PURPOSE: To determine the accuracy of MRI on postoperative pain syndrome (POPS), including early complications such as hematoma or infection. MATERIALS AND METHODS: Of the 54 patients with the POPS, we analyzed pre-operative MRI findings compared with operative findings on 39 patients, excluding nonunion, instability, metal failure and pseudarthrosis, who underwent an operation for POPS from December 1994 to June 1997. There were 25 men (64.1%) and 14 women (35.9%), aged from 16 to 68 years (average 44.5 years). They were divided into 5 subgroups and calculated for sensitivity, specificity and positive predictability. RESULTS: MRI accuracy in recurred disc was 84%, scar adhesion, recurred or developed stenosis, infection and hematoma was 100% for each overall accuracy of MRI was 93%. Average interval of reoperation in POPS was 3.2 years. In 21 cases (53.8%), symptoms persisted without pain-free interval after first operation. CONCLUSIONS: Early complications, including hematoma and infection, are easily detected with MRI. Especially if patient complains of severe leg pain or neurologic deficit, MRI is a good diagnostic tool. MRI is a useful method for evaluation of most cases of POPS, but it is limited in evaluating recurred disc or scar adhesion only in T1, T2 weighted image. Therefore, Gd-DTPA enhancement is necessary for an accurate diagnosis.
Cicatrix ; Constriction, Pathologic ; Diagnosis ; Female ; Gadolinium DTPA ; Hematoma ; Humans ; Leg ; Magnetic Resonance Imaging* ; Male ; Neurologic Manifestations ; Pain, Postoperative* ; Pseudarthrosis ; Reoperation ; Sensitivity and Specificity

Cubitus varus deformity is the late complication of the supracondylar fracture of humerus which is common in growing children. If the deformity is severe it causes tunctional problems as well as cosmetic ones necessitating conective osteotomy. Though many authors devised different methods of corrective osteotomy, the cosmetic results are not always satisfactory because of the development of the lazy S deformity hy the lateral prominence. Technically. the initial stahility of the osteotomy is also poor due to the poor contact of the osteotomy site. So we have devised a new quadrilateral displacement osteotomy to increase the initial stability of the osteotomy by creating a wedge on the osteotomy site & also to prevent the development of the lazy S deformity hy elimination of the Interal prominence. We treated 9 cases of cubitus varus deformity with the new quadrilateral displacement osteotomy. The correction technique was not difficult & the initial stahility of the osteotomy is rather good & the osteotomy is fixed by the conventional methods, & all of the cases were healed uneventfully. There developed no the lazy & deformity after osteotomy. We would like to report the details ot the supracondylnrquadrilateral displacemenl osteotomy.
Child ; Congenital Abnormalities* ; Humans ; Humerus ; Osteotomy*

Lactococcus garvieae is a Gram-positive cocci that has been known to be a fish pathogen, and considered as a low virulence organism rarely associated with human infection. We report a case of acute cholangitis with common bile duct (CBD) stone and bacteremia by L. garvieae bacteremia in a 70-year-old male. The patient presented with epigastric pain and was diagnosed with two CBD stones. Blood culture obtained prior to empiric antimicrobial therapy with ceftizoxime sodium showed growth with Escherichia coli and L. garvieae. The bacteria were confirmed by matrix-assisted desorption/ionization time-of-flight mass spectrometry. Initial attempt at endoscopic biliary drainage failed, and the patient underwent percutaneous transhepatic biliary drainage and subsequent stone removal. He occasionally ingested raw fish and had a history of gastric ulcer with acid suppression therapy, which could be possible risk factors for L. garvieae infection. This is the first case of L. garvieae bacteremia in acute cholangitis.

The prognosis for pancreatic cancer is still poor with a 5-year survival rate around 10%. We report a case of complete remission after palliative chemotherapy for pancreatic cancer in a 61-year-old-female. She presented with indigestion and weight loss. A computed tomography scan revealed a 1.8 cm mass in the pancreatic head. Carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) levels were elevated. The patient underwent endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) and the pathologic examination showed adenocarcinoma. Positron emission tomography (PET) and magnetic resonance imaging (MRI) of the pancreas showed a metastatic nodule in the S6 segment of the liver and a metastatic portocaval lymph node. The final diagnosis was stage IV pancreatic cancer. The patient received 24 cycles of palliative FOLFIRINOX regimen. Response evaluation demonstrated disappearance of all the lesions. She underwent pyloruspreserving pancreatoduodenectomy (PPPD). The pathologic examination of the surgical specimen showed complete remission of the pancreatic cancer. The patient is currently undergoing adjuvant chemotherapy.

BACKGROUND/AIMS: Liver cirrhosis is an end-stage liver disease. Ito cell is known to have central role in fibrogenes is of liver cirrhosis. But collagen content and Ito cell activity in liver cirr hosis have received little attention. So Ito cell activity and hepatocyte proliferation activity according to collagen content was investigated. WAF-1 and c- met were studied to evaluate the effect of cell cycle. METHODS: We analyzed 56 cases of liver cirrhosis ( viral:41, biliary:11, alcoholic:2, Wilson' s disease:2). Collagen content was measured by spectrophot ometry. Ito cell activity and prolifer ation index was measured by-SMA and Ki- 67 immunohistochemistry. RESULTS: In viral cirrhosis, high collagen group showed increased Ito cell activity compared to low collagen group. There was no difference in hepatocyte prolifer ation activity bet ween high and low collagen group in viral cirrhosis. In biliary cirrhos is, high collagen group showed increased Ito cell activity in septal zones compared to low collagen group. WAF- 1and c- met were negative in most of cases. CONCLUSION: Collagen content of liver cirrhosis is closely related to increment of activated Ito cells . Ito cell activity was prominent in septal zones than in parenchymal areas of viral cirrhosis and that was only significant in septal zones of biliary cirrhosis. There is no correlation bet ween collagen content and hepatocyte proliferation activity.
Cell Cycle ; Collagen* ; Fibrosis ; Hepatic Stellate Cells ; Hepatocytes* ; Immunohistochemistry ; Liver Cirrhosis* ; Liver Cirrhosis, Biliary ; Liver Diseases ; Liver*

No abstract available.
Antibodies*

OBJECTIVE: To evaluate the effects of botulinum toxin A (BT) dilution volume and post- injection exercise with electrical stimulation on muscle paralysis. METHOD: Eighteen New Zealand white rabbits are randomly assigned to 0.1 ml dilution group, 0.5 ml dilution group or control group. Control group did not receive any injection and 10 units of BT was diluted with 0.1 ml (B1) or 0.5 ml (B5) normal saline and injected to the both gastrocnemius muscles. The right lower limbs of experimental groups did not have any treatment after botulinum toxin A injection (B1C, B5C) and left lower limbs had stretching exercise after injection (B1S, B5S) for 2 hours using the pneumatic kicking machine. Electrical stimulation was also applied to the gastrocnemius muscle with the intensity of 20 mA to 30 mA to evoke plantar flexion of ankle joint. Muscle paralysis effect of BT was evaluated with compound muscle action potential (CMAP) amplitude of gastrocnemius muscle with the sciatic nerve stimulation before and 1 week after injection. RESULTS: There were significant CMAP amplitude decreases in all animals after BT injection. There were significant decreases of CMAP amplitudes in B5 group compared with that of B1 group (p<0.001). Left limbs with stretching exercise and electrical stimulation showed lower CMAP amplitude (p=0.01) compared with right limbs which did not have any treatment after BT injection. CONCLUSION: To maximize muscle paralysis effect of the botulinum toxin A, increasing dilution volume and performing post-injection stretching exercise with electrical stimulation are considered a good strategy.
Action Potentials ; Animals ; Ankle Joint ; Botulinum Toxins* ; Electric Stimulation ; Extremities ; Lower Extremity ; Muscle, Skeletal* ; Muscles ; Paralysis* ; Rabbits ; Sciatic Nerve ; Stroke ; Urinary Bladder Neck Obstruction

Clinical isolates of Enterobacteriaceae (189 Klebsiella, 61 Enterobacter, 32 Serratia, 19 E. coli, 7 Proteus, and 3 Citrobacter) from one university hospital were epidemiologically analyzed by using transferable R plasmids resistant beta-lactam antibiotics including broad-spectrum cephalosporins. About 30% of E. cloacae and S. marcescens and about 5% of K. pneumoniae were resistant to one or more broad-spectrum j3-lactam antibiotics including cefotaxim, ceftazidime, aztreonam, or cefoxitin but all isolates of E. aerogenes, K oxytoca, and P. mirabilis were susceptible. Thirty-six conjugative R plasmids including 8 plasmids resistant expanded-spectrum cephalosporins were obtained from multiple resistant K. pneumoniae (19), E. cloacae (9), E. coli (4), and C. freundii (1). Thirty-one plasmids were subjected to R plasmid analysis and classified 20 different plasmid types. Among them 5, 2, and 2 plasmids belong to 3 different types respectively showed identical molecular size, endonuclease fragment pattern by Southem hybridization pattern by TEM-1 probe, pI value by isoelctric focusing, and also identical antibiogram and biotype of wild strains harboring plasmids. But all of plasmids resistant to cefotaxim, ceftazidime, aztreonam or cefoxitin showed different palsmid anlysis patterns. These results indicate that the epidemic strains of 3 clonal types had been present in this hospital and anlysis using transferable R plasmid and bla gene can be used to discriminate multi-resistant clinical isolates of Enterobacteriaceae.
Anti-Bacterial Agents* ; Aztreonam ; Cefotaxime ; Cefoxitin ; Ceftazidime ; Cephalosporins ; Cloaca ; Dermatoglyphics* ; Enterobacter ; Enterobacteriaceae* ; Klebsiella ; Microbial Sensitivity Tests ; Mirabilis ; Plasmids* ; Pneumonia ; Proteus ; R Factors ; Serratia

STUDY DESIGN: Thirty-seven patients with spinal tuberculosis were evaluated according to surgical method. OBJECTIVES: To evaluate the effectiveness of posterior spinal instrumentation in the surgical treatment of patient with tuberculous spondylitis. SUMMARY OF LITERATURE REVIEWS: There are many debates about the effectiveness of posterior spinal instrumentation combined with anterior interbody fusion in tuberculous spondylitis. MATERIALS AND METHODS: From January 1995 to June 2000, 37 patients were divided into two groups depending on their use of posterior spinal instrumentation. Group I consist of thirteen patients who were treated with conventional anterior corpectomy and anterior interbody fusion using autogenous strut bone graft. Group II was composed of twenty-four patients who were treated with conventional anterior corpectomy and anterior interbody fusion combined with posterior spinal instrumentation. Changes of corrected kyphotic angle and complication were measured using pre-, post-operative and follow-up radiographs and chart review. RESULTS: In group I, six cases (46.2%) showed loss of corrected kyphotic angle. Of these six cases, five cases had initial kyphotic angle of more than 20 dgree and three cases had involvement of two or more vertebrae. All six cases had thoracic or thoracolumbar involvement. Comparing two groups, maintaining corrected kyphotic angle and low complication rates were obtained in group II during follow-up period. The change of deformity as followed. In thoracic area, the mean kyphotic angle of 26.5 dgree was reduced to 18 dgree postoperatively, At the most recent follow-up, the mean kyphotic angle was 31.5 dgree in group I, a loss of correction of 13.5 dgree . In group II, the mean kyphotic angle was corrected from 27 dgrees to 13.5 dgree after surgery. At the most recent follow-up, the mean kyphotic angle was 17.5 dgrees, a loss of correction of 4 dgree . CONCLUSION: Posterior spinal instrumentation combined with conventional anterior corpectomy and anterior interbody fusion were found to be effective for preventing loss of kyphotic angle and for maintaining stable bone fusion in patients with mean
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Spine ; Spondylitis* ; Transplants ; Tuberculosis, Spinal

Background: Thioacetamide is a classic hepatotoxic reagent which leads to the reproducible hepatic fibrosis in rats. Thioacetamide-induced fibrosis is an appropriate model for cirrhosis in humans due to the long duration of course and similiar histology. Thioacetamide produces hepatotoxicity through lipid peroxidation but it is unclear whether lipid peroxidation directly correlated with hepatic fibrosis. Pentoxifylline, a derivative of the methylxanthine, showed an antifibrogenic effect in cell cultures of human fibroblasts and some animal models. But this antifibrogenic effect is controversial. Pentoxifylline revealed a hepatoprotective effect in some toxic hepatitis. This hepatoprotective effect seems to influence cell cycle regulatory protein during regeneration. This study aimed to evaluate an effect of pentoxifylline on fibrosis and cell cycle regulatory protein during liver regeneration in thioacetamide-induced rat cirrhosis. Lipid peroxidation assay was compared with collagen content so as to evaluate the correlation with fibrosis. METHOD: Liver cirrhosis was induced by 0.03% oral administration of thioacetamide. Pentoxifylline was administered simultaneously with thioacetamide. The semiquantitative fibrosis index was measured based on histologic finding. Collagen content was estimated by spectrophotometric assay. Activated hepatic stellate cells were counted using alpha-SMA immunohistochemistry. Malondialdehyde, lipid peroxidation metabolite, was estimated by thiobarbituric acid reactive substance assay. Cell cycle regulatory protein was evaluated by western blot. RESULTS: There was no difference in semiquantitative fibrosis index, collagen content and hepatic stellate cell count between thioacetamide treated rats and simultaneous pentoxifylline treated rats. Lipid peroxidation product was not correlated with collagen content. Western blot showed no difference in cell cycle regulatory protein. CONCLUSION: Pentoxifylline does not show an antifibrogenic effect in thioacetamide-induced rat cirrhosis, in which thioacetamide induced hepatocellular damage and fibrosis. Lipid peroxidation may be a secondary effect rather than primary mediating mechanism in hepatic fibrosis.
Administration, Oral ; Animals ; Blotting, Western ; Cell Culture Techniques ; Cell Cycle* ; Collagen ; Drug-Induced Liver Injury ; Fibroblasts ; Fibrosis* ; Hepatic Stellate Cells ; Humans ; Immunohistochemistry ; Lipid Peroxidation ; Liver Cirrhosis* ; Liver Regeneration ; Liver* ; Malondialdehyde ; Models, Animal ; Negotiating ; Pentoxifylline* ; Rats* ; Regeneration ; Thioacetamide