PURPOSE: To evaluate dysphagia objectively and quantitatively, and ta clarify the effect of neck position and viscosity changes in patients with aspiration and laryngeal penetration. MATERIALS AND METHODS: We studied 35 patients with dysphagia and 21 normal controls using videofluoroscopy and scintigraphy. Videofluoroscopy was performed with barium with three different viscosity, and scintigraphy was done, with water, yogurt, and steamed egg mixed with Tc-99m tin colloid. 1f aspiration was found during videofluoroscopic examination, patients neck position was changed and study repeated. Videofluoroscopy was analyzed qualitatively. We calculated 7 quantitative parameters from scintigraphy. According to the videofluoroscopic findings, we divided patients into 3 subgroups; aspiration, laryngeal penetration, and no-aspiration group. RESULTS: The result of videofluoroscopy revealed that the most cornmon finding was the delay in triggering pharyngeal swallow. Pharyrigeal transit time (PTT) and pharyngeal swallowing efficiency(PSE) in patients with aspiration were significantly different from other groups. After neck position change, aspiration could be reduced in all of 7 patients, and laryngeal penetration reduced hy about 82%. PTT ancl PSE were also improved after position change. Aspiration and laryngeal penetration occurred more frequently in thin liquid swallowing than in thick liquid and solid swallowing. CONCLUSION: PTT and PSE were useful for the evaluation of dysphagia. Aspiration and laryngeal penetration could be reduced when appropriate position assumed, We could decrease the chance of aspiration by changing the patient diet consisIency. Scintigraphy might be useful tool to quantitate and follow up these changes.
Barium ; Colloids ; Deglutition ; Deglutition Disorders* ; Diet ; Evaluation Studies as Topic* ; Follow-Up Studies ; Humans ; Neck ; Ovum ; Radionuclide Imaging* ; Steam ; Tin ; Viscosity ; Water ; Yogurt

A case of 26 years old male having horseshoe kidney associated with giant hydronephrosis due to aberrant vessel was presented with a brief review of the literatures. The patient was managed by division of isthmus and nephrectomy with good result.
Adult ; Humans ; Hydronephrosis* ; Kidney* ; Male ; Nephrectomy

PURPOSE: With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications. MATERIALS AND METHODS: We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. RESULTS: The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%. CONCLUSION: Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.
Amputation ; Disease-Free Survival ; Extremities ; Female ; Femur ; Fibula ; Follow-Up Studies ; Humans ; Humerus ; Joint Instability ; Limb Salvage ; Male ; Neoplasm Metastasis ; Osteosarcoma ; Periprosthetic Fractures ; Recurrence ; Replantation ; Retrospective Studies ; Survival Rate ; Tibia ; Ursidae

No abstract available.
Observer Variation*

No abstract available.
Chylothorax*

Descending Necrotizing Mediastinitis (DNM) is a complication of oropharyngeal infections that can spread to the mediastinum. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. late diagnosis is the principal reason for the high mortality in DNM. An 18-year-old female admitted with Ludwig's angina from dental caries. Despite of combined antibiotics, dental extraction and drainge of submental abscess, infection spread to the cervical area. Chest computed tomogram revealed extension of the abscess to the pretracheal and periaortic space and development of bilateral pleural empyema. We performed bilateral cervical mediastinotomy and thoracotomy for drainage and debridement. Tracheostomy to secure the airway and postoperative pleural irrigation were performed. Postoperative course was uneventful and patient was discharged on the 40th postoperative day. It is important to perform chest CT scanning for early diagnosis of DNM when oropharyngeal infection spreads to the cervical area. Improved survival of patients with DNM implies early and radical surgical drainage and debridement via a cervical mediastinomy and thoracotomy.
Abscess ; Adolescent ; Anti-Bacterial Agents ; Debridement ; Delayed Diagnosis ; Dental Caries* ; Drainage ; Early Diagnosis ; Empyema, Pleural ; Female ; Humans ; Ludwig's Angina ; Mediastinitis* ; Mediastinum ; Mortality ; Thoracotomy ; Thorax ; Tomography, X-Ray Computed ; Tracheostomy

Giant cell myocarditis(GCM) is a rare inflammatory heart disease which is characterized by multinucleated giant cells and a granulomatous reaction. It usually progresses rapidly and results in a fatal course. We report a patient with giant cell myocarditis who was treated by cardiac transplantation. A 35-year-old male was admitted with dyspnea which had developed 4 months before. On echocardiography, the right and left ventricles were markedly dilated and severe global hypokinesia was noted. He was diagosed with dilated cardiomyopathy with secondary severe mitral regurgitation. His cardiac function deteriorated progressively. He underwent orthotopic heart transplantation. Grossly the heart was enlarged, weighing 420gm and round with a blunt apex. Both right and left ventricles were markedly dilated. There were numerous white patches, measuring up to 4cm, throughout the epi- and myocardium. Microscopically, extensive fibrosis and multiple exuberant granulomas with numerous scattered multinucleated giant cells were seen. Lymphocytes and eosinophils were also frequent. Coronary arteries were unremarkable. Neither microorganisms nor foreign materials were found. By serial endomyocardial biopsies of the transplanted heart, only mild perivascular lymphocytic infiltration was occasionally observed without any evidence of rejection or recurrence of giant cell myocarditis. The patient's postoperative course has been uneventful so far(postoperative 21 months). The etiology of GCM remains to be clarified, although various factors are suspected. No matter what the cause, our experience suggests that this grave disease might be treated well by heart transplantation.
Male ; Humans ; Biopsy

No abstract available.
Fatigue* ; Sciatica*

PURPOSE: Sentinel lymph node (SLNB) is the first confronted lymph node from primary lesion of tumor through lymphatic drainage, which is important for determining early metastasis and setting guidelines for treatment. We reported significant of sentinel lymph node biopsy in malignant melanoma (MM) and squamous cell carcinoma (SCC) of lower extremities. MATERIALS AND METHODS: Twenty-five cases of surgically treatment and being possible for follow up more than 1 year among the patients who were diagnosed as MM and SCC in this institution from Sep. 2005 to Jan. 2009, and 10 cases of them were performed SLNB. Average age was 64 years old, and 15 cases of male and 10 cases of female were in this group. RESULTS: 3 years overall survival rate was 100% and 3 years disease-free survival rate was 76%. Metastasis occurred in total 6 patients, 4 cases of inguinal lymph nodes, 1 case of soft tissue around knee, 1 case of left achilles tendon. In 15 cases of not performing SLNB, overall survival rate was 93.3% and disease-free survival rate was 73.3%. In 10 cases of performing SLNB, overall survival rate was 100% and disease-free survival rate was 90%. And only 1 case showed positive finding in the biopsy, and none of the 10 cases showed metastasis in follow-up. CONCLUSION: SLNB leads simpler and less complications compared to prior elective lymph node dissection, and shows high degree of accuracy. Throughout the SLNB, setting guidelines for treatment by accurate staging is thought to be helpful for increasing the survival rate in the patient with MM and SCC.
Achilles Tendon ; Biopsy ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Drainage ; Female ; Follow-Up Studies ; Humans ; Knee ; Lower Extremity ; Lymph Node Excision ; Lymph Nodes ; Male ; Melanoma ; Neoplasm Metastasis ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy ; Survival Rate

No abstract available.