We designed this study to analyze the causes of repeat surgery in the low back disorder after primary procedure, to evaluate the risk factors and to suggest the rational approachs can prevent and solve the problems related with repeat surgery. We retrospectively reviewed the medical record and radiographs of 24 patients who had sustained persistent or recurrent pain, failed to extended conservative therapy, showing abnormal myelogram and/or CT scan with nerve root compression, and with segmental instability consistent with patients symptom and sign after the primary procedures. We evaluated the functional outcome according to Kims(1986) criteria. The causes of remained or recurrent pain with neurologic symptom were persistent or aggravated lumbar spinal stenosis in 10 cases(42%), recurrent disc herniation in 4 cases(17%), infection in 3 cases(12%), instability in 2 cases(8%) and others in 5 cases(20%). Satisfactory outcome was recorded in 79%(19/24) of patients. The characteristics of the patients associated with satisfactory outcome were those who operated by recurrent disc herniation, instability, retained disc, metal malposition, and nerve root compression by bone chip. But the characteristics of the patients associated with unsatisfactory outcome were those who operated by infection, lumbar spinal stenosis aggravated by degenerative spondylosis and multiple herniated disc, inadequate decompression of lateral and/or foraminal stenosis in aged patients. The most common lesion site was on L4-5 disc, and unsatisfactory result was expected at the upper lumbar spine involvement. Favorable outcome could be expected in the presence of a pain-free interval more than 1 year from the date of the previous operation or persistent symptoms immediately after the initial operaion. We were expected the risk factors leading to repeat surgery were old aged(more than 60) patients, upper lumbar spine involvement and multiple lumbar disc herniation. Postoperative diskitis or osteomyelitis, pain free interval more than 1 month or less than 1 year, and those who had a revision on the lumbar spine previously could be considered as a poor prognostic indicators. When surgery is indicated for degenerative lumbar spinal disorders, adequate diagnostic tests and the execution of appropriate procedures based upon this information should be carried out to prevent the repeat surgery in the low back disorders. Adequate postoperative management can reduce the occurrence of failed back surgery syndrome and in cases necessitating repeat surgery, thorough analysis of causes following proper surgical stabilization can reduce the operative morbidity with early return to daily life.
Constriction, Pathologic ; Decompression ; Diagnostic Tests, Routine ; Discitis ; Failed Back Surgery Syndrome ; Humans ; Intervertebral Disc Displacement ; Medical Records ; Neurologic Manifestations ; Osteomyelitis ; Radiculopathy ; Reoperation* ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Spine ; Spondylosis ; Tomography, X-Ray Computed

No abstract available.
Hypnotics and Sedatives*

The superficial sural artery flap is supplied by the superficial sural artery that accompanies the sural nerve. The superficial sural artery connects distally with a peroneal artery septocutaneous perforator via a suprafascial network of vessels that permits the flap to be raised on its distal pedicle. We treated 10 patients who showed soft tissue defect of the lower third of the leg, around the ankle and the hindfoot with this flap. The causes of the soft tissue defect were trauma in 6 cases, pressure sore in 2 cases, squamous cell carcinoma in 1 case and osteomyelitis in 1 case. The sites of the soft tissue defect were the lower third of the leg in 5 cases, around the ankle in 2 cases and the hindfoot in 3 cases. The size of the soft tissue defect was from 5x6 cm to 8xl2 cm. All 10 flaps survived. Two flaps showed slight venous congestion which cleared in a few days. The time for flap dissection was 15 minutes in average. The results of our cases show that the distally based superficial sural artery flap is useful for the soft tissue coverage of the lower third of the leg, around the ankle and the hindfoot. The advantages of the flap are that the blood supply is reliable, elevation is easy and quick, the major arteries are not sacrificed and the donor site morbidity is negligible.
Ankle ; Arteries* ; Carcinoma, Squamous Cell ; Humans ; Hyperemia ; Leg ; Lower Extremity ; Osteomyelitis ; Pressure Ulcer ; Sural Nerve ; Tissue Donors

Unilaterl frontal hyperhidrosis, a rare disorder of the sweat gland with localized hyperhidrosis, ia discribed. A 13-year-old female patient had increased sweating on the left half of the forehead, recurring in summer season for 2 years. Quantitative sweat collection demonstrated that the sweat glands responsive to those stimuli, which were thermal (direct and indirect heat), gustatory and cholinergic stimulation. A marked increase in sweat gland activity was noted on the affected areas as compared to the contaralateral normal sites, in thermal and gustatory effect. But, carbachol stimulation was not responsive. Biosy specimen which taken from the positive site of starch iodine technique showed increase number of sweat glands and ducts with somewhat dilated sweat ducts.
Adolescent ; Carbachol ; Female ; Forehead ; Humans ; Hyperhidrosis* ; Iodine ; Seasons ; Starch ; Sweat ; Sweat Glands ; Sweating

The introduction of beta-adrenergic blocking agents for the treatment of glaucoma was a major advance in the continued search for medications that effectively control the intraocular pressure with minimal side effect. Beta-adrenergic blocking agents block the aqueous pump of the ciliary epithelium resulting in decreased aqueous formation and drop in intraocular pressure. The fact that beta-adrenergic blocking agents had an affinity to intraocular tissues containing melanin granules has been reported. The purpose of this study is to know that mechanism of decrease of intraocular pressure and an affinity to melanin granules of the beta-adrenergic blocking agents. Two drops of 1% befunolol were instilled in the albino and pigmented rabbits, and the eyes were enucleated on 1, 2, 6 and 24 hours after instillation. These eyes were studied with electron microscopic examination. The results were as follows: 1. In the non-pigment epithelium of the ciliary body, mitochondria became swollen. 2. These changes appeared earlier and were more remarkable in albino rabbits than in pigmented ones. 3. In pigmented rabbits, these changes appeared slowly, but continued for longer duration and it seems to be due to affinity of beta-adrenergic blocking agents to the melanin pigment. 4. Swelling of mitochondria at the non-pigmented epithelium of the ciliary body after instillation of beta-adrenergic blocking agents seems to be the pharmacological mechanism of the drugs against aqueous formation in the ciliary body.
Adrenergic beta-Antagonists ; Ciliary Body ; Epithelium* ; Glaucoma ; Intraocular Pressure ; Melanins ; Mitochondria ; Rabbits

BACKGROUND: Generalized aggressive periodontitis (GAP) is a destructive periodontal disease that can develop in young age. Only a few cases of full mouth rehabilitation, using dental implants, have been reported in a patient with aggressive periodontitis. CASE DESCRIPTION: This clinical report describes the treatment procedures and results of full mouth rehabilitation in a patient with aggressive periodontitis. After all teeth were extracted, 6 implants were placed in the maxilla and mandible, respectively. Fixed detachable implant prostheses were made. The patient was satisfied with the final results. She was followed for 10 months postloading. CLINICAL IMPLICATION: For a long-term success, continuous maintenance care is critical, as the contributing factors of the disease (such as immune factors or periodontal pathogens) may not be controlled adequately.
Aggressive Periodontitis ; Dental Implants ; Humans ; Immunologic Factors ; Mandible ; Maxilla ; Mouth ; Mouth Rehabilitation ; Periodontal Diseases ; Prostheses and Implants ; Tooth

No abstract available.
Drug Therapy* ; Lung*

Myocarditis is defined as the myocardial inflammation caused by various infectious agents (such as virus, rickettsia , bacteria, protozoa, fungus and parasites). The clinical manifestations of myocarditis ranges from the asymptomatic state due to focal inflammation to fulminant fatal congestive heart failure secondary to diffuse myocardial involvement. Clinically, in some cases, it may simulate an acute myocardial infarction. We experienced a case of acute fulminant myocarditis that presented as acute myocardial infarction initially, and then progressed into and recovered from congestive heart failure and multiorgan failure.
Asymptomatic Diseases ; Bacteria ; Estrogens, Conjugated (USP)* ; Fungi ; Heart Failure* ; Inflammation ; Myocardial Infarction ; Myocarditis* ; Rickettsia

No Abstract Available.
Brucella abortus* ; Brucella* ; Immunity, Humoral* ; Jeju-do* ; Recombinant Proteins*

No abstract available.
Pyelonephritis, Xanthogranulomatous*