Complications Following Burr Hole Craniostomy and Closed-System Drainage for Subdural Lesions / 대한신경손상학회지

OBJECTIVE: Burr hole craniostomy and closed-system drainage (BCD) is a common surgical procedure in the field of neurosurgery. However, complications following BCD have seldom been reported. The purpose of this study was to report our experiences regarding complications following BCD for subdural lesions. METHODS: A retrospective study of all consecutive patients who underwent BCD for presumed subdural lesions at one institute since the opening of the hospital was performed. RESULTS: Of the 395 patients who underwent BCD for presumed subdural lesions, 117 experienced surgical or nonsurgical complications. Acute intracranial hemorrhagic complications developed in 14 patients (3.5%). Among these, 1 patient died and 5 patients had major morbidities. Malposition of the drainage catheter in the brain parenchyma occurred in 4 patients, and opposite-side surgery occurred in 2 patients. Newly developed seizures after BCD occurred in 8 patients (2.0%), five of whom developed the seizures in relation to new brain lesions. Eighty-eight patients (22.3%) suffered from nonsurgical complications after BCD. Pulmonary problems (7.3%) were the most common nonsurgical complications, followed by urinary problems (5.8%), psychologic problems (4.3%), and cognitive impairments (3.8%). CONCLUSION: The incidence of complications after BCD for subdural lesions is higher than previously believed. In particular, catastrophic complications such as acute intracranial hematomas and surgical or management errors occur at rates that cannot be ignored, possibly causing medico-legal problems. Great caution must be taken during surgery and the postoperative period, and these complications should be listed on the informed consent form before surgery.

Ganglioneuroma of the Sacrum

Presacral ganglioneuromas are extremely rare benign tumors and fewer than 20 cases have been reported in the literature. Ganglioneuromas are difficult to be differentiated preoperatively from tumors such as schwannomas, meningiomas, and neurofibromas with imaging modalities. The retroperitoneal approach for resection of presacral ganglioneuroma was performed for gross total resection of the tumor. Recurrence and malignant transformation of these tumors is rare. Adjuvant chemotherapy or radiation therapy is not indicated because of their benign nature. We report a case of a 47-year-old woman with a presacral ganglioneuroma.

Left ventricular thrombi after simultaneous thrombotic occlusions of multiple coronary arteries presenting acute myocardial infarction: need anticoagulant?

No abstract available.

Left ventricular thrombi after simultaneous thrombotic occlusions of multiple coronary arteries presenting acute myocardial infarction: need anticoagulant?

No abstract available.

Removal of Anorectal Cancer by Endoscopic Submucosal Dissection / 대한내과학회지

Anorectal cancer is traditionally treated via abdominoperineal resection and/or chemoradiation. Currently, endoscopic submucosal dissection (ESD) is widely used to treat early gastrointestinal epithelial neoplasias. However, the use of ESD to treat lesions of the anal canal raises concerns that do not arise when treating lesions of the stomach and colorectum. Therefore, particular care is needed when treating lesions in the anal area. We recently treated a 75-year-old woman who was scheduled for surgical resection to treat anorectal cancer. The lesion was successfully removed using ESD. This is the first report of the use of ESD to treat anorectal cancer in Korea. Here, we present our case report and review the relevant literature.

Traumatic Pseudoaneurysm Related to Calcified Nodules of Cerebral Convexity Dura Mater in an American College Football Player

Repeated concussion is common among football players; however, these minor blunt head trauma rarely result in serious complications. We report a case of a young college football player who presented acute subdural hematoma, cerebral edema, and seizure due to pseudoaneurysm rupture. The pseudoaneurysm, located at the cortical branch of the middle cerebral artery, was speculated to be formed by dural calcification and adhesion with the underlying brain, possibly due to repeated concussions. Following successful excision of the pseudoaneurysm and control of brain swelling, the patient recovered without sequelae and was discharged after a short while.

Association between Change in Body Weight and Insulin Resistance in Individuals at Increased Risk of Diabetes / 대한내과학회지

BACKGROUND/AIMS: The present study aimed to investigate the associations between a change in body weight from 20 years of age to the present with insulin resistance and several parameters of metabolic syndrome in individuals at an increased risk of diabetes. METHODS: From patients with a diagnosis related to an increased risk of diabetes who were examined at our endocrinology clinic from January 2012 to December 2014, the present study recruited 125 individuals between 30 and 64 years of age with hemoglobin A1c levels from 5.7 to 6.4%. The change in body weight of each patient from 20 years of age to the present was retrospectively determined, and the associations of this change with insulin resistance and several parameters of metabolic syndrome were analyzed. RESULTS: The average gain in body weight after 20 years of age was 11.3 kg and there was no significance difference between the male and female patients. The proportion of overweight and obese patients at 20 years of age was 14%, but was 74% at the time of the visits to our endocrinology clinic. A change in body weight was significantly correlated with body mass index, insulin resistance, and waist circumference. Additionally, as the tertile of change in body weight increased, fasting insulin levels, insulin resistance, and the prevalence of abdominal obesity significantly increased. CONCLUSIONS: In the present study, an increase in body weight from 20 years of age to the present was correlated with insulin resistance and several parameters of metabolic syndrome in individuals at an increased risk of diabetes.

A Case of Diabetic Ketoacidosis Induced by Sodium-Glucose Cotransporter 2 Inhibitor / 임상당뇨병

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of oral antihyperglycemic drugs; inhibition of the cotransporter allows for increased renal glucose excretion that consequently leads to reduced plasma glucose level. We report a rare case of a 73-year-old woman with type 2 diabetes mellitus who developed severe ketoacidosis caused by an SGLT2 inhibitor. At admission, severe ketoacidosis with arterial PH 6.99 was observed, though her serum glucose level of 232 mg/dL was not excessively high. It is necessary to pay attention to patients with type 2 diabetes being treated with an SGLT2 inhibitor, as anorexia, diarrhea, dehydration, and weight loss can develop in conjunction with a high fat/protein diet.

Epithelioid Sarcoma in the Cervical Spine: A Case Report

Epithelioid sarcoma is a rare and highly malignant soft tissue neoplasm that most commonly occurs in the long bones. This uncommon tumor has a poor clinical outcome, and the modality of its treatment has not yet been fully established. The authors report an extremely rare presentation of epithelioid sarcoma in the cervical spine, along with its clinical progression, imaging, and pathology. The patient underwent three surgical procedures and adjuvant radiochemical management. He survived for 25 months with a good general condition and adapted well to his social activity. Systemic metastasis was not found, but the patient died of respiratory failure due to direct tracheal invasion of the tumor.

Multiple Spinal Cord Recurrences of an Intracranial Ependymoma after 14 Years

Ependymoma can spread via cerebrospinal fluid, but late spinal recurrences of intracranial tumor are very rare. We describe a case of a 33-year-old male who presented with multiple, delayed, recurrent lesions in the spinal cord from an intracranial ependymoma. The patient underwent gross total resection and postoperative radiation therapy 14 years prior to visit for a low grade ependymoma in the 4th ventricle. The large thoraco-lumbar intradural-extramedullary spinal cord tumor was surgically removed and the pathologic diagnosis was an anaplastic ependymoma. An adjuvant whole-spine radiation therapy for residual spine lesions was performed. After completion of radiation therapy, a MRI showed a near complete response and the disease was stable for three years.

Glomus Tumor in the Femoral Nerve

The glomus tumor of the peripheral nerve is one of the mesenchymal tumors originating in the epineurium, and is extremely rare. A 56-year-old man presented complaining of lancinating pain on the left thigh, which was provoked by pressure or exercise. Subsequent image study revealed a mass in the femoral nerve. Total surgical excision with the aid of intraoperative ultrasonography was performed and the pain was successfully controlled. The authors report an unusual case of a patient diagnosed with glomus tumor in peripheral nerve, with a review of the clinical features, imaging, and pathological findings.

Endovascular Management of Great Vessel Injury Following Lumbar Microdiscectomy

Great vessel injury is a rare but well-known complication of lumbar disc surgery, which may result in acute or fatal outcomes of delayed diagnosis. Thus, early detection and proper management is vital. The authors report a case of retroperitoneal hemorrhage with arteriovenous fistula and pseudoaneurysm after lumbar microdiscectomy. The patient was successfully managed by endovascular intervention using a stent graft. Endovascular repair is a minimally invasive and efficient treatment modality with considerably low morbidity and mortality.

Eosinophilic Myelitis in the Cervical Cord Mimicking Intramedullary Cord Tumor

Eosinophilic myelitis (EM) or atopic myelitis is a rare disease characterized by a myelitic condition in the spinal cord combined with allergic process. This disease has specific features of elevated serum IgE level, active reaction to mite specific antigen and stepwise progression of mostly the sensory symptoms. Toxocariasis can be related with a form of EM. This report describes two cases of cervical eosinophilic myelitis initially considered as intramedullary tumors. When a differential diagnosis of the intramedullary spinal cord lesion is in doubt, evaluation for eosinophilic myelitis and toxocariasis would be beneficial.

Detection of Adeno-associated Virus from Semen Suffering with Male Factor Infertility and Having Their Conception Partners with Recurrent Miscarriages

Adeno-associated virus (AAV) and human papillomavirus (HPV) DNAs were found in abnormal quality semen, early abortus and female genital tissues. It was suggested that they might cause male infertility and miscarriages. This study was performed to determine the detection rate of these viruses in the semen and to assess the relationship between the presence of virus and male factor infertility and recurrent miscarriages. Sixty-three of 99 recruited male were included in this study according to the completeness of follow-up and the sample availability. Fourteen male with normal reproductive capacity were allocated to control group, 15 male with abnormal results in semen analysis were grouped as male factor infertility (MF) group, and 34 male whose spouses have had history of repeated spontaneous abortions were designated as repeated miscarriage (RM) group. AAV and HPV were detected in semen by polymerase chain reaction. The detection rate of AAV in the MF infertility group and RM group was 60.0% and 50.0%, respectively, while 14.3% in the control group (p < 0.05). However, the differences in the detection rate of HPV were not statistically significant among groups. These results suggest that AAV could be related to repeated miscarriages and male infertility.

Carrier detection and prenatal diagnosis of hemophilia A in a Korean population by fluorescent pcr analysis of dinucleotide repeats in intron 13 and intron 22 of the factor VIII gene / 대한산부인과학회지

OBJECTIVE: To set up the methodology for fluorescent PCR analysis of intron 13 and intron 22 microsatellite polymorphisms of the factor VIII gene, and to identify the usefulness of intron 13 and intron 22 microsatellite polymorphism for the carrier detection and prenatal diagnosis of hemophilia A in the Korean population. METHODS: Intron 13 and intron 22 microsatellite polymorphisms of the factor VIII gene were analyzed in 30 unrelated Korean mothers of patients with severe hemophilia A using fluorescent PCR. RESULTS: Analysis of intron 13 and intron 22 microsatellite polymorphisms of the factor VIII gene was feasible by the fluorescent-PCR method. The expected heterozygosity rates of intron 13 and intron 22 polymorphisms of the factor VIII gene were 67% and 34%, respectively. Combined analysis of intron 13 and intron 22 polymorphisms revealed heterozygous patterns in 16 (53%) of 30 mothers studied. Using linkage analysis with intron 13 and intron 22 polymorphisms, we have attempted three cases of carrier detection and one cases of prenatal diagnosis in two families of patients with severe hemophilia A. CONCLUSION: These results suggest that flourescent-PCR analysis of the intron 13 and intron 22 microsatellite polymorphisms within the factor VIII gene is very useful in the carrier detection and prenatal diagnosis of hemophilia A in the Korean population.

Carrier detection and prenatal diagnosis of hemophilia A in a Korean population by fluorescent pcr analysis of dinucleotide repeats in intron 13 and intron 22 of the factor VIII gene / 대한산부인과학회지

OBJECTIVE: To set up the methodology for fluorescent PCR analysis of intron 13 and intron 22 microsatellite polymorphisms of the factor VIII gene, and to identify the usefulness of intron 13 and intron 22 microsatellite polymorphism for the carrier detection and prenatal diagnosis of hemophilia A in the Korean population. METHODS: Intron 13 and intron 22 microsatellite polymorphisms of the factor VIII gene were analyzed in 30 unrelated Korean mothers of patients with severe hemophilia A using fluorescent PCR. RESULTS: Analysis of intron 13 and intron 22 microsatellite polymorphisms of the factor VIII gene was feasible by the fluorescent-PCR method. The expected heterozygosity rates of intron 13 and intron 22 polymorphisms of the factor VIII gene were 67% and 34%, respectively. Combined analysis of intron 13 and intron 22 polymorphisms revealed heterozygous patterns in 16 (53%) of 30 mothers studied. Using linkage analysis with intron 13 and intron 22 polymorphisms, we have attempted three cases of carrier detection and one cases of prenatal diagnosis in two families of patients with severe hemophilia A. CONCLUSION: These results suggest that flourescent-PCR analysis of the intron 13 and intron 22 microsatellite polymorphisms within the factor VIII gene is very useful in the carrier detection and prenatal diagnosis of hemophilia A in the Korean population.

A Case of Esophageal Anthracosis with Polypoid Features / 대한소화기내시경학회지

Anthracosis mostly occurs at the lung and esophageal anthracosis has rarely been reported. As a result, the pathogenesis and prognosis of esophageal anthracosis is currently unclear. In previous reports, esophageal anthracosis has been mostly observed as relatively flat lesions that require differentiation from malignant melanoma. We report here on a case of esophageal anthracosis with polypoid features in a seventy year old male patient with hepatocellular carcinoma. The patient had undergone endoscopic examination and a 1 cm sized black polypoid lesion was observed. Pathology revealed macrophages phagocyting black carbon pigments beneath the mucosal epithelium and the diagnosis of esophageal anthracosis was made.

Ellagic Acid Shows Different Anti-proliferative Effects Between the MDA-MB-231 and MCF-7 Human Breast Cancer Cell Lines / 한국유방암학회지

PURPOSE: It has been demonstrated ellagic acid can inhibit tumor growth. However, the mechanism that elicits the anti-proliferative effect of ellagic acid is poorly understood. Our objective in this study was to evaluate the biological activity of ellagic acid by comparing the anti-proliferative effect and the apoptotic pathway of ellagic acid between the 2 human breast cancer cell lines. METHODS: The MCF-7 and MDA-MB-231 human breast cancer cell lines were used as cell models. The anti-proliferstive effect was evaluated by using a MTT assay. The cell cycle was analyzed by flow cytometry. Western blotting was performed to show the expressions of bcl-xL, cytochrome c, surviving, c-fos and pS2. RESULTS: The ellagic acid in the MDA-MB-231 cells showed significant anti-proliferative effects with dose dependent pattern. The anti-proliferative effects in MCF-7 cells were observed in only at a high concentration. Ellagic acid had no effect on the cell cycle in both breast cancer cells. In MDA-MB-231, the expression of bcl-xL was decreased with the decreasing concentration of ellagic acid. The expression of cytochrome c in the cytosol was increased with the decreased expression of bcl-xL. Ellagic acid also decreased the expression of survivin. In the MCF-7 cells, the expressions of bcl-xL and cytochrome c showed no change after treatment with ellagic acid even at a high dose. Ellagic acid was able to induce an up-regulation of c-fos and pS2 protein in MCF-7. CONCLUSION: Ellagic acid has an anti-proliferative effect in the MDA-MB-231 cells. This effect of ellagic acid is through the intrinsic pathway in MDA-MB-231 cells. However, the expression of bcl-xL showed no change in the MCF-7 cells. Ellagic acid has a different anti-proliferative effect between the two human breast cancer cell lines.

Preliminary Report on Usefulness of Adjacent Interspinous Stabilization using Interspinous Spacer Combined with Posterior Lumbosacral Spinal Fusion in Degenerative Lumbar Disease

OBJECTIVE: Posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease has the problems of adjacent level disease as well as surgical complications. An interspinous device used for dynamic stabilization can also be applied to the adjacent segment for spinal fusion to reduce the severity of these problems. The authors reviewed the adjacent interspinous stabilization using an interspinous spacer(CoflexTM paradigm spine,Germany) combined with posterior lumbar or lumbosacral spinal fusion in degenerative lumbar disease. Method: From January 2007 to July 2008, ten patients with degenerative lumbar disease underwent posterior lumbar or lumbosacral spinal fusion with adjacent interspinous stabilization using CoflexTM. The indications for this type were adjacent segmental disc protrusion, adjacent segmental degenerative changes or high surgical risk groups, such as elderly patients or osteoporotic patients undergoing multiple leveled fusions. CoflexTM was inserted into the adjacent segmental interspinous space. The control group consisted of fifteen patients, who underwent posterior lumbar or lumbosacral spinal fusion without interspinous stabilization. The radiological parameters and clinical outcomes were compared. All patients were followed-up for more than twelve months. RESULTS: The visual analogue scale(VAS) in both groups postoperatively and at the twelve month follow-up were improved. In the CoflexTM group, the postoperative and twelve month follow-up X-ray showed no significant change in posterior disc height, interpedicular height, segmental lordotic angle, flextion-extension angulation and translation and no significant segmental instability. The control group showed a higher level of segmental lordotic angle, translation and a lower posterior disc height, interpedicular height, flextion-extension angulation and three patients showed adjacent segmental instability. CONCLUSION: CoflexTM can be used to stabilize the adjacent segment of spinal fusion in degenerative lumbar disease and might be effective in preventing adjacent segmental degeneration. However, further study will be needed to confirm this observation.

DNA Methylation in Development

DNA methylation is one of many epigenetic mechanisms that regulate gene expression in the human body. From the view of epigenetics, there are two phases of development, one for germ cell development and another for embryo development. This review will discuss the basic mechanism of methylation, its role in gene expression, and the role of methylation in embryonic reprogramming. Methylation of genes is very critical to embryo development and should be explored further in order to increase our understanding of development.