No abstract available.
Muscular Dystrophy, Oculopharyngeal*

OBJECTIVE: There is a lack of knowledge regarding whether decompression is necessary in treating patients with epidural spinal cord compression (ESCC) grade 2. The purpose of this study was to compare the outcomes of minimally invasive surgery (MIS) without decompression and conventional open surgery (palliative laminectomy) for patients with hepatocellular carcinoma (HCC) spinal metastasis of ESCC grade 2.METHODS: Patients with HCC spinal metastasis requiring surgery were retrospectively reviewed. Patients with ESCC grade 2, medically intractable mechanical back pain, a Nurick grade better than 3, 3–6 months of life expectancy, Tomita score ≥5, and Spinal Instability Neoplastic Score ≥7 were included. Patients with neurological deficits, other systemic illnesses and less than 1 month of life expectancy were excluded. Thirty patients were included in the study, including 17 in the open surgery group (until 2008) and 13 in the MIS group (since 2009).RESULTS: The MIS group had a significantly shorter operative time (94.2±48.2 minutes vs. 162.9±52.3 minutes, p=0.001), less blood loss (140.0±182.9 mL vs. 1534.4±1484.2 mL, p=0.002), and less post-operative intensive care unit transfer (one patient vs. eight patients, p=0.042) than the open surgery group. The visual analogue scale for back pain at 3 months post-operation was significantly improved in the MIS group than in the open surgery group (3.0±1.2 vs. 4.3±1.2, p=0.042). The MIS group had longer ambulation time (183±33 days vs. 166±36 days) and survival time (216±38 days vs. 204±43 days) than the open surgery group without significant difference (p=0.814 and 0.959, respectively).CONCLUSION: MIS without decompression would be a good choice for patients with HCC spinal metastasis of ESCC grade 2, especially those with limited prognosis, mechanical instability and no neurologic deficit.
Back Pain ; Carcinoma, Hepatocellular ; Decompression ; Decompression, Surgical ; Humans ; Intensive Care Units ; Life Expectancy ; Minimally Invasive Surgical Procedures ; Neoplasm Metastasis ; Neurologic Manifestations ; Operative Time ; Prognosis ; Retrospective Studies ; Spinal Cord Compression ; Spinal Cord ; Spine ; Walking

Objective: : Cervical expansive laminoplasty is an effective surgical method to address multilevel cervical spinal stenosis. During surgery, the spinous processes of C2 and C7 are usually preserved to keep the insertion points of the cervical musculature and nuchal ligament intact. In this regard, dome-like laminectomy (undercutting of C7 lamina) instead of laminoplasty is performed on C7 in selected cases. However, resection of the lamina can weaken the C7 lamina, and stress fractures may occur, but this complication has not been characterized in the literature. The objective of the present study was to investigate the incidence and risk factors for C7 laminar fracture after C7 dome-like laminectomy and its impact on clinical and radiological outcomes. Methods: : Patients who underwent cervical open-door laminoplasty combined with C7 dome-like laminectomy (n=123) were classified according to the presence of C7 laminar fracture. Clinical parameters (neck/arm pain score and neck disability index) and radiologic parameters (C2–7 angle, C2–7 sagittal vertical axis, and C7–T1 angle) were compared between the groups preoperatively and at postoperatively at 3, 6, 12, and 24 months. Risk factors for complications were evaluated, and a formula estimating C7 fracture risk was suggested. Results: : C7 lamina fracture occurred in 32/123 (26%) patients and occurred at the bilateral isthmus in 29 patients and at the spinolaminar junction in three patients. All fractures appeared on X-ray within 3 months postoperatively, but patients did not present any neurological deterioration. The fracture spontaneously healed in 27/32 (84%) patients at 1 year and in 29/32 (91%) at 2 years. During follow-up, clinical outcomes were not significantly different between the groups. However, patients with C7 fractures showed a more lordotic C2–7 angle and kyphotic C7–T1 angle than patients without C7 fractures. C7 fracture was significantly associated with the extent of bone removal. By incorporating significant factors, the probability of C7 laminar fracture could be assessed with the formula 'Risk score = 1.08 × depth (%) + 1.03 × length (%, of the posterior height of C7 vertebral body)', and a cut-off value of 167.9% demonstrated a sensitivity of 90.3% and a specificity of 65.1% (area under the curve, 0.81). Conclusion : C7 laminar fracture can occur after C7 dome-like laminectomy when a substantial amount of lamina is resected. Although C7 fractures may not cause deleterious clinical outcomes, they can lead to an unharmonized cervical curvature. The chance of C7 fracture should be discussed in the shared decision-making process.

Objective: : Cervical expansive laminoplasty is an effective surgical method to address multilevel cervical spinal stenosis. During surgery, the spinous processes of C2 and C7 are usually preserved to keep the insertion points of the cervical musculature and nuchal ligament intact. In this regard, dome-like laminectomy (undercutting of C7 lamina) instead of laminoplasty is performed on C7 in selected cases. However, resection of the lamina can weaken the C7 lamina, and stress fractures may occur, but this complication has not been characterized in the literature. The objective of the present study was to investigate the incidence and risk factors for C7 laminar fracture after C7 dome-like laminectomy and its impact on clinical and radiological outcomes. Methods: : Patients who underwent cervical open-door laminoplasty combined with C7 dome-like laminectomy (n=123) were classified according to the presence of C7 laminar fracture. Clinical parameters (neck/arm pain score and neck disability index) and radiologic parameters (C2–7 angle, C2–7 sagittal vertical axis, and C7–T1 angle) were compared between the groups preoperatively and at postoperatively at 3, 6, 12, and 24 months. Risk factors for complications were evaluated, and a formula estimating C7 fracture risk was suggested. Results: : C7 lamina fracture occurred in 32/123 (26%) patients and occurred at the bilateral isthmus in 29 patients and at the spinolaminar junction in three patients. All fractures appeared on X-ray within 3 months postoperatively, but patients did not present any neurological deterioration. The fracture spontaneously healed in 27/32 (84%) patients at 1 year and in 29/32 (91%) at 2 years. During follow-up, clinical outcomes were not significantly different between the groups. However, patients with C7 fractures showed a more lordotic C2–7 angle and kyphotic C7–T1 angle than patients without C7 fractures. C7 fracture was significantly associated with the extent of bone removal. By incorporating significant factors, the probability of C7 laminar fracture could be assessed with the formula 'Risk score = 1.08 × depth (%) + 1.03 × length (%, of the posterior height of C7 vertebral body)', and a cut-off value of 167.9% demonstrated a sensitivity of 90.3% and a specificity of 65.1% (area under the curve, 0.81). Conclusion : C7 laminar fracture can occur after C7 dome-like laminectomy when a substantial amount of lamina is resected. Although C7 fractures may not cause deleterious clinical outcomes, they can lead to an unharmonized cervical curvature. The chance of C7 fracture should be discussed in the shared decision-making process.

Objective: The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group). Methods: A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model. Results: After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the Fgroup than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months. Conclusion Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.

OBJECTIVE: In addition to bone bridging inside a cage or graft (intragraft bone bridging, InGBB), extragraft bone bridging (ExGBB) is commonly observed after anterior cervical discectomy and fusion (ACDF) with a stand-alone cage. However, solid bony fusion without the formation of ExGBB might be a desirable condition. We hypothesized that an insufficient contact area for InGBB might be a causative factor for ExGBB. The objective was to determine the minimal area of InGBB by finite element analysis. METHODS: A validated 3-dimensional, nonlinear ligamentous cervical segment (C3–7) finite element model was used. This study simulated a single-level ACDF at C5–6 with a cylindroid interbody graft. The variables were the properties of the incorporated interbody graft (cancellous bone [Young’s modulus of 100 or 300 MPa] to cortical bone [10000 MPa]) and the contact area between the vertebra and interbody graft (Graft-area, from 10 to 200 mm²). Interspinous motion between the flexion and extension models of less than 2 mm was considered solid fusion. RESULTS: The minimal Graft-areas for solid fusion were 190 mm², 140 mm², and 100 mm² with graft properties of 100, 300, and 10000 MPa, respectively. The minimal Graft-areas were generally unobtainable with only the formation of InGBB after the use of a commercial stand-alone cage. CONCLUSION: ExGBB may be formed to compensate for insufficient InGBB. Although various factors may be involved, solid fusion with less formation of ExGBB may be achieved with refinements in biomaterials, such as the use of osteoinductive cage materials; changes in cage design, such as increasing the area of polyetheretherketone or the inside cage area for bone grafts; or surgical techniques, such as the use of plate/screw systems.
Biocompatible Materials ; Diskectomy* ; Finite Element Analysis* ; Ligaments ; Spinal Fusion ; Spine ; Transplants

The most common cause of isolated oculomotor nerve palsy is ischemia of the peripheral nerve caused by a disease, such as diabetes mellitus. Another common cause of isolated oculomotor nerve palsy is compression by an intracranial aneurysm, usually an posterior communicating artery aneurysm. However, it is extremely rare in the pituitary tumor. We report an unusual case of pituitary adenoma presenting with isolated oculomotor nerve palsy in the setting of pituitary apoplexy. We suggest that pituitary apoplexy should be included in the differential diagnosis of a patient with isolated oculomotor nerve palsy and early surgery should be considered for preservation of oculomotor nerve function.
Diabetes Mellitus ; Diagnosis, Differential ; Humans ; Intracranial Aneurysm ; Ischemia ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Peripheral Nerves ; Pituitary Apoplexy* ; Pituitary Neoplasms

Getah virus (GETV) infection causes sporadic outbreaks of mild febrile illness in horses and reproductive failure in pigs. In this study, we established a reverse transcription polymerase chain reaction (RT-PCR) method to detect GETV from suspected virus-infected samples. The reaction conditions were optimized and validated by using RNA extracted from GETV propagated in cell culture. A GETV-specific GED4 primer set was designed and used to amplify a 177 bp DNA fragment from a highly conserved region of the E1 glycoprotein gene in the GETV genome. RT-PCR performed with this primer set revealed high sensitivity and specificity. In the sensitivity test, the GED4 primer set detected GETV RNA at the level of 10(2.0) TCID₅₀/mL. In the specificity test, the GED4 primer set amplified only a single band of PCR product on the GETV RNA template, without non-specific amplification, and exhibited no cross-reactivity with other viral RNAs. These results suggest that this newly established RT-PCR method is useful for accurate identification of GETV infection in animals.
Alphavirus* ; Animals ; Cell Culture Techniques ; Diagnosis ; Disease Outbreaks ; DNA ; Genome ; Glycoproteins ; Horses ; Livestock* ; Methods ; Polymerase Chain Reaction* ; Reverse Transcription* ; RNA ; RNA, Viral ; Sensitivity and Specificity ; Swine

BACKGROUND AND OBJECTIVES: Most reports about coronary angiographic findings in acute myocardial infarction were done after thrombolytic therapy or several days after onset of symptom. The aim of this study is to evaluate coronary angiographic findings in patients with AMI within 24 hours after onset of symptoms and without thrombolytic therapy. Also we evaluated the correlation between the risk factors and severity of coronary artery disease. MATERIALS AND METHODS: We studied 70 patients with acute myocardial infarction admitted to Kyungpook National University Hospital (KNUH) from November 1997 to January 1999, and evaluated the clincial and coronary angiographic findings. We analyzed risk factors of coronary artery disease: age, total cholesterol, tiglyceride, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, hypertension, smoking, diabetes and family history of CAD. Coronary angiography was done immediately after the arrival at emergency room (door-to- angiography time). Exclusion criteria were delayed arrival (more than 24 hours after symptom onset), previous history of anticoagulation or medication of antiplatelet agents. RESULTS: 1) Among 70 patients (M/F: 53/17), 59 patients had Q wave myocardial infarction (QMI) (84%), 11 patients had non-Q wave-MI (NQMI) (16%). 2) The mean age was 61+/-12.2 years (range: 26 to 82 years). 3) The mean time from the onset of chest pain to angiography was 6.2+/-4.7 hours. 4) Twenty eight patients (40%) had one-vessel disease, 25 (36%) had two-vessel disease and 17 (24%) had three-vessel disease. 5) The location of infarct related arteries were as follows: LAD in 33 (47%), LCX in 13 (19%) and RCA in 24 (34%). 6) The mean diameter stenosis of infarct related artery (IRA) was 95+/-10.9%. According to the American College of Cardiology/American Heart Association (ACC/AHA) classification of IRA, type B lesion occurred most commonly in 56 patients (80%). 7) Thrombus was observed in 44 patients (63%) with QMI versus 3 patients (27%) with NQMI (p=0.006). 8) Calcifications of the wall of coronary arteries were observed in 28 patients (40%) and correlated with ages of patients. 9) History of cigarette smoking was present in 73%, hypertension in 31% and hypercholesterolemia in 15% of patients. The mean number of risk factor for each patient was 1.3. 10) Multivessel disease was significantly more frequent in patients who had two more risk factors. 11) The frequency of cigarette smoking was greater and the level of plasma triglyceride were higher in patients under 50 years of age. 12) One patient died during coronary angiography and another 2 patients died at 5 and 8 days after coronary angiography due to cardigenic shock. CONCLUSION: In immediate coronary angiographic findings in patients with AMI, multivessel disease and thrombus, and severe stenosis of IRA were observed more frequently than other studies after thrombolytic therapy or after several days of delay. Multivessel disease was significantly more frequent in the patients who had two or more risk factors of atherosclerosis.
Angiography ; Arteries ; Atherosclerosis ; Chest Pain ; Cholesterol ; Classification ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Emergency Service, Hospital ; Gyeongsangbuk-do ; Heart ; Humans ; Hypercholesterolemia ; Hypertension ; Lipoproteins ; Myocardial Infarction* ; Plasma ; Platelet Aggregation Inhibitors ; Risk Factors ; Shock ; Smoke ; Smoking ; Thrombolytic Therapy ; Thrombosis ; Triglycerides

BACKGROUND AND OBJECTIVES: The intracoronary stent may be useful in the preventing of abrupt closure and coronary restenosis after coronary angioplasty, and recently primary stenting has been one of therapeutic modalities. We assessed the clinical and angiographic results of primary NIR stenting in patients with acute myocardial infarction (AMI). MATERIALS AND METHODS: Between November 1997 to January 1999, 55 stentings with NIR stents were done in 51 patients with acute myocardial infarction. Angiographic follow-up was available at 7+/-2.3 days in 35 patients. RESULTS: 1) Among 51 patients (M/F: 37/14), 44 patients had Q-wave MI (86%), 7 patients had non-Q-wave MI (14%). 2) The mean age was 61+/-12.4 years (range: 26 to 82 years). 3) The mean time from the onset of chest pain to the arrival at emergency room was 4.6 +/- 4.2 hours. The mean door-to-balloon time was 93+/-46 minutes 4) Treated vessels were as follows: 28 in LAD, 17 in RCA, 10 in LCX. 5) The indications for stent implantation were suboptimal angiographic results after PTCA in 38 lesions (69%), dissection in 9 lesions (16%), abrupt vessel closure in 1 lesion and elective in 7 lesions (13%). 6) Single stent implantation was done in 47 patients. Overlapping stents were done in 4 patients. 7) A procedure related complication occurred in one patient, peri-stent dissection without flow limitation. 8) Full expansion of the stent failed in three lesions with coronary calcifications and the residual stenosis was 35, 40, 50% in each case. In these cases, in-stent thrombus was not demonstrated in follow up angiography. 9) The minimal lumen diameter increased from 0.11+/-0.39 to 2.96+/-0.40 mm. 10) Angiographic follow-up on 38 stents in 35 patients demonstrated in-stent thrombus in 3 stents, in-stent restenosis in 1 stent. But in-stent flow limitations were not found in these 4 cases and TIMI III flow were maintained. Patients with Q-wave MI and coronary thrombus on initial angiography were more prone to subacute thrombosis. CONCLUSION: The NIR stent could be used successfully in primary coronary stenting in acute myocardial infarction. The present study shows relatively low risk of subacute stent thrombosis. The rate of restenosis needs to be confirmed by long term study.
Angiography ; Angioplasty ; Chest Pain ; Constriction, Pathologic ; Coronary Restenosis ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Stents* ; Thrombosis