STUDY DESIGN: Retrospective case-control study. PURPOSE: To examine the hypothesis that the misuse of thrombin-containing local hemostatics (TCLH) increases the risk of postoperative spinal epidural hematoma (POSEH). OVERVIEW OF LITERATURE: Many studies have focused on hypocoagulability as a risk factor for POSEH. However, there are no prior reports on the increased risk of POSEH in hypercoagulable states. METHODS: Posterior instrumented lumbar spine surgery cases over 2 consecutive years were divided into two groups: a study group (98 patients in whom TCLH was used) and a control group (176 patients in whom TCLH was not used). The excess TCLH matrix that was not associated with blood clot was not removed from the patients in the study group. The senior author decided whether to use TCLH or not. Suction drains were used in all patients. The demographics, coagulation-related factors, and intraoperative factors of the patients in the two groups were analyzed. The development of POSEH was compared between the two groups. RESULTS: The two groups were homogenous in demographics (age and sex), coagulation-related factors (platelet count, prothrombin time, activated partial thromboplastin time, and platelet function analysis), and surgical factors (total blood loss, operation time, blood loss/10 minutes, number of fusion segments, posterolateral fusion/posterior lumbar interbody fusion, and virgin or revision surgery). POSEH developed more frequently in the patients in the study group than in those in the control group (14/98 patients, 14.3% vs. 3/176 patients, 1.7%, respectively; p=0.001; odds ratio, 17.1). CONCLUSIONS: TCLH causes blood clot not only at the edge of damaged vessels but also at the site of extravascular blood. Excess TCLH matrix not associated with blood clot at the epidural space can enhance POSEH development because early clotted hematomas do not drain through suction drains.
Blood Platelets ; Case-Control Studies ; Demography ; Epidural Space ; Hematoma ; Hematoma, Epidural, Spinal* ; Hemostatics* ; Humans ; Odds Ratio ; Partial Thromboplastin Time ; Prothrombin Time ; Retrospective Studies ; Risk Factors ; Spine ; Suction

Parkinson's disease (PD) is an irreversible neurological disorder with related locomotor dysfunction and is haracterized by the selective loss of nigral neurons. PD can be experimentally induced by 6-hydroxydopamine (6-OHDA). It has been reported that reactive oxygen species, which deplete endogenous glutathione (GSH) levels, may play important roles in the dopaminergic cell death characteristic of PD. Fucoidan, a sulfated algal polysaccharide, exhibits anti-inflammatory and anti-oxidant actions. In this study, we investigated whether fucoidan can protect against 6-OHDA-mediated cytotoxicity in SH-SY5Y cells. Cytotoxicity was evaluated by using MTT and LDH assays. Fucoidan alleviated cell damage evoked by 6-OHDA dose-dependently. Fucoidan reduced the number of apoptotic nuclei and the extent of annexin-V-associated apoptosis, as revealed by DAPI staining and flow cytometry. Elevation of lipid peroxidation and caspase-3/7 activities induced by 6-OHDA was attenuated by fucoidan, which also protected against cytotoxicity evoked by buthionine-sulfoximine-mediated GSH depletion. Reduction in the glutathione/glutathione disulfide ratio induced by 6-OHDA was reversed by fucoidan, which also inhibited 6-OHDA-induced disruption of mitochondrial membrane potential. The results indicate that fucoidan may have protective action against 6-OHDA-mediated neurotoxicity by modulating oxidative injury and apoptosis through GSH depletion.
Apoptosis ; Cell Death ; Flow Cytometry ; Glutathione ; Lipid Peroxidation ; Membrane Potential, Mitochondrial ; Nervous System Diseases ; Neurons ; Oxidopamine ; Parkinson Disease ; Reactive Oxygen Species

STUDY DESIGN: Literature review. OBJECTIVES: To propose possible mechanisms of osteoporotic back pain and its management with antiosteoporotic drugs. SUMMARY OF LITERATURE REVIEW: No general conclusion has yet been reached regarding whether osteoporosis without fractures can cause pain. Instead, only treatments for back pain without osteoporotic spine fractures have been reviewed in the previous literature. Although key studies of antiosteoporotic drugs have not investigated their analgesic efficacy, plausible mechanisms have been suggested. MATERIALS AND METHODS: The analgesic effects of antiosteoporotic agents available in Korea were reviewed. RESULTS: Rather than the long-term use of conventional analgesics or narcotics, antiosteoporotic drugs would be more beneficial because they can enhance bone strength and have fewer side effects. Both anabolic and antiresorptive agents available in Korea have been proven to have an analgesic effect against osteoporotic back pain, with or without fractures. Anabolic agents depend on skeletal effects. Among antiresorptive agents, bisphosphonates have both skeletal and extraskeletal mechanisms for analgesia. Calcitonin and selective estrogen receptor modulators mostly depend on extraskeletal effects. The order of analgesic strength for osteoporotic back pain is teriparatide > bisphosphonate > calcitonin. This implies that the analgesic effect of antiosteoporotic drugs primarily depends on their skeletal effects rather than on their extraskeletal effects. Moreover, because non-fracture osteoporotic pain has been recognized only in the spine, where fractures can occur without a sensible injury, pain may arise from undiscovered spine fractures. CONCLUSIONS: Antiosteoporotic drugs ameliorate osteoporotic back pain. Their analgesic strength is proportional to their fracture prevention efficacy.
Anabolic Agents ; Analgesia ; Analgesics ; Back Pain ; Bone Density Conservation Agents ; Calcitonin ; Diphosphonates ; Korea ; Narcotics ; Osteoporosis ; Selective Estrogen Receptor Modulators ; Spine ; Teriparatide

A 68-year old man diagnosed with Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) presented with multiple pneumonic infiltrations on his chest X-ray, and the patient was placed on a mechanical ventilator because of progressive respiratory failure. Urinary protein excretion steadily increased for a microalbumin to creatinine ratio of 538.4 mg/g Cr and a protein to creatinine ratio of 3,025.8 mg/g Cr. The isotope dilution mass spectrometry traceable serum creatinine level increased to 3.0 mg/dL. We performed a kidney biopsy 8 weeks after the onset of symptoms. Acute tubular necrosis was the main finding, and proteinaceous cast formation and acute tubulointerstitial nephritis were found. There were no electron dense deposits observed with electron microscopy. We could not verify the virus itself by in situ hybridization and confocal microscopy (MERS-CoV co-stained with dipeptidyl peptidase 4). The viremic status, urinary virus excretion, and timely kidney biopsy results should be investigated with thorough precautions to reveal the direct effects of MERS-CoV with respect to renal complications.
Aged ; Biopsy ; Coronavirus Infections/*diagnosis/virology ; Creatinine/blood/urine ; Dipeptidyl Peptidase 4/metabolism ; Humans ; In Situ Hybridization, Fluorescence ; Kidney/metabolism/*pathology ; Male ; Microscopy, Confocal ; Microscopy, Electron ; Middle East Respiratory Syndrome Coronavirus/*genetics/isolation & purification ; RNA, Viral/genetics/metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Serum Albumin/analysis

BACKGROUND: Postoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability. METHODS: This was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15. RESULTS: The remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application. CONCLUSIONS: With a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombin-containing local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.
Drainage ; Hematoma ; Hematoma, Epidural, Spinal* ; Hemostatics ; Humans ; Spine ; Suction* ; Thrombin ; Thrombophilia ; Vacuum

The average life expectancy of human immunodeficiency virus (HIV)-infected patients has improved dramatically following the advent of highly active anti-retroviral therapy. However, this increased life expectancy has led to a greater incidence of non-acquired immune deficiency syndrome related diseases, including cardiovascular diseases and other malignancies. Increased bone fragility is also a significant concern, with the incidence of osteoporosis and osteoporotic fractures 3- and 2-times more likely, respectively, among HIV-infected patients. Bone mineral density screenings for osteoporosis will therefore become more important as the HIV-infected population ages. Here, we describe six cases of osteoporotic fractures in HIV-infected patients in Korea.
Bone Density ; Cardiovascular Diseases ; HIV ; Humans ; Incidence ; Korea ; Life Expectancy ; Mass Screening ; Osteoporosis ; Osteoporotic Fractures*

Ciliary rootlet coiled coil protein (CROCC), the structural component that originates from the basal body at the proximal end of the ciliary rootlet, plays a crucial role in maintaining the cellular integrity of ciliated cells. In the current study, we cloned Xenopus CROCC and performed the expression analysis. The amino acid sequence of Xenopus laevis was related to those of Drosophila, cow, goat, horse, chicken, mouse and human. Reverse transcription polymerase chain reaction analysis revealed that CROCC mRNA encoding a coiled coil protein was present maternally, as well as throughout early development. In situ hybridization indicated that CROCC mRNA occurred in the animal pole of embryo during gastrulation and subsequently in the presumptive neuroectoderm at the end of gastrulation. At tailbud stages, CROCC mRNA expression was localized in the anterior roof plate of the developing brain, pharyngeal epithelium connected to gills, esophagus, olfactory placode, intestine and nephrostomes of the pronephric kidney. Our study suggests that CROCC may be responsible for control of the development of various ciliated organs.
Amino Acid Sequence ; Animals ; Basal Bodies ; Brain ; Chickens ; Clone Cells ; Drosophila ; Embryonic Structures ; Epithelium ; Esophagus ; Gastrulation ; Gills ; Goats ; Horses ; Humans ; In Situ Hybridization ; Intestines ; Kidney ; Mice ; Neural Plate ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger* ; Xenopus laevis ; Xenopus*

A 12-year-old spayed female mixed-bred dog presented with nasal bleeding of 2 days duration and a skin nodule in the left flank. No abnormalities were found in coagulation profiles and blood pressure. Cytological evaluation of the nodule revealed numerous characteristic round organisms having a nucleus and a bar within macrophages and in the background, consistent with leishmaniasis. In vitro culture was unsuccessful but PCR of the nodular aspirate identified the organisms as Leishmania infantum, and the final diagnosis was canine leishmaniasis. No history of travel to endemic countries was noted. Because the dog had received a blood transfusion 2 years before the illness, serological screening tests were performed in all donor dogs of the commercial blood bank using the commercial Leishmania ELISA test kit, and there were no positive results. Additional 113 dogs with hyperglobulinemia from Seoul were also screened with the same kits but no positive results were obtained. To the best of the author's knowledge this is the first autochthonous case of canine leishmaniasis in Korea.
Animals ; Base Sequence ; DNA, Protozoan/chemistry/genetics ; DNA, Ribosomal/chemistry/genetics ; Dog Diseases/*diagnosis/epidemiology ; Dogs ; Enzyme-Linked Immunosorbent Assay/veterinary ; Female ; Giant Cells/pathology ; Leishmania infantum/genetics/immunology/*isolation & purification ; Leishmaniasis, Visceral/diagnosis/*veterinary ; Molecular Sequence Data ; Polymerase Chain Reaction/veterinary ; Protozoan Proteins/genetics ; Republic of Korea ; Sequence Analysis, DNA/veterinary ; Serologic Tests/veterinary

PURPOSE: To compare and analyze length change of patella tendon after intramedullary nailing of tibial shaft fracture using transtendinous approach. MATERIALS AND METHODS: Thirty-two cases were analyzed from December, 1999 to December, 2005. Insall Salvati ratios were estimated. Severity of initial trauma, duration of nail retension, knee function and pain on change of length of patellar tendon was evaluated. RESULTS: Mean duration of nail retention was twenty-two months. The shortening of patella tendon was observed in 25 cases (p<0.001). The effect of AO type and the duration of nail retension on the decrease of Insall Salvati ratio was not significant (p>0.05, p=0.778). Lysholom score decrease to 89.5. There was no significant difference between the shortening of patellar tendon length and knee pain (p=0.058). CONCLUSION: After intramedullary nailing for closed tibia fracture, shortening of patellar tendon length is observed. That is irrelevant to the fracture type and the duration of nail retension. The shortening of patella tendon length may contribute to decreasing of knee function, but it was no significance of knee pain after intramedullary nailing.
Fracture Fixation, Intramedullary ; Knee ; Nails ; Patella ; Patellar Ligament ; Retention (Psychology) ; Tibia ; Tibial Fractures

Adiaspiromycosis is caused by pulmonary infection with Emmonsia. Inhalated spores of Emmonsia cause asymptomatic infection to necrogranulomatous pneumonia, depending on the burden of adiaspore and host immunity. For disease monitoring of wild rodents captured on Jeju Island in Korea, we examined the lung tissue of wild rodents histopathologically. Spores composed of thick three-layered walls were found following histopathological examination and were diagnosed as adiaspiromycosis. Adiaspiromycosis has been found in mammals in many parts of the world. To our knowledge, this is the first report of adiaspiromycosis of an Apodemus agrarius captured in Korea.
Animals ; Asymptomatic Infections ; Chrysosporium ; Korea ; Lung ; Mammals ; Murinae ; Pneumonia ; Rodentia ; Spores