OBJECTIVE: Stenosis or herniated nucleus pulposus (HNP) occupying lumbar intracanal and foraminal area is an important cause of double radicular symptoms. Using the combined interlaminar and paraisthmic approach, we performed decompression surgery in patients with co-existing intracanal and foraminal lesions. The objective of this study is to describe usefulness and outcome of combined interlaminar and paraisthmic approach surgery and to analysis the cause of poor outcome. METHODS: Between Apr 2009 and Apr 2014, 78 patients (42 males and 36 females) with intracanal and foraminal lesions were enrolled in this study. Patients with a vacuum disc, spondylolisthesis, instability or an isthmic defect on the preoperative dynamic view radiograph were excluded from this study. All patients underwent surgery through a combined approach for discectomy and decompression. The outcome of surgery was evaluated and classified into excellent, good, fair and poor. RESULTS: The results were excellent in 53 patients, good in 9, fair in 6 and poor in 10 during the follow-up. The outcome of the combined approach was excellent to fair in 87% (68 of 78) patients in our study. In the poor outcome group, three patients complained of early-onset relapsed pain (<1 month) and another seven patients complained of delayed-onset pain (>3 months). CONCLUSION: Combined approach for both intracanal and foraminal area lesions may be useful if selectively performed on patients whose facet joint is relatively intact, and that it is worthy of consideration as an alternative to fusion surgery; however, further studies are needed.
Constriction, Pathologic ; Decompression ; Diskectomy ; Follow-Up Studies ; Humans ; Male ; Radiculopathy ; Spinal Stenosis ; Spondylolisthesis ; Vacuum ; Zygapophyseal Joint

OBJECTIVE: We developed the Cognitive Perceptual Assessment for Driving (CPAD) to assess the driving ability of people with acquired brain injury. To find out the usefulness of this tool as a screening test for safe driving, we compared it with the Cognitive Behavioral Driver's Inventory (CBDI). METHOD: Subjects were 101 people with acquired brain injury who had driven a car before the injury. Each subject was evaluated with CPAD and CBDI. CPAD consisted of 8 tasks and 10 variables. We calculated CPAD score using 10 variables and compared CPAD with CBDI result and score. RESULTS: The average CPAD score was 49.65 7.97. According to CBDI test, the number of CBDI passing group was 36, borderline group was 27, and failing group was 38. CPAD variables and score showed significant correlation with CBDI score (p<0.05). There was significant difference in CPAD variables and score among the 3 groups (p<0.05). CONCLUSION: CPAD can be a useful tool for assessing the driving ability of the people with acquired brain injury.
Brain Injuries* ; Brain* ; Mass Screening

OBJECTIVE: To assess the usefulness of a pressure algometer to measure pressure pain threshold (PPT) for diagnosis of myofascial pain syndrome (MPS) in the upper extremity and trunk muscles. METHOD: A group of 221 desk workers complaining of upper body pain participated in this study. Five physiatrists made the diagnosis of MPS using physical examination and PPT measurements. PPT measurements were determined for several muscles in the back and upper extremities. Mean PPT data for gender, side, and dominant hand groups were analyzed. Sensitivity and specificity of Fischer's standard method were evaluated. PPT cut-off values for each muscle group were determined using an ROC curve. RESULTS: Cronbach's alpha for each muscle was very high. The PPT in men was higher than in females, and the PPT in the left side was higher than in the right side for all muscles tested (p<0.05). There was no significant difference in PPT for all muscles between dominant and non-dominant hand groups. Diagnosis of MPS based on Fischer's standard showed relatively high specificity and poor sensitivity. CONCLUSION: The digital pressure algometer showed high reliability. PPT might be a useful parameter for assessing a treatment's effect, but not for use in diagnosis or even as a screening method.
Female ; Hand ; Humans ; Male ; Mass Screening ; Muscles ; Myofascial Pain Syndromes ; Pain Threshold ; Physical Examination ; Sensitivity and Specificity ; Upper Extremity

Six cases of bileaflet mechanical mitral valve thrombosis were serially assessed by Doppler echocardiography and cinefluoroscopy during thrombolytic therapy with urokinase. Two patients had dual mechanical valve replacement in the aortic and mitral positions simultaneously. Bileaflet thrombosis was diagnosed by 2-dimensional echocardiography in three cases, Doppler echocardiography and cinefluoroscopy in six cases. Thrombolytic therapy using urokinase was successful in five patients (3 cases : UK 1,000,000 unit x 3 hours for 2 days, 2 cases ; UK 1,000,000 unit/24 hours for 5 and 7 days respecitively, 1 case ; UK 1,000,000 unit/hr x 3 hours for 1 day). The other one patients had massive cerebral thromboembolism and subsequently died. These study demonstrated the usefulness of Doppler echocardiography and cinefluoroscopy in diagnosis and serial assessment of thrombolytic therapy in the patients with mechanical mitral valve thrombosis.
Diagnosis* ; Echocardiography ; Echocardiography, Doppler ; Humans ; Mitral Valve* ; Thromboembolism ; Thrombolytic Therapy* ; Thrombosis* ; Urokinase-Type Plasminogen Activator*

Alopecia areata is a common cause of acquired circumscribed alopecia in childhood. In infancy alopecia areata is exceptional. No case of congenital alopecia areata has been documented yet. Thus, it is generally assumed that alopecia areata is acquired only postnatally, and it is believed that the presence of an alopecia at birth virtually excludes the diagnosis of alopecia areata. In this report, we document a case of congenitally developed alopecia areata that shows typical clinical and histological features of alopecia areata.
Alopecia Areata* ; Alopecia* ; Diagnosis ; Parturition

BACKGROUND/AIMS: Bowel wall thickening on CT has been reported to reflect colorectal carcinoma and colitis. The aim of this study was to evaluate the clinical significance of the large intestinal wall thickening on CT. METHODS: Between January 2006 and August 2010, medical records of 815 patients who underwent endoscopy after CT scans within 1 month were reviewed retrospectively. RESULTS: A total of 233 patients were included. The wall thickening was actually associated with abnormal endoscopic findings in 81.1% of the cases. The accuracy rate on diagnosis between CT and endoscopy was 63.5%. The discrepancy in diagnosis was higher in cases with left colon abnormality and short segment lesion. Abdominal pain was significantly more common in cases suspected malignancy on CT compared with colitis (p=0.047). Most of the malignancy diagnosed on CT involved the left side colon and most of the colitis involved the entire colon (p<0.001). The length of lesion was below 5 cm in 86.5% of the malignancy. Malignancy was more common in patients aged over 50 years with hemoglobin below 12 g/dL. The CT findings significantly suggestive of malignancy were lymph node enlargement and length of lesion below 5 cm (p=0.027 and p<0.001). CONCLUSIONS: The large intestinal wall thickening on CT was limited in the differential diagnosis of malignancy and colitis. Additional endoscopic evaluation is needed in patients with bowel wall thickening associated with lymph node enlargement and short segment lesion on CT in order to exclude malignancy.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colitis/*diagnosis/radiography ; Colonic Neoplasms/*diagnosis/radiography ; Colonoscopy ; Female ; Hemoglobins/analysis ; Humans ; Intestine, Large/*physiopathology ; Lymph Nodes/physiopathology ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: Recent studies have revealed recurrent alterations in the cell adhesion gene FAT4, a candidate tumor suppressor gene, in cancer. FAT atypical cadherin 4 (FAT4) is a transmembrane receptor involved in the Hippo signaling pathway, which is involved in the control of organ size. Here, we investigated the loss of FAT4 expression and its association with clinicopathological risk factors in gastric cancer. MATERIALS AND METHODS: We assessed the expression of FAT4 by using immunohistochemistry on three tissue microarrays containing samples from 136 gastric cancer cases, radically resected in the Soonchunhyang University Cheonan Hospital between July 2006 and June 2008. Cytoplasmic immunoexpression of FAT4 was semi-quantitatively scored using the H-score system. An H-score of > or =10 was considered positive for FAT4 expression. RESULTS: Variable cytoplasmic expressions of FAT4 were observed in gastric cancers, with 33 cases (24.3%) showing loss of expression (H-score <10). Loss of FAT4 expression was associated with an increased rate of perineural invasion (H-score <10 vs. > or =10, 36.4% vs. 16.5%, P=0.015), high pathologic T stage (P=0.015), high tumor-node-metastasis stage (P=0.017), and reduced disease-free survival time (H-score <10 vs. > or =10, mean survival 62.7+/-7.3 months vs. 79.1+/-3.1 months, P=0.025). However, no association was found between the loss of FAT4 expression and tumor size, gross type, histologic subtype, Lauren classification, lymphovascular invasion, or overall survival. CONCLUSIONS: Loss of FAT4 expression appears to be associated with invasiveness in gastric cancer.
Cell Adhesion ; Chungcheongnam-do ; Classification ; Cytoplasm ; Disease-Free Survival ; Genes, Tumor Suppressor ; Immunohistochemistry ; Organ Size ; Risk Factors ; Stomach Neoplasms*

BACKGROUND/AIMS: Ischemic colitis (IC) usually occurs in the elderly population and has a various clinical presentations from mild to severe forms. The aim of this study was to investigate the clinical outcomes according to the involved sites and colonoscopic findings in IC. METHODS: We retrospectively analyzed the medical records of 77 patients who had diagnosed with IC between January 2000 and July 2010. The clinical outcomes were compared according to numbers of the involved segments, location and endoscopic findings. RESULTS: Mean age of the patients was 70+/-11 years and male to female ratio was 1:1.26. Hematochezia (67.5%) and abdominal pain (63.6%) were the most common associated symptoms. The colonoscopic examination was performed at mean 4.6+/-3.7 days after the symptom onset. The most common involved segment was the sigmoid colon (72.7%). Duration of fasting, antibiotics therapy, hospital stay and mortality were significantly increased in the patients group with more involved segments (p<0.001, p=0.004, p<0.001, p<0.001, respectively). Duration of antibiotics therapy and hospital stay were significantly longer in the right colon involvement group (p=0.038, p=0.002, respectively). The time taken until the alleviation of symptoms and the white blood cells count were significantly longer and higher in the ulcer or gangrenous group (p=0.001, p=0.022, respectively). CONCLUSIONS: Evaluating the involved sites, the degree and severity of mucosal damage by colonoscopy may be important in predicting the clinical course and prognosis of the patients with IC. Early detection, careful monitoring and prompt treatment are crucial especially in the patients with ulcer or necrosis in colonscopic findings.
Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Colitis, Ischemic/*diagnosis/drug therapy/mortality ; Colon, Ascending/pathology ; Colon, Sigmoid/pathology ; Colonoscopy ; Female ; Humans ; Length of Stay ; Leukocyte Count ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies

OBJECTIVE: This study was undertaken to evaluate the clinical significance of ASCUS and AGUS in routine Papanicolaou smears. METHOD: A review of retrospective medical records was conducted on 267 women whose Papanicolaou smears yielded diagnoses of either ASCUS or AGUS from March, 1998 to December, 2000 at Youngdong Severance Hospital. RESULT: The incidences of ASCUS and AGUS on PAP smears are 1.3%(258 cases) and 0.1%(23 cases). Of these, 89 cases with ASCUS and 9 cases with AGUS had subsequent cervical biopsies. The biopsy cases with ASCUS showed 68(74.4%) cervicitis, 2(2.2%) hyperkeratosis, 1(1.1%) condyloma, 9(9.9%) CIN 1, 5(5.5%) CIN 2, 1(1.1%) CIN 3, 2(2.2%) microinvasive squamous cell carcinoma and 1(1.1%) adenocarcinoma. Those with AGUS showed 6(6.6%) cervicitis, 1(1.1%) CIN 2, 1(1.1%) CIN 3, 1(1.1%) endometrial cancer. Women under 35 year-old(P=0.012) or who had coital history in younger periods(before 20 years old, P=0.014) had much higher frequency of high grade lesion. The overall incidence of HSIL was higher in the group with ASCUS favoring SIL than in the group with unqualified ASCUS. (P=0.042) The group with AGUS also had much higher frequency of high grade lesion than the group with ASCUS. (P=0.043) CONCLUSION: Immediate colposopic evaluation should be performed for AGUS and ASCUS favoring SIL. Regarding ASCUS, high risk patients who are under 35 years old or who have early coital history(< 20 yrears old) also should undergo colposcopic examination. With the exception of the aboves, we propose HPV screening and HPV DNA testing for intermediate screening test.
Adenocarcinoma ; Adult ; Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Endometrial Neoplasms ; Female ; Human Papillomavirus DNA Tests ; Humans ; Incidence ; Mass Screening ; Medical Records ; Papanicolaou Test ; Retrospective Studies ; Uterine Cervicitis ; Young Adult

BACKGROUND/AIMS: Although intravenous proton pump inhibitor (PPI) has been used for the prevention of post endoscopic submucosal dissection (ESD) bleeding, the route of administration has not been confirmed. The aim of the present study was to compare the efficacy of intravenous and oral PPI administration for the prevention of delayed post ESD bleeding. METHODS: Total 166 consecutive patients were randomly assigned to 30 mg lansoprazol twice a day (PO group) and 120 mg pantoprazole intravenous injection (IV group) for 48 hours. Finally, 65 patients in PO group and 87 patients in IV group were analyzed. After ESD, all patients underwent follow up endoscopy after 24 hours and were observed the symptoms of bleeding up to 60 days after ESD. RESULTS: Age, sex and use of anticoagulants were not different between groups. At follow up endoscopy after 24 hours, oozing and exposed vessel was noted in 4.6% of PO group and 8.0% of IV group and there was no significant difference. Delayed bleeding occurred in 4 of 65 patients (6.2%) in the PO group and 8 of 87 patients (9.2%) in the IV group (p>0.999). By multivariate analysis, oozing or exposed vessels at follow up endoscopy were risk factors for delayed bleeding (OR=17.5, p=0.022). CONCLUSIONS: There was no significant difference in the delayed bleeding, length of hospital stay according to the administration route. Bleeding stigmata at follow up endoscopy was risk factor of delayed bleeding. Oral PPI administration can cost-effectively replace IV PPI for prevention of post ESD bleeding.
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use ; *Administration, Oral ; Aged ; Anticoagulants/therapeutic use ; Endoscopic Mucosal Resection/*adverse effects ; Female ; Gastroscopy ; Humans ; *Injections, Intravenous ; Lansoprazole/therapeutic use ; Male ; Middle Aged ; Odds Ratio ; Postoperative Hemorrhage/etiology/*prevention & control ; Prospective Studies ; Proton Pump Inhibitors/*therapeutic use ; Risk Factors ; Stomach Neoplasms/surgery