Total 7,446 pedicle measurements were made from T1 to L6. Direct dimensional measurements were obtained from dried adult human spinal columns. Parsmeters considered were the pedicle isthmus diameter in the coronal and sagittal planes, pedicle angles in the transverse and sagittal planes, and the depth to the anterior cortex in a line parallel to the midline of the vertetral body and along the pedicle axis. The results were as follows. 1. The widest pedicle transverse diameters were seen at L6, the narrowest at T4. 2. The widest pedicle superoinferior diameters were seen at T12, the narrowes at T1. 3. In the transverse plane, the posterolateral to anteromedial pedicle axis orientations were seen at all levels except at T12 and T12. 4. In the sagittal plane, the pedicles angled caudally at L5 and cephaladly from L3 to T1. 5. In the thoracolumbar junction, the percentage less than 6mm in the transverse diameters of pedicles is most high at L1(27%) and followed by at the level L2, T11 and T12. 6. The use of 6mm transpedicular screws can be expected to violate the cortex of the pedicles in a significant number in the upper lumbar spine. 7. The 5mm transpedicular screws can be used safely below the T11 level. 8. It is advisable to use roentgen image intensifier during insertion of the transpedicular screws.
Adult ; Humans ; Lumbar Vertebrae ; Spine

We report a case of 45-year-old woman of histologically proven malignant retroperitoneal fibrosis from signet ring cell type adenocarcinoma of the stomach. She had suffered from flank colicky pain for a duration of a month. We underwent ureterolysis with omental wrappine under the impression of retroperitoneal fibrosis due to miss-diagnosed chronic inflammation of periureteral tissue by frozen biopsy at the time of the operation. As urine leaks continued at the drain site for 22 days despite of nephrostomy tube placement, we underwent nephrectomy which revealed signet ring cell type adenocarcinoma. Gastrofiberscopic biopsy resulted in the same adenocarcinoma.
Adenocarcinoma* ; Biopsy ; Abdominal Pain ; Female ; Humans ; Inflammation ; Middle Aged ; Nephrectomy ; Retroperitoneal Fibrosis* ; Stomach

BACKGROUND/AIMS: The prognosis of primary hepatocellular carcinoma is extremely poor because of its large size, portal vein thrpombosis, extrahepatic metastasis and underlying liver cirrhosis. The aim, of this study is to evaluate the usefulness of ultrasound screening test for early detection of hepatocellular carcinoma in high-ridk populations. METHODS: We analysed 119 patients who were diagnosed with hepatocellular carcinoma by ultrasonography screening test in Yonsei University Severance Hospital from the period of January 1990 to December 1996. RESULT: The mean follow-up duration to the diagnosis of hepatocellular carcinoma was 30 months (range 3-75). The number of patients with single lesion was 89(75%). The mean diameter of the tumor was 3.0 cm (range 1-10) , 82 patients (70%) had masses measured less than 3cm in diameter. The Number of patients with elevated serum alphafetoprotein level above 400ng/ml was 29(25%). The median survival was 28 months in screening group, significant compared with 7 months in control group (p<0.001). CONCLUSIONS: Ultrasound follow-up in high-ridk group of hepatocellular carcinoma mede it possible to detect small tumors in a high percentage of cases. This may lead to an increase in the number of potentially curable tumors and hence an increase in the overall survival rate. So ultrasound screening test is important in the high-ridk group of hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Humans ; Liver Cirrhosis ; Mass Screening* ; Neoplasm Metastasis ; Portal Vein ; Prognosis ; Survival Rate ; Ultrasonography*

Hemobilia caused by pancreatic disease is very rare. The most common cause is a splenic artery pseudoaneurysm caused by acute and chronic inflammation of the pancreas. We experienced a case regarding as hemobilia as a complication of chronic relapsing pancreatitis in a 14 year-old boy. He was admitted with chief complaints of abdominal pain and hematemesis. Two years prior to admission, intermittent attacks of abdominal pain and vomiting began to develop. Recently he suffered a weight loss of 7.8kg due to poor oral intake but regain his usual weight after management by one month of total parenteral nutrition. On the day of admission abrupt onset of abdominal pain and massive hematermesis brought him to the emergency room of our hospital, and the area of active bleeding was on the 2 nd portion of duodenum proven by endoscopic examination. Bleeding control was failed with conservative management including blood transfusion, so whipple's operation was done on the 4 th day of admission. Ffter then bleeding was controlled, but he died of sepsis and cerebral infartion on the 20 th postoperative day.
Abdominal Pain ; Adolescent ; Aneurysm, False ; Blood Transfusion ; Duodenum ; Emergency Service, Hospital ; Hematemesis ; Hemobilia* ; Hemorrhage ; Humans ; Inflammation ; Male ; Pancreas ; Pancreatic Diseases ; Pancreatitis ; Pancreatitis, Chronic* ; Parenteral Nutrition, Total ; Sepsis ; Splenic Artery ; Vomiting ; Weight Loss

PURPOSE: This study aimed to estimate the prevalence of metabolic syndrome (MetS) in adolescents and adults and to compare the impact of body mass index (BMI) on MetS between adolescents and adults in Korea. MATERIALS AND METHODS: Data were used from 6,186 subjects aged 10 years or more who representatively participated in the Third Korean National Health and Nutrition Examination Survey. Body composition, blood test, and health behavioral factors were measured. We used the definition of MetS from the modified the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) for adolescents and the NCEP-ATP III for adults. RESULTS: The prevalence of MetS was 6.4 (95% CI 4.5-8.4) and 22.3 (95% CI 20.8-23.8) in adolescents and adults, respectively. The prevalence of MetS among normal, overweight and obese body types for both adolescents and adults differed significantly (p<0.001). After adjustment for covariates, the odds ratios (ORs) of obese and overweight body types on MetS compared with normal BMI in adolescents were 28.1 (95% CI 11.4-69.1) and 8.7 (95% CI 2.3-33.1), respectively. The ORs of obesity on MetS were 32.0 (95% CI 7.5-136.9), 32.2 (95% CI 12.8-80.8), 16.2 (95% CI 9.4-27.9), 7.6 (95% CI 4.7-12.2) and 9.9 (95% CI 6.8-14.6) for subjects in their 20's, 30's, 40's, 50's and older than 60, in order. CONCLUSION: We found that the prevalence of MetS increased with age and was more prevalent in males. Moreover, the group younger than 39 years of age had a higher chance of having MetS than the group older than 40 years of age. Weight control is more vital in the earlier stages of life for the prevention and management of MetS.
Adolescent ; Adult ; Age Factors ; Aged ; Child ; Female ; Health Surveys ; Humans ; Male ; Metabolic Syndrome X/*complications/epidemiology/prevention & control ; Middle Aged ; Obesity/*complications ; Odds Ratio ; Overweight/complications ; Prevalence ; Republic of Korea/epidemiology ; Young Adult

BACKGROUND: To evaluate clinical manifestations, endoscopic findings and response to treatment in adult Henoch-Sch?nlein purpura (HSP) patients with hemorrhagic gastroenteritis. METHODS: Twenty patients who were admitted to Kyungpook National University Hospital between 1996 and 2003 were included, based on the following criteria: 1) diagnosed as HSP according to the criteria proposed by Michel et al., 2) older than 15 years old and 3) had evidences of gastrointestinal (GI) bleeding. Thirteen HSP patients who were older than 15 years old and had no evidences of GI bleeding were recruited as controls. We evaluated the clinical features and findings of upper GI endoscopy and colonoscopy. RESULTS: Mean age and male to female ratio were not significantly different between patients with and without hemorrhagic gastroenteritis (age: 29.5 +/- 15.1 vs. 30.5 +/- 13.5; M:F=14:6 vs. 9:4, respectively). Patients with hemorrhagic gastroenteritis had a significantly higher frequency of petechiae on the upper extremities (p=0.015). In the multivariate analysis, petechial lesion on the upper extremities was a significant risk factor for hemorrhagic gastroenteritis (p=0.041). Mucosal lesions were found in 94.7% and 83.3% of patients on upper GI endoscopy and colonoscopy, showing that most patients (82.3%) had both upper and lower GI bleeding. Most patients with hemorrhagic gastroenteritis showed good response to high dose glucocorticoid therapy. Mortality and relapse rate were 10% and 5%, respectively. CONCLUSION: In adult HSP patients, presence of petechiae on upper extremities may be a risk factor for hemorrhagic gastroenteritis. The present data suggest that both upper and lower GI examinations are necessary for proper evaluation of HSP patients with hemorrhagic gastroenteritis.
Adolescent ; Adult* ; Colonoscopy ; Endoscopy ; Female ; Gastroenteritis* ; Gyeongsangbuk-do ; Hemorrhage ; Humans ; Male ; Mortality ; Multivariate Analysis ; Purpura* ; Recurrence ; Risk Factors ; Upper Extremity

In order to ascertain the normal values of the mid-sagittal canal diameter and the canal/body ratio of the cervical spine in Korean adults, ninety sets of cervical vertebral columns were examined. The average mid-sagittal canal diameters from C3 through C7 in the normal Korean are 13.2 +/- 1.3 millimeters in male and 13.1 +/- 2.6 millimeters in female. The normal average canal/body ratio of the cervical spine is 0.93 +/- 0.10 in male and 1.02 +/- 0.09 in female. The mid-sagittal canal diameter is largest in the White population and smallest in Asian, but there is no racial differences in the canal/body ratio, and the lower limit of normal canal/body ratio is 0.8 in Korean. The authors conclude that measurement of the canal/body ratio is more reliable than direct measuring of the mid-sagittal diameter of the cervical spinal canal in the diagnosis of cervical spinal stenosis or predicting the prognosis of cervical spinal cord injury.
Adult ; Aged ; Anthropometry ; Cervical Vertebrae/*anatomy & histology ; Female ; Human ; Korea ; Male ; Middle Age ; Spinal Canal/*anatomy & histology ; Support, Non-U.S. Gov't

Terephthaloyl chloride, a chemical of low molecular weight, is used as an intermediate by a fabric manufacturing industry. It is known to cause gastrointestinal, respiratory and skin irritation. However, it has not been reported as a cause of occupational asthma till now. We report a case of occupational asthma caused by prolonged exposure to terephthaloyl chloride in the workplace. A 38 year-old man visited at the Allergy Clinic because of cough, dyspnea and wheezing for 5 years. He had worked at a factory for 15 years where he was involved in the process of manufacturing fabrics. At presentation, he had no symptoms and showed no abnormality on physical examination. When challenged with vapor of terephthaloyl chloride, he experienced sneezing and paroxysmal cough in a couple of minutes, followed by dyspnea and wheezing at 10 min. He also experienced urticarial rashes on the face and chest. The pulmonary function tests showed an atypical prolonged immediate airway response. PC20 methacholine decreased from 5 mg/ml to 0.79 mg/ml 24 hours after the challenge. Light microscopic examination of bronchial biopsies showed loss of epithelium, thickening of basement membrane, submucosal fibrosis, and increased inflammatory cell infiltration. The immediate drop in FEV1 and urticarial rash to terephthaloyl chloride suggests the possibility of an immediate hypersensitivity immune reaction. Further studies are needed to clarify the exact mechanism of terephthaloyl chloride induced asthma.
Adult ; Asthma ; Asthma, Occupational* ; Basement Membrane ; Biopsy ; Cough ; Dyspnea ; Epithelium ; Exanthema ; Fibrosis ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Methacholine Chloride ; Molecular Weight ; Physical Examination ; Respiratory Function Tests ; Respiratory Sounds ; Skin ; Sneezing ; Thorax

Dermatomyositis (DM) is an idiopathic inflammatory myopathy (IIM) characterized by skeletal muscle inflammation and typical skin manifestations. Creatine kinase (CK) has traditionally been considered to be the most useful serum enzyme for the diagnosis and assessment of adult patients with IIM. To our knowledge, there has been no reported case of biopsy-proven DM without CK elevation in Korea, to date. Panniculitis is an uncommon cutaneous manifestation in adult patients with DM. A search of the PubMed database reveals fewer than 30 reported cases of panniculitis in adult patients with DM. Here, we report a case of a 42-year-old female who was diagnosed with biopsy-proven DM with normal serum CK levels and panniculitis.
Adult ; Creatine Kinase* ; Creatine* ; Dermatomyositis* ; Diagnosis ; Female ; Humans ; Inflammation ; Korea ; Muscle, Skeletal ; Myositis ; Panniculitis ; Skin Manifestations

Immunoglobulin G4 (IgG4)-related disease (RD) is an immune-mediated, systemic fibroinflammatory condition characterized by a lymphoplasmacytic infiltration of IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis. IgG4-RD has become recognized with increasing frequency since the turn of the century and may affect almost any organ. IgG4-RD also involves the meninges but, to the best of our knowledge, no case of IgG4-related intracranial pachymeningitis with periaortitis has been reported in Korea to date. Here, we report on a 65 year-old male with IgG4-RD involving the meninges and aorta.
Aorta ; Fibrosis ; Humans ; Immunoglobulins ; Korea ; Male ; Meninges ; Meningitis* ; Phlebitis ; Plasma Cells