OBJECTIVE: To investigate the effectiveness of radiographic parameters on segmental instability in the lumbar spine using Kinetic magnetic resonance imaging (MRI). METHODS: Segmental motion, defined as excessive (more than 3 mm) translational motion from flexion to extension, was investigated in 309 subjects (927 segments) using Kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration (DD), facet joint osteoarthritis (FJO), and ligament flavum hypertrophy (LFH). These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. RESULTS: The overall incidence of segmental instability was 10.5% at L3-L4, 16.5% at L4-L5, and 7.3% at L5-S1. DD and LFH at L3-L4 and FJO and LFH at L4-L5 were individually associated with segmental instability (p<0.05). At L4-L5, the following combinations had a higher incidence of segmental instability (p<0.05) when compared to other segments : (1) Grade IV DD with grade 3 FJO, (2) Grade 2 or 3 FJO with the presence of LFH, and (3) Grade IV DD with the presence of LFH. At L5-S1, the group with Grade III disc and Grade 3 FJO had a higher incidence of segmental instability than the group with Grade I or II DD and Grade 1 FJO. CONCLUSION: This study showed that the presences of either Grade IV DD or grade 3 FJO with LFH at L4-L5 were good indicators for segmental instability. Therefore, using these parameters simultaneously in patients with segmental instability would be useful for determining candidacy for surgical treatment.
Humans ; Hypertrophy ; Incidence ; Intervertebral Disc Degeneration ; Ligaments ; Magnetic Resonance Imaging ; Osteoarthritis ; Spine ; Zygapophyseal Joint

We describe here a case of traumatic neuroma that developed in the pancreas head as a rare complication of pancreatic surgery for pseudocyst. A 50-year-old man presented with septic shock. The patient was a heavy drinker with history of operation for pancreatic pseudocyst 28 years ago. On the radiologic examinations, a poorly defined mass-like lesion was found in the uncinate process of pancreas, and it had features of chronic pancreatitis and a stricture of the distal common bile duct. Whipple's operation was performed due to the diagnosis of suspected pancreas head cancer. The pancreas revealed an ill-demarcated 4 cm sized firm mass with grayish white fibrotic cut surface in the head portion. On the microscopic examination, the mass was composed of haphazard proliferations of nerve fascicles in a fibrocollagenous matrix and this case was diagnosed as traumatic neuroma. Although traumatic neruoma is a rare cause of a pancreatic mass, it should be included as a differential diagnosis of pancreatic mass in patients with a history of pancreatic surgery.
Common Bile Duct ; Constriction, Pathologic ; Diagnosis ; Diagnosis, Differential ; Head and Neck Neoplasms ; Head* ; Humans ; Middle Aged ; Neoplasms, Post-Traumatic ; Neuroma* ; Pancreas* ; Pancreatic Pseudocyst ; Pancreatitis, Chronic ; Shock, Septic

BACKGROUND/AIMS: The rate of internet utilization has been gradually increased especially due to recent introduction of mobile devices. In 2005, we evaluated the quality of medical information on the internet about endoscopy under conscious sedation. In the present study, we tried to find out whether there was a significant change in the quality of medical information between 2005 and 2012. MATERIALS AND METHODS: Using the five most frequently used internet search engines, we found top 20 internet sites with the key word 'sleeping endoscopy' and 'endoscopy under conscious sedation'. The quality of information was evaluated by the same checklist used in the previous study. RESULTS: With the key word 'sleeping endoscopy', 69 sites were found. Among them, 58 sites (84.1%) were made by general hospitals or private clinics. The definition of sleeping endoscopy was accurately mentioned in 50.7% (n=35) of the sites, whereas the rate was 57.1% in 2005. In 2012, information on sedative agents were mentioned in only 16 sites (23.2%) which was lower than 42.9% in 2005 (P<0.05). There were more information on complications of endoscopy in 2012. Using the key word 'endoscopy under conscious sedation', only 13 sites were found, and the quality of information in these sites was generally better than sites found with 'sleeping endoscopy'. CONCLUSIONS: Between 2005 and 2012, the quantity of information on endoscopy under sedation has increased. However, there were no definite improvement in the quality of information.
Checklist ; Conscious Sedation ; Endoscopy ; Hospitals, General ; Internet ; Quality Improvement ; Search Engine

BACKGROUND/AIMS: The rate of internet utilization has been gradually increased especially due to recent introduction of mobile devices. In 2005, we evaluated the quality of medical information on the internet about endoscopy under conscious sedation. In the present study, we tried to find out whether there was a significant change in the quality of medical information between 2005 and 2012. MATERIALS AND METHODS: Using the five most frequently used internet search engines, we found top 20 internet sites with the key word 'sleeping endoscopy' and 'endoscopy under conscious sedation'. The quality of information was evaluated by the same checklist used in the previous study. RESULTS: With the key word 'sleeping endoscopy', 69 sites were found. Among them, 58 sites (84.1%) were made by general hospitals or private clinics. The definition of sleeping endoscopy was accurately mentioned in 50.7% (n=35) of the sites, whereas the rate was 57.1% in 2005. In 2012, information on sedative agents were mentioned in only 16 sites (23.2%) which was lower than 42.9% in 2005 (P<0.05). There were more information on complications of endoscopy in 2012. Using the key word 'endoscopy under conscious sedation', only 13 sites were found, and the quality of information in these sites was generally better than sites found with 'sleeping endoscopy'. CONCLUSIONS: Between 2005 and 2012, the quantity of information on endoscopy under sedation has increased. However, there were no definite improvement in the quality of information.
Checklist ; Conscious Sedation ; Endoscopy ; Hospitals, General ; Internet ; Quality Improvement ; Search Engine