Percutaneous Iliosacral Screw Fixation with Cement Augmentation in Osteoporotic Sacral Fracture

PURPOSE: The prevalence of osteoporotic sacral fractures is increasing. Traditionally, conservative treatment is the 1st option, but it can increase the risk of comorbidity in the elderly. To reduce the complications and allow early mobility, iliosacral screw fixation with cement augmentation will be one of the treatment options for patients with osteoporotic sacral fractures. MATERIALS AND METHODS: This study reviewed 25 patients (30 cases) who had undergone percutaneous iliosacral screw fixation with cement augmentation for osteoporotic sacral fractures from July 2012 to December 2018 with a minimum follow up of six months. The clinical outcomes were assessed using the measures of pain (visual analogue scale [VAS] score), hospital stay and the date when weight-bearing started. All patients were evaluated radiologically for pull-out of screw, bone-union, and cement-leakage. RESULTS: Bone union was achieved in 30 cases (100%). The mean duration of the hospital stay was 24 days (4–66 days); weight-bearing was performed on an average nine days after surgery. The VAS scores immediately (3.16) and three months after surgery (2.63) were lower than that of the preoperative VAS score (8.3) (p<0.05). No cases of cement-leakage or neurologic symptoms were encountered. Two patients (6.7%) experienced a pulling-out of the screw, but bone-union was accomplished without any additional procedures. CONCLUSION: Percutaneous iliosacral fixation with cement augmentation will be an appropriate and safe surgical option for osteoporotic sacral fractures in the elderly in terms of early weight-bearing, pain reduction, and bone-union.

Impact of Fat Infiltration in Cervical Extensor Muscles on Cervical Lordosis and Neck Pain: A Cross-Sectional Study

BACKGROUND: Weakness of cervical extensor muscles causes loss of cervical lordosis, which could also cause neck pain. The aim of this study was to investigate the impact of fat infiltration in cervical extensor muscles on cervical lordosis and neck pain. METHODS: Fifty-six patients who suffered from neck pain were included in this study. Fat infiltration in cervical extensor muscles was measured at each level of C2–3 and C6–7 using axial magnetic resonance imaging. The visual analogue scale (VAS), 12-Item Short Form Health Survey (SF-12), and Neck Disability Index (NDI) were used for clinical assessment. RESULTS: The mean fat infiltration was 206.3 mm2 (20.3%) at C2–3 and 240.6 mm2 (19.5%) at C6–7. Fat infiltration in cervical extensor muscles was associated with high VAS scores at both levels (p = 0.047 at C2–3; p = 0.009 at C6–7). At C2–3, there was a negative correlation between fat infiltration of the cervical extensor muscles and cervical lordosis (r = −0.216; p = 0.020). At C6–7, fat infiltration in the cervical extensor muscles was closely related to NDI (p = 0.003) and SF-12 (p > 0.05). However, there was no significant correlation between cervical lordosis and clinical outcomes (VAS, p = 0.112; NDI, p = 0.087; and SF-12, p > 0.05). CONCLUSIONS: These results suggest that fat infiltration in the upper cervical extensor muscles has relevance to the loss of cervical lordosis, whereas fat infiltration in the lower cervical extensor muscles is associated with cervical functional disability.

Changes in Perceptions of Narcotic Analgesic Treatment and Quality of Life in Chronic Back Pain Patients

STUDY DESIGN: Prospective study. OBJECTIVES: This study was conducted to investigate changes in perceptions of treatment using narcotic analgesics and quality of life in chronic back pain patients. SUMMARY OF LITERATURE REVIEW: Negative perceptions of narcotic analgesics as pain killers have been established as factors affecting compliance and adherence. MATERIALS AND METHODS: A total of 140 patients who had chronic back pain for over 3 months were examined using clinical scales such as the Korean version of the Oswestry Disability Index (KODI), the Short Form-12 (SF-12), and a visual analog scale (VAS). The survey regarding narcotic analgesics classified patients as having positive perceptions if they reported absolutely not wanting to use them or being unlikely to use them at the primary interview and after 4 weeks of treatment. RESULTS: Ninety-four patients (68%) reported negative perceptions of narcotic analgesics at the primary interview. Sixty-one of those patients (64%) changed their perceptions, reporting positive perceptions after 4 weeks of treatment, as indicated by the ODI (p=0.01), SF-12 (p=0.01), and VAS (p=0.01) scores. A change from positive to negative perceptions after 4 weeks of treatment was observed in 13 patients (28%) who experienced adverse effects of narcotics treatment (p=0.01). Among the 33 patients (23%) whose negative perceptions did not change, dissatisfaction with previous treatment was found to be a contributing factor in 22 (66%). CONCLUSIONS: Clinical improvements after treatment using narcotic analgesics in chronic back pain patients resulted in a significant positive impact on perceptions about narcotic analgesics. Narcotic analgesics could be an alternative treatment choice in chronic back pain patients because of improvements in their quality of life.

Radial Overgrowth after Surgical Treatment for Pediatric Distal Radius Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to examine the influence of radial overgrowth after surgical treatment for pediatric distal radius fractures. MATERIALS AND METHODS: Twenty-two pediatric patients under the age of 10 years who underwent surgical treatment for a distal radius fracture without physeal injury were enrolled in this study. They were divided into 2 groups according to the ulnar fracture; distal radius alone fracture in 9 patients group and radioulnar both fracture in 13 patients group. The radial length, ulnar variance, and radial inclination at the last follow-up X-ray were measured using a simple lateral radiograph. The visual analogue scale (VAS) of distal radioulnar joint pain, the Mayo wrist score, and range of motion of the wrist were assessed for the clinical results. RESULTS: At mean follow-up period of 3.7 years, radial overgrowth was 2.2 mm (p=0.01) compared with the un-injured side. There was negative ulnar variance on the injured side, an average of 0.8 mm (p=0.01). Clinically, mean VAS was 0.2, and the Mayo wrist score was 99.3. No significant difference in radial overgrowth (p=0.32), ulnar variance (p=0.99), VAS (p=0.29), and the Mayo wrist score (p=0.34) was observed between groups. CONCLUSION: Radial overgrowth and negative ulnar variance was observed after surgical treatment of pediatric distal radius fracture without physeal injury. However, the radial overgrowth does not affect clinical outcomes.

A comparison between surgical resection and radiofrequency ablation in the treatment of hepatocellular carcinoma

PURPOSE: The aim of this study was to compare the therapeutic effects of radiofrequency ablation (RFA) and hepatic resection (HR) with regards to procedural morbidity, mortality, overall survival (OS) and disease-free survival (DFS) rates in hepatocellular carcinoma (HCC) patients. METHODS: Retrospective studies were performed based on the medical records of 129 patients who underwent curative HR, and 57 who patients received RFA for HCC, between 2005 and 2009. The inclusion criteria of HCC were the presence of three or fewer nodules 3 cm or less in diameter or a single nodule of 5 cm or less. RESULTS: The 1-, 3- and 5-year OS rates in the HR group were 91.3%, 78.8%, and 64.9%, compared to 94.4%, 74.0%, and 74.0% in the RFA group, with no significant difference between the two groups (P = 0.725). The estimated 1- and 3-year DFS rates were 70.0% and 53.0% in the HR group and 65.2% and 24.7% in the RFA group, respectively. The DFS rates of HR group were significantly higher than RFA group (P = 0.015). Multivariate analysis identified that recurrence (P = 0.036) and portal hypertension (P = 0.036) were associated with OS and that portal hypertension (P = 0.048) and increased serum alpha-FP (P = 0.008) were the factors significantly associated with DFS. CONCLUSION: HCC within Milan criteria should consider hepatectomy as the primary treatment if the patient's liver function and general conditions are good enough to undergo surgical operation. But in that RFA revealed similar overall survival to HR, RFA can be an alternative therapy for patients who are eligible for surgical resection.

Impact of lymph node ratio as a valuable prognostic factor in gallbladder carcinoma, focusing on stage IIIB gallbladder carcinoma / 대한외과학회지

PURPOSE: It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients. METHODS: Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed. RESULTS: LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients. CONCLUSION: LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.

The Effectiveness of Ultrasound Guidance in Caudal Epidural Block

STUDY DESIGN: A prospective study. OBJECTIVES: To evaluate the effectiveness of ultrasound guidance in caudal epidural block and sonographic feature of sacral hiatus. SUMMARY OF LITERATURE REVIEW: High success rate of ultrasound-guided regional nerve block has been reported and recently, ultrasound-guided nerve block in spinal field has been introduced. MATERIALS AND METHODS: Ultrasound-guided caudal epidural block was performed in 48 patients with radiating pain to leg. Patient was placed in the prone position and sonographic image of sacral hiatus was obtained using linear probe. After measuring the intercornual distance, thickness of sacrococcygeal membrane and depth of sacral canal in transverse view, then the probe was rotated 90degrees to obtain the longitudinal view of the sacral hiatus. Under ultrasound guidance, a 21-gauge needle was inserted into the sacral hiatus in parallel with sacrum base. After contrast dye injection, needle placement was checked by the fluoroscopy and then medication was injected into the caudal epidural space. We investigated the change of radiating pain after caudal epidural block using visual analogue scale(VAS). RESULTS: The intercornual distance was mean 16.4+/-2.3mm, thickness of sacrococcygeal membrane was mean 2.8+/-0.9mm and depth of sacral hiatus was mean 2.6+/-0.9mm. There was 97.9% success rate of the caudal epidural block under ultrasound guidance. The mean VAS for radiating pain was improved from 7.5+/-0.7 before the block to 2.8+/-1.5 after the block. CONCLUSIONS: Ultrasound-guided caudal epidural block seems to provide good anatomical landmark of sacral hiatus and an effective tool with high success.

Comparison of remnant to total functional liver volume ratio and remnant to standard liver volume ratio as a predictor of postoperative liver function after liver resection

BACKGROUNDS/AIMS: The future liver remnant (FLR) is usually calculated as a ratio of the remnant liver volume (RLV) to the total functional liver volume (RLV/TFLV). In liver transplantation, it is generally accepted that the ratio of the graft volume to standard liver volume (SLV) needs to be at least 30% to 40% to fit the hepatic metabolic demands of the recipient. The aim of this study was to compare RLV/TFLV versus RLV/SLV as a predictor of postoperative liver function and liver failure. METHODS: CT volumetric measurements of RLV were obtained retrospectively in 74 patients who underwent right hemihepatectomy for a malignant tumor from January 2010 to May 2013. RLV and TFLV were obtained using CT volumetry, and SLV was calculated using Yu's formula: SLV (ml)=21.585 x body weight (kg)0.732 x height (cm)0.225. The RLV/SLV ratio was compared with the RLV/TFLV as a predictor of postoperative hepatic function. RESULTS: Postheptectomy liver failure (PHLF), morbidity, and serum total bilirubin level at postoperative day 5 (POD 5) were increased significantly in the group with the RLV/SLV 30% (p=0.002, p=0.004, and p<0.001, respectively). But RLV/TFLV was not correlated with PHLF and morbidity (p=1.000 and 0.798, respectively). RLV/SLV showed a stronger correlation with serum total bilirubin level than RLV/TFLV (RLV/SLV vs. RLV/TFLV, R=0.706 vs. 0.499, R2=0.499 vs. 0.239). CONCLUSIONS: RLV/SLV was more specific than RLV/TFLV in predicting the postoperative course after right hemihepatectomy. To determine the safe limit of hepatic resection, a larger-scaled prospective study is needed.

Collision tumor of the ampulla of Vater - Coexistence of neuroendocrine carcinoma and adenocarcinoma: report of a case

Herein, we present a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma (collision tumor) in the ampulla of Vater, which has seldom been reported in the literature. A 51-year-old man presented with a month history of jaundice. MRCP disclosed about 1.9x1.8 cm sized heterogeneously enhancing mass in ampulla of Vater, causing obstructions of distal common bile duct. He underwent pylorus-preserving pancreaticoduodenectomy under the diagnosis on ampulla of Vater cancer. Pathologically, sections on the ampulla of Vater showed conventional ductal adenocarcinoma extended and collided with poorly differentiated neuroendocrine carcinoma. In conclusion, we hereby presented a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma in the ampulla of Vater.

The Influence of Fat Infiltration of Back Extensor Muscles on Osteoporotic Vertebral Fractures

STUDY DESIGN: Retrospective study. PURPOSE: To investigate the influence of fat infiltration at low back extensor muscles on osteoporotic vertebral fracture. OVERVIEW OF LITERATURE: In persons with stronger back muscles, the risk of osteoporotic vertebral fractures will likely be lower than in those persons with weaker back muscles. However, the degree of influence of fat infiltration of the back extensor muscle on osteoporotic vertebral fracture remains controversial. METHODS: Two hundred and thirty-seven patients who had undergone lumbar spine magnetic resonance imaging and bone mineral density (BMD) were enrolled in this study. The amount of low back extensor muscle was determined using the pseudocoloring technique on an axial view of the L3 level. The patients were divided into two groups: osteoporotic vertebral fracture group (group A) and non-fracture group (group B). The amount of low back extensor muscle is compared with BMD, degenerative change of disc, osteophyte grade of facet joint and promontory angle to reveal the association between these factors. RESULTS: A negative correlation is found between age and the amount of low back extensor muscle (p=0.001). The amount of low back extensor muscle in group A and group B was 60.3%+/-14.5% and 64.2%+/-9.3% respectively, thus showing a significantly smaller amount of low back extensor muscle in the osteoporotic vertebral fracture group (p=0.015). CONCLUSIONS: Fat infiltration of low back extensor muscle was increased in osteoporotic vertebral fracture patients. Therefore, fat infiltration of low back extensor muscle in an elderly person may be a risk factor of osteoporotic vertebral fracture.

Peribiliary cysts developed in normal underlying liver: report of a case

Peribiliary cysts, known as cystic dilatation, of the extramural peribiliary glands of the bile duct are rare, and are usually detectable under conditions of pre-existing hepatobiliary diseases such as liver cirrhosis. Preoperative diagnosis is often difficult, because they are usually asymptomatic. Distinction of peribiliary cysts from premalignant or malignant cystic lesions is mandatory. Herein, we report a case of peribiliary cyst, which was preoperatively assumed as unilobar Caroli's diseases in healthy young patients and briefly discuss the management of the condition.

Laparoscopic Total Mesorectal Excision in a Rectal Cancer Patient with Situs Inversus Totalis

Situs inversus totalis is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. A 41-yr-old woman, who had an ulcerating cancer on the rectum, was found as a case of situs inversus totalis. We present an overview of the operative technique for the first documented laparoscopic total mesorectal excision of a rectal cancer in the patient with situs inversus totalis. Careful consideration of the mirror-image anatomy permitted a safe operation using techniques not otherwise different from those used for the general population. Therefore, curative laparoscopic surgery for rectal cancer in this patient is feasible and safe.

Management of Thyroid Papillary Carcinoma Invading the Recurrent Laryngeal Nerve / 대한내분비외과학회지

PURPOSE: Invasion of the recurrent laryngeal nerve (RLN) by papillary carcinoma of the thyroid gland is rather infrequent. Tumor excision for this patients with invasion of the RLN has been categorized into two groups on the basis of completeness: (1) Resection of the RLN was required for complete excision, and (2) isolation of the RLN from thyroid cancer was mainly performed by sharp dissection to leave as little tumor as possible. Reconstruction of the nerve after complete tumor resection can be added as a supplementary procedure. This study was designed to analyze the clinical characteristics and surgical treatment of thyroid cancer invading the RLN. METHODS: At the Department of Endocrine Surgery of our hospital, 1,426 patients were diagnosed and operated on for papillary thyroid cancer during 36 months, from December 2004 to December 2006. Among them, 49 patients who revealed invasion of the recurrent laryngeal nerve were retrospectively evaluated for their age, gender, preoperative hoarseness and the operative method, change of their postoperative symptoms, radioiodine ablation, the laryngoscopic findings, recurrence and the prognosis. RESULTS: Of the 49 patients, 10 patients had preoperative hoarseness and 13 patients were treated by complete resection. We tried reconstruction of the recurrent laryngeal nerve with using the hypoglossi-recurrent nerve in one case, and with direct end-to-end anastomosis in two cases. The rest of the 36 patients were treated by shaving resection of thyroid and leaving the RLN intact. CONCLUSION: When a surgeon finds papillary carcinoma infiltrating a recurrent laryngeal nerve, regardless of the preoperative symptoms, preservation of the RLN and removal of as much tumor as possible will offer a good result.

Differential Effects of Typical and Atypical Antipsychotics on MK- 801-induced EEG Changes in Rats

We examined whether the abnormal EEG state by NMDA receptor blocker MK-801 can be reversed by typical and atypical antipsychotics differentially by comparing their spectral profiles after drug treatment in rats. The spectral profiles produced by typical antipsychotics chlorpromazine (5 mg/kg, i.p.) and haloperidol (0.5 mg/kg, i.p.) were differ from that by atypical antipsychotic clozapine (5 mg/kg, i.p.) in the rats treated with or without MK-801 treatment (0.2 mg/kg, i.p.) which produce behavioral abnormalities like hyperlocomotion and stereotypy. The dissimilarity between the states produced by antipsychotics and the control state was examined with the distance of the location of the canonical variables calculated by stepwise discriminant analysis with the relative band powers as input variables. Although clozapine produced more different state from normal state than typical antipsychotics, clozapine could reverse the abnormal schizophrenic state induced by MK-801 to the state closer to the normal state than the typical antipsychotics. The results suggest that atypical anesthetic can reverse the abnormal schizophrenic state with negative symptom to the normal state better than typical antipsychotic. The results indicate that the multivariate discriminant analysis using the spectral parameters can help differentiate the antipsychotics with different actions.

Spectral Analysis of EEG during Inhalation of Halothane, Enflurane, and Isoflurane in the Rat / 대한마취과학회지

The dose-related effects of halothane, enflurane, and isoflurane on the rat EEG were evaluated qusntitstively by spectral analysis of the EEG recorded from the rat skull. The anesthetics were inhaled by animal ventilator into 10L glass bottle, in which the preparated rats were placed, at various concentrations, and then bipolar EEG was recorded from the rat skull and its spectrum was calculated by power speetral analysis. The density of each spectral bands (delta 1-3.25, theta 3.5-7.75, alpha 8-12.25, and beta 13-31.75Hz), total density, delta ratio, spectral edge frequency, and medisn power frequency were derived from the spectra. With inspection of conventional EEG, 1.5 MAC of hslothane revealed spindles, but higher dose decreased the amplitude. 1.5 MAC of enflurane revealed a lot of spike waves but 2.0 MAC revealed several spike waves and decreased the amplitude, and 1.5 MAC isoflurane revealed isolated spike waves but 2.0 MAC revealed cerebro- electrical silence. In quantitative spectral analysis of EEG, significant EEG changes were identified during inhalation of all anestheties. In halothane dominent frequencies in EEG were delta waves at 1.5 MAC and 2.0 MAC. In enflurane dominent waves in EEG were theta waves at 1.5 MAC and 2.0 MAC and in isoflurane those were theta waves. Taken together, these findings suggest that analysis for EEG parameters derived from power spectral analysis could be applied to determine the depth of halothane, enflurane, and isoflurane anesthesia.

Spectrum Analysis of Rat EEG during Infusion of Thiopental and Ketamine / 대한마취과학회지

The dose-ralated dffects of intravenous infusion of thiopental and ketamine on the rat EEG were evaluated quantitatively by spectrum analysis of EEG recorded from the rat scalp. The anesthetics were infused into jugular vein at various rates ranging from 0 to 8ug/min/g body weight, and then bipolar EEG was recorded from the rat scalp and tis spectrum were calculated by powere wpectrum analysis. the density of each bands(delta 1-3.25, theta 3.5-7.75, alpha 8-12.15, beta 1.13-17.75, beta 2.18-20.75, and beta 3.21-31.75Hz) and total density were derived from the spectrums. In visual inspection of conventional EEG, low doses of thiopental increased the amplitudes of spinles. but higher doses decreased the amplitube gradually to electrical silence with increase of infusion rates. During infusion of higher doses of ketamine, two types of EEG were identified by the spectral patterns:The one was the cases in which increases of the power density over all frequency ranges were observed, and the other was those in which marked increases of density in specific frequency were observed. In thiopental infusion, the densities of all bands were increased to peak at 1~2ug/min/g and therafter were decreased with higher rates of infusion. In ketamine infusion, the densities were increased when the infusion rate was increased. These results suggest that, by the changing patterns of the band densities dervied from spectrum analysis of EEG, not only the effect on EEG of thiopental of tetamine can be quantified but also their differences of mechanisms of action on brain be reflected.

Evaluation of Anesthetic Effects of Enflurane by Spectrum Analysis of Rat EEG / 대한마취과학회지

To evaluate the depth of enflurane anesthesia, spectrum analysis of rat EEG was used. Bipolar EEG was recorded through one lead form rat scalp during inhalation with 1,2,3 and 4% of enflurane, and analysed to produce the spectrum from which the density of each band(delta 1-3.25Hz, theta 3.5-7.75Hz, alpha 8-12.75Hz, beta2 18-20.75Hz, and beta3 21-31.75Hz)and total density, and medican power frequency were calculated. Differences among the EEG patterns, which were represented by F values through discriminant analysis of those 8 variables, in each level of anesthesia were significant among all concentrations except between 1% and 2% enflurane administration. The results suggest that the discriminat anlysis for the EEG parameters derived from power spectrum analysis can apply to determine the level of enflurane anesthesia.

Influence of Enalapril on Blood Pressure in Spontaneously Hypertensive Rats

We aimed to evaluate the long term trantment of enalapril on the vascular response in the isolated aorta, and in anesthetized or pithed spontaneously hypertensive rats(SHR). In the isolated aorta, the increase in tension provoked by addition of KC1 16.7mM was attenuated by enalapril treatment(3mg/kg/day for 6 weeks), whereas the increment by addition of NE 0.1uM tension was not influenced. The frequency-dependent vasoconstricution induced by electrical field stimulation of aorta was also attenuated by enalapril treatment. In pithed SHR, the frequency-related hypertension provoked by electrical stimulation(10sec, 1ms with 40V) of sympathetic pregnglionic nerve was also attenuated by enalapril treatment. Neither dose-related vasorelaxation by acetylcholine addition in the aorta nor decrease of DBP by intravenously(i.v.)-injected aetylcholine was altered by enalapril treatment. However, beta2-agonist, salbutamol-induced vasorelaxation in enalapril-treated group, was more remarkable than that in control group. The hypotension by i.v.-but not by intracerebroventricularly-injected salbutamol strengthened by enalapril treatment. These results suggest that the suppression of development of hypertension by enalapril treatment may result from the reduction of adrenergic neurotransmission and activity to voltage dependent calcium channel by acting on vascular smooth muscle itself.