Congenital absence of the gallbladder is a rare anomaly and an interesting subject. The overall incidence of gallbladder agenesis is said to approximately 0.035% to 0.065%. It is extremely difficult to make the correct diagnosis of gallbladder agenesis preoperatively in symptomatic patients because its clinical and radiological features are like those of cholecystitis, cholelithiasis, or choledocholithiasis in patients with anatomically normal biliary tracts. Gallbladder agenesis is suspected when the surgeon or the pathologist has failed to identify the gallbladder in its usual position but ectopic location or necrosis of the gallbladder from any causes should be ruled out. Recently, two cases of gallbladder agenesis were encountered in adult patients. We summarize our experience and give a brief review of the literature.
Adult ; Biliary Tract ; Cholecystitis ; Choledocholithiasis ; Cholelithiasis ; Diagnosis ; Gallbladder* ; Humans ; Incidence ; Necrosis

This study was performed to evaluate the effects of acute withdrawal of antiepileptic drugs in epileptic patients during continuous BEG monitoring. One hundred sixty-five withdrawals in 134 patients who were candidates for epileptic surgery were included for this study. Clinical features and frequency of seizure were observed after drug withdrawal with daily monitoring of serum drug level. The phases after withdrawal of antiepileptics were divided into phase of therapeutic drug level, phase of falling drug level, and phase of subtherapeutic or undetectable(zero) drug level. There were significant increase in frequency of seizure and seizure of secondary generalization after acute withdrawal of antiepileptic drugs. Number of seizure during the period of drugs withdrawals was not correlated with onset age of epilepsy, duration of epilepsy, duration of medication, and number of administrated antiepiteptic drugs. The number of frequency of seizure before drug withdrawal was correlated with the number of frequency of withdrawal seizure. The number of seizure frequency after carbamazepine withdrawal was significantly higher during the phase of subtherapeutic or zero drug level, and not during phase of rapid falling antiepileptic drug level.
Age of Onset ; Anticonvulsants* ; Carbamazepine ; Epilepsy ; Generalization (Psychology) ; Humans ; Seizures*

This study was retrospectively undertaken to evaluate clinical manifestations, electroencephalographic findings, response to antiepileptic drugs and prognosis of 80 benign childhood epilepsy with centrotemporal spikes (BCECT) patients seen between 1967 and 1993 and followed up for more than 2 years. The age of onset ranges from 3 to 15 years. In 93 percent of patients, seizures appeared between 4 to 12 year-old, with peak of 5 year-old. The main manifestations of partial seizure were hemifacial spasm (53%) and oropharygeal signs (52%) with hypersalivation, abnormal sensation of mouth, gutteral sounds, swallowing difficulty and feeling of suffocation. The types of seizure consist of partial seizure(66%) and partial seizure with secondary generalization (34%). Distributions of seizure attack were nocturnal sleep (83%), diurnal sleep state(4%) and waking state (13%). The typical EEG findings were slow diaphasic high voltage centrotemporal spikes with unilateral (94%) and bilateral foci(6%) with normal background. In addition to typical EEG findings, there were associated with multifocal independent sharp-waves (8.9%) and generalized sharp-wave discharges (7.8%). BCECT patients were well controlled by antiepileptic drugs and had good prognosis. During the follow-up period (2-17years), we observed that all patient were well adapted to school and society. Seizures did not occur after adolescent period.
Adolescent ; Age of Onset ; Anticonvulsants ; Asphyxia ; Child ; Child, Preschool ; Deglutition ; Electroencephalography ; Epilepsy ; Epilepsy, Rolandic* ; Follow-Up Studies ; Generalization (Psychology) ; Hemifacial Spasm ; Humans ; Mouth ; Prognosis ; Retrospective Studies ; Seizures ; Sensation ; Sialorrhea

Spinal fixation using pedicle screws has recently been the focus of increased attention, but the adequate size of pedicle screw and maximum percentage fill as related to the pedicle diameter and are not well known. The objects of this study were to determine the ideal ratio among pedicle, drill and screw diameter, and to determine the maximum percentage fill of the screw without significant decrease of pull-out strength. The materials used for the experiments were 376 thoracic pedicles obtained from the 38 young pigs, and the diameters of pedicles ranged from 3.0 to 8.5mm. After 40% to 100% drilling as compared to pedicle diameter, screws were inserted carefully, and measurements were taken of the outer pedicle changes and pull-out strengths, and adequate drill and screw sizes as related to the diameters of given pedicles were determined. It was found that pull-out strength was the strongest after 60% drill, and the larger the drill diameter, the smaller the holding power, and the larger the screw diameter, the greater the holding power. Maximum pull-out strength was seen at 80-90% fill with 60% drill. After sequentially drilling each pedicle with increasingly larger drill bits, larger screws could be inserted with pedicle changes such as expansion, cutout, split fracture, and comminuted fracture. after larger drilling up to 100%, pedicle screws with diameters smaller than 115% of measured pedicle diameters could be safly inserted without fracture and significant decrease of pull-out strength. It is concluded that effective percentages of drill and screw diameters to the pedicle diameter are 60% and 80-90% respectively, and pedicle screw up to 115% of measured pedicle diameter can be safely inserted into pedicle without significant decrease of pull-out strength. It is thought that fresh pedicle has elasticity and larger screw can be inserted to the pedicle with strong holding after larger drilling.
Elasticity ; Fractures, Comminuted ; Pedicle Screws ; Swine

This study was conducted to get normal data of derrnatomal somatosensory evoked potentials (DSEP) from the lumbosacral dermatome and to evaluate the efficacy of DSEP in the diagnosis of lumbosacral radiculopathy. We examined scalp-recorded DSEP from stimulation of L4. L5 and Sl derrnatomes. DSEP was tested on 26 healthy adult volunteers (11 men and 15 women), age ranging from 22 to 66 years and 12 patients (7 men and 5 women) with lumbosacral radiculopathies. Norrnal values of P latenc! Of DSEP from stimulation of L4. L5 and S1 derrnatomes were 41.3+24.9 msec. 46.4+3.30 msec and 46.8+3.04 msec and the interside differences of the P, latency uere 1.57+1.06 msec, 1.06+0.93 msec and 1.38+0.89 msec, respectively. The latencies of DSEP were significantly influenced by age and height. But the amplitudes were not. In the seven of the twelve patients with lumbosacral radiculopathies the DSEP findings concurred with clinical, CT and/or MRI findings. In 5 cases DSEP gave different information, indicating no abnormality in three patients, more extended radiculopathy in one, and more reduced radiculopathy in one, compared with clinical and radiological findings. Above observations suggest that DSEP test is a simple. Noninvasive. Economic and useful alternative test for the diagnosis of lumboscral radiculopathy.
Adult ; Diagnosis ; Evoked Potentials, Somatosensory* ; Humans ; Magnetic Resonance Imaging ; Male ; Radiculopathy* ; Volunteers

Aortic pseudoaneurysms are rare. When aortic pseudoaneurysms are detected, they demand timely surgical intervention because they trend to increase in size and cause complications. We experienced a rare case of a chronic traumatic pseudoaneurysm located at the distal descending aorta associated with chest pain during trans-urethral resection of the prostate under spinal anesthesia. Diagnostic testing led to appropriate management.
Anesthesia, Spinal ; Aneurysm, False* ; Aorta, Thoracic ; Chest Pain* ; Diagnostic Tests, Routine ; Prostate* ; Thorax*

BACKGROUND AND OBJECTIVE: Percutaneous transluminal coronary angioplasty of chronic total occlusion has been limited by a relatively low success rate and a high restenosis rate. This study investigated procedural outcome, factors predictive of procedural success and safety of coronary angioplasty for chronic total coronary occlusion. MATERIALS AND METHODS: The study population was composed of 45 lesions attempting PTCA with or without stent implantation for recanalization of chronic total coronary occlusion between January 1997 and July 1999. The clinical and angiographic data of the 45 lesions were reviewed. The results of successful PTCA in 28 lesions were compared with those in 17 lesions whose PTCA was failed. RESULTS: The overall success of balloon angioplasty and stenting was achieved in 28 lesions (62.2%) and did not differ significantly by clinical variables. The most common cause of failure of balloon angioplasty was inability to pass the guide wire across the occlusion( 14 of 23 lesions, 61%). Procedural success was more common in patients with occlusions with a tapered entry configuration(77.2% vs. 47.8%, p=.042), with lesions without side branches(82.3% vs. 50%, p=.03). Multiple logistic regression analysis identified the absence of side branch(p<0.01) and the presence of a tapered entry configuration(p<0.05) as independent predictors of procedural success. One case(2.2%) needed emergency coronary bypass surgery after failure to recanalize the occluded vessel. There was no Q wave acute myocardial infarction, death. CONCLUSIONS: The favorable cases(>60%) of chronic total coronary occlusions can be successfully dilated by balloon angioplasty with or without stent implantation, with a major complication rate of 2.2%. Therefore, with careful patient selection, we need to try the aggressive recanalization for chronic total coronary occlusion.
Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary* ; Coronary Occlusion ; Emergencies ; Humans ; Logistic Models ; Myocardial Infarction ; Patient Selection ; Stents

BACKGROUND: Most surgeons prefer delivering cardioplegia alternatively via the aortic root and coronary sinus in patients undergoing coronary artery bypass graft surgery (CABG). Recently, some surgeons have delivered cardioplegia via the grafted vessel to the obstructed right coronary artery in order to preserve right ventricular function whenever retrograde cardioplegia is delivered. Thus, we have compared the effect on right ventricular preservation between the aforementioned two methods after cardiopulmonary bypass in patients undergoing a right CABG. METHODS: Twenty-eight patients undergoing an elective CABG with significant right coronary artery obstructive disease were allocated into 2 groups. In the alternative cardioplegia delivery group (A-group), cold blood cardioplegia was delivered via the aortic root and coronary sinus alternatively. In the simultaneous cardioplegia delivery group (S-group), cold blood cardioplegia was delivered via the coronary sinus and grafted vessel to the obstructed right coronary artery simultaneously. Hemodynamic measurements were obtained pre-bypass, at pericardial closure and at sternal closure. Data recorded included right ventricular ejection fraction, right ventricular volume index and right and left ventricular hemodynamics. RESULTS: There was no significant difference in the right ventricular ejection fraction between the two groups at pre-bypass, pericardial closure and sternal closure. In both groups, the right ventricular ejection fraction and cardiac index were not decreased, and the left ventricular ejection fraction was higher at pericardial closure than pre-bypass. However, in both groups, there was a decrease in the right andleft ventricular stroke work index and right ventricular stroke volume index at sternal closure. CONCLUSIONS: We have concluded that simultaneous cardioplegia delivery via the coronary sinus and grafted vessel to the obstructed right coronary artery was not superior to the alternative cardioplegia delivery via the aortic root and coronary sinus for preservation of right ventricular function in patients undergoing a right CABG.
Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Sinus ; Coronary Vessels* ; Heart Arrest, Induced* ; Hemodynamics ; Humans ; Stroke ; Stroke Volume ; Transplants ; Ventricular Function, Right

Objective/BACKGROUND: Serum levels of anti-acetylcholine receptor antibody (AChR-Ab), interleukin-2 (IL-2) and soluble interleukin-2 receptor (sIL-2R) may represent markers of disease severity in myasthenia gravis (MG). This study was performed to evaluate the correlations between disease severity and immunological parameters such as serum AChR-Ab, IL-2 and sIL-2R level and between each immunological parameters. METHODS: Serum levels of AChR-Ab, IL-2 and sIL-2R were measured in 30 MG patients and in 22 healthy controls. Results : Serum levels of AChR-Ab and sIL-2R were higher in MG than in healthy controls (p<0,01). The occurrence of IL-2 positive serum samples was 46.7% in MG but none in controls. There were no significant correlations between disease severity and immunological parameters and between each immunological parameters. Conclusions : Serum IL-2 and sIL-2R levels may not represent markers of disease severity in MG, In order to further document the correlation between each parameters, follow-up of individual patients with serial serum samplings may be necessary.
Humans ; Interleukin-2* ; Myasthenia Gravis

This study was performed to assess the relation of vibration perception threshol (VPT) and sensory nerve conduction velocity(SNCV) in diabetics and control, respecti vely. The subjects were 39 diabetics (22 men, 17 women) who consisted of 20 patients with neuropathy symptomS(complaining group) and 19 patients without neuropathy symptoms (noncomplaining group). The followings were obtained. 1. The duration of diabetes mellitus in complaining group was significantly longer than that of noncomplaining group(p<0.05). 2. VPT of thumb. Lateral malleolus and great toe in diabetics were significantly increased and SNCV of median. Ulnar and sural nerve were significantly delayed than those of control(p<0.01). 3. VPT of thumb and lateral malleolus in noncomplaining group were significantly increased and SNCV of median, radial and sural nerve were significantly delayed than of control (p<0 05) VPT of thumb, lateral malleolus and great toe in complaining group were significantly increased and SNCV of median, ulnar and sural nerve were significantly delayed than those of control(p<0.05). VPT of great toe in complaining group was significantly increased than that of noncomplaining group(P<0.05). 4. VPT test of thumb anf great toe were more sensitive and specific than ulnar SNCV test. The results suggest that measurement of VPT is a useful method in early diagnosis and follow-up of diabetic peripheral polyneuropathy.
Atrial Natriuretic Factor ; Diabetes Mellitus ; Early Diagnosis ; Humans ; Male ; Neural Conduction ; Polyneuropathies* ; Sural Nerve ; Thumb ; Toes ; Vibration*