Epidural hematoma associated with epidural anesthesia is rare. We describe a case of a epidural hematoma after continuous epidural anesthesia and analgesia for arthroscopic patella shaving. Anesthesia was indudced with 8 ml lidocaine, 2.0% with epinephrine, 1:200,000 and surgery proceeded. When additional boluses of bupivacaine were administered later, aspiration of the epidural catheter still yielded no blood. At the end of the operation, an epidural infusion of 0.125% bupivacaine was done 2 ml/hr by two-day infusor. In the third postoperative day, the patient suffered from acute myocardial infarction and then heparin was infused. In the fourth postoperative day, she complained lumbar back pain and developed depressed dorsiflexion (Grade II) of great toe in left foot during the infusion of heparin. Sagittal MRI showed posterior thickened epidural hematoma along the segments of T12-L4. Despite the delayed laminectomy and decompression, which was performed six days after her initial operation, she had a good postoperative response, followed by a complete neurological recovery.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Back Pain ; Bupivacaine ; Catheters ; Decompression ; Epinephrine ; Foot ; Hematoma* ; Heparin ; Humans ; Infusion Pumps ; Laminectomy ; Lidocaine ; Magnetic Resonance Imaging ; Myocardial Infarction ; Patella ; Toes

PURPOSE: It is reported that 65% of diabetic male patients over 60 of their age are impotent. However, there is no report concerning the effect of serum glucose control on erectile dysfunction in diabetic patient. This study was performed to evaluate the effects of serum glucose control on erectile dysfunction. MATERIALS AMD METHODS: The development of Diabetes mellitus was defined that the serum glucose level was above 200mg/dL in random test at 25 weeks. We designed the experimental specimen into 3 groups; group I: diabetic OLETF (Otsuka Long Evans Tokushima Fatty) rats without blood sugar control (n=10), group II: diabetic OLETF rats with blood sugar control with 4U insulin subcutaneous injection daily from 26 to 46 weeks (n=10), group III: diabetic OLETF rats with blood sugar control with 10U insulin subcutaneous injection daily from 26 to 46 weeks (n=10). We estimated the collagen content of penile tunica albuginea with the scanning electron microscopy and observed the endothelial layers of corpus cavernosum with the transmission electron microscopy in each group. RESULTS: The serum glucose level was 249 +/- 4.1mg/dL, 234 +/- 2.7mg/dL, 215 +/- 3.0mg/dL respectively in group I, II, III, and decreased in order of group II, III. The differences among groups were statistically significant (p<0.05). The thickness of collagen bundles of penile tunica albuginea was 0.98 +/- 0.1 micrometer, 0.94 +/- 0.3 micrometer, 0.92 +/- 0.1 micrometer respectively in group I, II, III, and decreased in order of group II, III. The differences among groups were statistically significant (p<0.05). The endothelial layers of corpus cavernosum were decreased in II, III. CONCLUSIONS: The serum glucose control in diabetic rats decreases the collagen con tents in penile tunica albuginea and the endothelial layers of corpus cavernosum.
Animals ; Blood Glucose* ; Collagen* ; Diabetes Mellitus ; Endothelium ; Erectile Dysfunction ; Humans ; Injections, Subcutaneous ; Insulin ; Male ; Microscopy, Electron, Scanning ; Microscopy, Electron, Transmission ; Rats* ; Rats, Inbred OLETF

No abstract available.
Acrocephalosyndactylia*

No abstract available.
Alopecia* ; Tissue Expansion Devices*

Most studies of limb lengthening have concentrated on the osteotomy. In the present study, the response of soft tissue (muscle, artery, nerve) to different length, rates or rhythms of distraction have been investigated to define the nature of any damage and to see whether new muscle is created. The purposes of the this study are to evaluate the optimum condition for soft tissue during limb lengthening and to study the effect of different rates & rhythms of tibial lengthening on the soft tissue in rabbits hy observing the changes of muscle, artery and nerve. We lengthened the right tihiae of fifty-four growing New Zealand white rabbits by callotasis. The left tibiae were used as control. The rabbits were divided into three different rates & rhythms groups: Group 1 (increments of 0.5mm /day, divided 2 times/day), Group II (increments of 0.5mm/day, divided 3 times/day), Group III (increments of 10mm/day, divided 2 times/day). Each Group was subdivided into three lengthening groups: 1 ( 10% lengthening), 2 (20% lengthening), 3 (30% lengthening). At the end of lengthening, histopathologic & histomorphometric studies were done on the medial heads of gastrocnemius muscles, the posterior tibial artery and the posterior tibial nerve. In the histopathological study, these were stained by hematoxylin eosin, PAS and observed by light microscopy. Electron microscopic examination was done in all samples. In light microscopic findings, the sum of scores of the following five suhjects, each counted from 0 to 3, were analysed for individual groups between the experimental side and the control by the Mann-Whitney test and the kruskal-Wallis test. The following conclusions were made hased on the above observations; 1. There was no significant difference between groups I, II and III, but there was a significant dif-ference between the 10%, 20% and 30% lengthening groups by histopathologic study. And the predominant responses of muscle to the lengthening were atrophy and endomysial fibrosis. 2. There was no change in the proportion of the muscle fiber types by histomophomeric study. 3.ln the initial phase, the muscle adaptation to the gradual lengthening was attained by sliding in Jess than 20% distraction but finally the muscle was regenerated by new muscle formation. 4. Major soft tissue complication to the gradual lengthening was induced by muscle. But arteries & nerves were well adapted to the gradual lengthening up to 30% Iengthening.
Arteries ; Atrophy ; Eosine Yellowish-(YS) ; Extremities ; Fibrosis ; Head ; Hematoxylin ; Microscopy ; Muscles ; Osteogenesis, Distraction ; Osteotomy ; Rabbits* ; Tibia ; Tibial Arteries ; Tibial Nerve

Pleomorphic (undifferentated) carcinoma is a rare histologic type of carcinomas of the gallbladder and an atypical carcinoid is thought to be an intermediated type between carcinoid tumor and small cell carcinoma. Dense core "neurosecretory" granules can be found in the above mentioned tumors. We experienced a case of a double tumor of the gallbladder in a 51-year old male patient. Grossly, a large solid mass, about 5.0 cm in diameter, was found in the fundic portion and the neck portion also had a small 1.5 cm-sized polypoid mass. Microscopically, these lesions had features of pleomorphic carcinoma and atypical carcinoid, respectively. Immunohistochemically, they manifested reactivity for neuron specific enolase. Ultrastructural study revealed neurosecretory granules in the cytoplasms of tumor cells of the fundic and neck masses. Although light microscopic features of these tumor masses are quite different, we consider that these tumors represent a spectrum of neuroendocrine differentiation.
Male ; Humans

BACKGROUND AND OBJECTIVES: There is little clinical data on the results of using Sirolimus-Eluting Stent (SES) for treating In-Stent Restenosis (ISR). We performed this study to evaluate the clinical outcomes for implanting SES for treating ISR in a real world hospital environment. SUBJECTS AND METHODS: A total of 30 patients with 32 ISRs (males: 73.3%, mean age: 60.2) (focal lesions: 21.9%, diffuse intra-stent lesions: 34.4%, proliferative lesions: 21.9%, total occlusions: 21.9%) were treated with SES after balloon predilation was performed. We evaluated the clinical results and the performed coronary angiography after 6 months. RESULTS: All the procedures were successful. The mean SES diameter and length were 3.0+/-0.3 mm and 27.1+/-5.5 mm, respectively, and the mean acute gain was 2.42+/-0.38 mm. No in-hospital major adverse cardiac events (MACE) were observed. Twenty five patients with 27 lesions (84.4%) underwent coronary angiography at their 6 month follow-up. The late loss and loss index were 0.41+/-0.56 mm and 0.18+/-0.22, respectively. The binary restenosis rate was 7.4% (2/27 lesions). The rate of target lesion revascularization was 3.7% (1/27 lesion). The incidence of MACE at 6 months was 3.3% (1/30 patient). CONCLUSION: Treating ISR with SES is a safe and effective procedure for reducing ISR without the occurrence of acute or sub-acute thrombosis.
Coronary Angiography* ; Coronary Artery Disease ; Coronary Restenosis ; Follow-Up Studies ; Humans ; Incidence ; Stents* ; Thrombosis

No abstract available.
Thanatophoric Dysplasia*

No abstract available.
Infant, Newborn ; Meconium Aspiration Syndrome* ; Meconium* ; Mortality ; Suction*

A prospective study had been performed in infants with hydronephrosis due to ureteropelvic junction stenosis to determine adequate management plan. Forty infants (47 renal units) were selected for the study during the period from January 1995 to July 1997 in the Department of Pediatrics, Asan Medical Center. They were diagnosed prenatally or early postnatally (<3 months of age) on the basis of renal ultrasonography and techotium-99m-mercap- toacetyltriglycerine (MAG3) scan. The antero-poste- rior pelvic diameter (APPD) was measured from serial renal ultrasonography and relative renal function and clearance half time (T1/2) were calculated from serial MAG3 scan. Those who had accompanying other urogenital anomalies or vesicoureteral reflux were excluded in this study. Follow-up tests (ultrasonography and MAG3 scan) and surgical corrections, if necessary, were performed according to the predetermined algorithrn. The male to female ratio was 3: 1. Hydronephrosis was involved the left side in 24 renal units, the right side in 9 renal units, and the bilateral sides in 14 renal units. All the hydronephrotic renal units were divided into 2 groups; Group A (19 renal units) those had taken surgical correction, and group B (28 renal units) those revealed spontaneous improvement without surgical correction. The mean follow-up duration was 7.2+/-6.3 months in group A and 14.1+/-12.6 months in group B. The mean APPD in the first postnatal renal ultrasonography was 19.4+6.8 mm in group A and 10.0+/-3.0mm in group B and this was statistically significant (P<0.01). The rela- tive renal function of group A in the first MAG3 scan was under 35% in 7 renal units and over 35M in 12 renal units. In group B, the relative renal function was over 35% in the all 28 renal units. Tl/2 in the first MAG3 scan was longer than 20 minutes in the all 19 renal units in group A. In group B, Tl/2 was shorter than 10 minutes in 15 renal units, between 10 minutes and 20 minutes in 6 renal units, and longer than 20 rninutes in 7 renal units. The mean APPD of the 7 renal units in group B of which Tl/2 was longer than 20 minutes was 12.62.6mm and that of group A was 19.4+/-6.8mrn and this was statistically significant (P<0.01). In conclusion, the renal ultrasonography and MAG3 scan can be used effectively to determine the degree of the stenosis of the ureteropelvic junction in hydronephosis during infancy. When the babies are diagnosed with hydronephrosis due to ureteropelvic junction stenosis in the early infantile period, serial renal ultrasonography and MAG3 scan play an important role in the decision of the management.
Chungcheongnam-do ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis* ; Infant ; Male ; Pediatrics ; Ultrasonography* ; Vesico-Ureteral Reflux