Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis: The Insertion Technique, the Fusion Levels and Direct Vertebral Rotation

The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved three-dimensional (3D) correction and it is accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complications. Many methods of screw insertion have been reported. The author has been using the K-wire method coupled with the intraoperative single posteroanterior and lateral radiographs, which is the most safe, accurate and fast method. Identification of the curve patterns and determining the fusion levels are very important. The ideal classification of adolescent idiopathic scoliosis should address the all patterns, predict the extent of accurate fusion and have good inter/intraobserver reliability. My classification system matches with the ideal classification system, and it is simple and easy to learn; and my classification system has only 4 structural curve patterns and each curve has 2 types. Scoliosis is a 3D deformity; the coronal and sagittal curves can be corrected with rod rotation, and rotational deformity has to be corrected with direct vertebral rotation (DVR). Rod derotation and DVR are true methods of 3D deformity correction with shorter fusion and improved correction of both the fused and unfused curves, and this is accomplished using pedicle screw fixation. The direction of DVR is very important and it should be opposite to the direction of the rotational deformity of the vertebra. A rigid rod has to be used to prevent rod bend-out during the derotation and DVR

Porphyra-334, a mycosporine-like amino acid, attenuates UV-induced apoptosis in HaCaT cells

The main aim of the current research was to study the effect of porphyra-334, one of mycosporine-like amino acids (MAAs), well known as UV-absorbing compounds, on UV-induced apoptosis in human immortalized keratinocyte (HaCaT) cells. Due to their UV-screening capacity and ability to prevent UV-induced DNA damage, MAAs have recently attracted considerable attention in both industry and research in pharmacology. Herein, human HaCaT cells were used to determine the biological activities of porphyra-334 by various in vitro assays, including proliferation, apoptosis and Western blot assays. The proliferation rate of UV-irradiated HaCaT cells was significantly decreased compared to the control group. Pretreatment with porphyra-334 markedly attenuated the inhibitory effect of UV and induced a dramatic decrease in the apoptotic rate. Expression of active caspase-3 protein was increased in response to UV irradiation, while caspase-3 levels were similar between cells treated with porphyra-334 and the non-irradiated control group. Taken together, our data suggest that porphyra-334 inhibits UV-induced apoptosis in HaCaT cells through attenuation of the caspase pathway

Effect of Direct Vertebral Rotation on the Uninstrumented Lumbar Curve in Thoracic Adolescent Idiopathic Scoliosis

Study DesignRetrospective study.PurposeTo determine the effect and direction of direct vertebral rotation (DVR) in the lowest instrumented vertebra (LIV) on the uninstrumented lumbar curve depending on the lumbar modifier used for the correction of thoracic adolescent idiopathic scoliosis.Overview of LiteratureDVR in the LIV should be implemented in a different direction to obtain better spontaneous lumbar correction depending on the preoperative lumbar spine modifier.MethodsWe retrospectively analyzed 160 patients with thoracic adolescent idiopathic scoliosis treated by pedicle screw instrumentation and rod derotation. Patients who had a distal fusion level between T11 and L1 were divided into two groups: the DVR group versus the No-DVR group. Each group was divided into subgroups depending on the lumbar modifier used: the DVR-A, B, and C groups versus the No-DVR-A, B, and C groups. The DVR-A group was subdivided into two subgroups depending on the direction of screw rotation in the LIV: the DVR-A-O group (opposite direction) and the DVR-A-S group (same direction).ResultsThere were no significant differences in the preoperative curve characteristics between the two groups. The preoperative lumbar curve was corrected in 70% of the patients in the DVR group and in 56% in the No-DVR group. Spontaneous coronal correction of the lumbar curve was better in the DVR-A-S group than that in the No-DVR-A group. However, the DVR-A-O group had the higher incidence of adding-on deformity. The DVR-B and C groups showed better spontaneous correction of lumbar coronal magnitude, apical vertebral translation, and rotation and the LIV tilting.ConclusionsIn lumbar modifiers B and C, screws in the LIV have to be rotated opposite to the direction of the screw rotation of the main thoracic curve; however, in modifier A, the screws have to be rotated in the same direction

Urinary bladder rupture during voiding cystourethrography

Voiding cystourethrography (VCUG) is a commonly performed diagnostic procedure for the evaluation of vesicoureteral reflux with urinary tract infection or congenital renal diseases in children. The procedure is relatively simple and cost-effective, and complications are very rare. The iatrogenic complication of VCUG range from discomfort, urinary tract infection to bacteremia, as well as bladder rupture. Bladder rupture is a rare complication of VCUG, and only a few cases were reported. Bladder rupture among healthy children during VCUG is an especially uncommon event. Bladder rupture associated with VCUG is usually more common in chronically unused bladders like chronic renal failure. Presented is a case of bladder rupture that occurred during a VCUG in a healthy 9-month-old infant, due to instilled action of dye by high pressure. This injury completely healed after 7 days of operation, and it was confirmed with a postoperative cystography. The patient's bladder volume, underlying disease, velocity of the contrast media instilled, catheter size, and styles of instillation are important factors to prevent bladder rupture during VCUG. Management of bladder rupture should be individualized, but the majority of infants are treated with the operation. In conclusion, bladder rupture is a rare complication, however, delicate attention is needed in order to prevent more dire situations

Surgical Treatment of Adult Degenerative Scoliosis

The rapid increase of elderly population has resulted in increased prevalence of adult scoliosis. Adult scoliosis is divided into adult idiopathic scoliosis and adult degenerative scoliosis. These two types of scoliosis vary in patient age, curve pattern and clinical symptoms, which necessitate different surgical indications and options. Back pain and deformity are major indications for surgery in adult idiopathic scoliosis, whereas radiating pain to the legs due to foraminal stenosis is what often requires surgery in adult degenerative scoliosis. When selecting a surgical method, major symptoms and underlying medical diseases should be carefully evaluated, not only to relieve symptoms but also to minimize postoperative complications. Surgical options for adult degenerative scoliosis include: decompression alone; decompression and limited short fusion; and decompression coupled with long fusion and correction of deformity. Decompression and limited short fusion can be applied to patients with a small Cobb's angle and normal sagittal imbalance. For those with a large Cobb's angle and positive sagittal imbalance, long fusion with correction of deformity is required. When long fusion is applied, a careful decision regarding the extent of fusion level should be made when selecting L5 or S1 as the distal fusion level and T10 or the thoracolumbar junction as the proximal fusion level. For the fusion extending to the sacrum, restoration of sagittal balance and rigid fixation with additional iliac screws should be considered. Any surgical procedures for adult degenerative scoliosis are known to have relatively high occurrences of complications; therefore, risks and benefits should be meticulously considered before selecting a surgical procedure

Imunosni odgovor BALB/c miševa oralno imuniziranih rekombinantnim cjepivom od serovara Salmonella Typhimurium s ugrađenim antigenima enterotoksigenog soja Escherichia coli

Salmonella Typhimurium ghost vaccines containing antigens of enterotoxigenic Escherichia coli (ETEC) were obtained by a strain harboring pMMP184, which carries a ghost cassette. The immune responses of BALB/c mice orally vaccinated with these ghost vaccines were determined in this study. Total IgG against S. Typhimurium were highly detected by the oral immunization route in BALB/c mice. IgGs against ETEC antigens in the ghost cells carrying F41 and intimin were detected at 4 weeks after vaccination. However, FedF elicited a delayed induction of IgGs, whereas FedA immune response failed to or barely induced IgGs after vaccination. Proliferations of CD3e/CD4-T cells were observed in splenocytes of BALB/c mice immunized with S. Typhimurium ghost cells carrying FedF. However, CD45R-B220/CD23-B cells were proliferated by ghost cells carrying FedA, F41, and intimin. The immunized BALB/c mice showed 25~50% protection against challenge with wild type S. Typhimurium, when compared to control mice. Therefore, it is assumed that oral vaccination of S. Typhimurium ghost cells has the potential to protect mice against pathogenic E. coli.Salmonella Typhimurium rekombinantna cjepiva što sadrže antigene enterotoksigenih sojeva Escherichia coli (ETEC) proizvedena su od soja koji posjeduje pMMP184 i nosi rekombinantnu kasetu. Istražen je imunosni odgovor BALB/c miševa oralno cijepljenih tim rekombinantnim cjepivima. Ustanovljena je visoka razina ukupnih IgG za S. Typhimurium nakon oralne imunizacije miševa BALB/c. Imunoglobulini IgG za antigene ETEC u rekombinantnom cjepivu koje sadrži F41 i intimin bili su dokazani četiri tjedna nakon cijepljenja. Ipak, FedF je potaknuo kasnu tvorbu imunoglobulina IgG, dok FedA nije potaknuo ili je potaknuo slab imunosni odgovor nakon cijepljenja. Proliferacija CD3e/CD4-T stanica bila je dokazana u splenocitima miševa BALB/c imuniziranih rekombinantnim cjepivom S. Typhimurium s ugrađenim FedF. Međutim, stanice CD45R-B220/CD23-B proliferirale su nakon cijepljenja rekombinantom FedA, F41 i intimin. Imunizirani miševi BALB/c pokazivali su 25~50% zaštitu nakon izazivačke infekcije serovarom S. Typhimurium u usporedbi s necijepljenim kontrolnim miševima. Stoga se pretpostavlja da oralno cijepljenje s rekombinantnim stanicama serovara S. Typhimurium ima potencijal da zaštiti miševe od infekcije patogenim sojevima E. coli

Determination of the Distal Fusion Level in the Management of Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis Using Pedicle Screw Instrumentation

Study DesignA retrospective study.PurposeTo determine the exact distal fusion level in the management of thoracolumbar/lumbar adolescent idiopathic scoliosis (TL/L AIS) using pedicle screw instrumentation (PSI).Overview of LiteratureThe selection of distal fusion level remains controversial in TL/L AIS.MethodsRadiographic parameters of 66 TL/L AIS patients were analyzed. The patients were grouped according to the distal fusion level; L3 group (fusion to L3, n=58) and L4 group (fusion to L4, n=8). The L3 group was subdivided into L3A (L3 crosses the mid-sacral line with rotation of less than grade II, n=33) and L3B (L3 does not cross the mid-sacral line or rotation is grade II or more, n=25) based on both bending radiographs. All of the patients in the L4 group had the same location and rotation of L3 in bending films as that of patients in the L3B group. An unsatisfactory result was defined as a lowest instrumented vertebral tilt (LIVT) of more than 10° or coronal balance of more than 15 mm.ResultsAmong the 3 groups, there was a significantly lesser correction in the TL/L curve and LIVT in the L3B group. Unsatisfactory results were obtained in 3 patients (9.1%) of the L3A group, in 15 patients (68.2%) of the L3B group, and in 1 patient (12.5%) of the L4 group with a significant difference.ConclusionsIn TL/L AIS treatment with PSI, the curve can be fused to L3 with favorable radiographic outcomes when L3 crosses the mid-sacral line with rotation of less than grade II in bending films. Otherwise, fusion has to be extended to L4

A case of McKusick-Kaufman syndrome

McKusick-Kaufman syndrome (MKS) is an autosomal recessive multiple malformation syndrome characterized by hydrometrocolpos (HMC) and postaxial polydactyly (PAP). We report a case of a female child with MKS who was transferred to the neonatal intensive care unit of Seoul National University Children's Hospital on her 15th day of life for further evaluation and management of an abdominal cystic mass. She underwent abdominal sonography, magnetic resonance imaging, genitography and cystoscopy which confirmed HMC with a transverse vaginal septum. X-rays of the hand and foot showed bony fusion of the left third and fourth metacarpal bones, right fourth dysplastic metacarpal bone and phalanx, right PAP and hypoplastic left foot with left fourth and fifth dysplastic metatarsal bones. In addition, she had soft palate cleft, mild hydronephroses of both kidneys, hypoplastic right kidney with ectopic location and mild rotation, uterine didelphys with transverse vaginal septum and low-type imperforated anus. She was temporarily treated with ultrasound-guided transurethral aspiration of the HMC. Our patient with HMC and PAP was diagnosed with MKS because she has two typical abnormality of MKS and she has no definite complications of retinal disease, learning disability, obesity and renal failure that develop in Bardet-Biedl syndrome, but not in MKS until 33 months of age. Here, we describe a case of a Korean patient with MKS

Misdiagnosis of fetus-in-fetu as meconium peritonitis

Fetus-in-fetu (FIF) is a rare congenital condition in which a fetiform mass is detected in the host abdomen and also in other sites such as the intracranium, thorax, head, and neck. This condition has been rarely reported in the literature. Herein, we report the case of a fetus presenting with abdominal cystic mass and ascites and prenatally diagnosed as meconium pseudocyst. Explorative laparotomy revealed an irregular fetiform mass in the retroperitoneum within a fluid-filled cyst. The mass contained intestinal tract, liver, pancreas, and finger. Fetal abdominal cystic mass has been identified in a broad spectrum of diseases. However, as in our case, FIF is often overlooked during differential diagnosis. FIF should also be differentiated from other conditions associated with fetal abdominal masses