A Systematic Review of Interspinous Dynamic Stabilization

BACKGROUND: A systematic literature review of interspinous dynamic stabilization, including DIAM, Wallis, Coflex, and X-STOP, was conducted to assess its safety and efficacy. METHODS: The search was done in Korean and English, by using eight domestic databases which included KoreaMed and international databases, such as Ovid Medline, Embase, and the Cochrane Library. A total of 306 articles were identified, but the animal studies, preclinical studies, and studies that reported the same results were excluded. As a result, a total of 286 articles were excluded and the remaining 20 were included in the final assessment. Two assessors independently extracted data from these articles using predetermined selection criteria. Qualities of the articles included were assessed using Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The complication rate of interspinous dynamic stabilization has been reported to be 0% to 32.3% in 3- to 41-month follow-up studies. The complication rate of combined interspinous dynamic stabilization and decompression treatment (32.3%) was greater than that of decompression alone (6.5%), but no complication that significantly affected treatment results was found. Interspinous dynamic stabilization produced slightly better clinical outcomes than conservative treatments for spinal stenosis. Good outcomes were also obtained in single-group studies. No significant difference in treatment outcomes was found, and the studies compared interspinous dynamic stabilization with decompression or fusion alone. CONCLUSIONS: No particular problem was found regarding the safety of the technique. Its clinical outcomes were similar to those of conventional techniques, and no additional clinical advantage could be attributed to interspinous dynamic stabilization. However, few studies have been conducted on the long-term efficacy of interspinous dynamic stabilization. Thus, the authors suggest further clinical studies be conducted to validate the theoretical advantages and clinical efficacy of this technique.

Immunohistochemical Localizaion of Carbonic Anhydrase Isozymes IV and IX in Rat Salivary Gland / 대한해부학회지

This study presents distribution of carbonic anhydrase (CA) isozymes IV and IX, membrane associated forms, and CA I and II, cytoplasmic forms, in rat parotid and submandibular glands using Western blot analysis and immunohistochemical staining. Western blot analysis demonstrated that CAs I, II and IX were found to be abundantly expressed, but CA IV was weakly expressed in parotid gland. Submandibular gland expressed abundant CAs I and II, weak CA IX, and undetectable level of CA IV. In hematoxylin-eosin staining, parotid gland was entirely composed of serous acini and their ducts while submandibular gland was mixed population of serous and mucous lobules. Most of lobules (submandibular gland proper type) contained mostly serous acini and their ducts with granular convoluted duct. Some lobules (sublingual gland type) contained mostly mucous acini with serous demilune and their ducts without granular convoluted duct. In parotid gland, CAs IV and IX were immunolocalized in duct cells and not in serous acinar cells. Immunoreactivity for CAs I and II was also detectable in duct cells. Serous acinar cells were positive for CA II, and negative for CA I. In submandibular gland, CAs IV and IX were immunolocalized in duct cells but not in acinar cells of both types of lobules. Immunoreactivity for CAs I and II was also detectable in duct cells of both types of lobules. Cells of serous acini and serous demilune were positive for CA II, and negative for CA I. Mucous cells were negative for both CAs I and II. These results demonstrate the distribution of CA isoenzymes in parotid and submandibular glands of the rat, and suggest CAs IV and IX as well as CAs I and II are related to electrolytes metabolism of saliva in duct cells.

A Simple Corrective Method for Prominent Ear

Various methods have been used to correct the prominent ear, in which the deformity is due to lack of formation of the normal antihelix. In 1963, Mustard presented a method which creates the antihelical fold by placing permanent mattress sutures through the cartilage without using any actual cartilaginous incisions. However, the main disadvantage of this method is difficulty in accurate full- thickness transcartilaginous suture without an injury to the anterior auricular skin. To solve this problem, the authors separated the anterior auricular skin from the cartilage by a subcision method using a 21-gauge needle without making a skin incision. Between 2001 and 2002, a total of 16 prominent ears in 12 patients were corrected by this method. Eight patients underwent unilateral correction and four patients underwent bilateral correction. Seven were female and 5 were male. Patients' age at operation ranged from 5 to 24 years(mean 9.7 years). Patients were followed up from 5 to 14 months(mean 8.6 months). No major complications were observed while using this method and good aesthetic result was achieved in all cases, except one recurrence case that needed revision procedure. This method is a simple and safe technique with reliable aesthetic results and no scar on the anterior auricular skin.

Expression of Proliferatin Cell Nuclear Antigen ( PCNA ) and P53 Protein in Skin Carcinomas

Basal cell carcinoma(BCC) and squamous cell carcinoma(SCC) are the most frequent neoplasms of the human skin. Ultraviolet radiation in sunlight is a well established mutagen of p53 gene and is the major epidemiological risk factor in the development of basal cell carcinoma and squamous cell carcinoma. There is no general agreement in the several studies about the percentage of p53 positive staining of BCCs and SCCs. To evaluate the relationship between p53 positivity, PCNA index and other clinicopathological parameters, immunohistochemistry for p53 protein and PCNA was performed in 20 cases of BCCs, 14 SCCs and 3 Bowen's disease. The results are as follows; 1) The immunostaining of p53 protein and PCNA is localized to the nuclei of the tumor cells and some of adjacent normal surface squamous epithelium, more intense in the periphery of the tumor nests. 2) The pattern of immunostaining of PCNA is similar to that of p53 protein. 3) There was no difference in the expression of p53 protein according to the location of tumors, age or sex of patients, except thickness. 4) There was no difference among the BCCs, SCCs and Bowen's disease in the percentage of positive staining of p53 protein and PCNA but the aggressive BCCs and the less differentiated SCCs showed more high PCNA index and more intense p53 immunostaining. Above results suggest that the expressions of p53 protein and PCNA are related to the differentiation and biological behavior such as infiltrating property of the tumor, and they may be used as adjuvant indicators of prognosis in the skin carcinomas.

Ultrastructural Changes of Cleft Lip Muscle Following Primary Cheiloplasty

The cleft lip is the most common congenital craniofacial anomaly, the anatomical difference in operated patient and normal person by several authors. Authors deserved the ultrastructural changes in secondary cleft lip patients treated with primary cheiloplasty. We obtained eighteen muscle specimens from the upper lip of 18 patients during the time of secondary lip revision. It was stained with Hematoxylin Eosin, Epon-toluidine blue and histochemical method, and examined by light microscope. Also it was examined by electron microscope with various stain and several steps. We found the extensive collagenous fibrosis with various atrophy of muscles by light microscope, and the myofibroblast with rER, mitochondria, and abundant intermediate filaments by electron microscope in 14 cases. We also found muscular atrophy characterized with variable size of muscle fibers by light microscope, and marked variation of muscle fiber size with sarcoplasmic vacuoles, myocytolysis and internal migration of nuclei by electron microscope in 4 cases. In conclusion, in the most cases the major part of the tissues were surrounded by progressive fibrosis, the mild muscular atrophy was seen at some cases.

A case of rigid spine syndrome with rimmed vacuolar myopathy

Rigid spine syndrome (RSS) is a childhood onset muscle disorder characterized by: marked limitation of motility of cervical and lumbar spine with severe lordosis, contracture of limb joints, mild and nonprogressive proximal muscle weakness, moderately elevated muscle enzymes, myopathic electromyographic patterns, and histological features of nonspecific myopathies. Here we present a 14-year-old girl with distinctive clinical features of rigid spine syndrome. She developed slowly progressive difficulty on walking because of joint contracture and rigid spine with severe lordosis since 4 years of age. There was mild but generalized muscle weakness. The serum creatine kinase was increased up to 743 IU/ml and the EMG studies showed combined features of myopathy and neuropathy. The muscle biopsy of vastus lateralis revealed the typical findings of rimmed vacuolar myopathy with perivascular inflammatory cell infiltration, which were consistent with the inclusion body myositis.

The usefulness of standardization of the nerve conduction study in the diagnosis and follow up of the demyelinating polyneuropathy

BACKGROUND: Nerve conduction study is an objective and quantitative diagnostic method for the diagnosis and follow-up study of polyneuropathy. Sometimes it is hard to interpret the nerve conduction study, because there are many segmental variables to test and uneven distribution of abnormalities in polyneuropathy. And there can be some interpersonal differences in the interpreting the results. It is obvious that one objective and quantitative value that represents the many segmental variables is helpful for the clinical interpretation and follow?up of polyneuropathy. METHODS: We evaluated 242 normal subjects and 71 patients with demyelinating polyneuropathy to find out a standardized representative value, distinguishing patients from normal subjects. The standardized representative value was made by combination of the some standardized segmental variables which showed marked differences between two groups. We evaluated the clinical usefulness of this value by comparing the sequential changes of this value with the clinical course. RESULTS: Statistically significant differences were present in each segmental value of the nerve conduction study between the groups of patients and normal persons. The diagnostic sensitivity of the segmental value was in range of 25.7%-81.8% in case of 2SD criteria. The diagnostic sensitivity of each functional standardized value - average of the segmental standardized values of same nature - was in range of 54.1%-89.9% in case of 2SD criteria. Using 3SD criteria the sensitivity was reduced to 20.9%-81.1%, more in sensory and mixed nerve than motor nerve. By combination of these functional standardized values, the diagnostic sensitivity could increase up to 79.1%-93.2% on 3SD criteria. CONCLUSION: The best combination which represents the NCV study is the average of the motor nerve terminal latency, the motor nerve conduction velocity, and the ratio of conduction block with 93.2% sensitivity and 100% specificity. This representative value well reflects the clinical course of patient in follow-up studies.

Clobazam as An Add on Therapy in Patients with Complex

Clobazam is one of the benzodiazepine compounds consisting of different structure compared to previously marketed other benzodiazepines. In rescent days, the antiepileptic effects of this drug has been recognized and used in epileptic patients. To confirm the efficacy and side effects of clobazam, we review the records of the 60 patients who was medicated clobazam more than 9 months. These patients had complex partial seizure with unsatisfactory control despite of adequate drug dosage and duration. Among these patients, the improved one were 23 (38. 3%), and tolerant one were 25 with 5.6 month mean remission duration. Only the 7 of 60 patients complained the adverse symptoms and this were not serious enough to discontinue medication. In conclusion, clobazam is relatively safe and efficacious medication enough to try for patients with unsatisfactory seizure control.

A Case of Lethal Catatonia in a Child

Lethal catatonia is a life-threatening febrile neuropsychiatric syndrome, mainly consist of bizzare behavior, mounting fever, extreme hyperactivity, stuporous exhaustion and evenlual death. Although the entity has been reported in the literaure for over 160 years, the rarity of the illness makes prompt recognition being very difficult tasks, particularly in young children. We experienced a typical case of lethal catatonia in 7-year-old boy who previously had no organic illness. Electroconvulsive therapy (ECT) was the most successful mode of treatment among many therapies attempted. We feel that this could be the youngest case in the literature of lethal catatonia.

A Case of Deep Cerebral Vein Thrombosis during Pregnancy

Thrombosis of deep cerebral veins including internal cerebral vein, great vein of Galen and straight sinus are frequently associated with thalamic and other deep cerebral infarction or hemorrhage, which lead to severe neurologic deficits or death. The pregnancy is one of the factors causing cerebral venous thrombosis in adult. We report a case of isolated deep cerebral vein thrombosis during pregnancy which was confirmed by MRI and angiogram.

A Case of Limbic Encephalitis Associated with Small Cell Lung Cancer: About Diagnostic MRI Findings

Limbic encephalitis is a rare paraneoplastic syndrome characterized by prominent memory impairment, affective and behavioral disturbances, and progressive intellectual deterioration. Among many different neoplasm known to cause limbic encephalitis, a small cell lung cancer is certainly the most frequently reported. We experienced a 64-years old male patient presented with clinical features consistent with limbic encephalitis. He was subsequently found to have small cell lung cancer and showed characteristic evolutional MRI features ; increased signal intensity on T2 weighted image in the bilateral medial temporal regions during early stage and progressive severe atrophy in the late stage.

A Case of Mixed Infected Cerebral Malaria

Cerebral malaria means that the patient with demonstrable asexual forms of Plasmodium falciparum in peripheral blood smear who have disturbed mental state and in whom other causes of encephalopathy, such as bacterial, fungal, or viral meningoenoephalitides, drug intoxications other metabolic disease have been excluded. In cerebral malaria, the mortality rate is up to 30% and most of death is within 96 hours, so is known as neurological emergency that urgent treatment should be required. A 42 years old male patients admitted our emergency room with spiking fever 2 days before admission and drowsy mental state at the moming of admission day. The patient traveled in Africal 2 weeks ago. On physical and neurologic examination, the hepatomegaly, drowsy mental state and divergent eyeball was observed. Brain CT scan was normal but pulmonary edema was seen in chest PA and mild increased protein(76mg/dl) was observed in spinal tapping. In peripheral blood smear, severe thrombocytopenia and trophozoa of ring form and band form wer found so diagnosed as mixed infected cerebral malaria. The patient was started the treatment of chloroguine and tetracycline and recovered 2 weeks after treatment. Cerebral malaria should be once considered as differential diagnosis in patients with unknown origin fever and mental confusion in intemalized society like modem.

A Case of Thymic Squamous Cell Carcinoma in Myasthenia Gravis

Myasthenia gravis is a disorder characterized by fluctuating muscle weakness. This is frequently associated with thymoma or thymic hyperplasia, and thymectomy is an important step of treatment. We present one case of primary wquamous cell carcinoma of the thymus in myasthenia gravis. Review of literature indicate relative good prognosis.

Intrathecal Synthesis of Immunoglobulin G (IgG) and Anti-Tbc Humoral Immune Response in the Tuberculous Meningitis

The Immunological diagnosis of tuberculous meningitis (TBM) requires the presence of de novo synthesis of immunoglobulin in the central nervous system. We investigated the CNS IgG synthetic rate and IgG antibody titers against lipoarabinomanan (LAM) and PPD antigens in the serum and CSF by using ELISA in patients with TBM and patients with only pulmonary tuberculosis (PTB). The CNS IgG synthetic rate was markedly increased in all 11 patients with TB with PTB (56.42+l886 mg/day vs 7.47+435 mg/day). On the other hand, abnormally elevated IgG titers in the CSF against either LAM or PPD antigen were present in all 7 patients with TBM and in 4 of 11 patients with PTB tested. The 4 patients with the false positivity showed markedly elevated IgG antibody titers in the sera suggesting the passive diffusion of IgG antibodies through the intact blood brain barrier from the sera to the CSF. It is likely that the simultaneous measurement of CNS IgG sythesis is an useful addition to the ELISA of IgG antibody titration against the antigens of M. tuberculare in the CSF for the accurate diagnosis of TBM, especially in the endemic area of tuberculosis.

A Case of Atypical Polymyositis Diagnosed as Muscular Dystrophy on Muscle Biopsy

Though the polymyositis, one of the common adult-onset myopathy, is treatable, the diverse clinical manifestation and course sometimes lead the clinician to incorrect diagnosis. Here we report a case of polymyositis, presented with atypical features and diagnosed as muscular dystrophy on muscle biopsy previously, but showed marked clinical improvement after combined treatment with prednisolone and methotrexate.