OBJECTIVE: This study assessed the efficacy of anterior cervical discectomy and fusion (ACDF) with cage alone compared with ACDF with plate instrumentation for radiologic and clinical outcomes in two-level cervical degenerative disease. METHODS: Patients with cervical degenerative disc disease from September 2004 to December 2009 were assessed retrospectively. A total of 42 patients received all ACDF at two-level cervical lesion. Twenty-two patients who underwent ACDF with cage alone were compared with 20 patients who underwent ACDF with plate fixation in consideration of radiologic and clinical outcomes. Clinical outcomes were assessed using Robinson's criteria and posterior neck pain, arm pain described by a 10 point-visual analog scale. Fusion rate, subsidence, kyphotic angle, instrument failure and the degenerative changes in adjacent segments were examined during each follow-up examination. RESULTS: VAS was checked during each follow-up and Robinson's criteria were compared in both groups. Both groups showed no significant difference. Fusion rates were 90.9% (20/22) in ACDF with the cage alone group, 95% (19/20) in ACDF with the plate fixation group (p = 0.966). Subsidence rates of ACDF with cage alone were 31.81% (7/22) and ACDF with plate fixation were 30% (6/20) (p = 0.928). Local and regional kyphotic angle difference showed no significant difference. At the final follow-up, adjacent level disease developed in 4.54% (1/22) of ACDF with cage alone and 10% (2/20) of ACDF with plate fixation (p = 0.654). CONCLUSION: In two-level ACDF, ACDF with cage alone would be comparable with ACDF with plate fixation with regard to clinical outcome and radiologic result with no significant difference. We suggest that the routine use of plate and screw in 2-level surgery may not be beneficial.
Arm ; Benzeneacetamides ; Diskectomy ; Follow-Up Studies ; Humans ; Neck Pain ; Piperidones ; Retrospective Studies

Intestinal tuberculosis is an infectious disease which is still prevalent in the developing countries including Korea. It may occur insidously, have a vague clinical marofestation, and take a chronic course. We have analyzed 101 cases of intestinal tuberculosis. proven by clinical and histopathologic diagnosis for 10yrs since 1977. The results are as follows: 1) Intestinal tbc was prevalent in the age of 20-30 and the male to female ratio was 1:1.7. 2) Among clinical manifestations, abdominal pain, and tenderness, general malaise and abdominal mass were observed in order of frequency. 3) Active pulmonary lesion was associated in 73 cases (73.3%). 4) Ileocecal region was the most frequent site of involvement in barium study and in colonoscopy. 5) The most frequent colonoscopic finding was multiple ulceration and pseudopolyposis and chronic granulomatous inflammation was noted in 58% on hitopathology. 6) Ulcerative type was the most common type 45.4% by intestinal x-ray and colonofiberscopic examination
Abdominal Pain ; Barium ; Colonoscopy ; Communicable Diseases ; Developing Countries ; Diagnosis ; Female ; Humans ; Inflammation ; Korea ; Male ; Tuberculosis* ; Ulcer

OBJECTIVE: This study was conducted to investigate the correlation between the degrees of injury on brain magnetic resonance imaging (MRI) and the time interval to recovery of consciousness in patients with diffuse axonal injury. METHODS: From January 2004 to December 2008, 25 patients with diffuse axonal injury were treated at our hospital. We retrospectively investigated the patients' medical records and radiological findings. We divided the patients into three groups according to the grade of MRI finding : grade I, small scattered lesions on the white matter of the cerebral hemisphere; grade II, focal lesions on the corpus callosum; and grade III, additional focal lesions on the brain stem. RESULT: Seven patients belonged to the grade I group; 10 to the grade II group; and 8 to the grade III group. The mean Glasgow Coma Scale (GCS) score of all patients at the time of admission was 7.28. Recovery of consciousness was observed in 23 of the 25 patients; the remaining two patients never regained consciousness. The time interval to recovery of consciousness (awake status) ranged from 1 day to 125 days (mean 22.1 days) : grade I group patients, within approximately 1 week (mean 3.7 days); grade II group patients, within approximately 2 weeks (mean 12.5 days); and grade III group patients, within approximately 2 months (mean 59.5 days). CONCLUSION: Our study results suggest a correlation between the mean time interval to recovery of consciousness in patients with diffuse axonal injuries and the degrees of brain injuries seen on MRI. Patients with grade I and II diffuse axonal injuries recovered consciousness within 2 weeks, while patients with grade III injuries required approximately 2 months.
Brain ; Brain Injuries ; Brain Stem ; Consciousness ; Diffuse Axonal Injury ; Glasgow Coma Scale ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Medical Records ; Retrospective Studies

Cerebral cavernous malformation with giant cysts is rare and literature descriptions of its clinical features are few. In this case study, the authors describe the clinical symptoms, radiological findings, and pathological diagnosis of cerebral cavernous malformations with giant cysts, reviewing the relevant literature to clearly differentiate this from other disease entities. The authors present a case of a 19-year-old male with a giant cystic cavernous malformation, who was referred to the division of neurosurgery due to right sided motor weakness (grade II/II). Imaging revealed a large homogenous cystic mass, 7.2x4.6x6 cm in size, in the left fronto-parietal lobe and basal ganglia. The mass had an intra-cystic lesion, abutting the basal portion of the mass. The initial diagnosis considered this mass a glioma or infection. A left frontal craniotomy was performed, followed by a transcortical approach to resect the mass. Total removal was accomplished without post-operative complications. An open biopsy and a histopathological exam diagnosed the mass as a giant cystic cavernous malformation. Imaging appearances of giant cavernous malformations may vary. The clinical features, radiological features, and management of giant cavernous malformations are described based on pertinent literature review.
Basal Ganglia ; Biopsy ; Caves ; Craniotomy ; Glioma ; Hemangioma, Cavernous, Central Nervous System ; Humans ; Male ; Neurosurgery ; Young Adult

OBJECTIVE: To determine the rationale for treating pure unruptured intracranial aneurysms(UIAs), it is mandatory to know the risk of each treatment modality. The purpose of this study is to evaluate the surgical risk for treating UIAs. METHODS: Between December 1994 and May 2005, 147 unruptured aneurysms in 135 patients were treated. The majority of these cases (94.6%) were treated with aneurysmal neck clipping. The remainder received aneurysmal wrapping (2.7%), trapping with bypass (2.0%), or proximal occlusion (0.7%). The clinical outcomes were evaluated in each patient by the Glasgow Outcome Scale at one month post-surgery. RESULTS: The patient pool consisted of 41 males and 94 females. The mean age was 55.9 years (range: 16~82). The aneurysms were located at middle cerebral artery in 63 (42.9%), anterior communicating artery 30 (20.4%), posterior communicating artery in 26 (17.7%), internal carotid artery(ICA) in 14 (9.5%), anterior choroidal artery in 4 (2.7%) and others in 10 (6.9%). One hundred fifteen (78.2%) of aneurysms were small (<10mm). Others were large (10 to 25mm) and giant (>25mm); 29 (19.7%) and 3 (2.1%) respectively. More than ninety percent (91.1%) of all patients recovered well. Mild to severe disability was seen in 8.7% of the patients. One patient succumbed to complications following injury to the ICA. CONCLUSION: The mortality and morbidity associated with UIA surgery at our hospital compared very favorably to the previous reported literature and with the previously established natural history of this disease.
Aneurysm ; Arteries ; Choroid ; Female ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm* ; Male ; Middle Cerebral Artery ; Mortality ; Natural History ; Neck

OBJECTIVE: We investigated the clinical and radiological advantages of unilateral laminectomy in posterior lumbar interbody fusion (PLIF) procedure comparing with bilateral laminectomy, under the same procedural condition including bilateral instrumentation and insertion of two cages, in patients with degenerative lumbar disease with unilateral leg symptoms. METHODS: We retrospectively reviewed 124 consecutive cases of PLIF via unilateral or bilateral approach between January 2006 and April 2010. In 80 cases (bilateral group), two cages were inserted via bilateral laminectomy, and in 44 cases (unilateral group), via unilateral laminectomy. The average follow-up duration was 29.5 months. The clinical outcomes were evaluated with the Visual Analogue Scale (VAS) and the Oswestry disability index (ODI). The fusion rates and disc space heights were determined by dynamic standing radiographs and/or computed tomography. Operative times, intra-operative and post-operative blood losses and hospitalization periods were also evaluated. RESULTS: In clinical evaluation, the VAS and ODI scores showed excellent outcomes in both groups. There were no significant differences in term of fusion rate, but the perioperative blood loss and the operative time of the unilateral group were lower than that of the bilateral group. CONCLUSION: Unilateral laminectomy can minimize the operative time and perioperative blood loss in PLIF procedure. However, the different preoperative disc height between two groups is a limitation of this study. Despite this limitation, solid fusion and satisfactory symptomatic improvement could be achieved uniquely by our surgical method. This surgical method can be an alternative surgical technique in patients with unilateral leg pain.
Follow-Up Studies ; Hospitalization ; Humans ; Laminectomy ; Leg ; Operative Time ; Retrospective Studies

BACKGROUND/AIMS: When undergoing endoscopic submucosal dissection (ESD), patients with liver cirrhosis (LC) may suffer from a high risk of bleeding, bacteremia and tissue vulnerability. There have been few reports evaluating the efficacy and safety of ESD in patients with LC. METHODS: From January 2004 to March 2010, 23 patients with LC (cirrhosis group) underwent ESD for superficial gastric neoplastic lesions. The number of patients with a liver function in the Child-Pugh classes A and B were 20 and 3, respectively. The clinical outcomes and complications were compared with 69 patients without LC (control group) that were matched for age and sex. RESULTS: The en bloc resection, R0 resection and en bloc plus R0 resection rates of the cirrhosis group were 82.6%, 91.3%, and 82.6%, respectively, and did not show significant differences from the rates of the control group. No local recurrence was found in either group during the follow-up period. The procedure length of time (41.0 vs 39.0 minutes), rate of bleeding (4.3% vs 7.2%) and rate of perforation (0.0% vs 1.4%) in the cirrhosis group were also comparable to the results from the control group. CONCLUSIONS: ESD was safely performed in patients with LC, and satisfactory outcomes were achieved with high en bloc and R0 resection rates for superficial gastric neoplastic lesions.
Bacteremia ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver ; Liver Cirrhosis ; Recurrence ; Retrospective Studies

BACKGROUND/AIMS: Second-look endoscopy is performed to check for the possibility of post-endoscopic submucosal dissection (ESD) bleeding and to perform prophylactic hemostasis in most hospitals; however, there is little evidence about the efficacy of second-look endoscopy. We investigated whether second-look endoscopy after ESD is useful in the prevention of post-ESD bleeding. METHODS: A total of 550 lesions with gastric epithelial neoplasms in 502 patients (372 men and 130 women) were treated with ESD between August 18, 2009 and August 18, 2010. After the exclusion of three lesions of post-ESD bleeding within 24 hours, 547 lesions (335 early gastric cancers and 212 gastric adenomas) were included for the final analysis. RESULTS: The occurrence rate of delayed post-ESD bleeding was not significantly different between the second-look group and the no second-look group (1% vs 2.5%, p>0.05). The only predictor of delayed bleeding was tumor size, regardless of second-look endoscopy after ESD (22.8+/-9.87 vs 15.1+/-10.47, p<0.05). There was no difference between the prophylactic hemostasis and nonprophylactic hemostasis groups, including the occurrence rate of delayed bleeding. In the second-look group with prophylactic hemostasis, the hospital stay was more prolonged than in the second-look group without prophylactic hemostasis, but there was no significant difference (p=0.08). CONCLUSIONS: Second-look endoscopy to prevent delayed bleeding after ESD provides no significant medical benefits.
Adult ; Aged ; Aged, 80 and over ; Female ; Gastrectomy/adverse effects ; Gastric Mucosa/surgery ; *Gastroscopy ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Hemorrhage/*diagnosis/etiology ; Retrospective Studies ; Risk Factors ; Second-Look Surgery ; Stomach/pathology/surgery ; Stomach Neoplasms/pathology/*surgery ; Time Factors

We report a 12 year-old girl patient with hypothalmic hamartoma presented a gelastic seizure for 11 years. On magnetic resonance images, a 10.5 mm-sized mass was detected that was originated from the tuber cinereum into the third ventricle. This mass was isosignal intensity on T1WI, slightly high signal intensity on T2WI and not enhanced with Gadolinium. On interictal EEG, the frequent spike or polyspike dischage was recorded from the left fronto-central area. On ictal EEG, the suspicious polyspike dischages followed by spike and wave discharge were recorded from the left or both fronto-central or fronto-centro-temporal area. On 18-FDG PET (18-fluorodeoxyglucose positron emission tomography), the glucose metabolism was decresed on the mass. We treated this lesion using gamma knife radiosurgery (18 Gy at 50% margin, 508.2 mm3 volume). After 6 months, the frequency of gelastic seizure was decreased.
Child ; Electroencephalography ; Electrons ; Female ; Gadolinium ; Glucose ; Hamartoma* ; Humans ; Metabolism ; Radiosurgery* ; Seizures* ; Third Ventricle ; Tuber Cinereum

OBJECTIVE: The study is conducted to define the preoperative radiological findings of Rathke's cleft cysts (RCCs) differentiating these lesions from other sellar/parasellar cystic tumors. METHODS: A retrospective study of 65 patients with RCC patients from two institutes (53 cases / 12 cases) was performed. All patients had preoperative magentic resonance imaging(MRI) studies, and computed tomography(CT) studies were available in 25 patients. RESULTS: Calcification detectable on CT scanning was present in only 8% of RCC patients. Of the patients who were available for precontrast CT images, 48% had cysts of low attenuation, 28% had cysts of the same attenuation, and 24% had cysts of increased attenuation relative to the brain. Of the patients who had postcontrast CT images, 84% showed no significant change following contrast agent administration, and 16% demonstrated rim enhancement. MR imaging revealed multiple patterns. In T1-weighted sequences, 55.4% showed hyperintense signals, 27.7% showed hypointense signals, 12.3% showed isointense signals, and we saw a mixed-intense signal in 4.6%. In T2-weighed images, we observed a hyperintense signal in 60%, a hypointense signal in 20%, a mixed-intense signal in 13.8%, and an isointense signal in the remaining 6.2%. In Gd-DTPA enhanced images, 72.3% of the 65 patients showed no enhancement either of the cyst contents or of the cyst wall, and 27.7% demonstrated rim enhancement. Forty-five of the 65 patients were preoperatively diagnosed as RCCs. CONCLUSION: RCCs show variable CT and MRI characteristics. There is no unique finding for this pathology. Thus, even with CT and MRI studies, differential diagnosis with other cystic lesions of the sellar/parasellar region remains difficult.
Academies and Institutes ; Brain ; Central Nervous System Cysts ; Diagnosis, Differential ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging ; Pathology ; Retrospective Studies ; Tomography, X-Ray Computed