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

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*

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: 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

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 aim of this study was to evaluate the efficacy and safety of levetiracetam in children younger than 4 years with intractable epilepsy. METHODS: A retrospective analysis of pediatric epilepsy patients was performed. Data were obtained from the medical records of 30 patients (male 19, female 11) with intractable epilepsy, who were treated with levetiracetam. RESULTS: Seizure types were partial in 18, and generalized in 12. Fifteen patients had symptomatic etiologies. The median age of the patients at the time of levetiracetam administration was 26 months old (range: 4-47 months). The median starting dose was 13 mg/kg/ day, and the median maintenance dose was 52 mg/kg/day (range: 10-123 mg/kg/day). Ten (10/30, 33%) patients experienced more than 50% reduction in seizure frequency, and 4 (4/30, 13%) partial epilepsy patients became seizure-free. Eight partial epilepsy patients (44%) had more than 50% seizure reduction, while 2 patients (17%) with generalized epilepsy did. All of patients with infantile spasms and Lennox-Gastaut syndrome except one, had less than 50% reduction in seizure frequency. Adverse events reported in 8 patients (27%), included lethargy, behavioral problems, sleep disturbance, and seizure aggravation. CONCLUSIONS:Levetiracetam is effective in children aged 4 years or less with intractable epilepsy, and also seems to be safe to use in this age group.
Aged ; Anticonvulsants ; Child ; Child, Preschool ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Female ; Humans ; Infant ; Infant, Newborn ; Intellectual Disability ; Lethargy ; Medical Records ; Piracetam ; Retrospective Studies ; Seizures ; Spasms, Infantile

Remyelination via the transplantation of oligodendrocyte precursor cells (OPCs) has been considered as a strategy to improve the locomotor deficits caused by traumatic spinal cord injury (SCI). To date, enormous efforts have been made to derive OPCs from human pluripotent stem cells (hPSCs), and significant progress in the transplantation of such cells in SCI animal models has been reported. The current methods generally require a long period of time (>2 months) to obtain transplantable OPCs, which hampers their clinical utility for patients with SCI. Here we demonstrate a rapid and efficient method to differentiate hPSCs into neural progenitors that retain the features of OPCs (referred to as OPC-like cells). We used cell sorting to select A2B5-positive cells from hPSC-derived neural rosettes and cultured the selected cells in the presence of signaling cues, including sonic hedgehog, PDGF and insulin-like growth factor-1. This method robustly generated neural cells positive for platelet-derived growth factor receptor-α (PDGFRα) and NG2 (~90%) after 4 weeks of differentiation. Behavioral tests revealed that the transplantation of the OPC-like cells into the spinal cords of rats with contusive SCI at the thoracic level significantly improved hindlimb locomotor function. Electrophysiological assessment revealed enhanced neural conduction through the injury site. Histological examination showed increased numbers of axon with myelination at the injury site and graft-derived myelin formation with no evidence of tumor formation. Our method provides a cell source from hPSCs that has the potential to recover motor function following SCI.
Animals ; Axons ; Behavior Rating Scale ; Cues ; Hedgehogs ; Hindlimb ; Humans* ; Methods ; Models, Animal ; Myelin Sheath ; Neural Conduction ; Oligodendroglia ; Platelet-Derived Growth Factor ; Pluripotent Stem Cells* ; Rats ; Spinal Cord Injuries* ; Spinal Cord*

PURPOSE: To examine the developmental outcome of preterm infants with cerebral insults and to evaluate the prognostic indicators for gross motor development. METHODS: Forty-eight preterm infants less than 37 weeks of gestation, who had been born at Seoul National University Bundang Hospital between March, 2004 and September, 2008 where the subjects of this. The infants' charts were reviewed to obtain data, including gestational age, birth weight, gender, 1/5 minute Apgar scores, neuroimaging findings, and others. RESULTS: Of the 48 patients, 29 infants (60.4%) were put into a normal developmental group and 19 (39.6%) were put into developmental delay group. Univariate analysis of the two groups showed that P values less than 0.05 were observed with respect to gestational age, premature rupture of membrane (PROM), respiratory distress syndrome, bronchopulmonary dysplasia, and patent ductus arteriosus. PROM and antenatal steroid showed statistically significant differences on a multivariate analysis. The same analysis method was applied to preterm infants less than a corrected age of 32 weeks. Multivariate analysis suggested that PROM showed statistically significant differences. Also, 48 patients were analyzed with respect to neuroimage finding. Twenty-five infants (52.1%) were assigned to a germinal matrix hemorrhage (GMH) group and 23 infants (47.9%) were allocated to a non-GMH group. Cesarean section delivery showed statistically significant difference according to univariate analysis. CONCLUSION: In preterm infants with cerebral insults, PROM and antenatal steroids were independent risk factors for impaired gross motor development.
Birth Weight ; Bronchopulmonary Dysplasia ; Cesarean Section ; Ductus Arteriosus, Patent ; Female ; Gestational Age ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Membranes ; Multivariate Analysis ; Neuroimaging ; Pregnancy ; Risk Factors ; Rupture ; Steroids