STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the significance of the intraoperative postural reduction for kyphotic deformity in unstable burst fracture and confirm the relations of postural reduction and the final correction after loss of correction by posterior instrumentation. SUMMARY OF LITERATURE REVIEW: The loss of kyphotic correction after instrumentation in unstable burst fracture is found. Some methods have been developed to reduce the loss of correction. MATERIALS AND METHODS: 24 short-segment pedicle screw instrumentations in the patients with a unstable burst fracture were performed. We measured sagittal index, wedge angle of vertebral body and anterior vertebral height preoperatively, intraoperatively, postoperatively and at final follow-up. RESULTS: Sagittal index was 20.2 degrees preoperatively, 7.5 degrees intraoperatively, 0.9 degrees postoperatively and 7.2 degrees at final follow-up, so the loss of correction was 32.6%. Wedge angle of vertebral body was 20.3 degrees preoperatively, 10.1 degrees intraoperatively, 6.8 degrees postopera-tively and 9.4 degrees at final follow-up, so the loss of correction was 19.3%. Anterior vertebral height was 57.0%, 79.3%, 85.0%, and 78.8% respectively, so the loss of correction was 22.1%. The loss of correction occurred more in the disc space and less in the vertebral body itself. Postural reduction corrected 63% of sagittal index, 50% of wedge angle of vertebral body and 52% of anterior vertebral height. CONCLUSIONS: Postural reduction corrected kyphotic deformity appropriately. The correction by posterior instrumentation in unstable burst fracture was lost in some amount. The final correction was similar to the one by postural reduction. It is important to obtain the maximum postural reduction intraoperatively to prevent kyphotic deformity caused by loss of correction after surgery.
Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Retrospective Studies

Owing to the low incidence of peptic ulcers in children, the early symptoms of the disease are sometimes overlooked, which result in grave complications such as a perforation or hemorrhagic shock. Recently, as a result of the increasing use of endoscopy, the incidence of peptic ulcers in children has increased. This means that the disease might have been underdiagnosed in the past. Although some cases of peptic ulcer perforation or bleeding in children were reported, a case of a peptic ulcer combined with a perforation and hemorrhage has not been reported. We experienced a 19 months old patient in shock with a perforated duodenal ulcer and hemorrhage.
Child* ; Duodenal Ulcer* ; Endoscopy ; Hemorrhage* ; Humans ; Incidence ; Infant ; Peptic Ulcer ; Peptic Ulcer Perforation ; Shock ; Shock, Hemorrhagic

A 48-year-old woman who was without any abnormal past medical history underwent colonoscopy as a screening procedure for colorectal disease. The procedure was uneventful and there was no sign of inflammation around the appendicular orifice or the luminal surface of the cecum. The patient did not complain of pain or significant discomfort throughout the procedure. She then developed pain in the right lower quadrant of the abdomen that evening and this persisted for four days. She visited the outpatient department and underwent abdominal ultrasonography, which showed a swollen appendix with a collection of pericecal fluid. Surgical exploration and appendectomy were performed; the final diagnosis was acute suppurative appendicitis. Colonoscopists should be aware of this rare complication and consider it when making the differential diagnosis of post-colonoscopy abdominal pain.
Acute Disease ; Appendicitis/diagnosis/*etiology/surgery ; Colonoscopy/*adverse effects ; Diagnosis, Differential ; Female ; Humans ; Middle Aged

BACKGROUD/AIMS: Obesity is a rising problem in industrialized countries. Numerous epidemiologic studies have shown a positive association between obesity and colorectal polyps. There are few studies investigating the association between colorectal adenomatous polyps and body fat composition in Korea. We tried to examine the relationship between body fatness and colorectal adenomatous polyps in health check-up subjects in Korea. METHODS: Six thousand seven hundred and six routine health check-up subjects, who visited our hospital between March 2002 and April 2005 and underwent distal colon examimation with sigmoidoscopy, were enrolled in this study. Among them, colonoscopy was done in 860 patients to evaluate the entire colon. We tried to reveal the relationship between body mass index (BMI) and size, location, number and histopathological type of polyps. BMI was used as an indicator of obesity. RESULTS: The mean value of BMI in total polyp-free group (23.8+/-2.9) was not different from that of the polyp group (24.5+/-2.8, p=0.09). The frequency of rectosigmoid polyps in obese patients (20.4%) was higher than that in non-obese patients (16.0%, p<0.05). The frequency of adenomatous polyp was not different between obese and non-obese group. Number of polyps (> or =4) correlated well with obesity. Moreover, age and triglyceride level in patients with colonic adenoma were significantly higher than in patients without colonic adenom. CONCLUSIONS: This study shows that obesity is not associated with colonic adenomatous polyp in Korean population. However, we observed that obesity may be associated with rectosigmoid colon polyps. Furthermore, age and triglyceride level might be the risk factors of colonic adenomatous polyps in Korean population.
Adenomatous Polyps/*complications/epidemiology/pathology ; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Colonic Neoplasms/*complications/epidemiology/pathology ; Colonic Polyps/complications/epidemiology/pathology ; Comorbidity ; Female ; Humans ; Korea ; Male ; Middle Aged ; Obesity/*complications/diagnosis/epidemiology ; Retrospective Studies ; Sigmoidoscopy

BACKGROUND/AIMS: Colonic diverticular bleeding cases account for 30-40% of the lower gastrointestinal bleeding, among which, 3-5% appear to be massive bleeding. The purpose of this study was to evaluate the risk factors for colonic diverticular bleeding diagnosed by colonoscopic examination. METHODS: Among the 1,003 patients, who were identified to have colonic diverticulosis including sleeding by diverticulitis and diverticular bleeding coding search, 216 patients had diverculosis, and they were divided into two groups: one with diverticular bleeding, and the other without bleeding. We evaluated the potential risk factors for diverticular bleeding, based on age, gender, location of diverticulum, comorbidities related to atherosclerosis, smoking, alcohol and medications, and compared them between both groups. RESULTS: Among the 216 patients, we observed colonic diverticular bleeding in 35 patients (16.2%). The mean age of the bleeding group was significantly older than that of non-bleeding group. No difference was observed regarding gender ratio. Right colonic diverticula were common in both groups, but there were higher proportion of patients with bleeding in bilateral diverticuosis. Old age, bilateral diverticulosis, presence of atherosclerosis related diseases (hypertension, diabetes mellitus, ischemic heart disease, obesity), use of aspirin, NSAIDs and calcium channel blocker, increased the risk of bleeding. In a multivariate analysis, use of aspirin and bilateral diverticulosis were identified as independent risk factors for colonic diverticular bleeding. CONCLUSIONS: Since the patients who took aspirin and/or had bilateral colonic diverticulosis increased the risk of bleeding from divertuculi. As such, caution and education of patients are required.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Aspirin/therapeutic use ; Calcium Channel Blockers/therapeutic use ; Colonic Diseases/*etiology ; Colonoscopy ; Diabetes Complications ; Diverticulum, Colon/*epidemiology ; Female ; Gastrointestinal Hemorrhage/epidemiology/*etiology ; Humans ; Hypertension/complications/drug therapy ; Logistic Models ; Male ; Middle Aged ; Myocardial Ischemia/complications ; Obesity/complications ; Odds Ratio ; Risk Factors

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is common in asthma patients. Proton pump inhibitor (PPI) therapy improves symptoms of asthma in some patients. The objective of this study was to investigate endoscopic findings of GERD in asthma patients and to assess the effect of gastric acid suppression with the PPIs on symptom improvement and pulmonary function. METHODS: From 105 consecutive patients with GERD symptoms during follow up for asthma, 45 patients were enrolled. Patients enrolled to this study were asked about GERD symptoms before and after treating with PPI. Endoscopic findings were described according to Los Angeles classification. The improvement of asthma symptoms and follow-up pulmonary function test were investigated after administration of PPIs. RESULTS: Esophageal symptoms such as heartburn and acid reflux were present in 25 patients (55.6%), and patients without esophageal symptoms were 20 (44.4%). The degree of endoscopic abnormality was not significantly different between groups with or without esophageal symptoms. The improvement of symptoms was seen in 44 patients (97.8%) except 1 patient after administration of PPIs. The number of patients classified to the low-dose group was 7 patients (15.6%) and that of patients classified to the standard-dose group was 38 patients (84.4%). The follow-up pulmonary function test, peak expiratory flow rate (L/sec) was improved in 3 patients (3 of 7, 42.9%) of the low-dose group, and in 24 patients (24 of 38, 63.2%) of the standard-dose group. The improvement of ventilatory function was not significantly different according to dose of PPIs. CONCLUSIONS: Treatment with PPIs is expected to improve subjective symptoms and ventilatory function in asthma patients.
Adrenergic beta-Agonists/therapeutic use ; Adult ; Aged ; Asthma/*complications/drug therapy ; Female ; Follow-Up Studies ; Gastroesophageal Reflux/complications/*drug therapy ; Gastroscopy ; Glucocorticoids/therapeutic use ; Humans ; Male ; Middle Aged ; Peak Expiratory Flow Rate ; Proton Pump Inhibitors/*therapeutic use ; Treatment Outcome

Esophagogastric varices are considered to be the most common complication in patients with portal hypertension. Among ectopic varices, rectal varices are infrequent but potentially serious complication. The etiology and pathogenesis of rectal varices remains controversial. Several kinds of treatment have been performed but standard treatment for rectal varices has not been established. Herein we report a case of rectal varix bleeding treated with endoscopic variceal ligation (EVL) and then evaluated by transrectal color doppler ultrasonography.
Hemorrhage* ; Humans ; Hypertension, Portal ; Ligation* ; Ultrasonography, Doppler, Color ; Varicose Veins*

BACKGROUND/AIMS: In spite of the improvement of medical treatment for the peptic ulcer disease (PUD), PUD is still one of the common upper gastrointestinal diseases. The purpose of this study was to evaluate the risk factors and general characteristics of Korean patients diagnosed as PUD at a single third referral center. METHODS: A total of 310 patients, diagnosed as PUD through endoscopy during one year of 2007 at Seoul National University Bundang Hospital were, retrospectively, evaluated regarding age, gender, Helicobacter pylori (H. pylori) positivity, clinical manifestations, comorbidities and medications. In addition, PUD was analyzed in the aspect of ulcer location, type of visit, gastrointestinal bleeding, and age. RESULTS: The mean age was 61.5 years old (48.1% over 65) and 208 (66.7%) patients were men. The rate of H. pylori infection was 47.8%, and any ulcerogenic medication history such as antiplatelet agents and NSAIDs was found to be 21.0% (65 patients). The rate of idiopathic peptic ulcer without evidence of H. pylori and NSAIDs was found to be 40.6% (126 patients). Among 310 PUD patients, bleeding symptoms such as melena, hematemesis and hematochezia occurred in 110 patients (35.5%). CONCLUSIONS: PUD was more prevalent in the elderly patients and frequently associated with bleeding. Substantial proportion of PUD patients had neither H. pylori infection nor history of ulcerogenic medications, suggesting of increasing prevalence of idiopathic PUD.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Female ; Gastrointestinal Hemorrhage ; Gastroscopy ; Helicobacter Infections/complications/diagnosis ; Helicobacter pylori ; Hematemesis ; Humans ; Male ; Melena ; Middle Aged ; Peptic Ulcer/*diagnosis/drug therapy/epidemiology ; Platelet Aggregation Inhibitors/therapeutic use ; Prevalence ; Referral and Consultation ; Retrospective Studies ; Risk Factors ; Sex Factors

BACKGROUND: The proportion of the aged (>60 years old) population is increasing in South Korea and it is expected to reach 30.8% in 2030. The aim of this study was to analyze the clinical characteristics of peptic ulcer disease in the aged population in South Korea. METHODS: A total of 134 patients (89 men and 45 woman) with peptic ulcers were investigated. The ulcers were diagnosed using esophagogastroduodenoscopy. The main symptom, the duration of the symptoms, the location of the ulcer, the presence of Helicobacter pylori as well as the history of Anti-Inflammatory Agents, Non-Steroidal (NSAID) use were analyzed. The parameters between the two age groups: under 60 years (n=73) and over 60 years (n=61), were compared. RESULTS: In the aged, the frequency of a Helicobacter pylori infection was lower. In a gastric ulcer (GU) in aged patients, the rate of Helicobacter pylori infection was less common than in younger GU patients. In aged duodenal ulcer (DU) patients, the rate of a Helicobacter pylori infection was similar to that of younger DU patients. Bleeding peptic ulcers were more common in NSAID-users than in nonusers. DU was less common in the aged group (29.5% vs. 47.9%, p=0.030) and the incidence of typical epigastric pain in the aged and young groups were similar (33.3% vs. 40.0%, p=0.439). The frequency of ulcer bleeding was not different (22.8% vs. 17.1%, p=0.425) between aged and young groups. However in the aged group, the NSAID users experienced more frequent ulcer bleeding than nonusers. The Helicobacter pylori (+) NSAID users are believed to have a higher tendency to bleed than the Helicobacter pylori (-) NSAID users but without statistical significance. Among the aged, 40% of the NSAID-nonusing peptic ulcer patients was Helicobacter pylori (-). The duration of symptoms was shorter in the aged. An atypical location of the aged and younger groups was similar (13.2% vs. 7.0%, p=0.352). CONCLUSION: In the aged gastric ulcer patients, factors other than NSAID and Helicobacter pylori are believed to play roles in the development of gastric uclers. However, in the aged duodenal ulcer patients, the role of Helicobacter pylori in the development of a duodenal ulcer was similar to that in the younger group. NSAID is believed to be an important risk factor in the bleeding of ulcers in aged patients. In addition, the Helicobacter pylori (+) NSAID users had more frequent bleeding than the Helicobacter pylori (-) NSAID users but without statistical significance.
Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Duodenal Ulcer ; Endoscopy, Digestive System ; Helicobacter pylori ; Hemorrhage ; Humans ; Incidence ; Korea* ; Male ; Morinda ; Peptic Ulcer* ; Risk Factors ; Stomach Ulcer ; Ulcer

Colonoscopy is a safe procedure and life-threatening complications occur rarely during diagnostic colonoscopy. There have been several reports of complications of colonoscopy, including bleeding, bowel perforation, bacteremia, vasovagal reactions and side effects of preparation and other more minor problems. The development of diaphragmatic hernia during diagnostic colonoscopy is extremely rare complication. We report a case of herniation and entrapment of the colon into the left thorax, via a small diaphragmatic defect caused by previous trauma, during diagnostic colonoscopy.
Bacteremia ; Colon ; Colonoscopy* ; Hemorrhage ; Hernia, Diaphragmatic ; Thorax