Progression of Ossification of the Posterior Longitudinal Ligament after Cervical Total Disc Replacement / 대한신경손상학회지

OBJECTIVE: Total disc replacement (TDR) is frequently performed anterior approaching method for the patients diagnosed with cervical disc herniation. This study aimed to assess the degree of ossification of the posterior longitudinal ligament (OPLL) progression after cervical TDR. METHODS: Twenty-two male soldiers who underwent cervical TDR surgery from 2009 to 2016 and were followed-up for more than 12 months were enrolled. The enrolled patients were classified as; 1) patients with pre-existing OPLL and without; and 2) patient showing progression of OPLL or not. RESULTS: Twenty-two men were included in the analysis. The mean follow-up period from the surgery was 41.4 months (range, 12–114 months). The mean age of all patients was 40.7 years (range, 31–52 years). TDR-only was used in 7 cases, and the hybrid surgery (TDR+ACDF) was used in 15 cases. The incidence of progression or newly development of OPLL was significantly higher in pre-existing OPLL group (p=0.01). In 11 cases showing the progression of the OPLL, the mean size of OPLL progression was 4.16 mm (range, 0.34–18.87 mm) in the longitudinal height and 1.57 mm (range, 0.54–3.91 mm) in thickness. CONCLUSION: The progression of OPLL after cervical TDR was more frequent in patients with pre-existing OPLL than in patients without OPLL. Even though TDR is a major alternative to the treatment of cervical lesions to preserve vertebral segmental motion, careful attention should be paid to whether TDR should be used in patients with OPLL and this should be fully explained to the patient.

A Case of Line Maintenance Work-Related Asthma

OBJECTIVES: To investigate the work-relation of the asthma of a 51-year old aircraft maintenance worker and his working environment METHODS: For 2 weeks, the patient went back into his workplace. The pulmonary function test including FEV1 was performed every other day morning in the hospital and peak expiratory flow rate(PEFR) self-monitoring was done 6 times a day. RESULTS: The patient has been worked as aircraft maintenance worker in line maintenance department since 1968. The pulmonary function test(PFT) with bronchodilator confirmed the asthma of the patient. He showed positive response to 2-weeks workplace challenge test. On 3rd day after stopping challenge exposure, FEV 1.0 was 1.04 L(55 % of baseline measurement). The result of PEFR self-monitoring showed progressively deteriorating pattern, baseline PEFR was 6.02 L/min but PEFR on 3rd day after stopping exposure was 2.43 L/min. CONCLUSIONS: The present case could be occupational asthma based on positive results of PEFR monitoring. Further research will be needed to find the specific agent to cause asthma in aircraft maintenance workers exposed to aviation fuel and jet stream exhausts.

The Study of Sexual Dysfunction in Patients with End Stage Renal Disease / 대한신장학회잡지

Sexual dysfunction is a common problem in patients with end stage renal disease. The pathogenesis of this problem is complex, and includes psychological factors, vascular, and neurological disorders, drug therapy, uremic intoxication and hormonal disturbances. However, we don't have any valid report because pathogenesis and physiologic significance is not proved clearly. With the questionnaire that we provided to our patients, we evaluated the sexual dysfunction in patients with end stage renal disease, and we treated our patient with antidepressants for males and estrogen for females. The results are as follows: 1) Sixty patients among 70 answered the sexual question. Among these, 46 patients (76%) complained of sexual dysfunction, 75% of male patients and 58% of female patients complained of impotence and mensturation disturbance, respectively. Especially, female patients complained of loss of libido as a whole. Also they said that they never tried to do anything to recover their sexual dysfunction. 2) After starting dialysis, 57% of patients showed decrease in coital frequency than before. 58% of patients showed no significant change in subjective sezual symptoms after dialysis. 18% of patients showed significant change in sexual function after anemia treatment. 3) Eighty-eight percents of males and one hundred percents of females treated with antidepressants and estrogen, respectively showed no effect. Finally, we found that sexual dysfunction is a common problem in chronic renal failure, but they never try to recover their conditions. Our therapeutic approach was not effective, but dialysis in CRF patient must be used for lifting the value of life, not by way of life extension. In addition we can make more effective treatment through objective study and psychological examination.

Clinical Trial of Endoscopic Botulinum Toxin Injection for the Treatment of Primary Achalasia / 대한소화기내시경학회지

Primary achalasia is a disorder of swallowing in which the lower esophageal sphincter fails to relax. Traditional treatment methods are balloon dilatation and myotomy, but these methods have critical complications and even fatal including esophageal perforation, gastroesophageal reflux, and continuing dysphagia. Botulinum toxin, which has been used for dystonias of skeletal muscles, is presented as a new alternative treatment method for achalasia, aimed to lowering of LES pressure by Pasricha et al. They also reported that endoscopic botulinum toxin injection into LES was effective, safe, and simple method without any significant complication. We report 7 cases of primary achalasia treated with endoscopic botulinum toxin injection, who showed clinical improvement without any complication. We compared results of pre-treatment with those of post-treatment using botulinum toxin in the aspects of clinical, radiological, manometrical recording in these cases. Symptomatic improvement was shown in 4 cases(57.1%), symptom score was decreased from 7.43+/-0.53 to 4.43+/-2.51(p=0.03), The luminal diameter at esophagogastric junction increased from a mean of 3.21+/-0,99 mm to 5.14+/-0.90 mm (p=0.015), and luminal diameter at esophageal body decreased from a mean of 40.29+/-19.37 mm to 32.71+/-15.45 mm (p=0.015). In follow up manometric recording, peristaltic waves at the body were recovered in 2 cases(28.6%), gastroesophageal pressure gradient(AP) was non-significantly decreased from 6.30+/-4.0 mmHg to 3.12+/-4.47 mmHg (p=0.45). One patient complained of transient chest pain within one hour after the botulinum toxin injection, but she did not need any medication. We concluded that botulinum injection was a simple, safe, and effective therapeutic method for primary achalasia, even though further evaluatian should be performed in the much more cases and the results of long term follow-up, and cost-effectiveness of this method.

Endoscopic Ligation of Large Gastric Varices Using a Detachable Snares and Rubber Bands / 대한소화기내시경학회지

Bleeding from gastric varices greater than 2cm in diameter represents a major limitation for endoscopic hemostasis. The endoscopic injection sclerotherapy (EIS) using conventional sclerosing agents is not satisfactory for the control of acute bleeding from gastric varices which have large diameter, fast blood flow and abundant collateral circulations. Endoscopic ligation using small rubber bands, known to be alternative to EIS, never obliterate large gastric varices greater than 2 cm in diameter. Obliteration therapy using Histoacryl (n-buty1-2-cyanoacrylate), known to be more satisfactory, has some drawback such as embolization. We per formed endoscopic ligation using detachable snares and rubber bands in 22 patients who had recently bleeding from gastric varices larger than 2 cm in diameter. For ligation of gastric varices larger than 2 cm in diameter, the detachable snares were used, and then for ligation of adjacent small gastric varices, rubber bands were used. In seven patients active bleedings were noted at initial endoscopy; 6 of them were successfully controlled by endoscopic ligation using detachable snares and rubber bands, but one patient who was uncontrolled by it died from bleeding and multiple organ failure. In remaining 15 patients, there were no active bleeding but red color signs on large gastric varices; all of them were successfully controlled by endoscopic ligation using detachable snares and rubber bands. Early rebleeding, fol lowing initial treatment, occurred in two patients (9.5%). So overall hemostatic rate of endoscopic ligation using the detachable snares and the rubber bands was 86.4% (19/22). Varices were nearly eradicated in 18 (85.7%) of the 21 survivors by ligation of 1-3 detachable snares (mean, l.3 snares) and 4-30 rubber bands (mean, 16,2 bands) in 2-6 sessions (mean, 3.2 sessions). During or after ligation, there were no serious complications, except transient epigastric pain or discomfort in 14.7% and fever in 1.3%. These results suggest that endoscopic ligation therapy with detachable snares and rubber bands is a safe and effective method for treatment of acute bleeding of gastric varices, especially gastric varices larger than 2 cm in diameter, which can not he controlled by conventional scleratherapy or variceal band ligation.