Chronic compression or ischemia of the spinal cord in the cervical spine causes a clinical syndrome known as cervical myelopathy. Recently, a new term “degenerative cervical myelopathy (DCM)” was introduced. DCM encompasses spondylosis, intervertebral disk herniation, facet arthrosis, ligamentous hypertrophy, calcification, and ossification. The pathophysiology of DCM includes structural and functional abnormalities of the spinal cord caused by static and dynamic factors. In nonoperative patients, cervical myelopathy has a poor prognosis. Surgical treatments, such as anterior or posterior decompression accompanying arthrodesis, arthroplasty, or laminoplasty, should be considered for patients with chronic progressive cervical myelopathy. Surgical decompression can prevent the progression of myelopathy and improve the neurologic status, functional outcomes, and quality of life, irrespective of differences in medical systems and sociocultural determinants of health. The anterior surgical approach to the cervical spine has the advantage of removing or floating the intervertebral disk, osteophytes, and ossification of the posterior longitudinal ligament that compress the spinal cord directly. The posterior surgical approach to the cervical spine is mainly used for multisegment spinal cord compression in patients with cervical lordosis. In this review article, we addressed the pathophysiology, clinical manifestations, differential diagnosis, and treatment options for DCM.

No abstract available.

PURPOSE: Lower caliceal stones treated with ESWL do fail to pass more frequently than middle or upper caliceal stones. We analyzed the results of ESWL of renal caliceal stones according to the location of calix. MATERIALS AND METHODS: We reviewed the stone-free rate in 119 caliceal stone patients treated with 3rd generation lithotriptor, EDAP LT-02 according to the caliceal location of the stone. Location of the stones were upper calix in 30, middle calix in 30, and lower calix in 59 patients. RESULTS: Stone-free rate was 90.0%(27/30 patients) in middle caliceal stones, 74.6%(44/59 patients) in lower caliceal stones, and 66.7%(20/30 patients) in upper caliceal stones. CONCLUSIONS: Stone-free rate of lower caliceal stones is higher than upper caliceal stones.
Humans ; Lithotripsy* ; Shock*

BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.
Acromioclavicular Joint ; Clavicle* ; Follow-Up Studies ; Humans ; Methods ; Radiography ; Shoulder

Granuloma gluteale infantum may be considered a complication oi the primary irritant type of diaper dermatitis and a modern disease due to the change in tae are of the napkin area. Most patients were infants who had worn plastic diapers and were treated with fluorinated topical corticasteroid cream for their diaper dermatitis. The lesions comorise one or several, soft and reddish brown or livid purple nodules on the napkin area. We report a typical case of granuloma gluteale infantum in a 13-month old female who had been treated with topical cortieosteroid crearn for her diaper derniat;lis. The granuloma regressed spontaneously after withdrawl of the topical corticosteroid and restricted use of the occlusive plastic diaper.
Dermatitis ; Female ; Granuloma* ; Humans ; Infant ; Plastics

PURPOSE: Pilomatrixoma is a benign, usually asymptomatic tumor. It presents clinically as a solitary superficial subcutaneous nodule measuring between 0.5 cm and 5 cm in diameter on the head or upper extremeties and has not been reported after skin graft. The objective of this article is to report our experience in treating pilomatrixoma which occurred after split thickness skin graft on the lower extremity. METHODS: A 56-year-old female was treated in August 2005 with a 0.5 X 0.5 cm firm subcutaneous nodule at recipient site of split thickness skin graft on the left medial thigh. The tumor was successfully removed by complete excision and histologic examination was followed. RESULTS: The diagnosis was pilomatrixoma which was characterized by a dual population of proliferating basophilic cells and diagnostic shadow cells. CONCLUSION: The tumor was successfully treated by complete resection. The authors report this very rare case of pilomatrixoma which occurred at recipient site of split thickness skin graft.
Basophils ; Diagnosis ; Female ; Head ; Humans ; Lower Extremity ; Middle Aged ; Pilomatrixoma* ; Skin* ; Thigh ; Transplants*

PURPOSE: This treatment planning study was undertaken to evaluate the impact of beam angle configuration of intensity-modulated radiotherapy (IMRT) on the dose of the normal liver in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The computed tomography datasets of 25 patients treated with IMRT for HCC were selected. Two IMRT plans using five beams were made in each patient; beams with equidistance of 72degrees (Plan I), and beams with a 30degrees angle of separation entering the body near the tumor (Plan II). Both plans were generated using the same constraints in each patient. Conformity index (CI), homogeneity index (HI), gamma index, mean dose of the normal liver (Dmean_NL), Dmean_NL difference between the two plans, and percentage normal liver volumes receiving at least 10, 20, and 30 Gy (V10, V20, and V30) were evaluated and compared. RESULTS: Dmean_NL, V10, and V20 were significantly better for Plan II. The Dmean_NL was significantly lower for peripheral (p = 0.001) and central tumors (p = 0.034). Dmean_NL differences between the two plans increased in proportion to gross tumor volume to normal liver volume ratios (p = 0.002). CI, HI, and gamma indices were not significantly different for the two plans. CONCLUSION: The IMRT plan based on beams with narrow separations reduced the irradiated dose of the normal liver, which would allow radiation dose escalation for HCC.
Carcinoma, Hepatocellular ; Humans ; Liver ; Radiotherapy, Intensity-Modulated ; Tumor Burden

Pulmonary surfactant (PS) therapy was proven to be highly successful for the treatment of respiratory distress syndrome in premature infants. As a results, early prophylactic (EP) PS therapy has been introduced recently in Europe, the US and Korea. However, no multi-center study was compared EP and late selective (LS) PS therapies in Korea. We performed a retrospective multi-center study to compare the outcomes of EP and LS PS therapies in very preterm infants. We analyzed clinical morbidity and mortality for 1,291 infants in 2010 (LS group) and 1,249 infants in 2011 (EP group); the infants were born <30 weeks of gestation and had birth weight < or =1,250 g, and were chosen from 53 neonatal intensive care units in Korea. Compared to the LS group (22.5%), the overall mortality was better in the EP group (19.9%) and there was no increased need for retreatment.There were additional benefits in the EP group such as fewer associated complications. To the best of knowledge, our study is the first nationwide Korean study to compare the outcomes of EP and LS therapies, and it provides evidences that EP PS therapy is important in very preterm infants to improve for survival and reduce morbidities.
Female ; Humans ; Infant, Extremely Premature ; Male ; Prevalence ; Pulmonary Surfactants/*administration & dosage ; Republic of Korea/epidemiology ; Respiratory Distress Syndrome, Newborn/diagnosis/*mortality/*prevention & control ; Risk Factors ; Secondary Prevention/methods/*statistics & numerical data ; Survival Rate ; Treatment Outcome

Pulmonary surfactant (PS) therapy was proven to be highly successful for the treatment of respiratory distress syndrome in premature infants. As a results, early prophylactic (EP) PS therapy has been introduced recently in Europe, the US and Korea. However, no multi-center study was compared EP and late selective (LS) PS therapies in Korea. We performed a retrospective multi-center study to compare the outcomes of EP and LS PS therapies in very preterm infants. We analyzed clinical morbidity and mortality for 1,291 infants in 2010 (LS group) and 1,249 infants in 2011 (EP group); the infants were born <30 weeks of gestation and had birth weight < or =1,250 g, and were chosen from 53 neonatal intensive care units in Korea. Compared to the LS group (22.5%), the overall mortality was better in the EP group (19.9%) and there was no increased need for retreatment.There were additional benefits in the EP group such as fewer associated complications. To the best of knowledge, our study is the first nationwide Korean study to compare the outcomes of EP and LS therapies, and it provides evidences that EP PS therapy is important in very preterm infants to improve for survival and reduce morbidities.
Female ; Humans ; Infant, Extremely Premature ; Male ; Prevalence ; Pulmonary Surfactants/*administration & dosage ; Republic of Korea/epidemiology ; Respiratory Distress Syndrome, Newborn/diagnosis/*mortality/*prevention & control ; Risk Factors ; Secondary Prevention/methods/*statistics & numerical data ; Survival Rate ; Treatment Outcome

BACKGROUND: As the necessity of adult living donor liver transplantation continues to increase, morbidity and mortality of donors has been considered vital. Thus, we performed a sequential analysis of our surgical experience in order to find ways to improve surgical outcomes in right liver donors. METHODS: We performed a retrospective sequential analysis of surgical outcomes of consecutive 245 right liver donors by 50 cases between October 2002 and November 2012. RESULTS: Hospital stay (13.78 to 10.98 days), operation time (432.76 to 389.98 minutes), amount of intra operative bleeding (577.70 to 502.56 mL), and perioperative transfusion rates decreased from the initial 50 cases to the last 45 cases. A total of 96 grade I complications by Clavien-Dindo classification decreased from 26 to 17. Ten and three cases had grade IIIa and IIIb complications, respectively. There were three cases of wound infection, two cases of duodenal ulcer bleeding, one case of pleural effusion, and four cases of bile leakage of grade IIIa complications, and one case of postoperative intestinal obstruction, one case of generalized peritonitis by small bowel perforation, and one case of bile leakage of grade IIIb complications. There was no mortality during the follow-up period. CONCLUSIONS: Although most complications with low-grade severity might be corrected by surgical refinement, efforts to reduce possible moderate to severe complications should be sustained.
Adult* ; Bile ; Classification ; Duodenal Ulcer ; Follow-Up Studies ; Hemorrhage ; Hepatectomy* ; Humans ; Intestinal Obstruction ; Length of Stay ; Liver Transplantation* ; Liver* ; Living Donors ; Mortality ; Peritonitis ; Pleural Effusion ; Retrospective Studies ; Tissue Donors ; Wound Infection