No abstract available.
Breast Neoplasms* ; Breast*

Since Luque introduced new posterior instrumentation by segmental sublaminar wiring for neuromuscular scoliosis in 1976, preliminary reports have been published regarding its use with Harrington rod or Luque rod for other types of scoliosis, traumatic lesions of the spine, and spondylolisthesis as well as for degenerative disorders and tumors. Its advantage includes rigid internal fixation which often obviates the requirement for postoperative immobilization and the significant correction of deformity. Disadvantages are longer operation time, increased blood loss and the risk of neurologic damage. Segmental spinal instrumentation was carried out using either Harrington rod or Luque rod in 30 cases of scoliosis; 16 in idiopathic scoliosis, 12 in paralytic scoliosis and 1 each in congenital scoliosis and neurofibromatosis, at the Department of Orthopedic Surgery, Seoul National University Hospital, for 3 years from January 1984 to December 1986, Twenty six cases had been followed for more than 1 year and following results were obtained. 1. In idiopathic scoliosis, average preoperative curve was 65.0 degrees and immediate postoperative curve was 27.9 degrees with 57.4% correction. There was 1.2 degrees loss of correction with an average follow-up of 19.5 months (14–28 months). 2. In papalytic scoliosis, average preoperative curve was 108.5 degrees and immediate postoperative curve was 55.5 degrees with 49.5% correction. There was little loss of correction with anaverage follow-up 24.5 months (13–38 months). 3. No neurological complication occurred as a result of sublaminar wiring. 4. Segmental spinal instrumentation is an effective method with an advantage of better correction, greater contouring of the spine to avoid flat back, and less external immobilization in the treatment of idiopathic or paralytic scoliosis without increased complication.
Congenital Abnormalities ; Follow-Up Studies ; Immobilization ; Methods ; Neurofibromatoses ; Orthopedics ; Scoliosis ; Seoul ; Spine ; Spondylolisthesis

Disseminated intravascular coagulation (DIC) is a pathological syndrome in which activation of coagulation cascade leads to fibrin clot formation, consumption of platelets and coagulation factors, and secondary fibrinolysis. We report a case of severe postoperative hemorrhagic diathesis due to DIC. A 59-year-old man was scheduled for reduction of tibia fracture and anatrophic nephrolithotomy of staghorn calculi. On the fifth postoperative day, second operation was performed for nephrectomy due to perirenal hematoma. Two days later, third operation was performed for hemostasis because of the continuous bleeding. Coagulation tests showed positive DIC profiles of thrombocytopenia, hypofibrinogenemia, increased fibrin degradation products, and prolonged prothrombin time and thrombin time. The patient recovered uneventfully and discharged on the 59th postoperative day.
Blood Coagulation Factors ; Calculi ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Fibrin ; Fibrin Fibrinogen Degradation Products ; Fibrinolysis ; Hematoma ; Hemorrhage* ; Hemorrhagic Disorders ; Hemostasis ; Humans ; Middle Aged ; Nephrectomy ; Postoperative Complications ; Prothrombin Time ; Thrombin Time ; Thrombocytopenia ; Tibia

BACKGROUND: The purpose of this study was to compare prospectively two different anesthetic techniques with isoflurane or propofol for postoperative nausea, vomiting and recovery after tonsillectomy in children. METHODS: Sixty children, ASA physical status I, were assigned randomly to one of two groups. In group I, anesthesia was induced with thiopental 5 mg/kg and maintained with isoflurane 1~1.5 vol%. In group P, anesthesia was induced with fentanyl 1 mcg/kg, propofol 2 mg/kg and maintained with propofol infusion 5~10 mg/kg/hr. Both group received vecuronium 0.1 mg/kg for tracheal intubation and were ventilated with 33% O2 in N2O. The time to extubation, time to eye opening, PACU time, incidence and numbers of postoperative nausea and vomiting, and degree of sedation were recorded as well as perioperative complications. RESULTS: There were no significant difference in the duration of anesthesia and PACU time between two groups. The time to extubation and eye opening of group P were significantly shorter than group I (p<0.05). The degree of sedation and incidence of postoperative nausea and vomiting of group P were significantly lower than group I (p<0.05). But the frequency of intraoperative bradycardia was significantly higher in group P than group I (p<0.05). CONCLUSIONS: Propofol-fentanyl anesthesia results in less nausea and vomiting during postoperative period and more rapid recovery compared to isoflurane anesthesia and may be recommended in children undergoing tonsillectomy and adenoidectomy.
Adenoidectomy ; Anesthesia* ; Bradycardia ; Child* ; Fentanyl ; Humans ; Incidence ; Intubation ; Isoflurane* ; Nausea ; Postoperative Nausea and Vomiting* ; Postoperative Period ; Propofol* ; Prospective Studies ; Thiopental ; Tonsillectomy* ; Vecuronium Bromide ; Vomiting*

No abstract available.
Neurofibromatoses* ; Scoliosis*

Upper G-I bleeding is a dangerous situation and effeetive control method without surgery is desirable. A hemostatic technique utilizing the dehydrating and fixative properties of pure ethanol was developed in Japan. This technique was performed through an endoscopic injector, in divided dose of 0,1 ~ 0.2 ml into several spots in the area surrounding the bleeding vessel in patients upper G-I bleeding excluding esophageal varies. We applieii this technique in treatment of 11 cases showing active bleeding of fresh blood clots. Rebleeding occurred in 2 cases(20%) and complete hemostasis was achieved in 9 cases(80%). We think this technique is safe and simple as an endoscopic hemostatic measure.
Ethanol* ; Hemorrhage* ; Hemostasis ; Hemostatic Techniques ; Humans ; Japan

A tectonic keratoplasty was performed with a keratoprosthesis using expanded polytetrafluoroethylene as a supporting skirt, on the left eye of a 23-year-old woman who needed an emergency corneal transplantation due to corneal perforation. The keratoprosthesis implanted, consisted of a supporting skirt which was made of expanded polytetrafluoroethylene (PTFE), and an optic portion which was made of polymethylmethacrylate (PMMA). The optic portion and the supporting skirt were attached by cyanoacrylate tissue adhesive (Histoacryl(R)). Two months post-operatively, the keratoprosthesis was extruded, leaving an opacified, vascularized cornea. A penetrating keratoplasty was performed 1 month later. The excised cornea was composed of granulation tissue. To our knowledge, this is the first case of tectonic keratoprosthesis using expanded PTFE as a supporting skirt in humans.
Adult ; Cornea/pathology/*surgery ; Corneal Opacity/pathology ; Female ; Granuloma/pathology ; Humans ; *Keratoplasty, Penetrating ; *Polytetrafluoroethylene ; *Prostheses and Implants ; Reoperation

No abstract available.
Amniotic Fluid* ; Female ; Meconium*

No abstract available.
Asphyxia* ; Brain Stem* ; Humans ; Infant, Newborn* ; Parturition*

In a conservative treatment of lumbar disc herniation, authors customarily had included the flexion exercise untill 1991. Thereafter, the extension exercise started to be included for the selected patients and this study was designed to assess the clinical outcome of the extension exercise compared to the flexion exercise in the conservative treatments of lumbar disc herniations. 55 consecutive patients (31 males and 24 females having ages ranging from 19-68 years with a mean of 37.2) were included in this prospective study. Criteria for inclusion in this group were: 1. Contained herniations of a single lumbar disc, documented by CT or MRI; 2. no other concurrent spine pathology; 3. conservative treatments with an uniform program including the extension exercise; 4. follow-up for a minimum of one year. For comparison with this prospective group, another 62 consecutive patients (36 males and 26 females having ages ranging from 17-63 years with a mean of 35.7) were selected who were treated during 1991 with flexion exercise before this study was designed and who were matched with the designed criteria except for the direction of exercise. Apart from the therapeutic exercise, the conservative treatments also included medication, physiotheraphy, epidural injection, and back school in the both groups uniformly. The clinical outcome of the extension exercise group indicated that 28 (50.9%) patients excellent, 23 (41.8%) patients good, three (5.5%) patients fair, and one (1.8%) patient failed outcomes. In the flexion exercise group, there were 23 (37.1%) excellent, 27 (43.5%) good, seven (11.3%) fair, and five (8.1%) failed outcomes. From these results, it would seem to follow that the extension exercise group had superior clinical outcome compared to the flexion exercise, i.e. higher excellent and good outcomes (92.7% vs. 80.6%) and lower poor and failed outcomes (7.3% vs. 19.4%), respectively, Moreover, the excellent outcome in terms of full recovery without any pain and disability was more common in the extension exercise group (50.9% vs. 37.1%). A better clinical outcome was obtained in the extension exercise group of patients who were younger than 40 years and who had a history of three months or less compared with those who were older and had longer history of disease. The sizes of disc protrusion did not affect the clinical outcome. In conclusion, we would recommend that the extension exercise, instead of the flexion exercise, should be included in the conservative treatment of a contained herniation of lumbar disc for a better clinical outcome.
Female ; Follow-Up Studies ; Humans ; Injections, Epidural ; Magnetic Resonance Imaging ; Male ; Pathology ; Prospective Studies ; Spine