BACKGROUND: It is well known that the prevalence of lung cancer is higher in idiopathic pulmonary fibrosis(IPF) patients than in the general population. This high prevalence is explained by the concept of 'scar carcinoma'. There have been several reports on the prevalence of histologic type of lung cancer in IPF with conflicting results. Despite of the high smoker rate in almost all previous reports, none considered the smoking history of patients. Therefore we performed a separate studies on fibrosis associated lung cancer and smoking associated lung cancer. The purpose of this study is to investigate the proportion of lung cancer in IPF that is fibrosis assiciated and to determine the most common histologic type in fibrosis associated lung cancer in IPF. METHODS: A retrospective review of medical records and radilolgic studies was performed for cases of lung cancer with IPF. We investigated smoking history, sequence of diagnosis of lung cancer and IPF, histologic type of lung cancer and the cancer location, especially whether the location is associated with fibrosis. To evaluate the proportion of fibrous associated lung cancer, the lung cancer in IPF were categorized according to the presence of fibrosis at cancer location. RESULTS: Fifty seven patients were subjects for this analysis. Six(11%) cases were diagnosed as lung cancer during follow-up for IPF, and both diseases were diagnosed simultaneously in the others. Ninety four percent of patients were smokers and the average smoking amount was 47.1±21.9 pack-year. Among the patients with IPF and lung cancer, 42(80.8%) cases were considered as 'fibrosis associated'. The remainder was 'not fibrosis associated' and probably was due to smoking etc. Although the most frequent histologic type was squamous cell carcinoma as a whole, adenocarcinoma was the prominent histologic type in 'fibrosis associated lung cancer.' CONCLUSION: Considering the proportion of 'fibrosis not associated lung cancer' in the patients with IPF and lung cancer, significant proportion of lung cancer in IPF may not be fibrosis induced. This may influence the distribution of histologic type of lung cancer in IPF.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Diagnosis ; Fibrosis* ; Follow-Up Studies ; Humans ; Idiopathic Pulmonary Fibrosis* ; Lung Neoplasms* ; Lung* ; Medical Records ; Prevalence ; Retrospective Studies ; Smoke ; Smoking

OBJECTIVES: The aim of this study was to assess the changes of the spasticity and gait pattern after botulinum toxin A injection on the gastrocnemius muscle. METHOD: Thirty five legs of twenty-six ambulatory cerebral palsy children aged from two to sixteen year old were treated. Botulinum toxin A (Allergan, USA) from 2 to 8 U/Kg bodyweight was injected on the gastrocnemius without sedation and electromyographic guidance. The modified Ashworth scale, the reflex excitability test were used for the assessment of spasticity. The changes of gait pattern were collected using 6 camera VICON system. All assessments were measured before and at two weeks after injection. RESULTS: 1) The modified Ashworth scale of ankle plantar flexor improved significantly. 2) The reflex excitability test result decreased significantly in gain. 3) The kinematic data showed significant improvements in sagittal plane of the ankle at two weeks after injection. The children with the genu recurvatum showed improvement in sagittal plane of the knee and those with the crouch gait didn't show aggravation of gait pattern after the injection. CONCLUSION: The intramuscular botulinum toxin A injection reduced the spasticity and improved the gait pattern in the cerebral palsied children with ankle plantar flexor spasticity.
Ankle ; Botulinum Toxins* ; Cerebral Palsy ; Child* ; Gait ; Humans ; Knee ; Leg ; Muscle Spasticity* ; Muscle, Skeletal ; Reflex

No abstract available.
Cell Line* ; Cytokines* ; Nitric Oxide*

STUDY DESIGN: A retrospective study. OBJECTIVES: To introduce an endoscopic anterior release and posterior total spondylectomy, and the evaluation of its clinical efficacy. SUMMARY OF LITERATURE REVIEW: A total spondylectomy was introduced for the treatment of primary and metastatic tumors of the spine, with many authors having reported favorable clinical results with its use. Endoscopic surgery has been used for various spinal disorders, including disc diseases or scoliosis, and has been widely used as it offers a minimally invasive technique, with a small surgical incision and very few complications. MATERIAL AND METHODS: Three primary spinal tumor cases were reviewed. The first case was a patient with a Ewing's sarcoma of the sacrum; the second was a giant cell tumor of the sacrum and the last was a giant cell tumor of the T10 vertebra. An endoscopic anterior release was initially performed, including the ligation and release of blood vessels, and soft tissue release, using laparoscopies for the 2 sacral tumors and a thoracoscopy for the thoracic tumor. The total spondylectomy were performed via a posterior approach. In two cases, the one with the Ewing's sarcoma of sacrum and the other with the giant cell tumor of the T10 vertebra, the reconstructions were performed using strut allografts and instrumentations. The average follow-up period was 19 months. RESULTS: Intraoperatively, the endoscopic anterior release made it possible to successful finish the anterior releases, with minimal incisions and blood losses. It also allowed a safer and faster posterior total spondylectomy, without significant complication. At the last follow-up, all patients had favorable clinical results, with no local recurrence in any case or fusions in the two cases that had to undergo reconstruction. CONCLUSION: Endoscopic anterior release and a posterior total spondylectomy was a favorable surgical procedure for primary tumors of spine. It made possible the safe and efficient finish the anterior release and posterior total excision of the affected vertebrae, using small incisions and with no complications.
Allografts ; Blood Vessels ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Laparoscopy ; Ligation ; Recurrence ; Retrospective Studies ; Sacrum ; Sarcoma, Ewing ; Scoliosis ; Spine* ; Thoracoscopy

STUDY DESIGN: A retrospective study. OBJECTIVES: To introduce an endoscopic anterior release and posterior total spondylectomy, and the evaluation of its clinical efficacy. SUMMARY OF LITERATURE REVIEW: A total spondylectomy was introduced for the treatment of primary and metastatic tumors of the spine, with many authors having reported favorable clinical results with its use. Endoscopic surgery has been used for various spinal disorders, including disc diseases or scoliosis, and has been widely used as it offers a minimally invasive technique, with a small surgical incision and very few complications. MATERIAL AND METHODS: Three primary spinal tumor cases were reviewed. The first case was a patient with a Ewing's sarcoma of the sacrum; the second was a giant cell tumor of the sacrum and the last was a giant cell tumor of the T10 vertebra. An endoscopic anterior release was initially performed, including the ligation and release of blood vessels, and soft tissue release, using laparoscopies for the 2 sacral tumors and a thoracoscopy for the thoracic tumor. The total spondylectomy were performed via a posterior approach. In two cases, the one with the Ewing's sarcoma of sacrum and the other with the giant cell tumor of the T10 vertebra, the reconstructions were performed using strut allografts and instrumentations. The average follow-up period was 19 months. RESULTS: Intraoperatively, the endoscopic anterior release made it possible to successful finish the anterior releases, with minimal incisions and blood losses. It also allowed a safer and faster posterior total spondylectomy, without significant complication. At the last follow-up, all patients had favorable clinical results, with no local recurrence in any case or fusions in the two cases that had to undergo reconstruction. CONCLUSION: Endoscopic anterior release and a posterior total spondylectomy was a favorable surgical procedure for primary tumors of spine. It made possible the safe and efficient finish the anterior release and posterior total excision of the affected vertebrae, using small incisions and with no complications.
Allografts ; Blood Vessels ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Laparoscopy ; Ligation ; Recurrence ; Retrospective Studies ; Sacrum ; Sarcoma, Ewing ; Scoliosis ; Spine* ; Thoracoscopy

No abstract available.
Humans* ; Leukemia*

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is one of the potentially life-threatening complications for patients with liver cirrhosis, and it has a mortality rate of over 20%. Early diagnosis of SBP and immediate use of an adequate antibiotic therapy are very important for achieving a better prognosis. The aim of our study was to assess the usefulness of reagent strips for making the rapid diagnosis of SBP. METHODS: A diagnostic paracentesis procedure was performed upon hospital admission in 257 cirrhotic patients (187 males, 70 females; mean age: 54 years) with ascites. Each fresh sample of ascitic fluid was tested using a reagent strip, and the result was scored as 0, 1+, 2+ or 3+. The leukocyte count, polymorphonuclear cell count, blood bottle culture, and chemistry of ascites were also done. RESULTS: We diagnosed 79 cases of SBP and 2 cases of secondary bacterial peritonitis by means of the polymorphonuclear cell count and the classical criteria. When a reagent strip result of 3+ was considered positive, the test's sensitivity was 86% (70 of 81), the specificity was 100% (176 of 176), and the positive predictive value was 94%. Furthermore, when a reagent strip result of 2+ or more was considered positive, the test sensitivity was 100% (81 of 81), the specificity was 99% (174 of 176), and negative predictive value was 99%. CONCLUSIONS: The use of reagent strips is a very sensitive and specific tool for the rapid diagnosis of SBP in cirrhotic patients. A positive result should be an indication for empirical antibiotic therapy, and a negative result may be useful as a screening test to exclude SBP.
Aged ; Ascitic Fluid/chemistry/cytology ; Bacterial Infections/*diagnosis/microbiology ; English Abstract ; Female ; Humans ; Liver Cirrhosis/complications ; Male ; Middle Aged ; Peritonitis/*diagnosis/etiology/microbiology ; Predictive Value of Tests ; *Reagent Strips ; Sensitivity and Specificity

OBJECTIVE: The purpose of this study was 1) to analyze clinically-executed cervical lateral mass screw fixation by the Kim's technique as suggested in the previous morphometric and cadaveric study and 2) to examine various complications and bicortical purchase that are important for b-one fusion. METHODS: A retrospective study was done on the charts, operative records, radiographs, and clinical follow up of thirty-nine patients. One hundred and seventy-eight lateral mass screws were analyzed. The spinal nerve injury, violation of the facet joint, vertebral artery injury, and the bicortical purchases were examined at each lateral mass. RESULTS: All thirty-nine patients received instrumentations with poly axial screws and rod systems, in which one hundred and seventy-eight screws in total. No vertebral artery injury or nerve root injury were observed. Sixteen facet joint violations were observed (9.0%). Bicortical purchases were achieved on one hundred and fifty-six (87.6%). Bone fusion was achieved in all patients. CONCLUSION: The advantages of the Kim's technique are that it is performed by using given anatomical structures and that the complication rate is as low as those of other known techniques. The Kim's technique can be performed easily and safely without fluoroscopic assistance for the treatment of many cervical diseases.
Cadaver ; Follow-Up Studies ; Humans ; Retrospective Studies ; Spinal Nerves ; Vertebral Artery ; Zygapophyseal Joint

BACKGROUND: Chronic obstructive pulmonary disease (COPD) may cause changes in the shape of the thoracic cage by increasing lung volume and hyperinflation. This study investigated changes in thoracic cage dimensions and related factors in patients with COPD. METHODS: We enrolled 85 patients with COPD (76 males, 9 females; mean age, 70.6±7.1 years) and 30 normal controls. Thoracic cage dimensions were measured using chest computed tomography at levels 3, 6, and 9 of the thoracic spine. We measured the maximal transverse diameter, mid-sagittal anteroposterior (AP) diameter, and maximal AP diameter of the right and left hemithorax. RESULTS: The average AP diameter was significantly greater in patients with COPD compared with normal controls (13.1±2.8 cm vs. 12.2±1.13 cm, respectively; p=0.001). The ratio of AP/transverse diameter of the thoracic cage was also significantly greater in patients with COPD compared with normal controls (0.66±0.061 vs. 0.61±0.86; p=0.002). In COPD patients, the AP diameter of the thoracic cage was positively correlated with body mass index (BMI) and 6-minute walk test distance (r=0.395, p<0.001 and r=0.238, p=0.028) and negatively correlated with increasing age (r=−0.231, p=0.034). Multiple regression analysis revealed independent correlation only between BMI and increased ratio of AP/transverse diameter of the thoracic cage (p<0.001). CONCLUSION: Patients with COPD exhibited an increased AP diameter of the thoracic cage compared with normal controls. BMI was associated with increased AP diameter in these patients.
Body Mass Index ; Female ; Humans ; Lung ; Male ; Pulmonary Disease, Chronic Obstructive* ; Spine ; Thorax ; Tomography, X-Ray Computed

BACKGROUND: Infectious conditions may increase the risk of venous thromboembolism. The purpose of this study was to evaluate the risk factor for combined infectious disease and its influence on mortality in patients with pulmonary embolism (PE).METHODS: Patients with PE diagnosed based on spiral computed tomography findings of the chest were retrospectively analyzed. They were classified into two groups: patients who developed PE in the setting of infectious disease or those with PE without infection based on review of their medical charts.RESULTS: Of 258 patients with PE, 67 (25.9%) were considered as having PE combined with infectious disease. The sites of infections were the respiratory tract in 52 patients (77.6%), genitourinary tract in three patients (4.5%), and hepatobiliary tract in three patients (4.5%). Underlying lung disease (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.926–7.081; p<0.001), bed-ridden state (OR, 2.84; 95% CI, 1.390–5.811; p=0.004), and malignant disease (OR, 1.867; 95% CI, 1.017–3.425; p=0.044) were associated with combined infectious disease in patients with PE. In-hospital mortality was higher in patients with PE combined with infectious disease than in those with PE without infection (24.6% vs. 11.0%, p=0.006). In the multivariate analysis, combined infectious disease (OR, 4.189; 95% CI, 1.692–10.372; p=0.002) were associated with non-survivors in patients with PE.CONCLUSION: A substantial portion of patients with PE has concomitant infectious disease and it may contribute a mortality in patients with PE.