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'Lumbar Degenerative Kyphosis' Is Not Byword for Degenerative Sagittal Imbalance : Time to Replace a Misconception

  • Lee, Chang-Hyun;Chung, Chun Kee;Jang, Jee-Soo;Kim, Sung-Min;Chin, Dong-Kyu;Lee, Jung-Kil;Korean Spinal Deformity Research Society
    • Journal of Korean Neurosurgical Society
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    • v.60 no.2
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    • pp.125-129
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    • 2017
  • Lumbar degenerative kyphosis (LDK) is a subgroup of the flat-back syndrome and is most commonly caused by unique life styles, such as a prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Unfortunately, LDK has been used as a byword for degenerative sagittal imbalance, and this sometimes causes confusion. The aim of this review was to evaluate the exact territory of LDK, and to introduce another appropriate term for degenerative sagittal deformity. Unlike what its name suggests, LDK does not only include sagittal balance disorder of the lumbar spine and kyphosis, but also sagittal balance disorder of the whole spine and little lordosis of the lumbar spine. Moreover, this disease is closely related to the occupation of female farmers and an outdated Asian life style. These reasons necessitate a change in the nomenclature of this disorder to prevent misunderstanding. We suggest the name "primary degenerative sagittal imbalance" (PDSI), which encompasses degenerative sagittal misalignments of unknown origin in the whole spine in older-age patients, and is associated with back muscle wasting. LDK may be regarded as a subgroup of PDSI related to an occupation in agriculture. Conservative treatments such as exercise and physiotherapy are recommended as first-line treatments for patients with PDSI, and surgical treatment is considered only if conservative treatments failed. The measurement of spinopelvic parameters for sagittal balance is important prior to deformity corrective surgery. LDK can be considered a subtype of PDSI that is more likely to occur in female farmers, and hence the use of LDK as a global term for all degenerative sagittal imbalance disorders is better avoided. To avoid confusion, we recommend PDSI as a newer, more accurate diagnostic term instead of LDK.

CONSTRUCTION OF HNGF-$\beta$ RECOMBINANT ADENOVIRUS & SCREENING OF ITS EXPRESSION AFTER TRANSFECTION INTO VARIOUS CELL LINES (말초신경재생을 위한 hNGF-$\beta$ recombinant Adenovirus의 제작 및 수종세포주에서 신경성장인자의 발현)

  • Gao, En-Feng;Chung, Hun-Jong;Ahn, Kang-Min;Kim, Yoon-Tae;Park, Hee-Jung;Sung, Mi-Ae;Kim, Nam-Yeol;Yoo, Sang-Bae;Myoung, Hoon;Hwang, Soon-Jung;Kim, Myung-Jin;Kim, Sung-Min;Jang, Jeong-Won;Lee, Jong-Ho
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.27 no.5
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    • pp.446-456
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    • 2005
  • Nerve growth factor(NGF) has a critical role in peripheral nerve regeneration. The aim of this study is to construct a well-functioning hNGF-$\beta$ recombinat adenovirus for the ultimate development of improved method to promote peripheral nerve regeneration with adenovirus mediated hNGF-$\beta$ gene transfection into Schwann cells. First PCR associated cloning of GFP-tagged hNGF-$\beta$ which was ligated into E1/E3 deleted adenoviral vector was performed and tranfected into E. coli to construct hNGF-$\beta$ recombinant adenovirus. After production of recombinat adenovirus in a large scale, its transfection efficiency, expression, and function were evaluated using cell lines or primarily cultured cells of HEK293 cells, Schwann cells, fibroblast(NIH3T3) and myocyte(CRH cells). GFP expression was observed in 90% of infected cells compared to uninfected cells. Total mRNA isolated from hNGF-$\beta$ recombinat adenoviru infected cells showed strong RT-PCR band, however, LacZ recombinant adenovirus infected or uninfected cells did not. NGF quantification by ELISA showed a maximal release of 18.865 +/- 0.31ng/mL at 4th day. PC-12 cells exposed to media with hNGF-$\beta$ recombinant adenovirus infected Schwann cell demonstrated higher levels of differentiation compared with controls. We generated hNGF-$\beta$ recombinant adenovirus and induced over expression of NGF successfully in nonneuronal and neuronal cells. Following these result, it is expected to develop an improved treatment strategy peripheral nerve regeneration using the hNGF-$\beta$ gene transfected cells.

A STUDY OF CLINICAL RESULTS ON STERI-OSS ENDOSSEOUS IMPLANTS (Steri-Oss 임플랜트의 임상 결과에 관한 연구)

  • Min, Young-Kyu;Kweon, Hyeog-Sin;Chung, Chae-Heon
    • The Journal of Korean Academy of Prosthodontics
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    • v.36 no.2
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    • pp.258-272
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    • 1998
  • This investigation evaluated patients who received Steri-Oss implants from the Dental Hospital of Chosun University during the period from March 1989 to August 1997. 346 fixtures of 127 patients were included in this study. The results were as follows ; 1.The follow-up period was defined as the period between the surgical placement of the implants and the last follow-up examination. The mean follow-up period was $2.17{\pm}1.21$ years. 2.The period between fixture installation and second surgery was $0.71{\pm}0.44$ years in the maxilla and $0.46{\pm}0.21$ years in the mandible. 3.The number of fixtures which were installed in the upper jaw(112) was less than that in the lower jaw(234) and in the posterior region(260) was more than in the anterior region(86). 4.The length of fixture which was most frequently used was 12 mm and least was 8mm. Screw implants were installed more than cylindrical implants. 3.8mm implant was the most common implans, followed by 4.5mm and 3.25mm. 5.The number of augmentation cases was more than that of non-augmentation cases and the rate of augmentation cases in the maxilla was more than that in the mandible. 6.Implant restorations for partial edentulos patients(94cases) were more than single- tooth implant restorations(33cases) or implant restorations for complete edentulos patients(10cases). 7.Free-standing prostheses for partially edentulous patients were more commom than any other type of connection between implants and natural teeth. 8.Plaque Index($0.95{\pm}0.74$) and Gingival Index($0.31{\pm}0.52$) were very similar around the natural teeth and reflected an acceptable level of plaque and gingivitis control. Mean value for keratinized mucosa index($1.93{\pm}1.20$) remained fairly constant around level 2(1-2 mm keratinized epithelium). 9.Patients were generally satisfied with implant in terms of comfort, function, speech and esthetics. 10.There was not a statistically significant differences in overall survial rate between implants placed in the maxilla (91.5%) and those placed in the mandible (93.8%). Fourteen implants lost before the prosthetic rehabilitation and eleven implants lost following variable periods in function after the prosthetic phase of the treatment. 11.Cause of implant failures was exfoliation or removal of fixture due to non-osseointegration before the prosthetic rehabilitation or due to fracture of fixture, masticatory pain after the prosthetic rehabilitation. 12.The survival rate of Steri-Oss implants using the Kaplan-Meier statistical analysis was 93.8% at 2 year and 86.6% at 5 year, In all cases, implant losses occured predominantly in the healing period. There was a steep decline in the rate of implant loss after the first year. 13.The survival rate of Steri-Oss implants in the anterior region was 94.8% at 2 year and 94.8% at 5 year and that in the posterior region was 92.8% at 2 year and 75.9% at 5 year. In conclusion, this study revealed a number of parameters and guidelines for achieving an optimal success rate in osseointegration.

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A case of Smith-Lemli-Opitz syndrome diagnosed by identification of mutations in the 7-dehydrocholesterol reductase (DHCR7) gene (7-dehydrocholesterol reductase (DHCR7) 변이로 진단된 Smith-Lemli-Opitz 증후군 1예)

  • Park, Mee Rim;Ko, Jung Min;Cheon, Chong-Keun;Kim, Gu-Hwan;Yoo, Han-Wook
    • Clinical and Experimental Pediatrics
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    • v.51 no.11
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    • pp.1236-1240
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    • 2008
  • Smith-Lemli-Opitz syndrome (SLOS) is a rare, autosomal recessive disease caused by an inborn error in cholesterol synthesis. Patients with this disease suffer from multiple malformations due to reduced activity of 7-dehydrocholesterol reductase (DHCR7), which increases 7-dehydrocholesterol (7DHC) and 8-dehydrocholesterol (8DHC) concentrations and decreases cholesterol concentration in body fluids and tissue. The SLOS phenotypic spectrum ranges from a mild disorder with behavioral and learning problems to a lethal disease characterized by multiple malformations. Here, we describe a newborn male with ambiguous genitalia who was diagnosed to have type II SLOS during the neonatal period. A clinical examination revealed low levels of unconjugated estriol in the maternal serum, and a variety of fetal ultrasound anomalies, including prenatal growth retardation. After birth, the infant was diagnosed to have congenital heart disease (Tetralogy of Fallot with severe pulmonary artery stenosis), cleft lip and palate, micrognathia, postaxial polydactyly, ambiguous genitalia, and cataracts. Clinical investigation revealed extremely low plasma cholesterol levels and the presence of mutation (homozygote of p.Arg352Gln) in the DHCR7 gene. The patient underwent palliative heart surgery (to widen the pulmonary artery) and received intravenous lipid supplementation. Cholesterol levels increased slightly, but not to normal values. The patient died from cardiopulmonary failure and sepsis 72 days after birth. This report provides the first description of a Korean patient with SLOS confirmed by verification of DHCR7 gene mutation and illustrates the need for early recognition and appropriate diagnosis of this disease.

The study about the cause of the Korean professional pitchers' injury and its classification (한국 프로야구투수들의 부상 발생원인 및 분류에 관한 연구)

  • Nam Joung-Chul;Kim Sang-Su;Lee Dong-Ho
    • The Journal of Korean Physical Therapy
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    • v.14 no.4
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    • pp.172-182
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    • 2002
  • Objectives: We did research in the cause of the Pitchers' injury and their recovery process to make a detailed injury list for the purpose of finding the cause of the Korean professional pitchers' injury and its classification. We drew the conclusion through the results as following. Methods: We posed a question to the 80 pitchers playing in the first team of the eight Korean professional baseball team and analyzed the 62 pieces of question paper except the paper having a mistake. We used SAS/PC statistical package in analyzing the data. Results: In the frequency of the pitchers' shoulder injury in the last three years, the injured of all the players were 61.3$\%$ and the injury free players were 28.7$\%$. The cause of the injury was 45.2$\%$ wrong pitching motion, which was the highest value. For the shape of a pain when injured, the reverberation ache feeling when he is hit in the weight commanded an absolute majority as 19.4$\%$. Those who had muscular pain were 17.7$\%$, which was felt mostly at the pitching motion. The most trouble name of the injured shoulder was bicepstendinitis as 16.1$\%$ while the injury of shoulder joint was the lowest as 1.6$\%$. As the most widely used treatment, 25.8 percent of all the players had taken an electronical thraphy after injury. 14.5 percent of the players who had an injury to the shoulder told that they have an operation and 85 percent of them didn't. As a sort of the operation, a repairing of labrum was 44.4 percent, which is the highest value and the 77.8 percent pitchers are performing a normal pitching through rehabilitation after the operation and 22.2 percent of them are undergoing rehabilitation training. Conclusion: The research have shown that the main cause of the injury, concerning the Korean professional pitchers throwing lots of ball in both matches and practices, is overuse syndrome, bad mechanism, muscle weakness and instability of balance. I think that the role of trainer, physical therapy, and team physician taking charge of the players' injury must learn physical test method by heart exactly to check up the state of the injury definitely at the initial phase. Moreover, when the cause of the injury part after a close examination is discovered, the scientific and good surgery is essential to the rehabilitation success and making a classification of shoulder instability is useful to make a operation plan as well as the players' rehabilitation, treatment.

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Selection of Surrogates and Analysis of Its Ovulation Status for the Production of Somatic Cell Cloned Piglets (체세포 복제돼지 생산에 있어서 대리모의 선발과 배란상태 분석)

  • Hyun Sang-Hwan;Jeung Yeon-Woo;Lee Eun-Song;Kim Hyun-Wook;Kim Gon-Hyung;Jeung Eui-Bae
    • Journal of Veterinary Clinics
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    • v.23 no.2
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    • pp.123-128
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    • 2006
  • Production of cloned pigs by somatic cell nuclear transfer (SCNT) has unlimited value for developing critical biotechnology such as xenotransplantation. Various efforts have been made to establish this technology, and several litters of live piglets have been produced after transfer of SCNT embryos. However, the efficiency is very low compared to piglet production by artificial insemination or natural mating. So far, most studies have been limited to in vitro production of SCNT embryos. This study was conducted to standardize a surrogate recipient (gilts) for transfer of SCNT embryos to improve pregnancy rate. Potential surrogate gilts over 7 months of age were checked for their estrous status by observing external signs; vaginal fluid, vulva redness, vulva swelling, and standing response to back pressure. Viscosity of vaginal fluid was evaluated and classified as none (0), medium (1), and strong (2). Vulva redness and swelling was respectively assessed by none or shrink (0), medium (1), strong (2). Back pressure was estimated by an immediate move (0), standing less than 10 sec (1), and standing over 10 see (2). And then ovulation status of each surrogate was classified as pre-ovulation (PO-17 surrogates), just prior to ovulation (JPO-20 surrogates), in ovulation (IO-12 surrogates), just after ovulation (JAO-14 surrogates) and after ovulation (AO-24 surrogates) at the time of surgery for embryo transfer (ET). Real-time ultrasonographic scanners have been used for pregnancy diagnosis by observing amniotic vesicles. The first pregnancy diagnosis was done on Day 30 after ET and then repeated 2-week interval. In the results, SCNT embryos transferred into JPO surrogates gave better pregnancy rates (45%) than others (4% to 11%) on Day 30 after ET. These result indicates that surrogate gilts in a status just prior to ovulation can offer optimal condition to establish pregnancy by transfer of SCNT pig embryos.

Intestinal Lymphangiectasia in a Yorkshire terrier Dog: Clinical Outcome, Clinicopathological and Histopathological Findings (요크셔테리어견에서 발생한 Intestinal Lymphangiectasia: 임상적 결과와 임상병리학적, 조직병리학적 소견)

  • Hwang Du-Na;Park Chul;Kang Byeong-Teck;Jeong Soon-Wuk;Sur Jung-Hyang;Park Hee-Myung
    • Journal of Veterinary Clinics
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    • v.23 no.2
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    • pp.175-179
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    • 2006
  • A 7-year-old, 3.16 kg intact male Yorkshire terrier had the history of abdominal distension, diarrhea, and weight loss. On the basis of history takings, physical examination, laboratory tests, radiography, ultrasonography, exploratory laparotomy, and histopathological examination, the dog was diagnosed definitely as intestinal lymphangiectasia. In this case, signs and results are consistent with those of other reports, but some clinicopathological findings such as hypocalcemia and hypocholesterolemia are not. This means that the findings were not completely in accord with the typical ones of intestinal lymphangiectasia in this dog. Prednisolone was prescribed to treat. However, it was not effective sufficiently. Thus, azathioprine was added to the regimen used in the first trial, and it was quite efficient in inducing remission in intestinal lymphangiectasia. The clinical signs were improved to the combined therapy. This case report demonstrates that the combined therapy for intestinal lymphangiectasia can be used as an alternative to only glucocorticoid therapy.

An anatomical study on the branching patterns of left coronary artery in the rats (흰쥐 왼쪽관상동맥의 분지 양상에 관한 해부학적 연구)

  • Ahn, Dong-Choon;Kim, In-Shik
    • Korean Journal of Veterinary Research
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    • v.47 no.1
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    • pp.7-17
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    • 2007
  • The left main descending artery (LMDA) of left coronary artery (LCA) in rats runs around the left side of conus arteriosus after arising from the aortic sinus and descends to the apex of heart with branching several branches into the wall of left ventricle (LV). The ligation site of LMDA for myocardial infarction (MI) is the 2~4 mm from LCA origin, between the pulmonary trunk and left auricle. The characteristics that rat heart has no interventricular groove on the surface and its coronary arteries run intramyocardially with branching several branches give the difficulty in surgery for MI which resulted in expected size. This study was aimed to elucidate the branching patterns of the left coronary artery for analysis of MI size and for giving the basic data to producing small MI intentionally in 2 male species that are widely used, Sprague-Dowley (SD) and Wistar-Kyoto (WKY), in the world. Red latex casting was followed by the microdissection in 27 and 28 hearts of SD and WKY male rats, respectively. The branching patterns of LMDA were classified into 3 major types and others based on the left ventricular branches (L). The Type I, Type II, Type III and others are shown in 55.6%, 22.2%, 14.8%, and 7.4% in SD, 60.7%, 10.7%, 7.1%, and 21.5% in WKY, respectively. The branching number of the first left ventricular branch (L1) that are distribute the upper one third of LV was 1.2~1.5, and its branching sites were ranging 0.9~2.1 ßÆ from LCA origin. L2, the second left ventricular branch distributing middle one third of LV, was the number of 1.2~1.4 and branching out ranging 5.1~5.7 mm. L3, the third left ventricular branch of LMDA distributing lower one third of LV, was the number of 1~1.5 and branching out ranging 7.0~9.3 mm from LCA origin. The common branch of L1 and L2 was branched from LMDA with the number of 1.1, and its site was located in the distance of mean of 1.5 mm and 2.8 mm in SD and WKY, respectively. The common branch of L2 and L3 was branched from LMDA with the number of 1, and its site was located in the distance of mean of 7.2 mm and 2.9 mm in SD and WKY, respectively. The right ventricular branches (R) of LMDA were short and branched in irregularly compared with L. The number of 1~4 of R were branched from LMDA. With regarding to the distribution area of L and the ligation site for MI, moderate MI (25~35% of LV) might be resulted in 70.4% and 60.7% in SD and WKY rats. Small MI might be produced intentionally if the ligation would be located at the 4~6 mm from LCA origin in the left side of LMDA. These data wold be helpful to expect the size of MI and to reproduce of small MI, intentionally, in rat hearts.

Therapeutic Compliance and Its Related Factors of Lung Cancer Patients (폐암환자의 치료순응도와 관련요인)

  • Kam, Sin;Park, Jae-Yong;Chae, Sang-Chul;Bae, Moon-Seob;Shin, Moo-Chul;Yeh, Min-Hae;Nam, Si-Hyun
    • Journal of Preventive Medicine and Public Health
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    • v.35 no.1
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    • pp.13-23
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    • 2002
  • Objectives : To investigate the therapeutic compliance and its related factors in lung cancer patients. Methods : The subjects of this study comprised 277 patients first diagnosed with lung cancer at Kyungpook National University Hospital between Jan 1999 and Sept 1999. Of these, 141(50.9%) participated in the study by properly replying to structured questionnaires. The data was analyzed using a simplified Health Decision Model. This model includes categories of variables covering therapeutic compliance, health beliefs, patient preferences, knowledge and experience, social interaction, sociodemographic and clinical characteristics. Results : The therapeutic compliance rate of the 141 study subjects was 78.0%. An analysis of health beliefs and patient preferences revealed health concern (p<0.05), dependency on medicine (p<0.05), perceived susceptibility and severity (p<0.05) as well as preferred treatment (p<0.01) as factors related to therapeutic compliance. Factors from the sociodemographic characteristics and clinical factors that were related to therapeutic compliance were age (p<0.01), monthly income (p<0.05), histological type (p<0.05) and clinical stage (p<0.05) of cancer. Conclusions : In order to improve therapeutic compliance in lung cancer patients it is necessary to educate the aged, low-income patients, or patients who have small cell lung cancer or lune cancer of an advanced stage for which surgery is not indicated. Additionally, it is essential for medical personnel to have a deep concern about patients who have poor lifestyles, a low dependency on medicine, or a high perceived susceptibility and severity. Practically, early diagnosis of lung cancer and thoughtful considerations of low-income patients are important. By means of population-based education in a community, we may promote attention to health and enhance the early diagnosis of lung cancer.

The Clinical Role of $^{99m}Tc$-(V)-DMSA Imaging in Patients with Head and Neck Cancer (두경부 종양에서 $^{99m}Tc$-(V)-DMSA 영상술의 진단적 유용성)

  • Bae, Sun-Kun;Lee, Jae-Tae;Park, June-Sik;Park, In-Kyu;Hyun, Dong-Woo;Lee, Young-Hak;Kim, Jeong-Gyun;Ahn, Byeong-Cheal;Choi, Ji-Yong;Sohn, Sang-Gyun;Lee, Kyu-Bo
    • The Korean Journal of Nuclear Medicine
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    • v.29 no.4
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    • pp.526-532
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    • 1995
  • Introduction : $^{99m}Tc$-(V)-DMSA is a tumor seeking agent that has been used to image medullary carcinoma of thyroid, soft tissue sarcoma and lung cancer. This study was designed to assess the clinical role of $^{99m}Tc$-(V)-DMSA in the diagnosis of head and neck cancers. We has evaluated the diagnostic efficacy of planar and SPECT imaging using $^{99m}Tc$-(V)-DMSA. Patients and Method : Sixty-eight patients with head and neck mass were included in this study. All subjects were diagnosed by biopsy or surgery. Planar and SPECT images were obtained at 2 or 3 hour after intravenous injection of 740 MBq(20 mCi) $^{99m}Tc$-(V)-DMSA. Seventeen patients also underwent SPECT in aging using dual head camera. Result : The diagnostic sensitivity of $^{99m}Tc$-(V)-DMSA planar and SPECT imaging was 65% and 90%, and specificity was 80% and 66%, respectively. The sensitivity of planar imaging in squamous cell carcinoma was similar to overall sensitivity Six metastatic lesion were first diagnosed by scintigraphy. But benign lesions such as Kikuchi syndrome, tuberculous lymphadenitis also revealed increased uptake. Conclusion : $^{99m}Tc$-(V)-DMSA imaging seems to be a promising method in the evaluation of patients with head and neck mass. We recommend SPECT imaging to delineate anatomic localization of the lesion.

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