Typical features of Ankylosing spondylitis are progressive ankylosis of the sacroiliac joint and ossification of the annulus fibrosus of discs, interlaminar & interspinous ligaments. Fixed kyphotic deformity in ankylosing spondylitis causes many problems, such as difficulty in looking forward, gastrointestinal problems, restricted cardiopulmonary functions and psychotic depression. There are limitations of conservative treatment to delay progression of the disease. So surgical osteotomy for the correction is inevitable. Osteotomy is indicated in poor horizontal vision, poor cardiopulmonary & gastrointestinal function and psychological & social problem. The purpose of this study is to assess the results of posterior closed wedge osteotomy in ankylosed kyphotic deformity. The posterior closed wedge osteotomy was performed for 30 patients in ankylosed kyphotic deformity between April 1995 and February 1997, who were 29 male and 1 female and whose average age at the time of operation was 35.7 years (17-54 yrs). Mean duration of the symptoms was 18 years (11-23 yrs). The level of correction was fully evaluated preoperatively with anterior and lateral radiographs of whole spine. The patient was placed pronely on an operating table which could be angulated in reverse direction. The determined correction level of the spine was exposed through the posterior midline approach. Following the insertion of pedicle screws, transpedicular decancellation was performed with curret and punch forceps. Posterior bony element and pedicle were completely removed. The correction was achieved by gradual extension of the operating table angulated previously and by opposing the surface of osteotomy. Then prebent rod was applied. Walking brace was applied in 2 weeks postoperatively. The osteotomy was performed at single level in 28 cases, double level in 2 cases. The level of osteotomy was distributed as follows; T10: 1 case, T12: 1 case, L2: 3 cases, L3: 14 cases, and L4: 13 cases. Mean correction angle was 48.7degrees (13degrees-72degrees ), and mean increment of height 13.7cm (4-23.5cm). There was no fatal complication. But 5 patients had paralytic ileus and 3 patients visual loss; one was permanent, the others were temporary. Temporary neurologic deficit was also noted in 5 cases. Posterior closed wedge osteotomy with transpedicular decancellation in ankylosed kyphotic deformity is relatively safe and simple procedure.
Ankylosis ; Braces ; Congenital Abnormalities* ; Depression ; Female ; Humans ; Intestinal Pseudo-Obstruction ; Ligaments ; Male ; Neurologic Manifestations ; Operating Tables ; Osteotomy* ; Sacroiliac Joint ; Social Problems ; Spine ; Spondylitis, Ankylosing* ; Surgical Instruments ; Walking

BACKGROUND: Polydactyly of the foot is one of the most frequent anomalies of the limbs. However, most classification systems are based solely on morphology and tend to be inaccurate and less relevant to surgical methods and results. The purpose of this study is to present our new classification of polydactyly of the foot, which can serve as a predictor of treatment and prognosis. METHODS: To find a correlation between the various morphologic traits of polydactyly of the foot and the treatment plan and outcomes, we reviewed 532 cases of polydactyly of the foot in 431 patients treated in our hospital, expanding on our previous study that described polydactyly based on the importance of metatarsal bone status and varus deformity. The records of patients were evaluated and compared with previous studies at other centers. RESULTS: Unsatisfactory results were seen in 36 cases, which included 5 cases of incomplete separation due to syndactylism, 23 cases of axis deviation, and 8 cases of remnants of extra-digit metatarsal bones. The locus of the polydactyly, or the digit which was involved, did not seem to affect the final postoperative outcomes in our study. Three factors-syndactylism, axis deviation, and metatarsal extension-are the major factors related to treatment strategy and prognosis. Therefore, we developed a new classification system using three characters (S, A, M) followed by three groups (0, 1, 2), to describe the complexity of polydactyly of the foot, such as S1A2M2. CONCLUSIONS: Our new classification could provide a communicable description to help determine the surgical plan and predict outcomes.
Axis, Cervical Vertebra ; Congenital Abnormalities ; Extremities ; Foot ; Humans ; Metatarsal Bones ; Polydactyly ; Prognosis ; Syndactyly

BACKGROUND AND OBJECTIVES: Cervical metastasis of unknown origin (MUO) comprises 3-5% of all head and neck malignancy. Standardized diagnostic approach is not established and standard treatment regimen is not established either. The purpose of this study was to evaluate diagnostic approaches to detect the primary site in patients with neck mass of metastatic squamous cell carcinoma and analyze treatment modalities and their outcomes as well. SUBJECTS AND METHOD: Of 710 patients who had been diagnosed with squamous cell carcinoma of the head and neck site from Jan. 1992 through Dec. 2005, 73 patients were referred to or visited our clinic regarding the presence of neck mass. With retrospective review of the medical record, the diagnostic approaches were evaluated. Thirty patients, in whom the primary sites were not found after all, were included for analysis of treatments and outcomes. RESULTS: The diagnostic steps that revealed the primary sites were as follows: physical examination in 29 cases (39.7%), conventional imaging (CT or MRI) in 5 cases (6.8%), PET scan in 1 case (1.4%), OPD based directed biopsy in 3 cases (4.1%), and intraoperative directed biopsy in 5 cases (6.8%). Primary sites were not detected in 30 cases (41.1%). Complete remission was obtained in 24 patients, for whom 5-year disease free survival rate was 62.1%. CONCLUSION: Thorough physical examination and directed biopsy are strongly recommended for the diagnosis of MUO, but the diagnostic value of PET scan needs to be followed up with more cases.
Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Disease-Free Survival ; Head ; Humans ; Medical Records ; Neck ; Neoplasm Metastasis ; Physical Examination ; Positron-Emission Tomography ; Prognosis* ; Retrospective Studies

BACKGROUND AND OBJECTIVES: We aimed to develop a Korean version of the velopharyngeal insufficiency (VPI) speech corpus system. SUBJECTS AND METHOD: After developing a 3-channel simultaneous speech recording device capable of recording nasal/oral and normal compound speech separately, voice data were collected from VPI patients aged more than 10 years with/without the history of operation or prior speech therapy. This was compared to a control group for which VPI was simulated by using a french-3 nelaton tube inserted via both nostril through nasopharynx and pulling the soft palate anteriorly in varying degrees. The study consisted of three transcriptors: a speech therapist transcribed the voice file into text, a second transcriptor graded speech intelligibility and severity and the third tagged the types and onset times of misarticulation. The database were composed of three main tables regarding (1) speaker's demographics, (2) condition of the recording system and (3) transcripts. All of these were interfaced with the Praat voice analysis program, which enables the user to extract exact transcribed phrases for analysis. RESULTS: In the simulated VPI group, the higher the severity of VPI, the higher the nasalance score was obtained. In addition, we could verify the vocal energy that characterizes hypernasality and compensation in nasal/oral and compound sounds spoken by VPI patients as opposed to that characgerizes the normal control group. CONCLUSION: With the Korean version of VPI speech corpus system, patients' common difficulties and speech tendencies in articulation can be objectively evaluated. Comparing these data with those of the normal voice, mispronunciation and dysarticulation of patients with VPI can be corrected.
Aged ; Articulation Disorders ; Cleft Palate ; Compensation and Redress ; Database Management Systems ; Demography ; Humans ; Nasopharynx ; Palate, Soft ; Speech Intelligibility ; Speech Therapy ; Velopharyngeal Insufficiency ; Voice

BACKGROUND AND OBJECTIVES: Diagnosis of thyroid disease requiring surgery and subsequent thyroidectomy may affect patients' emotion and quality of life. The purpose of this study is to evaluate the patients' understanding and concern about the disease and recovery rate after thyroidectomy, and therefore to enhance the satisfaction of hospitalization. SUBJECTS AND METHOD: MethodZZSeventy-seven patients undergoing thyroidectomy in a tertiary hospital from April 2009 to October 2009 were enrolled. Questionnaires were filled out on the admission day, discharge day, and 2 weeks after operation. Questionnaires consisted questions regarding the understanding of the disease, details of concern, recovery rate after surgery, and satisfaction on hospitalization duration. Retrospective chart review was also performed. RESULTS: Many patients (42.9%) acquired their knowledge of thyroid cancer through the internet. The possibility of voice change was the major concern before surgery (46.8%), whereas the major postoperative concern was adjuvant therapy (37.7%). The patient group with higher understanding of the disease showed higher recovery rate than the others at the time of discharge (mean postdischarge surgical recovery 67.4% vs. 55.3%, p=0.01). The patient group with lower understanding wanted longer hospitalization than the other group at discharge (p<0.001). CONCLUSION: Patient education about the thyroid disease may reduce patients' anxiety and therefore may enhance subjective recovery rate and satisfaction of hospitalization.
Anxiety ; Cognition ; Hospitalization ; Humans ; Internet ; Patient Education as Topic ; Quality of Life ; Surveys and Questionnaires ; Retrospective Studies ; Tertiary Care Centers ; Thyroid Diseases ; Thyroid Neoplasms ; Thyroidectomy ; Voice

Teeth wear with loss of posterior support often leads to symptoms such as irregular occlusal plane and excessive wear of anterior teeth. In such environment, establishing proper posterior support and harmonious anterior guidance and occlusal plane is recommended. In this case, the patient had excessively worn dentition with loss of posterior support, while denying surgical treatment due to her(his) history of osteoporosis, ibandronate injection, and risk of medication-related osteonecrosis of the jaw (MRONJ). To recover the vertical space needed for prosthetic restoration, full mouth rehabilitation with vertical dimension increase of remaining teeth was decided. Missing teeth in the posterior area were restored with mandibular removable partial denture. The treatment plan was determined through careful diagnosis, and every step of procedures including tooth preparation, provisional phase with the increased vertical dimension, and definitive prosthetic phase were carried out accordingly. Once the treatment was completed, the patient was satisfied functionally and esthetically. Periodic examination of oral hygiene, occlusal stability was conducted.

OBJECTIVES: This study was undertaken to confirm the clinical characteristics of recurrent pleomorphic adenoma (RPA), and to identify those factors that affect the development of malignant transformation (MT) from RPA. METHODS: The medical records of 270 patients, who were operated upon for parotid PA, were retrospectively reviewed. The pathologic specimens of a selected series of 23 patients were reviewed for histologic subtype and microscopic multi-nodularity. RESULTS: Mean age of initial operation in RPA without MT (RPA(-MT)) group was significantly lower than that of primary PA group. Mean age of the revision operation in RPA with MT (RPA(+MT)) group was significantly greater than that of RPA(-MT) group. Mean interval from operation to recurrence shortened after each revision operation. The risk of MT and additional recurrence increased significantly with recurrence. In RPA(-MT) group tumor recurrence occurred in 21.4% of patients despite a clear resection margin. CONCLUSION: The risk factors for MT may be an age of over 45 yr and multiple recurrences. However, younger patients are more at risk of recurrence. A clear resection margin cannot guarantee a cure in RPA, and it seems that parotid pleomorphic adenomas slowly gain malignant characteristics after repeated recurrences.
Adenoma, Pleomorphic ; Humans ; Medical Records ; Recurrence ; Retrospective Studies ; Risk Factors

BACKGROUND AND OBJECTIVES: Regional recurrence of head and neck squamous cell carcinoma (HNSCC) is the most common single type of treatment failure, and thus a challenging problem for the clinician. When planning management of regional recurrence, the grave outcome of the recurrence itself, and benefits and morbidity owing to the intervention must be taken into account. We analyzed the factors affecting salvage treatment outcomes of regional recurrence in head & neck squamous cell carcinoma. SUBJECTS AND METHOD: A retrospective analysis of medical records over a 10 year period (1994-2003) was conducted. Sixty-two patients with regional and locoregional recurrence were identified. Patients with local recurrence or distant metastasis were excluded. RESULTS: The median age of the population was 62 years. Sixty percent of the cases were regional, and the remainders were locoregional recurrences. The median time of recurrence was 16 months with an overall survival rate of 46.1%. Recurrence in a surgically virginal neck was associated with a favorable outcome. Factors associated with poor outcomes were node positive at initial presentation, neck dissection at initial treatment, recurrence at contralateral neck, incorporation of chemotherapy for salvage treatment, and subsequent recurrence after salvage treatment. CONCLUSION: In the management of patients with regional recurrence of HNSCC, the factors mentioned above should be taken into consideration regarding patient selection, salvage management plan, and patient counseling.
Carcinoma, Squamous Cell* ; Counseling ; Drug Therapy ; Head and Neck Neoplasms ; Head* ; Humans ; Medical Records ; Neck Dissection ; Neck* ; Neoplasm Metastasis ; Patient Selection ; Recurrence* ; Retrospective Studies ; Survival Rate ; Treatment Failure ; Treatment Outcome

Objectives: . We aimed to assess the genetic differences between cases of early-stage tongue cancer that were positive or negative for lymph node metastasis. Methods: . In total, 35 cases of tongue cancer with RNA sequencing data were enrolled in this study. The gene expression profile of the following two groups was compared: N0 group (T stage 1 or 2 with N0 stage) and N+ group (T stage 1 or 2 with N+ stage). Using the R and limma packages in the Bioconductor program, we extracted the differentially expressed genes (DEGs). Gene ontology and pathway enrichment analysis were performed using the Database for Annotation, Visualization and Integration Discovery (DAVID) online tool. Immune cell infiltration was analyzed using the CIBERSORT online program. Immunochemical staining of the cancer tissue was evaluated and The Cancer Genome Atlas (TCGA) data were analyzed to validate the identified DEGs. Results: . No significant differences were found in the infiltration of 22 types of immune cells. Among a total of 51 identified DEGs, 14 genes were significantly upregulated, while 37 genes were significantly downregulated (P<0.01; fold change >2). Pathway analysis revealed significant associations with the arachidonic acid metabolism-related pathway, calcium signaling, and the muscle contraction pathway. The following DEGs were the most significantly different between the two groups: DEFB4A, SPRR2B, DEFB103B, SPRR2G, DEFB4B, and FAM25A. TCGA data showed that DEFB4A and DEFB103B were more highly expressed in the N0 group than in the N+ group, although the difference did not achieve statistical significance. Immunochemical staining of cancer tissue revealed significantly higher expression of defensin in the N0 group. Conclusions . Defensin (DEFB4A, DEFB103B, DEFB4B) may be a novel biomarker for early regional metastasis in T1/2 tongue cancer.

BACKGROUND AND OBJECTIVES: We evaluated the role of temporary injection laryngoplasty in patients with unilateral vocal fold paralysis (UVFP) after cardiothoracic surgeries. SUBJECTS AND METHOD: Taking the introduction of injection laryngoplasty as a milestone, we divided patients into those who underwent cardiothoracic surgery with UVFP during the years 2001-2004, before the introduction of injection laryngoplasty as pre-injection group (n=83) and those who underwent after the introduction during the years 2000-2007 as post-injection group (n=103). Of the post injection group, patients who received injection laryngoplasty postoperatively before being discharged were defined as injection group (n=37). Patients were also divided into non-esophageal surgery group and esophageal surgery group. Clinical outcomes including the length of hospital stay and oral feeding initiation time were compared between the pre-injection group and the injection group within the same operation group. The degrees of aspiration were classified into 4 grades. RESULTS: In the non-esophageal surgery group, the injection group with aspiration grade III had shorter hospital stay and oral feeding initiation time after extubation compared to the pre-injection group with grade III aspiration (p=0.042). However, in the esophageal surgery group, there was no statistical difference between the pre-injection and injection groups. CONCLUSION: Temporary injection laryngoplasty can reduce the hospital stay and enhance oral feeding initiation in patients with aspiration due to UVFP after non-esophageal cardiothoracic surgeries.
Humans ; Laryngoplasty ; Length of Stay ; Paralysis ; Respiratory Aspiration ; Thoracic Surgery ; Vocal Cords