No abstract available.
Gastrectomy*

While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

OBJECTIVES: To evaluate the cross-sectional area (CSA) and the moment arm length (MAL) of the paraspinal muscles in the degenerative lumbar spondylolisthesis patients compared to the matched control patients, which is through contribution to the stability of the back. MATERIALS AND METHODS: We studied a comprised of 25 degenerative lumbar spondylolisthesis on L4/5 patients and a controlled group with 42 chronic lower back pain patients. In both groups, we measured body mass index (BMI, kg/m2). On the standing lateral radiographs, we measured the total lumbar lordosis, and segmental lumbar lorodosis using Cobb's methods. We measured the degree of slippage by Meyerding classification. The CSA of erector spinae (CSA) and CSA of psoas were measured at the L4/5 level by using the MRI. The statistical analysis were performed to know the relationship between the CSA and the MAL of erector spinae, and the BMI. Multifidus and erector spinae atrophy were evaluated at the L4/5 level and the degree of fatty atrophy was estimated using three grades : mild, moderate, and severe. RESULTS: The patient group and the controlled group BMI (kg/m2) were 25.27+/-3.8 and 24.47+/-3.24. In patient group, Meyerding classification grade I was 92%. Total lumbar lordosis and each segmental lordosis were measured mean angle 44.54degrees(24.9degrees~70.4degrees), and each 9.23degrees(L3/4), 10.27degrees(L4/5), 18.81degrees(L5/S1). Pearson's rho indicated a positive association between the CSA and BMI (rho=0.603, p= 0.001), between the CSA of psoas and BMI (rho=0.445, p=0.026), and between the CSA and MAL (rho=0.627, p=0.001) in the degenerative lumbar spondylolisthesis patients. In terms of the CSA versus MAL, there was a positive association in the both groups (rho=0.627, p=0.001, MAL=0.0008 CSA+/-5.293 in the degenerative lumbar spondylolisthesis group; rho=0.812, p=0.000, MAL=0.001 CSA+/-5.245 in the control group with using linear regression analysis). Independent t-test revealed that both groups had statistically different mean values (p=0.038) in terms of the CSA. Proportion of fat deposits in the multifidus and erector spinae muscle at the L3/4 level were all mild grades. CONCLUSION: The patients with degenerative lumbar spondylolisthesis had atrophied erector spinal muscles, which means harmful because of the poor compensation for the lower back load and poor assists to the lumbar stability. This suggests that the biomechanical factor of the muscles influence to the lumbar disability.
Animals ; Arm ; Atrophy ; Body Mass Index ; Compensation and Redress ; Humans ; Linear Models ; Lordosis ; Low Back Pain ; Muscles ; Spondylolisthesis

Complex regional pain syndrome (CRPS) along with post-operative syndrome in the lumbar spine shows confusing and duplicated symptoms, and this makes it difficult to make a clear differential diagnosis. Therefore, the patient with post-operative syndrome in the lumbar spine suffers losses of time and money, and the surgeon who diagnoses and treats post-operative syndrome in the lumbar spine also agonize from the patient's losses. It is necessary to provide these patients with a multidisciplinary approach to their disease and symptoms. We diagnosed herniation of an intervertebral disc of the lumbar spine (L4/5) and we performed discetomy twice in different hospitals. However, the symptoms did not improve, so we re-operated and performed discetomy along with monosegmental fixation using pedicular screws and interbody cages. There was improvement of pre-operation symptoms, but neurogenic symptoms occurred and then progressed after the surgery. Therefore, we report here on the case of CRPS that was diagnosed with the exclusion of the causes of post-operative syndrome in the lumbar spine, and the patient was finally effectively treated with spinal cord stimulation. Although differentiating post-operative syndrome in the lumbar spine from CRPS is difficult, we recommend suspecting CRPS as the cause of post-operative syndrome in the lumbar spine and taking CRPS as the main interest in order to diagnose and treat CRPS more effectively and accurately.
Diagnosis, Differential ; Felodipine ; Humans ; Intervertebral Disc ; Spinal Cord Stimulation ; Spine

Various types of tumor can occur in the subungual space, including glomus tumors, subungual exostosis, hemangioma, epidermal cysts, and malignant tumors. While fibromatosis can occur at various sites throughout the body, it is very rarely seen in the toe. Here, we are the first to report a case of superficial fibromatosis mimicking a glomus tumor in the subungual space of the second toe. The presentation of this condition shows the possibility of encountering uncommon superficial fibromatosis in the distal phalanx of the toe, and suggests that superficial fibromatosis should be included in the differential diagnosis of a glomus tumor in the toe.
Adult ; *Fibroma ; *Glomus Tumor ; Humans ; Male ; *Osteochondroma ; *Toes/pathology/surgery

The interphalangeal joint (IPJ) of the hallux has received little attention compared with the first metatarsophalangeal joint. But, the hallucal IPJ has several disorders such intra-articular fractures, dorsal dislocation, alignment disorder, and inflammatory or degenerative arthritis. Among these disorders septic arthritis of the IPJ of the hallux is rare. We report a case of sepsis of the hallucal IPJ and adjacent underlying osteomyelitis without neuropathic problem and was performed through infected soft tissue and osseous debridement, temporary antibiotic-impregnated cement spacer, and delayed intercalary allogenic fibular bone graft with K-wire fixation.
Arthritis, Infectious ; Debridement ; Dislocations ; Hallux ; Intra-Articular Fractures ; Joints ; Metatarsophalangeal Joint ; Osteoarthritis ; Osteomyelitis ; Sepsis ; Transplants

Ankylosing spondylitis (AS) is an inflammatory disease primarily affecting the spine. Osteoporosis can be a complication of AS and associated with low bone mineral density. As well, spinal fractures in the AS are usually unstable and may cause neurologic deficit at the mainly cervical region with low energy trauma. However, reports of lumbar compression fracture in AS are very rare. Thus, we report a 73-year-old male patient with osteoporotic L3 compression fracture with AS treated with kyphoplasty which has no symptom improvement with conservative treatment. Kyphoplasty is a useful procedure option in the treatment of the lumbar compression fracture in AS.
Bone Density ; Fractures, Compression ; Humans ; Kyphoplasty ; Male ; Neurologic Manifestations ; Osteoporosis ; Osteoporotic Fractures ; Spinal Fractures ; Spine ; Spondylitis, Ankylosing

BACKGROUND: To analyze and compare the clinical characteristics including bone mineral density (BMD) in a group who had operation of hip fracture with or without prior osteoporotic spinal compression fractures. METHODS: Two hundred forty patients who had undergone operation of hip fractures were evaluated, 127 patients who had with prior osteoporotic spinal compression fractures were in group I, and 113 patients without prior spinal fractures were in group II. In each group, we measured age, gender, body mass index (BMI, kg/m2), BMD (mg/cm3), type of hip fractures, concomitant diseases, presence of secondary hip fracture and history of percutaneous vertebroplasty. RESULTS: The mean age of group I was 79.4 years (male/female: 28/99) and that of group II was 77.6 years (male/female: 37/76). The mean BMI of group I was 21.3 kg/m2 and that in group II was 22.0 kg/m2. The mean BMD and T-score of group I were 41.1 mg/cm3 and -4.45 and those in group II were 51.0 mg/cm3 and -4.17 (P<0.05). The numbers of patients of neck and intertrochanter fracture of group I were 31 and 96 patients and those in group II were 61 and 52 patients. Sixty in group I and 45 in group II patients had concomitant diseases. Thirteen patients had undergone percutaneous vertebroplasty and 18 patients (7.5%) had second hip fractures. CONCLUSIONS: The hip fracture patients who had with prior osteoporotic spinal compression fractures had lower BMD compared to the hip fracture patients without previous spinal compression fractures.
Body Mass Index ; Bone Density ; Fractures, Compression ; Hip ; Hip Fractures ; Humans ; Neck ; Spinal Fractures ; Vertebroplasty

OBJECTIVES: Fracture of multiple sites can occur by minor trauma because decreased bone quality and bone density in osteoporotic patients. To investigate clinical characteristics of ankle fracture in osteoporotic patients over sixty-five years of age. MATERIALS AND METHODS: From January 2009 to December 2011, excluding distal tibial shaft and pilon fracture, 40 patients (over 65 years old) who were diagnosed the osteoporosis and observed over 6 months after ankle surgery. We measured age, gender, body mass index (BMI, kg/m2), bone mineral density (BMD, mg/cm3) and T-score through P-QCT. Type of fracture was classified into Danis-Weber and AO classification and whether or not of syndesmotic injury and concomitant disease. Surgery performed under AO principle. We investigated by wound healing, fixation failure and bone union during follow-up.
Animals ; Ankle ; Body Mass Index ; Bone Density ; Female ; Humans ; Male ; Osteoporosis ; Wound Healing ; Wound Infection

Central neurocytoma is a rare, well-differentiated neuronal tumor and is usually located in the lateral or third ventricle of young adults. Its overall prognosis is excellent with a low proliferative index. The majority of previously reported malignant variants rarely did recurred after tumor removal and regarded as benign tumor despite of histopathological malignant feature. Nevertheless, we experienced a case of malignant variant of the central neurocytoma with high proliferative index(Ki-67 labeling index >30%), which showed recurrence immediately after surgery and died within 3 months POD. Here, we describe the case with a review of the literatures.
Humans ; Neurocytoma* ; Neurons ; Prognosis ; Recurrence ; Third Ventricle ; Young Adult