Ultrasonographic and radiographic findings in 72 cases of pelvic masses which have been provedhistopathologically were analyzed. The results were as follows; 1. Among 72 cases, 28 cases were uterine massesand 44 cases were adnexal masses. 2. Pathologic accuracies of ultrasonographic diagnosis were 64.3% in uterinemasses, 70.5% in adnexal masses, and 68.1% in all pelvic masses. 3. Plain or IVP findings were not specific indiagnosis and showed secondary mass effects or functional disturbances. 4. Because of its high accuracy ofpathologic diagnosis and safety, ultrasonography can be regared as the most valuable and preferential study. Butin cases of cystic myomas, endometrioses, cystic missed abortions and huge masses, the accurate diagnoses weredifficult.
Abortion, Missed ; Diagnosis ; Endometriosis ; Female ; Myoma ; Pregnancy ; Ultrasonography

A fracture of the distal tibial articular surface is fortunately an uncommon injury, since it can be exeptionally difficult to manage. The term plafond is gar'nering general acceptance since there is no anatomic name for the specific location of this fracture. The term was introduced more than 50 years ago in American orthopaedic literature to describe these injuries. The literal meaning of plafond is the underside of a floor, i.e., a ceiling, so the term refers to that portion of the distal articular surface of the tibia which articulates with the superior articular surface of the talus. It excludes the medial malleolar joint surface. Fracture of the plafond have also been called compression, pylon, Malgaigne and explosion fractures. A plafond fracture is defined as one caused primarily from direct axial compression resulting in elevation andgor displacement of all or part of the distal articular surface of the tibia, excluding isolated or combined fractures of the medial and posterior malleoli that are recognizably caused by rotational forces. We reviewed 16 cases(14 patients) of tibial plafond fractures treated at the Department of Orthopaedic Surgery of Soan Chun Hyang University Hospital during 8.5 years period from June 1974 to December 1982. The longest duration of follow-up was 5 years and 6 months, the shortest, 6 months, and the average, 1 year and 6 months. They were classified according to Moore et al., and assessed according to the criteria of Joy et al. The following results were obtained: l. Of the 14 patients, male were 12, female were 2. 2. The average age of the patients was 38 years old. 3. The most common causative injury was fall-down. 4. The most common type in radiological study was dorsiflexion type. 5. In method of treatment, operative treatment was done in 9 cases and non-operative in 6 cases. 6, The average duration of the cast immobilization in non-operative treatment was 12 weeks and operative, 10 weeks. 7. Better results were obtained by operative treatment than non-operative treatment. 8, The complications were encounted in 1 case of non-operative, 2 cases of operative treatment. 9. We agree that the accurate anatomical reduction with rigid internal fixation assures better results in the tibial plafond fracture.
Clinical Study ; Explosions ; Female ; Follow-Up Studies ; Humans ; Immobilization ; Joints ; Male ; Methods ; Talus ; Tibia

Focal brainstem encephalitis due to Herpes simplex virus if a very rare infectious disease, occurs with a frequent of 1-2 million population per year. A 3 years old girl is described with infection due to Herpes simplex virus causing brainstem encephalitis. The diagnosis was established by enzyme immunosorbent assays of the cerebrospinal fluid and serum which demonstrated antibody responsed to Herpes simplex virus. The clinicopathological features, radiological findings, laboratories and brainstem biopsies are discussed in the context of the literature.
Biopsy ; Brain Stem* ; Cerebrospinal Fluid ; Child, Preschool ; Communicable Diseases ; Diagnosis ; Encephalitis* ; Female ; Herpes Simplex* ; Humans ; Simplexvirus*

BACKGROUND: When it is difficult to insure adequate blood vessels, an expanded polytetrafluoroethylene (e-PTFE) graft has been accepted as an alternative although its long-term patency is not equal to that of an autogenous arteriovenous fistula (AVF) for the purpose of performing hemodialysis. There being no hemodynamic guidelines for creating an autogenous or e-PTFE AVF, we prospectively investigated the difference in blood flows between autogenous and e-PTFE AVFs after internal AVF creation in order to identify an ideal AVF. METHODS: We performed color doppler ultrasonography on 15 patients who experienced AVF creation between December 1997 and December 1998 at the Wallace Memorial Baptist Hospital in Pusan and compared the volume flow per minute, the peak systolic velocity, and the cross-sectional area between an autogenous and an e-PTFE AVF. RESULTS: Eight (8) patients experienced an autogenous vein AVF creation, and seven (7) patients experienced an AVF creation using 4x6 mm graded e-PTFE (Impra(R)). 1. Average volume flow: 1611.87 +/-687.52 mL/min for autogenous AVFs and 1725.28+/-269.06 mL/min for e-PTFE AVFs (p=0.67). 2. Average peak systolic velocity: 128.98+/-52.83 cm/sec for autogenous AVFs and 81.71+/-8.93 cm/sec in e-PTFE AVFs (p=0.04). 3. Average cross-sectional area: 0.23+/-0.10 cm2 for autogenous AVFs and 0.34+/-0.02 cm2 for e-PTFE AVFs (p=0.02). 4. There were no postoperative complications, such as venous hypertension or distal ischemia, except for one puncture-site infection. CONCLUSIONS: There was no significant difference in volume flows between autogenous AVFs and 4x6 mm graded e-PTFE graft AVFs after internal AVF creation. In the e-PTFE graft AVFs, the cross-sectionalarea was greater and the peak systolic velocity was smaller compared with those of autogenous AVFs. These results suggest that, in e-PTFE AVF creation in order to maintain on adequate minute volume flow, it is important to minimized the cross-sectional area of the outflow vessel where the lower compliance of the e-PTFE graft increases outflow resistance. Also, we conclude that choosing the appropriate blood vessels and using a meticulous surgical technique are mandatory in establishing optimal hemodynamics for arteriovenous fistulae.
Arteriovenous Fistula* ; Blood Vessels ; Busan ; Compliance ; Hemodynamics ; Humans ; Hypertension ; Ischemia ; Kidney Failure, Chronic* ; Polytetrafluoroethylene* ; Postoperative Complications ; Prospective Studies ; Protestantism ; Renal Dialysis* ; Transplants* ; Ultrasonography, Doppler, Color ; Veins

PURPOSE: To evaluate long-term change in intraocular pressure (IOP) in eyes undergoing laser iridotomy (LI) and early phacoemulsification after LI in patients with acute angle-closure glaucoma (AACG). METHODS: The retrospective, comparative chart review included patients with AACG, Group A who underwent only LI and Group B who underwent early phacoemulsification within 1 month after LI. Patients were followed up on day 1; week 1; and months 1, 3, 6, and 12 after LI. IOP changes were studied. RESULTS: This study included a total 99 eyes from 99 patients, 37 in group A and 62 in group B. The mean IOP were not significantly different between the two groups at the initial visit or 1 month later. However, group B showed a consistently lower mean IOP that that of group A at 3, 6, and 12 months (p= 0.003, <0.001, <0.001, respectively). The prevalence of IOP increase to greater than 21 mmHg was 3 (8.11%), 5 (13.51%), and 5 patients (13.51%) in group A and 0, 2 (5.41%), and 1 patients (1.61%) in group B at 3, 6, and 12 months, respectively. Group B showed a significantly lower prevalence of IOP increase (p = 0.050, 0.038, 0.026). CONCLUSIONS: We found that patients treated with early phacoemulsification after LI had better outcomes of well-maintained IOP compared to those undergoing LI alone. For AACG patients with coexisting cataract, early phacoemulsification after LI can be considered as a reasonable treatment to maintain IOP.
Cataract ; Glaucoma, Angle-Closure* ; Humans ; Intraocular Pressure ; Phacoemulsification* ; Prevalence ; Retrospective Studies

Objectives: Medical artificial intelligence (AI) has recently attracted considerable attention. However, training medical AI models is challenging due to privacy-protection regulations. Among the proposed solutions, federated learning (FL) stands out. FL involves transmitting only model parameters without sharing the original data, making it particularly suitable for the medical field, where data privacy is paramount. This study reviews the application of FL in the medical domain. Methods: We conducted a literature search using the keywords "federated learning" in combination with "medical," "healthcare," or "clinical" on Google Scholar and PubMed. After reviewing titles and abstracts, 58 papers were selected for analysis. These FL studies were categorized based on the types of data used, the target disease, the use of open datasets, the local model of FL, and the neural network model. We also examined issues related to heterogeneity and security. Results: In the investigated FL studies, the most commonly used data type was image data, and the most studied target diseases were cancer and COVID-19. The majority of studies utilized open datasets. Furthermore, 72% of the FL articles addressed heterogeneity issues, while 50% discussed security concerns. Conclusions FL in the medical domain appears to be in its early stages, with most research using open data and focusing on specific data types and diseases for performance verification purposes. Nonetheless, medical FL research is anticipated to be increasingly applied and to become a vital component of multi-institutional research.

OBJECTIVES: In this study, we evaluated the efficacy of nebulized bovine pulmonary surfactant on experimentally induced otitis media with effusion (OME) in guinea pigs. METHODS: Twenty guinea pigs were divided into three groups. Four untreated animals served as normal controls. Experimental OME was established in both ears of the remaining 16 animals by a transbullar injection of 10 microL of Pseudomonas aeruginosa lipopolysaccharide in saline. Thereafter, the guinea pigs received nebulized phosphate buffered saline (n=8) or nebulized bovine pulmonary surfactant (n=8). Nebulization was given daily for 7 days. On day 8, all the animals' passive opening pressure (POP) of the Eustachian tube was measured and histopathological observations of the bulla were made by light microscopy. RESULTS: Nebulized bovine pulmonary surfactant significantly reduced the POP compared to that of saline nebulization. The bovine pulmonary surfactant improved the tubal patency and produced less histopathologcally-evident edematous bullar mucosa. CONCLUSION: Nebulization of bovine pulmonary surfactant plays an important role in treating otitis media with effusion in guinea pigs. Our results suggest that the chosen nebulized bovine pulmonary surfactant can be of good clinical benefit for treating OME in the future.
Animals ; Blister ; Ear ; Eustachian Tube ; Guinea ; Guinea Pigs ; Light ; Microscopy ; Mucous Membrane ; Otitis ; Otitis Media ; Otitis Media with Effusion ; Pseudomonas aeruginosa ; Pulmonary Surfactants

Temporary vessel occulusion is a useful technique which facilitates aneurysmal dissection and clipping, and reduces the risk of intraoperative aneurysal rupture; It may, however, result in postoperative stroke, and many authors have therefore used various agents for brain protection. Among these, barbiturate is well known. This study was undertaken to retrospectively review the effect of barbiturate on brain protection during short periods of ischemia. It involved patients with 146 anterior circulation aneurysms, who were divided into two groups: 43 who received intraoperative barbiturate burst suppression with sodium thiopental during temporary vessel occlusion and the remaining 103, who did not. Doses of thiopental 5mg/kg, usually singly or occasionally repeated at 10-mimute interval, were administered. All patients underwent general anesthesia using volatile isoflurane; mild hypothermia(32-34degreesC), mild hypocarbia(30-35mmHg), and normotension of 110-130mmHg were noted prior to permanent clipping, and mild hypertension(130-150mmHg) after clipping. In some cases, intraoperative scalp electroencep-halography was monitored. Clinical, radiological, and overall infarction were assessed postoperatively, and statistical analysis was perfomed. With regard to Hunt-Hess grades, number of episodes of occlusion, duration of temporary clip application lasting less than 13 minutes, and period of post-subarachnoid hemorrhage, no significant differences were seen between the two groups. Patients in whom barbiturate burst was suppressed showed a 4-hours delay in mean anesthetic recovery time, and after thiopental sodium was injected intravenously, systolic and mean arterial pressure(MAP), averaging 10-20mmHg, were lowered than in those without this suppression. In conclusion, we had found that under mild hypothermic anesthesia involving less than 13 minutes of temporary vessel occlusion, protection of the brain by barbiturate was not beneficial.
Anesthesia ; Anesthesia, General ; Aneurysm* ; Brain* ; Hemorrhage ; Humans ; Hypothermia* ; Infarction ; Ischemia ; Isoflurane ; Retrospective Studies ; Rupture ; Scalp ; Sodium ; Stroke ; Thiopental

Depression is one of the most devastating behavioral symptoms in demented patients but there is little evidence about effective and safe pharmacotherapy. We aimed to determine the effectiveness and safety of mirtazapine in treatment of depressed patients with Alzheimer's disease (AD). The consecutive patients with AD who have significant depression were assigned to an 8-week open-label, prospective study. Patients received mirtazapine 15-45 mg/day. The changes in Hamilton Depression Rating Scale (HAM-D) scores were primary outcome measurement. The change in Clinical Global Impression-Severity scale (CGI-S) scores and tolerability-safety profile were the secondary efficacy variables. Thirty-two out of 38 (84.2%) patients completed the study. There was a significant reduction in HAM-D and CGI-S between the pre- and post-treatment with mirtazapine (p<0.01). There was no significant side effect and cognitive deterioration. The results of this open-label pilot study suggest that mirtazapine may be an effective choice for treatment of depressed patients with AD.
Alzheimer Disease ; Behavioral Symptoms ; Dementia ; Depression ; Humans ; Mianserin ; Pilot Projects ; Prospective Studies

PURPOSE: To evaluate the association between multidrug resistance (MDR) gene and prognosis of acute lymphoblastic leukemia (ALL), several parameters were compared according to the expression status of MDR associated P-glycoprotein. METHODS: 40 bone marrow samples from 36 children of acute lymphoblastic leukemia were analyzed with immunohistochemical stain by C219 monoclonal antibody. RESULTS: 1) The expression of MDR associated P-glycoprotein was positive in 47% at the time of initial diagnosis & 66.7% at relapse. 2) There are no stastical difference between two groups in complete remission rate, relapse rate, mean 2 years survival rate. 3) Event free survival duration was 11.3 months (+/-8.5 months) in P-glycoprotein positive group, while 20 months (+/-7.3months) in P-glycoprotein negative group (P<0.05). 4) There are no stastical difference between two groups in the mean age, sex ratio, initial WBC and immunophenotype of subjects. CONCLUSION: These results suggested the possibility of adopting MDR associated P-glycoprotein in the design of therapeutic regimen and prognostification of childhood acute lymphoblastic leukemia. However, a prospective, randomized study incorporating a larger population should precede before a firm conclusion of significance would draw regarding the prognostic and the therapeutic implication of P-glycoprotein in childhood acute lymphoblastic leukemia.
Bone Marrow ; Child* ; Diagnosis ; Disease-Free Survival ; Drug Resistance, Multiple* ; Humans ; P-Glycoprotein* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prognosis ; Prospective Studies ; Recurrence ; Sex Ratio ; Survival Rate