OBJECTIVE: The purpose of this study is to compare the outcomes of two methods for stabilization and fusion: Postero-Lateral Fusion (PLF, pedicle screw fixation with bone graft) and Posterior Lumbar Interbody Fusion (PLIF, cage insertion) for spinal stenosis and recurred disc herniation except degenerative spondylolisthesis. METHODS: Seventy one patients who underwent PLF (n=36) or PLIF (n=35) between 1997 and 2001 were evaluated prospectively. These two groups were compared for the change of interbody space, the range of segmental angle, the angle of lumbar motion, and clinical outcomes by Prolo scale. RESULTS: The mean follow-up period was 32.6 months. The PLIF group showed statistically significant increase of the interbody space after surgery. However, the difference in the change of interbody space between two groups was insignificant (P value= 0.05). The range of segmental angle was better in the PLIF group, but the difference in the change of segmental angle was not statistically significant (P value=0.017). Angle of lumbar motion was similar in the two groups. Changes of Prolo economic scale were not statistically significant (P value=0.193). The PLIF group showed statistically significant improvement in Prolo functional scale (P value=0.003). In Prolo economic and functional scale, there were statistically significant relationships between follow-up duration (P value<0.001), change of interbody space (P value<0.001), and range of segmental angle (P value<0.001). CONCLUSION: Results of this study indicate that PLIF is superior to PLF in interbody space augmentation and clinical outcomes by Prolo functional scale. Analysis of clinical outcomes showed significant relationships among various factors (fusion type, follow-up duration, change of interbody space, and range of segmental angle). Therefore, the authors recommend instrumented PLIF to offer better clinical outcomes in patients who needed instrumented lumbar fusion for spinal stenosis and recurred disc herniation.
Follow-Up Studies ; Humans ; Prospective Studies ; Spinal Stenosis ; Spondylolisthesis

No abstract available.
Histiocytoma, Malignant Fibrous* ; Lung*

The vitelline duct is the primitive connection between the yolk sac and embryonic midgut, and undergoes involution between the seventh and ninth weeks of fetal development. A patent omphalomesenteric duct is a form of umbilical remnant with a communication between the umbilicus and intestine that requires surgical resection. Completely patent omphalomesenteric duct is very rare. We here report a case of intestinal obstruction with small bowel strangulation caused by patent omphalomesenteric duct in a 33-year-old man.
Adult ; Fetal Development ; Humans ; Intestinal Obstruction ; Intestines ; Umbilicus ; Vitelline Duct* ; Yolk Sac

Teratomas are tumors composed of derivatives of all three germinal cell layers. They have been described in a variety of organs in both children and adults, most commonly in the gonads. Extragonadal intraperitoneal teratomas are very rare. We here report a case of a large mature teratoma of the gastrohepatic ligament in a 20-year-old woman. To the best of our knowledge, a teratoma of the gastrohepatic ligament has never before been described, although there are a few reports of teratomas arising from the greater and lesser omentum.
Adult ; Child ; Female ; Gonads ; Humans ; Ligaments* ; Omentum ; Teratoma* ; Young Adult

A pseudocyst, one of the most prominent and definitive signs of pancreatitis, can also be cause by pancreatic carcinoma. However, a pancreas carcinoma and pancreatitis are sometimes indistinguishable. Reports of a pancreatic carcinoma coexisting with pancreatitis and a pseudocyst are rare. We have experienced a case of a pancreatic carcinoma, which was misdiagnosed as chronic pancreatitis with a pseudocyst. A 31-year-old man complaining of an epigastric pain visited our hospital. Ultrasonography (US) and computed tomography (CT) revealed two cystic lesions, about 8 and 2 cm in diameter, splenic vein thrombosis and diffuse inflammatory changes in the pancreatic body and tail. The value of the tumor marker, CA19-9, was 132 U/ml. Chronic pancreatitis with pseudocyst was suspected, and a cystogastostomy and splenectomy performed. A histological examination revealed a pancreatic pseudocyst. The patient was readmitted 7 months later due to abdominal pain. The serum CA19-9 level was 544 U/ml. The CT revealed severe diffuse inflammatory changes in the pancreatic body and tail. Percutaneous CT- guided fine-needle aspiration revealed a pancreatic adenocarcinoma. The differentiation between the pseudocyst of pancreatitis and the secondary cyst caused by a pancreatic carcinoma is important but is difficult or impossible in some cases. The CT features of pseudocysts secondary to a pancreatic carcinoma are identical to those of pseudocysts in pancreatitis. Even in retrospect, our case was difficult to differentiate from pancreatitis with pseudocysts. Our results indicate that whenever pancreatic cysts are encountered in patients with unusual presentation, further examinations, including percutaneous aspiration biopsies, should be performed to exclude malignancy.
Abdominal Pain ; Adenocarcinoma ; Adult ; Biopsy, Fine-Needle ; Biopsy, Needle ; Humans ; Pancreas ; Pancreatic Cyst ; Pancreatic Pseudocyst ; Pancreatitis ; Pancreatitis, Chronic* ; Splenectomy ; Splenic Vein ; Thrombosis ; Ultrasonography

Head and neck surgeons see many congenital cysts of the neck. Most of these cysts are thyroglossal duct cysts and branchial cleft cysts. Bronchogenic cysts are rare congenital malformations of the ventral foregut development. They are usually located in the mediastinum and intrapulmonary regions. Cervical bronchogenic cysts are unusual. Only 70 cases of bronchogenic cysts in the head and neck regions have been reported on and the majority of cases have been found in the pediatric population. We describe here a 61-year-old female who presented a palpable left neck mass. The preoperative diagnostic studies included chest X-ray and sonography-guided fine needle aspiration. The neck sonography showed the mass, but it could not rule out a pathologic lymph node. Aspirated material contained no cellular content. The mass was excised. The neck mass of the patient was diagnosed as a bronchogenic cyst. We suggest that the clinical observation of a lateral neck mass in an adult includes the possibility of a bronchogenic cyst in the differential diagnosis.
Adult ; Biopsy, Fine-Needle ; Branchioma ; Bronchogenic Cyst* ; Diagnosis, Differential ; Female ; Head ; Humans ; Lymph Nodes ; Mediastinum ; Middle Aged ; Neck ; Thorax ; Thyroglossal Cyst

Cytomegalovirus infections (CMV) of the gastrointestinal tract (GI) are common, and most often seen in patients with acquired immunodeficiency syndrome (AIDS), inflammatory bowel disease, or those receiving immunosuppressive therapy. CMV enteritis is uncommon in an immunocompetent individual. A CMV infection of the small bowel accounts for 4.3% of all CMV infections of the GI tract. The GI manifestations of CMV include: diarrhea, bleeding, obstruction and perforation, all of which are usually secondary to discrete erosions or ulceration. High mortality rates have been reported for CMV enteritis. Here, a rare case of CMV enteritis, resulting in segmental ileal ischemia, is reported in a 47-year old man following a traffic accident. On the 17th hospital day, he developed melena, watery diarrhea, fever and abdominal pain. An abdominal computed tomography (CT) on the 23rd hospital day showed an enlarged appendix with mild periappendiceal infiltration and segmental wall thickening in the terminal ileum. An ileocecal resection was performed. Pathological evaluation of the operative specimen revealed CMV inclusion bodies, with ulcerations. The patient was treated with ganciclovir therapy for 3 weeks after which his symptoms improved. If a CMV infection is highly suspected in multiply injured trauma victims, the earlier recognition of potential small bowel involvement can hopefully decrease the incidence of bleeding, ischemic demage to the bowel and perforation, which are usually fatal events.
Abdominal Pain ; Accidents, Traffic* ; Acquired Immunodeficiency Syndrome ; Appendix ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Diarrhea ; Enteritis ; Fever ; Ganciclovir ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileum ; Incidence ; Inclusion Bodies ; Inflammatory Bowel Diseases ; Ischemia* ; Melena ; Middle Aged ; Mortality ; Multiple Trauma* ; Ulcer

Hepatoid adenocarcinoma is a rare variant of adenocarcinoma of the stomach. The tumor has been found to be an alpha-fetoprotein (AFP) producing carcinoma arising in extrahepatic organs, and it mimics hepatocellular carcinoma in terms of morphology and function. Vascular invasion, usually prominent, is often complicated by extensive liver metastases, and vascular permeation, especially in the veins, has been described as a characteristic finding of this tumor. A patient with hepatoid adenocarcinoma of the stomach with a huge mass is described. Gastrofiberscopy revealed an elevated lesion with a central depression on the greater curvature of the antrum and with extrinsic compression on the lesser curvature and the duodenum. Computed tomography revealed a large lobulated mass in the lesser curvature of the stomach, attached from the liver, gall bladder and porta hepatitis to the pancreas. The AFP serum level was markedly elevated. After a diagnosis was made of AFP-producing stomach carcinoma with huge lymph node metastasis, subtotal gastectomy with wedge resection of the liver, and cholecystectomy including the huge mass ware performed. Microscopically, the tumor and intraabdominal huge mass showed mainly hepatoid differentiation. The tumor showed immunohistochemical positivity for AFP and huge lesser omental metastasis with adhesion to the liver and extensive venous invasion. Lymph node metastasis was not found. According to these histopathological findings, the tumor was diagnosed as hepatoid adenocarcinoma of the stomach with venous invasion. We report this rare variant of adenocarcinoma of the stomach, which mimics hepatocellular carcinoma in its propensity for venous permeation.
Adenocarcinoma* ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Cholecystectomy ; Depression ; Diagnosis ; Duodenum ; Hepatitis ; Humans ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Pancreas ; Stomach* ; Urinary Bladder ; Veins

Herein, a rare case of a spontaneous rupture of a liver abscess, resulting in pneumoperitoneum, is reported. A 71-year old female with uncontrolled diabetes mellitus, developed an acute abdomen. The chest x-ray and plain abdominal radiography findings revealed bilateral subphrenic free air, and the computed tomography suggested the rupture of a gas-containing pyogenic liver abscess in the left hepatic lobe, extending to the lesser omentum. An emergency laparotomy was performed, there was a ruptured pyogenic liver abscess in the left lobe, but no perforation of the hallow viscus organ. A left lobectomy of the liver, with surgical drainage, was performed. The occurrence of pneumoperitoneum secondary to the intraperitoneal rupture of a pyogenic liver abscess, is extremely rare. The condition is associated with high mortality as they are often misdiagnosis at a late stage as a hollow viscus perforation. Recently advances in computed tomography and ultrasound have resulted in liver abscesses being detect earlier. It must be borne in mind that a rupture of a gas-containing liver abscess can also mimic a perforation of the gastrointestinal tract.
Abdomen, Acute ; Aged ; Diabetes Mellitus ; Diagnostic Errors ; Drainage ; Emergencies ; Female ; Gastrointestinal Tract ; Humans ; Laparotomy ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic* ; Mortality ; Omentum ; Pneumoperitoneum* ; Radiography, Abdominal ; Rupture* ; Rupture, Spontaneous ; Thorax ; Ultrasonography

A case of a mucin-producing intrahepatic cholangiocellular carcinoma (MPCC) is reported. A 58-year old female presented with epigastric discomfort of several years duration. The physical examination and laboratory findings were normal. Abdominal ultrasonography (US) and computed tomography (CT) showed a focal dilatation of the right posterior intrahepatic bile duct. There was no abnormal mass in the liver parenchyma. Endoscopic retrograde cholangiopancreaticography (ERCP) showed a filling defect in the right posterior hepatic duct. There was no anatomical abnormality and abnormal staining on the heaptic angiography. At the operation, the right posterior hepatic duct was filled with mucin. The patient had a right posterior segmentectomy. Histologically, a 2.5 X 0.6 X 0.6 cm sized mucin-producing intrahepatic cholangiocellular carcinoma was found in segment 6 of the liver. The postoperative recovery was good, and the patient has had a good social life for the last 3 years, with no evidence of tumor recurrence. In patients with a focal dilatation of the intrahepatic bile duct on CT or US with no underlying cause, an intrahepatic malignancy has to be suspected.
Angiography ; Bile Ducts, Intrahepatic* ; Cholangiocarcinoma ; Dilatation* ; Female ; Hepatic Duct, Common ; Humans ; Liver ; Mastectomy, Segmental ; Middle Aged ; Mucins ; Physical Examination ; Recurrence ; Ultrasonography