Comparative Study of BMP-2 Alone and Combined with VEGF Carried by Hydrogel for Maxillary Alveolar Bone Regeneration

The effect of vascular endothelial growth factor (VEGF) combined with bone morphogenetic protein-2 (BMP-2) for bone regeneration is still controversial as to whether or not VEGF has a synergistic or additive effect. This study attempted to evaluate the synergistic effect of VEGF and BMP-2 compared to BMP-2 alone for maxillary alveolar bone regeneration using collagen sponge/hydrogel complex sheets in a canine model. After mixing BMP-2 and VEGF with a hyaluronic acid-based hydrogel (HAH), the collagen sponge/hydrogel complex was transplanted into maxillary alveolar bone defects (n=14) after the extraction of canine upper first molars on both sides. Bone regeneration was evaluated in three groups (control group without growth factors, experimental groups I and II with BMP-2 alone and BMP-2 and VEGF, respectively) using micro-computed tomography and histological staining. The total amount of new bone formations and bone mineral density were significantly higher in the group with BMP-2 only and the group with BMP-2 combined with VEGF than it in the control group. The area with positive staining of von Willebrand factor bone defect was significantly greater in the group with BMP-2 only and with dual growth factors than the control. BMP-2 released from the HAH promoted new bone formation. However, the combination of BMP-2 and VEGF did not show a synergistic or additive effect on bone regeneration at canine maxillary alveolar bone defects.

Osteogenic Response of Human Osteoblasts Derived from Mandible and Maxilla: A Preliminary Study

Primary Pontine Hemorrhage. An Analysis of 35 Cases and Research in Prognostic Factors / 대한뇌혈관외과학회지

OBJECTIVE: Primary pontine hemorrhage (PPH) accounts approximately for about 5~10% of intracranial hemorrhages, and overall mortality rate in recent studies is 40~50%. In a general way, primary treatment of PPH is conservative. Although some authors are trying to surgical treatment for PPH recently, treatment guideline still remains controversy. We report our study to establish the clinical and radiologic prognostic factors in PPH patients and present the guideline for surgical treatment. METHODS: We analyzed 35 patients with PPH admitted to our hospital between January 2000 and December 2006. Glasgow Coma Scale (GCS) scores were assessed on admission, and Glasgow Outcome Scale (GOS) scores on discharge. We divided the patients into two groups according to GOS score: (1) patients who had bad prognosis, and (2) patients who had good one. The two groups were compared for age, gender, hypertension, initial GCS, pupillary abnormalities, volume and location of hemorrhage, intraventricular and extrapontine extension, need for mechanical ventilation and hydrocephalus. RESULTS: Twenty-one patients (60%) were hypertensive. Twenty patients (57%) survived and six of them were capable of performing activities of daily living within 3 months of the hemorrhage. Significant prognostic factors were found with coma on admission, GCS score on admission, hematoma location, hematoma volume, need for mechanical ventilation and intraventricular hemorrhage. CONCLUSION: Initial GCS score, size and location of the hematoma, coma on admission, need for mechanical ventilation and intraventricular extension were significantly correlated to poor outcome in our study. If more large studies follow up including surgical outcome, we could make a surgical indication for PPH to improve the mortality and prognosis.

A study about early osteoconductivity of porous alloplastic carbonapatite and anorganic bovine xenograft in canine maixlliary augmentation model

Effect of pulsed electromagnetic field stimulation on the early bone consolidation after distraction osteogenesis in rabbit mandible model

Phenotypic and Genotypic Characteristics of Enteropathogenic E. coli Isolated from Children with Diarrhea in Gwangju City

BACKGROUND: Enteropathgenic Escherichia coli (EPEC) commonly causes infantile diarrhea in the developing countries. This study aims to find out the phenotypic and genotypic characteristics of EPEC in children with diarrhea in Gwangju city. METHODS: We isolated 35 strains from the stool obtained from diarrheal patients and investigated the presence of various virulence genes, adherence patterns, hemolysis, and antibiotic resistance patterns. RESULTS: All isolates were negative for the EPEC adherence factor (EAF) plasmid, and 14 isolates were bfpA-positive by PCR. The eae, tir, espA, and espB genes were analyzed by multiplex PCR. When the results of the four multiplex PCRs were analysed, we observed that the rate of the presence of eaegamma-tiralpha-espAalpha-espBalpha was highest. The incidence of enteroaggregative E. coli heat-stable enterotoxin (east) was 17.1%. Analysis of Hep-2 cell adherence showed three adherence patterns:the localized adherence pattern, the diffuse adherence pattern, the localized adherence-like pattern. In hemolysin assay, four isolates produced enterohemolysin. The resistance rate of isolates against tetracycline, streptomycin, ampicillin, and rifampin was 56%, 39%, 34%, and 34%, respectively. All isolates were susceptible to ciprofloxacin and colistin. CONCLUSION: In our study, the rate of the presence of eaegamma-tiralpha-espAalpha-espBalpha was the highest. Analysis of Hep-2 cell adherence showed various adherence patterns. Seventy-five percent of isolates were resistant to at least one antibiotic and 28% were resistant to four or more antibiotics.

Phenotypic and Genotypic Characteristics of Enteropathogenic E. coli Isolated from Children with Diarrhea in Gwangju City

BACKGROUND: Enteropathgenic Escherichia coli (EPEC) commonly causes infantile diarrhea in the developing countries. This study aims to find out the phenotypic and genotypic characteristics of EPEC in children with diarrhea in Gwangju city. METHODS: We isolated 35 strains from the stool obtained from diarrheal patients and investigated the presence of various virulence genes, adherence patterns, hemolysis, and antibiotic resistance patterns. RESULTS: All isolates were negative for the EPEC adherence factor (EAF) plasmid, and 14 isolates were bfpA-positive by PCR. The eae, tir, espA, and espB genes were analyzed by multiplex PCR. When the results of the four multiplex PCRs were analysed, we observed that the rate of the presence of eaegamma-tiralpha-espAalpha-espBalpha was highest. The incidence of enteroaggregative E. coli heat-stable enterotoxin (east) was 17.1%. Analysis of Hep-2 cell adherence showed three adherence patterns:the localized adherence pattern, the diffuse adherence pattern, the localized adherence-like pattern. In hemolysin assay, four isolates produced enterohemolysin. The resistance rate of isolates against tetracycline, streptomycin, ampicillin, and rifampin was 56%, 39%, 34%, and 34%, respectively. All isolates were susceptible to ciprofloxacin and colistin. CONCLUSION: In our study, the rate of the presence of eaegamma-tiralpha-espAalpha-espBalpha was the highest. Analysis of Hep-2 cell adherence showed various adherence patterns. Seventy-five percent of isolates were resistant to at least one antibiotic and 28% were resistant to four or more antibiotics.

Problems in osteogenic differentiation of rat bone marrow stromal cells

The effect of rhBMP-2 in human bone marrow-derived stem cells as osteogenic inducers

Surgical Anatomy of Lateral Extracavitary Approach to the Thoracolumar Spine: Cadaveric Study

OBJECTIVE: The lateral extracavitary approach(LECA) to the thoracolumbar spine is known as one of procedure which allows not only direct vision of pathologic lesion, but also ventral decompression, and dorsal fixation of the spine through the same incision. However, some drawbacks of LECA, including the technically- demanding, time-consuming, unfamiliar surgical anatomy and excessive blood loss, make surgeons to hesitate to use this approach. This study is to provide the surgical anatomy of LECA using cadavers, for detailed informations when LECA is considered for the surgery. METHODS: We performed the 10 cadaveric studies, 7 male and 3 female, and careful dissection was carried out on right side of thoracolumbar region, except one for thoracic region. The photographs with micro-lens were taken to depict the close-up findings and for demonstrating detailed anatomy. RESULTS: The photographs and hand-drawings demonstrated the relationships among the musculature, segmental vessels and nerve roots seen during each dissection plane. The lateral branches of dorsal rami of spinal nerve and the transverse process were confirmed to be the most important landmark of this approach. CONCLUSION: We concluded that detailed anatomical findings for LECA through this step-by-step dissection would be useful during operative intervention to reduce the intraoperative complications in LECA.

The Effect of Intraventricular Methotrexate in a Patient of Disseminated Anaplastic Oligodendroglioma: Case Report

Oligodendrogiomas account for about 4 per cent of intracranial gliomas and surgery is known to be an essential first step to establish an accurate diagnosis and when oligodendrogliomas recur with or without anaplastic features after initial resection, radiation and chemotherapy consisting of the administration of procarbazine, lomustine, and vincristine are usually indicated. We report our experience of an excellent result with intraventricular methotrexate chemotherapy for a patient with disseminated anaplastic oligodendroglioma. A 29-year-old male patient presented with diplopia and headache for two months. MRI showed a irregular, faintly enhanced mass in the posterior fossa. The hisotological diagnosis was an anaplaplastic oligodendroglioma and he was treated with chemotherapy of PCV regimen and radiotherapy followed by surgery. CSF dissemination was revealed by a follow-up MRI during the period. Intraventricular methotrexate(0.175mg/kg) was given twice a week for 4 weeks through ommaya reservoir and the size of the multiple tumors was decreased significantly on follow-up MRI. This case report suggests that an aggressive treatment involving intravent-ricular chemotherapy may be helpful even when anaplastic oligodendrogliomas disseminates to leptomeninges.

The Preemptive Analgesic Effect of Intravenous Ketamine after Lumbar Spine Instrumentation / 대한마취과학회지

BACKGROUND: Well-localized and noxious stimuli are found to produce long-lasting neuronal sensitization. Ketamine is a NMDA receptor antagonist and exerts antinociceptive effects in many pain tests. The aim of this study was to investigate the pre-emptive and analgesic sparing effect of intravenous ketamine in adults aged 30-53 after lumbar spinal instrumentation surgery. METHODS: We compared the effects of preoperative and postoperative intravenous ketamine 0.5 mg/kg on pain after lumbar spinal instrumentation in a double-blind, randomized study in 30 adult patients. After the induction of anesthesia, patients were allocated randomly to receive ketamine intravenously either before (n = 15) or immediately after (n = 15) surgery. Patients were instructed to ask for analgesics whenever they required pain relief and all demands were recorded. Intravenous patient-controlled analgesia (PCA) using butorphanol 16 mg and ketorolac 150 mg was introduced after recovery from general anesthesia. Visual analogue scale (VAS) pain scores were recorded at 1, 2, 3, 4, 5, 6, 9, 12, 24, 36 and 48 hours postoperatively and the total infusion dose of PCA drugs were assessed at 24 hours postoperatively. RESULTS: VAS scores in the preoperative group were significantly lower than in the postoperative group during the first 9 hours after cessation of the operation. The total infusion dose of PCA drugs was significantly lower in the preoperative group (butorphanol 9.1 +/- 0.3 mg, ketorolac 85.3 +/- 2.5 mg) than postoperative group (butorphanol 10.7 +/- 0.2 mg, ketorolac 100.3 +/- 2 mg) (P < 0.05). No serious adverse reactions occurred. CONCLUSIONS: Preoperative intravenous ketamine 0.5 mg/kg in lumbar spinal instrumentation is more effective in reducing postoperative analgesic requirements than it is when given after the operation.

Intraoperative radiation therapy as an adjunctive therapy for huge and highly vascular parasagittal meningiomas

This case presents a 34-year-old man who had a huge parasagittal meningioma. Initial treatment consisted of preoperative external carotid artery embolization and partial tumor resection. During the resection, we found that the tumor invaded the adjacent calvarium, and due to massive hemorrhage, total removal of the tumor was impossible. The patient was treated with intraoperative radiation therapy (IORT) (25 Gy via 16 MeV) as an adjunctive therapy. Eight months after IORT, we were able to remove the tumor completely without surgical difficulties. IORT can be considered an useful adjunctive therapy for the superficially located, huge, and highly vascular meningioma.

Normal ECG Standard in Preterm and Term Neonates in the First Day of Life

PURPOSE: To obtain the normal standard of the electrocardiogram(ECG) in newborn infants, METHODS: Standard 12-lead ECG recordings of 146 healthy neonates of gestational age above 30 weeks recorded in 24 hours after birth were analyzed for the following parameters: heart rate, QRS axis, PR interval, QTc interval, R and S wave amplitude. RESULTS: The mean gestational age of preterm(between 30 and 37 weeks) and term infants was 33.2 +/-2.4 and 38.4+/-3.2 weeks, and the mean birth weight was 2,168+/-371 g and 3,254+/-436 g, respectively. There was no meaningful difference between two groups in heart rate, PR interval, QTc interval, and QRS axis. Amplitudes of R waves in V1>-V6 leads and S waves in V2, V3 and V5 leads in term baby group were significantly larger than those in preterm baby group. The sum of amplitudes of R and S waves was largest in V2. The amplitude of combined R+S waves in V2 and V3 leads was significantly larger than that in V5 and V6 leads in both groups. This difference was more prominent in tbaby group. CONCLUSION: The results suggest that the increase in cardiac muscular mass and progressive right ventricular predominance are in accordance with the increase in gestational age.

Three Cases of Symptomatic Huge Arachnoid Cysts

Congenital arachnoid cysts are commonly located at sylvian cistern or middle cranial fossa which are usually asymptomatic and incidentally found. Posterior fossa cysts, however, are usually large when diagnosed, and symptomatic. Three cases of large posterior fossa cysts were recognized on the diagnostic MRI investigation for infantile spasm, developmental delay, and the precocious puberty. Surgical decompression of the cysts by craniectomy, cyst excision and fenestration were performed successfully in two patients with arachnoid cysts in the cerebellopontine cistern and the suprasellar, right cerebellopontine, and prepontine cisterns, but an additional cystoperitoneal shunt was needed in a case with the cyst in the quadrigemial cistern with obstructive hydrocephalus. Infantile spasm was treated with vigabatrin and pyridoxine, and the true precocious puberty was managed with LHRH analogue(Decapeptyl ).

Two Cases of Multicystic Encephalomalacia in a Surviving Co-twin with One Intrauterine Fetal Death / 대한주산의학회잡지

Various anatomical defects have been described in the surviving co-twin who had stillborn, macerated monozygotic co-twin with disseminated intravascular coagulation. The suggested mechanism was the transfer of emboli or thromboplastic materials of dead fetus to co-twin through placental vascular anastomoses. Multicystic encephalomalacia is the condition defined anatomically by the presence of multiple cavities in the great part of both cerebral hemispheres. The most common pathogenesis is circulatory disturbance caused by neonatal asphyxia during the perinatal period. We experienced two cases of monozygotic twin with deceased co-twin at 26 weeks, 33 weeks of gestation and confirmed the diffuse multicystic encephalomalacia by cranial ultrasonography and MRI in a surviving co-twin. Only one patient has been followed who showed spastic cerebral palsy and severe mental retardation. We report two cases of multicystic encephalomalacia in a surviring co-twin with a intrauterine fetal death and its related literatures.

Infant with Fanconi Anemia Presenting with Myelodysplastic Syndrome / 대한소아혈액종양학회지

PURPOSE: Fanconi anemia(FA) is a rare autosomal recessive disorder characterized by progressive bone marrow failure and congenital malformations. Patients with FA have aplastic anemia(> 90%), leukemia(10~15%), myelodysplasia(5%) and liver(5%) and other tumors(5%). In the International FA Registry study myelodysplasia in FA patients was detected at a median of 13 years. Presentation of FA with myelodysplasia in an infant should be extremely rare. CASE: A 3-month-old infant presented with anemia and poor feeding. The initial hemogram showed: hemoglobin, 4.6 g/dL; MCV, 104.1 fL/pg; white cell count, 4,300/microL; neutrophils, 450/microL; platelets, 23,000/microL. The bone marrow was normocellular, with findings of macrocytic anemia and dyserythropoiesis, and less than 5% of myeloid blasts, compatible with myelodysplastic syndrome(refractory anemia). The patient had multiple cafe-au-lait spots, hypopigmented nevi, broad nasal bridge, micrognathia, and thumb and toe anomalies. FA was confirmed by chromosomal hypersensitivity to diepoxybutane and mitomicin C. Supportive treatment with oxymetholone and prednisolone failed to improve hematologic and clinical findings. The patient succumbed to sepsis, pneumonia and meningitis due to Pseudomonas aeruginosa at 20 month of age. Clonal cytogenetic anomalies were not found. CONCLUSION: We reported here a rare case of FA presenting with myelodysplasia at the age of 3 month.

Asymptomatic Pheochromocytoma: A case report

Pheochromocytomas are catecholamine-producing tumors that typically cause hypertension. They are rare tumors that can pose problems in diagnosis and detection. Although they usually present classic symptoms, they can at times present symptoms that mimic other clinical conditions. Especially, children have fewer malignant tumors, non-extra-adrenal tumors, and tumors with greater bilaterality and multiplicity. The diagnosis of pheochromocytomas is based upon clinical suspicion and biochemical study. Radiologic localization is obtained before operation because of the variable location of this tumor. The treatment of choice is surgical resection. We reports a case of asymptomatic pheochromocytoma that was treated with tumor excision. To prevent intraoperative and postoperative complications, precise preoperative diagnosis and localization, as well as adequate preoperative management, are necessary.

High Cervical Chordoma Removed via Median Labiomandibular Glossotomy Approach

The authors report two cases of high cervical spinal chordomas that were removed via the median labiomandibular glossotomy(MLG) approach. One patient was a 62-year-old female in whom an extradural chordoma was found at the level of C3 vertebra with huge prevertebral extension, and causing dyspnea and dysphagia; the other was a 47-year-old female, found to be suffering from a chordoma of C2 vertebral body, which was found incidentally. After removal of the tumors, ventral instrumented fusions were performed in both patients, who showed good recoveries with only minor complications. The MLG approach is radical, and rarely performed by neurosurgeons, but for treatment of an expanded high cervical lesion that needs ventral surgery and seems to be inaccessible via the conventional transoropharyngeal or anterolateral retropharyngeal route, it should be considered. The authors discuss the clinicopathological characteristics of spinal chordomas and general considerations of the MLG approach to high cervical lesions, and briefly describe the surgical techniques involved in this approach.

A Clinical Study of Fanconi's Anemia / 대한소아혈액종양학회지

BACKGROUND: Fanconi's anemia(FA) is an autosomal recessive disease characterized by aplastic anemia and congenital malformations. As up to 30% of patients have no physical stigmata, the modern diagnosis of FA rests on chromosomal breakage of patient's cells induced by chemical clastogens such as diepoxybutane(DEB) or mitomycin-C(MMC). METHODS: We reviewed the clinical manifestations, laboratory findings, diagnostic methods, treatment and outcome of 6 patients diagnosed to have a FA at the Chonnam University Hospital for the last 6 years. RESULTS: Six cases(16.2 %) were found to have FA among 37 aplastic children who were diagnosed during the same period. The mean age at diagnosis was 6.3 years which was the usual onset of hematologic findings. All patients had features of aplastic anemia, and had one or more anomalies, such as low birth weight, hyperpigmentation, cafeau-lait spots, mental retardation, developmental delay, peculiar face(broad nasal bases, epicanthal folds, micrognathia), polydactyly, microcephaly, short stature, and dislocation of hip. We found increased breaks in cultured cells with DEB and MMC in 5 cases tested. The median duration of follow-up was 30 months. Oxymetholone and prednisolone treatment was partially beneficial in three cases. Immunosuppressive treatment with ALG/ATG was not successful in two cases tried. Four cases are living now, without transfusion in three. Two patients were died of disseminated fungal infection and transplant-related problems, respectively. CONCLUSIONS: Fanconi's anemia should be sought carefully in any patients with aplastic anemia because the prognosis, treatment modality, and the approach to bone marrow transplantation are quite different when the hematologic disorder is inherited rather than acquired.