Postprandial Changes in Gastrointestinal Hormones and Hemodynamics after Gastrectomy in Terms of Early Dumping Syndrome

Purpose@#This study aimed to examine the early postprandial changes in gastrointestinal (GI) hormones and hemodynamics in terms of early dumping syndrome after gastrectomy for gastric cancer. @*Materials and Methods@#Forty patients who underwent gastrectomy for gastric cancer and 18 controls without previous abdominal surgery were enrolled. Before and 20 minutes after liquid meal ingestion, blood glucose, glucagon-like peptide-1 (GLP-1), and GLP-2 concentrations and superior mesenteric artery (SMA) and renal blood flow were measured.The patients' heart rates were recorded at 5-minute intervals. All subjects were examined for dumping syndrome using a questionnaire based on Sigstad's clinical diagnostic index. @*Results@#The postprandial increases in blood glucose, GLP-1, and GLP-2 levels as well as SMA blood flow and heart rate were greater in patients who underwent gastrectomy than in controls (all P<0.010). Patients who underwent gastrectomy showed a significantly decreased renal blood flow (P<0.001). Among patients who underwent gastrectomy, distal gastrectomy was a significant clinical factor associated with a lower risk of early dumping syndrome than total gastrectomy (hazard ratio, 0.092; 95% confidence interval, 0.013–0.649; P=0.017).Patients who underwent total gastrectomy showed a greater postprandial increase in blood glucose (P<0.001), GLP-1 (P=0.030), and GLP-2 (P=0.002) levels as well as and heart rate (P=0.013) compared to those who underwent distal gastrectomy. @*Conclusions@#Early postprandial changes in GI hormones and hemodynamics were greater in patients who underwent gastrectomy than in controls, especially after total gastrectomy, suggesting that these changes play a crucial role in the pathophysiology of early dumping syndrome.

Considerations for patient selection: Prepectoral versus subpectoral implant-based breast reconstruction

BACKGROUND@#In recent years, breast implants have been frequently placed in the subcutaneous pocket, in the so-called prepectoral approach. We report our technique of prepectoral implant-based breast reconstruction (IBR), as well as its surgical and aesthetic outcomes, in comparison with subpectoral IBR. We also discuss relevant considerations and pitfalls in prepectoral IBR and suggest an algorithm for the selection of patients for IBR based on our experiences.@*METHODS@#We performed 79 immediate breast reconstructions with a breast implant and an acellular dermal matrix (ADM) sling, of which 47 were subpectoral IBRs and 32 were prepectoral IBRs. Two-stage IBR was performed in 36 cases (20 subpectoral, 16 prepectoral), and direct-to-implant IBR in 43 cases (27 prepectoral, 16 subpectoral). The ADM sling supplemented the inferolateral side of the breast prosthesis in the subpectoral group and covered the entire anterior surface of the breast prosthesis in the prepectoral group.@*RESULTS@#The postoperative pain score was much lower in the prepectoral group than in the subpectoral group (1.78 vs. 7.17). The incidence of seroma was higher in the prepectoral group (31.3% vs. 6.4%). Other postoperative complications, such as surgical site infection, flap necrosis, implant failure, and wound dehiscence, occurred at similar rates in both groups. Animation deformities developed in 8.5% of patients in the subpectoral group and rippling deformities were more common in the prepectoral group (21.9% vs. 12.8%).@*CONCLUSIONS@#The indications for prepectoral IBR include moderately-sized breasts with a thick well-vascularized mastectomy flap and concomitant bilateral breast reconstruction with prophylactic mastectomy.

Clinicopathologic characteristics and survival rate in patients with synchronous or metachronous double primary colorectal and gastric cancer

PURPOSE: Double primary colorectal cancer (CRC) and gastric cancer (GC) represent the most common multiple primary malignant tumors (MPMT) in Korea. The recognition and screening of hidden malignancies other than the primary cancer are critical. This study aimed to investigate the clinicopathologic characteristics and survival rates in patients with synchronous or metachronous double primary CRC and GC.METHODS: Between January 1994 and May 2018, 11,050 patients were diagnosed with CRC (n=5,454) or GC (n=5,596) at Gil Medical Center. MPMT and metastatic malignant tumors were excluded from this study. A total of 103 patients with double primary CRC and GC were divided into two groups: the synchronous group (n=40) and the metachronous group (n=63). The incidence, clinicopathologic characteristics, and survival rate of the two groups were analyzed.RESULTS: The incidence of synchronous and metachronous double primary CRC and GC was 0.93%. Double primary CRC and GC commonly occurred in male patients aged over 60 years with low comorbidities and minimal previous cancer history. There were significant differences between the synchronous and metachronous groups in terms of age, morbidity, and overall survival. Metachronous group patients were 6 years younger on average (P=0.009), had low comorbidities (P=0.008), and showed a higher 5-year overall survival rate (94.8% and 61.3%, P < 0.001) in contrast to synchronous group.CONCLUSION: When primary cancer (CRC or GC) is detected, it is important to be aware of the possibility of the second primary cancer (GC or CRC) development at that time or during follow-up to achieve early detection and better prognosis.

Long-term oncologic outcomes in pathologic tumor response after neoadjuvant chemoradiation for locally advanced rectal cancer

PURPOSE: The status of tumor regression in rectal cancer after neoadjuvant concurrent chemoradiotherapy (CCRT) has significant effect on tumor recurrence and patient survival. The aim of this study was to evaluate the long-term oncologic outcomes of rectal cancer patients presenting complete response or down-staging of rectal cancer compared to patients with non-response after neoadjuvant therapy in advanced mid-to-lower rectal cancer.METHODS: We retrospectively reviewed 79 patients with stage II/III mid-to-lower rectal cancer following neoadjuvant CCRT between March 2003 and April 2012. Patients were classified into three groups according to down-staging tumor response after neoadjuvant CCRT: complete response group (CRG), partial response group (PRG), and non-response group (NRG).RESULTS: Of the 79 patients in the study, eight (10.1%), 31 (39.2%), and 40 (50.7%) were classified as CRG, PRG, and NRG, respectively. Median follow-up period was 57 months. There was significant difference in local recurrence (P=0.012) between the three groups, yet there was no significant difference in overall survival (CRG, 100%; PRG, 82.5%; NRG, 74.0%; P=0.244). There was a significant difference in disease-free survival (CRG, 100%; PRG, 90.1%; NRG, 57.7%; P=0.006).CONCLUSION: Tumor response with complete response or down-staging provided better oncologic outcomes in terms of disease-free survival and local recurrence in locally advanced rectal cancer patients.

A comparison of short-term outcomes of laparoscopic-assisted total gastrectomy and open total gastrectomy in early gastric cancer

PURPOSE: This study aimed to compare the postoperative outcomes of open total gastrectomy (OTG) and laparoscopic-assisted total gastrectomy (LATG) and prove that postoperative outcomes of LATG can be improved through a surgeon's experience.METHODS: 62 patients who underwent OTG and 82 patients who underwent LATG were enrolled in this study. To objectively assess the postoperative outcomes, we decided to apply the Clavien-Dindo classification. This study was performed based on postoperative complications occurring within 30 days after total gastrectomy.RESULTS: There was no statistically significant difference between the two groups with regard to intraoperative transfusion (P>0.99), overall postoperative complications (P>0.99), and major postoperative complications (P=0.731). Leakage of esophagojejunostomy was the most common complication after LATG. There is no statistically significant difference in the number of overall postoperative complications between the early LATG and late LATG groups (P=0.349). However, there is significant difference in the number of major complications between the two groups (P=0.026).CONCLUSION: LATG is not inferior to OTG and improved by learning in terms of postoperative outcomes in this study.

Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis

PURPOSE: This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC). MATERIALS AND METHODS: The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups. RESULTS: The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001). CONCLUSIONS: Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG.

Unaided Stapling Technique for Pure Single-Incision Distal Gastrectomy in Early Gastric Cancer: Unaided Delta-Shaped Anastomosis and Uncut Roux-en-Y Anastomosis

PURPOSE: Intracorporeal anastomosis is the most difficult procedure during pure single-incision distal gastrectomy (SIDG) that affects its generalization. We introduced unaided delta-shaped anastomosis (uDelta), a novel anastomosis technique, for gastroduodenostomy after pure SIDG, and compared the results with those of previously reported Roux-en-Y anastomosis (RY). MATERIALS AND METHODS: Between March 2014 and March 2015, SIDG with D1+ lymph node dissection was performed for early gastric cancer through a 2.5-cm transumbilical incision without any additional port. uDelta was performed by the operator alone, without any intracorporeal assistance. RESULTS: uDelta was performed on 11 patents, and uncut RY was performed on 5-patients without open or multiport conversion. R0 resection was performed in all cases. No significant differences were observed in mean age and body mass index between patients who underwent uDelta or RY. Mean operation times were 214.5+/-36.2 minutes for uDelta and 240.8+/-65.9 minutes for RY, which was not significantly different. Reconstruction time for uDelta was shorter than that for RY, with marginal statistical significance (26.1+/-8.3 minutes vs. 38.0+/-9.1 minutes, P=0.05). There were no intraoperative transfusions, 30-day mortality, or anastomosis-related complications in either group. Average length of hospital stay was 8.2+/-1.9 days in the uDelta group and 7.2+/-0.8 days in the RY group (P=0.320). CONCLUSIONS: After carefully considering indications, uDelta can be a feasible and can be a reproducible reconstruction method after SIDG in early gastric cancer.

New Era of Treatment of Osteoporotic Spine Fracture for Nonorthopaedic Doctor / 대한골다공증학회지

As we get older, our bones get thinner and their strength decreases. Osteoporosis is a disease in which bones become very weak and are more likely to break. It often develops unnoticed over many years, showing no symptoms or discomfort until a bone breaks. Fractures caused by osteoporosis occur most often in the spine. These spinal fractures-called vertebral compression fractures-occur in nearly 700,000 patients each year. They occur almost twice as often as do other fractures typically linked to osteoporosis, such as broken hips and wrists. Recently, several reports have been published on the results of vertebral augmentation procedures and fusion. However, many questions have been raised about the amount of pain relief that can be expected after such procedures. Although these few studies have sparked some debates in the medical community, it is important to remember that many procedures have also shown significant improvement in relief in back pain from vertebral compression fractures.

Debates of the Effectiveness of Vertebroplasty / 대한골다공증학회지

Vertebroplasty has become a common treatment for painful osteoporotic vertebral fractures, but there is limited evidence to support its use. We are debating what the effectiveness of vertebroplasty. Especially, published paper by Buchbinder using multicenter, randomized, double-blind, placebo-controlled trial methods, there were no beneficial effect of vertebroplasty as compared with a sham procedure in patients with painful osteoporotic vertebral fractures, at 1 week or at 1, 3, or 6 months after treatment. We have some problems about the risk of subsequent vertebral fractures, particularly in vertebrae that are adjacent to treated levels, sometimes after cement has leaked into the adjacent disk. But according to the previous many study and my experiences, Percutaneous vertebroplasty should be considered as a valid therapeutic option in symptomatic acute amyelic osteoporotic vertebral fractures with refractory pain after a short period of analgesic drug therapy. Therefore, I reviewed Buchbinder's result and previous similar papers.

The Sagittal Alignment of Spine in Conservatively Treated Osteoporotic Compression Fractures of Thoracolumbar Junction / 대한골다공증학회지

OBJECTIVES: To evaluate the radiological outcomes of conservative treatment for osteoporotic compression fractures in thoracolumbar junction. MATERIALS AND METHODS: 20 osteoporotic compression fracture cases of thoracolumbar junction (group I) which were treated conservatively using TLSO brace were evaluated compared with 20 osteoporotic spine cases (group II), between August 2010 and March 2012. The mean age was 65.3, ranging from 57 to 71 years old. The average follow up period was 27.4, ranging from 17 to 35 months. The bone marrow density (BMD) was recorded at the initial assessment. The lumbar lordotic angles with compression ratios on the initial and the last follow-up plain lateral radiograph were measured, and the sagittal alignments of spine were evaluated. RESULTS: In group I, the average compression ratios initially and at the last follow up were 23.5% and 33.7% respectively, and the average lumbar lordotic angles initially and at the last follow up were 30.8degrees and 22.6degrees respectively. In group II, the average lumbar lordotic angles initially and at the last follow up were 40.3degrees and 39.9degrees respectively. In group I, the compression ratio was significantly increased, and the lumbar lordotic angle was decreased at the final follow up. In group II, the difference of lumbar lordotic angles was not significant statistically. CONCLUSIONS: In most, the osteoporotic compression fractures can be successfully managed conservatively. But, in some cases of thoracolumbar junction, the further collapse of vertebral body and the change of lumbar lordotic angle can be developed, and then sagittal alignment of spine can be disrupted.

Spinal Cord Injury and Osteoporosis / 대한골다공증학회지

Osteoporosis is one of the major complications in patients with SCI (spinal cord injury). The neurologic lesion and subsequent immobilization induce early and acute bone loss. During the first months post-injury, demineralization occurs exclusively in the sublesional areas and predominantly in weight-bearing sites. The high bone loss associated with modification in bone matrix composition is very likely at the origin of the pathologic fractures occurring spontaneously or in response to minor trauma. The pathogenesis of osteoporosis after SCI was generally considered disuse. But, the lack of mechanical factors alone cannot explain the considerable bone loss. Currently, the pathogenesis of SCI-induced bone loss is considered the result of high rate of bone turnover characterized by bone formation-resorption uncoupling. But, the duration and patterns of bone loss after SCI remain still unknown. In addition the question of whether alterations in qualitative bone properties are confined to the paralyzed limbs or affect the whole skeleton remains open.

The Value of Postoperative Serum Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 Levels for the Early Detection of Gastric Cancer Recurrence after Curative Resection

PURPOSE: This study aimed to evaluate the value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels to detect gastric cancer recurrence. MATERIALS AND METHODS: We retrospectively reviewed 154 patients who developed recurrence within 2 years after curative gastric cancer surgery and analyzed the relationship between postoperative CEA and CA19-9 levels and recurrence. We readjusted the cut-off values to improve the detection of recurrence. Subgroup analysis according to clinicopathologic variables was performed to further investigate the relationship between recurrence and CEA and CA19-9 levels. RESULTS: The sensitivity and specificity for elevated CEA levels to detect recurrence were 40.6% and 89.5%, respectively, and those for CA19-9 were 34.2% and 93.6%, respectively. The sensitivity and specificity for elevation of either tumor marker were 54.3% and 84.0%, respectively; those for elevation of both tumor markers were 19.2% and 98.4%, respectively. By readjusting the cut-off values from 5.0 ng/ml to 5.2 ng/ml for CEA and from 37.00 U/ml to 30.0 U/ml for CA19-9, the sensitivity was increased from 34.2% to 40.2% for CA19-9, while there was no increase in sensitivity for CEA. In subgroup analysis, the sensitivity of CEA was higher in patients with elevated preoperative CEA levels than in patients with normal preoperative CEA levels (86.7% versus 33.7%; P<0.001). Furthermore, the sensitivity of CA19-9 was higher in patients with elevated preoperative CA19-9 levels than in patients with normal preoperative CA19-9 levels (82.61% versus 26.83%; P<0.001). CONCLUSIONS: CEA and/or CA19-9 measurement with the readjusted cut-off values allows for more effective detection of gastric cancer recurrence.

Effects of Screening on Gastric Cancer Management: Comparative Analysis of the Results in 2006 and in 2011

PURPOSE: This study aimed to analyze the effect of screening by using endoscopy on the diagnosis and treatment of gastric cancer. MATERIALS AND METHODS: The clinicopathologic characteristics of gastric cancer were compared in individuals who underwent an endoscopy because of symptoms (non-screening group) or for screening purposes (screening group). The distributions of gastric cancer stages and treatment modalities in 2006 and 2011 were compared. RESULTS: The proportion of patients in the screening group increased from 45.1% in 2006 to 65.4% in 2011 (P<0.001). The proportion of stage I cancers in the entire patient sample also increased (from 60.5% in 2006 to 70.6% in 2011; P=0.029). In 2011, the percentages of patients with cancer stages I, II, III, and IV were 79.9%, 8.2%, 10.9%, and 1.1%, respectively, in the screening group, and 47.9%, 10.8%, 29.8%, and 11.5%, respectively, in the non-screening group. The proportion of laparoscopic and robotic surgeries increased from 9.6% in 2006 to 48.3% in 2011 (P<0.001), and endoscopic submucosal dissection increased from 9.8% in 2006 to 19.1% 2011 (P<0.001). CONCLUSIONS: The proportion of patients diagnosed with gastric cancer by using the screening program increased between 2006 and 2011. This increase was associated with a high proportion of early-stage cancer diagnoses and increased use of minimally invasive treatments.

The Effect of Combined Enteral and Parenteral Nutrition for Anastomotic Leakage after Gastric Cancer Surgery

PURPOSE: The effectiveness of enteral nutrition for patients with anastomotic leakage after gastric cancer surgery is controversial. The purpose of this study is to compare effectiveness between combined enteral nutrition with parenteral nutrition (EPN) and total parenteral nutrition (TPN). METHODS: Patients who underwent gastric cancer surgery for primary gastric cancer from April 2010 to August 2012 were reviewed. Clinicopathologic characteristics, complication, laboratory tests, and body weight (Bwt) were compared between EPN and PN. RESULTS: Among patients with postoperative leakage within postoperative 1 month (n=43), 13 patients were supported by EPN and 23 patients by TPN. Clinicopathologic characteristics, including preoperative Bwt, body mass index, nutritional status, other complications, and TNM stage were similar. Preoperative serum albumin and Bwt were similar between EPN and TPN. However, after 1 week of nutritional support, albumin at EPN was significantly higher than that of PN (3.52+/-0.3 and 3.25+/-0.3; P=0.010). Adjusted by preoperative Bwt, preoperative nutritional status, and difference in Bwt between preoperative and pre-nutritional support period, decrease of Bwt between pre-nutritional support and discharge was significantly less at EPN than at TPN (-4.5+/-5.4% and -6.3+/-4.1%; P=0.001). CONCLUSION: In terms of the maintenance of serum albumin and Bwt during nutritional support, EPN may be a better supportive option than TPN for patients with anastomotic leakage after gastric cancer surgery.

Efficacy of Percutaneous Vertebroplasty in Osteoporotic Vertebral Compressive Fractures / 대한골다공증학회지

Osteoporosis is an age-related progressive skeletal disease characterised by low bone mass and microarchitectural deterioration, with a consequent increase in bone fragility and susceptibility to fracture. The prevalence of osteoporosis increases dramatically with age, for both men and women. The most frequent osteoporotic fracture is the vertebral compression fracture. Osteoporotic vertebral compression fracture is known to cause physical, functional and mental side effects and complications such as lowered quality of life and increased mortality rate. The lifetime risk of such fractures will increase as the median age of the population continues to rise. Most of the patients can be treated successfully with conservative therapy, but in some cases pain persists and may result to general weakness and aggravation of osteoporosis from long time bed rest. Operative intervention should be considered for these patients. But, Operative interventions such as fusion and application of instrumentation are less attractive in these elderly patients, due to increased risks of anaesthesia, poor quality of bone and invasiveness. To reduce the risks of operative intervention a new treatment, vertebroplasty was introduced and it became popular as a treatment for osteoporotic fractures. As a treatment procedure, vertebroplasty is widely used due to its non-invasiveness. Moreover, many studies reported improvements in clinical symptoms upon obtaining immediate postoperative pain relief and vertebral stability. But, the complications such as cement leakage, nerve damage, new compression fracture in adjacent level, pulmonary embolism, infections must be considered. The purpose of this study is to assess the efficacy, safety and complications of vertebroplasty as a treatment in painful osteoporotic vertebral compression fractures by means of review of the current literature.

Operative Risk Assessment of Degenerative Spinal Disorder Comparing with Total Hip Replacement

STUDY DESIGN: Retrospective study. OBJECTIVES: To assess the operative risks and complications of posterior decompression and fusion for degenerative spine disorders, we compared single level posterior decompression and posterolateral fusion of lumbar spine with total hip arthroplasty which have been evaluated in many reports and articles on complications and operative risks. SUMMARY OF LITERATURE REVIEW: There has been no study comparing the relative risks of spinal surgery with total hip arthroplasty. MATERIALS AND METHODS: One hundred and thirty-six subjects (mean age 69.6 years) who received single level posterior decompression and posterolateral fusion for degenerative lumbar disorders from February 2000 to May 2010 were selected as group A, and 136 subjects (mean age 67.2 years) who received total hip arthroplasty during the same period were selected as group B. A comparative analysis was performed according to age, gender, pre-operative ASA status based on their underlying medical conditions, total operative time, blood loss, hospitalization period, incidence of major and minor complications and functional recovery at the time of final follow up using retrospective and statistical manners from medical records and radiologic evaluations. RESULTS: The total operative time and blood loss were longer in group A with statistical significance (P<0.01). Major complications were frequent in group B with 16 cases and in group A with 6 cases (P<0.05). There were no significant differences in the total hospitalization period, incidence of minor complications and post-operative functional recovery. CONCLUSIONS: The present study revealed no increased operative risks for surgery for degenerative lumbar disorders compared with total hip arthroplasty in similar age groups.

Correlation of Adjacent Segmental Disease with Tilt Angles of the Upper and Lower Instrumented Vertebra in the Degenerative Lumbar Scoliosis

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the correlation of adjacent segmental disease with tilt angles of the upper and lower instrumented vertebra after instrumented posterolateral fusion for degenerative lumbar scoliosis. SUMMARY OF LITERATURE REVIEW: There has been no study of radiologic measurement and decision of fusion level using the angle of pedicle screws inserted for treatment of degenerative lumbar scoliosis. MATERIALS AND METHODS: From 2004 to 2008, 74 patients that underwent decompression and posterolateral fusion for degenerative lumbar scoliosis were included in this study. In all cases, instrumentation and posterolateral fusion were both performed. The sex ratio was 31:43, the mean age was 68.7 years and the mean follow up duration was 37.4 months. The angle between each upper end plate of the upper vertebral body and lower end plate of the lower vertebral body of the fusion, and the line parallel to the axis of the sagittal line of vertebrae was each defined as UIV-a and LIV-b. The correlation of development of adjacent segment disease and UIV-a, and LIV-b angle was investigated. RESULTS: Sum of the absolute value of UIV-a and LIV-b had a statistically significant positive correlation with that of adjacent segment disease. Also, UIV-a alone, had a statistically positive correlation with the development of proximal adjacent segment disease. CONCLUSIONS: Since it is proven that adjacent segment disease has positive correlation with the sum of the absolute value of UIV-a and LIV-b, the extent of fusion should be adjusted to make the line parallel to the line perpendicular to the sagittal surface.

Differentiation of Osteoporotic Fracture from Metastatic Fracture in Spine using MRI / 대한골다공증학회지

OBJECTIVES: To determine that compression fracture of L5 and posterior convexity of the vertebral body on MRI are useful indicators of spinal metastasis. MATERIALS AND METHODS: Forty seven cases of vertebral compression fractures with magnetic resonance imaging (MRI) were reviewed. They were classified into two groups: the metastatic fracture (MF) group (n=23) and the osteoporotic fracture (OF) group (n=24). Each cases were evaluated according to their MRI findings of fracture site location, and the presence of posterior convexity of the vertebral body, intact midseptum and anterior signal change. Conventional T1 and T2 weighted images were obtained. Statistical analysis was done using the paired t-test and fisher's exact test. RESULTS: The MF group had 100% incidence of fracture in L5 (P<0.01). The incidence of positive posterior convexity was also 100%. The incidence of a positive anterior signal change was 67% (n=16) and intact septum was seen in 16 patients (67%). In the OF group, there were no fractures in L5 (16 cases with L1 fractures [67%]) and only 3 cases with posterior convexity (12.5%). Midseptum was intact in 19 cases (79%) and 6 patients with positive anterior signal change (25%). CONCLUSIONS: The location of vertebral fracture, especially in L5 and convex deformity of posterior vertebral body are reliable indicators of spinal metastasis.

The Relationship between the Pedicle Screw Loosening and Bone Mineral Density after Transpedicular Spinal Instrumentation / 대한골다공증학회지

OBJECTIVES: We have analyzed relationship between pedicle screw loosening and bone mineral densitiy (BMD) after spinal arthrodesis with pedicle screw. MATERIALS AND METHODS: We have chosen 31 cases that had screw loosening radiologically on the follow up X-ray among the patients who underwent spinal arthrodesis with pedicle screws, and compared Saville's index that was measured by lateral view of preoperative X-ray with Dual energy X-ray absortiometry (DEXA) score.

Correlation Analysis of BMD in Proximal Femur and Spine According to Age / 대한골다공증학회지

OBJECTIVES: To analogize the test results through analyzing the correlation of bone mineral density (BMD) values between 2 sites (proximal femur and lumbar spine). MATERIALS AND METHODS: Among the 1557 cases that underwent BMD test on their proximal femur and lumbar spine without history of trauma or disease of the hip or lumbar region, according to their age, they were divided into 4 groups, and the T-score and Z-score of the proximal femur and lumbar spine were each investigated. RESULTS: The correlation figured out through the regression analysis was that, considering the lumbar spine value as the independent variable (L), and the proximal femur value as the dependant variable (H), the T-score was H=0.508xL-0.723 in group 1, H=0.445xL-0.649 in group 2, H=0.363xL-1.124 in group 3 and H=0.404xL-1.467 in group 4. The correlation coefficient of T-score value of the 2 sites of each group was 0.58, 0.59, 0.47, 0.54 each, and which were statistically significant. Z-score was H=0.485xL-0.514 in group 1, H=0.451xL-0.141 in group 2, H=0.390xL-0.401 in group3, L=0.897xH-0.481 in group 4. CONCLUSION: On the BMD test performed in an age group of over 40 years old, T-score and Z-score each showed significant increase and this is thought to be related to low bone mineral due to bone mineral decrease because of the old age. Also, in cases with lesion in the hip joint or spine, there is a clinical usefulness of analogizing the result of the other region with a result of a single region.