No abstract available.
Mucopolysaccharidosis II* ; Retinaldehyde* ; Tomography, Optical Coherence*

OBJECTIVE: To determine clinical and radiological factors that predict the successful outcome of percutaneous disc decompression (PDD) in patients with lumbar herniated nucleus pulposus (HNP). METHODS: We retrospectively reviewed the clinical and radiological features of patients who underwent lumbar PDD from April 2009 to March 2013. Sixty-nine patients with lumbar HNP were studied. Clinical outcome was assessed by the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Multivariate logistic regression analysis was performed to assess relationship among clinical and radiological factors and the successful outcome of the PDD. RESULTS: The VAS and the ODI decreased significantly at 1 year follow-up (p<0.01). One year after PDD, the reduction of the VAS (DeltaVAS) was significantly greater in the patients with pain for <6 months (p=0.03) and subarticular HNP (p=0.015). The reduction of the ODI (DeltaODI) was significantly greater in the patients with high intensity zone (p=0.04). Multivariate logistic regression analysis revealed the following 5 factors that were associated with the successful outcome after PDD: pain duration for <6 months (odds ratio [OR]=14.036; p=0.006), positive straight leg raising test (OR=8.425, p=0.014), the extruded HNP (OR=0.106, p=0.04), the sequestrated HNP (OR=0.037, p=0.026), and the subarticular HNP (OR=10.876, p=0.012). CONCLUSION: PDD provided significant improvement of pain and disability of patients. The results of the analysis indicated that the duration of pain <6 months, positive straight leg raising test, the subarticular HNP, and the protruded HNP were predicting factors associated with the successful response of PDD in patients with lumbar HNP.
Decompression* ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Leg ; Logistic Models ; Radiculopathy ; Regression Analysis ; Retrospective Studies ; Treatment Outcome

PURPOSE: Charcot-Marie-Tooth disease type 2A (CMT2A) is caused by mutations in the mitofusin 2 (MFN2) genes associated with variable central nervous system (CNS) involvement. The authors report a case of a middle-aged woman with genetically confirmed CMT type 2 (CMT2), combined with delayed-onset bilateral optic neuropathy. CASE SUMMARY: A 47-year-old woman presented with complaints of subacute decrease of visual acuity in both eyes. Her corrected visual acuity was 20/200 in the right eye and 20/320 in the left eye. Fundus photographs revealed bilateral disc pallor and diffuse retinal nerve fiber layer defects. No papillomacular bundle defect was observed. Goldmann perimetry showed central scotoma in both eyes. She had suffered from muscle wasting of the legs and foot deformities such as high arches and hammer toes since childhood and required a wheelchair for ambulation. A series of CMT gene mutation tests revealed an MFN2 gene mutation, c.617C>T (p.Thr206Ile), and the patient was diagnosed with CMT2A. CONCLUSIONS: Charcot-Marie-Tooth disease is a common inherited neuromuscular disorder and CMT2A, an axonal CMT neuropathy, is associated with bilateral optic neuropathy. Therefore, suspecting CMT and testing for gene mutations as part of the work-up in patients with subacute bilateral optic neuropathy associated with peripheral neuropathy is critical.
Axons ; Central Nervous System ; Charcot-Marie-Tooth Disease* ; Female ; Foot Deformities ; Hammer Toe Syndrome ; Humans ; Leg ; Middle Aged ; Nerve Fibers ; Optic Nerve Diseases* ; Pallor ; Peripheral Nervous System Diseases ; Retinaldehyde ; Scotoma ; Visual Acuity ; Visual Field Tests ; Walking ; Wheelchairs

Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.
*Hepatectomy/statistics & numerical data ; Humans ; *Laparoscopy/statistics & numerical data ; Liver/*surgery ; Liver Diseases/pathology/surgery ; Liver Neoplasms/pathology/surgery ; Postoperative Complications/epidemiology ; Questionnaires ; Republic of Korea

Eisenmenger's syndrome consists of high pulmonary vascular resistance with reversed or bidirectional shunt at aortopulmonary, ventricular, or atrial level. Noncardiac surgery for a patient with this syndrome is challenging because both the perioperative morbidity and mortality are high. We describe the anesthetic management of a 66-year-old female patient with Eisenmenger's syndrome secondary to the tetralogy of Fallot (TOF), who was operated on for the fractured neck of her left femur. Anesthesia was induced with etomidate and sufentanil and was maintained with propofol and sufentanil without any inhalational anesthetics (total intravenous anesthesia). To maintain the systemic vascular resistance, we administered norepinephrine throughout the surgery and the postoperative care. The patient was discharged 20 days after the operation without any complications.
Aged ; Anesthesia ; Anesthetics ; Eisenmenger Complex ; Etomidate ; Female ; Femur ; Humans ; Neck ; Norepinephrine ; Postoperative Care ; Propofol ; Sufentanil ; Tetralogy of Fallot ; Vascular Resistance

PURPOSE: The purpose of this study was to evaluate the treatment result of surgical resection after preoperative chemotherapy in inoperable gastric cancer patients. MATERIALS AND METHODS: We analyzed 18 gastric cancer patients who underwent gastric resection after preoperative chemotherapy because they showed some clinical response to chemotherapy (15 with distant metastasis and 3 with locally advanced lesions). The mean postoperative follow-up period was 15.3+/-15.5 (1~56) months. RESULTS: In 15 patients with distant metastasis, 2 (13.3%) showed complete response (CR), 10 (66.7%) partial response (PR), 2 (13.3%) stable disease (SD), and 1 (6.7%) progressive disease (PD). The clinical response rate was 80.0%. Five subtotal gastrectomies, 4 total gastrectomies, and 6 extended total gastrectomies were performed. Two cases of CR were alive without recurrence for 4 and 26 months, respectively. Mean survival period in PR case was 37.7 months, but 2 cases of SD and 1 case of PD died after 11.7, 17.9, and 0.9 months, respectively. Postoperative survival was significantly associated with the response to chemotherapy (P<0.01). The mean survival period of the 10 patients with a complete resection was 44.1 months, which was significantly better than that of the 5 patients with an incomplete resection (9.8 months, P=0.03). Among 3 patients with locally advanced gastric cancer, 2 cases showed PR to chemotherapy, and complete resection was possible only by gastrectomy for those patients. CONCLUSION: In some selected cases, surgical resection was achievable after preoperative chemotherapy for patients with inoperable metastatic or locally advanced gastric cancer.
Drug Therapy* ; Follow-Up Studies ; Gastrectomy ; Humans ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Stomach Neoplasms*

Calcitriol therapy is an important treatment for the prevention and control of secondary hyperparathyroidism in continuous ambulatory peritoneal dialysis (CAPD) patients. However, this often has been limited by the associated hypercalcemia and hyperphosphatemia due to increase in intestinal calcium and phosphorus absorption. Many studies reported that these limitations could be avoided by changing routes, frequency and dose of calcitriol treatment. But, there are still controversy about each methods and the results on the PTH response to conventional calcitriol treatment in CAPD patients. This study was performed to evaluate the factors affecting the response to oral calcitriol in CAPD patients. A retrospective study was done in 92 CAPD patients with secondary hyperparathyroidism(intact PTH level >200pg/ml) on oral calcitriol treatment. After baseline study of serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine and intact PTH, calcitriol therapy was begun via oral rou- te, daily. Serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine, intact FI'H and other bio- chemical markers were checked at 3 month, 6 month after treatment. Parathyroid gland ultrasonography was performed to detect parathyroid hypertrophy and nodule and to measure the diameter of parathymid gland. All the patients were divided into two groups according to percent reduetion of i-PTH(initial PTH PTH after 3, 6 months)X100/initial PTH(%),deltaPTH during oral calcitriol therapy for 3 and 6 months(group I ; delta PTH >30%, group II ; delta PTH <30%). RESULT: 1) All 92 patients(mean age 46.5 11.3yr, M: F 45: 47, mean CAPD duration 51.3 39.4 months) were administered oral calcitriol, daily. Mean calcitriol dose during 3 month was 0.43 0.22Mg and during 6month 0.43 0.24Mg. 2) After 3-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, initial phosphorus, intial total alkaline phosphatase and duration of CAPD between group I and II(406.7+/-196.5 vs. 871.0+/-478Apglml, 6.2+/-2.6 vs. 13.1+/-5.2mm, 5.0+/-1.3 vs. 5.7+/-1.3mg/dl, 93.7+/-4L1 vs. 171.9+/-137.6IU/L, 40.1+/-34.9 vs. 73.5+/-37.8months, p< 0.05, respectively). 4) After 6-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, intial total alkaline phosphatase and duration of CAPD between group I and II(474.1+/-266.6 vs. 889.7+/-485.4pg/ml, 6.4+/-2.7 vs. 14.5+/-5.1mm, 107.9+/-80.1 vs. 180.7+/-121.5IU/L, 40.5+/- 32.9 vs. 81.8+/-35.3months, p<0.05, respectively). 5) The significant negative correlation was shown between deltaPTH and the duration of peritoneal dialysis, the diameter of parathyroid gland, initial PTH level and PTH response during 3-month and 6-month oral calcitriol treatment. The response to oral calcitriol was poor when i-PTH level more than 500pg/ml(kappa 0.429, p value <0.01), the diameter of parathyroid gland more than 10.0mm(kappa 0.641, p value<0.01), the duration of CAPD more than 55months(kappa 0.524, p value< 0.01). These data suggested that initial i-PTH level, the diameter of parathyroid gland size and the duration of CAPD were independent risk factors of the poor response to oral calcitriol therapy in CAPD patients with secondary hyperparathyroidism.
Absorption ; Alkaline Phosphatase ; Calcitriol* ; Calcium ; Creatinine ; Humans ; Hypercalcemia ; Hyperparathyroidism, Secondary* ; Hyperphosphatemia ; Hypertrophy ; Parathyroid Glands ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Phosphorus ; Retrospective Studies ; Risk Factors ; Ultrasonography

Immunoadjuvant activities of the extract (KM-110) from Korean mistletoe ( Viscum album coloratum) on the induction of humoral and cellular responses against Keyhole limpet hemocyanim (KLH) as an antigen and allogenic tumor cells were examined. When mice were immunized subcataneously (s.c.) with KLH admixed with KM-110, more than 1000-times higher antibody titers to KLH than those immunized with KLH alone was observed. KM-110 induced high level of KLH- specific IgG1, IgG2a and IgG2b antibodies. In an in vitro analysis of lymphocytes proliferation to KLH on week 4, the splenocytes of mice treated with KLH and KM- 110 exhibited significantly higher proliferating activity than those treated with KLH alone. In addition, the culture supernatnats obtained from the splenocytes of mice treated with both KLH and KM-110 showed high level of IL-2 and IL-4. In the test of cellular immune responses, KM-110 enhanced the DTH reaction to KLH in mice. Furthemore, cytotoxic T-lymphocyte (CTL) activity using an allogenic CTL induction model where C57BL/6 (H-2b) mice were injected with allogenic P815 (H-2d) mastocytoma cells admixed with or without KM-110, mice treated with P815 cells and KM-110 showed higher cytatoxic activity against allogenic tumor cells than those treated without KM-110. This results suggest that KM-110 may possess adjuvant activities to potentially enhance humoral as well as cellular immune responses against antigens.
Animals ; Antibodies ; B-Lymphocytes ; Immunity, Cellular* ; Immunoglobulin G ; Interleukin-2 ; Interleukin-4 ; Lymphocytes ; Mastocytoma ; Mice ; Mistletoe* ; T-Lymphocytes ; T-Lymphocytes, Cytotoxic ; Viscum album* ; Viscum*

Immunological effect of the extract (KM-110) from Korean mistletoe (Viscum album coloratum) was examined. Lymphocytes obtained from KM-110-administrated mice showed increased responsiveness to mitogens, concanavalin-A (Con.A) and lipopolysaccharide (LPS). In order to study cytokine induct ability of the KM-110, macrophages from the Balb/c mice were cultivated in the medium containing the extract. the macrophages were shown to induce secretion of tumor necrosis factor-alpha (TNF-alpha), interleukin 1 and 6 (IL-1, IL-6) and interferon-gamma (INF-gamma). We then tested antitumor activity of the macrophages activated by the KM-110. Peritoneal macrophages harvested from the KM110-treated Balb/c mice exhibited cytotoxicity against the syngeneic 3LL carcinoma cells. ...continue...
Animals ; Interferon-gamma ; Interleukin-1 ; Lymphocytes ; Macrophages ; Macrophages, Peritoneal ; Mice ; Mistletoe* ; Mitogens ; Tumor Necrosis Factor-alpha ; Viscum album* ; Viscum*

Osteoid Osteoma occurs anywhere in skeleton. They are most common in lower extremity, particularly femur about 40%. Two-thirds of femoral lesions is in the intertrochanter or intracapsular regions of the hip. The lesion is usually cortical and may extend into the periosteal or endosteal surface of the bone. It is rare in the cancellous bone. We experienced a case of osteoid osteoma in intertrochanteric cancellous portion of the femur in 50 year old man. Many complained right hip pain worsend three weeks before his visit. Radiograph shows sclerosis around a lucent nidus in cancellous portion. The lesion did not extend to the endosteal surface. We have removed nidus and surrounding reactive portion completely with curettage. Follow up radiographic results after 20 weeks, showed no evidence of recurrence.
Adult* ; Curettage ; Femur* ; Follow-Up Studies ; Hip ; Humans ; Lower Extremity ; Middle Aged ; Osteoma, Osteoid* ; Recurrence ; Sclerosis ; Skeleton