Approaching to high lumbar level, the width of laminar decrease and conventional laminectomy for the management of L1-2 or L2-3 disc herniation may cause fracture of inferior articular facets of L1 or L2 vertebrae. We performed anterolateral approach to preserve posterior elements(destruction of which may cause later spinal instability), for the management of high lumbar disc herniation.
Laminectomy ; Spine

No abstract available.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a very rare hematological malignancy in children that is characterized by bruise-like skin lesions, with or without bone marrow involvement. Because the clinical course of BPDCN is highly aggressive and fatal in adults, allogeneic hematopoietic stem cell transplantation (HSCT) is recommended as the optimal treatment. Due to its rarity, the pediatric experience with BPDCN is limited and standard treatment has so far not been defined. We report a case of a 14-year-old boy with BPDCN involving the skin, bone marrow and lymph nodes. The patient was treated with high-risk group acute lymphoblastic leukemia protocol. He achieved a complete remission after induction chemotherapy and still maintains clinical remission without HSCT for 17 months after initial diagnosis.
Adolescent ; Adult ; Bone Marrow ; Child ; Dendritic Cells ; Diagnosis ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation ; Humans ; Induction Chemotherapy ; Lymph Nodes ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Skin

BACKGROUND: Currently, data on the role of tacrolimus and mini-dose methotrexate (MTX) in pediatric unrelated hematopoietic stem cell transplantation (HSCT) is limited. We report the outcomes of unrelated hematopoietic stem cell recipients, evaluating engraftment status, incidence of acute and chronic graft-versus-host disease (GVHD) and toxicities after use of tacrolimus and mini-dose MTX for GVHD prophylaxis.METHODS: Thirty-five children who received tacrolimus and mini-dose MTX as prophylaxis from January 2004 to December 2013 were reviewed. All patients received tacrolimus beginning the day prior to transplant at a dose of 0.03 mg/kg/day by continuous intravenous infusion. MTX was administered at a dose of 5 mg/m2 IV on days 1, 3, 6 and 11.RESULTS: Median age at transplantation was 8.42 years (range 0.75-18.9 years). Seventeen patients received human leukocyte antigen (HLA) fully matched donor transplants and 18 received partially mismatched transplants. All but two patients who received unrelated cord blood transplants showed successful engraftment. The median time to ANC recovery was 12 days. The incidence of acute GVHD was 33.3% including 15.1% grade III-IV GVHD. Localized chronic GVHD developed in only 2 of 27 (7.4%) evaluable patients. Lower tacrolimus levels during days 1-21 were associated with a higher incidence of acute GVHD (P=0.033). The estimated 4-year event free survival and overall survival of the patients were 71.2% and 80.0%.CONCLUSION: Overall, the combination of tacrolimus and mini-dose MTX could be effectively administered in the setting of pediatric unrelated HSCT.
Child ; Disease-Free Survival ; Fetal Blood ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Incidence ; Infusions, Intravenous ; Korea ; Leukocytes ; Methotrexate ; Tacrolimus ; Tissue Donors

No abstract available.
Echocardiography* ; Humans ; Mitral Valve*

Suction curettage is a relatively safe procedure to induce abortion of first trimester pregnancy with a very low complication rate. But, in order to do that, cervix should be dilated enough to pass operating devices. We experienced a case of first trimester pregnancy terminated successfully using transvaginal misoprostol when suction curettage was failed due to severely cervical stenosis after LEEP conization.
Cervix Uteri ; Conization ; Constriction, Pathologic ; Female ; Humans ; Misoprostol* ; Pregnancy ; Pregnancy Trimester, First ; Vacuum Curettage

From Jan. 1991 to Apr. 1996, 99 cases of microsurgical tubal reversal were performed in the Department of Obstetrics and Gynecology, Chunchon Sacred Heart Hospital of Hallym University. 80 cases among them were followed up over 1 year postoperatively. The results were as follows : 1. The mean age of total 99 women was 32.5 years(24~42 years), and the average interval between tubal sterilization and tubal reversal was 7.2 years(1~17 years). 2. The methods of sterilization were laparoscopic fallope ring in 59 cases(59.6 %), laparoscopic electrocautery in 30 cases(30.3 %), tubal ligation during cesarean section in 9 cases(9.1 %) and minilap in 1 case. 3. The most common reason for tubal reversal was remarriage(61 case, 61.6 %) and the next was desire for son(16 cases, 16.2 %). 4. 80 cases(81 %) among the total 99 women were followed up over 1 year postoperatively. Intrauterine pregnancy was documented in 59 cases(73.7 %), 53 viable fetuses and 6 spontaneous abortions. Ectopic pregnancy was noted in 3 cases(3.8 %). 5. Pregnancy rates according to maternal age were as follows ; 88.9 % in less than 30 years, 70.3 % in 30~34 years, 71.4 % in 35~39 years. Two normal pregnancies were resulted from 4 women over 39 years. 6. Pregnancy rates according to the method of sterilization were as follows ; 78 % in fallope ring, 89 % in tubal ligation during cesarean section, 55 % in electrocautery. The statistical differences between each groups were not significant(p = 0.053). 7. Pregnancy rates according to the site of anastomosis were as follows ; 81.4 % in isthmicisthmic, 67.1 % in isthmic-ampulla. There was significant statistical difference between them(p = 0.011). 8. Pregnancy rates according to the postoperative tubal length were as follows ; 60 % in less than 4cm, 66 % in 4~6 cm, 95.4 % in more than 6cm(p = 0.024). 9. Among the 59 pregnant women, 38 pregnancies(65.4 %) were resulted within six months after surgery, 48(82.3 %) within one year, and 55(94.2 %) within 2 years. 10. Pregnancy rates according to the interval from tubal sterilization to tubal reversal were as follows ; 89.6 % in less than 5years of interval, 74.5 % in 5~10 years, 44.4 % in 11~15 years(p = 0.230).
Abortion, Spontaneous ; Cesarean Section ; Electrocoagulation ; Female ; Fetus ; Gangwon-do ; Gynecology ; Heart ; Humans ; Maternal Age ; Obstetrics ; Pregnancy Rate* ; Pregnancy* ; Pregnancy, Ectopic ; Pregnant Women ; Sterilization ; Sterilization, Tubal

BACKGROUND: The causes of the pleural effusion are remained unclear in a the substantial number of patients with exudative effusions determined by an examination of the fluid obtained via thoracentesis. Among the various tools for diagnosing exudative pleural effusions, thoracoscopy has a high diagnostic yield for cancer and tuberculosis. Medical thoracoscopy can also be carried out under local anesthesia with mild sedation. The aim of this study was to determine diagnostic accuracy and safety of medical thoracoscopy. METHODS: Twenty-five patients with exudative pleural effusions of an unknown cause underwent medical thoracoscopy between October 2005 and September 2006 in Konyang University Hospital. The clinical data such as age, gender, preoperative pulmonary function, amounts of pleural effusion on lateral decubitus radiography were collected. The vital signs were recorded, and arterial blood gas analyses were performed five times during medical thoracoscopy in order to evaluate the cardiopulmonary status and acid-base changes. RESULTS: The mean age of the patients was 56.8 years (range 22-79). The mean depth of the effusion on lateral decubitus radiography (LDR) was 27.49 mm. The medical thoracoscopic pleural biopsy was diagnostic in 24 patients (96.0%), with a diagnosis of tuberculosis pleurisy in 9 patients (36%), malignant effusions in 8 patients (32%), and parapneumonic effusions in 7 patients (28%). Medical thoracoscopy failed to confirm the cause of the pleural effusion in one patient, who was diagnosed with tuberculosis by a pericardial biopsy. There were no significant changes in blood pressure, heart rate, acid-base and no major complications in all cases during medical thoracoscopy (p>0.05). CONCLUSIONS: Medical thoracoscopy is a safe method for patients with unknown pleural effusions with a relatively high diagnostic accuracy.
Anesthesia, Local ; Biopsy ; Blood Gas Analysis ; Blood Pressure ; Diagnosis ; Heart Rate ; Humans ; Pleural Effusion ; Pleurisy ; Radiography ; Thoracoscopy* ; Tuberculosis ; Vital Signs

OBJECTIVES: Hypertrophic cardiomyopathy (HCM) has been of great interest to clinicians because of its diverse clinical, morphologic, pathophysiologic and molecular genetic manifestations. We investigated the frequencies and clinical manifestations according to the types in Maron's classification of HCM. METHODS: Patients with HCM who were seen at our institution from June 1999 to July 2001 were retrospectively reviewed. Echocardiographic patterns were classified by Maron's classification. RESULTS: Of 62 patients (M/F=39/23, 56+/-14.8 years), 6 patients (9.7%) were type I (relatively mild left ventricular hypertrophy confined to the anterior portion of ventricular septum), 10 patients (16.1%) were type II (hypertrophy of the anterior and posterior septum in the absence of free-wall thickening), 25 patients (40.3%) were type III (diffuse hypertrophy of substantial portion of both the ventricular septum and anterolateral free wall), 1 patients (1.6%) were type IV (hypertrophy in the posterior septum or anterolateral free wall) and 20 patients (32.3%) were type V (apical hypertrophy). Compared with western countries in which the type III was most common, type III was also most common in Korea, but type V was more common in Korea. Systolic anterior motion of mitral leaflet (SAM) were noted in 12 patients in which 10 patients had type III. 43 of 62 patients (69.4%) had chest pain (33.9%), dyspnea on exertion (30.6%), palpitation (1.6%) and syncope (3.2%). 19 of 62 patients (30.6%) had no subjective symptoms, and there was no significant statistical difference between types. Three of 62 patients had anomalous insertion of papillary muscle at mitral valve. SUMMARY: The most common type was type III, and SAM was found mostly in type III. Anomalous insertion of papillary muscle was noted in 3 out of 62 cases. There was no differences in subjective symptom between the types.
Cardiomyopathy, Hypertrophic* ; Chest Pain ; Classification ; Dyspnea ; Echocardiography* ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Korea ; Mitral Valve ; Molecular Biology ; Papillary Muscles* ; Retrospective Studies ; Syncope ; Ventricular Septum

A spontaneous coronary artery dissection is a rare cause of acute myocardial ischemia. However, its precise etiology, pathogenesis, prevalence and treatment is unclear. The clinical presentation of a spontaneous coronary artery dissection can be sudden death or an acute coronary syndrome and sometimes no symptoms are present. We report a case of a 39-year-old man with a spontaneous coronary artery dissection in the right coronary artery. He presented with a history of chest pain persisting for 4 hours. The initial electrocardiogram showed a ST segment elevation in lead II III and aVF. He received intravenous urokinase, but no improvement in his symptoms was observed and the electrocardiographic changes did not resolve. A rescue coronary angiogram was performed, which demonstrated an area of dissection in the distal right coronary artery with resultant TIMI II flow. A 3.5x36 mm MAC stent was deployed across the lesion. After implanting the stent, the remainder of his stay was uncomplicated and he has remained asymptomatic at the time of this review.
Acute Coronary Syndrome ; Adult ; Chest Pain ; Coronary Vessels* ; Death, Sudden ; Electrocardiography ; Humans ; Myocardial Infarction* ; Myocardial Ischemia ; Prevalence ; Stents ; Urokinase-Type Plasminogen Activator