assay were performed simultaneously with the single voided fresh urine samples from 130 subjects. The sensitivity and specificity of the BTA TRAK assay were compared to those of urine cytology and analyzed according to the stage or grade. The subjects were also divided into 4 groups according to the degree of hematuria and the influence of hematuria on the result of the BTA TRAK assay was evaluated. RESULTS: The overall sensitivity and specificity of the BTA TRAK assay for detecting bladder cancer were 82.8% and 65.3%, respectively and those of urine cytology were 44.8% and 100%. The sensitivity of the BTA TRAK assay was significantly higher than that of urine cytology in bladder cancer with lower stage and grade. On univariate and multivariate analysis, gross hematuria and the presence of bladder cancer affected the results of the BTA TRAK assay significantly. In cases following after transurethral resection of bladder tumor (TURB), the sensitivity and specificity of the BTA TRAK assay for detecting recurrent bladder cancer were 100% and 79.5%, respectively. CONCLUSIONS: The BTA TRAK assay was more sensitive but less specific than voided urine cytology. Because gross hematuria affected the result of the BTA TRAK assay independently, it appears reasonable to delay the BTA TRAK assay until gross hematuria subsides in cases with gross hematuria. In cases following after TURB, the BTA TRAK assay appears to be useful for detecting recurrent bladder cancer.
Diagnosis ; Hematuria ; Multivariate Analysis ; Prospective Studies ; Sensitivity and Specificity ; Urinalysis ; Urinary Bladder Neoplasms* ; Urinary Bladder*

BACKGROUND: The aim of this study was to assess the feasibility of targeted ultrasound imaging on apoptosis with annexin A5 microbubbles (A5MB) in acute doxorubicin-induced cardiotoxicity. METHODS: Avidinated and octafluoropropan-filled phospholipid microbubbles were conjugated with biotinylated annexin A5. To confirm the specific binding of A5MB, flow cytometry was performed with hydrogen peroxide induced apoptosis in rat aorta smooth muscle cells incubated with fluorescein-5-isothiocyanate (FITC) labeled annexin A5 and A5MB. Adult male rats were injected intraperitoneally with 5 mg/kg doxorubicin weekly for 3 weeks (n = 5). Control rats were injected with normal saline (n = 5). At 24 hours after the final treatment, triggering imaging was performed 15 min after an intravenous bolus injection of A5MB for washout of freely circulating microbubbles. After echocardiography, the heart was isolated for histological detection of apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. RESULTS: In the in vitro tests, fluorescence intensity was low for healthy cells and high for apoptotic cells when incubated with FITC-labeled annexin A5 and A5MB. Rats treated with doxorubicin showed significant contrast opacification of the myocardium on contrast echocardiography using A5MB. However, no opacification was observed in control rats. Apoptosis was confirmed by TUNEL assay in doxorubicin treated rats. CONCLUSION: Acute doxorubicin-induced cardiomyopathy based on early apoptosis can be assessed and imaged with targeted ultrasound imaging using A5MB in rats.
Adult ; Animals ; Annexin A5 ; Aorta ; Apoptosis ; Avidin ; Cardiomyopathies ; Doxorubicin ; Echocardiography ; Flow Cytometry ; Fluorescein-5-isothiocyanate ; Fluorescence ; Heart ; Humans ; Hydrogen Peroxide ; In Situ Nick-End Labeling ; Male ; Microbubbles ; Myocardium ; Myocytes, Smooth Muscle ; Rats

Myxoma is the most common primary cardiac tumor. It usually develops on the interatrial septum, and occurs in the left atrium in more than 75% of cases. Myxoma in the ventricle is much less common and accunts for only 5% of cases. A myxoma arising from mitral valve is exceedingly rare and is normally located on the atrial side of valve, with an eqivalent distribution between the anterior and posterior leaflets. We report a case of myxoma that arose from both the interatrial septum and anterior mital leaflet, which has not been previously reported in the literature.
Heart Atria ; Heart Neoplasms ; Mitral Valve ; Myxoma*

PURPOSE: A new therapeutic approach is needed in patients with metastatic renal cell carcinoma (RCC) because of a dismal prognosis. MN/CA9 is a transmembrane glycoprotein that was first identified in the human cervical carcinoma cell line, HeLa. Since MN/CA9 protein is highly expressed in RCC tissues, but not in normal kidney, we constructed a tumor-specific replication-competent adenoviral vector utilizing MN/CA9 promoter (Ad-MN/CA9-E1a) and demonstrated its selective cytotoxicity toward MN/CA9-expressing RCC cells in vitro. MATERIALS AND METHODS: MN/CA9-positive (HeLa, SK-RC-52) and MN/ CA9-negative (SK-RC-29) cells were used. RT-PCR assay for MN/CA9 mRNA was performed in each cells. Ad5 E1a protein production in each cells after infection with Ad-MN/CA9-E1a was determined by western blot analysis. In vitro cytotoxicity assay was performed for assessing the selective cytotoxicity of Ad-MN/CA9-E1a to MN/CA9-expressing cells. RESULTS: RT-PCR assay showed that a distinct 255-bp fragment corresponding to the sequence within MN/CA9 cDNA was detected in HeLa and SK-RC-52 cells, but SK-RC-29 cells did not have MN/CA9 transcripts. Western blot analysis demonstrated that HeLa and SK-RC-52 cells showed much stronger Ad5 E1a protein expressions compared with SK-RC-29. In vitro cytotoxicity assay revealed that the growth of MN/CA9-positive cells was significantly inhibited with 0.1-1MOI of Ad-MN/CA9-E1a, but the growth of MN/CA9-negative cells (SK-RC-29) could only be inhibited by as many as 100MOI. CONCLUSIONS: These results suggest that a novel replication-competent adenoviral vector mediated by MN/CA9 promoter, Ad-MN/CA9-E1a, can selectively replicate in MN/CA9-expressing cancer cells with cytotoxic effects and may be utilized for the treatment of RCC.
Adenoviridae* ; Blotting, Western ; Carcinoma, Renal Cell* ; Cell Line ; DNA, Complementary ; Genetic Therapy* ; Glycoproteins ; Humans ; Kidney ; Prognosis ; RNA, Messenger ; Virus Replication