Bone Cement-Augmented Percutaneous Short Segment Fixation: An Effective Treatment for Kummell's Disease?

OBJECTIVE: The aim of this prospective study was to evaluate the efficacy of bone cement-augmented percutaneous short segment fixation for treating Kummell's disease accompanied by severe osteoporosis. METHODS: From 2009 to 2013, ten patients with single-level Kummell's disease accompanied by severe osteoporosis were enrolled in this study. After postural reduction for 1-2 days, bone cement-augmented percutaneous short segment fixation was performed at one level above, one level below, and at the collapsed vertebra. Clinical results, radiological parameters, and related complications were assessed preoperatively and at 1 month and 12 months after surgery. RESULTS: Prior to surgery, the mean pain score on the visual analogue scale was 8.5+/-1.5. One month after the procedure, this score improved to 2.2+/-2.0 and the improvement was maintained at 12 months after surgery. The mean preoperative vertebral height loss was 48.2+/-10.5%, and the surgical procedure reduced this loss to 22.5+/-12.4%. In spite of some recurrent height loss, significant improvement was achieved at 12 months after surgery compared to preoperative values. The kyphotic angle improved significantly from 22.4+/-4.9degrees before the procedure to 10.1+/-3.8degrees after surgery and the improved angle was maintained at 12 months after surgery despite a slight correction loss. No patient sustained adjacent fractures after bone cement-augmented percutaneous short segment fixation during the follow-up period. Asymptomatic cement leakage into the paravertebral area was observed in one patient, but no major complications were seen. CONCLUSION: Bone cement-augmented percutaneous short segment fixation can be an effective and safe procedure for Kummell's disease.

Posterior Lumbar Interbody Fusion Using an Unilateral Cage: A Prospective Study of Clinical Outcome and Stability

OBJECTIVE: The purpose of this study was to evaluate the clinical and radiological results of instrumented posterior lumbar interbody fusion (PLIF) using an unilateral cage. METHODS: Seventeen patients with unilateral radiculopathy who underwent bilateral percutaneous screw fixation with a single fusion cage inserted on the symptomatic side for treatment of focal degenerative lumbar spine disease were prospectively enrolled in this study. Their clinical results, radiological parameters, and related complications were assessed 10 days, 3 months, and 12 months postoperatively. RESULTS: There was no pseudarthrosis, instrumented fusion failure, significant cage subsidence, or retropulsion in any patient. The surgery restored the disc space height and maintained it as of 12 months postoperatively and did not exacerbate the lumbar lordotic and scoliotic angles. All patients had excellent or good outcomes according to the modified MacNab's criteria. The mean pain score according to the visual analogue scale was 7.5 preoperatively but had improved to 2.5 when reassessed 3 months postoperatively. The improvement was maintained as of 12 months postoperatively. CONCLUSION: In cases of uncomplicated unilateral radiculopathy, PLIF using a single cage can be an effective and safe procedure with the advantage of preserving the posterior elements of the contralateral side. A shorter operative time and greater cost-effectiveness than for PLIF using bilateral cages can be expected.

Fatal Subdural Empyema Following Pyogenic Meningitis

Subdural empyema is a rare form of intracranial sepsis associated with high morbidity and mortality. The most frequent cause is extension of paranasal sinusitis through emissary veins or of mastoiditis through the mucosa, bone, and dura mater. Development of subdural empyema after pyogenic meningitis is known to be very unusual in adults. We report a rare case of fatal subdural empyema, an unusual complication of pyogenic meningitis. Our bitter experience suggests that subdural empyema should be borne in mind in patient with pyogenic meningitis who exhibit neurological deterioration.

Chronic Spinal Epidural Hematoma Related to Kummell's Disease

Chronic spinal epidural hematoma related to Kummell's disease is extremely rare. An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture was transferred to our institute. Lumbar spine magnetic resonance images revealed vertebral body collapse with the formation of a cavitary lesion at L1, and a chronic spinal epidural hematoma extending from L1 to L3. Because of intractable back pain, a percutaneous vertebroplasty was performed. The pain improved dramatically and follow-up magnetic resonance imaging obtained three days after the procedure showed a nearly complete resolution of the hematoma. Here, we present the rare case of a chronic spinal epidural hematoma associated with Kummell's disease and discuss the possible mechanism.

Resection of a Congenital Left Atrial Appendage Aneurysm without Extracorporeal Circulation / 대한흉부외과학회지

A left atrial appendage aneurysm is a very rare medical condition which can develop by an inflammatory reaction or a degenerative change. If there is no accompanying anomaly, a left atrial appendage is considered a congenital disease. The majority of left atrial appendage aneurysms are detected incidentally because they usually do not cause any symptoms. Surgery is indicated, even for asymptomatic patients, because of the risk of life-threatening complications, such as atrial fibrillation, supraventricular tachycardia, systemic embolization, and cardiac arrest. Left atrial appendage aneurysms are usually treated by a median sternotomy with extracorporeal circulation, especially if the aneurysm has a broad base or contains a thrombus, but can treated by thoracotomy without extracorporeal circulation. We report a case of a successfully treated left atrial appendage aneurysm that was misdiagnosed as a partial pericardial defect without extracorporeal circulation in a 13-year old child.

Clinial Analysis of Surgical Management for Descending Necrotizing Mediastinitis / 대한흉부외과학회지

BACKGROUND: Descending necrotizing mediastinitis (DNM) is a life-threatening cervico-mediastinal infection extending from the oropharynx or periodontal space. We reviewed clinical outcomes of DNM patients that underwent surgical management. MATERIAL AND METHOD: We analyzed the demographic and surgical data from 8 patients (6 males and 2 females) that underwent surgical management for DNM between August 2003 and August 2007. RESULT: The mean age was 56.6+/-12.3 (34~72) years. Types of DNM were I (n=2), IIA (n=1), and IIB (n=5), based on the classification system of Endo et al. Four patients were septic at the time of operation. The infectious organism was identified in three cases and turned out to be Streptococcus. ICU stay was 24.3+/-17.9 (3~58) days, and hospital stay was 49.1+/-33.8 (20~125) days. There were two deaths (25%), both of which were due to multi-organ failure. CONCLUSION: Despite aggressive surgical drainage and appropriate medical management, DNM still had a high mortality rate. Early diagnosis and prompt surgical intervention are key to DNM management. In addition, transcervical drainage should be used in limited disease only.

Histomorphological Comparison of the Coronary Artery and Available Graft Conduits / 대한흉부외과학회지

BACKGROUND: The histomorphological properties of the left anterior desecending artery (LAD), the left internal thoracic arteries (LITA), the radial arteries (RA) and the intercostal arteries (ICA) were studied for their use as a conduit for coronary artery bypass grafting (CABG), and we compared them with each other. MATERIAL AND METHOD: All the vessels were harvested from nineteen cadavers (17 males and 2 females). The mid-portion of the LAD, the mid-portion of the LITA, the distal RA and the mid-portion of the 5th ICA were obtained. All of them were stained with hematoxylin-eosin and with Van Gieson's elastin stain. The morphological characteristics were examined and the thicknesses of the intima and media (I/M ratio: the intima to media ratio) were compared using one-way ANOVA tests. RESULT: The mean age of the cadavers was 61.5+/-9.6 years. The LITA and ICA were elastic arteries, and the LAD and RA were muscular arteries. The I/M ratio showed statistically significant differences: 0.07+/-0.03 in the LITA, 0.16+/-0.11 in the ICA, 0.45+/-0.29 in the RA and 0.93+/-0.52 in the LAD, respectively. CONCLUSION: This study showed that the degrees of intimal hyperplasia of the CA and the various conduits for CABG were different significantly. The ICA was found to have relatively favorable characteristics as a coronary bypass conduit, but its suitability for clinical use is a challenging issue.

Relationships of Tinnitus to Frequency and Hearing Loss in Elderly Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus in elderly patients has been well noticed by many physicians, and it was especially related to age induced hearing loss. Moreover, there were many hypothesis and suggestions in mechanisms and characteristics in senile tinnitus but there have been little studies examining the features of tinnitus in elderly patients. So we tried to reveal features of tinnitus in elderly patients. SUBJECTS AND METHOD: We examined the tinnitus of 75 different ears of patients who aged over 60 years old. Also, features of tinnitus were analyzed in aspect of sound and Hz. Additionally, we analyzed hearing levels, tinnitus levels of those patients and questionnaires for tinnitus. RESULTS: Most patients complained of ringing sound. 57 (76.0%) ears indicated high pitched ringing sound, and 16 (21.3%) ears had low pitched beating sound. The number of patients who had hearing disturbance and tinnitus was 60 (96.8%). But in the case of hearing loss, the number of ears with more than 30 dB was 35 (58.3%). Other 25 (41.7%) patients also had hearing disturbance but didn't complain of significant hearing disturbance. CONCLUSION: A large number of elderly patients complained of tinnitus in nearly high pitched ringing sound and hearing disturbance. These findings can be helpful in the treatment of tinnitus when considering medications and hearing aids in aged persons.

Association of the GSTP1 and NQO1 Polymorphisms and Head and Neck Squamous Cell Carcinoma Risk

The GSTP1 and NQO1 have been reported to be associated with an increased risk for smoking related head and neck squamous cell carcinoma (HNSCC). The purpose of this study was to determine the effect of these metabolic gene polymorphisms on the risk of HNSCC. The study population included 294 histologically confirmed HNSCC cases and 333 controls without cancer. Genotyping analysis of the GSTP1 Ile105Val and NQO1 Trp139Arg genes was performed by polymerase chain reaction-based techniques on DNA prepared from peripheral blood. The Mantel-Haenszel chi-square test was used for statistical analysis. The allele frequencies of the GSTP1 and NQO1 polymorphisms were not statistically significant between cases and controls. In analyzing the association between smoking amounts and genetic polymorphisms, GSTP1 and NQO1 polymorphisms were associated with cigarette smoking amounts in cases. G allele containing genotypes in GSTP1 and T allele containing genotypes in NQO1 were associated with a tobacco dose-dependent increase in risk of HNSCC and these genotype distributions were statistically significant (p<0.05). We found that the GSTP1 105Val allele and NQO1 139Arg allele were associated with tobacco dose-dependent increase in risk of HNSCC. GSTP1 and NQO1 genotype polymorphisms may play an important role in the development of smoking related HNSCC.

Morphological Change of Mouse Inner Ear Hair Cells after Noise Exposure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mechanism of inner ear hair cell distortion after noise exposure has been well described. The present study was designed to determine the response to the auditory system of a genetically well-defined laboratory mouse in preparation for examining the effect of noise on mice with specific genetic mutations. So it is important to recognize the relationship between noise exposure duration and hair cell morphological changes. We try to reveal the hearing loss and inner ear hair cell morphological changes after applying the noise protocol. SUBJECTS AND METHOD: The mice were BALB/c hybrids and aged 8 weeks. Six mice served as non-noise-exposed controls and 8 mice were exposed for 3 hours per day to white band noise with a center frequency from 0.2 kHz to 70 kHz and a sound pressure level of 120 dB. And we divided the noise exposure group into 3 subgroups(1 day, 3 day, 5 day noise exposure group). We checked the photographs of FITC phalloidin stain and scanning electron microscopy of cochlea after noise exposure. RESULTS: The hearing level of mice decreased after noise exposure. We could see the stereocilia damage in cochlea after FITC phalloidin stain in cochlea and sterocilia loss was more severe in basal turn. In scanning electron microscopy, morphological changes of stereocilia were observed to be more severe in the cochlear basal turn than other area. Significant hair cell loss in the cochlear basal turn could be calculated using cochleocytogram. CONCLUSION: 120dB broad white band noise can damage the hair cell of cochlea in mice. These changes were especially severe in the cochlear basal turn. Noise exposure duration is the other important factor in damaging cochlear hair cells. Therefore, we can guess that harmful noise level and noise exposure duration are the main risk factors that injure the inner ear hair cell.

Endonasal Endoscopic Removal of Nasopharyngeal Angiofibroma: Comparison with Conventional Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the improvement in endoscopic sinus surgery skills, most benign tumors of the sino-nasal tract as well as chronic sinusitis are managed with the endonasal endoscopic technique. We have applied endoscopic surgery for juvenile nasopharyngeal angiofibroma (JNA) since 1996. Endonasal endoscopic removal was compared with conventional surgery in the aspect of morbidity, operating time, admission period, and postoperative complications. MATERIALS AND METHOD: Nineteen cases of JNA had been operated by the first author at the Asan Medical Center between 1991 and 2004. Retrospective study was performed with medical records and imaging studies for tumor staging, surgical methods, operation time, and surgical results. Of 19 cases, endonasal endoscopic removal (EER) was applied in 12 cases. EER was compared with conventional surgery (medial maxillectomy). RESULTS: Operation time (55+/-13.1 minutes) and hospitalization periods (5+/-1.3 days) in the cases of EER were shorter than those of conventional surgery (165+/-48.2 minutes, 10+/-0.9 days, respectively, p<0.05). Bleeding amount estimated with differences between preoperative and postoperative hemoglobin levels was smaller in EER (-0.9+/-1.2 g/dL) than in conventional surgery (-2.4+/-1.4 g/dL, p<0.05). CONCLUSION: Fleshy consistency, encapsulation, and benign nature of JNA enable en bloc removal through endonasal endoscopic approach. EER has many advantages over conventional surgery regarding operation time, recovery time, and bleeding amount as well as cosmetic and functional merits.

Lateral Alotomy Approach for Nasal Vestibular and Nasal Septal Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many approaches for treatment of nasal vestibular and septal lesions. If the lateral alotomy approach is employed, nasal vestibular and septal lesions can be easily exposed and excised. We analyzed the advantages and disadvantages of the lateral alotomy approach. MATERIALS AND METHODS: Our review of those who had been operated via lateral alotomy approach included, 2 cases of nasal vestibular papilloma, 1 squamous cell carcinoma, 1 angioleiomyoma, 1 myxoid sarcoma or 1 septal perforation. Operative procedures, surgical outcomes and postoperative complications were reviewed retrospectively. RESULTS: Using lateral alotomy approach, all lesions were easily exposed and completely resected. Lateral alotomy approach offered straight view of the lesions and the operator used both hands during the procedure. Patients were closely observed for about 2 years (19-28 months) without complications. And no patients complained of wound scar. CONCLUSION: Nasal vestibular and anterior nasal septal lesions can be easily exposed via lateral alotomy approach. This approach has the advantage of being able to use both hands by the operator.

Effect of Endoscopic Sinus Surgery in Samter's Triad Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic sinusitis with nasal polyposis, asthma and aspirin sensitivity characterize Samter's triad. The sinusitis associated with the triad is often difficult to treat and aggravates the asthmatic symptoms. This study was conducted to evaluate the feature of the triad and the outcome of endoscopic sinus surgey (ESS) as a treatment for chronic paranasal sinusitis with nasal polyposis in patients with Samter's triad. MATERIALS AND METHOD: The study group contained 16 patients with the triad who were compared with the control group (60 patients). The study was conducted in retrospective fashion focusing clinical characteristics, recurrence and re-operation rate of sinusitis and severity of asthma. RESULTS: ESS in Samter's triad patients was effective on the improvement of nasal symptoms. Fourteen of 16 patients recurred after ESS. Seven patients of 14 patients received systemic steroid therapy. Four patients of 7 patients underwent revision surgery. Three patients had asthmatic attack after postoperative use of analgesics. There was no significant improvement of asthmatic symptoms after ESS. CONCLUSION: This study suggests that the surgical intervention was less effective on Samter's triad patients. The recurrence and reoperation rate of nasal polyposis in Samter's triad patients were high. The use of NSAID should be avoided after ESS in asthmatics with nasal polyposis.

Midterm Results of Modified Central Shunt in Patients of Pulmonary Atresia with Ventricular Septal Defect: Two cases report / 대한흉부외과학회지

We operated on two neonates with a technical modification of the standard central shunt. The anatomic diagnosis was pulmonary atresia with ventricular septal defect and patent ductus arteriosus. In operation, the aorto - shunt graft anastomosis was created in a side-to-side ashion. During follow-up both pulmonary arteries and main pulmonary artery were well grown. And when the patients were 10 and 18 months of age, Lecompte procedures were Performed. This technique has the advantage of creating a short, straight-lying shunt that is less like to kink.

The relationship between grip strength and radius bone mineral density in postmenopausal women

BACKGROUND: Several studies have reported that muscle strength and bone mineral density have a significant positive correlation and most previous literature on muscle strength and bone mineral density examined their association. To evaluate the association between grip strength and radius bone mineral density, more precise PQCT was used rather than SPA or DEXA. METHODS: The study was performed from June to August 1999 in Pundang community with 154 postmenopausal women who undertaken osteoporosis screening program who participated in this study. Bone mineral density was measured at the radius using PQCT (peripheral quantitive computed tomograpy). Grip and pinch strength were measured in both the dominant and nondominant hands using a dyanometer. Other data were obtained from the questionnaire. RESULTS: Grip and pinch strength of the dominant hands were significantly higher than the nondominant hands. There was no significant difference in bone mineral density by exercise and fracture history. Age-adjusted partial correlation analysis indicated a significant positive correlation of radius BMD with dominant hands grip strength. Significant positive correlations also were found between radius BMD and pinch strength. CONCLUSION: Subjects with stronger grip strength had a low BMD. There was a significant positive correlationship between bone mineral density and dominant hand grip strength. especially with the more positive association of cortical BMD with forearm circumference. The data suggest that grip strength is a weak predictor of radius bone mineral density and provide a feasible way of predicting it.

The relationship between the Alzheimer's Disease Assessment Scale and other measures of dementia

BACKGROUND: The cognitive subscale of the Alzheimer's Disease Assessment Scale(ADAS-Cog) has been extensively valiated in assessing cognitive function in patients with Alzheimer's Disease(AD) and used as an efficacy measure in clinical trials of AD. There is a need for additional data on the relationship between cognitive performance and other measures of dementia to fully assess the value of the ADAS-Cog as a measure of treatment efficacy. METHODS: We used data from 53 AD participants in 8 multicenter clinical drug trials to examine the distribution of baseline ADAS-Cog scores in relation to Mini-Mental State Examination(MMSE), Global Deterioration Scale(GDES), Katz Index of Activity of Daily Living(ADL), Lawton Instrumental Activity of Daily Living(IADL), Geriatric Depression Scale(GDS) and Mini-Nutritional Assessment(MNA). RESULTS: The ADAS-Cog score was statistically significantly correlated with MMSE (R=-0.755, P<0.001), GDES(R=0.403, P<0.003), ADL(R=-0.532, P<0.001), IADL(R=-0.626, P<0.001) and MNA(R=-0.427, P=0.004) scores. But GDS scores were not associated with ADAS-Cog scores.(R= -0.123, P=0.396) CONCLUSIONS: This study characterizes the relationship between ADAS-Cog scores and other commonly used measures of dementia in AD patients. As expected, baseline scores on ADAS-Cog and MMSE demonstrated significantly high correlation. The relatively weaker correlation between ADAS-Cog and GDES scores may be related to the fact that GDES does not evaluate cognitive function only. There are also significant correlations between ADAS-Cog and ADL, IADL, and MNA which indicate the severity and progression of dementia in AD patients. Further studies with larger samples including cognitive function of broader spectrum need to confirm the findings in this study.