Many believe the reduction in the number of mobile segments causes an increased strain in the unfused segments, predisposing them to early degeneration. This degeneration of the adjacent segment could be a cause of low back pain after spinal fusion. The clinical manifestations supporting the increased stress of the unfused segments are the significant incidence rates of spondylolisthesis, spondylolysis acquisita and spinal stenosis. However, there was a paucity of reports in the literature on the histological observation at the adjacent, unfused sgements. Therefore, the purpose of this study was to observe the histological changes of the unfused, mobile segments following fixation in the cat spine. The cat lumbar spines from L6 to L7 were fixed posteriorly with acrylic cement and wires. Histological and histochemical observation of the upper adjacent segment were performed after H-E, trichrome, reticulin and Safranin-O staining at postoperative 6 and 12 months, respectively. The results were as follows: 1. There were mild degenerative changes in the intervertebral disc, but no evidence of definitive degeneration in the articular cartilage of the facet joints at postoperative 6 months in the spinal fixation group. 2. The marked degenerative changes of the intervertebral disc were shown at postoperative 12 months in the spinal fixation group. Of 5 cats sacrificed at 12 months, 3 cats had irregular configuration of the fiber's arrangement of the annulus fibrosus. 3. At postoperative 12 months in the spinal fixation group, marked degeneration was noted on the articular cartilage of the adjacent facet joints. Through this study, it is clarified that degenerativce changes of the intervetebral disc and facet joint at the adjacent segments will develop after certain period of time following spinal fusion. Especially the facet joints of the adjacent, unfused segment were found to be most vulnerable to the adverse effects. This may be responsible for the back pain in the future after spine fusion.
Animals ; Back Pain ; Cartilage, Articular ; Cats* ; Incidence ; Intervertebral Disc ; Low Back Pain ; Reticulin ; Spinal Fusion ; Spinal Stenosis ; Spine* ; Spondylolisthesis ; Spondylolysis ; Zygapophyseal Joint

STUDY DESIGN: This retrospective study was designed to find the causes of adjacent-segment changes and to investigate the correlation between these changes and clinical results in long-term follow-up patients after instrumental lumbar fixation and posterolateral fusion. OBJECTIVE: To quantify how immobilization of a rigid spinal segment fixation effect the pre-existing degenerated adjacent-segment and to observe the adjacent-segment changes, contributing factors of adjacent-segment changes and to investigate the the correlation between clinical results and adjacent-segment changes. SUMMARY OF LITERATURE REVIEW: The reduction in the number of mobile lumbar segments with posterior instrumentation and fusion causes an increased stress in the unfused segment, predisposing them to early degeneration. In addition, the adjacent-segment above the rigid fixation is a particular problem in the previously degenerative spine, which accelerated degeneration at adjacent-segment Many clinical studies reported that stress of the adjacent-segment could develop the significant incidence of spondylolisthesis, spondylolysis and spinal stenosis. MATERIALS AND METHODS: Forty patients were retrospectively reviewed who underwent wide laminectomy and intertransverse fusion with posterior instrumentation. Inclusion in the study required minimum of 5 years of clinical and radiographic follow-up. Nineteen patients were diagnosed as degenerative spondylolisthesis, degenerative scoliosis in 8, pure spinal stenosis in 6 and lytic spondylolisthesis in 7. The most common fused segments were L4-5 in 16. Initial radiographs including plain radiogram, CT and MRI were classified with respect to presence of degeneration adjacent to fused segments. A preoperative spinal instability was diagnosed when any of the following conditions were noted at adjacent above the fusion: 1) >15degrees angulatory instability, 2) >3mm translation, 3) >5degrees lateral angulation, 4) >grade 1 rotational deformity, and postoperative adjacent changes were diagnosed 1) same as preoperative instability criteria, 2) fracture, 3) spinal stenosis, 4) spondylolysis. Clinical results were categorized as poor, fair, good and excellent. RESULTS: Of 40 patients, 16(40%) patients had significant adjacent-segment changes such as instability in six, fracture in aye, spinal stenosis in four and lysis in one. Incidence of adjacent- segment changes was significantly higher in more than 54-years old. Degenerative scoliosis had a higher adjacent-segment chanties and showed statistically significant between preoperative disease and adjacent-segment changes. Nine patients who had a preoperative instability showed significant adjacent-segment changes. Of remained 31 patients, only 7 patients had adjacent-segment changes. There was a statistically significant difference according to preexisting adjacent-segment degeneration. All five patients with grade 3 degeneration developed significant adjacent-segment changes. In overall clinical results, all 7 poor cases had significant adjacent-segment changes. Of them,5 patients should undergo reoperation. CONCLUSION: Inevitable compensatory mechanism occurs at adjacent segment, resulting from stress concentration and alteration in motion kinematics after fusion. The most important factors associated with adjacent-segment changes were age, pre-existing degeneration and preoperative instability. The adjacent-segment changes had a significant correlation with poor clinical results.
Biomechanical Phenomena ; Congenital Abnormalities ; Follow-Up Studies* ; Humans ; Immobilization ; Incidence ; Laminectomy ; Magnetic Resonance Imaging ; Middle Aged ; Reoperation ; Retrospective Studies ; Scoliosis ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Spondylolysis

A Clinical observation on 272 cases of epidemic encephalitis admitted to the Department of Pediatrics, Chonnam University Hospital with 5 year duration from 1971 to 1975 was carried out and the serum protein fractions were studied paperelectrophoretically on 28 cases in 1975 The following results are obtained. : 1) The peak age group was from 6 to 10 years old, and the male to female ratio was 1.7:1 2) The complaints on admission were fever(100%), neck stiffness(78.3%), Kernig's sign(71.7%), vomiting(64.0%), unconsciousness(59.6%), and headache(57.4%), in order of frequency. 3) Laboratory findings were as follows ; In the most cases(79.4%), peripheral leukocytosis with increased polymorphocyte was noted. And the findings of C.S.F. showed; Pleocytosis (98.5%), increased protein content(90.1%), normal or slightly increased sugar content(97.8%) and within normal limits of chloride level. 4) Mortality rate was 20.2% 5) The total protein and beta-globulin level showed no change and decreased albumin and A/G ratio. The gamma-globulin level showed increased initially and thereafter decreased to normlal limits gradually.
Beta-Globulins ; Child ; Encephalitis, Arbovirus* ; Female ; gamma-Globulins ; Humans ; Jeollanam-do ; Leukocytosis ; Male ; Mortality ; Neck ; Pediatrics

From January 1981 to December 1991, forty patients with localized advanced carcinoma of the pancreas were treated at the Department of Therapeutic Radiology, Seoul National University Hospital. The treatment protocol consisted of two split course external radiation therapy with each 2000 cGy over two weeks separated by two week rest period. Intravenous 5-fluorouracil (5-FU) was administered on the first three days of each radiotherapy course. Twenty three of these patients were treated by maintenance 5-FU or FAM (5-FU, adriamycin, mitomycin) chemotherapy. Median survival was 9 months and the 2-year survival rate was 10.0%. Good prognostic indicators were good performance status, palliative bypass surgery and tumor located in the head of pancreas.
Clinical Protocols ; Doxorubicin ; Drug Therapy ; Fluorouracil ; Head ; Humans ; Pancreas ; Pancreatic Neoplasms* ; Radiation Oncology ; Radiotherapy ; Seoul ; Survival Rate

The clinical data of 27 patiets with hypophosphatemic rickets treated with phosphate and 1alpha-hydroxyvitamin D were analysed retrospectively. The median age at diagnosis was 4 years, and the main clinical manifestations were bowleg and short stature. Among total 24 families, 5 families (21%) had X-linked dominant mode of inheritance, 1 family (4%) had autosomal dominant mode and 17 families (71%) had no family history, The serum phosphorus concentration rose from initial value of 2.7+/-0.13mg/dl to 3.5+/-0.19mg/dl. The serum alkaline phosphatase was reduced from 871+/-63IU/L to 393+/-41IU/L. Healing of rickets was demonstrated by radiography. Patients treated for at least two years before the onset of puberty had an increase in the mean height SD score from -1.58 to -0.79. Orthopedic surgeries for severe lower extremity deformity were performed in 11 patients, of whom 8(73%) were dignosed over 5 years of age. Complications of therapy were as follows; 12 patients (44%) developed more than one episode of hypercalciuria, 5 patients (19%) developed more than one episode of hypercalcemia, and nephrocalcinosis was noted in 5(33%) out of 15 patients by renal ultrasound. The group with nephrocalcinosis had a higher incidence of hypercalemic episodes than the group without nephrocalcinosis. In conclusion, treatment of hypophosphatemic rickets results in healing of rickets and acceleration of growth, and we must evaluate complications of therapy such as hypercalcemia and nephrocalcinosis.
Acceleration ; Adolescent ; Alkaline Phosphatase ; Congenital Abnormalities ; Diagnosis ; Humans ; Hypercalcemia ; Hypercalciuria ; Incidence ; Lower Extremity ; Nephrocalcinosis ; Orthopedics ; Phosphorus ; Puberty ; Radiography ; Retrospective Studies ; Rickets ; Rickets, Hypophosphatemic* ; Ultrasonography ; Wills

No abstract available.
Liver* ; Neoplasm Metastasis*

No abstract available.
Hemorrhage*

PURPOSE: To determine whether neoadjuvant androgen deprivation therapy (NADT) improves clinical outcomes in patients with prostate cancer treated with definitive radiotherapy. MATERIALS AND METHODS: We retrospectively reviewed medical records of 201 patients with prostate cancer treated with radiotherapy between January 1991 and December 2008. Of these, 156 patients with more than 3 years of follow-up were the subjects of this study. The median duration of follow-up was 91.2 months. NADT was given in 103 patients (66%) with median duration of 3.3 months (range, 1.0 to 7.7 months). Radiation dose was escalated gradually from 64 Gy to 81 Gy using intensity-modulated radiotherapy technique. RESULTS: Biochemical relapse-free survival (BCRFS) and overall survival (OS) of all patients were 72.6% and 90.7% at 5 years, respectively. BCRFS and OS of NADT group were 79.5% and 89.8% at 5 years and those of radiotherapy alone group were 58.8% and 92.3% at 5 years, respectively. Risk group (p = 0.010) and radiation dose > or =70 Gy (p = 0.017) affected BCRFS independently. NADT was a significant prognostic factor in univariate analysis, but not in multivariate analysis (p = 0.073). Radiation dose > or =70 Gy was only an independent factor for OS (p = 0.007; hazard ratio, 0.261; 95% confidence interval, 0.071-0.963). CONCLUSION: NADT prior to definitive radiotherapy did not result in significant benefit in terms of BCRFS and OS. NADT should not be performed routinely in the era of dose-escalated radiotherapy.
Follow-Up Studies ; Humans ; Medical Records ; Multivariate Analysis ; Prostatic Neoplasms* ; Radiotherapy* ; Radiotherapy, Intensity-Modulated ; Retrospective Studies

No abstract available.
Spondylosis*

No abstract available.
Pressure Ulcer*