BACKGROUND: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. METHODS: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. RESULTS: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. CONCLUSIONS: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

Thromboembolism is one of the major complications during coil embolization of an aneurysm, which usually causes familiar neurological deficits, such as, weakness, aphasia, etc. We report a rare complication by thromboembolism after coil embolization causing hemiballism. A 69-year-old female presented with unruptured posterior communicating artery aneurysm and was treated by coil embolization. After the procedure, the patient showed global aphasia and right hemiparesis, and there were small multiple, scattered infarctions on the left middle cerebral artery territory. The neurologic deficit subsided after five days, but hemballism occurred thereafter. There was no other medical history to explain the hemiballism. The patient was treated with clonazepam and antiepileptics and the hemiballism subsided at postoperative day 20. We report a case of rare complication, hemiballism, during coil embolization.

Endoluminal reconstruction of an intracranial aneurysm using flow-diverting devices, such as the pipeline embolization device (PED), is a new treatment modality with good clinical outcomes. The device was originally indicated for challenging cases, such as wide-necked large or giant aneurysms, and is gaining popularity as a reliable treatment for nearly all intracranial aneurysms. The overall complication rate of flow-diverting devices use is 17.0%, including occlusion of side-branching or perforating arteries, rerupture of the aneurysm, in-stent thrombosis, and, rarely, stent migration. We report a rare complication of the PED: delayed migration of the PED after successful stent implantation during treatment of an unruptured vertebral artery dissecting aneurysm, which resulted in rupture of the aneurysm. Further, we discuss technical steps that can be taken to prevent this potential complication.

Eleven patients with uric acid nephrolithiasis(Five with uric acid stones alone and six with both uric acid and calcium stone) underwent long-term treatment(0.5 to 3.75 years, mean of 2.33 years) with potassium citrate(30 to 80 mEq/day. usually 60mEq/day). Urinary pH increased from low(5.0-6.0) to normal(6.5-7.0) during treatment. Urinary content of uric acid which was 584+/-150 mg, day. slightly increased to 595+/-163 mg/day following treatment. Serum content of uric acid which was 6.45+/-0.9 mg%, slightly decreased to 6.1+/-0.8 mg%. The protein matrix was round in all 11 cases. And 4 types of nucleus were found. which were ca. oxalate, ca. phosphate, dried blood and suture material During the period' (Jan. 1987-Mar. 1990) of preventive management(enough fluid intake. restiction of animal protein and Polycitra-K), no new stones were found.
Animals ; Calcium ; Humans ; Hydrogen-Ion Concentration ; Nephrolithiasis* ; Potassium Citrate* ; Potassium* ; Sutures ; Uric Acid*

PURPOSE: Anaplastic thyroid cancer (ATC) is rare and has a poor prognosis. The aim of this study was to analyze the clinicopathologic characteristics of patients diagnosed with ATC expected to undergo curative thyroidectomy, with the goal of finding differences between patients surviving > or =6 months and <6 months. METHODS: From 1981 to 2010, 24 patients underwent thyroidectomy due to ATC. Among those patients, 12 suspected of distant metastasis preoperatively were excluded. The remaining 12 patients were analyzed by retrospective review of electronic medical records. RESULTS: Median age was 55 years, and the male to female ratio was 1:5. All patients presented with neck mass at initial diagnosis. Five patients lived <6 months and seven patients lived > or =6 months after operation. In patients surviving > or =6 months, all lesions were <5 cm and all patients underwent total thyroidectomy. In patients surviving <6 months, two of the four lesions were >5 cm, and two of the five patients underwent less than total thyroidectomy (P = 0.287 and 0.152, respectively). All patients with lesion size <5 cm underwent total thyroidectomy and showed a shorter median operation time (P = 0.182 and 0.033, respectively). CONCLUSION: ATC showed female predominance. Patients initially presented with neck mass, and median age was 55 years. In patients with ATC who are expected to undergo curative thyroidectomy, surgery should actively be considered as primary therapy for patient survival when the size is <5 cm.
Electronics ; Electrons ; Female ; Humans ; Male ; Neck ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

OBJECTIVE: Transfemoral catheter angiography (TFCA) is a basic procedure in neurovascular surgery with increasing importance in surgical and non-invasive treatments. Unfortunately, resident neurosurgeons have relatively few opportunities to perform TFCA in most institutions. We report a method developed in our hospital for training resident neurosurgeons to perform TFCA and evaluate the efficacy of this training. METHODS: From May 2011 to September 2011, a total of 112 consecutive patients underwent TFCA by one resident neurosurgeon supervised by two neuroendovascular specialists. Patients who underwent elective diagnostic procedures were included in this study. Patients who underwent endovascular treatment were excluded. Demographic data, indications for TFCA, side of approach, number of selected arteries, and complications were analyzed. RESULTS: This study included 64 males and 48 females with a mean age of 51.6 (12-81) years. All procedures were performed in the angiography suite. Common indications for procedures were as follows: stroke-induced symptoms in 61 patients (54.5%), Moyamoya disease and arteriovenous malformation in 13 patients (11.6%), and unruptured intracranial aneurysm in eight patients (7.1%). Right and left femoral puncture was performed in 98.2% and 1.8% of patients, respectively. A total of 465 selective angiographies were performed without complications. Angiographic examination was performed on 4.15 vessels per patient. CONCLUSION: TFCA can be performed safely by resident neurosurgeons based on anatomical study and a meticulous protocol under the careful supervision of neuroendovascular specialists.
Angiography ; Arteries ; Arteriovenous Malformations ; Catheters ; Cerebral Angiography ; Female ; Humans ; Internship and Residency ; Intracranial Aneurysm ; Male ; Moyamoya Disease ; Organization and Administration ; Punctures ; Specialization

OBJECTIVE: To present the profiles of spinal cord tumors that can be removed through a unilateral hemilaminectomy and to demonstrate its usefulness for benign spinal cord tumors that significantly occupy the spinal canal. METHODS: From June 2004 to October 2010, 25 spinal cord tumors were approached with unilateral hemilaminectomy. We calculated the cross-sectional occupying ratio (CSOR) of tumor to spinal canal before and after the operations. RESULTS: The locations of the tumors were intradural extramedullary in 20 cases, extradural in 2, and intramedullary in 3. The levels of the tumors were lumbar in 12, thoracic 9, and cervical 4. In all cases, the tumor was removed grossly and totally without damaging spinal cord or roots. The mean height and width of the lesions we195re 17.64 mm (3-47.5) and 12.62 mm (4-32.7), respectively. The mean CSOR was 69.40% (range, 27.8-96.9%). Postoperative neurological status showed improvement in all patients except one whose neurologic deficit remained unchanged. Postoperative spinal stability was preserved during the follow-up period (mean, 21.5 months) in all cases. Tumor recurrence did not develop during the follow-up period. CONCLUSION: Unilateral hemilaminectomy combined with microsurgical technique provides sufficient space for the removal of diverse spinal cord tumors. The basic profiles of the spinal cord tumors which can be removed through the unilateral hemilaminectomy demonstrate its role for the surgery of the benign spinal cord tumors in various sizes.
Follow-Up Studies ; Humans ; Laminectomy ; Microsurgery ; Neurologic Manifestations ; Recurrence ; Spinal Canal ; Spinal Cord ; Spinal Cord Neoplasms*

PURPOSE: Most treatment decisions for breast cancer patients are based on an assesment of prognostic factors. Tumor markersB (p53, c-erbB2, bcl-2, Cathepsin D) have been evaluated for their prognostic factors and many studies suggest that these factors as assessed by immunohistochemistry (IHC) may be helpful for treatment decisions, while the risk group for high relapse can not be discriminated by single tumor marker alone. In order to obtain useful prognostic information, several tumor marker expressions must be combined and weighted. METHODS: The expressions of ER, PR, p53, c-erbB2, bcl-2, Cathepsin D were detected by IHC on paraffin-embedded sections from 449 primary breast cancer patients treated at Seoul National University Hospital between January 1996 and December 1998. In the present study, tumor marker expressions were analyzed along with conventional clinicopathologic factors. Additionally, correlations between various tumor marker expressions were examined and combinations of tumor marker expressions relating pathologic parameters currently in use for primary breast cancer prognosis were investigated. RESULTS: ER, PR, bcl-2, Cathepsin D expressions were related to smaller tumor size and PR was related to less axillary nodal involvement. ER, PR, bcl-2 expressions were related to good NG and HG, while p53 expression wasrelatedto poor NG and HG. ER and PR expression were related to bcl-2 expression, c-erbB2 expression was related to p53 expression and c-erbB2 expression was related to Cathepsin D expression. ER /bcl-2 was more prevalent in NG 1 and HG III tumors. ER /p53 and p53 /bcl-2 were more prevalent in NG 2/3 and HG I/II tumors. p53 /c-erbB2 was more prevalent in NG 1 tumors. CONCLUSION: Combinations of tumor marker expressions ER/bcl-2, ER/p53, p53/c-erbB2, p53/bcl2 provides more detailed information concerning cancer aggressiveness.
Breast Neoplasms* ; Cathepsin D* ; Cathepsins* ; Equidae ; Humans ; Immunohistochemistry ; Prognosis ; Recurrence ; Seoul

BACKGROUND: The histopathological classification of an invasive breast carcinoma in its earliest phases is fraught with pitfalls. We wanted to clarify the biology and the clinicopathological features of a microinvasive carcinoma, which are not fully understood, by comparing then with those of an in-situ cancer. Particular attention was paid to identifying the novel markers which might be representative of a microinvasive carcinoma. METHODS: From January 1986 to December 1996, a total of 72 microinvasive carcinomas, defined as in-situ carcinomas with invasion present in less than 10% of the histological section, were found. Their paraffin blocks were chosen for immunohistochemical staining against four molecules. RESULTS: Microinvasive carcinomas had a greater primary-tumor size (2.66+/-0.17 cm vs 2.21+/-0.19 cm, p=0.045) and a larger number of metastatic axillary nodes (0.21+/-0.25 vs 0.06+/-0.16, p=0.019) than DCIS (Ductal carcinoma in situ). In terms of nuclear grade (p=0.198) and comedo type (p=0.562), there were no statistical significances between microinvasive carcinomas and DCIS. Among three primary- tumor features (size, comedo component, and nuclear grade), a tumor size> or =2.5 cm had a marginal significance affecting the incidence of axillary-node metastasis in microinvasive carcinomas (p=0.081). Of the investigational prognostic factors determined by using immunohistochemical staining, p53 expression was observed more frequently in microinvasive tumors than in DCIS (p=0.031). CONCLUSION: A microinvasive carcinoma is thought to be transitional disease entity between the in-situ to the invasive forms. In spite of the marginal statistical significance of the result a microinvasive carcinoma larger than 2.5 cm could be an indication for axillary-node dissection. In addition, p53 mutation might play an important biological role in the progression from a noninvasive to an invasive form. Also the results provide further evidence that p53 mutation might have potential use as a molecular marker.
Biology ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Classification ; Incidence ; Neoplasm Metastasis ; Paraffin

OBJECTIVE: To evaluate the morphometry of the anterior thalamoperforating arteries (ATPA). METHODS: A microanatomical study was performed in 79 specimens from 42 formalin-fixed adult cadaver brains. The origins of the ATPAs were divided into anterior, middle, and posterior segments according to the crowding pattern. The morphometry of the ATPAs, including the premammillary artery (PMA), were examined under a surgical microscope. RESULTS: The anterior and middle segments of the ATPAs arose at mean intervals of 1.75+/-1.62 mm and 5.86+/-2.05 mm from the internal carotid artery (ICA), and the interval between these segments was a mean of 3.17+/-1.64 mm. The posterior segment arose at a mean interval of 2.43+/-1.46 mm from the posterior cerebral artery (PCA), and the interval between the middle and posterior segments was a mean of 3.45+/-1.39 mm. The mean numbers of perforators were 2.66+/-1.19, 3.03+/-1.84, and 1.67+/-0.98 in the anterior, middle, and posterior segments, respectively. The PMA originated from the middle segment in 66% of cases. A perforator-free zone was located >2 mm from the ICA in 30.4% and >2 mm from the PCA in 67.1% of cases. CONCLUSION: Most perforators arose from the anterior and middle segments, within the anterior two-thirds of the posterior communicating artery (PCoA). The safest perforator-free zone was located closest to the PCA. These anatomical findings may be helpful to verify safety when treating lesions around the PCoA and in the interpeduncular fossa.
Adult ; Arteries* ; Brain ; Cadaver ; Carotid Artery, Internal ; Crowding ; Humans ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery