BACKGROUND: Serumc alpha-fetoprotein(aFP) is a useful diagnostic test on hepatocellular carcinoma(HCC) However, it is still questionable appropriate screening test or not. METHODS: A total of 24,050 patients who visited the General Health Screening Center of Asan Medical Center from June, 1993 to June, 1994 were reviewed by chart and telephone survey. Among them 70 cases where serum aFP were elevated > 20ng/ml and 16 cases where HCC was suspected by abdominal ultrasonogram were selected and investigated for the existence of HCC. Four groups were divided into HBsAg(+), Anti-HCV(+), increased AST/ALT(abnormal LFT) and normal gruoup. Each group was evaluated for sensitivity, specificity, positive predictive value and negative predictive value of serum aFP for HCC. RESULTS: The prevalence of elevated aFP was 0.29%(70/24,050). There was a statistically significant difference between sexes. And the total number of HCC as 10 cases (42/100,000). With aging, the prevalence of HCC was increased. The prevalence rate of elevated serum aFP and HCC had significant difference in anti-HCV(+), HBsAg(+) and abnormal LFT group compared to normal group (sGOT < 40U/I, HBsAg(-) and Anti-HCV(-)) (P < 0.01). In our study, sensitivity and positive predictive value of serum aFP for HCC were 100% and 14% in anti-HCV(+) group, 83.3% and 8.6% in abnormal LFI group, 80% and 8.0% in HBsAg(+) group, and 0% in normal group, respectively. CONCLUSIONS: Serum aFP as a screening test for HCC in asymptomatic healthy people does not seem to be not valid. But it seems to be appropriate when it is applied for cases of abnormal LFT(sGOT > 40U/l or sGPI > 40U/l), HBsAg(+) and Anti HCV(+) people.
Adult* ; Aging ; alpha-Fetoproteins* ; Chungcheongnam-do ; Diagnostic Tests, Routine ; Humans ; Mass Screening* ; Prevalence ; Sensitivity and Specificity ; Telephone ; Ultrasonography

Purpose: With the increasing incidence of recompression fractures after vertebroplasty or kyphoplasty, this study analyzed the risk factors that affect the occurrence of recompression vertebral fractures, such as cement distribution, existence of avascular necrosis (Kummell’s disease), type of procedures, bone mineral density, sex, and age. Materials and Methods: Two hundred and thirty-eight patients who underwent vertebroplasty or kyphoplasty at the author’s clinic from 2005 to 2015 were enrolled in this study. The patients were divided into four groups according to the distribution of injected cement. The patients were classified as type 1 and type 2 when injected cement was contacted only to the upper or lower endplate of the body respectively. They were classified as type 3 when both the upper and lower endplates were contacted by injected cement. When neither the upper nor the lower endplate was contacted, the patients were called type 4. This study statistically evaluated the effects of the risk factors, including the cement distribution on the incidence of recompression vertebral fracture after vertebroplasty or kyphoplasty. Results: There were 59 cases (24.8%) of recompression fracture after vertebroplasty or kyphoplasty, among the 238 cases. According to the analysis, the recompression of the vertebral body after vertebroplasty or kyphoplasty occurred more often when the compression fracture was accompanied by osteonecrosis at the body (p<0.05). The patients who had injected cement distributed at both upper and lower plate simultaneously (type 3) had a lower incidence of recompression fracture of the vertebral body after vertebroplasty or kyphoplasty (p=0.008). In addition, the kyphoplasty group had a lower incidence of recompression after the procedure than vertebroplasty group (p=0.02). Conclusion Careful attention should be given to these patients with osteonecrosis at the compression fracture level through a preoperative evaluation. In addition, if the injected cement does not contact both the upper and lower endplates, careful observation is required during the follow-up period based on the high incidence of vertebral recompression fractures proven through this study. Further technical and biomechanical research and efforts will be needed to make the cement contact both endplates.

Breast reconstruction with free TRAM flap is a common procedure. However patients with abdominal scars can be confronted with a challenging problem in performing flap reconstruction. The inadequate blood supply around the scar can result in various skin complications in flap or donor site, but there are no reported guidelines in our country. From May 1999 to March 2003, a total of 38 breast reconstructions using free TRAM flaps were performed for 37 patients, of whom 12 had abdominal scars from previous operations; 7 had midline vertical scars and 4 had low transverse scars from Cesarean section or total hysterectomy, 3 had right lower quadrant oblique scars from appendectomy (2 also had transverse scars from Cesarean section). We attempted to minimize flap and donor site complications by modifying classic free TRAM flap designs and procedures according to the characteristics of the abdominal scars and performed periodic follow-up observations of flaps and donor sites for presence of complications and also gave surveys for patient satisfaction on the reconstructed breast. All 38 patients underwent successful breast reconstructions with neither skin complications around the scar nor flap loss and 96.4% patients reported being very satisfied or satisfied with the results.
Appendectomy ; Breast* ; Cesarean Section ; Cicatrix* ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Mammaplasty* ; Patient Satisfaction ; Pregnancy ; Skin ; Tissue Donors

Despite the careful regulation of serum calcium, calcification of cutaneous and subcutaneous tissues may occur. Calcification is the deposition of insoluble calcium salts; when it occurs in cutaneous tissues, it is known as calcinosis cutis. Calcinosis cutis is classified into four types: metastatic calcinosis cutis, dystrophic calcinosis cutis, idiopathic calcinosis cutis, and subepidermal calcified nodule. From January 2000 to May 2001, we have experienced 3 patients with calcinosis cutis. Two cases were dystrophic calcinosis cutis associated with radiation therapy and old burn scar with complications of delayed wound healing after punch biopsy, despite of conservative treatment for several weeks. Another was idiopathic calcinosis cutis. We performed surgical treatments in all cases: wide excision and pectoralis major muscle rotational flap coverage, wide excision and split-thickness skin graft, and excision and direct closure. No patients experienced wound healing problems. We believed surgical excision and appropriate reconstruction procedure is an effective theraphy in localized or ulcerated and chronic infected calcinosis cutis.
Biopsy ; Burns ; Calcinosis* ; Calcium ; Cicatrix ; Humans ; Salts ; Skin ; Subcutaneous Tissue ; Transplants ; Ulcer ; Wound Healing

PURPOSE: Although muscle hernia has been well described in the lower-extremity, muscle hernias in the upper extremity are extremely rare. As with lower extremity muscle hernias, the forearm muscle hernia may result from forced exertion of strenuous activity or following blunt trauma. The objective of this paper is to report an extraordinary case of forearm muscle hernia after radial forearm sensory tendocutaneous free flap with references. METHODS: A 58-year-old male patient received wide excision and radical neck dissection and lower lip reconstruction with radial forearm sensory tendocutaneous free flap for squamous cell cancer on the lower lip. 16 weeks after the operation, he complained of protruding mass on the forearm and the size was increasing. In postoperative 18 weeks, MRI showed herniation of flexor digitorum superficialis. For unaesthetic cause and preventing progress, the authors performed direct fascial closure and Mesh graft. RESULTS: In 12 months after the surgery there was no recurrence and the patient remained symptom-free. CONCLUSION: Pain on extremity exertion and unaesthetic buldge of forearm due to forearm muscle hernia were the primary indications for surgery which consist of direct closure, fasciotomy, fascia lata onlay graft, fascia lata inlay graft, etc. The authors experienced uncommon forearm muscle hernia after radial forearm free flap and satisfying result of treatment.
Extremities ; Fascia Lata ; Forearm ; Free Tissue Flaps ; Hernia ; Humans ; Inlays ; Lip ; Lower Extremity ; Male ; Middle Aged ; Muscles ; Neck Dissection ; Neoplasms, Squamous Cell ; Recurrence ; Transplants ; Upper Extremity

PURPOSE: To examine the relationship between the progression of a kyphotic deformity and the magnetic resonance imaging (MRI) findings in conservatively treated osteoporotic thoracolumbar compression fracture patients. MATERIALS AND METHODS: This study categorized the patients who underwent conservative treatment among those patients who underwent treatment under the suspicion of a thoracolumbar compression fracture from January 2007 to March 2016. Among them, this retrospective study included eighty-nine patients with osteoporosis and osteopenia with a bone density of less than −2.0 and single vertebral body fracture. This study examined the MRI of anterior longitudinal ligament or posterior longitudinal ligament injury, superior or inferior endplate disruption, superior of inferior intravertebral disc injury, the presence of low signal intensity on T2-weighted images, and bone edema of intravertebral bodies in fractured intravertebral bodies. RESULTS: In cases where the superior endplate was disrupted or the level of bone edema of the intravertebral bodies was high, the kyphotic angle, wedge angle, and anterior vertebral compression showed remarkably progression. In the case of damage to the anterior longitudinal ligament or the superior disc, only the kyphotic angle was markedly prominent. On the T2-weighted images, low signal intensity lesions showed a high wedge angle and high anterior vertebral compression. On the other hand, there were no significant correlations among the posterior longitudinal ligament injury, inferior endplate disruption, inferior disc injury, and the progression of kyphotic deformity and vertebral compression. The risk factors that increase the kyphotic angle by more than 5° include the presence of injuries to the anterior longitudinal ligament, superior endplate disruption, and superior disc injury, and the risk factors were 21.3, 5.1, and 8.5 times higher than those of the uninjured case, and the risk differed according to the level of bone edema. CONCLUSION: An osteoporotic thoracolumbar compression fracture in osteoporotic or osteopenic patients, anterior longitudinal ligament injury, superior endplate and intravertebral disc injury, and high level of edema in the MRI were critical factors that increases the risk of kyphotic deformity.
Bone Density ; Bone Diseases, Metabolic ; Congenital Abnormalities ; Edema ; Fractures, Compression ; Hand ; Humans ; Kyphosis ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Osteoporosis ; Retrospective Studies ; Risk Factors ; Spinal Fractures

PURPOSE: To investigate the radiological efficacy of polymethylmethacrylate (PMMA) augmentation of pedicle screw operation in osteoporotic vertebral compression fractures (OVCF) patients. MATERIALS AND METHODS: Twenty OVCF patients, who underwent only posterior fusion using pedicle screws with PMMA augmentation, were included in the study. The mean follow-up period was 15.6 months. The demographic data, bone mineral density (BMD), fusion segments, number of pedicle screws, and amount of PMMA were reviewed as medical records. To analyze the radiological outcomes, the radiologic parameters were measured as the time serial follow-up (preoperation, immediately postoperation, postoperation 6 weeks, 3, 6 months, and 1 year follow-up). RESULTS: A total of 20 patients were examined (16 females [80.0%]; mean age, 69.1±8.9 years). The average BMD was −2.5±0.9 g/cm2. The average cement volume per vertebral body was 6.3 ml. The mean preoperative Cobb angle of focal kyphosis was 32.7°±7.0° and was improved significantly to 8.7°±6.9° postoperatively (p<0.001), with maintenance of the correction at the serial follow-up, postoperatively. The Cobb angle of instrumented kyphosis, wedge angle, and sagittal index showed similar patterns. In addition, the anterior part of fractured vertebral body height averaged 11.0±5.0 mm and was improved to 18.5±5.7 mm postoperatively (p=0.006), with maintenance of the improvement at the 3-month, 6-month, and 1-year follow-up. CONCLUSION: The reinforcement of pedicle screws using PMMA augmentation may be a feasible surgical technique for OVCF. Moreover, it appears to be appropriate for improving the focal thoracolumbar/lumbar kyphosis and is maintained well after surgery.
Body Height ; Bone Density ; Female ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphosis ; Medical Records ; Osteoporosis ; Pedicle Screws ; Polymethyl Methacrylate

Purpose: To examine the relationship between total fat infiltration (TFI) rate, which quantifies the reduction of muscles around the spineand is an important factor for sarcopenia, and the factors affecting osteoporotic vertebral compression fracture. Materials and Methods: Patients treated for osteoporotic compression fractures of the lumber spine from January 2012 to December2016 were analyzed retrospectively. Among them, this study included ninety-eight patients who were 1) diagnosed with osteoporosis witha bone mineral density (BMD) T score of less than 2.5 g/cm2, 2) received vertebroplasty or kyphoplasty for lumbar fractures, 3) involved onesegment of the lumbar spine, and 4) were followed-up for more than one year. The TFI rate confirmed by analyzing magnetic resonanceimagings with the Image J program was studied. Based on this, the relationship between the TFI of the multifidus and erector spinaemuscles and the factors of osteoporosis were analyzed. Results: The mean TFI of the multifidus and erector spinae was 14.66±10.16. The spine BMD showed a positive correlation with the hipBMD, but a negative correlation with the TFI. A positive correlation was observed between the hip BMD and body mass index. In addition,vitamin D was positively correlated with both the hip and spine BMD but negatively correlated with the TFI rate. Conclusion Muscle growth helps treat osteoporosis, and can prevent fractures that occur frequently in osteoporosis patients. Increasingthe vitamin intake can also slow the progression of muscle atrophy.

Purpose: Verifying a reliable predictor of the progression of vertebral deformity in patients with acute osteoporotic fractures of the lumbar spine may be useful. A qualitative analysis of the muscle near the spine was performed using magnetic resonance imaging (MRI), and its correlation with a spinal deformity was determined under the hypothesis that the causes of the kyphotic deformity are associated with muscle reduction in the multifidus and erector spinae. Materials and Methods: The study was performed in a retrospective manner using the electronic medical records of patients who presented to the author’s institution between January 2007 and March 2018, and were diagnosed with an acute lumbar fracture. The fat infiltration rates of the multifidus and erector spinae were measured using MRI taken at the time of injury, and the mean value was defined as the total fat infiltration rate (TFI). Based on lateral radiographs of the lumbar spine at the one-year follow-up, the loss of height of the vertebral body, the kyphotic angle and the wedge angle were measured. The statistical significance was confirmed by calculating the Pearson correlation coefficient. Results: One hundred twenty-nine patients, of which 30 were male and 99 were female, were examined. The mean age was 71.28 years. The mean T-score was - 3.53±0.79 g/cm2 , and the mean fat infiltration was 15.20%±11.99%. TFI was positively correlated with age (R=0.373, p<0.001), compression rate (R=0.369, p<0.001), and Cobb’s angle (R=0.386, p<0.001) after a one year follow-up, but negatively correlated with the BMD score (R= - 0.252, p=0.004). As the fracture progressed to the lower lumbar level, the compression rate (R= - 0191, p=0.030) and wedge angle (R= - 0.428, p<0.001) at the time of injury tended to decrease. Conclusion In patients with osteoporotic vertebral fractures, the fat infiltration rate may be an important predictor of conservative treatment. The prognosis of patients with a high-fat infiltration rate should be explained during patient education, and the patients must be monitored closely through short-term outpatient follow-up.

Background: Nipple reconstruction is usually performed as a delayed procedure in patients with breast cancer who undergo skin-sparing mastectomy and breast reconstruction surgery using a deep inferior epigastric perforator (DIEP) flap. The authors designed this study to evaluate the utility of breast reconstruction based on a DIEP flap and immediate nipple reconstruction. Methods: A retrospective review was conducted of all patients who underwent breast reconstruction performed by a single plastic surgeon from October 2016 to June 2018. Through a questionnaire and chart review, we compared surgical results and complications in cases of single-stage nipple reconstruction after skin-sparing mastectomy (n=17) with patients who underwent delayed nipple reconstruction after skin-sparing mastectomy, modified radical mastectomy, or simple mastectomy (n=7). Results: In a subjective analysis using clinical photos, the immediate nipple reconstruction group had higher scores than their counterparts in an evaluation of the nipple-areolar complex (NAC) (NAC placement, 3.34 vs. 3.04; nipple projection, 3.05 vs. 3.03; nipple size, 3.30 vs. 3.29). No significant differences between the groups were found in terms of complications. Conclusions Simultaneous nipple reconstruction is a reliable surgical method with economic advantages. No differences were found in terms of outcomes and complications in comparison to delayed reconstruction. Therefore, surgeons can consider simultaneous nipple reconstruction without particular concerns about asymmetry or necrosis.