OBJECTIVE: We previously reported excellent early and midterm clinical results of anterior cervical microforaminotomy (ACMF) for patients with cervical radiculopathy caused by disc herniation or foraminal stenosis. ACMF is accepted as a minimally invasive functional spinal surgery, but its long-term outcomes are unknown. The purpose of this study is to evaluate the long-term clinical and radiographic results of ACMF. METHODS: We performed a questionnaire survey and retrospective analysis of 13 patients with cervical radiculopathy who underwent ACMF from 1998 to 2002. Clinical and radiographic data from these 13 patients (one-level operations in seven patients, and two-level operations in six patients) were analysed. We measured disc height, sagittal plane displacement and sagittal plane angulation to evaluate instability. RESULTS: Thirteen patients answered the questionnaires. Mean follow-up was 77.3 months (ranged from 498 to 110 months). The surgical outcome was excellent in three patients (23%) and good in nine patients (69%). One patient had only a fair outcome, but there were no cases of recurrence, reoperation or additional surgery. Twelve of 13 patients were satisfied with the results of their surgery. On the average, the loss of disc height was 0.84mm(16.6% of preoperative disc height), increase of displacement was 0.47mm and increase of sagittal plane angulation was 0.65degrees. All patients maintained stability during the follow-up period. Although the patient sample included in this study is a different sample from that surveyed in our previous study of mid-term results, the long-term radiographic outcomes showed that the parameters of instability tended to decrease in comparison to those midterm results. Three-dimensional computed tomography scans showed signs indicative of bone remodeling, including regrowth of the resected bone and gradual fusion around the uncovertebral joint (UVJ) where ACMF was performed. In spite of bone regeneration around the UVJ, the neural foramen appeared to be well maintained in all patients. CONCLUSION: In the long-term, ACMF is clinically effective method for the treatment of cervical radiculopathy, although disc height was decreased and sagittal angulation was increased. UVJ with mild hypermobility that was apparent at midterm appears to be restored during long-term follow-up. The efficacy of this procedure should be evaluated in additional studies involving large patient series.
Bone Regeneration ; Bone Remodeling ; Cervical Vertebrae ; Constriction, Pathologic ; Displacement (Psychology) ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Joints ; Surveys and Questionnaires ; Radiculopathy ; Recurrence ; Reoperation ; Retrospective Studies ; Spondylosis

The only effective treatment for subfoveal neovascular membrane in age-related macular degeneration is laser photocoagulation, which is associated with decreased visual acuity following treatment in most patients. Radiation treatment for subfoveal neovascular membrane has been tried, but its effectiveness and necessary dose are not determined yet. Twelve eyes with subfoveal neovascular membranes received X-ray radiation with the dose of 1980cGy or 1440cGy. After a minimum 6 month follow-up, 4 eyes had improved, 6 eyes had stable and 2 eyes had worsened visual acuity. To date no negative side effects have been observed. We could not find difference in visual outcome between two dose groups due to the small sample size. Regarding the poor natural course of age-related macular degeneration, these results suggest a possible beneficial effect of radiation treatment with total dose of 1980 or 1440cGy and justify the further treatments and evaluations of the radiotherapy.
Follow-Up Studies ; Humans ; Light Coagulation ; Macular Degeneration* ; Membranes* ; Radiotherapy* ; Sample Size ; Visual Acuity

OBJECTIVE: The purpose of this study was to assess long-term clinical outcomes and radiographic changes in patients with lumbar spinal stenosis with grade I degenerative spondylolisthesis who underwent microsurgical bilateral decompression via unilateral laminotomy, as a minimally invasive surgery. Method: Medical records of twenty-five patients who underwent the surgery between 1999 and 2005 were retrospectively evaluated. Clinical outcomes were evaluated through interviews over telephone with standardized questionnaires. Preoperative and postoperative radiographs were taken from all patients in neutral and dynamic lateral views. The mean follow-up period after surgery was 38.5 months(range 9-57 months). RESULTS: Seventy-two percent of patients were either pain free(48%) or doing well with occasional acetaminophens(24 %), and satisfied with the treatment. The most improved preoperative symptom was neurogenic intermittent claudication, which was ameliorated in 94.7% of patients(excellent 84.2%, good 10.5%, fair 5.3%). Postoperative vertebral slippage was also measured and appeared to be slightly increased but this was not statistically significant. Postoperative dynamic angulation did not change significantly compared to the preoperative value. CONCLUSION: Microsurgical bilateral decompression via unilateral laminotomy achieved a satisfactory decompression and symptomatic relief without extensive destruction of the weight-bearing structures and functional mobile segments. This treatment can be an effective modality for patients with lumbar spinal stenosis associated with mild degenerative spondylolisthesis.
Decompression ; Follow-Up Studies ; Humans ; Intermittent Claudication ; Laminectomy ; Medical Records ; Surveys and Questionnaires ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis ; Telephone ; Weight-Bearing

We present a case of an athetoid cerebral palsy with quadriparesis caused by kyphotic deformity of the cervical spine, severe spinal stenosis at the cervicomedullary junction, and atlantoaxial instability. The patient improved after the first surgery, which included a C1 total laminectomy and C-arm guided righ side unilateral C1-2 transarticular screw fixation. C1-2 fixation was not performed on the other side because of an aberrant and dominant vertebral artery (VA). Eight months after the first operation, the patient required revision surgery for persistent neck pain and screw malposition. We used intraoperative VA angiography with simultaneous fluoroscopy for precise image guidance during bilateral C1-2 transarticular screw fixation. Intraoperative VA angiography allowed the accurate insertion of screws, and can therefore be used to avoid VA injury during C1-2 transarticular screw fixation in comorbid patients with atlantoaxial deformities.
Angiography ; Cerebral Palsy ; Congenital Abnormalities ; Fluoroscopy ; Humans ; Laminectomy ; Neck Pain ; Quadriplegia ; Spinal Stenosis ; Spine ; Vertebral Artery

The benefits of radio-chemotherapy in HIV-negative primary central nervous system (CNS) lymphomas were analyzed in 40 patients, who received radiotherapy to the brain or craniospinal axis with the total dose of 4460-5940 cGy to the primary tumor. Radiotherapy was followed by systemic chemotherapy, mainly with the cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) regimen, in 16 of the patients. Follow-up ranged from four to 95 months with a median of 15 months. The relapse rate was 72.5%, and 83% of the relapses occurred within the radiation field. Median survival was 19 months and the two-year survival rate was 41%. Survival was significantly influenced by treatment method and radiation dose when measured by univariate analysis; median survival and the two-year survival rate was 29 months and 63% after radio-chemotherapy, while 13.5 month and 29% after radiotherapy alone (p= 0.027), and 22 months and 49% with doses of 50 Gy or more, but 12.5 months and 13% with doses less than 50 Gy (p=0.009). However, statistical significance was lost in multivariate analysis. These results might suggest the short-term efficacy of radio-chemotherapy, however, cautious observation is needed to confirm long-term effects.
Adolescence ; Adult ; Aged ; Antineoplastic Agents, Combined/therapeutic use* ; Antineoplastic Agents, Combined/adverse effects ; Bleomycin/administration & dosage ; Central Nervous System Neoplasms/therapy* ; Central Nervous System Neoplasms/mortality ; Cyclophosphamide/administration & dosage ; Disease-Free Survival ; Doxorubicin/administration & dosage ; Epirubicin/administration & dosage ; Female ; Human ; Lymphoma/therapy* ; Lymphoma/mortality ; Male ; Mechlorethamine/administration & dosage ; Methotrexate/administration & dosage ; Middle Age ; Neoplasm Recurrence, Local ; Prednisolone/administration & dosage ; Procarbazine/administration & dosage ; Radiotherapy Dosage ; Radiotherapy, Adjuvant/adverse effects ; Survival Rate ; Treatment Failure ; Vincristine/administration & dosage

PURPOSE: Early prediction of prognosis of children resuscitated from cardiac arrest is a major challenge. We investigated the utility of electroencephalography (EEG) and laboratory studies for predicting of neurologic outcome in children resuscitated from cardiac arrest. METHODS: We retrospectively analyzed medical records of patients who were resuscitated from cardiac arrest from 2006 to 2015 at the Gil Medical Center. Patients aged one month to 18 years were included. EEG analysis included background scoring, reactivity and seizure burden. EEG background was classified score 0 (normal/organized), score 1 (slow and disorganized), score 2 (discontinuous or burst suppression), and score 3 (suppressed and featureless). Neurologic outcome was evaluated by Pediatric Cerebral Performance Category (PCPC) at least 6 months after cardiac arrest. RESULTS: Total 26 patients were evaluated. Nine patients showed good neurologic outcome (PCPC 1, 2, 3) and 17 patients showed poor neurologic outcome (PCPC 4, 5, 6). Patients of poor neurologic outcome group showed EEG background score 3 in 88.2%, whereas 44.4% in patients of good neurologic outcome group (P=0.028). Electrographic ictal discharges except non-convulsive status epilepticus were presented in 44.4% of good neurologic outcome group and 5.9% of poor neurologic outcome group (P=0.034). Ammonia and lactate levels were higher and pH levels were lower in poor outcome group than good neurologic outcome group. CONCLUSION: Suppressed and featureless EEG background is associated with poor neurologic outcome and electrographic seizures are associated with good neurologic outcome.
Ammonia ; Child* ; Electroencephalography* ; Heart Arrest* ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid ; Medical Records ; Prognosis ; Retrospective Studies ; Seizures ; Status Epilepticus

The prognostic impact of body mass index (BMI) in patients with upper tract urothelial carcinoma (UTUC) is an ongoing debate. Our study aimed to investigate the prognostic role of BMI in patients treated with radical nephroureterectomy (RNU) for UTUC from a multi-institutional Korean collaboration. We retrospectively reviewed data from 440 patients who underwent RNU for UTUC at four institutions in Korea. To avoid biasing the survival estimates, patients who had previous or concomitant muscle-invasive bladder tumors were excluded. BMI was categorized into approximate quartiles with the lowest quartile assigned to the reference group. Kaplan-Meier and multivariate Cox regression analyses were performed to assess the influence of BMI on survival. The lower quartile BMI group showed significantly increased overall mortality (OM) and cancer specific mortality (CSM) compared to the 25%-50% quartiles and upper quartile BMI groups. Kaplan-Meier estimates showed similar results. Based on multivariate Cox regression analysis, preoperative BMI as a continuous variable was an independent predictor for OM and CSM. In conclusion, preoperative underweight patients with UTUC in Korea survive less after RNU. Preoperative BMI may provide additional prognostic information to establish risk factors.
Aged ; Asian Continental Ancestry Group ; Body Mass Index ; Carcinoma, Transitional Cell/*mortality ; Cystectomy/*mortality ; Female ; Humans ; Kidney Pelvis/surgery ; Male ; Nephrectomy/*mortality ; Republic of Korea ; Retrospective Studies ; Thinness/*mortality ; Ureter/surgery ; Urinary Bladder/surgery ; Urologic Neoplasms/*mortality/pathology/*surgery ; Urothelium/pathology/*surgery

No abstract available.
Aged ; Bronchiectasis/*diagnosis/microbiology ; Humans ; Male ; Mycobacterium/classification/*genetics/isolation & purification ; Mycobacterium Infections/*diagnosis/microbiology ; Phylogeny ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/chemistry/genetics/metabolism ; Republic of Korea ; Sequence Analysis, DNA

INTRODUCTION: In the lateral window approach for a maxillary sinus bone graft, there has been considerable controversy regarding the placement of a barrier membrane over the osteotomy site. In particular, when there is no damage to the Schneiderian membrane, clinicians should decide whether to use a barrier membrane or not, considering the benefits and costs. This study presents the clinical cases to demonstrate that only repositioning the detached window can lead to satisfactory bony healing of the grafted material without using a barrier membrane in the lateral approach for a maxillary sinus bone graft. MATERIALS AND METHODS: Five consecutive patients were treated with the same surgical procedures. After performing the antrostomy on the lateral maxillary wall using a round carbide bur and diamond bur, the bony window was detached by a gentle levering action. After confirming no perforation of the Schneiderian membrane, the grafting procedure was carried out the detached window of the lateral maxillary wall was repositioned over the grafted material without using a barrier membrane. A gross examination was carried out at the postoperative 6 month re-entry, and the the preoperative and postoperative dental computed tomography (CT) at re-entry were compared. RESULTS: All the procedures in the 5 patients went on to uneventful healing with no complications associated with the bone graft. Satisfactory bone regeneration without the interference of fibrous tissue on the gap between the repositioned window and lateral wall of the maxillary sinus was observed in the postoperative 6 month re-entry. The CT findings at re-entry revealed the, reconstruction of the external cortical plate including repositioned bony window. In addition, the loss of the discontinuity of the lateral maxillary wall was confirmed. CONCLUSION: This preliminary report showed that the detached window, which was just repositioned on the grafted material, could function as a barrier membrane in the lateral approach for a maxillary sinus bone graft. Therefore additional morphometric and histologic studies will be needed.
Bone Regeneration ; Cost-Benefit Analysis ; Dental Implants ; Diamond ; Humans ; Maxillary Sinus ; Membranes ; Nasal Mucosa ; Osteotomy ; Transplants

Histiocytic sarcoma is a rare, lymphohematopoietic malignant tumor comprised of tumor cells with the morphological and immunophenotypic features of mature histiocytes. A 35-year-old man presented with a disseminated histiocytic sarcoma that first occurred in the spinal cord and metastasized to the skin and lymph nodes. The tumor cells of the primary histiocytic sarcoma of the spinal cord were very large epithelioid cells with abundant eosinophilic cytoplasms and large, round-to-oval nuclei. In contrast, the metastatic histiocytic sarcoma of the skin was composed of relatively small polygonal cells with well-defined cell borders and high N/C (nucleus/cytoplasm) ratios. Immunohistochemically, both tumors were diffusely positive for histiocyte-associated antigens; but negative for epithelial, melanocyte, lymphoid, and dendritic cell antigens. It is important to recognize the morphological features and immunohistochemical characteristics of metastatic cells in order to ensure accurate diagnoses.
Adult ; Cytoplasm ; Dendritic Cells ; Diagnosis ; Eosinophils ; Epithelioid Cells ; Histiocytes ; Histiocytic Sarcoma* ; Humans ; Lymph Nodes ; Melanocytes ; Skin* ; Spinal Cord*