Growth factors influencing the function of chondrocytes are insulin-like growth factor I(IGF-I), basic fibroblast growth factor(bFGF), transforming growth factor-beta1(TGF-beta1), and epidermal growth factor(EGF). To find out the role of four kinds of growth factors in the biosynthesis of type I and II collagen represented as the phenotype of the disc cells, we cultured the disc cells isolated from rabbit intervertebral discs primarily and then checked cell proliferation, the expression of type I and II procollagen mRNA, and the immunohistochemical stains with type I and II collagen antibodies during in vitro culture in the maintenance medium containing low serum concentration with adding four kinds of growth factors. The results are as follows. FBS(10% Fetal bovine serum) group showed the highest cell proliferation potential. EGF and TGF groups showed remarkable cell proliferation, but there was no significant difference in IGF and FGF groups comparing to control group. A partial clone that encodes the rabbit type II procollagen C-propeptide region(RbCo12A1) was successfully isolated by reverse transcription-polymerase chain reaction using total RNA extracted from articular chondrocytes of rabbits. The identity of the cDNA clone was confirmed by DNA sequencing of the polymerase chain reaction products. A comparison of human al(II) cDNA sequence showed high sequence homology(83.6%). Type I procollagen mRNA expressed highly in EGF group. FGF, IGF, and TGF groups showed no significant expression comparing to control group. FBS group showed lower expression than control group. Type II procollagen expression was increased with passage of time, so at Day 10 it was the highest in all groups. Control group showed the highest expression among 6 experimental groups. The expression of type II procollagen in FGF and TGF groups was slightly lower than that of control. EGF and IGF groups showed markedly decreased expression comparing to control group. That in FBS group was the lowest, so it was three times lower than control group. In immunohistochemical stains with type I collagen, there was no difference among control, FBS, and EGF groups. FGF, IGF, and TGF groups showed increased positivity on stain comparing to control group, but the positivity didnt exceed 10%. For type II collagen, EGF and FGF groups showed decreased positivity, but there was no significant difference in FBS, IGF, and TGF groups comparing to control group. On the basis of this study, it may be concluded that TGF-pl showed the possibility of regeneration or delay the degeneration process of the intervertebral disc through the contribution to the stimulatory effects of cell proliferation and the synthesis of type II collagen. For the clinical use of this, more studies about the combination effects with FBS or other kinds of growth factors and finding out the ideal concentration about TGF-pl will be needed.
Antibodies ; Cell Proliferation ; Cells, Cultured* ; Chondrocytes ; Clone Cells ; Collagen Type I ; Collagen Type II ; Collagen* ; Coloring Agents ; DNA, Complementary ; Epidermal Growth Factor ; Fibroblasts ; Humans ; Intercellular Signaling Peptides and Proteins* ; Intervertebral Disc* ; Phenotype ; Polymerase Chain Reaction ; Procollagen ; Rabbits ; Regeneration ; RNA ; RNA, Messenger ; Sequence Analysis, DNA

No abstract available.
Spondylolisthesis* ; Zygapophyseal Joint*

The results of surgical treatment for isthmic spondylolisthesis in children and adolescent have been well documented. Successful clinical results with fusion can be expected in children and adolescent. But in adults, instability was not the only problem. In addition to their instability, adults were more likely to have degenerative disc changes and nerve compression not solved by fusion only. The role of decompression in the surgical treatment of adult isthmic spondylolisthesis remains controversial. Anterior interbody fusion could obtain indirect decompression of nerve root through widening of intervertebral space. Posterolateral fusion with transpedicular fixation could get direct decompression. So, the purpose of this study is to compare the clinical results of the anterior interbody fusion and the posterolateral fusion with transpedicular fixation for the treatment of isthmic spondylolisthesis in adults. We reviewed the clinical data of 40 adult patients who had been taken operation due to isthmic spondylolisthesis from June, 1977 to June, 1994. The anterior interbody fusion was performed in 20 patients (Group I) and the posterolateral fusion with transpedicular fixation was performed in 20 patients (Group II). The mean age of group I was 44.1 years old (21-62), and that of group II was 41.3 years old (21-57). The gender of patients was 8 males and 12 females in group I, and 5 males and 15 females in group II. The symptoms and signs of group I and II were similar. The duration of follow-up was average 3.6 years (1.1-16 years) in group I and average 2.3 years (1.1-6 years) in group II. The anterior slippage of group I by Taillard method was 16.1% and was corrected into 10.4% after opera-up was average 3.6 years (1.1-16 years) in group I and average 2.3 years (1.1-6 years) in group II. The anterior slippage of group I by Taillard method was 16.1% and was corrected into 10.4% after operation. That of group II was 15.2% and corrected into 9.8% after operation. The fusion rate at 12 months after operation was 90% in group I and 95% in group II. The clinical results were analysed by Kim's criteria that was focused on the improvement of clinical symptoms. The satisfactory results were obtainted in 85 % of group I and 90 % of group II. So there was no significant difference of clinical results between the anterior interbody fusion and the posterolateral fusion with transpedicular fixation for the treatment of isthmic spondylolisthesis in adults (p<0.05).
Adolescent ; Adult* ; Child ; Decompression ; Female ; Follow-Up Studies ; Humans ; Male ; Spondylolisthesis

No abstract available.
Lithium Chloride* ; Lithium*

No abstract available.
Humans ; Infant, Newborn*

BACKGROUND: Hemophagocytic lymphohistiocytosis(HLH) is a rare and fatal disorder in children. Recently its clinical characteristics and etiology of uncontrolled activation of cellular immune system in genetically predirected patients have keen elucidated. The authors analyzed the clinical characteristics and response to immunosuppressive agents of HLH patients in single institute. METHODS: The authors retrospectively analyzed various clinical data including CSF and bone marrow examination at diagnosis and follow up period in the 6 patients who were diagnosed as HLH at Asan Medical Center during last 2 years. Antithymocyte globulin(ATG : 10 mg/kg/day) and methylprednisolone(methyl-PD: 5 mg/kg/day) for 5 consecutive days as induction treatment and cyclosporin A(CsA) as maintenance treatment after induction with weekly intrathecal methotrexate for 5-6 weeks were given to the recently diagnosed 3 patients. RESULTS: All the patients except one were infants. Persistent fever, hepatosplenomegaly and pancytopenia were observed in all the patients. Family history of suspicious HLH was observed in 4 patients(67%). The characteristic elevated serum triglyceride(TG) level and/or decreased fibrinogen level were noted in all. Mild to moderate CSF pleocytosls with increased lymphocytes and monocytes was also observed in all during the disease course. Variable degree of nonqr-Langerhans cell histiocytic infiltration and hemophagocytosis were observed in all the cases. Of the 3 patients treated with ATG and methyl-PD, one achieved complete remission and the others achieved partial remission within 2 weeks of treatment, but all expired after 5 months, remission with CsA. Regardless of treatment regimen, all the 6 patients expired due to CNS sequelae of HLH. CONCLUSIONS: HLH mainly developed in infants. Persistant fever, hepatosplenomegaly and pancytopenia were observed in most cases with the characteristic change of serum TG and/or fibrinogen level. HLH should be included in the differential diagnosis in patients with these features especially when the family history of suspicious HLH is present, and histologic comfirmation of HLH could be easily accomplished with bone marrow study in most cases. Remission induction of HLH could be achieved with immunosuppressive treatment but it was difficult to maintain long term remission.
Bone Marrow ; Bone Marrow Examination ; Child ; Chungcheongnam-do ; Cyclosporine ; Diagnosis ; Diagnosis, Differential ; Fever ; Fibrinogen ; Follow-Up Studies ; Humans ; Immune System ; Immunosuppressive Agents ; Infant ; Lymphocytes ; Lymphohistiocytosis, Hemophagocytic* ; Methotrexate ; Monocytes ; Pancytopenia ; Remission Induction ; Retrospective Studies

BACKGROUND: Despite the development of empiric antibiotics in treatment of neutropenic fever(NF) in pediatric cancer patients, bacterial infection is still the most important cause of death in these patients. In this study the authors analyzed clinical characteristics and tried to find out the possible risk factors of the pediatric cancer patients who succumbed to the documented bacterial infection after episodes of neutropenic fever. METHODS: 17 pediatric cancer patients expired after episodes of neutropenic fever(NF) in the pediatric department of Asan Medical Center from Mar. 1990 to Feb. 1996 were grouped by the results of bacterial culture. 7 cases (Group A) had documented bacterial culture results and 10 cases (Group B) had negative culture results. The clinical characteristics of these two groups were analyzed retrospectively. RESULTS: There were no differences in the types of cancer between the two groups. All the documented bacteria were gram negative organisms and all cultured from the blood. There were no differences between the two groups in the treatment duration, known risk factors of infection before and at the onset of fever, antibiotics administered, and interval from the onset of NF to the administration of antibiotics. The response rate of initial empiric antibiotics was lower in group A(14%) compared to Group B(40%), even though all the cultured organisms except 2 cases in Group A were sensitive to initial empirical antibiotics. Septic shock was the cause of death in 86% of Group A patients, but only in 10% of Group B patients. The other causes of death were progression of cancer, bleeding, hepatic failure, adult respiratory distress syndrome and multiple organ failure, which showed no difference between the 2 groups. The interval from the onset of fever to death was significantly shorter in Group A(6.2+/-2.3 days) compared to Group B(24.9+/-18.6 days). CONCLUSIONS: Bacterial infection is still the most frequent cause of death after NF. Most patients succumbed to the documented bacterial infection showed rapid progression of bacteremia to septic shock despite administration of sensitive antibiotics. The known risk factors of infection before the onset of NF and other treatment factors shows no differences between the two groups in this study. These results suggest that the bacteremia is obvious risk factor of poor outcome after NF episode, and antibiotics alone may be insufficient to prevent the rapid progression of septic shock in these patients.
Anti-Bacterial Agents ; Bacteremia ; Bacteria ; Bacterial Infections ; Cause of Death* ; Chungcheongnam-do ; Fever* ; Hemorrhage ; Humans ; Liver Failure ; Multiple Organ Failure ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Risk Factors ; Shock, Septic

Pathological laughing and crying(PLC) is a condition that is characterized by episodic, brief, contextually inappropriate, uncontrollable outbursts of laughing and/or crying. It can be observed in patients with various neurological disorders. PLC often causes distress in interpersonal functioning and activities for patients and their families. PLC can be recognized easily with proper understanding of the condition and its nature. Also it generally shows good response to various pharmacological treatments. This review aims to encourage the diagnosis and treatment of PLC by providing definition and clinical presentation of PLC, analysis of its pathophysiology and various current treatment options.
Crying* ; Diagnosis ; Humans ; Nervous System Diseases

No abstract available.
Acute Kidney Injury*

Ocular rosacea is the eye manifestations of rosacea, which involves the lids, conjunctiva, and cornea. A recent study revealed that all patients with cutaneous rosacea had some degree of ocular involvement which is often undiagnosed. It is difficult to make a diagnosis of ocular rosacea because it lacks clinical or pathological hallmarks. However, early diagnosis and treatment are emphasized to decrease morbidity and prevent potential blindness. We report a case of ocular rosacea in a 49 year-old man who showed blepharoconjunctivitis, keratitis, and cutaneous manifestations of persistent erythema, telangiectasia, and papules. The ocular symptoms and signs had improved significantly with tetracycline therapy.
Blindness ; Conjunctiva ; Cornea ; Diagnosis ; Early Diagnosis ; Erythema ; Eye Manifestations ; Humans ; Keratitis ; Middle Aged ; Rosacea* ; Telangiectasis ; Tetracycline