Background: The conventional magnetic resonance imaging (MRI) grading system for foraminal stenosis (FS), known as the Lee classification, was introduced in 2010 and is widely utilized in clinical practice. Previous studies have reported that the conventional grading system for FS lacks prediction ability for surgical treatment. The purpose of this study was to develop a novel MRI grading system for lumbar FS with improved prediction ability for surgical treatment by incorporating facet effusion to indicate segmental instability. Methods: We retrospectively reviewed patients diagnosed with lumbar FS between 2011 and 2017 who had a follow-up period of at least 5 years. The FS severity was assessed using a conventional MRI grading system developed by Lee et al. We recorded whether the patient underwent surgical treatment for FS during the follow-up period and the time from the initial diagnosis to surgery. Survival analysis using a Kaplan-Meier curve and log-rank test was performed to verify the impact of FS severity on the surgical treatment. We performed additional survival analysis after modifying the grading system by incorporating the presence of excessive facet joint effusion assessed using axial MRI. We also compared the discrimination ability of the modified and conventional grading systems using Uno’s concordance index (C-index). Results: In total, 235 patients with a mean age of 63.7 years were included in this study. During the mean follow-up period of 8.1 years, 63 patients underwent surgical treatment for FS. The conventional grading system revealed no significant difference in survival between the grade 2 and 3 groups (p = 0.104). Conversely, the modified grading system revealed a significant difference in survival between the new grade 2 and 3 groups (p < 0.001). After modification, the discrimination ability, assessed using Uno’s Cindex, significantly improved from 0.69 to 0.73. Conclusions The Facet Effusion-Incorporating Grading System, which adds excessive facet joint effusion to the conventional MRI grading framework, demonstrated improved predictive value for surgical treatment and better discriminatory ability compared with the original system.

The dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in Korea. Obesity is defined as a body mass index > or =25 kg/m2 in Korea. Current estimates are that 32.8% of adults are obese: 36.1% of men and 29.7% of women. The prevalence of being overweight and obese in national surveys is increasing steadily. Early detection and the proper management of obesity are urgently needed. Weight loss of 5% to 10% is the standard goal. In obese patients, control of cardiovascular risk factors deserves the same emphasis as weight-loss therapy. Since obesity is multifactorial, proper care of obesity requires a coordinated multidisciplinary treatment team, as a single intervention is unlikely to modify the incidence or natural history of obesity.
Adult ; Body Mass Index ; Comorbidity ; Female ; Humans ; Incidence ; Korea ; Male ; Natural History ; Obesity* ; Overweight* ; Prevalence ; Risk Factors ; Weight Loss

BACKGROUND AND PURPOSE: There is little information available about the effects of Emergency Medical Service (EMS) hospital notification on transfer and intrahospital processing times in cases of acute ischemic stroke. METHODS: This study retrospectively investigated the real transfer and imaging processing times for cases of suspected acute stroke (AS) with EMS notification of a requirement for intravenous (IV) tissue-type plasminogen activator (t-PA) and for cases without notification. Also we compared the intra-hospital processing times for receiving t-PA between patients with and without EMS prehospital notification. RESULTS: Between December 2008 and August 2009, the EMS transported 102 patients with suspected AS to our stroke center. During the same period, 33 patients received IV t-PA without prehospital notification from the EMS. The mean real transfer time after the EMS call was 56.0+/-32.0 min. Patients with a transfer distance of more than 40 km could not be transported to our center within 60 min. Among the 102 patients, 55 were transferred via the EMS to our emergency room for IV t-PA. The positive predictive value for stroke (90.9% vs. 68.1%, p=0.005) was much higher and the real transfer time was much faster in patients with an EMS t-PA call (47.7+/-23.1 min, p=0.004) than in those without one (56.3+/-32.4 min). The door-to-imaging time (17.8+/-11.0 min vs. 26.9+/-11.5 min, p=0.01) and door-to-needle time (29.7+/-9.6 min vs. 42.1+/-18.1 min, p=0.01) were significantly shorter in the 18 patients for whom there was prehospital notification and who ultimately received t-PA than in those for whom there was no prehospital notification. CONCLUSIONS: Our results indicate that prehospital notification could enable the rapid dispatch of AS patients needing IV t-PA to a stroke centre. In addition, it could reduce intrahospital delays, particularly, imaging processing times.
Emergencies ; Emergency Medical Services ; Humans ; Retrospective Studies ; Stroke ; Tissue Plasminogen Activator

OBJECTIVE: Hydrocephalus is a common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and patients who develop hydrocephalus after SAH typically have a worse prognosis than those who do not. This study was designed to identify factors predictive of shunt-dependent chronic hydrocephalus among patients with aneurysmal SAH, and patients who require permanent cerebrospinal fluid diversion. METHODS: Seven-hundred-and-thirty-four patients with aneurysmal SAH who were treated surgically between 1990 and 2006 were retrospectively studied. Three stages of hydrocephalus have been categorized in this paper, i.e., acute (0-3 days after SAH), subacute (4-13 days after SAH), chronic (> or =14 days after SAH). Criteria indicating the occurrence of hydrocephalus were the presence of significantly enlarged temporal horns or ratio of frontal horn to maximal biparietal diameter more than 30% in computerized tomography. RESULTS: Overall, 66 of the 734 patients (8.9%) underwent shunting procedures for the treatment of chronic hydrocephalus. Statistically significant associations among the following factors and shunt-dependent chronic hydrocephalus were observed. (1) Increased age (p < 0.05), (2) poor Hunt and Hess grade at admission (p < 0.05), (3) intraventricular hemorrhage (p < 0.05), (4) Fisher grade III, IV at admission (p < 0.05), (5) radiological hydrocephalus at admission (p < 0.05), and (6) post surgery meningitis (p < 0.05) did affect development of chronic hydrocephalus. However the presence of intracerebral hemorrhage, multiple aneurysms, vasospasm, and gender did not influence on the development of shunt-dependent chronic hydrocephalus. In addition, the location of the ruptured aneurysms in posterior cerebral circulation did not correlate with the development of shunt-dependent chronic hydrocephalus. CONCLUSION: Hydrocephalus after aneurysmal SAH seems to have a multifactorial etiology. Understanding predisposing factors related to the shunt-dependent chronic hydrocephalus may help to guide neurosurgeons for better treatment outcomes.
Aneurysm ; Aneurysm, Ruptured ; Animals ; Cerebral Hemorrhage ; Hemorrhage ; Horns ; Humans ; Hydrocephalus ; Meningitis ; Prognosis ; Retrospective Studies ; Subarachnoid Hemorrhage ; Ventriculoperitoneal Shunt

BACKGROUND: Recently, the incidence of cardiovascular diseases has increased in Korea. Hypercho-lesterolemia is a major risk factor for cardiovascular diseases. Atorvastatin (Lipitor(R)) is prescribed for the treatment of hyperlipidemia in Korea, but its effect has not been studied. Therefore, we investigated the lipid lowering effect of atorvastatin in Koreans. METHODS: This study included 82 hypercholesterolemic patients who visited the Department of Family Practice of Ajou University Hospital from January 1, 2000 to December 31, 2001. The mean age of the subjects was 47.8 years in the range of 27 to 66 years. Our study included 41 controls and 41 subjects who were administered atorvastatin 20 mg daily for 3 months. Fasting serum lipid levels were measured at baseline and at 3 months. Specific dietary and exercise interventions were not instructed. RESULTS: At 3 months, the serum total cholesterol and LDL were significantly lower in atorvastatin group than in the control group (Total cholesterol; -5.5+/-16.7%, vs 25.5+/-15.8%, P<0.05, LDL cholesterol; 1.4+/-28.5%, vs -30.1+/-28.9%, P<0.05). The serum triglyceride in atorvastain group showed no significant difference relative to the controls (Control: -5.8+/-34.2%, Atorvastatin: -3.5+/-54.8%, P=0.81). But, Serum triglyceride level decreased by -14.3+/-33.2% in the control and -39.0+/-23.2% in the atorvastatin group among the patients whose baseline triglyceride level was over 200 mg/dl (P<0.05). There was no significant differences in HDL-cholesterol (Control: 3.0+/-22.6%, ATORVASTATIN: -0.9+/-18.8%, P=0.38). The effect of atorvastatin was not influenced by age, sex, BMI and other risk factors. CONCLUSION: Atorvastatin lowered significantly the serum total cholesterol, LDL and triglycerides in Korea. Regardless of age, sex, BMI, but had no effect on HDL level.
Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Family Practice ; Fasting ; Humans ; Hypercholesterolemia* ; Hyperlipidemias ; Incidence ; Korea ; Risk Factors ; Triglycerides

Henoch-Schonlein purpura is an immunologically mediated systemic leukocytoclastic vasculitis of small vessels that is characterized by symmetric nontraumatic, nonthrombocytopenic, painless palpable purpura on the lower extremities and buttock, arthralgias on usually the knees and ankles, gastrointestinal symptoms and glomerulonephritis. Although the jejunum and ileum are most frequently affected, any portion of gastrointestinal tracts may be involved. Generally, gastrointestinal manifestations of Henoch-Schonlein purpura are the edematous wall of involved bowel, submucosal hemorrhage and erosion. We experienced a 56-year-old man with Henoch-Schonlein purpura who initially presented acute abdominal pain with portal vein and superior mesenteric vein thrombosis.
Abdominal Pain ; Ankle ; Arthralgia ; Buttocks ; Gastrointestinal Tract ; Glomerulonephritis ; Hemorrhage ; Humans ; Ileum ; Jejunum ; Knee ; Lower Extremity ; Mesenteric Veins* ; Middle Aged ; Portal Vein* ; Purpura ; Purpura, Schoenlein-Henoch* ; Thrombosis* ; Vasculitis ; Venous Thrombosis

The report of massive intratumoral hemorrhage from vestibular schwannoma is rare. A 66-year-old female who had suffered from disturbance of hearing for one year developed severe headache and dizziness. Brain MRI showed crescent shaped mass in the left cerebellopontine angle. A left suboccipital approach revealed an 3X3cm-sized encapsulated mass. The tumor was totally extirpated together with clot. Histologically the tumor was schwannoma with massive hemorrhage. Postoperative course was uneventful. The authors report the rare case of vestibular schwannoma presenting with intratumoral hemorrhage with review of possible pathophysiology and associated factor.
Aged ; Brain ; Cerebellopontine Angle ; Dizziness ; Female ; Headache ; Hearing ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Neurilemmoma ; Neuroma, Acoustic*

This study examined the human fibroblasts cell attachment to commercially pure titanium surface which had been instrumented by 3 types of periodontal instruments. Commercially pure titanium plates were uniformly scaled using plastic, stainless steel, titanium curette. these all experimental groups 65 undirectional strokes with the designated curettes. Alteration of the surfaces due to instrumentation was evaluated by Form Talysurf(R) and reported as Ra value(mean surface roughness). Then other experimental groups were immersed in a cell suspension of human gingival fibroblasts(1x10(5) cell/ml). After 3 days of culture, cell attachment and morphology was observed by SEM, and attached cell were counted by Hemocytometer. A significant difference in mean Ra value was observed for surface instrumented by metal curette compared to either control surface or surface instrumented by the plastic curette(P<0.01). No stastically significant difference was noted between control surface and those instrumented by the plastic curette. SEM observation showed that cell morphology and attachment to the commercially pure titanium plate was similar appearance on the all experimental groups. Experimental groups instrumented by titanium curette and stainless steel curette were more attached cell number than control group, but experimental group instrumented by plastic curette were similar with control groups(P<0.01). In summary, metal curette produced an significant alteration of the commercially pure titanium surface and more favorable surface topography for cell attachment. Otherwise plastic curette was insignificantly altered the commercially pure titanium surface(P<0.01).
Cell Count ; Fibroblasts* ; Humans* ; Plastics ; Stainless Steel ; Stroke ; Titanium*