OBJECTIVE: The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes. METHODS: A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs: subsidence, C2–C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain. RESULTS: In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups: however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425); fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31). CONCLUSION: Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.
Animals ; Arm ; Bone Plates ; Cervical Vertebrae ; Diskectomy* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Lordosis ; Neck ; Prospective Studies* ; Spinal Fusion ; Visual Analog Scale

BACKGROUND AND OBJECTIVES: Turner syndrome (TS) is known to be caused by a total or partial deletion of one X-chromosome. Besides short stature and failure to enter puberty due to ovarian dysgenesis, auricular malformations, middle ear diseases and hearing impairment are also other clinical features of Turner syndrome. The goal of this study is to report otologic and audiologic characteristics in a group of children with Turner syndrome and correlate with these findings to karyotype. SUBJECTS AND METHOD: We retrospectively reviewed the outpatient charts of those who visited at our department for otologic and audiologic screening test between 2008 and 2011. All 23 TS children (46 ears) were enrolled under regular control of their pediatric endocrinologist for treatment with growth hormon and Estrogen. The mean age was 12.6 years (6-24 years). All children were evaluated by otologic history taking, otoscopy, pure tone audiometry and karyotyping. Furthermore, 16 children undertook auditory brain stem response (ABR) test and 10 children temporal bone computed tomography (CT). RESULTS: Abnormal otoscopic findings were found in 48% (22 ears), abnormal otologic history in 70% (16 children), and abnormal audiologic findings in 70% (32 ears). According to karyotyping, the total p-arm deletion group (74%) showed unfavorable audiologic results. ABR test and temporal bone CT did not show any unique findings, except five poor pneumatization of mastoid. CONCLUSION: Hearing impairment can be present at early age in Turner syndrome. Careful follow up during childhood is necessary to detect early ear and hearing problems for active intervention. Karyotype may be used as a predictor for future hearing impairment.
Audiology ; Audiometry ; Child ; Ear ; Ear Diseases ; Ear, Middle ; Estrogens ; Evoked Potentials, Auditory, Brain Stem ; Hearing ; Hearing Loss ; Humans ; Karyotype ; Karyotyping ; Mass Screening ; Otoscopy ; Outpatients ; Puberty ; Retrospective Studies ; Temporal Bone ; Turner Syndrome

BACKGROUND: Since the time various strategies have been introduced to overcome the ABO-blood barrier including local infusion therapy (LIT), plasmapheresis and rituximab, the graft and patient survival outcome of ABO-incompatible (ABOi) adult living donor liver transplantation (ALDLT) has remarkably improved. But, the need for LIT under rituximab prophylaxis should be reevaluated because of high incidence of the LIT-related complications. The aim of this study was to verify the safety and efficacy of the protocol without local infusion therapy in ABOi ALDLT. METHODS: From November 2008 to December 2010, 43 cases of ABO-incompatible adult living donor liver transplantation were performed. In all cases, the spleen was preserved. From the 1st to 20th case, LIT was employed (group I, n=20). From the 21th case onwards, LIT was eliminated from the protocol (group II, n=23). The 3-month and 1-year patient and graft survival rates were compared between the two groups. The clinical parameters including recipient, donor and graft-related factors were also compared. The graft function was assessed in each group based on the serial changes in serum AST/ALT, total bilirubin and prothrombin time. RESULTS: There was 1 case of in-hospital mortality (2.3%) among the 43 cases. Overall 3-month and 1-year patient and graft survival rate was 97.7% and 92.1% during a mean period of 11.4 +/- 0.4 (0.9~28.9) months. There was no significant difference in the 3-month and 1-year patient and graft survival rates (95.0 vs. 100% and 90.0 vs. 92.9%, P=0.60) between groups. LIT-related complications occurred in 4 patients (20.0%). One case of antibody-mediated rejection occurred in group II. Both groups showed no difference in graft function at postoperative 3rd month. CONCLUSIONS: ABOi ALDLT without splenectomy and LIT resulted in promising outcomes. Therefore, LIT can be safely eliminated from the protocol.
Adult ; Antibodies, Monoclonal, Murine-Derived ; Bilirubin ; Graft Survival ; Hospital Mortality ; Humans ; Incidence ; Liver ; Liver Transplantation ; Living Donors ; Plasmapheresis ; Prothrombin ; Rejection (Psychology) ; Rituximab ; Spleen ; Splenectomy ; Tissue Donors ; Transplants

While receiving appropriate treatment, patients with tuberculosis occasionally have unusual, paradoxical reactions, with transient worsening of lesions or the development of new lesions. This report is a case of tuberculosis brain abscess and tuberculosis peritonitis with intra-abdominal abscess that developed during appropriate anti-tuberculosis chemotherapy. A 45-year-old male patient had been diagnosed as with all-drug susceptible pulmonary tuberculosis with pleurisy. Subsequently, the patient underwent standard treatment with anti-tuberculosis therapy; the pulmonary lesions improved. Three months after initial treatment, the patient developed brain abscesses and peritonitis. With the addition of corticosteroid treatment, the patient's neurologic symptoms were relieved. Exploratory laparotomy with surgical drainage was performed and a diagnosis of tuberculosis peritonitis was confirmed on biopsy. Anti-tuberculosis therapy was continued for 19 months, the patient improved eventually without further complications, although the therapeutic regimen had not been altered. In this case, the paradoxical response to treatment may have been involved in the pathogenesis of disease.
Abdominal Abscess ; Biopsy ; Brain ; Brain Abscess ; Drainage ; Humans ; Laparotomy ; Male ; Middle Aged ; Neurologic Manifestations ; Peritonitis ; Peritonitis, Tuberculous ; Pleurisy ; Tuberculosis ; Tuberculosis, Pulmonary

A 34-year-old woman complained of left facial palsy and numbness on the left thigh that began two weeks prior with headaches. Brain MRI revealed ill-defined patchy T2 weighted high signal intensities in the right medial temporal lobe and thalamus without contrast enhancement. Ten days later, when she complained of sensory symptoms below the 7th thoracic cord, we found an enhancing lesion in the lower cervical cord on the MRI. The result from the brain biopsy was consistent with anaplastic astrocytoma.
Adult ; Astrocytoma* ; Biopsy ; Brain* ; Facial Paralysis ; Female ; Headache ; Humans ; Hypesthesia ; Magnetic Resonance Imaging ; Spinal Cord* ; Temporal Lobe ; Thalamus ; Thigh

A 34-year-old woman complained of left facial palsy and numbness on the left thigh that began two weeks prior with headaches. Brain MRI revealed ill-defined patchy T2 weighted high signal intensities in the right medial temporal lobe and thalamus without contrast enhancement. Ten days later, when she complained of sensory symptoms below the 7th thoracic cord, we found an enhancing lesion in the lower cervical cord on the MRI. The result from the brain biopsy was consistent with anaplastic astrocytoma.
Adult ; Astrocytoma* ; Biopsy ; Brain* ; Facial Paralysis ; Female ; Headache ; Humans ; Hypesthesia ; Magnetic Resonance Imaging ; Spinal Cord* ; Temporal Lobe ; Thalamus ; Thigh

PURPOSE: To reveal clinical usefulness of functional MRI (fMRI) using sensorymotor and language stimuli for demonstrating anatomic relationship between sensorimotor or language cortices and lesions in the planning of brain tumor surgery. MATERIALS AND METHODS: This study included 12 right-handed patients with brain tumors in or around sensorimotor or language cortices. Eleven patients were evaluated with primary motor and sensory stimuli. Of these patients, six patients were also evaluated with language stimuli. One patient was evaluated with language stimuli only. For fMR imaging, a 1.5T scanner was used and the EPI BOLD technique was employed. For postprocessing image, the SPM99 program and a program made by our department was utilized. We evaluated whether sensorimotor and language stimuli activate sensorimotor and language cortices. And also, clinical efficacy of revealing anatomic relationship between cerebral cortices and lesions for planning neurosurgical operation were evaluated. Finally, we compared post-operative neurologic function with pre-operative neurologic function in same patients. RESULTS: The fMRI examination was successful in identifying the functional cortices and depicting anatomic relationship between functional cortices and lesions in all patients. In nine patients of 11 patients with identified sensorimotor cortices, postoperative grade of manual motor test was not changed, compared with preoperative grade. Whereas postoperative improved than preoperative grade in one patient of remaining two patients, postoperative aggravated than preoperative grade in the other. This result was due to atherosclerotic lacunar infarction, regardless of tumor resection. Postoperative deficit of language function was not found in seven patients with identified language cortices. CONCLUSION: fMRI could be a helpful method for determining the best approach to neurosurgical treatment in patients with brain tumors in or around sensorimotor or language cortices.
Brain Neoplasms* ; Brain* ; Cerebral Cortex ; Humans ; Magnetic Resonance Imaging* ; Stroke, Lacunar

PURPOSE: To investigate the prevalence rate of fatty liver disease and its related factors of women in rural area. METHODS: Seven hundreds and fifty four adult females (above age 30) at eleven Community Health Centers in Koryung County were recruited from 3 March 2001 to 30 May 2001. Abdominal ultrasonography, height, weight, and blood pressure were measured. A questionnaire interviewing method was used to collect life style data. RESULTS: The prevalence of fatty liver disease was 13.4%. By simple analysis, age(p<0.05), diabetes mellitus(p<0.01), salt intake(p<0.05), and obesity (p<0.01) were significantly associated with fatty liver disease. In multiple logistic regression analysis, the risk for fatty liver in above 50 age group was 2.7 (95% CI: 1.25-5.99) times higher than that in 30-49 age group, overweight was 10.3 (95% CI: 5.26-19.99) times higher than normal group, 3.9 times (95% CI: 1.84-8.38) higher in person with diabetes mellitus than those without and the risk of current drinkers was 2.0 times (95% CI: 1.03-3.85) higher than non-drinkers. CONCLUSION: Above findings suggested that risk factors significantly related with fatty liver were age, BMI, diabetes mellitus, and drinking in adult women.
Adult* ; Blood Pressure ; Community Health Centers ; Diabetes Mellitus ; Drinking ; Fatty Liver* ; Female ; Humans ; Life Style ; Logistic Models ; Obesity ; Overweight ; Prevalence* ; Risk Factors* ; Ultrasonography ; Surveys and Questionnaires

BACKGROUND: Vascular endothelial growth factor (VEGF) is a potent angiogenic peptide with biologic effects that include regulation of hematopoietic stem cell development, extracellular matrix remodeling, and inflammatory cytokine generation. VEGF plasma levels are elevated in circulation during tumor growth and bone marrow proliferative status. In this study, to investigate the role of VEGF expression in patients with aplastic anemia (AA), VEGF protein expression and microvessel density (MVD) were evaluated. METHODS: Immunohistochemical staining for detecting VEGF protein was performed by the labeled avidin-biotin method on the formalin-fixed and paraffin embedded bone marrow biopsy samples of 25 patients with severe AA and 10 normal controls. Microvessels were scored in at least 3 areas (x200 fields) of the highest MVD in representative sections of each bone marrow biopsy specimen using immunohistochemistry for CD34 antigen. RESULTS: In AA, megakaryocytes and histiocytes expressed less intense cytoplasmic VEGF than in control (P < 0.05). However, plasma cells had higher VEGF immunoreactivity in AA than in control. MVD was significantly lower in patients with AA (21.43+/-7.24), compared to controls (27.65+/-3.44) (P < 0.05). MVD had a strong correlation with bone marrow cellularity. Also, the degree of VEGF immunoreactivity was correlated with bone marrow cellularity and MVD. CONCLUSION: Angiogenesis as assessed by MVD and VEGF expression seems to have a role in the pathogenesis of AA.
Anemia, Aplastic* ; Antigens, CD34 ; Biopsy ; Bone Marrow ; Cytoplasm ; Extracellular Matrix ; Hematopoietic Stem Cells ; Histiocytes ; Humans ; Immunohistochemistry ; Megakaryocytes ; Microvessels ; Paraffin ; Plasma ; Plasma Cells ; Vascular Endothelial Growth Factor A*

In the metastatic CNS lymphoma, parenchymal involvement, especially in both temporal lobes, is rare. A 54-year-old man complained of memory impairment and personality changes that began two weeks prior. He had ulcerated skin lesions and multiple subcutaneous nodules. Brain MRI revealed a diffuse low in T1WI, high in T2WI, and contrast-enhancement in both temporal lobes. Treatment was done with acyclovir and dexamethasone, and symptoms were improved. One week later, symptoms were aggravated and a brain biopsy was performed. The result was a peripheral T-cell lymphoma. (J Korean Neurol Assoc 19(4):417~422, 2001)
Acyclovir ; Biopsy ; Brain ; Dexamethasone ; Humans ; Lymphoma ; Lymphoma, T-Cell* ; Lymphoma, T-Cell, Peripheral ; Magnetic Resonance Imaging ; Memory ; Middle Aged ; Skin ; T-Lymphocytes* ; Temporal Lobe* ; Ulcer