The atlantoaxial joint has a little stability and is secured and supported chiefly by soft tissue such as ligaments and articular capsule, so it has free motions to all directions. Relaxation or rupture of these supportive structures due to inflammation or trauma may cause instability or subluxation, and it results in compression of the spinal cord and it reveals various neurologic symptoms. The atlantoaxial rotatory subluxation, the rare disease found in children mostly, is known to be one of the reasons of the temporal torticollis in children. An adult type is very rare, but it is possible to be combined with rheumatoid arthritis and/or trauma, but we experienced the 25-year-old female patient who had the atlantoaxial rotatory subluxation spontaneously without rheumatoid arthritis and/or trauma, so we report this case with review of literature.
Adult ; Arthritis, Rheumatoid ; Atlanto-Axial Joint ; Axis, Cervical Vertebra ; Child ; Female ; Humans ; Inflammation ; Joint Capsule ; Ligaments ; Neurologic Manifestations ; Rare Diseases ; Relaxation ; Rupture ; Spinal Cord ; Torticollis

Thyrotoxic periodic paralysis (TPP) is rare in white Caucasian but a few in Asian. A 36-year-old man presented with suddenly developed paraparesis was brought by ambulance. He got some medications and injection for the upper respiratory infection in the morning of admission day. On admission he revealed bilateral proximal muscle weakness without pain. He didn't have any specific medical history of himself and his family. The laboratory results on admission revealed severe hypokalemia (2.1 mM/l). Potassium replacement was immediately started and his symptom was gone. We found TSH was extremely decreased (<0.005 microIU/ml) but T3 and T4 were within normal level. We guess TPP was induced by some drugs to the patient with sub-clinical hyperthyroidism. Hyperthyroidism is not always clinically apparent and then may be easily missed. However just a single medication or injection that is usually prescribed can induce critical progressive hypokalemia.
Adult ; Ambulances ; Asian Continental Ancestry Group ; Humans ; Hyperthyroidism* ; Hypokalemia ; Muscle Weakness ; Paralysis ; Paraparesis ; Potassium

PURPOSE: The objectives of this study are to describe the outcome of adolescent idiopathic scoliosis (AIS) patients treated with Video Assisted Thoracoscopic Surgery (VATS) plus supplementary minimal incision in the lumbar region for thoracic and lumbar deformity correction and fusion. MATERIALS AND METHODS: This is a case series of 13 patients treated with VATS plus lumbar mini-open surgery for AIS. A total of 13 patients requiring fusions of both the thoracic and lumbar regions were included in this study: 5 of these patients were classified as Lenke type 1A and 8 as Lenke type 5C. Fusion was performed using VATS up to T12 or L1 vertebral level. Lower levels were accessed via a small mini-incision in the lumbar area to gain access to the lumbar spine via the retroperitoneal space. All patients had a minimum follow-up of 1 year. RESULTS: The average number of fused vertebrae was 7.1 levels. A significant correction in the Cobb angle was obtained at the final follow-up (p = 0.001). The instrumented segmental angle in the sagittal plane was relatively well-maintained following surgery, albeit with a slight increase. Scoliosis Research Society-22 (SRS-22) scores were noted have significantly improved at the final follow-up (p < 0.05). CONCLUSION: Indications for the use of VATS may be extended from patients with localized thoracic scoliosis to those with thoracolumbar scoliosis. By utilizing a supplementary minimal incision in the lumbar region, a satisfactory deformity correction may be accomplished with minimal post-operative scarring.
Adolescent ; Child ; Female ; Humans ; Male ; Scoliosis/*surgery ; Thoracic Surgery, Video-Assisted/*methods ; Treatment Outcome

OBJECTIVE: To confirm practical usefulness of the newly invented automatic identifying instrument for the spinal epidural space. METHOD: Epidural block with blind approach has been done for the patients who suffered from lower back pain with radiating pain due to spinal disorders. Conventional blind approaches using the glass syringe (control group) and the newly invented instrument (experimental group) were applied to each 30 patients, respectively. Epidurography was used for the confirmation to conclude success or not. RESULTS: Two cases were failed in the control group. One case showed injected contrast media in the interspinal ligament, another case revealed dura-puncture. But there was no failure in the experimental group. The mean timefrom skin-penetration to epidurography was 299.7+/-13.6 second in control group and 184.0+/-16.3 second in experimental group. The mean time from changing to glass syringe (control group) or epidural detector (experimental group) to epidurography was 146.0+/-14.0 second in control group and 60.0+/-7.0 second in experimental group. The time for epidural block was much less in experimental group (p<0.001). CONCLUSION: This newly invented epidural detector could make the epidural block easier, safer, and faster. We suggest this instrument is useful complementary method for spinal epidural procedure.
Back Pain ; Contrast Media ; Epidural Space* ; Glass ; Humans ; Ligaments ; Low Back Pain ; Syringes

OBJECTIVE: To investigate the relationship between autonomic neuropathy and peripheral neuropathy through analysis of heart rate variability (HRV) in diabetic patients, and ultimately to investigate usefulness for HRV analysis for quantitative evaluation and prediction of diabetic autonomic neuropathy. METHOD: We performed nerve conduction study (NCS), H- reflex, and HRV test with 42 diabetic patients. We classified patients by presence of peripheral neuropathy and abnormality of H-reflex, respectively. By comparing standard deviation of RR interval (SDNN), high frequency (HF), low frequency (LF), very low frequency (VLF), and total power (whole level of frequency, TP) of HRV, we analyzed the relationship between these parameters and duration of diabetes, age, and results from NCS. RESULTS: There were significant differences of SDNN, HF, TP according to the presence or the absence of peripheral neuropathy. There were significant differences of SDNN, HF according to the presence or the absence of H-reflex abnormality. SDNN and HF had reversed-relationship to the degree of H-reflex abnormality. CONCLUSION: We expect HRV might be used as an efficient quantitative method to detect diabetic autonomic neuropathy and suggest HRV to be used for early detection of diabetic peripheral neuropathy.
Diabetic Neuropathies* ; Evaluation Studies as Topic* ; H-Reflex ; Heart Rate* ; Heart* ; Humans ; Neural Conduction ; Peripheral Nervous System Diseases ; Reflex

PURPOSE: The purpose of this study is to report the comparative results of thoracoscopic correction achieved via cantilever technique using a 4.5 mm thin rod and the poly-axial reduction screw technique using a 5.5 mm thick rod in Lenke type 1 adolescent idiopathic scoliosis (AIS). MATERIALS AND METHODS: Radiographic data, Scoliosis Research Society (SRS) patient-based outcome questionnaires, and operative records were reviewed for forty-nine patients undergoing surgical treatment of scoliosis. The study group was divided into a 4.5 mm thin rod group (n = 24) and a 5.5 mm thick rod group (n = 25). The radiographic parameters that were analyzed included coronal curve correction, the most caudal instrumented vertebra tilt angle correction, coronal balance, and thoracic kyphosis. RESULTS: The major curve was corrected from 49.8degrees and 47.2degrees pre-operatively to 24.5degrees and 18.8degrees at the final follow-up for the thin and thick rod groups, respectively (50.8% vs. 60.2% correction). There were no significant differences between the two groups in terms of kyphosis, coronal balance, or tilt angle at the time of the final follow-up. The mean number of levels fused was 6.2 in the thin rod group, compared with 5.9 levels in the thick rod group. There were no major intraoperative complications in either group. CONCLUSION: Significant correction loss was observed in the thin rod system at the final follow-up though both groups had comparable correction immediately post-operative. Therefore, the thick rod with poly axial screw system helps to maintain post-operative correction.
Adolescent ; Adult ; *Bone Screws ; Female ; Humans ; Male ; Retrospective Studies ; Scoliosis/radiography/*surgery ; Thoracic Surgery, Video-Assisted/*methods ; Treatment Outcome

BACKGROUND/AIMS: The Model for End-Stage Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The MELD score is a reliable measurement of mortality risk and is suitable for a disease severity index in patients with end-stage liver disease. We examined the validity of the MELD as a disease severity index for patients with end-stage liver disease. METHODS: We investigated the 379 patients with liver cirrhosis hospitalized between January 1995 and May 2001. We retrospectively reviewed the hospital records to verify the diagnosis of cirrhosis and to collect exact patient information about their demographic data, portal hypertensive complications and laboratory data. The ability to classify patients with liver cirrhosis according to their risk of death was examined using the concordance c-statistic. RESULTS: The MELD score performed well in predicting death within 3 months with a c-statistic of 0.73 with etiology and 0.71 without etiology. The significant clinical, laboratory variables on 3 month survival in patients with liver cirrhosis are serum bilirubin, ascites and hepatic encephalopathy. The addition of portal hypertensive complications to the MELD score did not improve the accuracy of the MELD score. CONCLUSIONS: The MELD score is a useful disease severity index for the patients with end-stage liver disease and provides reliable measurement of short term survival over a wide range of liver disease severity and diverse etiology.
Adult ; Bilirubin/blood ; Creatinine/blood ; Female ; Humans ; International Normalized Ratio ; Liver Cirrhosis/blood/*mortality ; Male ; Middle Aged ; Risk Factors ; Severity of Illness Index ; Survival Rate

PURPOSE: Interindividual genetic differences in susceptibility to chemical carcinogens are one of the most important host factors in human cancer. The genetically determined differences in metabolism, related to cytochrome P450 (CYP450) genes have been reported to be associated with various cancer susceptibility. The present study was set up to establish the frequency of the polymorphic genotypes of two CYP450 (CYP2E1/PstI and CYP2E1/DraI) isozymes in Korea, to evaluate a possible increased incidence of the genotype associated with higher cervical cancer risks among Korean cervical cancer patients. MATERIALS AND METHODS: In this study, extracted DNAs from 228 cervical cancer patients and 360 normal healthy controls were analysed with the polymerase chain reaction-restriction fragment length polymosphism (PCR-RFLP) method. RESULTS: In the CYP 2E1 genotypes, detected by PstI or RsaI digestion, there were no statistically remarkable differences between the cervical cancer patients and control groups. And when the cervical cancer patients were divided into subgroups with respect to the age, the frequency of CYP 2E1/PstI polymorphisms in the cervical cancer patients under the 40 years old was not significantly higher compared to the controls or the patients above the 40 years old and, c1/c1 genotype was prominent in this type of polymorphism. The frequency of CYP 2E1/DraI polymorphisms in the cervical cancer patients was not significantly higher compared to the controls, and D/D genotype was prominent in this type of polymorphism. In cervical carcinoma, the polymorphic genotypes of CYP 2E1 were not correlated to other parameters including clinical stage, histological tumor type, and degree of differentiation. CONCLUSION: These results suggest that individuals carrying CYP 2E1/PstI (c1/c1) or CYP 2E1/DraI (D/D) alleles are not genetically susceptible to cervical cancer in Korea.
Adult ; Alleles ; Carcinogens ; Cytochrome P-450 CYP2E1* ; Cytochrome P-450 Enzyme System* ; Cytochromes* ; Digestion ; DNA ; Genetic Predisposition to Disease* ; Genotype ; Humans ; Incidence ; Isoenzymes ; Korea ; Metabolism ; Uterine Cervical Neoplasms*