Objective To evaluate the clinical efficacy of three chemotherapy regimens and partial excision of the affected vertebrae for spinal tuberculosis. Methods Between December 1998 and November 2003, 76 cases with spinal tuberculosis were treated with chemotherapy and surgical intervention. All pa-tients were divided into three groups randomly to receive one of three different courses of chemotherapy. Among these, 38 cases were selected to receive ultra-short-course chemotherapy regimen with 2SHRZ/ 2.5H2R2Z2, 23 of short-course with 3SHRZ/5H2R2Z2, and 15 of standard with 3SHRZ/9H2R2Z2. The duration of the preoperative chemotherapy of the three groups was about the same with an average of 21 days (15 to 40 days). All patients underwent anterior partial excision of the affected vertebrae, large iliac strut graft and anterior or posterior fixation. Results The mean follow-up time of the ultra-short-course, short-course and standard chemotherapy groups were 23, 28 and 45 months respectively. The observed indices included: 1) Clinical manifestation: disappearance of TB symptoms, the nerve function recovered, life and the work activ-ities. 2) Lab tests: both ESR and CRP data or either of them in normal or near normal status. 3) X-ray, CT and MRI examination: abscesses, new lesion, absorption of the bone grafts, translucent line between bone graft and vertebral body, and correction of kyphotic deformity. 4) Ultrasonic examination: no opaque dark area at the sites where there might be the paravertebral or gravity abscesses. 5) Drug complications: the hepatic and renal function of patients at follow up were normal or close to normal. The follow-up showed that all the three groups achieved excellent results. Conclusion Treatment of spinal tuberculosis with anterior partial excision of pathologic vertebrae, large iliac strut graft and anterior or posterior internal instrumental fixation in either ultra-short-course, short-course or standard chemotherapy all achieved excellent therapeutic effects. There was no difference among three different courses of chemotherapy.

Objective To investigate the effect of hypertonic saline on TNF-а, IL-1β, S-100β level following focal cerebral ischemia-reperfusion injury in rats and explore the mechanisms involved. Methods Ninety rats were randomized equally into 4 groups,namely the pseudo-operated group (A group),untreated IR injury group (B group),C group (4.2% hypertonic saline) and D group (7.5% hypertonic saline). Cerebral ischemia was induced by middle cerebral artery occlusion for 2 h followed by administration of the corresponding treatments in group C and D. After 22 h of reperfusion , TNF-а, IL-1β, S-100βexpression in the ischemic brain tissue were measured by enzyme-linked immunosorbent assay (ELISA). Results After hypcrtonic saline treatment, the two saline-treated groups showed significant reduction in TNF-а、IL-1β、S-100β levels , but were still higher than pseudo-operated group(A group). Compared with B group, significant difference can be seen among C and D group. Conclusion Hypcrtonic saline can reduce cerebral TNF-а、IL-1β、S-100βlevel of isehemia-reperfusion injury.

Nowadays the prevalence of gastroesophageal reflux disease (GERD) seems to be increasing in Korea, and many physicians are concerned about the disorder. However GERD has a broad spectrum of symptoms, and diverse diagnostic and therapeutic approaches. In addition, the prevalence, symptomatology, clinical pictures, and even diagnosis and treatment approaches of GERD are different between in Korea and in Western countries. In this review I will discuss the diagnostic and therapeutic approaches for patients with GERD, especially from a Korean point of view
Diagnosis* ; Esophagitis, Peptic ; Gastroesophageal Reflux* ; Humans ; Korea ; Prevalence

Objective To study the effect of rhein on the process of tubular epithelial-mesenchymat transformation in kidney of diabetic rats. Methods Wistar male rats were randomly assigned to 3 groups: Control group (N group, n=12),diabetic group(D group, n=12), rhein treatment group(R group, n=12).The rats of rhein treatment group were treated with daily intragastric administration of periment. The excretion of urinary protein and serum creatine were measured. Histological changes of renal tissue were observed by HE and MASSON stain. Immunohistochemistry was performed to investigate the expression of E-cadherin, α-SMA,FN and TGF-β1 in kidney. Results Compared with the control group, the tubulointerstitial injury and the accumulation of extraeellular matrix protein in diabetic models were obvious(P＜0.01).Compared with the control group, the expression of E-cadherin was decreased significantly and the expression of α-SMA,FN and TGF-β1 was increased significantly in diabetic group. E-cadherin was negatively correlated with TGF-β1(rs=-0.60,P＜0.05),α-SMA and FN was positively correlated with TGF-β1(rs=0.88,P＜0.05;rs:0.91,P＜0.01).In comparison with diabetic group,rhein could up-regulate the expression of E-cad and down-regulate the expression of α-SMA and FN in renal tubular epithelial cells(P＜0.01).Conclusion Rhein could protect kidney by ameliorating interstitial fibrosis in diabetic rats. The mechanism may be depend on down-regulating the expression of TGF-β1 and suppressing tubular epithelial-mesenchymal transformation.

Renewed interest has been shown in transthoracic endoscopic sympathectomy(TES) for the treatment of upper limb hyperhidrosia. TES has many advantages such as simplicity, minimal trauma, benign postoperative course and early ambulation. One-lung ventilation is mandatory to get the clear view of the anatomy of the sympathetic chain during TES. It is well known that hypoxic pulmonary vasoconstriction(HPV) plays an important role to protect hypoxemia during the atelectasis induced by one-lung ventilation. Thoracic sympathectomy may have effects on pulmonary vasculature(HPV) and hemodynamics during one-lung anesthesia. We tried to investigate these effects in 20 patients undergoing TES. Hemodynamic effects were evaluated by measuring mean arterial yressure, heart rate and central venous pressure. And HPV was evaluated by arterial blood gas analysis. All of these parameters were checked 10 minutes after endotracheal intubation in supine position, lateral decubitus position, one-lung ventilation and l0 minutes and 20 minutes after thoracic sympathectomy. Mean arterial blood pressure was decreased from 81.9+/-2.89 to 73.2+/-2.49 mmHg after thoracic sympathectomy and heart rate was decreased from 104.4+/-3.12 to 88.2+/-2.31beats/min. Arterial oxygen tension was decressed from 570.5+/-17.9 to 521.4+/-23.2mmHg after position change, and decreased to 271.1+/-28.1 mmHg under one-lung ventilation, and finally decreased to 217.0+/-18.3 mmHg after thoracic sympathectomy. With the above results, we can conclude that patients for TES should be carefully observed during and after the procedure, and hypoxic pulmonary vasoconstriction may be impaired after TES.
Anesthesia ; Anoxia ; Arterial Pressure ; Blood Gas Analysis ; Central Venous Pressure ; Early Ambulation ; Gases* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation, Intratracheal ; Lung* ; One-Lung Ventilation ; Oxygen ; Pulmonary Atelectasis ; Supine Position ; Sympathectomy* ; Upper Extremity ; Vasoconstriction ; Ventilation*

The aim of this retrospective study was to compare the amount of marginal bone loss between upper anterior area and upper posterior area with 71 upper single-tooth restorations on 2 stage machined Branemark implants since Jan 1995. The second aim was to compare the bone defect group which had dehiscence and fenetration and the others in the upper anterior region. The results were as follows. 1. The most frequent reason of missing tooth in the upper anterior region was trauma by 61%. While upper posterior region showed various reasons such as congenital missing, advanced periodontitis, trauma. 2. Peri-implantitis with fistula occurred 1 of 41 implants in the upper anterior group in 1 year after loading and 2 of 32 implants in the upper posterior group failed before loading. The 1 year success rate of upper anterior group was 97.56 %, and 93.75 % for upper posterior group. 3. The mean marginal bone loss in the upper anterior group was 0.44 +/- 0.25 mm, while 0.57+/- 0.32 mm in the upper posterior group. There was stastically significant difference in the amount of mean marginal bone loss (P<0.05). 4. The mean marginal bone loss of bone defect group was 0.40+/- 0.10 mm at one year, and 0.48+/- 0.26 mm for the control group. No statistically significant difference of mean marginal bone loss was showen between bone defect group and the others at implantation. According to the results, the upper anterior region showed less marginal bone loss than the upper posterior region. In case of missing single upper tooth, careful consideration on recipient residual ridge to determine proper implant diameter and length, sufficient healing time, proper loading would lead to implant success. Single tooth implants in the maxilla seemed to be an alternative to fixed partial dentures without damage to adjacent teeth.

BACKGROUND: Cardiac problems are common and are a major cause of death in both Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD). Early diagnosis and proper management are very important for prolonging life expectancy, improving mobility and the quality of life in dystrophinopathic patients. The object of this study was to assess the cardiac dysfunction in dystrophinopathic patients. METHODS: We reviewed the clinical and laboratory findings of 53 male patients with DMD/BMD. The diagnosis was based on clinical criteria suggested by the European neuromuscular center, dystrophin gene analysis and immunohistochemistry of dystrophinopathic patients. We investigated 12-lead electrocardiography (EKG) findings, cardiac echocardiography findings and exon deletion analysis of dystrophin by multiplex polymerase chain reaction. RESULTS: The mean age of 53 patients was 20.98+/-7.85 years old. On EKG findings of DMD/BMD patients, 50 patients (94.3%) revealed abnormal findings (DMD 36 [94.7%]/BMD 14 [93.3%]). Of the forty nine patients investigated by cardiac echocardiography, 25 patients (51.1%) showed abnormal echocardiographic findings (DMD 18 [51.4%]/BMD 7 [50.0%]), 18 patients (36.7%) had dilated cardiomyopathy, and 7 (14.3%) patients had cardiac symptoms (DMD 4 [11.4%] /BMD 3 [21.4%] numbers). There was no difference in the neurological disability score between normal echocardiographic finding patients and abnormal patients. On DNA analysis by multiplex PCR, the proximal exon deletion of dystrophin genes (exon 1-30) has a significant association with cardiac involvement compared to those of distal exon deletion (exon 31-60) (p=0.034). CONCLUSIONS: Because DMD/BMD patients mostly have affected cardiac dysfunctions without clinical symptoms, early diagnosis and appropriate management of asymptomatic cardiac dysfunctions is very important.
Cardiomyopathy, Dilated ; Cause of Death ; Diagnosis ; DNA ; Dystrophin ; Early Diagnosis ; Echocardiography ; Electrocardiography ; Exons ; Humans ; Immunohistochemistry ; Life Expectancy ; Male ; Multiplex Polymerase Chain Reaction ; Muscular Dystrophies* ; Muscular Dystrophy, Duchenne ; Quality of Life

Spasmodic torticollis (ST) is a focal dystonia caused by a tonic or intermittent spasms of the neck muscles. Botulinum toxin type A has been known to be one of the effective treatments for the cervical dystonia. We report the result of low dose botulinum toxin type A injection in 26 patients with spasmodic torticollis. In addition to the careful neurological examination, a needle polymyographic analysis was used to identify muscles responsible for ST. The most common combination of the involved muscles was splenius capitus and sternocleidomastoid muscle. The mean dose of botulinum toxin used in the patient was 100 units (range ; 80-140 units). Mean dose of 25 units (range ; 20-30 units) for levator scapula, 30 units (range ; 20-40 units) for semispinalis, 37 units (range ; 25-50 units) for sternocleidomastoid, 40 units for trapezius and 58 units (range ; 40-100 units) for splenius capitus muscle were injected. Using Tsui score (for objective response rating scale) and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS ; for objective and subjective response rating scale), we assessed the patient before and 2, 6 and 10 weeks after the botulinum toxin injection. Seventeen of the 26 (65%) showed improvement on TWSTRS objective response rating scale, and 18 (69%) on Tsui scale. Comparing to the baseline score measured by Tsui scale, the amount of improvement was 37.1% (range 20-88%). Twenty one of the 26 (80.7%) reported improvement on subjective rating scale (TWSTRS). Twenty of the 21 responder on the subjective rating scale felt improvement within a week after the botulinum toxin injection. The beneficial effect lasted for 0.5 to longer than 9 months (mean ; 3.5months). We compared the result with that of the other studies in which larger doses of botulinum toxin were injected into the neck muscles selected on clinical ground. There was no significant difference of response rate and duration of beneficial effects. In our study, only two patients developed transient complications ; one
Botulinum Toxins* ; Botulinum Toxins, Type A ; Dystonic Disorders ; Humans ; Muscles ; Neck Muscles ; Needles ; Neurologic Examination ; Paraspinal Muscles ; Scapula ; Spasm ; Superficial Back Muscles ; Torticollis*

Adolescent ; Asthma ; therapy ; Child ; Humans ; Quality of Life ; Respiratory Therapy ; methods ; Surveys and Questionnaires ; Treatment Outcome

The idiopathic inflammatory myopathies form a heterogeneous group of disorders which differ in their severity, tempo of evolution, pattern of muscle involvement, associated clinicai features, pathological characteristics and response to therapy. According to the current literatures, dermatomyositis related with connective tissue disease constitutes 20% of all idiopathic inflammatory myopathies, but it seems that the case of dermatomyositis accompanied by scleroderma which is reported here is rare. We report a case of a 22-year oid female patient who was admitted to hospital due to progressive quadriparesis with deformity due to contracture and muscle atrophy of 1 year duration. There were whitish macules on the face and trunk ; bilateral periorbital heliotrope rash ; Gottron's papules on the dorsal aspect of the interphalangeal and metacar-phalangeal joints ; sclerotic skin texture ; and severe muscle atrophy and dysphagia. Laboratory examination revealed increaed creatine kinase, myopathic features were confirmed by electrophysiologic study, and subcutaneous calcification was seen on plain X-ray film. On skin and muscle biopsy, the characteristic features of dermatomyositis with scleroderma were seen.: dermal sclerosis, perifascicular atrophy, interstitial fibrosis and vasculitis. The patient died on the 28th hospital day due to sepsis.
Atrophy ; Biopsy ; Congenital Abnormalities ; Connective Tissue Diseases ; Contracture ; Creatine Kinase ; Deglutition Disorders ; Dermatomyositis* ; Exanthema ; Female ; Fibrosis ; Humans ; Joints ; Muscular Atrophy ; Myositis ; Quadriplegia ; Sclerosis ; Sepsis ; Skin ; Vasculitis ; X-Ray Film