Background: In the cervicothoracic junction (CTJ), there is limited working space to perform the posterior-only approach. Therefore, a combined anterior approach is required in some cases. However, the great vessels and sternum obstruct the anterior corridor and make the anterior approach difficult. We analyzed relevant anatomical structures encountered during the anterior approach in the CTJ and evaluated the feasibility of previously reported surgical corridors. Methods: We retrospectively examined 49 patients who underwent neck computed tomography angiography between January 2015 and May 2020. Using the coronal images, we measured the intercarotid artery angle (ICAA), intercarotid artery distance (ICAD), shape of the brachiocephalic trunk (BCT), and position of the BCT base. We then measured the most cranial level requiring manubriotomy for the anterior approach (ML), the most caudal level accessible through the superior corridor (SC), and the most caudal level through the inferior corridor (IC) according to the surgeon’s line of sight using the sagittal axis image. Results: The mean ICAA and ICAD were 50.83° ± 15.23° and 33.38 ± 12.11 mm, respectively. Notably, BCT shape was of the convex type in most cases (42.9%), followed by the straight type (36.7%). In addition, the base of BCT was most commonly located inside the body (49%). Moreover, ICAA and ICAD were significantly greater in men. Although men mostly had the BCT base inside the body (64.3%), female mostly had it on the edge of the body (47.6%). Notably, ML showed the highest frequency (16.3%) in the T1 lower and upper bodies. Furthermore, through SC and IC, it was possible to approach the T4 lower body and T6 midbody, respectively. SC showed the highest frequency (16.3%) in the T3 lower body, and IC showed the highest frequency (20.4%) in the T5 midbody. Conclusions ICAA and ICAD were larger and higher in men. BCT was convex and located inside the body in most cases. The accessible level of ML, SC, and IC were T1, T3, and T5, respectively. For the anterior approach in the CTJ, preoperative vascular and accessible level analysis of corridors is essential to decide on the appropriate corridor and reduce complications.

BACKGROUND: Discharge after day-surgery can be delayed for postoperative pain in a video-assisted thoracic sympathicotomy (VATS). However, there seems to be no research about postoperative pain after a VATS. We examined the characteristics of patients and operative factors, and compared the severity of postoperative pain according to different anesthetics. METHODS: We examined the age, sex, obesity index, and pain tolerance in 194 VATS patients of ASA physical status 1 or 2. The patients were randomly divided into two groups each with 97 patients. Group P was anesthetized with propofol, and group E with enflurane. We measured the visual analog scale (VAS) score at 5 minute, 2 hours, and 6 hours after arrival at the recovery room. RESULTS: There was no difference in the VAS score according to age, sex, obesity index, or pain tolerance. The VAS score at coughing was significantly higher than at rest. The VAS score in group P was higher than group E, but there was no significant difference. The patients who had a complication of a pneumothorax had a significantly higher VAS score. CONCLUSIONS: Postoperative pain seems to be aggravated by remaining air within the thorax after VATS.
Anesthetics ; Cough ; Enflurane ; Humans ; Obesity ; Pain, Postoperative ; Pneumothorax ; Propofol ; Recovery Room ; Thoracic Surgery, Video-Assisted ; Thorax ; Visual Analog Scale

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Atmospheric Pressure ; Cerebral Hemorrhage ; Electronics ; Electrons ; Humans ; Humidity ; Incidence ; Meteorology ; Retrospective Studies ; Seasons ; Subarachnoid Hemorrhage ; Weather

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Atmospheric Pressure ; Cerebral Hemorrhage ; Electronics ; Electrons ; Humans ; Humidity ; Incidence ; Meteorology ; Retrospective Studies ; Seasons ; Subarachnoid Hemorrhage ; Weather

A holy grail of curing neurodegenerative diseases is to identify the main causes and mechanisms underlying neuronal death. Many studies have sought to identify these targets in a wide variety of ways, but a more important task is to identify critical molecular targets and their origins. Potential molecular targets include advanced glycation end products (AGEs) that can promote neuronal cell death, thereby contributing to neurodegenerative disorders such as Alzheimer disease or Parkinson disease. In this study, we showed that AGE-albumin (glycated albumin) is synthesized in microglial cells and secreted in the human brain. Our results provide new insight into which microglial cells can promote the receptor for AGE-mediated neuronal cell death, eventually leading to neurodegenerative diseases.
Alzheimer Disease ; Brain ; Cell Death ; Glycosylation End Products, Advanced ; Humans ; Microglia ; Neurodegenerative Diseases ; Neurons ; Parkinson Disease

BACKGROUND AND OBJECTIVES: The left ventricular mass is known to be influenced by both hemodynamic and non-hemodynamic factors. Body size and gender are the most representative non-hemodynamic factors. This study was performed to establish the influences of these variables on the variation of the left ventricular mass in healthy Korean adults. SUBJECTS AND METHODS: 368 subjects (male=184, female=184), with a normal body mass index and blood pressure, were included in the echocardiographic analysis from the echocardiography database of the Hanyang University Hospital and of the Yangpyung Epidemiologic Survey 2004. The left ventricular mass was calculated using the equation: 1.04x(IVSd+LVDd+PWTd)3-LDVs3)x0.8+0.6. The stroke volume was calculated (mL/beat) using Teichholz's formula. The stroke work (SW in gram-meters/beat [g-m/beat]) was computed as the cuff systolic BPxstroke volumex0.0144. RESULTS: The stroke work (SW) was the most important factor associated with the LV mass (adjusted R2=0.501, p<0.001), and body weight, age and gender were independent factors (adjusted R2=0.642). In a regression model, including stroke work, gender and height2.7, the LV mass was predicted by the equation: 54.9+7.62xheight (m2.7)+0.67xSW (g-m/beat)-13.2xgender (male=1, female=2)(constant=54.9+/-14.7 g, adjusted R2=0.576, SEE=21.67, p=0.001). CONCLUSION: As with the studies in the western countries, the stroke work, gender and height2.7 were important determinants of the left ventricular mass in Korean adults with a normal weight and normal blood pressure.
Adult* ; Blood Pressure* ; Body Mass Index ; Body Size* ; Body Weight ; Echocardiography ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Ideal Body Weight* ; Stroke ; Stroke Volume

PURPOSE: Polychlorinated biphenyls (PCBs, Aroclor 1254), synthetic chlorinated organic compounds, are known to decrease thyroid function, sperm count, and fertility, and increase the risk of testicular cancer; they may have serious effects on male reproduction. The aim of this study was to investigate the possible protective role of palmiwon on PCB-induced spermiotoxicity in rats. MATERIALS AND METHODS: 90-day-old male Sprague Dawley rats were randomly divided into three groups, each consisting of ten animals. The control group (Group I) received corn oil, the second group of rats (Group II) was administered 2 mg/kg body weight/day of Aroclor 1254+corn oil intraperitoneally for 30 days. The third group of rats (Group III) was treated with 2 mg/kg body weight/day of Aroclor 1254+corn oil intraperitoneally plus palmiwon (300 mg/day) orally for 30 days. Twenty-four hours after the last treatment, the animals were killed by decapitation. Their serum testosterone levels was measured before and after the experimental medication was taken, and the number and motility of sperm, which had been collected from the cauda epididymal region, were evaluated. RESULTS: The results of this experiment show that treatment with palmiwon significantly improved sperm motility and number in rats that had been exposed to PCBs. There was no marked difference in body weight, testis weight, or epididymis weight among the groups. Nor were there any significant pathological differences in the testes among the groups. CONCLUSIONS: Palmiwon has the potential for treating PCB-induced spermiotoxicity. More experiments with larger samples and a longer period of treatment are needed.
Animals ; Aroclors ; Biphenyl Compounds ; Body Weight ; Corn Oil ; Decapitation ; Epididymis ; Fertility ; Humans ; Male ; Polychlorinated Biphenyls ; Rats ; Rats, Sprague-Dawley ; Reproduction ; Sperm Count ; Sperm Motility ; Spermatozoa ; Testis ; Testosterone ; Thyroid Gland

Metastatic gastric cancer is extremely rare and gastric metastasis from ovarian adenocarcinoma has rarely been reported. All of the previously reported metastatic lesions presented as an ulcerative lesions. We report a case of 49-year-old woman in which gastric metastasis from ovarian adenocarcinoma presented as a submucosal tumor without ulceration on endoscopic examination. Gastrointestinal stromal tumor was suspected on endoscopic ultrasound (EUS) examination. It was confirmed histopathologically as metastatic ovarian adenocarcinoma after endoscopic submucosal dissection (ESD) with enucleation. Submucosal tumor of the stomach in patients with ovarian carcinoma should not be overlooked and ESD with enucleation may be a viable option when EUS with fine needle aspiration is not available.
Adenocarcinoma ; Biopsy, Fine-Needle ; Female ; Gastrointestinal Stromal Tumors ; Humans ; Middle Aged ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms ; Ulcer

OBJECTIVE: The authors evaluate results of transfacet pedicle sparing approach for high lumbar disc herniation to avoid injury of nerve roots and the cauda equina. METHODS: Seven patients treated by transfacet pedicle sparing approach for high lumbar disc herniation were reviewed. Some thoracolumbar kyphotic patients on whom posterior procedures underwent additional posterior lumbar interbody fusion and posterolateral fusion using the mesh cage and spinal instrumentation. RESULTS: Clinical symptoms improved in all seven patients. Rigid spinal stability and correction of thoracolumbar kyphosis could be performed by the spinal instrumentation methods. CONCLUSION: The advantages of the transfacet pedicle sparing approach are less invasive, easy decompression the nerve root directly and avoidance of the risk of injury to the cauda equina while the dura is being retracted. Additionally, thoracolumbar kyphosis could be corrected. Transfacet pedicle sparing approach is an useful procedure in the surgical treatment of high lumbar disc herniation.
Cauda Equina ; Decompression ; Humans ; Kyphosis

OBJECTIVE: The maintenance of the correction of kyphotic deformity is one of the difficult problem in tuberculous spondylitis after anterior debriment and fusion with tricortical bone graft. The goal of this study is to find out the efficacy of titanium mesh cage impacted with autogenous bone chip in tuberculous spondylitis treated with anterior intervertebral fusion. MATERIALS AND METHODS: Twelve patients were treated with anterior intervertebral fusion using titanium mesh cage for tuberculous spondylitis from January 1996 to June 1999. We analized the changes in the correction of kyphotic deformity, changes of ESR and CRP, fusion state and recurrence after anterior intervertebral fusion with titanium mesh cage. RESULTS: Clinical symptoms were improved in all twelve patients without any neurologic complications. The mean kyphotic angle corrected was 7.3 degrees immediately after operation, but the loss of correction of kyphotic angle was 2.2 degrees after 3 months and 2.6 degrees after 6 months. We found that the loss of correction of kyphotic deformity occurred mainly within the first 3 months after surgery. Only one patient, suffered from acute hepatic failure after first operation and had an insufficient anti-tuberculous medication therapy, showed recurrence of tuberculous spondylitis after 6 months. The patient underwent a second operation with posterior fixation procedure with good outcome. The changes of ESR and CRP were not specifically important factor to reveal recurrence of tuberculosis of the spine in our series. CONCLUSION: The surgical procedure of tuberculous spondylitis using titanium mesh cage with bone chip seems to be an effective procedure to minimize loss of the correction of kyphotic deformity without any aggravating inflammatory change and recurrence with titanium mesh cage, when sufficient debridement and anti-tuberculous chemotherapy are achieved.
Congenital Abnormalities ; Debridement ; Drug Therapy ; Humans ; Liver Failure, Acute ; Recurrence ; Spine ; Spondylitis* ; Titanium* ; Transplants ; Tuberculosis