No abstract available.

STUDY DESIGN: In a prospective study of 38 patients undergoing lumbar pedicle screw instrumentation 200 pedicle hole were tested intraoperatively using electrical stimulation. OBJECTIVES: To evaluate the searching stimulus intensity at pedicle in Korean and to identify the most vulnerable root in transpedicular screw fixation of lumbosacral spine. MATERIALS AND METHOD: Electromyelogram(EMG) was monitored from eight lower extremity muscles bilaterally. Constant current stimulation pulses(0.2msec duration) were delivered through a ball-tipped nasopharyngeal probe used to evaluate each pedicle hole, and evaluated for searching stimulus intensity, the current necessary to evoked EMG RESULTS: The searching stimulus intensity above 5 mA were 194 cases(97.0%), above 7mA 151cases(75.5%), above 10 mA 107 cases(53.5%) and below 5 mA were 6 cases(3.0%). The vastus medialis muscle is most sensitive in L2(100%), L3(83.3%), tibialis anterior is in L4(68.4%), peroneus longus is in L5(44.2%) and gastrocnemious is in S1(64.5%). CONCLUSIONS: Stimulus-evoked EMG monitoring is a valuable and efficacious adjunct to lumbar pedicle screw instrumentation. A stimulation threshold greater than 5 mA reliably indicates adequate screw position and the root located at infero-medial side of pedicle is most vulnerab18 in transpedicular screw fixation.
Electric Stimulation ; Humans ; Lower Extremity ; Muscles ; Prospective Studies ; Quadriceps Muscle ; Spine

The ultrastructural changes of sciatic nerve and immunohistochemical changes of beta-catenin, PCNA, substance P were studied at the proximal segment of rat sciatic nerve after compression injury. We used 90 Sprague Dawley rats and the sciatic nerve compressed using silicon tube. We divided experimental groups which were the compression group for 1 hour (1C), for 2 hours (2C), and for 3 hours (3C), the release group for 1 day (1C1R) and 3 days (1C3R) after the compression for 1 hour, the release group for 1 day (2C1R) and 3 days (2C3R) after the compression for 2 hours, the release group for 1 day (3C1R) and 3 days (3C3R) after the compression for 3 hours. The rats were sacrified and took the sciatic nerve specimen. The specimens were investigated under the light microscope after hematoxylin & eosin, toluidin blue, and immunohistochemical stainings. In the H & E finding, the axon of the 1C disappeared, but recovered at the 1C3R. The part of nerve fibers at the 2C were swollen, but began to be partially recovered at 2C3R. Most nerve fibers were enlarged at the 3C, but markedly decreased at the 3C1R. The beta-catenin reaction disappeared at the 1C, but almost recovered at the 1C3R. This reaction of the 2C disappeared in the large fibers, but began to be recovered in the small fibers at the 2C1R. This reaction of the 3C disappeared in the large fibers, but began to be recovered at the 3C1R and 3C3R. The PCNA reaction prominently appeared at the 1C3R and 2C3R, the more prominent reaction at the 3C1R, and markedly increased reaction at the 3C3R. The substance P reaction of the 1C1R was mild positive, and the 2C1R and 3C1R were strong positive. In the toluidin blue staining, the myelin sheaths near the perineurium began to be thickened at the 1C, but almost recovered at the 1C3R. Many myelin sheaths became to be very thickened at the 2C and 3C, but almost recovered at the 2C3R and 3C3R. In the electron microscopic findings, the myelin sheaths of the 1C underwent the demyelination with the separated lamellae and the increase microtubules. At the 1C3R, the axolemma was attached on the myelin sheath and the axon was recovered. the myelin sheaths of the 2C underwent the demyelination with the separated axolemma. At the 2C1R, the myelin sheath was recovered by the developing Schwann cells, many intraaxonal mitochondria of demyelinated nerve fibers. At the 2C3R, the myelin sheath tended to be recovered by the increased rough endoplasmic reticulum and mitochondria of Schwann cells, many intraaxonal mitochondria of demyelinated nerve fibers. The myelin sheaths of the 3C began to be underwent severe demyelination from the middle portion of the sheath and the vacuolization of intraaxonal mitochondria. At the 3C1R, the myelin sheaths were recovered and contained many extended microtubules, mitochondria, and small granules. At the 3C3R, severe demyelinated nerve fibers were recovered by increasing microtubules. The proximal retrograde degeneration of sciatic nerve by the acute compression appeared the loss of the axons and the swelling of nerve fibers. The beta-catenin reaction was disappeared by the compression, but recovered by releasing. This reaction may be played a important role of the recover of demyelination. The PCNA reaction of Schwann cells was increased by the nerve compression. In the substance P finding, the pain after the compression appeared at the 1 day after releasing. Electron microscopic changes after sciatic nerve compression were the demyelination, the separated lamellae and the increase of intraaxonal microtubules. After releasing, the nerve fibers were recovered by developing Schwann cell, the intraaxonal mitochondria, and the transported granules through extending microtubules.
Animals ; Axons ; beta Catenin* ; Demyelinating Diseases ; Endoplasmic Reticulum, Rough ; Eosine Yellowish-(YS) ; Hematoxylin ; Microtubules ; Mitochondria ; Myelin Sheath ; Nerve Fibers ; Peripheral Nerves* ; Proliferating Cell Nuclear Antigen* ; Rats* ; Rats, Sprague-Dawley ; Retrograde Degeneration ; Schwann Cells ; Sciatic Nerve ; Silicones ; Substance P*

No abstract available.
Humans ; Pulmonary Atresia* ; Siblings* ; Ventricular Septum*

No abstract available.
Embryonic Structures* ; Humans* ; Upper Extremity*

BACKGROUND: Menopause is an independent risk factor in metabolic syndrome which induced an alteration of the lipid metabolism by hormonal changes. Apolipoprotein A5 gene (APOA5) was related to the regulation of triglyceride and high density lipoprotein cholesterol (HDL-C) level with biosynthesis and decomposition. This study was conducted to investigate the relationship between APOA5 polymorphism and metabolic syndrome in Korean postmenopausal women. METHODS: This study included 307 postmenopausal women with anthropometric and biochemical measurement in 2010-2011. The polymorphism of APOA5 was analyzed by polymerase chain reaction-restriction fragment length polymorphism method with MseI restriction enzyme. RESULTS: The metabolic syndrome prevalence with TT genotype was significantly lower than the frequency in those with TC/CC (27.09%, 38.46%, and 45.71% for TT, TC, and CC, respectively; P < 0.05). Multiple regression analysis of metabolic syndrome risk factors indicated that postmenopausal women with CC genotype had a higher risk with 3 times than that in TT genotype (P < 0.05). APOA5 C carriers showed an increased risk of triglyceride level (odd ratio, 2.93 and 1.85 for CC and TC+CC, respectively; P < 0.05). Interestingly, HDL-C was related to triglyceride directly in comparison to APOA5. CONCLUSION: The results of this study indicate that APOA5 has an influence on serum triglyceride and HDL-C, which contribute to metabolic syndrome in Korean postmenopausal women.
Apolipoproteins ; Apolipoproteins A ; Cholesterol ; Cholesterol, HDL ; Female ; Genotype ; Humans ; Lipid Metabolism ; Lipoproteins ; Menopause ; Metabolic Syndrome X ; Polymorphism, Single Nucleotide ; Prevalence ; Risk Factors ; Triglycerides

2D echocardiography (2DE) is a well established tool for the diagnosis of the mechanical complications after acute myocardial infarction (AMI) such as free wall and ventricular septal rupture. However, the extension of the rupture and the relationship with contiguous anatomic structures may not be clearly defined by 2DE. Real-time 3D echocardiography (RT3DE) is known to provide surgical enface view allowing complete visualization of the cardiac structures and comprehension of their spatial orientations to other anatomic structures. Obtaining such information with RT3DE before operation in AMI patient with mechanical complication may be essential for the optimal surgical treatment. We report a case of extensive ventricular wall rupture from the posterior wall to the ventricular septum after AMI demonstrated by RT3DE.
Comprehension ; Diagnosis ; Echocardiography ; Echocardiography, Three-Dimensional* ; Humans ; Myocardial Infarction* ; Rupture* ; Ventricular Septal Rupture ; Ventricular Septum*

Dieulafoy's lesion is an unusual cause of massive gastrointestinal bleeding resulting from the erosion of an abnormally large submucosal artery. Recently, improvement of endoscopic techniques has made effective hemostasis possible in most cases of Dieulafoy's lesion. Aspirin, which is an anti-inflammatory agent, increases the incidence of major upper gastrointestinal complications. Gastroduodenal mucosal injury associated with aspirin therapy in patients in the acute phase of Kawasaki disease is a rare complication that may require urgent medical intervention. We experienced a rare case of active bleeding from Dieulafoy's lesion in the stomach who was treated with oral aspirin in the acute phase of Kawasaki disease. If there is massive hematemesis during the treatment of Kawasaki disease, Dieulafoy's lesion should be considered even though it is rare.
Arteries ; Aspirin ; Child* ; Hematemesis ; Hemorrhage* ; Hemostasis ; Humans ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Stomach

No abstract available.
Hemangioma* ; Polyhydramnios*

PURPOSE: A model and a program was developed for training surgeons in laparoscopic urethrovesical anastomosis in order to improve the laparoscopic suture technique for urologists with no previous experience. MATERIALS AND METHODS: The procedures were performed on a pelvic trainer using a videolaparoscopic unit. The program consisted of a simple suture, urethrovesical anastomosis with interrupted sutures, and urethrovesical anastomosis with continuous sutures. The trainees enrolled in this study were 5 residents from the urologic department who had little experiences in laparoscopic suturing. The trainees performed each procedure 10 times and the elapsed time was recorded. Univariate analysis of the general linear model was used to assess the significance of progression. RESULTS: In the first lesson of the simple suture, the mean elapsed time was 5.45+/-3.00 minutes (range 2.78-9.83minutes) and each trainee demonstrated a difference in the elapsed time for suturing. After the tenth lesson was complete, the mean elapsed time was 1.48+/-0.17 minutes (range 1.35- 1.70 minutes) and the time differences between each trainee decreased. In urethrovesical anastomosis with interrupted sutures, the mean elapsed time decreased from 24.07+/-3.97 minutes at the 1st lesson (range 16.13- 29.47 minutes) to 13.10+/-2.53 minutes (range 11.75-19.47 minutes) after 10 lessons. In urethrovesical anastomosis with continuous sutures, the mean time decreased from 39.61+/-3.60 minutes (range 34.41-45.71 minutes) after one lesson to 30.42+/-5.75 minutes (range 19.50-38.82 minutes) after 10 lessons. There were significant differences in the elapsed time up to the 2nd lesson compared with the 10th lesson in all procedures (p-value<0.05). CONCLUSIONS: The skills of the trainee can be improved by a model and a program for training laparoscopic urethrovesical anastomosis. In particular, urethrovesical anastomosis, in which many urologists find difficulty, may become more accessible using this model and program.
Anastomosis, Surgical ; Laparoscopy ; Linear Models ; Suture Techniques ; Sutures