No abstract available.
Ascorbic Acid* ; Child* ; Humans

PURPOSE: This study was to measure the angle between the femoral epicondylar axis and the femoral posterior condylar axis, to clarify which axis can be used as a guideline to achieve proper rotational align- ment of femoral component in total knee arthroplasty. MATERIAL AND METHODS: From Jan. 1997 to Dec. 1998, the axial images of MRI of 121 patients who sustained acute knee injury were selected to measure the posterior-epicondylar angle(the angle between the femoral epicondylar axis and the femoral posterior condylar axis). Congenital anomaly or any fracture cases were all excluded. Comparisons were made according to gender and ages and the student t-test was used to evaluate the statistical differences. RESULTS: The mean posterior-epicondylar angle was a 4.8(+- 2.0) and there was no significant statisti- cal difference between gender and ages except 3rd decade. CONCLUSION: It can induce an insufficient external rotation of the femoral component in total knee arthroplasty, if we usually do 3 of external rotation of femoral component from the posterior condylar axis.
Arthroplasty* ; Axis, Cervical Vertebra* ; Femur* ; Humans ; Knee Injuries ; Knee* ; Magnetic Resonance Imaging

Malignant chondroid syringoma, previously called "mixed tumor of the skin of the salivary gland type"is a fairly uncommon type of sweat gland tumor. Malignant chondroid syringoma frequently arises from the trunk and extremities, whereas the benign tumor is common to the head region. The present case occurred in a female. The malignant nature of the tumor was evident from repeated recurrences after excision of the mass and histopathological study. Lack of response to radiotherapy and chemotherapy led to widespread metastasis. We report a case of malignant chondroid syringoma with lung metastasis in a 39-year-old female patient and response to chemotherapy. We also reviewed the literatures of malignant chondroid syringoma.
Adenoma, Pleomorphic* ; Adult ; Drug Therapy ; Extremities ; Female ; Head ; Humans ; Lung* ; Neoplasm Metastasis* ; Radiotherapy ; Recurrence ; Salivary Glands ; Skin ; Sweat Glands

BACKGROUND: Regional anesthesia for cesarean section is associated with a high incidence of nausea and/or vomiting (N&V) during the operation. Metoclopramide and droperidol have been known to be effective in the prevention of N&V. However, they have been reported to induce some adverse effects such as sedation. We evaluated the efficacy of metoclopramide and droperidol in the prevention of N&V in spinal and epidural anesthesia for cesarean section. METHODS: A prospective randomized double-blind study was performed on 180 parturients scheduled for elective cesarean section. They were allocated into spinal or epidural (n = 90, each) anesthesia groups and each group into either a placebo, metoclopramide, or droperidol drug group (n = 30, each). After delivery, 2 ml saline, 10 mg metoclopramide, or 0.625 mg droperidol was given to the parturients, respectively. Incidences of N&V and sedation during the operation were checked, and the other adverse effects of the anesthesias such as hypotension and visceral pain were compared among the groups. The height of sensory blockade was also checked. RESULTS: Epidural anesthesia was more related with N&V than spinal (P = 0.030). Among the groups there was a significant difference in the incidence of N&V (P = 0.002). There were fewer parturients with N&V in the droperidol group than in the placebo group during epidural anesthesia (P = 0.021). During both spinal and epidural anesthesia more parturients in the droperidol group had sedation than placebo or metoclopramide groups (P = 0.0001) and more in the metoclopramide group than in the pacebo group (P = 0.01). No differences were found in incidences of hypotension and in the height of sensory block among the groups. There were more parturients with visceral pain during epidural anesthesia (P = 0.031). CONCLUSIONS: Epidural anesthesia provoked N&V more frequently than spinal anesthesia for cesarean section. Only droperidol was effective in the prevention of N&V during epidural anesthesia, but had a more sedative effect than metoclopramide during either spinal or epidural anesthesia.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Cesarean Section* ; Double-Blind Method ; Droperidol* ; Female ; Hypnotics and Sedatives ; Hypotension ; Incidence ; Metoclopramide* ; Nausea* ; Pregnancy ; Prospective Studies ; Visceral Pain ; Vomiting*

There are several rnethods to correct the tibial bony defect including resection, cement filling, autograft or allograft and metal augmentation. The purpose of this study is to find the adequate treatment method of tibia bony defect through analysis of the result with above methods. From Sep. 1993 to Dec. 1997, the authors analyzed 93 cases of tibial medial bony defect corrected by overresection of lateral condyle, allograft and metal wedge or block among 358 cases of primary total knee arthroplasty(TKA) operated at Asan Medical Center. All cases were devided into four groups according to the treatment method; group A(31 cases) with overresection of lateral condyle, group B(37 cases) with metal wedge, group C(21 cases) with metal block and group D(4 cases) with allograft. The mean follow up period was 23.6 months(12 56 months). The results were as follows, 1. There were no definite statistical difference between group A, B, C and D in HSS knee score, ROM, correction of deformity. But in group D, there is one case of loss of the correction. 2. Loosening of the implant was not noted, but 17 cases of mild bony resorption was found just beneath the implant. It was particularly prominent in group B(9 cases) than group A(5 cases) and C(3 cases). 3. Among 4 cases of allograft, one has developed collapse of allograft. 4. 3 cases of deep infection developed only in group C, which were followed by revision TKA. Although further follow up study should be carried out, we concluded that resection of lateral tibial condyle, allograft, metal augmentation is a good substitute to the correction of the tibial bony defect in primary TKA.
Allografts ; Autografts ; Chungcheongnam-do ; Congenital Abnormalities ; Follow-Up Studies ; Knee ; Tibia

Primary papillary serous carcinoma of the peritoneum(PPSCP) is vere rare. It has been suggested that PPSCP derives from embryonal coelomic epithelium with m llerian ducts potential. PPSCP can develop from a single or multicentric focus. The clinical and histologic disease entities are similar to those of primary papillary serous carcinoma of the ovary, but PPSCP involves the ovarian surface only minimally(microscopic disease) or spares the ovaries entirely. We have experienced a case of primary papillary serous carcinoma of the peritoneum and report this case with brief review of the concerned literature.
Epithelium ; Female ; Ovary ; Peritoneum*

The complications of bile duct stone are cholangitis, pancreatitis, obstructive jaundice, liver abscess, and secondary biliary cirrhosis. Liver abscess may produce pyothorax, peritonitis, subphrenic abscess, and pyogenic pericarditis. The case studies of pyogenic pericarditis secondary to pyogenic liver abscess are rarely reported. Stones greater than 20mm in diameter are difficult or impossible to remove with a standard basket or balloon after sphincterotomy. There are several nonsurgical treatment options for large bile duct stone: mechanical lithotripsy, endoprosthesis, extracorporeal shock-wave lithotripsy (ESWL), electrohydraulic lithotripsy, contact dissolution therapy, and laser lithotripsy. We experienced a case of large bile duct stone which complicated by pyogenic pericarditis, liver abscess, and pyothorax. He treated with antibiotics, closed thoracostomy, partial pericardiectomy, and removal of bile duct stones by extracorporeal shock-wave and mechanical lithotripsy after endoscopic sphincterotomy and nasobiliary drainage.
Anti-Bacterial Agents ; Bile Ducts* ; Bile* ; Cholangitis ; Drainage ; Empyema ; Empyema, Pleural* ; Jaundice, Obstructive ; Lithotripsy ; Lithotripsy, Laser ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver Cirrhosis, Biliary ; Liver* ; Pancreatitis ; Pericardiectomy ; Pericarditis* ; Peritonitis ; Sphincterotomy, Endoscopic ; Subphrenic Abscess ; Thoracostomy

Dieulafoy lesion is very small and easily overlooked as a course of massive, often recurrent hemorrhage that results from the crosion of a submucosal artery, typically in the gastric cardia or fundus. The clinical picture of Dieulafoy lesion is quite uniform: patients commonly present with massive hemorrhage and melena without any relevant history. The diagnostic procedure of choice in patients with severe gastrointestinal bleeding is emergency endoscopy. The lesion is rare but potentially life threatening source of upper gastrointestinal bleeding. Before the endoscopic era, the prognosis for patients with these lesions was quite poor. However, recent reports have described the success of endoscopic therapy in the management of Dieulafoy lesion. We performed emergency endoscopy in 3 patients who had massive or recurrent episode of upper gastrointestinal bleeding, identified to the Dieulafoy lesion. We tried to Endoscopic "0" band ligation, successfully in hemostasis and prevention of recurrence.
Arteries ; Cardia ; Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis ; Humans ; Ligation* ; Melena ; Prognosis ; Recurrence

Aniskiasis is caused by the accidental infestation of human by larvae of marine mammals found in saltwater fish and squid. The clinical picture may be severe enough to stimulate an acute surgical abdomen. More commonly, colicky pain, diffuse abdominal tenderness, nausea, vomiting, fever, and leukocytosis are seen. Gastroscopically, 2-to 4-cm larvae can be seen penetrating the mucosa. More characteristically, the larvae burrow into the mucosa of the stomach. Here they produce eosinophilic granulomatous tumors with edema, thickening, and induration which may be mistaken for gastric canceer. The pathalogic changes are thought to be the result of a hypersensitivity reaction. We report a case of chronic gastric anisakiasis, which was diagnosed as submucosal tumor with massive bleeding.
Abdomen ; Anisakiasis* ; Abdominal Pain ; Decapodiformes ; Edema ; Eosinophils ; Fever ; Hemorrhage* ; Humans ; Hypersensitivity ; Larva ; Leukocytosis ; Mammals ; Mucous Membrane ; Nausea ; Stomach ; Vomiting

Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. On method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hepatoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designated as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscelianeous cancer 49 cases respectively. 4) There were 57.7% who had had surgery, and 3.7% of whom had had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. Fro group 2 and 3 C-arm image intensifier was used. In group 1, a 22 gauze 10cm long needle was inserted at the lower border of the 12th rib on each side about 7cm from the midline. The average distance from the middle was 6.60+/-0.61cm on the left side and 6.60+/-0.83cm on the right side in group 2, and 5.46+/-0.76 on the left side and 5.49+/-0.69cm on the right side in group 3. The average depth to which the needle was inserted was 8.60+/-0.52cm on the left side and 8.74+/-0.60cm on the right side in group 2, and 8.96+/-0.63cm on the left side and 9.18+/-0.57cm on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly. 51.8% on the left side and 54.4% on the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6% on the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows the spread upward along the anterior margin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, 39.17+/-6.69ml of 0.5% -1% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block 40.00+/-4.26ml of 50% alcohol was injected for the semipermanent block. In group 2, 13.75+/-4.48ml of 1% lidocaine were used as the test block and followed by 46.17+/-4.37ml of 50% alcohol was injected as the semipermanent block. In group 3, 15.63+/-1.19ml of 1% lidocaine for test block followed by 15.62+/-1.20ml of pure alcohol and 16.05+/-2.58ml of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanet block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But in some cases it was 3 to 5 months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nervel block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerver block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.
Abdomen ; Abdominal Pain ; Bile Ducts ; Bupivacaine ; Carcinoma, Hepatocellular ; Colon ; Contrast Media ; Drug Therapy ; Female ; Flushing ; Humans ; Lidocaine ; Male ; Nausea ; Needles ; Pain, Intractable ; Pancreatic Neoplasms ; Prone Position ; Ribs ; Spine ; Splanchnic Nerves* ; Stomach ; Stomach Neoplasms ; Thorax ; Urinary Bladder ; Vomiting