STUDY DESIGN: Prospective study. PURPOSE: To compare clinical and radiological outcomes of open vs. minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). OVERVIEW OF LITERATURE: MI-TLIF promises smaller incisions and less soft tissue dissection resulting in lower morbidity and faster recovery; however, it is technically challenging. METHODS: Twenty-five patients with MI-TLIF were compared with 25 matched open TLIF controls. A minimum 2 year follow-up and a statistical analysis of perioperative and long-term outcomes were performed. Potential complications were recorded. RESULTS: The mean ages for the open and MI-TLIF cases were 44.4 years (range, 19-69 years) and 43.6 years (range, 20-69 years), respectively. The male:female ratio was 13:12 for both groups. Average follow-up was 26.9 months for the MI-TLIF group and 29.3 months for the open group. Operative duration was significantly longer in the MI-TLIF group than that in the open group (p<0.05). No differences in estimated blood loss, duration to ambulation, or length of stay were found. Significant improvements in the Oswestry disability index and EQ-5D functional scores were observed at 6-, 12-, and 24-months in both groups, but no significant difference was detected between the groups. Fusion rates were comparable. Cage sizes were significantly smaller in the MI-TLIF group at the L5/S1 level (p<0.05). One patient had residual spinal stenosis at the MI-TLIF level, and one patient who underwent two-level MI-TLIF developed a deep vein thrombosis resulting in a pulmonary embolism. CONCLUSIONS: MI-TLIF and open TLIF had comparable long-term benefits. Due to technical constraints, patients should be advised on the longer operative time and potential undersizing of cages at the L5S1 level.
Follow-Up Studies ; Humans ; Length of Stay ; Operative Time ; Prospective Studies ; Pulmonary Embolism ; Spinal Stenosis ; Venous Thrombosis ; Walking

A 63-year-old gentleman presented with a one-year duration of progressive neurogenic claudication. However, unlike most patients who presents with leg symptoms, his pain was felt in his scrotal and perianal region. This was exacerbated with walking and standing, but he had immediate relief with sitting. An magnetic resonance imaging (MRI) was performed which showed severe central canal stenosis. An L3/4 and L4/5 surgical decompression and a transforaminal lumbar interbody fusion was performed, and the patient made good recovery with immediate resolution of symptoms. Although rare, spinal stenosis should be considered a differential when approaching a patient with perianal and scrotal claudication, even in the absence of leg claudication. An MRI is useful to confirm the diagnosis. This rare symptom may be a sign of severe cauda equina compression and we recommend decompression with predictable good results.
Cauda Equina ; Constriction, Pathologic ; Decompression ; Decompression, Surgical ; Diagnosis ; Humans ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Spinal Stenosis* ; Walking

A 44-year-old male presented with symptoms of spinal cord compression secondary to metastatic prostate cancer. An urgent decompression at the cervical-thoracic region was performed, and there were no complications intraoperatively. Three hours postoperatively, the patient developed acute bilateral lower-limb paralysis (motor grade 0). Clinically, he was in class 3 hypovolemic shock. An urgent magnetic resonance imaging (MRI) was performed, showing no epidural hematoma. He was managed aggressively with medical therapy to improve his spinal cord perfusion. The patient improved significantly, and after one week, he was able to regain most of his motor functions. Although not commonly reported, spinal cord ischemia post-surgery should be recognized early, especially in the presence of hypovolemic shock. MRI should be performed to exclude other potential causes of compression. Spinal cord ischemia needs to be managed aggressively with medical treatment to improve spinal cord perfusion. The prognosis depends on the severity of deficits, and is usually favorable.
Adult ; Decompression ; Hematoma ; Humans ; Magnetic Resonance Imaging ; Male ; Paralysis ; Perfusion ; Prognosis ; Prostatic Neoplasms ; Shock* ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Ischemia*

Adult ; Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; instrumentation ; methods ; Diskectomy ; instrumentation ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Prospective Studies ; Spinal Fusion ; instrumentation ; methods

OBJECTIVE: To translate the English version of the London Chest Activity of Daily Living scale (LCADL) into a Korean version and to determine the reliability and validity of the Korean version in patients with chronic obstructive pulmonary disease (COPD). METHODS: The English version of LCADL was translated into Korean and back-translated into English. Subsequently, the back-translated version was reviewed and compared with the original, and thus the final K-LCADL was obtained. To evaluate the validation of the K-LCADL, patients simultaneously completed a pulmonary function test, a 6-Minute Walk Test (6MWT), and questionnaires, including the modified Medical Research Council (mMRC) dyspnea scale, the Korean version of the St. George's Respiratory Questionnaire (K-SGRQ), the Korean version of the COPD Assessment Test (K-CAT), and the Korean version of the EuroQoL-5 Dimensions (K-EQ-5D). To assess test-retest reliability, the K-LCADL was again administered to the same patients within 2 weeks from initial assessment. RESULTS: A total of 94 patients participated in the present study. The total K-LCADL score was positively correlated with the K-SGRQ (r=0.802, p < 0.001), the mMRC dyspnea scale (r=0.603, p < 0.001), and the K-CAT score (r=0.714, p < 0.001), and negatively correlated with the K-EQ-5D (r=−0.764, p < 0.001), 6MWT (r=−0.635, p < 0.001), forced expiratory volume in one second 1 (r=−0.416, p=0.002), and forced vital capacity (r=−0.397, p=0.023). Intraclass correlation coefficient of the K-LCADL was 0.951 (p < 0.001). CONCLUSION: The K-LCADL is a reliable and valid questionnaire for evaluating limitation of activities of daily living in patients with COPD.
Activities of Daily Living ; Dyspnea ; Forced Expiratory Volume ; Humans ; Pulmonary Disease, Chronic Obstructive* ; Reproducibility of Results ; Respiratory Function Tests ; Thorax* ; Vital Capacity

PURPOSE: In order to determine the value of first-pass MR imaging in the diagnosis of myocardial ischemia, first-pass perfusion abnormality of coronary artery stenosis was observed in MRI after gadopentate dimeglumine (Gd-DTPA) enhancement. MATERIALS AND METHODS: The left anterior descending (LAD) coronary arteries of six dogs were subjected to approximately 70% stenosis confirmed by coronary angiography. Half an hour after adenosine and 99mTc-sestamibi infusion, Gd-DTPA (0.2 mmol/kg) and methylene blue were administered and termination was induced with potassium chloride. SE T1-weighted and single-photon emission computed tomography (SPECT) images were subsequently obtained and the findings of perfusion defect compared with specimen stain. Three dimensionally reconstructed MR images were used to measure signal intensity (SI) of normal myocardium and perfusion defect from their sectional and total volume. RESULTS: Five of six dogs with LAD artey stenosis ranging from 66% to 73% displayed perfusion defect on MRI, SPECT, and specimen stain, but the remaining dog with stenosis of 58% showed no such defect. MRI showed the perfusion defect as distinct low SI, enabling the measurement of percentage perfusion defect (24.4+/-5.4%), which increased inferiorly. SI of normal myocardium and perfusion defect decreased inferiorly; their difference indicated stenosis-induced perfusion loss according to section location. Volumetric SI of normal myocardium and perfusion defect were 3.42+/-0.52 and 2.16+/-0.45, respectively (p < 0.05). CONCLUSION: Gd-DTPA enhanced MRI displayed first-pass perfusion abnormality of coronary artery stenosis as perfusion defect with distinct low SI ; this enabled the measurement of its volume and SI changes according to section location, and thus indicated the value of first-pass MR imaging in the diagnosis of myocardial ischemia.
Adenosine ; Animals ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis* ; Coronary Vessels* ; Diagnosis ; Dogs ; Gadolinium DTPA* ; Magnetic Resonance Imaging* ; Methylene Blue ; Myocardial Ischemia ; Myocardium ; Perfusion* ; Potassium Chloride ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

No abstract available.
Lutein* ; Lymphangioma, Cystic*

A porcine parvovirus, designated as VRI-1, was isolated from a 30-day-old piglet. Replicative form of viral DNA from ST cells infected with VRI-1 was directly cloned into pUC19. The cloned DNA fragment contained the entire nonstructural and structural protein genes, covering approximately 85% of the viral genome. The nucleotide sequence of VRI-1 showed 99.4~99.5% identity in the nonstructural protein (NS) and 99.0~99.2% identity in the structural protein with previously reported PPV strains, respectively. Among the cloned genes, two types of defective genomes with deletion of 100 and 247 nucleotides at almost similar location of 3' region within NS gene were also identified in this study.
Base Sequence* ; Clone Cells ; DNA ; DNA, Viral ; Genome* ; Genome, Viral ; Nucleotides ; Parvovirus, Porcine*

BACKGROUND: Lamivudine has been found to suppress hepatitis B virus (HBV) consistently, and several trials have shown significant reductions in necroinflammatory activity and delayed progression of fibrosis. In terms of histologic improvements, fibosis is one of the most important factors in predicting long-term outcome in chronic hepatitis. The objective of this analysis was to determine the correlation between improvement in degree of fibrosis and pretreatment histological activity in lamivudine-treated patients with chronic hepatitis B. METHODS: Paired liver biopsy in 47 patients who were treated with lamivudine and followed up for 52 weeks were analysed. Histological changes were evaluated by a histopathologist and scored according to Knodell's histology activity index (HAI). RESULTS: At the end of one year, 33/47 (70.2%) showed improvement in necroinflammatory score and only 14.9% (7/47) showed worsening. The improvement in fibrosis score was noted in 21.3% (10/47). The improvement in fibrosis was significantly related with pretreatment periportal inflammation (p<0.05), portal inflammation (p<0.01) and fibrosis score (p<0.01). The loss of HBeAg occurred in 60% of fibrosis improvement group and interestingly, regression of fibrosis was noted in patients without loss of HBeAg. CONCLUSIONS: Pretreatment histologic activity is an important predictor for improvement in fibrosis after lamivudine treatment for chronic hepatitis B.
Biopsy ; Fibrosis* ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Inflammation ; Lamivudine* ; Liver

A human Echinostoma hortense infection was diagnosed by gastroduodenoscopy. An 81-year-old Korean male, living in Yeongcheon-shi, Gyeongsangbuk-do and with epigastric discomfort of several days duration, was subjected to upper gastrointestinal endoscopy. He was in the habit of eating fresh water fish. Two live worms were found in the duodenal bulb area and were removed using an endoscopic forcep. Based on their morphological characteristics, the worms were identified as E. hortense. The patient was treated with praziquantel 10 mg/kg as a single dose. The source of the infection in this case remains unclear, but the fresh water fish consumed, including the loach, may have been the source. This is the second case of E. hortense infection diagnosed by endoscopy in Korea.
Aged ; Aged, 80 and over ; Animals ; Duodenal Diseases/*diagnosis/drug therapy/parasitology ; Echinostoma/*growth & development ; Echinostomiasis/*diagnosis/drug therapy/parasitology ; Endoscopy, Gastrointestinal ; Female ; Fishes/parasitology ; Food Parasitology ; Human ; Korea ; Male ; Praziquantel/therapeutic use