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1.  The Clinical and Radiological Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Single Level Fusion 
Asian Spine Journal  2011;5(2):111-116.
Study Design
This is a retrospective study that was done according to clinical and radiological evaluation.
We analyzed the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody single level fusion.
Overview of Literature
Minimally invasive transforaminal lumbar interbody fusion is effective surgical method for treating degenerative lumbar disease.
The study was conducted on 56 patients who were available for longer than 2 years (range, 24 to 45 months) follow-up after undergoing minimally invasive transforminal lumbar interbody single level fusion. Clinical evaluation was performed by the analysis of the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) and the Kirkaldy-Willis score. For the radiological evaluation, the disc space height, the segmental lumbar lordotic angle and the whole lumbar lordotic angle were analyzed. At the final follow-up after operation, the fusion rate was analyzed according to Bridwell's anterior fusion grade.
For the evaluation of clinical outcomes, the VAS score was reduced from an average of 6.7 prior to surgery to an average of 1.8 at the final follow-up. The ODI was decreased from an average of 36.5 prior to surgery to an average of 12.8 at the final follow-up. In regard to the clinical outcomes evaluated by the Kirkaldy-Willis score, better than good results were obtained in 52 cases (92.9%). For the radiological evaluation, the disc space height (p = 0.002), and the whole lumbar lordotic angle (p = 0.001) were increased at the final follow-up. At the final follow-up, regarding the interbody fusion, radiological union was obtained in 54 cases (95.4%).
We think that if surgeons become familiar with the surgical techniques, this is a useful method for minimally invasive spinal surgery.
PMCID: PMC3095800  PMID: 21629486
Minimally invasive; Transformainal; Lumbar interbody; Single level fusion
2.  Pediatric Lumbar Epidural Abscess Combined with Cauda Equina Syndrome: Case Report 
Asian Spine Journal  2011;5(2):133-137.
Pyogenic epidural abscess is a very rare disease. Once it occurs, it promptly progresses and can cause neurologic paralysis. Mean age of onset has been reported to be 57 years. Here we report making a diagnosis of pyogenic lumbar epidural abscess accompanying cauda equina syndrome in a 10-year-old girl. We treated this case successfully with surgical drainage and antibiotics. We report our case with a review of the literature.
PMCID: PMC3095804  PMID: 21629490
Lumbar epidural abscess; Couda equina syndrome
3.  Metabolic syndrome, lifestyle risk factors, and distal colon adenoma: A retrospective cohort study 
AIM: To investigate relationships between colorectal adenoma incidence, metabolic syndrome (MS) components and lifestyle factors.
METHODS: We conducted a retrospective cohort study using data from individuals who had multiple sigmoidoscopies for colon cancer at the Health Promotion Center of Ulsan University Hospital in Korea from 1998 to 2007.
RESULTS: By multivariate analysis, the incidence of distal colon adenoma was increased by more than 1.76 times in individuals with at least one component of MS compared to those without a component of MS. After adjustment for age, gender, smoking, drinking, and physical exercise, only high body mass index (BMI) was significantly associated with the incidence of distal colon adenoma (Hazard ratio 1.66, 95% confidence interval 1.05-2.62).
CONCLUSION: Our results suggest that high BMI may increase the risk of colorectal adenoma in Korean adults.
PMCID: PMC3199563  PMID: 22046093
Body mass index; Distal colon adenoma; Korea; Lifestyle risk factor; Metabolic syndrome
4.  A coronary heart disease prediction model: the Korean Heart Study 
BMJ Open  2014;4(5):e005025.
The objectives of this study were to develop a coronary heart disease (CHD) risk model among the Korean Heart Study (KHS) population and compare it with the Framingham CHD risk score.
A prospective cohort study within a national insurance system.
18 health promotion centres nationwide between 1996 and 2001 in Korea.
268 315 Koreans between the ages of 30 and 74 years without CHD at baseline.
Outcome measure
Non-fatal or fatal CHD events between 1997 and 2011. During an 11.6-year median follow-up, 2596 CHD events (1903 non-fatal and 693 fatal) occurred in the cohort. The optimal CHD model was created by adding high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides to the basic CHD model, evaluating using the area under the receiver operating characteristic curve (ROC) and continuous net reclassification index (NRI).
The optimal CHD models for men and women included HDL-cholesterol (NRI=0.284) and triglycerides (NRI=0.207) from the basic CHD model, respectively. The discrimination using the CHD model in the Korean cohort was high: the areas under ROC were 0.764 (95% CI 0.752 to 0.774) for men and 0.815 (95% CI 0.795 to 0.835) for women. The Framingham risk function predicted 3–6 times as many CHD events than observed. Recalibration of the Framingham function using the mean values of risk factors and mean CHD incidence rates of the KHS cohort substantially improved the performance of the Framingham functions in the KHS cohort.
The present study provides the first evidence that the Framingham risk function overestimates the risk of CHD in the Korean population where CHD incidence is low. The Korean CHD risk model is well-calculated alternations which can be used to predict an individual's risk of CHD and provides a useful guide to identify the groups at high risk for CHD among Koreans.
PMCID: PMC4039825  PMID: 24848088
5.  Association between Hepatitis B Surface Antigen Seropositivity and Metabolic Syndrome 
Infection with hepatitis B virus (HBV) may be a risk factor for cardiovascular disease. We investigated the relationship between HBV infection and metabolic syndrome.
We performed a cross-sectional study of 9,474 Korean men and women who were at least 20 years old and who underwent a routine health check-up at Ulsan University Hospital in Ulsan, South Korea between March 2008 and February 2009. The associations of hepatitis B surface antigen (HBsAg) seropositivity with the presence of metabolic syndrome and its components were investigated by logistic regression analysis. Data were analyzed separately for males and females.
HBsAg seropositivity was significantly negatively associated with hypertriglyceridemia and metabolic syndrome in men (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.29 to 0.50; P < 0.001 and OR, 0.75; 95% CI, 0.57 to 0.98, P = 0.033). In women, HBsAg seropositivity was also significantly negatively associated with hypertriglyceridemia, but not with metabolic syndrome (OR, 0.40; 95% CI, 0.17 to 0.91; P = 0.029 and OR, 0.80; 95% CI, 0.38 to 1.66, P = 0.545).
HBV infection was significantly negatively associated with hypertriglyceridemia and metabolic syndrome in men and hypertriglyceridemia in women.
PMCID: PMC3978189  PMID: 24724003
Hepatitis B; Metabolic Syndrome; Triglycerides
6.  Chronic pure radiculopathy in patient with organizing epidural hematoma around C8 nerve root 
European Spine Journal  2012;21(Suppl 4):450-452.
Spontaneously occurring spinal epidural hematomas are uncommon clinical findings, and the chronic form is the rarest and its most frequent location is the lumbar spine. Pure radicular involvement is far less frequent than myelopathy. We report a case of progressive radiculopathy in a 52-year-old man with spontaneously occurring cervical epidural hematoma (SCEH). The patient had left hand weakness and numbness for 4 months. MRI scan showed small space-occupying lesion around left 8th cervical nerve root. After surgery we confirmed chronic organizing epidural hematoma. To the best of our knowledge, this is the second reported case in the worldwide literature of pure radiculopathy in a patient with chronic SCEH.
PMCID: PMC3369032  PMID: 22249307
Spontaneous epidural hematoma; Radiculopathy; Chronic
7.  Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion 
European Spine Journal  2011;20(10):1635-1643.
We retrospectively evaluated 488 percutaneous pedicle screws in 110 consecutive patients that had undergone minimally invasive transforaminal lumbar interbody fusion (MITLIF) to determine the incidence of pedicle screw misplacement and its relevant risk factors. Screw placements were classified based on postoperative computed tomographic findings as “correct”, “cortical encroachment” or as “frank penetration”. Age, gender, body mass index, bone mineral density, diagnosis, operation time, estimated blood loss (EBL), level of fusion, surgeon’s position, spinal alignment, quality/quantity of multifidus muscle, and depth to screw entry point were considered to be demographic and anatomical variables capable of affecting pedicle screw placement. Pedicle dimensions, facet joint arthritis, screw location (ipsilateral or contralateral), screw length, screw diameter, and screw trajectory angle were regarded as screw-related variables. Logistic regression analysis was conducted to examine relations between these variables and the correctness of screw placement. The incidence of cortical encroachment was 12.5% (61 screws), and frank penetration was found for 54 (11.1%) screws. Two patients (0.4%) with medial penetration underwent revision for unbearable radicular pain and foot drop, respectively. The odds ratios of significant risk factors for pedicle screw misplacement were 3.373 (95% CI 1.095–10.391) for obesity, 1.141 (95% CI 1.024–1.271) for pedicle convergent angle, 1.013 (95% CI 1.006–1.065) for EBL >400 cc, and 1.003 (95% CI 1.000–1.006) for cross-sectional area of multifidus muscle. Although percutaneous insertion of pedicle screws was performed safely during MITLIF, several risk factors should be considered to improve placement accuracy.
PMCID: PMC3175862  PMID: 21720727
Risk factor; Percutaneous; Pedicle screw; Minimally invasive; TLIF
8.  Temozolomide Chemotherapy in Patients with Recurrent Malignant Gliomas 
Journal of Korean Medical Science  2006;21(4):739-744.
Numerous studies have demonstrated the clinical activity of temozolomide, a second-generation alkylating agent, against malignant brain tumors, however, its activity has not been reported in an Asian population. This study analyzed the efficacy and toxicity of temozolomide in 25 adult patients with recurrent or progressive malignant gliomas after surgery and standard radiation therapy with or without chemotherapy, enrolled in our institution since July 2000. Sixteen patients had glioblastoma multiforme (GBM), six with anaplastic astrocytoma, and three with anaplastic oligodendroglioma. Of the 25 patients, 3 (12%) achieved a complete response (CR), 8 (32%) achieved a partial response (PR), 6 (24%) had stable disease (SD), and 8 (32%) had progressive disease (PD). Two patients achieved a CR, 4 patients achieved a PR, 3 patients had SD and 7 patients had PD in GBM, and 1 patient achieved a CR, 4 patients achieved a PR, 3 patients had SD, 1 patient had PD in the non-GBM patients. Median progression free survival was 8 weeks in GBM and 22 weeks in the non-GBM patients. The median overall survival of each group was 17 weeks and 28 weeks. Temozolomide demonstrated moderate activity in recurrent and progressive malignant gliomas without serious toxicity.
PMCID: PMC2729901  PMID: 16891823
Glioma; Drug Therapy; Recurrence; temozolomide

Results 1-8 (8)