PURPOSE: The purpose of this study is to describe the anglographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid arteries and to evaluate the extent of anglographic assessmant needed before embolization. MATERIALS AND METHODS: We retrospectively reviewed 10 cervicofacial vascular lesions with previously ligated carotid artery, which were 6 cases of arteriovenous malformation, 2 cases of carotid cavernous fistula, 1 case of hemangioma and 1 case of arteriovenous realformation with carotid cavernous fistula. The previously ligated arteries are proximal external carotid artery (n=5), branches of external carotid artery (n=2) and common carotid artery (n=3). Common carotid artery or internal carotid artery (n=9), vertebral artery (n=5), ipsilateral external carotid artery (n=4), contralateral external carotid artery (n=5), costocervical trunk (n=2), thyrocervical trunk (n=2) were assessed by conventional angiography. Angiography of both carotid and vertebral arteries was performed in 5 cases. RESULTS: The collateral vascular channels were inferolateral trunk of internal carotid artery (n=8), vertebral artery (n=5), contralateral external carotid artery (n=5), ipsilateral external carotid artery (n=4), deep cervical artery (n=2) and ascending cervical artery (n=l). Embolizations were performed in 9 cases with operative cannulation(n=4), embolization via collateral branches of ipsilateral external carotid artery (n=l), embolization via collateral branches of contralateral external carotid artery (n=3) and balloon occulusion via direct puncture (n=l). CONCLUSION: The collateral channels in cervicofacial vascular lesions with previouly ligated carotid artery were inferolateral trunk of internal carotid artery, contralateral or ipsilateral external carotid artery, vertebral artery, deep cervical artery and ascending cervical artery on angiography. Complete anglographic assessment of possible collateral channels is mandatory for the effective and safe embolization.
Angiography ; Arteries ; Arteriovenous Malformations ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Fistula ; Hemangioma ; Punctures ; Retrospective Studies ; Vertebral Artery

PURPOSE: To evaluate the degree of contrast enhancement of intracranial tumors on delayed (6-8min.) MR imaging after administration of Gd-DTPA. MATERIALS AND METHODS: Both immediate and delayed post-contrast MR imagings were studied prospectively in 35 patients. with brain tumors (11 gliomas, 6 meningiomas, 4 neurinomas, 5 parencymal metastases, 5 hemangioblastoma, 4 others) at either 0.5 T or 2.0 T unit. After precontrast TI-, proton-density, and T2-weighted spin echo images were obtained, each patient underwent Tl-weighted imaging immediately following infusion of 0.1 mmol/Kg of Gd-DTPA. Subsequently, the second postcontrast Tl-weighted images were obtained with no additional injection of the contrast media. Time-interval between the postcontrast immediate and the delayed images was approximately 6-8 minutes. Degree of contrast enhancement of the lesions was assessed both visually and quantitatively. For quantitative study, contrast enhancement ratio(CER) of tumors was calculated in both immediate and delayed post-contrast images. RESULTS: There was stronger visual enhancement in 7 of 11 cases with gliomas and 3 of 5 cases with parenchymal metastasis on delayed images when compared with immediate images, whereas all 10 cases of extraaxial tumors(meningiomas and neurinomas) showed decreased enhancement on delayed images. Quantitatively, mean CERs of gliomas and metastases were higher on delayed study than on immediate study by 20. 5% and 49.2%, respectively. Extraaxial tumors showed decrease of CER on delayed study by 19.7% as compared with that of immediate study. Hemangioblastomas showed visually poor enhancement on delayed image in 4 cases and equal enhancement on both immediate and delayed images in remaining one case, and quantitatively demonstrated decrease of CER on delayed study by 15.4%. CONCLUSION: Since there was more conspicuous contrast enhancement in many intraaxial tumors such as gliomas and metastases on 6-8 minutes delayed post-contrast MR study, the delayed post-contrast study may be needed in some intraaxial tumors for their characterization, and may also be helpful for the differential diagnosis between intraaxial and extraaxial tumors.
Brain Neoplasms* ; Brain* ; Contrast Media ; Diagnosis, Differential ; Gadolinium DTPA ; Glioma ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging* ; Meningioma ; Neoplasm Metastasis ; Neurilemmoma ; Prospective Studies

The authors reviewed 1134 pediatric patients in the ebergency room in this hospital during 5 years period from Jan. 1979. to Dec. 1979. The results were obtained as follows: 1) Among the patients visiting the emergency room, the patients under 15 years of age were 6.1%(1134) of total emergency patients(18447). 2) The male to female ratio was 1.5:1. 3) The highest age group was in the 3-5 years, and the patients in this age group were occupied 23.8%. The age distribution showed that 57.7% was under the 5 years of age. 4) Seasonal distribution of patients showed high incidence in summer(June, July, and Aug.). 5) The most popular time of visiting the emergency room was between 8:00 P.M. to 12:00 P.M. at which time about 32.8% of patients were seen. 6) Distribution of cases as follows: Respiratory disease 35.7%, accident 177% and gastrointestinal disease 14.8%, in turn, kusted reseoectuvely in decresing order of frequency. URI was the most frequency, 25.1% of the total cases, The next diseases were diarrhea(9.5%), Bronchitis(6.6%) and febrile convulsion(6.3%) in turn decreasing order. 7) The most frequent case in various age groups was Respiratory disease. 8) Admission rate of total pediatric patients visiting ER was 7.4% by recommendation. Rate against recommendation of admission was 3.2% of total pediatric patients visiting ER. 9) We think the number of pediatric emergent patient is increasing due to understanding of community inhabitant.
Age Distribution ; Emergencies* ; Emergency Service, Hospital* ; Female ; Gastrointestinal Diseases ; Humans ; Incidence ; Male ; Seasons ; Statistics as Topic*

A statistical observation was performed on 13,317 cases of neonates who had been delivered at Taegu Catholic Hospital during the past 3 years from Jan, 1st 1988 to Dec. 31st 1990. The results obtained were as follows: 1) Among 13,317 neonates, the male was 7,234 and the female 6,083, with the sex ratio of male to female being 1.19:1 2) Percentage distribution by birth weight was 5.6% for 2.500gm or less, 3.3% for 4,001gm or more. The mortality rate was 8.4 per 1,000 live births and 61.1% for very low birth weight infants. 57.1% of neonatal death occured within 24 hours after birth and the most common cause of death was prematurity (53.6%). 3) The mean growth data at birth were as following: Weight: 3,253+/-484gm in male, 3,160+/-456gm in female; Height: 50.11+/-2.59cm in male, 49.57+/-2.50cm in female; Head circumference: 33.60+/-1.74cm in male, 33.12+/-1.64cm in female; Chest circumference: 32.83+/-1.83cm in male, 32.41+/-1.75cm in female. 4) Among 13,317 noenates, 352 (2.6%) were under 37 wks and 555 (4.2%) above 42 wks and 92.6% very low birth weight infants under 37 wks. 5) 44.2% of 13,317 neonates, was the highest-density distribution which was between 47.5~52.4cm by length and 3,001~3,500gm by weighing. 6) The admission rate was 13.7% and the causes of admission in order of frequency were neonatal infection (47.9%), premature or low birth weight infant (12.9%), neonatal jaundice (11.3%), asphyxia neonatorum (6.9%), respiratory disress syndrome (5.4%), etc. 7) Among all neonates, 2.2% had neonatal asphyxia (a 1-minute Apgar score of 6 or less). The highest incidence was 19.7% in the breech delivery group by delivery mode and 33.6% in the prematurity by gestational age. 8) The types of delivery in order of frequency were spontaneous vaginal delivery (72.5%), Cesarean section (21.9%), vacuum delivery (5.0%), breech delivery (0.5%) and forceps delivery (0.1%). 9) The incidence of twin babies was 182 (91 pairs), 1.37% of all neonates, 1 pair per 145 neonates. Of all twins, 50.5% were below 2,500gm of birth weight and 20.9% premature. 10) The incidence of neonatal jaundice was 63.0%. Of icteric neonates, 8.2% had pathologic jaundice treated by phototherapy or exchange transfusion. 11) Among all neonates, there were 7,705 cases (57.9%) with high risk factors; the order of frequency was Cesarean section (37.8), meconium stained (13.3%), premature rupture of membranes over 24 hours (12.7%), birth weight 2,500gm or less (9.6%), etc.
Apgar Score ; Asphyxia ; Asphyxia Neonatorum ; Birth Weight ; Cause of Death ; Cesarean Section ; Daegu ; Female ; Gestational Age ; Head ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn* ; Infant, Very Low Birth Weight ; Jaundice ; Jaundice, Neonatal ; Live Birth ; Male ; Meconium ; Membranes ; Mortality ; Parturition ; Phototherapy ; Pregnancy ; Risk Factors ; Rupture ; Sex Ratio ; Surgical Instruments ; Thorax ; Twins ; Vacuum

Several studies have reported the associations between airborne particles and/or ozone and respiratory diseases. This study examined whether such an association could be seen in Seoul, one of the greatest city in Korea. We compiled daily records of hospital visits in Seoul from November 1, 1995 to October 31, 1996. The daily averages of ozone and particle matter whose diameter is 10 micrometer or less(PM10) from all monitoring stations were computed. Daily respiratory hospital visits were regressed on temperature, humidity, day of weak indicators, seasonal variation indicators, and air pollution. Each pollutant was first examined individually and then two pollutant models were fitted. RESULTS : Both PM10 and Ozone were associated with increased risk of respiratory hospital visits. The relative risk of respiratory hospital visits for 50 microgram/m3 increase in PM10(lagged 2 days) was 1.11(95% confidence interval: 1.05-1.18). The PM10 associations was insensitive to alternative methods of control for weather, including exclusion of extreme temperature days and control for temperature on another day. The ozone results were more sensitive to the approach for weather control. The relative risk of respiratory hospital visits for 0.01 ppm increase in O3 was 1.08(95% confidence interval 1.00-1.17). The magnitude of the PM10 effect in Seoul, where SO2 was essential present, was similar to that reported in the Europe and United states. In conclusion, The consistency of investigations of the health effects of air pollution suggest that attention should be paid to the control of air pollution.
Air Pollution* ; Europe ; Humidity ; Korea ; Ozone ; Seasons ; Seoul* ; United States ; Weather

PURPOSE: Recently, massive proteinuria has been observed in some transplant patients after switching cyclosporine A (CsA) to sirolimus. To evaluate the pathogenesis of sirolimus-associated proteinuria, we investigated the early changes in slit diaphragm molecules by various administrative conditions of sirolimus and CsA. METHODS: In vitro-Mouse podocytes were incubated with buffer (C), sirolimus (10 microg/mL) after CsA (10 microg/mL) (C-S), sirolimus only (S) and CsA and sirolimus simultaneously (C+S) for 12, 24, and 48 hours. In vivo-twenty four SPF female Wistar rats were divided into 4 groups buffer (C), sirolimus after 2 weeks of CsA (C-S), sirolimus only (S) and CsA and sirolimus simultaneously (C+S). All groups were treated by intraperitoneal injection every other day for 4 weeks (CsA: 25 mg/kg, sirolimus: 0.5 mg/kg). The changes in mRNA of slit diaphragm molecules were examined by RT-PCR. RESULTS: The mRNA of nephrin was significantly decreased in group C-S and C+S in vitro. In vivo, the mRNA of nephrin in all groups using sirolimus and the mRNA of podocin in group C-S and C+S were decreased. Microscopically, group C-S and C+S showed small vacuolization and calcification in proximal tubular epithelial cells. Immunohistochemistry using nephrin and podocin antibodies did not show remarkable decrease of staining along the glomerular capillaries. Electron-microscopically, focal fusion of foot processes was seen in group C-S and C+S. CONCLUSION: This study suggests the decrease of slit diaphragm molecules (nephrin and podocin) in podocyte may be one of the causes of sirolimus associated proteinuria, and podocyte injury by sirolimus may need a primary hit by CsA to develop the proteinuria.
Antibodies ; Capillaries ; Cyclosporine ; Diaphragm ; Epithelial Cells ; Female ; Foot ; Humans ; Immunohistochemistry ; Injections, Intraperitoneal ; Intracellular Signaling Peptides and Proteins ; Membrane Proteins ; Podocytes ; Proteinuria ; Rats, Wistar ; RNA, Messenger ; Sirolimus ; Transplants

The results with management of urethral stricture are disappointing, with a high rate of early and late recurrence. Recently, the success of internal urethrotomy has made us question the role of open urethroplasty in the management of urethral strictures. Thus a clinical evaluation was made on 116 patients with urethral stricture in the Department of Urology, Masan Koryo General Hospital, during the period from May 1985 to July 1991. The or stricture was incomplete in 92 cases and complete in 24 cases. The length of stricture was less than 1cm in 86 cases, 1 to 2cm in 19 cases, more than 2cm in 3 cases and multiple strictures in 8 cases. The treatment modality of incomplete urethral stricture was internal urethrotomy in 68 cases and urethroplasty in 9 cases regardless of length, and dilatation in 15 cases with mild stricture. Incomplete urethral stricture, internal urethrotomy was carried out in 7 cases with less than 1cm long stricture and urethroplasty in 17 cases regardless of length. The overall success rate in incomplete urethral stricture was 88.2 % in internal urethrotomy and 88.9 % in urethroplasty, and in complete urethral stricture, 85.7 % in internal urethrotomy and 82. 4% in urethroplasty. We think that visual internal urethrotomy is a valuable initial method, when stricture is incomplete or less than 1cm in length in cases of complete urethral stricture.
Constriction, Pathologic ; Dilatation ; Hospitals, General ; Humans ; Recurrence ; Urethral Stricture* ; Urology

Septic pulmonary embolism occurs when septic material becomes detached from its origin and infiltrates into the pulmonary parenchyma causing significant clinical symptoms. It is uncommon in children and mostly related to intravascular catheterization, endocarditis, pelvic thrombophlebitis, and soft tissue infection. We report a case of a 5-year-old boy who experienced septic pulmonary embolism originating from a left shoulder abscess after traumatic injury. Magnetic resonance imaging of the shoulder revealed a multifocal subcutaneous and intramuscular abscess with septic arthritis. The initial chest radiograph showed suspicious pneumonic infiltration with nodular opacities. A percutaneous catheter was inserted to drain the shoulder abscess, and cefazedone, a first-generation cephalosporin, was administered intravenously. Two days later, a chest radiograph taken for the follow-up of the initial pneumonic infiltration with nodular opacities demonstrated aggravation of multifocal nodular lesions in bilateral lung fields, with one of the nodular cavities containing an air-fluid level. Despite the absence of significant respiratory symptoms, chest computed tomography showed multifocal necrotic nodules and cavity lesions with feeding vessel signs dominantly in the left lower lung field, which is characteristic of septic pulmonary embolism. Methicillin-susceptible Staphylococcus aureus was isolated from the shoulder abscess, whereas repeated blood and sputum cultures did not reveal any bacterial growth. With resolution of clinical symptoms as well as the finding of chest computed tomography, the patient was discharged 18 days after admission in a stable condition. Regression of the multifocal pulmonary nodular lesions was noticed on the subsequent chest imaging studies performed 45 days after the treatment.
Abscess ; Arthritis, Infectious ; Catheterization ; Catheters ; Child* ; Child, Preschool* ; Endocarditis ; Follow-Up Studies ; Humans ; Lung ; Magnetic Resonance Imaging ; Male ; Pulmonary Embolism* ; Radiography, Thoracic ; Shoulder ; Soft Tissue Infections* ; Sputum ; Staphylococcus aureus ; Thorax ; Thrombophlebitis

OBJECTIVE: The plate cage system is an intradiscal cage combining with an integrated plate. To evaluate its suitability for an clinical application, the authors present a retrospective analysis of outcome assessment of our series. METHODS: From March 1998 to November 2001, fifty three patients with degenerative cervical disease underwent anterior cervical interbody fusion with the PCB(R)(PCB(R) instrument, SCIENT'X, Paris, France). Single level fusion was accomplished in 31 patients, two levels in 19 patients, and three levels in two patients. RESULTS: All patients were improved without intraoperative complications ; excellent in 28(52.9%), good in 15(28.3%), and satisfactory in 10(18.8%). Four cases of screw loosening were identified, however, there was no cage backout, worsening of symptom or reoperation due to screw loosening. The bony fusion was confirmed in all patients by cervical flexion and extension X-ray and computed tomography during follow-up. CONCLUSION: The design of this plate cage system appears to prevent bone-graft recipient site and donor site complications, provides immediate stability, and restores height and lordosis.
Animals ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Lordosis ; Reoperation ; Retrospective Studies ; Tissue Donors

Caudal epidural anesthesia has become widely accepted as a means of providing postoperative pain relief and mtraoperative supplementation to general anesthesia for children. Caudal anesthesia was given to 63 infants and children under 15 years of age, who received lower abdominal surgery. After thiopental sodium 4-5 mg/kg IV and 1-2Vo1% halothane inhalation, caudal block was performed in the lateral position. Halothane was stopped immediately after caudal block and only 50% NO in oxygen was inhaled through the mask during operation. The patients were randomly divided into four groups: Group 1; 0.33% bupivacaine 0.7 ml/kg, Group 11; 0.33% bupivacaine 1.0 ml/kg, Group III; fentanyl 1 ug/kg combined with 0.33% bupivacaine 1.0 ml/kg, Group IV; 1.5% lidocaine 1.0 ml/kg. The time of onset, duration of analgesia, side effects during and after operation, intial voiding time, and use of analgesics in the ward were observed. The results were as follows: 1) Caudal block was successful at the 1st attempt in most cases. 2) During operation, supplementation of other inhalational anesthesies were need. 3) In all groups, surgical anesthesia could be obtained within 10 minutes. 4) Intraoperative adverse effects were not detected except for minimal movements on skin incision and spermatic cord traction in 12 cases and vomiting in 2 cases. 5) Postoperative analgetic effects were good in all groups, especially in fentanyl group. 6) In most cases, patients ean void within 6 hours without urinary catheterization. 7) Postoperative analgesics were not needed and patients parent's were highly satisfied with caudal anesthesia in all cases. From the above results, it was suggested that caudal anesthesia with 0.33% bupivacaine or 1.5% lidocaine without potent inhalational anesthetics was satisfactory for lawer abdominal surgery and l ug/kg of fentanyl had some benefits in postoperative analgesia in children.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; Bupivacaine ; Child ; Fentanyl ; Halothane ; Humans ; Infant ; Inhalation ; Lidocaine ; Masks ; Oxygen ; Pain, Postoperative ; Skin ; Spermatic Cord ; Thiopental ; Traction ; Urinary Catheterization ; Urinary Catheters ; Vomiting