STUDY DESIGN: A retrospective study was made of patients undergoing posterolateral fusion of the lumbar spine. OBJECTIVES: To compare the clinical outcomes of the patients who underwent posterolateral fusion of the lumbar spine with commercially available allogeneic bone graft with those patients in a similar consecutive control group who underwent posterolateral fusion of the lumbar spine with autogenic bone graft and to determine whether the commercially available allogeneic bone is useful for postero-lateral fusion of the lumbar spine. SUMMARY OF LITERATURE REVIEW: Major differences exist in the ability of an allogeneic bone graft to regenerate a viable cellular network as compared to an autogenic bone graft. This is related to the immunologic response of the host to the foreign bone. The fusion rate of deep freezing allogeneic bone graft was reported as 80-100%. MATERIALS AND METHODS: Seventy-nine patients with spondylolisthesis treated with decompression, fixation with pedicle screws and posterolateral fusion were retrospectively reviewed. Nineteen patients (group 1) were treated with commercially available allogeneic bone (Tutoplast) graft mixed with autogenic bone and the remaining 60 patients (group 2) were treated with autogenic bone graft. Operating time, amount of transfusion, duration of hospital stay, symptom improvement, fusion rate, duration of fusion, and complications were studied. RESULTS: There were no significant differences between the two groups in terms of duration of hospital stay, amount of transfusion, symptom improvement, and complications . However, there were significant differences between the allogeneic and autogenic groups in terms of operating time (212.3 versus 230.9 minutes), fusion rate (36.8% versus 98.3%), and duration of fusion (10.2 versus 6.4 months), respectively. CONCLUSIONS: Commercially available allogeneic bone is less useful for posterolateral fusion of the lumbar spine.
Decompression ; Freezing ; Humans ; Length of Stay ; Retrospective Studies ; Spine* ; Spondylolisthesis ; Transplants

No abstract available.
Spine*

No abstract available.
Moyamoya Disease*

STUDY DESIGN: A retrospective study was performed in obese and nonobese patients undergoing lumbar spine surgery. OBJECTIVES: To report perioperative complications and surgical outcomes in obese patients who underwent lumbar surgery compared with a similar consecutive control group to determine whether obesity is a predictor of poor outcome as well as a factor associated with perioperative complications in lumbar spine surgery. SUMMARY OF LITERATURE REVIEW: Perioperatiye challenges in managing the obese patient include anesthesia considerations related to impaired preoperative cardiac and respiratory function, technical difficulties associated with incubation, positioning, and gaining venous and arterial access for monitoring and administering medications. Obesity has also been implicated in delayed wound healing and thrombophlebitis. MATERIALS AND METHODS: One hundred twenty seven patients with spondylolisthesis treated with decompression and fusion were retrospectively evaluated. Forty four patients were obese and remaing eighty three patients were nonobese. The operation time, amount of transfusion, duration of hospital stay and clinical outcomes were studied. RESULTS: There were no significant differences between the obese and control groups in terms of duration of surgery (224 versus 200 min), amount of transfusion (2.6 versus 2.2 pint), duration of hospital stay (21.3 versus 19.7 days), and symptom improvement (74fo versus 73fo). CONCLUSIONS: Obesity is not a predictor of poor outcome as well as a factor associated with high perioperative complication rate in lumbar spine surgery.
Anesthesia ; Decompression ; Humans ; Length of Stay ; Obesity* ; Retrospective Studies ; Spine* ; Spondylolisthesis ; Thrombophlebitis ; Wound Healing

OBJECTIVES: To determine if unilateral pedicle screw fixation is comparable to bilateral fixation in one-or two-segment lumbar spinal fusion. METHODS: Eighty-eight patients with spinal stenosis or spondylolisthesis were assigned to either unilateral or bilateral pedicle screw instrumentation groups. Demographic variables, preoperative diagnosis, number of fusion segments, and kinds of instrumentation used were similar between the two treatment groups. RESULTS: There were no significant differences between the two groups in terms of blood loss, clinical results, time at which fusion was complete, fusion rate, and complication rate. There were significant differences between the two groups in terms of duration of operating time, duration of hospital stay, medical expenses. The number of fusion segments or kinds of instrumentation did not affect the fusion rate, time at which fusion was complete, or clinical outcomes. Metal failure rate of unilateral fixation was higher in patients with spondylolytic spondylolisthesis than in patients with spinal stenosis. CONCLUSIONS: Unilateral pedicle screw fixation was as effective as bilateral pedicle screw fixation in lumbar spinal fusion independent of the number of fusion segments (one or two segments) or pedicle screw systems. Unilateral pedicle screw fixation is not recommended for spondylolytic spondylolisthesis patients who were treated with Gill' s decompression.
Decompression ; Diagnosis ; Humans ; Length of Stay ; Spinal Fusion* ; Spinal Stenosis ; Spondylolisthesis

Recently, the use of internal fixation device in spine is popular due to several advantages. The advantages are to make short segmental fusion possible, to obtain early stability, and to reduce the needs of external immobilization. But, we can easily observe the hardware failures such as screw breakage and loosening. The purpose of this study is to evaluate the contributing factors to hardware complications through analysis of the problem cases. The authors reviewed complicated 17 (6.7%) cases out of 271 patients who was done posterior decompression and spinal fusion with transpedicular screws for spinal stenosis or spondylolisthesis from Jan. 1986 to Dec. 1994. We reviewed the clinical data, radiograph, and bone mineralo-densitometry. Seventeen patients (6.7%) had hardware complications: breakage of the screw in 5 cases, loosening of the screw in 11 cases, displacement of the rod in 1 case. The duration from the operation to the onset of complications was 1.3 years (4 month-6 years). More complications were occurred in the distal segments (13 cases) than in the proximal segments (4 cases). In 6 cases of 17 cases, we could observe the incomplete spinal fusion. We performed the bone mineralodensitometry (BMD, DEXA) in 30 patients. Among them, 6 cases had hardware complications-5 cases of screw loosening and 1 case of screw breakage. The average BMD (1.048g/cm2) of 24 patients without hardware complications was higher than that (0.890g/cm2) of 6 patients with complications (p<0.05). The duration of wearing the external support after surgery was also checked. Removal of hardware was performed in 5 cases due to pain, but the others were treated conservatively because of no symptom. Hardware complications were found mainly in the distal segment and was related to bone mineral density. Checking the bone mineral density in preoperative state helps to decide on the indication of surgical intervention. Through follow-up X-ray, spinal fusions can be carefully observed, and the duration of external support can be decided.
Bone Density ; Decompression ; Follow-Up Studies ; Humans ; Immobilization ; Internal Fixators ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylolisthesis

PURPOSE: This study was performed to find the clinical significance in protein C as a differential marker in the beginning stage of infection and prognosis factor in severe infection among pediatric patients who were admitted due to fever. METHODS: A total of 40 pediatric patients who had temperatures higher than 37.5degrees C on admission at the Department of Pediatrics, Chungnam National University between December, 2002 and August, 2003 were enrolled. Total white blood cell count(WBC), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) and protein C were performed for those patients on admission. Clinical progress, diagnosis and prognosis were reviewed for these patients. The 40 patients were divided into two groups based on the diagnosis of bacterial and nonbacterial infections. RESULTS: Twenty patients(50%) were suspected of bacterial infections that showed positive results in blood, sputum, urine, and spinal cord fluid. There were eight cases with bacterial pneumonia, five with urinary tract infection, four with bacterial meningitis, two with cellulitis, and one with typhoid fever. The remaining 20 patients were diagnosed with nonbacterial infections because they had negative results in blood cultures. ESR and CRP were increased beyond normal range in both groups. However, protein C was significantly decreased in the bacterial infection group and yet normal range in the nonbacterial infection group(P<0.05). CONCLUSION: Protein C can be used as a differential marker in order to distinguish between bacterial and nonbacterial infections. In addition, protein C can possibly be used as a prognostic factor that can predict severe infection.
Bacterial Infections* ; Blood Sedimentation ; Cellulitis ; Chungcheongnam-do ; Diagnosis ; Fever* ; Humans ; Leukocytes ; Meningitis, Bacterial ; Pediatrics ; Pneumonia, Bacterial ; Prognosis ; Protein C* ; Reference Values ; Spinal Cord ; Sputum ; Typhoid Fever ; Urinary Tract Infections

No abstract available.
Chickens* ; Yolk Sac*

No abstract available.
Child* ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-alpha*

OBJECTIVE: To determine the effects of respiration on the size of lung cysts by comparing inspiratory and expiratory high-resolution CT (HRCT) scans. MATERIALS AND METHODS: The authors evaluated the size of cystic lesions, as seen on paired inspiratory and expiratory HRCT scans, in 54 patients with Langerhans cell histiocytosis (n = 3), pulmonary lymphangiomyomatosis (n = 4),confluent centrilobular emphysema (n = 9), paraseptal emphysema and bullae (n= 16), cystic bronchiectasis (n = 13), and honeycombing (n = 9). Using paired inspiratory and expiratory HRCT scans obtained at the corresponding anatomic level, a total of 270 cystic lesions were selected simultaneously on the basis of five lesions per lung disease. Changes in lung cyst size observed during respiration were assessed by two radiologists. In a limited number of cases (n = 11), pathologic specimens were obtained by open lung biopsy or lobectomy. RESULTS: All cystic lesions in patients with Langerhans cell histiocytosis, lymphangiomyomatosis, cystic bronchiectasis, honeycombing, and confluent centrilobular emphysema became smaller on expiration, but in two cases of paraseptal emphysema and bullae there was no change. CONCLUSION: In cases in which expiratory CT scans indicate that cysts have become smaller, cystic lesions may communicate with the airways. To determine whether, for cysts and cystic lesions, this connection does in fact exist, paired inspiratory and expiratory HRCT scans are necessary.
Comparative Study ; Cysts/*radiography ; Female ; Human ; Lung Diseases/*radiography ; Lung Diseases, Interstitial/radiography ; Male ; Middle Age ; Pulmonary Emphysema/radiography ; Respiration ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed/*methods