Squamous cell carcinoma from the draining sinus of chronic osteomylitis has been recognized as a rare complication. The incidence of this complication is between 0.23% and 1.6% in cases of osteomyelitis. The cause of development of carcinoma at the site of chronic osteomyelitis is not well understood. This is a disease of middle aged men, and tibia is the most common site. Biopsy of squamous cell carcinoma which arises in the proliferating edge of the cutaneous ulcer and invades the bone, should include tissues from all sites of ulcer and bone marrow spaces. Histological diagnosis may be difficult because of preexisting metaplasia and pseudoepitheliomatous hyperplasia. Amputation at the adequate level is the treatment of choice. Four cases of squamous cell carcinoma involving tibia, metatarsal bone or calcaneus are reported with review of literatures.
Amputation ; Biopsy ; Bone Marrow ; Calcaneus ; Carcinoma, Squamous Cell ; Diagnosis ; Epithelial Cells ; Humans ; Hyperplasia ; Incidence ; Male ; Metaplasia ; Metatarsal Bones ; Middle Aged ; Osteomyelitis ; Tibia ; Ulcer

A total of 48 subjects harbouring Trichuris trichiura, Ascaris lumbricoides, hookworm and/or Enterobius vermicularis were treated with oxantel/pyrantel pamoate tablets (100 mg of each) in a single dose of 20 mg base per kg of body weight. In all 37 cases of A. lumbricoides and 8 cases of A. duodenale infections cured completely, and the mean recovered worm-load was 3.8 with a range of 1-21 and 5.8 with a range of 3-9 respectively. In T. trichiura infection, 32(71.1%) of 45 cases cured completely and the average egg reduction rate was 90.8 per cent. The mean recovered worm-load was 14.6 with a rnage of 1-77 worms. On the other hand, in E. vermicularis infection, 37 (84.1 %) of 44 patients were negative eggs by anal swab tests on the 10 to 11th days and 27 (61.4%) on the 20 to 21st days after treatment. The mean recovered worm-load was 17.7 with a range of 1-62. Only one patient with Trichostrongylus orientalis treated with this drug showed no eggs in his stools throughout the post-treatment examinations. Side effects were not noted in all treated cases. These findings demonstrate that a single dose of oxantel/pyrantel pamoate tablets can be considered a drug of choice for multiple infections with these nematodes.
parasitology-helminth-nematoda ; Trichuris trichiura ; Ascaris lumbricoides ; hookworm ; Enterobius vermicularis ; chemotherapy ; oxantel/pyrantel pamoate

A total of 56 subjects with multiple nematode infections with T. trichiura, Ascaris, hookworms and Enterobius were treated with oxantel and pyrantel pamoate mixture in a paratable suspension(50 mg of each per ml). A single dose of 10 mg per kg body weight in each cured 100 per cent of 54 subjects with Ascaris, 97.1 per cent of 35 subjects with hookworms, 77.8 per cent of 36 with Enterobius and 73.2 per cent of 56 subjects with T. trichiura infestation. The mean egg per gram stool reduction rate in T. trichiura infection was 91.9%. Of the 31 subjects infected with Ancylostoma doudenale 96.8% were cured with a single dose and 4 infected with Necator americanus showed a 100% cure rate with a similar daily dose on 3 consecutive days. Side effects were few and mild. There was no clinical or laboratory evidence of drug toxicity. These findings show a single dose of oxantel and pyrantel pamoate mixture to be a highly effective and acceptable treatment for multiple infections with these nematodes.
parasitology-helminth-nematoda ; Trichuris trichiura ; Ascaris lumbricoides ; hookworm ; Enterobius vermicularis ; chemotherapy-oxantel pamoate-pyrantel pamoate

The fractures of the both forearm bones are extremely common in children. Between the radius and ulna, there is normally through an arc of 180° rotation. To restore full rotation, rotational deformity and angulation after fracture must be corrected. The goal of treatment of the unstable forearm fracture is to increase the function of the forearm and hand as well as to get solid bone union. The general principle of treatment of forearm fracture in children is conservative due to remodeling and spontaneous correction ability. Thus, most fractures at any level need not and should not be treated by open reduction and internal fixation. But the operation will be perform frequently who shortly before maturity. We reviewed twenty-three children between 8-13 age, who had dsiplaced both forearm bones fracture, and who were treated with fixation using K-wire(14 cases) or plate(9 cases). Of the twenty-three fractures, sixteen were unsatisfactory reduction with more than 10° of angulation after initial closed reduction, two were loss of reduction in cast immobilization, and five were internally fixed primarily because of soft tissue interposition between fragment. The results were as follows. l. Operation time was 51.4 minutes in K-wire group and 86.7 minutes in plate group. 2. Bone union occured in all cases, at 7.3 weeks in K-wire fixation group and 8.9 weeks in plate fixation group. And immobilization period 7 weeks in K-wire fixation group and 4 weeks in plate fixation group. 3. Functional results were satisfactory all cases in both group. 4. The advantage of K-wire is a simple safe operation with minimal morbidity and small scar and compares with the extensive approach need for plate fixation which often giving a poor cosmetic result. Moreover, a second operation, with significant morbidity, is need to remove the plate after solid union. In Conclusion, this method is a favorable altenative to plate fixation of children forearm fractures. It allows rapid bone union with minimal morbidity, complication and scar.
Child ; Cicatrix ; Congenital Abnormalities ; Forearm ; Hand ; Humans ; Immobilization ; Methods ; Radius ; Ulna

No abstract available.
Heart Atria*

No abstract available.
Free Tissue Flaps* ; Humans ; Leriche Syndrome* ; Lower Extremity*

PURPOSE: This study was conducted to examine the clinical significance IV-contrasted helical abdomen computed tomography (CT) as a diagnostic screening tool to evaluate hollow viscus injury in blunt abdominal trauma patients. METHODS: This is a retrospective study encompassing 108 patients, presenting to Korea University Medical Center (KUMC) Emergency Department (ED) from January 2007 to December 2007, with an initial CT finding suggestive of intra-abdominal injury. An initial non-enhanced abdomen CT was taken, followed by an enhanced CT with intravenous contrast. Patients' demographic data, as well as the mechanisms of injury, were inquired upon and obtained, initial diagnosis, as dictated by specialized radiologists, were added to post-operational (post-OP) findings and to additional CT findings acquired during their hospital stays, and all were combined to arrive at final diagnosis. Initial CT findings were further compared with the final diagnosis, yielding values for sensitivity, specificity, and accuracy, as well as positive and negative predictive values. Patients were further divided into two groups, namely, those that underwent operational intervention and those that did not. The initial CT findings of each group were subsequently compared and analyzed. RESULTS: Initial CT scans revealed abnormal findings in a total of 212 cases - solid organ injuries being the most common finding, as was observed in 97 cases. Free fluid accumulation was evident in another 69 cases. Based on the CT findings, 77 cases (71.3%) were initially diagnosed as having a solid organ injury, 20 cases (18.5%) as having a combined (solid organ + hollow viscus) injury, and 11 cases (10.2%), as having an isolated hollow viscus injury. The final diagnosis however, were somewhat different, with only 67 cases (62.0%) attributed to solid organ injury, 31 cases (28.7%) to combined injury (solid + hollow), and 10 cases (9.3%) to hollow viscus injury. The sensitivity (CI 95%) of the initial helical CT in diagnosing hollow viscus injury was 75.6%, and its specificity was 100%. The accuracy in diagnosing hollow viscus injury was also meaningfully lower compared to that in diagnosis of solid organ injury. Among patients initially diagnosed with solid organ injuries, 10 patients (2 from follow-up CT and 8 from post-OP finding) turned out to have combined injuries. A total of 38 patients underwent an operation, and the proportion of initial CT findings suggesting free air, mesenteric hematoma or bowel wall thickening turned out to be significantly higher in the operation group. CONCLUSION: Abdominal CT was a meaningful screening test for hollow viscus injury, but the sensitivity of abdominal CT was significantly lower in detecting hollow viscus injury as compared to solid organ injury. This calls for special consideration and careful observation by the ED physicians when dealing with cases of blunt abdominal trauma.
Abdomen ; Academic Medical Centers ; Emergencies ; Follow-Up Studies ; Hematoma ; Humans ; Korea ; Length of Stay ; Mass Screening ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, Spiral Computed

PURPOSE: We purposed to determine the effects of urinary typsin inhibitor (ulinastatin) on the outcomes of severe sepsis and septic shock patients. METHODS: This is a prospective case control study of severe sepsis and septic shock patients who visited emergency department of university hospital from January 2005 to June 2008. For study group, 100,000 U of ulinastatin was initially infused and then additional infusions of ulinastatin were determined by the mean arterial pressure. We compared the predicted mortality and the actual in-hospital mortality between the ulinastatin group and the control group. We also compared the improvement of the SOFA score according to time between the groups. RESULTS: There were 43 patients in the ulinastatin group and 126 patients in the control group. The predicted mortality and the actual mortality of the ulinastatin group were 31.2% and 18.6%, respectively. The predicted and actual mortalities of the control group were 33.1% and 27.0%, respectively. The improvement of the SOFA score for the ulinastatin group was 6.8+/-3.9 and 5.0+/-4.5 at 0 and 24 hours (p<0.001), 6.5+/-3.7 and 3.9+/-4.3 at 0 and 48 hours (p<0.001) and, 6.3+/-3.6 and 3.0+/-4.1 at 0 and 72 hours (p<0.001). For the control group, the change of the SOFA score was 4.9+/-2.9 and 5.8+/-4.1 at 0 and 24 hours (p=0.003), 5.0+/-2.8 and 5.1+/-4.2 at 0 and 48 hours (p=0.760) and, 4.8+/-2.7 and 4.34.1 at 0 and 72 hours (p=0.105). CONCLUSION: The ulinastatin group showed significantly lower mortality than the predicted mortality and the ulinastatin group's SOFA score was improved in the early hospital days.
Arterial Pressure ; Case-Control Studies ; Emergencies ; Glycoproteins ; Hospital Mortality ; Humans ; Prospective Studies ; Sepsis ; Shock, Septic ; Trypsin

Inflammatory fibroid polyp is a relatively rare, benign polyp which is composed of fibraus connective tissue, blood vessels, and infiltration of eosinophils. The majority of inflammatory fibroid polyps has been reported with pathologic specimen in stomach and small intestine. We performed the gastrofiberscopy and endoscopic ultrasonogram of an inflammatory fibroid polyp, which reveals central ulcerated polypoid mass originated in the submucosa of antral portion of the stomach. So we report a case of endoscopic and endoscopic ultrasonographic findings of inflammatory fibroid piolyp in stomach. The etiolagy and pathology are discussed with the review of the literatures.
Blood Vessels ; Connective Tissue ; Eosinophils ; Intestine, Small ; Leiomyoma* ; Pathology ; Polyps* ; Stomach* ; Ulcer ; Ultrasonography

PURPOSE: Sphincter preservation is one of the main goal in the treatment of rectal cancer, but surgical management of cancer of the lower third of the rectum continues to evolve. The aim of this study was to evaluate the oncologic safety and to assess the functional results of coloanal anastomosis following ultra low anterior resection (CAA/ uLAR) in distal rectal cancer. METHODS: Thirty-six patients underwent coloanal anastomosis following ultralow anterior resection between January 2000 and February 2005. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 6 cm in length. All patients were followed up for fecal incontinence and frequency of bowel movement after diverting ileostomy closure. All patients were evaluated for local or systemic recurrences. RESULTS: The mean age of the patients was 58.7 (34~82) years. The median follow-up period was 24.5 (6~55) months. The types of anastomosis were straight anastomosis (n=25), colonic J pouch formation (n=10) and coloplasty (n=1). The twenty-nine patients of thirty-one patients underwent diverting ileostomy were performed ileostomy repair. The twenty-two patients had frequency after ileostomy repair. There is no statistical correlation of reservoir type and frequency (P=0.604). But the relationship between adjuvant radiation and frequency is statistically correlated (P=0.012). Postoperative complications were anastomotic leakage (n=5), but mostly radiological minor leakage, transient paralytic ileus (n=2), and anastomotic stenosis (n=1). The local recurrence rate is 3% and systemic recurrence occurred in 5 patients (14%), most patients were in Astler-Coller stage C. CONCLUSIONS: Ultralow anterior resection and coloanal anastomosis in low lying rectal cancer did not seem to affect recurrence. This procedure has poor functional outcome in early period but normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation.
Anastomotic Leak ; Autonomic Pathways ; Colon ; Colonic Pouches ; Constriction, Pathologic ; Deception* ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Ileostomy ; Intestinal Pseudo-Obstruction ; Postoperative Complications ; Rectal Neoplasms* ; Rectum ; Recurrence