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Singh R, Kim HS, Adsul N, Kashlan ON, Woon Oh S, Noh JH, Moon SC, Park CH, Jang IT, Hoon Oh S. X-rays and scans can fail to differentiate hip pathology from lumbar spinal stenosis: Two case reports. Surg Neurol Int 2019; 10:165. [PMID: 31583162 PMCID: PMC6763674 DOI: 10.25259/sni_173_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/26/2019] [Indexed: 11/11/2022] Open
Abstract
Background: Occasionally, hip pathologies may present alone or combined with lumbar spine pathology, especially lumbar stenosis. Although the history and clinical examination may help differentiate between the two, hip X-rays alone without accompanying magnetic resonance imaging (MRI) studies may prove unreliable. Case Descriptions: Case 1 – A 72-year-old male presented with the sudden onset of severe back and left posterior thigh pain. Straight leg raising test was positive at 70° (right) and 60° (left), and he had left lower extremity numbness and weakness. The lumbar MRI showed L5-S1 spinal stenosis. Although X-rays of both hips were negative, the MRI showed bilateral femoral neck fractures. He underwent screw fixation of the hip fractures and later underwent endoscopic decompression of the spinal stenosis. Case 2 – A 35-year-old male presented with low backache and right hip pain of 1 month’s duration. The neurological examination was normal, except for positive straight leg raising bilaterally at 60°. The spine MRI was normal. However, despite negative X-ray of both hips, the hip MRI revealed avascular necrosis (AVN) of both femoral heads requiring subsequent orthopedic management. Conclusion: Hip pathology may mimic lumbar spinal stenosis. In the two cases presented, plain X-rays failed to document hip fractures (case 1) and AVN (case 2), respectively, both of which were later diagnosed on MRI studies.
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Affiliation(s)
- Ravindra Singh
- Department of Orthopaedics and Spine, Private Practice, Jaypee Hospital, Noida, Uttar Pradesh
| | - Hyeun-Sung Kim
- Departments of Neurosurgery Nanoori Hospital, Seoul, Republic of Korea
| | - Nitin Adsul
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Sung Woon Oh
- Departments of Neurosurgery Nanoori Hospital, Seoul, Republic of Korea
| | - Jung Hoon Noh
- Departments of Neurosurgery Nanoori Hospital, Seoul, Republic of Korea
| | - Soeng Cheol Moon
- Departments of Orthopaedics, Nanoori Hospital, Seoul, Republic of Korea
| | - Chang Hwan Park
- Medical School, Medical School University of Debrecen, Debrecen, Hungary
| | - Il Tae Jang
- Departments of Neurosurgery Nanoori Hospital, Seoul, Republic of Korea
| | - Seong Hoon Oh
- Departments of Neurosurgery Nanoori Hospital, Seoul, Republic of Korea
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Kim HS, Singh R, Adsul NM, Oh SW, Noh JH, Park JH, Jang ILT, Oh SH. Acute burst fracture in Kummell's disease with acute onset neurological deficit: a case report on role of spinal stability and technical notes on "pivot ligamentotaxis". BMC Surg 2019; 19:49. [PMID: 31088435 PMCID: PMC6518690 DOI: 10.1186/s12893-019-0511-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 04/25/2019] [Indexed: 12/13/2022] Open
Abstract
Background Kummell’s Disease has insidious progression. Neurological deficit is usually slow in onset and progression and only few cases of acute neurological deficit have been reported. We came across a case of Kummell’s disease which progressed to burst fracture, developed neurological deficit within two weeks. We managed patient with “pivot ligamentotaxis” and Polymethylmethacrylate augmented, posterior compressed, short segment percutaneous pedicle screw fixation. Case presentation Eighty-three years old woman following fall was on conservative management at another hospital. She had no neurological deficit. A week later her back pain aggravated and two weeks later developed bilateral buttock pain, bilateral lower limb weakness and diminished sensation in the sacral area. Radiological investigations (X-rays, Magnetic resonance imaging and Computed tomography) showed L1 vertebral body fracture with vacuum cleft and fracture fragment retropulsed into the spinal canal. A diagnosis of Kummell’s disease with burst fracture of L1 vertebra & neurological deficit was made. Patient was managed with Polymethylmethacrylate augmented, posterior compressed, short segment percutaneous pedicle screw fixation. The reduction of the retropulsed fragment was achieved by virtue of “Pivot ligamentotaxis”. The patient got relieved of the symptoms (Preoperative VAS 8 and postoperative VAS 3) and was allowed brace assisted ambulation on first postoperative day. Conclusion This study reports acute occurrence of the burst fracture in unstable vertebra inflicted by Kummell’s disease and role of spinal stability in recovery. We achieved closed reduction of the fracture fragments and relief of the cord compression by posterior compression with “pivot ligamentotaxis”.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Seoul, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, ZIP-06048.
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Hospital, Seoul, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, ZIP-06048
| | - Nitin Maruti Adsul
- Department of Neurosurgery, Nanoori Hospital, Seoul, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, ZIP-06048
| | - Sung Woon Oh
- Department of Neurosurgery, Nanoori Hospital, Seoul, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, ZIP-06048
| | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Hospital, Seoul, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, ZIP-06048
| | - Jun Hwan Park
- Medical School University of Debrecen, Debrecen, Hungary
| | - I L Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Seoul, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, ZIP-06048
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Republic of Korea
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Oh SW, Singh R, Adsul NM, Noh JH, Park JH, Kim HS, Jang IT, Oh SH. Anatomical Relationship of the Vertebral Artery With the Lateral Recess: Clinical Importance for Posterior Cervical Foraminotomy. Neurospine 2019; 16:34-40. [PMID: 30943705 PMCID: PMC6449823 DOI: 10.14245/ns.1836304.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 11/24/2022] Open
Abstract
Objective Vertebral artery injuries during posterior cervical foraminotomy are rare, but can be fatal. Therefore, we investigated the anatomical correlation between the lateral recess and the vertebral artery.
Methods On axial cuts of cervical magnetic resonance imaging from 108 patients, we measured the distance between the vertebral arteries and the medial border of the facet joints. The anatomical vertebro-facet distance (AVFD), surgical vertebro-facet distance (SVFD), and vertebro-facet angle (VFA) were measured.
Results The mean AVFD values on the right side at the C3–4, C4–5, C5–6, and C6–7 levels showed statistically significant differences. On the right side, the mean SVFD values were equivalent to the AVFD values. The mean values of the VFA on the right side at all levels showed statistically significant differences. For all measurements, the greatest differences were seen between the C5–6 and C6–7 levels, and higher levels were associated with smaller distances from the lateral recess. The mean values of the AVFD on the right and left sides showed statistically significant differences at all levels, and the distances on the left were smaller than those on the right.
Conclusion The vertebral artery is closer to the lateral recess at higher cervical levels than at lower cervical levels. The largest distances were found at the C5–6 and C6–7 levels, and the left vertebral arteries were closer to the lateral recess than the right vertebral arteries.
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Affiliation(s)
- Sung Woon Oh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | | | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Jun Hwan Park
- Medical School University of Debrecen, Debrecen, Hungary
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
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Kim HS, Damani N, Singh R, Adsul NM, Oh SW, Noh JH, Jang IT, Oh SH. Endoscopic Resection of Symptomatic Cervical Facet Cyst in Ankylosing Spondylitis. World Neurosurg 2019; 127:99-102. [PMID: 30930316 DOI: 10.1016/j.wneu.2019.03.220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extradural benign cysts located in close proximity to the facet joints are called juxtafacetal cysts. Only about 3.5% of such cysts occur in the cervical spine. To our knowledge, there has been no published article on the endoscopic resection of a cervical facet cyst, and this is the first report. CASE DESCRIPTION A 48-year-old male presented with a chief complaint of severe axial neck pain (visual analog scale score 9) and right scapular pain. The patient had no related radiculopathy or myelopathy, and neurologic status was intact. There was severe limitation of cervical spine movements. Plain radiographs indicated age-related degenerative changes with typical features of ankylosing spondylitis with a bamboo spine appearance and gross fusion of all the vertebrae. The only mobile cervical spinal level was C6-C7. Axial magnetic resonance imaging revealed a right-sided juxtafacetal lesion at C6-C7 level that was hyperintense on T2 and hypointense on T1 imaging. A percutaneous endoscopic posterior cervical foraminotomy at right-sided C7-T1 was performed under general anesthesia. The cyst was removed, and adequate decompression of the C7 root was achieved. Postoperative magnetic resonance imaging and computed tomography scan showed adequate foraminotomy and decompression of the neural structures. The patient had gross relief of neck pain (visual analog scale score 2). CONCLUSIONS The findings suggest that ankylosing spondylitis may cause formation of a juxtafacetal cyst at the mobile levels in a relatively less mobile cervical spine. The endoscopic resection of such cysts is a minimally invasive novel procedure that can cure such patients successfully without unwanted fusion surgery.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea.
| | - Neelesh Damani
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Nitin Maruti Adsul
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Sung Woon Oh
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Il Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Hospital, Incheon, Seoul, Republic of Korea
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5
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Kim M, Kim HS, Oh SW, Adsul NM, Singh R, Kashlan ON, Noh JH, Jang IT, Oh SH. Evolution of Spinal Endoscopic Surgery. Neurospine 2019; 16:6-14. [PMID: 31618807 PMCID: PMC6449828 DOI: 10.14245/ns.1836322.161] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/25/2019] [Indexed: 12/20/2022] Open
Abstract
Innovations in the development of endoscopic spinal surgery were classified into different generations and reviewed. Future developments and directions for endoscopic spinal surgery were discussed. Surgical therapy for spinal disease has been gradually changing from traditional open surgery to minimally invasive spinal surgery. Recently, endoscopic spinal surgery, which initially was limited to the treatment of soft tissue lesions, has expanded to include other aspects of spinal disease and good clinical results have been reported. As the paradigm of spinal surgery shifts from open surgery to endoscopic surgery, we discussed the evolution of endoscopic spine surgery in our literature review. Through this description, we presented possibilities of future developments and directions in endoscopic spine surgery.
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Affiliation(s)
- Manyoung Kim
- Department of Orthopaedic Surgery, The Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Sung Woon Oh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | | | - Ravindra Singh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | | | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Il Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
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Kim HS, Kashlan ON, Singh R, Adsul NM, Yong Z, Oh SW, Noh JH, Jang IT, Oh SH. Percutaneous Transforaminal Endoscopic Radiofrequency Ablation of the Sinuvertebral Nerve in an Olympian with a Left L5 Pedicle/Pars Interarticularis Fracture-Associated Left L5-S1 Disk Desiccation. World Neurosurg X 2019; 3:100032. [PMID: 31225524 PMCID: PMC6584597 DOI: 10.1016/j.wnsx.2019.100032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 01/24/2023] Open
Abstract
Background Irritation of the sinuvertebral nerve by a posterior or posterolateral disk desiccation can cause somatic referred pain that can mimic a lumbar radiculopathy. We present a case of a patient presenting with this condition and the positive result in pain improvement after endoscopic radiofrequency ablation of the sinuvertebral nerve. Case Description An 18-year-old Olympic runner presented to our clinic with back pain and left leg pain in a clear L5 distribution. He did not have a history of trauma. His imaging did not demonstrate any lesion causing compression of the left L5 nerve root as expected. He was found to have a left healing L5 pedicle fracture and ipsilateral chronic L5 pars interarticularis fracture. He was also found to have an ipsilateral minor left L5-S1 disk desiccation. His visual analog scale (VAS) score was 7. After a positive provocative diskogram, the patient underwent percutaneous transforaminal endoscopic radiofrequency ablation of the left L5 sinuvertebral nerve, which was irritated by the left L5-S1 disk desiccation. At his 6-month follow-up visit, the patient's VAS score was 1. Conclusions It is important for clinicians to remember that back-associated leg pain can be caused by somatic referred pain because of irritation of the sinuvertebral nerve. Endoscopic radiofrequency of this nerve can be beneficial in pain control, but further randomized prospective trials are needed to study these techniques further.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Osama Nezar Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | | | - Zhang Yong
- Department of Neurosurgery, Second People's Hospital of Guangdong Province, Guangdong, China
| | - Sung Woon Oh
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Il Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Hospital, Incheon, Republic of Korea
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Jeon JY, Kim SK, Kim KS, Song SO, Yun JS, Kim BY, Kim CH, Park SO, Hong S, Seo DH, Seo JA, Noh JH, Kim DJ. Clinical characteristics of diabetic ketoacidosis in users and non-users of SGLT2 inhibitors. Diabetes Metab 2019; 45:453-457. [PMID: 30639566 DOI: 10.1016/j.diabet.2019.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022]
Abstract
AIM This study investigated the clinical characteristics of diabetic ketoacidosis (DKA) and compared the DKA characteristics between patients treated with and without SGLT2 inhibitors. METHODS Data were collected from patients aged ≥ 18 years admitted for DKA at nine centres in Korea between September 2014 and April 2017. The electronic medical records of these subjects were retrospectively reviewed. Based on their history of medications taken before admission, subjects were classified as either users or non-users of SGLT2 inhibitors and their clinical characteristics of DKA were compared. RESULTS During the study, the main subtype of DKA episodes (n = 523) was identified as type 2 diabetes (51%). Average hospitalization duration was 11 days, and average intensive care unit (ICU) time was 2.5 days. The in-hospital mortality rate was 3%, but no users of SGLT2 inhibitors died during DKA treatment. In patients taking SGLT2 inhibitors (n = 15), DKA manifested at 124 days, on average, after starting the inhibitors (range: 7-380 days). Also, SGLT2 inhibitors users had significantly lower plasma glucose levels (413 mg/dL) compared with non-users (554 mg/dL), and longer ICU stays (4 vs. 2 days; P = 0.019). CONCLUSION In this report of recent data on the clinical features of DKA in Korea, patients using SGLT2 inhibitors needed longer treatment in ICUs compared with non-users and had lower levels of blood glucose, whereas DKA associated with SGLT2 inhibitors was rare.
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Affiliation(s)
- J Y Jeon
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
| | - S-K Kim
- Department of Internal Medicine, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea
| | - K-S Kim
- Department of Internal Medicine, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea
| | - S O Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - J-S Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - B-Y Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - C-H Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - S O Park
- Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Republic of Korea
| | - S Hong
- Division of Endocrinology and Metabolism, Department of Internal medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - D H Seo
- Division of Endocrinology and Metabolism, Department of Internal medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - J A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Ansan, Republic of Korea
| | - J H Noh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - D J Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea.
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Kim HS, Singh R, Adsul NM, Oh SW, Noh JH, Jang IT. Management of Root-Level Double Crush: Case Report with Technical Notes on Contralateral Interlaminar Foraminotomy with Full Endoscopic Uniportal Approach. World Neurosurg 2018; 122:505-507. [PMID: 30476660 DOI: 10.1016/j.wneu.2018.11.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Double crush of a nerve at the root level is not common. We describe here a double crush of the right L4 nerve with foramina to far lateral disk (ventral) and extraforaminal (dorsal) compression. The double crush was managed by endoscopy with a contralateral uniportal approach from the left interlaminar space. Right lateral recess stenosis at the same level was subsequently managed with the same approach. CASE DESCRIPTION A 79-year-old lady presented to our clinic with a low backache, right leg pain, and weakness. On her right side, the straight leg raise test was 70 degrees, great toe dorsiflexion was grade 3/5, and hypoesthesia was present in the L4 dermatome. Her preoperative visual analog scale score was 9. Magnetic resonance imaging showed right lateral recess stenosis and a double compression of L4 nerve root from the dorsal and ventral sides. A diagnosis of right lateral recess stenosis with double crush of the right L4 nerve root was made. The patient was managed with percutaneous endoscopic contralateral interlaminar foraminotomy from the left interlaminar approach. She got relief for the symptoms and her postoperative visual analog scale score was 2. Magnetic resonance imaging and computed tomography showed nerve root decompression and well-preserved facet joints. CONCLUSIONS We conclude that the management of double crush at the nerve root level with interlaminar contralateral approach endoscopy (percutaneous endoscopic contralateral interlaminar foraminotomy) can deal with the issue effectively with facet joint preservation and other benefits of the minimally invasive spine procedure.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea.
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea
| | | | - Sung Woon Oh
- Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea
| | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea
| | - Il Tae Jang
- Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea
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Kim HS, Singh R, Adsul NM, Oh SW, Noh JH, Kim PY, Park JH, Park CH, Jang IT. Symptomatic Tuberculous Ligamentum Flavum Cyst Treated by Full Endoscopic Resection: Review with Technical Notes. World Neurosurg 2018; 122:112-115. [PMID: 30391612 DOI: 10.1016/j.wneu.2018.10.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tuberculosis (TB) of the posterior spinal element is an uncommon condition. In a developed country its diagnosis is becoming difficult due to low incidence. CASE DESCRIPTION A 60-year-old lady presented with low back pain and right leg pain for 6 months. On examination there was tenderness over L4 and L5, a positive straight leg raise test at 70 degrees on the right side and free on the left, and sensory involvement on the right L5 dermatome. Initial magnetic resonance imaging (MRI) showed an L4-5 ligamentum flavum cyst, high signal intensity in the right pedicle and facet joint. It was considered to be a degenerative spinal disorder. Later MRI showed increased size of the cyst, and computed tomography revealed erosion of the right pedicle of the L5 vertebrae, which raised the suspicion of the tubercular pathology. Initially the patient was managed for a degenerative spinal disorder. Later, when tubercular pathology was suspected, she underwent full endoscopic uniportal stenosis decompression and excision biopsy of the cyst. The histology of the cyst revealed chronic granulomatous inflammation with central necrosis. The diagnosis of a TB cyst was confirmed, and antitubercular therapy was started. CONCLUSION TB of the posterior elements of the spine is a diagnostic challenge in developed parts of the world. We describe the first likely case of tubercular ligamentum flavum cyst, which was managed by a full endoscopic uniportal approach.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea.
| | - Ravindra Singh
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Nitin Maruti Adsul
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Sung Woon Oh
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Jung Hoon Noh
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea
| | - Patrick Y Kim
- University of Mississippi Medical Center, Department of Neurosurgery, Jackson, Mississippi, USA
| | | | | | - Il Tae Jang
- Department of Neurosurgery Nanoori Hospital, Gangnam, Seoul, Republic of Korea
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Kim JW, Jung HY, Won DY, Shin YS, Noh JH, Kang TI. Landscape of Elderly Suicide in South Korea: Its Trend According to Age, Gender, and Educational Attainment. Omega (Westport) 2018; 82:214-229. [PMID: 30360680 DOI: 10.1177/0030222818807845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
South Korea has one of the highest suicide rates in the world, and the most alarming suicide rate is among its elders. This study aims to understand the social, historical, and cultural context of the Korean older adults and examine suicide trends based on that understanding. The results show that the suicide risk increases with age, the male suicide rate outweighs that of females, and the suicide rate decreases with educational attainment. In addition, several suggestions for reducing elderly suicide rate are addressed, including differentiating the existing social services for elders by age and expanding suicide prevention programs beyond schools to communities so that all people in need can access them.
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Affiliation(s)
- J W Kim
- Department of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea
| | - H Y Jung
- Department of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea.,Research Institute of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea
| | - D Y Won
- Department of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea
| | - Y S Shin
- Research Institute of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea
| | - J H Noh
- Department of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea.,Baekseok University, Cheonan, Republic of Korea
| | - T I Kang
- Department of Social Welfare, Daelim University, Anyang, Republic of Korea.,Choong Hyun Community Welfare Center, Seoul, Republic of Korea
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Roh YH, Noh JH, Gong HS, Baek GH. Comparative study on the effectiveness of a corticosteroid injection for carpal tunnel syndrome in patients with and without Raynaud's phenomenon. Bone Joint J 2017; 99-B:1637-1642. [PMID: 29212687 DOI: 10.1302/0301-620x.99b12.bjj-2017-0371.r2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/03/2017] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare the efficacy of a corticosteroid injection for the treatment of carpal tunnel syndrome (CTS) in patients with and without Raynaud's phenomenon. PATIENTS AND METHODS In a prospective study, 139 patients with CTS were treated with a corticosteroid injection (10 mg triamcinolone acetonide); 34 had Raynaud's phenomenon and 105 did not (control group). Grip strength, perception of touch with a Semmes-Weinstein monofilament and the Boston Carpal Tunnel Questionnaires (BCTQ) were assessed at baseline and at six, 12 and 24 weeks after the injection. The Cold Intolerance Severity Score (CISS) questionnaire was also assessed at baseline and 24 weeks after the injection. RESULTS The two groups had similar baseline BCTQ scores, but the scores in the Raynaud's phenomenon group were significantly higher than those in the control group at 12 and 24 weeks after the injection. Throughout the 24-week follow-up, there were no significant differences in the mean grip strength between the groups, whereas the mean Semmes-Weinstein monofilament sensory index for the control group was significantly higher than that of the Raynaud's phenomenon group. The mean CISSs were not significantly different between the groups at baseline and at 24 weeks. After 24 weeks, 11 patients (32%) in the Raynaud's phenomenon group and 16 (15%) in the control group required carpal tunnel decompression (p = 0.028). Multivariable analysis indicated that concurrent Raynaud's phenomenon (odds ratio (OR) 2.6) and severe electrophysiological grade (OR 2.1) were independently associated with a failure of treatment after a corticosteroid injection. CONCLUSION Although considerable improvements in symptoms will probably occur in patients with Raynaud's phenomenon who have CTS, they have higher risk of poor functional outcomes and failure of treatment than those without Raynaud's phenomenon. Cite this article: Bone Joint J 2017;99-B:1637-42.
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Affiliation(s)
- Y H Roh
- Ewha Womans University, College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, South Korea
| | - J H Noh
- Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon-si, Gangwon-do 24289, South Korea
| | - H S Gong
- Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Sungnam 13620, South Korea
| | - G H Baek
- Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
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12
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Abstract
UNLABELLED Metabolic syndrome is a constellation of medical conditions that arise from insulin resistance and abnormal adipose deposition and function. In patients with metabolic syndrome and De Quervain tenosynovitis this might affect the outcome of treatment by local corticosteroid injection. A total of 64 consecutive patients with De Quervain tenosynovitis and metabolic syndrome treated with corticosteroid injection were age- and sex-matched with 64 control patients without metabolic syndrome. The response to treatment, including visual analogue scale score for pain, objective findings consistent with De Quervain tenosynovitis (tenderness at first dorsal compartment, Finkelstein test result), and Disability of the Arm, Shoulder, and Hand score were assessed at 6, 12, and 24 weeks follow-up. Treatment failure was defined as persistence of symptoms or surgical intervention. Prior to treatment, patients with metabolic syndrome had mean initial pain visual analogue scale and Disability of the Arm, Shoulder, and Hand scores similar to those in the control group. The proportion of treatment failure in the metabolic syndrome group (43%) was significantly higher than that in the control group (20%) at 6 months follow-up. The pain visual analogue scale scores in the metabolic syndrome group were higher than the scores in the control group at the 12- and 24-week follow-ups. The Disability of the Arm, Shoulder, and Hand scores of the metabolic syndrome group were higher (more severe symptoms) than those of the control group at the 12- and 24-week follow-ups. Although considerable improvements in symptom severity and hand function will likely occur in patients with metabolic syndrome, corticosteroid injection for De Quervain tenosynovitis is not as effective in these patients compared with age- and sex-matched controls in terms of functional outcomes and treatment failure. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Y H Roh
- 1 Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - J H Noh
- 2 Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, Korea
| | - H S Gong
- 3 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - G H Baek
- 3 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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13
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Roh YH, Lee BK, Baek JR, Park MH, Noh JH, Gong HS, Baek GH. Effect of metabolic syndrome on the outcome of corticosteroid injection for carpal tunnel syndrome. J Hand Surg Eur Vol 2016; 41:963-969. [PMID: 27313183 DOI: 10.1177/1753193416654447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Diffuse peripheral nerve impairment is common in metabolic syndrome: in patients with metabolic syndrome and carpal tunnel syndrome this might affect the outcome of treatment by local corticosteroid injection. A total of 55 consecutive patients with carpal tunnel syndrome and metabolic syndrome treated with corticosteroid injection (10 mg triamcinolone acetonide) were age and sex matched with 55 control patients without metabolic syndrome. Grip strength, perception of touch with Semmes-Weinstein monofilaments and Boston Carpal Tunnel Questionnaires were assessed at the baseline and at 6, 12 and 24 weeks follow-up. The two groups had similar pre-operative grip strength and Boston Carpal Tunnel Questionnaire scores. The Boston Carpal Tunnel Questionnaire symptom and function scores of the metabolic syndrome group were significantly greater than the control group at 12 and 24 weeks follow-up. Except for significantly greater grip strength at the 12-week follow-up in the control group, there were no significant differences in grip strength between the groups. Semmes-Weinstein monofilament sensory index for the control group was significantly greater than that of the metabolic syndrome group throughout the 24-week follow-up. After 24 weeks, five patients (13%) in the control group and 13 patients (27%) in the metabolic syndrome group had had carpal tunnel surgery. Patients with metabolic syndrome are at risk for poor functional outcome and failure of treatment after corticosteroid injection for carpal tunnel syndrome. LEVEL OF EVIDENCE Treatment benefits III.
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Affiliation(s)
- Y H Roh
- 1 Department of Orthopaedic Surgery, Gachon University School of Medicine, Incheon, Korea.,Current affiliation: Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - B K Lee
- 1 Department of Orthopaedic Surgery, Gachon University School of Medicine, Incheon, Korea
| | - J R Baek
- 1 Department of Orthopaedic Surgery, Gachon University School of Medicine, Incheon, Korea
| | - M H Park
- 1 Department of Orthopaedic Surgery, Gachon University School of Medicine, Incheon, Korea
| | - J H Noh
- 2 Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, Korea
| | - H S Gong
- 3 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - G H Baek
- 3 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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14
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Noh JH, Kyiung HS, Yoon KH, Roh YH. Supplementary tibial fixation in anterior cruciate ligament reconstruction - Direct cortical fixation using spiked washer screw vs. post-tie using washer screw. Acta Orthop Belg 2016; 82:358-364. [PMID: 27682300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We compare clinical outcomes of two different supplementary tibial fixation in anterior cruciate ligament (ACL) reconstruction using free tendon Achilles allograft. Eighty subjects underwent ACL reconstruction using Endobutton CL for femoral fixation and Bio-interference screw for tibial fixation. Supplementary tibial fixation was performed as direct -cortical fixation using spiked washer screw (group I) or as post-tie using washer screw (group II). -Lachman test, pivot shift test, IKDC classification, Lysholm score, and side-to-side difference (SSD) were evaluated. Thirty six in group I and thirty five in group II could follow up for at least 2 years. At the last follow-up, 7 in group I and 1 in group II showed 2+ or 3+ in Lachman test (p = 0.027). Mean SSD was 2.4mm in group I and 1.4mm in group II (p = 0.048). Post-tie using washer screw was more effective than direct cortical fixation using spiked washer screw to restore stability. Level of evidence : Therapeutic Level I ; Randomized controlled clinical trial.
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Choi HS, Hong JW, Lee JH, Noh JH, Kim DJ. Association of heart rate with albuminuria in a general adult population: the 2011 Korea National Health and Nutrition Examination Survey. Intern Med J 2016; 45:428-35. [PMID: 25533739 DOI: 10.1111/imj.12672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/14/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Albuminuria is associated with increased risk of multiple adverse health outcomes, such as progressive renal failure, cardiovascular disease and death. However, in the general population, it is uncertain whether albuminuria is associated with elevated heart rate, which is an independent and powerful risk factor for cardiovascular disease. AIM To investigate whether an elevated heart rate is an independent factor associated with albuminuria in the general adult population of Korea. METHODS A cross-sectional analysis was carried out on 5198 Korean adults aged 19 years or older who participated in the fifth (2011) Korea National Health and Nutrition Examination Survey (KNHANES V-2). RESULTS The prevalence of albuminuria showed an increasing trend throughout the whole range of heart rate, even after adjusting for confounders (P = 0.002). The increment was most profound at the heart rate of 70-75 and >76 beats per minute (b.p.m.; P = 0.011). In multiple logistic regression analysis, age (P < 0.001), hypertension (P < 0.001), diabetes (P < 0.001), hypertriglyceridaemia (P = 0.025), estimated glomerular filtration rate (P = 0.028) and heart rate (P = 0.023) were independently associated with the presence of albuminuria in Korean adults. Compared with participants with heart rate ≤ 64 b.p.m., the odds ratio (95% CI) for albuminuria was 1.50 (1.15-1.96) for those with heart rate ≥ 76 b.p.m. CONCLUSIONS The prevalence of albuminuria is independently associated with heart rate in the general adult population of Korea.
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Affiliation(s)
- H S Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Koyang, Gyeonggi-do, South Korea
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16
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Noh JH, Fowlkes JD, Timilsina R, Stanford MG, Lewis BB, Rack PD. Pulsed laser-assisted focused electron-beam-induced etching of titanium with XeF2: enhanced reaction rate and precursor transport. ACS Appl Mater Interfaces 2015; 7:4179-4184. [PMID: 25629708 DOI: 10.1021/am508443s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In order to enhance the etch rate of electron-beam-induced etching, we introduce a laser-assisted focused electron-beam-induced etching (LA-FEBIE) process which is a versatile, direct write nanofabrication method that allows nanoscale patterning and editing. The results demonstrate that the titanium electron stimulated etch rate via the XeF2 precursor can be enhanced up to a factor of 6 times with an intermittent pulsed laser assist. The evolution of the etching process is correlated to in situ stage current measurements and scanning electron micrographs as a function of time. The increased etch rate is attributed to photothermally enhanced Ti-F reaction and TiF4 desorption and in some regimes enhanced XeF2 surface diffusion to the reaction zone.
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Affiliation(s)
- J H Noh
- Department of Materials Science, Engineering, University of Tennessee , Knoxville, Tennessee 37996, United States
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17
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Kim DH, Choi MG, Noh JH, Sohn TS, Bae JM, Kim S. Clinical significance of skip lymph node metastasis in gastric cancer patients. Eur J Surg Oncol 2014; 41:339-45. [PMID: 25454830 DOI: 10.1016/j.ejso.2014.09.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/21/2014] [Accepted: 09/18/2014] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Given the recent increase in the incidence of early gastric cancer, there is greater interest in identifying a minimally invasive therapy. The purpose of this study was to analyze the patterns of lymph node metastasis in patients with gastric cancer and to elucidate the clinical significance of skip metastasis. METHODS We retrospectively analyzed patterns of lymph node metastasis (LNM) and clinicopathologic factors related to skip metastasis. RESULTS Among 2963 patients with gastric cancer, 997 patients (33.6%) were detected as having LNM, and 27 patients (2.7%) with skip metastasis were detected among 997 patients with LNM. Skip metastasis were detected more frequently in the elderly. Compared with the N1 group, the skip metastasis group showed lower frequency of vascular invasion, and compared with the stepwise N2 group, the skip metastasis group showed smaller tumor size and a significantly higher incidence of negative lymphatic, vascular, and perineural invasion. CONCLUSIONS Currently there is no way to predict N2 station LNM including skip metastasis, D2 LN dissection for gastric cancer is thought to be the appropriate treatment, even during early stage disease. Minimally invasive therapy should be performed cautiously in consideration of possible skip metastasis.
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Affiliation(s)
- D H Kim
- Department of Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - M G Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J H Noh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - T S Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J M Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - S Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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18
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Lee JH, Choi MG, Min BH, Noh JH, Sohn TS, Bae JM, Kim S. Predictive factors for lymph node metastasis in patients with poorly differentiated early gastric cancer. Br J Surg 2012; 99:1688-92. [PMID: 23023388 DOI: 10.1002/bjs.8934] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2012] [Indexed: 01/03/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection is gaining popularity in the treatment of early gastric cancer. This study aimed to identify clinicopathological factors predictive of lymph node metastasis in patients with the poorly differentiated early gastric cancer to assess the feasibility of using endoscopic submucosal dissection for these cancers. METHODS The records of patients with poorly differentiated early gastric cancer who had undergone gastric cancer surgery between January 2002 and December 2009 were reviewed. Associations between clinicopathological factors and the presence of lymph node metastasis were analysed by univariable and multivariable logistic regression analysis. RESULTS Some 1005 patients were included in the analysis. Univariable analysis indicated that lymph node metastasis was associated with sex, ulceration, tumour size, depth of invasion, macroscopic type, lymphatic invasion and venous invasion. Logistic regression revealed that lymph node metastasis was significantly associated with sex, tumour size, depth of tumour invasion and lymphatic involvement. In the group with none of these risk factors (men with mucosal tumour no larger than 2 cm in size, with no lymphatic involvement), lymph node metastasis was present in four (3·2 per cent) of 124 patients. CONCLUSION In the present study 3·2 per cent of patients who were negative for all identified risk factors had lymph node metastasis. The use of endoscopic submucosal dissection should be considered carefully in the treatment of poorly differentiated early gastric cancer.
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Affiliation(s)
- J H Lee
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Ilwon-dong, Gangnam-gu, Seoul, Korea
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Roberts NA, Noh JH, Lassiter MG, Guo S, Kalinin SV, Rack PD. Synthesis and electroplating of high resolution insulated carbon nanotube scanning probes for imaging in liquid solutions. Nanotechnology 2012; 23:145301. [PMID: 22433664 PMCID: PMC3362830 DOI: 10.1088/0957-4484/23/14/145301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
High resolution and isolated scanning probe microscopy (SPM) is in demand for continued development of energy storage and conversion systems involving chemical reactions at the nanoscale as well as an improved understanding of biological systems. Carbon nanotubes (CNTs) have large aspect ratios and, if leveraged properly, can be used to develop high resolution SPM probes. Isolation of SPM probes can be achieved by depositing a dielectric film and selectively etching at the apex of the probe. In this paper the fabrication of a high resolution and isolated SPM tip is demonstrated using electron beam induced etching of a dielectric film deposited onto an SPM tip with an attached CNT at the apex.
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Affiliation(s)
- N A Roberts
- Department of Materials Science and Engineering, University of Tennessee, Knoxville, TN 37996, USA
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20
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Jung H, Bae JM, Choi MG, Noh JH, Sohn TS, Kim S. Surgical outcome after incomplete endoscopic submucosal dissection of gastric cancer. Br J Surg 2010; 98:73-8. [PMID: 21136563 DOI: 10.1002/bjs.7274] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Endoscopic resection of early gastric cancer is a relatively new and attractive treatment, but occasionally fails to remove all cancer lesions completely. This study aimed to elucidate clinicopathological factors that could be helpful in predicting residual tumour in the surgical specimen after incomplete endoscopic submucosal dissection (ESD). METHODS Patients who underwent gastrectomy because of incomplete ESD between August 2004 and August 2008 were analysed. Clinicopathological characteristics were reviewed retrospectively from prospectively collected medical records. Patients were classified into groups with and without residual tumour. Pathology results following gastrectomy were compared with those of incomplete ESD. RESULTS A total of 118 patients were included. The incidence of residual tumour in the surgical specimen was 24·6 per cent after incomplete ESD. Elevated/flat-type cancers, large tumours (at least 2 cm) and those limited to the mucosa had significantly higher incomplete ESD rates. Cancer limited to the mucosa and the presence of tumour in the lateral margin were associated with residual tumour in the surgical specimen (both P = 0·001). CONCLUSION Radical gastrectomy should be performed if pathological examination reveals a positive lateral resection margin after ESD.
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Affiliation(s)
- H Jung
- Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
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21
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Bae HJ, Song JH, Noh JH, Kim JK, Jung KH, Eun JW, Xie HJ, Ryu JC, Ahn YM, Kim SY, Lee SH, Yoo NJ, Lee JY, Park WS, Nam SW. Low frequency mutation of the Ephrin receptor A3 gene in hepatocellular carcinoma. Neoplasma 2009; 56:331-4. [PMID: 19469653 DOI: 10.4149/neo_2009_04_331] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
EphA3 is a component of the Eph/ephrin tyrosine kinase system, which participates in vasculature development. This receptor/ligand system is associated with various signaling pathways related to cell growth and viability, cytoskeletal organization, cell migration, and anti-apoptosis. Accumulated evidence suggests that aberrant regulation of EphA3 and its genetic alterations are implicated in the development and progression of various cancers. However, despite a high incidence of EphA3 over-expression, no such investigation has been performed in hepatocellular carcinoma. Thus, we investigated genetic alterations of the EphA3 gene in 73 cases of hepatocellular carcinoma by single-strand conformational polymorphism and sequencing. One novel D219V missense mutation was found in the extracellular domain of EphA3, and two genetic alterations in the intracellular sterile-alpha-motif (SAM) domain of EphA3 appeared to be polymorphisms. Although the functional assessments of this mutant are incomplete, it is believed that this novel EphA3 mutation may contribute to the development of hepatocellular carcinoma.
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Affiliation(s)
- H J Bae
- Department of Pathology, Microdissection Genomics Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
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22
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Xie HJ, Bae HJ, Noh JH, Eun JW, Kim JK, Jung KH, Ryu JC, Ahn YM, Kim SY, Lee SH, Yoo NJ, Lee JY, Park WS, Nam SW. Mutational analysis of JAK1 gene in human hepatocellular carcinoma. Neoplasma 2009; 56:136-40. [PMID: 19239328 DOI: 10.4149/neo_2009_02_136] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED The <em>Janus kinase 1</em> (JAK1) gene encodes a cytoplasmic tyrosine kinase that is noncovalently associated with a variety of cytokine receptors and plays a nonredundant role in cell proliferation, survival, and differentiation. The mutated forms of JAK1 often altered the activation of JAK1 and then changed the activation of JAK1/STAT pathways, and this may contribute to cancer development and progression. Thus, to investigate whether genetic mutations of JAK1 gene are associated in hepatocellular carcinoma (HCC) progression, we analyzed genetic alterations of JAK1 gene in 84 human HCCs by single-strand conformational polymorphism (SSCP) and direct sequencing. Of 24 exons of JAK1 gene, 12 exons were previously reported to have mutations, we searched genetic alteration of JAK1 in these exons. Overall, one missense mutation (1.2%) was found. In addition, 12 cases (14%) were found to have single nucleotide polymorphism (14%) in exon 14. Taken together, we found one novel missense mutation of JAK1 gene in hepatocellular carcinomas with some polymorphisms. Although the functional assessment of this novel mutant remains to be completed, JAK1 mutation may contribute to the tumor development in liver cancer. KEYWORDS JAK1 gene, hepatocellular carcinoma, mutation.
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Affiliation(s)
- H J Xie
- Department of Pathology, Microdisection Genomic Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Choi MG, Sohn TS, Park SB, Paik YH, Noh JH, Kim KM, Park CK, Kim S. Decreased expression of p12 is associated with more advanced tumor invasion in human gastric cancer tissues. Eur Surg Res 2009; 42:223-9. [PMID: 19279387 DOI: 10.1159/000208521] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Accepted: 11/03/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS p12(DOC-1) is a well-known growth suppressor; however, its role in gastric carcinogenesis is still unclear. We investigated the expression of p12(DOC-1) in gastric cancer tissues and its possible correlation with p53 expression, and determined its clinical significance. METHODS Immunohistochemical staining using the tissue array method was performed on 180 human gastric carcinomas. The clinicopathological features and prognostic significance were analyzed. RESULTS Of the 180 tissue samples, p53 expression was positive in 85 (47.2%) and p12(DOC-1) expression was negative in 140 (77.8%). The negative expression of p12(DOC-1) was significantly associated with a more advanced depth of tumor invasion and stage (p < 0.05). No apparent correlation was found between p12(DOC-1) and p53 expressions. The 5-year survival rate of the p12(DOC-1)-positive cases (53.7%) was higher than that of the p12(DOC-1)-negative cases (39.3%); however, neither p12(DOC-1) nor p53 expression status had any statistically significant prognostic value. Multivariate analysis revealed that lymph node metastasis, distant metastasis, lymphatic invasion and perineural invasion were independent prognostic factors. CONCLUSIONS This is the first report that suggests that p12(DOC-1) may be involved in the development and progression of gastric cancer. Further studies are required to clarify its exact role in the mechanism of gastric carcinogenesis.
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Affiliation(s)
- M-G Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ha TK, An JY, Youn HK, Noh JH, Sohn TS, Kim S. Indication for endoscopic mucosal resection in early signet ring cell gastric cancer. Ann Surg Oncol 2007; 15:508-13. [PMID: 18071825 DOI: 10.1245/s10434-007-9660-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 09/16/2007] [Accepted: 09/17/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to compare the clinicopathological characteristics of an early signet ring cell carcinoma (SRC) with an early undifferentiated carcinoma (mucinous, poorly differentiated adenocarcinoma) and early differentiated carcinoma (well or moderately differentiated tubular adenocarcinoma, papillary adenocarcinoma) and find indications for endoscopic mucosal resection (EMR) in early SRC. METHODS 1520 patients with early gastric cancer (EGC), who underwent a curative gastrectomy, were analyzed retrospectively. Among them, 388 patients with SRC were compared with 253 patients with undifferentiated carcinoma (UDC) and 879 with a differentiated carcinoma (DC). RESULTS SRC was more common in young female patients than UDC. SRC had a tendency to be confined to the mucosa, with smaller size than UDC. The lymph node metastasis rate for SRC was lower than that for UDC, but similar to that of DC. Multivariate analysis revealed lymph node metastasis (LNM) to be associated with the depth of invasion, tumor size, histological type, and lymphatic involvement. SRC had no LNM in the case of a mucosal tumor, smaller than 2 cm, and in the absence of lymphatic involvement. The prognosis of SRC was more favorable than UDC. CONCLUSIONS Early SRC has different characteristics from early UDC. In view of the lower rate of lymph node metastasis and better prognosis, we suggest that EMR can be performed on patients with early SRC limited to the mucosa, less than 2cm in size, and with no lymphatic involvement.
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Affiliation(s)
- T K Ha
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, South Korea
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An JY, Choi MG, Noh JH, Sohn TS, Kang WK, Park CK, Kim S. Gastric GIST: a single institutional retrospective experience with surgical treatment for primary disease. Eur J Surg Oncol 2007; 33:1030-5. [PMID: 17428635 DOI: 10.1016/j.ejso.2007.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 02/13/2007] [Indexed: 11/20/2022]
Abstract
AIMS Because gastric GISTs show variable clinical behavior, we reviewed our experience with primary gastric GISTs after surgical treatment and imatinib mesylate treatment for advanced disease. METHODS Between December 1995 and December 2005, 111 patients who underwent surgical treatment for primary gastric GISTs were enrolled in this study. Patients were grouped according to the risk assessment classification, and clinicopathological features, tumor recurrence and patient survival were assessed. RESULTS One patient was included in the very low risk group, 35 in the low risk group, 31 in the intermediate risk group and 44 in the high-risk group. All patients with very low, low and intermediate risk GISTs and 70% of patients with high risk GISTs underwent R0 resection. While there was no recurrence or metastasis in patients with very low, low and intermediate risk GISTs, 23% of those with high risk GISTs showed a distant metastasis at diagnosis and 35% of these patients had a recurrence after R0 resection. The overall 5-year survival rate of the high risk patients was 77.1%. Nineteen patients received imatinib mesylate therapy due to an incomplete resection or recurrence; 7 with no measurable lesion at the CT scan by a local tumor control showed no tumor progression after imatinib mesylate therapy, however, 12 patients with measurable lesions showed variable clinical courses after treatment. The overall 5-year survival rate of 19 patients with imatinib mesylate treatment was 80.0%. CONCLUSIONS The clinical outcome of the very low, low and intermediate risk gastric GISTs was excellent, while high risk gastric GISTs had a high rate of recurrence and therefore a less favorable outcome. A complete resection is the most important treatment for cure; however imatinib mesylate treatment may improve the clinical outcome of the patients with metastatic or recurrent gastric GISTs.
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Affiliation(s)
- J Y An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-Gu, Seoul, Republic of Korea
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An JY, Heo JS, Noh JH, Sohn TS, Nam SJ, Choi SH, Joh JW, Kim SJ. Primary malignant retroperitoneal tumors: Analysis of a single institutional experience. Eur J Surg Oncol 2007; 33:376-82. [PMID: 17129700 DOI: 10.1016/j.ejso.2006.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 10/11/2006] [Indexed: 11/15/2022] Open
Abstract
AIMS In order to achieve complete resection in the surgical management of retroperitoneal tumors, it is crucial to know the tumor's anatomical location relative to neighboring organs. METHODS Forty-nine patients with primary malignant retroperitoneal tumors were divided by tumor location into two groups [upper abdomen (group 1) or lower abdomen (group 2)], and clinicopathological features, tumor recurrence, and patient survival were assessed. RESULTS No significant differences in preoperative clinical characteristics existed between two groups, and liposarcoma was the most frequently observed tumor type. The difference in the rates of complete resection between the two groups was not statistically significant (75.9% for group 1 and 85% for group 2). En-bloc combined resection was performed in 52% and 30% of patients in groups 1 and 2, respectively. The local recurrence rate in group 2 (31.3%) was higher than that in group 1 (9.5%), despite the fact that the differences in rates of complete resection and distant recurrence rates (14.3% in group 1 and 12.5% in group 2) between the two groups were not statistically significant. The overall 5-year survival rates were 67.9% for group 1 and 43.2% for group 2 (p=0.038). The 5-year survival rate of patients with tumors smaller than 10 cm was 78.4%, while that of patients with tumors larger than 10 cm was 38.1% (p=0.017). The 5-year survival rate after complete excision was 61%, whereas that after incomplete resection or biopsy only was 40.0% (p<0.0001). CONCLUSIONS An upper abdominal tumor location is a positive prognostic factor even if small tumor size (<10 cm) and complete resection of the tumor are still more important factors to improve outcome in patients with malignant primary retroperitoneal tumors. Because complete resection was shown to be the most important prognostic factor, an aggressive and careful surgical approach is recommended for the treatment of such tumors.
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Affiliation(s)
- J Y An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea
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Lee J, Lim T, Uhm JE, Park KW, Park SH, Lee SC, Park JO, Park YS, Lim HY, Sohn TS, Noh JH, Heo JS, Park CK, Kim S, Kang WK. Prognostic model to predict survival following first-line chemotherapy in patients with metastatic gastric adenocarcinoma. Ann Oncol 2007; 18:886-91. [PMID: 17298958 DOI: 10.1093/annonc/mdl501] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study was to devise a prognostic model for metastatic gastric cancer patients undergoing first-line chemotherapy. PATIENTS AND METHODS A retrospective analysis was carried out on 1455 gastric cancer patients, who received first-line chemotherapy from September 1994 to February 2005. RESULTS At multivariate level, poor prognostic factors were no previous gastrectomy [P = 0.003; relative risk (RR), 1.191; 95% confidence interval (CI) 1.061-1.338], albumin < 3.6 g/dl (P = or <0.001; RR, 1.245; 95% CI 1.106-1.402), alkaline phosphatase > 85 U/l (P = or <0.001; RR, 1.224; 95% CI 1.092-1.371), Eastern Cooperative Oncology Group performance status of two or more (P = or <0.001; RR, 1.690; 95% CI 1.458-1.959), the presence of bone metastases (P = 0.001; RR, 1.460; 95% CI 1.616-1.836), and the presence of ascites (P = or < 0.001; RR, 1.452; 95% CI 1.295-1.628). Of 1434 patients, 489 patients (34.1%) were categorized as low-risk group (zero to one factors), 889 patients (62.0%) as intermediate-risk group (two to four factors), and 56 patients (3.9%) as high-risk group (five to six factors). Median survival durations for low, intermediate, and high-risk groups were 12.5 months, 7.0 months, and 2.7 months, respectively. CONCLUSIONS This model should facilitate the individual patient risk stratification and thus, more appropriate therapies for each metastatic gastric cancer patient.
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Affiliation(s)
- J Lee
- Division of Hematology/Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Noh JH, Park JK, Lee HJ, Kwon SK, Lee SH, Park JH, Ko KS, Rhee BD, Lim KH, Kim DJ. Depressive symptoms of type 2 diabetics treated with insulin compared to diabetics taking oral anti-diabetic drugs: a Korean study. Diabetes Res Clin Pract 2005; 69:243-8. [PMID: 16046024 DOI: 10.1016/j.diabres.2004.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Revised: 05/24/2004] [Accepted: 10/13/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the depressive symptoms of type 2 diabetic patients who were treated with insulin compared to those diabetics treated with oral anti-diabetic drugs in Korea. METHODS A total 204 outpatients with type 2 diabetes were invited to complete a questionnaire using the Beck depression inventory (BDI) to measure depressive symptoms. Age, gender, body mass index, serum lipid profile, and a social history including marital status, occupation and educational background were also assessed. The presence of diabetic complications was evaluated by examining the patients' medical records. Diabetic patients who were not treated with anti-diabetic drugs were excluded. All the study subjects were classified into two groups based on their mode of therapy: the oral drug group and insulin group. The insulin group included patients treated with insulin-oral drug combinations as well as those treated solely with insulin. RESULTS Overall, 32.4% of our diabetic subjects showed depressive symptoms with the criterion being a BDI score > or = 16. Compared to the oral drug group, the insulin group showed a significantly higher frequency of depressive symptoms (insulin group, 48.0%; oral drug group, 27.3%; p<0.01) and higher BDI scores (insulin group, 16.6+/-10.7; oral drug group, 12.6+/-8.7; p<0.01). Moreover, after an adjustment for social factors, the degree of hyperglycemia and the presence of diabetic complications, the insulin group showed a significantly higher frequency of depression (odds ratio 4.38, 95% CI 1.66-11.6, p=0.003), compared to the oral drug group. CONCLUSIONS The data showed that insulin treatment is related to the presence of depressive symptoms, and the importance of more careful psychological support of Korean insulin-treated type 2 diabetic patients is strongly suggested.
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Affiliation(s)
- J H Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University College of Medicine, Republic of Korea
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Son HJ, Song SY, Kim S, Noh JH, Sohn TS, Kim DS, Rhee JC. Characteristics of submucosal gastric carcinoma with lymph node metastatic disease. Histopathology 2005. [PMID: 15693888 DOI: 10.1111/j.1365-2559.2005.02049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To study the correlation between lymph node metastatic disease and various pathological parameters. Lymph node metastasis is the most important factor in determining the prognosis of patients with early gastric cancer and is significantly associated with the submucosal invasion of neoplastic cells. However, the depth of submucosal layer as well as the depth of submucosal tumour invasion varies among different cases. METHODS AND RESULTS We studied various pathological parameters including the macroscopic appearance, location, size, area, differentiation, invasion depth, vascularity and fibrosis of submucosal gastric carcinomas (SMGC), using 248 age- and sex-matched tissue samples. The presence of lymphatic emboli, a larger area, greater size, a non-flat gross type and an increased vascularity of the tumour were significantly associated with node-positive SMGC. Among the three depth-related parameters, the ocular scale measurement, the sm3 method and the sm2 method, only the ocular scale measurement showed a significant correlation with node-positive SMGC. Using multivariate analysis, the incidence of lymph node metastasis increased in the lymphatic tumour emboli and in the tumours that invaded more than half of the submucosal layer. CONCLUSIONS These histological indicators seem to be a feasible and easy way to predict lymph node metastatic disease from limited surgery specimens. Pathologists should carefully investigate the lymphatic invasion of tumour cells and measure the invasion depth of the tumour.
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Affiliation(s)
- H J Son
- Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
AIM To study the correlation between lymph node metastatic disease and various pathological parameters. Lymph node metastasis is the most important factor in determining the prognosis of patients with early gastric cancer and is significantly associated with the submucosal invasion of neoplastic cells. However, the depth of submucosal layer as well as the depth of submucosal tumour invasion varies among different cases. METHODS AND RESULTS We studied various pathological parameters including the macroscopic appearance, location, size, area, differentiation, invasion depth, vascularity and fibrosis of submucosal gastric carcinomas (SMGC), using 248 age- and sex-matched tissue samples. The presence of lymphatic emboli, a larger area, greater size, a non-flat gross type and an increased vascularity of the tumour were significantly associated with node-positive SMGC. Among the three depth-related parameters, the ocular scale measurement, the sm3 method and the sm2 method, only the ocular scale measurement showed a significant correlation with node-positive SMGC. Using multivariate analysis, the incidence of lymph node metastasis increased in the lymphatic tumour emboli and in the tumours that invaded more than half of the submucosal layer. CONCLUSIONS These histological indicators seem to be a feasible and easy way to predict lymph node metastatic disease from limited surgery specimens. Pathologists should carefully investigate the lymphatic invasion of tumour cells and measure the invasion depth of the tumour.
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Affiliation(s)
- H J Son
- Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lim DH, Kim DY, Kang MK, Kim YI, Kang WK, Park CK, Kim S, Noh JH, Joh JW, Choi SH, Sohn TS, Heo JS, Park CH, Park JO, Lee JE, Park YJ, Nam HR, Park W, Ahn YC, Huh SJ. Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view. Br J Cancer 2004; 91:11-7. [PMID: 15162146 PMCID: PMC2364765 DOI: 10.1038/sj.bjc.6601896] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The risk of locoregional recurrence in resected gastric adenocarcinoma is high, but the benefit of adjuvant treatment remains controversial. In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradiotherapy after D2 gastrectomy and analysed the patterns of failure for 291 patients. Adjuvant chemotherapy consisted of five cycles of fluorouracil and leucovorin, and concurrent radiotherapy was given with 4500 cGy from the second cycle of chemotherapy. With a median follow-up of 48 months, 114 patients (39%) showed any type of failure, and the local and regional failures were seen in 7% (20 out of 291) and 12% (35 out of 291), respectively. When the recurrent site was analysed with respect to the radiation field, in-field recurrence was 16% and represented 35% of all recurrences. Our results suggest that adjuvant chemoradiotherapy has a potential effect on reducing locoregional recurrence. Moreover, low locoregional recurrence rates could give a clue as to which subset of patients could be helped by radiotherapy after D2 gastrectomy. However, in order to draw a conclusion on the role of adjuvant radiotherapy, a randomised study is needed.
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Affiliation(s)
- D H Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - D Y Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea. E-mail:
| | - M K Kang
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - Y I Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - W K Kang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - C K Park
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - S Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - J H Noh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - J W Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - S H Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - T S Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - J S Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - C H Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - J O Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - J E Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - Y J Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - H R Nam
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - W Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - Y C Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
| | - S J Huh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea
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Kim DJ, Cho NH, Noh JH, Lee MS, Lee MK, Kim KW. Lack of excess maternal transmission of type 2 diabetes in a Korean population. Diabetes Res Clin Pract 2004; 65:117-24. [PMID: 15223223 DOI: 10.1016/j.diabres.2003.11.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 11/06/2003] [Accepted: 11/26/2003] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to assess the familial clustering of type 2 diabetes and to investigate the presence of excess maternal transmission of type 2 diabetes in Korea. The medical records of 56,492 subjects (31,680 men and 24,812 women), who attended the Health Promotion Center were examined. The subjects were questioned about their parents' diabetes status. All study subjects were classified into the three groups (normal fasting glucose (NFG), impaired fasting glucose (IFG), and diabetes). Offspring with paternal diabetes (odds ratio 2.54, 95% CI 2.22-2.91, P < 0.001) and those with maternal diabetes (odds ratio 3.10, 95% CI 2.76-3.49, P < 0.001) were at increased risk for diabetes when compared to subjects without parental diabetes and adjusted for other clinical and biochemical variables. Offspring with bilineal parental diabetes were at a greater risk for diabetes (odds ratio 6.09, 95% CI 4.55-8.16, P < 0.001) when compared to subjects without parental diabetes. In both genders, offspring with maternal diabetes showed no increased risk for diabetes (odds ratio 1.22, 95% CI 0.92-1.37, P + 0.266 in men; odds ratio 1.31, 95% CI 0.95-1.81, P = 0.104 in women) when compared with those with paternal diabetes. The data suggested that parental type 2 diabetes was an independent risk factor for offspring type 2 diabetes in this Korean population. Excess maternal transmission of type 2 diabetes was not observed.
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Affiliation(s)
- D J Kim
- Department of Internal Medicine, Inje University College of Medicine, Koyang, South Korea
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Park SH, Kim DY, Heo JS, Lim DH, Park CK, Lee KW, Choi SH, Sohn TS, Kim S, Noh JH, Kim YI, Park JO, Kim K, Kim WS, Jung CW, Im YH, Lee MH, Park K, Park CH, Kang WK. Postoperative chemoradiotherapy for gastric cancer. Ann Oncol 2003; 14:1373-7. [PMID: 12954575 DOI: 10.1093/annonc/mdg366] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We report the results of postoperative chemoradiotherapy after curative resection in gastric cancer patients. PATIENTS AND METHODS Patients with gastric cancer staged IB to IV(M0) were treated with chemoradiotherapy after curative resection with extensive (D2) lymph node dissection. Nodal metastases were observed in 261 (90%) patients. The chemotherapy consisted of fluorouracil 400 mg/m(2) plus leucovorin 20 mg/m(2) for 5 days, followed by 4500 cGy of radiotherapy for 5 weeks with fluorouracil and leucovorin on the first 4 days and the last 3 days of radiotherapy. Two 5-day cycles of chemotherapy were given 4 weeks after the completion of radiotherapy. RESULTS Of 290 patients accrued, 229 (79%) patients completed chemoradiotherapy as planned. With a median follow-up of 49 months, 114 (34%) patients have relapsed: 33 (29%) locoregional relapses, 76 (67%) peritoneal relapses and 41 (36%) distant metastases. The 5-year overall and relapse-free survivals were 60% and 57%, respectively. Tolerance was acceptable, the main toxicity being neutropenia. CONCLUSIONS This postoperative chemoradiotherapy after curative resection of gastric cancer was feasible, with acceptable toxicities. Whether this adjuvant therapy in gastric cancer patients that have undergone a D2 lymph node dissection impacts on survival or reduces the incidence of relapses remains to be studied.
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Affiliation(s)
- S H Park
- Division of Hematology and Oncology, Department of Medicine, Cancer Center, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
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Choi SJN, Yoo HS, Noh JH, Chung SY, Kim SK. Mycophenolic acid-induced apoptotic signal transduction in MOLT-4 T-cell. Transplant Proc 2003; 35:564-6. [PMID: 12591533 DOI: 10.1016/s0041-1345(02)04015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- S J N Choi
- Department of Surgery, Kwagju Christian Hospital, Kwangju, South Korea
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Choi SJN, Noh JH, Yoo HS, Chung SY, Cho CK, Lee WJ, Kim SI, Kim YS, Kim SK, Park KI. Simultaneous laparoscopic cholecystectomy and kidney transplantation: report of two cases. Transplant Proc 2003; 35:319-20. [PMID: 12591421 DOI: 10.1016/s0041-1345(02)04009-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S J N Choi
- Division of Transplantation Surgery, Department of Surgery, Chonnam National University Medical School, Kwangju, South Korea
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Park JH, Noh JH, Lee KW, Lee SK, Kim SJ, Choi SH, Heo JS, Chon SE, Paik SW, Koh KW, Lee JH, Choi MS, Kim YI, Lee BB, Joh JW. Safety of the donor with right hepatic lobectomy in the living donor liver transplantation. Transplant Proc 2003; 35:57-8. [PMID: 12591306 DOI: 10.1016/s0041-1345(02)03949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J H Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
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Abstract
AIMS This study aims to analyse the histological pattern of nodal involvement in gastric B-cell lymphoma and to detect early involvement of the lymph nodes. METHODS AND RESULTS Histological findings of 37 resected primary gastric lymphomas with 1313 regional lymph nodes were analysed. The primary tumour was classified into four groups: MALT lymphoma, MALT lymphoma with a minor large B-cell lymphoma (<20%), large B-cell lymphoma with MALT lymphoma, and large B-cell lymphoma without MALT lymphoma. Histological patterns of nodal involvement were divided into sinusoidal, subsinusoidal/marginal, follicular, and diffuse patterns. Semi-nested polymerase chain reaction (PCR) analysis for IgH gene rearrangement was performed. Nodal involvement was found in 2/13 (15%) MALT lymphomas, 5/6 (83%) MALT lymphomas with a minor large B-cell lymphoma, 9/12 (75%) large B-cell lymphomas with MALT lymphoma, and 6/6 (100%) large B-cell lymphomas without MALT lymphoma. The MALT lymphoma and MALT lymphoma with a minor large B-cell lymphoma showed a predominantly sinusoidal and subsinusoidal pattern, whereas diffuse pattern predominated in large B-cell lymphomas without MALT lymphoma and large B-cell lymphomas with MALT lymphoma. The follicular pattern was least common, being observed in 10.2% of large B-cell lymphomas without MALT lymphoma and large B-cell lymphomas with MALT lymphoma. Sinusoidal obliteration with permeation of small monocytoid cells into subsinusoidal zone is a characteristic finding suggesting early nodal involvement of MALT lymphoma. CONCLUSIONS Histological patterns of nodal involvement in gastric B-cell lymphoma vary according to the histological grade. Immunostaining for CD20 with or without PCR analysis for IgH gene rearrangement would be a useful ancillary method to confirm lymphomatous involvement.
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MESH Headings
- Adult
- Aged
- DNA-Binding Proteins/analysis
- Diagnosis, Differential
- Female
- Follow-Up Studies
- Gene Rearrangement
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunohistochemistry
- Lymph Nodes/chemistry
- Lymph Nodes/metabolism
- Lymph Nodes/pathology
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Middle Aged
- Prognosis
- Proto-Oncogene Proteins/analysis
- Proto-Oncogene Proteins c-bcl-6
- Receptors, Complement 3d/analysis
- Stomach Neoplasms/genetics
- Stomach Neoplasms/metabolism
- Stomach Neoplasms/pathology
- Transcription Factors/analysis
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Affiliation(s)
- Y H Ko
- Department of Diagnostic Pathology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Formaldehyde is a low molecular weight chemical and can elicit acute and chronic health related problems. Most of the inhaled formaldehyde is retained in the upper respiratory tract due to its extraordinary solubility. Therefore, cases of formaldehyde-induced occupational asthma are sporadic despite its widespread use in industrial processes. We herein report upon a case of occupational asthma due to formaldehyde, which was confirmed by workplace challenge including working environmental assessments, and by formaldehyde inhalation challenge using a specially designed closed-circuit apparatus. To investigate the possible involvement of an IgE-mediated mechanism, both in vitro and in vivo tests were done. IgE antibody specific for formaldehyde-human serum albumin conjugate (F-HSA) was not detected by ELISA, and no specific cutaneous reactivity to F-HSA was noted by either skin prick or intradermal test. The patient was diagnosed with formaldehyde-induced occupational asthma not associated with an IgE mediated mechanism.
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Affiliation(s)
- C W Kim
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul 120-752, Korea
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