Induced Life-Threatening Electrolyte Imbalance in Sub-clinical Hyperthyroidism -A case report-

Thyrotoxic periodic paralysis (TPP) is rare in white Caucasian but a few in Asian. A 36-year-old man presented with suddenly developed paraparesis was brought by ambulance. He got some medications and injection for the upper respiratory infection in the morning of admission day. On admission he revealed bilateral proximal muscle weakness without pain. He didn't have any specific medical history of himself and his family. The laboratory results on admission revealed severe hypokalemia (2.1 mM/l). Potassium replacement was immediately started and his symptom was gone. We found TSH was extremely decreased (<0.005 microIU/ml) but T3 and T4 were within normal level. We guess TPP was induced by some drugs to the patient with sub-clinical hyperthyroidism. Hyperthyroidism is not always clinically apparent and then may be easily missed. However just a single medication or injection that is usually prescribed can induce critical progressive hypokalemia.

Positioning of Lumbar Facet Joints by Analysis of Surface Anatomy in Korean Adults

OBJECTIVE: To determine the Korean adult standard of mean length and depth from spinous process which is palpable landmark of back to each facet joint. METHOD: The horizontal line was made between the posterior end of each facet joint, and the rectangular line was made on the horizontal line at the level of spinous process, respectively. We measured the length from the point of intersection to the posterior end of each facet joint (SFL), and the depth from the tip of spinous process to the point of intersection (SFD). All parameters were measured in 30 volunteers (Exp. 1) using computed tomography and in 30 cadavers (Exp. 2). RESULTS: The lower lumbar spine revealed the longer SFL (p0.05). There was no correlation with height and weight, either (r<0.04). CONCLUSION: We measured the standard for SFL and SFD in Korean. We suggest that these results will be useful in clinical practice including blind approach of spinal intervention to the facet joints.

Development of the Automatic Identifying Instrument for the Spinal Epidural Space

OBJECTIVE: To confirm practical usefulness of the newly invented automatic identifying instrument for the spinal epidural space. METHOD: Epidural block with blind approach has been done for the patients who suffered from lower back pain with radiating pain due to spinal disorders. Conventional blind approaches using the glass syringe (control group) and the newly invented instrument (experimental group) were applied to each 30 patients, respectively. Epidurography was used for the confirmation to conclude success or not. RESULTS: Two cases were failed in the control group. One case showed injected contrast media in the interspinal ligament, another case revealed dura-puncture. But there was no failure in the experimental group. The mean timefrom skin-penetration to epidurography was 299.7+/-13.6 second in control group and 184.0+/-16.3 second in experimental group. The mean time from changing to glass syringe (control group) or epidural detector (experimental group) to epidurography was 146.0+/-14.0 second in control group and 60.0+/-7.0 second in experimental group. The time for epidural block was much less in experimental group (p<0.001). CONCLUSION: This newly invented epidural detector could make the epidural block easier, safer, and faster. We suggest this instrument is useful complementary method for spinal epidural procedure.

The effects of sonication on human osteoarthritis cartilage in ex vivo tissue culture / 대한정형외과연구학회지

This study was initiated to investigate the effect of ultrasound(US) stimulation on therapeutic effects on human osteoarthritic cartilage repair. Cartilage explants from human osteoarthritic knee were sonicated for 10 minutes every day using continuous wave at frequency 1 MHz US signals with spatial and temporal average intensities of 0, 40, 200, 500 and 700mW/cm2. One group of explants was exposed to sham ultrasound as a control. After 1 week of culture, the intensity-dependent effects of US on DNA, proteoglycan (PG) and collagen synthesis were measured by 3H-thymidine, 35S-sulfate, 3H-proline incorporation, respectively. The expression of PG and type II collagen released into medium were measured by DMB (dimethylmethylene blue) method and western blot analysis. Safranin O/fast green and immunohistochemical staining with anti-collagen type II antibody were performed using the serial sections of cartilage explants. The histochemical examination showed that the expression of PG at the pericellular area in the deep layer increased continuously up to 700mW/cm2. In contrast, the depth of the superficial layer significantly decreased after treatment of sonication at 500 and 700mW/cm2. The expression of PG and type II collagen assessed by the isotope incorporation was significantly enhanced to the level up to 140%, 120% respectively, although US had no stimulatory effect on cell proliferation. These results suggest that optimum intensity of US for the effective expression of extracellular matrix in osteoarthritic cartilage may be around 200mW/cm2. In conclusion, our study suggests the possibilities that sonication may be therapeutically utilized for the repair of human osteoarthritic cartilage.

Effects of human serum and TGF-beta on proliferation and redifferentiation of human articular chondrocytes / 대한정형외과연구학회지

In monolayer culture, articular chondrocytes are well known to proliferate and dedifferentiate by seum and transforming growth factor-beta(TGF-beta). These dedifferentiated cells regain the ability to express type II collagen in alginate bead culture. In this study, the effects of human serum and TGF-beta on the proliferation and phenotypical change of human chondrocytes were examined in both monolayer and alginate bead culture. Proliferation was measured by 3H-thymidine incorporation and cell counting, chondrocytic phenotype by Western blot analysis of type II collagen expression, and proteoglycan synthesis by dimethylmethylene blue assay. Both human serum and TGF-beta synergistically increased the proliferation of chondrocytes in monolayer culture. Human serum had effect to maintain the type II collagen expression, even with enhanced level, in monolayer culture and showed redifferentiation in alginate culture, similar to fetal bovine serum control. TGF-beta enhanced the production of proteoglycan in monolayer culture. In conclusion, the present study demonstrated that human serum and TGF-beta could be used as potent additives to increase chondrocyte proliferation and maintain its phenotype.