For securing large, giant, and wide-neck aneurysms, conventional coil embolization has substantial limitations, such as incomplete occlusion, recanalization, and a high recurrence rate. To overcome these limitations, a novel paradigm was suggested and, as a result, flow-diverting device was developed. The flow-diverting device is an innovative and effective technique to allow securing of large, giant, and wide-neck aneurysms. In numerous studies, the flow-diverting device has shown better outcomes than coil embolization. However, the flow-diverting device has also some risks, including rupture of aneurysm, intracerebral hemorrhage, and ischemic stroke. In addition, with more experience, unexpected complications are also reported.5) 7) In the present case, we experienced a delayed ischemic stroke at 27 days after endovascular treatment. The patient had multiple aneurysms and, among them, we treated a large posterior communicating artery aneurysm using Pipeline™ Embolization Device. The patient was tolerable for 25 days, but then suddenly presented intermittent right hemiparesis. In the initial diffusion magnetic resonance imaging (MRI), there was no acute lesion; however, in the follow-up MRI, an acute ischemic stroke was found in the territory of anterior choroidal artery which was covered by Pipeline Embolization Device. We suspect that neo-intimal overgrowth or a tiny thrombus have led to this delayed complication. Through our case, we learned that the neurosurgeon should be aware of the possibility of delayed ischemic stroke after flow diversion, as well as, long-term close observation and follow-up angiography are necessary even in the event of no acute complications.
Aneurysm ; Angiography ; Arteries ; Cerebral Hemorrhage ; Choroid ; Diffusion Magnetic Resonance Imaging ; Embolization, Therapeutic ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Magnetic Resonance Imaging ; Paresis ; Recurrence ; Rupture ; Stroke* ; Thrombosis

For the diagnosis and treatment of the labral pathology, the cross sectional morphology of the labrum is needed. Fifty-four labra (male: female=44: 10) from 32 adult Korean cadavers were cut in radial and perpendicular fashions to their longitudinal axis. Each labrum was divided into 8 segments, resulting 8 equally distanced points. To analyze the 432 cut surfaces, which consisted of 378 labra and 54 transverse acetabular ligaments cut surfaces, all dimensions of the cut surfaces were measured, and the attachment patterns, including the sublabral slit, observed. The shapes of the cut surfaces were classified into four types (3 subtypes of triangle and 1 quadrangle) and the attachment patterns into five types. At the anterior portion of the labrum, which other studies reported as the predilection area for labral tears, there were several common findings: 1) Tall triangular shapes were dominant (61.1%) or relatively common type (25.9%). 2) The average heights of the labrum were longer (7.4 and 7.0 mm) than at the other sites (4.0 - 6.8 mm). 3) The attachment types with no extra-extended portion (68.5%) and sublabral slits (39.0%) were most commonly observed. It was concluded that there were different types of cut surface and attachment patterns of the acetabular labrum, and these findings had a tendency to be distributed with some labral tears. These anatomical data are believed could be useful in the management of an acetabular labral pathology.
Acetabulum/*anatomy & histology/pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Human ; Magnetic Resonance Imaging ; Male ; Middle Aged

PURPOSE: To evaluate the safe triangle within the femoral triangle for the potential space of the true anterior hip approach. MATERIALS AND METHODS: Cadaveric dissections were carried out on 28 femoral triangles from 14 cadavers. This study measured the length of the direct head of the rectus femoris from the anterior inferior iliac spine (AIIS) to the patella upper pole, the AIIS to the lateral border of the femoral nerve, and the entry point of the femoral nerve and vessel branches to the rectus. The safe portion within the risky femoral triangle was analyzed and applied to two clinical situations, a femoral head fracture and septic hip arthritis. RESULTS: The examination showed that there were three terminal branches to the rectus femoris from the femoral nerve. The entry point of the first branch was at the proximal 20.0-28.9% portion of the rectus femoris. The second and the third branch entered at the proximal 22.5-37.5% and 24.9-41.0%, portion, respectively. The vessel entry was at 21.4-37.3%. The length from the AIIS to the femoral nerve was 3.5- 8.0 cm. Using this space, the procedure was easier to perform in the two situations mentioned above. CONCLUSION: The space within the femoral triangle between the proximal 20% of the rectus femoris and iliacus can be used as one of the potential spaces for femoral head fracture fixation and septic hip irrigation in children, and as an arthroscopy portal.
Arthritis ; Arthroscopy ; Cadaver ; Child ; Femoral Nerve ; Fracture Fixation ; Head ; Hip* ; Humans ; Patella ; Quadriceps Muscle ; Spine

Cadmium intoxication has been associated with the dysregulation of iron homeostasis. In the present study, we investigated the effect of cadmium on the expression of ferroportin 1 (FPN1), an important iron transporter protein that is involved in iron release from macrophages. When we incubated cadmium with J774 mouse macrophage cells, FPN1 mRNA levels were significantly increased in a dose- and time-dependent manner. Furthermore, the cadmium-induced FPN1 mRNA expression was associated with increased levels of FPN1 protein. On the other hand, cadmium-mediated FPN1 mRNA induction in J774 cells was completely blocked when cells were co-treated with a transcription inhibitor, acitomycin D. Also, cadmium directly stimulated the activity of the FPN1-promoter driven luciferase reporter, suggesting that the cadmium up-regulates FPN1 gene expression in a transcription-dependent manner. Finally, cadmium exposure to J774 macrophages increased intracellular reactive oxygen species (ROS) levels by ~ 2-fold, compared to untreated controls. When J774 cells were co-treated with antioxidant N-acetylcystein, the cadmium-induced FPN1 mRNA induction was significantly attenuated. In summary, the results of this study clearly demonstrated that cadmium increased FPN1 expression in macrophages through a mechanism that involves ROS production, and suggests another important interaction between iron and cadmium metabolism.
Animals ; Cadmium ; Cation Transport Proteins ; Gene Expression ; Hand ; Homeostasis ; Iron ; Luciferases ; Macrophages ; Mice ; Reactive Oxygen Species ; RNA, Messenger

Macrophages play a key role in iron metabolism by recycling iron through erythrophagocytosis. Ferroportin-1 (FPN1) is a transporter protein that is known to mediate iron export from macrophages. Since divalent metals often interact with iron metabolism, we examined if divalent metals could regulate the expression of FPN1 in macrophages. J774 macrophage cells were treated with copper, manganese, zinc, or cobalt at 10, 50, or 100 microM for 16 to 24 h. Then, FPN1 mRNA and protein levels were determined by quantitative real-time PCR and Western blot analyses, respectively. In addition, effects of divalent metals on FPN1 promoter activity were examined by luciferase reporter assays. Results showed that copper significantly increased FPN1 mRNA levels in a dose-dependent manner. The copper-induced expression of FPN1 mRNA was associated with a corresponding increase in FPN1 protein levels. Also, copper directly stimulated the activity of FPN1 promoter-driven reporter construct. In contrast, manganese and zinc had no effect on the FPN1 gene expression in J774 cells. Interestingly, cobalt treatment in J774 cells decreased FPN1 protein levels without affecting FPN1 mRNA levels. In conclusion, our study results demonstrate that divalent metals differentially regulate FPN1 expression in macrophages and indicate a potential interaction of divalent metals with the FPN1-mediated iron export in macrophages.
Blotting, Western ; Cobalt ; Copper ; Gene Expression ; Ions ; Iron ; Luciferases ; Macrophages ; Manganese ; Metals ; Real-Time Polymerase Chain Reaction ; Recycling ; RNA, Messenger ; Zinc

Xanthogranulomatous epididymitis is extremely uncommon inflammatory disease of the epididymis that may result in massive destruction of the organ. It's clinical manifestation mimics epididymal tumor or abscess, which does not allow easy discrimination between theses diseases. We report here on a case of xanthogranulomatous epididymitis in a 69 years old man that, did not respond to antibiotic therapy.
Abscess ; Aged ; Discrimination (Psychology) ; Epididymis ; Epididymitis* ; Humans ; Male

The bone mass and microarchitecture are important determinants of bone strength, with microarchitectural deterioration being one of the specific changes associated with osteoporosis. The purpose of this study was to evaluate and compare the results of microcomputed tomography (micro-CT) and histomorphometry of biopsied specimens. A bone biopsy was performed on the iliac crest of 10 normal premenopausal Korean women. Measurements of the bone mineral density (BMD), micro-CT, and bone histomorphometry were performed. The bone volume, as determined by both micro-CT and histomorphometry, was significantly correlated (r=0.88, p < 0.01). The osteoid surface was correlated with both the bone volume (r=0.84, p < 0.01) and the structure model index (SMI) (r= -0.89, p < 0.01) measured by micro-CT. The SMI was correlated with both the bone volume (r=-0.85, p < 0.01) and the total hip BMD (r=-0.65, p < 0.05). In conclusion, some, but not all of the parameters of the micro-CT, were well correlated with the bone histomorphometric results. Micro-CT and histomorphometry appear to be complementary techniques in the study of bone microarchitecture.
Adult ; Biopsy ; Bone Density ; Bone and Bones/*anatomy & histology/*radiography ; Female ; Human ; Support, Non-U.S. Gov't ; *Tomography, X-Ray Computed

BACKGROUND: The purpose of this study is to evaluate the disease-free survival (DFS) and overall survival (OS) of patients with stage IIB osteosarcoma at a single institution for 20 years and to compare the results according to the chemotherapy protocols. METHODS: From Jan 1988 to Nov 2008, 167 patients with osteosarcoma were treated at our hospital and among them, 117 patients (67 males and 50 females) with stage IIB osteosarcoma were evaluable. Their mean age was 22.6 years (range, 8 months to 71 years). Seventy-eight cases underwent the modified T10 (M-T10) protocol (group 1), 23 cases underwent the T20 protocol (group 2) and 16 cases underwent the T12 protocol (group 3). The DFS and OS were calculated and compared according to the chemotherapy protocols. RESULTS: At a mean follow-up of 78.9 months, 63 patients were continuously disease-free (63/117), 6 patients were alive after having metastatic lesions, 7 patients died of other cause and 41 patients died of their disease. The 5- and 10-year OS rates were 60.2% and 44.8%, respectively and the 5- and 10-year DFS rates were 53.5% and 41.4%, respectively. There was no significant difference of the OS and DFS between the chemotherapy protocols (p = 0.692, p = 0.113). CONCLUSIONS: At present, we achieved success rates close to the internationally accepted DFS and OS. We were able to achieve the higher survival rates using the M-T10 protocol over the 20 years. However, there was no significant difference of results between the chemotherapy protocols. We think the M-T10 protocol will achieve more favorable results in the near future.
Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*therapeutic use ; Bleomycin/administration & dosage ; Bone Neoplasms/*drug therapy/*mortality/surgery ; Chemotherapy, Adjuvant ; Child ; Child, Preschool ; Cyclophosphamide/administration & dosage ; Dactinomycin/administration & dosage ; Disease-Free Survival ; Doxorubicin/administration & dosage ; Female ; Follow-Up Studies ; Humans ; Infant ; Kaplan-Meier Estimate ; Leucovorin/administration & dosage ; Male ; Methotrexate/administration & dosage ; Middle Aged ; Neoadjuvant Therapy ; Osteosarcoma/*drug therapy/*mortality/surgery ; Survival Rate ; Vincristine/administration & dosage ; Young Adult

OBJECTIVES: This study was conducted to develop the Korean version of Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS) for measuring neuroleptic side effects by self-rating method and to examine the reliability and validity in the schizophrenic patients medicated by neuroleptics and normal controls. METHODS: We made 51-item, 4-point scale of Korean version LUNSERS through translation, reverse translation and supervision by specialists. Sixty two schizophrenics diagnosed by DSM-IV criteria and medicated with neuroleptics completed LUNSERS twice with one week interval. Second LUNSERS and UKU side effect rating scale (UKU) by psychiatrist were administered to the schizophrenics at the same time. Normal controls also completed LUNSERS. RESULTS: The test-retest reliability (r=0.86, p<0.01) of LUNSERS and the concurrent validity (r=0.81, p<0.001) against UKU were good. But the neuroleptic doses and total scores of side effect items didn't show significant correlation. By the ROC curve analysis, the total scores of side effect items differentiated the medicated patients from non-medicated controls but not for the red herring items. CONCLUSION: Korean-version of LUNSERS has good reliability and validity. And it was also proved to be an useful assessment tool for measuring the extent of neuroleptic side effects systematically instead of UKU in clinical trials.
Antipsychotic Agents ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Organization and Administration ; Psychiatry ; Reproducibility of Results ; ROC Curve ; Specialization

Background: Denosumab (DMB) is a bone antiresorptive agent used to treat osteoporosis or metastatic cancer of the bones. However, denosumab-associated osteonecrosis of the jaw (DRONJ) has become a common complication in cancer patients. The prevalence of osteonecrosis of the jaw (ONJ) in cancer patients is estimated to be similar for both bisphosphonate-related cases (1.1 to 1.4%) and denosumab-related cases (0.8 to 2%), with the addition of adjunctive therapy with anti-angiogenic agents reportedly increasing its prevalence to 3%. (Spec Care Dentist 36(4):231–236, 2016). The aim of this study is to report on DRONJ in cancer patients treated with DMB (Xgeva ® , 120mg).Case presentation In this study, we identified four cases of ONJ among 74 patients receiving DMB therapy for meta‑ static cancer. Of the four patients, three had prostate cancer and one had breast cancer. Preceding tooth extraction within 2 months of the last DMB injection was found to be a risk factor for DRONJ. Pathological examination revealed that three patients had acute and chronic inflammation, including actinomycosis colonies. Among the four patients with DRONJ referred to us, three were successfully treated without complications and had no recurrence following surgical treatment, while one did not follow up. After healing, one patient experienced a recurrence at a different site.Sequestrectomy in conjunction with antibiotic therapy and cessation of DMB use proved to be effective in managing the condition, and the ONJ site healed after an average 5-month follow-up period. Conclusion Conservative surgery, along with antibiotic therapy and discontinuation of DMB, was found to be effec‑ tive in managing the condition. Additional studies are needed to investigate the contribution of steroids and antican‑ cer drugs to jaw bone necrosis, the prevalence of multicenter cases, and whether there is any drug interaction with DMB.