Acute Kidney Injury due to Menstruation-related Disseminated Intravascular Coagulation in an Adenomyosis Patient: A Case Report

The authors report a case of acute kidney injury (AKI) resulting from menstruation-related disseminated intravascular coagulation (DIC) in an adenomyosis patient. A 40-yr-old woman who had received gonadotropin for ovulation induction therapy presented with anuria and an elevated serum creatinine level. Her medical history showed primary infertility with diffuse adenomyosis. On admission, her pregnancy test was negative and her menstrual cycle had started 1 day previously. Laboratory data were consistent with DIC, and it was believed to be related to myometrial injury resulting from heavy intramyometrial menstrual flow. Gonadotropin is considered to play an important role in the development of fulminant DIC. This rare case suggests that physicians should be aware that gonadotropin may provoke fulminant DIC in women with adenomyosis

Surgical treatment of severe angular kyphosis with myelopathy - Anterior and posterior approach with pedicle screw instrumentation

Study Design. Retrospective study. Objective. To evaluate the outcomes of anterior decompression and fusion followed by posterior instrumented fusion using pedicle screws without intentional correction of severe angular kyphosis deformity with myelopathy. Summary of Background Data. Treatment of severe angular kyphosis with myelopathy is extremely difficult and dangerous. Although surgical circumferential spinal osteotomy via a single posterior approach has been reported in several studies, serious neurologic complications are a possible outcome. Materials and Methods. Among 51 patients surgically treated for angular kyphosis from 1988 to 2004, 16 patients ( follow- up period, 32 - 168 months; mean, 72 months) with severe ( > 70 degrees) angular kyphosis with progressive myelopathic symptoms underwent anterior decompression and fusion, followed by posterior pedicle screw instrumentation and bone graft without attempted correction of the deformity. Radiologic assessment, clinical findings including pain and daily activity scores, and neurologic status using the modified Frankel grade were analyzed before surgery and at the last follow- up. Results. Curve progression or nonunion did not occur in any of the cases. The mean pain and daily activity score were 3.1 and 2.3 before surgery and 4.7 and 4.2 after surgery, respectively. The modified Frankel grade indicated that every patient but one had improved neurologic function by one or more grades. Nine ( 75%) of 12 patients with ankle clonus, 10 ( 71%) of 14 patients with Babinski sign, and 6 ( 55%) of 11 patients with bowel and bladder dysfunction showed full improvement at the last follow-up. Postoperative complications included 1 screw pullout case and 2 infection cases which resolved without incidence. Conclusion. Anterior decompression and fusion followed by posterior pedicle screw instrumentation and fusion without correction effectively improved neurologic symptoms and halted progression of kyphotic deformity in cases of severe angular kyphosis with myelopathy.OAIID:oai:osos.snu.ac.kr:snu2008-01/102/0000004226/4SEQ:4PERF_CD:SNU2008-01EVAL_ITEM_CD:102USER_ID:0000004226ADJUST_YN:YEMP_ID:A076317DEPT_CD:801CITE_RATE:2.793FILENAME:E015T_Spine-2008_Song_Surgical treatment of severe angular kyphosis.pdfDEPT_NM:의학과EMAIL:[email protected]:YCONFIRM:

Korean mistletoe lectin (KML-IIU) and its subchains induce nitric oxide (NO) production in murine macrophage cells

Synthesis of nitric oxide (NO) is one of the important effector functions of innate immune cells. Although several reports have indicated mistletoe lectins induce immune cells to produce cytokines, studies regarding the activities of the lectins in the production of NO have been very limited. Here, we report on the induction of NO synthesis in a murine macrophage cell line, RAW264.7, by Korean mistletoe lectin (KML-IIU). When the macrophage cells were treated with KML-IIU in the presence of a suboptimal concentration of IFN-γ, NO production was induced in a concentration-dependent manner. Significantly higher levels of NO were induced by subchains of the KML-IIU (A and B), which have lower toxicities, as compared to the hololectin. Furthermore, expression of the inducible nitric oxide synthase (iNOS) gene was elevated in accordance with the level of NO production. When the synthase was inhibited by iNOS inhibitors (L-NIL and L-NAME), NO production was specifically reduced in a concentration-dependent manner. Our studies demonstrate that the KML-IIU and its subchains induce NO production in murine macrophage cells via activation of the iNOS gene expression, suggesting that the KML-IIU subchains may be used as an immunomodulator to enhance the effector functions of innate immune cells.Accepted versio

Giant juvenile fibroadenoma of the breast: a case report and brief literature review

A girl (age, 12 years 11 months) consulted the pediatric endocrinology clinic because of a rapidly growing right breast mass over 13 cm observed during the preceding 3 months. A surgical excision was performed, and the mass was diagnosed as a giant juvenile fibroadenoma. Giant juvenile fibroadenomas are rare, usually occurring between 10 and 18 years of age, and characterized by massive and rapid enlargement of an encapsulated mass. The etiology is believed to be an end-organ hypersensitivity to normal levels of estrogen. We report a case of giant juvenile fibroadenoma and present a review of the diagnostic workup and management of a large breast tumor during adolescence

Prevalence and clinical features of arthralgia/arthritis in healthy pregnant women

The authors prospectively investigated 155 pregnant women, without a history of rheumatic disease who visited the Department of Obstetrics and Gynecology for routine antenatal care, to evaluate the prevalences and clinical features of arthralgia and arthritis in healthy pregnant women. Mean of the 155 subjects' ages was 31.8 +/- 3.8 (years, +/-SD). Arthralgia was found in 26 (16.7%) and arthritis in 15 (9.6%) pregnant women. Arthralgia or arthritis developed in the third trimester (28-40 weeks of gestation), except in one case (16 weeks of gestation). Most commonly involved joints were the proximal interphalangeal (n = 19, 12.2%). Rheumatoid factor and antinuclear antibody were negative in patients with arthritis. Ten women (6.8%) had persistent arthralgia for over 6 weeks, post-delivery. Four of them were followed up at Rheumatology Clinic and were diagnosed as having spondyloarthropathy (1), or unspecified arthralgia (3). In conclusion, arthralgia is common during pregnancy and most frequent in proximal interphalangeal joints

Spatiotemporal dynamics and functional correlates of evoked neural oscillations with different spectral powers in human visual cortex

Objective: To investigate spatiotemporal characteristics and functional correlates of evoked oscillations (EOs) at different frequency bands in human visual cortex. Methods: Flash visual evoked potentials (FVEPs) were recorded from 11 epilepsy patients with intracranial electrodes placed over the occipital and adjacent cortices. Spatiotemporal characteristics of spectral powers and correlation with various visual responses elicited by electrical cortical stimulations were analyzed in the same electrodes. Results: High gamma (60-150 Hz) EOs were first recorded in the cuneus and lingual gyri around the calcarine sulcus. Low gamma (30-60 Hz) EOs appeared also in the mesial occipital cortex slightly later and lasted longer than high gamma EGOs. In contrast, lower frequency (LF) < 30 Hz EOs were recorded more diffusely from occipital surfaces with delayed onset and longer duration. High gamma EOs were predominantly associated with simple form visual responses, whereas low gamma and LF EOs were with intermediate form and LF EOs with complex form responses. Conclusions: FVEP spectral power analysis directly recorded from human visual cortex showed distinct spatiotemporal distributions in high and low gamma, or LF bands that have different functional correlates. Significance: Phase-locked EOs in these frequency bands may have special neuroanatomical and functional organization during early visual processing. Crown Copyright (C) 2013 Published by Elsevier Ireland Ltd. on behalf of International Federation of Clinical Neurophysiology

Suppressive activity of RGX-365 on HMGB1-mediated septic responses

RGX-365 is the main fraction of black ginseng conmprising protopanaxatriol (PPT)-type rare ginsenosides (ginsenosides Rg4, Rg6, Rh4, Rh1, and Rg2). No studies on the antiseptic activity of RGX-365 have been reported. High mobility group box 1 (HMGB1) is recognized as a late mediator of sepsis, and the inhibition of HMGB1 release and recovery of vascular barrier integrity have emerged as attractive therapeutic strategies for the management of sepsis. In this study, we examined the effects of RGX-365 on HMGB1-mediated septic responses and survival rate in a mouse sepsis model. RGX-365 was administered to the mice after HMGB1 challenge. The antiseptic activity of RGX-365 was assessed based on the production of HMGB1, measurement of permeability, and septic mouse mortality using a cecal ligation and puncture (CLP)-induced sepsis mouse model and HMGB1-activated human umbilical vein endothelial cells (HUVECs). We found that RGX-365 significantly reduced HMGB1 release from LPS- activated HUVECs and CLP-induced release of HMGB1 in mice. RGX-365 also restored HMGB1-mediated vascular disruption and inhibited hyperpermeability in the mice. In addition, treatment with RGX-365 reduced sepsis-related mortality in vivo. Our results suggest that RGX- 365 reduces HMGB1 release and septic mortality in vivo, indicating that it is useful in the treatment of sepsis