The Discriminating Ability of a Prognosis According to the TNM, Okuda, CLIP, JIS, and BCLC Staging Systems for Hepatocellular Carcinoma

PURPOSE: There is yet no ideal single staging system for hepatocellular carcinoma (HCC). The aim of this study was to analyze HCC survival times according to the TNM, Okuda, CLIP, JIS, and BCLC staging systems and their prognostic discrimination ability. METHODS: A retrospective analysis of medical records and statistical data from the Korean statistical information service was done for HCC patients diagnosed at Bundang CHA hospital between June, 1992 and February, 2009. RESULTS: During follow-up, 121 (72%) of 168 people died and 1, 3 and 5 year overall survival rates were, respectively, 58%, 35% and 25%. In the analysis of discriminative ability of each staging system, the CLIP staging system showed the highest LR chi-square value, and the lowest AIC value (p<0.05). Therefore, the CLIP staging system appears to be superior to the other systems. CONCLUSION: Of the 5 staging systems in this study, the CLIP staging system was superior to the other systems, but the results of many other studies from different countries have varied. It is necessary to establish the staging system suitable for each country's actual circumstances.

Duodenal Perforation due to Hemoclipping for the Dieulafoy's Lesion in a Duodenal Diverticulum / 대한소화기내시경학회지

Duodenal diverticulum usually originates in the second portion of the duodenum and occasionally causes duodenal obstruction, hemorrhage, perforation and diverticulitis. A bleeding from Dieulafoy's lesion in a duodenal diverticulum is rare. It is not easily dignosed and treated by forward viewing endoscopy. Recently, a case was reported describing the hemorrhage from the Dieulafoy's lesion in a duodenal diverticulum which was treated by hemoclip with forward viewing endoscopy. Hemoclip application is considered to be the most appropriate endoscopic treatment, because sclerotherapy, electrocoagulation or band ligation for Dieulafoy's lesion in the duodenal diverticulum may increase risk of duodenal perforation. We report a case of duodenal perforation due to hemoclip application for the treatment of Dieulafoy's lesion in a duodenal diverticulum.

Gliomatosis Cerebri: Clinical Features and Prognosis

OBJECTIVES: Gliomatosis cerebri is an uncommon primary brain tumor characterized by diffuse neoplastic proliferation of glial cells, with the preservation of the underlying cytoarchitecture. The aim of this study is to evaluate clinical features, outcome of surgical treatment and adjuvant therapy of gliomatosis cerebri. METHODS: Between Jan. 1990 and Dec. 2000, 12 patients were diagnosed with gliomatosis cerebri based on characteristic radiological and histological findings. The patients' age ranged from 18 to 77(mean 44) years and the male to female ratio was 7: 5. Nine patients underwent decompressive surgery and three, biopsy only. Postoperative radiation therapy was given in all cases except three. In addition to radiation therapy, four patients received chemotherapy. The mean duration of follow-up period was 18.8 months. RESULTS: The most common presenting symptom were seizure and motor weakness. The mean duration of symptom was 5.9 months. There was 5 bilateral lesions and tumor involved corpus callosum in 5, basal ganglia-thalamus in 4, and brain stem in 2. There was no operative mortality but four patients died during the follow-up. The mean survival period for 11 patients was 20.5 months from the time of diagnosis. In univariate analysis, the lesion involving corpus callosum, basal ganglia-thalamus and brain stem correlated significantly with the short length of survival(p<0.05). Also, postoperative radiation as a adjuvant therapy prolonged the patient's survival(p<0.05). CONCLUSIONS: In the management of gliomatosis cerebri patients, early detection by MR imaging, active management of increased intracranial pressure, decompressive surgical removal and postoperative adjuvant therapy such as radiation is thought to be a good treatment modality.

Novel Maintenance Therapy with Lamivudine in Patients with Chronic Active Viral Hepatitis B / 대한간학회지

BACKGROUND/AIMS: This study was conducted to determine the effect of novel long-term maintenance treatment with lamivudine by gradual lengthening of the medication interval in patients with chronic active viral hepatitis B. METHOD: All patients were non-responder, relapsed or intolerable patients to previous interferon therapy. Patients were divided into a drug-interval changing study and a daily continual medication control group. Drug-interval changing protocol with gradual lengthening of the medication interval after conversion to undetectable HBV-DNA in serum and reduction of serum aminotransferase to normal level was monitored monthly. RESULTS: Before treatment, 15 patients of the drug-interval change group and 11 patients of the daily medication group were similar in laboratory and pathologic findings. Mean follow-up periods were 12.8 moths and 11.4 months respectively. HBeAg seroconversion rate was higher in patients in the daily medication group (86.7% vs. 40.0%, p<0.05). The odds of loss of HBeAg, development of anti-HBe, and suppression of HBV-DNA are about 11 times, 7 times, and 8 times higher in the drug-interval change group compared with the daily medication group, respectively (p<0.05). CONCLUSION: Drug-interval lengthening method was effective in long-term suppression of viral replication with low cost.

Anterior Screw Fixation of Type II Odontoid Fracture

No abstract available.

Posterior C1-2 Transarticular Screw Fixation without C1-2 Sublaminar Wiring in Atlantoaxial Instability

No abstract available.

Adefovir dipivoxil for the treatment of lamivudine resistant hepatitis B mutants / 대한간학회지

No abstract availalbe.

Anterior and Posterior Fusion on Reduction-failure Unilateral Interfacetal Dislocation

OBJECTIVE: Unilateral interfacetal dislocation(UID) is a common injury in cervical spine, but diagnosis is somewhat difficult due to mild subluxation. Management of'locked facet' is not established yet and many authors advocate posterior fusion to secure stability. Because most of UID patients have minimal neurological symptom with normal activity, we tried anterior and posterior fusion simultaneously. PATIENTS AND METHODS: Various parameters, such as the radiological findings, operation time and methods, kinds of fixation devices, post-operative stability, neurological outcomes in 10 UID-patients, who showed no satisfactory closed reduction with Gardner tong traction. These patients underwent anterior fixation following posterior open reduction and fusion to maintain the definite stability. RESULTS: Median age was 40 years(18-64 range) and the male to female ratio was 7:3. Causes of injury consisted of 6 car accident, 3 fall-down, 1 diving accident. Mechanism of injury was flexion in all ten cases. Levels of injury were 2 in C4-5, 5 in C5-6 and 3 in C6-7. Operations were performed within 5 days of injury in eight patients. In two patients, who had no reduction procedures were operated on the 23rd day and the 4th month respectively. Kinds of device were: 7 titanium wire and 3 steel wire in posterior wiring, 9 Caspar nonlocking plate and 1 Orion locking plate in anterior plate fixation. All patients were ambulated at post-operative one day with Philadelphia cervical collar and showed post-operative stability with improved neurological outcome. CONCLUSION: In UID patients who failed in closed reduction with traction, anterior discectomy and bone fusion and plating following posterior open reduction and wiring proved good results.

Ventriculotransverse Sinus Shunt for Hydrocephalus

The new operative technique of ventriculotransverse sinus shunt for hydrocephalus is introduced in this paper. This method has been applied to 6 hydrocephalic patients with Pudenz-Heyer low pressure valve in our department of Kyungpook National University Hospital from June 1990 to to May 1992. 4 cases including 2 high pressure hydrocephalus of all the patients improved in neurologic deficit within 2 weeks postoperatively. 2 Cases of normal pressure hydrocephalus installed the same shunt showed no improvement without any shunt valve dysfunction, so the shunts were revised to ventriculoperitoneal shunts. The choice of transverse sinus rather than superior sagittal sinus for CSF recipient of shunt seems more reasonable anatomically and physiologically. And this procedure could first apply to the poor risk patients with local anesthesia in such cases with old age, deteriorated, and to the patients requiring revision of the other shunting. To confirm the effect and perspect for continuous using this new technique, more patients applying this method and long term follow-ups of them should be needed.

Ventriculotransverse Sinus Shunt for Hydrocephalus

The new operative technique of ventriculotransverse sinus shunt for hydrocephalus is introduced in this paper. This method has been applied to 6 hydrocephalic patients with Pudenz-Heyer low pressure valve in our department of Kyungpook National University Hospital from June 1990 to to May 1992. 4 cases including 2 high pressure hydrocephalus of all the patients improved in neurologic deficit within 2 weeks postoperatively. 2 Cases of normal pressure hydrocephalus installed the same shunt showed no improvement without any shunt valve dysfunction, so the shunts were revised to ventriculoperitoneal shunts. The choice of transverse sinus rather than superior sagittal sinus for CSF recipient of shunt seems more reasonable anatomically and physiologically. And this procedure could first apply to the poor risk patients with local anesthesia in such cases with old age, deteriorated, and to the patients requiring revision of the other shunting. To confirm the effect and perspect for continuous using this new technique, more patients applying this method and long term follow-ups of them should be needed.

Intracranial Aneurysms with Intraventricular Hemorrhage and Ventricular Dilatation

Clinical analysis and review were made on the 65 aneurysmal patients who had intraventricular hemorrhage(IVH) confirmed on preoperative brain CT among a total of 268 patients operated on intracranial aneurysms. The study was made on aneurismal sites, the severity of IVH, postoperative ventricular dilatation and the result of treatment. The frequency of IVH among the 268 aneurysmal patients with direct clipping was 24.3%. Aneurysms originated from anterior communicating artery had the highest frequency(49.2%), followed by from posterior communicating artery(15.4%). On the severity of IVH, the frequency of severe IVH was 49.2%, the highest. The second was mild IVH, 32.3%. Forty five percent accounted for ventricular dilatation. By ventricular size index, mild dilatation was 7.7%;moderate, 13.8%;and severe dilatation, 20%. 11 patients(16.9%) undersent CSF shunting procedure. The treatment for the 65 aneurysmal patients with IVH ended in:survivor, 58 patients(98.3%), good recovery, 32.3% and 7 deaths, the rate of mortality was 10.7%.

Posterior Fixation and Fusion for the Lumbar Spondylolisthesis

From March 1990 to February 1992, 40 cases of lumbar spondylolisthesis underwent transpedicle fixation and fusion using VSP system and PWB system. The diagnosis were isthmic types in 17 cases(male;9, female;8) and degenerative types in 23 cases(male;5, female;18), ranging in ages from 34 to 68 years with a mean age of 52 years. The preoperative slip measured less than 20% in 11 cases, between 20 and 40% in 27 cases and more than 40% in 2 cases. At an average 19 months follow up(range;9~33months), the degree of slip correction averaged 43% in isthmic group, 51% in degenerative group, a solic fusion based on radiologic evaluation was achieved in 85%. Overall results showed 77% good, 18% fair and 5% poor. Complications included superficial infection in 2 cases, screw breakage in 1 case and screw loosening in 2 cases.