Efficacy of Antibiotic-Loaded Cement Augmentation for Correcting Low Grade Pedicle Screw Loosening / 대한신경손상학회지

Objective@#Altered biomechanics and bone fragility can contribute to pedicle screw loosening. This study aimed to evaluate the efficacy of antibiotic-loaded cement augmentation for correcting symptomatic screw loosening as a minimally invasive alternative to open revision surgery. @*Methods@#Ten consecutive patients who underwent percutaneous cement augmentation for pedicle screw loosening were included in this study. Low grade pedicle screw loosening was deemed clinically relevant in cases of continuous back pain with significant radiolucent halo zones at a vertebral level without screw backing out or stripping. We analyzed the screw loosening at the main location of halo formation. All patients were treated by fluoroscopyguided antibiotic-loaded cement augmentation of the loosened pedicle screws. Patient demographics and pre- and postoperative data were also assembled and analyzed. @*Results@#Most (80%) halo formation locations were the inferior type. Augmentation was technically feasible in all but one patient, in whom the procedure was unsuccessful due to access difficulty. This patient ultimately underwent percutaneous screw re-implantation via a different trajectory. The other nine patients in whom cement filling was satisfactory reported significant pain relief at the final follow-up. Moreover, no severe complications such as wound infection or repeated screw loosening occurred during the follow-up period. @*Conclusion@#The most common halo formation location was the inferior type. In cases without access difficulty, antibiotic-loaded cement augmentation for the treatment of low grade pedicle screw loosening can relieve pain and avoid extensive open surgery.

Rapidly Progressive Atypical Vertebral Hemangioma: A Case Report / 대한신경손상학회지

Vertebral hemangiomas are common, benign, and asymptomatic tumors that rarely extend into the epidural space or involve the posterior elements. Surgery is recommended for aggressive vertebral hemangiomas if symptoms are severe or evolve rapidly. A 57-year-old male patient was admitted to our department for several months of back pain. A computed tomography (CT) scan and magnetic resonance imaging (MRI) were suggestive of T12 hemangioma without the involvement of the spinal canal or posterior elements. Despite aggressive conservative treatments, such as medications or nerve blocks, the back pain worsened. The CT and MRI 2 months later revealed a lesion involving the vertebral body and posterior elements with extension into the epidural space and with spinal cord compression. The patient underwent surgery for bone cement-augmented percutaneous screw fixation followed by low-dose radiotherapy. Histological examination confirmed the diagnosis of atypical hemangioma, specifically an epithelioid hemangioendothelioma.

The Endovascular Treatment for Iliac Vein Compression Syndrome

PURPOSE: Iliac vein compression syndrome (IVCS), first characterized by Cockett and Thomas in 1965, is the development of iliofemoral deep venous thrombosis due to compression of the left common iliac vein against the spine and pelvic brim by the right common iliac artery. Thrombectomy treatment of the underlying compression is essential if significant long-term sequelae are to be avoided. Surgical treatment options include venous reconstruction or venous bypass, but treatment using endovascular techniques have recently been described. This study was conducted to evaluate the usability of endovascular treatment (esp. thrombolysis with stent insertion) in a venous outflow obstruction resulting from IVCS. METHOD: During a 2-year period, 20 patients (17 women, 3 men; mean age, 60 years) presented with clinical and imaging findings consistent with IVCS. All patients presented with leg edema or pain. The mean duration of symptom onset was 6.6+/-4.4 days, ranging from 1 to 15 days. All patients were evaluated using a Duplex scan, computerized tomography and venography. After the ascending venography had been performed, an infusion catheter system was placed, and urokinase infused locally into the thrombus burden. After near complete clot dissolution, the residual left common iliac vein stenosis was treated by means of angioplasty and the placement of a Wallstent. All patients continued to receive oral warfarin. Patients were followed-up by means of clinical visits, and the stent patency was assessed by means of a Duplex scan or computerized tomography. RESULT: The total dose of urokinase used and the duration of infusion were 2.28+/-0.93 million unit, ranging from 1.00 to 5.20 and 46.8+/-14.8 hours, ranging from 14 to 72 hours, respectively. Grade III (complete lysis) thrombolysis was achieved in 17 patients. All 17 patients successfully received a Wallstent. The initial clinical success was 100%, with complete resolution of symptoms in all patients. One patient, with combined ovarian cancer, had a recurrent symptomatic deep vein thrombosis and complete occlusion of the stent due to thrombosis 2 months after treatment. However, no other patients showed evidence of deep vein thrombosis after treatment. The overall patency rate of the stenting at 18 months was 94.1%. There were no deaths, pulmonary embolism, cerebral hemorrhage or major bleeding complications. CONCLUSION: These results suggested that the treatment of iliac vein compression syndrome, using catheter directed thrombolytic therapy and venous stent insertion, was a safe and effective method at the mid term evaluation. These patients will continue to be followed up with screening tests to further define the long-term patency.

The Significance of Lymphatic, Venous, and Neural Invasion as Prognostic Factors in Patients with Gastric Cancer

PURPOSE: Some controversies exist over the prognostic values of lymphatic, venous, and neural invasion in patients with gastric cancer. This study was conducted to confirm the prognostic values of these histopathologic factors in gastric cancer patients who received a gastrectomy. MATERIALS AND METHODS: Data for clinicopathologic factors and clinical outcomes were collected retrospectively from the medical records of 1,018 gastric cancer patients who received a gastrectomy at Yeungnam University Medical Center between January 1995 and December 1999. A statistical analysis was done using the SPSS program for Windows (Version 10.0, SPSS Inc., USA). The Kaplan-Meier method was used for the survival analysis. Prognostic factors were analyzed by using a multivariate analysis with Cox proportional hazard regression model. RESULTS: Ages ranged from 21 to 79 (median age, 56). A univariate analysis revealed that age, tumor size, location, gross type, depth of invasion, extent of gastrectomy or lymph node dissection, lymph node metastasis, distant metastasis, lymphatic invasion, venous invasion, neural invasion, pathologic stage, histologic type, and curability of surgery had statistical significance. Among these factors, lymph node metastasis, curability of surgery, neural invasion, lymphatic invasion, and depth of invasion were found to be independent prognostic factors by using a multivariate analysis. Venous invasion showed no prognostic value in the multivariate analysis. CONCLUSION: Neural invasion and lymphatic invasion are useful parameters in determining a prognosis for gastric cancer patients.

The Significance of Lymphatic, Venous, and Neural Invasion as Prognostic Factors in Patients with Gastric Cancer

PURPOSE: Some controversies exist over the prognostic values of lymphatic, venous, and neural invasion in patients with gastric cancer. This study was conducted to confirm the prognostic values of these histopathologic factors in gastric cancer patients who received a gastrectomy. MATERIALS AND METHODS: Data for clinicopathologic factors and clinical outcomes were collected retrospectively from the medical records of 1,018 gastric cancer patients who received a gastrectomy at Yeungnam University Medical Center between January 1995 and December 1999. A statistical analysis was done using the SPSS program for Windows (Version 10.0, SPSS Inc., USA). The Kaplan-Meier method was used for the survival analysis. Prognostic factors were analyzed by using a multivariate analysis with Cox proportional hazard regression model. RESULTS: Ages ranged from 21 to 79 (median age, 56). A univariate analysis revealed that age, tumor size, location, gross type, depth of invasion, extent of gastrectomy or lymph node dissection, lymph node metastasis, distant metastasis, lymphatic invasion, venous invasion, neural invasion, pathologic stage, histologic type, and curability of surgery had statistical significance. Among these factors, lymph node metastasis, curability of surgery, neural invasion, lymphatic invasion, and depth of invasion were found to be independent prognostic factors by using a multivariate analysis. Venous invasion showed no prognostic value in the multivariate analysis. CONCLUSION: Neural invasion and lymphatic invasion are useful parameters in determining a prognosis for gastric cancer patients.

Prognostic Factors and Survival Rates of Stage III Gastric Cancer Patients after a Gastrectomy

PURPOSE: There have been some controversies over the therapeutic principles of advanced gastric cancer, and the results of treatment have been variable, especially for stage III disease. This study was conducted to define the prognostic factors of stage III gastric cancer. MATERIALS AND METHODS: This retrospective study was based on the medical records of 179 patients with stage III disease who received a gastrectomy from January 1990 to December 1994. The 5-year survival rate was analyzed according to the age, sex, tumor location, tumor size, Borrmann's type, depth of invasion, lymph-node metastasis, ratio of metastatic lymph nodes, type of surgical resection, extent of lymph- node dissection, curability of resection, postoperative chemotherapy, and pathological stage. The statistical analysis was done by using the Kaplan-Meier method, the log-rank test, and the Cox proportional hazards model. RESULTS: The overall 5-year survival rate was 61.6%. the 5-year survival rates according to subgroup were 69.7% for stage IIIa (100% for T2N2, 70.0% for T3N1, 68.6% for T4N0), and 54.1% for stage IIIb (T3N2) (P<0.05). Among various clinicopathologic factors of stage III gastric cancer, the age of the patient, the tumor location, the gross type of tumor, the type of gastric resection, the extent of lymph-node dissection, the curability of resection, and the subgroups of stage III were statistically significant in the univariate survival analysis. The multivariate analysis defined the curability of resection, the extent of lymph-node dissection, the type of operation, the stage of disease, and the age of the patient as independent prognostic factors. CONCLUSION: A curative surgical resection and an extended lymph-node dissection are thought to be most important for improving the survival rate in stage III gastric cancer patients.

Health of Apartment Guards and Associated Factors / 영남의대학술지

OBJECTIVES: The purpose of this investigation was to study the health status of apartment guards and associated factors. MATERIALS AND METHODS: This investigation was conducted for 1 month starting from August, 1997. Study population in this cross-sectional survey consisted of 182 guards of apartments located throughout the district of Taegu. Each subject completed a questionnaire about his general characteristics, health behaviors, job descriptions, subjective GIT symptoms and somatization and depression using Symptom Checklist-90-Reversion (SCL-90-R) by self administrated questionnaire and personal interview). RESULTS: Study subjects had one or more GIT symptoms(53.3%), somatization symptoms(83.5%) and depression symptoms(79.7%). The mean scores of GIT, somatization and depression symptoms were not different among the age groups and based on marital status, respectively, but, significantly different by education level(p<0.05). The mean scores of GIT, somatization and depression symptoms were not different among the age groups and hased on marital status, respectively, but, significantly different by regular diet and by the subject's health status(p<0.05). The mean scores of GIT, somatization and depression symptoms were not different by duration of shift work, by job tenure and by the number of managed houses but, those of somatization and depression symptoms were significantly different by level of job satisfaction(p<0.05). CONCLUSION: The health statuses of guards at apartments were different from other shift workers because of health worker effects and characteristics of their jobs.