The Taylor's approach is a special paramedian approach to enter the L5-S1 interspace. The L5-S1 interspace is the largest in vertebral column. This approach is particularly useful when the interspace has been narrowed by pathologic bone destruction such as rheumatoid arthritis or osteoarthritis. Surgery in geriatric patients is associated with a markedly higher incidence of perioperative complication or mortality rate. Optimal anesthetic management of geriatric patients depends on understanding of the normal anatomy and physiologic changes in response to drug in aging. We studied of 3-geriatric patients with Taylor's approach. These patients had problems with respiratory dysfunction and anatomic constraints, which make other approaches unfeasible.
Aging ; Arthritis, Rheumatoid ; Humans ; Incidence ; Mortality ; Osteoarthritis ; Spine

Amebiasis is an infectious disease caused by Entameba histolytica. Amebiasis remains an extremely important consideration in the differential diagnosis of diarrhea, especially when there is associated bleeding. It is imperative that appropriate studies to establish or exclude the diagnosis of amebiasis be carried out in all patients who present with a clinical and sigmoidoscopic picture of colitis, and that patients treated with metronidazole for amebiasis have adequate clinical and parasitological follow-up. We have experienced one case of intestinal amebiasis with protein losing enteropathy in 30month-old boy whose chief complaint was mild fever, vomiting and blood tinged diarrhea. His laboratory findings were compatible with protein losing enteropathy. The diagnosis of amebiasis is confirmed by observation of trophozoite of E. histolytica in the stools. A brief review with related literatures is also presented.
Amebiasis ; Colitis ; Communicable Diseases ; Diagnosis ; Diagnosis, Differential ; Diarrhea ; Dysentery, Amebic* ; Fever ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Metronidazole ; Protein-Losing Enteropathies* ; Tolnaftate ; Trophozoites ; Vomiting

To further define the prognostic factors associated with long term survival of hepatocellular carcinoma, we retrospectively studied 371 patients with pathologically diagnosed hepatocellular carcinoma who underwent curative hepatic resection between 1991 and 1995. We included the 16 patients who underwent noncurative hepatic resection in calculating overall survival. The male to female ratio was 5.1 to 1 and their average age was 52.5 years. About 20 variables were subject to univariate and multivariate analysis and their survivals were calculated using the Kaplan-Meier method. 55.6% of (220 of 396) patients had liver cirrhosis and 73.2% of (290 of 396) patients were positive in HBsAg. Operative mortality and inhospital death rate were 1.5% and 0.8%, each and postoperative morbidity rate was 22.5%. The cumulative 1, 3 and 5 year survival rates including noncurative resected cases were 85.9%, 67.2% and 54.8%, respectively. The cumulative 1, 3 and 5 year survival rates of 371 curative resected cases were 87.3%, 68.7% and 56.4%, respectively. Disease free 1, 3, 5 year survival rates of 371 curative resected cases were 74.8%, 48.2% and 40.8%, respectively. The factors such as alpha- fetoprotein, Child's classification, prothrombin time, extent of liver resection, and number of tumor were statistically significant factors associated with cumulative survival.(p<0.05) And alpha-fetoprotein, total necrosis after TACE, viral hepatitis, and invasion of portal vein were significant factors associated with cumulative disease free survival. Only alpha-fetoprotein was associated significantly with cumulative survival and cumulative disease free survival. Length to the resection margin was not significantly associated with survival.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Classification ; Disease-Free Survival ; Female ; Fetal Proteins ; Hepatectomy ; Hepatitis ; Hepatitis B Surface Antigens ; Humans ; Liver ; Liver Cirrhosis ; Male ; Mortality ; Multivariate Analysis ; Necrosis ; Portal Vein ; Prothrombin Time ; Retrospective Studies ; Survival Rate

OBJECTIVES: The purpose of present study is to identify the differences between temperament and character traits among adolescents classified by ego resilience and ego control level. METHODS: A Junior Temperament and Character Inventory (TCI) was performed on participants, and a California Child Q-Test (CCQ) was tested for by the parents of the adolescent participants. RESULTS: The result of the factor analysis and discriminant analysis show that the participants are classified into three different groups based on CCQ score and item response patterns. The three groups are named the ego resilience group, the undercontrolled group, and the overcontrolled group. The ego resilience group indicates that they have a high level of interest and curiosity but yet they are not easily tempered. Moreover, they behave proactively with a reasonable level of responsibility in order to improve themselves. In contrast, among the undercontrolled group, it is observed that, although the group shows even higher level of interest, curiosity and honesty, they are careless, more impulsive, and have a lack of delayed gratification and shame. CONCLUSION: The overcontrolled group shows that they are the most cautious and reflective group among the three but also show emotional instability such as strong criticism and passive-aggressiveness. In this study, implications and limitations are discussed.
Adolescent ; California ; Child ; Ego ; Exploratory Behavior ; Humans ; Parents ; Temperament

Ulnar nerve compression at the elbow can occur at any site that begins proximally at the arcade of Struthers and end distally where the nerve exits the flexor carpi ulnaris muscle in the forearm. We experienced one case of ulnar nerve palsy due to multiple ganglion cysts which had occured at the elbow joint. A complete excision of ganglion cysts and anterior transposition of the ulnar nerve were performed. The clinical result was satisfactory
Elbow Joint ; Elbow* ; Forearm ; Ganglion Cysts* ; Ulnar Nerve Compression Syndromes ; Ulnar Nerve* ; Ulnar Neuropathies*

To determine whether the PPARalpha agonist fenofibrate regulates obesity and lipid metabolism with sexual dimorphism, we examined the effects of fenofibrate on body weight, white adipose tissue (WAT) mass, circulating lipids, and the expression of PPARalpha target genes in both sexes of high fat diet-fed C57BL/6J mice. Both sexes of mice fed a high-fat diet for 14 weeks exhibited increases in body weight, visceral WAT mass, as well as serum triglycerides and cholesterol, although these effects were more pronounced among males. Feeding a high fat diet supplemented with fenofibrate (0.05% w/w) reduced all of these effects significantly in males except serum cholesterol level. Females on a fenofibrate-enriched high fat diet had reduced serum triglyceride levels, albeit to a smaller extent compared to males, but did not exhibit decreases in body weight, WAT mass, and serum cholesterol. Fenofibrate treatment resulted in hepatic induction of PPAR alpha target genes encoding enzymes for fatty acid beta-oxidation, the magnitudes of which were much higher in males compared to females, as evidenced by results for acyl-CoA oxidase, a first enzyme of the beta-oxidation system. These results suggest that observed sexually dimorphic effects on body weight, WAT mass and serum lipids by fenofibrate may involve sexually related elements in the differential activation of PPARalpha.
Adipose Tissue/drug effects/metabolism ; Animals ; Body Composition/drug effects ; Body Weight/drug effects ; Diet ; Dietary Fats/pharmacology ; Female ; Gene Expression Regulation/drug effects ; Lipids/blood/*metabolism ; Liver/drug effects/metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Obesity/*metabolism/pathology ; Organ Weight/drug effects ; Procetofen/*pharmacology ; Receptors, Cytoplasmic and Nuclear/*agonists ; *Sex Characteristics ; Time Factors ; Transcription Factors/*agonists

The expression of inducible nitric oxide synthase (iNOS) is a critical factor in both normal physiological functions and the pathogenesis of disease. This study was undertaken to determine the molecular mechanism by which nitric oxide (NO) exerts negative feedback regulation on iNOS gene expression. Isolated rat hepatocytes stimulated with cytokines exhibited a marked increase in NO production as well as iNOS mRNA and protein levels, which were significantly reduced by pretreatment of the NO donors S-nitroso-N-acetyl-D, L-penicillamine (SNAP) and V-PYRRO/NO. This effect of SNAP was inhibited when NO was scavenged using red blood cells. Pretreatment with oxidized SNAP, 8-Br-cGMP, NO2-, or NO3- did not suppress the cytokine-induced NO production. Moreover, LPS/ IFN-gamma-stimulated RAW264.7 cells, which produce endogenous NO, expressed lower levels of iNOS, IL-1beta, IL-6 and TNF-alpha mRNAs, without changes in their mRNA half-lives, than those in the presence of the iNOS inhibitor NG-monomethyl- L-arginine. The iNOS gene transcription rate exhibited an 18-fold increase after cytokine stimulation, which was significantly inhibited by SNAP pretreatment. SNAP also blocked cytokine- induced increase in NF-kappa B activation, iNOS promoter activity, nuclear translocation of cytosolic NF-kappa B p65 subunit, and I kappa B alpha degradation, which correlated with its inhibitory effect on phosphorylation and ubiquitination of I kappa B. These data indicate that NO down-regulates iNOS gene expression and NO production by inhibiting the post-translational processes of I kappa B alpha thereby preventing NF-kappa B activation. These results identify a novel negative feedback mechanism whereby NO down-regulates iNOS gene expression.
Animals ; Cell Line ; Cell Nucleus/metabolism ; Cyclic GMP/*analogs & derivatives/pharmacology ; Cytokines/genetics/metabolism ; *Down-Regulation ; Hepatocytes/metabolism ; I-kappa B/*metabolism ; Lipopolysaccharides/pharmacology ; Nitric Oxide/biosynthesis/*physiology ; Nitric-Oxide Synthase/biosynthesis/*genetics ; Penicillamine/*analogs & derivatives/pharmacology ; Phosphorylation ; Promoter Regions (Genetics)/genetics ; *Protein Processing, Post-Translational ; Protein Transport ; Rats ; Research Support, Non-U.S. Gov't

Purpose: Placing dental implants in areas with low bone density or in conditions where bone healing is suppressed is challenging for clinicians. An experiment using a rodent model was performed with the aim of determining the efficacy of host modulation by increasing the systemic level of cholesterol sulfate (CS) using Irosustat in the context of the bone healing process around dental implants. Methods: In 16 ovariectomised female Sprague-Dawley rats, 2 implant fixtures were placed in the tibial bones (1 fixture on each side). At 1 week after surgery, the high-CS group (n=8) received Irosustat-mixed feed, while the control group (n=8) was fed conventionally. Block specimens were obtained at 5 weeks post-surgery for histologic analysis and the data were evaluated statistically (P<0.05). Results: Unlike the high-CS group, half of the specimens in the control group demonstrated severe bone resorption along with a periosteal reaction in the cortex. The mean percentages of bone-to-implant contact (21.5%) and bone density (28.1%) near the implant surface were significantly higher in the high-CS group than in the control group (P<0.05), as was the number of Haversian canals (by 5.3). Conclusions Host modulation by increasing the CS level may enhance the osseointegration of dental implants placed under conditions of impaired bone healing.

PURPOSE: Recurrence is one of the most common complications after primary correction for hallux valgus deformities. The purpose of this study was to evaluate the usefulness of Scarf osteotomy with axial decompression in the treatment of recurrent hallux valgus. MATERIALS AND METHODS: From April 2006 to April 2011, 14 cases (12 patients) of recurrent hallux valgus were managed with shortening Scarf osteotomy. Preoperative and postoperative radiographs were reviewed for the measurement of the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the amount of the 1st metatarsal shortening. Clinical outcomes including the visual analogue scale (VAS), the AOFAS score, and the range of motion [ROM] of the 1st metatarsophalangeal (MTP) joint were evaluated. RESULTS: The mean HVA decreased from 27.9 degrees to 5.2 and the mean IMA decreased from 12.9 to 3.4. The mean VAS improved from 5.3 to 0.3 and the mean AOFAS score improved from 41 to 90. The mean amount of the 1st metatarsal shortening was 3.4 mm (2-5). The mean ROM of the 1st MTP joint improved from 22 degrees (15-35) to 68 (55-75). CONCLUSION: Scarf osteotomy associated with axial decompression can be a useful revision procedure for the treatment of recurrent hallux valgus deformity.
Congenital Abnormalities ; Decompression ; Hallux Valgus* ; Hallux* ; Joints ; Metatarsal Bones ; Osteotomy* ; Range of Motion, Articular ; Recurrence

Unilateral femoral neck factures are common and their incidence is increasing. However, simultaneous bilateral femoral neck fractures are rare. Although cases of simultaneous bilateral femoral neck fractures have been reported, most were caused by strong muscle contractions during electroconvulsive therapy. Simultaneous bilateral femoral neck fractures caused by a simple fall are an extremely rare injury; therefore, limited literature is available, and no case has been reported in Korea. We report herein a case of simultaneous bilateral femoral neck fractures caused by a simple fall. An 83-year-old woman visited the emergency department with bilateral hip joint pain and gait disturbance, which developed 1 day after a fall. Tenderness and severe limitation in left hip joint range of motion and mild limitation in right hip joint range of motion were observed on a physical examination. A Garden type IV femoral neck fracture in the left hip joint and a Garden type I femoral neck fracture in the right hip joint were observed on plain radiography. She underwent right screw fixation and left bipolar hemiarthroplasty 2 days after admission. The patient could walk using a walker 4 weeks postoperatively. Bone union in the right femoral neck was observed at the 3 month follow-up. No specific findings were observed at the left hip hemiarthroplasty site.
Aged, 80 and over ; Electroconvulsive Therapy ; Emergency Service, Hospital ; Female ; Femoral Neck Fractures ; Femur Neck* ; Follow-Up Studies ; Gait ; Hemiarthroplasty ; Hip ; Hip Joint ; Humans ; Incidence ; Korea ; Muscle Contraction ; Physical Examination ; Radiography ; Range of Motion, Articular ; Walkers