BACKGROUND: Antibiotic therapy has proven an effective method of treatment on the majority of patients with pyogenic lung abscess and infected bulla. When medical therapy has failed, pulmonary resection is the current generally recommended therapy. But nowdays complications of percutaneous tube drainage has decreased with the use of small catheter. So we evaluated the effect of percutaneous tube drainage as an alternative therapy to the pyogenic lung abscess and infected bulls refractory to medical therapy in preference of the pulmonary resection. METHOD: Nine cases of the lung abscess and three cases of infected bulls which has large cavity size over 6cm, and has underlying diseases such as lung cancer, diabetes mellitus, refractory to over 1 week of antibiotics, were performed percutaneous tube drainage with All Purpose Drainage catheter(Medi-tech, Watertown, USA) under fluoroscopy. RESULTS: All the cases except one case which complicated empyema was improved clinically. Fever was down within 4days of percutaneous tube drainage(mean : 1.9days). Mean duration of tube drainage was 9.9days. CONCLUSION: Percutaneous tube drainage is an effective and relatively safe procedure in the management of lung abscesses that do not response to medical therapy We speculate this procedure should be considered as an alternative therapy for the lung abscess refractory to medical therapy in preference to the surgery. The safety and effectiveness of this procedure in infected bulla should be evaluated with an additional study.
Anti-Bacterial Agents ; Catheters ; Diabetes Mellitus ; Drainage* ; Empyema ; Fever ; Fluoroscopy ; Humans ; Lung Abscess* ; Lung Neoplasms ; Lung*

Diver's bone lesion was described for the first time by Grutzmacher in 1941. Ten cases of osteonecrosis of the femoral head in divers were analysed on the basis of clinical and pathologic feature. The pathologic feature of the osteonecrosis in divers was not reported in Korea previously. The cases were observed from March, 1985 to June, 1988. The authors treated the cases with total hip replacement and obtained good results. The results were as follows:1. The average ate age at the time of operation was 41.5 years. 2. The average follow-up was 20.4 months. 3. The specimens were confirmed as osteonecrosis mieroscopically. 4. By Meyer's modification of Marcus and Enneking classification the average stage was 3.7. 5. Divers bone lesion was increased with the length of diving experiences:diving depth, diving time, age and with bends. 6. The pathologic feature of osteonecrosis in divers differ from that of idiopathic avascular or aseptic osteonecrosis and could be differentiated easily. 7. After total hip replacement, according to Harris hip rading score system, all results were good.
Arthroplasty, Replacement, Hip ; Classification ; Decompression Sickness ; Diving ; Follow-Up Studies ; Head ; Hip ; Korea ; Osteonecrosis

Malignant lymphoma is mainly found in lymphnodes but extralymphatic organs may be rarely involved. Malignant lymphoma of the orbit is relatively rare representing less than 1% of all non-Hodgkin's lymphoma. All lymphoid tumors of the orbit are radiosensitive and are mainly treated wiht curative intent by irradiation. We report a case of orbital malignant lymphoma in a 41-year-old male patient. He received radiation therapy and subsequent enucleation and till now is clinically free of the disease.
Adult ; Humans ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Male ; Orbit* ; Radiotherapy*

OBJECTIVE: To describe the inappropriate application of spinal orthosis and the frequency of the noncompliance and to identify the relating factors for compliance of spinal orthosis in patients with spinal metastasis. METHOD: Twenty patients diagnosed as spinal instability due to spinal metastasis and applied with Knight-Taylor thoracolumbosacral orthosis or Knight lumbosacral orthosis were interviewed about the mobility and pain. Visual analogue scale (VAS) about severity of back pain and discomfort was also applied to each patient. RESULTS: Nine of the twenty patients were considered as being in poor compliance group. Six of eleven patients with good compliance had inappropriate application method or fitting problems. Inability to walk, poor walking endurance, greater degree of discomfort were related to the poor compliance of the spinal orthosis in patients with spinal metastasis. CONCLUSION: Even with intensive education about the need for spinal orthosis and the method for application, there is high probability that the patients did not use the orthosis or use the orthosis incorrectly especially when patients cannot walk (or cannot walk enough time) and complain severe discomfort.
Back Pain ; Compliance ; Education ; Humans ; Neoplasm Metastasis* ; Orthotic Devices* ; Walking

PURPOSE: It has been suggested that prostaglandins (PGs) play an important role in ischemia-reperfusion (IR) organ injury. However, the significance of PGs is not well documented for a testicular IR injury. The purpose of this study was to assess the potential role of PGs in rat testicular ischemia and IR injury MATERIALS AND METHODS: Sprague-Dawley male rats were divided into 7 groups, each containing 7 rats. The right spermatic cord was clamped with vascular clamps for 30 minute (group B, C), 90 minute (D, E) and 240 minute (F, G). Groups B, D, and F were ischemia groups and the group C, E, and G were reperfusion groups. Reperfusion was carried out after ischemia lasting 30, 90 and 240 min. The levels of thromboxane B2 (TxB2), 6-keto-PGF1alpha and prostaglandins E2 (PGE2) were measured using High-Performance Liquid Chromatography (HPLC). RESULTS: The levels of TxB2 were significantly elevated in groups D, E, F, and G than in the controls (p<0.05, each group). The TxB2 levels in the ischemia group F were significantly decreased compared to that of group D (p<0.05). The histological features shown in groups D, and F were typical ischemic changes, but atypical in groups B, and C. The most severe damage was noted in group G. These features were well matched with the changes of TxB2 in testicular ischemia and IR injury. The levels of 6-keto-PGF1alpha were significantly elevated in all the ischemia and IR groups compared to that of the controls (p<0.05). CONCLUSIONS: These results suggested that TxB2 might have an active role in testicular IR injury, although PGE2 and 6-keto-PGF1alpha seemed not to have an active role.
Animals ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Dinoprostone ; Eicosanoids* ; Humans ; Ischemia ; Male ; Prostaglandins ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury* ; Spermatic Cord ; Thromboxane B2

BACKGROUND: Osteoporosis, one of the most common metabolic bone disease, might be influenced by the severity of Parkinson's disease (PD). Objectives : We investigated the relationship between the Bone Mineral Density (BMD) and the severity of PD in postmenopausal and senile women. METHODS: We measured BMD of lumbar spine (L1-L4) by Dual energy X-ray absorptiometry (DEXA; Hologic QDR-4500A). We compared BMD between patient group (30 patients with PD) and control (183 postmenopausal and senile health women). The patients were divided into two groups according to osteoporosis and analyzed the following potential factors influencing BMD in PD; age, duration of symptom, age of onset, Hoehn and Yahr stage (H-Y stage), UPDRS motor score, duration of treatment, body mass index (BMI), dominant symptom such as tremor or rigidity. RESULTS: 1. BMD was significantly decreased with aging (p <0.01) in control group, but BMD tend to decreased with aging in PD (p=0.08). 2. BMD of patient group was significantly lower than that of control group (p<0.001). 3. BMD of osteoporosis group was significantly related to BMI (p<0.05) and conversely related to H-Y staging(p <0.05), UPDRS motor score (p <0.01). 4. However, BMD of osteoporosis group were not related to age, duration of symptom, age of onset, dominant symptom and duration of treatment (p>0.05). CONCLUSION: Osteoporosis is related to H-Y stage, UPDRS motor score and BMI as well as aging in PD.
Absorptiometry, Photon ; Age of Onset ; Aging ; Body Mass Index ; Bone Density* ; Bone Diseases, Metabolic ; Female ; Humans ; Osteoporosis ; Parkinson Disease* ; Spine ; Tremor

STUDY DESIGN: Retrospective interventional study. PURPOSE: To introduce a free-hand pedicle screw (PS) insertion technique without fluoroscopic guidance in the C7 vertebra and evaluate the procedure's feasibility and radiologic outcomes. OVERVIEW OF LITERATURE: Although PS insertion at C7 has been recognized as a critical procedure in posterior cervical fusion surgery, conventional techniques for C7 PS have several limitations. METHODS: Thirty two patients (64 screws) who underwent PS insertion in C7 with the novel technique were included in this study. Postoperative clinical and radiological outcomes were evaluated. Special attention was paid to the presence of any problems in the screw position including cortical breaches of the PS and encroachment of the PS into the spinal canal or the vertebral foramen. This novel technique for PS insertion in C7 without fluoroscopy guidance had three key elements. First, the ideal PS entry point was chosen near the C6-7 facet joint using preoperative images. Second, the convergent angle distance was measured at axial computed tomography (CT) imaging, which defined the distance between the tip of C7 spinous process and the extended line passing through the pedicle axis from the ideal entry point. Third, the cranial-caudal angle distance was measured in sagittal CT images, which defined the distance between the tip of the C7 spinous process and the extended line passing through the pedicle axis. RESULTS: Cortical breach on postoperative CT images was observed in three screws. All violated only the lateral wall of the affected pedicle. The breached screws occurred in the initial five cases. Postoperative neurologic deterioration was not observed in any patient, regardless of cortical breaching. CONCLUSIONS: The novel technique successfully allows for C7 PS to be placed and is associated with a low rate of cortical breach.
Axis, Cervical Vertebra ; Feasibility Studies* ; Fluoroscopy ; Humans ; Retrospective Studies ; Spinal Canal ; Spine ; Zygapophyseal Joint

PURPOSE: We designed this study to evaluate the interobserver reliability of magnetic resonance imaging (MRI), post-myelographic computed tomography (CT-myelogram) and myelography for the diagnosis of lumbar spinal stenosis. MATERIALS AND METHODS: Thirty two patients with lumbar spinal stenosis were evaluated preoperatively by MRI, CT-myelography, and myelography by four observers. For each set of scans, the examiners assessed the presence or absence of; 1) intervertebral disk protrusion, 2) facet arthrosis, 3) ligamentum flavum hypertrophy, and 4) nerve root impingement. The severities of 1) central, 2) lateral, 3) foraminal and 4) entire spinal stenosis were graded using a four-point scale range from 1 (no stenosis) to 4 (severe stenosis). RESULTS: Kappa statistical analysis revealed moderate interobserver agreement in terms of disk protrusion (0.49), nerve root impingement (0.42) and lateral stenosis grade based on MRI. Low levels of agreement were found for facet arthrosis and ligamentum flavum hypertrophy. Relatively higher levels of agreement were found for nerve root impingement, lateral stenosis and entire stenosis, graded by MRI and for central stenosis graded by myelography. CONCLUSION: The results of this study reflect that MRI showed relatively higher levels of interobserver reliability than the other diagnostic modalities in the evaluation of patients with lumbar spinal stenosis.
Constriction, Pathologic ; Diagnosis ; Humans ; Hypertrophy ; Intervertebral Disc ; Ligamentum Flavum ; Magnetic Resonance Imaging* ; Myelography ; Spinal Stenosis*

PURPOSE: Skin graft is useful treatment in burn wound. The major disadvantage of traditional skin graft is related to recipient site scarring and donor site morbidity. Then we present our successful experience of using skin graft after advancement flap. METHODS: The study is based on 22 patients who has deep 2nd burn wound with eschar and 3rd degree burn wound. We performed split-thickness skin graft in 17 patients, and fullthickness skin graft in 5 patients. After undermining of wound margin about 1.3 cm~4 cm, we performed suture of wound marginal skin and subcutaneous tissue with absorbable suture materials. Then we harvested skin according to reduced wound size, and we applied donor skin in recipient area. RESULTS: The skin graft area of the 17 patients who had split skin-thickness graft showed a decline of 25% compared with that of the initial burn wound. 5 patents who had full-thickness skin graft also showed a decrease of 10% in the skin graft area compared with that of the initial burn wound. All Grafts were well taken in 22 patients without skin loss. By observing the progress 12 to 15 months after the operation, minor hypertrophic scar on the boundary of grafted skin area was observed in the 2 patents and hypertrophic scar or contracture was not seen in all 22 patients. CONCLUSION: Skin graft after advancement flap can be used as a treatment in deep 2nd degree and 3rd degree burn wound. Compared with traditional skin graft, the result seems to be good cosmetically and functionally.
Burns* ; Cicatrix ; Cicatrix, Hypertrophic ; Contracture ; Humans ; Skin* ; Subcutaneous Tissue ; Sutures ; Tissue Donors ; Transplants* ; Wounds and Injuries

OBJECTIVE: The purpose of this study was to determine the normal morphometric landmarks of the uniting and dividing points of the brachial plexus (BP) in the periclavicular region to provide useful guidance in surgery of BP injuries. METHODS: A total of 20 brachial plexuses were obtained from 10 adult, formalin-fixed cadavers. Distances were measured on the basis of the Chassaignac tubercle (CT), and the most lateral margin of the BP (LMBP) crossing the superior and inferior edge of the clavicle. RESULTS: LMBP was located within 25 mm medially from the midpoint in all subjects. In the supraclavicular region, the upper trunk uniting at 21 +/- 7 mm from the CT, separating into divisions at 42 +/- 5 mm from the CT, and dividing at 19 +/- 4 mm from the LMBP crossing the superior edge of the clavicle. In the infraclavicular region, the distance from the inferior edge of the clavicle to the musculocutaneous nerve (MCN) origin was 49 +/- 1 mm, to the median nerve origin 57 +/- 7 mm, and the ulnar nerve origin 48 +/- 6 mm. From the lateral margin of the pectoralis minor to the MCN origin the distance averaged 3.3 +/- 10 mm. Mean diameter of the MCN was 4.3 +/- 1.1 mm (range, 2.5-6.0) in males (n = 6), and 3.1 +/- 1.5 mm (range, 1.6-4.0) in females (n = 4). CONCLUSION: We hope these data will aid in understanding the anatomy of the BP and in planning surgical treatment in BP injuries.
Adult ; Brachial Plexus ; Cadaver ; Clavicle ; Female ; Humans ; Male ; Median Nerve ; Musculocutaneous Nerve ; Pectoralis Muscles ; Ulnar Nerve