We compared the results of two surgical techniques by retrospective study of 60 elderly patients (65 years or older) who underwent either decompression alone or fusion for the treatment of two-level or more lumbar spinal stenosis.
During the period of 2003 and 2008, two-level or more decompression alone or fusion was performed for lumbar spinal stenosis by three surgeons at our institution. Patients were allocated to two groups by surgical modality, namely, to a decompression group (31 patients) or a fusion group (29 patients). Overall mean age was 71.1 years (range, 65-84) and mean follow-up was 5.5 years (range, 3-9). A retrospective review of clinical, radiological, and surgical data was conducted.
No significant difference between the two groups was found with respect to age, follow-up period, surgical levels, or preoperative condition. At the last follow-up, correction of lumbar lordotic angle (determined radiologically) was better in the fusion group. However, clinical outcomes including visual analogue scale, Oswestry Disability Index, and the Odom's criteria were not significantly different in the two groups. On the other hand, surgical outcomes, such as, operation time, estimated blood loss, and surgical complications were significantly better in the decompression alone group.
Our findings suggest that decompressive laminectomy alone achieves good outcomes in patients with two-level or more lumbar spinal stenosis, associated with an advanced age, poor general condition, or osteoporosis.
Laminectomy; Spinal fusion; Spinal stenosis
In this study, we investigated the secretome of human oligodendrocytes (F3.Olig2 cells) generated from human neural stem cells by transduction with the gene encoding the Olig2 transcription factor. Using mRNA sequencing and protein cytokine arrays, we identified a number of biologically important secretory proteins whose expression has not been previously reported in oligodendrocytes. We found that F3.Olig2 cells secrete IL-6, PDGF-AA, GRO, GM-CSF, and M-CSF, and showed prominent expression of their corresponding receptors. Co-expression of ligands and receptors suggests that autocrine signaling loops may play important roles in both differentiation and maintenance of oligodendrocytes. We also found that F3.Olig2 cells secrete matrix metalloproteinases and matrix metalloproteinase-associated proteins associated with functional competence of oligodendrocytes. The results of our secretome analysis provide insights into the functional and molecular details of human oligodendrocytes. To the best of our knowledge, this is the first systematic analysis of the secretome of oligodendrocytes.
Mammalian bite injuries create a public health problem because of their frequency, potential severity, and increasing number. Some researchers have performed fragmentary analyses of bite wounds caused by certain mammalian species. However, little practical information is available concerning serious mammalian bite wounds that require hospitalization and intensive wound management. Therefore, the purpose of this study was to perform a general review of serious mammalian bite wounds.
We performed a retrospective review of the medical charts of 68 patients who were referred to our plastic surgery department for the treatment of bite wounds between January 2003 and October 2012. The cases were analyzed according to the species, patient demographics, environmental factors, injury characteristics, and clinical course.
Among the 68 cases of mammalian bite injury, 58 (85%) were caused by dogs, 8 by humans, and 2 by cats. Most of those bitten by a human and both of those bitten by cats were male. Only one-third of all the patients were children or adolescents. The most frequent site of injury was the face, with 40 cases, followed by the hand, with 16 cases. Of the 68 patients, 7 were treated with secondary intention healing. Sixty-one patients underwent delayed procedures, including delayed direct closure, skin graft, composite graft, and local flap.
Based on overall findings from our review of the 68 cases of mammalian bites, we suggest practical guidelines for the management of mammalian bite injuries, which could be useful in the treatment of serious mammalian bite wounds.
Bites and stings; Wounds and injuries; Antibiotic prophylaxis; Plastics
Absorbable materials offer many advantages in the reconstruction of orbital walls; however, the possibility of postoperative enophthalmos after complete absorption cannot be excluded. We evaluated the postoperative results of absorbable mesh plates used as onlay implanting on the medial orbital wall to determine whether they are suitable for medial orbital wall reconstruction.
The study included 20 patients with medial orbital wall fractures who were followed up for more than 2 years postoperatively. We used absorbable mesh plates in all of the patients. We measured the following: the changes in the expanded orbital volume by comparing the preoperative and postoperative computed tomography (CT) scans and the degree of clinical enophthalmos.
There were no major complications associated with the use of absorbable materials such as infection, migration, or extrusion of mesh plates during the long-term follow-up. The orbital volumetric changes between the preoperative and postoperative CT scans were not statistically significant. However, the expanded orbital volume was not related to the degree of clinical enophthalmos.
The reconstructed orbital wall may provide supportive scar tissue to the orbital contents even after the absorbable materials have dissolved completely. Absorbable mesh plates could be another option for the reconstruction of the medial orbital wall.
Absorbable implants; Orbital fractures; Follow-up studies
The aim of the present study was to investigate the relationship between three major allergic diseases, asthma, allergic rhinitis (AR), and atopic dermatitis (AD), and psychological and behavioural problems in preschoolers based on a community survey.
A cross-sectional survey was conducted using a modified International Study of Asthma and Allergies in Childhood questionnaire to determine the prevalence of symptoms and diagnosed allergic diseases, and a Korean version of the Child Behaviour Checklist to assess internalizing, externalizing, and sleep problems among 780 preschoolers. Five-hundred and seventy-five preschoolers with valid data were included in this study.
The prevalence of lifetime diagnosis and treatment in the past 12 months was 8.7% and 4.4% for asthma, 24.4% and 19.2% for AR, and 35.1% and 16.6% for AD, respectively. Scores for internalizing and sleep problems were significantly higher in those diagnosed with AR. Preschoolers who had been treated for AD in the past 12 months had higher attention problem and attention-deficit/hyperactivity disorder scores. Sleep problems were more severe in moderate to severe AD compared to control and mild AD groups, categorised according to SCOring index of AD. The severity of sleep problems correlated positively with the percentage of eosinophils in peripheral blood.
Psychological and behavioural problems differed among the three major allergic diseases, weaker association for asthma and stronger association for AR and AD. The results of this study may lead to the identification of potential underlying shared mechanisms common to allergic diseases and psychological and behavioural problems.
Preschool child; psychometrics; asthma; allergic rhinitis; atopic dermatitis
We have observed, anecdotally, that the incidence of primary spontaneous intracerebral hemorrhage (sICH), as well as spontaneous subarachnoid hemorrhage, varies in accordance with seasonality and meteorological conditions. This retrospective single-hospital-based study aimed to determine the seasonality of sICH and the associations, if any, between the occurrence of sICH and meteorological parameters in Incheon city, which is a northwestern area of South Korea.
Electronic hospital data on 708 consecutive patients admitted with primary sICH from January 2008 to December 2010 was reviewed. Traumatic and various secondary forms of ICHs were excluded. Average monthly admission numbers of sICH were analyzed, in relation with the local temperature, atmospheric pressure, humidity, and daily temperature range data. The relationships between the daily values of each parameter and daily admission numbers of sICH were investigated using a combination of correlation and time-series analyses.
No seasonal trend was observed in sICH-related admissions during the study period. Furthermore, no statistically significant correlation was detected between the daily sICH admission numbers and the meteorological parameters of temperature, atmospheric pressure and humidity. The daily temperature range tended to correlate with the number of daily sICH-related admissions (p = 0.097).
This study represents a comprehensive investigation of the association between various meteorological parameters and occurrence of spontaneous ICH. The results suggest that the daily temperature range may influence the risk of sICH.
Meteorology; Seasonality; Spontaneous intracerebral hemorrhage; Weather
The objectives of the present study were to characterize the natural course of initially non-operated traumatic acute subdural hematoma (ASDH) and to identify the risk factors of hematoma progression.
Retrospective analysis was performed using sequential computed tomography (CT) images maintained in a prospective observational database containing 177 ASDH cases treated from 2005 to 2011. Patients were allocated to four groups as followings; 136 (76.8%) patients to the spontaneous resolution group, 12 (6.8%) who underwent operation between 4 hours and 7 days to the rapid worsening group (RWG), 24 (13.6%) who experienced an increase of hematoma and that underwent operation between 7 and 28 days to the subacute worsening group (SWG), and 5 (2.8%) who developed delayed aggravation requiring surgery from one month after onset to the delayed worsening group (DWG). Groups were compared with respect to various factors.
No significant intergroup difference was found with respect to age, mechanism of injury, or initial Glasgow Coma Scale. The presence of combined cerebral contusion or subarachnoid hemorrhage was found to be a significant prognostic factor. Regarding CT findings, mixed density was common in the RWG and the SWG. Midline shifting, hematoma thickness, and numbers of CT slices containing hematoma were significant prognostic factors of the RWG and the SWG. Brain atrophy was more severe in the SWG and the DWG.
A large proportion of initially non-operated ASDHs worsen in the acute or subacute phase. Patients with risk factors should be monitored carefully for progression by repeat CT imaging.
Acute subdural hematoma; Chronic subdural hematoma; X-ray computed tomography
We present a case of acute hydrocephalus secondary to cervical spinal cord injury in a patient with diffuse ossification of the posterior longitudinal ligament (OPLL). A 75-year-old male patient visited the emergency department with tetraparesis and spinal shock. Imaging studies showed cervical spinal cord injury with hemorrhage and diffuse OPLL from C1 to C4. We performed decompressive laminectomy and occipitocervical fusion. Two days after surgery, his mental status had deteriorated to drowsiness with dilatation of the right pupil. Findings on brain computed tomography revealed acute hydrocephalus and subarachnoid hemorrhage in the cerebellomedullary cistern, therefore, extraventricular drainage was performed immediately. Acute hydrocephalus as a complication of cervical spine trauma is rare, however, it should be considered if the patient shows deterioration of neurologic symptoms.
Hydrocephalus; Spinal cord injuries; Ossification of the posterior longitudinal ligament of the spine
We attempted to identify the presence of a so called 'March effect (or phenomenon)' (which had long been known as a 'July effect' in western countries), a transient increase in adverse outcomes during an unskilled period for new interns and residents in a teaching hospital, among a cohort of patients with spontaneous subarachnoid hemorrhage (sSAH).
A total of 455 consecutive patients with sSAH from our department database from 2008 to 2010 were enrolled retrospectively and the admission month, patient demographics and clinical characteristics, treatment modalities and discharge outcomes were analyzed. Multivariate regression analysis was used to determine whether unfavorable discharge and in-hospital mortality showed a significant increase during the unskilled months for new interns and residents (from March to May) in a pattern suggestive of a "March effect".
Among 455 patients with sSAH, 113 patients were treated during the unskilled period (from March to May) and the remaining 342 patients were treated during the skilled period (from June until February of the next year). No statistically significant difference in demographics and clinical characteristics was observed between patients treated during these periods. In addition, the mortality and unfavorable discharge rates of the un-skilled period were 16.8% and 29.7% and those of the skilled period were 15.5% and 27.2%, respectively. However, no statistically significant difference was observed between them.
Findings of our study suggest that there was no 'March effect' on the mortality rate and unfavorable discharge rate among patients with sSAH in our hospital during the study period.
Spontaneous subarachnoid hemorrhage; March effect; Mortality rate; July effect; Teaching hospital
Previous studies suggest that maternal characteristics may be associated with neonatal outcomes. However, the influence of maternal characteristics on birth weight (BW) has not been adequately determined in Korean populations. We investigated associations between maternal characteristics and BW in a sample of 813 Korean women living in the Seoul metropolitan area, Korea recruited using data from the prospective hospital-based COhort for Childhood Origin of Asthma and allergic diseases (COCOA) between 2007 and 2011. The mean maternal age at delivery was 32.3 ± 3.5 yr and prepregnancy maternal body mass index (BMI) was 20.7 ± 2.5 kg/m2. The mean BW of infant was 3,196 ± 406 g. The overall prevalence of a maternal history of allergic disease was 32.9% and the overall prevalence of allergic symptoms was 65.1%. In multivariate regression models, prepregnancy maternal BMI and gestational age at delivery were positively and a maternal history of allergic disease and nulliparity were negatively associated with BW (all P < 0.05). Presence of allergic symptoms in the mother was not associated with BW. In conclusion, prepregnancy maternal BMI, gestational age at delivery, a maternal history of allergic disease, and nulliparity may be associated with BW, respectively.
Cohort Studies; Birth Weight; Infant, Newborn; Mothers; Family Characteristic; Body Mass Index; Allergy and Immunology
Although there is no consensus on the ideal treatment of the craniocervical instability, biomechanical stabilization and bone fusion can be induced through occipito-cervical fusion (OCF). The authors conducted this study to evaluate efficacy of OCF, as well as to explore methods in reducing complications.
A total of 16 cases with craniocervical instability underwent OCF since the year 2002. The mean age of the patients was 51.5 years with a mean follow-up period of 34.9 months. The subjects were compared using lateral X-ray taken before the operation, after the operation, and during last follow-up. The Nurick score was used to assess neurological function pre and postoperatively.
All patients showed improvements in myelopathic symptoms after the operation. The mean preoperative Nurick score was 3.1. At the end of follow-up after surgery, the mean Nurick score was 2.0. After surgery, most patients' posterior occipito-cervical angle entered the normal range as the pre operation angle decresed from 121 to 114 degree. There were three cases with complications, such as, vertebral artery injury, occipital screw failure and wound infection. In two cases with cerebral palsy, occipital screw failures occurred. But, reoperation was performed in one case.
OCF is an effective method in treating craniocervical instability. However, the complication rate can be quite high when performing OCF in patients with cerebral palsy, rheumatoid arthritis. Much precaution should be taken when performing this procedure on high risk patients.
Atlanto-occipital joint; Postoperative complications; Cerebral palsy; Rheumatoid arthritis
The prevalence of allergic diseases has risen over the last few decades. Many factors, including environmental factors such as those related to diet, have been considered. Among dietary factors, intake of antioxidant-related nutrients has been associated with the risk of allergic disease. We investigated the association of antioxidant nutritional status with allergic rhinitis (AR) in Korean schoolchildren aged 6-12 years.
Subjects were 4,554 children in Seoul, Korea. The risk of allergic disease was measured using the Korean version of the International Study of Asthma and Allergies in Childhood, and dietary intake was measured by a semi-quantitative food frequency questionnaire. Intake of vitamins A (including retinol and β-carotene), C, and E was used in the analysis.
Vitamin C intake was negatively associated with an increased risk of current symptoms (adjusted odds ratio, 0.886; 95% confidence interval, 0.806-0.973). There was no association between AR and intake of vitamin A, retinol, β-carotene, or vitamin E. Total serum IgE level and sensitization to allergen did not differ according to nutrient intake.
The group of children with increased vitamin C consumption had fewer AR symptoms, despite the lack of a difference in total serum IgE level or allergen sensitization. These findings suggest that nutrient intake, especially that of vitamin C, influences AR symptoms.
Allergic rhinitis; antioxidant; vitamin C
The authors reviewed their experiences of combined surgery (open door laminoplasty with unilateral screw fixation) for unstable multi-level cervical stenosis, to clarify the situation regarding the surgical approach most appropriate for the treatment of diffuse unstable multi-level cervical stenosis.
From January 2011 to January 2012, combined surgery was performed for unstable multi-level cervical stenosis by one surgeon at our institution. The subjects of this study were 6 men of mean age 53.7 years (range, 48-71) with a mean follow-up of 9.3 (range, 3-14) months. All imaging studies showed severe multi-level cervical stenosis with spinal cord signal change, and instability or kyphotic deformity. A retrospective review of clinical, radiological, and surgical data was conducted.
Average laminoplasty level was 4.8 and the average screw fixation level was 5.0. Japanese Orthopedic Association score improved from an average of 5.2 to 11.2 points. According to Nurick's grades and Odom's criteria, symptom improvement was statistically significant. On the other hand, Cobb's angle changes were not significant. Average operation time was 5.86 hours with an average blood loss of 460 mL. No significant surgical complication was encountered.
Despite the small cohort and the short follow-up duration, the present study demonstrates that laminoplasty with unilateral screw fixation is a safe and effective treatment for unstable multi-level cervical stenosis.
Laminoplasty; Lateral mass screw fixation; Japanese Orthopedic Association score
To perform a comparative study between two groups of populations, titanium (T) group versus stainless steel (S) group, who were clipped with titanium and stainless steel materials, respectively, the incidence of regrowth from the original aneurysms, the clip slippage, and post-clipping seizure attack were analyzed. The patients were followed more than 5 years after microsurgical cerebral aneurysms clipping.
Data from 1986 through 2008 were extensively reviewed on a consecutive series of 3,770 patients who referred for ruptured/unruptured cerebral aneurysms. Forty-seven patients in the S group and 48 in the T group who met inclusion criteria, were selected for this study.
The incidence of regrowth were noted that two out of total 47 patients (4.3%) in the S group, and none in the T group. The clip slippage was not observed in both groups. And there was no statistical difference (p = 0.242) in terms of regrowth between two groups. Seven out of 47 cases (14.9%) developed post-clipping seizure in the S group. On the other hand, two (4.2%) of 48 patients presented the symptom in the T group. Also, there was no significant difference (p = 0.091) between two groups.
The metallic types of clip employed for the microsurgical cerebral aneurysm clipping does not have any significant clinical outcome differences in this study.
Microsurgical clipping; Aneurysm; Stainless steel aneurysmal clip; Titanium aneurysmal clip
Human rhinovirus (HRV) is a nonenveloped, single stranded RNA virus belonging to the family Picornaviridae. HRV infections can cause both upper and lower respiratory illnesses in children and adults. Lower respiratory illnesses are more likely to occur in specific high risk groups, including infants, and children and adults with asthma. The relationships between rates of infection and the risk of clinical illness and exacerbation are not completely understood. Recent studies employing polymerase chain reaction and other molecular techniques indicate that there are new branches on the HRV family tree, and one characteristic of recently detected viruses is that they cannot be detected by standard tissue culture. Here we review the current literature and discuss new advances in understanding the link between HRV and asthma.
Asthma; human rhinovirus; infection
Ectomesenchymal chondromyxoid tumor (ECMT) is a rare tumor, exclusively arising in the anterior tongue. Thirty-eight cases have been reported in the English literature. It usually presents as a sessile protrusion and shows round to spindle cells embedded in myxoid to chondroid stroma. Tumor cells are almost always positive for polyclonal glial fibrillary acidic protein (GFAP). We report our experience in the recent treatment of a case of ECMT, the third case in 3 years. The mass in the anterior tongue revealed characteristic morphologic features of ECMT and the expression of polyclonal GFAP. Although ECMT should be differentiated from other mesenchymal tumors including myoepithelioma, its clinical, morphological, and immunohistochemical features enable its diagnosis, especially when pathologists are aware of it.
Tongue; Ectomesenchymal chondromyxoid tumor
We performed this study to assess the prevalence of sensitization to aeroallergens and to analyze the difference between prevalence rates according to children's ages and residential areas. In this nationwide cross-sectional study, first grade students of 45 elementary schools and 40 middle schools were randomly selected, and skin prick tests were performed for 18 inhalant allergens between October and November 2010. Of 7,829 analyzed subjects, 3,753 (47.9%) were sensitized to at least one aeroallergen. Sensitization to Dermatophagoides farinae was found to be the most prevalent in elementary schoolchildren (32.4%), followed by Dermatophagoides pteronyssinus, Tyrophagus putrescentiae, Japanese hop, and oak. In middle schoolchildren, D. pteronyssinus yielded the highest prevalence (42.7%), followed by D. farinae, T. putrescentiae, Japanese hop, and cat. In middle schoolchildren, the sensitization rate to aeroallergens in metropolitan, urban, and rural areas was 57.2%, 54.3%, and 49.8%, respectively (P = 0.019). In this age group, the sensitization rate in low, middle, high, and very high income groups was 53.8%, 51.8%, 59.0%, and 59.6%, respectively (P = 0.002). In conclusion, the sensitization rate is 47.9% and house dust mite is the most prevalent allergen in the pediatric population in Korea. The rate is higher in metropolitan areas and the highest income group than in rural areas and low income groups.
Skin Tests; Child; Dermatophagoides pteronyssinus; Dermatophagoides farinae
Exacerbations of childhood asthma and rhinovirus infections both peak during the spring and fall, suggesting that viral infections are major contributors to seasonal asthma morbidity.
To evaluate rhinovirus infections during peak seasons in children with asthma, and to analyze relationships between viral infection and illness severity.
Fifty-eight children with asthma ages 6-8 years provided 5 consecutive weekly nasal lavage samples during September and April; symptoms, medication use, and peak flow were recorded. Rhinoviruses were identified using multiplex PCR and partial sequencing of viral genomes.
Viruses were detected in 36-50% of the specimens, and, 72-99% of the viruses were rhinoviruses. There were 52 different strains (including 16 HRV-C) among the 169 rhinovirus isolates; no strains found in more than two collection periods, and all but two children had a respiratory infection. Virus-positive weeks were associated with greater cold and asthma severity (p<0.0001 and p=0.0002 respectively). Furthermore, virus-positive illnesses had increased duration and severity of cold and asthma symptoms, and more frequent loss of asthma control (47% vs. 22%, p=0.008). While allergen-sensitized vs. non-sensitized children had the same number of viral infections, the former had 47% more symptomatic viral illnesses (1.19 vs. 0.81 per month, p=0.03).
Rhinovirus infections are nearly universal in children with asthma during common cold seasons, likely due to a plethora of new strains appearing each season. Illnesses associated with viruses have greater duration and severity. Finally, atopic asthmatic children experienced more frequent and severe viral-induced illnesses.
The combination of viral infection and allergy increases the morbidity of respiratory illness in children with asthma.
asthma; children; viral respiratory tract infection; human rhinovirus; allergic sensitization; wheezing; cold symptoms; illness
To investigate the prevalence of asthma and determine its risk factors in elementary school students in Seoul.
A modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to survey 4,731 elementary school students from five areas in Seoul between April and October, 2008.
In elementary school children, the lifetime and recent 12-month prevalence of wheezing were 11.7% and 5.6%, respectively. The lifetime prevalence of asthma diagnosis was 7.9%, and the recent 12-month prevalence of asthma treatment was 2.7%. Male sex (adjusted odds ratio [aOR], 1.90; 95% confidence interval [CI], 1.36-2.66), history of atopic dermatitis (AD) (aOR, 2.76; 95% CI, 1.98-3.84), history of allergic rhinitis (AR) (aOR, 3.71; 95% CI, 2.61-5.26), history of bronchiolitis before 2 years of age (aOR, 2.06; 95% CI, 1.39-3.07), use of antibiotics during infancy for >3 days (aOR, 1.88; 95% CI, 1.35-2.62), parental history of asthma (aOR, 2.83; 95% CI, 1.52-5.27), exposure to household molds during infancy (aOR, 1.84; 95% CI, 1.18-2.89), and the development or aggravation of asthma symptoms within 6 months after moving to a new house (aOR, 11.76; 95% CI, 5.35-25.86) were the independent risk factors for wheezing within 12 months.
The prevalence of wheezing and asthma in elementary school students in 2008 was similar to that in the past decade. Male sex, history of AD, history of AR, history of bronchiolitis before 2 years of age, parental asthma, use of antibiotics during infancy, exposure to molds in the house during infancy, and development or aggravation of asthma symptoms within 6 months after moving to a new house, could be risk factors for wheezing within 12 months.
Asthma; prevalence; risk factor; childhood
Many patients assume that allergic reactions against foods are responsible for triggering or worsening their allergic symptoms. Therefore, it is important to identify patients who would benefit from an elimination diet, while avoiding unnecessary dietary restrictions. The diagnosis of food allergy depends on the thorough review of the patients's medical history, results of supplemented trials of dietary elimination, and in vivo and in vitro tests for measuring specific IgE levels. However, in some cases the reliability of such procedures is suboptimal. Oral food challenges are procedures employed for making an accurate diagnosis of immediate and occasionally delayed adverse reactions to foods. The timing and type of the challenge, preparation of patients, foods to be tested, and dosing schedule should be determined on the basis of the patient's history, age, and experience. Although double-blind, placebo-controlled food challenges(DBPCFC) are used to establish definitively if a food is the cause of adverse reactions, they are time-consuming, expensive and troublesome for physician and patients. In practice, An open challenge controlled by trained personnel is sufficient especially in infants and young children. The interpretation of the results and follow-up after a challenge are also important. Since theses challenges are relatively safe and informative, controlled oral food challenges could become the measure of choice in children.
Oral food challenge; Food allergy; Child
Mast cells are activated by specific allergens and also by various nonspecific stimuli, which might induce physical urticaria. This study investigated the functional expression of temperature sensitive transient receptor potential vanilloid (TRPV) subfamily in the human mast cell line (HMC-1) using whole-cell patch clamp techniques. The temperature of perfusate was raised from room temperature (RT, 23~25℃ to a moderately high temperature (MHT, 37~39℃ to activate TRPV3/4, a high temperature (HT, 44~46℃ to activate TRPV1, or a very high temperature (VHT, 53~55℃ to activate TRPV2. The membrane conductance of HMC-1 was increased by MHT and HT in about 50% (21 of 40) of the tested cells, and the I/V curves showed weak outward rectification. VHT-induced current was 10-fold larger than those induced by MHT and HT. The application of the TRPV4 activator 4α-phorbol 12,13-didecanoate (4αPDD, 1µM) induced weakly outward rectifying currents similar to those induced by MHT. However, the TRPV3 agonist camphor or TRPV1 agonist capsaicin had no effect. RT-PCR analysis of HMC-1 demonstrated the expression of TRPV4 as well as potent expression of TRPV2. The [Ca2+]c of HMC-1 cells was also increased by MHT or by 4αPDD. In summary, our present study indicates that HMC-1 cells express Ca2+-permeable TRPV4 channels in addition to the previously reported expression of TRPV2 with a higher threshold of activating temperature.
Mast cell; TRPV cation channels; TRPV4 protein; Temperature; Non-selective cation channel; Human
Anterior cervical corpectomy with fusion (ACF) or laminoplasty may be associated with substantial number of complications for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with significant cord compression. For more safe decompression and stabilization in multilevel cervical OPLL with prominent cord compression, we propose circumferential cervical surgery (selective ACF and laminoplasty) based on our favorable experience.
Twelve patients with cervical myelopathy underwent circumferential cervical surgery and all patients showed multilevel OPLL with signal change of the spinal cord on magnetic resonance imaging (MRI). A retrospective review of clinical, radiological, and surgical data was conducted.
There were 9 men and 3 women with mean age of 56.7 years and a mean follow up period of 15.6 months. The average corpectomy level was 1.16 and laminoplasty level was 4.58. The average Japanese Orthopedic Association score for recovery was 5.1 points and good clinical results were obtained in 11 patients (92%) (p < 0.05). The average space available for the cord improved from 58.2% to 87.9% and the average Cobb's angle changed from 7.63 to 12.27 at 6 months after operation without failure of fusion (p < 0.05). Average operation time was 8.36 hours, with an estimated blood loss of 760 mL and duration of bed rest of 2.0 days. There were no incidences of significant surgical complications, including wound infection.
Although the current study examined a small sample with relatively short-term follow-up periods, our study results demonstrate that circumferential cervical surgery is considered favorable for safety and effectiveness in multilevel OPLL with prominent cord compression.
Ossification of the posterior longitudinal ligament; Anterior cervical corpectomy with fusion; Laminoplasty; Japanese Orthopedic Association score
We report here on an uncommon case of metastatic choriocarcinoma to the lung, brain and lumbar spine. A 33-year-old woman was admitted to the pulmonary department with headache, dyspnea and hemoptysis. There was a history of cesarean section due to intrauterine fetal death at 37-weeks gestation and this occurred 2 weeks before admission to the pulmonary department. The radiological studies revealed a nodular lung mass with hypervascularity in the left upper lobe and also a brain parenchymal lesion in the parietal lobe with marginal bleeding and surrounding edema. She underwent embolization for the lung lesion, which was suspected to be an arteriovenous malformation according to the pulmonary arteriogram. Approximately 10 days after discharge from the pulmonary department, she was readmitted due to back pain and progressive paraparesis. The neuroradiological studies revealed a hypervascular tumor occupying the entire L3 vertebral body and pedicle, and the tumor extended to the epidural area. She underwent embolization of the hypervascular lesion of the lumbar spine, and after which injection of polymethylmethacrylate in the L3 vertebral body, total laminectomy of L3, subtotal removal of the epidural mass and screw fixation of L2 and L4 were performed. The result of biopsy was a choriocarcinoma.
Metastatic choriocarconoma; Spinal metastasis
Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hemorrhage, usually occurring in the older patients, with a good surgical prognosis. Burr hole craniostomy is the most frequently used neurosurgical treatment of CSDH. However, there have been only few studies to assess the role of the number of burr holes in respect to recurrence rates. The aim of this study is to compare the postoperative recurrence rates between one and two burr craniostomy with closed-system drainage for CSDH.
From January 2002 to December 2006, 180 consecutive patients who were treated with burr hole craniostomy with closed-system drainage for the symptomatic CSDH were enrolled. Pre- and post-operative computed tomography (CT) scans and/or magnetic resonance imaging (MRI) were used for radiological evaluation. The number of burr hole was decided by neurosurgeon's preference and was usually made on the maximum width of hematoma. The patients were followed with clinical symptoms or signs and CT scans. All the drainage catheters were maintained below the head level and removed after CT scans showing satisfactory evacuation. All patients were followed-up for at least 1 month after discharge.
Out of 180 patients, 51 patients were treated with one burr hole, whereas 129 were treated with two burr holes. The overall postoperative recurrence rate was 5.6% (n = 10/180) in our study. One of 51 patients (2.0%) operated on with one burr hole recurred, whereas 9 of 129 patients (7.0%) evacuated by two burr holes recurred. Although the number of burr hole in this study is not statistically associated with postoperative recurrence rate (p > 0.05), CSDH treated with two burr holes showed somewhat higher recurrence rates.
In agreement with previous studies, burr hole craniostomy with closed drainage achieved a good surgical prognosis as a treatment of CSDH in this study. Results of our study indicate that burr hole craniostomy with one burr hole would be sufficient to evacuate CSDH with lower recurrence rate.
Burr hole; Chronic subdural hematoma; Recurrence