BACKGROUND: Total occlusion of the infrarenal abdominal aorta is a very rare disease in clinical practice. The clinical outcome may be poor unless management is attempted promptly. Surgical bypass has been recommended as the treatment of choice for these lesions. However, there was relatively high surgical mortality and morbidity associad with aorto-bifemoral bypass graft in patients with other systemic disease, especially coronary artery disease. As a result, the use of, thrombolysis with percutaneous transluminal angioplasty (PTA) has recently been extended to this disease as an alternative method to surgery. PTA is technically simpler with less morbidity and mortality than surgery.We report our experience with thrombolysis and balloon angioplasty of total aortic occlusion in 14 patients between March 1991 and December 1996. METHODS: Fourteen patients, whose mean age was 59+/-13 years (11 male, 3 female), serve as the study's patients. Aortography was introduced via transbrachial artery. The end hole multipurpose catheter with guidewire was introduced into the thrombotic portion of the total occlusion. Urokinase was infused into the thrombus through the catheter if there were no contraindications. in sysremic thrombolysis. Thrombolytic therapy was continued until the thrombi was resolved and flow was restored. Balloon dilatation was followed in residual stenotic lesions. Stents were implanted in case of suboptimal results after ballooning. RESULTS: Clinical findings were resting leg pain in 6 patients, gangrene in 5 patients, and claudication in 3 patients. The causes of aortic occlusion were thromboembolism in 4 patients and thrombosis of an atherosclerotic aorta in 10 patients. Location of obstruction was below the renal artery in all cases. The clinical outcome of interventional therapy was successful in all cases except one patients. Operative treatment was undertaken in 2 cases because they could not received thrombolytic therapy due to contraindication and complication of thrombolytic therapy (gastrointestinal bleeding). Near normal revascularization was achieved in 3 patients by thrombolytic therapy only. PTA was performed at the stenotic after thrombolytic therapy in 4 patients. Stenting were performed at the stenotic sites after balloon dilatation in another 4 patients. There was bleeding complication in one case. CONCLUSIONS: Interventional therapy such as thrombolytic therapy with PTA is an effective and safe treatment modality for abdominal aortic total occlusion in selected cases. These techniques were very useful in some high risk patients who received surgical bypass procedures.
Angioplasty ; Angioplasty, Balloon ; Aorta ; Aorta, Abdominal* ; Aortography ; Arteries ; Catheters ; Coronary Artery Disease ; Dilatation ; Gangrene ; Hemorrhage ; Humans ; Leg ; Male ; Mortality ; Rare Diseases ; Renal Artery ; Stents ; Thromboembolism ; Thrombolytic Therapy ; Thrombosis ; Transplants ; Urokinase-Type Plasminogen Activator

Axis, Cervical Vertebra ; Bite Force ; Dental Implants ; Finite Element Analysis ; Mandible ; Osseointegration ; Prostheses and Implants ; Rehabilitation

PURPOSE: The frontal sinuses are a pair of triangularly shaped, air-filled chambers lined by mucoperiosteum and located between the inner and outer tables of the frontal bone. Until recently, our understanding of gender variations in craniofacial anatomy has been chiefly built upon anthropometric studies, which typically employ facial surface measurements or plain film radiography. The aim of this study i to determine the sizes of the frontal sinus in both sexes in Koreans. METHODS: 95 Korean subjects who underwent maxillofacial 3-Dimensional computed tomography(CT) between January 2009 and December 2009 were enrolled. Frontal sinus dimensions and forehead measurements were taken at midline and at 10, 20, and 30mm to the left and right of midline using sagittal, coronal, and axial images. The data was analyzed for significant differences between measurements made at the selected points in the frontal sinus, for left to right variations, for gender variations, and for racial differences. RESULTS: The mean thickness of the anterior table ranged from 2.31 to 3.23mm. Mean anteroposterior depth of the frontal sinus ranged from 7.38 to 9.45mm and did not vary significantly at any distance from midline. Frontal sinus height was greatest at midline(mean=29.24mm) and progressively lessened at lateral distances. Mean total width at the level of the supraorbital ridge was 53.66mm. For all measurements, no significant left to right variation was noted. Comparing the sexes, males were found to have greater dimensions in most frontal sinus measurements, though these differences were only found to be significant at or close to midline. The male forehead was marked by more acute nasofrontal angle(133.3degrees versus 141.6degrees) and a steeper posterior forehead inclination(14.9degrees versus 7.7degrees). CONCLUSION: Using CT imaging, forehead and frontal sinus dimensions have been described. Generally, males had larger overall frontal sinus dimensions. And Korean had similar sized frontal sinus to Caucasian in height and width. But in AP distance Korean had lesser measurement. The result of this study may be helpful in the comprehension of normal size of frontal sinus in Korean.
Comprehension ; Forehead ; Frontal Bone ; Frontal Sinus ; Humans ; Male

BACKGROUND: Correct preoperative staging of esophageal cancer is a prerequisite for adequate treatment. We prospectively compared the accuracy of positron emission tomography (PET) with [fluorine-18]FDG in the staging of esophageal cancer to that of computed tomography (CT). MATERIAL AND METHOD: The findings of FDG PET and of chest CT including lower neck and the upper abdomen of 20 biopsy-proven squamous cell carcinoma patients (male, 19; female, 1; mean age, 61) were compared with the pathologic findings obtained from a curative esophagectomy with lymph node dissection. RESULT: The sensitivities of FDG PET and CT for diagnosis of primary tumor were the same, 90.0% (18/20). Both FDG PET and CT failed to show the primary tumor in 2 of 20 patients; one had a 1cm sized carcinoma in situ and the other had T1 stage cancer. By using the results of the pathologic examinations of 193 removed lymph node groups, we calculated the diagnostic sensitivities, specificities and accuracies of PET and CT (*x2 p < 0.005). Sensitivity** Specificity Accuracy* PET 55.6%(30/54) 97.1%(135/139) 85.5%(165/193) CT 13.0%(7/54) 98.6%(137/139) 74.6%(144/193) One of four patients with a false-positive for PEThad had active pulmonary tuberculosis. Among the 24 tumor involved lymph node groups, PET failed to show tumor metastasis in 5 lymph node groups abutting the tumor and in 14 lymph node groups located where the decay correction was not performed. CONCLUSION: Based on the above findings, it is suggested that [F-18]FDG-PET is superior to CT in the detection of nodal metastases and in the staging of patients with esophageal cancer.
Abdomen ; Carcinoma in Situ ; Carcinoma, Squamous Cell ; Diagnosis ; Electrons* ; Esophageal Neoplasms* ; Esophagectomy ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Positron-Emission Tomography* ; Prospective Studies ; Sensitivity and Specificity ; Tomography, Emission-Computed ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary

Intraoperative antegrade colonic irrigation for single stage procedure in left colon cancer obstruction is a preferred technique recently however, synchronous pathology cannot be detected. A new device that enables easy intraoperative irrigation and colonoscopy before resection of tumor was devised. PURPOSE: To evaluate the efficacy of the new device for single stage procedure in left colon cancer obstruction. METHODS: The new device (NICI; MITech co., Ltd, Seoul, Korea) consists of a Y-shaped teflon tube of maximum diameter 2.9, 3.5 and 4.1 cm, one proximal end is designed to connect with the dilated colon just proximal to the lesion. Two distal branches are for drainage of fecal matter and for retrograde insertion of irrigation catheter and subsequent colonoscope respectively. RESULTS: There were 53 patients (27 male, median age 64, range; 28~82) who underwent this procedure. No extraintestinal leaks were encountered. The volume of saline used was 12 (range; 6 to 27) Liters over 14 (range; 9 to 22) minutes. Subsequent colonoscopic examination added 10 (range, 8 to 15) minutes to the entire operation in 28 patients. There were one anastomotic leakage and 2 wound infections, however, there was no operative mortality. On-table colonoscopy resulted in extended resection in 3 cases because of synchronous malignancy in frozen biopsy and found synchronous polyps in 13 of 28 cases. CONCLUSIONS: The new device enabled safe, simple and time saving single stage surgical management of left colon cancer obstruction. The ability to perform on-table colonoscopy enabled treatment of synchronous bowel pathology.
Anastomotic Leak ; Biopsy ; Catheters ; Colon* ; Colonic Neoplasms* ; Colonoscopes ; Colonoscopy ; Drainage ; Humans ; Male ; Mortality ; Pathology ; Polyps ; Polytetrafluoroethylene ; Seoul ; Wound Infection

We report a case of prostatic abscess in a 46-year old man with chronic myelocytic leukemia. Preoperative transrectal ultrasonography and computerized tomography confirmed the diagnosis of prostatic abscess, which was treated with pus drainage via transurethral resection of prostate and broad-spectrum antibiotics.
Abscess* ; Anti-Bacterial Agents ; Diagnosis ; Drainage ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Middle Aged ; Suppuration ; Transurethral Resection of Prostate ; Ultrasonography

PURPOSE: Congenital spinal dermal sinus tract is a rare lesion connecting skin to deeper structures including neural tissue. It results from the failure of the neuroectoderm to separate from the cutaneous ectoderm in the third to fifth week of gestation. The common locations are the lumbosacral and occipital regions. Sometimes it extends to spinal canal. In this paper we report a case of congenital spinal dermal sinus tract in the coccyx. METHODS: A 21-month-old male child born after an uncomplicated full-term pregnancy was admitted to our institute with a midline dermal sinus and a cartilaginous protrusion in the coccygeal region. There were no signs of infection. Neurologic examination showed no functional deficit in both lower limbs. He was treated with complete excision of the tract and an underlying accessory cartilage. RESULTS: The spinal dermal sinus tract was extended from the skin to the coccyx. The stalk was loosely attached to the accessory cartilage of coccyx. At that point, it was dissected from the accessory cartilage and resected. The accessory cartilage was also resected at the bone and cartilage junction. During the follow-up period of 6 months, the wound healed well without any complication nor recurrence. CONCLUSION: Congenital spinal dermal sinus tract is known as a form of spinal dysraphism. In order to prevent complications, timely surgical intervention including complete resection of sinus tract with correction of associated abnormalities is of utmost importance.
Cartilage ; Child ; Coccyx ; Ectoderm ; Follow-Up Studies ; Humans ; Infant ; Lower Extremity ; Male ; Neural Plate ; Neurologic Examination ; Pregnancy ; Recurrence ; Sacrococcygeal Region ; Skin ; Spina Bifida Occulta ; Spinal Canal ; Spinal Dysraphism

PURPOSE: According to various medical publications, it is believed that epinephrine should not be injected in fingers. However numerous articles show the successful use of local anesthetic with epinephrine in the digits. Epinephrine-mixed lidocaine solution enables to maintain a bloodless field for operation and provides long duration of local anesthesia when patient was wide awake. METHODS: From May 2009 to December 2009, ten patients underwent flexor tendon reconstruction with local anesthesia using epinephrine. No tourniquet was necessary. Before operation, all patients were injected with local anesthetics using 1% lidocaine 20 mL and 0.1% epinephrine 0.1 mL. RESULTS: There was no case of digital necrosis nor gangrene in the epinephrine injection. All 10 patients actively could move the finger through a full range of motion. All procedures were performed without sedation nor tourniquet and we could obtain a good vision of operative field and patients were comfortable. The patient make his or her fingers move through a full range of active motion before the skin is closed. Phentolamine was not required to reverse the vasoconstriction in any patients. CONCLUSION: The assertation that epinephrine should not be injected into the fingers is clearly no longer valid. The epinephrine injection allowed the authors to adjust flexor tendon surgery without risks associated with general anesthesia. It also enables to ensure longer anesthetic duration and bloodless operative field, and prevent post operative complications. In case of flexor tendon surgery, the use of epinephrine injection is recommended because of the advantages of local anesthesia.
Anesthesia ; Anesthesia, General ; Anesthesia, Local ; Anesthetics, Local ; Dietary Sucrose ; Epinephrine ; Fingers ; Gangrene ; Humans ; Lidocaine ; Necrosis ; Phentolamine ; Range of Motion, Articular ; Skin ; Tendons ; Tourniquets ; Vasoconstriction ; Vision, Ocular

PURPOSE: The purpose of this study was to evaluate the problems and the quality of the Internet Web-sites for management of short stature in childhood and adolescent. METHODS: We evaluated 105 Web-sites identified from 5 search engines, Naver, Daum, Korean Yahoo, Nate and Empas, using the word of 'height and/or short stature'. According to Web-site author, total Web-sites were classified as academy & society, physician, commercials, portal site, oriental medicine, and unidentified. We accessed how well the Web-sites informed people about the diseases by of short stature. RESULTS: Of the 105 Web-sites, 98 were accessible. 45 Web-sites (46%) were operated by oriental medicine group. Difference in IS between oriental medicine group and non-oriental medicine groups was significant (P<0.001). CONCLUSION: A great portion of Web-sites on short stature was operating by oriental medicine group. Oriental medicine Web-sites had a tendency to be omitted essential information on short stature and occasionally even had unhealthy information. This investigation could have a adverse influence that internet navigators for short stature might miss a chance of managing in time and there were huge increasing medical expense. There was strongly demand for reliable national certification system to certify to exellent quality for medical and health Web-sites.
Adolescent ; Certification ; Humans ; Internet* ; Medicine, East Asian Traditional ; Search Engine

Staged procedures are preferred to single stage procedures in emergency based left colonic obstruction or perforation because of the safety. PURPOSE: To evaluate whether the single stage procedure in emergency based left colonic pathology is not safe. METHODS: We compared medical records of single stage procedure (SP, n=22 male; 10, mean age: 60+/-17, range: 26-82 Yrs) with Hartmanns procedure (HP, n=23 male; 13, mean age: 58+/-16, range: 18-90 Yrs) and diverting loop colostomy (DC, n=19, male; 12, mean age: 59+/-19, range: 19-80 Yrs) in these 4 years. All the patients were admitted via emergency room. Intraoperative colonic irrigation method with newly developed irrigation device (MITech co., Ltd, Seoul, Korea) was used for SP. APACHE III scoring system was applied to evaluate the physiologic status of the patients. Preoperative data were compared with the 1st and 3rd postoperative day (POD). RESULTS: There were no statistically significant differences in patient demographics and preoperative APACHE III scores. The improvement of APACHE III score was significant in SP and DC on the 3rd POD from 29.6+/-20.9 to 22.9+/-10.2 and 25.7+/-13.3 to 21.4+/-14.8 (P<0.05). There was also a significant improvement in DC (25.7+/-13.3 to 21.9+/-12.9, P<0.05) on the 1st POD, however, there was only a tendency of improvement in SP (29.6+/-20.9 to 26.1+/-12.3) without statistical significance. The scores in HP showed no improvement on the 1st and 3rd POD. There were 3 operative mortalities in HP and one in DC. CONCLUSIONS: Our results suggest that the safety of the single stage procedure with newly developed colonic irrigation device is comparable to palliative decompressive loop colostomy and better than Hartmanns procedure in emergency based left colonic pathology.
APACHE ; Colon* ; Colostomy ; Demography ; Emergencies* ; Emergency Service, Hospital ; Humans ; Male ; Medical Records ; Mortality ; Pathology* ; Seoul