• Title/Summary/Keyword: Posterior-only approach

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Clinical and anatomical importance of foramen magnum and craniocervical junction structures in the perspective of surgical approaches

  • Berin Tugtag Demir;Simge Esme;Dilara Patat;Burak Bilecenoglu
    • Anatomy and Cell Biology
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    • v.56 no.3
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    • pp.342-349
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    • 2023
  • This study was conducted to investigate the clinical and anatomical importance of the relevant region from the perspective of surgical approaches by determining the morphometric analysis of the craniocervical junction and foramen magnum (FM) region and determining their distances from important anatomical points. This research was carried out with 59 skulls found at the Anatomy Laboratories of Erciyes and Ankara Medipol University. Metric measurements of FM and condyle, FM shape, condyle-fossa relationship, and pharyngeal tubercle (PT) were made in mm-based dry bone samples of unknown age and sex. The distance between the anterior notches and the FM was 87.01±4.35, the distance between the anterior notches and the PT was 77.70±4.24, the distance between the PT-sphenooccipital junction was 13.23±2.42, and the FM index was 81.86±7.47. The anteroposterior and transverse lengths of FM were determined as 33.80±2.99 and 27.72±2.30, respectively. The morphometric and morphological data available regarding the craniocervical junction showed significant differences between populations. Comprehensive knowledge of this topic will provide a better approach to treat Arnold Chiari Malformation, FM meningiomas, and other posterior cranial fossa lesions. Therefore, we believe that FM and craniocervical junction morphology will be a guide not only for anatomists, but also for radiologists, neurosurgeons, ENT surgeons, and orthopedists.

Giant Intrathoracic Meningocele and Breast Cancer in a Neurofibromatosis Type I Patient

  • Malla, Hridayesh Pratap;Park, Bong Jin;Koh, Jun Seok;Jo, Dae Jean
    • Journal of Korean Neurosurgical Society
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    • v.59 no.6
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    • pp.650-654
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    • 2016
  • Intrathoracic meningoceles are relatively rare entities found in patients with neurofibromatosis type I (NF1). Given that both the BRCA1 and NF-1 genes are located on the same long arm of chromosome 17, one would expect concurrence of neurofibromatosis and breast cancer. However, incidence of such co-disorders is very rare in the literature. Here, the authors report a case of a 50-year-old female patient with NF-1 and concurrent cancer of the left breast, who had a huge bilobulated intrathoracic meningocele with thoracic dystrophic scoliosis, treated surgically via a posterior-only approach for the meningocele and spinal deformity in the same setting.

A Naive Multiple Imputation Method for Ignorable Nonresponse

  • Lee, Seung-Chun
    • Communications for Statistical Applications and Methods
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    • v.11 no.2
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    • pp.399-411
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    • 2004
  • A common method of handling nonresponse in sample survey is to delete the cases, which may result in a substantial loss of cases. Thus in certain situation, it is of interest to create a complete set of sample values. In this case, a popular approach is to impute the missing values in the sample by the mean or the median of responders. The difficulty with this method which just replaces each missing value with a single imputed value is that inferences based on the completed dataset underestimate the precision of the inferential procedure. Various suggestions have been made to overcome the difficulty but they might not be appropriate for public-use files where the user has only limited information for about the reasons for nonresponse. In this note, a multiple imputation method is considered to create complete dataset which might be used for all possible inferential procedures without misleading or underestimating the precision.

Bayesian Reliability Estimation for Small Sample-Sized One-shot Devices (작은 샘플 크기의 One-shot Devices를 위한 베이지안 신뢰도 추정)

  • Mun, Byeong Min;Sun, Eun Joo;Bae, Suk Joo
    • Journal of Applied Reliability
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    • v.13 no.2
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    • pp.99-107
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    • 2013
  • One-shot device is required to successfully perform its function only once at the moment of use. The reliability of a one-shot device should be expressed as a probability of success. In this paper, we propose a bayesian approach for estimating reliability of one-shot devices with small sample size. We employ a gamma prior to obtain the posterior distribution. Finally, we compare the accuracy of the proposed method with general maximum likelihood method.

Determinacy on a Maximum Resolution in Wavelet Series

  • Park, Chun-Gun;Kim, Yeong-Hwa;Yang, Wan-Youn
    • Journal of the Korean Data and Information Science Society
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    • v.15 no.2
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    • pp.467-476
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    • 2004
  • Recently, an approximation of a wavelet series has been developed in the analyses of an unknown function. Most of articles have been studied on thresholding and shrinkage methods for its wavelet coefficients based on (non)parametric and Bayesian methods when the sample size is considered as a maximum resolution in wavelet series. In this paper, regardless of the sample size, we are focusing only on the choice of a maximum resolution in wavelet series. We propose a Bayesian approach to the choice of a maximum resolution based on the linear combination of the wavelet basis functions.

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Pena Operation as a Redo Procedure for Anorectal Malformation (항문직장기형 재 수술로서 Pena술식)

  • Lee, Jong-Won;Kim, Hyun-Young;Choi, Seung-Eun;Jung, Seung-Eun;Lee, Seong-Cheol;Park, Kwi-Won;Kim, Woo-Ki
    • Advances in pediatric surgery
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    • v.8 no.2
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    • pp.119-125
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    • 2002
  • The aim of this study was to evaluate the posterior sagittal anorectoplasty (PSARP) as a re-do operation in patients who failed initial repair of anorectal malformation. Nine patients (4 boys and 5 girls) who had previous failed surgery for anorectal malformation underwent secondary operations through posterior sagittal approach. The main reasons of surgery were constipation (n=3) and persistent anatomical derangement in spite of previous correction surgery (n=6). In addition to constipation, the former group (n=3) had various anatomical defects, and the latter group (n=6), of course, had constipation in some degrees. Patients ranged in age from 2 to 19 years (median 3 years) with only one over the age of 6 years. The primary procedures included PSARP (n=8) and anoplasty (n=1). The rectum was mobilized from surrounding structures through posterior sagittal approach and anatomical defects were corrected. The rectum underwent reconstruction, which involved relocation of the rectum and anus within the limits of the intact muscle complex. Patients underwent follow-up for periods ranging from 6 to 77 months (mean 37 months) after surgery. Anatomical corrections of all the defects were successfully fulfilled in 9 patients. All the patients were satisfied with the functional results after redo-PSARP compared with the preoperative defecatory function. This study suggests that (1) some of the patients with troublesome constipation may have anatomical defects, prominent or hidden, (2) surgeons should suspect the possibility of anatomical defect as the cause of incontinence and (3) preoperative thorough investigation to reveal the anatomical defects should be included in estimating patients with severe incontinence after previous surgery and planning the correction for failed previous surgery as well.

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Effect of Social Norm on Consumer Demand: Multiple Constraint Approach

  • Choi, Sungjee;Nam, Inwoo;Kim, Jaehwan
    • Asia Marketing Journal
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    • v.22 no.1
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    • pp.41-60
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    • 2020
  • The goal of the study is to understand the role of social norm in purchase decisions where demand is revealed in the form of multiple-discreteness. Consumers are socially engaged in various activities through the expectation from others in their community. Actions or decisions are likely to reflect this influence. This implicit or explicit social norm is revealed as the rules, regulations, and standards that are understood, shared, endorsed, and expected by group members. When consumers' decisions are in distance from the norm, they come to face discomfort such as shame, guilt, embarrassment, and anxiety. These pressure act as a constraint as opposed to utility in their decision making. In this study, the effect of social norms on consumer demand is captured via multiple constraint model where constraints are not only from budget equation but also from psychological burden induced by the deviation from the norm. The posterior distributions of model parameters were estimated via conjoint study allowing for heterogeneity via hierarchical Bayesian framework. Individual characteristics such as age, gender and work experience are also used as covariates for capturing the observed heterogeneity. The empirical results show the role of social norm as constraint in consumers' utility maximization. The proposed model accounting for social constraint outperforms the standard budget constraint-only model in terms of model fit. It is found that people with longer job experience tend to be more robust and resistant to the deviation from the norm. Incorporating social norm into the utility model allows for another means to disentangle the reason for no-purchase as 'not preferred' and 'not able to buy'.

Partial Pediculectomy for Spondylolisthesis with Radicular Pain Combined with Severe Osteoporosis (하지 방사통과 심한 골다공증을 동반하는 척추전전위증을 위한 척추경 부분절제술)

  • Park, Myoung Jin;Shin, Ho;Cho, Ha Young;Lee, Seung Myoung;Jeong, Seong Hun;Song, Jin Kyu;Jang, Suk Jung
    • Journal of Korean Neurosurgical Society
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    • v.29 no.1
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    • pp.51-57
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    • 2000
  • Objective : For relief of back pain related to spondylolisthesis, fusion with or without internal fixation may be necessary. Currently, bilateral wide posterior decompression and fusion with or without internal fixation are used for treatment of spondylolisthesis. In case of severe osteoporosis, discectomy may be done without fusion to decompress the nerve roots. However, the procedure may aggravate radicular symptom because slippage may increase and thus foramen may become narrower. In these settings, inferomedial partial pediculectomy has been done in our institution, The object of this study was to evaltuate such cases with regard to per- and postoperative clinical courses. Patients and Methods : Fifteen patients complaining radicular pain with mild or no back pain underwent inferomedial partial pediculectomy. It was done in lytic spondylolisthesis after extension of isthmic defect. In degenerative spondylolisthesis of L4-5 interspace, intertransverse pediculectomy was done via paraspinal approach not to injure the posterior segment with intact isthmus. But, in degenerative spondylolisthesis of L5-S1 interspace however, partial pediculectomy was done after making artificial isthmic defect via midline approach. Then, reconstructive laminoplasty of L5 was performed to avoid iatrogenic instability resulted from artificial isthmic defect. They were followed up for average 14.4 months(3-31 months). Results : Radiating pain was relieved in all cases(100%). Postoperative result was excellent in 7 cases(46.7%), good in 7(46.7%) and fair in 1(6.6%). Only 1 case(6.7%) showed increase in slippage during follow-up period. Conclusion : Inferomedial partial pediculectomy is considered as a useful procedure for severely osteoporotic patients with spondylolisthesis with regards to keeping stability and decompressing the nerve roots.

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Radiographic study of the distribution of maxillary intraosseous vascular canal in Koreans

  • Lee, JuHyon;Kang, Nara;Moon, Young-Mi;Pang, Eun-Kyoung
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.38
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    • pp.1.1-1.4
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    • 2016
  • Background: This study aimed to investigate the distribution and prevalence of intraosseous loop (anastomosis between posterior superior alveolar artery and infraorbital artery) in Koreans detected on computed tomography (CT) images taken prior to sinus augmentation surgery. Methods: From the 177 patients who underwent sinus augmentation with lateral approach at Ewha Womans University Department of Implant Dentistry, 284 CT scans were evaluated. The canal height (CH), ridge height (RH), and canal height from the sinus floor (CHS) were measured on para-axial views at the first premolar, first molar, and second molar. The horizontal positions of the bony canals in the lateral wall were also classified. One-way analysis of variance (ANOVA) and t test were used to estimate the statistical differences (p < 0.05). Results: The intraosseous loops were detected in 92 CT scans (32 %). The mean vertical height of the bony canals from the alveolar crest (CH) was $23.45{\pm}2.81$, $15.92{\pm}2.65$, and $16.61{\pm}2.92mm$ at the second premolar, first molar, and second molar, respectively. In the horizontal positions of the bony canals, intraosseous type was the most predominant. The canal heights more than 15 mm and less than 17 mm were most prevalent (33.7 %) and those under 13 mm were 12.0 %. Conclusions: The radiographic findings in this study could be used to decide the lateral osteotomy line avoiding potential vascular complication. However, only one third of the canals could be detected in CT scans; a precaution should be taken for the possibility of severe bleeding during lateral osteotomy.

Titanium Mesh Cage for Anterior Stabilization in Tuberculous Spondylitis : Is It Safe?

  • Bak, Koang-Hum;Cheong, Jin-Hwan;Kim, Jae-Min;Kim, Choong-Hyun;Kim, Seung-Bum
    • Journal of Korean Neurosurgical Society
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    • v.40 no.6
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    • pp.412-418
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    • 2006
  • Objective : The safety of titanium metal cages in tuberculous spondylitis has not been investigated. We evaluated the outcome and complications of titanium mesh cages for reconstruction after thoracolumbar vertebrectomy in the tuberculous spondylitis. Methods : There were 17 patients with 18 operations on the tuberculous spondylitis in this study. Sixteen patients were operated with anterior corpectomy and reconstruction with titanium mesh cage followed by posterior transpedicular screw fixations on same day, two pateints were operated by either anterior or posterior approach only. After the affected vertebral body resection and pus drainage from the psoas muscle, titanium mesh cage, filled with morselized autogenous bone, was inserted. All the patients had antituberculosis medication for 18 months. The degree of kyphosis correction and the subsidence of cage were measured in the 15 patients available at a minimum of 2 years. Outcome was assessed with various cross-sectional outcome measures. Recurrent infection was identified by serial ESR[Erythrocyte Sedimentation Rate] and CRP[Cross Reactive Protein]. Results : There was no complication from the use of a titanium mesh cage. Recurrent infection was not detected in any case. Average preoperative of $9.2^{\circ}$ was reduced to $-2^{\circ}$ at immediate postoperative period, and on final follow up period kyphotic angle was measured to be $4.5^{\circ}$. Postoperatively, subsidence was detected in most patients especially at ambulation period, however further subsidence was prevented by the titanium mesh cage. Osseous union was identified in all cases at the final follow-up. Conclusion : The cylindrical mesh cage is a successful instrument in restoring and maintaining sagittal plane alignment without infection recurrence after vertebrectomy for tuberculous spondylitis.