STUDY DESIGN: A retrospective-based study. OBJECTIVES: To evaluate the usefulness of iliac screws in the surgical correction of sagittal imbalance by changes of spinopelvic parameters. SUMMARY OF LITERATURE REVIEW: Although reports exist regarding the fusion rates on lumbosacral fusion by iliac screws, no previous studies address the issue of changes of spinopelvic parameters on surgical correction of sagittal imbalance by iliac screws. MATERIALS AND METHODS: We analyzed a total of 23 patients who were operated on by pedicle subtraction osteotomy and posterior fusion on sagittal imbalance. Patients were divided into two groups: 1) non-iliac screw fixation and; 2) iliac screw fixation. The two groups were compared during the preoperative and postoperative stages, and the last follow-up spinopelvic parameters of two groups. RESULTS: Spinopelvic parameters, except for pelvic incidence, were corrected after surgery; some corrected values of spinopelvic parameters were lost during follow-up. There was a statistically significant difference in the last follow-up period between lumbar lordosis and pelvic tilt. Values of postoperative lumbar lordosis and pelvic tilt was similar to each other; however, during the follow-up period corrected values of spinopelvic parameters of non-iliac screw fixation group were more lost. There were no statistically significant changes in postoperative and last follow-up sacral slope and pelvic incidence. CONCLUSIONS: Sagittal imbalance could be corrected by pedicle subtraction osteotomy, and corrected values of lumbar lordosis and pelvic tilt of iliac screw fixation group could be maintained well compared to non-iliac screw fixation. Iliac screw fixation could be useful for maintenance of corrected values of spinopelvic parameters in surgical correction of sagittal imbalance.
Animals ; Follow-Up Studies ; Humans ; Incidence ; Lordosis ; Osteotomy

STUDY DESIGN: Retrospective study. OBJECTIVES: We analyzed the clinical results of thoracic myelopathy caused by ossification of yellow ligament (OYL) and to explore prognostic factors after surgical treatment. SUMMARY OF LITERATURE REVIEW: Thoracic myelopathy due to OYL is difficult to treat; surgery is considered as treatment of choice. However, studies of the clinical results and prognostic factors are few due to its rare presentation. MATERIALS AND METHODS: Twenty six patients who had surgery for thoracic myelopathy caused by OYL were evaluated from February 2002 to April 2012. We describe the analysis of the clinical results after surgery and prognostic factors. RESULTS: Modified Japanese orthopedic association (JOA) score was recorded in all patients by 5.7+/-1.3 points (range, 2-9 points) preoperatively, 7.8+/-1.7 points (range, 4-10 points) postoperatively, and 8.4+/-2.1 points (range, 5-11 points) at final follow-up. Hirabayashi recovery rate was recorded by 60.2+/-20.2% (range, 45.5-72.0%) postoperatively, 64.5+/-17.3% (range, 50.2-75.1%) at final follow-up. The Visual Analogue Scale (VAS) score was also improved by 7.6+/-1.8 points (range, 7-10 points) preoperatively, 4.5+/-1.3 points (range, 3-6 points) postoperatively, and 3.8+/-1.6 points (range, 2-5 points) at final follow-up. Both modified JOA score and VAS score improved significantly (p<0.05). In prognostic factor analysis, OYL type on CT axial image, duration of symptom, and preoperative severity of myelopathy was significant (p<0.05). CONCLUSION: We showed the effectiveness of surgery on patients who suffer from thoracic myelopathy caused by OYL and that OYL type identified by CT axial image, duration of symptom, and preoperative severity of myelopathy were significant prognostic factors.
Asian Continental Ancestry Group ; Follow-Up Studies ; Humans ; Ligaments* ; Orthopedics ; Retrospective Studies ; Spinal Cord Diseases*

BACKGROUND AND OBJECTIVES: As a prognostic factor, the association of Hashimoto's thyroiditis (HT) with papillary thyroid carcinoma (PTC) is still controversial. The aim of this study is to compare clinicopathologic parameters between PTC alone and PTC with HT patients. SUBJECTS AND METHOD: We reviewed the medical record retrospectively. 205 patients underwent thyroid surgery from January 2006 to December 2008. Among the 205 patients, 120 patients were included in this study. We compared various clinicopathologic parameters such as gender, tumor size, multifocality, lymphovascular invasion, extrathyroidal extension, central lymph node metastasis, and lateral lymph node metastasis between PTC alone and PTC with HT patients. RESULTS: 18.3% of PTC patients were associated with HT. There were no significant differences in clinocopatholgic parameters such as gender, tumor size, multifocality, lymphovascular invasion, extrathyroidal extension, central lymph node metastasis or lateral lymph node metastasis. Tumor recurrences were found in 6 out of 98 cases of PTC alone and in 3 out of 22 cases of PTC with HT. There was no significance between two groups (p=0.363). CONCLUSION: Results indicate that HT may not be associated with clinicopathologic factors in PTC.
Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroiditis*

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate clinical & radiologic significance about complications of spinopelvic fixation with iliac screw in patients with adult spinal deformity. SUMMARY OF LITERATURE REVIEW: Complications of iliac screw fixation in adult spinal deformity patients was obscure in spite of the good results of iliac screw fixation. MATERIALS AND METHODS: We analyzed 27 patients, followed over 1-year, with adult spinal deformity (lumbar degenerative kyphosis, degenerative lumbar scoliosis, flat back syndrome). The study was done for complications of iliac screw fixation by clinical and radiological evaluations. RESULTS: Post-operative iliac screw prominence were 15 cases (55.5%), iliac screw breakage was 1 case (3.7%), bursitis was 1 case (3.7%), sacroiliac joint pain were 5 cases (18.5%), halo sign around iliac screw were 23 cases (85.1%), and 3 cases (11.1%) were performed reoperation. There was no significance between halo sign and sacroiliac joint pain. CONCLUSIONS: Iliac screw fixation is a very useful operative method without severe complications on spinopelvic fixation. There are some complications of iliac screw fixation and iliac screw prominence is a most common problem, but few counterplan exits. So, further studies about reducing complication method, management protocols of iliac screw complication were needed.
Adult ; Bursitis ; Congenital Abnormalities ; Humans ; Kyphosis ; Reoperation ; Retrospective Studies ; Sacroiliac Joint ; Scoliosis

BACKGROUNDS/AIMS: The diagnosis for cystic neoplasm of pancreas is based on the morphologic criteria through imaging studies, but the pre- and postoperative diagnoses are often inconsistent. This study aims at the analysis of clinical characteristics and the results of surgical treatments. METHODS: A retrospective review was performed on 93 patients who have undergone surgery for pancreatic cystic diseases in our hospital from January 2001 to February 2013. Among them, 69 patients were confirmed as cystic neoplasms based on pathologic findings. Their clinical manifestations, diagnostic accuracy, surgical method and complications, pathologic findings were analyzed. RESULTS: Serous cystic neoplasm was the most common (n=22), followed by mucinous cystic neoplasm (n=18), intraductal papillary mucinous tumor (n=11), solid pseudopapillary tumor (n=9), neuroendocrine tumor (n=7), and cystic lymphangioma (n=2). The most common clinical symptom is abdominal pains (49.3%). Preoperative imaging studies were consistent with pathological findings in 72% of patients. Cystic fluid CEA levels of 400 ng/ml or more were reliable to detect mucin secreting tumors. Pancreatoduodenectomy was performed for 13 cases and the remaining 54 patients were treated with left-side pancreatectomy. Malignancy was found in 9 cases (13%) of mucin secreting tumors; 5 cases (27.8%) in mucinous cystic neoplasm and 4 cases (36.4%) in intraductal papillary mucinous tumor. Two of these survived without recurrences during the follow-up periods. CONCLUSIONS: Exact treatment protocols for cystic neoplasm of pancreas are not decided because tumors are found with atypical forms. Surgical management is suggested for resectable tumors because a good prognosis can be expected with proper surgery if precancerous lesions are suspected at the time of discovery.
Abdominal Pain ; Clinical Protocols ; Follow-Up Studies ; Humans ; Lymphangioma, Cystic ; Mucins ; Neoplasms, Cystic, Mucinous, and Serous ; Neuroendocrine Tumors ; Pancreas ; Pancreatectomy ; Pancreatic Cyst ; Pancreaticoduodenectomy ; Prognosis ; Recurrence ; Retrospective Studies

STUDY DESIGN: Retrospective study. OBJECTIVES: As we analyze the incidence and the risk factor for proximal junctional problem after surgical treatment of lumbar degenerative sagittal imbalance, we want to contribute to reducing the junctional problem of surgical treatment of lumbar degenerative sagittal imbalance. SUMMARY OF LITERATURE REVIEW: Surgical treatment of degenerative spinal deformity has increased. Rigid fixation was a risk factor for degenerative change of adjacent segment and failure, and it remains a big challenge for the junctional problem of surgical treatment. However, research on the correlation with risk factors is rare. MATERIALS AND METHODS: Forty four patients (mean age 66.5; range, 50-74) who had surgery due to lumbar degenerative sagittal imbalance were evaluated by the risk factor associated with junctional problems from January, 2005 to December, 2011. The risk factors were analyzed by surgical factor (proximal fusion level, using iliac screw, correction or undercorrection of lumbar lordosis compared with pelvic incidence) and patient factor (age, bone marrow density, body mass index). RESULTS: Junctional problems occurred in 18 patients (41%) out of 44 patients. Among these problems, there were 10 cases of fractures, 8 cases of junctional kyphosis, and 4 cases of proximal screw pull out. . Among the risk factors, only the correction or undercorrection of lumbar lordosis compared with pelvic incidence in surgical factor was statistically significant. Other surgical factors and patient factors were not statistically significant. CONCLUSIONS: Junctional problems after a surgical treatment of lumbar degenerative sagittal imbalance were common. However, we could not know the exact risk factor of junctional problems except the degree of correction of lumbar lordosis compared with pelvic incidence, because most of the risk factors were not statistically significant. So, further evaluations of the risk factor of lumbar degenerative sagittal imbalance are required.
Animals ; Bone Marrow ; Congenital Abnormalities ; Humans ; Incidence ; Kyphosis ; Lordosis ; Retrospective Studies ; Risk Factors*

BACKGROUND AND OBJECTIVES: Differentiated thyroid cancer (DTC) in children and adolescents is an advanced type of disease that has frequent recurrence and metastasis. But DTC in children and adolescents has a more favorable outcome than those in adults. We report the clinical features and treatment outcomes in children and adolescents who have undergone surgeries. SUBJECTS AND METHOD: We studied 16 patients younger than 21 years old who were diagnosed as DTC from August 1995 to January 2011. We retrospectively reviewed for the following factors: clinical features, tumor size, multifocality, pathologic type, regional or distant metastasis, recurrence, complications, extent of surgery, postoperative I-131 therapy with medical records, imaging studies, and pathologic reports. RESULTS: The mean follow-up periods were 87 months. As an initial operation, a total thyroidectomy alone was performed on 4 patients, central compartment neck dissection on 7 patients, a modified radical neck dissection on 5 patients. On the pathologic reports, observed were 14 papillary thyroid cancer patients, 2 follicular thyroid cancer patients. Extrathyroidal extension was observed in 10 patients. Cervical lymph node involvement was noted in 11 patients. Two patients exhibited local lymph node recurrences, and one patient distant metastasis in the lung. After an additional operation and radioactive iodine therapy, they are alive at the present time, without recurrence. CONCLUSION: Even with the limited number of cases in our study, we found that pediatric DTC has common extrathyroidal extension and lymph node metastasis. Careful surgical approach may protect postoperative complications. Regular follow up can detect recurrence earlier and could ensure disease free survival in pediatric DTC.
Adolescent ; Adult ; Child ; Dietary Sucrose ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Iodine ; Lung ; Lymph Nodes ; Medical Records ; Neck Dissection ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Treatment Outcome

BACKGROUNDS/AIMS: Choledochal cyst of the bile duct is characterized by cystic dilatation of the intra- or extrahepatic bile ducts. It is a relatively uncommon disease and there is still much controversy regarding its etiology as being congenital or acquired. METHODS: The medical records of 60 patients who underwent surgical treatments for choledochal cyst between April 1995 and April 2009 at the Gachon University Gil Hospital were reviewed retrospectively. To compare the clinical characteristics, patients under 19 years of age were grouped into children and the others were grouped into adults. RESULTS: Of the overall 60 patients, 24 were grouped into children and 36 were grouped into adults. Female predominance was common in both groups (M : F=1 : 6.5). The most common clinical symptom was abdominal pain (73.3%) in both groups. Children had remarkable jaundice (33.3% vs. 0%) and gastrointestinal symptoms including nausea and vomiting. Fever and chills were more common in children because of the associated complications of cholangitis. According to the Todani classification, type I was the most common form of choledochal cyst in both groups, and type IVa was significantly more common in children than adults (45.3% vs. 16.7%). Thirty patients (50%) had anomalous pancreaticobiliary ductal union which was confirmed by preoperative imaging studies or intraoperative cholangiography. All patients except for one child underwent cyst excision with hepaticojejunostomy. CONCLUSIONS: There was no significant difference in the clinical characteristics of choledochal cysts between children and adults. However, combined diseases especially bile duct malignancy were common in aged patients, early detection and more aggressive surgery is necessary for patients with choledochal cysts.
Abdominal Pain ; Adult ; Aged ; Bile Ducts ; Bile Ducts, Extrahepatic ; Child ; Chills ; Cholangiography ; Cholangitis ; Choledochal Cyst ; Dilatation ; Female ; Fever ; Humans ; Jaundice ; Medical Records ; Nausea ; Retrospective Studies ; Vomiting

STUDY DESIGN: A retrospective study about spinal intradural tumor. OBJECTIVES: We analyzed clinical symptom, findings of MRI, and surgical outcome of spinal intradural tumor. SUMMARY OF LITERATURE REVIEW: Intradural tumors are not commonly reported and they show non-specific clinical features. MATERIALS AND METHODS: In this study, 18 patients who underwent surgical treatment and radiologically and pathologically diagnosed as spinal intradural tumor from 1997 to 2009 were reviewed. We evaluated pain, neurological symptoms, location of tumor as well as degrees of signal intensity and its enhancement of MRI(T1 and T2). And clinical outcomes were analyzed according to Klekamp-Samii scoring system and Visual Analogue Scale(VAS). RESULTS: All patients were clinically suffered from back pain and radiating pain of lower extremity including 3 patients with neurological symptoms. We radiologically found single tumor in 16 cases and masses more than two lesion in 2 cases. 1 case was located on cord level(T7), 14 cases cauda equine level, and 3 cases sacral level. We performed laminectomy in 18 cases and posterior instrumentation was applied to 8 cases. In clinical features, mean Klekamp-Samii score was improved from 21.6 to 23.5(p<0.05) and VAS was recovered from 5.2 to 3.0 (p<0.05). CONCLUSIONS: Spinal intradural tumor has non-specific clinical symptoms. Therefore we should perform MRI to find intradural tumor and active management including surgical treatment should be performed due to clinically good results.
Back Pain ; Humans ; Laminectomy ; Lower Extremity ; Retrospective Studies

BACKGROUND/AIMS: Pancreas transplantation (PT) as the ultimate treatment for insulin-dependent diabetes has been the subject of debate clinically. Marked improvements in patient and graft survival, and decreases in postoperative morbidity have been achieved due to technical refinements, improved immunosuppressants, and better postoperative management. Here, we report our 18-year experience with PT performed at our institute. METHODS: All recipients who underwent deceased donor or living donor PT between July 1992 and December 2009 were included. We reviewed the medical records, including operation records, progress, and laboratory findings during follow-up. Graft and patient survival were analyzed using the Kaplan-Meier method. RESULTS: In total, 119 cases of pancreas transplantation were performed between July 1992 and December 2009 at our institute. Indications for pancreas transplantation were type I diabetes in 93 (78.2%) patients and type II diabetes in 16 (13.4%) patients. The transplanted pancreas was obtained from a deceased donor in 108 cases (90.8%) and a living donor in 11 cases (9.2%). Median follow-up duration was 39.3 months posttransplantation (range 0~176 months). Overall graft survival rates at 1, 5, and 10 years were 81.6%, 63.4%, and 57.1%, respectively. Following the introduction of tacrolimus as an immunosuppressant in 1999, graft survival at 1, 5, and 10 years was 89.1%, 72.9%, and 66.2%, and overall patient survival at 1, 5, and 10 years was 93.0%, 86.0%, and 86.%, respectively. CONCLUSIONS: Considering the quality of life and long-term patient survival, PT is an effective treatment strategy in non-obese diabetic patients requiring insulin regardless of the type of diabetes.
Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppressive Agents ; Insulin ; Korea ; Living Donors ; Medical Records ; Pancreas ; Pancreas Transplantation ; Quality of Life ; Tacrolimus ; Tissue Donors ; Transplants