Surgical and anesthetic management in patients with complex vascular lesions is often challenging. Cardiopulmonary bypass followed by total circulatory arrest, deep hypothermia and barbiturate cerebral protection are efficacious adjuncts in the surgical treatment of giant basilar artery aneurysm. These techniques were utillized in two large basilar artery aneurysm patients with good results, and the surgical and anesthetic considerations are reviewed.
Aneurysm* ; Basilar Artery* ; Cardiopulmonary Bypass ; Humans ; Hypothermia* ; Intracranial Aneurysm

OBJECTIVE: The purpose of this study is to determine the efficacy of anterior lumbar interbody fusion(ALIF) for the patients with focal type of degenerative flat back. METHODS: The authors reviewed clinical and radiologic data of 16 patients with focal type of degenerative flat back who underwent ALIF during the period between December 1999 and November 2000. The operation procedure was ALIF using titanium or carbon fiber cages of lordotic angle, which were filled with allograft or autograft mixed with allograft through minilaparotomy. RESULTS: The majority of the patients were female(15 female: 1 male) and the mean age was 60.1 years. Six patients were operated on one level, ten on two levels. The mean follow up period was 10.7 months. The mean operation time was 131minutes and the average estimated blood loss was 133ml. Transfusion was not needed in any case. The mean preoperative lumbar lordotic angle was 4.1 degree(-7.4-41.6) and improved to 17.5 degree(-4.5-41.9) postoperatively. Radiological fusion was achieved in 13 patients(81%). The Oswestry disability index score improved from 62.5% to 23.9% and the patient's subjective improvement rate was 80%. Complications were infection in one patient, incisional hernia in one, symptomatic pseudoarthrosis in one and transient sympathetic disturbance in left leg in three. CONCLUSION: In a subset of the patients with degenerative flat back who showed disc degeneration in one or two levels, ALIF using cages improved patient's symptoms effectively. It seems that ALIF through minilaparotomy can be one of the surgical options in the treatment of the focal type of degenerative flat back.
Allografts ; Autografts ; Carbon ; Female ; Follow-Up Studies ; Hernia ; Humans ; Intervertebral Disc Degeneration ; Laparotomy ; Leg ; Pseudarthrosis ; Titanium

Moyamoya disease is a rare progressive occlusive disease of the internal carotid arteries. We report a case of combined spinal-epidural anesthesia in a patient with Moyamoya disease presenting for Cesarean section. Hypotension associated with spinal anesthesia for Cesarean section is the most common and serious adverse effect despite the use of uterine displacement and volume preload. We continuously infused phenylephrine and ephedrine to prevent hypotension. The intraoperative hemodynamic state was stable. The patient had no significant postoperative complications.
Anesthesia ; Anesthesia, Spinal ; Carotid Artery, Internal ; Cesarean Section ; Displacement (Psychology) ; Ephedrine ; Female ; Hemodynamics ; Humans ; Hypotension ; Moyamoya Disease ; Phenylephrine ; Postoperative Complications ; Pregnancy

Surgical resection of esophageal cance has played a prominent role in both cure and palliation. The radiologic evaluation of postesophagectomy patients is directed at the detection of normal and pathological appearances after surgical resection. Since early detection of recurrent tumor is important in the management of patients who have undergone esophagectomy, we undertook a retrospective study to evaluate the findings of recurrence on CT in postesophagectomy patients. Between January 1988 and July 1991, 26 patients who had undergone transthoracic esophagectomy with esophagogastrostomy for epidermoid carcinoma of the esophagus with following reoccurance were examined by chest CT. The group included 25 male and one female patients were aged 45-71 years(mean, 53). All patients had studies done immediate post operative 7-10 days. The CT were performed with a CT 9800 scanner (GE Medical System, Milwaukee) after administration of oral contrast media and intravenous injection of contrast media. The findings seen on CT were cnfirmed by biopsy in five cases and by clinical, radiological follow-up manifestation in 21 cases. The abnormalities that were demonstrated on follow-up CT were adenopathy-mediastinal node(ten cases) or abdominal node(five cases), local recurrence-previous tumor site (five case), anastomotic siteI(two cases) or thoracases), peicardial effusion(two cases). Our results indicate that serial chest CT play an important role in the evaluation of the patients after transthoracic esophagectomy with esophagogastrotomy.
Biopsy ; Carcinoma, Squamous Cell ; Contrast Media ; Esophageal Neoplasms* ; Esophagectomy* ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Injections, Intravenous ; Male ; Recurrence ; Retrospective Studies ; Thorax* ; Tomography, X-Ray Computed*

BACKGROUND AND OBJECTIVES: The purpose of the study was to compare the mastoid air-cell volume of the patients with superior semicircular canal dehiscence syndrome (SCDS) and that of the control patients with otosclerosis and temporal bone (TB) fracture. SUBJECTS AND METHODS: Ten patients with SCDS were enrolled and 10 patients with bilateral otosclerosis and TB fracture were selected as control groups by age and sex matching. To measure the mastoid air-cell volume, 3D reconstruction software was used. RESULTS: In 10 patients with SCDS, the mean age was 44.5 years, ranging from 16 to 79 years (M : F=4 : 6). Mean mastoid air-cell volume in the SCDS side was 3319.9 mm3, whereas 4177.2 mm3 in the normal side (p=0.022). Mean mastoid air-cell volume in the right side of otosclerosis patients was 6594.3 mm3 and it was not different from 6380.5 mm3 in the left side (p=0.445). Mean mastoid air-cell volume in normal side of TB fracture was 6477.2 mm3. The mastoid air-cell volume in the SCDS side was significantly smaller than that of otosclerosis and TB fracture patients (p=0.009, p=0.002, respectively). The mastoid air-cell volume in the normal side of SCDS was significantly smaller than that of TB fracture (p=0.019), but not significant with that of otosclerosis (p=0.063). CONCLUSIONS: Our findings revealed that the mastoid air-cell volume in the SCDS side was significantly smaller than control group, which suggest that the decreased mastoid pneumatization is closely related to the generation of SCDS.
Humans ; Mastoid ; Otosclerosis ; Semicircular Canals ; Temporal Bone

BACKGROUND AND OBJECTIVES: The purpose of the study was to compare the mastoid air-cell volume of the patients with superior semicircular canal dehiscence syndrome (SCDS) and that of the control patients with otosclerosis and temporal bone (TB) fracture. SUBJECTS AND METHODS: Ten patients with SCDS were enrolled and 10 patients with bilateral otosclerosis and TB fracture were selected as control groups by age and sex matching. To measure the mastoid air-cell volume, 3D reconstruction software was used. RESULTS: In 10 patients with SCDS, the mean age was 44.5 years, ranging from 16 to 79 years (M : F=4 : 6). Mean mastoid air-cell volume in the SCDS side was 3319.9 mm3, whereas 4177.2 mm3 in the normal side (p=0.022). Mean mastoid air-cell volume in the right side of otosclerosis patients was 6594.3 mm3 and it was not different from 6380.5 mm3 in the left side (p=0.445). Mean mastoid air-cell volume in normal side of TB fracture was 6477.2 mm3. The mastoid air-cell volume in the SCDS side was significantly smaller than that of otosclerosis and TB fracture patients (p=0.009, p=0.002, respectively). The mastoid air-cell volume in the normal side of SCDS was significantly smaller than that of TB fracture (p=0.019), but not significant with that of otosclerosis (p=0.063). CONCLUSIONS: Our findings revealed that the mastoid air-cell volume in the SCDS side was significantly smaller than control group, which suggest that the decreased mastoid pneumatization is closely related to the generation of SCDS.
Humans ; Mastoid ; Otosclerosis ; Semicircular Canals ; Temporal Bone

Herpes zoster is viral infection that presents unilateral skin rash or vesicle along the sensory nerve. It is known that pediatric herpes zoster rarely occurs and usually not so severe when it developed, except in immunocompromised children. We report an uncommon case of herpes zoster ophthalmicus in a 9-year-old boy. He presented with acute onset of vesiculopapular rash covering his left forehead, upper eyelid. He was treated with oral acyclovir and stellate ganglion block, with complete resolution without sequelae. In addition, we also review the literature on herpes zoster in childhoods.
Acyclovir ; Child ; Exanthema ; Eyelids ; Forehead ; Herpes Zoster ; Herpes Zoster Ophthalmicus ; Humans ; Stellate Ganglion

We experienced a case of tuberculous epididymitis in 3-year-old boy who presented with a chief complaint of right scrotal swelling without evidences of tuberculosis of other organs. Physical examination revealed bilateral epididymal induration and beaded vas with another firm and tender nodule on right epididymal tail. During anti-Tbc chemotherapy, right scrotal draining sinus developed and so right epididymectomy was performed. Tuberculous epididymitis was confirmed pathologically.
Child, Preschool* ; Drug Therapy ; Epididymitis* ; Humans ; Male ; Male* ; Physical Examination ; Tuberculosis

Because of its usually abnormal mesorchial attachments the undescended testis is more prone to undergo torsion than normally-sited organ, but the incidence of this complication appears to have lessened in recent years. We present two cases with torsion of the unilateral cryptorchid testis and a review of the literature. Two cryptorchids complained of the painful mass on the inguinal area. Exploration revealed testicular torsion and orchiectomy was done.
Cryptorchidism ; Incidence ; Male ; Orchiectomy ; Spermatic Cord Torsion ; Testis*

OBJECTIVE: The purpose of this study was to investigate the prevalence of dental anomalies in outpatient clinics. METHODS: The subjects of this study were 3,133 patients who visited the clinic between January 2009 and June 2011. The dental records and panoramic films of the patients and detection of supernumerary, missing, and impacted teeth, transposition, and peg lateralis were reviewed. The results were analyzed according to gender and types and locations of dental anomalies. RESULTS: Among the patients, 362 had dental anomalies, with a prevalence rate of 11.55%. Congenital missing teeth (5.71%) ranked first in the categories, and impacted teeth (3.09%) ranked second. The percentage of patients having supernumerary teeth, peg lateralis, and dislocated teeth were 1.79%, 1.66%, and 0.45%, respectively. CONCLUSIONS: Congenital missing teeth and impacted teeth are, respectively, the first and second most common dental anomalies in Korean dental patients.
Dental Records ; Humans ; Outpatients ; Prevalence ; Tooth ; Tooth, Impacted ; Tooth, Supernumerary