OBJECTIVE: This retrospective study aimed to compare clinical outcomes in terms of pain relief and recurrence rate between fragmentectomies and conventional microdiscectomies in patients with lumbar disc herniation (LDH). METHODS: Between January 2008 and May 2011, a total of 175 patients met the inclusion criteria of this study. The visual analogue scale (VAS) scores of back and radicular pains were recorded before surgery, 2 and 6 weeks after surgery. Recurrence was defined when a patient had the same pattern of preoperative symptoms and was confirmed with magnetic resonance imaging. RESULTS: Seventy-four patients (42.3%) were suitable for fragmentectomy, and 101 patients underwent conventional microdiscectomy. There were no significant differences in VAS scores between the fragmentectomy and conventional microdiscectomy groups 2 and 6 weeks after surgery. During the follow-up period, 3 patients (4.05%) in the fragmentectomy group and 7 patients (6.93%) in the conventional microdiscectomy group relapsed. CONCLUSION: If patients are selected according to well-defined criteria, fragmentectomy can be a good surgical option for LDH, in the physiological aspect of preserving healthy intervertebral disc materials.
Follow-Up Studies ; Humans ; Intervertebral Disc ; Magnetic Resonance Spectroscopy ; Recurrence ; Retrospective Studies

Hypoplasia of the internal carotid artery is a rare congenital anomaly. Agenesis, aplasia, and hypoplasia of the internal carotid artery (ICA) are frequently associated with cerebral aneurysms in the circle of Willis. Authors report two cases with congenital hypoplasia of the ICA accompanying with the aneurysms. Transfemoral cerebral angiography (TFCA) in one patient identified nonvisualization of the left ICA. Bilateral anterior cerebral artery (ACA) and middle cerebral artery (MCA) were supplied from the right ICA accompanying with two aneurysms at anterior communicating artery (AcoA) and A1 portion of the left ACA. TFCA in another patient demonstrated hypoplastic left ICA and left ACA filled from the right ICA accompanying with AcoA aneurysm. Left MCA was filled from basilar artery via posterior communicating artery (PcoA). Skull base computed tomography (CT) in two patients showed hypoplastic carotid canal. Authors performed direct aneurysmal neck clipping. Follow up CT angiography (CTA) at one year after surgery did not show regrowth or new development of the aneurysm. In patients with hypoplastic ICA, neurosurgeons should be aware of the possibility of development of the aneurysms, presumably because of hemodynamic process. Direct aneurysmal neck clipping is a good treatment modality. After operation, regular CTA, magnetic resonance angiography (MRA) or TFCA is needed to find progressive lesion and to prevent cerebrovascular attack (CVA).
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Basilar Artery ; Carotid Artery, Internal* ; Cerebral Angiography ; Circle of Willis ; Follow-Up Studies ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Angiography ; Middle Cerebral Artery ; Neck ; Skull Base

PURPOSE: A spinal cord partial block technique (PBT) with dynamic multileaf collimator (dMLC) for the reduction of the spinal cord dose while keeping the tumor dose unchanged has been developed and its effectiveness has been examined. MATERIALS AND METHODS: Conventional 3-D conformal therapy treatment plan is deigned prior to the PBT application. Beam parameters such as, number of beams, beam directions were determined during 3-D conformal therapy planning process. The shape and the weight of the partial block for optimizing the dose distribution are designed with the forward intensity modulated radiation therapy (fIMRT). Eight cases of lung cancer, in which it was found to be impossible to deliver enough doses to targets with the conventional technique because the doses of the normal lungs or the spinal cords were over the tolerance limit, are used to verify the usefulness of this technique. Comparison of the dose volume histogram (DVH) is performed to compare the treatment plan. RESULTS: PBT plan cauld reduce the maximum dose to the spinal cord up to 29.7% and the mean dose to the lungs up to 11.1%. CONCLUSION: All of the cases showed that the PBT plans are better than the conventional 3-D plans and the spinal cord doses or the normal lung doses can be reduced to tolerance limit
Lung Neoplasms* ; Lung* ; Spinal Cord

OBJECTIVE: Unilateral facet dislocation of the cervical spine occurs by flexion and rotation injuries and cannot be easily reduced by axial traction. We analyzed 14 consecutive patients with unilateral facet dislocation of the cervical spine to increase knowledge about anatomical reduction of locked facet and factors for successful reduction. METHODS: Fourteen patients (10 men and 4 women) with unilateral facet dislocation of the cervical spine were retrospectively analyzed. Plain X-ray, computerized tomography scan, and magnetic resonance imaging were performed. All patients underwent manual reduction and surgery with anterior interbody fusion and plate fixation. The manual reduction was performed by neck flexion and rotation to the opposite side of dislocation, followed by rotation and flexion of the head toward the side of dislocation and extension with relaxation of traction. Mean follow-up period was 17 months. The level of spine, amount of subluxation, combined facet fracture, and time from injury to initial reduction were analyzed using the data obtained from medical records. RESULTS: Thirteen (93%) patients were reduced successfully. Immediate reduction was achieved in 7 patients but failed in 7 patients. Seven patients underwent delayed closed reduction under general anesthesia, and successful reduction was achieved in 6 patients. Only one patient with bone chips between articular facets failed to achieve anatomical reduction. CONCLUSION: In order to reduce the locked facet more easily and safely, we recommend manipulative traction with anterior interbody fusion and plate fixation under general anesthesia after being aware of spinal cord injury with magnetic resonance imaging.
Anesthesia, General ; Dislocations* ; Follow-Up Studies ; Head ; Humans ; Magnetic Resonance Imaging ; Male ; Medical Records ; Neck ; Relaxation ; Retrospective Studies ; Spinal Cord Injuries ; Spine* ; Traction

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.