Postoperative Follow-up Study Research Articles

Sixty Years of Innovation in Biomechanical Orthognathic Surgery: The State of the Art and Future Directions

Craniofacial surgery is proposed and performed for a variety of reasons, ranging from congenital or acquired malformations to emotional disorders and parafunctions of the masticatory, respiratory, auditory, and visual systems. Surgery of the mandible and its orthostatic repositioning is the most common of these corrections of craniofacial anomalies. Throughout the history of these procedures, various techniques have been proposed and perfected, but always with a high rate of minor and major complications. The recurrence rate of mandibular malposition is high, as is the temporary loss of facial sensitivity and motor skills. These outcomes are often related to the choice of surgical technique rather than the skill of the surgeon, which is considered to be one of the most important factors in the final outcome. Surgical techniques involving direct manipulation of the vascular-nervous bundles, such as bilateral sagittal split osteotomy, clearly present the possibility of major or minor complications. In this study, an orthognathic surgical technique, performed by the same team for over 40 years and now available through a 20-year postoperative patient follow-up study, is presented with a literature review relating it to biomechanical concepts and bone remodeling to analyze the evolution of orthognathic surgery since it became common practice to correct maxillofacial discrepancies. In this review, we also present a case report in which previous orthodontic treatment prepared a patient for surgical correction of mandibular bone discrepancy without the need for combined maxillary and/or genioplasty, and we describe the most commonly used techniques today, as well as their advantages and disadvantages. The combination of established concepts together promotes favorable stability of mandibular osteotomies, functional anatomical positioning of the temporomandibular joint, reduced risk of injury to the mandibular vasculo-nervous bundle, and good aesthetics with positive patient acceptance and no relapse, thus these are the objectives for proposing innovative treatments that combine the technologies available today.

An XGBoost Machine Learning Based Model for Predicting Ki-67 Value ≥ 15% in T2NXM0 Stage Primary Breast Cancer Receiving Neoadjuvant Chemotherapy Using Clinical Data and Delta-Radiomic Features on Ultrasound Images and Overall Survival Analysis: A 5-Year Postoperative Follow-Up Study.

Objective: To establish a model based on clinical and delta-radiomic features within ultrasound images using XGBoost machine learning to predict proliferation-associated nuclear antigen Ki-67 value ≥ 15% in T2NXM0 stage primary breast cancer (BC). Method: Data were collected from 228 randomly selected BC patients who received ultrasound screening and postoperative pathologic assessment from April 2015 to September 2018. The patients were classified into the study group (n = 80) and control group (n = 148), and the data were apportioned into the training set and test set at a 7:3 ratio based on time intervals. In the training set, crucial factors were identified from clinical features and grayscale and delta-radiomic features within ultrasound images, by using the chi-square test, t-test, and rank-sum test. The clinical model, imaging model, and combined model were built using multivariate logistic regression, respectively. The model's predictive performance and clinical net benefit were assessed using DeLong's method and decision curve analysis. Meanwhile, an XGBoost algorithm is used to establish a prediction model to verify the above results. Results: The crucial factors affecting Ki-67 value ≥ 15% included BMI, lymph node metastases, BC volume, CA153, pathology type, tumor boundaries, tumor morphology, elastography score, and delta-radscore. The predictive performance of the combined model [AUC 0.857, OR 0.0290, 95% CI 0.793-0.908] was considerably improved on the training set than the clinical model [AUC 0.724, OR 0.0422, 95% CI 0.648-0.792] and the imaging model [AUC 0.798, OR 0.0355, 95% CI 0.727-0.857]. The decision curve analysis also confirmed that the combined model delivered a higher clinical net benefit, and the verification on the test set yielded similar results. The nomogram and the calibration curve plotted based on the combined model achieved satisfactory clinical effects. The SHAP value of the XGBoost algorithm also confirmed that lymph node metastasis, BC volume, elastography score, and delta-radscore are the best independent factors for predicting BC Ki-67 value ≥ 15%. Conclusion: The XGBoost machine learning-based combined model integrating clinical features and delta-radiomic features on ultrasound images was able to predict the Ki-67 value ≥ 15% in an efficient and noninvasive manner, providing important clues for clinical decision-making and follow-up in BC.

Analysis of survival factors after hepatic resection for colorectal cancer liver metastases: Does the R1 margin matter?

The effect of liver margin on colorectal cancer liver metastases (CRLM) after hepatectomy has been controversial. In this study, we conducted a postoperative follow-up study of 205 patients with CRLM to clarify whether a positive margin is significant and to define the risk factors affecting CRLM survival. The data of 205 patients with CRLM who underwent surgical treatment at the Third Hospital of Peking University in the Department of General Surgery from January 2009 to December 2020 were retrospectively analyzed. The general data, surgical data and postoperative follow-up of the patients were statistically analyzed. There were 130 cases (63.4%) of R0 resection and 75 cases (36.6%) of R1 resection. There were 136 males and 69 females, age 61 ± 11 years, and body mass index (BMI 24.5 ± 3.3 kg/m2). The overall survival rates at 1, 3, and 5 years for the entire cohort were 93.4%, 68.4%, and 45.5% in the R0 resection group vs. 93.2%, 53.7%, and 42% in the R1 resection group, respectively, which were not statistically significant (P = 0.520). The 1-, 3-, and 5-year disease-free survival rates of 63.2%, 33.3%, and 29.7% were significantly better in the R0 resection group than in the R1 resection group of 47.9%, 22.7%, and 17.7% (P = 0.016), respectively. After multivariable analysis, carbohydrate antigen 19-9 (CA19-9) > 39 U/ml (HR = 2.29, 95% CI: 1.39-3.79, P = 0.001), primary tumor perineural invasion (HR = 1.78, 95% CI: 1.01-3.13, P = 0.047), and BMI > 24 kg/m2 (HR = 1.75, 95% CI: 1.05-2.93, P = 0.033) were independently associated with poorer overall patient survival. The number of liver metastases >2 (HR = 1.65, 95% CI: 1.10-2.47, P = 0.016), the maximum diameter of metastases ≥50 mm (HR = 1.67, 95% CI: 1.06-2.64, P = 0.026), and vascular invasion of the primary tumor (HR = 1.65, 95% CI: 1.03-2.64, P = 0.038) were also independently associated with poorer disease-free survival. In patients undergoing hepatectomy for CRLM, the negative effect of the R1 margin should be downplayed, and although the disease-free survival of the R1 margin is shorter than that of the R0 margin, it has no impact on overall survival. To improve overall survival, extra attention should be given to the factors of preoperative BMI, preoperative CA19-9, and the presence of perineural invasion of the primary tumor.

Research on pharyngeal bacterial flora in transoral atlantoaxial operation and the postoperative follow-up study

ObjectivesTo study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of nerve function of patients with craniovertebral junction disorders who were treated with transoral approach operations.MethodsThis research analyzed 20 cases collected from October 2009 to May 2010. All these patients were with CVJ disorders, including 8 males and 12 females, aged 2 to 66 (38.1 on average), and they were all treated with transoral approach operations. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points, including 3 days before operation/before gargling, 3 days after continuous gargling/after anesthesia intubation on the day of operation, after intraoperative cleaning and washing of the mouth, and after intraoperative iodophor immersion. The microflora was stained by means of smear and further counted after an investigation by microscope. The neural function of patients was evaluated by the ASIA classification and the JOA scores. All patients but two with posterior stabilization performed respectively underwent transoral atlantoaxial reduction plate (TARP) fixation consecutively in the same sitting. A regular reexamination of cervical vertebra with lateral and open mouth X-ray, CT and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesions and tumor recurrence.ResultsThis bacteriological research showed that the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state after a series of oral preoperative preparations and intraoperative iodophor disinfection, which was considered as type I incision. The bacterial culture results of the mucosa samples of the posterior pharyngeal wall collected at different time points showed significant differences (χ2 = 42.762, P = 0.000). All the patients had improvement in ASIA, and their neural functions were improved to different levels after operation. There was a significant difference in JOA scores before and after operation (t = 8.677, P = 0.000). Postoperative imaging examination showed that the atlantoaxial screw position was good and firm, and the CVJ disorders were treated appropriately.ConclusionIt is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach.

Topical Ethanol Therapy for Human Papillomavirus in Atheroma

We have developed ethanol therapy for infectious atheroma based on the experience of two cases in which ethanol was injected into the liver cyst and the cyst shrank. For 64 infectious atheromas, atheroma contents were excreted and the cyst wall was contacted with 76% ethanol gauze for 5 minutes. Postoperatively, the cyst was washed daily as an open drainage. All cases were cured 10 days postoperatively, and no side effects. Postoperative follow-up study results in 36 cases showed no recurrence in an average of 5 years. Pathological examination revealed koilocytosis in 14 of 25 cases (56.0%), which is considered to be an indirect finding of viral infection. The changes in human papillomavirus (HPV 16) before and after ethanol therapy in 25 cases using the Bi-Digital O- ring Test (BDORT) decreased significantly from 1026.0 ng (BDORT units) preoperatively to 1.6ng (BDORT units) postoperatively. In also 12 cases follow- up study without microscopy HPV 16 same decreased from 1064.2ng to 1.2ng (BDORT unit) using BDORT with atheroma photographs. In total, HPV 16 could be demonstrated in 37 of 64 cases (57.8%) using BDORT. Temporal changes of HPV 16 used for BDORT in 7 cases after contact with ethanol were inactivated after 3 minutes 30 seconds. The involvement of HPV 16 is suggested as the cause of atheroma. It is speculated that ethanol inactivated HPV 16 of atheroma, which stopped the turnover of the squamous epithelium and prevented recurrence. Ethanol therapy for infectious atheroma is useful as an original new one-stage surgery because it is a simple procedure and has no side effects or recurrence.

Impact of Subthalamic Deep Brain Stimulation on Impulse Control Disorders in Parkinson's Disease: A Prospective Study.

Impact of subthalamic deep brain stimulation (DBS) on impulse control disorders (ICD) in Parkinson's disease (PD) remains controversial. The objectives of this study were to analyze the natural history of ICD between baseline and 1 year after subthalamic DBS in patients with PD and to identify predictive factors, taking into account the positions of the active contact and stimulation parameters. We analyzed postoperative modifications of ICD based on the multicentric, prospective Predictive Factors and Subthalamic Stimulation in Parkinson's Disease cohort. ICD status and Ardouin Scale of Behaviour in PD were assessed at baseline and 1 year following subthalamic DBS. Location of active contacts within the 3 subthalamic nucleus functional territories was investigated. A total of 217 were patients included. Of the patients, 10.6% had ICD at baseline of which 95.6% improved at 1 year following subthalamic DBS; 3.6% of the patients experienced de novo ICD at 1 year following subthalamic DBS. Dopamine agonist dose reduction (from 309.8 to 109.3 mg) was the main driver of ICD regression (P = 0.05). Higher preoperative dyskinesias were associated with poorer ICD evolution (P = 0.04). Whereas baseline apathy was a risk factor of de novo ICD (P = 0.02), ICD improvement correlated with postoperative apathy (P = 0.004). Stimulation power and position of active contacts-mainly located within the sensorimotor part of the subthalamic nucleus-did not influence ICD. This 1-year, postoperative follow-up study showed ICD regression and dopaminergic drug reduction with optimal position of the active contacts within the subthalamic nucleus. Whereas patients with PD with preoperative ICD were prone to postoperative apathy, we also showed that those with preoperative apathy had a higher risk to experience postoperative de novo ICD, further highlighting the meaningful influence of postoperative management of dopaminergic medication on outcome and the continuum between apathy and ICD. © 2020 International Parkinson and Movement Disorder Society.

Development of dementia in patients with femoral neck fracture who experience postoperative delirium-A three-year follow-up study.

It remains unclear to what extent postoperative delirium (POD) affects the incidence of dementia in hip fracture patients, and the methods used to detect delirium and dementia require validation. The aim of this study was to investigate the development of dementia within 3years of femoral neck fracture repair surgery, with a focus on POD as a potential predictive factor. Patients were assessed for cognition, delirium, depression, psychological well-being, and nutritional status during their hospitalization as well as 4, 12, and 36months after the operation. Logistic regression models were used to analyse factors associated with POD and factors associated with the development of dementia. The study sample consisted of 135 patients without a history of dementia, of whom 20 (14.8%) were delirious preoperatively and 75 (55.5%) postoperatively. Three years after their operations, 43/135 patients (31.8%) were diagnosed with dementia. A greater portion of patients diagnosed with dementia (39/43, 90.6%) than patients with no dementia (36/92, 39.1%) were included among the 75 patients who had experienced POD (P<0.001). In a logistic regression model, after adjustment for covariates (age, sex, diabetes, delirium pre-and postoperatively, hyperactive delirium, days with delirium, urinary tract infection, and Mini Nutritional Assessment score), POD emerged an independent predictor for the development of new dementia (odds ratio, 15.6; 95% confidence interval, 2.6-91.6) within 3years after the operation. Geriatric hip fracture patients who exhibit POD should be monitored closely for the development of dementia.

Effectiveness of arthroscopically assisted surgery for ankle fractures

Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: This meta-analysis was performed to determine whether the arthroscopically assisted open reduction and internal fixation (ORIF) for ankle fractures is more beneficial than the conventional ORIF. Methods: Articles in electronic medial databases were searched between March 1983 and August 2016, including Pubmed and SCOPUS. We included the studies with comparative design comparing the surgical outcomes between the arthroscopically assisted ORIF for ankle fractures and the conventional ORIF. Finally, two RCTs and two retrospective comparative studies were included for analysis. Mean and standard deviation (SD) of postoperative functional scores, number of subjects, and P-values were extracted from the studies. In addition, postoperative follow-up period, fracture type, and study quality were collected. Results: The pooled effect size of the four studies 0.535 (95% CI, 0.247 to 0.823) in Hedges’s g, which favored the arthroscopically assisted ORIF over conventional ORIF. There was no evidence of publication bias in funnel plot and in Egger’s test (p=0.534). Conclusion: The arthroscopically assisted ORIF for ankle fractures were more beneficial than the conventional ORIF in the current evidences. However, since it needs more medical cost and longer operation time, possible additional complications and cost effectiveness are to be validated in future studies.

Effectiveness of arthroscopically assisted surgery for ankle fractures: A meta-analysis

IntroductionThis meta-analysis was performed to determine whether the arthroscopically assisted open reduction and internal fixation (ORIF) for ankle fractures is more beneficial than the conventional ORIF. MethodsArticles in electronic medial databases were searched between March 1983 and August 2016, including Pubmed and SCOPUS. We included the studies with comparative design comparing the surgical outcomes between the arthroscopically assisted ORIF for ankle fractures and the conventional ORIF. Finally, two RCTs and two retrospective comparative studies were included for analysis. Mean and standard deviation (SD) of postoperative functional scores, number of subjects, and P-values were extracted from the studies. In addition, postoperative follow-up period, fracture type, and study quality were collected. ResultsThe pooled effect size of the four studies 0.535 (95% CI, 0.247–0.823) in Hedges’s g, which favored the arthroscopically assisted ORIF over conventional ORIF. There was no evidence of publication bias in funnel plot and in Egger’s test (p=0.534). ConclusionThe arthroscopically assisted ORIF for ankle fractures were more beneficial than the conventional ORIF in the current evidences. However, since it needs more medical cost and longer operation time, possible additional complications and cost effectiveness are to be validated in future studies.

A Liver Mass Found After Subtotal Gastrectomy

Question: A 37-year-old woman underwent routine postoperative follow-up imaging study. Two months prior, she had undergone radical subtotal gastrectomy for advanced gastric cancer and a hysterectomy with bilateral salpingo-oophorectomy for Krukenberg tumor from gastric cancer. After surgery, she had no particular symptoms or abnormal findings on physical examination. Preoperative serum carcinoembryonic antigen (CEA) was 0.84 ng/mL (normal range, 0-5), CA 72-4 was 19.26 U/mL (normal range, 0-8.2), and CA 19-9 was 94.2 U/mL (normal range, 0-37).

Psychological status and quality of life in acoustic neuroma patients with facial palsy after microsurgery: a 1-year postoperative follow-up study.

Psychological status and quality of life in postoperative acoustic neuroma patients were well documented. However, few studies have been proceed in China and investigated in a relative homogenous group. To assess the psychological status and quality of life in patients with facial palsy operated by an identical surgeon in Shanghai, China. We retrospectively reviewed 24 patients who had undergone microsurgery via a retrosigmoid approach in 2009-2010. Each patient was followed up with MRI/CT image and facial palsy evaluation. A mailed comprehensive questionnaire was used to assess the psychological status and quality of life for these patients. Meanwhile, a telephone interview was previously carried out for the consents. Statistical analysis was performed using Stata software. We found that a proportion of anxiety and depression existed among the postoperative acoustic neuroma patients, although a relative physical health was reserved. Facial palsy caused by microsurgery treatment may be a key factor triggered and involved in the psychiatric symptoms and clinicians must be aware that early involvement of a clinical psychologist may be very helpful.

The application of functional magnetic resonance imaging integrated neuronavigation in localization and lingual function protection

To evaluate the clinical practicability of integration of functional magnetic resonance imaging (fMRI) data into neuronavigation as a tool to localize the language area and their relationship with the lesion for the preoperative planning, intraoperative guidance and postoperative follow-up study of brain functions during minimally invasive surgeries in or adjacent to functional areas. Eighty eight patients with intracranial lesions located in or adjacent to the functional language area underwent fMRI (including examinations of lingual and visual function, and motor functions of the limbs and tongue). fMRI data was entered into a neuronavigation system for image fusion and preoperative registration and correction; minimally invasive neurosurgery was performed with fMRI navigation. The shortest distance between the lesion and the functional cortex was less than 5 mm in 6 patients and was more than 5 mm but less than 10 mm in another 10 patients, respectively. 10 patients were recovered and improved in another 6 between 3 - 6 months after surgery, The follow-up time was between 3 months and 1 year. The morbidity rate was 6.8% (6/88). There was no postoperative mortality. Various brain areas were widely activated when the patients were reading and understanding the Chinese words. The unilateral speech functional maps were located in left Brodmann's 9, 46, 17, 18 and 19 areas. fMRI-integrated neuronavigation can locate functional language areas and played an important role in intraoperative protection of functional lingual areas, execution of individualized therapeutic regimens, minimization of surgical complications and determination of prognosis. Total surgical resection was safe for lesions > 10 mm from functional lingual areas.

Does minimally invasive mitral valve surgery improve quality of life postoperatively - A postoperative follow-up study

Objective: Aim of this study was to analyse if minimal invasive mitral valve surgery (MIC-MVS) led to an improved postoperative quality of life (QoL), less wound pain and faster convalescence as compared to conventional mitral valve surgery (C-MVS) at 3 months follow-up postoperatively.

Fluoroscopically-Guided Posterior Approach for Shoulder Magnetic Resonance Arthrography: Comparison with Conventional Anterior Approach

Copyrights © 2011 The Korean Society of Radiology Purpose: To prospectively evaluate the usefulness of the fluoroscopically-guided posterior approach compared with the anterior approach for shoulder magnetic resonance (MR) arthrography. Materials and Methods: Institutional review board approval and informed consent were obtained. Among 60 shoulder MR arthrographies performed on 59 patients with symptomatic shoulders, an intra-articular injection was performed (30 cases using the anterior approach and 30 using the posterior approach). Procedurerelated pain was assessed by using a 5 score visual analogue scale (VAS). Depth of the puncture and standardized depth of puncture by body mass index (BMI) were recorded. The contrast leakage along the course of the puncture was evaluated by reviewing the MR. The statistical analyses included the Mann-Whitney U and Kruskal-Wallis test. Results: There was no significant difference in VAS scores between the anterior and posterior groups (1.77 ± 1.10 vs. 1.80 ± 0.96). Depth of puncture and standardized depth of puncture by BMI were significantly shorter in the posterior group than those in the anterior group (4.4 ± 0.8 cm and 1.8 ± 0.3 cm vs. 6.6 ± 0.9 cm and 2.8 ± 0.4 cm, p < 0.001), respectively. The incidence of contrast leakage was more frequent in the posterior group (p = 0.003). Conclusion: The posterior approach will be useful in shoulder MR arthrography with a suspected anterior pathology, a postoperative follow-up study or obese patient. Index terms Shoulder Magnetic Resonance Arthrography Anterior Approach Posterior Approach Fluoroscopically-Guided Posterior Approach for Shoulder Magnetic Resonance Arthrography: Comparison with Conventional Anterior Approach 견관절 자기공명 관절조영술에서 고식적 전방 접근법과 비교한 투시유도하 후방 접근법

Health-Related Quality of Life in Children and Adolescents Undergoing Surgery for Pectus Excavatum

This study evaluated health-related quality of life (HRQoL) in children and adolescents undergoing cosmetic surgery for pectus excavatum (PE) compared to a group of healthy children. The Intervention Group consisted of 172 children and adolescents undergoing surgery for PE between 2003 and 2005, aged 8-20 years; 86% were males. A postoperative follow-up study was conducted one to three years after surgery. None of the children had had the metal bar removed when they answered the questionnaires. The Control Group consisted of healthy schoolchildren (n=387), 201 females and 186 males (9-20 years).The generic health-related quality of life questionnaires, the Child Health Questionnaire CHQ-CF87 (child version), and CHQ-PF50 (parent version) were used in both groups. A Nuss assessment questionnaire modified for Adults (NQ-mA) and a single-step questionnaire (SSQ) on quality of life and health status were only used in the Intervention Group; these questionnaires also included questions about the remembered preoperative status. The response rates in the Intervention and Control Groups were 69% and 70%, respectively. The HRQol was significantly better in the Intervention Group compared to the Control Group in 9 out of 14 subscales (CHQ-CF 87): General Health (p<0.05), Physical Functioning, Self-Esteem, Emotional Role, Role Functioning-Physical (p<0.01) and Mental Health, Family Activities, Bodily Pain, Role Functioning-Behavioral (p<0.001). The scores of the children and the parents correlated well in all subscales (rho range from 0.19-0.55, p<0.05-0.001) except for the Role Functioning-Physical scale (rho=0.17). Significant differences between the parent and child scores were found in six scales. The children reported significantly lower scores in Global Behavior, Global Health, Behavior (p<0.05), Bodily Pain (p<0.01), and Mental Health (p<0.001). The parents reported significantly lower scores in the Self Esteem scale (p<0.01). Self-esteem and body concept scored significantly higher postoperatively (p<0.001) in NQ-mA and SSQ. HRQol was significantly better in the Intervention Group compared to healthy controls at the same age. In five subscales Self-Esteem, Behavior, Emotional Role, Mental Health and Family Activities, the PE group had a better HRQoL.

The impact of lesions and epilepsy on personality and mood in patients with symptomatic epilepsy: A pre- to postoperative follow-up study

To discern more static and lesion based from more dynamic epilepsy-driven features of depression and personality in focal symptomatic epilepsy, change in personality and mood was examined as a function of focus lateralization and seizure outcome after epilepsy surgery. Self-reported personality and depression were assessed before and 1 year after epilepsy surgery in 151 consecutive patients with temporal (N=125) or extratemporal lobe epilepsy (N=26). At baseline only depressed mood (31%) and introversion (38%) appeared elevated, the first being more frequent in right lateralized epilepsies, the latter being pronounced in temporal lobe epilepsy. After surgery, seizure freedom was associated with a significant change in neuroticism as well as with improvements in mood and symptoms of an organic psycho-syndrome. Differential changes were observed for seizure-free left (enhanced emotional stabilization) versus right temporal resected patients (decreased anxiety and impulsivity, less vegetative symptoms). Apart from elevated depression and introversion scores which showed some relation to pathology, no major deviant personality features could be discerned. While seizure freedom related improvements may indicate both epilepsy and reactively driven behavioral changes, the differential recovery observed in seizure-free left versus right temporal resected patients indicate epilepsy-specific behavioral dysfunction.

Treatment of Myelopathy Due to Cervicothoracic OPLL Via Open Door Laminoplasty

Postoperative long-term follow-up study of open door laminoplasty for the ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Techniques and outcomes of open door laminoplasty were described. The efficacy of this procedure was discussed and compared with other surgical methods for thoracic OPLL reported in the literature. OPLL of the thoracic spine is often associated with cervical OPLL or ossification of the yellow ligament (OYL) of the thoracic spine; therefore, it is extremely difficult to determine the most appropriate surgical therapeutic procedure. There are very few detailed reports about extensive laminoplasty for OPLL of the thoracic spine. The subjects included in this study consisted of 13 consecutive patients of thoracic OPLL who were surgically treated between 1994 and 2003 by the open door laminoplasty using the spinal processes and ligament complex as spacers for the open side. The number of manipulated lamina, including the cervical spine, was from 7 to 14 (mean 10 laminae), the follow-up period was 75 months on average. We evaluated the clinical symptoms by the JOA scoring method and postoperative bone union and thoracic kyphosis by plain x-ray photograph and computed tomography. Postoperatively, the JOA score improved from an average of 5.5 to 8.5 out of a maximum of 11 points and the mean recovery rate by Hirabayashi method was 54.5%. In all cases, bone union was seen at the hinge side between the opened lamina and the lateral mass. Neither restenosis of the opened lamina nor marked progression of kyphosis were seen on the final follow-up observation in any patient. There was no postoperative spinal cord injury. Open door laminoplasty is a useful procedure for OPLL of the thoracic spine. This method enables wide-range posterior decompression, especially for the continuous type OPLL extending from the cervical spine to the thoracic spine, even if the apex of the thoracic kyphosis is included.

Demonstration of Large Bladder Diverticulum on Bone Scan

A 74-year-old man underwent low anterior resection for rectal cancer. Technetium-99m methylene diphosphonate (MDP) bone scanning was performed as part of the patient's postoperative follow-up study. Scans revealed an area of increased tracer uptake in the left hemipelvis. Coronal single-photon emission computed tomography and caudal images clearly separated the lesion from the skeletal structures. Transverse magnetic resonance images showed a large diverticulum originating from the left lateral wall of the bladder. The pelvic findings on the bone scan were the result of tracer retained within this diverticulum.

Intestinal Behçet's disease: breath-hold MR imaging.

To determine the feasibility of magnetic resonance (MR) imaging in the evaluation of intestinal Behçet's disease. Eight patients diagnosed to have intestinal Behçet's disease prospectively underwent MR imaging. Five patients had previously undergone abdominal surgery for intestinal Behçet's disease 27-81 months previously. Breath-hold T2-weighted single-shot fast spin echo, T1-weighted multiplanar spoiled gradient recalled echo, and postgadolinium-enhanced fat-suppressed T1-weighted opposed-phase multiplanar spoiled gradient recalled echo images were obtained. MR findings were analyzed by three independent radiologists in terms of the presence and location of bowel wall thickening and ulcer, maximal bowel wall thickness, grade of bowel wall enhancement, and presence and nature of extraluminal manifestations. K statistics were used to evaluate interobserver variability. Seven cases (88%), including the five cases with previous operations, demonstrated bowel thickening of more than 9 mm and increased enhancement. Ulcer was depicted in four cases (50%) in the terminal ileum or an anastomosis site. Three cases (38%) showed extraluminal manifestation, such as mesenteric infiltration around the involved bowel (two cases) and a sinus tract to subhepatic abscess from perforation (one case). Breath-hold MR imaging is useful for the evaluation of bowel wall thickening, enhancement, mesentery infiltration, and abscess formation. Characteristic ulcerative lesions may be also depicted on T1- and T2-weighted breath-hold images. MR imaging is a useful method for postoperative follow-up study for the evaluation of recurrence.

O-6-84 - Predictors for the outcome in cervical myelopathy. A postoperative follow-up study in 219 cases

O-6-84 - Predictors for the outcome in cervical myelopathy. A postoperative follow-up study in 219 cases