OBJECTIVE: A modified surgical technique of posterior cervical foramintomy called posterior cervical inclinatory foraminotomy (PCIF) was introduced in previous preliminary article. PCIF allows better preservation of facet joint and capsule than conventional techniques. The authors conducted a study to investigate long-term outcomes of PCIF. METHODS: We retrospectively reviewed demographic, radiologic, and clinical data from the patients who underwent PCIFs at our institution. Criteria included a minimum of 48 month follow-up and PCIFs for patients with radiculopathy from foraminal stenosis (C2-T1; single or multilevel) with persistent or recurrent root symptoms despite conservative treatment for more than 3 months. Patients who had undergone previous cervical operation were excluded. The visual analogue scale (VAS) score was used for clinical follow-up, and radiologic follow-up was performed to compare the changes of cervical sagittal alignment, focal angle and disc-space height of treated segment. RESULTS: The PCIFs were performed between April 2007 and March 2011 on 46 patients (32 males and 14 females) with a total of 73 levels affected. The average duration of follow-up was 74.4 months. Improvements in radiculopathic pain were seen in 39 patients (84.7%), and VAS score decreased from 6.82±1.9 to 2.19±1.9. Posterior neck pain also improved in 25 patients (71.4%) among 35 patients, and VAS score decreased from 4.97±2.0 to 2.71±1.9. The mean disc-space heights of treated segment were 5.41±1.03 mm preoperatively and decreased to 5.17±1.12 mm postoperatively. No statistically significant changes in cervical sagittal alignment, focal angle were seen during the follow-up period (Cox proportional hazards analysis and Student t-test, p>0.05). CONCLUSION: The PCIF is highly effective in treating patients with cervical spondylotic radiculopathy, leading to long-lasting relief in pain. Long-term radiologic follow-up showed no significant spinal angular imbalance.
Constriction, Pathologic ; Follow-Up Studies ; Foraminotomy* ; Humans ; Male ; Neck Pain ; Radiculopathy ; Retrospective Studies ; Spondylosis ; Zygapophyseal Joint

Gastric stump cancer is defined as cancers that develop in the gastric remnant after the gastric resection of nonmalignant lesions or malignant lesions. The interval between gastrectomy and the detection of gastric stump cancer must be over 5 years in nonmaligant lesions and 10 years in malignant lesions. Symptoms of gastric stump cancer are not specific, so, diagnosis is often delayed. Early detection and curative operation is very important in gasric stump cancer and follow-up endoscopic examination is the most importaint diagnostic tool to detect gastric stump cancer. Recently we experienced a case of early gastric stump cancer. We report review of the literature to remind the important of gastric stump cancer and the important of follow-up endoscopic examination.
Diagnosis ; Esophagus* ; Follow-Up Studies ; Gastrectomy* ; Gastric Stump* ; Intestines* ; Stomach*

PURPOSE: The CA-19-9 antigen is a commonly used tumor marker for pancreatic and bile duct neoplasms. It is well known that the CA-19-9 antigen is a good predictor of resectability, prognosis and recurrence. The aim of this study was to evaluate the efficacy of the CA-19-9 antigen as preoperative resectability and postoperative recurrence markers in pancreatic and bile duct neoplasms. METHODS: Between February 1995 and June 2001, 234 patients, with pancreatic and bile duct neoplasms, at the Department of Surgery, Samsung Medical Center, were followed up with the CA-19-9 antigen, both preoperatively and postoperatively. The ROC curve was used to analyze the relationship between a radical resection and the preoperative CA-19-9 antigen. During the postoperative follow- up, 124 patients that had radical resections, and postoperative follow-up for the CA-19-9 antigen, were studied for this relationship using Chi-square tests. RESULTS: The cut-off values in the pancreatic (P=0.527) and bile duct (P=0.688) neoplasms were 325.50 U/ml and 58.35 U/ml, respectively, using the ROC curve for the relationship between a radical resection and the preoperative CA-19-9 antigen, although the result was statistically insignificant. From the 124 patients used for the statistical analysis, 64 had a recurrence, of which 57 showed an increase in the CA-19-9 antigen, with the 7 showing no elevation. 60 patients had no recurrence, of which 28 showed an increase in the CA-19-9 antigen. The elevation of the CA-19-9 antigen was analyzed between the recurrence and no recurrence groups using Chi-square tests, which revealed a statistical significance (P<0.001). CONCLUSION: In patients with pancreatic and bile duct neoplasms, the CA-19-9 antigen could not predict the preoperatie resectability, but was a clinically effective follow-up marker for a recurrence.
Bile Duct Neoplasms* ; Bile Ducts ; CA-19-9 Antigen* ; Follow-Up Studies ; Humans ; Pancreatic Neoplasms ; Prognosis ; Recurrence ; ROC Curve

OBJECTIVE: The risk factors of reoperation after microdecompression (MD) for lumbar spinal stenosis (LSS) are unclear. In this study, we presented the outcomes of MD for degenerative LSS and investigated the risk factors associated with reoperation. METHODS: A retrospective review was conducted using the clinical records and radiographs of patients with LSS who underwent MD. For clinical evaluation, we used the Japanese Orthopedic Association (JOA) scoring system for low back pain, body mass index, and Charlson comorbidity index. For radiological evaluation, disc height, facet angle, and sagittal rotation angle were measured in operated segments. Also the Modic change and Pfirrmann grade for degeneration in the endplate and disc were scored. RESULTS: Forty-three patients aged 69±9 years at index surgery were followed for 48±25 months. The average preoperative JOA score was 6.9±1.6 points. The score improved to 9.1±2.1 points at the latest follow-up (p<0.001). Seven patients (16.3%) underwent reoperation. Clinical and radiological factors except operation level and Pfirrmann grade showed a p-value >0.1. Patients with Pfirrmann grade IV and lower lumbar segment had a 29.1% rate of reoperation (p=0.001), whereas patients without these factors had a 0% rate of reoperation. CONCLUSION: Moderate disk degeneration (Pfirrmann IV) in lower lumbar segments is a risk factor of disk herniation or foraminal stenosis requiring reoperation after MD in LSS.
Asian Continental Ancestry Group ; Body Mass Index ; Comorbidity ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Laminectomy ; Low Back Pain ; Orthopedics ; Reoperation* ; Retrospective Studies ; Risk Factors ; Spinal Stenosis*

OBJECTIVES: Compared with all other patterns, isolated right colon ischemia has been found to be more associated with coronary artery disease and a poor prognosis. However, there has been no research on comparing isolated left side ischemic colitis (ILIC) and non-ILIC with vascular assessment. The aim of the present study was to evaluate the clinical and laboratory findings between these two different forms of ischemic colitis (IC). METHODS: We retrospectively investigated differences in clinical features, course, and mesenteric vascular (superior mesenteric artery, SMA; inferior mesenteric artery, IMA) findings between ILIC and non-ILIC patients who were hospitalized at Kosin University Gospel Hospital from 2004 to 2010. RESULTS: Our study population comprised 221 patients, all of whom met our entry criteria of biopsy-proven or -compatible IC. Of the 221 patients, 46 (20.8%) had non-ILIC. Congestive heart failure and hypercholesterolemia were more frequently observed in the non-ILIC group (P = 0.003 and P = 0.020, respectively). SMA atherosclerosis and SMA stenosis were more frequently observed in the non-ILIC group (P = 0.006 and P = 0.001, respectively). Recovery periods were longer in the non-ILIC group (P = 0.039), and mortality was lower in the ILIC group (6.9% vs. 17.3%, P = 0.026). CONCLUSIONS: ILIC has favorable outcomes compared with non-ILIC. Furthermore, non-ILIC showed a close relationship with SMA atherosclerosis and SMA stenosis, which should be investigated carefully in the clinical field.
Atherosclerosis ; Colitis, Ischemic* ; Colon ; Constriction, Pathologic ; Coronary Artery Disease ; Heart Failure ; Humans ; Hypercholesterolemia ; Ischemia ; Mesenteric Arteries ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Mortality ; Prognosis ; Retrospective Studies

No abstract available.
Gonadotropin-Releasing Hormone* ; Humans ; Hypogonadism* ; Male*

OBJECTIVE: We studied the effects of the age factor in pregnant women who are over the age of 35 on pregnancy, parturition and verified its usefulness in the future managements of the old aged pregnancy. METHODS: Out of 2,526 mothers who delivered in Dongguk university hospital from April 2000 to June 2003, we selected 183 mothers who aged more than 35 years as a study group, and 150 mothers aged between 25 and 29 years as a control group. We then statistically evaluated and analyzed the two groups. RESULTS: Study group consumed up to 7.24%. Placenta previa, male birth delivery, abnormal presentation, low birth weight, iron deficiency anemia and preterm labor was noted more in the study group. Likewise, preterm delivery, pregnancy induced hypertension and cesarean section rates were significantly high in the study group. CONCLUSION: Pregnancy in old age is currently a rising trend. Whlie they might have the tendency to show prenatal complications, neonatal complication and difficult decision making in delivery method, early detection and treatment of presumable complications by adequate antenatal care and appropriate selection of delivery method can reduce the section rates and obtain relatively successful pregnancy outcome.
Age Factors ; Anemia, Iron-Deficiency ; Cesarean Section ; Decision Making ; Female ; Humans ; Hypertension, Pregnancy-Induced ; Infant, Low Birth Weight ; Infant, Newborn ; Male ; Mothers ; Obstetric Labor, Premature ; Parturition ; Placenta Previa ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women*

Dislodgement of a crown or extension bridge and the loosening of a retainer of a bridge is a serious clinical problem in fixed restoration. Generally these problems are considered to be associated with deformation of the restoration. During biting, the restoration is subjected to complex forces and deforms considerably within the limit of its elasticity. Deformation of the restoration under the occlusal force induces excessive stress in the cement film, which then leads to the cement fracture. Such a fracture may eventually cause loss of the restoration. Because most of the past retention tests for full veneer crown were done without fatigue loading, they were not exactly simulating intraoral environment. And the purpose of this study was to evaluate the effect of cyclic cantilever loading on the retentive strength of full veneer crowns depending on different type of cements and taper of prepared abutment. Steel dies with 8degrees or 16degrees convergence angle were fabricated through milling and crowns with the same method. These dies and crowns were divided into 8 groups. Group 1: 16degrees taper die, cementation with zinc phosphate cement, without loading Group 2: 16'taper die, cementation with zinc phosphate cement, with loading Group 3: 8degrees taper die, cementation with zinc phosphate cement, without loading Group 4: 8degrees taper die, cementation with zinc phosphate cement, with loading Group 5: 16degrees taper die, cementation with Panavia 21, without loading Group 6: 16degrees taper die, cementation with Panavia 21, with loading Group 7: 8degrees taper die, cementation with Panavia 21, without loading Group 8: 8degrees taper die, cementation with Panavia 21, with loading After checking the fit of die and crown, the luting surface of dies and inner surface of crowns were air-abraded for 10 seconds. The crowns were cemented to the dies, with cements mixed ac cording to the manufacturer' s recommendations. A static load of 5 kg was then applied for 10 min utes with static loading device. Twenty-four hours later, group 1,3,5,7 were only thermocycled, group 2,4,6,8 were subjected to cyclic loading after thermocycling. Retentive tests were performed on the Instron machine. From, the finding of this study, the following conclusions were obtained. 1. Panavia 21 showed significantly higher retentive strength than zinc phosphate cement for all groups(p<0.05). 2. There was a significant difference in the retentive strength between 8degrees and 16degrees taper for zinc phosphate cement(p<0.05), but no significant difference for Panavia 21(p>0.05). 3. Cyclic loading significantly decreased the retentive strength for all groups (p<0.05) . 4. For zinc phosphate cement, there was 35% reduction of the retentive strength after loading in the 16degrees taper die, 25% in the 8degrees taper die, and for Panavia 21, 21% in the 16degrees taper die, 18% in the 8degrees taper die.
Bite Force ; Cementation ; Crowns* ; Elasticity ; Fatigue ; Steel ; Zinc ; Zinc Phosphate Cement

Object : This study was conducted to evaluate the surgical results of the active treatment of unruptured intracranial aneurysms (UIAs) and to suggest treatment indications. METHODS: Operations were performed on 49 patients with 52 UIAs between 1999 and 2005. Medical records and radiologic studies of the patients with UIAs were retrospectively reviewed. The clinical outcomes were evaluated in each patient by the modified Glasgow Outcome Scale (m-GOS) one month after operation. RESULTS: UIAs had a high frequency of a middle cerebral artery (MCA) and an internal carotid artery (ICA) aneurysm. Forty-four UIAs (84.6%) ranged between 5 mm to 15 mm in diameter. Fortysix UIAs were treated by clipping, 2 by wrapping, and coil embolization was used in 3 UIAs. In one patient, which had only one UIA, one procedure and one operation was performed. There was no surgical mortality. In most patients, surgical complications or neurological deteriorations were not found. In three patients, minor neurological deficits of ptosis (2 patients) and spinal subdural hematoma (1 patient) were newly developed after operation. However the patients completely recovered within 3 months after operation. Finally, the surgical mortality and morbidity rate was 0%. CONCLUSION: If the UIAs are larger than 5 mm in diameter and located in a susceptible area for rupture, surgical treatment should be considered for the UIAs. If operation is performed by an expert neurosurgeon, surgical clipping is one of the best treatment modalities with or without endovascular treatment.
Aneurysm ; Carotid Artery, Internal ; Embolization, Therapeutic ; Glasgow Outcome Scale ; Hematoma, Subdural, Spinal ; Humans ; Intracranial Aneurysm* ; Medical Records ; Middle Cerebral Artery ; Mortality ; Retrospective Studies ; Rupture ; Surgical Instruments

PURPOSE: A spontaneous rupture is a rare but life-threatening complication in patients with a hepatocellular carcinoma (HCC). Whether this condition has any influence on the subsequent outcome following a resection is unclear. Therefore, the long-term results of liver resection were compared in patients with and without a tumor rupture. METHOD: This retrospective study was conducted on 17 patients with a spontaneous rupture of an HCC out of 256 with an HCC who underwent hepatic resection. RESULTS: Reduced hemoglobin and albumin, as well as increased leukocytosis, a poor Child Class, large tumor and portal vein tumor thrombosis were more frequent clinical findings in patients with a ruptured HCC. The postoperative complication and extrahepatic recurrence rates were similar between the two groups. The 1- and 3- year survival rates in the 17 patients with a ruptured HCC were 41.2 and 17.7%, respectively, while these were 80.3 and 48.3%, respectively, in the 239 patients without a rupture. However, when these patients were compared exclusively with the 8 patients with a corresponding AJCC/UICC 6th ed. TNM stage IIIB disease without a rupture (50 and 0%, respectively), no significant difference was found in the overall survival rates between the groups. CONCLUSION: The surgical outcomes of stage matched patients with and without a ruptured HCC were similar.
Carcinoma, Hepatocellular* ; Child ; Humans ; Leukocytosis ; Liver ; Portal Vein ; Postoperative Complications ; Prognosis* ; Recurrence ; Retrospective Studies ; Rupture ; Rupture, Spontaneous ; Survival Rate ; Thrombosis