The confirmatory diagnosis of Moyamoya disease has been obtained by invasive angiographic examination. We report the results of MRI and transcranial doppler sonography of three cases ol Moyamoya disease, which ws disgnosed by clinical and angiography. We think that the diagnosis of Moyamoya disease can be made by noninvasive MRI and transcranial doppler sonography without conventional invasive angiography.
Angiography ; Diagnosis ; Magnetic Resonance Imaging* ; Moyamoya Disease* ; Ultrasonography, Doppler, Transcranial*

Rhino-orbital mucormycosis is the most frequently fatal fungal infection commonly occurring in patients with poorly controlled diabetes mellitus and and those who are immunocompromised, and requires prompt treatment. We describe a case of rhino-or-bital mucormycosis with orbital cellulitis and paranasal sinusitis, as seen on initial MR images, which on follow-up images had evol ved to orbitofacial infarction. MR imaging was useful for the demonstration of orbitofacial infarction, seen as areas of lack of enhancement and thus suggesting vascular invo l vement by mucor hyphae.
Diabetes Mellitus ; Follow-Up Studies ; Humans ; Hyphae ; Infarction* ; Magnetic Resonance Imaging* ; Mucor ; Mucormycosis* ; Orbital Cellulitis ; Sinusitis

STUDY DESIGN: A retrospective study. OBJECTIVES: The purpose of this study was to compare the results between Smith-Petersen and pedicle subtraction osteotomies for fixed sagittal imbalance, and to determine the specific indications for each. LITERATURE REVIEW SUMMARY: Smith-Petersen (SPO) and pedicle subtraction osteotomies (PSO) are the techniques most commonly used to correct fixed sagittal imbalance of the spine, but there are no reports regarding the superiority of either technique. A Smith-Petersen osteotomy is an anterior opening wedge osteotomy, which hinges on the posterior edge of the intervertebral disc, while a pedicle subtraction osteotomy is a posterior closing wedge osteotomy, without distracting the anterior column, with the hinge on the anterior aspect of the vertebral body. MATERIALS AND METHODS: Thirty patients (mean age 40.1 years, range 20 ~64 years), who underwent a SPO, were compared with forty-one patients (mean age 54.5 years, range 21 ~73 years) who underwent a PSO. The SPO was carried out in more than three segments (3 SPOs) in fourteen of the SPO group. The average follow-up periods were 4.6 years, ranging from 2 to 11.5 years, and 3.8 years, ranging from 2 to 7.1 years, for the SPO and PSO groups, respectively. Patients were evaluated by standing radiographs, chart review and outcome questionnaires. RESULTS: The mean correction of the kyphotic angle at the osteotomy sites for the SPOs was 10.7 per segment, and for those with 3 SPOs and the PSO group the average total corrections were 33.0+/-9.2 and 31.7+/-9.0, respectively. However, the improvement in sagittal balance was less statistically significantly with 3 SPOs (5.5+/-4.5 cm) than with a PSO (11.2+/-7.2 cm; p<0.01). Comparing 3 SPOs to one PSO, the SPO group decompensated the patients more substantially to the concavity (p<0.02). The mean estimated blood loss (adding up all anterior and posterior surgeries) for the procedures were 1398+/-738 (1392+/-664 mL in the 3 SPO group), and 2617+/-1645 mL in the SPO and PSO groups, respectively (p<0.001; p<0.01). The total operative times for the SPO versus the PSO groups were similar, with no statistical difference. There were substantial complications in both groups, with 13 in the 30 SPO and 30 in the 41 PSO patients. In the SPO group, 1 patient had a non-union at an osteotomy site; in the PSO group, 2 patients had a non-union at an osteotomy site. The mean Oswestry score improved from 42.3+/-14.2 to 21.3+/-14.8 postoperatively at the last visit for the SPO group and, it improved from 47.9+/-15.8 preoperatively to 29.7+/-18.3 at the last visit in PSO group (p=0.35). CONCLUSIONS: When comparing 3 Smith-Petersen osteotomies to one pedicle subtraction osteotomy, the corrections of kyphosis were almost identical, but the improvement in the C7 plumb was significantly better in the PSO group. There was a significantly greater likelihood of decompensating the patient to the concavity with the 3 SPOs than with a single PSO (p<0.02). The total operative time for the SPO versus the PSO groups showed no statistical difference. However, the blood loss was substantially greater in the PSO group (p<0.001).
Follow-Up Studies ; Humans ; Intervertebral Disc ; Kyphosis ; Operative Time ; Osteotomy* ; Surveys and Questionnaires ; Retrospective Studies ; Spine

STUDY DESIGN: A retrospective study. OBJECTIVES: The purpose of this study was to compare the results between Smith-Petersen and pedicle subtraction osteotomies for fixed sagittal imbalance, and to determine the specific indications for each. LITERATURE REVIEW SUMMARY: Smith-Petersen (SPO) and pedicle subtraction osteotomies (PSO) are the techniques most commonly used to correct fixed sagittal imbalance of the spine, but there are no reports regarding the superiority of either technique. A Smith-Petersen osteotomy is an anterior opening wedge osteotomy, which hinges on the posterior edge of the intervertebral disc, while a pedicle subtraction osteotomy is a posterior closing wedge osteotomy, without distracting the anterior column, with the hinge on the anterior aspect of the vertebral body. MATERIALS AND METHODS: Thirty patients (mean age 40.1 years, range 20 ~64 years), who underwent a SPO, were compared with forty-one patients (mean age 54.5 years, range 21 ~73 years) who underwent a PSO. The SPO was carried out in more than three segments (3 SPOs) in fourteen of the SPO group. The average follow-up periods were 4.6 years, ranging from 2 to 11.5 years, and 3.8 years, ranging from 2 to 7.1 years, for the SPO and PSO groups, respectively. Patients were evaluated by standing radiographs, chart review and outcome questionnaires. RESULTS: The mean correction of the kyphotic angle at the osteotomy sites for the SPOs was 10.7 per segment, and for those with 3 SPOs and the PSO group the average total corrections were 33.0+/-9.2 and 31.7+/-9.0, respectively. However, the improvement in sagittal balance was less statistically significantly with 3 SPOs (5.5+/-4.5 cm) than with a PSO (11.2+/-7.2 cm; p<0.01). Comparing 3 SPOs to one PSO, the SPO group decompensated the patients more substantially to the concavity (p<0.02). The mean estimated blood loss (adding up all anterior and posterior surgeries) for the procedures were 1398+/-738 (1392+/-664 mL in the 3 SPO group), and 2617+/-1645 mL in the SPO and PSO groups, respectively (p<0.001; p<0.01). The total operative times for the SPO versus the PSO groups were similar, with no statistical difference. There were substantial complications in both groups, with 13 in the 30 SPO and 30 in the 41 PSO patients. In the SPO group, 1 patient had a non-union at an osteotomy site; in the PSO group, 2 patients had a non-union at an osteotomy site. The mean Oswestry score improved from 42.3+/-14.2 to 21.3+/-14.8 postoperatively at the last visit for the SPO group and, it improved from 47.9+/-15.8 preoperatively to 29.7+/-18.3 at the last visit in PSO group (p=0.35). CONCLUSIONS: When comparing 3 Smith-Petersen osteotomies to one pedicle subtraction osteotomy, the corrections of kyphosis were almost identical, but the improvement in the C7 plumb was significantly better in the PSO group. There was a significantly greater likelihood of decompensating the patient to the concavity with the 3 SPOs than with a single PSO (p<0.02). The total operative time for the SPO versus the PSO groups showed no statistical difference. However, the blood loss was substantially greater in the PSO group (p<0.001).
Follow-Up Studies ; Humans ; Intervertebral Disc ; Kyphosis ; Operative Time ; Osteotomy* ; Surveys and Questionnaires ; Retrospective Studies ; Spine

PURPOSE: This study was designed to investigate the characteristics and classification of congenital color vision deficiency (CVD) by the SNU computerized color test (SCCT) that was developed to sufficiently utilize the advantages of a computer. METHODS: Hardy-Rand-Rittler test (HRR test), Nagel anomaloscope and SCCT were performed on 60 eyes of 30 CVD patients and 30 normal subjects and the results were compared. RESULTS: In normal subjects, the error scores were all zero at all colors by SCCT. By SCCT protan color defectives showed a peak at hue 0 red in 7 eyes (29.2%), at hue 150 green in 3 eyes (12.5%), at hue 180 green in 18 eyes (75%), and at hue 330 red in 2 eyes (8.3%). By SCCT, deutan color defectives showed a peak at hue 0 red in 2 eyes (5.6%), at hue 150 green in 24 eyes (66.7%), at hue 180 green in 2 eyes (5.6%), and at hue 330 red in 23 eyes (63.9%). CONCLUSIONS: SCCT showed specific axes in CVD patients, with accuracy and high sensitivity to diagnosis. SCCT appears to be useful clinically as a color vision test to diagnose and classify CVD patients.
Classification* ; Color Vision Defects* ; Color Vision* ; Diagnosis ; Humans

Esophageal achalasia is a primary motility disorder characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. Achalasia is a chronic disease that causes progressive irreversible loss of esophageal motor function. The recent development of high-resolution manometry has facilitated the diagnosis of achalasia, and determining the achalasia subtypes based on high-resolution manometry can be important when deciding on treatment methods. Peroral endoscopic myotomy is less invasive than surgery with comparable efficacy. The present guidelines (the “2019 Seoul Consensus on Esophageal Achalasia Guidelines”) were developed based on evidence-based medicine; the Asian Neurogastroenterology and Motility Association and Korean Society of Neurogastroenterology and Motility served as the operating and development committees, respectively. The development of the guidelines began in June 2018, and a draft consensus based on the Delphi process was achieved in April 2019. The guidelines consist of 18 recommendations: 2 pertaining to the definition and epidemiology of achalasia, 6 pertaining to diagnoses, and 10 pertaining to treatments. The endoscopic treatment section is based on the latest evidence from meta-analyses. Clinicians (including gastroenterologists, upper gastrointestinal tract surgeons, general physicians, nurses, and other hospital workers) and patients could use these guidelines to make an informed decision on the management of achalasia.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.