The pectus carinatum or anterior protrusion of the sternum is a less common than pectus excavatum. It occurs more frequently in boys than girls and associated musculoskeletal abnormalities, spinal scoliosis is most common. Ravitch first reported correction of chondromanubrial prominence in 1952, resecting the multiple deformed costal cartilages and performing a double osteotomy on sternum. We have experienced one case of pectus carinatum and obtained satisfactory postoperative results. The deformity was corrected by the subchondral resection of multiple deformed costal cartilage, bilaterally, with single osteotomy on sternum and fracture of the posterior cortex to correct anterior angulation. Postoperative course was uneventful. We report this case with brief review of the literature.
Cartilage ; Congenital Abnormalities ; Female ; Funnel Chest ; Humans ; Musculoskeletal Abnormalities ; Osteotomy ; Scoliosis ; Sternum

BACKGROUND/AIMS: It have been reported that operative mortality and morbidity rate rise significantly when emergency cholecystectomy is performed in critically ill patients with acute cholecystitis(AC), and many studies have also concluded that delayed or interval laparoscopic cholecystectomy(LC) in patients with AC demonstrated high conversion rate and complication rate compared with early LC. However, if the acutely inflamed gallbladder(GB) is decompressed by emergent percutaneous gallbladder drainage(PGBD), it may decrease the technical difficulty of LC allowing successful delayed LC or may decrease the wound complication of delayed open cholecystectomy, when the patient is in better condition. The purpose of this retrospective study was to assess the outcome of delayed cholecystectomy focused on LC following PGBD in patients with AC METHODS: A total of 181 patients with AC were divided into PGBD(n= 66) and non-PGBD group(n= 115), and each group were subdivided into PGBD-delayed LC(after 72 hours of admission, n= 32), PGBD-open cholecystectomy(n= 20), non-PGBD-early LC(within 72 hours of admission, n= 40), non- PGBD-delayed LC(n= 17), non PGBD-open cholecystectomy group(n= 58) and others. PGBD group had higher incidence of comorbidity compared with non-PGBD group. Outcomes of cholecystectomy was assessed by conversion rate and morbidity rate(chi2 test), LC time and hospital stay(median test) for LC, and morbidity for open cholecystectomy in PGBD group compared with those of non PGBD group. RESULTS: PGBD promptly relieved of symptom of AC in 94 % of patients and showed 3 % of technical failure and 4.5 % of complication rate. Compared with non PGBD-early and delayed LC group, the PGBD-delayed LC group showed longer LC time(median 110 min vs 82.5, p < 0.05, vs 95 min), a little lower conversion rate(12.5 % vs 22.5 % vs 17.6 %), similar morbidity rate(19% vs 17.5 % vs 29 %) and prolonged total hospital stay(median 12.5 days vs 7 days, p < 0.001, vs 10 days). In open cholecystectomy series, PGBD group showed lower morbidity rate compared with non PGBD group(5% vs 24 %, p < 0.05) CONCLUSION: Unlike to open cholecystectomy series, PGBD did not significantly improve the outcome of LC for AC as assessed by conversion and morbidity rate and hospital stay compared with non PGBD. Thus we can conclude that although PGBD is a safe and effective emergency procedure for AC, it should be limited to higher risk group such as elderly or critically ill patients and to acalculous cholecystitis.
Acalculous Cholecystitis ; Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute* ; Comorbidity ; Critical Illness ; Drainage* ; Emergencies ; Gallbladder* ; Humans ; Incidence ; Length of Stay ; Mortality ; Retrospective Studies ; Wounds and Injuries

BACKGROUND: Anti-apoptotic proteins may be involved in tumor development, progression and the response to treatment. Bcl-2 is by far the most studied anti-apoptotic protein. A novel infibitor of apoptosis, designat ed survivin, and the heat shock proteins (HSPs) have recently been found in many human cancers. Immunohistochemical methods were used to determine the expression level of survivin, HSP 70 and bcl-2 in non-small cell lung cancer (NSCLC) to evaluate their clinical significance. METHODS: Tissue array slides were obtained from 99 surgically resected NSCLCs. Immunohistochemical staining was performed by an immuno-peroxidase technique using an avidin-biotinylated horseradish peroxidase complex. Anti-survivin rabbit polyclonal antibodies, anti-HSP70 mouse monoclonal antibodies and anti-bcl-2 mouse monoclonal antibodies were used as the primary antibodies. RESULTS: Positive ataining of survivin was detected in 33.3% of the cases. Survivin positivity is associated with to females and recurrence. A nonstatistically significant trend toward increased survivin expression was observed in non-smokers, and its expression inversely correlated with the number of cigarettes smoked in smokers. HSP70 was detected in 84.8% but this did not correlate with the clinicopathologic characteristics. Bcl-2 was detected in 18.2% and its and its expression correlated to tumor recurrence. No significant difference in the median survival time was noted in a comparison of al cases with survivin expression and those without. There was no association betwwen HSP70 or bcl-2 expression and survival. CONCLUSIONS: Survivin expression was significantly associated with females and tumor recurrence. In addition its expression was inversely associated with the number of cigarettes smoked. However, HSP70 and bcl-2 expression were not associated with the clinical parameters or survival. This suggests that measuring the survivin levels may be useful in identifying patients at high risk for disease recurrence. Therefore, survivin might be a new diagnostic/therapeutic target in cancer.
Animals ; Antibodies ; Antibodies, Monoclonal ; Apoptosis ; Apoptosis Regulatory Proteins ; Carcinoma, Non-Small-Cell Lung ; Female ; Heat-Shock Proteins ; Horseradish Peroxidase ; Humans ; Immunohistochemistry ; Lung* ; Mice ; Recurrence ; Smoke ; Tobacco Products

PURPOSE: To determine whether Ultravist(R) test can enable the surgeon to differentiate complete from partial small bowel obstruction in patients with adhesive small bowel obstruction and whether partial small bowel obstruction can be treated nonoperatively. METHODS: Ninety-two patients who had postoperative small bowel obstructions without any toxic signs underwent Ultravist(R) test. Ultravist(R) (40 ml) mixed with 40 ml of distilled water was administrated either orally or via nasogastric tube to each patient. Serial plain abdominal radiographs were taken 4, 6, and 8 hours later. RESULTS: A total of 58 patients (63%) whose contrast medium reached the colon within the first 8 hours were considered to have partial obstruction (test positive) and were successfully treated with intravenous hydration and nasogastric decompression. The remaining 34 patients (36.9%), in whom the contrast medium failed to reach the colon within the first 8 hours (test negative), were regarded as having complete obstruction. Twenty-three of those patients (67.6%) underwent surgery and the other 11 (32.4%) received conservative treatment. Adhesion bands with complete bowel obstruction were observed in all 23 surgical patients during laparotomy. All the patients with partial bowel obstruction were treated successfully with nonoperative methods. Positive Ultravist(R) test as an indicator for nonoperative treatment had a sensitivity of 84.5%, a specificity of 100%, an accuracy of 88% and a false negative rate of 12%. CONCLUSION: Ultravist(R) can be used to differentiate partial from complete intestinal obstruction. All patients with evidence of Ultravist(R) reaching the colon within 8 hours were treated successfully with non-operative methods.
Adhesives ; Colon ; Decompression ; Humans ; Intestinal Obstruction ; Laparotomy ; Sensitivity and Specificity ; Water

OBJECTIVE: The purpose of this study was to evaluate the efficiency of transvaginal ultrasonography for detection of fetal anomalies in first trimester. METHODS: This cohort included pregnant women between 9~14 weeks of gestation from April 2000 to April 2002 at department of Obstetrics and Gynecology, Sanggye Paik hospital, Inje university. Besides ACOG (1993) criteria, we scan nuchal translucency, FHR, cranium, abdominal wall and nuchal lesion using transvaginal sonography. If the anatomical survey was normal, the women underwent routine 18~24 weeks anomaly scans. RESULTS: 20 fetuses were identified as having 21 anomalies. Central nervous system anomaly (38%: 8/21) was the most frequent type of malformation. The other detected anomalies were isolated disorders of the lymphatic system 28% (6/21: two cystic hygromas and four nuchal edema), cystic hygroma associated with hydrops 14% (3/21), abdominal wall defects 14% (3/21), skeletal dysplasia 5% (1/21). Of the 20 fetuses that was diagnosed, 14 patients had elective first-trimester abortion, two had spontaneous fetal deaths, four were delivered at term. CONCLUSION: Besides offering the possibility of early termination, first trimester sonography has the advantage of identifying a transient sonographic sign, nuchal edema, which can be used as a marker in screening for fetal chromosomal abnormalities.
Abdominal Wall ; Central Nervous System ; Chromosome Aberrations ; Cohort Studies ; Edema ; Female ; Fetal Death ; Fetus ; Gynecology ; Humans ; Lymphangioma, Cystic ; Lymphatic System ; Mass Screening ; Nuchal Translucency Measurement ; Obstetrics ; Pregnancy ; Pregnancy Trimester, First* ; Pregnant Women ; Skull ; Ultrasonography

Adalimumab, a recombinant human IgG monoclonal antibody, selectively blocks tumor necrosis factor-alpha (TNF-alpha) and has been successfully used in the treatment of immune-mediated diseases. In particular, its efficacy has been proven in the treatment of rheumatoid arthritis, spondylarthritis, lymphoproliferative diseases and inflammatory bowel disease. Its use has also been studied for the treatment of psoriasis and yet, paradoxically, cases of new onset or exacerbation of psoriasis continue to increase in patients undergoing treatment with anti TNF-alpha agents. A 51-year-old woman had arthritis for a year and was diagnosed with psoriatic arthritis. After she had received adalimumab for psoriatic arthritis five times during one year, erythematous eruptions were found on her entire body. She then stopped adalimumab therapy for two months, although her skin lesions did not resolve. The patient was diagnosed with psoriasis through biopsy and began using cyclosporine, a topical steroid used for treatment of psoriasis.
Antibodies, Monoclonal, Humanized ; Arthritis ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Biopsy ; Cyclosporine ; Female ; Humans ; Immunoglobulin G ; Inflammatory Bowel Diseases ; Middle Aged ; Psoriasis ; Skin ; Spondylarthritis ; Tumor Necrosis Factor-alpha ; Adalimumab

To determine the clinical target volumes considering vascularity and cellularity of tumors, the software was developed for mapping of the analyzed biological clinical target volumes on anatomical images using regional cerebral blood volume (rCBV) maps and apparent diffusion coefficient (ADC) maps. The program provides the functions for integrated registrations using mutual information, affine transform and non-rigid registration. The registration accuracy is evaluated by the calculation of the overlapped ratio of segmented bone regions and average distance difference of contours between reference and registered images. The performance of the developed software was tested using multimodal images of a patient who has the residual tumor of high grade gliomas. Registration accuracy of about 74% and average 2.3 mm distance difference were calculated by the evaluation method of bone segmentation and contour extraction. The registration accuracy can be improved as higher as 4% by the manual adjustment functions. Advanced MR images are analyzed using color maps for rCBV maps and quantitative calculation based on region of interest (ROI) for ADC maps. Then, multi-parameters on the same voxels are plotted on plane and constitute the multi-functional parametric maps of which x and y axis representing rCBV and ADC values. According to the distributions of functional parameters, tumor regions showing the higher vascularity and cellularity are categorized according to the criteria corresponding malignant gliomas. Determined volumes reflecting pathological and physiological characteristics of tumors are marked on anatomical images. By applying the multi-functional images, errors arising from using one type of image would be reduced and local regions representing higher probability as tumor cells would be determined for radiation treatment plan. Biological tumor characteristics can be expressed using image registration and multi-functional parametric maps in the developed software. The software can be considered to delineate clinical target volumes using advanced MR images with anatomical images.
Axis, Cervical Vertebra ; Blood Volume ; Diffusion ; Glioma ; Humans ; Neoplasm, Residual

OBJECT: Spontaneous pontine hemorrhage can be diagnosed by CT or MRI, but the clinical course is variable according to the location of the hemorrhage. MATERIALS AND METHODS: Author attempted to analyse 39 cases of spontaneous pontine hemorrhage, considering factors to influence their prognosis, admitted in Inje University Busan Paik Hospital from 1998 to 2002. RESULT: Pontine hemorrhage was classified according to the finding of CT scan;4 cases of Type I (hematoma, localized in the tegmentum), 18 cases of Type II (those in the tegmentolaterally), 16 in Type III (those in the basis pontis mainly with tegmentum and midbrain). Male to female ratio was 31:8, mean age was 48.2 years (9-76 years). Initial Glascow Coma scale was 7.6 (3-14), and mean follow-up period was 5.1 months (0.1-52 months). Associated diseases were as follows;hypertension;20, pulmonary tuberculosis;2, hypertension with D.M;1. Treatment modality was consisted of 36 conservative treatment, 1 stereotactic hematoma aspiration, 2 Gamma-Knife radiosurgery for associated cavernous malformations. Prognosis was good at following order of the tegmentotectal, tegmentolateral type. CONCLUSION: The prognosis of tegmentotectal, tegmentolateral type hemorrhage was better than basis pontis. The little volume of the hematoma, the better prognosis.
Busan ; Coma ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage* ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Male ; Prognosis ; Radiosurgery

PURPOSE: The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated. MATERIALS AND METHODS: Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy. RESULTS: With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients. CONCLUSION: CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited.
Chemoradiotherapy ; Chemotherapy, Adjuvant ; Cisplatin* ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Induction Chemotherapy ; Joints ; Mucositis ; Multivariate Analysis ; Neoplasm Metastasis ; Radiotherapy, Intensity-Modulated* ; Survival Rate