A most common site for the isthmic spondylolisthesis is at fifth lumbar vertebra(L5) and far less at fourth(L4). The pathogenic lesion in the pars interarticularis is essentially the same in LA and L5 isthmic spondylolisthesis, but the clinical characteristics may differ each other according to their anatomical and biomechanical differences. A retrospective review of 24 patients of LA(study group) and 27 patients of L5(control group) isthmic spondylolisthesis was undertaken for their medical records and radiographs to compare the clinical characteristics in each groups. Included in each groups were all patients who were surgically treated during the same period and followed for more than two years after surgery. In the study group, 18 of 24 patients were females having an average age of 42.5 years(ranging 34-65), while in the control group, 17 of 27 patients were males having an average age of 38,1 years (ranging 13-59). The symptoms were severe leg pain in most of the study group, but in the control group, the leg pain and back pain were equally complained. The degrees of slip were similar in two groups, but a narrowing of dise space at slip segment was more prominent in study group. The lateral radiographs taken in flexion and extension revealed more changes of slip in study group (4.7mm in study group vs 2.8mm in control group in averages), and more angular motion at slip segment in study group unless the dise space is not severely narrowed. A spinal stenosis in CT findings was disclosed in almost all patients of study group and in 18 patients of control group. The sizes of L5 transeverse process were bigger than twice as those of L4 in 17(70.8%) patients including 9(37.5%) sacralizations of L5 in suty group, while in control group they were only 8(29.6%) patients with no sacralization. The heights of intercreastal line revealed no difference in two groups. The surgical procedures in study group were fusion only in two and decompression with fusion in 22(91.7%) patients and those in control group were fusion only in 11 and decompression with fusion in 16(59.3%) paticnts. The satisfactory results of treatment were in 21(87.5%) patients of study group and 25(92.6%) patients of control group without significant difference between two groups. In conclusion, the L4 spondylolytic spondylolisthesis compared to L5 lesion was more unstable and developed spinal stenosis more often. The surgical treatment and decompression procedure were also more needed in L4 lesions particularly in agend women.
Back Pain ; Decompression ; Female ; Humans ; Leg ; Male ; Medical Records ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis

OBJECTIVE: The presence of the various cytokines in human peritoneal fluid has been evaluated incompletely. Changes in cytokine lefels may be related to activation of peritoneal macrophage and T-lymphocyte, development of endometriosis, and infertility. This study assesses peritoneal fluid levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-alpha) in infertile women with endometriosis and normal women without endometriosis. Design : Prospective and case-control study in university hospital. MATERIALS AND METHODS: Cytokine levels in peritoneal fluid obtained during laparotomy or laparoscopy from 21 patients in infertile patients in infertile patients with endometriosis and 24 controls undergoing laparotomy or laparoscopy with no evidence of pelvic endometriosis were determined by enzymelinked immunosorbent assay. RESULTS: The mean levels of interleukin-6 in infertile patients with endometriosis and controls were 72.7+/-23.7 pg/ml and 18.5+/-9.7 pg/ml respectively (p=0.02). Similarly, the mean levels of interleukin-8 in infertile patients with endometriosis was significantly higher than that of controls (445.0+/-89.6, vs 45.1+/-48.4, p=0.04). The mean concentration of interleukin-10 in infertile patients with endometriosis was significantly lower than that of controls (1.09+/-0.04 vs 2.19+/-0.03, p=0.03). The level of tumor necrosis factor-alpha was not significantly different between the two study groups. CONCLUSIONS: Increased IL-6 and IL-8 and decreased IL-10 levels in the peritoneal fluid may be related to pathogenesis in the endometriosis and infertility, suggesting that partially contribute to the disturbed immune regulation observed in infertili women with endometriosis.
Ascitic Fluid* ; Case-Control Studies ; Cytokines ; Endometriosis* ; Female ; Humans ; Infertility ; Interleukin-10 ; Interleukin-6 ; Interleukin-8 ; Laparoscopy ; Laparotomy ; Macrophages, Peritoneal ; Prospective Studies ; T-Lymphocytes ; Tumor Necrosis Factor-alpha

PURPOSE: Latissimus dorsi myocutaneous flap (LDMCF) is a commonly used technique for breast reconstruction following breast-conserving surgery. However, this technique has a high incidence of donor site seroma. The aim of this study is to evaluate the effect of donor-site quilting on seroma formation. METHODS: A retrospective review of 95 patients who underwent immediate breast reconstruction with LDMCF from May of 2006 through February of 2007 was performed. Patients were divided into Group A, in which only a closed suction drain was used, and Group B, in which quilting and a closed suction drain were used. The outcome measures were age, body mass index (BMI), mastectomy volume, duration of drain, total volume of postoperative seroma, length of hospital stay, and incidence of postoperative aspiration. RESULTS: In Group B, the total amount of seroma, duration of drain, and length of hospital stay were significantly reduced (P<0.05). However, the incidence of postoperative aspiration was not different between Group A and Group B (P=0.06). CONCLUSION: The quilting technique reduces the volume of postoperative seroma and may help prevent of seroma after LDMCF.
Body Mass Index ; Female ; Humans ; Incidence ; Length of Stay ; Mammaplasty ; Mastectomy ; Mastectomy, Segmental ; Outcome Assessment (Health Care) ; Retrospective Studies ; Seroma ; Suction ; Tissue Donors

No abstract available.
Hematoma*

No abstract available.
Subarachnoid Hemorrhage, Traumatic*

No abstract available.
Wandering Spleen*

Background/Aims: The aim of this study was to compare antimicrobial resistance, clinical features, and outcomes of community-onset Escherichia coli (COEC) and Klebsiella pneumoniae (COKP) bacteremia. Methods: The medical records of patients diagnosed with E. coli or K. pneumoniae bacteremia in the emergency department of a 750-bed secondary care hospital in Daegu, Korea from January 2010 to December 2016 were retrospectively reviewed. Results: A total of 866 patients with COEC bacteremia and 299 with COKP bacteremia were enrolled. COEC bacteremia, compared to COKP bacteremia, had higher rates of 3rd generation cephalosporin (3GC) (18.8% vs. 8.4%, p < 0.001) and f luoroquinolone (FQ) (30.4% vs. 8.0%, p < 0.001) resistance. The patients with COKP bacteremia had higher Charlson comorbidity indices (CCI) (1.8 ± 2.0 vs. 1.5 ± 1.8, p = 0.035), Pittsburgh bacteremia scores (PBS) (2.0 ± 2.6 vs. 1.3 ± 1.8, p < 0.001), and 30-day mortality (14.44% vs. 8.8%, p = 0.008) than the patients with COEC bacteremia. Age younger than 70 years, male sex, polymicrobial infections, pneumonia, intra-abdominal infection, PBS ≥ 2, and Foley catheter insertion were independent predictive factors for COKP bacteremia compared to COEC bacteremia in the multivariate analysis. CCI, PBS, and intensive care unit admission were independent risk factors for 30-day mortality in the multivariate analysis. Conclusions 3GCs and FQs are still useful for the empirical treatment of patients with probable COKP bacteremia. The patients with COKP bacteremia had worse outcomes because of its greater severity and more frequent underlying comorbidities.

The clinical significance of myocardial bridges (MBs) is variable, and most patients are asymptomatic. However, angina, myocardial infarction and sudden death, associated with MBs, have been reported. Intracoronary stents offer a novel, and potentially definitive, treatment for myocardial ischemia associated with clinically significant MBs. We describe the use of intracoronary stenting for primary angioplasty in a patient with an anterior myocardial infarction associated with MBs.
Angioplasty ; Death, Sudden ; Humans ; Myocardial Infarction* ; Myocardial Ischemia ; Stents*

Actinomycosis is a chronic, granulomatous suppurative disease caused by Actinomyces species. Actinomyces is an anaerobic, gram positive organism that requires special techniques for culture and isolation. Actinomycosis is characterized by formation of multiple abscesses, draining sinuses, abundant granulations (sulfur granule) and dense fibrous tissue. The three major clinical presentations include the cervicofacial, thoracic, and abdominal regions. Since A. israelii is a normal inhabitant of the oral cavity, to make a definitive diagnosis it must be recovered from closed tissue spaces, draining sinuses, or abscesses, or it must be shown to be invasive in histopathologic sections. The drug of choice is penicillin. Because of the dense fibrous tissue surrounding the colonies of organisms and the concentration of organisms in clusters, high doses of pharmacologic agents must be used for long periods, and radical surgical excision should accompany antibiotic therapy if possible. We report three cases of abdominal actinomycosis, preoperatively impressed as appendicitis and pelvic abscess, which was diagnosed by a histological study of operative specimens. The possible pathogenic mechanisms causing clinical symptoms are discussed.
Abscess ; Actinomyces ; Actinomycosis* ; Appendicitis ; Diagnosis ; Mouth ; Penicillins

OBJECTIVE: The distribution of disorders changes according to the change of environment or customs with time. Geriatric disorders are increasing along with the increase of the life span. A new therapeutic method may change the management of a certain disease. As a Korean neurosurgeon, they should have sufficient knowledge on certain disorders that are common or practically significant in Korea. There are few reports to evaluate the distribution or trends of neurosurgical disorders in Korea. We evaluated the distribution and trends of neurosurgical disorders of the patients who admitted to a neurosurgical department of a university hospital in Korea during a 5-year-period. METHODS: From January 1997 to December 2001, the total number of admission was 4, 772. The total number of operation was 2, 603. We used a standardized database model for collection of the patient data, which was developed by one of us. Disorders are classified into 13 categories, such as head injury, spine injury, vascular disorders, degenerative spinal disorders, cranial tumors, spinal tumors, infection, peripheral nerve disorders, functional disorders, pain, congenital disorders, and others. RESULTS: Head injury(32.5%), vascular disorders(27.7%), spine injury(15.5%), and degenerative spinal disorders(11.5%) occupied 87.2% of total disorders of the inpatient. The age distribution was peak at 61-75 year old group, about 60% of the total inpatients was 45 year old or more. During this 5-year-period, patients more than 60 year old were increasing, while patients of 16-30-year-old group were decreasing. The proportions of the head injury and vascular disorders were decreasing, while those of the degenerative spinal disorders, spine injury and cranial tumors were increasing. CONCLUSION: We should pay attention to the common or increasing disorders. It seems to be of value to collect and analyze the neurosurgical epidemiological data for education and planning of the neurosurgical manpower.
Age Distribution ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Craniocerebral Trauma ; Data Collection ; Education ; Epidemiology ; Head ; Humans ; Incidence ; Inpatients ; Korea ; Middle Aged ; Neurosurgery ; Peripheral Nerves ; Spine ; Vascular System Injuries