No abstract available.
Dacryocystorhinostomy*

PURPOSE: The solid variety of cerebella r tumors in adult is relatively uncommon. This study is to describe the characteristic MR findings of various solid cerebellar tumors in adult. METHODS: Twenty three cerebellar solid tumors from 22 consecutive patients over age of 15 with surgical confirmations were retrospectively evaluated with MR imaging. H istologic diagnosis included hemangioblastoma (n=6), metastasis (n=6), high-grade astrocytoma (n=3), and medulloblastoma (n=8). The MR findings were reviewed with attention to the size, the signal intensity of the tumors, pattern of enhancement, tumoral margin, degree of peritumoral edema, signal void vascular structures within and/or around the tumor, and location in relation to attachment to the pial surface of the tumor. RESULTS: Solid hemangioblastomas consistently showed slightly low or iso signal intensity on T1 -weighted images and high intensity on T2-weighted images, dense homogeneous enhancement, and signal void vessels within and/or around the mass. Metastatic tumors showed various find ings with predominantly low or iso signal intensity on T2-weighted images. Medulloblastomas was midline and/or paramidline in location, and had larger mass formation. High-grade astrocytomas revealed nonspecific MR findings with no signal void vessels. CONCLUSION: Hemangioblastoma, metastasis, malignant astrocytoma, and medulloblastoma should be included in differential diagnosis of solid cerebellar tumors in adult. Dense homogeneous enhancement and signal void vessels are characteristic of hemangioblastoma. The signal intensity of the tumor, and presence of signal void vessels, location and enhancement pattern can be some value in differential diagnosis of solid cerebellar tumors in adult.
Adult* ; Astrocytoma ; Cerebellar Neoplasms* ; Diagnosis ; Diagnosis, Differential ; Edema ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging ; Medulloblastoma ; Neoplasm Metastasis ; Retrospective Studies

BACKGROUND: Positive end expiratory pressure (PEEP) ventilation is well established as an integral part of the management of patients with the acute lung injury. PEEP is a key element in the treatment of hypoxemia resulting from pulmonary edema. Pulmonary capillary pressure (Pcap) is the most important factor influencing lung edema formation, and an understanding of how Pcap is altered by variations of PEEP or pulmonary arterial occlusion pressure (PAOP) is important to improve the treatment of acute lung injury patients. This study was performed to evaluate the effects of PEEP on the pulmonary capillary pressure in acute lung injury patients. METHODS: This was a prospective study of 11 acute lung injury patients. The effect of PEEP on pulmonary circulation at four different levels (0,4,8, and 12cm H2O) was analyzed. Pcap was estimated visually at bed side with Swan Ganz catheters. The pulmonary vasculature was analyzed by calculating the pressure difference at the arterial and venous parts of the circulation. RESULTS: As PEEP increased from 0 to 12 cm H2O, the mean puhnonary arterial pressure (PAP) and Pcap increased respectively from 22.7 ± 7.4 to 25.3 ± 7.3 mmHg and 15.3 ± 3.3 to 17.8 ±3.2 mmHg (p<0.05). Similarly, PAOP increased from 9.8 ± 2.1 to 12.8 ± 2.1 mmHg and the central venous pressure increased from 6.1 ± 1.6 to 9.3 1: 2.3 mmHg(p<0.05). However, the pressure gradient at the arterial (PAP-Pcap) and venous (Pcap-Pcwp) part of pulmonary circulation remained unchanged at all evaluated PEEP levels. CONCLUSION: Although Pcap increasoo gradually with increased PEEP, the pressure gradient at the arterial and venous part of the pulmonary vasculature remained unchanged at all evaluated PEEP levels in acute lung injury patients.
Acute Lung Injury* ; Anoxia ; Arterial Pressure ; Capillaries* ; Catheters ; Central Venous Pressure ; Edema ; Humans ; Lung ; Positive-Pressure Respiration* ; Prospective Studies ; Pulmonary Circulation ; Pulmonary Edema ; Ventilation

No abstract available.

We reviewed 56 patients who received mandibulotomy at Yonsei medical center between 1989 and 1999. We also analysed the complications associated with mandibulotomy and its contributing factors. The complications occur in 16 patients(28.6%) and are classified into two categories; intraoperative and postperative complications. Nonunion was observed in 5 patients and osteoradionecrosis in 5. The patients who received preoperative radiation therapy were more tend to develop nonunion and osteoradionecrosis. This study suggests the benefits of mandibulotomy as a surgical approach to oral cancer: 1. Paramedian osteotomy was recommended for preservation of neurovascular bundle and ease of surgical access. 2. By using thin saw blade, reapproximation was improved with minimal bone loss. 3. osteotomy on anterior mandible which lies outside the usual portals of radiation therapy decreases the incidence of osteoradionecrosis.
Humans ; Incidence ; Mandible ; Mouth Neoplasms* ; Osteoradionecrosis ; Osteotomy

PURPOSE: The purpose of this study is to determine predictive MR features for grading of astrocytic gliomas and to evaluate the accuracy of MR grading in these tumors. MATERIALS AND METHODS: We retrospectively reviewed 135 cases of supratentorial astrocytic gliomas in adult (age > 15 years), all of which were proved by open biopsy. Two observers analysed MR images independently with criteria of margin, edema, mass effect, signal heterogeneity, necrcosis, cyst formation, hemorrhage, tumor vascularity, enhancement degree, and enhancement size. The patterns of enhancement were categorized into no, homogeneous, heterogeneous, thin smooth rim, thin irregular rim, and thick irregular rim enhancement patterns. Observers finally diagnosed each case as one of low-grade astrocytoma, anaplastic astrocytoma or glioblastoma multiforme. RESULTS: Statistically significant MR features for grading of these tumors were revealed as necrosis (p < 0. 001), edema (0.008), and signal heterogeneity (p < 0.025). When compared with histopathologic grading, MR graded correctly 76%-77% of cases in two tiered system(low-grade astrocytoma versus high-grade astrocytoma), but only 67%-69% of cases in three tiered system(low-grade astrocytoma, anaplastic astrocytoma, glioblastoma multiforme). No contrast enhancement was seen in 45% and 23% of low-grade astrocytoma and anaplastic astrocytoma respectively. Glioblastoma multiforme frequently showed thick irregular rim enhancement (57%), but no enhancement at all in 8%. CONCLUSION: We have concluded that necrosis and edema are significant predictive MR features for gradomg of supratentorial astrocytic gliomas in adult, and MR was correct in 76%--77% of cases for predicting pathologic grading of astrocytomas in two tiered system.
Adult* ; Astrocytoma* ; Biopsy ; Edema ; Glioblastoma ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Necrosis ; Neoplasm Grading* ; Population Characteristics ; Retrospective Studies

The purpose of this study is to evaluate the effects of surface treatment and composition of reinforcement material on fracture strength of fiber reinforced composite inlay bridges. The materials used for this study were I-beam, U-beam TESCERA ATL system and ONE STEP(Bisco, IL, USA). Two kinds of surface treatments were used; the silane and the sandblast. The specimens were divided into 11 groups through the composition of reinforcing materials and the surface treatments. On the dentiform, supposing the missing of Maxillary second pre-molar and indirect composite inlay bridge cavities on adjacent first pre-molar disto-occlusal cavity, first molar mesio-occlusal cavity was prepared with conventional high-speed inlay bur.The reinforcing materials were placed on the proximal box space and build up the composite inlay bridge consequently. After the curing, specimen was set on the testing die with ZPC. Flexural force was applied with universal testing machine (EZ-tester; Shimadzu, Japan). at a cross-head speed of 1 mm/min until initial crack occurred. The data wasanalyzed using one-way ANOVA/Scheffes' post-hoc test at 95% significance level. Groups using I-beam showed the highest fracture strengths (p < 0.05) and there were no significant differences between each surface treatment (p > 0.05). Most of the specimens in groups that used reinforcing material showed delamination. 1. The use of I-beam represented highest fracture strengths (p < 0.05). 2. In groups only using silane as a surface treatment showed highest fracture strength, but there were no significant differences between other surface treatments (p > 0.05). 3. The reinforcing materials affect the fracture strength and pattern of composites inlay bridge. 4. The holes at the U-beam did not increase the fracture strength of composites inlay bridge.
Inlays* ; Molar

PURPOSE: Acute appendicitis is one of the most common diseases requiring surgical treatment. Delayed diagnosis, which causes complications like perforation of the appendix, abscess formation, or misdiagnosis, leads to unnecessary surgery. Many scoring systems have been suggested for the diagnosis of acute appendicitis. This study aims to evaluate the clinical value of previous scoring systems. METHODS: This study was conducted with a total of 270 patients who had visited the National Police Hospital (NPH) Emergency Room for acute abdominal symptoms from January to June 2008. The Alvarado and the Ohmann scores were applied retrospectively based on the patients' records. We found 3 criteria which were relatively objective and clinically meaningful; then, we designed a new 10 points scoring system. RESULTS: The sensitivity and the specificity of the Alvarado scoring system were 83.23% and 64.42%, respectively, whereas those of the Ohmann scoring system were 74.85% and 66.35%, respectively. The sensitivity and the specificity of the NPH scoring system were found to be 78.4% and 68.9%, respectively. The Ohmann scoring system showed a little lower sensitivity, and the NPH scoring system showed a little higher specificity, but the differences were not statistically significant. CONCLUSION: Our study indicates that the scoring systems considered are not useful diagnostic methods for primary screening and diagnosis of acute appendicitis.
Abscess ; Appendicitis ; Appendix ; Delayed Diagnosis ; Diagnostic Errors ; Emergencies ; Humans ; Mass Screening ; Police ; Retrospective Studies ; Sensitivity and Specificity ; Unnecessary Procedures

PURPOSE: The aim of this study was to compare three methods of hernioplasty: high ligation (HL), tissue repair (TR), and tension free (TF) and to determine the usefulness of high ligation for repair of indirect inguinal hernia in young adults. METHODS: One hundred thirty two patients who were under the age of 25 and who underwent repair of their inguinal hernia between January 2001 and December 2005 were reviewed retrospectively by using their inpatient and outpatient records and phone calls. Sixty seven, 23 and 42 patients underwent HL, TR and TF, respectively. The clinical features that were analyzed included location, type, signs and symptoms, operation method, complications and recurrence. RESULTS: The operation times were (mean+/-SD) 46.2+/-19.1, 56.0+/-11.5, and 61.8+/-14.9 minutes for HL, TR and TF, respectively. For the post-operative complications, there was 1 case of wound infection (1.5%) and 1 case of scrotal hematoma (1.5%) for HL; 1 case of wound infection (4.4%) and 1 case of scrotal swelling (4.4%) for TR; 3 cases of wound infection (7.0%), 2 cases of scrotal swelling (4.7%), 1 cases of intermittent pain (2.3%) and 1 case of scrotal hematoma (2.3%) for TF. Two patients in the HL group had recurrences, but there was no recurrence in the TR and TF groups. CONCLUSION: High ligation hernioplasty in young adults showed a shorter operation time, but there were no differences in the rate of complications between the methods. In the case of recurrence, it can be corrected by performing tissue repair or tension free hernioplasty because the normal anatomy may be preserved even after operation. Therefore, high ligation hernioplasty proved to be a useful method for repair of indirect inguinal hernia in young adults. In contrast, for the recurred or older age patients, tissue repair or tension free hernioplasty may be a more useful method.
Hematoma ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Inpatients ; Ligation* ; Outpatients ; Recurrence ; Retrospective Studies ; Wound Infection ; Young Adult*

PURPOSE: This study was undertaken to investigate the preoperative diagnosis, indication for operation, postoperative complication, postoperative medical treatment and recurrence rate in patients with Crohn's disease who were treated with operation. METHODS: Forty patients with Crohn's diseases had been operated on at the Department of Surgery, Yonsei University College of Medicine during the period from Jan 1986 to May 1999 and they were reviewed retrospectively. We studies symptoms, surgical indications, preoperative and postoperative treatments, involvement sites, types of operation and recurrence rate in Crohn's disease. RESULTS: The male to female ratio was 1.5: 1, and age distribution was from 8 to 69 years old with mean age of 33 years old. The duration of symptoms varies from within 1 day to above 10 years and most of them had within 1 month as 17 cases (42.5%). Symptoms are abdominal pain, hematochezia, anorexia, abdominal mass and diarrhea. The most frequent symptom was the abdominal pain as 85%. Crohn's disease was diagnosed only 45% before operation, less than what we expected. In another hand it surprised us find out that tuberculosis enteritis was diagnosed as much as 20%. The most common indication of operation was medical treatment failure as 13 cases, and fistula was 7 cases, intestinal obstruction with stenosis and tumor were 6 cases each other. The involvement of small bowel was most common as 40%, and the most common operative findings were ulceration and fistula for 17 cases and 12 cases respectively. Small bowel cases were treated with segmental resection and anastomosis in all 16 cases. Large bowel cases were performed right hemicolectomy in 10 cases and total colectomy in 1 case. Both small and large bowel involvement cases, right hemicolectomy was done in 4 cases, right hemicolectomy and segmental resection of small bowel was done in 6 cases. The recurrence rate of postoperative medical treatment was 16% and 28% for 5 years and 10 years respectively. The recurrence rate with no postoperative medical treatment was 13% and 26% for each 5 years and 10 years. There was no significantly difference in both groups. CONCLUSION: The major surgical indications for Crohn's disease were medical treatment failure, fistula and intestinal obstruction. Specially in Korea, differential diagnosis with tuberculosis enteritis was very important. Postoperative complication and recurrence rate has relatively low incidence. Our study suggest that postoperative medical treatment was controversial.
Abdominal Pain ; Adult ; Age Distribution ; Aged ; Anorexia ; Colectomy ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis ; Diagnosis, Differential ; Diarrhea ; Enteritis ; Female ; Fistula ; Gastrointestinal Hemorrhage ; Hand ; Humans ; Incidence ; Intestinal Obstruction ; Korea ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Treatment Failure ; Tuberculosis ; Ulcer