Fusion Rates of Instrumented Lumbar Spinal Arthrodesis according to Surgical Approach: A Systematic Review of Randomized Trials

BACKGROUND: Lumbar spine fusion rates can vary according to the surgical technique. Although many studies on spinal fusion have been conducted and reported, the heterogeneity of the study designs and data handling make it difficult to identify which approach yields the highest fusion rate. This paper reviews studies that compared the lumbosacral fusion rates achieved with different surgical techniques. METHODS: Relevant randomized trials comparing the fusion rates of different surgical approaches for instrumented lumbosacral spinal fusion surgery were identified through highly sensitive and targeted keyword search strategies. A methodological quality assessment was performed according to the checklist suggested by the Cochrane Collaboration Back Review Group. Qualitative analysis was performed. RESULTS: A literature search identified six randomized controlled trials (RCTs) comparing the fusion rates of different surgical approaches. One trial compared anterior lumbar interbody fusion (ALIF) plus adjunctive posterior transpedicular instrumentation with circumferential fusion and posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF). Three studies compared PLF with circumferential fusion. One study compared three fusion approaches: PLF, PLIF and circumferential fusion. CONCLUSIONS: One low quality RCT reported no difference in fusion rate between ALIF with posterior transpedicular instrumentation and circumferential fusion, and PLIF and circumferential fusion. There is moderate evidence suggesting no difference in fusion rate between PLF and PLIF. The evidence on the fusion rate of circumferential fusion compared to PLF from qualitative analysis was conflicting. However, no general conclusion could be made due to the scarcity of data, heterogeneity of the trials included, and some methodological defects of the six studies reviewed.

The Effect of Cefazolin on Mechanical Properties and Antibacterial Reactions of Calcium Phosphate Cement / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the change of mechanical properties and the effect of antibacterial reactions in calcium phosphate cement (CPC) mixed with cefazolin. MATERIALS AND METHODS: We made CPC and a sodium alginate solution and we mixed in variable dosages of cefazolin and then we made a standard sized cement mold. With that we performed compression stress tests, drug releasing tests and antibacterial tests. RESULTS: We found the typical appearance of hydroxyapatite (HA) in the cement mixed with cefazolin. The compressive strength of the cement mixed with cefazolin was higher than that of the cement not mixed with cefazolin and the higher strength cement had a smaller pore size and less porosity. The sodium alginate solution showed the maximum compressive strength at 2 & 4 wt%, but this was decreased at 6 wt%. Cefazolin was released in proportion to the concentration for the first 8 days on the drug releasing test and then a similar amount was released until the tenth day. An antibacterial effect was detected at all dosages of cefazolin on the antibacterial test. CONCLUSION: The compressive strength of the cement mixed with cefazolin was higher than that of the cement not mixed with cefazolin. The drug was released from the cement in a proper fashion and the antibacterial effect was preserved.

Risk Factors for Recurrence After Surgical Treatment of a Malignant Phyllodes Tumor of the Breast / 한국유방암학회지

PURPOSE: Malignant phyllodes tumors are rare breast tumors. Information on the prognosis and optimal treatment of these lesions is not yet sufficient. The aim of this study was to determine parameters that predict the recurrence of malignant phyllodes tumors of the breast. METHODS: Retrospectively, we reviewed the medical records and pathological slides of 23 patients with malignant phyllodes tumors that had undergone surgical treatment from 1988 to 2006. The age of the patients, tumor size, type of surgery, resection margin, adjuvant therapy and pathological characteristics of the tumors such as stromal hypercellularity, cellular phleomorphism, mitosis, margins, and stromal pattern were examined. RESULTS: The mean age of the patients was 41 yr. The tumor size ranged from 1 cm to 25 cm, with a median of 7.42 cm. The median follow-up time was 29.0 months. Recurrence was observed in 6 patients (26.1%) and the 5-yr disease free survival was 48.9%. Risk factors for recurrence of a malignant phyllodes tumor were a mitotic index greater than 10 per high-powered field (p=0.0242) and an invasive margin (p=0.0437). CONCLUSION: Frequent mitosis and an invasive margin were the principal determinants of recurrence. Patients with poor prognostic components should be treated more aggressively and the patients need more close follow-up.

Alpha-tocopherol Prevents H2O2-induced Tight Junction Occludin Disruption in Blood-Brain Barrier / 체질인류학회지

Vitamin E is the most important lipid-soluble antioxidant in humans. Although alpha-tocopherol is suggested that it has protective effect from many diseases, little is known about the prevention of occludin alteration in tight junction of blood-brain barrier (BBB) under pathologic insults producing reactive oxygen species (ROSs). In this study, the effects of alpha-tocopherol on H2O2-induced tight junction occludin were studied. Primary culture of rat brain microvessel endothelial cells was investigated with confocal microscopy, Western blot, and cell viability assay. Alpha-tocopherol had no apparent cytotoxicity up to 2.8 mM. The preincubation with alpha-tocopherol suppressed the H2O2-induced cytotoxicity in Alamar Blue assay and phase contrast microscopy. In confocal laser microscopy and Western blot, H2O2-induced loss of occludin was suppressed by preincubation with alpha-tocopherol. The present findings provide evidence that alpha-tocopherol may be beneficial for cellular protection from pathologic insults. Since alpha-tocopherol was demonstrated to have far fewer adverse effects, it would become a noteworthy nutrient or drug for the treatment of neurodegenerative diseases.

A Case of Lichen Planus/Lupus Erythematosus Overlap Syndrome / 대한피부과학회지

Lichen planus(LP) and lupus erythematosus(LE) may occur infrequently as an overlap syndrome. The term comprises a heterogenous group of patients who have clinical, histological and/or immunopathological characteristics of both diseases at the same time. We report a case of LP/LE overlap syndrome in a 42-year-old man who has had a red to violet colored patch with atrophy and telangiectasia on the left arm for 2 years. The biopsy of the left arm showed histological features consistent with LP and LE at the same lesion. Direct immunofluorescence also showed features consistent with LP and LE at the same lesion.

A Case of Prurigo Pigmentosa Supposedly Relevant to the Swimming Suit / 대한피부과학회지

Prurigo pigmentosa is a rare and recurrent inflammatory dermatosis characterized clinically by severe pruritic erythematous papules and reticulated pigmentation symmetrically distributed on the trunk and neck in young adolescent females. The pathogenesis remains unclear but environmental factors such as friction from the clothing and para-amino compounds used in manufacturing of clothing have been suspected. We report a case of prurigo pigmentosa that was supposedly relevant to the swimming suit and treated with dapsone and minocycline resulting in significant clinical improvement.

A Case of Dystrophic Calcinosis Cutis in a burn scar / 대한피부과학회지

Calcinosis cutis is the deposition of insoluble calcium salts in the skin. Dystrophic calcinosis cutis is diagnosed when calcium is deposited in the previous damaged tissue and the values of calcium and phosphorus levels are normal. We report a case of dystrophic calcinosis cutis in a 32-year-old man. He had experienced a burn accidentally on the left anterior thigh at 2 years old. About 1 year ago, an ulcer developed on the burn scar. He found the chalky material in an ulcer and removed it, then the ulcer healed. But, new ulcers developed in a linear pattern. Histopathologically, amorphous eosinophilic materials that were black with Von Kossa stain were deposited in the dermis.

Development of In Vitro Blood-Brain Barrier Model with Bovine Brain Microvessel Endothelial Cells / 체질인류학회지

The in vitro blood-brain barrier (BBB) model was established with bovine brain microvessel endothelial cells (BBMECs). The characteristics of BBMECs were identified by morphological and functional studies. BBMECs began to grow as spindle shaped cells and distinctly formed the monolayer of whirling appearance by 6 to 7 days after plating. Transendothelial electrical resistance (TEER) of the monolayer increased through 11 days and then started to decrease. The gamma-GTP activity (1791.5+/-397.8 nmol/min/mg of protein) and alkaline phosphatase activity (15.0+/-7.8 micromol/min/mg of protein) were high. BBMECs in culture were characterized by the binding of anti-vWF, anti-ZO-1, anti-vimentin, and anti-fibronectin antibodies. They failed to react with anti-GFAP, anti-GalC, and antineurofilament 160/200 kD antibodies, markers for astrocyte, oligodendrocyte, and neuron, respectively. Decreasing order of the permeability through the BBMEC monolayers of paracellular transport model drugs was mannitol, sucrose, and PEG-4000. The permeability of transcellular transport model drugs, progesterone and propranolol was much higher than that of paracellular transport model drugs. The BBMECs cultured on porous membrane have been qualified as an in vitro BBB model and also can be used for the BBB transport study in the drug development and for the BBB transport mechanism of drugs.

A Case of Dermatomyositis Associated with Esophageal Cancer showing Vesicular and Bullous Lesions / 대한피부과학회지

Dermatomyositis is a rare inflammatory myopathy with characteristic skin manifestations and muscular weakness. Vesicle or bulla formation in the dermatomyositis is rare and probably related to the presence of an internal malignant process. We report a case of dermatomyositis associated with esophageal cancer in a 72-year old man who had vesicles and bullae on his arms. He had erythema and edema on the face, chest, abdomen, back and legs for 20 days. Tense vesicles and bullae were found on his forearms and hands. Diagnosis of dermatomyositis was established by clinical manifestations, muscle enzyme study, electromyogram and histopathological findings of the skin. Adenocarcinoma of esophagus was found by gastroendoscopy. He was treated with total esophagectomy and topical steroid, but died of pneumonia and septicemia.

Calcified Mesoblastic Nephroma in an Adult: A Case Report

Mesoblastic nephroma is an uncommon renal tumor reported in infants but rarely in adults. We describe a case of calcified mesoblastic nephroma occurring in an adult. It is difficult, on the basis of radiologic images, to differentiate between calcified mesoblastic nephroma and calcified renal cell carcinoma.

A Case of Milia-like Idiopathic Calcinosis Cutis and Periorbital Syringomas in Down Syndrome / 대한피부과학회지

Down syndrome is associated with a large number of abnormal skin features including syringoma. Milia-like idiopathic calcinosis cutis is one of the rare dermatoses associated with Down syndrome. It has been reported in children with Down syndrome and clinically suggested as milia. The histological features show small nodular foci of calcium within the papillary dermis and transepidermal elimination of calcium deposits occasionally. We describe a 14-year-old female affected by Down syndrome, who had whitish papules on both the dorsal hands and feet and periorbital syringomas. Histopathological findings of the papule on the dorsal hand showed calcium deposits as amorphous, basophilic masses in the upper dermis and focal discharge of calcium by means of transepidermal elimination.

The Change of Portal Hemodynamics before and after Transjugular Intrahepatic Portosystemic Shunt according to Variceal Type: Gastric and Esophageal varix

PURPOSE: To investigate the changes occurring in portal hemodynamics in patients with esophageal and gastric varices, according to variceal type, before and after TIPS. MATERIALS AND METHODS: Between January 1994 and June 1999, we evaluated 22 of 44 patients who had undergone TIPS and endoscopy on admission. In these 22, hepatic venous and main portal venous pressure were measured. On the basis of endoscpic findings, the esophageal and gastric varices were classified as one of three types. Changes in portal hemodynamics in relation to the diameter of the portal vein, mean portosystemic gradient before and after TIPS, delta MPSG, and the presence of hepatic encephalopathy and gastrorenal shunt were all evaluated. RESULTS: Endoscopy indicated that there were ten Type-I cases, nine Type-II, and three Type-III. The diameter of the main portal vein was 14.95 +/-1.79 mm in Type I cases, and 13.35 +/-1.59 mm in Type II. Before TIPS, main portal venous pressure was 31.40 +/-6.79 mmHg (Type I) and 22.80 +/-4.26 mmHg (Type II), and the mean portosystemic gradient was 16.10 +/-7.0 mmHg (Type I), and 11.20 +/-5.36 mmHg (Type II). After TIPS, the pressure readings were 25.70 +/-7.60 mmHg (Type I) and 17.80 +/-6.52 mmHg (Type II), while those relating to were 10.80 +/-4.94 mmHg (Type I) and 5.25 +/-3.67 mmHg (Type II). delta MPSG was 6.04 +/-2.98 mmHg (Type I) and 5.91 +/-3.98 mmHg (Type II). Angiography revealed that the gastrorenal shunt was Type I in 10% of cases, Type II in 77%, and Type III in 33%. Hepatic encephalopathy after TIPS occured in three Type-I cases, three-Type- II, and two Type-III. CONCLUSION: The diameter of the main portal vein was significantly smaller, and portal venous pressure and mean portosystemic gradient before and after TIPS significantly lower in patients with dominant gastric varices than in those with dominant esophageal varices (p<0.05). Gastrorenal shunt was more frequent among patients with dominant gastric varices. No difference in the incidence of hepatic encephalopathy after TIPS was noted between those with dominant gastric varices and those with the esophageal variety.

Development of a Cognitive Rehabilitation Program for Patients with Schizophrena / 신경정신의학

OBJECTS: The purpose of this study was to investigate the effects of cognitive differentiation training program-Korean version(a training program of attention and conceptual abilities) on cognitive function, psychopathology and problem solving skills in patients with schizophrenia. METHODS: A total of patients diagnosed as schizophrenia using DSM-IV were randomly assigned to 2 groups. The training group went through a total of 22 sessions of cognitive differentiation training (60min/sessionX2sessions/wkX11wks). The attention-placebo control group received psychoeducation program during the same period. Arithmetic, vocabulary, similarities, picture completion of Wechsler Adult Intelligence Scale-Korean version, Positive and Negative Syndrome Scale, and Social Problem Solving Scales were administered to all patients, both before and after the training program. RESULTS: In the arithmetic scores(F=6.35, af=1, p=0.018) of Wechsler Adult Intelligence Scale-Korean version, and total scores(F=6.35, af=1, p=0.018) and problem solving skill scale scores (F=4.88, af=1, p=0.036) of social problem solving scale, interaction effects of training was significant. CONCLUSION: Our findings suggest that cognitive differentiation training program-Korean version is effective on improving auditory attention and problem solving skills in patients with schizophrenia.

Transcatheter Arterial Embolizations of Arterial Bleeding in Patients with Pelvic Bone Fracture

PURPOSE: To evaluate the usefulness of transcatheter arterial embolization (TAE) of arterial bleeding in patients with pelvic bone fracture. MATERIALS AND METHODS: We retrospectively evaluated 13 injured arteries of seven patients with pelvic bone fracture. In order to evaluate the sites and types of arterial injuries, angiography was performed, followed by TAE using Gelfoam and a coil. The parameter of technical success is non-visualization of extravasation and pseudoaneurysm in injured arteries. We investigated (1) the survival rate and complications of TAE; (2) the relationship of arterial injuries to findings, as seen on plain film; and (3) the influence of BP on arrival and the time interval between trauma and TAE on prognosis. RESULTS: Angiography revealed (1) extravasation of contrast media in four patients; (2) extravasation and pseudoaneurysm in two; and (3) extravasation and abrupt cut-off of an artery in one. The injured arteries involved( n=13), were the internal iliac (n=3), superior gluteal (n=3), inferior gluteal (n=2), obturator (n=2), ili-olumbar (n=2), and internal pudendal (n=1). TAE was technically successful and in no case were there complications. Vital signs improved in four patients, but three others died due to hypovolemia. In five patients the site of arterial injury, as seen on plain films, was consistent pelvic bone fracture but in one patient more severe arterial injury was noted at the contralateral side of more severe pelvic bone fracture, and in one other arterial injury was observed only at the contralateral side of pelvic bone fracture. In this study, BP at arrival was a more important prognostic indication than was the time interval between trauma and TAE. CONCLUSION: For the management of arterial bleeding after blunt pelvic trauma, TAE is the procedure of choice.

Late-life Schizophrenia / 신경정신의학

The author attempted to study on the characteristics of schizophrenia in the elderly by reviewing the literature both on late-onset schizophrenia and early-onset schizophrenia which had extended into middle and old ages. Interest in the elderly schizophrenia has increased greatly overseas since the 1980's. In particular, elderly schizophrenia is different from those of early adulthood in regard of clinical symptoms and response to drug therapy. Therefore, a thorough understanding of the elderly schizophrenia not only helps evaluateing and treating these patients but also leads us to a more comprehensive understanding of the disease. The author reviewed the changes of concepts and etiology, clinical manifestations, prognosis, neurological features, relations to dementia, differential diagnosis with other psychiatric disorders, and drug therapy of late-life schizophrenia. The elderly schizophrenic patients differ from the young schizophrenics in regard of pharmacokinetics and pharmacodynamics. And because the elderly patients are prone to have other medical problems or adverse drug effects, clinicians should be careful in choosing which drug to use and in adjusting its dosage. Especially, due to the high risk of tardive dyskinesia when using classical antipsychotics, the study on atypical antipsychotics such as clozapine and risperidone has increased. Up to now the study on elderly schizophrenia is not sufficient in korea and needs more attention in the future.

Neuropsychological Functioning and Dimensions of Symptoms in Schizophrenia / 대한정신약물학회지

OBJECTIVES: On the basis of the relationship between positron emission tomography and symptom profiles in schizophrenia by Liddle et al, the authors attempted to investigate the related brain regions associated with clinical symptoms by studying the correlations between the performance of neuro-psychological tests likely to reflect functioning of dorsolateral preftontal, orbitofiontal or cingulate, parietal, and temporal cortices and 3 dimensions (psychotic or reality distortion, negative, and disorganization) of symptoms. METHODS: 41 subjects with a confirmed diagnosis of schizophrenia were scored for each of the three dimensions by Positive and Negative Syndrome Scale. Subjects performed 12 neuropsychological tests designed to measure impairment in specific areas of the brain. RESULTS: According to partial co-rrelations to remove possible confounding variables, the neuropsychological correlates of psychotic(reality distortion) and disorganization dimensions were some tests considered to be related to dorsolateral prefrontal and parietal lobes, and cingulate and dorsolateral preliontal cortices, respectively. CONCLUSION: The results support a part of hypotheses, a specific relation between disorganization and cingulate cortex. In addition our results suggest the possibile relations between a psychotic dimension and functions of dorsolateral prefrontal and parietal lobes, and between a disorganization one and functions of cingulate and dorsolateral prefrontal cortices. The authors believe that our study supports different neural circuits associated with each of dimensions of symptoms, particularly psychotic and disorganization, in schizophrenia.

Effects of Cognitive Differentiation Training of Intergrated Psychological Therapy to the Basic Cognitive Functions in Schizophrenic Patients / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the effects of cognitive differentation training of Integrated Psychological Therapy(a training program of executive function,concept formation,language,and abstraction) on micro-level cognitive function such as attention,memory and reaction time in patients with schizophrenia. METHODS: Twenty-four inpatients diagnosed as schizophrenia using DSM-lV were randomly assigned to 2 group. The training group went through a total of 12 sessions of cognitive differentiation training for 4 weeks. The control group received psychoeducation Timer of Vienna Test System were administered to all patients, both before and after the training program. RESULTS: 1) In the attention and concentration scores of Wechsler Memory Scale-Revised, between group, within group and interaction effects of training were not significant. 2) In the short-term memory scores of Wechsler Memory Scale-Revised, within group effect of training was significant(F(1,24)=15.09,p<0.05), but the between group and interaction effects did not reach significance. 3) In the long-term memory scores of Wechsler Memory Scale-Revised, within group effect of training was significant(F(1,24)=15.09,p<0.05), but the between group and interaction effects did not reach significance. 4) In the reaction time scores of Decision-Reaction Timer,interaction effect of training was significant(F(1,24)=5.18,p<0.05). 5) In the motor time scores of Decision-Reaction Timer,between group,within group and interaction effects of training were not significant. 6) In the decision time scores of Decision-Reaction Timer,interaction effect of training was significant(F(1,24)=6.00,p<0.05). CONCLUSION: Our findings suggest that cognitive differentiation training of Integrated Psychological Therapy is partly effective on improving micro-level cognitive functions such as reaction time(especially,decision time)in patients with schizophrenia.

Cognitive Rehabilitation for Schizophrenia / 신경정신의학

It is widely accepted that patients with schizophrenia show disturbances in their cognitive function. Recently, due to the increase of the possibilities of therapeutic intervention for cognitive deficits, cognitive rehabilitation is being tried by clinicians in the management of schizophrenia. Our study has considered several questions that have been raised in relation to cognitive rehabilitation. 1) What is cognitive rehabilitation? ; 2) What are its strategies? ; 3) What strategy of cognitive rehabilitation is appropriate to several cognitive deficits? ; 4) What kind of cognitive rehabilitation methods are possible according to the information processing model for schizophrenia? ; 5) What is its clinical considerations? ; 6) On what theoretical basis does the critical view of cognitive rehabilitation have its roots? ; 7) Which direction should it follow? Despite its limitation, there are still great possibilities for the future of cognitive rehabilitation, and we feel that it should be tried for patients with schizophrenia in this country.

Intelligence and Neuropsychological Tests Findings in Obsessive-Compulsive Disorder / 수면정신생리

OBJECTIVES: This study was aimed to investigate the differences in intelligence and neuropsychological test findings between patients with obsessive-compulsive disorder (OCD) and normal controls, and to find out brain functions. METHODS: To examine the brain functions, Halsted Reitan neuropsychological test, computerized neuropsychological test, Wechsler Memory scale and K-WAIS were applied. Subjects of this study consisted of 12 patients with OCD and 17 normal controls who were matched for age, handedness and education year. RESULTS: The verbal intelligence of OCD was significantly higher than that of normal controls. But there was no significant difference in total and performance intelligence between groups. The total time of tactual performance test in OCD was significantly delayed than that in normal controls. Also the visual recall or Wechsler memory scale in OCD was more impaired than that in normal controls. CONCLUSION: These findings support that visual-spatial memory, which is related to basal ganglia, is impaired in OCD.

Smoking Status in Psychiatric Inpatients / 대한정신약물학회지

OBJECTIVES: There is a trend to make health care facitilities smoke-free because of the overwhelming data associating tobacco smoking and passive smoking with serious health risks except closed psychiatric units. this study was designed to estimate the feasibility of smoking bans on psychiatric inpatient units as a pilot study by assessing smoking incidence, nicotine addiction score and smoking patterns of the psychiatric inpatients. METHODS: The psychiatric inpatients admitted to one mental hospital from June 1 to June 30, 1994 answered to the questionnaires including Fagerstroms Tolerance Questionnaire (8 items) and modified smoking motives questionnaires (21 items). Also the medical records of the patients were examined for sociodemographic data and diagnosis. RESULTS: The smoking incidence of the psychiatric inpatients was 72.7%. After admission to the closed unit, 42.7% of the patients increased the amount of smoking. The mean Fagerstrom Tolerance Questionnaire was 4.89+/-2.38, which was less than nicotine addiction score. Many patients smoked for relief of their stresses. CONCLUSION: There is a need to set a smoke-free or smoke-control psychiatric unit. These data indicate that smoking can be stopped on inpatient psychiatry units if the patients' stresses could be well controlled by some methods other than smoking.