To evaluate a relationship of lumbar lordosis between asymptomatic group and low back pain group, lumbar lordotic angle was measured from standing lateral lumbosacral roentogenogram of 360 men and women between 20 and 49 years of age. We excluded the patients with back deformity, moderate to severe degenerative change of lumbosacral spine, leg length discrepency, and degenerative change of lower leg in both groups. The lumber lordodsis angle was measured with two ways, lumbosacral angle and lumbolumbar angle respectively. Two angles have a line parallel to the top of second lumbar vertebra as the proximal boundary. The distal border of the lumbosacral angle is a line parallel to the top of sacrum. The distal border of the lumbolumbar angle is a line parallel to the bottom of fifth lumbar vertebra. With statistical analysis of the results, we came to followiing conclusion: 1. The mean lumbolumbar angle was 33.62° +0.62° (SEM: standard error of the mean) and the mean lumbosacral angle was 49.91° +0.59° in asymptomatic group. 2. The mean lumbolumbar angle was 34.79° +0.68° and the mean lumbosacral angle was 50.35° +0.76° in low back pain group. 3. No significant difference in lumbosacral and lumbolsacral angle between asymptomatic and low back pain group was identified using general linear models procedure(P>0.5). 4. Analyzing the data by sex, no significant difference in lumbosacral and lumbosacral angle was identified using general linear models procudure(P>0.05). 5. Analyzing the data by age group, no significant difference in lumbosacral angle was identified (P>0.05), but significant difference in lumbolsacral angle was identified using general linear models procedure(P=0.0045).
Animals ; Congenital Abnormalities ; Female ; Humans ; Leg ; Linear Models ; Lordosis ; Low Back Pain ; Male ; Sacrum ; Spine

BACKGROUND: Recent advances in the understanding of acute pain mechanisms show that inflammatory pain is the result of changes in the nervous system. Preemptive analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurons and, therefore, may reduce postoperative pain. In previous studies, we demonstrated that modest dose of i.v. morphine infusion before surgical incision significantly decreased postoperative pain. We studied whether or not intravenous fentanyl infusion before induction could affect postoperative pain and analgesic demands, when compared with intravenous fentanyl infusion at 30min after skin incision. METHODS: Female patients scheduled for total abdominal hysterectomy were randomly assigned to one of two groups of prospectively studied in a double-blind manner. Group I (n=14) and II (n=15) received intravenous fentanyl (4 g/kg) before induction of anesthesia and at 30min after skin incision, respectively. Postoperative pain relief was provided with epidural fentanyl and local anesthetics from a PCA system (Medex Walkmed). Postoperative visual analogue pain scores, analgesics requirements and side effects were examined and compared between groups for postoperative 2 days. RESULTS: VAS at rest were significantly less in group I than in group II 1hrs after surgery (p<0.05). VAS on movement were significantly less in group I than in group II 1hr (p<0.01) and 6hrs after surgery (p<0.05). Patient-controlled analgesics consumption in group I was not significantly less than in group II for postoperative 2 days. CONCLUSIONS: Administration of intravenous fentanyl before skin incision has better outcome in preemptive analgesia than that of 30 min after skin incision. But, further studies would be needed to evaluate preemptive effect of i.v. fentanyl.
Acute Pain ; Analgesia ; Analgesics ; Anesthesia ; Anesthetics, Local ; Female ; Fentanyl* ; Humans ; Hysterectomy ; Morphine ; Nervous System ; Neurons ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Prospective Studies ; Skin

PURPOSE: Using proteomic analysis, this study was performed to see the characteristics of proteins expression in the muscles of spastic cerebral palsy patients. MATERIALS AND METHODS: We studied twelve specimens from six patients with spastic cerebral palsy, three patients with myelomeningocele, and three normal people who underwent orthopaedic surgeries due to trauma. We studied the extracted proteins showing differences in the two-dimensional electrophoresis, and the prominent thirteen proteins were re-evaluated by proteomics and the reverse transcriptional polymerase chain reaction, which was to clarify the relationship between gene and protein expression. RESULTS: Among fifteen proteins, six proteins were found to be higher in normal people, and nine were found to be higher in the groups of patients by spot histogram. The results of proteomic analysis with MALDI-TOF for fifteen proteins showed that the expression of DJ-1 was related to cerebral palsy. CONCLUSION: This study shows that strong expression of DJ-1 is related to spasticity and cerebral palsy. We showed for the first time the possibility of any relationship between spastic condition and DJ-1 expression.
Cerebral Palsy ; Electrophoresis ; Humans ; Meningomyelocele ; Muscle Spasticity ; Muscles ; Polymerase Chain Reaction ; Proteins ; Proteomics

Leptin, which is a plasma protein produced by the obese gene, is expressed and secreted by adipocytes. The clearance of lepdn from the circulation is unknown. But, markedly elevated serum leptin concentrations have recently been reported in patients with chronic renal failure. The purpose of the present study was to investigate plasma leptin concentration of patients with chronic renal failure and evaluate the factors affecting plasma leptin levels. Plasma leptin, insulin, and body mass index were determined in 34 patients with chronic renal failure and 55 control subjects. The plasrna leptin concentrations were not significantly different between patients with chronic renal failure and control subjects (9.4+/-11.8 vs 4.9+/-4.2ng/ml, P>0.05). The serum leptin concentrations were not significantly higher in both male and female CRF patients compared with control subjects (3.96+/-5.72 vs 2.48+/-1.65, P=0.1947, 17.07+/-14.02 vs 7.49+/-4.63ng/ml, P=0.07, respectively). And, there was no significant correlation between serum creatinine and plasma leptin. However, there was significant correlation between plasma leptin concentration and insulin level (P<0.05). We fit a multiple linear regre- ssion analysis with plasma leptin level as the dependent variable in CRF. Sex (male vs female) (P< 0.001) and insulin (P=0.004) were independently associated with plasma leptin level in CRF. These results suggested that plasma leptin level was regulated or affected by multiple factors inclu- ding sex and insulin resistance. Additional study is required to evaluate relationship between plasma leptin and insulin resistance in chronic renal failure.
Adipocytes ; Body Mass Index ; Creatinine ; Female ; Humans ; Insulin ; Insulin Resistance ; Kidney Failure, Chronic* ; Leptin* ; Male ; Plasma*

Here we report a single-stage operation we performed on a patient with a large schwannoma that extended from the lower clivus to the cervico-thoracic junction caudally. A number of authors have previously performed multilevel laminectomy to remove giant schwannomas that extend for considerable length. This technique has caused cervical instability such as kyphosis or gooseneck deformity on several occasions. We removed the tumor with a left lateral suboccipital craniectomy with laminectomy only at C1 and without any subsequent surgery-related neurologic deficits. However, this technique requires meticulous preoperative evaluation on existence of Cerebrospinal fluid (CSF) cleft between the tumor and spinal cord on magnetic resonance imaging, of tumor origin located at the upper cervical root, and of detachment of tumor from the origin site.
Cerebrospinal Fluid ; Congenital Abnormalities ; Cranial Fossa, Posterior ; Humans ; Kyphosis ; Laminectomy* ; Laminoplasty ; Magnetic Resonance Imaging ; Neurilemmoma* ; Neurologic Manifestations ; Spinal Cord ; Spinal Cord Neoplasms

BACKGROUND AND OBJECTIVES: Epistaxis is a common occurrence and most of us have at least one episode in a life time. These episodes are usually minor events and resolved spontaneously, although those who need help can be admitted. It is important to know about etiologic factors of each case of epistaxis, sex and age distribution of patients, bleeding site, seasonal incidence and methods of management. MATERIAL AND METHOD: We performed a retrospective study of epidemiology, etiology and control methods and their effectiveness in patients of epistaxis who visited Korea Veterans Hospital out-patient department in otolaryngology and emergency room from January, 1990 to December, 1999. RESULTS: It was more prevalent in male and commonly occured in the left nasal cavity. Incidence of epistaxis was the greatest in the month of May and the least in August. Among the age groups of patients, it was most prevalent among the fifties followed by the twenties. The most common cause was idiopathic, with the local causes being more attributable. It was found to easily occurr in the convex side with septal deformity. Kiesselbach's area was the most common bleeding site, although when compared with previous reports, the incidence rate has been decreasing. Recurrent bleeding was more common in posterior epistaxis. Most cases were adequately managed with anterior nasal packing (65.4%), but in the minority, posterior nasal packing and blood transfusion were needed. CONCLUSION: Incidence of bleeding have increased and the most frequent bleeding sites have become more variable, because of the increasing rate of air pollution, cerebrovascular accidents and heart diseases. Epistaxis easily occurred when the atmospheric changes were severe. Further prospective studies are mandatory to clarify the correlation between epistaxis and multifactorial causes.
Age Distribution ; Air Pollution ; Blood Transfusion ; Congenital Abnormalities ; Emergency Service, Hospital ; Epidemiology ; Epistaxis* ; Heart Diseases ; Hemorrhage ; Hospitals, Veterans ; Humans ; Incidence ; Korea ; Male ; Nasal Cavity ; Otolaryngology ; Outpatients ; Retrospective Studies ; Seasons ; Stroke

PURPOSE: To evaluate the usefulness of dynamic MR imaging in the differential diagnosis of intracranial tumorand abscess. MATERIALS AND METHODS: Dynamic MR images of 36 patients with surgically or clinically provenintracranial enhancing lesions were retrospectively reviewed. These lesions comprised 15 metastases, 14 gliomas,and seven abscesses. Images were sequentially obtained every 30 seconds for 3-5 minutes using the spin-echotechnique(TR/TE : 200 msec/15 msec) after bolus injection of gadolinium dimeglumine(2-3cc/sec). The dynamics ofcontrast enhancement of the lesions was analyzed visually and by calculating the sequential contrast-enhancementratio(CER). RESULTS: CER during the 30-second early dynamic phase was 93.16 in metastases, 67.78 in gliomas, and48.3 in abscesses(ANOVA, p<0.005). The contrast enhancement pattern of metastases showed rapidly increased signalintensity(SI) up to 30 seconds, followed by a relatively rapid decrease; less time was then required to reach theCER peak. In gliomas, SI increased gradually up to 180 seconds and then took a longer time to reach the CER peak.The SI of abscesses was similar to that of gliomas, with a more gradual increase for 30-60 seconds and a longertime for the CER peak to be reached. CONCLUSION: The contrast enhancement pattern and CER parameters seen ondynamic MRI can help differentiate intracranial tumor and abscess.
Abscess ; Brain Abscess* ; Brain Neoplasms* ; Brain* ; Diagnosis, Differential ; Gadolinium ; Glioma ; Humans ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Retrospective Studies

Schwannoma is a tumor that arises from neural sheath Schwann cells of peripheral nerves. Schwannoma is mostly solitary, except when it occurs in association with Von Recklinghausen's disease. Solitary schwannoma can occur in association with a nerve anywhere within the body, but rarely occurs in the pelvis. Microscopically, the tumors can be divided into hypercellular bundles of spindle-shaped cells (Antoni A area) and areas of lower cellularity, with loose myxomatous arrangement of cells and fibers (Antoni B area). Complete resection of pelvic schwannoma is a curative treatment. We report a case of benign presacral cystic schwannoma that caused recurrent acute urinary retention in a 79-year-old woman, along with a review of the literature.
Aged ; Female ; Humans ; Neurilemmoma* ; Neurofibromatosis 1 ; Pelvis ; Peripheral Nerves ; Schwann Cells ; Urinary Retention*

Among intracranial meningiomas, falcotentorial meningiomas, occurring at the junction of the falx cerebri and tentorial dural folds, are extremely rare. Because of their deep location, they are surrounded by critical structures, and have been regarded as one of the most challenging lesions for surgical treatment. In this study, we describe our surgical strategy for falcotentorial meningiomas and provide a review of our experience.
Adult ; Aged ; Dura Mater/pathology ; Female ; Humans ; Male ; Meningeal Neoplasms/pathology/*surgery ; Meningioma/pathology/*surgery ; Middle Aged

BACKGROUND: Frailty is considered to be a clinical syndrome characterized by decreased physiological reserves associated with a greater risk of health-related problems, hospitalization, and death. The current study examined hospitalization, falls, cognitive decline and disability between robust, prefrail and frail elderly in one year. METHODS: 110 participants aged 65 or more who visited two senior welfare centers in Seoul from February 2008 to June 2008 were surveyed again from March 2009 to June 2009 with demographic characteristics, number of chronic diseases and medication, study of osteoporotic fractures (SOF) frailty index, instrumental activity of daily living (IADL), depression, mini-mental state examination-Korean version (MMSE-K), falling history and admission history within one year. These results were compared with participants' previous survey done one year ago. RESULTS: Among total 110 subjects, 48 (44%) robust, 30 (27%) prefrail, and 32 (29%) frail subjects changed to 26 (24%), 54 (49%), and 30 (27%) respectively over the year. There were statistical significances in age, number of chronic disease, depressive mood, MMSE, falls, hospitalization, IADL disability contributing to frailty (P < 0.05). Frailty defined by SOF frailty index was associated with greater risk of adverse outcomes. Frail subjects had a higher age-adjusted risk of cognitive function decline (odds ratio [OR], 3.57), disability (OR, 9.64), fall (OR, 5.42), and hospitalization (OR, 4.45; P < 0.005). CONCLUSION: The frailty index like SOF frailty index might predict risk of falls, disability, hospitalization, and cognitive decline in the elderly, emphasizing special attention to the individuals showing frailty in outpatient examination.
Aged ; Chronic Disease ; Depression ; Frail Elderly ; Hospitalization ; Humans ; Osteoporotic Fractures ; Outpatients ; Retrospective Studies