Pavlov’s Ratio of the Cervical Spine in a Korean Population: A Comparative Study by Age in Patients with Minor Trauma without Neurologic Symptoms

Background@#There are many studies on the vertebral body-to-canal ratio, the so-called Pavlov’s ratio of the cervical spine. However, there are no studies on its relation with age to clarify each bony component’s contribution to the spinal canal formation and its size. The aim of this study was to investigate differences and changes in the vertebral body-to-canal ratio according to age in an asymptomatic population. @*Methods@#This is a cross-sectional study of 280 asymptomatic individuals. A total of 140 men and 140 women representing each decade of life from the first to the seventh were included in this study. The anteroposterior length of the vertebral body and canal from C3 to C6 was measured on sagittal radiographs to calculate the vertebral body-to-canal ratio. @*Results@#The average Pavlov’s ratio was significantly larger (p < 0.001) in the first decade of life. The average Pavlov’s ratio of the individuals in the first decade of life was 1.09 between C3 and C6 (1.08 at C3, 1.07 at C4, 1.11 at C5, and 1.13 at C6; range, 0.78–1.51). There was no significant difference among the other decades of life. @*Conclusions@#We assessed the Pavlov’s ratio of the cervical spine in an asymptomatic population. It is our belief that the spinal canal size is the largest in the first decade of life, and the Pavlov’s ratio becomes almost fixed throughout life after maturity.

Giant Tophi Involving Both Suprapatellar Pouches and Upper Poles of the Patellae: Treatment with Febuxostat and the 6 Years Follow-Up / 대한정형외과학회잡지

Tophi is one of the clinical manifestations of gout. On the other hand, it does not draw the patient's attention when it is asymptomatic, which leads to delayed management. The current case is a typical example of delayed diagnosis and management. The authors' preferred management of tophi was medical not surgical, even though the hitherto therapeutic issue has been conservative versus surgical. The authors chose conservative treatment in the osteolytic lesion resulting from huge tophi in the patella, and the report the results of 6 years follow-up.

Public Attention to Crime of Schizophrenia and Its Correlation with Use of Mental Health Services in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: This study was performed to examine the effects of the public attention to ‘crime of schizophrenia’ on the use of mental health services in patients with schizophrenia using big data analysis. METHODS: Data on the frequency of internet searches for ‘crime of schizophrenia’ and the patterns of mental health service utilization by patients with schizophrenia spectrum disorders by month were collected from Naver big data and the Health Insurance Review and Assessment Services in Korea, respectively. Their correlations in the same and following month for lagged effect were examined. RESULTS: The number of outpatients correlated negatively with public attention to ‘crime of schizophrenia’ in the same month. The lagged relationship between public attention and the number of admissions in psychiatric wards was also found. In terms of sex differences, the use of outpatient services among female patients correlated negatively with public attention in the same month while the number of male patients' admissions in both same and following month correlated positively with public attention. CONCLUSION: These findings suggested that public attention to ‘crime of schizophrenia’ could negatively affect illness behavior in patients with schizophrenia.

Incidentally discovered renal arteriovenous malformation

No abstract available.

Double-Layered Medial Meniscus / 대한정형외과학회잡지

We report on the case of double-layered medial meniscus, which was overlying anterior to mid portion of the medial meniscus. The upper accessory meniscus was connected to the anterior portion of the normal medial meniscus. And its periphery was connected to the joint capsule. The posterior portion of the upper accessory meniscus was connected to the joint capsule. This case demonstrates an interesting and rare anatomical abnormality of the medial meniscus. We report on the case with a review of the literature.

Preoperative Nutritional Status of the Surgical Patients in Jeju

BACKGROUND: To assess the preoperative nutritional status of patients with various disorders and to provide data for pre- and postoperative patient management plans, particularly in the elderly. There is no published information on age-matched and disease-matched preoperative nutritional/immunologic status for orthopedic patients, especially in the elderly, in Jeju. METHODS: In total, 331 patients with four categories of orthopedic conditions were assessed: 92 elective surgery patients, 59 arthroplasty patients, 145 patients with fractures, and 35 infection patients. Malnutrition was defined as body mass index (BMI) below 18 kg/m2 of expected body weight (below 20% of normal), serum albumin/globulin ratio below 1.5 (normal range, 1.5 to 2.3), albumin level below 3.5 g/dL, total lymphocyte count below 1,500 cells/mm3, and lymphocyte/monocyte ratio below 5 versus 1. RESULTS: In 92 elective surgery patients, the average BMI was 23 kg/m2, hemoglobin was 15 g/dL, lymphocytes (2,486 cells)/monocytes (465 cells) ratio was 6.1, and the albumin (4.4 g/dL)/globulin (2.5 g/dL) ratio as a protein quotient was 1.7. Among the 59 hip and knee arthroplasty patients, the average BMI was 25 kg/m2, hemoglobin was 12 g/dL, lymphocytes (2,038 cells)/monocytes (391 cells) ratio was 6.6, and albumin (4.1 g/dL)/globulin (2.4 g/dL) ratio was 1.6. No subject showed malnutrition. Among the 145 fracture patients, the average BMI was 23 kg/m2. The hemoglobin level was 13 g/dL, monocytes (495 cells)/lymphocytes (1,905 cells) ratio was 1 versus 4.6, and albumin (4.1 d/gL)/globulin (2.5 d/gL) ratio was 1.6. However, both ratios decreased after 70 years of age. Among the 17 of 35 infection patients, albumin levels were below 3.5 g/dL, the average BMI was 22 kg/m2, lymphocytes (1,532 cells)/monocytes (545 cells) ratio was 2.4 versus 1, and albumin (3.0 g/dL)/globulin (3.3 g/dL) ratio was 0.9, while in 18 patients albumin levels were over 3.5 g/dL, the average BMI was 22 kg/m2, hemoglobin was 12 g/dL, lymphocytes (1,998 cells)/monocytes (583 cells) ratio was 3 versus 1, and albumin/globulin ratio was 1.4. Thus, in the infection group, approximately 50% of the patients showed poor nutrition and immunosuppression. CONCLUSIONS: It was found that nutritional and immune condition deteriorated gradually to some degree in elderly patients over 60 years of age.

Two Cases of Cecal Schwannoma Which Were Removed by Endoscopic Mucosal Resection

Schwannoma in colorectum is a rare subepithelial polyp of mesenchymal origin, which is derived from the neural sheath, and most of reported cases were removed surgically. We, herein, describe two cases of schwannoma of the cecum, which were removed by endoscopic mucosal resection. A 34-year-old man and a 62-year-old man presented with abdominal discomfort and bowel habit change. The patients were diagnosed with a subepithelial tumor in the cecum on colonoscopy and underwent endoscopic mucosal resection under a tentative impression as neuroendocrine tumor, such as carcinoid tumor. Histopathology and immunohistochemistry confirmed the colonic lesion to be a benign schwannoma.

Acute pyelonephritis with anaplastic thyroid carcinoma producing granulocyte colony-stimulating factor

Paraneoplastic leukocytosis was defined as elevated white blood cell (WBC) levels caused by cytokines, likely produced by the tumor itself, without evidence of infection or myeloproliferative disease. We report a case of anaplastic thyroid carcinoma with leukocytosis caused by elevated production of granulocyte colony-stimulating factor (G-CSF) by the carcinoma. Initially, acute pyelonephritis (APN) was diagnosed and treatment for APN was ongoing, but the WBC count steadily increased to 68.8x10(9)/L. She was diagnosed with anaplastic thyroid carcinoma on her neck mass, and the serum concentration of G-CSF was found to be markedly increased at 1,010 pg/mL. In spite of supportive care, the patient's condition rapidly deteriorated and the patient died on day 23 of hospital stay. Leukocytosis without definite evidence of infection could be a paraneoplastic manifestation in patients with malignant tumors, and paraneoplastic leukocytosis may be related to poor prognosis.

Acute pyelonephritis with anaplastic thyroid carcinoma producing granulocyte colony-stimulating factor

Paraneoplastic leukocytosis was defined as elevated white blood cell (WBC) levels caused by cytokines, likely produced by the tumor itself, without evidence of infection or myeloproliferative disease. We report a case of anaplastic thyroid carcinoma with leukocytosis caused by elevated production of granulocyte colony-stimulating factor (G-CSF) by the carcinoma. Initially, acute pyelonephritis (APN) was diagnosed and treatment for APN was ongoing, but the WBC count steadily increased to 68.8x10(9)/L. She was diagnosed with anaplastic thyroid carcinoma on her neck mass, and the serum concentration of G-CSF was found to be markedly increased at 1,010 pg/mL. In spite of supportive care, the patient's condition rapidly deteriorated and the patient died on day 23 of hospital stay. Leukocytosis without definite evidence of infection could be a paraneoplastic manifestation in patients with malignant tumors, and paraneoplastic leukocytosis may be related to poor prognosis.

Adjunctive Cilostazol versus High Maintenance Dose of Clopidogrel in Patients with Hyporesponsiveness to Chronic Clopidogrel Therapy

PURPOSE: Whether addition of cilostazol is superior to increasing dose of clopidogrel in patients with hyporesponsiveness to chronic clopidogrel therapy is unknown. MATERIALS AND METHODS: We studied 73 patients with hyporesponsiveness to clopidogrel on standard dual antiplatelet therapy for more than 2 weeks. Clopidogrel hyporesponsiveness was defined as percent inhibition of P2Y12 reaction units (PRU) <30% on VerifyNow P2Y12 assay. Patients were randomly assigned to increased dose of clopidogrel (aspirin 100 mg+clopidogrel 150 mg daily: group A, n=38) or to receiving additional cilostazol (aspirin 100 mg+clopidogrel 75 mg+cilostazol 100 mg bid daily: group B, n=35). RESULTS: Baseline percent inhibition of PRU and PRU was similar between 2 groups (13.0+/-10.2% versus 11.8+/-9.7%, p=0.61, and 286.3+/-54.7 versus 295.7+/-53.7, p=0.44, respectively). At follow-up, percent inhibition of PRU was higher and PRU was lower significantly in group B than in group A (38.5+/-17.9% versus 28.3+/-16.6%, p=0.02, and 207.3+/-68.2 versus 241.3+/-76.7, p=0.050, respectively). Among those still showing hyporesponsiveness to clopidogrel at follow-up (21 patients in group A, 10 patients in group B), 12 patients completed further crossover study. Compared to the baseline, magnitude of change in percent inhibition of PRU and PRU showed an improved tendency after the crossover (from 2.7+/-8.7% to 15.8+/-18.4%, p=0.08, and from -18.6+/-58.0 to -61.9+/-84.3, p=0.08). CONCLUSION: Adjunctive cilostazol improved clopidogrel responsiveness better than the higher maintenance dose of clopidogrel in hyporesponsive patients with chronic clopidogrel therapy.

Evaluation of Sensitivity and Specificity of DNA Chip for Diagnosis of Granular Corneal Dystrophy II

PURPOSE: To evaluate the sensitivity and specificity of the DNA chip method in diagnosing patients with granular corneal dystrophy type II (GCD II) induced by mutation of the betaigh3 gene. METHODS: Two hundred twenty-seven patients who visited Severance Eye hospital, corneal dystrophy clinic, from 1 July 2006 to 30 September 2007 were included in this study after history taking and review of their medical records. All subjects were examined by slit lamp microscopy, and blood sampling was done. The sampled blood was used in DNA sequencing and the DNA chip method. RESULTS: Among 227 subjects, 125 (54.6%) patients had GCD II and 103 (45.4%) patients showed normal results according to the DNA sequencing method. The sensitivity and specificity of the DNA chip method were both 100%, while the sensitivity of the slit lamp method was 99.19% and the specificity was 100%. CONCLUSIONS: The DNA chip method for diagnosing GCD II is a more simple, time-saving, and accurate method than DNA sequencing method, and the sensitivity and specificity were both 100%.

The effect of Treponema denticola immunoinhibitory protein on cytokine expression in T cells / 대한치과보존학회지

Immunoinhibitory protein extracted from sonicated Treponema denticola have been shown to suppress cell cycle progression of human lymphocytes. To study in detail about the effect of this microorganism on the function of lymphocytes, we investigated the levels of Interleukin-2 (IL-2) and Interleukin-4 (IL-4) production by T lymphocytes before and after the addition of 12.5 microg/ml T. denticola sonicated extracts. In this study, levels of IL-2 and IL-4 produced from T cells pretreated with sonicated extracts were evaluated by using the quantitative sandwich enzyme immunoassay technique. In response to phytohemagglutinin (PHA) stimulation, T cell produced increased levels of IL-2 and IL-4. However, the expressions of both cytokines were significantly inhibited when PHA activated-T cells were pre-exposed to sonicated T. denticola extracts (p < 0.05). These findings suggest that the T. denticola sonicated extracts induced-immunosuppression in Th1 and Th2 cell functions could be a part of the pathogenic mechanism of the endodontic failure associated with this microorganism.

Analgesic Effects of Addition of Neostigmine or Morphine into Intraarticular Bupivacaine in Simple Arthroscopic Knee Surgery / 대한마취과학회지

BACKGROUND: Intra-articular (IA) bupivacaine, morphine, or neostigmine were known to produce an analgesic effect in knee arthroscopic surgery. But there were some arguing reports about the analgesic efficacy of addition of morphine or neostigmine into IA bupivacaine and IA administration of these drugs in a simple arthroscopic surgery. We performed this study to determine whether the addition of morphine or neostigmine into IA bupivacaine produces superior analgesic effect or increases patient satisfaction than IA bupivacaine alone. METHODS: Fifty-one patents for simple arthroscopic knee surgery were allocated to 4 groups following their addition into IA 0.5% bupivacaine 20 ml; placebo (Group 1, n = 10), neostigmine 500ng (Group 2, n = 16), morphine 2 mg (Group 3, n = 11) or neostigmine 250ng and morphine 1 mg (Group 4, n = 14). Anesthesia was performed with propofol, fentanyl and vecuronium. The VAS scores and patient satisfaction in 1, 3, 6, 12, and 36 hours after surgery were compared in addition to the side effects between groups. RESULTS: The VAS score of Group 2 (2.6 +/- 0.8), 3 (2.8 +/- 0.4) and 4 (2.3 +/- 0.9) are lower than that of Group 1 (3.3 +/- 0.7) at 1 hour after surgery (P = 0.038). The VAS scores were decreased by the following order: Group 1, Group 2 or 3 and Group 4, at 1 and 24 hours after surgery, (P = 0.048 and 0.036 respectively). The distribution of patient satisfaction was significantly different at 24 hour after surgery (P = 0.036), in which rate of patients showing good or fair in Group 2, 3 and 4 were larger than that of Group 1 (P = 0.057, 0.032 and 0.014, respectively). There was no significant difference in the incidence of side effects between groups. CONCLUSIONS: We concluded that the addition of morphine 2 mg, neostigmine 500ng or each morphine 1 mg and neostigmine 250ng into IA bupivacaine showed a similar analgesic effect, patients satisfaction and side effect during 36-hours postoperative period, compared with IA bupivacaine alone, except for the better analgesic effect in an immediate-postoperative period.

A Case of Gastric Ulcer Associated with Mucormycosis / 대한소화기내시경학회지

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection. Rhinocerebral and pulmonary involvement are the most common forms and usually occur in immunecompromised patients. Gastrointestinal involvement is extremely rare, the stomach being the most frequently involved site among them. When gastric mucormycosis presents as an invasive fungal infection the prognosis is extremely poor. Alternatively when the fungus may colonize the gastric mucosa without invasion of the blood vessels, the prognosis is good. Early diagnosis and tirnely institution of aggressive treatment is essential for the patients with mucormycosis. We report a 72-year-old man of gastric mucormycosis confirmed by histologic examination of endoscopic biopsy specimen. The patient was admitted. to intensive care unit under the diagnosis of adult respiratory distress syndrome and sepsis. He has been suffered from 5 years of end stage renal disease and 4 months of pulmonary tuberculosis and managed by continuous ambulatory peritoneai dialysis and anti-tubereulosis medications. On the 5th hospital day, esophagogastroduodenoscopy was underwent to remove the pieces of thermometer accidentaly broken, which revealed the 1.0 cm ulcerative lesion on the posterior wall of the upper body of stomach. The base of ulcer was coated with whitish-yellow dirty exudates and slightly irregular and the margin was nodular. The mucosae were friable and easily bled with light touch. The histologic examination of biopsy specimen revealed the multiple non-septated fungal hyphae branching right-angle.

A Case of Gastric Ulcer Associated with Mucormycosis / 대한소화기내시경학회지

Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection. Rhinocerebral and pulmonary involvement are the most common forms and usually occur in immunecompromised patients. Gastrointestinal involvement is extremely rare, the stomach being the most frequently involved site among them. When gastric mucormycosis presents as an invasive fungal infection the prognosis is extremely poor. Alternatively when the fungus may colonize the gastric mucosa without invasion of the blood vessels, the prognosis is good. Early diagnosis and tirnely institution of aggressive treatment is essential for the patients with mucormycosis. We report a 72-year-old man of gastric mucormycosis confirmed by histologic examination of endoscopic biopsy specimen. The patient was admitted. to intensive care unit under the diagnosis of adult respiratory distress syndrome and sepsis. He has been suffered from 5 years of end stage renal disease and 4 months of pulmonary tuberculosis and managed by continuous ambulatory peritoneai dialysis and anti-tubereulosis medications. On the 5th hospital day, esophagogastroduodenoscopy was underwent to remove the pieces of thermometer accidentaly broken, which revealed the 1.0 cm ulcerative lesion on the posterior wall of the upper body of stomach. The base of ulcer was coated with whitish-yellow dirty exudates and slightly irregular and the margin was nodular. The mucosae were friable and easily bled with light touch. The histologic examination of biopsy specimen revealed the multiple non-septated fungal hyphae branching right-angle.