The Taylor's approach is a special paramedian approach to enter the L5-S1 interspace. The L5-S1 interspace is the largest in vertebral column. This approach is particularly useful when the interspace has been narrowed by pathologic bone destruction such as rheumatoid arthritis or osteoarthritis. Surgery in geriatric patients is associated with a markedly higher incidence of perioperative complication or mortality rate. Optimal anesthetic management of geriatric patients depends on understanding of the normal anatomy and physiologic changes in response to drug in aging. We studied of 3-geriatric patients with Taylor's approach. These patients had problems with respiratory dysfunction and anatomic constraints, which make other approaches unfeasible.
Aging ; Arthritis, Rheumatoid ; Humans ; Incidence ; Mortality ; Osteoarthritis ; Spine

No abstract available.
Drug Therapy* ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Leukemia, Myeloid, Acute*

There are few reports about generalized hypertrichosis after treatment with topical minoxidil , even though there are numerous reports about generalized hypertrichosis after treatment with oral minoxidil. We experienced a rare case of generalized hypertrichosis after treatment with 3% topical minoxidil in a 5-year-old boy. He visited our hospital for generalized hypertrichosis on face, trunk, arm after treatment with 3% topical minoxidil for 2 months due to alopecia areata. The laboratory examination including CBC, SMA and the level of corticotropin releasing hormone, luteinizing hormone, follicular stimulating hormone, cortisol, estradiol, testosterone were within normal limits. Two months after discontinuation of treatment with 3% topical minoxidil, the hair started to shed and six months after discontinuation of topical minoxidil, he showed almost complete resolution.
Alopecia Areata ; Arm ; Child, Preschool ; Corticotropin-Releasing Hormone ; Estradiol ; Hair ; Humans ; Hydrocortisone ; Hypertrichosis* ; Luteinizing Hormone ; Male ; Minoxidil* ; Testosterone

Despite improvements in surgical technique, immunosuppressive therapy, and follow-up care, a considerable number of patients with kidney transplants die as a consequence of sepsis and throm-boembolism. The incidence of thromboembolism is higher in patients older than 40 years of age. Prominent among these is an increased incidence of acute myocardial infarction(AMI) in patients receiving corticosteroids. We encountered a rare case that septic shock due to artificial abortion, ARF, and DIC complicated by AMI. A 25-year-old female complained of fever, and watery diarrhea. She was emmergently admitted due to shock. Physical examination demonstrated hypotension and fever. WBC count was 45,300/mL. Elevated FDP, D dimer, CK with dominance of the MB isoenzyme, and troponin-I. EKG showed ST segment elevation in leads aVF, V3-V6. She was treated with cefuroxime, netilmycin, and dalteparin. Cultures obtained from the sputum, urine, and blood did not yield any microorganisms. Although sepsis could not be confirmed, sepsis was highly suspected from the clinical features. This is a rare case in which septic shock, ARF, and DIC complicated by AMI in a young female renal allograft patient. Since AMI in the absence of underlying conditions has been rarely described, we wish to bring attention to the diagnosis of this disorder in a young female allograft recipient and without any other predisposing abnormality.
Adrenal Cortex Hormones ; Adult ; Allografts* ; Cefuroxime ; Dacarbazine ; Dalteparin ; Diagnosis ; Diarrhea ; Electrocardiography ; Female ; Fever ; Follow-Up Studies ; Humans ; Hypotension ; Incidence ; Kidney ; Kidney Transplantation ; Myocardial Infarction* ; Physical Examination ; Sepsis* ; Shock ; Shock, Septic ; Sputum ; Thromboembolism ; Troponin I

PURPOSE: Recent studies have reported the association of obesity and advanced stage prostate cancer. We researched the association between body mass index(BMI), which is widely used to diagnose obesity, and the prostate-specific antigen(PSA) screening test for prostate cancer. METERIALS AND METHODS: The authors examined the association between BMI and PSA for 26,193 men who visited the health promotion center at our medical center from July 1998 to June 2004. The BMI(weight in kg/height in m2) was calculated from the measured height and weight and this was categorized as follows: BMI<18.5(underweight), BMI 18.5-23.0(normal weight), BMI 23.0-27.5(overweight), BMI>27.5(obesity). We measured the mean PSA value of each BMI category. After adjust for age, we evaluated the PSA according to BMI by using error bars and 95% confidence intervals. RESULTS: The patients' age distribution was from 20 to 90 years old and their mean age was 46.1. The mean PSA value increased in a linear fashion with an increase in the age category(p<0.001), while it decreased in a linear fashion with an increase in the BMI category(p<0.001). After adjusting for age, the mean PSA value also decreased in a linear fashion with an increase in the BMI category(p<0.001). CONCLUSIONS: Men with an elevated BMI tend to have a lower value of PSA and to be misdiagnosed with prostate cancer. The PSA value should considered in relation to age and the BMI for the early detection of prostate cancer.
Age Distribution ; Aged, 80 and over ; Body Mass Index* ; Health Promotion ; Humans ; Male ; Mass Screening ; Obesity ; Prostate-Specific Antigen* ; Prostatic Neoplasms

PURPOSE: In present study, we evaluated the relationship between prostate stone and lower urinary tract symptoms(LUTS) and the effect of medications. MATERIALS AND METHODS: Between July 2005 and June 2007, 328 male patients who underwent transrectal ultrasonography(TRUS) were included in this study. 237 patients who had prostate stone with or without LUTS were divided into 3 groups by the prostate stone size(3-5mm, 6-10mm and larger than 11mm). These patients were also divided into 3 groups according to the prostate stone location(the periurethral group, the peripheral group and the multiple site group). The change of the maximum flow rate(Qmax) and the International Prostate Symptom Score(IPSS) were measured 6 months after treatment with alpha-blocker and 5-alpha reductase inhibitor(5-ARI). RESULTS: 275 of the 328 patients who underwent TRUS complained of LUTS and 200(72.7%) of these 275 patients had prostate stone; 37(69.8%) of the 53 patients who did not have LUTS had prostrate stone. No statistical significance was found between LUTS and the presence of prostate stone (p=0.664). We found that the patients with LUTS showed a trend to have larger stone, but this was not statistically significant(p=0.792). The location of prostate stone tended to be periurethral for the patients with LUTS (p=0.047). The patient group with resistant to pharmacological manage of their LUTS had stones larger than 11mm, but this had no statistical significance(p=0.615). A lesser therapeutic result was related with periurethral stones(p<0.001). CONCLUSIONS: There is no statistical relation for the presence of prostate stone with LUTS. The patients with prostate stone that was located in the periurethral area had more LUTS and less medical benefit.
Male ; Humans

No abstract available.
Erythropoietin* ; Humans* ; Kidney Failure, Chronic*

Squamous cell carcinomas (SCCs) of the head and neck are malignant tumors with their ability to invade and metastasis, which can affect the prognosis. The molecular pathogenesis of SCC of the head and neck is still not clear. Further understanding of the molecular alteration in SCC of the head and neck will be enable to provide more accurate and useful prognostic markers and more effective treatments. Maspin, a member of the serpin family of protease inhibitors, is known to have tumor-suppressor functions. However, association between its expression level and survival has not been demonstrated in Head and Neck cancer. Using the immunohistochemical technique to examine the expression levels of maspin in 30 cases of SCC in head and neck, the results showed that 73.3% of the cases expressed low to intermediate levels of maspin and 26.6% of the cases expressed high levels of maspin. The clinicopathological features of the SCC cases were also compared with the maspin expression level, and the results were that high maspin expression was significantly associated with the absence of lymph node metastasis. More importantly, higher maspin expression was significantly associated with better results of disease free survival time period, so it is suggested that high maspin expression may be a favorable prognostic marker for SCC of the head and neck.
Carcinoma, Squamous Cell* ; Disease-Free Survival ; Head and Neck Neoplasms ; Head* ; Humans ; Lymph Nodes ; Neck* ; Neoplasm Metastasis ; Prognosis ; Protease Inhibitors

OBJECTIVE: To define the mechanism associated with abnormal septal motion (ASM) after coronary artery bypass graft surgery (CABG) using comprehensive MR imaging techniques. MATERIALS AND METHODS: Eighteen patients (mean age, 58 +/- 12 years; 15 males) were studied with comprehensive MR imaging using rest/stress perfusion, rest cine, and delayed enhancement (DE)-MR techniques before and after CABG. Myocardial tagging was also performed following CABG. Septal wall motion was compared in the ASM and non-ASM groups. Preoperative and postoperative results with regard to septal wall motion in the ASM group were also compared. We then analyzed circumferential strain after CABG in both the septal and lateral walls in the ASM group. RESULTS: All patients had normal septal wall motion and perfusion without evidence of non-viable myocardium prior to surgery. Postoperatively, ASM at rest and/or stress state was documented in 10 patients (56%). However, all of these had normal rest/stress perfusion and DE findings at the septum. Septal wall motion after CABG in the ASM group was significantly lower than that in the non-ASM group (2.1+/-5.3 mm vs. 14.9+/-4.7 mm in the non-ASM group; p < 0.001). In the ASM group, the degree of septal wall motion showed a significant decrease after CABG (preoperative vs. postoperative = 15.8+/-4.5 mm vs. 2.1+/-5.3 mm; p = 0.007). In the ASM group after CABG, circumferential shortening of the septum was even larger than that of the lateral wall (-20.89+/-5.41 vs. -15.41+/-3.7, p < 0.05) CONCLUSION: Abnormal septal motion might not be caused by ischemic insult. We suggest that ASM might occur due to an increase in anterior cardiac mobility after incision of the pericardium.
Contrast Media/diagnostic use ; *Coronary Artery Bypass ; Coronary Disease/*surgery ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; Image Interpretation, Computer-Assisted ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Pericardium/surgery ; Retrospective Studies ; Statistics, Nonparametric ; Ventricular Septum/*physiopathology

PURPOSE: To investigate changes in the size and degree of signal enhancement of reperfused myocardium during the subacute stage of an ischemic episode, using Gd-DTPA-polylysine enhanced magnetic resonance imaging. MATERIALS AND METHODS: In six cats, the left anterior descending artery was occluded for 150 minutes, and this was followed by reperfusion. Contrast enhanced T1-weighted spin echo magnetic resonance imaging using gadolinium diethylene triamine penta acetic acid-polylysine (Gd-DTPA-polylysine) was performed on the 1st , 2nd, and 6th days of the reperfusion period. The size of ischemic myocardium was estimated each day on MR images by measuring the size of signal enhanced area and the degree of signal enhancement according to time was measured. After sacrificing the animals on day 6, the myocardial specimen was histochemically stained with 2,3,5-triphenyltetrazoliumchloride(TTC). RESULTS: Signal enhancement and the size of the ischemic myocardium, as seen on MR images,decreased linearly during the six days of the subacute stage. On the 6th day, however, signal intensity was still higher than that of normal myocardium, and the size of signal enhanced area measured on MR images was significantly larger than on TTC-stained specimens (p<0.001). CONCLUSION: We conclude that the size of enhanced area and degree of signal enhancement decreased linearly during the subacute stage of reperfused myocardialinfarction and that the area of MR signal enhancement during the acute stage includes both irreversibly andreversibly damaged myocardium.
Animals ; Arteries ; Cats* ; Gadolinium ; Magnetic Resonance Imaging ; Myocardial Infarction ; Myocardium ; Reperfusion