Preoperative Radiographic Simulation for Partial Uncinate Process Resection during Anterior Cervical Discectomy and Fusion to Achieve Adequate Foraminal Decompression and Prevention of Vertebral Artery Injury

Methods@#We retrospectively reviewed patients who underwent cervical magnetic resonance imaging and computed tomography angiography for preoperative ACDF evaluation. The segments were classified according to the presence of foraminal stenosis. The height, thickness, anteroposterior length, horizontal distance from the uncinate process to the VA, and vertical distance from the uncinate process baseline to the VA of the uncinate process were measured. The distance between the uncinate anterior margin and the resection trajectory (UAM-to-RT) was measured. @*Results@#There were no VA injuries or root injuries among the 101 patients who underwent ACDF (163 segments, mean age of 56.3±12.2). Uncinate anteroposterior length was considerably longer in foramens with foraminal stenosis, whereas uncinate process height, thickness, and distance between the uncinate process and VA were not significantly associated with foraminal stenosis. There were no significant differences in radiographic parameters based on uncinate degeneration. The UAM-to-RT distances for adequate decompression were 1.6±1.4 mm (range, 0–4.8 mm), 3.4±1.7 mm (range, 0–7.1 mm), 4.0±1.7 mm (range, 0–9.0 mm), and 4.5±1.2 mm (range, 2.5–7.5 mm) for C3–C4, C4–C5, C5–C6, and C6–C7, respectively. @*Conclusions@#More than half of the uncinate process in the anteroposterior plane should be removed for adequate neural foramen decompression. Foraminal stenosis or uncinate degeneration did not alter the relative anatomy of the uncinate process and the VA and did not impact VA injury risk.

Physical Activity Patterns and Their Associated Factors Measured by Global Physical Activity Questionnaire Survey among Korean / 대한스포츠의학회지

Research on physical activity and health is actively being conducted. In the Korea National Health and Nutrition Examination Survey (KNHANES), the Global Physical Activity Questionnaire (GPAQ) was newly introduced in 2014. The purpose of this study was to investigate the levels of physical activity and related factors in Koreans who were assessed through the GPAQ by dividing the physical activity by occupation, leisure, and transport domain. This study used data from the KNHANES (2014–2016), the study population of which included 17,357 participants aged 12 to 80 years. We compared the differences in physical activity by sociodemographic factors, health-related factors, and psychological health-related factors. Moreover, we also compared the mean metabolic equivalent of task and daily sitting time according to physical activity domain by sex and age group. Finally, we investigated the sociodemographic factors, health-related factors, and psychological health-related factors that significantly affect the average physical activity per week. The various factors were found to differ in the frequency of physical activity levels. In addition, there was a difference in the amount of physical activity per occupation, leisure, and transport domain in each age group. Finally, age, sex, high-density lipoprotein cholesterol levels, arthritis, allergic rhinitis and sinusitis, sleeping time, and perceived health status significantly affected physical activity. The levels of physical activity significantly differed by sociodemographic factors, health-related factors, and psychological health-related factors. There was also a difference in the physical activity levels according to the age and sex per each domain of physical activity.

The Use of Total Intravenous Anesthesia Without Muscle Relaxation in Amyotrophic Lateral Sclerosis Patient

66-year-old woman with amyotrophic lateral sclerosis was scheduled for closed reduction and external fixation of left tibio-fibula. Total intravenous anesthesia using 2% propofol and remifentanil was done without muscle relaxant to avoid possible postoperative respiratory complication and pulmonary aspiration. The surgery had done without difficulty and she recovered from anesthesia promptly without respiratory complication and pulmonary aspitation. She discharged satisfactorily 15 days after surgery.

Usefulness of Doppler Parameter in Patients with Renal Transplantation

PURPOSE: The purpose of this study is to assess the usefulness of Doppler parameters in transplanted kidney function. MATERIALS AND METHODS: Doppler parameters, including resistive index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end diastolic velocity (EDV) were measured in the interlobar artery of 55 transplant recipients. Patients were grouped according to glomerular filtration rate (GFR): Group A (GFR or = 30 ml / min / 1.73 m2, n = 28). Doppler parameters were compared between groups and correlated with the GFR. RESULTS: GFR (40.1 +/- 26.9) showed a significant negative correlation with RI (0.69 +/- .08) (p = .002, r = -.414). RI (0.72 vs. 0.67), PI (1.42 vs. 1.23), and EDV (10.5 vs. 15.3) differed significantly between groups (p < .05), however, PSV was not (36.9 vs. 47.1). Patients in group A (n = 11) with a lower RI than the mean had significantly lower PSV (31.7 vs. 45.1; p = .027) and EDV (11.1 vs. 16.7; p = .017), compared with such patients in group B (n = 21). CONCLUSIONS: Doppler parameters are useful for evaluation of function of transplanted kidney. Even if the RI is normal, PSV and EDV may be used as hemodynamic indicators.

Intrahepatic Portosystemic Venous Shunt: Successful Embolization Using the Amplatzer Vascular Plug II

A 67-year-old woman presented with memory impairment and behavioral changes. Brain MRI indicated hepatic encephalopathy. Abdominal CT scans revealed an intrahepatic portosystemic venous shunt that consisted of two shunt tracts to the aneurysmal sac that communicated directly with the right hepatic vein. The large tract was successfully occluded by embolization using the newly available AMPLATZERTM Vascular Plug II and the small tract was occluded by using coils. The patient's symptoms disappeared after shunt closure and she remained free of recurrence at the 3-month follow-up evaluation.

Autogenous Osteochondral Grafting for Treating Osteochondral Defect of the Femoral Condyle of the Knee Joint / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the outcomes of an autologous osteochondral graft (Mosaicplasty) for treating chondral defects of the femoral condyle and We assessed the factors affecting the clinical results. MATERIALS AND METHODS: This study enrolled 18 patients (19 cases) who underwent an autogenous osteochondral graft to treat a osteochondral defect in the femoral condyle from July 2000 to June 2006. The average age was 26.2 years old (age range: 16-48 years old). Among the patients, 17 cases were men. In 14 cases, the osteochondral defects were localized in the medial femoral condyle and only 5 cases showed a defect in the lateral femoral condyle. The average size of the osteochondral defects was 4.2 cm2 (1-13 cm2). The Lysholm knee scoring scale and the Tegner's activity score were applied for clinical evaluation. Further, we carried out simple X-ray for all the cases and we performed MRI in 5 cases for the radiological evaluation. Tthe factors affecting the clinical results were also analyzed and the complications were evaluated. RESULTS: The average follow-up period was 22 months (range: 6-55 months). Eighten out of 19 cases (94.7%) were able to return to ordinary life. The Lysholm knee scoring scale and the Tegner's activity score indicated much better clinical results for small lesions and for young patients. For the radiological results, all the cases displayed a decrease in the size of radiolucent zones on the follow up X-ray. Among the 5 cases for which an MRI was performed, graft unions were observed in 3 cases, but 2 cases displayed continuous peri-graft edema. Any other complications involving the donor and recipient site were not observed. CONCLUSION: We conclude that autogenous osteochondral grafting is useful for specific patients depending on the size of the lesion and the patient's age. It is a valuable treatment option for osteochondral defects in the knee joint.

Genotype, Coagulase Type and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolated from Dermatology Patients and Healthy Individuals in Korea

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent dermatology pathogens in hospitals and increasingly recognized in communities. We determined PFGE pattern of SmaI-restricted genomic DNA, coagulase type, and antimicrobial susceptibility of MRSA isolated in 2008 from dermatology inpatients and healthy hospital employees in A Hospital and from primary school children in Iksan city, Korea. Overall, the isolation rate of MRSA was 3.8% from the 788 normal persons: 4.9% from hospital employees and 1.1% from primary school children. MRSA was isolated in six of 13 (46.2%) family members of four school children with MRSA. The most prevalent coagulase serotype was II from patients and V from healthy individuals. Ten of twenty and six of twenty MRSA isolates from patients and from healthy personnel, respectively, had identical PFGE patterns, suggesting that these are originated from identical clones. Against MRSA from patients, only vancomycin was the most active (MIC range or =90% to amikacin, clindamycin, ciprofloxacin, erythromycin, fusidic acid, gentamicin and tetracycline. In conclusion, the MRSA carriage rates of healthy hospital workers were relatively high, 2.3~7.7%, depending on groups. Family members of a few primary school children with MRSA showed a high carriage rate, suggesting that intrafamily transmission occurred. MRSAs isolated from dermatology inpatients were relatively more resistant to various antimicrobial agents, including mupirocin, but all isolates were susceptibility to vancomycin.

Autologous Chondrocyte Implantation for Treating Chondral Defects of the Femoral Condyle

PURPOSE: We wanted to evaluate the clinical and objective results of autologous chondrocyte implantation (ACI) on a femoral chondral defect of the knee. MATERIALS AND METHODS: We evaluated 14 patients who had been operated on with ACI on the chondral defect of the knee between December 2000 and December 2005. There were 11 males and 3 females with the average age of 33 years (range: 17~44 years) and the mean size of the defect was 5.9 cm2 (range: 2.0~10 cm(2)). Seven cases were due to osteochondritis dissecans, and others were due to traumatic defect. The mean follow-up period was 26 months (range: 12~42 months). Lysholm's and Tegner's scores were used for evaluation. A 2nd look arthroscopic examination and a biopsy were carried out in 6 cases and MRI was done in 3 cases for evaluating cartilage regeneration. RESULTS: The mean Lysholm's and Tegner's scores were improved 60 to 84, and 2.4 to 4.1, respectively. According to the ICRS (International cartilage repair society) assessment, the gross appearance of the regenerated cartilage was graded as the following: 1 normal, 1 nearly normal, 3 abnormal and 1 severely abnormal. MRI demonstrated cartilage regeneration in 2 out of 3 cases. There were 2 cases of graft hypertrophy and 1 case of graft adhesion as complications. CONCLUSION: The clinical results were significantly improved according to Lysholm's and Tegner's scores. However, the gross appearances and histological results gave less satisfactory results. We conclude that a more sophisticated surgical technique and the long term follow-up results are necessary.

Spectrum of Axillary Disorders (Excluding Metastasis from Breast Cancer): Radiological and Pathological Correlation: A Pictorial Essay

Axillary disorders originate from an axillary lymph node, subcutaneous fat layer, accessory breast, nerve, vessel and muscle. The most common causes of a palpable axillary mass are a lymph node pathology containing a benign axillary lymphadenopathy, and malignant lymph nodes such as a metastatic lymphadenopathy from breast cancer and a malignant lymphoma. For the detection of masses in the axilla, mammography and sonography are the imaging modalities of choice. We present a spectrum of various axillary masses with correlative radiological imaging and pathological findings in this pictorial essay. Knowledge of the radiological findings of various axillary disorders is useful for a differential diagnosis and for preventing unnecessary invasive procedures.

Effects of Benzoapyrene, 2-Bromopropane, Phenol and 2,3,7,8-Tetrachlorodibenzo-p-Dioxin on Proinflammatory Cytokines Gene Expression by Mice Spleen Cells

The detrimental effects of environmental pollutants on the health of the individual are generally accepted, although the mechanisms of these effects remain to be incompletely understood. In the present study, we examined the effects of B[a]P, 2-BP, phenol and TCDD on proinflammatory cytokine gene expression in mice spleen cells which were stimulated with anti-CD3. 10-9M TCDD increased IFN gammar and TNF alpha gene expression, but suppressed IL-1 gene expression. 10-6M phenol inhibited IL-1, IL-6 and TNF alpha gene expression, and 10-6M of 2-BP downregulated TNF alpha gene expression. However, 10-6M of B[a]P did not influence on IL-1, IL-6, IFN gammar and TNF alpha gene expression. These findings suggest that TCDD may impair the immune functions of mice by enhancing proinflammatory cytokines production, whereas phenol and 2-BP may impair the functions by inhibiting the production of these cytokines.

Treatment of Lumbar Spinal Stenosis with Diabetes Mellitus / 대한척추외과학회지

STUDY DESIGN: This retrograde study was designed to compare the clinical features and postoperative clinical results between diabetic and non-diabetic patients who had been performed decompression and arthrodesis with instrumentation. SUMMARY OF LITERATURE REVIEW: There are controversies in the treatment results of diabetic patients. OBJECTIVE: To identify poor results in the patients of lumbar spinal stenosis accompanied diabetes mellitus and to find out variables influencing postoperative results among diabetics. MATERIALS AND METHODS: We analyzed 27 diabetic patients and sex, age-matched 27 non-diabetic patients who were diagnosed as lumbar spinal stenosis and operated from April, 1995 to December, 1998. In all patients, duration of symtoms, sensory and motor deficits, comorbidity, level of operations were investigated and in diabetics, duration of diabetes, amount of insulin administered before operation and presence of diabetic neuropathy were included. Clinical results, postoperative complications were compared between diabetics and non-diabetics. RESULTS: Considerable improvement was reported by 19(71%) in diabetic group and 21(78%) in non-diabetic group. Complication rate such as of infection and delayed wound healing was not higher in diabetic group than non-diabetic group. Duration of diabetes and amount of insulin before operation did not affected the result of operations. CONCLUSION: The outcome of surgery was similary successful in the two groups.

A Case of laparoscopic cystectomy for large adenomyotic cyst within myometrium with bilateral endometriomas / 대한산부인과학회잡지

Adenomyotic cysts are not uncommon disease, but their sizes are mostly lesser 5 mm. Reports of large adenomyotic cyst ( >5 mm ) are vere rary. These large sized hemorrhagic cysts arise from small sized cyst and may be caused by progressive expansion of cyst due to progressive menstrual bleeding. And the active secreting of cystic wall may play a part in making the large cyst. Authors observed a case of large adenomyotic cyst within myometrium occuring in o 39-year-old woman, and she was accompanied with both ovarian endometriomas. The cyst was 3 *3 cm sized, and had chocolate-colored thick viscous contents. Histologically, cystic wall was lined with endometrial type epithelium. Epithelium were composed of single layer columnar, partly ciliated cells. Stroma under glandular epithelium were thin throughout the cyst and resembled morphologically endometrial stroma in endometriosis and had red cells and hemosiderin-laden macrophages in places. We experienced one case of large adenomyotic cyst, so we report the case with a brief review of the concerned literatures.