Access to the craniofacial skeleton and skull base requires osteotomies. An adequate exposure of neoplasms occupying the skull base and the oral cavity and oropharynx, especially retromolar trigone, is very important for precise tumor ablation. The demonstration by Tessier of the capacity for large segments of bone to survive removal and replacement has enabled skull base tumor surgery to grow into a subspeciality. Through the refined craniofacial exposure osteotomies, the surgery is safer, the operation shorter, and the result better both oncologically and reconstructively. We experienced 24 cases of exposure osteotomies consisting of 12 cases transzygomatic approaches, 1 case tranglabellar osteotomy, 1 case lateral transmaxillary approach, 1 case Le Fort II & midline splitting, and 9 cases mandibulotomy. There was no significant complication except a local wound infection in transzygomatic approach and one case of minimal malocclusion after parasymphyseal mandibulotomy. The orthotopic bone graft and the rigid fixation enables the postoperative morbidity to decrease. It seems that the previously inaccessible craniofacial tumors can be treated through the various exposure osteotomies.
Malocclusion ; Mouth ; Oropharynx ; Osteotomy* ; Skeleton ; Skull Base ; Transplants ; Wound Infection

OBJECTIVE: To analyze the clinical characteristics of obese infertile women. MATERIAL AND METHOD: Height, weight, body mass index, menstrual pattern, glucose, insulin, glucose / insulin ratio, dehydroepiandrosterone sulfate (DHEA-S), testosterone, free testosterone and plasminogen activator inhibitor (PAI-1) of 15 obese infertile women were tested. RESULTS: Of 15 obese infertile women, the number of diabetes mellitus, hyperinsulinemia, and insulin resistance was 2 (13%), 2 (13%), 2 (13%), respectively. The incidence of increased DHEA-S, testosterone, and free testosterone was 7 (47%), 1 (7%), 6 (40%), respectively. Notably, all patients showed increased PAI-1. CONCLUSIONS: Obesity is associated with infertility as well as many kinds of health problems. Obesity is closely related to insulin resistance and it also causes hyperandrogenism. Increased PAI-1 is one of the important causes of thrombophilia. Consequently, in the workup of obese infertile patient, many aspects of health problems should be considered.
Body Weight ; Dehydroepiandrosterone Sulfate ; Diabetes Mellitus ; Female ; Glucose ; Humans ; Hyperandrogenism ; Hyperinsulinism ; Incidence ; Infertility ; Insulin ; Insulin Resistance ; Obesity ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Testosterone ; Thrombophilia

Clear cell carcinoma of ovary is a rare epithelial ovarian tumor, and increased in its incidence recently. Clear cell carcinoma of ovary was known t,o be highly malignant than other epithelial ovarian tumors. The clinical and pathologic findings of two casea af clear cell carcinoma of ovary are reported and reviewed briefly.
Female ; Incidence ; Ovary*

No abstract available.
Hearing* ; Humans ; Tinnitus*

Pigmented villonodular synovitis and synovial chondromatosis are known as a poup of interrelated tumorous disorders that involve the lining of the joints, hursa and tendon sheath. Pigmented villonodular synovitis consists of proliferatin synovia1 tissue containing histiocytes, librohlasts, multinucleated giant cells, and capillaries that can destroy dense fihrous tissue, form soft tissue masses, and invade bone. Synovial chondromatosis consists of hyaline cartilage nodules within the synovium and synovial joint cavities, develop multiple loose fragments of cartilage within the joint. They may represent a reactive inflammatory process or henign neoplasm and usually occur in latge synovial joints, including the knee, hip and ankle. There are some reports stating that pigmented villonodular synovitis has coexisted with synovial chondromatosis. but none have reported that they occurred simultaneously in a large single joint. This is a report on a diagnosed and arthroscopicully treated pigmented villonodular synovitis and synovial chondromatosis that occurred simultaneously in the same ankle joint.
Ankle Joint* ; Ankle* ; Capillaries ; Cartilage ; Chondromatosis, Synovial* ; Giant Cells ; Hip ; Histiocytes ; Hyaline Cartilage ; Joints ; Knee ; Synovial Membrane ; Synovitis, Pigmented Villonodular* ; Tendons

No abstract available.
Bacteroides fragilis* ; Bacteroides*

No abstract available.
Transplantation*

BACKGROUND: Do-Not-Resuscitate(DNR) order has been used without specific legislation commonly in hospitals of Korea. We designed this study to assess the current use of DNR order in the emergency department and to make a database for establishing a policy for DNR order, especially in ER. METHODS: We retrospectively reviewed medical records of 164 patients who expired in the emergency department of Severance hospital from Sep. 1996 to Aug. 1997. We evaluated age, sex, diagnosis, specific department involved, whether written orders were made and medical care after decision of DNR. The patients were divided into 2 groups : DNR vs CPR. To determine factors influencing DNR decision, we searched for presence of malignancy, irreversible shock, unconsciousness and chronic illness. The logistic regression analysis was used for statistical significance. RESULTS: We found that 102(62.2%) out of 164 expired patients had a DNR order. But only in 59% of cases, were written DNR order on the chart. Factors which had the most influence on decision of DNR were malignancy and age. The sex, chronic illness, irreversible shock, and unconsciousness were not significant factors. CONCLUSION: We found malignancy and old age as an important factor when DNR order had been made. But further evaluation of other factors may be necessary to establish definitely a policy for DNR order.
Cardiopulmonary Resuscitation ; Chronic Disease ; Diagnosis ; Emergency Service, Hospital ; Humans ; Korea ; Logistic Models ; Medical Records ; Retrospective Studies* ; Shock ; Unconsciousness

OBJECTIVE: To identify the neurobehavioral impairment in the traumatic brain injured (TBI) patients and to determine the relationship between the neurobehavioral impairment and functional recovery. METHOD: We analyzed and compared Functional Independence Measure (FIM) scores and neurobehavioral psychometry results in 16 patients with severe TBI. The neurobehavioral psychometry tests included Minimental Status Examination (MMSE), Galvestone Orientation and Amnesia Test (GOAT) as screening tools, Korean Wechsler Intelligence Scale (KWIS) for intelligence, Wechsler Memory Scale-Revised (WMS-R) test for memory function, Color Trail test (CTT) 1 and 2 for attention and concentration, Grooved Pegboard Test (GPT) and Finger Tapping Test (FTT) for motor function, Wisconsin Card Sorting Test (WCST) for executive function, and Symptom Checklist-90-Revision (SCL-90-R) for personality. RESULTS: At discharge, neurobehavioral psychometry of the TBI patients showed impairment of the attention and concentration as demonstrated by severe and moderate impairment in CTT 1 and CTT 2, repectively. Memory disturbance was also noted by the result of mental retardation in WMS-R. But GOAT and MMSE showed normal, KWIS was below average. Motor dysfunction was seen in GPT and FTT and mild executive dysfunction in WCST. Functional recuperation was influenced by attention and concentration, as the FIM score has significant correlation with CTT 1 and FTT. CONCLUSION: The TBI patients have the pervasive neurobehavioral impairment, especially severe dysfunction in the memory, attention and concentration. And functional recovery was significantly correlated with attention. The neurobehavioral psychometry will be useful in neurobehavioral evaluation in TBI patients. A further prospective study using Neurobehavioral psychometry would bring a more precise and valuable information.
Amnesia ; Brain Injuries ; Brain* ; Executive Function ; Fingers ; Goats ; Humans ; Intellectual Disability ; Intelligence ; Mass Screening ; Memory ; Wisconsin

Prostatic adenocarcinoma is a common genitourinary malignancy which frequently is assiciated with bony metastasis at initial diagnosis. The detection of bony metastasis is important because it often alters the therapeutic strategy. The radionuclide one scintigraphy is known to be the most sensitive diagnostic method in detecting bony metastasis from prostatic adenocarcinoma. In the histologic grading of prostatic adenocarcinoma, the Gleason's grading system is the most widely employed one which is based on the degree of glandular differentiation and the growth patterns of tumor in relation to the prostatic stroma. The purpose of this study is to know the correlation of Gleason's grade and bone scintigraphic findings in prostatic carcinoma. We analyzed 99mTc-diphosphonate bone scintigraphies of 19 cases with prostatic adenocarcinoma confirmed by transurethral prostatic biopsy. Ten of the 19 cases showed asymmetrical multiple radioisotope uptake suggesting bony metastases and their Gleason's grade were 4 or 5 in seven cases. The remaining three cases were Gleason's grade 2 or 3. Another nine cases showed symmetrical radioisotope uptake with normal renal imaging suggesting no bony metastases and their Gleason's grade were 1,2 or 3 in seven cases. The remaining two cases of these nine cases were Gleason's grade 4 and 5. As the results, there was a correlation between the Gleason's grade and bone scintigraphic findings. The asymmetrical multiple skeletal uptake of radioisotope may suggest that the Gleason's grade is likely to be higher.
Adenocarcinoma ; Biopsy ; Diagnosis ; Methods ; Neoplasm Metastasis ; Radionuclide Imaging