Fresh autogenous bone is regarded as the most effective biologic resource for repair or reconstruction of the skeletal system. Disadvantages, however, are related to doner site morbidity and include the risk of wound infection, increased blood loss, prolonged anesthesia time, and additional postoperative discomfort. To avoid the disadvantages of fresh autogenous bone graft, we started to use Tutoplast processed allograft to the operation of spinal disorders of elderly patients. The purpose of this article is to evaluate the incorporation ability of the allograft and possibility of it for suitable substitutes for autogenous bone graft. From March 1995 to October 1996, twenty-seven elderly patients at Nowon Eulji hospital received operation for mainly stenotic lumbar spine disorders. Surgical procedures to all patients consisted of massive decompression, posterior instrumentation and bilateral posterolateral fusion and were done by same surgeon. The types of bone graft used for 54 cases of posterolateral lumbar spine fusion included 40 cases of autograft alone, 8 cases of Tutoplast processed allograft alone and 6 cases of a combination of autograft and the allograft. Of the 40 cases using the autograft only, 37 cases(92.5%) showed good bone incorporation and fusion mass formation but all eight cases using only Tutoplast processed allograft showed complete resorption within postoperative three to five months. Of the six cases using mixture of autograft and the allograft, three had incomplete but largely appropriate bone mass formation. There was great statistical difference(p<0.001) between autograft and the allograft in bone incorporation ability and concluded that Tutoplast processed allograft was not appropriate for the purpose of solid bone mass formation on posterolateral lumbar spine fusion.
Aged ; Allografts* ; Anesthesia ; Autografts* ; Decompression ; Humans ; Spine* ; Transplants ; Wound Infection

Sparganosis is a tissue-invading disease caused hy plerocercoid of Spirometra mansoni91. Usually, uncooked snakes or flogs and infected water are primary sources of sparganosis. Sparganosis found in the lower extremities, abdominal wall, breast, inguinal region and scrotum. Simple radiographs show linear or elongated calcification. Serodiagnostic tests have also heen used widely. Confirmative diagnosis of sparganosis is made by surgical removal of the worm. We experienced a case of sparganosis in a 48-year old male in the calf. We report a case and review related articles hriefly.
Abdominal Wall ; Breast ; Diagnosis ; Humans ; Lower Extremity ; Male ; Middle Aged ; Scrotum ; Snakes ; Sparganosis* ; Spirometra

A 56-year old female who had an atrial septal defect with tricuspid regurgitation received a patch repair and tricuspid annuloplasty. During weaning from cardiopulmonary bypass (CPB), bright red blood filled the endotracheal tube and breathing circuit. We suctioned the blood through the endotracheal tube. The bleeding was massive (about 400 ml) but the airway could be cleared with endotracheal suction. We irrigated endotracheal tube with normal saline with phenylephrine. The weaning of CPB was done and protamine was administered. The bleeding ceased when protamine was administered. Weaning from CPB was accomplished uneventfully. We found a little bleeding in the right main stem bronchus by flexible bronchoscopy but did not do any more procedures. In the intensive care unit, the patient had stable vital signs and good respiratory function. The patient was extubated without any problems at postoperative 1 day and transferred to ward without any complications.
Bronchi ; Bronchoscopy ; Cardiopulmonary Bypass* ; Female ; Heart Septal Defects, Atrial ; Hemoptysis* ; Hemorrhage ; Humans ; Intensive Care Units ; Middle Aged ; Phenylephrine ; Respiration ; Suction ; Tricuspid Valve Insufficiency ; Vital Signs ; Weaning

BACKGROUND: Most surgeons prefer delivering cardioplegia alternatively via the aortic root and coronary sinus in patients undergoing coronary artery bypass graft surgery (CABG). Recently, some surgeons have delivered cardioplegia via the grafted vessel to the obstructed right coronary artery in order to preserve right ventricular function whenever retrograde cardioplegia is delivered. Thus, we have compared the effect on right ventricular preservation between the aforementioned two methods after cardiopulmonary bypass in patients undergoing a right CABG. METHODS: Twenty-eight patients undergoing an elective CABG with significant right coronary artery obstructive disease were allocated into 2 groups. In the alternative cardioplegia delivery group (A-group), cold blood cardioplegia was delivered via the aortic root and coronary sinus alternatively. In the simultaneous cardioplegia delivery group (S-group), cold blood cardioplegia was delivered via the coronary sinus and grafted vessel to the obstructed right coronary artery simultaneously. Hemodynamic measurements were obtained pre-bypass, at pericardial closure and at sternal closure. Data recorded included right ventricular ejection fraction, right ventricular volume index and right and left ventricular hemodynamics. RESULTS: There was no significant difference in the right ventricular ejection fraction between the two groups at pre-bypass, pericardial closure and sternal closure. In both groups, the right ventricular ejection fraction and cardiac index were not decreased, and the left ventricular ejection fraction was higher at pericardial closure than pre-bypass. However, in both groups, there was a decrease in the right andleft ventricular stroke work index and right ventricular stroke volume index at sternal closure. CONCLUSIONS: We have concluded that simultaneous cardioplegia delivery via the coronary sinus and grafted vessel to the obstructed right coronary artery was not superior to the alternative cardioplegia delivery via the aortic root and coronary sinus for preservation of right ventricular function in patients undergoing a right CABG.
Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Sinus ; Coronary Vessels* ; Heart Arrest, Induced* ; Hemodynamics ; Humans ; Stroke ; Stroke Volume ; Transplants ; Ventricular Function, Right

OBJECTIVE: To investigate whether injured corticospinal tract (CST) could recover after rehabilitative therapy in hemiplegic patients with cerebral palsy using diffusion tensor tractography (DTT) which is known to be useful in detecting microscopic white matter lesion in vivo. METHOD: Sixteen hemiplegic patients (mean age, 13.6 months) were enrolled. Diffuse tensor image (DTI) and gross motor functional measurement (GMFM) evaluation were performed before rehabilitative therapy and at follow-up. We measured the fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of CST in the affected and unaffected hemisphere. To evaluate asymmetry of affected and unaffected CST, asymmetry index of fractional anisotropy (AA) and asymmetry index of apparent diffusion coefficient (AD) were measured. RESULTS: The FA value of the affected CST was lower than that of the unaffected CST and the ADC value was higher than that of the unaffected CST in initial and follow up DTT (p<0.001). Compared with the result of initial DTT, the results of follow up DTT demonstrated that the FA value of both CST was increased (p=0.000). A significant increase in AA was showed in all patients (p=0.000) and the increase of AA had significant correlation with the increase of FA of affected CST, but not with the unaffected CST (r=0.537, p=0.032). CONCLUSION: DTT would be a powerful modality not only for diagnosis and prognosis of cerebral palsy, but also assessment of microstructural change of CST after rehabilitative therapy.
Anisotropy ; Cerebral Palsy ; Diffusion ; Diffusion Tensor Imaging ; Follow-Up Studies ; Humans ; Prognosis ; Pyramidal Tracts

BACKGROUND/AIMS: A few studies showed that hood-cap assisted colonoscopy (CAC) had improved cecal intubation rate and cecal intubation time but did not help in finding colon polyps in comparison with conventional colonoscopy (CC). However, other studies have shown different results. Therefore, we investigated the efficacy of CAC for the cecal intubation time and polyp detection rate. METHODS: Patients for colonoscopy in Busan St. Mary's Medical Center were enrolled to this randomized controlled trial between July 2010 and September 2010. The evaluated outcomes were polyp detection rate, adenoma detection rate, and cecal intubation time in all patients, in difficult cases (history of previous abdominal or pelvic surgery, obesity, old age), and in the expert and non-expert groups. RESULTS: A total of 260 patients enrolled in this study were randomly allocated to the CAC group (n=130), or CC group (n=130). The overall cecal intubation time was shorter in the CAC group (5.7+/-3.4 min vs. 7.8+/-5.7 min, P<0.001). The polyp detection rate was higher in the CAC group (58.4% vs. 43%, P=0.008). The cecal intubation time in the expert and non-expert groups were shorter in the CAC group (expert: 4.1+/-2.2 min vs. 5.5+/-2.0 min, P=0.001; non-expert: 6.7+/-3.7 min vs. 9.4+/-5.9 min, P=0.001). CONCLUSIONS: The use of CAC improved the detection rate of colon polyps and shortened the cecal intubation time for both the expert and non-expert groups.
Adenoma ; Colon ; Colonoscopy ; Humans ; Intubation ; Obesity ; Polyps

BACKGROUND: Esophageal doppler is discribed as a non-invasive alternative to cardiac output (CO) estimation by thermodilution, the current bedside "gold standard". This study was designed to evaluate the accuracy of CO estimations performed by esophageal doppler (EDCO), compared to those obtained using a continuous CO pulmonary flotation catheter (TDCO). METHODS: In 16 patients undergoing off-pump coronary artery bypass surgery, CO was measured simultaneously by the esophageal doppler and the thermodilution method, after induction (A), after sternotomy (B), after coronary revascularization (C), and after sternal closure (D). Agreement between the TDCO and EDCO estimations was assessed by analyzing their mean differences and the distribution of these differences. Relative CO changes (percentages of the previous value) was analyzed by the same method. RESULTS: Both absolute CO values and relative CO changes by esophageal doppler showed a considerable scatter compared to those obtained using the thermodilution method. The bias (EDCO-TDCO) between the two mehtods was -0.8 +/- 2.7 L/min for A, -0.9 +/- 2.5 L/min for B, -0.9 +/- 3.6 L/min for C, and -0.6 +/- 2.7 (mean +/- 2 SD) L/min for D. On analyzing changes in CO, no significant method bias was found but 2 SD of the bias were +/- 74% for A to B, +/- 100% for B to C, and +/- 83% for C to D. CONCLUSIONS: These results suggest that CO estimations by esophageal doppler cannot replace estimations by the thermodilution method in patients undergoing off-pump coronary artery bypass graft surgery.
Bias (Epidemiology) ; Cardiac Output* ; Catheters ; Coronary Artery Bypass, Off-Pump* ; Humans ; Sternotomy ; Thermodilution* ; Transplants

Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory bone disorder presenting with sterile osteomyelitis, most often presenting in childhood. Although the etiology is understood incompletely, its association with other auto-inflammatory diseases including inflammatory bowel disease (IBD); psoriasis; Wegener’s disease; arthritis; and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome suggests that dysregulated innate immunity may play an important role in the pathogenesis. We report a case of a 13-year-old boy with CRMO associated with Crohn’s disease (CD) successfully treated with infliximab after failure of non-steroidal anti-inflammatory drug (NSAID) treatment. He initially was diagnosed with CRMO based on symmetric and aseptic bone lesions with no fever, lack of response to antibiotic treatment, vertebral involvement, and normal blood cell counts. Despite five months of NSAID treatment, his musculoskeletal symptoms were aggravated, and he developed gastrointestinal symptoms. Finally, he was diagnosed with CRMO associated with CD. Due to the severity of symptoms, infliximab was initiated and produced symptom improvement. This case supports infliximab as another choice for treatment of bowel symptoms in addition to the bone and joint symptoms of CRMO when other first-line treatments are ineffective.

With recent advances in molecular diagnostic methods and targeted cancer therapies, several molecular tests have been recommended for gastric cancer (GC) and colorectal cancer (CRC). Microsatellite instability analysis of gastrointestinal cancers is performed to screen for Lynch syndrome, predict favorable prognosis, and screen patients for immunotherapy. The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor has been approved in metastatic CRCs with wildtype RAS (KRAS and NRAS exon 2–4). A BRAF mutation is required for predicting poor prognosis. Additionally, amplification of human epidermal growth factor receptor 2 (HER2) and MET is also associated with resistance to EGFR inhibitor in metastatic CRC patients. The BRAF V600E mutation is found in sporadic microsatellite unstable CRCs, and thus is helpful for ruling out Lynch syndrome. In addition, the KRAS mutation is a prognostic biomarker and the PIK3CA mutation is a molecular biomarker predicting response to phosphoinositide 3-kinase/AKT/mammalian target of rapamycin inhibitors and response to aspirin therapy in CRC patients. Additionally, HER2 testing should be performed in all recurrent or metastatic GCs. If the results of HER2 immunohistochemistry are equivocal, HER2 silver or fluorescence in situ hybridization testing are essential for confirmative determination of HER2 status. Epstein-Barr virus–positive GCs have distinct characteristics, including heavy lymphoid stroma, hypermethylation phenotype, and high expression of immune modulators. Recent advances in next-generation sequencing technologies enable us to examine various genetic alterations using a single test. Pathologists play a crucial role in ensuring reliable molecular testing and they should also take an integral role between molecular laboratories and clinicians.