Methods: Ambulatory patients who underwent single-level PVP for thoracolumbar OVF with a follow-up of at least 24 months were retrospectively reviewed. The patients were divided into two groups depending on the presence of symptomatic recollapse at the cemented vertebra: (1) recollapsed (RC) group and (2) noncollapsed (NC) group. The patient characteristics and radiographic measurements associated with sagittal imbalance were analyzed at each follow-up visit. Results: Overall, 134 patients (RC group, n=28; NC group, n=106) were enrolled. The mean fracture-free interval was 3.2 months (range, 1.2–25.1 months). The multivariate binary logistic regression analysis identified low bone mineral density (p =0.047), degree of dynamic mobility within the vertebra (p =0.025), and sagittal imbalance as significant risk factors for recollapse (p =0.013; odds ratio, 5.405). The progression of sagittal imbalance and thoracolumbar kyphosis (T10–L2) was more significant in the RC and sagittal imbalance groups than in the NC group (both p =0.000). Conclusions Sagittal imbalance, lower bone mineral density, and dynamic mobility within the vertebra are associated with the recollapse of cemented vertebrae following PVP. Sagittal imbalance, rather than local kyphosis or thoracolumbar kyphosis, is particularly significant in that it results in more progressive collapse and sagittal deformity and is accompanied by substantial back pain and neurological deficits. Therefore, a stricter and more active management, including anti-osteoporosis medication, is required for the treatment of OVF with sagittal imbalance of the spine.

Background: The purpose of this study was to compare clinical outcomes and complications of primary and revision surgery in patients with adult spinal deformity (ASD) accompanied by sagittal imbalance. Revision surgery has been associated with poor clinical outcomes and increased risk of complications. Previous studies comparing primary versus revision surgery included data for a wide variety of diseases and ages, but few investigated patients with ASD with sagittal imbalance undergoing anterior and posterior combined surgery. Methods: Retrospective cohort analysis of prospectively collected data. We identified 60 consecutive patients with ASD combined with sagittal imbalance who underwent primary or revision surgery; of these, 6 patients were excluded for lack of a minimal 2-year follow-up. Patients’ surgical and radiological data, clinical outcomes, and complications were reviewed. Results: There were 30 patients in the primary group and 24 patients in the revision group. Patient characteristics, including the prevalence of sarcopenia, were similar between the two groups. Pedicle subtraction osteotomy was performed more frequently in the revision group although there was no statistically significant difference between groups. The primary group had more proximal junctional problems, whereas the revision group had more rod breakage (p < 0.05). There were significant improvements in clinical outcomes in both groups when the preoperative and 2-year postoperative values were compared. The Oswestry disability index and visual analog scale score were similar in both groups 2 years postoperatively. Conclusions Considering the greater pain and disability at the time of the revision procedure, revision patients benefited more from surgery at the 2-year follow-up than the primary surgery patients. Complication rates were similar between the groups except for proximal junctional problems and rod breakage. Therefore, revision surgery should not be avoided in the treatment of ASD patients with sagittal imbalance.

Background: The purpose of this study was to compare clinical outcomes and complications of primary and revision surgery in patients with adult spinal deformity (ASD) accompanied by sagittal imbalance. Revision surgery has been associated with poor clinical outcomes and increased risk of complications. Previous studies comparing primary versus revision surgery included data for a wide variety of diseases and ages, but few investigated patients with ASD with sagittal imbalance undergoing anterior and posterior combined surgery. Methods: Retrospective cohort analysis of prospectively collected data. We identified 60 consecutive patients with ASD combined with sagittal imbalance who underwent primary or revision surgery; of these, 6 patients were excluded for lack of a minimal 2-year follow-up. Patients’ surgical and radiological data, clinical outcomes, and complications were reviewed. Results: There were 30 patients in the primary group and 24 patients in the revision group. Patient characteristics, including the prevalence of sarcopenia, were similar between the two groups. Pedicle subtraction osteotomy was performed more frequently in the revision group although there was no statistically significant difference between groups. The primary group had more proximal junctional problems, whereas the revision group had more rod breakage (p < 0.05). There were significant improvements in clinical outcomes in both groups when the preoperative and 2-year postoperative values were compared. The Oswestry disability index and visual analog scale score were similar in both groups 2 years postoperatively. Conclusions Considering the greater pain and disability at the time of the revision procedure, revision patients benefited more from surgery at the 2-year follow-up than the primary surgery patients. Complication rates were similar between the groups except for proximal junctional problems and rod breakage. Therefore, revision surgery should not be avoided in the treatment of ASD patients with sagittal imbalance.

Methods: Patients who completed a questionnaire on back-pain between October 2016 and October 2017 were enrolled in this study. Appendicular skeletal muscle index (ASMI), cross-sectional area (CSA) index, fatty infiltration (FI) rate of the paraspinal muscles, and lumbar extensor strength index (LESI) were measured and compared between no back-pain and back-pain group. Correlations between LESI and ASMI, CSA index, and FI rate were analyzed. The back-pain group was further divided according to ASMI into sarcopenia and non-sarcopenia subgroups and by our newly developed back muscle degeneration risk index based on correlation coefficients between LESI and CSA index, FI rate. Differences in ASMI, CSA index, FI rate, LESI, and Visual Analog Scale (VAS) score between subgroups were analyzed. Results: The ASMI, CSA index, FI rate, and LESI differed significantly between back-pain and pain-free groups. The LESI demonstrated the strongest correlation with FI rate. There were no significant differences in VAS score and back muscle degeneration index in the back-pain group when divided according to the presence of sarcopenia. However, there was a significant difference in VAS score between back-pain patients when classified according to high and low back muscle degeneration risk index. Conclusions We suggest that the degree of back pain is more strongly associated with back muscle degeneration than with sarcopenia. This back muscle degeneration risk index, reflecting both back muscle morphology and function, could be a useful parameter for evaluation of back pain and muscle degeneration.

PURPOSE: Spinopelvic dissociation which occurs by high energy trauma with associated fractures is rare. Treatment is difficult and only a few studies on treatment of spinopelvic dissociation have been reported. Therefore we evaluated spinopelvic dissociation patients treated with iliac screw. MATERIALS AND METHODS: We analyzed patients who underwent surgery using an iliac screw from 2005 to 2010. Preoperative radiologic classification was performed using the level of the transverse fracture line of the sacrum, shape of the fracture, and Roy-Camille classification. Neurologic evaluation was performed using Gibbons classification. Eleven patients underwent surgery with a pedicle screw in 1 level (L5 to S1) and bilateral iliac screws were added. RESULTS: A total of 11 patients were included in this study. The level of the transverse fracture line of the sacrum was mainly at S2, and there were mostly type 3 or 4 in Roy-Camille classification. Bony union was checked in 11 patients without metal failure. Six of 7 patients were treated by posterior decompression. Among them, 5 patients recovered from neurological deficit and 1 patient still had a sensory disorder on both lower legs. CONCLUSION: The more displacement of fracture, the more neurologic deficit occurred. In addition, we think that aggressive surgical treatment for spinopelvic dissociation should be considered, because a good clinical result was achieved with 1 level (L5 to S1) fixation and bilateral iliac screw fixation.
Classification ; Decompression ; Humans ; Hylobates ; Leg ; Neurologic Manifestations ; Pedicle Screws ; Sacrum ; Sensation Disorders

OBJECTIVE: To determine the feasibility and safety of performing laparoscopically assisted vaginal hysterectomy (LAVH) for uteri weighing 500 g or more and evaluate the advantages and complications of LAVH. METHODS: A subpopulation of 30 women with uteri weighing 500 g or more from group of 412 patients undergoing LAVH between Mar, 2003 to Feb, 2005. We reviewed medical records and analyzed these cases about age, parity, history of previous abdominal surgery, preoperative indications, postoperative pathologic diagnosis, mean operation times, weight of extracted uterus, change of hemoglobin, hospital stay, and complications. RESULTS: The mean age was 44.8+/-3.88 years. The mean parity was 1.78+/-0.76. Previous operation history was 16 cases (53.3%). The most common indication of operation was palpable abdominal mass. The most common pathologic diagnosis was leiomyoma. The mean operation time was 126.40+/-39.30 minutes. The mean weight of uterus was 621.23+/-107.28 g. The mean hemoglobin change was 1.57+/-1.14 g/dL. The mean hospital stay was 3.74+/-0.88 days. The only complication of operation was superficial trocar site bleeding (1 case). CONCLUSION: LAVH is a safe and effective alternative to total abdominal hysterectomy of the uteri weighing 500 g or more in selective groups.
Diagnosis ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Leiomyoma ; Length of Stay ; Medical Records ; Parity ; Surgical Instruments ; Uterus*

OBJECTIVE: To evaluate the indications, advantages and complications of laparoscopically assisted vaginal hysterectomy (LAVH), retrospectively. METHODS: From Mar. 2003 to Feb. 2004, clinical trials of LAVH (n=154) were performed in the Department of Obstetrics and Gynecology, Kangbuk Samsung Medical Center, School of Medicine, University of Sungkyunkwan, Seoul, Korea. Medical records of patients who underwent LAVH were reviewed. The results were evaluated according to characteristics of patients, history of previous abdominal surgery, preoperative surgical indications, postoperative diagnosis, mean operation times, weight of uterus, change of hemoglobin, hospital stay, associated diseases, concomitant procedures and complications. RESULTS: The mean age was 46.09 +/- 6.67 years. The mean parity was 2.08 +/- 0.94. Tubal ligation, vaginal bleeding, leiomyoma was the most common previous abdominal surgery, preoperative surgical indication, and postoperative diagnosis, respectively. The mean operation time was 130.66 +/- 67.68 minutes. The mean uterine weight was 259.27 +/- 123.48 gm. The mean hemoglobin change was 1.61 +/- 1.12 g/dL. The mean hospital stay was 3.44 +/- 1.83 days. The complication rate was 3.2% (5 cases); bladder injury (3 cases) being the most common complication. CONCLUSION: LAVH appears to be beneficial in many aspects. The further development of laparoscopic instruments and skills will reduce limitations and complications of LAVH and will hopefully allow the utilization of this technique to expand to include other clinical indications and concomitant procedures.
Diagnosis ; Female ; Gynecology ; Humans ; Hysterectomy, Vaginal* ; Korea ; Leiomyoma ; Length of Stay ; Medical Records ; Obstetrics ; Parity ; Retrospective Studies ; Seoul ; Sterilization, Tubal ; Urinary Bladder ; Uterine Hemorrhage ; Uterus

Malaria is a major parasitic disease in tropical areas. Three to five hundred million people suffer from the disease and it kill a million people per year. Blood smear observation was developed for the diagnosis of malaria, but the examination needs skilled experts and exact diagnosis is time consuming. A kit based on immunochromatography can be a reliable and rapid method for clinical diagnosis, even in the hands of inexperienced personnel. However, all such currently developed kits can only diagnose P. falciparum malaria. In our previous report, the C-terminal region of P. vivax merozoite surface protein 1 (PvcMSP) was cloned and expressed in E. coli. In the present study, we developed an immunochromatographic kit using this PvcMSP for the diagnosis of specific antibody to P. vivax malaria in serum samples. The kit was used to examine sera from vivax malaria patients and non-malaria-infected person and the test showed 100% sensitivity (78/78) and 98.3% specificity (58/59). This result demonstrated that the immunochromatographic kit for P. vivax antibody detection is applicable for the rapid and precise diagnosis of P. vivax malaria.
Animals ; Antibodies, Protozoan/*analysis ; *Chromatography ; Human ; *Immunologic Techniques ; Korea ; Malaria, Vivax/*parasitology ; Plasmodium vivax/*immunology ; *Reagent Kits, Diagnostic/*standards

Henoch-Shonlein(H-S) purpura, or anaphylactoid purpura is a hypersensitivity vasculitis characterized by palpable purpura usually on buttock and low extremities; arthralgia mostly polyarhtralgia in the absence of frank arthritis; gastraintestinal involvement with colicky abdominal pain, nausea, vomiting, diarrhea, constipation and bleeding; and renal involvement, manifested chiefly by hematuria and proteinuria. Gastrointestinal involvement is seen in 70 percent of pediatric patients and one third of adult patients. Any portion of the gastrointestinal tract distal to the esophagus maybe involved, but most frequently affected sites are jejunum and ileum. We report one case of H-S purpura with duodenal involvement observed in 16, male patient.
Abdominal Pain ; Adult ; Arthralgia ; Arthritis ; Buttocks ; Constipation ; Diarrhea ; Esophagus ; Extremities ; Gastrointestinal Tract ; Hematuria ; Hemorrhage ; Humans ; Ileum ; Jejunum ; Male ; Nausea ; Proteinuria ; Purpura* ; Purpura, Schoenlein-Henoch ; Vasculitis, Leukocytoclastic, Cutaneous ; Vomiting