STUDY DESIGN: The indications of the lumbosacral spinal fusion has been very controversial. The posterior lumbar interbody fusion has the popularity of the spinal fusion: coaption of large surface areas of cancellous bone without shear forces, anatomic restoration and maintenance of more normal dimensions of the joint space, total discectomy as preparation for the fusion, and the accomplishment of better neural decompression without creating instability of the spine. OBJECTIVES: To evaluate the long-term results of the surgical management of degenerative lumbar disease by the modified transdiscal posterior lumbar interbody fusion technique using cancellous chip graft were analyzed. SUMMARY OF LITERATURE REVIEW: The disadvantages of classical posterior lumbar interbody fusion has a injury of nerve root by extensive retraction with the insertion of peg grafts into the disc space, compression of root by graft retropulsion, inadeguate removal of annulus fibrosus and end plates from excessive bleeding from venous plexus of spinal canal and from vertebral cancellous bone. MATERIALS & METHOD: Author's 43 cases who had transpedicular instrumentation and modified transdiscal PLIF using cancellous chip graft since 1989 in the Department of Orthopedic Surgery, Korea University Hospital were analyzed, retrospectively. After preparation of the interspace has been complete by total discectomy, removal of the cartilaginous end plates and perforation of the cortical plates using the ring curette, cancellous chip grafts are inserted into the interspace with the Funnel technique. The structural success of each fusion was documented by sequencial radiographs. The criteria for fusion included: homogenous amalgamation of the fusion mass and vertebral bodies, trabeculation, mass configuration, and no motion demonstrable by hyperflexion studies. The results obtained were as follows: 1. Stable fusion was obtained in 39 patients(91%) at post-operative 6 months. 2. Clinically no patient developed neurologic deficit after fusion and 41 patients (95.3%) had good results by Gill's criteria. 3. No significant complications influencing operative result were observed except minor complications such as paralytic ileus, transient dysuria and superficial infection. 4. In conclusion, modified transdiscal PLIF procedure using cancellous chip graft showed excellent clinical and radiological results to achieve spinal fusion and the procedure is technically feasible and should be considered more widely employed.
Decompression ; Diskectomy ; Dysuria ; Hemorrhage ; Humans ; Intestinal Pseudo-Obstruction ; Joints ; Korea ; Neurologic Manifestations ; Orthopedics ; Retrospective Studies ; Spinal Canal ; Spinal Fusion ; Spine ; Transplants*

No abstract available.
Cervix Uteri* ; Female ; Health Expenditures*

PURPOSE: Pain is the most distressing feature of cancer patients. Thoracoscopic splanchnicectomy, first performed in 1993, has caused a resurgence of interest in surgical treatment of such excruciating pain. We wish to introduce a method of splanchnicectomy. METHODS: Five patients underwent a splanchnicectomy for intractable cancer pain, over a period of 11 months. We evaluated the type of splanchnicectomy performed and the results. The procedure was done using a double lumen catheter to deflate the lung at the operation side under general anesthesia with the patient in the lateral decubitus position. A small opening was made with scissors in the pleura of the 5th intercostal space to expose the terminal branch of the greater splanchnic nerve. Six-Seven branches of splanchnic nerve were cut downward until the splanchnic nerve trunk and then cut. A left thoracoscopic splanchnicectomy was done in one case, and a bilateral thoracoscopic splanchnicectomy in four cases. RESULTS: The splanchicectomy appears to result in significant reduction of abdominal pain in all cases. There were no postoperative complications. CONCLUSION: As a conclusion, thoracoscopic splanchnicectomy is the treatment of choice for intractable intraabdominal cancer pain, affording drug cessation and recovery of daily activity in most patients.
Abdominal Pain ; Anesthesia, General ; Catheters ; Humans ; Lung ; Pleura ; Postoperative Complications ; Splanchnic Nerves ; Thoracoscopy

Endoscopic variceal ligation (EVL) is effective for the management of bleeding esophageal varices, and its use is widespread now. EVL necessitates the use of overtubes. Two primary techniques have been used for overtube placement; one is with endoscope, and the other is with bougie dilator. Overtube placement with endoseope is not without risk. There are reportd of esophageal or pharyngeal laceration or perforation. Overtube placement with bougie dilator circumvents this risk, but it is rather cumbersome to use. The authors devised a safe and easy method for overtube placement, and applied it to a number of patients to test its safety and convenience. First, overtube-dilator assembly was prepared as follows. A Rigiflex achalasia dilator (balloon 30mm OD, 10cm length; Microvasive Co) was lubricated and inserted into the overtube. A tenth of the balloon tip was protruded out of the overtube, then the balloon was insufflated with air at 10-15 psi. Second, standard endoscopy was performed, followed by placement of guide wire in the stomach. Overtube-dilator assembly was lubricated and introduced over the wire as a rail. Once the overtube was properly positioned, the balloon was deflated, and the balloon and wire were removed as a whole, which completed overtube placement. For 65 patients with esophageal variceal bleeding, 82 procedures of EVL were performed using the new technique. Overtube-dilator assembly was easy to prepare and handle. This technique added little time to the procedure and minimizes patients discomfort. No patient suffered major complications such as bleeding, laceration or perforation. This novel method for overtube placement was safe and convenient for use in EVL. It can also be applied to other procedures using overtube such as endoscopic foreign body removal.
Endoscopes ; Endoscopy ; Esophageal Achalasia ; Esophageal and Gastric Varices ; Foreign Bodies ; Hemorrhage ; Humans ; Lacerations ; Ligation* ; Stomach

Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.
Adenoma ; Classification ; Incidence ; Japan ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms*

Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.
Adenoma ; Classification ; Incidence ; Japan ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms*

PURPOSE: To report a case of bilateral central serous chorioretinopathy (CSC) after blunt trauma with rapid remission. CASE SUMMARY: A 44-year-old man visited our clinic after blunt trauma around the right eye. At the first examination, no ocular problem was detected except a periorbital contusion. After one week, the patient complained of visual disturbance in his right eye. Fundus examination showed subretinal fluid in his right eye, and fluorescein angiography (FAG) showed typical smoke-stack pattern leakage, which lead to a diagnosis of CSC. Three days later, the patient complained of visual disturbance in his left eye, which was then also diagnosed as CSC. After 2 more weeks, the subretinal fluid in the right and left eyes had decreased. After 3 weeks, the subretinal fluid was almost completely absorbed in both eyes. CONCLUSIONS: Central serous chorioretinopathy can develop after blunt trauma, especially with a rapid clinical course. Thus, periodic ophthalmologic examination is needed after the first examination for blunt trauma of the eye.
Adult ; Central Serous Chorioretinopathy* ; Contusions ; Diagnosis ; Fluorescein Angiography ; Humans ; Subretinal Fluid

A five month female was referred complaining of intermittent vomiting with protrusion of a sausage-like mass through the oral cavity. Esophageal endoscopy and esophagogram revealed a mass in the upper esophagus, which was diagnosed as a fibrovascular polyp. Under general anesthesia, the mass was grasped through the oral cavity with a forcep and ligated and excised at the base, where a stump arose from the posterior wall of the cervical esophagus. The pathology was confirmed as a fibrovascular polyp, which is a rare benign esophageal lesion occurring mostly in adult males, and has not been reported in infancy.
Blood Vessels/pathology ; Case Report ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/pathology* ; Esophageal Neoplasms/blood supply ; Esophagoscopy ; Female ; Fibrosis ; Human ; Infant ; Polyps/surgery ; Polyps/pathology* ; Polyps/blood supply

OBJECTIVES: The aim of this study was to evaluate the risk factors of suicide attempt in patients with alcohol dependence. METHODS: A total of 68 patients admitted to the hospital for alcohol dependence were divided into two groups according to history of suicide attempt. In this study, sociodemographic variables, characteristics of alcohol drinking, and clinical scales were compared between the two groups. RESULTS: Regarding sociodemographic and clinical features, the alcoholic group with history of suicide attempt included more patients with no spouse, using medical aid in social security, and history of depressive disorder. Regarding characteristics of alcohol drinking, ages of first alcohol problems and first admission for alcohol problems were significantly younger in the attempter group. Patients in the attempter group had been drinking more and had higher frequency of delirium tremens and psychiatric admission. Regarding clinical scales, significantly higher scores for suicide ideation, depression, anxiety, and impulsiveness were observed in the attempter group. Among the scores for Temperament and character inventory, the score for persistence was significantly lower in the attempter group. After controlling for other compounding factors, depressive disorder [p=0.006, odds ratio (OR)=32.2] and suicide ideation (p=0.029, OR=1.2) were significant factors showing correlation with suicide attempt. CONCLUSION: Results of this study suggest that assessment and management of the depressive disorder and suicide ideation are necessary for suicide prevention in patients with alcohol dependence.
Alcohol Drinking ; Alcohol Withdrawal Delirium ; Alcoholics ; Alcoholism ; Anxiety ; Depression ; Depressive Disorder ; Drinking ; Humans ; Male ; Odds Ratio ; Risk Factors ; Social Security ; Spouses ; Suicide ; Temperament ; Weights and Measures

BACKGROUND/AIMS: HBV infection can be seen after organ transplantation. The presence of anti-Bs in serum means protection from HBV infection. If amino acids were mutated in 'a' determinant which was a common antigenic epitope of HBsAg, escape from humoral immunity can occur. Recently, in chronic HBV infected patients who received liver transplantation but reinfected by HBV, many authors reported mutations in 'a' determinant sequence. However, in renal transplantation, there were few reports about HBV infection and 'a' determinant mutation after transplantation. Therefore, we studied the incidence of HBV reinfection after renal transplantation and also tried to analyze 'a' determinant sequence in those patients. METHODS: We reviewed HBsAg-egative patients who received renal transplantation in our hospital, but turned HBsAg positive after transplantation. We selected two patients who were anti-Bs positive before transplantation but turned HBsAg positive after transplantation, and analyzed 'a' determinant of amino acid sequence of these patients. RESULTS: Among 1682 patients who were HBsAg negative before transplantation, 21 patients were turned HBsAg positive after transplantation. Among them, 6 patients were anti-Bs positive before transplantation. Sequence analysis of the 'a' determinant amino acid in two patients whose HBsAg turned positive after transplantation revealed no evidence of mutation in comparison with previously reported subtype 'a' determinant sequences. CONCLUSION: In renal transplantation, HBV could be reinfected in patients who had been anti-Bs positive before transplantation even without mutation in 'a' determinant region.
Amino Acid Sequence ; Amino Acids ; Hepatitis B Surface Antigens ; Humans ; Immunity, Humoral ; Incidence ; Kidney Transplantation* ; Liver Transplantation ; Organ Transplantation ; Sequence Analysis* ; Transplants ; United Nations