OBJECTIVE: To analyze the clinical courses and outcomes after anterior lumbar interbody fusion (ALIF) for the treatment of postoperative spondylodiscitis. METHODS: A total of 13 consecutive patients with postoperative spondylodiscitis treated with ALIF at our institute from January, 1994 to August, 2013 were included (92.3% male, mean age 54.5 years old). The outcome data including inflammatory markers (leukocyte count, C-reactive protein, erythrocyte sedimentation rate), the Oswestry Disability Index (ODI), the modified Visual Analogue Scale (VAS), and bony fusion rate using spine X-ray were obtained before and 6 months after ALIF. RESULTS: All of the cases were effectively treated with combination of systemic antibiotics and ALIF with normalization of the inflammatory markers. The mean VAS for back and leg pain before ALIF was 6.8+/-1.1, which improved to 3.2+/-2.2 at 6 months after ALIF. The mean ODI score before ALIF was 70.0+/-14.8, which improved to 34.2+/-27.0 at 6 months after ALIF. Successful bony fusion rate was 84.6% (11/13) and the remaining two patients were also asymptomatic. CONCLUSION: Our results suggest that ALIF is an effective treatment option for postoperative spondylodiscitis.
Anti-Bacterial Agents ; Blood Sedimentation ; C-Reactive Protein ; Discitis* ; Humans ; Leg ; Male ; Spine

BACKGROUND: This scientific statement is intended to provide a systematic review of new evidences in dyslipidemia and inflammation for primary stroke prevention. METHODS: Using a structured literature search, we identified major observational studies, clinical trials, meta-analyses, and updated major guidelines published between July 2007 and November 2010. In addition to the brief summary of earlier evidences employed in the first edition of Korean clinical practice guideline for primary prevention of stroke, we summarized the newly identified evidences. RESULTS: For dyslipidemia, observational studies further support a strong association between ischemic stroke and high total and low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol. Two clinical trials and 6 meta-analyses confirm statin efficacy for primary prevention of stroke in high risk patients. Efficacy of other lipid-lowering agents is not established. For inflammation, inflammatory markers might help to identify patients having high risk for stroke or cardiovascular event and to decide whether statin therapy is indicated, but its usefulness for broad population needs to be confirmed. CONCLUSIONS: Writing committee will continue to keep an eye on upcoming evidences to timely update the guideline for primary stroke prevention in dyslipidemia and inflammation.
Cholesterol ; Dyslipidemias ; Eye ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Lipoproteins ; Meta-Analysis as Topic ; Practice Guidelines as Topic ; Primary Prevention ; Stroke ; Writing

In this study, we investigated the effect of methanolic extract isolated from the root of Lycoris aurea (LA) on the growth of cancer cells and the tube formation activity of endothelial cells. Various cancer cells were treated with LA at doses of 0.3, 1, 3, 10 or 30 microg/ml and LA significantly suppressed the growth of several cancer cell lines, including ACHN, HCT-15, K-562, MCF-7, PC-3 and SK-OV-3, in a dose-dependent manner. We also found that LA induced cell cycle arrest at G2/M phase in ACHN renal cell adenocarcinoma cells. Further study demonstrated that LA concentration-dependently inhibited the tube formation, which is a widely used in vitro model of reorganization stage of angiogenesis, in human umbilical vein endothelial cells. Collectively, these results show that LA inhibits the growth of cancer cells and tube formation of endothelial cells and the growth-inhibitory effect of LA might be mediated, at least in part, by blocking cell cycle progression.
Carcinoma, Renal Cell ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Line ; Endothelial Cells ; Human Umbilical Vein Endothelial Cells ; Lycoris ; Methanol

OBJECTIVE: To establish normative data for spinal canal AP diameter from cervical vertebra to sacrum in the Korean young and to assess the exposed spinal canal after laminectomy which was related with restenosis by post-laminectomy membrane formation. METHODS: From PET/CT, axial bone-window CT of 83 young adults (20-29 years) were obtained, and we measured AP diameters of C3, C5, C7, T1, T4, T8, T12, L1, L3, L5 and S1. We also measured exposed AP diameter of C3, C5, C7, T1 and T2 above imaginary line for laminectomy. RESULTS: The shortest mean AP diameter was at C5 (14.5+/-1.5 mm), and the longest was at S1 (17.4+/-2.3 mm). AP diameter increased from C3 (14.6+/-1.1 mm) to T1 (16.1+/-1.2 mm) at cervical spine. In the thoracic spine, the diameter gradually decreased from T1 (16.1+/-1.2 mm) to T8 (14.6+/-1.3 mm) and increased to T12 (16.7+/-1.2 mm). The diameter decreased from L1 (16.7+/-1.3 mm) to L3 (15.7+/-1.9 mm), and it increased to S1 (17.4+/-2.3 mm) at lumbar spine. Exposed AP diameter above imaginary line for laminectomy was the longest at C3 (4.8+/-1.2 mm) and gradually decreased to T1 (3.3+/-0.9 mm) and T2 (0 mm). CONCLUSIONS: Spinal AP diameter was the shortest in the mid-cervical area (C5) and increased to the upper thoracic area. From the upper thoracic vertebra, the diameter gradually decreased to the mid-thoracic vertebra (T8) and then increased to the lower thoracic vertebra. Lumbar vertebra also was similar with thoracic vertebra. Below T2, there was no exposed dural sac after laminectomy. This means that restenosis by post-laminectomy membrane formation can occur above T1.
Cervical Vertebrae ; Female ; Humans ; Laminectomy ; Lumbar Vertebrae ; Membranes ; Sacrum ; Spinal Canal ; Spine ; Thoracic Vertebrae ; Young Adult

BACKGROUND: Although several hospital-based stroke studies were published, there has not been any reliable data representing the clinical characteristics of stroke in Korea. We analyzed the clinical characteristics of patients with ischemic stroke registered in the Korean Stroke Registry (KSR), which is the largest prospective hospital-based nation-wide stroke registry in Korea. METHODS: The KSR provided standardized protocols for collecting data, which includes the data of demographics, subtypes of stroke, risk factors, and neurological outcome at discharge. The brain imaging studies, including CT or MRI, were performed in all cases. RESULTS: KSR registered 10,811 patients of acute ischemic stroke between Nov. 2002 and Jun. 2004. The large-artery atherosclerosis was the most common subtype (37.3%), followed by small vessel occlusion (30.8%). Hypertension (65.4%) was the most common risk factor, followed by smoking (34.5%) and diabetes (28.3%). Although most of the hypertensive and diabetic patients had been diagnosed before the stroke, less than 45.4% and 32.5% of them were under regular control. The steno-occlusive lesion of extracranial carotid artery was only 29.3% and the ratio of intra- to extracranial artery disease was more than 2 in KSR. Only 20.5% of patients were admitted within 3 hours after stroke onset and 2.1% were treated with intravenous thrombolysis. In-hospital case-fatality was 5.2%, which is relatively comparable to those of previous studies. CONCLUSIONS: The KSR provided informative data in understanding the clinical characteristics of ischemic stroke in Korea. Further analysis of KSR will facilitate clinical trials and development of guidelines for the management of stroke patients.
Arteries ; Atherosclerosis ; Carotid Arteries ; Cerebrovascular Disorders ; Demography ; Epidemiology ; Humans ; Hypertension ; Korea ; Magnetic Resonance Imaging ; Neuroimaging ; Prospective Studies* ; Registries ; Risk Factors ; Smoke ; Smoking ; Stroke*

Staphylococcal scalded skin syndrome is a systemic disease with a clinical spectrum ranging from subcorneal pustules, patterned exfoliation to extensive erosion and peeling of skin by the exfoliative toxin of group II Staphylococcus aureus. This disease occurs mainly in infancy and children below five years and it isn't easy to differentiate from other vesicular diseases clinically, but skin biopsy shows an epidermal split at the granular layer. The form and severity of staphylococcal scalded skin syndrome will vary according to defense system and toxic factors. Treatment is effective antibiotics, and the mortality rate increases to 5% in children. In our four cases, symptoms were erythema and fever, followed by formation of large bullae and denuded skin. On laboratory findings, leukocytosis was noted in three cases, and S. aureus was confirmed by culture of eye discharge in all cases. Our cases improved with antibiotic therapy. We experienced four cases of staphylococcal scalded skin syndrome which were presented with vesicle and exfoliative skin lesion and treated successfully.
Anti-Bacterial Agents ; Biopsy ; Child ; Erythema ; Fever ; Humans ; Leukocytosis ; Mortality ; Skin ; Staphylococcal Scalded Skin Syndrome* ; Staphylococcus aureus

BACKGROUND: Cell lines can be established when the cells are clonally selected and propagated continuously in vitro culture system. Recently we established a B cell line (KEB1) from the bone marrow cells of the patient infected with Epstein-Barr virus (EBV). METHODS: The patient's initial platelet count was 1,000/microliter and peripheral blood smear showed atypical lymphocytes accounting 20% of the differentials of WBC. Antibodies to EBV and PCR for EBV were positive but heterophil antibody was negative. Mononuclear cells were obtained by Ficoll-paque separation and suspended in RPMI media with 10% FCS. After incubation in 37degrees C, 5% CO2 incubator, cells grew continuously and finally immortalized to B cell line. RESULTS: Cells showed abundant, clear basophilic cytoplasms and a few vacuoles. Cells had granular reaction in PAS stain and were positive to B cell antibodies. Immunohistochemical stain showed positive expression for EBV antibody. Electron microscopic finding of cultured cells showed several viral particles, and immunoelectron microscopic finding showed electron dense expression. Immunophenotyping of cultured cells was positive for B lymphoid lineage, and karyotypings had hypotetraploidy. Cells expressed MAGE and SSX gene. Cytotoxicity showed relative resistance to mistletoe and several chemotherapeutic agents compared to leukemic cell line. CONCLUSION: KEB1 cell line was established from the bone marrow cells of the patient with infectious mononucleosis. The characteristics of the cell lines including morphology, immunophenotype, karyotype, gene analysis (MAGE, SSX) and chemosensitivity were analyzed. There should be further studies of these cell lines including gene analysis, telomerase activity and cytokine production. This cell line might be helpful to establish another normal lymphocyte cell line and to predict the toxicity of chemotherapy.
Antibodies ; Basophils ; Bone Marrow Cells* ; Bone Marrow* ; Cell Line* ; Cells, Cultured ; Cytoplasm ; Drug Therapy ; Herpesvirus 4, Human* ; Humans ; Immunophenotyping ; Incubators ; Infectious Mononucleosis ; Karyotype ; Karyotyping ; Lymphocytes ; Mistletoe ; Platelet Count ; Polymerase Chain Reaction ; Telomerase ; Vacuoles ; Virion

PURPOSE: This study was performed to analyze the endoscopic findings in Henoch-Schonlein purpura patients, and to compare the differences in endoscopic findings according to age and gastrointestinal symptoms. METHODS: We examined children with Henoch-Schonlein purpura aged 3 to 15 years between September 1996 and October 2002. The total number studied was 65, consisting of 41 boys and 24 girls. Endoscopy was performed and the results were analysed. RESULTS: Among 65 cases, 12 cases of duodenitis, nine cases of gastritis and duodenitis, six cases of duodenal erosion, five cases of gastritis, five cases of duodenal ulcer, two cases of gastric ulcer and one case of colonic erosion were noted. Endoscopic abnormality was found in 38 of 53 who had gastrointestinal symptoms, and in two of 12 who didn't have gastrointestinal symptoms. CONCLUSION: Most of the gastrointestinal symptoms in Henoch-Schonlein purpura patients were relieved without complication. But in some cases severe symptoms such as hematemesis, melena, and abdominal pain localized to epigastric area were developed when diagnosis was delayed. Prompt endoscopy will be helpful for diagnosis and therapy of Henoch-Schonlein purpura with gastrointestinal involvement.
Abdominal Pain ; Child* ; Colon ; Diagnosis ; Duodenal Ulcer ; Duodenitis ; Endoscopy ; Female ; Gastritis ; Hematemesis ; Humans ; Melena ; Purpura, Schoenlein-Henoch* ; Stomach Ulcer

Bone marrow necrosis is a rare complication of a variety of diseases affecting the marrow. The cause and incidence are unknown, and reports of treatment response are rare. We describe a case of relapsed acute mixed type leukemia with bone marrow necrosis. The patient was a 10 year old female diagnosed with acute mixed type leukemia four years ago. She had been on second remission state for 1 year, presented with severe back pain, tenderness in lower extremities, low-grade fever and general weakness. Her level of serum lactic dehydrogenase on admission was increased. Bone marrow aspiration from both posterior iliac crest showed marrow necrosis. Subsequent examination showed the same feature. Hip MRI showed heterogenous low signal intensity in both iliac bone on T-1 weighted image and heterogenous high signal intensity on T-2 wieghted image. Remission induction therapy was started but she expired on 59th hospital day due to the complication of sepsis.
Back Pain ; Bone Marrow* ; Child ; Female ; Fever ; Hip ; Humans ; Incidence ; Leukemia* ; Lower Extremity ; Magnetic Resonance Imaging* ; Necrosis* ; Oxidoreductases ; Remission Induction ; Sepsis

PURPOSE: The N-myc amplification is one of well known poor prognostic markers in neurblastoma. Because the traditional detection method, Southern blot, is expensive, labor-intensive and time-consuming, the detection of N-myc amplification is not routinely performed in Korea. The purposes of this study are to develop polymerase chain reaction (PCR) for detecting N-myc amplification in neuroblastoma tumor tissue, and to elucidate the clinical significance of N-myc amplification. METHODS: The clinical data and paraffin embedded tumor specimen of 54 neuroblastoma cases were collected from 10 medical centers in Korea. We have developed semiquantitative method of estimating gene copy number that uses differential PCR. N-myc gene primers (RC N-myc, N-myc 7-1) are amplified together with primers from a single-copy internal control gene (beta-globin). After ethidium bromide-stained agarose gel electrophoresis, the ratio of the two PCR products, which stands for N-myc amplification, is determined. Kaplan-Meier survival analysis was performed to evaluate the prognostic significance of N-myc amplification. RESULTS: The differential PCR was very effective, less expensive, less labor-intensive, and simple detection method for N-myc amplification. The percentage of N-myc amplification was higher in the patients older than 1 year old (34.1%: 14/41), when they were compared to the patients younger than 1 year old (16.7%: 2/12). The percentage of N-myc amplification was higher in the patients who have primary tumor at adrenal gland (40.9%: 9/22) than who have primary tumor at retroperitoneum (17.6%: 3/17) or at mediastinum (16.7%: 2/12). In Stage I, II, and III patients, the mean survival time of N-myc amplified group was 18 months and that of N-myc umamplified group was 64 months (Log Rank 4.35, P=0.037). CONCLUSION: The differential PCR was very effective, less expensive, less labor-intensive, and simple detection method for N-myc amplification. The N-myc amplification is one of poor prognostic indicators in Neuroblastoma.
Adrenal Glands ; Blotting, Southern ; Electrophoresis, Agar Gel ; Ethidium ; Gene Dosage ; Genes, myc ; Humans ; Korea ; Mediastinum ; Neuroblastoma* ; Paraffin ; Polymerase Chain Reaction* ; Prognosis ; Survival Rate