The authors reported a case of clozapine-induced agranulocytosis that combined with serious complications in a 37-years-old male patient with chronic schizophrenia. Clozapine-induced agranulocytosis developed on Day 51 of clozapine treatment. The patient was transferred to hematologic department and then treated by massive antibiotics in aseptic room. After the injection of G-CSF, WBC count increased to the normal range. But the day after the normalization of WBC count, patient's general condition was worsened with fever and mild rigidity, and also CK, LDH, BUN/Cr, and LFT was increased. The patient's elevated laboratory findings with those of physical signs and symptoms suggested the neuroleptic malignant syndrome and acute renal failure. Eventually steroid was administered to the patient, and then patient's general condition and laboratory findings were normalized. We suggest that the identification of risk factors and careful regular blood monitoring is the best method for the prevention of clozapine-induced agranulocytosis. After the onset of clozapine-induced agranulocytosis, clozapine should be discontinued immediately and proper antibiotic therapy with administration of G-CSF should be done, as soon as possible. And we emphasize the importance of the education and the establishment of therapeutic relationship with patients and their family also.
Acute Kidney Injury ; Agranulocytosis* ; Anti-Bacterial Agents ; Clozapine ; Education ; Fever ; Granulocyte Colony-Stimulating Factor ; Humans ; Male ; Neuroleptic Malignant Syndrome ; Reference Values ; Risk Factors ; Schizophrenia

No abstract available.
Braces*

In cases of L4-5 spinal fusions, L5-S1 segment used to be included in the fusion traditionally for fear of progressive deterioration of the lumbosacral motion segment after fusion above. The purpose of this study was to evaluate the advisability of extension to L5-S1 segment in cases of L4-5 fusion for an isolated pathologic condition in L4-5 sement. A retrospective review of 72 patients with spinal fusion for an isolated pathologic condition in L4-5 segment was undertaken to compare the clinical results and adverse effects in two groups. One group consisted of 39 patients with floating L4-5 fusion(SF), and the other group consisted of 33 patients with L4-S1 fusion(LSF). The age, pathologic condition at L4-5, and the fusion method(lateral fusion) were matched in two groups. The mean follow-up period was 43.6 months(ranging 24-69 months). Comparisons were made for operative problems, post-operative complications, the amount of changes in angular motion at the adjacent segments to fusion at the last follow-up compared to the pre-operative motion, and the clinical results of treatment. The LSF group took 38 more minutes and lost 245 grams of more blood in averages to complete the additional surgical procedures compared with those in SF group. Several considerable post-operative complications were one deep infection in SF group and three metal failures of sacral fixation with subsequent two fusion failures in LSF group which were mostly concerned with the sacral fixations. The changes of angular motion at follow up compared to pre-operative motion in SF group were 1.5° gain in average (ranging 3° loss-6° gain) in L3-4 segment and 0.6° gain in average (ranging 5° loss-5° gain) in the L5-S1 segment. Those in L3-4 segment of LSF were 2.8° gain in average (ranging 2°-loss 9° gain). Therefore the higher stress and subsequent degeneration are more likely expected above the L4-S1 fusion rather than below the L4-5 fusion. The satisfactory clinical results were 89.7% in SF group and 87.9% in LSF group without significant difference between two groups. In conclusion there is no need to include the L5-S1 segment in the L4-5 fusion when the pathology is limited to L4-5 segment.
Follow-Up Studies ; Humans ; Pathology ; Retrospective Studies ; Spinal Fusion

A most common site for the isthmic spondylolisthesis is at fifth lumbar vertebra(L5) and far less at fourth(L4). The pathogenic lesion in the pars interarticularis is essentially the same in LA and L5 isthmic spondylolisthesis, but the clinical characteristics may differ each other according to their anatomical and biomechanical differences. A retrospective review of 24 patients of LA(study group) and 27 patients of L5(control group) isthmic spondylolisthesis was undertaken for their medical records and radiographs to compare the clinical characteristics in each groups. Included in each groups were all patients who were surgically treated during the same period and followed for more than two years after surgery. In the study group, 18 of 24 patients were females having an average age of 42.5 years(ranging 34-65), while in the control group, 17 of 27 patients were males having an average age of 38,1 years (ranging 13-59). The symptoms were severe leg pain in most of the study group, but in the control group, the leg pain and back pain were equally complained. The degrees of slip were similar in two groups, but a narrowing of dise space at slip segment was more prominent in study group. The lateral radiographs taken in flexion and extension revealed more changes of slip in study group (4.7mm in study group vs 2.8mm in control group in averages), and more angular motion at slip segment in study group unless the dise space is not severely narrowed. A spinal stenosis in CT findings was disclosed in almost all patients of study group and in 18 patients of control group. The sizes of L5 transeverse process were bigger than twice as those of L4 in 17(70.8%) patients including 9(37.5%) sacralizations of L5 in suty group, while in control group they were only 8(29.6%) patients with no sacralization. The heights of intercreastal line revealed no difference in two groups. The surgical procedures in study group were fusion only in two and decompression with fusion in 22(91.7%) patients and those in control group were fusion only in 11 and decompression with fusion in 16(59.3%) paticnts. The satisfactory results of treatment were in 21(87.5%) patients of study group and 25(92.6%) patients of control group without significant difference between two groups. In conclusion, the L4 spondylolytic spondylolisthesis compared to L5 lesion was more unstable and developed spinal stenosis more often. The surgical treatment and decompression procedure were also more needed in L4 lesions particularly in agend women.
Back Pain ; Decompression ; Female ; Humans ; Leg ; Male ; Medical Records ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis

The percutaneous pinning is a simple, effective method for the treatment of displaced supracondylar fractures of the humerus in children. But there is some controversy in the number of pins used and the method of pin insertion. The cross pinning method provides more stability at the fracture site but the risk of ulnar nerve damage is higher than in lateral pinning method, The senenty-one displaced extension type supracondylar fractures were treated by closed reduction and percutaneous cross pinning from January 1991 to October 1994. Among them, the medial pin was inserted in elbow extension in twenty-eight cases and in forty- three cases the medial pin was inserted in elbow flexion. Ulnar nerve injury occured postoperatively in six cases, in which the pin was inserted with the elbow in flexion position. These results may suggest that when percutaneous cross pinning method is selected to fix the supracondylar fracture of the humerus, it would be safer to insert one or two lateral pins with the elbow in full flexion position followed by one medial pin in extension position in order to reduce the risk of loss of reduction and ulnar nerve damage.
Child ; Elbow ; Humans ; Humerus ; Methods ; Ulnar Nerve

We present a case of medial malleolus and deltoid ligament loss with extensive overlying soft tissue defect from crushing injury. The resultant gross medial ankle instability necessitated deltoid ligament reconstruction using a bone-patellar tendon graft.
Ankle ; Child ; Humans ; Ligaments ; Patella ; Patellar Ligament ; Tendons ; Transplants

Schwannoma, also referred to as neurilemmoma, neurinoma, and perineural fibroblastoma, is the most frequent solitary tumor of the peripheral nerves. It is an encapsulated sheath tumor consisting or two components: a highly ordered cellular component( Antoni A area) and a loose, myxoid tomponent( Antoni B area ). It is usually solitary and may be benign or malignant, solid or cystic, encapsulated or diffuse. It rarely occurs in the retroperitoneal space. We report a very rare case of Schwannoma developed in the muscular layer of the bladder wall and review the relevant literatures.
Neurilemmoma* ; Peripheral Nerves ; Retroperitoneal Space ; Urinary Bladder*

BACKGROUND: For the efficacy of pain relief, the adequate infusion dosage and the side effects of epidural butorphanol was compared with those of epidural fentanyl. METHODS: Forty consenting, healthy, term parturients who had undergone Caesarean section under epidural lidocaine anesthesia received 0.1% bupivacaine/ butorphanol 50 ug/ml (Group 1, n=20) or 0.1% bupivacaine/fentanyl 5 ug/ml (Group 2, n=20) using patient controlled epidural analgesia (PCEA) were evaluated. RESULTS: Total amount of 48hr consumption was 19.4 mg (butorphanol) and 1546.8 ug (fentanyl). There were no significant differences between two groups in total infusion doses of above drugs, VAS score and side effects. The putative potency ratio of fentanyl/butorphanol was 1/12.5. CONCLUSIONS: Although both butorphanol and fentanyl were useful and safe drug for PCEA for postoperative pain control, combination of butorphanol and bupivacaine provided more economically effective analgesia.
Analgesia ; Analgesia, Epidural* ; Anesthesia ; Bupivacaine* ; Butorphanol* ; Cesarean Section* ; Female ; Fentanyl* ; Humans ; Lidocaine ; Pain, Postoperative ; Pregnancy

Skip lesion is not uncommon feature in osteosarcoma and considered to be importantly associated with poor prognosis factor, and thus, should be excised with the main mass. The accurate pre-operative evaluation of the intramedullary extent of osteosarcoma is essential, because it determines the level of bone resection. Among the reliable detection methods, bone scan has a drawback of high rate of false negative results and regional MRI has a difficulty to cover the whole involved lesions without clinical suspicion. The authors report a case of osteosarcoma of the distal femur with a proximal skip lesion that was not detected by either regional MR imaging or by bone scan, but which was visualized by FDG-PET/CT.
Complement System Proteins ; Femur ; Neoplasm Metastasis ; Osteosarcoma ; Prognosis

BACKGROUND: The analgesic efficacy and safety of transdermal fentanyl patch(TDFP) combined with intravenous ketorolac administration were evaluated. METHODS: TDFP releasing 75 mcg/h (Group 1) or 50 mcg/h (Group 2) or placebo (Group 3) were applied to 60 women at 2 hours before abdominal gynecologic surgery. Postoperatively, patients self-administered intravenous ketorolac as required using patient controlled analgesia. Each group was assessed following 48 hours with respect to vital signs, VAS pain score, satisfaction score, side effects, and cumulative ketorolac use. RESULTS: After operation, pain score and ketorolac demand were significantly lower and satisfaction score and side effects were significantly higher in TDFP group (Group 1, 2) than control group (Group 3). CONCLUSIONS: If TDFP is applied 2 hour before surgery, combined with a bolus dose of 200 mcg i.v. fentanyl at induction of anesthesia and ketorolac i.v. infusion in the postoperative period, it provides a significant degree of background analgesia without respiratory depression.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia ; Female ; Fentanyl* ; Gynecologic Surgical Procedures ; Humans ; Hysterectomy* ; Ketorolac* ; Postoperative Period ; Respiratory Insufficiency ; Vital Signs