No abstract available.
Head* ; Pancreas*

BACKGROUND: There is a long-standing controversy whether melanocytes in vitiligo of more than 1 year duration are actually lost or still present. Resolving this matter is essential in understanding the underlying pathology and for the development of the treatment. On previous immunohistochemical and ultrastructural studies of vitiligo lesions, damage of melanocyte and keratinocyte in early lesions were reported and complete absence of melanocyte in long standing lesions were known. OBJECTIVE: This study aimed to determine the existence of the differences in pathologic changes in melanocytes according to the duration of the lesion. METHODS: We investigated the vitiliginous skin samples from 31 patients with early(less than 1 year duration) vitiligo and 30 patients with long standing(l to 5 years duration) vitiligo under the electron microscopy. RESULTS: Multiple degenerative changes in melanocytes were observed in the early and long standing lesions. In long standing lesions, degeneration of melanocytes including pyknotic, in-dented nuclei, vacuolated cytoplasms and blunted dendrites were more pronounced than early lesions. Even in long standing lesions, definite or presumptive melanocytes were observed in 16(53.3%) of 30 cases. CONCLUSION: Our results suggest that the melanocytes of vitiligo lesions were damaged and that the percentage of degenerative changes increase in accordance with the duration of the lesion. However, in long standing lesions as well as in early lesions, some residual melanocytes can be observed ultrastructurally.
Cytoplasm ; Dendrites ; Humans ; Keratinocytes ; Melanocytes ; Microscopy, Electron ; Pathology ; Skin ; Vitiligo*

BACKGROUND: Androgenic alopecia, commonly known in men as male pattern baldness is the gradual balding of the scalp in response to androgens in genetically predisposed individuals. Androgens can gradually transform large scalp hair follicles to smaller vellus ones, causing balding. The mechanisms involved are unclear, although androgens are believed to act on the epithelial hair follicle via the mesenchymal derived dermal papilla. During pregnancy, hair growth is increased, as estrogen appears to prolong the anagen phase, and postpartum hair loss may be related to a rapid decrease in estrogen. OBJECTIVE: The aim of the present study was to evaluate the difference of the expressions of androgen receptors(AR) and estrogen receptors(ER) by monoclonal antibodies in biopsy specimens between bald area and non-bald area. METHODS: Immunohistochemical analysis of AR and ER receptor were preformed on the paraffine-embedded tissue sections of bald area and non-bald area in 6 cases of androgenic alopecia using anti-AR and anti-ER monoclonal antibodies with avidin-biotin peroxidase complex procedure. RESULTS: The results were that androgen receptors were higher level in bald area and estrogen receptors showed no difference between bald and non-bald area. CONCLUSION: This study supports that locally increased androgen activities may be related with hair loss in androgenic alopecia and estrogens have less relationship in the pathogenesis of androgenic alopecia.
Alopecia* ; Androgens ; Antibodies, Monoclonal ; Biopsy ; Estrogens* ; Hair ; Hair Follicle ; Humans ; Male ; Peroxidase ; Postpartum Period ; Pregnancy ; Receptors, Androgen* ; Receptors, Estrogen* ; Scalp

OBJECTIVE: In Korea, early vertebroplasty (EVP) or delayed vertebroplasty (DVP, which is performed at least 2 weeks after diagnosis) were performed for the treatment of acute osteoporotic compression fracture (OCF) of the spine. The present study compared the outcomes of two surgical strategies for the treatment of single-level acute OCF in the thoracolumbar junction (T12-L2). METHODS: From 2004 to 2010, 23 patients were allocated to the EVP group (EVPG) and 27 patients to the DVP group (DVPG). Overall mean age was 68.3+/-7.9 and minimum follow-up period was 1.0 year. Retrospective study of clinical and radiological results was conducted. RESULTS: No significant differences in baseline characteristics were observed between the two groups. As expected, mean duration from onset to vertebroplasty and mean duration of hospital stay were significantly longer in the DVPG (17.1+/-2.1 and 17.5+/-4.2) than in the EVPG (3.8+/-3.3 and 10.8+/-5.1, p=0.001). Final clinical outcome including visual analogue scale (VAS), Oswestry Disability Index, and Odom's criteria did not differ between the two groups. However, immediate improvement of the VAS after vertebroplasty was greater in the EVPG (5.1+/-1.3) than in the DVPG (4.0+/-1.0, p=0.002). The proportion of cement leakage was lower in the EVPG (30.4%) than in the DVPG (59.3%, p=0.039). In addition, semiquantitative grade of cement interdigitation was significantly more favorable in the EVPG than in the DVPG (p=0.003). Final vertebral body collapse and segmental kyphosis did not differ significantly between the two groups. CONCLUSION: Our findings suggest that EVP achieves a better immediate surgical effect with more favorable cost-effectiveness.
Follow-Up Studies ; Fractures, Compression* ; Humans ; Korea ; Kyphosis ; Length of Stay ; Osteoporosis ; Retrospective Studies ; Spine ; Vertebroplasty*

OBJECTIVE: Although there is no consensus on the ideal treatment of the craniocervical instability, biomechanical stabilization and bone fusion can be induced through occipito-cervical fusion (OCF). The authors conducted this study to evaluate efficacy of OCF, as well as to explore methods in reducing complications. METHODS: A total of 16 cases with craniocervical instability underwent OCF since the year 2002. The mean age of the patients was 51.5 years with a mean follow-up period of 34.9 months. The subjects were compared using lateral X-ray taken before the operation, after the operation, and during last follow-up. The Nurick score was used to assess neurological function pre and postoperatively. RESULTS: All patients showed improvements in myelopathic symptoms after the operation. The mean preoperative Nurick score was 3.1. At the end of follow-up after surgery, the mean Nurick score was 2.0. After surgery, most patients' posterior occipito-cervical angle entered the normal range as the pre operation angle decresed from 121 to 114 degree. There were three cases with complications, such as, vertebral artery injury, occipital screw failure and wound infection. In two cases with cerebral palsy, occipital screw failures occurred. But, reoperation was performed in one case. CONCLUSION: OCF is an effective method in treating craniocervical instability. However, the complication rate can be quite high when performing OCF in patients with cerebral palsy, rheumatoid arthritis. Much precaution should be taken when performing this procedure on high risk patients.
Arthritis, Rheumatoid ; Atlanto-Occipital Joint ; Cerebral Palsy ; Consensus ; Follow-Up Studies ; Humans ; Postoperative Complications ; Reference Values ; Reoperation ; Vertebral Artery ; Wound Infection

OBJECTIVE: Anterior cervical corpectomy with fusion (ACF) or laminoplasty may be associated with substantial number of complications for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with significant cord compression. For more safe decompression and stabilization in multilevel cervical OPLL with prominent cord compression, we propose circumferential cervical surgery (selective ACF and laminoplasty) based on our favorable experience. METHODS: Twelve patients with cervical myelopathy underwent circumferential cervical surgery and all patients showed multilevel OPLL with signal change of the spinal cord on magnetic resonance imaging (MRI). A retrospective review of clinical, radiological, and surgical data was conducted. RESULTS: There were 9 men and 3 women with mean age of 56.7 years and a mean follow up period of 15.6 months. The average corpectomy level was 1.16 and laminoplasty level was 4.58. The average Japanese Orthopedic Association score for recovery was 5.1 points and good clinical results were obtained in 11 patients (92%) (p < 0.05). The average space available for the cord improved from 58.2% to 87.9% and the average Cobb's angle changed from 7.63 to 12.27 at 6 months after operation without failure of fusion (p < 0.05). Average operation time was 8.36 hours, with an estimated blood loss of 760 mL and duration of bed rest of 2.0 days. There were no incidences of significant surgical complications, including wound infection. CONCLUSION: Although the current study examined a small sample with relatively short-term follow-up periods, our study results demonstrate that circumferential cervical surgery is considered favorable for safety and effectiveness in multilevel OPLL with prominent cord compression.
Asian Continental Ancestry Group ; Bed Rest ; Decompression ; Female ; Follow-Up Studies ; Humans ; Incidence ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Male ; Orthopedics ; Retrospective Studies ; Spinal Cord ; Spinal Cord Diseases ; Spinal Cord Ischemia ; Wound Infection

OBJECTIVE: The objectives of the present study were to characterize the natural course of initially non-operated traumatic acute subdural hematoma (ASDH) and to identify the risk factors of hematoma progression. METHODS: Retrospective analysis was performed using sequential computed tomography (CT) images maintained in a prospective observational database containing 177 ASDH cases treated from 2005 to 2011. Patients were allocated to four groups as followings; 136 (76.8%) patients to the spontaneous resolution group, 12 (6.8%) who underwent operation between 4 hours and 7 days to the rapid worsening group (RWG), 24 (13.6%) who experienced an increase of hematoma and that underwent operation between 7 and 28 days to the subacute worsening group (SWG), and 5 (2.8%) who developed delayed aggravation requiring surgery from one month after onset to the delayed worsening group (DWG). Groups were compared with respect to various factors. RESULTS: No significant intergroup difference was found with respect to age, mechanism of injury, or initial Glasgow Coma Scale. The presence of combined cerebral contusion or subarachnoid hemorrhage was found to be a significant prognostic factor. Regarding CT findings, mixed density was common in the RWG and the SWG. Midline shifting, hematoma thickness, and numbers of CT slices containing hematoma were significant prognostic factors of the RWG and the SWG. Brain atrophy was more severe in the SWG and the DWG. CONCLUSION: A large proportion of initially non-operated ASDHs worsen in the acute or subacute phase. Patients with risk factors should be monitored carefully for progression by repeat CT imaging.
Atrophy ; Brain ; Contusions ; Glasgow Coma Scale ; Hematoma* ; Hematoma, Subdural, Acute* ; Hematoma, Subdural, Chronic ; Humans ; Prospective Studies ; Retrospective Studies ; Risk Factors* ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

OBJECTIVE: Traumatic atlanto-occipital dislocation (AOD) results from high energy trauma and is an uncommon and usually fatal injury due to an injury to the cervicomedullary junction. Recently, improved prehospital management, early diagnosis and effective treatment led to increasing reports of survival. This study of patients with AOD initial imaging modalities recognizes the clinical features and diagnostic considerations for a quick diagnosis. METHODS: In this article, five survived adult patients with traumatic AOD are presented and retrospectively reviewed. Diagnosis was made by lateral cervical spine x-ray, cervical computed tomography (CT), or magnetic resonance imaging(MRI). Treatment consisted of early immobilization, respiratory support, and subsequent occipitocervical fusion. RESULTS: Four patients were male and the other one was female. Three were diagnosed early and the others were delayed in confirmations. One was type I AOD and four were type II AOD. All patients were applied occipitocervical fusion. Two cases were worse; neurological states and the other three that showed no change. Lateral X-ray film of all patients in the prevertebral soft tissue swelling at the C2 level was noted. The mean thickness of prevertebral soft tissue C2 level was 17.88 mm(15.18 to 20.17mm). Two were in the normal range of dens-basion index(DBI), three showed abnormalities, and Power's ratio was abnormal in 3 patients. CONCLUSION: As for damages caused by a strong external force in patients with severe prevertebral soft tissue swelling at C2 level abnormaly, the doctor determines whether more should be carefully AOD and considers 3D CT or MRI to confirm AOD in these patients.
Adult ; Atlanto-Occipital Joint ; Dislocations ; Early Diagnosis ; Female ; Humans ; Immobilization ; Magnetic Resonance Spectroscopy ; Male ; Reference Values ; Retrospective Studies ; Spine ; X-Ray Film

OBJECTIVE: Traumatic atlanto-occipital dislocation (AOD) results from high energy trauma and is an uncommon and usually fatal injury due to an injury to the cervicomedullary junction. Recently, improved prehospital management, early diagnosis and effective treatment led to increasing reports of survival. This study of patients with AOD initial imaging modalities recognizes the clinical features and diagnostic considerations for a quick diagnosis. METHODS: In this article, five survived adult patients with traumatic AOD are presented and retrospectively reviewed. Diagnosis was made by lateral cervical spine x-ray, cervical computed tomography (CT), or magnetic resonance imaging(MRI). Treatment consisted of early immobilization, respiratory support, and subsequent occipitocervical fusion. RESULTS: Four patients were male and the other one was female. Three were diagnosed early and the others were delayed in confirmations. One was type I AOD and four were type II AOD. All patients were applied occipitocervical fusion. Two cases were worse; neurological states and the other three that showed no change. Lateral X-ray film of all patients in the prevertebral soft tissue swelling at the C2 level was noted. The mean thickness of prevertebral soft tissue C2 level was 17.88 mm(15.18 to 20.17mm). Two were in the normal range of dens-basion index(DBI), three showed abnormalities, and Power's ratio was abnormal in 3 patients. CONCLUSION: As for damages caused by a strong external force in patients with severe prevertebral soft tissue swelling at C2 level abnormaly, the doctor determines whether more should be carefully AOD and considers 3D CT or MRI to confirm AOD in these patients.
Adult ; Atlanto-Occipital Joint ; Dislocations ; Early Diagnosis ; Female ; Humans ; Immobilization ; Magnetic Resonance Spectroscopy ; Male ; Reference Values ; Retrospective Studies ; Spine ; X-Ray Film

OBJECTIVE: Discectomy and/or spinal fusion have been the standard treatment options with proven effectiveness to treat degenerative spinal disease. To treat patients with more physiologic effective methods, there have been many efforts to develop various kinds of devices such as posterior dynamic stabilization and disc replacement. We reviewed our early experiences with the combined use of a partial disc replacement device, PDN-Solo(R) (Raymedica, Minneapolis, MN, USA) and an interspinous device, Coflex(R) (Fixanos, Pefonnas, France) in two.level lumbar degenerative disease. METHODS: A total of 13 patients with two.level lumbar degenerative disease underwent an operation from June 2003 to September 2004. A retrospective review of the clinical and radiological data was conducted for all the cases. The intervertebral disc height, the segmental lordotic angle and the total lumbar lordosis were measured. The clinical outcomes were evaluated by using the visual analogue scale (VAS), the Oswestry disability index (ODI) and MacNab's criteria. RESULTS: There were nine men and four women (mean age 34.4 years, range 21-64 years). The mean follow up period was 36.6 months (range 36-43 months). The average segmental lordotic angle of the PDN level was changed from 8.96degrees to 8.41degrees and that of the Coflex level was changed from 5.49degrees to 2.95degrees. The total lumbar lordotic angle was decreased from 33.74degrees to 32.40degrees. The intervertebral disc height of the PDN level was changed from 7.56 mm to 8.41 mm and that of the Coflex level was changed from 9.33 mm to 9.89 mm. The average degree of recovery from back pain was 5.6 points (from 8.9 to 3.3) and the average degree of recovery from leg pain was 4.4 points (from 7.5 to 3.1). The average degree of ODI recovery was 41.7 points (from 67.1 to 25.4). According to MacNab's criteria, the results were excellent in 4 patients (30.8%) and good in 7 patients (53.8%). CONCLUSION: Using the PDN with the Coflex may avoid rigid fixation in specially selected cases with two.level disease, i.e., those patients with spinal stenosis and a herniated lumbar disc. But further biomechanical tests and more longterm follow.up are needed.
Animals ; Back Pain ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Leg ; Lordosis ; Male ; Retrospective Studies ; Spinal Diseases ; Spinal Fusion ; Spinal Stenosis