No abstract available.
Neoplasm Metastasis*

BACKGROUND: Recent advances in laboratory information systems have largely been focused on automation. However, the phlebotomy services have not been completely automated. To address this issue, we introduced an automated reception and turnaround time (TAT) management system, for the first time in Korea, whereby the patient's information is transmitted directly to the actual phlebotomy site and the TAT for each phlebotomy step can be monitored at a glance. METHODS: The GNT5 system (Energium Co., Ltd., Korea) was installed in June 2013. The automated reception and TAT management system has been in operation since February 2014. Integration of the automated reception machine with the GNT5 allowed for direct transmission of laboratory order information to the GNT5 without involving any manual reception step. We used the mean TAT from reception to actual phlebotomy as the parameter for evaluating the efficiency of our system. RESULTS: Mean TAT decreased from 5:45 min to 2:42 min after operationalization of the system. The mean number of patients in queue decreased from 2.9 to 1.0. Further, the number of cases taking more than five minutes from reception to phlebotomy, defined as the defect rate, decreased from 20.1% to 9.7%. CONCLUSIONS: The use of automated reception and TAT management system was associated with a decrease of overall TAT and an improved workflow at the phlebotomy room.
Automation, Laboratory ; Efficiency, Organizational/*standards ; Phlebotomy/*statistics & numerical data ; Republic of Korea ; Time Factors ; Workflow

OBJECTIVE: Although posterior wiring techniques have been commonly used with good results in treating the traumatic atlantoaxial instabilities, screw fixation technique has been gaining popularity to secure atlantoaxial arthrodesis in recent years. The purpose of this study is to compare the surgical results of posterior arthrodesis for the traumatic atlantoaxial instability between these two methods. METHODS: Twenty patients underwent 21 procedures over a 6-year period with a mean follow-up of 23 months. The most common condition of traumatic atlantoaxial instability was dens fracture(15 patients) followed by transverse atlantal ligament injury(4 patients), and traumatic os odontoideum(2 patients). Thirteen posterior wiring and eight posterior screw fixations were performed. Among 13 wiring methods, nine Galli fusions, two occipito-cervical fusions, one Brooks fusion, and one C1-C3 fusion were done. RESULTS: No patient developed neurological worsening after surgery. Compared to wire method, all patients of screw group had significant pain reduction when the patients was younger than 50 years old(p=0.01). The postoperative changes in distances of space available for cord(SAC) was not statistically significant between wire and screw methods(p=0.7). The rate of complication(23% in wire vs 25% in screw) was comparable to two methods. Although two screw malposition(25%) among screw fixations were developed, all revealed solid fusion without additional surgeries. The rate of fusion(85% in wire vs 100% in screw) was excellent in screw group. Postoperative loss of reduction, including redisplacement and kyphosis, was present only in wire group(31%). Two(15%) of wire fusions had redisplacement; both of these patients were type 2 dens fracture. Three procedures(23%) of wire fusions resulted in kyphotic change which occurred when delayed surgeries were done between 40 days and 90 days(mean: 63 days) after trauma. CONCLUSION: Considering both reduction loss and fusion rate, wire method caused more spinal deformity than screw method(38% vs 0%). This study demonstrates that screw method is a better surgical option for management of traumatic atlantoaxial instability.
Arthrodesis* ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Ligaments

No abstract available.
Prognosis* ; Subarachnoid Hemorrhage, Traumatic*

No abstract available.
Humans*

PURPOSE: To determine the frequency of complications and diagnostic accuracy of CT-guided percutaneous automated gun biopsy, and to compare the results with those reported for fine needle aspiration. MATERIALS AND METHODS: Using automated biopsy devices, 118 CT-guided percutaneous biopsies of pulmonary lesions were performed. An 18-gauge needle was used. Final diagnosis was made with operation or other methods. We retrospectively analyzed the frequency of complications and diagnostic yields of 118 biopsies. RESULT: Four of 118(3.3%) patients developed pneumothorax and two of these required chest tube insertion. Other complications were resolved spontaneously. 106 biopsies (89.8%) yielded sufficient tissue for pathologic evaluation. For cases of malignant and of benign disease, sensitivity was 91.8% and 87.7% respectively ; the corresponding figures for diagnostic accuracy were 88.5% and 78.9%. CONCLUSION: CT-guided automated gun biopsy of the pulmonary lesions is safe, witha pneumothorax rate comparable to that of fine needle aspiration. In the absence of a trained cytologist at the time of biopsy, the diagnostic accuracy of automated gun biopsy of pulmonary lesions compared favorably with the reported accuracy of fine needle aspiration.
Biopsy* ; Biopsy, Fine-Needle ; Chest Tubes ; Diagnosis ; Needles ; Pneumothorax ; Retrospective Studies

To identify the corresponding cord segment for each root at the level of conus medullaris, a dissecting microscopic study was carried out on the spinal cord of 14 adult cadavers. We measured following contents:1) the longitudinal extent of the medullary segment of origin of each root:2) the distance from the lowest rootlet of the conus to the highest portion of the medullary segment of each root:3) the distance from the conus tip to the lowest portion of the medullary segment of each root:4) the morphological features of root-spinal cord juncton, intrathecal anastomoses, and others. We measured on the basis of the last rootlet ecause of no clear distinction between the conus and filum terminale. Our values showed considerable variation from one case to another. The average length of the whole lumbar and sacral segment was 50 mm and 30 mm, respectively. The S-1 root was the largest. Intrathecal intersegmental anastomoses were found in all cases examined, and usually consisted of small caliber rootlets connecting the spinal roots of adjacent segments. We emphasize the importance of microsurgical structure of conus medullaris when performing an operation of dorsal root entry zone or myelotomy for the relief or spasticity or intractable pain of lower extremities.
Adult ; Cadaver ; Cauda Equina ; Conus Snail* ; Humans ; Lower Extremity ; Muscle Spasticity ; Pain, Intractable ; Spinal Cord ; Spinal Nerve Roots

Malignant fibrous histiocytoma(MFH) is well known as a soft tissue tumor of the extremities and retroperitoneum, but MFH of the skull is very rare. We report a case of MFH arising from the temporal bone in a 27-year-old male. This tumor presented as an osteolytic lesion and soft tissue mass on the left temporal bone without obvious invasion of the underlying brain parenchyma. The patient underwent tumor and bone removal, follwed by radiation therapy. Hostologic examination disclosed pleomorphic spindle cells in a storiform pattern and tumor cells showed positive reaction for vimentin, lysozyme, alpha 1-antitrypsin and (1-antichymotrypsin in immunohistochemical stain.
Adult ; alpha 1-Antitrypsin ; Brain ; Extremities ; Histiocytoma, Malignant Fibrous* ; Humans ; Male ; Muramidase ; Skull ; Temporal Bone* ; Vimentin

OBJECTIVE: Using the standardization of disease diagnosis of disease, and surgical procedures, the authors have made a clinical application for the analysis of inpatient data with the ability to search for information pertinent for writing of clinical articles. METHODS: A client-server system and database software was developed for networking. For clinical application, a computerized daily report has been developed. Data from Neurosurgical patients admitted at Soonchunyang University Hospital from January to December 1998 were analyzed with this system. Data for clinical articles was obtained using the search mode, information such as orbital infarction syndrome following intracranial aneurysm surgery and epidemiological analysis or geriatric neurosurgical patients. RESULTS: For the daily report it takes approximately 10 minutes to input the patients demographic information, name of disease, diagnosis and surgical procedure. The daily report also numbers and sorts the inpatients according to large categories of diagnosis, reports the ratio between inpatients and operative patients. The annual report that was obtained was very accurate and gave rapid statistics for the one year. By retrospective study for the past 18 years, we calculated the incidence of orbital infarction syndrome following intracranial aneurysm surgery as 1.4%, and also estimated the population of geriatric inpatients as 18.3% by retrospective study. CONCLUSIONS: It has been found to be most useful to make a daily and annual report for tracking and research purposes. For use in clinical articles, it can be possible to do a search of the patients using the standardized disease, diagnosis and neurosurgical procedures application and obtain pertinent information in a timely manner.
Diagnosis ; Epidemiology* ; Humans ; Incidence ; Infarction ; Inpatients ; Intracranial Aneurysm ; Neurosurgical Procedures* ; Orbit ; Retrospective Studies ; Writing

OBJECTIVE: The the international classification of disease and surgical procedure has been found to be a lengthy and time-consuming text for use by neurosurgeons. A more subject matter related classification system is needed for use by this specialty. The author has developed a more comprehensive and standardized classification system specified for diagnosis of neurological disease and neurosurgical procedures. METHODS: Standardization of disease was completed by modifying the name of disease according to that which was used for daily report past 10 years, and from textbook of neurosurgery. The fields of international coding are continued in each. Neurosurgical procedures were designated and modified according to Current Procedure Terminology 96. Client-server system will be used for networking and database software applications have been developed. RESULTS: Disease was classified in 14 large categories and 379 subcategories. Diagnosis was classified in 12 large categories and 43 subcategories. Neurosurgical procedure has 20 large and 202 subcategories. The international coding system such as ICD-10 and ICD-9CM is maintained for the diagnosis and procedures to each category. CONCLUSIONS: It could be possible to make and use a standardized database model of disease, diagnosis and neurosurgical procedures to be used by physician.
Classification ; Clinical Coding ; Diagnosis ; Epidemiology* ; International Classification of Diseases ; Neurosurgery ; Neurosurgical Procedures*