OBJECTIVE: The authors conducted this study to investigate the safety and efficacy of decompressive surgery alone in the treatment of lumbar spinal stenosis in the elderly population. METHODS: All charts and records of 323 patients aged 65 years or older who underwent lumbar spinal decompressive surgery without fusion for lumbar spinal stenosis in the period from September 2003 to August 2007 were reviewed. RESULTS: A total of 323 patients were identified. Mean age among patients were 72.6years. 197 patients(60.9%) underwent wide decompression, 95 patients(29.4%) had microscopic partial decompression, and 31 patients(9.5%) underwent bilateral decompression via unilateral approach. Perioperative morbidity seen was among 16 patients(4.9%). There were 5 patients(1.5%) reoperated for hematoma formation. Another 5 patients(1.5%) developed wound infection. Cerebrospinal fluid(CSF) leakage were noted among 3 patients(0.9%). 2 patients(0.6%) had urinary difficulty, and Steven Johnson syndrome developed in one patient(0.3 %). Clinical outcome was evaluated using Macnab's classification. 40 patients(12.4%) had excellent results, 241 patients(74.8%) had good results, 34 patients(10.3%) had fair results and 8 patients(2.5%) had poor outcome. CONCLUSION: Decompressive laminectomy alone is a relatively safe and effective treatment option for the elderly.
Aged ; Decompression ; Hematoma ; Humans ; Laminectomy ; Spinal Stenosis ; Wound Infection

The present study was performed in order to investigate the correlation among the number of T zone histiocytes, the clinicopathologic parameters and the patient's survival. The subjects in this study were 131 advanced gastric carcinomas including 86 follow-up cases and 41 early gastric carcinomas. The infiltration of T zone histiocytes into tumor tissues was investigated using the immunohistochemical method with andti s-100 protein, nd the data obtained were evaluated statistically. T zone histiocytes were scattered among the cancer cells and in areas formed clusters within the cancer stroma. These cells were abundantly present in tumor tissues and around lymphoid follicles but were rarely seen in surrounding normal stomach tissue. Analysis of the number of T zone histiocytes showed no correlation between the number of T zone histiocytes and the clinicopathologic features except the degree of lymphocytic infiltration within the advanced and the early gastric carcinomas. Survival of the patients with a marked infiltration of T zone histiocytes in stage III was longer than that with mild infiltration of T zone histiocytes, but there was no statistical significance(P value=0.084). Multivariate regressio analysis revealed that the depth of invasion(P value=0.0074) and the lymphocytic infiltration(P value=0.0152) were the important prognostic factors. The results indicate that good prognosis is expected in cases with less deep invasion and high lymphocytic infiltration, and that the number of T zone histiocytes is in proportio to the degree of lymphocyte infiltration within the tumor, although not directly correlated with the patient's survival.

Cholangiocarcinomas have several histologic types, but intrahepatic cholangiocarcinoma with sarcomatous change is rare. A 71-year-old man was admitted to our hospital because of fever which had lasted two months. Ultrasonography (US) of the upper abdomen demonstrated a huge hepatic mass with central solid and peripheral cystic portions, and computed tomography (CT) revealed a heterogeneous hepatic mass with a central area in which enhancedment was delayed. Magnetic resonance imaging (MRI) disclosed a huge mass of predominantly low signal intensity at T1WI, and peripheral portions of high signal intensity and a central portion of intermediate signal intensity at T2WI. The pathologic diagnosis was cholangiocarcinoma with sarcomatous change.
Abdomen ; Aged ; Cholangiocarcinoma* ; Diagnosis ; Fever ; Humans ; Magnetic Resonance Imaging ; Ultrasonography

The author studied the effect of the recirculation on the energy metabolism in acute focal cerebral ischemia. Acute focal cerebral ischemia was produced by transorbital occlusion of the left middle cerebral artery with a Heifetz clip under the operating microscope. The animals were divided into three groups according to the duration of the ischemia. Each group was reperfused for 1, 4 and 7 hour by removing the clip from the artery. In 1-hour ischemic group ATP and GTP was reduced to 38% and IMP to 40% of the sham control. After 7-hour recirculation in this group ATP was resynthesized to 85%, GTP to 85%, and IMP to 180% of the sham control. In 3-hour ischemic group ATP was reduced to 19%, GTP to 23%, and IMP to 29% of the sham control. In this group ATP, GTP and IMP rose to 43%, 49% and 84%, respectively after 7-hour recirculation ATP, GTP and IMP were markedly reduced in 5-hour ischemic group, and despite recirculation these substances continued to decrease and none of them were detected after 7-hours of recirculation, It was suggested that the restoration of the circulation must be accomplished within 1-hour or at least within 3-hour of the ischemic insult of the cats to prevent the irreversible brain infarction.
Adenosine Triphosphate ; Animals ; Arteries ; Brain Infarction ; Brain Ischemia ; Cats ; Edema* ; Energy Metabolism* ; Guanosine Triphosphate ; Ischemia ; Middle Cerebral Artery

STUDY DESIGN: Retrospective study. PURPOSE: This retrospective study aimed to determine the incidence of adjacent level new fractures in a sandwich constellation (one or two untreated vertebrae between two cemented vertebrae) compared with that in other constellations formed by two-level percutaneous vertebroplasty (PVP). It also aimed to investigate the potential factors contributing to adjacent new fractures in a sandwich constellation. OVERVIEW OF LITERATURE: There are few studies regarding the intervening intact vertebral body between two cemented vertebrae. Clinical data from previous studies investigation this sandwich situation, too, have been vague. METHODS: Clinical data were obtained from 132 patients who had two cemented vertebral bodies, irrespective of whether they had undergone one or two PVP sessions between January 2013 and June 2016 at a single institution. Cases with one or two intact vertebral levels between the two cemented vertebrae were classified into group 1 (n=47), and cases with two consecutive cemented bodies or more than three levels of intervening configurations were classified into group 2 (n=85). Demographic data and radiological parameters for new fractures after PVP were compared between the two groups, and the rates of subsequent adjacent fractures were investigated. RESULTS: The incidence of single-level sandwich constellations was quite uncommon (7.7%). The overall incidences of adjacent fracture were 29.8% (14/47) in group 1 and 14.1% (12/85) in group 2. This difference was statistically significant (p=0.03). Approximately 80% (11/14) of the adjacent new fractures in group 1 developed at an intervening level. The patient demographics and radiological parameters for subsequent fractures after PVP did not statistically correlate with the risk of adjacent new fractures in group 1. CONCLUSIONS: Because they were subjected to double-load shifts, sandwich constellations were prone to re-fractures after PVP. These vertebral configurations required more aggressive management for osteoporosis.
Demography ; Humans ; Incidence ; Osteoporosis ; Retrospective Studies ; Spine ; Vertebroplasty

Ondine's curse refers to the failure of automatic breathing during sleep associated with preservation of voluntary respiratory controls. This syndrome of Ondine's curse usually result from both bilateral and unilateral medullary tegmental infarcts. We report a case of a 56-year old hypertensive man who showed automatic respiratory failure during sleep and bilateral medullary infarcts in brain MRI.
Brain ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Respiration ; Respiratory Insufficiency*

BACKGROUND: Several abnormalities of the autonomic regulation of the heart have been noted after acute myocardial infarction(AMI). Measurement of heart rate(HR) variability has been reported to provide indirect, noninvasive estimate of the cardiac efferent parasympathetic activity. The purposes of this study were to get the information on heart rate variability after AMI and to determine its relation to clinical and hemodynamic data. METHODS: We measured HR variability in 28 patients(23 men and 5 women : mean age, 56.6+/-10.4 years) 3-15days after AMI, in 25 patients with unstable angina and in 21 normal subjects by using triangular interpolation of the frequency distribution histogram om normalto-normal RR intervals from Holter tapes. RESULTS: HR variability was lower in AMI than unstable angina patients(357.9+/-118.6 versus 426.1+/-122.5 msec : p<0.05) and normal subjects(525.1+/-137.4 msec : p<0.025). There was no difference for infarct site, thrombolytic therapy, presence of Q-wave. HR variability was significantly related to mean 24-hour HR, left ventricular ejection fraction(all p<0.0001), left ventricular end diastolic diameter(p<0.05). HR varability was lower in patients belonging to Killip class 2-4 and who reqired the use of diuretics or digitalis(all p<0.05). CONCLUSION: After AMI, HR variabillity was reduced and significantly related to clinical and hemodynamic indexes of severity. Measurement of HR variability early after AMI may offer important clinical information for the early high stratification of patients.
Angina, Unstable ; Autonomic Nervous System ; Diuretics ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Male ; Myocardial Infarction* ; Thrombolytic Therapy

There are many methods for postoperative pain relief. For example,intramusoular or in- travenous administration of analgesics,nerve block,wound infiltration or intravenous injaction with local anesthetics, epidural or intrathecal injection of opioids or local anesthetics, TENS, cryoanalgesia, psychological support are available, We managed postoperative pain by means of intrathecal morphine injection or epidural morphine with bupivacaine mixture administration. In the group 1, morphine 0.2mg was injected intrathecally just after the operation. In the group 2, the mixture of morphine with bupivacaine was infused into epidural space continuously for 3days. The results were as follows; 1. The pain score was significantly decreased in group 2 compared to group 1.(P<0.05) 2. In group 1,there was signficantly more itehing sensation than in group 2.(P<0.05), but there were no significst differences in other complications 3. There was no significant difference in gas passing time. 4. The feeling of satisfaction was high in both groups,and there was no significant difference. 5. It was technically more difficult and the cost was higher in group 2.
Analgesics, Opioid ; Anesthetics, Local ; Bupivacaine* ; Epidural Space ; Injections, Spinal ; Morphine* ; Pain, Postoperative ; Sensation ; Transcutaneous Electric Nerve Stimulation

PURPOSE: It is known that cyclooxygenase (COX)-2 expression is increased in Barrett's esophagus and esophageal adenocarcinomas. We studied COX-2 expression and the effect sulindac has on the genesis of Barrett's esophagus and adenocarcinoma in rats undergoing esophagogastroduodenal anastomosis (EGDA). MATERIALS AND METHODS: Fifty-one rats were divided into a control group (n=27), a 500ppm sulindac-treated group (n=15) and 1000 ppm sulindac-treated group (n=9). Randomly selected rats were killed by diethyl ether inhalation at 20 and 40 weeks after surgery. RESULTS: At 40 weeks, rats treated with 1000 ppm sulindac showed narrower esophageal diameter and milder inflammation than the control rats. At 40 weeks, the incidence of Barrett's esophagus was similar between control and sulindac-treated groups, but the incidence of adenocarcinoma was significantly lower in the 1000ppm sulindac-treated group than either the control or 500 ppm sulindac-treated groups. COX-2 was significantly increased in the lower esophagus of control rats killed at 40 weeks. Cyclin D1 expression was negligible in the sulindac- treated group compared with the control group. CONCLUSION: We suggest that the chemopreventive effect of sulindac is related to decreased COX-2 and cyclin D1 expression, which may be influenced by reduced inflammation.
Adenocarcinoma/etiology/metabolism/*prevention & control ; Animals ; Antineoplastic Agents/therapeutic use ; Barrett Esophagus/etiology/metabolism/prevention & control ; Blotting, Western ; Cyclin D1/metabolism ; Cyclooxygenase 2/metabolism ; Duodenogastric Reflux/*complications ; Esophageal Neoplasms/etiology/metabolism/*prevention & control ; Immunohistochemistry ; Male ; Proliferating Cell Nuclear Antigen/metabolism ; Rats ; Rats, Sprague-Dawley ; Sulindac/*therapeutic use

From March 1985 to June 1997, 451 patients of spontaneous pneumothorax treated at Kangbuk Samsung Hospital were reviewed retrospectively. Most of the patients were male (male to female ratio, 8.2:1). The mean age of the primary spontaneous pneumothorax (PSP) was 26.8 years, and that of secondary spontaneous pneumothorax (SSP) was 53.1 years. 330 out of 451 patients (73%) were PSP. The causes of the SSP were mostly pulmonary tuberculosis and COPD: 87 patients (72%), and 24 patients (19.2%), respectively. All the patient were treated by one of the following modalities: 1)rest and oxygen therapy in 42 patients, 2) closed thoracostomy in 208 patients, 3) thoracotomy in 156 patients, 4) VATS bullectomy in 45 patients. The mean duration of postoperative chest tube drainage was as following: thoracotomy 8.3 days, VATS bullectomy 4.7 days. For recent 3 consecutive years, VATS bullectomy has become the more frequently applied operative procedure than thoracotomy in the treatment of surgically indicated PSP, from 33% in 1994 to 78% in 1996. With the minimally invasive thoracoscopic surgery being more prevalent, VATS bullectomy will be able to be the 1st choice of treatment not only for the recurrent pneumothoracies but also for the some selected cases of the 1st episode pneumothoracies. To verify this approach as clinically acceptable one in terms of cost-effectiveness, recurrence rate, etc, a large scale of multi-institutional clinical study will be needed in a sooner time.
Chest Tubes ; Drainage ; Female ; Humans ; Male ; Oxygen ; Pneumothorax* ; Pulmonary Disease, Chronic Obstructive ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracostomy ; Thoracotomy ; Tuberculosis, Pulmonary