STUDY DESIGN: A retrospective review of annulus fibrosus repair (AR) using a novel technique with a conventional implant. PURPOSE: The purpose of this study was to present the feasibility and clinico-radiological outcomes of a novel AR technique using a conventional implant to minimize recurrence following a lumbar discectomy (LD). OVERVIEW OF LITERATURE: Conventional repair techniques to prevent recurrence following LD have several drawbacks. The AR surgical technique has received little attention as an adjunct to LD. METHODS: A total of 19 patients who underwent novel AR following LD, and who were available for follow-up for at least three years, were enrolled in this study. Several variables, including the type and size of disc herniation, and the degree of disc degeneration, were evaluated preoperatively. Postoperatively, the presence of clinical and radiological recurrence of disc herniation was evaluated from pain intensity and functional statuses, as well as an enhanced L-spine magnetic resonance imaging at the final follow-up. The presence of a peripheral hollow rim and inserted anchor mobilization were also evaluated during the follow-up. RESULTS: During follow-ups, there were no recurrences of disc herniation or complications, including neurovascular complications. Pain and functional disability improved significantly after surgery, and the improvement was maintained throughout the three-year follow-up period. No mobilization or implant peripheral hollow rim was observed during the follow-up. CONCLUSIONS: This study examined the feasibility of a novel and easily available annulus implant technique following LD. These results suggest performing AR with this technique may be a valuable alternative for optimizing outcomes, if the procedure is performed in proper candidates.
Diskectomy* ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Recurrence ; Retrospective Studies

Malignant gastrointestinal stromal tumors (GISTs) are rare non-epithelial, mesenchymal neoplasms of the gastrointestinal tract that metastasize or recur in 30% of patients who undergo surgical resection with curative intent. A 59-year-old man visited our hospital for an examination of a palpable mass in the left abdomen. Fourteen months prior to his visit, the patient underwent gastric wedge resection to remove a GIST of the gastric cardia. At the time of surgery, no evidence of metastatic disease was observed and the pathological interpretation was a high-risk GIST. A follow-up computed tomography scan of the abdomen revealed a partially necrotic solid mass (9.8 x 7.6 cm) and enhancing mass in the spleen (2.3 cm). On exploration, multiple masses were found in the liver, greater omentum, and mesentery. Here, we report a case of recurring GIST of the stomach that metastasized to the spleen. To the best of our knowledge, few reports of metastasis to the spleen exist.
Abdomen ; Cardia ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Liver ; Mesentery ; Middle Aged ; Neoplasm Metastasis ; Omentum ; Spleen ; Stomach

PURPOSE: The aim of this study was to determine the reliability and validity of the Visual Analogue Scale (VAS), as a pain measurement tool in children and adolescents who visit the Pediatric Emergency Department (PED). METHODS: This was a prospective, descriptive study, using convenience sampling, of all children between the ages of 5 and 16 years who presented to a PED. The children were excluded who did not cooperate, who altered mentality or sensorium, who were clinically unstable or required admission to the intensive care unit, or who were developmentally delayed. Children were asked to mark their pain severity on the standardized 100-mm VAS, being instructed to slide the marker to the point on the scale that best described their pain. They were also asked to describe their pain as "none", "mild", "moderate", "severe", or "worst". RESULTS: A total of 716 children and adolescents were enrolled with a mean age of 9.7+/-3.6 years. Males accounted for 439(61.3%). In the children and adolescent who rated their pain as none, (n=10), the mean score was 3.9 mm (95% CI = 0.7 to 7.1); for mild (n=292), the mean score was 30.1 mm (95% CI=28.8 to 31.5); and for moderate pain (n=209) the mean score was 52.4 mm (95% CI=51.2 to 53.6). For those with severe pain (n=187), the mean score was 75.0 mm (95% CI=73.5 to 76.5), and for those who considered their pain the worst (n=18), the mean score was 94.7 mm (95% CI=90.0 to 99.5) (p=0.000). There was no significant relationship between VAS and sex, injury mechanism, or location of pain (p=0.387, p=0.233, p=0.144). The VAS was higher in patients who visited at night on ordinary days (p=0.022) and who were diagnosed with a fracture (71.1+/-20.0 mm) or headache (60.5+/-21.0 mm) (p=0.000). The value was also higher in patients who needed admission (64.9+/-21.5 mm) and an operation (70.7+/-23.0 mm) (p=0.000, p=0.000). CONCLUSION: This study demonstrates the quantification via the VAS of pain severity in children and adolescents who visit to the PED. This scale can be used as a tool for triage, pain management, and deriving a prognosis in the PED.
Adolescent ; Child ; Emergencies ; Headache ; Humans ; Intensive Care Units ; Male ; Pain Management ; Pain Measurement ; Prognosis ; Prospective Studies ; Reproducibility of Results ; Triage

BACKGROUND: Recently, patients' demands for emergency medicine are increasing, and most of prehospital medical care, including basic life support, cardiopulmonary resuscitation and triage, are provided by paramedics or emergency medical technicians. Evaluation of the adequacy of prehospital management and triage has become important for improving the quality and the effectiveness of the emergency medical system. METHODS: The 202 patients who were transferred by ambulance with paramedics, nurses, or emergency medical technicians to the Emergency Department in Gil Medical Center from July 1, 1999, to September 31, 1999, were enrolled. This study was conducted prospectively by using the emergency physician's log and newly devised protocols recorded by paramedics or nurses. RESULTS: 1) Male to female ratio was 1:0.8, and the peak age of the patients were the 4th(18.8%) and 6th decade(15.3%). 2) Of the 202 patients, 84 patients were transferred for trauma and 118 for medical problems. The mean transfer time was 6+/-1.73 minutes. 3) The validities of prehospital triage and decisions using the trauma severity measure and the disease severity measure, were 33.3% in trauma patients and 57.6% in medical patients. 4) The results for the adequacy rate in prehospital management analyzed by using the rate of necessity of treatment, performance of treatment, and adequate treatment were as follows: oxygen supply, 38.1/41.6/93.8; wound dressing, 19.3/71.8/92.9; immobilization of the cervical spine, 15.8/56.3/92.9; application of a spinal board, 12.9/42.3/72.7; application of a splint, 9.9/50.0/60.0; manual maintenance of an airway, 9.9/55.0/63.6; and CPR, 4.5/66.7/0.5) Kind of ALS(Advanced Life Support) were not conducted(peripheral IV, EKG, intubation medical administration, defibrillation, pacing). The rates of necessity of treatment were as follows: peripheral IV, 40.6%; ECG monitoring, 23.3%; endotracheal intubation, 8.9%; medical administration, 8.9%; defibrillation, 3.5%; and pacing, 1.5%. CONCLUSION: The adequacy of prehospital triage and decisions using trauma and disease severity measures was relatively low. To improve the adequacy of BLS(Basic Life Support) and to increase the performance of ALS(Advanced Life Support), we must create challenges to develop new protocols and to supplement new equipment.
Allied Health Personnel ; Ambulances ; Bandages ; Cardiopulmonary Resuscitation ; Electrocardiography ; Emergencies ; Emergency Medical Technicians ; Emergency Medicine ; Emergency Service, Hospital ; Female ; Humans ; Immobilization ; Intubation ; Intubation, Intratracheal ; Male ; Oxygen ; Prospective Studies ; Spine ; Splints ; Triage* ; Wounds and Injuries

BACKGROUND: Most surgeons favor the pledgeted suture technique for heart valve replacements because they believe it decreases the risk of paravalvular leak (PVL). We hypothesized that the use of nonpledgeted rather than pledgeted sutures during mitral valve replacement (MVR) may decrease the incidence of prosthetic valve endocarditis (PVE) and risk of a major PVL. METHODS: We analyzed 263 patients, divided into 175 patients who underwent MVR with nonpledgeted sutures from January 2003 to December 2013 and 88 patients who underwent MVR with pledgeted sutures from January 1995 to December 2001. We compared the occurrence of PVL and PVE between these groups. RESULTS: In patients who underwent MVR with or without tricuspid valve surgery and/or a Maze operation, PVL occurred in 1.1% of the pledgeted group and 2.9% of the nonpledgeted group. The incidence of PVE was 2.9% in the nonpledgeted group and 1.1% in the pledgeted group. No differences were statistically significant. CONCLUSION: We suggest that a nonpledgeted suture technique can be an alternative to the traditional use of pledgeted sutures in most patients who undergo MVR, with no significant difference in the incidence of PVL.
Endocarditis ; Heart Valves ; Humans ; Incidence ; Mitral Valve* ; Suture Techniques* ; Sutures ; Tricuspid Valve

PURPOSE: Airway management and ventilation at the pre-hospital stage are essential and very critical to patient welfare. In Korea, however, methods other than the use of a bag valve mask are hardly used at the pre-hospital stage by emergency medical technicians (EMTs). This study survey the current state of airway management and respiratory first aid at the pre-hospital stage. METHODS: A questionnaire survey of 356 EMTs was conducted by distributing questionnaires directly to first-class EMTs who participated in clinical training at emergency centers or by sending questionnaires and receiving answers by E-mail. The questionnaire solicited information concerning general characteristics of EMTs, monthly frequency of pre-hospital airway management of patients and the will of EMTs. Subjects were divided into two groups according to governmental subdivision or presence of training within 1-year. RESULTS: Concerning airway management and ventilation at the pre-hospital stage, the use of methods other than nasal prong and simple mask was very rare. As to the reasons, the respondents mentioned the shortage of manpower and lack of knowledge/experience. There was no significant difference in the ratio of pre-hospital airway management between urban and suburban/rural settings. Training within 1-year was not related to increased enforcement of airway management. CONCLUSION: In Korea, pre-hospital airway management is not well implemented by EMTs. Causes are deficiency of rescuer, less actual patient treatment experience and deficiency of knowledge/experience. Education and work experience can influence pre-hospital airway management. But, most pre-hospital airway management is unaffected by education and work experience.
Airway Management ; Surveys and Questionnaires ; Electronic Mail ; Emergencies ; Emergency Medical Technicians ; First Aid ; Humans ; Korea ; Masks ; Ventilation

We report a partial fetus-like structure (homunculus) in benign ovarian mature cystic teratoma removed from a 23-yr-old female. The cyst displayed various tissues derived from the three germ layers. The homunculus had a distinguished fetal cranial structure with one upper extremity. A partially developed osteocartilagenous skeleton was identified in the cranial structure of the homunculus. Intracranial structures such as cerebral cortex, retinal pigment, and leptomeninges were extruded from the partially disrupted calvarium.
Adult ; Female ; Human ; Ovarian Cysts/*pathology ; Ovarian Neoplasms/*pathology ; Pregnancy ; Teratoma/*diagnosis/*pathology

OBJECTIVE: Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. METHODS: Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. RESULTS: All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed > or =2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. CONCLUSION: Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route.
Cavernous Sinus ; Central Nervous System Vascular Malformations* ; Fistula ; Humans ; Meningeal Arteries ; Punctures ; Superior Sagittal Sinus

PURPOSE: We report a case of idiopathic orbital myositis with sudden onset of unilateral visual loss and hypertrophy of the lateral rectus muscle at the apex of the orbit that was diagnosed using orbital biopsy and treated with intravenous corticosteroids. CASE SUMMARY: We examined a 20-year-old woman who complained of decreased visual acuity and binocular diplopia for 2 weeks. She showed 40-prism diopter left esotropia at the primary position. Her visual acuity with eyeglasses was 0.7 and 0.2 in the right and left eyes, respectively. Brain magnetic resonance imaging (MRI) revealed a round mass on the left lateral rectus muscle at the apex of the orbit with optic nerve compression. We planned orbital biopsy to exclude orbital lymphoma and other biopsy-requiring diseases. After 3 weeks, the visual acuity of her left eye decreased to 0.02. Repeated MRI revealed enlargement of all extraocular muscles on the left orbit. With biopsy showing several lymphocytes infiltrating muscle fibers, we made a diagnosis of idiopathic orbital myositis. Intravenous injection of corticosteroids was administered during hospitalization. After 2 weeks of corticosteroid therapy, the visual acuity of her left eye was improved to 0.63, the esotropia disappeared, and the enlargement of the left lateral rectus muscle was improved on orbital MRI. CONCLUSIONS: For non-specific idiopathic orbital myositis located at the apex of the orbit and enlargement of the extraocular muscle in a short period with decreased visual acuity, administration of intravenous injection of corticosteroids before orbital biopsy could help restore vision.
Adrenal Cortex Hormones ; Biopsy ; Brain ; Diagnosis* ; Diplopia ; Esotropia ; Eyeglasses ; Female ; Hospitalization ; Humans ; Hypertrophy ; Injections, Intravenous ; Lymphocytes ; Lymphoma ; Magnetic Resonance Imaging ; Muscles ; Optic Nerve ; Orbit* ; Orbital Myositis* ; Telescopes ; Visual Acuity ; Young Adult

PURPOSE: The purpose of this study was to compare the clinical outcomes between laparoscopic (LS) and conventional open splenectomies (OS) in benign splenic diseases. METHODS: We retrospectively reviewed the medical records of patients who had undergone a splenectomy between June 1991 and April 2004. The patients' demographics and operative outcomes were also evaluated. RESULTS: Fifty-four patients were identified; LS and OS were performed in 41 and 13 patients, respectively. The age, gender and operative times between the two groups were similar. The time to resumption of oral intake was faster in the LS patients (2.0 +/- 0.9 vs. 4.0 +/- 5.1 days; P<0.0001). The length of hospital stay was shorter in the LS patients (4.0 +/- 2.4 vs. 12.0 +/- 7.4 days; P<0.0001). There were also significantly lower perioperative complications in the LS compared to the OS patients (4.8 vs. 38.5%; P=0.0017). In the patients with idiopathic thrombocytopenic purpura (ITP), there were no differences in the detection rate of an accessory spleens and the treatment response between the two groups. CONCLUSION: This study shows that LS is a safer than OS, and is an excellent surgical method: earlier diet tolerance, shorter hospital stay and fewer perioperative complications, with good cosmesis. Also, there was no difference in the surgical responses to treatment between the two procedures. Therefore, LS can become the gold standard for the treatment of benign diseases of the spleen.
Demography ; Diet ; Humans ; Length of Stay ; Medical Records ; Operative Time ; Purpura, Thrombocytopenic, Idiopathic ; Retrospective Studies ; Spleen ; Splenectomy* ; Splenic Diseases*