OBJECTIVE: To investigate an appropriate depth of needle insertion during trigger point injection into the rhomboid major muscle. METHODS: Sixty-two patients who visited our department with shoulder or upper back pain participated in this study. The distance between the skin and the rhomboid major muscle (SM) and the distance between the skin and rib (SB) were measured using ultrasonography. The subjects were divided into 3 groups according to BMI: BMI less than 23 kg/m2 (underweight or normal group); 23 kg/m2 or more to less than 25 kg/m2 (overweight group); and 25 kg/m2 or more (obese group). The mean+/-standard deviation (SD) of SM and SB of each group were calculated. A range between mean+1 SD of SM and the mean-1 SD of SB was defined as a safe margin. RESULTS: The underweight or normal group's SM, SB, and the safe margin were 1.2+/-0.2, 2.1+/-0.4, and 1.4 to 1.7 cm, respectively. The overweight group's SM and SB were 1.4+/-0.2 and 2.4+/-0.9 cm, respectively. The safe margin could not be calculated for this group. The obese group's SM, SB, and the safe margin were 1.8+/-0.3, 2.7+/-0.5, and 2.1 to 2.2 cm, respectively. CONCLUSION: This study will help us to set the standard depth of safe needle insertion into the rhomboid major muscle in an effective manner without causing any complications.
Back Pain ; Humans ; Muscles ; Needles* ; Overweight ; Pneumothorax ; Ribs ; Shoulder ; Skin ; Superficial Back Muscles* ; Thinness ; Trigger Points* ; Ultrasonography

PURPOSE: This study attempts to know functional results and gait analysis usefulness in patients with bone tumor around knee joint tumors who underwent prosthesis knee joint reconstruction. MATERIALS AND METHODS: Retrospective study was conducted with 7 patients out of 30 patients who underwent prosthesis knee joint reconstruction after wide marginal excision for bone tumor around knee in orthopedics of this hospital from 2001 to 2010. Functional assesment and gait analysis were perforemed. RESULTS: For the SF-36 score, while 'role physical' and 'role emotional' items showed 100% (100 points) high scores individually, general health, physical function, vitality, and social function showed low scores. The mean score of MSTS was 88.1% (23.8 points [17-27]), indicating a relatively high score. For the gait analysis, mean gait velocity was 97.2 m/s, mean cadence was 105.6 step/min, mean stride length was 111.3 m, mean step length was 61.5 cm, swing phase was 39.8%cycle, stance phase was 60.1%cycle, mean single limb support was 37.1%cycle, mean double limb support was 13.0%cycle, and mean push off was 60.7%cycle. CONCLUSION: It is expected that prosthesis reconstruction after wide marginal excision for bone tumor around knee has relatively good functional results. Gait analysis was considered one of method which showed gait phase and assessed functional ability objectively by quantitative assessment post operative patient condition. It might help treatment and post operative rehabilitation planning with the fuctional assessment.
Equidae ; Extremities ; Gait ; Humans ; Knee ; Knee Joint ; Orthopedics ; Prostheses and Implants ; Retrospective Studies

Rhabdoid meningioma is an uncommon meningioma variant, which was initially described in 1998 by Perry et al.. It is classified as a variant corresponding to grade III in the recent World Health Organization(WHO) classification of tumors of the nervous system, because of its unique histopathological features and its highly aggressive clinical course. To date there were still a lot of arguments about their developmental patterns and the treatment strategy especially for rhabdoid meningiomas lacking other histological features of malignancy. Although the exact causes of rhabdoid transformation of a benign meningioma are unknown, malignant transformation long duration after surgical resection under an underlying predilection for malignancy is suggested in our case. And we suggest that any histological rhabdoid features in recurrent meningiomas or even in primary cases seem to indicate the malignant clinical course and the need for aggressive treatments, because transformation from a benign or atypical one to a malignant one seems to occur at last.
Classification ; Meningioma* ; Nervous System Neoplasms ; World Health ; World Health Organization

OBJECTIVE: The purpose of this study was to analyze outcomes and identify prognostic factors in patients with cerebral metastases from non-small cell lung cancer (NSCLC) treated with gamma knife radiosurgery (GKS) particularly, focusing on associations of biomarkers and systemic treatments. METHODS: We retrospectively reviewed the medical records of 134 patients who underwent GKS for brain metastases due to NSCLC between January 2002 and December 2012. Representative biomarkers including epidermal growth factor receptor (EGFR) mutation, K-ras mutation, and anaplastic lymphoma kinase (ALK) mutation status were investigated. RESULTS: The median overall survival after GKS was 22.0 months (95% confidence interval [CI], 8.8–35.1 months). During follow-up, 63 patients underwent salvage treatment after GKS. The median salvage treatment-free survival was 7.9 months (95% CI, 5.2–10.6 months). Multivariate analysis revealed that lower recursive partition analysis (RPA) class, small number of brain lesions, EGFR mutation (+), and ALK mutation (+) were independent positive prognostic factors associated with longer overall survival. Patients who received target agents 30 days after GKS experienced significant improvements in overall survival and salvage treatment-free survival than patients who never received target agents and patients who received target agents before GKS or within 30 days (median overall survival: 5.0 months vs. 18.2 months, and 48.0 months with p-value=0.026; median salvage treatment-free survival: 4.3 months vs. 6.1 months and 16.6 months with p-value=0.006, respectively). To assess the influence of target agents on the pattern of progression, cases that showed local recurrence and new lesion formation were analyzed according to target agents, but no significant effects were identified. CONCLUSION: The prognosis of patients with brain metastases of NSCLC after GKS significantly differed according to specific biomarkers (EGFR and ALK mutations). Our results show that target agents combined with GKS was related to significantly longer overall survival, and salvage treatment-free survival. However, target agents were not specifically associated with improved local control of the lesion treated by GKS either development of new lesions. Therefore, it seems that currently popular target agents do not affect brain lesions themselves, and can prolong survival by controlling systemic disease status.
Biomarkers ; Brain ; Carcinoma, Non-Small-Cell Lung ; Follow-Up Studies ; Humans ; Lymphoma ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis* ; Phosphotransferases ; Prognosis ; Radiosurgery* ; Receptor, Epidermal Growth Factor ; Recurrence ; Retrospective Studies ; Salvage Therapy

Trigeminal neuralgia (TN) is a common condition that produces pain in the orofacial area. However, the exact cause of TN is still unknown. Various etiologies such as tumor, multiple sclerosis and other compressive lesions have been implicated as possible causes. A 35-year-old woman was admitted due to right facial pain which was diagnosed as TN. A brain MRI revealed sphenoidal sinusitis with epidural empyema. We report a case of complicated sinusitis with epidural empyema presenting as TN.
Adult ; Brain ; Empyema* ; Facial Pain ; Female ; Humans ; Magnetic Resonance Imaging ; Multiple Sclerosis ; Sinusitis ; Sphenoid Sinusitis* ; Trigeminal Neuralgia*

PURPOSE: Recently, as the number of transobturator tape (TOT) procedures has increased, recurrence after this procedure has been frequently reported. However, there are no standard guidelines for treatment. We describe our experience with shortening the previously implanted tape in patients with recurrent stress urinary incontinence after the TOT procedure. MATERIALS AND METHODS: We enrolled 10 women who underwent shortening of the previously implanted tape and were followed up for 3 years. Shortening of the previously implanted tape was done by a figure-eight suture with 1-0 Prolene. One year after TOT shortening, we investigated continence status, patient satisfaction by means of a questionnaire, maximal flow rate (Qmax), and postvoid residual urine volume. Three years after TOT shortening, we evaluated continence status and patient satisfaction. RESULTS: The mean period of TOT shortening was 4.2 months (range, 1-12 months) after the TOT procedure. One year after TOT shortening, 7 patients showed complete dryness, 2 patients showed improvement, and 1 patient reported failure. Eight patients were very satisfied or satisfied with the 1-year result after TOT shortening. The mean preoperative and postoperative Qmax were 23.8 and 26.7ml/s, respectively, and there was no significant difference. Three years after TOT shortening, 6 patients showed complete dryness, 2 patients showed improvement, and 2 patients reported failure. Among them,1 had failed from 1 year after TOT shortening and the other had shown 1 year of complete dryness. Eight patients were very satisfied or satisfied and 2 patients were dissatisfied with the 3-year result after TOT shortening. CONCLUSION: Most of the patients who underwent TOT shortening reported satisfaction as well as improvement of incontinence after a 3-year follow up. Therefore, we suggest that TOT shortening may be recommended primarily in patients with recurrent stress urinary incontinence after the TOT sling procedure.
Female ; Follow-Up Studies ; Humans ; Patient Satisfaction ; Polypropylenes ; Recurrence ; Suburethral Slings ; Sutures ; Urinary Incontinence ; Urinary Incontinence, Stress

No abstract available.

INTRODUCTION: The authors present a retrospective analysis of the clinical features and prognostic factors of long-term survival in gliomatosis cerebri. METHODS: The authors reviewed the clinical features of 27 cases of gliomatosis cerebri treated between August 1988 and January 2001. Age at diagnosis ranged from 19 to 62(median 41) years and the male to female ratio was 18:9. Most cases presented as a headache or seizure and the mean duration of symptoms was 9.6 months. An ill defined, diffuse high signal intensity lesion extending two lobes or more, without a central necrotic center in T2-weighted magnetic resonance(MR) imaging was characteristic. All patients underwent histological confirmation by craniotomy(12 cases), stereotactic biopsy(14 cases) and stereotactic biopsy followed by craniotomy(1 case). External beam radiation therapy was administered in every case except two, one of which expired within a month of surgery and the other refused treatment. RESULTS: Mean survival time after diagnosis was 41.1 months. By univariate analysis, the symptom duration(lower than 12 months) and the Karnofsky performance scale at discharge(lower than 70), focal enhancement on preoperative MR imaging, postoperative increased intracranial pressure sign, pathologic grade(high grade) and p53(>5%) were correlated with the length of survival(p-values were 0.07, 0.00, 0.007, 0.001, 0.04, and 0.02 respectively). CONCLUSION: We suggest that:1) gliomatosis cerebri can be diagnosed by a combination of MR imaging and histopathological examination:2) confusion with extensive glioma is possible due to vague diagnostic criteria, and so survival might be better than expected had discrete diagnosis been made. 3) Initial active management for increased ICP and further radiation therapy might be an important therapy.
Biopsy ; Diagnosis ; Female ; Glioma ; Headache ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Male ; Neoplasms, Neuroepithelial ; Retrospective Studies ; Seizures ; Survival Rate

PURPOSE: We compared the effects of newly developed diode laser (Bison 808 nm Diode laser) on the treatment of peri-implantitis with conventional products (Picasso 810 nm Diode laser) by comparing the surface temperature of titanium disc and bacterial sterilization according to laser power. MATERIALS AND METHODS: The titanium disc was irradiated for 60 seconds and 1 – 2.5 W using diode laser 808 nm and 810 nm. The surface temperature of the titanium disc was measured using a temperature measurement module and a temperature measurement program. In addition, in order to investigate the sterilizing effect according to the laser power, 808 nm laser was irradiated after application of bacteria to sandblasted large-grit acid-etched (SLA) and resorbable blast media (RBM) coated titanium discs. The irradiated disks were examined with scanning electron microscopy. RESULTS: Both 808 nm and 810 nm lasers increased disk surface temperature as the power increased. When the 810 nm was irradiated under all conditions, the initial temperature rise rate, the descending rate, and the temperature change before and after was higher than that of 808 nm. Disk surface changes were not observed on both lasers at all conditions. Bacteria were irradiated with 808 nm, and the bactericidal effect was increased as the power increased. CONCLUSION: When applying these diode lasers to the treatment of peri-implantitis, 808 nm which have a bactericidal effect with less temperature fluctuation in the same power conditions would be considered safer. However, in order to apply a laser treatment in the dental clinical field, various safety and reliability should be secured.
Bacteria ; Lasers, Semiconductor* ; Microscopy, Electron, Scanning ; Peri-Implantitis* ; Sterilization* ; Titanium

PURPOSE: To draw attention to patient safety and increase its awareness among medical students, we developed a program that teaches patient safety based on common medical error cases. The aim of this study is to introduce this program and improve student receptivity to it. METHODS: As part of the "Patient, Doctor, and Society" course, third-year medical students participated in 8 hours of a medical error education program. Students discussed recent, typical medical lawsuits that were generated from internal medicine, surgery, pediatrics, obstetrics and gynecology, neurosurgery, medication, anesthesia, and blood transfusion cases. Students weighed these issues in small groups, using various discussion methods. After finishing the program, students completed a course evaluation questionnaire. RESULTS: The students rated this program as satisfactory, highly motivating, and helpful in preparing their future practices. They responded that although the cases were interesting, some were difficult. They stated that the small group discussion techniques encouraged them to take active part in the discussion and to consider the cases more deeply. CONCLUSION: Small group discussion of medical error cases is an effective method for students to study patient safety.
Anesthesia ; Blood Transfusion ; Group Processes ; Gynecology ; Humans ; Internal Medicine ; Malpractice ; Medical Errors ; Neurosurgery ; Obstetrics ; Patient Safety ; Pediatrics ; Safety Management ; Students, Medical ; Surveys and Questionnaires