The cervical spine plays a critical role in supporting the skull, maintaining horizontal gaze, and facilitating walking. Its unique characteristics, including the widest range of motion among spinal segments, have led to extensive research on cervical sagittal alignment. Various parameters have been proposed to evaluate cervical alignment, with studies investigating their clinical significance, correlation with symptoms, and implications for surgical interventions. Recent findings suggest that cervical sagittal alignment not only impacts the cervical spine but also influences global spine-pelvic alignment through compensatory mechanisms. This comprehensive review examines classical and new parameters of cervical sagittal alignment and considers the dynamic and muscular factors associated with it.

BACKGROUND AND PURPOSE: Visual assessment of medial temporal-lobe atrophy (MTA) has been quick, reliable, and easy to apply in routine clinical practice. However, one of the limitations in visual assessments of MTA is the lack of widely accepted age-adjusted norms and cutoff scores for MTA for a diagnosis of Alzheimer's disease (AD). This study aimed to determine the optimal cutoff score on a T1-weighted axial MTA Visual Rating Scale (VRS) for differentiating patients with AD from cognitively normal elderly people. METHODS: The 3,430 recruited subjects comprising 1,427 with no cognitive impairment (NC) and 2003 AD patients were divided into age ranges of 50–59, 60–69, 70–79, and 80–89 years. Of these, 446 participants (218 in the NC group and 228 in the AD group) were chosen by random sampling for inclusion in this study. Each decade age group included 57 individuals, with the exception of 47 subjects being included in the 80- to 89-year NC group. The scores on the T1-weighted axial MTA VRS were graded by two neurologists. The cutoff values were evaluated from the area under the receiver operating characteristic curve. RESULTS: The optimal axial MTA VRS cutoff score from discriminating AD from NC increased with age: it was ≥as ≥1, ≥2, and ≥3 in subjects aged 50–59, 60–69, 70–79, and 80–89 years, respectively (all p < 0.001). CONCLUSIONS: These results show that the optimal cutoff score on the axial MTA VRS for diagnosing of AD differed according to the decade age group. This information could be of practical usefulness in the clinical setting.
Aged ; Alzheimer Disease* ; Atrophy* ; Cognition Disorders ; Dementia* ; Diagnosis ; Humans ; Korea* ; Pemetrexed ; ROC Curve

Intussusception is a serious disease where part of the intestine slides into an adjacent part of the intestine. Adult intussusception is mainly due to benign or malignant neoplasm. Therefore, in most cases of adult intussusception, treatment by surgery would be preferable to conservative therapy. However, we report on a 28-year-old female patient who underwent intussusception operation delayed 3 months. Abdominal computed tomography 3 months ago showed a small bowel intussusception measuring 20 cm long. Three months later, the previously identified small bowel intussusception appeared without change. The patient underwent surgery, and ectopic gastric mucosa was observed in the biopsy. Therefore, Meckel's diverticulum was diagnosed.
Abdominal Pain ; Adult* ; Biopsy ; Female ; Gastric Mucosa ; Humans ; Intestines ; Intussusception* ; Meckel Diverticulum*

No abstract available.
Adolescent ; Chromosomes, Human, Pair 11 ; Chromosomes, Human, Pair 4 ; Gene Rearrangement ; Histone-Lysine N-Methyltransferase/*genetics ; Humans ; Male ; Myeloid-Lymphoid Leukemia Protein/*genetics ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/*genetics

Vitelline veins are a pair of embryonic structures. The veins develop the portal vein system. Serious problems occur if the vitelline vein does not regress and becomes an aneurysm. Thrombus formation in the vitelline vein aneurysm could lead to portal vein thrombosis and portal hypertension unless promptly and correctly treated. Though vitelline vein aneurysm is an extremely rare anomaly, it rapidly progresses to portal vein thrombosis that requires prompt diagnosis and treatment. We reported a case of neonatal vitelline vein aneurysm and thrombosis that was cured by prompt operation.
Aneurysm* ; Diagnosis ; Embryonic Structures ; Humans ; Hypertension, Portal ; Infant, Newborn ; Portal Vein ; Thrombosis* ; Veins* ; Venous Thrombosis ; Vitellins*

Insulin deficiency due to destruction of pancreatic beta-cells is a typical characteristic of type 1 diabetes mellitus (DM). In 2000 Imagawa proposed a novel diagnostic model defining "fulminant type 1 DM" as developing rapidly without any evidence of autoimmunity, and ever since there have been many reports regarding the matter in Japan. In 2004, the first fulminant type 1 diabetes case was reported in Korea; however, there have been few reports since then. We present a case of a 60-year-old man who suffered from excessive thirst and polyuria after myalgia. Laboratory findings revealed a high blood glucose level and evidence of diabetic ketoacidosis, but the HbA1c level was within the normal range. The serum C-peptide level was very low and antibodies to glutamic acid decarboxylase were negative. These findings suggested fulminant type 1 diabetes. This patient has shown improvement in symptoms and examination results without complications after being treated with insulin therapy with hydration, throughout 6-months follow-up period.
Aged* ; Antibodies ; Autoimmunity ; Blood Glucose ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 1* ; Diabetic Ketoacidosis ; Follow-Up Studies ; Glutamate Decarboxylase ; Humans ; Insulin ; Japan ; Korea ; Middle Aged ; Myalgia ; Polyuria ; Reference Values ; Thirst

BACKGROUND: Performance of antibody screening and identification tests before blood transfusion is important because the unexpected presence of red cell antibodies may cause hemolytic transfusion reactions. Many patients with malignancy undergo transfusion in order to overcome pancytopenia due to disease itself or chemotherapy. We investigated the type distribution of unexpected red cell antibodies in cancer patients and compared our results with those of other institutions. METHODS: From January 2008 to June 2011, 30,989 serum samples were screened using a LISS/Coombs card and ID-DiaCell I, II (DiaMed AG, Morat, Switzerland). Data-Cyte Plus Reagent Red Blood Cells (Medion Diagnostics, Dudingen, Switzerland) were used in performance of antibody identification tests. RESULTS: Out of 30,989 serum samples, 180 cases (0.58%) showed screening-positive results, and unexpected antibodies were identified in 72 cases. The type of unexpected antibody observed most often in cancer patients was a member of the Rh antibody group, anti-E in 17 cases (29.8%), followed by anti-Lea in five cases (8.8%) and anti-e in three cases (5.3%). While Rh group antibodies were observed in the colon cancer group, non-Rh group antibodies were observed in the rectal cancer group. And, in the genitourinary cancer group, Lewis group antibodies were more frequently detected than others. CONCLUSION: Findings from our study demonstrated a type distribution of unexpected red cell antibodies that was similar to those reported in previous studies. Compared with non-cancerous patients, no difference in type distribution of unexpected red cell antibodies was observed in cancer patients. Some antibodies were frequently observed in certain cancer groups. Further comprehensive research on unexpected antibodies based on location or histologic type of cancer is needed.
Antibodies ; Blood Group Incompatibility ; Blood Transfusion ; Colonic Neoplasms ; Erythrocytes ; Humans ; Mass Screening ; Pancytopenia ; Rectal Neoplasms ; Urogenital Neoplasms

Alpha-thalassemia (alpha-thalassemia), which is prevalent in the Mediterranean region, is caused by deficient synthesis of the alpha-globin chains. It is commonly caused by HBA1 and/or HBA2 gene deletion and is diagnosed by DNA sequence analysis. The proband was a 38-year-old woman who was found to have microcytic and hypochromic anemia on a routine health checkup. Results of the Hb electrophoresis (EP) and direct sequencing of the HBA1 and HBA2 genes were found to be normal. As multiplex ligation-dependent probe amplification (MLPA) for the HBA1 and HBA2 genes revealed heterozygous deletion, she was diagnosed with heterozygous alpha+-thalassemia. Although routine laboratory tests revealed similar findings in the proband's father, brother and niece, MLPA revealed heterozygous deletions of the HBA1 or HBA2 gene in her brother and niece. In summary, we report a case of heterozygous alpha+-thalassemia in a Korean family that was detected by MLPA. We recommend that patients with suspected hemoglobinopathies should be followed-up further with MLPA, especially when Hb EP shows a normal pattern.
alpha-Globins ; alpha-Thalassemia ; Anemia, Hypochromic ; Electrophoresis ; Fathers ; Female ; Gene Deletion ; Hemoglobin A, Glycosylated ; Hemoglobinopathies ; Humans ; Mediterranean Region ; Multiplex Polymerase Chain Reaction ; Sequence Analysis, DNA ; Siblings

Pneumatosis intestinalis is an uncommon disorder characterized by an accumulation of gas in the bowel wall. We described three cases undertaking liver transplantation. The patients developed diarrhea in three cases and high fever in two. An abdominal X-ray and computed tomography scan demonstrated extensive pneumatosis intestinalis in the colon with pneumoperitoneum mimicking hollow organ perforation. However, the patients had no abdominal symptoms and there was no evidence of peritonitis. The infection work-up was negative except one case with cytomegalovirus antigenemia. After one week of conservative management including bowel rest and antibiotic therapy, their pneumoperitoneum resolved spontaneously without any complication. Pneumatosis intestinalis should be considered as a differential diagnosis after adult liver transplantation with patients suffering from watery diarrhea and fever. Pneumoperitoneum, air-density in mesentery and retroperitoneum in patients with pneumatosis intestinalis without signs of peritonitis improved with conservative management, which included bowel rest and antibiotic therapy.
Adult ; Colon ; Cytomegalovirus ; Diagnosis, Differential ; Diarrhea ; Fever ; Humans ; Liver ; Liver Transplantation ; Mesentery ; Mortuary Practice ; Peritonitis ; Pneumoperitoneum ; Stress, Psychological

PURPOSE: The aim of this study was to review the epidemiology, clinical features, diagnosis, and effect of treatments of aspergillosis infections in adult liver transplantation patients. METHODS: We retrospectively studied the cases of aspergillosis among 625 (164 deceased donor liver transplantation (DDLT), 461 living donor liver transplantation (LDLT)) adult liver transplantation recipients (> or =18 yrs old) operated between May 1996 to May 2008. RESULTS: Fourteen cases of aspergillosis infection were detected, which consisted of 9 cases of invasive aspergillosis, 5 cases of aspergilloma in maxillary sinuses which occurred before the transplantation. One patient with invasive aspergillosis, who had received liver transplantation overseas and had post-operation care in our center, was also included. Among the 8 cases (1.28%) of invasive aspergillosis (excluding one case operated overseas), 6 cases (3.7%) were DDLT and 2 cases (0.4%) LDLT (P-value<0.05). Among the 6 patients with early onset of invasive aspergillosis, 5 patients (1.8%) had fluconazole and only 1 patient (0.3%) had itraconazole as prophylactic antifungal agent (P-value<0.05). The three cases with localized lesions in the lung survived after lobectomy, but the disseminated and inoperable cases died. CONCLUSION: The incidence of invasive aspergillosis was lower in LDLT cases and prophylactic itraconazole might be more effective than fluconazole. Paranasal aspergilloma, detected before transplantation had no relation with posttransplant invasive aspergillosis infection. Patients who had localized lesion in the lung, and underwent surgery had better survival than who could not.
Adult ; Antifungal Agents ; Aspergillosis ; Fluconazole ; Humans ; Incidence ; Itraconazole ; Liver ; Liver Transplantation ; Living Donors ; Lung ; Maxillary Sinus ; Retrospective Studies ; Tissue Donors ; Transplants