STUDY DESIGN: Retrospective study. PURPOSE: To investigate influence of bone mineral density (BMD) on the surgical correction of lumbar degenerative kyphosis (LDK). OVERVIEW OF LITERATURE: No studies so far have reported the influence of BMD on the surgical correction of LDK. METHODS: Forty LDK patients with more than 2 years follow-up were studied. Pelvic incidence (PI), pelvic tilt, sacral slope, sagittal vertical axis (SVA), lumbar lordosis (LL), and thoracic kyphosis were measured preoperatively, immediate postoperatively and at final follow-up. Adverse outcomes: proximal adjacent fractures, sagittal decompensation, pseudoarthrosis, and cage subsidence were documented. RESULTS: There were 37 females and 3 males. Average age was 65.1+/-4.5 years and mean follow-up was 34.2+/-16.7 months. 42.5% were Takemitsu type 3 curves, 27.5% type 2, 20.0% type 4 and 10.0% type 1. 37.5% had osteopenia, 40.0% osteoporosis and 22.5% had severe osteoporosis. SVA improved from 237.0+/-96.7 mm preoperatively to 45.3+/-41.8 mm postoperatively (p=0.000). LL improved from 10.5degrees+/-14.7degrees to -40.6degrees+/-10.9degrees postoperatively (p=0.000). At final follow-up SVA deteriorated to 89.8+/-72.2 mm and LL to 34.7degrees+/-15.8degrees (p=0.000). The association between late sagittal decompensation, pseudoarthrosis, or proximal adjacent fractures and osteoporosis was insignificant. The difference between immediate postoperative LL and PI (PIDiff) had a significant association with sagittal decompensation and pseudoarthrosis. CONCLUSIONS: Osteoporosis did not influence the degree of correction, late sagittal decompensation, proximal adjacent fractures, and pseudoarthrosis in LDK. PIDiff had a significant association with sagittal decompensation and pseudoarthrosis.
Animals ; Axis, Cervical Vertebra ; Bone Density* ; Bone Diseases, Metabolic ; Female ; Follow-Up Studies* ; Humans ; Incidence ; Kyphosis* ; Lordosis ; Male ; Osteoporosis ; Pseudarthrosis ; Retrospective Studies

STUDY DESIGN: A retrospective comparative study. PURPOSE: To provide an ideal correction angle of lumbar lordosis (LL) in degenerative flat back deformity. OVERVIEW OF LITERATURE: The degree of correction in degenerative flat back in relation to pelvic incidence (PI) remains controversial. METHODS: Forty-nine patients with flat back deformity who underwent corrective surgery were enrolled. Posterior-anterior-posterior sequential operation was performed. Mean age and mean follow-up period was 65.6 years and 24.2 months, respectively. We divided the patients into two groups based on immediate postoperative radiographs-optimal correction (OC) group (PI-9degrees< or =LL or =55degrees). Radiological and clinical results were analyzed. RESULTS: Patients in OC group had significantly less correction loss and maintained normal sagittal alignment (sagittal vertical axis<5 cm), as compared to patients in UC group (p<0.05). LL of low PI group significantly maintained within 9degrees better than high PI group (p<0.05). Oswestry disability index (ODI) significantly decreased at last follow-up, as compared to preoperative state. However, there was no significant difference in last follow-up ODI between the groups. CONCLUSIONS: In flat back deformity, correction of LL to within 9degrees of PI will result in better sagittal balance. Thus, we recommend sufficient LL to prevent correction loss, especially in patients with high PI.
Animals ; Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Incidence ; Lordosis* ; Retrospective Studies

The benefits of radio-chemotherapy in HIV-negative primary central nervous system (CNS) lymphomas were analyzed in 40 patients, who received radiotherapy to the brain or craniospinal axis with the total dose of 4460-5940 cGy to the primary tumor. Radiotherapy was followed by systemic chemotherapy, mainly with the cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) regimen, in 16 of the patients. Follow-up ranged from four to 95 months with a median of 15 months. The relapse rate was 72.5%, and 83% of the relapses occurred within the radiation field. Median survival was 19 months and the two-year survival rate was 41%. Survival was significantly influenced by treatment method and radiation dose when measured by univariate analysis; median survival and the two-year survival rate was 29 months and 63% after radio-chemotherapy, while 13.5 month and 29% after radiotherapy alone (p= 0.027), and 22 months and 49% with doses of 50 Gy or more, but 12.5 months and 13% with doses less than 50 Gy (p=0.009). However, statistical significance was lost in multivariate analysis. These results might suggest the short-term efficacy of radio-chemotherapy, however, cautious observation is needed to confirm long-term effects.
Adolescence ; Adult ; Aged ; Antineoplastic Agents, Combined/therapeutic use* ; Antineoplastic Agents, Combined/adverse effects ; Bleomycin/administration & dosage ; Central Nervous System Neoplasms/therapy* ; Central Nervous System Neoplasms/mortality ; Cyclophosphamide/administration & dosage ; Disease-Free Survival ; Doxorubicin/administration & dosage ; Epirubicin/administration & dosage ; Female ; Human ; Lymphoma/therapy* ; Lymphoma/mortality ; Male ; Mechlorethamine/administration & dosage ; Methotrexate/administration & dosage ; Middle Age ; Neoplasm Recurrence, Local ; Prednisolone/administration & dosage ; Procarbazine/administration & dosage ; Radiotherapy Dosage ; Radiotherapy, Adjuvant/adverse effects ; Survival Rate ; Treatment Failure ; Vincristine/administration & dosage

PURPOSE: Peripheral T-cell lymphomas(PTCL) show diverse clinical and histological characteristics and should be understood as mixtures of heterogeneous entities. Although many clinical and biological parameters have been proposed for classifying PTCL into different prognostic groups, few parameters have turned out to be appropriate for classification. To investigate the clinical significance of FUO presentation in PTCL, comparisons of clinical parameters were performed using non-FUO presentation as a control. MATERIALS AND METHODS: 66 cases of Korean PTCL were divided into FUO group and non-FUO group according to the presentation and compared with each other. RESULTS: Among 66 patients of PTCL, 19 patients presented with FUO. Compared with non-FUO group, FUO group showed no significant age and sex ratio differences. FUO group showed more advanced stage, worse performance status than non-FUO group. Predominant sites of definite diagnosis were skin, gastrointestinal tract and liver in FUO group and nasal cavity and paranasal sinus in non-FUO group. There were no significant differences between histologic classifications of both groups. Survival analysis revealed significant differences between both groups. FUO group showed significantly shorter survival. Prognostic factor analysis(multivariate) was done with stage, LDH level, performance status, and FUO status. FUO status, stage and performance status were significant determinants of survival, but LDH level proved to have no prognostic implication. CONCLUSION: PTCL with FUO presentation showed such distinct characteristics that the authors propose fever of unknown origin(FUO) as a clinical parameter for classifying PTCL. Further studies are needed to identify biological parameters which characterize PTCL with FUO presentation.
Classification ; Diagnosis ; Fever of Unknown Origin* ; Fever* ; Gastrointestinal Tract ; Humans ; Liver ; Lymphoma* ; Nasal Cavity ; Prognosis ; Sex Ratio ; Skin ; T-Lymphocytes

Despite the overall satisfactory results of total hip arthroplasty, post-operative complications continue to occur. To minimize these problems, computer-assisted total hip arthroplasty using navigation or robot-assisted systems is being developed. A navigation system is defined as a system that locates a position in three-dimensional space and traces the target spot, and a robot-assisted system is defined as a system that performs operations automatically with mechanical robot arms based on prior preoperative planning. Computer-assisted surgeries have shown superior results to conventional methods in implant positioning, fixation, and accurate lower extremity alignment in the limited reports available. However, computer-assisted surgeries take longer compared to conventional methods. Due to the extra time needed, the risk of postoperative infection and blood loss is considered to be higher. Nevertheless, robot-assisted system is being developed for the field of hip arthroplasty, and thus its efficacy and accuracy needs to be further investigated. Since these methods have other advantages compared to conventional methods, they are the focus of much interest.
Arm ; Arthroplasty ; Hip ; Lower Extremity ; Surgery, Computer-Assisted

STUDY DESIGN: A retrospective study. OBJECTIVES: We analyzed the risk factors and relevance of lumbar lordosis on the incidence of adjacent segment disease after posterior lumbar interbody fusion. SUMMARY OF LITERATURE REVIEW: Maintaining lumbar sagittal balance is important for decreasing the incidence of adjacent segment disease after posterior lumbar interbody fusion. MATERIALS AND METHODS: Among the patients who had undergone posterior lumbar interbody fusion of 1 or 2 levels between August 2001 and October 2008, we analyzed 153 patients who were available for at least three years of follow-up; among the subjects, 115 were males and 38 were females. Mean age among the patients at the time of initial surgery was 60.3 (range, 41-82) and mean followup period was 5.6 years (range, 3-11). The causative diseases were spinal stenosis in 78 cases, degenerative spondylolisthesis in 51 cases, isthmic spondylolisthesis in 23 cases, and degenerative disc disease in 1 case. At last follow-up, there were 52 cases (33.9%) of adjacent segment disease. Among them were found 21 cases (40.4%) of disc degeneration, 17 cases (32.7%) of instability, and 14 cases (26.9%) of simultaneous disc degeneration and instability. A total of 10 patients (6.5%) underwent a revision operation, and the mean period from initial to revision operation was 5.5 years (range, 3.1-10.3). We analyzed the correlation between risk factors of adjacent segment disease and the incidence of the disease depending on the gap between lumbar lordosis and pelvic incidence, and compared the clinical results of the 2 groups using modified Whitecloud classification. RESULTS: The incidence of adjacent segment disease was not statistically significant for patient age, sex, BMD, degree of obesity, causative disease, and the level of previous surgery. However, the incidence of adjacent segment disease was statistically higher in patients who had more than 9 degrees gap between lumbar lordosis and pelvic incidence (p=0.013). In our analysis of clinical results, 63.5% of the group of patients who developed adjacent segment disease and 80.2% of the group without adjacent segment disease had good or satisfactory results (p=0.031). CONCLUSIONS: Maintaining lumbar sagittal balance is important for decreasing the incidence of adjacent segment disease after posterior lumbar interbody fusion, and close observation is needed in patients with 9 or more degrees gap between lumbar lordosis and pelvic incidence.
Animals ; Classification ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intervertebral Disc Degeneration ; Lordosis* ; Male ; Obesity ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Spondylolisthesis

It has been well known that the survivors of retinoblastoma are prone to have osteosarcoma. But the secondary tumor usually occurs in bilateral, hereditary type of retinoblastoma. We report one case of osteosarcoma in a survivor of unilateral, sporadic retinoblastoma. A fourteen year old male presented with a painfully swollen distal forearm of 2 month duration. He had enucleated his left eye 10 years ago due to retinoblastoma with no other adjuvant therapy. We managed him with our conventional protocol and identified deletion of Rb gene from his pathological specimen by using the PCR-RFLP method. This result is unusual for unilateral nonhereditable retinoblastoma and may suggest gene level change even in sporadic cases. And Rb gene study may be helpful for unilateral, sporadic retinoblastoma patient in detecting the possibility of late osteosarcoma.
Adolescent ; Base Sequence ; Case Report ; DNA Primers ; *Gene Deletion ; *Genes, Retinoblastoma ; Human ; Magnetic Resonance Imaging ; Male ; Molecular Sequence Data ; Osteosarcoma/complications/*genetics/pathology ; Retinoblastoma/complications/*genetics/pathology ; Support, Non-U.S. Gov't ; Survivors

Granulocytic sarcoma is a localized tumor that's composed of immature cells of the granulocytic series. The tumor may be involved anywhere in the body, but we present here a rare case that involved the gastrointestinal tract (and especially the stomach). Granulocytic sarcoma may represent the initial manifestation of blast transformation or it may herald the onset of acute leukemia from myelodysplastic syndrome. We report here on a case of gastric granulocytic sarcoma in a patient with transformed acute leukemia from myelodysplastic syndrome. A 56-year-old male who was suffering with myelodysplastic syndrome (RARS) for 5 years presented with upper abdominal pain. Gastrofiberoscopy revealed an elevated lesion with central erosion at the posterior wall of the gastric upper body, which histologically proved to be a granulocytic sarcoma. The peripheral blood smear and bone marrow examination showed acute myeloid leukemia.
Abdominal Pain ; Bone Marrow Examination ; Gastrointestinal Tract ; Humans ; Leukemia ; Leukemia, Myeloid, Acute ; Lymphocyte Activation ; Male ; Middle Aged ; Myelodysplastic Syndromes ; Sarcoma ; Sarcoma, Myeloid ; Stress, Psychological

BACKGROUND/AIMS: Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy (R-CHOP) has improved survival in patients with diffuse large B-cell lymphoma (DLBCL) and weakened the prognostic power of the international prognostic index (IPI). We evaluated the efficacy of the IPI and revised IPI (R-IPI) in patients with DLBCL who were treated with R-CHOP, focusing on extranodal site number (ENS) because extranodal involvement occurs frequently in Koreans. METHODS: A total of 126 R-CHOP-treated patients with stage III/IV DLBCL were analyzed. We performed a retrospective analysis of the clinicopathologic factors and verified the predictive power of the standard IPI and R-IPI. Various numbers of extranodal sites were analyzed for further stratification, and we set the extranodal site-modified IPI (E-IPI) as the IPI when the number of extranodal sites was stratified as < 3 vs. > or = 3. RESULTS: A univariate analysis showed that ENS was associated with complete response (CR, p = 0.04), event-free survival (EFS, p = 0.01), and overall survival (OS, p < 0.001) when the ENS cut-off was set at > or = 3. A multivariate analysis revealed that an ENS > or = 3 remained associated with EFS (p < 0.01; hazard ratio [HR], 2.60; 95% confidence interval [CI], 1.29 to 5.26) and OS (p < 0.01; HR, 3.52; 95% CI, 1.68 to 7.35). The IPI was effective for determining prognosis in terms of OS (p = 0.04) but not EFS (p = 0.17). The R-IPI was effective in terms of both variables (p = 0.02 and 0.04, respectively), as was the E-IPI (p = 0.01 and 0.001, respectively). CONCLUSIONS: An ENS < 3 vs. > or = 3, rather than the original < 2 vs. > or = 2, was the most significant prognostic factor for EFS and OS. All three indices were predictive, but only the E-IPI identified the high-risk group of R-CHOP-treated Korean patients with disseminated DLBCL.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal/*administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/*administration & dosage ; Cyclophosphamide/administration & dosage ; Doxorubicin/administration & dosage ; Female ; Humans ; Korea ; Lymphoma, Large B-Cell, Diffuse/*drug therapy/*pathology ; Male ; Middle Aged ; Prednisone/administration & dosage ; Prognosis ; Retrospective Studies ; Vincristine/administration & dosage ; Young Adult

OBJECTIVE: Neurologic complications during carotid artery stenting (CAS) are usually associated with distal embolic event. These embolic incident during CAS are highly associated with the carotid plaque instability. The current study was undertaken to identify the angiographic characteristics of carotid plaque vulnerability, which was represented as filling defect in the cerebral protection filters during CAS. METHODS: A total of 107 patients underwent CAS with use of a distal protection filter. Angiographic carotid plaque surface morphology was classified as smooth, irregular, and ulcerated. To determine predictable factors of filling defect in the protection filters, 11 variables were retrospectively analyzed which might influence filling defect in the protection filters during CAS. RESULTS: Filling defects during CAS were presented in the 33 cerebral protection filters. In multivariate analysis, angiographic ulceration [odds ratio (OR), 6.60; 95% confidence interval (CI) : 2.24, 19.4; p=0.001], higher stenosis degree (OR, 1.06; 95% CI : 1.00, 1.12; p=0.039), and coexistent thrombus (OR, 7.58; 95% CI : 1.69, 34.05; p=0.08) were highly associated with filling defect in the cerebral protection devices during CAS. Among several variables, angiographic surface ulceration was the only significant factor associated with flow stagnation during CAS (OR, 4.11; 95% CI : 1.33, 12.72; p=0.014). CONCLUSION: Plaque surface morphology on carotid angiography can be a highly sensitive marker of plaque instability during CAS. The independent risk factors for filling defect in the filter devices during CAS were plaque ulceration, stenosis degree, and coexistent thrombus.
Angiography ; Carotid Arteries ; Constriction, Pathologic ; Humans ; Multivariate Analysis ; Plaque, Atherosclerotic ; Retrospective Studies ; Risk Factors ; Stents ; Thrombosis ; Ulcer