Ticlopidine is a powerful inhibitor of platelet aggregation which is induced by adenosine diphosphate. Ticlopidine has been shown to be effective in reducing combined stroke, myocardial infarction, reocclusion of coronary stent. The principal side effects of ticlopidine are severe neutropenia, rash and gastrointestinal upset. Recently, we experienced two cases of severe neutropenia associated with ticlopidine. One was administered ticlopidine to prevent subacute thrombosis after intracoronary stent implantation in unstable angina pectoris. Thirty days of therapy, her absolute neutrophil count (ANC) had dropped to 14/mm3 . The other patient was presented with recurrent episodes of cerebral infarction, for which he had undergone right carotid angiogram. The carotid angiogram demonstrated tight stenosis of right internal carotid artery. Carotid artery stenting was performed at right internal carotid artery without any complications. Twenty seven days of ticlopidine therapy, his ANC had dropped to 111/mm3. The ticlopidine was stopped, and they were given granulocyte-colony stim-ulating factor 250 microgram/day subcutaneous injection until their ANC was up to 1000/mm3. They were discharged with normal neutrophil count and no other complications.
Adenosine Diphosphate ; Angina, Unstable ; Carotid Arteries ; Carotid Artery, Internal ; Cerebral Infarction ; Constriction, Pathologic ; Exanthema ; Granulocyte Colony-Stimulating Factor ; Humans ; Injections, Subcutaneous ; Myocardial Infarction ; Neutropenia* ; Neutrophils ; Platelet Aggregation ; Stents ; Stroke ; Thrombosis ; Ticlopidine*

The clinicolaboratory findings, cardiac catheterization, and outcome of operation were analyzed in 78 patients with tetralogy of Fallot, which were diagnosed by echocardiography, cardiac catheterization, and a cardiac angiography and confirmed by operation at Dong San Hospital, Keimyung University, during a 4(1/2)-year period from January 1984 to June 1988. The following results were obtained : 1) Out of the 78 cases, 45 were male and 64 were female. 2) The electrocardiogram showed right axis deviation in 71 cases(91%) and right ventricular hypertrophy in 66 cases(84.6%). 3) Chest X-ray revealed that, the cardiothoracic ratio was normal or decreased in 68 cases(87.3%), and cardiac apex elevation was noticed in 57 cases(73%). 4) Pulmonary stenosis were chiefly valvular and infundibular type(53.8%). 5) The associated heart diseases with TOF were patent foramen ovale(64.1%), right sided aortic arch(19.2%), and secundum ASD(10.3%), in that order. 6) There was an intimate correlation between secondary polycythemia and thrombocytopenia. 7) Among the 78 Cases, 73 cases had total correction, 1 case had shunt operation, and 4cases had total correction after shunt operation. The highest mortality rate occurred in the cases of total correction after shunt operation(25%). The cases with a main pulmonary artery size of 1/3 to 2/3 against, the aorta had a higher mortality than the other group, and no cases expired in the group with a ratio of more than 2/3. The overall surgical mortality was 8.9%.
Angiography ; Aorta ; Axis, Cervical Vertebra ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Electrocardiography ; Female ; Heart Diseases ; Humans ; Hypertrophy, Right Ventricular ; Male ; Mortality ; Polycythemia ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Tetralogy of Fallot* ; Thorax ; Thrombocytopenia

No abstract available.
Humans ; Kidney Failure, Chronic* ; Peritoneal Dialysis, Continuous Ambulatory*

Following chemotherapy for acute myelomoncytic leukemia, an 3-year-old boy developed several painful erythematous indurated patches at previous sampling sites and at the site where an arm board and adhesive tape were used in securing an intravenous infusion set. The lesions rapidly progressed to ulcers with central black eschars. Biopsies and cultures demonstrated a fungus, Aspergillus flavs, as the etiologic agent, without evidence of systemic dissemination. Local care, including s irgical debridement, were performed. The patient also received treatment with intravenous; amphotericin B followed by oral itraconazole. Six months later, the skin lesions had healed, leaving some scar and deformities.
Adhesives ; Amphotericin B ; Arm ; Aspergillosis* ; Aspergillus ; Biopsy ; Child* ; Child, Preschool ; Cicatrix ; Congenital Abnormalities ; Debridement ; Drug Therapy ; Fungi ; Humans ; Infusions, Intravenous ; Itraconazole ; Leukemia* ; Male ; Skin ; Ulcer

No abstract available.
DNA* ; Lymphoma, Non-Hodgkin*

PURPOSE: An autologous dermal fat graft has several advantages, over other viable or synthetic sling materials, in expenditure, postoperative complication and biocompatibility of the host. We investigated the success rate and risk factors of a pubovaginal sling, using an autologous dermal fat graft, in female stress urinary incontinence. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 30 women that underwent a pubovaginal sling, using a dermal fat graft. The preoperative evaluations included: age, Stamey grade, Blaivas type, urodynamic study and previous pelvic operation history. We observed the postoperative results using questionnaire research during the follow-up (cured: no urine leakage and satisfactory, improved: urine leak< or =4 times/week and satisfactory, failed: urine leakage>4 times/week or unsatisfactory). The risk factors affecting the postoperative outcomes and complications were also analyzed. RESULTS: The success rate was 90.0% (success rate was calculated by cured rate plus improved rate, cured rate: 53.3%, improved rate: 36.7%), with the follow-up periods ranging from 6 to 24 months. A wound infection, requiring hospitalization, developed in one patient, but no other significant complications related to dermal graft were noted. Within the preoperative evaluations, the Blaivas type and a previous pelvic operation history were statistically related to the success rate (p<0.05). CONCLUSIONS: The Blaivas type and previous pelvic operation history are meaningful factors for predicting the success rate. The use of a dermal fat graft might be beneficial in the treatment of stress urinary incontinence in terms of its cost and success rate. However, a lower abdominal scar, of more than 5cm in length, and postoperative infections remain in some patients. Therefore it might be necessary to find another useful material for to treat female stress urinary incontinence.
Cicatrix ; Female* ; Follow-Up Studies ; Health Expenditures ; Hospitalization ; Humans ; Medical Records ; Postoperative Complications ; Surveys and Questionnaires ; Retrospective Studies ; Risk Factors ; Transplants* ; Urinary Incontinence* ; Urodynamics ; Wound Infection

PURPOSE: While numerous methods have been introduced to repair hypospadias, no single method is effective for repairing all hypospadias. We reviewed our experience of hypospadias repair to determine the best surgical method and the efficacy of the treatment modality. MATERIALS AND METHODS: We reviewed the hospital charts of 32 patients who had undergone hypospadias surgery from January 1993 to January 2002. Group 1 included patients who were operated on before 1998 and group 2 had those who had operations after 1998 with only the TIP(tubularized incised plate) method. The surgical procedures that were performed on the patients were onlay island flap(6), Mathieu(2), Hodgson's type III(2), Mustard(2), TIP(14), Transverse island flap(5), and Thiersch-Duplay(1). The mean operative time, mean hospital days, mean duration of catheter drainge, and complication rates of the two groups were compared. RESULTS: In group 2, operation time was reduced(142.9+/-69.4 versus 172.5+/-93.4 min)(p<0.05), but the two groups showed no significant differences in mean hospital days(11.9+/-2.8 days. versus 12.3+/-1.6 days) and mean duration of catheter drainge (9.8+/-24 versus 10.5+/-3.6 days). In group 1 and group 2, complication rates were 67% (12 of 18) and 14%(2 of 14), respectively(p<0.05). CONCLUSIONS: Our data show shorter operative time and lower complication rates using the TIP method for various types of hypospadias. Therefore, the TIP method seems to be a safe method of surgery for any type of hypospadias.
Catheters ; Female ; Humans ; Hypospadias* ; Inlays ; Male ; Operative Time ; Urethra

PURPOSE: Although percutaneous aspiration and sclerotherapy is a simple, noninvasive and cost-effective therapy for symptomatic renal cysts, the recurrence rate is high. Recently, a laparoscopy has been attempted on symptomatic renal cysts. To assess the clinical efficacy and safety of the laparoscopic cyst marsupialization, the clinical characteristics and operative parameters were evaluated, and compared with the results of sclerotherapy. MATERIALS AND METHODS: Between November 1993 and February 2003, 71 patients with symptomatic simple renal cysts were treated with either laparoscopic marsupialization or sclerotherapy. Respectively, 26 of 31 laparoscopy patients and 27 of 40 sclerotherapy patients were followed-up over a 2 months period and included in this study. The laparoscopic marsupialization was accomplished with either transperitoneal (15 patients) or retroperitoneal approaches (11). The sclerotherapy was composed of percutaneous aspiration followed by an injection of 99% ethanol. RESULTS: The clinical characteristics, including cyst size, location and laterality, were no different in either group. The mean follow-up durations were 19.7 and 18.1 months in laparoscopy and sclerotherapy groups, respectively. Comparing the laparoscopy with the sclerotherapy group, the operation time (106.2 vs. 15.3 min.), hospital stay (7.8 vs. 4.6 days) and complication rate (23.1 vs. 3.7%) were significantly decreased in the sclerotherapy group. However, the success rate (96.2 vs. 77.8%) was significantly increased in the laparoscopy group. With either the transperitoneal or retroperitoneal approaches in the laparoscopy group, there was no statistical difference in the operative time, hospital stay and complication and success rates. CONCLUSIONS: For a symptomatic renal cyst, laparoscopic marsupialization is an effective therapy, with a high success rate on the long-term follow-up. The clinical results, according to the approach method, were not different for the transperitoneal and retroperitoneal approaches.
Ethanol ; Follow-Up Studies* ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Recurrence ; Sclerotherapy*

BACKGROUND: Emergence agitation (EA) is one of the most common complications after general anesthesia. The goal of this retrospective study was to determine the risk factors of EA in adult patients who underwent general anesthesia. METHODS: We retrospectively investigated the medical records of 5,358 adult patients who stayed in the postanesthesia care unit (PACU) of our hospital after general anesthesia during the 1-year period from January 2014 to December 2014. Psychological and behavioral status in the PACU was determined by the Aono four-point scale. Grade of 3 or 4 were considered as manifestations of EA. Multiple variables assessed EA risk factors. RESULTS: Two-hundred-forty-five patients (4.6%) developed EA. In multivariate analysis, male gender (OR = 1.626, P = 0.001), older age (OR = 1.010, P = 0.035), abdominal surgery (OR = 1.633, P = 0.002), spine surgery (OR = 1.777, P = 0.015), longer duration of anesthesia (OR = 1.002, P < 0.001), postoperative nausea and vomiting (OR = 20.164, P < 0.001) and postoperative pain (OR = 3.614, P < 0.001) were risk factors of EA. CONCLUSIONS: Male gender and older patients were risk factors of EA after general anesthesia in adult patients. Careful attention is needed for patients who receive abdominal or spine surgery, and who receive prolonged anesthesia. Adequate postoperative analgesia and antiemetic therapy should be provided to reduce the incidence of EA.
Adult* ; Analgesia ; Anesthesia ; Anesthesia Recovery Period ; Anesthesia, General* ; Delirium ; Dihydroergotamine* ; Humans ; Incidence ; Male ; Medical Records ; Multivariate Analysis ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Retrospective Studies ; Risk Factors* ; Spine

Chordomas are congenital tumor which develop from remnant of the notochord. Most of them arise at the clivus Blumenbachii, at the junction of the sphenoidal and occipital bones or sacrococcygeal region. Rarely chordomas arise at the thoracic spine, which compress the spinal cord epidurally and sometimes invade the substance of the spinal cord. The authors report a case of chordoma at T9-T10 vertebral level in which the characteristic "physaliferous" cells were found in the slides of operative specimen. The tumor was compressing the spinal cord and extending into body and lamine of the vertebra, which resulted the patient, 52 year-old Korean male, in paraplegia.
Chordoma* ; Cranial Fossa, Posterior ; Humans ; Male ; Middle Aged ; Notochord ; Occipital Bone ; Paraplegia ; Sacrococcygeal Region ; Spinal Cord ; Spine*