Closed medullary nailing has become increasingly popular in the management of fractures of the femur because of a high rate of union, a low rate of complications, and excellent return of function. But it requires good facility and excellent surgical skill. The authors experienced two cases of iatrogenic femur neck fracture during closed medullary nailing of femur shaft fracture.
Femoral Neck Fractures ; Femur Neck ; Femur

No abstract available.
Needles* ; Prostatitis*

A virus-associated hemophagocytic syndrome is characterized by high fever, liver dysfunction, coagulation abnormalities, pancytopenia, and a benign histiocytic proliferation with prominent hemophagocytosis in bone marrow, lymph node, spleen, and liver. Three phases of disease progression can be defined. In the first week, there is mild leukocytosis and myeloid hyperplasia in the marrow and the fever is resistant to antipyretics and antibiotics. In the second phase, usually corresponding to the 2nd to 3rd week of the illness, the fever persists and jaundice and hepatosplenomegaly may develop and the marrow now reveals the presence of atypical or transformed T lymphocytes and a scattering of histiocytes with hemophagocytosis. In the third phase, the disease progresses to a full-blown hemophagocytic syndrome with coagulopathy and lung infiltrates. The marrow in this stage is usually hypoplastic with florid histiocytic proliferation and hemophagocytosis and the patients usually die within 1-2 months. We describe a pregnant woman with fatal hemophagocytic syndrome. Virologic study strongly suggests that Epstein-Barr virus implicated in the pathogenesis of this patient.
Anti-Bacterial Agents ; Antipyretics ; Bone Marrow ; Disease Progression ; Female ; Fever ; Herpesvirus 4, Human* ; Histiocytes ; Humans ; Hyperplasia ; Jaundice ; Leukocytosis ; Liver ; Liver Diseases ; Lung ; Lymph Nodes ; Lymphohistiocytosis, Hemophagocytic* ; Pancytopenia ; Pregnancy* ; Pregnant Women ; Spleen ; T-Lymphocytes

No abstract available.
Humans ; Inpatients* ; Pediatrics ; Retrospective Studies*

The 8 cases of left ventricular thrombus detected by the 2 D echocardiography or left ventriculography, after acute transmural anterior myocardial infarction were effectively lysed by the thrombolytic agents and heparin therapy. The thrombolytic agents were either urokinase or tissue plasminogen activator. Urokinase was infused intravenously at a dose of 1.0 million unit for three days. And tissue plasminogen activator was infused at a dose of 100mg for a day. In all cases, the thrombi were completely lysed. At follow up, no recurrence of left ventricular thrombus was found. We have experienced 2 cases of peripheral embolization in which, left ventricular thrombi were protruding nonmobile type. The one was the embolic cerebral infarction, the other was transient hoarseness and paresthesia on the left foot, which may be transient ischemic attack. These results show that left ventricular thrombi can be treated by intravenous thrombolytic agents without life-threatening complication. However, for the better establishment of the risk and benefit of therapy further investigation is needed.
Cerebral Infarction ; Echocardiography ; Fibrinolytic Agents ; Follow-Up Studies ; Foot ; Heparin ; Hoarseness ; Ischemic Attack, Transient ; Myocardial Infarction* ; Paresthesia ; Recurrence ; Thrombolytic Therapy* ; Thrombosis* ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator

Thallium-201 brain SPECT is utilized in the diagnosis of brain tumor especially in cases where CT or MRI findings alone cannot differentiate malignant lesion from benign. Recently we came across two cases of positive T1-201 brain SPECT in clinically suspected brain tumor patients that turned out to be hemorrhagic cerebral infarction instead on biopsy. The findings in these cases demonstrate that thallium-201 accumulation may occur by the breakdown of the blood-brain barrier and phagocytic cell infiltration in the liquefaction stage of infarction.
Biopsy ; Blood-Brain Barrier ; Brain ; Brain Neoplasms ; Cerebral Infarction* ; Diagnosis ; Humans ; Infarction ; Magnetic Resonance Imaging ; Phagocytes ; Tomography, Emission-Computed, Single-Photon

No abstract available.
Pancreaticoduodenectomy*

Functional voiding disorder is characterized by symptoms referable to the genitourinary organs without organic obstruction or neurovesical dysfunction. In an attempt to understand possible mechanisms of symptoms of functional voiding disorder in young male adult, we retrospectively reviewed the urodynamic findings of 51 men with functional voiding disorder between the ages of 19 and 51 (mean 40.7 years). Presenting symptoms are divided into three groups: 1) Sx. of irritation(irritation group) in 17 patients; 2) Sx. of bladder outlet obstruction(BOO group) in 25 patients; 3) Sx. of bladder outlet obstruction with episodes of overdistention (overdistention group) in 9 patients. On filling cystometry, time of first filling sense and urge sense was delayed significantly in overdistention group and involuntary contraction was found in 5 patients with BOO(20%), in 3 patients with irritation(18%), and in 1 patients with episodes of overdistention. In overdistention group, maximal voiding detrusor pressure was significantly lower and amount of postvoiding residual urine was significantly larger than other two group on pressure/flow study. Total voiding time and time to maximal uroflow rate were delayed significantly in BOO and overdistention group. Pseudo detrusor-sphincter-dyssynergia was found in 3 patients among 25 patients with BOO. Therefore, we were able to find correlations between specific symptomatic group and urodynamic parameters by this result. Results of urodynamic assessment were divided into 5 categories: Impaired detrusor contractility(IDC), detrusor instability(DI), obstruction, sensory urge syndrome, and equivocal studies. DI was found in 20% of patients with irritation or BOO. IDC was found in 80% of patients with episodes of overdistention and in 24% of patients with BOO. Thorough care is necessary in determining the treatment modality, and in follow up evaluation for patients showing IDC, DI or obstruction on urodynamic study. Conclusively, urodynamic study is thought to afford the opportunity in identifying these specific voiding disorder.
Adult ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urodynamics* ; Young Adult*

Because there is difficulty in the suture of renal pelvis, extended pyelolithotomy for the renal or pelvic calculi gives often complication such as urine leakage or infection, which result in the fibrosis and stricture of the region. Seven cases of renal stones are treated with new method using 8F Trumpet-shaped Nelaton Catheter. The proximal portion of the Nelaton Catheter inserted into the renal pelvis through the incised opening is made to arrive the lumen of the urinary bladder and the Trumpet-shaped distal portion is made to fix with the suture of the renal pelvis and capsules. After five to seven days, the catheter is removed by cystoscopic manipulation. It seems that the method is easy and feasible to decrease the complication of the extended pyelolithotomy for renal calculi.
Calculi ; Capsules ; Catheters* ; Constriction, Pathologic ; Fibrosis ; Kidney Calculi ; Kidney Pelvis ; Stents* ; Sutures ; Ureter* ; Urinary Bladder

PURPOSE: We report on a modified four-corner bladder neck suspension using a manufactured Tension-free Vaginal Tape (TVT) carrier for moderate-degree cystocele, with a simultaneous TVT procedure, for stress urinary incontinence (SUI). MATERIALS AND METHODS: The operation was performed in 21 SUI patients with moderate cystocele. Seven patients were operated on under local anesthesia, and the others under general anesthesia. Two incisions were made over the suprapubic area, and a midline incision over the anterior vaginal wall for the TVT procedure. For cystocele repair, bilateral parallel incisions were made over both the lateral vaginal walls. Through the lateral incisions, a dissection was carried out to expose the vesicopelvic fascia. Then a Gore-Tex suture was placed on each side. Each suture incorporated the entire vaginal wall, excluding the epithelium, cardinal ligament and pubocervical fascia. We made two pinholes at the end of the TVT carrier for the suture materials to be threaded through. Using the TVT carrier, each thread was transferred to the ipsilateral suprapubic incisions through the retropubic space. Each side of the ligature was tied together under the subcutaneous space, and the TVT procedure completed. RESULTS: Mean operation time and hospitalization days were 75+/-24 minutes and 3.3+/-2.19 days, respectively. The cystocele was fully corrected in 19 patients (90.5%), and diminished to grade I in 2. There were no significant operative or postoperative complications, including bladder perforations or retropubic hematomas, etc. CONCLUSIONS: It is suggested that the repair of cystocele and incontinence, using a TVT device, is an effective treatment for moderated cystocele, with a simple technique, low morbidity and high cure rate.
Anesthesia, General ; Anesthesia, Local ; Cystocele* ; Epithelium ; Fascia ; Hematoma ; Hospitalization ; Humans ; Ligaments ; Ligation ; Neck ; Polytetrafluoroethylene ; Postoperative Complications ; Suburethral Slings* ; Sutures ; Urinary Bladder ; Urinary Incontinence