Objective : This study assessed the safety and efficacy of one level unilateral laminotomy bilateral decompression (ULBD) with the placement of a device for intervertebral assisted motion (DIAM) compared with one level ULBD only in elderly patients with degenerative lumbar spinal stenosis (DLSS). Methods : A non randomized prospective analysis was performed on 16 patients who underwent one level ULBD with DIAM (Group A) and 20 patients with one level ULBD only (Group B) between February 2007 and March 2008. Radiographic imaging, visual analog scale (VAS) and MacNab outcome scale were obtained before and after surgery at a mean interval of 21 months (range 17-27 months). Results : The disc height, interpedicular distance, slip distance and segmental lordotic angle were similar between two groups. In the group A, there was no significant difference between the pre- and post-operative imaging in terms of the sagittal balance and disc height. Both groups showed significant improvement in the clinical outcomes. In addition, there was significantly less low-back pain in the group A than in the group B at the last follow up, while the clinical improvement of the leg pain and MacNab outcome scale showed no significant difference in the two groups. There were no major complications or DIAM associated complications. Conclusion : ULBD with DIAM is a safe and efficacious treatment for selective elderly patients with DLSS, particularly for relieving low back pain comparing to ULBD. ULBD with DIAM did not alter the disc height or sagittal alignment at the mean 21 months follow-up interval.
Objective : Blood blister-like aneurysms (BBAs) resemble arterial dissections. The purpose of this study was to investigate the relationship between these two disease entities and highlight commonalities and distinct features. Methods : Among 871 consecutive patients with aneurysmal subarachnoid hemorrhage, 11 BBAs of internal carotid artery and seven vertebral artery dissections (VADs) with a short segmental eccentric dilatation (Mizutani type 4), which is morphologically similar to a BBA, were selected. The following clinical factors were studied in each group : age, gender, risk factors, Hunt and Hess grade (HHG), Fisher grade (FG), vasospasms, hydrocephalus, perioperative rebleeding rate, and treatment outcome. Results : The mean age was 47.9 years in the BBAs group and 46.4 years in the type 4 VADs group. All the BBA patients were female, whereas there was a slight male predominance in the type 4 VAD group (male : female ratio of 4 : 3). In the BBA and type 4 VAD groups that underwent less aggressive treatment to save the parent artery, 29% (n=2/7) and 66.6% (n=2/3), respectively, eventually required retreatment. Perioperative rebleeding occurred in 72.7% (n=8) and 28.6% (n=2) of patients in the BBA and type 4 VAD groups, respectively. There was no statistical difference in the other clinical factors in both groups, except for the male dominancy in the type 4 VAD group (p=0.011). Conclusion : BBAs and ruptured type 4 VADs have a similar morphological appearance but there is a distinct clinical feature in gender and perioperative rebleeding rates. Complete isolation of an aneurysm from the parent artery might be the most important discipline for the treatment of these diseases.
Objects: This study was aimed to find out correlation between life style and cardiopulmonary function and body fat. Methods: We divided two groups by the score of behavior modification therapy questionnaire. Westudied tendency of change of cardiopulmonary function and body fat for medication of Mahuang capsule by ergogenic aids and placebo with circuit training. We got the results for Exercise stress test and Segmental Bioelectrical Impedence Analysis. Results: 1. High Score Group in Behavior Modification Therapy Questionnaire significantly(p<.05) showed elevation of Lean Body Mass, Body Fat, Waist Circumference and not significantly elevation of Body Weight, But Basal Metabolic Rate was declined. Low Score Group in Behavior Modification Therapy Questionnaire significantly(p<.05) showed elevation of Waist Circumference and not significantly elevation of Body Weight and Body Fat, Lean Body Mass but decline of Basal Metabolic Rate, Waist to Hip Ratio 2. High Score Group in Behavior Modification Therapy Questionnaire significantly(p<.05) showed elevation of $VO_{2max}$ and not significantly elevation of the rest. Low Score Group in Behavior Modification Therapy Questionnaire significantly(p<.05) showed elevation of rest Heart Rate, Diastolic Blood Pressure, and not significantly elevation of the rest except for METs Conclusion: High score group in Behavior Modification Therapy Questionnaire showed significantly elevation of body composition, but had no relationship with Cardiopulmonary function
Choi, Ho Yong;Hyun, Seung-Jae;Kim, Ki-Jeong;Jahng, Tae-Ahn;Kim, Hyun-Jib
Journal of Korean Neurosurgical Society
/
v.60
no.1
/
pp.75-81
/
2017
Objective : Spinal deformity surgery has the potential risk of massive blood loss. To reduce surgical bleeding, the use of tranexamic acid (TXA) became popular in spinal surgery, recently. The purpose of this study was to determine the effectiveness of intra-operative TXA use to reduce surgical bleeding and transfusion requirements in spinal deformity surgery. Methods : A total of 132 consecutive patients undergoing multi-level posterior spinal segmental instrumented fusion (${\geq}5$ levels) were analyzed retrospectively. Primary outcome measures included intraoperative estimated blood loss (EBL), transfusion amount and rate of transfusion. Secondary outcome measures included postoperative transfusion amount, rate of transfusion, and complications associated with TXA or allogeneic blood transfusions. Results : The number of patients was 89 in TXA group and 43 in non-TXA group. There were no significant differences in demographic or surgical traits between the groups except hypertension. The EBL was significantly lower in TXA group than non-TXA group (841 vs. 1336 mL, p=0.002). TXA group also showed less intra-operative and postoperative transfusion requirements (544 vs. 812 mL, p=0.012; 193 vs. 359 mL, p=0.034). Based on multiple regression analysis, TXA use could reduce surgical bleeding by 371 mL (37 % of mean EBL). Complication rate was not different between the groups. Conclusion : TXA use can effectively reduce the amount of intra-operative bleeding and transfusion requirements in spinal deformity surgery. Future randomized controlled study could confirm the routine use of TXA in major spinal surgery.
Purpose: This study was designed to investigate the changes in soluble interleukin-2 receptor (sIL-2R) level in sera and urines of children with primary nephrotic syndrome, eliminating the confounding effects of age, proteinuria, and steroid treatment. Methods: Soluble IL-2R was measured by ELISA in sera and urines from patients with minimal change nephrotic syndrome or focal segmental glomerulosclerosis as well as from healthy controls. The serum levels and urinary sIL-2R/creatinine ratios were compared between control group and the 12 patient groups divided by their ages (0-1, 2-4, over 5 years), and presence or absence of proteinuria and/or steroid treatment (PU+Tx-, PU+Tx+, PU-Tx+, PU-Tx-). Results: Though the differences were not statistically significant probably because of the small numbers, serum sIL-2R levels seemed to be higher in younger age groups both in patients and control group. Nephrotic children did not show higher serum levels than normal children. Among the patients, proteinuric condition seemed to raise and steroid treatment tended to suppress the serum sIL-2R levels. Urinary sIL-2R/creatinine ratios were higher in younger age groups, more significantly in patients (P<0.001). Proteinuria and steroid treatment affected the urinary sIL-2R/creatinine ratios by the same way as the serum sIL-2R levels. Serum sIL-2R levels and urinary sIL-2R/creatinine ratios were not different between groups of different histologic findings or steroid responsiveness (P>0.05). Conclusion: Serum sIL-2R levels and the urinary sIL-2R/creatinine ratios were higher in younger age, and they were not higher in nephrotic patients compared to control group. The patients in relapse showed higher levels, while the levels were suppressed with steroid treatment. In proteinuric state, urinary sIL-2R/creatinine ratios reflected serum sIL-2R levels.
The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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v.26
no.1
/
pp.63-74
/
2013
Objective : Low level laser therapy(LLLT) is conjugated many different diseases such as skin disease, nervous system disease, cardiovascular disease, etc. This study was tried to survey the conjugation of LLLT in field of ophthalmology, otolaryngology and dermatology of Korean Medicine. Methods : In this study, LLLT deal with the field of ophthalmology, otolaryngology and dermatology was searched at Pubmed and NDSL. We searched Pubmed and NDSL with the title "Laser Therapy and Low-Level" for the last 10 years and analyzed disease, laser type, sample size, effect, journal and year. Results : Using Pubmed and NDSL, 8 treatises were researched. About 8 treatises, 7 treatises were papers in field of dermatology, 1 treatise was ophthalmology. And about 8 treatises, 6 treatises were foreign papers and 2 treatises were domestic papers on clinical application of laser status. Mainly used type of laser was a He-Ne laser and Diode laser. The diseases were ocular hypertension, acne, ulcers in patients with leprosy sequelae, freckles, segmental-type vitiligo lesions, diabetes-linked skin lesion, facial skin melanin and elasticity, atopic dermatitis symptom. As a result, we found that treat group had more improvement than control group in 7 of the 8 treatises, that treat group had no difference control group on effect significantly only 1 treatise. Conclusions: As therapeutic tool, LLLT's application range is very wide in the field of ophthalmology, otorhinolaryngology, and dermatology. Keep up with the increasing interest of domestic and foreign about laser therapy, clinical tries on the use of laser will be studied steadily. It is necessary to have sustained attention and research on the point of view of the Korean Medicine.
Background: The fibular free flap has been used as the standard methods of segmental mandibular reconstruction. The objective of mandibular reconstruction not only includes restored continuity of the mandible but also the recovery of optimal function. This paper emphasizes the advantage of the fibular free flap reconstruction over that of locking mandibular reconstruction plate fixation. Methods: The hospital charts of all patients (n=20) who had a mandibular reconstruction between 1994 and 2013 were retrospectively reviewed. Eight patients had plateonly fixation of the mandible, and the remaining 12 had vascularized fibular free flap reconstruction. Complications and outcomes were reviewed and compared between the 2 groups via statistical analysis. Results: Overall complication rates were significantly lower in the fibular flap group (8.3%) than in the plate fixation group (87.5%; p =0.001). Most (7/8) patients in the plate fixation group had experienced plate-related late complications, including plate fracture or exposure. In the fibular flap group, no complications were observed, except for a single case of donor-site wound dehiscence (1/12). Conclusion: The fibular free flap provides a more stable support and additional soft tissue support for the plate, thereby minimizing the risk of plate-related complications. Fibular free flap is the most reliable option for mandibular reconstruction, and we believe that the flap should be performed primarily whenever possible.
Kim, Won-Joong;Lee, Sang-Ho;Shin, Song-Woo;Rivard, Charles H.;Coillard, Christine;Rhalmi, Souad
Journal of Korean Neurosurgical Society
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v.37
no.5
/
pp.364-369
/
2005
Objective: Spinal instrumentation without fusion often fails due to biological failure of intervertebral joints (spontaneous fusion, degeneration, etc). The purpose of this study is to investigate the influence of fixation rigidity on viability of intervertebral joints. Methods: Twenty pigs in growing period were subjected to posterior segmental fixation. Twelve were fixed with a rigid fixation system(RF) while eight were fixed with a flexible unconstrained implant(FF). At the time of the surgery, a scoliosis was created to monitor fixation adequacy. The pigs were subjected to periodic radiological examinations and 12pigs (six in RF, six in FF) were euthanized at 12-18months postoperatively for analysis. Results: The initial scoliotic curve was reduced from $31{\pm}5^{\circ}$ to $27{\pm}8^{\circ}$ in RF group (p=0.37) and from $19{\pm}4^{\circ}$ to $17{\pm}5^{\circ}$ in FF group (p=0.21). Although severe disc degeneration and spontaneous fusion of facet joints were observed in RF group, disc heights of FF group were well maintained without major signs of degeneration. Conclusion: The viability of the intervertebral joints depends on motion spinal fixation. Systems allowing intervertebral micromotion may preserve the viability of intervertebral discs and the facet joint articular cartilages while maintaining a reasonably stable fixation.
Background: Forward head posture (FHP) is a postural alignment of the cervical vertebrae that leads to increased gravitational load on cervical segmental motions. The overhead arm lift test assesses the ability to actively dissociate and control low cervical flexion and move the shoulders through overhead flexion. Objects: The purpose of this study was to explore muscle activities in the upper trapezius (UT), serratus anterior (SA), sternocleidomastoid (SCM), and lower trapezius (LT) alongside changes in head position during the overhead arm lift test in individuals with FHP. Methods: Fifteen subjects with forward head posture and fifteen subjects with normal subjcects were enrolled in this study. The patients performed the overhead arm lift test, and muscle activities of the UT, SCM, SA, and LT were measured using surface electromyography and by evaluating changes in head position. Independent t-tests were used to detect significant differences between the two groups and Cohen's d was calculated to measure the size of the mean difference between the groups. Results: The FHP group demonstrated significantly increased muscle activity of the UT ($32.46{\pm}7.64$), SCM ($12.79{\pm}4.01$), and LT ($45.65{\pm}10.52$) and significantly decreased activity in the SA ($26.65{\pm}6.15$) than the normal group. The change in head position was significantly higher in the FHP group ($6.66{\pm}2.08$) than the normal group. Effect sizes for all parameters assessed were large between the two groups. Conclusion: The subjects with excessive FHP displayed were unable to fix their heads in position during the overhead arm lift test. The overhead arm lift test can thus be used in clinical settings to confirm control of the neck in these subjects.
The purpose of this study was to investigate the relationship between dietary fat intake, anthropometric data, blood lipids, C-reactive protein, and adiponectin in Korean male college students. Forty-eight subjects were divided into 2 groups based on dietary fat intake: UERF (under 30% of energy ratio for fat source), AERF (above 30% of energy ratio for fat souce). We collected dietary intake data using 24-hour dietary recall for 3 days. Anthropometric and biochemical parameters were measured by using standard methods. Segmental body composition analysis was carried out using an 8-electrode multifrequency bioelectrical impedance method of body fat estimation. There was no significant difference in anthropometric data and serum lipid profile between UERF and AERF group. Serum C-reactive protein level was significantly higher in the AERF group compared to the UERF group. Although there was no significant difference in serum adiponectin level between UERF and AERF groups, subjects had lower adiponectin levels. Correlation data show that serum adiponectin level was positively correlated with vegetable intake (p < 0.05). In addition, dietary fat intake had a positive correlation with meat (p < 0.01), whereas a negative correlation with grain (p < 0.01), vegetables (p < 0.05), and fish (p < 0.05). These results suggest that the increased fat intake of non-obese Korean male college students is associated with their increased serum C-reactive protein concentration. Therefore, proper guidelines on fat intake and nutrition education are necessary for the prevention and management of metabolic syndromes.
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