One of various decompression methods in treatment of spinal stenosis is the indirect instrumental decompression. Theoretically, the distraction of the disc space can widen the intervertebral foramen of the stenotic segment and even increase the canal diameter by distracting the posterior annulus as well as reduce the extent of decompressive laminectomy site. The indirect instrumental decompression, however, was not guaranteed to maintain the restored discal height because of the loss of fixation strength between rod and screw, viscoelasticity of vertebra itself, bone density, type of screw and rod, and operative technique. As well the magnitude of the stresses on the instrumentation particularly at the rod-screw interface may depend on rod-contouring in order to make mormal sagittal curvature of the lumbar spines. Therefore, the aim of this experimental study was to evaluate the effect of different rod-contour on the axial sliding strength in Compact Cotrel-Dubousset (CCD) instrumentation. Axial sliding strength was tested by Universal Test Machine (Instron). Test was performed for 3 groups of different rodcontouring on the biomechanical axial strength: straight rod (no contour), 10 and 20 contouring rod. The length of contact surface between rod and screw was measured with Fuji pressure sensitive film. The study was performed using 6.5 mm open body screws and 7 mm rods of CCD instrumentation. Axial sliding strength of straight rod was 2518.6N, 1871.8N in 10 and 1528.8N in 20 contouring rod. The length of contact surface between rod and screw significantly decreased according to degree of rod contouring; 9.88mm in straight rod, 9.08mm in 10 and 8.57mm in 20 contouring rod. There was a statistically significant linear correlation (R=0.96) between failure load and length of contact surface. Therefore, this study has shown that excessive contour of the rod in order to make normal sagittal curvature of the lumbar spine using CCD instrumentation cannot provide sufficient axial sliding strength. That may be a cause of loss of restored disc space height after surgery.
Bone Density ; Decompression ; Laminectomy ; Spinal Stenosis ; Spine

No abstract available.
Myelography*

Though thymoma is considered benign in a histopathologic specimen, its unusual behavior makes it important for surgeons to manage this neoplasm as cancerous lesion. Hence we clinically analysed the surgical cases of thymoma in our hospital, and we suggest the risk factors for its prognosis. From January 1987 to December 1994, we experienced 41 surgical cases of thymoma, excluding thymic carcinoma and cysts. There were 21 male and 20 female; age ranged from 16 to 64 years. Among them, myasthenia gravis was present in 22 patients (53.7%). Surgical treatment consisted of complete resection in 31 patients, partial resection in 7 patients, and biopsy only in 3 patients. According to Masaoka's classification, there were 27 patients in stage I, 4 patients in stage II, and 10 patients in stage III. Histopathology was of epithelial type in 14 patients, lymphocytic type in 11, and mixed type in 19. Eleven patients had adjuvant radiotherapy, chemotherapy, or both and there was no surgical mortality. Postoperative follow-up ranged from 1 to 88 months (mean 36 months) and three patients died and 5 patients suffered recurrences during the follow-up period. Postoperative risk factors were advanced Masaoka stage, invasiveness, and surgical method.
Biopsy ; Classification ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Mortality ; Myasthenia Gravis ; Prognosis ; Radiotherapy, Adjuvant ; Recurrence ; Risk Factors* ; Thymoma*

BACKGROUND: Intravenous catheter-related complication among the hospitalized patients has been increasing recently in Korea, since many hospitals has tried to save expenses by replacing the foreign-made catheter with domestic-made intravenous catheter. We studied the incidence rate of catheter-related complication and compared the incidence of catheter-related complication between domestic-made and foreign-made ones. We also studied to elucidate whether the morphologic characteristics of the intravenous catheter will effect the incidence of catheter-related complication. METHOD: From July 1 to Sept 30, 1998, we surveyed the incidence rate of intravenous catheter-related complication among the hospitalized patients in the wards of Medicine. Surgery, Obstetric, and Neonatal Intensive Care Unit in Guro Hospital, Korea University Medical center. We also compared the incidence of complication between domestic-made catheter (catheter A) and foreign-made catheter (catheter B) of three different gages (24G, 22G and 18G). The morphologic characteristics of intravenous catheters has been studied by electron microscopy. RESULT: Complication associated with use of intravenous catheter had been occurred 263 out of 459 cases (57.3%), among those cases, non-infectious complication and infectious complication were 173 cases (37.7%) and 90 cases (19.6%), respectively. Totally, catheter A group showed higher complication than catheter B group [62.0% (160/258) vs 51.2% (103/201), P=.021]. Analysis on the incidence rate of complication according to the products did not show significant differences in the noninfectious complication in every gage groups. However the infectious complication occurred higher in the domestic-made catheter A group than among the foreign-made catheter B group [(24G: 6% vs 0%, P=.026), (22G: 25.6% vs 9.6%, P=.001), (18G: 36.8% vs 13.4%, P=.002)]. Duration of catheter life did not show the difference between catheter A group and catheter B group [48.5hrs vs 50.3hrs, P=.474]. The analysis on risk factors for complication showed that catheter A group is highly related (odd ratio 1.85). The morphologic analysis of the catheter by using electron microscopy showed that the angles in the tip of the introducing needle of catheter Aand catheter Bare 60degrees and 45degrees , respectively, and the bevel between introducing needle and catheter sheath are 50degrees and 27degrees, respectively. CONCLUSION: There was a higher incidence rate of complication related to domestic-made catheter usage, which might influence increasing the period of the hospitalization and the expenses due to the complication. The study of cost effectiveness analysis needs to be performed regarding intravenous catheter-related complication. Morphologically, catheter A showed more blunt angle in the tip and transition area of the introducing needle than the angle of catheter B, which is considered to influence the higher complication incidence. It needs to improve the quality of domestic-made intravenous catheter.
Academic Medical Centers ; Catheter-Related Infections ; Catheters ; Cost-Benefit Analysis ; Female ; Hospitalization ; Humans ; Incidence* ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Microscopy, Electron ; Needles ; Obstetric Surgical Procedures ; Prospective Studies* ; Risk Factors

Primary lymphoma of the uterus is a rare disease, the reported characteristic MR imaging findings being homogeneous intermediate signal intensity of the indistinct mass on T1- and T2-weighted images, and the preservation of endome-trial lining and uterine architecture. We report a case of primary uterine lymphoma which showed tumoral necrosis, endometrial disruption and diffuse anterior vagi-nal wall involvement.
Case Report ; Female ; Human ; Lymphoma, Lymphoblastic/*diagnosis ; *Magnetic Resonance Imaging ; Middle Age ; Necrosis ; Uterine Neoplasms/*diagnosis ; Uterus/pathology

Clostridium septicum is a toxin producing anaerobic, motile, spore-forming, spindle shaped Gram positive rod that may cause devastating systemic illness in patients with neutropenia and underlying hematologic or gastrointestinal malignancy. Clostridium septicum sepsis usually have fulminating clinical courses, and unless the appropriate antibiotics are administered soon after admission, the outcome is fatal. We experienced a case of sepsis due to Clostridium septicum, in a 65-year-old woman with peripheral T-cell lymphoma and diabetes mellitus. She was admitted due to abdominal pain, fever, chilling, nausea, vomiting and watery diarrhea, followed by rapidly progressive course. This patient was not improved by intensive care and continuous antibiotic therapy, expired at the 4th hospital day. Clostridium septicum grew from premortem blood cultures.
Abdominal Pain ; Aged ; Anti-Bacterial Agents ; Clostridium septicum* ; Clostridium* ; Diabetes Mellitus ; Diarrhea ; Female ; Fever ; Humans ; Critical Care ; Lymphoma, T-Cell, Peripheral ; Nausea ; Neutropenia ; Sepsis* ; Vomiting

PURPOSE: An association between primary hyperparathyroidism and well differentiated thyroid carcinoma has been frequently reported. However, there have been few reports of secondary hyperparathyroidism associated with thyroid carcinoma. This study was performed to evaluate the prevalence of thyroid nodule including thyroid carcinoma in patients with secondary hyperparathyroidism and to suggest more proper diagnostic approach for such cases. METHODS: A retrospective study was performed on fifty-two patients who underwent parathyroid surgery for secondary hyperparathyroidism between March, 1986 and December, 2003. RESULTS: In 20 patients (38.5%), thyroid surgery was added because of coexistent thyroid nodules. Five (25%) out of the 22 patients with coexistent thyroid nodule had thyroid carcinoma. Among the 5 thyroid carcinoma patients, 4 had papillary carcinomas and one had a follicular carcinoma. Mean size of thyroid carcinomas was 1.4 cm (0.3~3.0 cm). CONCLUSION: The prevalence of thyroid carcinoma in patients with secondary hyperparathyroidism was higher than that in the general population. An aggressive diagnostic approach (ultrasonography and FNAB) should be considered when the patients with secondary hyperparathyroidism present with thyroid nodules.
Carcinoma, Papillary ; Humans ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary* ; Prevalence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule*

BACKGROUND: Disinfectants play an important role in preventing nosocomial infection. But the misuse of disinfectants may lead to waste money and decrease the effectiveness of disinfectants by emergence of resistant-bacteria. We studied to evaluate the in vitro bactericidal activity of various disinfectants used in the hospital against major nosocomial pathogens. METHOD: Disinfectants studied were chlorhexidine (0.05%, 0.1 %, 02%, 0.5%, 1%), hibicol 0.5%, alkyl diaminoethyl glycine (0.01 %. 0.05%, 0.1%. 0.5%, 1%), benzalkonium chloride (0, 1%, 0.3%), hydrogen peroxide (1.5%,3%), isopropyl alcohol 70%, potadine iodine(7.5%, 10%), and gentian violet (0.01 %, 0.1%, 1%). Bactericidal activity of disinfectants was assessed against MRSA (methicillin-resistant S. aureus), P. aeruginosa, VRE (vancomycin-resistant enterococci), K. pneumoniae. CNS (coagulase-negative staphylococci) and C albicens. Those microorganisms were obtained from the patients with hospital-acquired infections, In vitro susceptibility was determined using a macrodilution method with various exposure times to several concentrations of disinfectants of 30sec, 1 min, 2 min, 5 min, 15 min and 30 min. RESULT: Microorganism studied were killed after exposure to hibicol 0,5%, isopropyl alcohol 70%, pcradme iodine (7.5%, 10%) within 30sec. 0.05% chlorhexidine needs exposure time above 5 min for bactericidal action. 0.01% alkyl diaminoethyl glycine needs exposure time above 15 min. 0.1% and 0.3% benzalkonium chloride needs exposure time above 1 min. MRSA and P. aeruginosa were killed within 30sec after exposure to gentian violet (GV), but against CNS, 0.01% GV needs exposure time for 15min and 0.1% and 1% GV needs exposure time for 2 min. C. albicans were killed above 1 min. K. pneumoniae was not killed at all. H202 was ineffective for all tested bacteria. CONCLUSION: The results of this study show most disinfectants used in our hospital demonstrated bactericidal activity against major nosocomial pathogens. In-house diluted, 3% H202 failed to demonstrate killing of any microorganisms tested. The appropriate selection of disinfectants regarding to concentration and exposure time was necessary to inhibit growth of major nosocomial pathogens.
2-Propanol ; Bacteria ; Benzalkonium Compounds ; Chlorhexidine ; Cross Infection ; Disinfectants* ; Gentian Violet ; Glycine ; Homicide ; Humans ; Hydrogen Peroxide ; Iodine ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia

PURPOSE: Central compartment reoperation for recurrent thyroid carcinoma is challenging to surgeons due to the scar tissues and adhesions and the distortion of the normal anatomic relationships. This study was carried out to investigate the central neck recurrence patterns and the surgical morbidity of reoperation for patients with papillary thyroid carcinoma. METHODS: The study population was comprised 68 papillary thyroid carcinoma patients (15 males and 53 females, median age: 50.8 years [range: 12~78 years]) who underwent reoperation for recurrent tumors in the central compartment of the neck between January 1999 and June 2007. All of the patients had undergone prior total thyroidectomy. RESULTS: Of the 68 patients, 21 recurrences occurred in the proper thyroid tissue of the thyroid bed, 43 in the central neck nodes and 4 in a combination of the central nodes and proper thyroid tissue. The common recurrent site from the proper thyroid tissue were at the berry ligaments and at the level of the upper one-third of the recurrent laryngeal nerves, while the common nodal recurrence sites were the lower-most portion of the paratracheal nodes and the right paraesophageal nodes (the lymph nodes posterior to the right recurrent laryngeal nerve). Eleven cases of transient hypocalcemia (17.5%, 11/63) and 3 cases of permanent hypocalcemia (4.3%, 3/63) were noted after reoperation. Recurrent laryngeal nerve injury occurred in 5 patients (8.1%, 5/62), but three of them were intentionally resected with the recurrent cancers. CONCLUSION: Reoperation for central neck recurrence of papillary thyroid carcinoma is associated with a higher complication rate. Meticulous surgical dissection of the central compartment based on the recurrent patterns is important to reduce injury to the recurrent laryngeal nerves and parathyroid glands.
Carcinoma ; Cicatrix ; Female ; Fruit ; Humans ; Hypocalcemia ; Intention ; Ligaments ; Lymph Nodes ; Male ; Neck ; Recurrence ; Recurrent Laryngeal Nerve ; Recurrent Laryngeal Nerve Injuries ; Reoperation ; Thyroid Gland ; Thyroid Neoplasms

PURPOSE: Men with documented chronic prostatitis, with elevated serum prostate specific antigen (PSA), were investigated to assess whether treatment lowers serum PSA and thus avoids unnecessary biopsies. MATERIALS AND METHODS: The medical records of 46 men who presented with serum PSA higher than 4ng/ml, and subsequently diagnosed with chronic prostatitis, were retrospectively reviewed. After the administration of antibiotics and anti-inflammatory drugs for 4 to 8 weeks, the follow-up PSA levels were determined, and those with levels higher than 4ng/ml underwent a prostate biopsy. RESULTS: The mean PSA level decreased 61% from 11.66ng/ml before, to 3.79ng/ml after, treatment (p<0.001). In 30 patients the serum PSA level decreased to below 4ng/ml (mean 1.69), with these patients no longer having an indication for a prostate biopsy. In the remaining 16 patients the serum PSA level remained elevated above 4ng/ml, so they underwent a prostate biopsy. Pathological study revealed benign prostatic hyperplasia in 11 cases and prostate cancer in 5. The PSA level in patients associated with benign prostatic hyperplasia decreased 61.9% with treatment, from 19.96 to 7.88ng/ml (p=0.006) and the PSA in those associated with prostate cancer decreased 30.6% with treatment, from 12.85 to 7.32ng/ml (p<0.05). CONCLUSIONS: This study demonstrates that chronic prostatitis can cause elevation of serum PSA levels, and when identified, antibiotics and anti-inflammatory treatment can lower these levels and an unnecessary prostate biopsy can be avoided.
Anti-Bacterial Agents ; Biopsy ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Prostatitis* ; Retrospective Studies