Methods: Patients with congenital scoliosis who underwent SSPPCF using a pedicle screw system were reviewed. We identified the following three surgical indications: (1) hemivertebra or wedge vertebra over the thoracic or thoracolumbar region with structural lumbar curves, (2) hemivertebra or wedge vertebra at the lumbar region with significant pelvic obliquity or sacral slanting, and (3) mixed or complex congenital scoliosis. The demographic, perioperative, and radiographic data of these patients were collected. Results: Thirty-four patients were reviewed. The mean patient age was 14.6±3.4 years. There were 13 hemivertebrae, three wedged vertebrae, two butterfly vertebrae, three hemivertebrae with butterfly vertebra, eight unsegmented bars, and five multiple complex lesions. The average surgical duration was 219.4±68.8 minutes. The average blood loss was 1,208.4±763.5 mL. Seven patients required allogeneic blood transfusion. The mean hospital stay duration was 6.1±2.5 days. The complication rate was 11.8% (4/34): one patient had severe blood loss, one had rod breakage, and two had distal adding-on. The Cobb angle reduced from 65.9°±17.4° to 36.3°±15.3° (p<0.001) with a correction rate (CR) of 44.8%±17.4%. The regional kyphotic angle decreased from 39.9°±20.5° to 27.5°±13.9° (p=0.001) with a CR of 19.3%±49.6%. Radiographic parameters (radiographic shoulder height, clavicle angle, T1 tilt, cervical axis, pelvic obliquity, coronal balance, and apical vertebral translation) showed significant improvement postoperatively. Conclusions SSPPCF was a feasible option for adolescent patients with congenital scoliosis who were skeletally matured.

Methods: A total of 30 sets of images, including plain radiographs, computed tomography scans, and magnetic resonance imaging scans, were randomly selected from our hospital patient database. All patients had undergone deformity correction surgery for kyphosis. Twelve spine surgeons from the Asia-Pacific region (six different countries) independently evaluated and classified the deformity types and proposed their surgical recommendations. This information was then compared with standard deformity classification and surgical recommendations. Results: The kappa coefficients for the classification were as follows: 0.88 for type 1A, 0.78 for type 1B, 0.50 for type 2B, 0.40 for type 3A, 0.63 for type 3B, and 0.86 for type 3C deformities. The overall kappa coefficient for the classification was 0.68. Regarding the repeatability of osteotomy recommendations, kappa values were the highest for Ponte’s (Schwab type 2) osteotomy (kappa 0.8). Kappa values for other osteotomy recommendations were 0.52 for pedicle subtraction/disc-bone osteotomy (Schwab type 3/4), 0.42 for vertebral column resection (VCR, type 5), and 0.30 for multilevel VCRs (type 6). Conclusions Excellent accuracy was found for types 1A, 1B, and 3C deformities (ends of spectrum). There was more variation among surgeons in differentiating between one-column (types 2A and 2B) and two-column (types 3A and 3B) deficiencies, as surgeons often failed to recognize the radiological signs of posterior column failure. This failure to identify column deficiencies can potentially alter kyphosis management. There was excellent consensus among surgeons in the recommendation of type 2 osteotomy; however, some variation was observed in their choice for other osteotomies.

BACKGROUND: Dyspnea and a limitation in exercise performance are important cause of disability in patients with chronic obstructive pulmonary disease (COPD). A depleted nutritional state is a common problem in pati ents with a severe degree of chronic airflow limitation. This study was carried out to assess the factors determining the maximum exercise capacity in patients with COPD. METHODS: The resting pulmonary function, nutritional status, and maximum exercise performance was assessed in 83 stable patients with moderate to severe COPD. The nutritional status was evaluated by bioelectrical impedance analysis. Maximum exercise performance was evaluated by maximum oxygen uptake(VO2max). RESULTS: Among the 83 patients, 59% were characterized by nutritional depletion. In the delpleted group, a significantly lower peak expiratory flow rate(p<0.05), Kco(p<0.01) and maximum inspiratory pressure(p<0.05), but a significantly higher airway resistance(p<0.05) was observed. The maximum oxygen uptake and the peak oxygen pulse were lower in the depleted group. The VO2max correlated with some of the measures of the body composition : fat-free mass (FFM), fat mass (FM), body mass index(BMI), intracellular water index (ICW index), and pulmonary function: forced vital capacity(FVC), forced inspiratory vital capacity(FIVC), diffusion capacity(DLCO) : or maximum respiratory pressure: maximum inspiratory pressure(PImax), maximum expiratory pressure(PEmax). Stepwise regression analysis demonstrated that the FFM, DLCO and FIVC accounted for 68.8% of the variation in the VO2max. CONCLUSIONS: The depletion of the FFM is significant factor for predicting the maximum exercise performance in patients with moderated to severe COPD.
Body Composition ; Diffusion ; Dyspnea ; Electric Impedance ; Humans ; Nutritional Status ; Oxygen ; Pulmonary Disease, Chronic Obstructive*

Intraoperative antegrade colonic irrigation for single stage procedure in left colon cancer obstruction is a preferred technique recently however, synchronous pathology cannot be detected. A new device that enables easy intraoperative irrigation and colonoscopy before resection of tumor was devised. PURPOSE: To evaluate the efficacy of the new device for single stage procedure in left colon cancer obstruction. METHODS: The new device (NICI; MITech co., Ltd, Seoul, Korea) consists of a Y-shaped teflon tube of maximum diameter 2.9, 3.5 and 4.1 cm, one proximal end is designed to connect with the dilated colon just proximal to the lesion. Two distal branches are for drainage of fecal matter and for retrograde insertion of irrigation catheter and subsequent colonoscope respectively. RESULTS: There were 53 patients (27 male, median age 64, range; 28~82) who underwent this procedure. No extraintestinal leaks were encountered. The volume of saline used was 12 (range; 6 to 27) Liters over 14 (range; 9 to 22) minutes. Subsequent colonoscopic examination added 10 (range, 8 to 15) minutes to the entire operation in 28 patients. There were one anastomotic leakage and 2 wound infections, however, there was no operative mortality. On-table colonoscopy resulted in extended resection in 3 cases because of synchronous malignancy in frozen biopsy and found synchronous polyps in 13 of 28 cases. CONCLUSIONS: The new device enabled safe, simple and time saving single stage surgical management of left colon cancer obstruction. The ability to perform on-table colonoscopy enabled treatment of synchronous bowel pathology.
Anastomotic Leak ; Biopsy ; Catheters ; Colon* ; Colonic Neoplasms* ; Colonoscopes ; Colonoscopy ; Drainage ; Humans ; Male ; Mortality ; Pathology ; Polyps ; Polytetrafluoroethylene ; Seoul ; Wound Infection

BACKGROUND: Interleukin-1 (IL-1) and neutrophil appear to contribute to the pathogenesis of acute respiratory distress syndrome (ARDS). Elastase, as well as reactive oxygen species released from activated neutrophil, are thought to play pivotal roles in the experimental models of acute lung leak. This study investigated whether ICI 200,355, a synthetic elastase inhibitor, can attenuate acute lung injury induced by IL-1 in rats. MATERIALS AND METHODS: We intratracheally instilled either saline or IL-1 with and without treatment of ICI 200,355 in rats. Lung lavage neutrophils, lung lavage cytokine-induced neutrophil chemoattractant(CINC) concentration, lung lavage protein concentration, lung myeloperoxidase(MPO) activity and lung leak index were measured at 5 hours of intratracheal treatment. RESULTS: In rats given IL-1 intratracheally, lung lavage neutrophils, lung lavage CINC concentration, lung lavage protein concentration, lung MPO activity and lung leak index were higher. Intratracheal ICI 200,355 administration decreased lung lavage neutrophils, lung MPO activity and lung leak index, respectively, but did not decreased lung lavage CINC concentration. CONCLUSION: These results suggest that ICI 200,355 decreases lung inflammation and leak without decreasing lung lavage CINC concentration in rats given IL-1 intratracheally.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Interleukin-1* ; Leukocyte Elastase* ; Lung ; Models, Theoretical ; Neutrophils* ; Pancreatic Elastase ; Pneumonia ; Rats* ; Reactive Oxygen Species ; Respiratory Distress Syndrome, Adult

BACKGROUND: Interleukin-1 (IL-1) and neutrophil appear to contribute to the pathogenesis of acute respiratory distress syndrome (ARDS). Elastase, as well as reactive oxygen species released from activated neutrophil, are thought to play pivotal roles in the experimental models of acute lung leak. This study investigated whether ICI 200,355, a synthetic elastase inhibitor, can attenuate acute lung injury induced by IL-1 in rats. MATERIALS AND METHODS: We intratracheally instilled either saline or IL-1 with and without treatment of ICI 200,355 in rats. Lung lavage neutrophils, lung lavage cytokine-induced neutrophil chemoattractant(CINC) concentration, lung lavage protein concentration, lung myeloperoxidase(MPO) activity and lung leak index were measured at 5 hours of intratracheal treatment. RESULTS: In rats given IL-1 intratracheally, lung lavage neutrophils, lung lavage CINC concentration, lung lavage protein concentration, lung MPO activity and lung leak index were higher. Intratracheal ICI 200,355 administration decreased lung lavage neutrophils, lung MPO activity and lung leak index, respectively, but did not decreased lung lavage CINC concentration. CONCLUSION: These results suggest that ICI 200,355 decreases lung inflammation and leak without decreasing lung lavage CINC concentration in rats given IL-1 intratracheally.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Interleukin-1* ; Leukocyte Elastase* ; Lung ; Models, Theoretical ; Neutrophils* ; Pancreatic Elastase ; Pneumonia ; Rats* ; Reactive Oxygen Species ; Respiratory Distress Syndrome, Adult

BACKGROUND: Smoking is the most important and consistent determinant of the development and progression of COPD(Ed Note : Define COPD). The fact that cigarette smokers develop a different type of COPD, chronic bronchitis and emphysema, with different clinical and pathological aspects, suggests that the development of COPD has a relationship with other smoking-associated factors beyoud just a simple smoking history. The aim of this was to analyze the smoking habits and history of patients with COPD and to evaluate the development of different types of COPD accordint to patient's smoking habits. METHOD: To evaluate the differences in the smoking patterens of patients with chronic bronchitis and emphysema, a pulmonary function test was conducted, and the smoking history and patterns was obtained through a smoking history questionnaire by a direct personal interview from 333 male cigarette smokers diagnosed with COPD, in the Yeungnam university medical center(190 patients diagnosed with chronic bronchitis, 143 patients diagnosed with emphysema). RESULT: The patients with emphysema smoked earlier and had a higher smoking history(ie, more pachyears, more total amounts of smoked cigarette, and more deep inhalation and longer duration of plain cigarette exposure) than those with chronic bronchitis. The depth of ingalation was also significantly higher in the emphysema patients after taking into account age, cumulative cagarette consumption and the type of cigarette smoked. CONCLUSION: Emphysema was more associated with the increasing degree of inhalation as assessed by the depth of inhalation. A high alveolar smoke exposure may be a significant risk factor for the development of emphysema.
Bronchitis, Chronic* ; Emphysema* ; Humans ; Inhalation ; Male ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Risk Factors ; Smoke* ; Smoking* ; Tobacco Products

BACKGROUND: With cases of chronic obstructive pulmonary disease(COPD), weight loss and low body weight have been found to correlate with increased mortality and poor prognosis. Therefore, nutritional aspects are an important part of the treatment in cases of COPD. In Korea, there is only limited data available for the changes of resting pulmonary function in relation to nutritional status. This study was carried out to investigated the differences of resting pulmonary function in relation to the nutritional status of patients with COPD. METHOD: 83 stable patients, with moderate to severe COPD, were clinically assessed for their nutritional status and resting pulmonary function. The patients' nutritional status was evaluated by body weight and fat-free mass (FFM), which was assessed by bioelectrical impedance analysis. According to their nutritional status, the 83 patients were divided into two groups, designated as the depleted, and non-depleted, groups. RESULT: Of the 83 patients, 31% were characterized by body weight loss and depletion of FFM, whereas 28% had either weight loss or depleted FFM. In the depleted group, significantly lower peak expiratory flow rate(p<0.05) and Kco(p<0.01), but significantly higher airway resistance(Raw, p<0.05) were noted. There was no difference for the non-depleted group in forced expiratory volume at one second, residual volume, inspiratory vital capacity, or total lung capacity. Maximal inspiratory pressure(PImax) was also significantly lower in the depleted group(p<0.05). CONCLUSION: We conclude, from our clinical studies, that nutritional depletion is significantly associated with the change in resting pulmonary function for patients with moderate to severe COPD.
Body Weight ; Electric Impedance ; Forced Expiratory Volume ; Humans ; Korea ; Mortality ; Nutritional Status* ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Residual Volume ; Total Lung Capacity ; Vital Capacity ; Weight Loss

Appropriate pathologic diagnosis of small cell lung cancer (SCLC) is essential in order to apply the aggressive treatment modalities. But several subtypes of SCLC were suggested by various authors based on morphological features. Among them, the incidence of small cell lung cancer (SCLC) combined with squamous cell and/or adenocarcinoma, combined small cell lung cancer, represent less than 1% to 3% of SCLC tumors. Because of the rarity of SCLC combined with squamous cell and/or adenocarcinoma, very little is known about the clinical characteristics and response to therapy of these tumor. We report a case of SCLC combined with squamous cell and adenocarcinoma in 68 year old male who experienced pneumonectomy of the left lung.
Adenocarcinoma* ; Aged ; Carcinoma, Small Cell* ; Carcinoma, Squamous Cell* ; Diagnosis ; Humans ; Incidence ; Lung* ; Male ; Pneumonectomy ; Small Cell Lung Carcinoma

BACKGROUND: Lung cancer incidence is gradually leveling off in developed countries but is continuing to rise in Korea. Because of the rapid increasing in smoking prevalence among women and youngers, the lung cancer incidence is expected to increase within next three and four decades. The aims of the present study are to analyses the smoking habits in patients with lung cancer and to evaluate of the relative risk of smoking habits in patients with lung cancer. METHOD: The present investigation was hospital-based, case control study. It included data from 93 case subjects with lung cancer and 1132 controls with disease unrelated to smoking using smoking history questionnaire by direct personal interview. RESULT: Compared with non-smoker, those who smoked more than 50 years had an odds ratio for lung cancer of 8.8(1.8-20.7). The odds ratios was 8.5(3.5-20.7) for those whose total number of cigarettes per days exceeded 41 and 5.5(2.3-13.3) for men with started habitual smoking less than 20 years old. The risk was increased in men with more than 41 pack years of cigarette smoking(OR:5.5, 95% CI:2.6-11.9). Odds ratios associated with cigarette smoking were 2.5(1.1-5.8), 5.1(2.6-10.4) for exsmoker and current smoker, respectively and 2.2(1.0-4.6) for non-filter smoker with more than 16 years. CONCLUSION: There was a clear dose-response relationship between the risk of lung cancer and smoking. We conclude that smoking dose is important risk factor for lung cancer and smoking habits may be, also.
Case-Control Studies ; Developed Countries ; Female ; Humans ; Incidence ; Korea ; Lung Neoplasms* ; Lung* ; Male ; Odds Ratio ; Prevalence ; Surveys and Questionnaires ; Risk Factors ; Smoke* ; Smoking* ; Tobacco Products ; Young Adult