No abstract available.
Osteoma, Osteoid*

STUDY DESIGN: A case of brain infarction due to occlusion of vertebral artery after cervical spine fracture is reported. OBJECTIVES: Documentation of possibility and clinical significances of brain infarction as one of grave complications after cervical spine injury. SUMMARY OF LITERATURE REVIEW: Occlusion of vertebral artery and consequent brain infarction can be associated with cervical spine injuries because vertebral arteries course through the transverse foramina from sixth to second corvical vertebrae. Infarction of vertebrobasilar system may cause impairment of cerebral, cerebellar, or brain stem function and can occasionally bring grave functional loss, even death. MATERIALS AND METHODS: A case of occlusion of vertebral artery and consequent cerebral infarction after cervical spine fracture in a 66 year-old man. Brain CT and angiogram were performed. He was managed with anticoagulants. RESULTS: Neurologic deficits from brain infarction disappeared after 2 weeks. CONCLUSIONS: Attention to the possibility of these complications and awareness of their clinical features seem to be mandatory in managing cervical spine injury patients.
Aged ; Anticoagulants ; Brain ; Brain Infarction ; Brain Stem ; Cerebral Infarction* ; Humans ; Infarction ; Neurologic Manifestations ; Spine* ; Vertebral Artery*

Storage of platelet concentrates in platelet additive solution (PAS) with plasma removal has many advantages, including reduction of allergic reactions, contributing to the available plasma pool for fractionation or transfusion, and employment of pathogen reduction technology. In order to decrease platelet activation for improvement of in vivo viability, PAS should be designed for optimization of aerobic metabolism using compounds such as glucose, acetate, citrate, phosphate, and electrolytes. After a thorough discussion, particularly on the efficacy and regulations, use of the buffy coat method as well as application of a new generation of PAS may likely be the future direction of platelet storage in Korea.
Blood Platelets* ; Citric Acid ; Electrolytes ; Employment ; Glucose ; Hypersensitivity ; Korea ; Metabolism ; Plasma ; Platelet Activation ; Social Control, Formal

The authors report 2 cases of nerve root herniation after discectomy of a large lumbar disc herniation caused by an unrecognized dural tear. Patients complained of the abrupt onset of radiating pain after lumbar discectomy. Magnetic resonance imaging showed cerebrospinal fluid signal in the disc space and nerve root displacement into the disc space. Symptoms improved after the herniated nerve root was repositioned. Clinical symptoms and suggestive radiologic image findings are important for early diagnosis and treatment.
Diskectomy ; Displacement (Psychology) ; Early Diagnosis ; Humans ; Magnetic Resonance Imaging

The intrathecal drug delivery system (ITDDS), an effective treatment tool for intractable spasticity and pain, is associated with various complications but breakage of the catheter is rare. We report the case of a 50-yr-old man with ITDDS, in whom an intrathecal catheter was severed, resulting in a 28.6-cm-long intrathecal fragment. The catheter completely retracted into the intrathecal space from the anchor site. The catheter was severed during spine flexion, and the total distal fragment was repositioned in the intrathecal space. Although the outcome of ITDDS was associated with the length or diameter of the broken catheter, no neurologic complications occurred in our patient. Thus, we inserted another catheter instead of removing the old one. Thereafter, the patient has been regularly followed up, and no neurologic complications have developed during the 28 months.
Brachial Plexus/injuries ; Catheters ; Drug Delivery Systems ; *Equipment Failure ; Fluoroscopy ; Humans ; Infusion Pumps, Implantable/*adverse effects ; Injections, Spinal/instrumentation ; Male ; Middle Aged ; Morphine/therapeutic use ; Pain/*drug therapy/etiology

OBJECTIVE: Embryo transfer is a critical step in assisted reproduction. However, the different aspects of the procedure were not fully estimated. The aim of this study is to evaluate the impact of each aspect in the procedure to success of pregnancy. METHODS: Medical records of 525 fresh IVF/ICSI cycles were reviewed retrospectively. All embryo transfers were performed under ultrasonography guidance and after removal of cervical mucus. Assessed primary variables are difficulty of procedure (easy, moderate, and difficult), presence of blood in the catheter, types of catheter (soft or hard) and physician factor, and confounding variables are age of patient, total number of oocytes, number of transferred embryos, the highest grade of embryo, endometrial thickness. Measured outcomes were clinical pregnancy (visible fetal heart beat by ultrasonography) and live-birth rate. Univariate analysis and multivariate analysis by logistic regression test were used. RESULTS: Among the variables of embryo transfer procedure, the difficulty of procedure was the only significant factor influencing both clinical pregnancy (OR: 0.402, 95% CI: 0.205-0.789, easy vs. moderately difficult) and live birth rate (OR: 0.380, 95% CI: 0.178-0.841, easy vs. moderately difficult). The difference between moderately difficult and very difficult procedure was not significant. Presence of blood was significant for live-birth rate (OR: 0.512, 95% CI: 0.267-0.980). Types of catheter and physician factor were not significant factors. CONCLUSION: The difficulty of the transfer procedure and presence of blood in catheter are significant factors influencing ART outcome.
Catheters ; Cervix Mucus ; Confounding Factors (Epidemiology) ; Embryo Transfer* ; Embryonic Structures* ; Fertilization in Vitro ; Fetal Heart ; Humans ; Live Birth ; Logistic Models ; Medical Records ; Multivariate Analysis* ; Oocytes ; Pregnancy Rate* ; Pregnancy* ; Reproduction ; Retrospective Studies ; Ultrasonography

Acute antibody-mediated rejection (AMR) developing simultaneously with acute cellular rejection has been rarely reported as a long-term complication of renal transplantation, and it can present on top of another chronic pathology affecting the graft. A 51-year-old female patient with chronic kidney disease of unknown etiology received renal transplantation 12 years ago from a living unrelated donor with 3 HLA mismatches. She received induction therapy with methylprednisolone and was maintained on steroids, mycophenolate mofetil and cyclosporine A (CsA). For a period of twelve years post-transplantation, she was clinically and biochemically stable. She presented with a rise in serum creatinine (SCr.) from 1.3 mg/dL to 2.4 mg/dL but did not have proteinuria. Graft biopsy revealed findings suggestive of acute cellular rejection on top of antibody-mediated rejection (type II) and chronic calcineurin inhibitor toxicity. Panel reactive antibody (PRA) test levels were 3.6%, 91.7% for class I and II respectively. The patient was treated with high-dose methylprednisolone for 3 days but serum creatinine was not fully normalised. After 2 weeks from initial methyl-PDS pulse therapy, she received intravenous immunoglobulin, plasma exchange and anti-CD20 (rituximab). Cyclosporine was changed to tacrolimus. She achieved a complete response, and SCr. was maintained at 1.3 mg/dL without proteinuria. Follow-up PRA test levels were 0%, 75% for class I and II. Current therapies have had considerable success in reversing mixed, acute humoral and cellular rejection since it is being identified quickly and treated aggressively. The best use of rituximab to treat AMR should be evaluated in controlled trials using dosing strategies that include longer courses or retreatment schedules.
Antibodies, Monoclonal, Murine-Derived ; Appointments and Schedules ; Biopsy ; Calcineurin ; Creatinine ; Cyclosporine ; Female ; Follow-Up Studies ; Graft Rejection ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Kidney Transplantation ; Methylprednisolone ; Middle Aged ; Mycophenolic Acid ; Plasma Exchange ; Plasmapheresis ; Proteinuria ; Rejection (Psychology) ; Renal Insufficiency, Chronic ; Retreatment ; Rituximab ; Steroids ; Tacrolimus ; Transplants ; Unrelated Donors

To evaluate the pinhole scintigraphic findings and its significance, authors retros- pectively compared the pinhole bone scintigrams and corresponding radiograms of 16 lesions in 14 patients with fibrous dysplasia. They were diagnosed pathologically in 10 lesions and radiologically in 6 lesions. The mean age of patients was 41.1 years. The mean interval between two studies was 1.1 days. Locations were ribs 7, pelvic bone 4, clavicle l, long bones 4(femur 2, titbia 1, humerus 1). The radiographic findings were as follows: the central portions were radiolucent(n=9), ground-glass opacities(n=5) or sclerotic(n=2) and the peripheral appearance were sclerotic rim(n-5), septation(n=7), cortical perforation (n=10) and invisible cortical thinning(n=9). Pinhc>le scintigraphic findings were as follows: Central portions showed normal 1+ uptake in 6 cases(radiolucent 5, ground-glass opacity 1), slightly increased 2+ uptake in cases(radiolucent 4, ground-glass opacity 3), and marked 3+ uptake in,3 cases(ground-glass opacity 1, sclerotic 2). The 15 of 16 lesions showed more intense uptake in the peripheral portion: slightly increased 2+ uptake corresponding to the sclerotic rim(5/5) and unvisible cortical thinning(1/9), and irregular foci of marked 3 + uptake corresponding to septation(7/7), cortical perforation(10/10) and invisible cortical thinning (8/9). One of 16 lesions showed homogeneous 2t uptake. In conclusion, pinhole scintigram provides information on regional activity of the fibrous dysplasia, which would be helpful in diagnosis, prediction of prognosis and determination of treatment plan.
Clavicle ; Diagnosis ; Humans ; Humerus ; Pelvic Bones ; Prognosis ; Ribs

Polyoma virus (PV) nephropathy is a known cause of graft loss after renal transplantation. In a renal transplant patient suspected of graft rejection, it is important to discriminate between PV induced interstitial nephritis and acute cellular rejection, because of similar pathologic findings. After the loss of the first allograft secondary to PV nephropathy, transplant graft nephroureterectomy before retransplantaton may have an influence in the recurrence of PV nephropathy. However, this question has not been completely resolved. Case: A 23-year-old male underwent first renal transplantation from his HLA haploidentical 25 year-old-sister. His renal function had been good with cyclosporine, steroid and azathioprine until 9 months after transplantation, when his serum creatinine level rose to 2.2 mg/dL. A renal biopsy revealed features of tubulitis and we confirmed PV nephropathy through a positive PV monoclonal antibody reaction to inclusion body. After gradual loss of graft function, he underwent hemodialysis. After 48 months of hemodialysis, the patient underwent cadaveric renal retransplantation without transplant graft nephroureterectomy. Thrombocytopenia and suspected delayed graft function occurred after 2 days of transplantation. A graft biopsy revealed thrombotic microangiopathy. Improved graft function was attained after a temporary stop of tacrolimus and ATGAM(R) bridging therapy. The patient is maintaining satisfactory graft function 33 months after retransplantation without clinical and serological evidence of recurrent PV infection.
Allografts ; Azathioprine ; Biopsy ; Cadaver ; Creatinine ; Cyclosporine ; Delayed Graft Function ; Graft Rejection ; Humans ; Inclusion Bodies ; Kidney Transplantation ; Male ; Nephritis, Interstitial ; Polyomavirus* ; Recurrence ; Renal Dialysis ; Tacrolimus ; Thrombocytopenia ; Thrombotic Microangiopathies ; Transplants* ; Young Adult