Showing papers by "Seok Won Kim published in 2012"

Gene expression profiling of papillary thyroid carcinomas in Korean patients by oligonucleotide microarrays

Abstract: Purpose: The incidence of papillary thyroid carcinomas (PTCs) is rapidly increasing in Korea. Analyzing the gene expression profiling (GEP) of PTCs will facilitate the advent of new methods in diagnosis, prognostication, and treatment. We performed this study to find the GEP of Korean PTCs. Methods: We performed oligonucleotide microarray analysis with 19 PTCs and 7 normal thyroid glands. Differentially expressed genes were selected using a t-test (|fold| ＞3) and adjusted Benjamini-Hochberg false discovery rate P-value ＜ 0.01. Quantitative reverse transcription-polymerase chain reaction (QRT-PCR) was used to validate microarray data. A classification model was developed by support vector machine (SVM) algorithm to diagnose PTCs based on molecular signatures. Results: We identified 79 differentially expressed genes (70 up-regulated and 9 down-regulated) according to the criteria. QRT-PCR for five genes (CDH3, NGEF, PROS1, TGFA, MET) was confirmatory of the microarray data. Hierarchical cluster analysis and a classification model by the SVM algorithm accurately differentiated PTCs from normal thyroid gland based on GEP. Conclusion: A disease classification model showed excellent accuracy in diagnosing PTCs, thus showing the possibility of molecular diagnosis in the future. This GEP could serve as baseline data for further investigation in the management of PTCs based on molecular signatures.

Clinical efficacy of bone cement augmented screw fixation for the severe osteoporotic spine.

Abstract: OBJECTIVE Transpedicular instrumentation of the osteoporotic spine is a challenge for the spine surgeon due to the probability of screw loosening and the potential possibility of nonunion. The purpose of this study was to evaluate the clinical efficacy of bone cement augmented screw fixation in patients with severe osteoporosis. METHODS Between February 2004 and August 2007, 250 patients with severe osteoporosis (T-score on BMD < -3.0) that had screw fixation were included in this study. The patients were divided into two groups (Group I: 157 patients that underwent bone cement augmented screw fixation that had a variety of spine spinal diseases including fractures, and Group II: 93 patients with severe osteoporosis that had screw fixation without bone cement augmentation). The imaging and clinical features were analyzed, including bone cement augmented levels, fusion rate and related complications. The visual analog scale (VAS), Oswestry disability questionnaire (ODI) and modified MacNab's criteria were used for the assessment of pain and functional capacity. RESULTS In both groups, a significant improvement in the VAS and ODI was achieved. 146 out of 157 patients (93%) in Group I and 83 out of 93 patients (90%) in Group II were graded as an excellent or good result according to the modified MacNab's criteria. None of the patients experienced serious complications. However, there were two cases with neurological deterioration as a result of bone cement extravasation in Group I. For Group II, there were five cases of screw loosening that required re-operation for bone cement augmentation. CONCLUSION Whether bone cement augmentation was performed or not, it was possible to achieve satisfactory results in patients with severe osteoporosis. However, if used carefully, bone cement augmented transpedicular screwing can reduce screw loosening and pullout in patients with severe osteoporosis.

Spontaneous Concomitant Intracranial and Spinal Subdural Hematomas in Association with Anticoagulation Therapy

Abstract: Simultaneous intracranial and spinal subdural hematomas are extremely rare. In most cases, they are attributed to major or minor trauma and iatrogenic causes, such as those resulting from spinal puncture. To the best of the authors' knowledge, there has been only two reports of spontaneous concomitant intracranial and spinal subdural hematomas in a patient receiving anticoagulant therapy who had an absence of evident trauma history. We report on a case of spontaneous concomitant intracranial and spinal subdural hematomas that occurred in association with anticoagulant therapy and present a review of the relevant literature.

Predicting Nonsentinel Lymph Node Metastasis Using Lymphoscintigraphy in Patients with Breast Cancer

Abstract: Several models for predicting the likelihood of nonsentinel lymph node (NSLN) metastasis using histopathologic parameters in sentinel-positive breast cancer patients have been proposed. In this study, we established a new model that uses sentinel lymphoscintigraphic findings and histopathologic parameters as covariates and assessed its predictive performance. Methods: The analysis included breast cancer patients (n = 301 women) who underwent sentinel lymphoscintigraphy (SLS) using 99mTc-labeled human serum albumin, had sentinel lymph node biopsy results positive for metastasis, and subsequently underwent complete axillary lymph node dissection. First, we devised a grading system relating SLS patterns to the risk of NSLN metastasis positivity. Second, we developed a multivariate logistic regression model for the prediction of NSLN metastasis using the SLS pattern and histopathologic parameters as covariates and compared its performance with that of the extensively validated Memorial Sloan-Kettering Cancer Center model using receiver-operating-characteristic curve analysis. Results: The SLS visual grade was strongly correlated with the presence of NSLN metastases. A well-calibrated prediction model for NSLN metastasis was constructed using SLS grade and histopathologic findings. The mean area under the curve of our model was 0.812, which is significantly greater than that of the Memorial Sloan-Kettering Cancer Center model (P

Bone cement-augmented short segment fixation with percutaneous screws for thoracolumbar burst fractures accompanied by severe osteoporosis.

Abstract: OBJECTIVE The purpose of this study was to determine the efficacy of bone cement-augmented short segment fixation using percutaneous screws for thoracolumbar burst fractures in a background of severe osteoporosis. METHODS Sixteen patients with a single-level thoracolumbar burst fracture (T11-L2) accompanying severe osteoporosis treated from January 2008 to November 2009 were prospectively analyzed. Surgical procedures included postural reduction for 3 days and bone cement augmented percutaneous screw fixation at the fracture level and at adjacent levels without bone fusion. Due to the possibility of implant failure, patients underwent implant removal 12 months after screw fixation. Imaging and clinical findings, including involved vertebral levels, local kyphosis, canal encroachment, and complications were analyzed. RESULTS Prior to surgery, mean pain score (visual analogue scale) was 8.2 and this decreased to a mean of 2.2 at 12 months after screw fixation. None of the patients complained of pain worsening during the 6 months following implant removal. The percentage of canal compromise at the fractured level improved from a mean of 41.0% to 18.4% at 12 months after surgery. Mean kyphotic angle was improved significantly from 19.8° before surgery to 7.8 at 12 months after screw fixation. Canal compromise and kyphotic angle improvements were maintained at 6 months after implant removal. No significant neurological deterioration or complications occurred after screw removal in any patient. CONCLUSION Bone cement augmented short segment fixation using a percutaneous system can be an alternative to the traditional open technique for the management of selected thoracolumbar burst fractures accompanied by severe osteoporosis.

Solitary Lymphoblastic Lymphoma of the Thoracic Spine

Abstract: Non-Hodgkin's lymphoma rarely originates from bone, and even more infrequently from a vertebral body. Lymphoblastic lymphoma is a rare type of non-Hodgkin's lymphoma, and results from an abnormality in adaptive immune cells. A 27-year-old man presented with a two-month history of night sweats, weight loss, and severe back pain. Radiological studies demonstrated an osteolytic lesion compressing the subarachnoid space at the T11 level. Posterolateral fusion with decompression was performed and a pathologic examination confirmed lymphoblastic lymphoma of the B-cell precursor type. To our knowledge, this is the first report of solitary lymphoblastic lymphoma from B-cell precursors in of the thoracic spine. Herein, we discuss the presenting symptoms and the management of this rare case of lymphoblastic lymphoma.

Symptomatic myelopathy caused by ossification of the yellow ligament.

Abstract: Objective This study was performed to describe the clinical presentation, surgical outcome in patients with symptomatic myelopathy caused by ossification of the yellow ligament (OYL). Methods The authors reviewed consequent 12 patients in whom posterior decompressive laminectomies were performed for OYL from 1999 to 2005. Diagnostic imagings including simple radiographs, computed tomography and magnetic resonance images were performed in each case. The patients were reviewed to evaluate the clinical presentation, surgical outcome and complications of the operation. Results In all patients, OYL was located in the lower thoracic region and all patients presented with numbness on both limbs and pain. Among them, 5 patients presented with gait disturbance due to paraparesis and two patients had sphincter dysfunction. Decompressive laminectomy through a posterior approach using microscope resulted in improvement of symptoms in all patients, but, recovery was incomplete in a half of the patients. The mean postoperative Japanese orthopaedics association (JOA) score was 7.9 when compared with 4.9 in preoperative assessment and the mean recovery rate was 65%. Dural tear was noticed in four patients, so dural repair was performed, but there were no neurological deficits related to neural injury. Conclusion OYL is an uncommon cause of myelopathy but it can lead to debilitating thoracic myelopathy. Careful decompressive laminectomy can achieve favorable results.

Isolated Coccygeal Tuberculosis

Abstract: Isolated tuberculosis of the coccyx is extremely rare. A 35-year-old man presented with a 3-month history of coccygeal and gluteal pain. Computed tomography and magnetic resonance imaging revealed osseous destruction and a large enhancing mass involving the coccyx with anterior and posterior extension. Pathologic examination of the surgical specimen revealed necrosis, chronic granulomatous inflammation, and multinucleated giant cells consistent with tuberculosis. This case highlights the importance of considering tuberculosis as a diagnosis even though unusual sites are involved.

Electrophysiological and behavioral changes by phosphodiesterase 4 inhibitor in a rat model of alcoholic neuropathy.

Abstract: OBJECTIVE: Alcoholic neuropathy is characterized by allodynia (a discomfort evoked by normally innocuous stimuli), hyperalgesia (an exaggerated pain in response to painful stimuli) and spontaneous burning pain. The aim of the present study is to investigate the effect of rolipram, a phosphodiesterase 4 inhibitor, against alcohol-induced neuropathy in rats. METHODS: Allodynia was induced by administering 35% v/v ethanol (10 g/kg; oral gavage) to Spraue-Dawley rats for 8 weeks. Rolipram and saline (vehicle) were administered intraperitoneally. Mechanical allodynia was measured by using von Frey filaments. Somatosensory evoked potential (SEP) was proposed as complementary measure to assess the integrity of nerve pathway. RESULTS: The ethanol-induced mechanical allodynia began to manifest from 3 week, and then peaked within 1 week. Beginning from 3 week, latency significantly started to increased in control group. In rolipram treated rats, the shorter latency was sustained until 8 weeks (p<0.05). The mechanical allodynia, which began to manifest on the 3 weeks, intraperitoneal injections of rolipram sustained statistical difference until 8 weeks, the final week of the study (p<0.05). CONCLUSION: This study suggests that rolipram might alleviate mechanical allodynia induced by alcohol in rats, which clearly has clinical implication.

Sixth and twelfth cranial nerve palsies following Basal skull fracture involving clivus and occipital condyle

Abstract: Oblique basal skull fractures resulting from lateral crushing injuries involving both clivus and occipital condyle are rare due to their deep locations. Furthermore, these fractures may present clinically with multiple cranial nerve injuries because neural exit routes are restricted in this intricate region. The authors present an interesting case of basal skull fractures involving the clivus and occipital condyle and presenting with sixth and contralateral twelfth cranial nerve deficits. Clinico-anatomic correlations and the courses of cranial nerve deficits are reiterated. To the authors' knowledge, no other report has been previously issued on concomitant sixth and contralateral twelfth cranial nerve palsies following closed head injury.

Recurrent Bacterial Meningitis Accompanied by A Spinal Intramedullary Abscess

Abstract: Bacterial meningitis is rarely complicated by an intradural spinal abscess, and recurrent meningitis is an uncommon presentation of a spinal intramedullary abscess. Here, we report a 63-year-old patient with recurrent meningitis as the first manifestation of an underlying spinal intramedullary abscess. To the best of our knowledge, no previous report has been issued on recurrent meningitis accompanied by a spinal intramedullary abscess in an adult. In this article, the pathophysiological mechanism of this uncommon entity is discussed and the relevant literature reviewed.

Gunshot injury to the anterior arch of atlas.

Abstract: Penetrating injuries to the upper cervical spine resulting from gunshots are rare in South Korea due to restrictions of gun use. Moreover, gunshot wounds to the upper cervical spine without neurological deficits occur infrequently because of the anatomic location and surrounding essential structures. We present an uncommon case involving the surgical removal of a bullet located in the anterior arch of first cervical vertebra (C1) via a transoral approach without neurological complications or subsequent mechanical instability.

Radiological analysis of symptomatic complications after bilateral laminotomy for lumbar spinal stenosis.

Abstract: Objective The purpose of this study was to describe the various symptomatic complications following decompressive bilateral laminotomy for treating lumbar spinal stenosis.

Paraspinal Muscle Sparing Versus Percutaneous Screw Fixation: A Comparative Enzyme Study of Tissue Injury during the Treatment of L4-L5 Spondylolisthesis

Abstract: Objective Screw fixation via the paraspinal muscle sparing approach and by percutaneous screw fixation are known to diminish the risk of complications, such as, iatrogenic muscle injury as compared with the conventional midline approach. The purpose of this study was to evaluate tissue injury markers after these less traumatic screw fixation techniques for the treatment of L4-L5 spondylolisthesis. Methods Twenty-two patients scheduled for posterior lumbar interbody fusion (PLIF) at the L4-L5 segment for spondylolisthesis were prospectively studied. Patients were divided into two groups by screw fixation technique (Group I: paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Levels of serum enzymes representing muscle injury (CK-MM and Troponin C type 2 fast), pro-inflammatory cytokine (IL-8), and anti-inflammatory cytokine (IL-1ra) were analyzed using ELISA techniques on the day of the surgery and 1, 3, and 7 days after the surgery. Results Serum CK-MM, Troponic C type 2 fast (TNNC2), and IL-1ra levels were significantly elevated in Group I on postoperative day 1 and 3, and returned to preoperative levels on postoperative day 7. No significant intergroup difference was found between IL-8 levels despite higher concentrations in Group I on postoperative day 1 and 3. Conclusion This study shows that percutaneous screw fixation procedure is the preferable minimally invasive technique in terms of minimizing muscle injury associated with L4-L5 spondylolisthesis.