No abstract available.
Empathy ; Humans

Objective: : This study aimed to investigate the efficacy of transverse process (TP) hook system at the upper instrumented vertebra (UIV) for preventing screw pullout in adult spinal deformity surgery using the pedicle Hounsfield unit (HU) stratification based on K-means clustering. Methods: : We retrospectively reviewed 74 patients who underwent deformity correction surgery between 2011 and 2020 and were followed up for >12 months. Pre- and post-operative data were used to determine the incidence of screw pullout, UIV TP hook implementation, vertebral body HU, pedicle HU, and patient outcomes. Data was then statistically analyzed for assessment of efficacy and risk prediction using stratified HU at UIV level alongside the effect of the TP hook system. Results: : The screw pullout rate was 36.4% (27/74). Perioperative radiographic parameters were not significantly different between the pullout and non-pullout groups. The vertebral body HU and pedicle HU were significantly lower in the pullout group. K-means clustering stratified the vertebral body HU ≥205.3, <137.2, and pedicle HU ≥243.43, <156.03. The pullout rate significantly decreases in patients receiving the hook system when the pedicle HU was from ≥156.03 to < 243.43 (p<0.05), but the difference was not statistically significant in the vertebra HU stratified groups and when pedicle HU was ≥243.43 or <156.03. The postoperative clinical outcomes improved significantly with the implementation of the hook system. Conclusion : The UIV hook provides better clinical outcomes and can be considered a preventative strategy for screw-pullout in the certain pedicle HU range.

PURPOSE: Hyperglycemia, hypoalbuminemia and other factors make diabetic CRF patient vulnerable to salt and fluid retention, which is partial explanation of high mortality rate of DM dialysis patients. This prospective study was carried out to investigate the different membrane characteristics associated with ultrafiltration between diabetic and non diabetic CAPD patients. METHODS: Among new CAPD patients from May 2001 to January 2004 in our hospitals, 60 patients who had complete data more than 12 month were enrolled. Peritoneal equilibration test and D/P1hr Na using 4.25% dialysate, daily ultrafiltration and urine volume, serum albumin and glucose level, daily exposed and daily absorbed glucose amount through the peritoneal cavity and clinical indices were measured at 1st, 6th, and 12th months after initiation of CAPD. We analyzed data with independent t test, repeated measure of ANOVA and multiple regression by STATA. RESULTS: We can summarized the RESULTS: Changes of body weight, total body water, daily ultrafiltration volume (UFV), D/P4Cr, UFV during PET and RRF were not significantly different between DM and non-DM at 1st, 6th, and 12th months. But 1st month serum albumin was lower in DM (p=0.01). Daily exposed glucose amount was significantly higher in DM group at 1st and 12th months (161.7+/-44.5 g/day vs. 140.3+/-21.1 g/day and 157.4+/-43.8 g/ day vs. 134.0+/-11.3 g/day, p=0.019, p=0.006, respectively). At 1st month, D/P1hr Na was not significantly different between DM and non-DM but DM group showed getting higher (D/P)1hr Na at 6th and 12th month (p=0.04, p=0.006, respectively). Factors associated with D/P1hr Na were DM (beta-coeff= -0.015, p=0.042), log hs CRP (beta-coeff=0.012, p= 0.025), 24 hours dialysate albumin (beta-coeff=-0.010, p=0.000), and D/P4Cr (beta-coeff=0.150, p=0.000). CONCLUSION: Diabetic CAPD patients showed more rapid increase of D/P1hr Na during initial 1 year. It might be due to more rapid deterioration of water channel function with time on PD. In terms of achieving adequate ultrafiltration in diabetic peritoneal dialysis patient with time, higher concentration of glucose or icodextrin containing dialysate might be needed to overcome decreased water channel function.
Body Water ; Body Weight ; Dialysis ; Glucose* ; Humans ; Hyperglycemia ; Hypoalbuminemia ; Membranes ; Mortality ; Peritoneal Cavity ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Prospective Studies ; Serum Albumin ; Ultrafiltration*

PURPOSE: The main treatment modality of peripheral arterial occlusive disease (PAOD) of the lower extremities has shifted from traditional bypass surgery (BS) to a less invasive endovascular intervention (EI), but there is still conflicting data about the differences in long-term patency between the two modalities The purpose of this study was to analyze restenosis rates of femoral EI and to compare both anatomical and functional results between EI and femorodistal BS. METHODS: Between July 2003 and June 2009, 88 limbs (61 patients) and 47 limbs (43 patients) with femoral artery PAOD were treated with EI and BS, respectively. A retrospective analysis of prospectively collected data was performed by reviewing medical records, radiologic images and noninvasive vascular studies. Patient demographics and risk factors were analyzed. Technical outcomes such as restenosis rates, patency rates and functional outcomes using modified questionnaires were evaluated. RESULTS: The restenosis rates for EI at 6 months, 1 year, 2 years and 3 years were 10.4%, 20.1%, 41.1% and 52.7%, respectively, and the mean restenosis duration was 36.5+/-3.24 months. Comparison of patency rates between EI and BS showed no significant difference (P=0.204) in TASC C and D lesions. Functional outcome analysis showed that both EI and BS improved functional status after treatment, and comparison between the two groups showed that BS had a better functional improvement than EI (P=0.010). CONCLUSION: EI could provide equivalent patency rates compared with BS, but for TASC C and D lesions, BS is still a preferred treatment modality based on better functional outcomes.
Arterial Occlusive Diseases ; Atherosclerosis ; Demography ; Extremities ; Femoral Artery ; Humans ; Lower Extremity ; Medical Records ; Prospective Studies ; Surveys and Questionnaires ; Retrospective Studies ; Risk Factors

This prospective study surveyed the prevalence of peripheral arterial disease (PAD) in Korean patients with coronary arterial disease (CAD) or cerebrovascular disorder (CVD). From March 2010, 576 hospitalized patients in cardiovascular or stroke center were enrolled as the study group. Ankle-brachial index (ABI) was measured and the cut-off point for diagnosing PAD was < or = 0.9 at rest. A total of 424 hospitalized patients in the Department of Surgery and aged > or = 50 yr was enrolled as the control group. The prevalence of PAD was significantly higher in the study group than the control group (7.6% vs 1.7%; P < 0.001). To analyze the relationship of other vascular diseases and PAD, the patients were regrouped; group A (no CAD or CVD), group B (CAD only), group C (CVD only), and group D (CAD and CVD). Compared with group A, those with other vascular diseases (group B, C, D) had significantly higher prevalence of PAD, diabetes, dyslipidemia, renal insufficiency and claudication. The trend that patients with CAD or CVD are at risk of PAD is observed in this cross-sectional study in Koreans. Routine ABI measurement is recommended in these high-risk groups for early detection and proper management of PAD.
Aged ; Ankle Brachial Index ; Cerebrovascular Disorders/complications/*epidemiology ; Coronary Artery Disease/complications/*epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Peripheral Arterial Disease/*epidemiology/etiology ; Prevalence ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors

PURPOSE: Previous reports demonstrated that nitric oxide (NO) plays immuno-regulatory role in immune responses including allograft rejection response. However, its possible role in xenograft rejection has not been examined. The purpose of this study is to elucidate possible immunoregulatory role of NO in skin xenograft rejection by determining the expressions of chemokines and cytokines in the presence or absence of iNOS inhibitors. METHODS: C57BL/6J mice were grafted with Lewis rat tail skin. The mice were injected intraperitoneally with potent inhibitor of iNOS, aminoguanidine (AMG, 200 mg/kg). Graft survival was monitored and cytokine and chemokine mRNA expressions were measured by real-time RT-PCR in context with iNOS expression on day 3, 5, 7 and 9. These data were compared with those of control mice (saline injected). RESULTS: Compared with the control mice, the AMG treated mice showed delayed xenograft rejection by approximately 3 days (8.9+/-0.7 days vs 11.7+/-1.2 days). Infiltrations of CD11b+, MOMA-2+ cells and neutrophils were significantly reduced but not CD4+ and CD8+ cells in AMG treated graft. The expression of cytokines such as IL-1beta, IL-2, IL-6, IL-12, IFN-gamma in AMG treated graft significantly decreased (P<0.01) whereas IL- 10, TNF-alpha and TGF-beta1 were not changed or enhanced. Additionally, the expression of CC-chemokines such as RANTES and MIP-1alpha significantly reduced (P<0.01) whereas CXC-chemokines such as IP-10 and MIG did not change. CONCLUSION: These data imply that NO suppression by iNOS inhibitor may prolong rat to mouse skin xenograft survival through a selective inhibition of pro-inflammatory cytokines and chemokines. The possible role of NO in transplant rejection can be, therefore, extended to regulation of cytokine and chemokine expressions.
Allografts ; Animals ; Chemokine CCL3 ; Chemokine CCL5 ; Chemokines ; Cytokines ; Graft Rejection ; Graft Survival ; Heterografts* ; Interleukin-12 ; Interleukin-2 ; Interleukin-6 ; Mice ; Neutrophils ; Nitric Oxide ; Rats ; RNA, Messenger ; Skin* ; Tail ; Transforming Growth Factor beta1 ; Transplantation, Heterologous ; Transplants ; Tumor Necrosis Factor-alpha

Endovascular aneurysm repair (EVAR) is used with increasing frequency in the management of high-risk abdominal aortic aneurysm (AAA) patients. We report a delayed open repair for a persistent type I endoleak after EVAR in a patient with co-morbidities. An infrarenal AAA with a transverse diameter of 9.86 cm was detected on CT angiography; it extended from 8 mm below the renal artery to both common iliac arteries. The infrarenal angle was 90 degrees. After insertion of a Zenith stent graft (COOK, USA), a type I endoleak was detected on aortography, and several balloon dilatations were performed. The procedure was finished with a sustained type I endoleak. The endoleak persisted after 5 days on Doppler ultrasound, so open repair was performed. Total operative time was 240 minutes, and the duration of supra-celiac aorta clamping was approximately 35 minutes. The patient suffered an acute myocardial infarction on postoperative day 7 and recovered with conservative management. The patient was discharged on postoperative day 29.
Aneurysm ; Aorta ; Aortic Aneurysm, Abdominal ; Aortography ; Constriction ; Dilatation ; Endoleak ; Humans ; Iliac Artery ; Myocardial Infarction ; Operative Time ; Renal Artery ; Stents ; Transplants

PURPOSE: The prevalence and treatment patterns of abdominal aortic aneurysm (AAA) vary according to ethnicity and region. This study analyzed nationwide data on the epidemiology, practice patterns, and mortality rates of AAA in Korea.MATERIALS AND METHODS: Data from patients treated for AAA from 2012 to 2016 were extracted from the Korean Health Insurance Review and Assessment (HIRA) database.RESULTS: A total of 30,766 patients in Korea had treatment codes for AAA and 2,618 patients were treated for ruptured AAA. Of the 6,356 patients treated surgically, 1,849 and 4,507 underwent open surgical aneurysmal repairs (OSAR) or endovascular aneurysmal repairs (EVAR), respectively. The number of surgical treatments performed annually for AAA increased from 1,129 cases in 2012 to 1,501 cases in 2016. The number of EVAR cases increased from 753 to 1,109 during these five years, while the number of OSAR cases remained similar, at 376 and 392, respectively. The 30-day mortality rates after EVAR and OSAR were 4.2% and 10.6%, respectively. The mortality rates were significantly higher in patients with hypertension, dyslipidemia, chronic renal disease, diabetes mellitus, and congestive heart failure. There were significant differences in the prevalence, proportion of EVAR, and mortality rates according to the regional area.CONCLUSION: The prevalence of AAA and the proportion of EVAR in Korea increased in the past 5 years, while the rupture rate and the proportion of OSAR remained similar. To minimize mortality and regional discrepancies, nationwide registry and treatment standardization are needed.
Aneurysm ; Aortic Aneurysm, Abdominal ; Cross-Sectional Studies ; Diabetes Mellitus ; Dyslipidemias ; Epidemiologic Studies ; Epidemiology ; Heart Failure ; Humans ; Hypertension ; Insurance, Health ; Korea ; Mortality ; National Health Programs ; Prevalence ; Renal Insufficiency, Chronic ; Rupture

Purpose: After the publication of the ACOSOG (American College of Surgeons Oncology Group) Z0011 trial, the rate of axillary lymph node dissection has reduced. Thus, the need for intraoperative frozen section biopsy of sentinel lymph nodes (SLNs) has become controversial. We identified patients for whom intraoperative SLN frozen section biopsy could be omitted and found that frozen section biopsy rate can be reduced. Methods: We reviewed the records of patients with tumors ≤5 cm in diameter who underwent breast-conserving surgery between January 2013 and December 2019 at Seoul St. Mary’s Hospital. Clinicopathological and imaging characteristics were compared according to number of positive SLNs (0–2 SLNs positive vs. ≥3 SLNs positive). Results: A total of 1,983 patients were included in this study. Thirty-two patients (1.6%) had at least 3 positive SLNs. Patients with ≥3 positive SLNs had significantly larger tumors and were more frequently high-grade tumors (P < 0.001 and P = 0.002, respectively). Identification of suspicious lymph nodes on imaging studies was also associated with the presence of ≥3 positive SLNs (hazard ratio, 11.54; 95% confidence interval, 4.42–30.10). All patients with none or only 1 suspicious lymph node on any imaging modality (n = 647, 32.6%) had 0–2 positive SLNs. Also, among patients with clinical T1-stage tumors and at least 2 suspicious lymph nodes on only 1 imaging modality (n = 514, 25.9%), only 2 cases had ≥3 positive SLNs. Conclusion We found that intraoperative SLN frozen biopsy could be omitted in patients using tumor size and axillary lymph node status on imaging modality.