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.

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.

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.

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: To determine the clinical feature, surgical management of primary and recurrent disease, predictive factors for outcome, and impact of multimodality therapy in retroperitoneal sarcoma. MATERIALS AND METHODS: 60 patients were confirmed pathologically as soft-tissue sarcoma of the retroperitoneum by operation or needle biopsy in Seoul National University Hospital from 1983 to 1995. A retrospective analysis was performed. RESULTS: The abdominal mass was common presenting symptom. Histologically liposarcomas(25%) and leiomyosarcomas(23.3%) were most common, and MFHs(11.7%) and malignant schwannomas(11.7%) followed. The overall 5 year survival rate was 54.6%. Complete resection was possible in 51.7% of patients and strongly predicts outcome (<0.0001). These patients had a median survival of 130 months compared to 20 months for those undergoing partial resection and 9 months for those with unresectable tumors. 11(35%) of completely resected patients have had local recurrence. These patients underwent reoperation when feasible. Complete resection of recurrent disease was performed in 10 patients(90%), with a 42 months median survival time after reoperation. Resection of adjacent organ was performed in 19 patients. 14 of these were completely resected, and showed 100% of 5 year survival rate. Tumor grade was not a significant predictor of outcome. Gender, histologic type, encapsulation, stage, resectability, combined resection were significant prognostic factors by univariate analysis. But resectability was only independent prognostic factor on mutivariate analysis. Radiation therapy and chemotherapy could not be shown to have significant impact on survival. CONCLUSION: Complete resection is the most important prognostic factor of retroperitoneal sarcoma. Extensive and aggressive surgery must be considered including resection of adjacent organs. Multiple resection seems to improve survival in recunent cases.
Biopsy, Needle ; Drug Therapy ; Humans ; Recurrence ; Reoperation ; Retrospective Studies ; Sarcoma* ; Seoul ; Survival Rate

PURPOSE: Primary aldosteronism due to an adrenal cortical adenoma is a surgically curable disease. However, hypertension is known to persist postoperatively in many patients. The aim of this study was to determine the factors influencing the long-term outcome of blood pressure after an adrenalectomy for a primary aldosteronism and to evaluate the changing pattern of renin and aldosterone. METHODS: Forty-two cases of primary aldosteronism, which were operated on and followed up at the Department of Surgery, Seoul National University Hospital from January 1986 to June 2001 were included in this study. The subjects were classified into a normotensive group and a hypertensive group and the two groups were compared according to the clinical, biochemical and pathological parameters. RESULTS: After surgery, the aldosterone concentration was decreased and the plasma renin activity was increased. During a mean follow-up period of 28 months, 31 patients (73.8%) had a normal blood pressure without an antihypertensive treatment. The significant risk factors for persistent hypertension were a family history of hypertension, a long duration of preoperative hypertension, a poor response of preoperative spironolactone. The hypertensive group had a higher level of postoperative plasma renin activity and an aldosterone concentration in the long-term follow-up period after surgery. CONCLUSION: A family history of hypertension, the duration of hypertension and the response to spironolactone were factors influencing persistent hypertension after surgery for a primary aldosteronism. A high level of plasma renin activity and aldosterone during the follow-up period is related to the persistent hypertension. Therefore, early detection and surgery for a primary aldosteronism would reduce the preoperative cardiovascular changes and improve the postoperative outcome.
Adrenalectomy ; Adrenocortical Adenoma ; Aldosterone ; Blood Pressure ; Follow-Up Studies ; Humans ; Hyperaldosteronism* ; Hypertension ; Plasma ; Renin ; Risk Factors ; Seoul ; Spironolactone

PURPOSE: A medullary carcinoma of the breast (MC) is a well-circumscribed tumor composed of poorly differentiated cells growing in a syncytium with an accompanying stroma. However, the prognosis of a MC is considered as more favorable than that of an infiltrating ductal carcinoma (IDC). In the present study, we characterized MC in terms of prognosis by comparing a MC group with an IDC control group. We describe the distribution of other clinicopathological characteristics, as well as the prevalence and the prognostic importance of generally well known risk factors, for breast cancer and compare the results. METHODS: Clinical data from hospital records and pathological materials were available from 60 patients with tumors that had been initially diagnosed from Jan. 1981 to Dec. 1999 at the Department of Surgery in Seoul National University Hospital as having a MC. We analyzed the survival and the prognostic factors of those patients and compared the results with those for an IDC control group. RESULTS: The 60 cases of MC showed more risk factors, such as young age, high nuclear grade, poor histologic grade, negative hormone receptors, p53 overexpression, c-erb-B2 expression, and high proliferative index (Ki 67), than the IDC cases did. However, the prognosis of MC was better than that of IDC. Most of the risk factors were of highly significant prognostic importance in the IDC control group. In the MC group, only lymph-node status and young age were significantly important for disease-free survival. CONCLUSION: We found MC to be biologically unique, and patients with MC have a better prognosis than those with IDC. We propose that MC patients with axillary lymph-node metastasis and young age be considered as a high-risk group for recurrence.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Medullary ; Disease-Free Survival ; Giant Cells ; Hospital Records ; Humans ; Neoplasm Metastasis ; Prevalence ; Prognosis ; Recurrence ; Risk Factors ; Seoul