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

Background: The reliability and validity of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans (K-HADS-A) has not been studied in Korean surgical patients. This study aimed to validate the usefulness of K-HADS-A for measuring preoperative anxiety in Korean surgical patients. Additionally, the effect of preoperative anxiety on postoperative quality of recovery was evaluated. Methods: Preoperative anxiety in 126 inpatients with planned elective surgery was measured using the K-HADS-A. The postoperative quality of recovery was measured using the Korean version of the Quality of Recovery-15. The validity and reliability of the K-HADS-A were evaluated. The differences in quality of recovery on the first and seventh day postoperatively were then compared between the anxious and non-anxious groups. Results: There was a statistical correlation between the K-HADS-A and Anxiety Likert Scale. The goodness-of-fit indices of the structural equation model showed how well the data from the K-HADS-A match their concept. The Kaiser-Meyer-Olkin value was 0.848, and the P value of Bartlett’s test of sphericity was < 0.001. Cronbach’s alpha was high at 0.872. The K-HADS-A had an acceptable level of validity and reliability. Postoperative quality of recovery was significantly lower in the anxious group (postoperative day 1: t = 2.058, P = 0.042; postoperative day 7: t = 3.430, P = 0.002). Conclusions The K-HADS-A is an acceptable tool for appropriately assessing preoperative anxiety in Korean surgical patients. Assessing preoperative anxiety is valuable, because preoperative anxiety affects the postoperative quality of mental and physical recovery.

No abstract available.
Dental Enamel* ; Wound Healing* ; Wounds and Injuries*

Multiple primary malignant neoplasms (MPMN) are defined by the presence of multiple primary cancers of multicentric origin and/or different tissues. The incidence of MPMN is less than 1% in Korea and recently seems to be increased due to early detection of cancer and prolonged survival of cancer patients. Previous investigations suggest that non-Hodgkin's lymphoma (NHL) may be associated with chronic liver disease and hepatocellular carcinoma (HCC). The pathogenesis of this association is thought to be due to chronic antigenic stimulation, the presence of HBsAg, and immunosuppressive therapy. We report a case of synchronous NHL and HCC in a 54-year-old man which is thought to be associated with hepatitis B virus infection. Pathological examination and immunohistochemical study of neck lymph node and liver mass biopsies showed diffuse large cell lymphoma and HCC, respectively. He was treated initially with EPOCH (etoposide, vincristine, doxorubicin, cyclophosphamide and prednisolone) chemotherapy for NHL and transarterial chemoembolization with doxorubicin, mitomycin-c, lipiodol, and gelfoam for HCC.
Biopsy ; Carcinoma, Hepatocellular* ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Early Detection of Cancer ; Ethiodized Oil ; Gelatin Sponge, Absorbable ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Incidence ; Korea ; Liver ; Liver Diseases ; Lymph Nodes ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin* ; Middle Aged ; Mitomycin ; Neck ; Vincristine

PURPOSE: The purpose of this study was to evaluate silver in situ hybridization (SISH) as an effective test to identify HER2 gene amplification in patients with breast cancer. METHODS: A systematic literature review was used to evaluate the effectiveness of SISH. The literature review covered from October 27, 2009 to December 1, 2009, and eight domestic databases including KoreaMed and foreign databases including Ovid-MEDLINE, EMBASE, and Cochrane Library were used. Keywords, such as 'silver in situ hybridization' and 'SISH', were used to search 63 documents. Ten studies regarding the evaluation of diagnostics were included in the final evaluation. The Scottish Intercollegiate Guidelines Network (SIGN) tool was used by two evaluators to independently evaluate the quality of the ten studies. RESULTS: A total of ten studies (nine diagnostic evaluation studies and one correlation study) were identified to evaluate SISH. The effectiveness of this test was evaluated based on diagnostic accuracy, concordance rate, and correlation with fluorescence in situ hybridization (FISH) results. The sensitivity of SISH was 0.81-1.00, and the specificity was 0.82-1.00. The positive predictive value was 0.95-1.00, negative predictive value was 0.81-1.00, and the test accuracy was 0.90-1.00. The concordance rate of SISH was 87.0-100% and two studies reported a correlation with FISH results. The body of evidence as a whole suggests a Grade D for SISH. CONCLUSION: SISH is a safe and useful procedure in patients with breast cancer and at least grade D evidence based on existing positive studies.
Predictive Value of Tests ; Breast Neoplasms

Periodontal ligament (PDL) is the connective tissue located between the tooth root and alveolar bone. In a previous study, PDLs22 was isolated as a PDL-specific gene by using subtractive hybridization between cultured PDL fibroblasts and gingival fibroblasts. It was also suggested that PDLs22 plays important roles in the development, differentiation and maintenance of periodontal tissues. However, little is known about functional study of PDLs22 using recombinant protein in PDL fibroblast differentiation and periodontium formation. In this study, in order to produce the PDLs22 recombinat protein, PDLs22-expression vector were constructed and expressed its protein in various host cell and temperature conditions. The results were as follows: 1. PDLs22 protein was not strongly expressed in the induction system using pRSET-PDLs22 construct. 2. When the BL21(DE3) pLysS was used as a expression host, PDLS22 protein was strongly expressed in the induction system using pHCEIIBNd-PDLs22 construct. 3. The PDLs22 protein was recognized at a molecular weight of 28 kDa in western blots. 4. Almost of the expressed PDLs22 protein was not soluble and observed like as inclusion body. 5. The protein solubility was not improved after modification of induction time and temperature during PDLs22 protein production. In this study, the system for the PDLs22 protein production was connstructed. However, the results suggest that further studies will be needed to produce the considerable amount of PDLs22 recombinat protein, which can use for the periodontal regeneration.
Blotting, Western ; Connective Tissue ; Fibroblasts ; Inclusion Bodies ; Molecular Weight ; Periodontal Ligament ; Periodontium ; Regeneration ; Solubility ; Tooth Root

No abstract available.
Fibroblasts* ; Glycyrrhetinic Acid* ; Humans*

The purpose of this study was to determine the minimal inhibitory concentration (MIC) of cefuroxime axetil, semisynthetic cefalosporin, for some putative periodotopathogens; F. nucleatum, A. actinomycetemcomitans P. intermedia and P. gingivalis. To investigate the efficacy of cefuroxime axetil, several antibiotics, amoxicillin, metronidazole, and ciprofoxacine, were used as control. The MIC was measured by Murray's method. The MIC of cefuroxime axetil against some putative microbes, as a single use regimen, was relatively high in comparison with that of the other antibiotics used in this study. The MIC of cefuroxime axetil/metronidazole against some putative microbes, as a simultaneous regimen, was similar to that of the other antibiotics used in this study. The manimal level of cefuroxime concentration in gingival fluid was 9 microgram/ml at 36hr after the first dose. In conclusion, within the limited experiment, metronidazole/ cefuroxime axetil therapy of periodontitis may provide a therapeutic benefits in reducing the periodontopathogens.

OBJECTIVE: Recently, carotid artery stenting (CAS) has become as the first choice of treatment for carotid artery stenosis. Although there are many differences in the outcomes of patients receiving stents among many different study groups, some reports suggest that stenting can be performed with periprocedural complication rates similar to those of a carotid endarterectomy (CEA). In this study, we investigated 39 cases of CAS. METHODS: From May 2003 to March 2007, 39 patients undergoing CAS were reviewed. We analyzed the 30-day morbidity/mortality rate. A minor stroke was defined as a new neurological deficit that either resolved completely within 30 days or increased the NIH Stroke Scale by< or =3. A major stroke was defined as a new neurological deficit that persisted for 30 days and increased the NIH Stroke Scale by> or =4. RESULTS: Among 39 patients, a minor stroke was noted in three patients (7.7%), and there were no major strokes and deaths. The overall 30-day stroke and death rate was 7.7% (n = 3). CONCLUSION: With the evolution and maturation of equipment and technique, carotid angioplasty and stenting (CAS) is increasingly being used for the treatment of carotid artery disease.
Angioplasty ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Stenosis* ; Endarterectomy, Carotid ; Humans ; Mortality ; Stents* ; Stroke

Primary small intestinal lymphoma is relatively uncommon. Small bowel tumors are difficult to diagnose, because they are usually asymptomatic in the initial phase, and they are not easily detected by traditional methods of investigating the small intestine. This case shows a successfully detected and treated gastrointestinal bleeding from rare ileal mucosa-associated lymphoid tissue lymphoma, using double balloon endoscopy.
Aged ; Arteries ; Capsule Endoscopy ; Constriction, Pathologic ; Gastrointestinal Hemorrhage ; Humans ; Ileal Neoplasms/*diagnosis/pathology ; Intestinal Mucosa/pathology ; Lymphoid Tissue/*pathology ; Lymphoma, B-Cell, Marginal Zone/*diagnosis/pathology ; Male