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

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

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

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

BACKGROUND: Endoscopic variceal ligation (EVL) has been widely used to control acute variceal bleeding. However, eradication of varices with EVL is difficult and rebleeding following successful EVL is frequently problematic. Our aims were to assess the efficacy of EVL for treatment of acute variceal bleeding and to evaluate risk factors associated with rebleeding during follow-up period. METHODS: One-hundred and five patients were included, who had undergone EVL due to bleeding of esophageal varices. Retrospective analysis was performed about hemostatic success rate, rebleeding rate and risk factors for rebleeding. RESULTS: Hemostatic success rate was 84.8% (89/105). During follow-up period, eradication of varices was observed in 5.7% (6/105), downgrading in 44.8% (47/105), no change of grade in 35.2% (37/105), and progression of varices was observed in 3.8% (4/105). Mean number of sessions for eradication were 3.3 (range, 2 to 8). Rebleeding was observed in 55.2% (58/105), and rebleeding rate increased with lapse of time, as 24.5% after 3 months, and 37.1% in 6 months, and 50.7% in 12 months, respectively. Multivariate analysis for risk factors of rebleeding showed that number of sessions of variceal ligation was associated with significant reduction of rebleeding (p=0.01, OR 0.184). CONCLUSION: EVL was effective for hemostasis of acute variceal bleeding, but progression of varices and rebleeding episodes were common. Adequate follow-up evaluation is mandatory, and repeated variceal ligation is required for eradication of varices and secondary prevention of bleeding.
Esophageal and Gastric Varices* ; Follow-Up Studies ; Hemorrhage ; Hemostasis ; Humans ; Ligation* ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Secondary Prevention ; Varicose Veins

BACKGROUND/AIMS: This study was performed to evaluate whether the prevalence rates of primary antibiotic resistance in Helicobacter pylori (H. pylori) isolates and the eradication rate of H. pylori could be different between cancer and non-cancer patients. METHODS: H. pylori were isolated from gastric mucosal biopsy specimens obtained from 269 Koreans, who did not have any eradication therapy history and were diagnosed as one of the following diseases; chronic gastritis, benign gastric ulcer, duodenal ulcer or gastric cancer. The susceptibilities of the H. pylori isolates to amoxicillin, clarithromycin, metronidazole, tetracycline, azithromycin, ciprofloxacin, levofloxacin and moxifloxacin were examined with the agar dilution method. In addition, eradication rate of H. pylori was evaluated. RESULTS: There was no significant difference in the primary antibiotic resistance to above eight antibiotics among chronic gastritis, peptic ulcer disease and gastric cancer. Furthermore there was no difference of antibiotic resistance between cancer and non-cancer patients, and there was no difference of eradication rate of H. pylori according to disease. CONCLUSIONS: Primary antibiotic resistance and H. pylori eradication rate were not different between cancer and non-cancer patients.
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use ; Adult ; Aged ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Chronic Disease ; Clarithromycin/therapeutic use ; *Drug Resistance, Bacterial ; Drug Therapy, Combination ; Duodenal Ulcer/complications/microbiology ; Female ; Gastritis/complications/microbiology ; Helicobacter Infections/drug therapy/*epidemiology/microbiology ; Helicobacter pylori/*drug effects/isolation & purification ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Omeprazole/therapeutic use ; Peptic Ulcer/complications/microbiology ; Proton Pump Inhibitors/therapeutic use ; Republic of Korea ; Stomach Neoplasms/complications/microbiology

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/AIMS: To minimize injury, less invasive surgery including laparascopic surgery and endoscopic mucosal resection are increasingly used for the treatment of gastric cancer nowadays. Therefore, accurate preoperative staging is important to decide adequate treatment modality. Endoscopic ultrasonography (EUS) is reported to be an accurate diagnostic modality to evaluate the depth of tumor invasion. Especially, evaluation of T-2 stage is important to determine operation. We tried to reveal the factors affecting the accuracy of EUS for the evaluation of T-2 stage gastric cancer. METHODS: Among 367 patients who underwent EUS to evaluate preoperative stage, we compared EUS findings and histopathological findings retrospectively. RESULTS: A total of 270 patients were diagnosed as early gastric cancer, and 97 patients as advanced gastric cancer. The overall concordance rate was 78.2% (287/367), over-estimation rate 14.2% (52/367), and under-estimation rate 7.6% (28/367). Among T-2 stage cancer, over-estimation rate was 27.0% (20/74), and under-estimation rate 21.6% (16/74). These were relatively high compared with those with over-estimation. Among T1 lesions, 20.6% (22/107) were over-estimated as the invasion into proper muscle layer. Compared with sm1 lesion (17.9%), sm3 lesions showed higher over-estimateion rate (25.7%). In the presence of submucosal fibrosis, sm1 lesions were over-estimated as T-2 lesion. Sm2 and sm3 lesions were not related to submucosal fibrosis. Factors affecting over-estimation as T-2 lesions were the size of tumor, the presence of submucosal fibrosis and connective tissue hyperplasia, and ulcer (p<0.05). Microscopic invasion did not affect the accuracy of EUS findings. CONCLUSIONS: In T-2 gastric cancer, the presence of submucosal fibrosis, tumor size, and ulcer were the affecting factors for the over-estimation of the depth of invasion using EUS in gastric cancer. To improve preoperative diagnostic accuracy in T-2 stage cancer, a new diagnostic improvement in EUS is needed.
Adult ; Aged ; Aged, 80 and over ; *Endosonography ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity ; Stomach Neoplasms/pathology/*ultrasonography

Gastrojejunocolic fistula (GJCF) is mainly thought to be a late complication of inadequate gastric surgery such as insufficient gastric resection or inappropriate vagotomy. The pathogenesis of fistula formation has been accounted to the perforation of a retained jejunal marginal ulcer into the transverse colon. Most patients with GJCF present a common symptom triad of faecal vomiting, chronic diarrhea and weight loss. We recently experienced a patient with GJCF who had been suffering from diarrhea for a long period of time. He had undergone gastric surgery 8 years previously for peptic ulcer disease at another hospital. After detailed preoperative evaluation with duodenoscopy, upper gastrointestinal series, colonofiberscopy, barium enema and abdominal CT, he underwent surgery-resection of the gastric stump and segmental resection of the jejunum and transverse colon with Roux-en-Y gastrojejunostomy. Recent advances in surgical technique such as vagotomy, and medical therapy have remarkably decreased the incidence of both stomal ulcer and GJCF in peptic ulcer disease. However, gastrojejunocolic fistula should be recognized as one of the late severe complications observed after a gastrectomy with Billroth-II reconstruction, since this disease may occur even 20 years after the first operation. We report the case of a 52-year old man with gastrojejunocolic fistula with review of the literature.
Barium ; Colon, Transverse ; Diarrhea ; Duodenoscopy ; Enema ; Fistula* ; Gastrectomy* ; Gastric Bypass ; Gastric Stump ; Humans ; Incidence ; Jejunum ; Middle Aged ; Peptic Ulcer ; Tomography, X-Ray Computed ; Ulcer ; Vagotomy ; Vomiting ; Weight Loss