The Efficacy and Perioperative Complications Associated with Lumbar Spinal Fusion Surgery, Focusing on Geriatric Patients in the Republic of Korea

OBJECTIVE: The purpose of this study was to examine the efficacy and perioperative complications associated with lumbar spinal fusion surgery, focusing on geriatric patients in the Republic of Korea. METHODS: We retrospectively investigated 485 patients with degenerative spinal diseases who had lumbar spinal fusion surgeries between March 2006 and December 2010 at our institution. Age, sex, comorbidity, American Society of Anesthesiologists (ASA) class, fusion segments, perioperative complications, and outcomes were analyzed in this study. Risk factors for complications and their association with age were analyzed. RESULTS: In this study, 81 patients presented complications (16.7%). The rate of perioperative complications was significantly higher in patients 70 years or older than in other age groups (univariate analysis, p=0.015; multivariate analysis, p=0.024). The perioperative complications were not significantly associated with the other factors tested (sex, comorbidity, ASA class, and fusion segments). Post-operative outcomes of lumbar spinal fusion surgeries for the patients were determined on the basis of MacNab's criteria (average follow up period : 19.7 months), and 412 patients (85.0%) were classified as having "excellent" or "good" results. CONCLUSION: Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery, whereas other factors were not significant. However, patients' satisfaction or return to daily activities when compared with younger patients did not show much difference. We recommend good clinical judgment as well as careful selection of geriatric patients for lumbar spinal fusion surgery.

Nitric Oxide Modulation of GABAergic Synaptic Transmission in Mechanically Isolated Rat Auditory Cortical Neurons

The auditory cortex (A1) encodes the acquired significance of sound for the perception and interpretation of sound. Nitric oxide (NO) is a gas molecule with free radical properties that functions as a transmitter molecule and can alter neural activity without direct synaptic connections. We used whole-cell recordings under voltage clamp to investigate the effect of NO on spontaneous GABAergic synaptic transmission in mechanically isolated rat auditory cortical neurons preserving functional presynaptic nerve terminals. GABAergic spontaneous inhibitory postsynaptic currents (sIPSCs) in the A1 were completely blocked by bicuculline. The NO donor, S-nitroso-N-acetylpenicillamine (SNAP), reduced the GABAergic sIPSC frequency without affecting the mean current amplitude. The SNAP-induced inhibition of sIPSC frequency was mimicked by 8-bromoguanosine cyclic 3',5'-monophosphate, a membrane permeable cyclic-GMP analogue, and blocked by 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide, a specific NO scavenger. Blockade of presynaptic K+ channels by 4-aminopyridine, a K+ channel blocker, increased the frequencies of GABAergic sIPSCs, but did not affect the inhibitory effects of SNAP. However, blocking of presynaptic Ca2+ channels by Cd2+, a general voltage-dependent Ca2+ channel blocker, decreased the frequencies of GABAergic sIPSCs, and blocked SNAP-induced reduction of sIPSC frequency. These findings suggest that NO inhibits spontaneous GABA release by activation of cGMP-dependent signaling and inhibition of presynaptic Ca2+ channels in the presynaptic nerve terminals of A1 neurons.

The Outcome of Corpus Callosotomy for Intractable Epilepsy: 10 Years Experience of Corpus Callosotomy

OBJECTIVE: The purpose of this study is to evaluate the effect of the corpus callosotomy and to elucidate possible prognostic factors. METHODS: The cases of 39 patients who underwent corpus callosotomy were reviewed retrospectively. Clinical outcomes were analyzed using Engel's classification, with consideration of various presurgical conditions and the extent of the callosal resection during follow-up more than one year. RESULTS: Satisfactory outcome (Engel's class I, II) was obtained in 20 patients (51%) of 39 patients. In 36 cases with drop attack seizures, the class I, II outcomes were 22 patients (61%). When the patients were grouped according to the extent of callosal resection, the class I, II outcomes were 50% of the patients with anterior 1/2 or 2/3, 50% of those with anterior 4/5 callosotomy, and 57% of those with total callosotomy, respectively. The mean follow-up period was 34 months (24 to 58 months). CONCLUSION: Although it is not statistically significant, the patients who had underwent total callosotomy show better outcomes than those with partial callosotomy. Corpus callosotomy is efficacious in controlling medically intractable epilepsy in appropriately selected patients.

Two Cases of Allopurinol hypersensitivity syndrome / 대한피부과학회지

Allopurinol hypersensitivity syndrome typically occurs in persons with preexisting renal failure, weeks to months after allopurinol is begun, the patient develops a generalized rash that often evolves to exfoliative erythroderma. Associated with the dermatitis is fever, leukocytosis, hepatitis, typically worsening of renal function. Two patients developed erythematous skin rash one month and 15 days, respectively, after allopurinol therapy. They were treated with high dose prednisolone for three weeks, but one patient died to pneumonia and sepsis, and the other patient improved and followed up.

A Case of Squamous Cell Carcinoma Metastasized from Esophageal Carcinoma / 대한피부과학회지

We report a case of squamous cell carcinoma originating from esophageal carcinoma. 2 X 3cm sized, flesh-colored, soft, movable nodules were detected on the scalp in a 59-year-old man. He was made a diagnosis of squamous cell carcinoma in the distal esophagus a year ago. Histopathologic examination showed that the tumor had multiple mitoses and horn pearls, but there was no connection between the epidermis and the tumor nests. In immunohistochemical stains, cytokeratin- high molecular weight and EMA was positive, but CEA was negative.

A Case of Malignant Eccrine Poroma / 대한피부과학회지

Malignant eccrine poroma is a rare malignant cutaneous tumor arising from intraepithelial eccrine duct and it may develop either spontaneously or from a long standing eccrine poroma. We report a case of malignant eccrine poroma on the antihelix of the right ear in a 37-year-old female, previously diagnosed as a benign eccrine poroma with shave biopsy specimens. Histological findings are well-defined tumor cell nests disseminated in dermis. Each cell has a large, hyperchromatic atypical nuclus. The atypical mitoses, dyskeratoses, intracytoplasmic vacuolations and duct-like structures are observed. She was treated with wide surgical excision and local skin flaps.

A Case of Malignant Fibrous Histiocytoma Treated with Gluteus Maximus Musculocutaneous Flap / 대한피부과학회지

The major problem of the treatment of the sacral ulcer is that the area is under too much pressure. Thus, in a case of skin graft after the removal of a lesion, if the padding is not enough, the ulcer will recur. The gluteus maximus muscle has an abundant volume of subcutaneous fat and muscle, and provides the pressure site with enough padding. Therefore, the gluteus maximus musculocutaneous flap has been most commonly used for the treatment of the sacral pressure ulcer. We herein report a case of malignant fibrous histiocytoma in the sacral area treated with the gluteus maximus musculocutaneous flap.

A Case of Vitiligo Induced by Diphenylcyclopropenone in a Patient with Malignant Melanoma / 대한피부과학회지

DPCP(diphencyclopropenone) has been used for the treatment of alopecia areata or verruca. Common side effects due to topical treatment with DPCP are pruritus, blistering, cervical lymphadenopathy and urticaria. Rarely, vitiligo can be induced by topical treatment with DPCP as a complication on the pigmentary system. Herein we report a case of vitiligo induced by DPCP in a patient with malignant melanoma. She was diagnosed with malignant melanoma in her 4th toe, Rt., a year ago. As part of adjuvant therapy, DPCP was topically applied to the inguinal area every week. After 4 months, vitiligo appeared on the area of DPCP application.

Two Cases of Malignant Melanoma, Microscopically Metastasized in Sentinel Lymph Node / 대한피부과학회지

Early diagnosis and treatment are essential for a successful treatment of malignant tumor. The malignant melanoma is notoriously acknowledged as threatening and known to readily metastasize during the early stages. The solid tumors including malignant melanoma frequently metastasize to regional lymph nodes via lymphatic vessels. During the latest clinical amelioration, it has been clearly conspicuous that early discovery of metastatic pathological alteration in sentinel lymph nodes could prevent prophylactic regional lymph node dissection. Additionally, an application of an appropriate treatment is conceivable by accurately recognizing the stages of the illness. For malignant melanoma clinically without palpable lymph nodes, through the application of lymphoscintigraphy and vital dye staining, we report two cases of malignant melanoma, microscopically metastasized in the sentinel lymph node and review the previous literatures.

Patients' Evaluation on Foodservice in University and General Hospitals / 대한지역사회영양학회지

This study was conducted to investigate and to improve the actual condition of food service for patients in hospitals. For this purpose, were distributed to 283 patients admitted to a university hospital and three general hospitals between January 27 and February 15, 1997. The department participated in the study included internal medicine, surgery, obstetrics, orthopedics and so forth. For meal time, 61.1% of patients wanted to eat breakfast at 8 am, 55.8% lunch at noon, and 73.5% dinner at 6 pm. The patients complained about unsatisfactory hospital food itself by 37.8%, about insufficient food amount by 19.6%, about menu with no choice by 41.2% and about low variety of the meals by 32.7%. Sixty two point nine percent of the subjects enjoyed snacks between meals because of poor appetite at meal time(46.1%), delayed food service(39.9%) and others(11.2%). The types of diet were mainly regular ones(58.6%) with some high protein(12.4%) and diabetic sensitive ones(7.1%). As eating place, the patient's prefered bed(51.9%), room-table(27.2%) and dining room(17.7%). Fifty-five percent of them also wanted hospital foods available to their caring relatives.