STUDY DESIGN: A retrospective study of patients with a posterolateral spinal fusion for an unstable thoracolumbar junction. OBJECTIVES: To evaluate the efficacy of a posterolateral spinal fusion for an unstable thoracolumbar junction. SUMMARY OF LITERATURE REVIEW: Posterolateral spinal fusions are well documented for their efficacy in the lumbar and lumbosacral spine, and have also been applied to the thoracolumbar junction in the lumbar area. The thoracolumbar junction, however, is a little different from the lumbar spine, in its anatomical and biomechanical aspects, and posterolateral fusions have not been well evaluated in these respects. MATERIALS AND METHODS: Fourteen consecutive patients, who had posterolateral spinal fusions, with instrumentation for an unstable condition, including T12-L1 segment, and followed for more than one year, were included. In 11 patients, all the fractures had been decompressed posteriorly, for degenerative conditions in 2, and for a neoplastic pathology in the other one. The radiographs concerning the lateral fusion mass were reviewed according to Lenke's classification, the change in the segmental sagittal angle of the fused segment and the fixation failure of the instrumentation. The medical records relating to the neurological recovery were reviewed using the modified Frankel grading, and the overall clinical results of treatment by the Kirkaldy-Willis criteria. RESULTS: All patients disclosed big, bilateral and solid fusion masses, with the exception of one patient who revealed a big, solid fusion mass on one side, and small, thin fusion mass on the other. No patient revealed more than 3 degrees of mobility on flexion-extension lateral radiographs, any evidence of fixation failure of the instrumentation. The neurological recovery, by the modified Frankel grading system, showed an average 1.3 improvement. The clinical results were excellent in 6, good in 6 and fair in 2 patients, with no poor results. CONCLUSIONS: A posterolateral spinal fusion can be effectively applied in an unstable thoracolumbar junction, such as in the lumbar and lumbosacral spine, provided there is precise preparation of the graft beds, enough bone grafts and correction of the excessive kyphotic angle by the compression fixation of the posterior instrumentation.
Classification ; Humans ; Medical Records ; Pathology ; Retrospective Studies ; Spinal Fusion ; Spine ; Transplants

BACKGROUND: Osteoporosis after menopause is known as a disease that needs preventive measures before medical treatment. Many patients, however, do not undergo hormone therapy to prevent it. This paper investigates some obstacles to hormone replacement therapy (HRT). METHOD: A total of 85 menopausal women who under went bone-mineralodensitometry (BMD) examination at Chuncheon Sungshim Hospital Health Care Clinic from May, 1995 to April, 1997 were the subjects of our study. We interviewed them by telephone, examined their medical records including their BMD results. We also examined what the obstacles were for them to receive HRT for osteoporosis. RESULTS: The average age of the subjects was 55.8years. Only 40 women (47%) replied that they knew beforehand the purpose of the BMD examination. The rest of the subjects replied that they simply went through the examination because it was inclusive to health items. Those who had heard of HRT for osteoporosis were only 43 people because(50.1%), and those who did not currently receive HRT amounted to 32 (74.4%). The reasons why they do not undergo the therapy were fear of cancer, no symptoms related to osteoporosis, financial difficulty, and weight gain. Among the 32 subjects, only 1 person replied that she would not receive the HRT even if the above obstacles were removed. Therefore, it seems that most of our subjects would receive HRT if such obstacles removed. Those who were currently receiving HRT were 11 people(12.9%). According to the open questionnaire, many of them replied that they do not feel any inconvenience while receiving the HRT, but some of them complained of epigastric pain, dysmenorrhea, or mastalgia. They replied that after the HRT they felt no arthralgia and felt far better in body and mind than before treatment. All the 11 people replied that they will continue to receive the HRT. CONCLUSION: The main reason why so few people received HRT for osteoporosis proved to be the lack of knowledge of the therapy. Even those who had heard of HRT complained about the negative aspects, which in fact can be overcome, and as a result a considerable number of them do not receive HRT. Therefore we conclude that in order to increase the number of patients who will undergo HRT for osteoporosis after menopause we need to strengthen education about the merits of this therapy rather than just performing BMD examination.
Arthralgia ; Delivery of Health Care ; Dysmenorrhea ; Education ; Female ; Gangwon-do ; Hormone Replacement Therapy* ; Humans ; Mastodynia ; Medical Records ; Menopause ; Osteoporosis ; Osteoporosis, Postmenopausal* ; Telephone ; Weight Gain ; Surveys and Questionnaires

Infants with Sandhoff disease typically appear normal until 3–6 months of age. As the disease progresses, they present with symptoms such as loss of motor skills, exaggerated startle response to loud noise, seizures, visual loss, and paralysis. We encountered a rare case of a 22-month-old girl with Sandhoff disease characterized by progressive motor weakness and dysphagia, who initially showed signs of aspiration at 20 months of age. The major problems related to dysphagia were oromotor dysfunction and abnormal feeding posture. Within 3 months of identification of difficulty in swallowing, the patient showed a significant decrease in food intake, with rapid deterioration of nutritional status. We report our case with a review of the literature.
Deglutition Disorders ; Deglutition* ; Eating ; Female ; Humans ; Infant ; Motor Skills ; Noise ; Nutritional Status ; Paralysis ; Posture ; Reflex, Startle ; Sandhoff Disease* ; Seizures

Duodenal lipomas are relatively uncommon and asymptomatic unless they are large. Tumors greater than 4 cm in diameter can cause obstructive symptoms as a result of intussusception necessitating a surgical resection. However, acute upper gastrointestinal bleeding is an extremely rare complication. Duodenal lipomas are most often submucosal but they can also be subserosal. Their shape can vary, and they can be either sessile or pedunculated. The overlying mucosa is usually normal but it may be ulcerated. Those that cause symptoms require treatment. Endoscopic snare polypectomy has been used to treat clinically symptomatic lipomas. A detachable snare may reduce the risk of complications after a polypectomy, including bleeding and perforation. We report a case of duodenal lipoma accompanied by massive upper GI bleeding that was treated by an endoscopic polypectomy using a detachable snare.

A 34 year-old excavator driver was found dead at stone quarry in Cheongwon, North Chungcheong Province, with a severely burnt mobile phone in his shirt pocket and with his chest bruised and ribs fractured. An emergency physician examined him and said that high pressure from an explosion damaged his lungs and heart, leading to his death. So, a number of Korean and foreign newspapers reported that phone battery explosion killed the man. Autopsy showed that the deceased had fractures all over the chest and lacerations of the heart and the lungs. The damages seemed too extensive to be caused by a single mobile phone explosion. Lithium-ion polymer batteries used in mobile phones can catch fire by external forces but they hardly explode like a bomb. We recommended police to reinvestigate the scene and co-worker. So, police reinvestigated the accident scene and the co-worker. The co-worker told police that he hit the deceased while reversing his drill rig at a stone quarry. The incident reminds of us that our postmortem investigation system must be revised.
Autopsy ; Bombs ; Cellular Phone ; Emergencies ; Explosions ; Fires ; Heart ; Humans ; Lacerations ; Lung ; Mandrillus ; Periodicals ; Police ; Polymers ; Ribs ; Thorax

BACKGROUND: Acute pyelonephritis in women can be treated with trimethoprim-sulfamethoxazole (SXT), fluoroquinolone, aminoglycosides, second- and third- generation cephalosporins. The purpose of this study is to provide basic informations for the choice of the most effectve and economic first-line antibiotics among several agents to clinicians, who manage community- acquired acute pyelonephritis. METHODS: We investigated antibiotic sensitivities of 130 organisms isolated from urine culture of 165 patients, who admitted to Catholic University St. Vincent's Hospital due to community-acquired acute pyelonephritis from February 2001 to November 2002. All those patients had more than 105 cfu/mL on urine culture and we analyzed the usage of antibiotics and clinical course in those patients. RESULTS: Among 130 isolates, 120 isolates were E. coli, 6 K. pneumoniae, 1 K. oxytoca, 1 Enterobacter aerogenes and 2 Proteus mirabilis. Among 120 E. coli, the rates of resistance were 59.2% to piperacillin, 58.3% to cephalothin, 36.7% to sulfamethoxazole, 19.2 % to gentamicin, and 7.5% to ciprofloxacin in order. For 120 E. coli isolates, 100%, 99.2%, 99.2%, 99.2%, and 97.5% were susceptible to imipenem, cefotaxime, cefuroxime, amikacin, and piperacillin/tazobactam, respectively. Among 165 patients, 130 patients who had positive urine or blood culture, were divided into three groups according to the first-line antibiotics administered on the day of admission. Gentamicin (5 mg/kg q 24h) were infused to 90 patients, and 9 (10%) of 90 patients revealed clinical manifestations of therapeutic failure such as persistent fever and pyuria in group I. Cefuroxime were administered to 36 patients in group II and all 36 patients revealed evidences of clinical success such as defervescence and absence of pyuria. Intravenous antibiotics changed to oral administration of the first-, second-cephalosporin, and trimethoprim- sulfamethoxazole in all patients except one patient, who received oral fluoroquinolone according to the results of antibiotic sensitivities. CONCLUSION: Cefuroxime, amikacin, and the third- generation cephalosporins showed excellent antibacterial activity against isolated organisms from women with acute pyelonephritis in this study, and gentamicin could be used as initial empiric regimen with careful monitoring of clinical response and antibiotic sensitivities of isolated microorganisms. These findings would be useful informations to physicians, who are trying to use low-priced antibiotics with narrow spectrum antibacterial activity, sparing more expensive and broad spectrum antibiotics in managing urinary tract infections.
Administration, Oral ; Amikacin ; Aminoglycosides ; Anti-Bacterial Agents* ; Cefotaxime ; Cefuroxime ; Cephalosporins ; Cephalothin ; Ciprofloxacin ; Enterobacter aerogenes ; Female ; Fever ; Gentamicins ; Humans ; Imipenem ; Piperacillin ; Pneumonia ; Proteus mirabilis ; Pyelonephritis* ; Pyuria ; Sulfamethoxazole ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Tract Infections

Ingestion of strong acids or strong alkalies may produces severe inflammation on the mucosa of the esophagus and this may also causes esophageal stricture. Several forms of non-operative dilatations have been utilized for the treatment of esophageal stricture and they have shown good results. Yet some patients do not achieve acceptable symptom relief despite of intensive dilatation. Temporary placement of esophageal stent has recently been used in some of these patients. Furthermore, mitomycin C has been used as a conservative treatment for refractive esophageal stricture in children, yet its efficacy has not been well established. We experienced a case of a 64-year old man with severe, recurrent esophageal stricture, and this was successfully managed by temporary placement of an esophageal stent, together with a spray of mitomycin C. We report on this case along with the review of the literature.
Alkalies ; Child ; Dilatation ; Eating* ; Esophageal Stenosis* ; Esophagus ; Humans ; Inflammation ; Lye* ; Middle Aged ; Mitomycin* ; Mucous Membrane ; Stents*

Schwannoma is usually benign, encapsulated spindle cell tumor which arises from schwann cells of nerve sheath. It can occur anywhere along neural tissue that consist of schwann cells in the nerve sheath, but the most common sites are head, neck and extremities. Schwannoma may rarely arise from gastrointestinal tract and retroperitoneal space. The tumor usually asymptomatic but they, as it grows and increase in size, can produce signs and symptoms of compressive effect. They are found incidentally and misdiagnosed for other benign conditions both clinically and radiologically. We report a rare case of intraabdominal schwannoma that induced stenosis of superior mesenteric artery with a brief review of literatures.
Constriction, Pathologic* ; Extremities ; Gastrointestinal Tract ; Head ; Mesenteric Artery, Superior* ; Neck ; Neurilemmoma* ; Retroperitoneal Space ; Schwann Cells

PURPOSE: Since 2001, breast cancer has been the most common type of cancer observed in Korean women. Due to improved screening and treatment, multiple primary cancer (MPC) in association with breast cancer has been more prevalent. However, there is a lack of information regarding MPC in Korea. Therefore, this study was conducted to provide an overview of the clinical characteristics of MPC that occurs in association with breast cancer. METHODS: We retrospectively investigated 149 patients with MPC, including breast cancer patients, who were treated between July 1989 and December 2005 at the Breast clinic in Asan Medical Center. Patients with contra-lateral breast cancer as well as patients that experienced a recurrence of breast cancer were excluded from this study. We studied the clinical characteristics of patients including the mean age, stage of disease, hormone receptor status, cause of death, common cancers that were combined with breast cancer, the time interval between the onset of breast cancer and other cancers, and mean survival. We considered the cancer to be synchronous if a second cancer has been diagnosed at least six months before the diagnosis of an initial primary cancer, however, other forms of cancer were considered to be metachronous. RESULTS: Of 149 patients, 146 patients were female (98.0%) and 3 were male (2.0%). The mean age of the study group was 51.5, which is higher than the mean age of 47.3 that was observed in breast cancer patients at our hospital during the same period (p<0.001). Forty-four of the patients evaluated in this study had synchronous cases of cancer, whereas the remaining 88 patients had metachronous MPC. In metachronous cancers, the average time between diagnosis with the primary cancer and the secondary cancer was 5.2 yr. The most common cancer found to be combined with breast cancer included cancer of the thyroid (45, 29.2%), cervix and uterus (28, 18.2%), stomach (19, 12.3%), colon and rectum (15, 9.7%), ovary (11, 7.1%) and lung (9, 5.8%). CONCLUSION: Thyroid cancer is the cancer most commonly associated with breast cancer, and the mean age of MPC patients was higher than that of patients who only had breast cancer. Due to the improved survival length and treatment, MPC associated with breast cancer is now a greater concern.
Breast Neoplasms* ; Breast* ; Cause of Death ; Cervix Uteri ; Chungcheongnam-do ; Colon ; Diagnosis ; Female ; Humans ; Korea ; Lung ; Male ; Mass Screening ; Neoplasms, Second Primary ; Ovary ; Rectum ; Recurrence ; Retrospective Studies ; Stomach ; Thyroid Neoplasms ; Uterus

We describe a 39-year-old man with spontaneous rupture of a gastric stromal tumor causing hemoperitoneum. Ultrasonography showed a large mass broadly abutting the stomach and liver. Computed tomography demonstrated a heterogeneous enhanced mass arising from the stomach and focal perforation of the tumor with hemoperitoneum; endoscopic ultrasonography showed an exophytic heterogeneous mass originating from the gastric muscle layer. Angiography revealed that the right gastric artery was the main artery supplying the tumor. A gastric stromal tumor with bloody fluid in the peritoneal cavity was seen at the laparotomy. The tumor was excised completely, and subsequent histological and immunohistochemical studies indicated that it was a gastric stromal tumor. We report a relatively rare case of gastric stromal tumor causing hemoperitoneum due to spontaneous rupture of the tumor.
Adult ; Angiography ; Arteries ; Endosonography ; Hemoperitoneum ; Humans ; Laparotomy ; Liver ; Muscles ; Peritoneal Cavity ; Rupture, Spontaneous ; Stomach