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1.  Fluoroscopic Radiation Exposure during Percutaneous Kyphoplasty 
Objective
The author measured levels of fluoroscopic radiation exposure to the surgeon's body based on the different beam directions during kyphoplasty.
Methods
This is an observational study. A series of 84 patients (96 vertebral bodies) were treated with kyphoplasty over one year. The patients were divided into four groups based on the horizontal and vertical directions of the X-Ray beams. We measured radiation exposure with the seven dosimetry badges which were worn by the surgeon in each group (total of 28 badges). Twenty-four procedures were measured in each group. Cumulative dose and dose rates were compared between groups.
Results
Fluoroscopic radiation is received by the operator in real-time for approximately 50% (half) of the operation time. Thyroid protectors and lead aprons can block radiation almost completely. The largest dose was received in the chest irrespective of beam directions. The lowest level of radiation were received when X-ray tube was away from the surgeon and beneath the bed (dose rate of head, neck, chest, abdomen and knee : 0.2986, 0.2828, 0.9711, 0.8977, 0.8168 mSv, respectively). The radiation differences between each group were approximately 2.7-10 folds.
Conclusion
When fluoroscopic guided-KP is performed, the X-Ray tube should be positioned on the opposite side of the operator and below the table, otherwise the received radiation to the surgeon's body would be 2.7-10 times higher than such condition.
doi:10.3340/jkns.2011.49.1.37
PMCID: PMC3070893  PMID: 21494361
Kyphoplasty; Radiation exposure; Fluoroscopic guidance; Dosimetry; Radiation safety; Fluoroscopy
2.  Therapeutic Considerations of Percutaneous Sacroplasty for the Sacral Insufficiency Fracture 
Sacral insufficiency fracture is a debilitating injury not easily found in general radiologic examinations and is rarely diagnosed, since its symptoms are obscure. It is known to frequently occur in patients with osteoporosis, but the treatment has not yet been established and various kinds of treatment methods are being attempted. Sacroplasty is sometimes performed by applying percutaneous vertebroplasty which is known to be a less invasive treatment. Since the course of diagnosis of sacral insufficiency fracture is difficult and clear guidelines for treatments have not yet been established, many spine surgeons fail to diagnose patients or speculate on treatment methods. We report our experience in diagnosing a sacral insufficiency fracture in a 54-year-old healthy female patient using MRI and treating her with sacroplasty. From a therapeutic point of view, we then cover the usefulness, effects and characteristics relating to the complications of sacroplasty, along with literature review.
doi:10.3340/jkns.2010.47.1.58
PMCID: PMC2817518  PMID: 20157381
Sacroplasty; Sacrum; Insufficiency fracture; Vertebroplasty; Kyphoplasty
3.  Pedicular and Extrapedicular Morphometric Analysis in the Korean Population : Computed Tomographic Assessment Relevance to Pedicle and Extrapedicle Screw Fixation in the Thoracic Spine 
Objective
To evaluate the anatomical parameters that must be considered when performing thoracic transpedicular or extrapedicular screw fixation.
Methods
We selected 958 vertebrae (1,916 pedicles) from 98 patients for analysis. Eight parameters were measured from CT scans : the transverse outer pedicular diameter, transverse inner pedicular diameter, length, angle, chord length of the pedicles and the transverse width, angle, and chord length of the pedicle-rib units.
Results
The age of the patients ranged from 21 to 82 years (mean : 48.2 years) and there were 57 men and 41 women. The narrowest transverse outer pedicular diameter was at T5 (4.4 mm). The narrowest pedicle length was at T1 (15.9 mm). For pedicle angle, T1 was 31.6 degrees, which was the most convergent angle, and it showed the tendency of the lower the level, the lesser the convergent angle. The chord length showed a horizontal pattern with similar values at all levels. For the PRU width, T5 showed a similar pattern to the pedicle width at 13.4 mm. For the PRU angle, T1 was the largest angle at 46.2 degrees and the tendency was the lower the level, the narrower the angle. For chord length, T1 was the shortest at 46.9 mm and T8 was the longest at 60.1 mm.
Conclusion
When transpedicular screw fixations carried out at the mid-thoracic level, special care must be taken because there is a high chance of danger of medial wall violation. In these circumstances, extrapedicular screw fixation may be considered as an alternative treatment.
doi:10.3340/jkns.2009.46.3.181
PMCID: PMC2764013  PMID: 19844615
Pedicle screws; Extrapedicular screws; Thoracic spine; Pedicle morphology; Spine fixation; Morphology
4.  Spontaneous Ligamentum Flavum Hematoma in the Rigid Thoracic Spine : A Case Report and Review of the Literature 
Ligamentum flavum hematoma is a rare condition. Twenty cases including present case have been reported in English-language literature. Among them, only one case reported in pure thoracic spine. A 72-year-old man presented with thoracic myelopathy without precedent cause. Magnetic resonance images revealed a posterior semicircular mass which was located in T7 and T8 level compressing the spinal cord dorsally. T7-8 total laminectomy and extirpation of the mass was performed. One month later following surgery, the patient fully recovered to normal state. Pathologic result was confirmed as ligamentum flavum hematoma. Ligamentum flavum hematoma of rigid thoracic spine is a very rare disease entity. Most reported cases were confined to mobile cervical and lumbar spine. Surgeons should be aware that there seems to be another different pathogenesis other than previously reported cases of mobile cervical and lumbar spine.
doi:10.3340/jkns.2008.44.1.47
PMCID: PMC2588285  PMID: 19096657
Ligamentum flavum; Hematoma; Thoracic spine; Myelopathy
5.  A Case of Intra- and Extra-Mural Hematomas During Recanalization for Chronic Total Occlusion 
Korean Circulation Journal  2010;40(11):596-600.
An intramural hematoma is an accumulation of blood between the internal and external elastic membranes within the medial space, whereas an extramural hematoma is a dilution and/or dissemination of blood throughout the adventitia. Intra- and extra-hematomas are observed by intravascular ultrasound during percutaneous coronary intervention (PCI). The patient described herein presented with angina pectoris. Her coronary angiogram showed diffuse narrowing of the mid-left anterior descending artery and total occlusion of the distal right coronary artery (RCA). Intra- and extra-mural hematomas developed during PCI of the RCA; however, the lesions were covered successfully using long drug-eluting stents.
doi:10.4070/kcj.2010.40.11.596
PMCID: PMC3008832  PMID: 21217938
Hematoma; Ultrasonography, interventional
6.  Two Separate Episodes of Intramedullary Spinal Cord Metastasis in a Single Patient with Breast Cancer 
Intramedullary spinal cord metastases are very rare. Patients with breast cancer as the primary source of intramedullary spinal cord metastases tend to do better than other types of cancer. We report the very unusual case of a woman with breast cancer who had two separate episodes of intramedullary spinal cord metastasis.
doi:10.3340/jkns.2010.48.2.162
PMCID: PMC2941861  PMID: 20856667
Intramedullary; Cervical; Thoracolumbar; Metastases; Breast cancer; Surgical treatment
7.  Learning Curves for Colonoscopy: A Prospective Evaluation of Gastroenterology Fellows at a Single Center 
Gut and Liver  2010;4(1):31-35.
Background/Aims
Colonoscopy training programs and the minimal experience with colonoscopy required to be considered technically competent are not well established. The aim of this study was to determine the colonoscopy learning curves and factors associated with this difficult procedure at a single center.
Methods
A total of 3,243 colonoscopies were performed by 12 first-year gastroenterology fellows, and various clinical factors were assessed prospectively for 22 months. Acquisition of competence (success rate) was evaluated based on two objective criteria: (i) the adjusted completion rate (>90%) and (ii) cecal intubation time (<20 minutes).
Results
The overall success rate in reaching the cecum in less than 20 minutes was 72.8%. The cecal intubation time was 9.34±4.13 minutes (mean±SD). Trainees' skill at performing cecal intubation in <20 minutes reached the requisite standard of competence after 200 procedures. Cecal intubation time decreased significantly from 11.3 to 9.4 minutes after 100 procedures and improved continuously thereafter. Female patients and advanced patient age (over 60 years) were associated with prolonged cecal intubation time (>20 minutes). Surgery of the uterus and ovaries was significantly correlated with delayed cecal intubation time, but not after sufficient colonoscopy experience.
Conclusions
The minimum number of procedures to reach technical competence was 200. The cecal intubation time was longer in female and older patients.
doi:10.5009/gnl.2010.4.1.31
PMCID: PMC2871602  PMID: 20479910
Colonoscopy; Learning curves; Fellows
8.  Extensive Late-Acquired Incomplete Stent Apposition After Sirolimus-Eluting Stent Implantation 
Korean Circulation Journal  2010;40(1):50-53.
Late-acquired incomplete stent apposition (ISA) is frequently observed after drug-eluting stent (DES) implantation. Most incidences of late-acquired ISA induced by positive vascular remodeling were of the focal type and occurred in a single vessel. We present an unusual case of a 45-year-old male subject diagnosed with late-acquired ISA that occurred in multiple vessels.
doi:10.4070/kcj.2010.40.1.50
PMCID: PMC2812799  PMID: 20111654
Drug-eluting stent; Ultrasonography, interventional

Results 1-8 (8)