Clinical Experience of Bevacizumab for Radiation Necrosis in Patients with Brain Metastasis

Background@#As the application of radiotherapy to brain metastasis (BM) increases, the incidence of radiation necrosis (RN) as a late toxicity of radiotherapy also increases. However, no specific treatment for RN is indicated except long-term steroids. Here, we summarize the clinical results of bevacizumab (BEV) for RN. @*Methods@#Ten patients with RN who were treated with BEV monotherapy (7 mg/kg) were retrospectively reviewed. RN diagnosis was made using MRI with or without perfusion MRI. Radiological response was based on Response Assessment in Neuro-Oncology criteria for BM. The initial response was observed after 2 cycles every 2 weeks, and maintenance observed after 3 cycles every 3-6 weeks of increasing length intervals. @*Results@#The initial response of gadolinium (Gd) enhancement diameter maintained stable disease (SD) in 9 patients, and 1 patient showed partial response (PR). The initial fluid-attenuated inversion recovery (FLAIR) response showed PR in 4 patients and SD in 6 patients. The best radiological response was observed in 9 patients. Gd enhancement response was 6 PR and 3 SD between 15-43 weeks. Reduction of FLAIR showed PR in 5 patients and SD in 4 patients. Clinical improvement was observed in all but 1 patient. Five patients were maintained on protocol with durable response up to 23 cycles. However, 2 patients stopped treatment due to primary cancer progression, 1 patient received surgical removal from tumor recurrence, and 1 patient changed to systemic chemotherapy for new BM. Grade 3 intractable hypertension occurred in 1 patient who had already received antihypertensive medication. @*Conclusion@#BEV treatment for RN from BM radiotherapy resulted in favorable radiological (60%) and clinical responses (90%). Side effects were expectable and controllable. We anticipate prospective clinical trials to verify the effect of BEV monotherapy for RN.

A Comparative Evaluation of Absorbable and Nonabsorbable Sutures for Open Repair of Achilles Tendon Rupture: A Pilot Study / 체질인류학회지

This pilot study was performed to compare the functional and clinical results including complications after surgery in the open repair of Achilles tendon rupture with regard to the type of suture material. A consecutive series of twenty patients with acute Achilles tendon rupture who underwent open repair were enrolled in this pilot study. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The Korean version of the Foot and Ankle Outcome Score (FAOS) and complications were assessed to evaluate functional and clinical result. Mean total Foot and Ankle Outcome Score (FAOS) was 89.8 (range, 71.1~100) in the nonabsorbable suture group and 82.7 (range, 61.9~92.5) in the absorbable suture group (p=0.22). All patients returned to their previous life activity. The absorbable suture group had fewer postoperative complications (10%) than the nonabsorbable suture group (20%), but there was no significant difference between two groups (p=0.45). This pilot study showed that use of an absorbable suture for Achilles tendon repair had functional and clinical results comparable to those of the nonabsorbable suture. However, a use of an absorbable suture was associated with a lower incidence of complications than the use of nonabsorbable suture. Therefore, these results have to be confirmed in a randomized controlled cohort trial with larger population.

Acute Segmental Rupture of Achilles Tendon by Sport Injury: A Case Report / 대한족부족관절학회지

Tendoachilles rupture has recently seen an increase in frequency, accounting for up to 40% of all tendon ruptures. However, an acute segmental rupture of the Achilles tendon is very rare with only one case caused by predisposing factors, such as steroid injection. In this report, we highlight an unusual clinical presentation of a segmental rupture of the Achilles tendon without any underling predisposing factor and without direct trauma. Herein, we discuss its mechanism. Twelve months after surgical repair with open technique, this patient became fully functional again in daily activity.

Effects of Scytosiphon lomentaria on osteoblastic proliferation and differentiation of MC3T3-E1 cells

BACKGROUND/OBJECTIVES: Bone formation and bone resorption continuously occur in bone tissue to prevent the accumulation of old bone, this being called bone remodeling. Osteoblasts especially play a crucial role in bone formation through the differentiation and proliferation. Therefore, in this study, we investigated the effects of Scytosiphon lomentaria extract (SLE) on osteoblastic proliferation and differentiation in MC3T3-E1 cells. MATERIALS/METHODS: A cell proliferation assay, alkaline phosphatase (ALP) activity assay, alizarin red staining and protein expression analysis of osteoblastic genes were carried out to assess the osteoblastic proliferation and differentiation. RESULTS: The results indicated that treatment of SLE promoted the proliferation of MC3T3-E1 cells and improved ALP activity. And, SLE treatment significantly promoted mineralized nodule formation compared with control. In addition, cells treated with SLE significantly upregulated protein expression of ALP, type 1 collagen, bone morphogenetic protein 2, runt-related transcription factor 2, osterix, and osteoprotegerin. CONCLUSIONS: The results demonstrate that SLE promote differentiation inducement and proliferation of osteoblasts and, therefore may help to elucidate the transcriptional mechanism of bone formation and possibly lead to the development of bone-forming drugs.

Efficacy of Additive Trans-cuff Augmentation Sutures for Proximal Humeral Fractures Stabilized by Locking Plates in Elderly Patients

BACKGROUND: The purpose of our study was to evaluate the functional and radiologic outcomes of additive augmentation sutures through rotator cuff for proximal humeral fractures stabilized locking plate in elderly patients. METHODS: We enrolled 74 patients over the age of 60 years who received internal fixation using locking plates for proximal humeral fractures. Of these, 50 patients had additive augmentation sutures through rotator cuff. The mean age at the time of surgery was 72.1 years (range, 60-89 years), and the mean follow-up period was 17.5 months (range, 12-62 months). The humeral neck-shaft angle and humeral head height were used as radiological markers to assess the effect of additive augmentation sutures through rotator cuff. We allocated the patients who received additive augmentation sutures into group A and those who did not into group B. RESULTS: At the final follow-up, the mean Korean Showlder Society score and Constant scores were 88.96 +/- 12.1 and 86.6 +/- 11.9, respectively, in group A and 86.21 +/- 11.8 and 85.3 +/- 11.7, respectively, in group B (p=0.368, 0.271). At the final follow-up, the mean loss in humeral neck-shaft angle from the time of immediate postoperative measurement was 1.6degrees in group A and 4.8degrees in group B, whereas the mean loss in humeral head height was 0.82 mm in group A and 0.52 mm in group B (p=0.029, 0.178). CONCLUSIONS: The surgical outcomes of internal fixation using locking plates for proximal humeral fractures were clinically and radiologically good in elderly patients over the age of 60 years without any observable complications. Further, the loss of humeral head shaft angle at the final follow-up from its initial postoperative measurement was significantly smaller in patients who received an additive augmentation suture than in those who did not. Thus, we conclude that augmentation sutures are a beneficial option for elderly patients that clinicians can consider at the time of surgical decision making.

Efficacy of Additive Trans-cuff Augmentation Sutures for Proximal Humeral Fractures Stabilized by Locking Plates in Elderly Patients

BACKGROUND: The purpose of our study was to evaluate the functional and radiologic outcomes of additive augmentation sutures through rotator cuff for proximal humeral fractures stabilized locking plate in elderly patients. METHODS: We enrolled 74 patients over the age of 60 years who received internal fixation using locking plates for proximal humeral fractures. Of these, 50 patients had additive augmentation sutures through rotator cuff. The mean age at the time of surgery was 72.1 years (range, 60-89 years), and the mean follow-up period was 17.5 months (range, 12-62 months). The humeral neck-shaft angle and humeral head height were used as radiological markers to assess the effect of additive augmentation sutures through rotator cuff. We allocated the patients who received additive augmentation sutures into group A and those who did not into group B. RESULTS: At the final follow-up, the mean Korean Showlder Society score and Constant scores were 88.96 +/- 12.1 and 86.6 +/- 11.9, respectively, in group A and 86.21 +/- 11.8 and 85.3 +/- 11.7, respectively, in group B (p=0.368, 0.271). At the final follow-up, the mean loss in humeral neck-shaft angle from the time of immediate postoperative measurement was 1.6degrees in group A and 4.8degrees in group B, whereas the mean loss in humeral head height was 0.82 mm in group A and 0.52 mm in group B (p=0.029, 0.178). CONCLUSIONS: The surgical outcomes of internal fixation using locking plates for proximal humeral fractures were clinically and radiologically good in elderly patients over the age of 60 years without any observable complications. Further, the loss of humeral head shaft angle at the final follow-up from its initial postoperative measurement was significantly smaller in patients who received an additive augmentation suture than in those who did not. Thus, we conclude that augmentation sutures are a beneficial option for elderly patients that clinicians can consider at the time of surgical decision making.

Treatment for Hallux Valgus with Chevron Metatarsal Osteotomy in Patients over 60 Years Old / 대한족부족관절학회지

PURPOSE: To treat hallux valgus in old age patients with chevron metatarsal osteotomy and to see the subsequent clinical and radiological outcomes. MATERIALS AND METHODS: 23 cases of 18 hallux valgus patients of age 60 years or older who received proximal or distal corrective osteotomy from April 2007 to August 2009 and were followed up for at least 1 year were included in the study. The mean age at operation was 65 years (range, 60~81 years), and the mean follow-up period was 2 years and 6 months (range, 1 year~3 years 6 months). Clinical outcome was assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, complications, satisfaction rate, as well as measurements and comparison of pre- and postoperative hallux valgus angles, the 1st~2nd intermetatarsal angle, and the position of hallucal medial sesamoid bone. RESULTS: The AOFAS score was improved from preoperative average of 35.1 (range, 13-47) to average 85.1 at last follow-up (range, 75-100). Patients were satisfied about the operation in 21 cases (91.3%). Preoperative hallux valgus angle was 31.7degrees on average (range, 19.1degrees-48.9degrees), and 4.9degrees on average at last follow-up (range, 0.3degrees-21.2degrees). The 1st~2nd intermetatarsal angle was 14.4degrees on average (range, 8.7degrees-25.7degrees) and 3.1degrees on average at last follow-up (range, 0.6degrees-7.5degrees). The hallucal medial sesamoid bone position was improved from preoperative average 3.5 (range, 3-4) to postoperative average 1.0 (range, 0-2). CONCLUSION: Proximal and distal metatarsal osteotomy treatment yielded good clinical and radiological outcomes in old age hallux valgus patients.

Effects of Pilocarpine-induced Seizures on the Neuronal Cell Death, Mossy Fiber Sprouting and Neurogensis in the Hippocampus of Mice / 체질인류학회지

Present study was performed to delineate the inter-relationship among neuronal death, mossy fiber sprouting (MFS) and neurogenesis in hippocampal formation of pilocarpine-treated mice. Status epilepticus was induced by intraperitoneal administration of 300 mg/kg pilocarpine in male ICR and C57BL/6 mouse. The severity of seizure was evaluated using 5 grades of Racine scales for first 4 hr after pilocarpine injection. Fluro-Jade C (FJC) staing, NeoTimm's staining and immunohistochemistry for BrdU were employed to evaluate neuronal cell death, MFS and neurogenesis, respectively. All animals in the present study induced seizures over grade 3 of Racine scale by pilocarpine injection. ICR mice show higher seizure severity (mean Racine scale; 4.37) than C57BL/6 mice do (mean Racine scale; 3.22), while the latency times for the first seizure over Racine scale grade 3 are from 15 min to 20 min and showed no difference between the 2 strains. In ICR mouse, numerous FJC-positive cells in hilus of hippocampus were detected at 4 h after pilocarpine injection, while they were not detected at that time in C57BL/6 mouse. The number of FJC-positive neuronal cells, which were densely found in the pyramidal layer of CA1, CA3 and hilus polymorphic regions of hippocampus, reached peak at 3 days after injection and then few cells were found at 7 days after injection in both strains. In control animals, BrdU positive cells in dentate subgranular layer which represent the hippocampal neurogenesis were more numerous in C57BL/6 than in ICR. The number of BrdU positive cells significantly increased at 2 days after pilocarpine injection and reached the peak at 8 days after injection and returned to control level at 15 day after injection in both strains. The percent increase of the BrdU positive cell was more prominent in ICR mouse. MFS was found at 2 weeks after the injection and the intensity of MFS was getting strong at 4 weeks after injection. There was no differences in MFS grading between 2 strains. These results suggest that there are some inter-relationships among the seizure severity, hippocampal neuronal cell death and hippocampal neurogenesis, but they don't have any significant relationships with the mossy fiber sprouting from dentate granule cells.

Antioxidant activity and analysis of proanthocyanidins from pine (Pinus densiflora) needles

In this study, we evaluated the antioxidant activity of pine needle extracts prepared with hot water, ethanol, hexane, hot water-hexane (HWH), and hot water-ethanol (HWE), using the DPPH (1,1-diphenyl-2-picrylhydrazyl) radical method. The hot water extract possessed superior antioxidant activity than the other extracts. We also compared the antioxidant activity of pine needle extracts through ROS inhibition activity in a cellular system using MC3T3 E-1 cells. The hot water extract exhibited the lowest ROS production. The pattern of HPLC analysis of each extract indicated that the hot water extract contained the highest proanthocyanidin level. The pine needle hot-water extract was then isolated and fractionated with Sephadex LH-20 column chromatography to determine the major contributor to its antioxidant activity. The No.7 and 12 fractions had high antioxidant activities, that is, the highest contents of proanthocyanidins and catechins, respectively. These results indicate that the antioxidant activity of procyanidins from the hot water extract of pine needles is positively related to not only polymeric proanthocyanidins but also to monomeric catechins. Moreover, the antioxidant activity of the pine needle hot water extract was similar to well-known antioxidants, such as vitamin C. This suggests that pine needle proanthocyanidins and catechins might be of interest for use as alternative antioxidants.

Comparison of methods for proanthocyanidin extraction from pine (Pinus densiflora) needles and biological activities of the extracts

Flavonoids are known to be effective scavengers of free radicals. In particular, proanthocyanidins are flavonoids that possess cardiovascular protection, antioxidative activities, and immunomodulatory activities. Here, we evaluated proanthocyanidin contents in the total polyphenolic compounds of pine needle extracts prepared by hot water, ethanol, hexane, hot water-hexane (HWH), and hot water-ethanol (HWE). Analysis of each extract indicated that the ethanol extract contained the highest proanthocyanidin concentration. The HWH and hexane extracts also contained relatively high concentrations of proanthocyanidin. On the other hand, proanthocyanidin content analyses out of the total polyphenolic compounds indicated that the HWH extract contained the highest content. These results suggest that HWH extraction is a suitable method to obtain an extract with a high level of pure proanthocyanidins and a relatively high yield. The HWH extract possessed superior activity in diverse antioxidative analyses such as 2,2-diphenyl-1-picrylhydrazyl (DPPH), ferrous ion chelating (FIC), and ferric-ion reducing power (FRAP) assays. In addition, upon assessing the effects of the pine needle extracts on macrophages (Raw 264.7 cell), the HWH extract exhibited the highest activity. In this study, we discerned an efficient extraction method to achieve relatively pure proanthocyanidins from pine needles and evaluated the biological functions of the resulting extract, which could potentially be used for its efficacious components in functional food products.

Clinical Analysis of Blepharospasm and Apraxia of Eyelid Opening in Patients with Parkinsonism

BACKGROUND AND PURPOSE: Blepharospasm (BSP) and apraxia of eyelid opening (AEO) have been reported as dystonia related with parkinsonism. However, systematic analysis of clinical characteristics of BSP and AEO in parkinsonism has been seldom reported. To investigate the clinical characteristics of BSP and AEO in parkinsonism and to find out the clinical significance to differentiate parkinsonism. METHODS: We enrolled 35 patients who had BSP with or without AEO out of 1113 patients with parkinsonism (913 IPD, idiopathic Parkinson's disease; 190 MSA, multiple system atrophy, 134 MSA-p, 56 MSA-c and 10 PSP, progressive supranuclear palsy). We subdivided MSA into MSA-p (predominantly parkinsonism) and MSA-c (predominantly cerebellar) according to the diagnostic criteria proposed by Quinn. We analyzed the clinical features of BSP and parkinsonism including onset age, onset interval to BSP, characteristics of BSP, presence of AEO, coexisted dystonias on the other body parts, severity of parkinsonism and relationship with levodopa treatment. RESULTS: BSP with or without AEO were more frequently observed in atypical parkinsonism (PSP, 70%; MSA-p, 11.2%; MSA-c, 8.9%) than in IPD (0.9%). Reflex BSP was observed only in atypical parkinsonism (4 MSA-p, 1 MSA-c and 2 PSP). BSP preceding parkinsonism (Pre-BSP) was observed mainly in atypical parkinsonism (2 MSA-p, 1 MSA-c, 1 PSP and 1 IPD). The presence of AEO was more frequent in atypical parkinsonism than in IPD, but isolated AEO was not detected. BSP related to levodopa ('off' symptom or 'peak-dose' effect) were observed only in IPD. CONCLUSIONS: Reflex BSP, Pre-BSP and the presence of AEO may be a unique feature of atypical parkinsonism. BSP related to levodopa might be representative of IPD. No differences were found in the clinical features of BSP between MSA-p and MSA-c.

A Case of Familial Spinocerebellar Ataxia Type 8

Spinocerebellar ataxia type 8 (SCA8), originally described in a family characterized by pure cerebellar ataxia, is caused by the expansion of combined CTA/CTG repeats on chromosome 13q21. We experienced a 26-year-old man who presented with a 10-years history of slowly progressive gait ataxia, dysarthria and blepharospasm. We performed genetic studies for SCA1, 2, 3, 6, 7 and 8, and detected CTA/CTG repeat expansion in the SCA8 gene. We now report the first Korean familial case of SCA8 confirmed by genetic study.

A Case of Human Rabies Confirmed by Polymerase Chain Reaction

The human rabies is a fatal infectious disease invading the central nervous system. There are many cases of clinically suspicious human rabies encephalitis in Korea since 1906. A 53-year old man was admitted to the Department of Neurology because of rapidly progressive dysphagia. His sputum was examined and the rabies virus was found by the polymerase chain reaction technique. So we report a case of human rabies encephalitis confirmed by detection of the rabies virus from his saliva.

The efficacy of Kinesio taping in patients with a low back pain

BACKGROUND: Kinesio taping is a treatment for pain and dysfunction of musculoskeletal system, using tapes which have a similar elasticity to skin. This study was done to find out about the efficacy of kinesio taping on patients with a low back pain. METHODS: This study was performed in patients with a non-specific low back pain who had visited the Inchon International Airport Construction Authority Clinic from January 2000 to April 2000. We performed taping to a randomized case group and a placebo to control group during the first 3 days. After the first 3 days, we assessed the changes of improvement in low back pain with visual-analogue pain scale (VAS) . From the second visit on, we also started carrying out kinesio taping in the control group. RESULTS: The total number of patients participating in this study was 43, but 4 patients did not complete the study stopped. After the first 3 days, control group showed just 0.93 of the VAS score improvement, while randomized case group showed 2.55(p=0.003). The VAS score of case and control group were 3.18 and 3.03 respectively, which showed improvement at the end point of treatment compared with the first score. CONCLUSIONS: Kinesio taping was more efficacious than placebo in patients with a nonspecific low back pain.

A Case of Adrenomyeloneuropathy Confirmed by Serum Very Long Chain Fatty Acids Level

A 31-year-old male patient was admitted to the department of neurology for progressive spastic paraparesis and sen-sory deficit in bilateral lower legs. On review of system, he had decreased libido and mild urinary frequency. On neuro-logic examination, he showed paraparesis, lower limb hypesthesia, bilateral hyperactive knee jerk and bilateral positive Babinski sign. The nerve conduction studies were sensori-motor demyelinating polyneuropathy. For spastic paraparesis and peripheral neuropathy, we approached adrenomyeloneuropathy and ascertained elevated serum very long chain fatty acids (VLCFA) level. (J Korean Neurol Assoc 19(4):427~430, 2001)

A Case of Myasthenia Gravis associated with Idiopathic Thrombocytopenic Purpura

Myasthenia gravis has been associated with a variety of autoimmune diseases, but the association of myasthenia gravis with idiopathic thrombocytopenic purpura has been rarely reported. A previously healthy 33-year-old female presented with a 10-month history of easy fatigability, motor weakness, diplopia and menorrhage. Clinical and labora-tory findings supported the diagnosis of myasthenia gravis and idiopathic thrombocytopenic purpura. After a thymecto-my, there were surprising improvements not only in muscle strength, but also of thrombocytopenia. Though this associ ?ation may be incidental, the patient's progress suggests that idiopathic thrombocytopenic purpura may be closely relat-ed to myasthenia gravis immunologically because both diseases developed simultaneously and showed good therapeu-tic responses after a thymectomy.

The sociodemographic factors which influence marital satisfactionduring the school age stages of the family life cycle

No abstract available.