OBJECTIVE: The purpose of our retrospective study is to evaluate the surgical outcome of patients who underwent unila- teral approach for bilateral decompression surgery for lumbar spinal stenosis and to compare outcomes between geriatric and younger patients. METHODS: We reviewed records of 85 patients with an average age of 64 years at the time of surgery after the unilateral laminotomy for bilateral decompression of degenerative lumbar spinal stenosis between 2005 and 2007. To compare clinical and functional outcomes between younger and geriatric patients, they were divided by age into 2 groups: Group A included patients 65 years of age or older and Group B contained patients younger than 65 years. The study parameters were set to ensure a follow-up period of at least 3 months and hospital records and phone-call review were analyzed for patients' clinical and demographic data, co-morbidity, type of stenosis, clinical and functional outcomes. Clinical outcomes were measured using the scale of Finneson and Cooper and the visual analog scale score for leg and back pain. Functional outcome was assessed with change of walking distance of patients. RESULTS: Follow-up was completed in 80(94.1%) of 85 patients and Group A included 44 patients and Group B did 36 patients. The number of decompressed level showed 2.26 with similar results in both groups(group A, 2.25; Group B, 2.28). The number of co-morbidity was significantly higher incidence of 2.36 in geriatric patients than that of 1.67 in younger individuals. Other demographic data and type of stenosis were similar between two groups. For each back and leg pain, 86.3%(Group A: 86.4%; Group B, 80.6%) and 83.8%(Group A: 90.9%; Group B: 80.6%) had an excellent-to-fair operative result under the scale of Finneson and Cooper. Improvement rate of walking distance was 81.5% of patients and higher in group B(89.3%) than in group A(75.6%), however, there was not statistical significance. Three major complications were occurred in all patient groups, the first patient with chronic renal failure suffered from immediately postoperative epidural hematoma and the second patient had wound dehiscence. The third patient with no improvement was operated with fusion surgery at the other hospital nonetheless she had not improved until now. CONCLUSIONS: The ULBD allowed sufficient and safe decompression of the neural structures and adequate preservation of vertebral stability with acceptable complication rates. This technique could provide a minimally invasive approach for LSS in elderly patients frequently having comorbidities as well as younger one.
Aged ; Back Pain ; Comorbidity ; Constriction, Pathologic ; Decompression ; Dietary Sucrose ; Follow-Up Studies ; Hematoma ; Hospital Records ; Humans ; Incidence ; Kidney Failure, Chronic ; Laminectomy ; Leg ; Retrospective Studies ; Spinal Stenosis ; Walking

OBJECTIVES: To investigate whether the aspects of Pap smear affect cervical abnormality in our country. METHODS: We compared the sensitivity of Pap smear of 241 cases of pathologic proven CIN & invasive cancer, compared to that of 655 cases with normal cervical biopsy, and reviewed the history of the test of 138 cases, retrospectively. RESULTS: The sensitivity of the test was 89.6%, 92.7% in CIN & invasive cancer group, respectively, with 96.9% specificity. Among 241 cases, 138 cases were examined for the frequency of test during the 3 years with the result of 2.42, 2.17/3yr in CIN and invasive cancer. And distribution of the test was not different between the two groups. The mean intervals of last two Pap smear before diagnosing final pathology in CIN and cancer were 12.1, 13.7 months, respectively, with no statistical significance (p>0.05). CONCLUSION: We concluded that in our country the aspects of Pap smear such as frequency and interval do not influence the result of cervical abnormality, so recommend the annual Pap test as a screening.
Biopsy ; Cervical Intraepithelial Neoplasia* ; Mass Screening ; Papanicolaou Test* ; Pathology ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVE: The aim of this study is to describe the surgical outcome and determine prognostic factors of thoracic ossified ligamentum flavum(OLF). METHODS: From April 1998 to November 2001, 32 consecutive patients with symptomatic thoracic OLF were treated surgically in our institution. Among them, the authors conducted a retrospective analysis of 28 patients in whom preoperative magnetic resonance imaging and computed tomogram were available. Decompressive laminectomy including removal of OLF mass was performed in each case. Mean follow-up period was 25.2 months, ranged from 3 to 46 months. RESULTS: Twenty-two patients(79%) showed functional improvement, in whom average Nurick Grade changed from 3.6 to 2.5 after surgery. Fifteen of eighteen patients presented with motor weakness, six of seven with leg or back pain and one of three with leg numbness or paresthesia improved respectively. No patient had deteriorated postoperatively. Clinical presentation and preoperative Nurick Grade were significant predictive factors for surgical outcome(p=0.004 and p<0.001, respectively). In addition, combined facet joint hypertrophy and/or compressive anterior element indicated poor prognosis(p=0.008). CONCLUSION: Appropriate evaluation and sufficient surgical decompression for combined compressive elements on imaging study could improve the functional prognosis in thoracic OLF.
Back Pain ; Decompression, Surgical ; Follow-Up Studies ; Humans ; Hypertrophy ; Hypesthesia ; Laminectomy ; Leg ; Ligamentum Flavum* ; Magnetic Resonance Imaging ; Paresthesia ; Prognosis ; Retrospective Studies ; Spine* ; Zygapophyseal Joint

OBJECTIVE: Gait pattern in patients with lumbar degenerative kyphosis (LDK) is disturbed because trunk bends forward due to decreased lumbar lordosis. Surgical therapy in LDK is required when conservative management fails. We investigated kinematic and kinetic changes of the pelvis, hip, and knee joints on the sagittal plane in patients with LDK before and after operation. METHOD: Fifteen patients underwent operations between March 1999 and September 2003. Gait analysis was performed for all patients. RESULTS: Total lumbar lordotic angle increased from 10.50 degrees +/-11.22 degrees to 26.71 degrees +/-8.80 degrees postoperation. In gait analysis, anterior pelvic tilting angle increased from maximum 7.86 degrees +/-9.69 degrees, minimum 4.40 degrees +/-9.82 degrees to maximum 12.61 degrees +/-5.36 degrees, minimum 9.68 degrees +/-5.63 degrees (p<0.05). Maximum hip flexion angle changed from 31.39 degrees +/-11.71 degrees to 35.83 degrees +/-5.84 degrees (p<0.05). Maximum knee flexion angle in terminal stance phase decreased from 13.32 degrees +/-7.34 degrees to 8.30 degrees +/-6.38 degrees (p<0.05). CONCLUSION: After corrective operation, an increase of lumbar spine lordosis and anterior pelvic tilt with decrease of knee flexion were observed. However, an increase of maximum hip flexion secondary to increased anterior pelvic tilting influenced ambulation negatively. Therefore, stretching of the hip flexor and strengthening of the hip extensor are required before and after operation.
Animals ; Decompression Sickness ; Gait ; Hip ; Humans ; Knee ; Knee Joint ; Kyphosis* ; Lordosis ; Lower Extremity* ; Pelvis* ; Spine ; Walking

Multiple primary tumors are defined as cases involving primary malignant tumors of different histologic origins in one person. Recently, the number of reports dealing with multiple primary tumors has been increasing due to more developed diagnostic procedures and patients with longer survival rates. Both the occurrence of multiple primary tumors and the primary adenocarcinoma of the duodenum are infrequent, accounting for less than 1% of all carcinoma of the gastrointestinal tract. Also, It has been reported that duodenal bulb cancer combined with early gastric cancer is extremely rare. One case was experienced involving duodenal bulb cancer combined with early gastric carcinoma, and is herein reported with a review of related literatures.
Adenocarcinoma* ; Duodenum ; Gastrointestinal Tract ; Humans ; Stomach ; Stomach Neoplasms* ; Survival Rate

Flexible fiberoptic bronchoscopy is a useful tool for the diagnosis and management for diseases of the airway. Although it has been known to be a relatively safe procedure; in some cases, mild complications can occur after fiberoptlc bronchoscopy. However, fatal complications such as bacteremia, pneumonia, myocardial infarction, severe obstruction of the airways, respiratory failure or death have been reported. Among them, infectious complications following flexible fiberoptic bronchoscopy occur sometimes, although most of them are self-limited. We recently experienced a case of severe Klebsiella pneumoniae pneumonia in a patient presenting with fever following flexible fiberoptic bronchoscopy, We report this case to discuss the potential complications of fiberoptic bronchoscopy with a review of literature.
Bacteremia* ; Bronchoscopy* ; Diagnosis ; Fever ; Humans ; Klebsiella pneumoniae ; Klebsiella* ; Myocardial Infarction ; Pneumonia* ; Respiratory Insufficiency

Granular cell tumors (GrCTs) of the spinal cord are rare benign tumors with a high rate of local recurrence. Only 6 cases of spinal GrCTs have been reported. GrCT is difficult to distinguish from other benign tumors such as schwannoma using imaging. A radiological "speckled dots" sign may be a useful differentiating feature of GrCT based upon experience with two cases and a review of the literature.
Diagnosis, Differential ; Granular Cell Tumor ; Magnetic Resonance Imaging ; Neurilemmoma ; Recurrence ; Spinal Cord

Purpose: This study aimed to evaluate local tumor progression-free survival (LTPFS) and overall survival (OS) after percutaneous radiofrequency ablation (RFA) for solitary colorectal liver metastases (CLM) <3 cm and to identify the risk factors associated with poor LTPFS and OS after percutaneous RFA. Methods: This study screened 219 patients who underwent percutaneous RFA for CLM between January 2013 and November 2020. Of these, 92 patients with a single CLM <3 cm were included. LTPFS and OS were calculated using the Kaplan-Meier method, and the differences between curves were compared using the log-rank test. Risk factors for LTPFS and OS were assessed using Cox proportional-hazard regression models. Results: Technical efficacy was achieved in the first (n=91) or second (n=1) RFA sessions. During the follow-up (median, 20.0 months), cumulative LTPFS rates at 1, 3, and 5 years were 92.4%, 83.4%, and 76.5%, respectively. During the follow-up (median, 27.8 months), the corresponding OS rates were 97.5%, 81.3%, and 74.8%, respectively. In multivariable Cox regression analyses, the group with both tumor-puncturing RFA and a T4 stage primary tumor (hazard ratio, 3.3; 95% confidence interval, 1.1 to 10.2; P=0.037) had poor LTPFS. In the univariable analysis, no factors were significantly associated with poor OS. Conclusion Both LTPFS and OS were promising after percutaneous RFA for a single CLM <3 cm. The group with both tumor-puncturing RFA and a T4 stage primary tumor showed poor LTPFS. No risk factors were identified for poor OS.

BACKGROUND: Classically, bone marrow (BM) has been the sole source of hematopoietic stem cell transplantation, but limitations of conventional bone marrow transplantation have stimulated a search for alternative sources of stem cells. METHODS: We compared hematopoietic stem cell activity of normal bone marrow (BM), in vivo G-CSF-stimulated bone marrow (G-CSF BM), and G-CSF-mobilized peripheral blood (G-CSF PB) by immunophenotyping, clonogeneicity, and long-term culture-initiating cell (LTC-IC) analysis. RESLUTS: The average numbers of CD34+/HLA-DR- cells after CD34+ cells isolation from each stem cell source were 59.64 +/- 8.70%, 91.39 +/- 1.98%, and 95.75 +/- 2.08% in normal BM, G-CSF BM, and G-CSF PB, respectively (normal BM vs. G-CSF BM, normal BM vs. G-CSF PB, p<0.0001). And the average numbers of CD34+/CD38- cells were 66.23 +/- 9.33%, 95.08+/- 2.09%, and 91.76 +/- 4.59% in normal BM, G-CSF BM, and G-CSF PB, respectively (normal BM vs. G-CSF BM, normal BM vs. G-CSF PB, p<0.0001). The numbers of CFU-GM was significantly higher in G-CSF PB (53.2 +/- 4.05) and G-CSF BM (52.5 +/- 3.63) than that of normal BM (31.3+/- 5.50) (p<0.0001). Also the numbers of CFU-GEMM and CFU-Mk were also significantly higher in G-CSF PB (110.3 +/- 8.79 and 13.3 +/- 1.49) and G-CSF BM (109.7 +/- 10.78 and 11.2 +/- 1.69) than that of normal BM (48.8 +/- 1.48 and 8.5 +/- 1.72) (p<0.05). Comparison of LTC-IC in the three sources of stem cells showed that G-CSF PB and G-CSF BM were superior to normal BM at five weeks of culture (p<0.05). CONCLUSIONS: These data suggest that the amount of both early progenitor cells and late progenitor cells in G-CSF PB and G-CSF BM are higher than that of normal BM. And our results further support that the higher stem cell transplantation using G-CSF-mobilized PB and in vivo G-CSF-stimulated BM can lead to more rapid and sustained engraftment even in cases of high risk of rejection.
Bone Marrow Transplantation ; Bone Marrow* ; Granulocyte Colony-Stimulating Factor* ; Granulocyte-Macrophage Progenitor Cells ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells* ; Immunophenotyping ; Myeloid Progenitor Cells ; Stem Cell Transplantation ; Stem Cells

OBJECTIVES: Various techniques of cervical laminoplasty have been developed to decompress the spinal canal in patients with multilevel cervical spondylotic myelopathy. This study compared the early surgical outcomes between unilateral open-door laminoplasty and midline splitting cervical laminoplasty. MATERIALS AND METHODS: From March 2004 to August 2005, we performed cervical laminoplasty in 34 patients with cervical myelopathy. Of these patients, 24 were treated by unilateral open-door laminoplasty (open-door group) and 10 by midline splitting cervical laminoplasty (splitting group). The mean duration of follow up was 9.2 months in the open-door group and 15.8 months in the splitting group. We retrospectively analyzed neurological outcomes using the Japanese Orthopedic Association (JOA) score, and compared the radiological changes between the two groups. RESULTS: Postoperative JOA score and recovery rate were 13.29+/-4.01 and 56.28+/-44.91% in the open-door group and 15.75+/-0.88 and 72.69+/-19.99% in the splitting group. There was no statistical difference between the two groups (p>0.05). Regarding the radiological assessment, the increase of postoperative axial canal area was 63.23+/-23.24% in the open-door group and 42.30+/-14.96% in the splitting group (p<0.05). CONCLUSION: There was no statistical difference in the neurological outcome when the early surgical outcomes of the open-door group and the splitting group were compared. However, the open-door group showed wider cervical spinal canal areas than the splitting group.
Asian Continental Ancestry Group ; Cervical Vertebrae ; Female ; Follow-Up Studies ; Humans ; Orthopedics ; Retrospective Studies ; Spinal Canal ; Spinal Cord Diseases