BACKGROUND: A large amount of blood is lost during spinal fusion surgery; therefore, a blood transfusion is required. In this study, we analyzed the amount of transfusion and hemodynamic changes in relation to the count of fusion segments in lumbosacral spinal surgeries. METHODS: We analyzed 67 patients who had undergone lumbosacral fusion. They were divided into five groups according to the levels of fusion segments (one level: Group 1, two levels: Group 2, three levels: Group 3, four levels: Group 4 and above three levels: Groups 3+4). Total amounts of transfusion and perioperative hemodynamic changes were compared among each group. RESULTS: Of the total 67 cases, 40 cases were Group 1, 19 cases were Group 2, five cases were Group 3, three cases were Group 4, and eight cases were Groups 3+4. Average volume of Red Blood Cell (RBC) transfusion per operation was 703+/-463 mL (Group 1), 934+/-372 mL (Group 2), 1,677+/-847 mL (Group 3), 1,231+/-412 mL (Group 4), and 1,509+/-669 mL (Group 3+4); and average volume of fresh frozen plasma (FFP) per operation was 55+/-141 mL (Group 1), 108+/-181 mL (Group 2), 306+/-368 mL (Group 3), 567+/-260 mL (Group 4), and 404+/-317 mL (Groups 3+4). Eight patients received transfusion of Platelet Concentrate (PC); each patient received 10 units (400 mL). The preoperative mean level of hemoglobin and platelet was 13.62+/-1.47 g/dL and 245+/-60x10(3)/microliter, postoperatively, 10.26+/-1.14 g/dL and 150+/-46x10(3)/microliter. CONCLUSION: As the fusion segments increase, the need for transfusion of RBC, FFP, and PC increases. Application of the Maximum Surgical Blood Order Schedule (MSBOS) system is required in the planning of spinal fusion, especially in multiple segments.
Appointments and Schedules ; Blood Platelets ; Blood Transfusion ; Erythrocytes ; Hemodynamics ; Hemoglobins ; Humans ; Lumbosacral Region ; Plasma ; Spinal Fusion

BACKGROUND: A large amount of blood is lost during spinal fusion surgery; therefore, a blood transfusion is required. In this study, we analyzed the amount of transfusion and hemodynamic changes in relation to the count of fusion segments in lumbosacral spinal surgeries. METHODS: We analyzed 67 patients who had undergone lumbosacral fusion. They were divided into five groups according to the levels of fusion segments (one level: Group 1, two levels: Group 2, three levels: Group 3, four levels: Group 4 and above three levels: Groups 3+4). Total amounts of transfusion and perioperative hemodynamic changes were compared among each group. RESULTS: Of the total 67 cases, 40 cases were Group 1, 19 cases were Group 2, five cases were Group 3, three cases were Group 4, and eight cases were Groups 3+4. Average volume of Red Blood Cell (RBC) transfusion per operation was 703+/-463 mL (Group 1), 934+/-372 mL (Group 2), 1,677+/-847 mL (Group 3), 1,231+/-412 mL (Group 4), and 1,509+/-669 mL (Group 3+4); and average volume of fresh frozen plasma (FFP) per operation was 55+/-141 mL (Group 1), 108+/-181 mL (Group 2), 306+/-368 mL (Group 3), 567+/-260 mL (Group 4), and 404+/-317 mL (Groups 3+4). Eight patients received transfusion of Platelet Concentrate (PC); each patient received 10 units (400 mL). The preoperative mean level of hemoglobin and platelet was 13.62+/-1.47 g/dL and 245+/-60x10(3)/microliter, postoperatively, 10.26+/-1.14 g/dL and 150+/-46x10(3)/microliter. CONCLUSION: As the fusion segments increase, the need for transfusion of RBC, FFP, and PC increases. Application of the Maximum Surgical Blood Order Schedule (MSBOS) system is required in the planning of spinal fusion, especially in multiple segments.
Appointments and Schedules ; Blood Platelets ; Blood Transfusion ; Erythrocytes ; Hemodynamics ; Hemoglobins ; Humans ; Lumbosacral Region ; Plasma ; Spinal Fusion

Purpose: Although the taller-than-wide (TTW) sign has been regarded as one of the most specific ultrasound (US) features of thyroid malignancy, uncertainty still exists regarding the US probe’s orientation when evaluating it. This study investigated which US plane would be optimal to identify the TTW sign based on malignancy risk stratification using a registry-based imaging dataset. Methods: A previous study by 17 academic radiologists retrospectively analyzed the US images of 5,601 thyroid nodules (≥1 cm, 1,089 malignant and 4,512 benign) collected in the webbased registry of Thyroid Imaging Network of Korea through the collaboration of 26 centers. The present study assessed the diagnostic performance of the TTW sign itself and fine needle aspiration (FNA) indications via a comparison of four international guidelines, depending on the orientation of the US probe (criterion 1, transverse plane; criterion 2, either transverse or longitudinal plane). Results: Overall, the TTW sign was more frequent in malignant than in benign thyroid nodules (25.3% vs. 4.6%). However, the statistical differences between criteria 1 and 2 were negligible for sensitivity, specificity, and area under the curve (AUC) based on the size effect (all P<0.05, Cohen’s d=0.19, 0.10, and 0.07, respectively). Moreover, the sensitivity, specificity, and AUC of the four FNA guidelines were similar between criteria 1 and 2 (all P>0.05, respectively). Conclusion A longitudinal US probe orientation provided little additional diagnostic value over the transverse orientation in detecting the TTW sign of thyroid nodules.

PURPOSE: The aim of this study was to understand the pathogenesis of the enophthalmos of Horner's syndrome. METHODS: We performed right cervical sympathectomy in 10 Sprague-Dawley rats weighing 200~300 grams at 8 weeks of age. We obtained bilateral extraocular muscle and fat from all 10 rats. These tissues were observed under light and electron microscopy. RESULTS: After 8 weeks, ptosis and enophthalmos were seen in the right eye in all rats. We found no change bilateral fat, but the right extraocular muscle fibers had smaller diameters than the left. The right intermuscular distance was longer than the left upon light microscopy and the right extraocular muscle contained fewer and smaller mitochondria than the left extraocular muscle upon electron microscopy. CONCLUSIONS: Based on these results, it is believed that enophthalmos resulted from extraocular muscle atrophy that resulted from decreasing metabolism of mitochondria in Horner's syndrome. However, enophthalmos in Horner's syndrome requires more intensive study.
Animals ; Enophthalmos ; Eye ; Horner Syndrome ; Light ; Microscopy ; Microscopy, Electron ; Mitochondria ; Muscles ; Muscular Atrophy ; Rats ; Rats, Sprague-Dawley ; Sympathectomy

BACKGROUND: As the population with chronic degenerative disease or functional impairment has increased in terms of the advanced aging society, the inevitability of home health services for the homebound have been augmented as a token of the trend toward the nuclear family along with the family capacity of care declined. For the past several years, home nursing service facilities have been enlarged and partially have been fulfilling these requirements. However, there are a great number of demands for home health service by physicians. Thereupon, we designed the following study to observe the cases of home visits by a medical office practice and to provide some information about the need of the home visit and its clinical features. METHODS: The study was conducted reviewing currently remained 84 data of home visit records at a home-visit- specialized medical office practice for 10 months in 1999. Its information collected was as below: patient's sex, age, frequency and duration of visit, distance to visit location, reason being homebound, and reason for visit. RESULTS: Of the reviewed records of 84 patients, comprised of 356 home visits, the median age of the patients was 67.5 years. They were visited 2 times as a median and with a median duration of 4 days. Physician drove a median distance of 6.1km one-way. Most common diagnoses were cancer and cerebrovascular diseases, equally with 10.8%. Reasons for being homebound were neurologic problem (28.6%), frail elderly (21.4%), terminal illness (20.2%) in order. Sixty two patients (73.8%) were permanently homebound and 12 patients (14.3%) were not. Reasons for visits were routine follow-up (42.1%) and evaluation of a new problem (19.9%) in the chronic homebound and terminal illness care (17.1%). While 102 visits (28.6%) should have begun by doctor-based visit, 233 visits (65.4%) including routine follow-up could be considered to be replaced for home nursing services. Even out of 233 visits, not all could be replaced and some should remain as physician's regular follow-up. CONCLUSION: There were needs of home visit in both permanent and transient homebound patients, in cases of exacerbation, new problem and routine follow-up of chronic homebound patients, and also in acute illness of previously healthy persons. To meet the needs of homebound patients in seeing the physician, and to offer adequate health services, the physician's role should be acknowledged in home nursing service, and home visit by physician should be institutionalized and carried into effect.
Aged ; Aging ; Diagnosis ; Follow-Up Studies ; Frail Elderly ; Health Services ; Home Nursing ; House Calls* ; Humans ; Nuclear Family ; Physician's Role ; Seoul*

PURPOSE: Genetic polymorphisms in antioxidant defense and detoxification genes may modulate the levels of oxidative stress biomarkers. METHODS: A total of 301 healthy preschool-aged children in the Seoul and Kyung-gi areas were recruited. DNA was extracted from blood for genotyping of manganese superoxide dismutase (Mn-SOD) Val16Ala, glutathione S-transferase (GST) P1 Ile105Val, GSTT1 present/null, and GSTM1 present/null polymorphisms by PCR-restriction fragment length polymorphism or multiplex PCR analyses. In addition to a questionnaire survey, the levels of urinary 8- hydroxyl-2-deoxiguanosine (8-OHdG) and plasma malondialdehyde (MDA) were measured by ELISA. RESULTS: Significantly higher urinary 8-OHdG concentrations were observed in GSTP1 Ile/Val + Val/Val genotype (p = 0.030), and tended to be higher in Mn-SOD Val/Val genotype (p = 0.065). On the other hand, exposure to environmental tobacco smoking (ETS) and interaction between ETS and gene polymorphisms did not significantly influence either urinary 8-OHdG concentrations or serum MDA. CONCLUSION: Based on our findings, GSTP1 Ile/Val gene polymorphisms might modulate the levels of oxidative stress biomarkers in healthy preschool children.
Biomarkers ; Child ; Child, Preschool* ; DNA ; Enzyme-Linked Immunosorbent Assay ; Genotype ; Glutathione Transferase ; Gyeonggi-do ; Hand ; Humans ; Malondialdehyde ; Multiplex Polymerase Chain Reaction ; Oxidative Stress ; Plasma ; Polymorphism, Genetic ; Seoul ; Smoking ; Superoxide Dismutase*

PURPOSE: This study attempted to investigate the effects of supply of highly concentrated (30%) oxygen on human ability of visuospatial cognition using time course data analysis of functional Magnetic Resonance Imaging (fMRI). MATERIALS AND METHODS: To select an item set in the visuospatial performance test, two questionnaires with similar difficulty were developed through group testing. A group test was administered to 263 college students. Two types of questionnaire containing 20 questions were developed to measure the ability of visuospatial cognition. Eight college students (right-handed male, average age of 23.5 yrs) were examined for fMRI study. The experiment consisted of two runs of the visuospatial cognition testing, one with 21% level of oxygen and the other with 30% oxygen level. Each run consisted of 4 blocks, each containing control and visuospatial items. Functional brain images were taken from 3T MRI using the single-shot EPI method. Using the subtraction procedure, activated areas in the brain during visuospatial tasks were col-orcoded by t-score. To investigate the time course data in each activated area from brain images, 4 typical regions (cerebellum, occipital lobe, parietal lobe, and frontal lobe) were selected. RESULTS: The average accuracy was 50.63 +/-8.63 and 62.50 +/-9.64 for 21% and 30% oxygen respectively, and a statistically significant difference was found in the accuracy between the two types of oxygen (p<0.05). There were more activation areas observed at the cerebellum, occipital lobe, parietal lobe and frontal lobe with 30% oxygen administration. The rate of increase in the cerebellum, occipital lobe and parietal lobe was 17% and that of the frontal lobe, 50%. Especially, there were increase of intensity of BOLD signal at the parietal lobe with 30% oxygen administration. The increase rate of the left parietal lobe was 1.4% and that of the right parietal lobe, 1.7%. CONCLUSION: It is concluded that while performing visuospatial tasks, high concentrations of oxygen administration make oxygen administration sufficient, thus making neural network activate more, and the ability to perform visuospatial tasks increase.
Brain ; Cerebellum ; Cognition ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging* ; Male ; Occipital Lobe ; Oxygen* ; Parietal Lobe ; Surveys and Questionnaires ; Statistics as Topic*

PURPOSE: This study attempted to investigate the effects of supply of highly concentrated (30%) oxygen on human ability of visuospatial cognition using time course data analysis of functional Magnetic Resonance Imaging (fMRI). MATERIALS AND METHODS: To select an item set in the visuospatial performance test, two questionnaires with similar difficulty were developed through group testing. A group test was administered to 263 college students. Two types of questionnaire containing 20 questions were developed to measure the ability of visuospatial cognition. Eight college students (right-handed male, average age of 23.5 yrs) were examined for fMRI study. The experiment consisted of two runs of the visuospatial cognition testing, one with 21% level of oxygen and the other with 30% oxygen level. Each run consisted of 4 blocks, each containing control and visuospatial items. Functional brain images were taken from 3T MRI using the single-shot EPI method. Using the subtraction procedure, activated areas in the brain during visuospatial tasks were col-orcoded by t-score. To investigate the time course data in each activated area from brain images, 4 typical regions (cerebellum, occipital lobe, parietal lobe, and frontal lobe) were selected. RESULTS: The average accuracy was 50.63 +/-8.63 and 62.50 +/-9.64 for 21% and 30% oxygen respectively, and a statistically significant difference was found in the accuracy between the two types of oxygen (p<0.05). There were more activation areas observed at the cerebellum, occipital lobe, parietal lobe and frontal lobe with 30% oxygen administration. The rate of increase in the cerebellum, occipital lobe and parietal lobe was 17% and that of the frontal lobe, 50%. Especially, there were increase of intensity of BOLD signal at the parietal lobe with 30% oxygen administration. The increase rate of the left parietal lobe was 1.4% and that of the right parietal lobe, 1.7%. CONCLUSION: It is concluded that while performing visuospatial tasks, high concentrations of oxygen administration make oxygen administration sufficient, thus making neural network activate more, and the ability to perform visuospatial tasks increase.
Brain ; Cerebellum ; Cognition ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging* ; Male ; Occipital Lobe ; Oxygen* ; Parietal Lobe ; Surveys and Questionnaires ; Statistics as Topic*

The significance of intraoperative electrophysiologic monitoring during microvascular decompression was evaluated prospectively in 261 patients with the hemifacial spasm from 1985 to 1995. The patients were divided into a monitored group and a non-monitored group. Identification of the offending vessels was facilitated by the monitoring during the surgical procedure and the complication rate of the monitored group was significantly lower than that of the non-monitored group (p< 0.05). In addition, the abnormal muscle response continued to improve during the follow-up period, thus the electrophysiological status of the hemifacial spasm after the microvascular decompression improved significantly with time (p< 0.05). In conclusion, intraoperative monitoring is useful for identifying the exact offender among multiple vessels, and lowering the complication rate of the microvascular decompression for the hemifacial spasm.
Adult ; *Decompression, Surgical ; *Facial Muscles ; Female ; Follow-Up Studies ; Human ; Male ; Middle Age ; *Monitoring, Intraoperative ; Spasm/physiopathology/*surgery

It is noted that Streptococcus mutans (S. mutans) triggers dental caries establishment by two major factors: the synthesis of organic acids, which demineralize dental enamel, and the synthesis of glucans, which mediate the attachment of bacteria to the tooth surface. Therefore, it is noted that the development of a more effective, substantial and safe preventive agent that works against dental caries and periodontal disease is required at this time. For this reason, the present study was designed to investigate the effect of croton seed ethanol extracts on the growth, acid production, adhesion, and insoluble glucan synthesis of S. mutans. In this case, the ethanol extract of croton seed showed concentration dependent inhibitory activity against the growth, acid production and adhesion of S. mutans. Especially, it is important to note that it has produced significant inhibition at the concentration of 0.1 and 0.2 mg/ml as compared to the control group. Moreover, these results suggest that the application of croton seed extract may be considered to be a useful method for the prevention of dental caries.
Bacteria ; Croton ; Dental Caries ; Dental Enamel ; Ethanol ; Glucans ; Methods ; Periodontal Diseases ; Streptococcus mutans ; Streptococcus ; Tooth