Spondylometaphyseal dysplasia (SMD) is an extremely rare, which affects the spine and metaphy-ses of the tubular bones on terms of enchondrogenesis. Children who had Kozlowski dwarfism, type of SMD are not recognized until they reach school age since they have normal clinical feature, weight and size in early childhood. Authors experienced a typical case of Kozlowski type of SMD in a 10 years old male who had i) generalized platyspondyly with anterior tapering of vertebrae ii) generalized metaphyseal dysplasia iii) minimal changes in the carpal and tarsal bones. This case is to be reported with review of references.
Child ; Dwarfism ; Humans ; Male ; Spine ; Tarsal Bones

Between 1989 and 1993, 31 patients who had undergone ACL reconstruction using autogenous patellar bone-tendon-bone were studied to evaluate the effects on knee joint function. After having harvested the central one third of the patellar tendon, it was positioned isometrically through tunnels of tibia and femur and also central defect of the patellar ligament was sutured loosely. Clinically Hospital for special surgery(HSS) knee socre by Marshall 1997, manual knee test, knee extention and flexion angles, Cybex test, KT-2000 measurments and radiological study were performed for subjective and objective symptoms at the average follow-up 33 months (range 18-72 months). Quadriceps weakness of strength less than 80% of the normal side was present in 61% of patients, patellofemoral joint pain in 15%, AP translation more than 3mm in 23%, flexion contracture of 5 degree or more in 29%. Hospital for special surgery(HSS) knee score was improved from 35 to 46 in average during follow-up period. The height of the patella was increased in 2 cases and decreased in 6 cases within normal variation which was not significant statistically. The above results indicate that importance of postoperative rehabilitation program and extension position of knee joint after surgery place a major emphasis on the avoidance of flexion contracture and on the improvement of joint function.
Contracture ; Femur ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Knee ; Patella ; Patellar Ligament ; Patellofemoral Joint ; Rehabilitation ; Tibia ; Transplants

BACKGROUND: In the majority of cases, sternal instability and wound infection concomitantly present after a cardiac operation following conventional median sternotomy, and these complications have a major influence on the postoperative course. The aim of this study is to compare the results of the different sternal wiring techniques on sternal infection. MATERIAL AND METHOD: Between April 2004 and December 2008, 157 adult patients underwent cardiac operation through a median sternotomy. 86 patients who had undergone standard peristernal wiring were included in group A, whereas 71 patients who had undergone modified Robicsek sternal wiring were included in group B. The incidences of sternal wound complications in the two groups were assessed. RESULT: The mean age of the group B patients was older than that of the group A patients (61+/-10 years vs 57+/-13 years). The incidence of preoperative left ventricular dysfunction (ejection fraction <30%), chronic obstructive pulmonary disease, renal failure requiring dialysis and diabetes mellitus were significantly higher in Group B, whereas the other perioperative risk factors for infection were not significantly different between the two groups. Two patients in group A experienced superficial wound infection, whereas 4 patients in group B displayed superficial wound infection, but the difference was not statistically significant (p=0.255). Yet poststernotomy deep sternal wound infection appeared in 6 patients of group A, whereas none of the patients in group B displayed this malady. CONCLUSION: The modified Robicsek sternal wiring technique showed greater sternal stability even for the patient with a high risk for infection, and the technique caused a lower incidence of deep sternal wound infection.
Adult ; Diabetes Mellitus ; Dialysis ; Humans ; Incidence ; Pulmonary Disease, Chronic Obstructive ; Renal Insufficiency ; Risk Factors ; Sternotomy ; Sternum ; Ventricular Dysfunction, Left ; Wound Infection

OBJECTIVES: Many recent studies of relationship between geriatric depression and changes in brain have examined the structural abnormalities in hippocampus. Using MRI, the hippocampal volumes of patients with major depression were measured and compared with control subjects for research of above relationship. METHOD: Fourteen patients (early-onset five, late-onset nine) with major depressive disorder based on DSM-IV and fourteen age-matched normal controls are included. Applying semiautomated computer program to MRI, we measured and compared the hippocampal volumes in two groups. Moreover we identified the laterality and the correlation of the volumes with age of onset, duration of education, numbers of psychiatric admission, duration of illness, MMSE scores at admission, and severity of depression. RESULT: No significant difference was observed between the hippocampal volumes of patients with major depressive disorder and those of control subjects. A significant correlation in patients was observed between duration of illness and left hippocampal volume to cerebral volume ratio. In early-onset depressed patients, left hippocampal volume was larger than in late-onset depressed patients and the positive correlation was observed between MMSE scores at admission and left hippocampal volume to cerebral volume ratio. In late-onset depressed patients, there was the negative correlation between numbers of psychiatric admission and MMSE scores at admission as well as and between cerebral volume and age of onset. CONCLUSION: Our study indicated no change in the volume of hippocampus among geriatric major depressive patients. So we suggest that more extensive and systematic studies for structural abnormality of hippocampus will be required.
Age of Onset ; Aged* ; Brain ; Depression ; Depressive Disorder, Major* ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Hippocampus ; Humans ; Magnetic Resonance Imaging

This study was conducted to investigate the effect of breastfeeding education experience on knowledge, control beliefs, and future intention toward breastfeeding to consider the needs of breastfeeding education program of university students. The breastfeeding knowledge, control beliefs and related habits of 445 male and female college students were evaluated between September 1, 2011 to April 30, 2012. Data were collected from self-administered questionnaires and analyzed using SPSS for Window V.17.0. chi2-test, t-test and ANOVA were used for the calculation of differences between groups. The percentage of students who intended to breastfeed their baby was 80.7% (male: 73.6%, female: 84.2%). Only 21.6% of students experienced breastfeeding education. Students planned to get information related to breastfeeding from their mothers (32.4%), breastfeeding experts (23.8%) and Medical doctors & nurses (10.6%). breastfeeding education group showed higher knowledge level (14.46 vs 10.56) and control beliefs (3.48 vs 3.16) to breastfeeding than non-education group (p < 0.001). General attitude toward breastfeeding was similar between groups; the specific intention to breastfeed for 6 months was higher in the education group (83.3% vs 58.2%) (p < 0.01). Percentage of students who gave correct answers to knowledge questions related to breastfeeding was also higher in the breastfeeding education group than non-education group (72.3% vs 52.8%). Among 20 questions, only 2 questions showed no significant differences between the groups. These findings suggested that breastfeeding education was effective in encouraging or improving breastfeeding practices.
Breast Feeding* ; Education* ; Female ; Humans ; Intention ; Male ; Mothers ; Surveys and Questionnaires

Lymphorrhea is a common complication after inguinal dissection for exposure of the femoral artery. Injury of the lymphatics occurs frequently because they are anatomically close to blood vessels. Uncontrolled lymph drainage increases postoperative morbidity, and wound infection may follow. Despite current treatment options, lymphorrhea after inguinal dissection is still difficult to manage and results in a prolonged hospital stay. A vacuum-assisted closure device was used in a 72-year-old woman who had lymphorrhea after vascular surgery by groin incision. Vacuum-assisted control for lymphorrhea resulted in earlier closure of the wound and reduced the length of hospital stay.
Aged ; Blood Vessels ; Drainage ; Female ; Femoral Artery ; Groin ; Humans ; Length of Stay ; Lymphatic System ; Negative-Pressure Wound Therapy ; Wound Infection

BACKGROUND: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). MATERIAL AND METHOD: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). RESULT: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was 97+/-44 minutes in group A and 77+/-18 minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was 156+/-87 cc in group A and 147+/-87 cc in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was 31.7+/-25.3 months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. CONCLUSION: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.
Blister ; Chest Tubes ; Drainage ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Operative Time ; Pleurodesis ; Pneumothorax ; Recurrence ; Reoperation ; Retrospective Studies ; Thoracic Surgery, Video-Assisted

Guillain-Barre syndrome (GBS) is acute inflammatory demyelinating polyradiculoneuropathy, which is often related to post-infectious etiology. However, GBS has also been reported to be caused by non-infectious factors such as trauma. This report describes a rare case of post-traumatic GBS with dramatic response to immunoglobulin therapy. And here, we also discussed about the importance of differential diagnosis with critical illness polyneuropathy.

PURPOSE: Routine pancreatico-splenectomy with total gastrectomy should no longer be considered as the standard surgical procedure for gastric cancer because of the lack of proven surgical benefit for survival. The aim of this study is to evaluate the clinicopathologic factors and the survival of patients with locally advanced gastric cancer and they had undergone combined pancreatico-splenectomy with a curative intent. Material and Methods: We retrospectively reviewed a total of 118 patients who had undergone total gastrectomy with distal pancreatico-splenectomy from 1990 to 2001. The patients were divided into 2 groups: 90 patients who were free from cancer invasion (group I), and 28 patients with histologically proven cancer invasion into the pancreas (group II). The various clinicopathologic factors that were presumed to influence survival and the survival rates were analyzed. RESULTS: The rate of pathological pancreatic invasion was 23.7%. The tumor stage, depth of invasion, pancreas invasion, lymph node metastasis, lymph node ratio, curability and the hepatic and peritoneal metastasis were statistically significance on univariate analysis. Among these factors, the tumor stage, lymph node ratio and curability were found to be independent prognostic factor on multivariate analysis. The 5-years survival rates were 36.2% for group I and 13.9% for group II. The morbidity rate was 22.1%, and this included pancreatic fistula (5.1%), intra-abdominal abscess (4.2%) and bleeding (4.2%). The overall mortality rate was 6.8%. CONCLUSION: Combined distal pancreatico-splenectomy with total gastrectomy with a curative intent was selectively indicated for those patients with visible tumor invasion to the pancreas, a difficult complete lymph node dissection around the distal pancreas and spleen, and no evidence of liver metastasis or peritoneal dissemination.
Abdominal Abscess ; Gastrectomy* ; Hemorrhage ; Humans ; Liver ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreas ; Pancreatic Fistula ; Retrospective Studies ; Spleen ; Stomach Neoplasms* ; Survival Rate

PURPOSE: To investigate the relationship of improvement in erectile function (EF) with improvement in lower urinary tract symptoms (LUTS) and to assess the contribution of tamsulosin dose to the improvement of EF apart from the indirect influence of LUTS improvement in men with LUTS and erectile dysfunction (ED). MATERIALS AND METHODS: Fifty patients received tamsulosin 0.2 mg/d for the first 4 weeks and were subsequently divided into two groups by patient-reported outcomes. Nonescalators were maintained starting dose and escalators increased to 0.4 mg for the remaining 8 weeks. International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5), and underwent uroflowmetry were evaluated at baseline, and weeks 4 and 12. RESULTS: LUTS parameters were significantly improved in both groups but insignificant between the 2 groups. The degree of the improvement in the total IPSS and in the voiding, storage, and quality of life (QoL) subscores were significantly correlated with the degree of the improvement in EF; this was especially prominent in patients successfully treated LUTS. The escalators experienced a significantly greater increase in IIEF-5 scores than did the nonescalators (3.3 vs. 1.5). CONCLUSIONS: Dose escalation provided similar LUTS improvement in patients with refractory to starting dose. The improvements of LUTS were correlated with the improvement of EF. The increase in the IIEF-5 score was significantly higher in escalators. These findings imply that tamsulosin may contribute to the improvement in EF through the improvement of LUTS and QoL and direct relaxation of the corpus cavernosum in a dose-dependent fashion.
Elevators and Escalators ; Erectile Dysfunction ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prostatic Hyperplasia ; Quality of Life ; Relaxation ; Sulfonamides