PURPOSE: The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. METHODS: We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection <8 weeks (group A, n = 105) to those who had surgery > or =8 weeks (group B, n = 48) after neoadjuvant CRT. RESULTS: Of 153 patients, 117 (76.5%) were male and 36 (23.5%) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7% vs. group B, 77.6%; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8% vs. group B, 14.3%; P = 0.068). A total of 111 (group A, 75 [71.4%] and group B, 36 [75%]) patients were downstaged and 26 (group A, 17 [16.2%] and group B, 9 [18%]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7% vs. group B, 66.7%; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. CONCLUSION: It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.
Chemoradiotherapy ; Disease-Free Survival ; Female ; Humans ; Male ; Neoadjuvant Therapy ; Polymerase Chain Reaction ; Postoperative Complications ; Preoperative Period ; Rectal Neoplasms ; Recurrence

Spinal dural arteriovenous fistulas are rare abnormal connections of artery and vein within the dura, at the level of the intervertebral foramen. A 57-year-old male developed weakness in both lower extremities and sphincteric dysfunction, which had stepwisely, progressive and fluctuating course since 6 months ago. He showed areflexia in both ankle & right knee. T-spine MRI showed high signal intensity with ill defined margin in T2WI and intensely enhanced by con-trast agent through lower thoracic and lumbosacral spinal cord. Selective spinal angiography revealed a dural arteriove-nous fistula with a nidus at thoracolumbar vertebral level, supplied by the internal iliac artery and enlarged medullary veins. Superselective angiographic embolization was done. Clinically, his symptoms has been ameliorated. We report a rare case of thoracic myelopathy due to spinal dural arteriovenous fistulas exclusively supplied by the branches of internal iliac artery.
Angiography ; Ankle ; Arteries ; Central Nervous System Vascular Malformations* ; Fistula ; Humans ; Iliac Artery* ; Knee ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord ; Spinal Cord Diseases* ; Veins

BACKGROUND: Decreased activities of daily living (ADL) in elderly people are related to decreased quality of life and death and are a clinically important issue. However, few studies have investigated the various characteristics and risk factors for a decline in ADL among elderly in-patients in geriatric hospitals in Korea. METHODS: In total, 163 elderly in-patients with dementia in three geriatric hospitals located in Incheon, Gwangju and Yongin, Korea were surveyed prospectively for associated factors of a decline in ADL after 6 months. RESULTS: On average, the subjects were 79.4+/-7.6 years old, and 67.5% were female. Approximately 63% had Alzheimer type dementia, 36.8% only attended primary school, 73.0% were widowed, and 38.7% had been admitted to hospitals for less than 1 year. The Korean version of the Mini Mental State Examination (K-MMSE) score was 14.1+/-6.5, and the clinical dementia rating was 1.9+/-0.9. In total, 8.6% were bed-ridden and 59.5% and 64.6% had never experienced fecal and urinary incontinence, respectively. Total ADL scores declined after 6 months follow-up, and significantly associated factors were low K-MMSE score, fecal incontinence, and co-existence of fecal and urinary incontinence. CONCLUSION: Low K-MMSE scores, fecal incontinence, and the co-existence of fecal and urinary incontinence were associated with ADL declines in elderly in-patients with dementia in long-term care hospitals located in three cities in Korea.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Dementia ; Fecal Incontinence ; Female ; Follow-Up Studies ; Humans ; Korea ; Long-Term Care ; Prospective Studies ; Quality of Life ; Risk Factors ; Urinary Incontinence ; Widowhood

PURPOSE: Sometimes chronic subdural hematoma can be developed following posttraumatic subdural hygroma. The purpose of this study is to investigate its incidence, the duration required for their conversion, and characteristic CT and MR findings of subdural hygroma and chronic subdural hamatoma. MATERIALS AND METHODS: We studied 8 patients with persistent posttraumatic subdural hygroma which consquently developed chronic subdural hamatoma. The patients were examined with CT initially and foilowed-up with CT in 3 and MR in 5. We analyzed the location of the lesion, the change of the density or signal intensity, the change of the size, and the degree of enhancement and mass effect. RESULTS: The duration required for the formation of hematoma was 48-166 days (mean, 76 days). The characteristic CT findings of subdural hygroma were a crescentric lesion with CSF density along the inner table without contrast enhancement. The mass effect was minimal. The CT findings of chronic subdural hematoma were higher density than that of hygroma in all cases, increase in thickness and size in 3 cases, and contrast enhancement along the inner membrane of the hematoma in 5 cases. The signal intensities of the subdural hygroma were identical to those of CSF on both T1 and T2 weighted images, whereas, those of chronic subdural hematoma were higher. CONCLUSION: The increased signal intensity on T1 weighted MR images and increased attenuation or contrast enhancement of the lesion on CT may suggest the conversion of subdural hygroma into chronic subdural hematoma.
Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Lymphangioma, Cystic ; Membranes ; Subdural Effusion*

OBJECTIVE: To translate the MD Anderson Dysphagia Inventory (MDADI) which is a self-administered questionnaire that assesses effect of dysphagia on the quality of life for patients with head and neck cancer, into Korean and to verify the validity and reliability of the Korean version of MDADI. METHODS: We performed 6 steps for the cross-cultural adaptation which consisted of translation, synthesis, back translation, review by an expert committee, cognitive debriefing, and final proof reading. A total of 34 dysphagia patients with head and neck cancers from Seoul National University Hospital answered the translated version of the questionnaire for the pre-testing. The patients answered the same questionnaire 2 weeks later to verify the test-retest reliability. RESULTS: One patient was excluded at second survey because he changed his feeding strategy. Overall, 33 patients completed the study. Linguistic validations were achieved by each step of cross-cultural adaptation. We gathered statistically strong construct validity (Spearman rho for subdomain scores to total score correlation range from 0.852 to 0.927), internal consistency for subdomains (Cronbach's alpha coefficients range from 0.785 to 0.889) and test-retest reliability (intra-class correlation coefficient range from 0.820 to 0.955) CONCLUSION: The Korean version of the MDADI achieved linguistic validations and demonstrated good construct validity and reliability. It can be a useful tool for screening and treatment planning for the dysphagia of patients with head and neck cancers.
Deglutition Disorders ; Head ; Head and Neck Neoplasms ; Humans ; Linguistics ; Mass Screening ; Neck ; Quality of Life ; Reproducibility of Results ; Surveys and Questionnaires

No abstract available.
Postural Orthostatic Tachycardia Syndrome* ; Syncope

BACKGROUND: It is not possible to measure how much activity is required to understand and code a medical data. We introduce an assessment method in clinical coding, and applied this method to neurosurgical terms. METHODS: Coding activity consists of two stages. At first, the coders need to understand a presented medical term (informational activity). The second coding stage is about a navigating terminology browser to find a code that matches the concept (code-matching activity). Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT) was used for the coding system. A new computer application to record the trajectory of the computer mouse and record the usage time was programmed. Using this application, we measured the time that was spent. A senior neurosurgeon who has studied SNOMED CT has analyzed the accuracy of the input coding. This method was tested by five neurosurgical residents (NSRs) and five medical record administrators (MRAs), and 20 neurosurgical terms were used. RESULTS: The mean accuracy of the NSR group was 89.33%, and the mean accuracy of the MRA group was 80% (p=0.024). The mean duration for total coding of the NSR group was 158.47 seconds, and the mean duration for total coding of the MRA group was 271.75 seconds (p=0.003). CONCLUSION We proposed a method to analyze the clinical coding process. Through this method, it was possible to accurately calculate the time required for the coding. In neurosurgical terms, NSRs had shorter time to complete the coding and higher accuracy than MRAs.

BACKGROUND: It is not possible to measure how much activity is required to understand and code a medical data. We introduce an assessment method in clinical coding, and applied this method to neurosurgical terms.METHODS: Coding activity consists of two stages. At first, the coders need to understand a presented medical term (informational activity). The second coding stage is about a navigating terminology browser to find a code that matches the concept (code-matching activity). Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT) was used for the coding system. A new computer application to record the trajectory of the computer mouse and record the usage time was programmed. Using this application, we measured the time that was spent. A senior neurosurgeon who has studied SNOMED CT has analyzed the accuracy of the input coding. This method was tested by five neurosurgical residents (NSRs) and five medical record administrators (MRAs), and 20 neurosurgical terms were used.RESULTS: The mean accuracy of the NSR group was 89.33%, and the mean accuracy of the MRA group was 80% (p=0.024). The mean duration for total coding of the NSR group was 158.47 seconds, and the mean duration for total coding of the MRA group was 271.75 seconds (p=0.003).CONCLUSION: We proposed a method to analyze the clinical coding process. Through this method, it was possible to accurately calculate the time required for the coding. In neurosurgical terms, NSRs had shorter time to complete the coding and higher accuracy than MRAs.
Animals ; Clinical Coding ; Humans ; Medical Informatics ; Medical Record Administrators ; Methods ; Mice ; Neurosurgeons ; Systematized Nomenclature of Medicine

PURPOSE: To obtain spatial information on the acetabular fossa concerning `transacetabular screw' insertion through the acetabular fossa parallel to the quadrilateral surface for fixing an acetabular fracture. MATERIALS AND METHODS: Each hemipelvis harvested from 25 adult fresh frozen cadavers was sectioned into eight segments. This resulted in seven measuring points located along the outer margin of the acetabular fossa. At these points, we measured and compared the vertical thicknesses of cartilage and bone from the quadrilateral surface. RESULTS: The average thickness of the thinnest portion of the acetabular fossa floor was 3.9+/-1.9 mm. The entire thickness of the bone and cartilage measured vertically from the quadrilateral surface at the 7 points ranged from 12.7+/-2.1 mm to 17.8+/-3.8 mm. The thinnest safe space of exposed threads of the `transacetabular screw' inserted through the acetabular fossa was consistently just below the posterior conus of the lunate surface, measuring 4.8+/-1.6 mm (p<0.05). At the other points, it measured 8.3-10.8 mm. CONCLUSION: We suggest that `transacetabular screws' can be inserted safely if due consideration is paid to the spatial characteristics of on the acetabular fossa. Screw insertion into the postero-inferior portion of the acetbular fossa should be done carefully.
Acetabulum* ; Adult ; Cadaver ; Cartilage ; Conus Snail ; Humans

Background: Isolated polyethylene insert exchange (IPIE) has not been established as a treatment option for hyperextension instability after primary total knee arthroplasty (TKA). The purpose of the study was to evaluate the survival rate and clinical outcomes of IPIE for the treatment of instability with or without hyperextension after TKA. Methods: This study retrospectively reviewed 46 patients who underwent IPIE for symptomatic prosthetic knee instability by dividing them into 2 groups based on the presence of hyperextension (without for group I and with for group IH). Patient demographics, clinical scores, radiographic data, range of motion (ROM), and surgical information were collected. Clinical failure was defined as a subsequent surgery following IPIE for any reason. The survival rate of IPIE and differences in demographics, clinical scores, and ROM were compared. Results: There were 46 patients (91% were women) with an average age of 70.1 years and a mean follow-up of 44.8 months. The average time between primary TKA and IPIE surgery was 6.5 ± 4.2 years, and during IPIE, 2 out of the 8 cruciate-retaining inserts were converted to “deep-dish“ ultracongruent inserts while the insert thickness increased from 11.9 ± 1.8 mm to 17.1 ± 3.1 mm. After IPIE surgery, a significantly thicker tibial insert was used in the group with hyperextension (15.39 ± 2.4 mm for group I, 18.3 ± 2.9 mm for group IH; p < 0.001 by independent t-test), and no significant differences were observed in the ROM and clinical scores before and after IPIE between the 2 groups. The overall survival rate for IPIE was 83% at 5 years and 57% at 10 years, and there were no statistically significant differences between the groups using the Cox proportional hazards regression model. Conclusions IPIE demonstrated an overall survival rate of 83% at 5 years with no difference in the recurrence of instability regardless of hyperextension. This study highlighted the effectiveness of using thicker inserts to resolve instability without significant differences in the ROM or clinical scores between the groups, suggesting its potential as a decision-making reference for surgeons.