Lumbar hernias are rare posterolateral abdominal wall defects that may be congenital or acquired. There are two types of lumbar hernia, the superior lumbar hernia through Grynfeltt triangle, and the inferior lumbar hernia through Petit triangle. Many techniques have been described for the surgical repair of lumbar hernias including primary repair, local tissue flaps, and conventional mesh repair. But these open techniques require a large skin incision. We report a case of superior lumbar hernia, which was successfully repaired using a laparoscopic approach.
Abdominal Wall ; Hernia ; Skin

In this paper, waveform preserving coding technique is proposed for the bio-signals based on wavelet transform local maxima representation. In order to efficiently encode the bio-signal, it utilize the inherent property of bio-signals that sharp waves corresponding to the local maxima in wavelet domain contain the most of the clinically significant information in general. The testing sets of ECG and EEG are experimented to select the appropriate wavelet basis and to demonstrate the usefulness regarding to coding efficiency. The spline basis is more suitable in designing the coder than the Harr basis since the spline basis produces less number of local maxima than the Harr basis. The proposed wavelet method based on spline basis outperforms the conventional subband coding technique in terms of wave form degradation and coding efficiency. The actual transmission experiment using external communication network and the general personal computer demonstrates the applicability to telemedicine system handling the bio-signals.
Clinical Coding ; Electrocardiography ; Electroencephalography ; Microcomputers ; Telemedicine* ; Wavelet Analysis

PURPOSE: This study was performed to compare osteogenic capacity according to the scaffold, i.e., calcium metaphosphate on purified bovine collagen (Lubboc(R)). MATERIALS AND METHODS: Calcium metaphosphate and Lubboc blocks were immersed within a bone marrow cell suspension from New Zealand white male rabbit anterior superior iliac spine to produce cell-biomaterial complexes. These were cultured for 5 weeks in osteogenic media and differences with bone densitometry, light microscopic examination, electron microscopic examination, concentration of osteocalcin from osteoblasts were then evaluated. RESULTS: In light microscopic examination, more organized tissue was observed in the Lubboc(R) group. By electron microscopy osteoblasts and the matrix were densely overlapped on the surface of the Lubboc(R) group, whereas cells were scattered on the calcium metaphosphate. Immunohistologic examination for osteocalcin was definitely positive in the Lubboc(R) group, but the reaction on the calcium metaphosphate was unclear, and densitometry revealed that Lubboc(R) (0.028 gms/cm2) showed a statistically significant higher density than calcium metaphosphate (0.026 gms/cm2). CONCLUSION: Highly purified bovine collagen was more effective than calcium metaphosphate in osteogenesis in vitro.
Bone Marrow Cells ; Calcium* ; Collagen ; Densitometry ; Heterografts* ; Humans ; Male ; Microscopy, Electron ; New Zealand ; Osteoblasts* ; Osteocalcin ; Osteogenesis* ; Spine

Despite recent improvements in operative techniques, immunosuppression and organ procurement, failure of a hepatic allograft remains an important risk to liver recipients. In the absence of any effective method of extracorporeal support, the only alternative to death for these patients is retransplantation. The causes of hepatic allograft failure were listed as primary nonfunction, technical included hepatic artery thrombosis or portal vein thrombosis, and rejection. Hepatic artery thrombosis remain one of most serious complication after liver transplantation and can be associated with one of three typical syndrome: acute, massive hepatic necrosis, biliary tract necrosis and leakage, relapsing bacteremia. The early diagnosis of hepatic artery thrombosis is very important and screening with duplex ulrtasound can allow the recognition of early hepatic artery thrombosis. The emgent revascularization of hepatic artery thrombosis in asymptomatic patient and retransplantation in symptomatic patient lead to improved graft salvage and patient survival. We report one case of hepatic retransplantation due to hepatic artery thrombosis. The patient with 30 years old man underwent primary hepatic transplantation due to liver cirrhosis with hepatocellular carcinoma. After 6th postoperative day of primary transplantation, liver transaminase began to elevate and not responded to steroid pulse therapy. Thereafter bile leakage, evident in T-tube cholangiogram was noted. Explolaparotomy was performed and showed hepatic artery thrombosis and necrosis of donor aspect of extrahepatic biliary tree. On next day, retransplantation was performed. Thereafter secondary graft function was slowly regained but the patient was recoverd and discharged.
Adult ; Allografts ; Bacteremia ; Bile ; Biliary Tract ; Carcinoma, Hepatocellular ; Early Diagnosis ; Hepatic Artery ; Humans ; Immunosuppression ; Liver ; Liver Cirrhosis ; Liver Transplantation ; Mass Screening ; Massive Hepatic Necrosis ; Necrosis ; Thrombosis ; Tissue and Organ Procurement ; Tissue Donors ; Transplants ; Venous Thrombosis

BACKGROUND: Nitrous oxide is a safe analgesics which has analgesic and sedative effects without loss of consciousness. The advantage of Nitrous oxide is that it has a rapid onset time and that we can modulate duration of its action. The purpose of this experiment is to obtain the safe and effective concentration of Nitrous oxide in Emergency Department as use of analgesics and sedative drugs. METHODS: Twenty volunteers were investigated according to double blind method. Nitrous oxide was administrated to volunteer subjects at different concentrations ; 33%, 50%, 67% each. Then we evaluated the Pain score, Blood pressure, Heart rate, Respiratory rate, Oxygen saturation and its side effects. RESULTS: Pain Score were 8.4+/-2.1 at 33%, 6.1+/-1.5 at 50%, and 3.65+/-2.2 at 67% of Nitrous oxide. Pain Score is decreased significantly following administration of Nitrous oxide at concentration of 50%, 67%(P<0.05). There was no difference between preadministration group and postadministration group. While no remarkable change in systolic blood pressure, heart rate, and oxygen saturation. Respiratory rate showed significant increase when 679o of Nitrous oxide was administrated. There was no side effect in administration of 33% of Nitrous oxide. When 50% of Nitrous oxide was administrated, there were dizziness 5(25%), paresthesia 2(10%), nausea 1(5%), palpitation 1(5%) and hyperethesia 1(5%). At 679o of Nitrous oxide, there were nausea 7(35%), dizziness 6(30%), paresthesia 5(25%), headache 5(25%), diplopia 2(10%), dysphoria 2(10%), salivation 1(5%), dyspnea 1(5%), nystagmus 1(5%), tinnitus 1(5%) and euphoria1 (5%). Incidence of side effect increased as the concentration of Nitrous oxide was increased. CONCLUSION: We can conclude that safe and effective concentration of Nitrous oxide is 50% as analgesics and sedative drugs in the emergency department.
Analgesics ; Blood Pressure ; Diplopia ; Dizziness ; Double-Blind Method ; Dyspnea ; Emergency Service, Hospital ; Headache ; Heart Rate ; Hemodynamics* ; Hypnotics and Sedatives ; Incidence ; Nausea ; Nitrous Oxide* ; Oxygen ; Paresthesia ; Respiratory Rate ; Salivation ; Tinnitus ; Unconsciousness ; Volunteers

Software modules for interactive display, manipulation and retrieval of medical images have been designed for a Picture Archiving and Communications System (PACS). The target of these modules is not for a high-end diagnostic workstation for radiologists, but for a PC-based low cost clinical workstation for a referring physician. This software is constructed based on a concept of an object-oriented language which is designed to be modular and expandable. It consists of several functional modules: (a) a communication module for image retrieval, (b) a standard module for the interpretation of the DICOM images, (c) a user interface module for the non-computer oriented clinicians and (d) a tool module for viewing and manipulating images as well as editing the annotation.
Image Processing, Computer-Assisted/instrumentation* ; Radiology Information Systems* ; Software*

Primary Signet-ring-cell adenocarcinoma of the urinary bladder is an extremely rare variant that promotes considerable interest, 21 cases reported as of 1981. Morphologically, this tumor is identical to signet-ring-cell carcinomas of the gastrointestinal tract, breast, lung and nasal cavity, and differentiation must be carried out with great care. Characteristically, primary signet-ring-cell adenocarcinoma carries a poor prognosis with early penetration of the mucosa, submucosa, and muscularis. This tumor is sessile, infiltrates early, extends locally to adjacent organs, and metastasized late. Many patients reported died of local extension with ureteral obstruction and uremia rather than wide spread metastasis. We are reporting two cases of primary signet-ring-cell adenocarcinoma of the urinary bladder treated with radical cystectomy and transurethral resection with radiotherapy, which died of local extension with ureteral obstruction and uremia, with pathological findings and review of the literatures.
Adenocarcinoma* ; Breast ; Cystectomy ; Gastrointestinal Tract ; Humans ; Lung ; Mucous Membrane ; Nasal Cavity ; Neoplasm Metastasis ; Prognosis ; Radiotherapy ; Uremia ; Ureteral Obstruction ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: Sporadic colorectal cancers, with DNA microsatellite instability (MSI), have been characterized by a predilection area of proximal colon, younger age onset, exophytic growth and larger tumor size. MSI colorectal cancers have recently been had a good survival rate. The aim of this study is to determine the MSI status in sporadic colorectal cancers, and compare their clinical and pathological characteristics with those of MSS (Microsatellite Stable) cancers. METHODS: Between March 1995 and December 1997, deep frozen fresh tissue of 107 eligible colorectal cancer patients, who underwent surgical resections, were used for analysis. Hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis, patients were excluded. All the patients were registered on a colorectal cancer database, and followed up completely with regular visits for a potential recurrence. Genomic DNA was prepared by the SDS-proteinase K and phenol chloroform extraction methods. The DNA was amplified by PCR at five microsatellite loci (BAT26, BAT25, D2S123, D5S346, and D17S250) to evaluate the MSI. The PCR products were separated in 6% polyacrylamide gels, containing 5.6 M urea, followed by autoradiography. The MSI was defined as being over 2 marker positive, and the MSS as 1 marker positive, all marker negatives were classed as MSS. The survival rates were calculated by the Kaplan- Meier methods. RESULTS: MSI was noted at 16/107 (15%), with mean ages for the patients of 51.8 vs. 58.6 years old for MSI and MSS, respectively. For the patients under 40 years old 5 (31.3%) vs. 6 (6.6%) had MSI and MSS, respectively (P<0.01). The cancer was located in the right colon in 12 of each of the MSI and MSS (P<0.01). There were no MSI rectal cancer tumors. The average tumor sizes were 7.6 3.6 cm vs. 5.3 2.2 cm (P<0.01) for MSI and MSS, respectively, but there were no correlations with the frequency of associated polyps, recurrence and distant metastasis between MSI and MSS. The cells were well differentiated (12.5% vs. 17.6%), moderately differentiated (68.8% vs. 76.9%), poorly differentiated (6.2% vs. 3.3%), and mucinous type (12.5% vs. 2.2%), with MSI and MSS, respectively. The overall survival rates were 93.8% vs. 73.8% for MSI and MSS (P=0.07), respectively. CONCLUSIONS: Sporadic colorectal cancer, with DNA microsatellite instability (MSI), was located predominantly in the proximal colon, in the younger age onset, and larger size of tumor. The survival rate of the patients with MSI tumors were good, but with no statistical significance.
Adenomatous Polyposis Coli ; Adult ; Autoradiography ; Chloroform ; Colon ; Colorectal Neoplasms* ; Colorectal Neoplasms, Hereditary Nonpolyposis ; DNA* ; Gels ; Humans ; Microsatellite Instability* ; Microsatellite Repeats* ; Mucins ; Neoplasm Metastasis ; Phenol ; Polymerase Chain Reaction ; Polyps ; Rectal Neoplasms ; Recurrence ; Survival Rate ; Urea

We report on a case of torsion of an accessory spleen occurring in a 19-year-old female. She was admitted with a three-day history of left-upper quadrant pain that became slowly aggravated. On physical examination, left-side abdominal tenderness was observed, most markedly in the left upper quadrant, but no rebound tenderness was noted. Contrast-enhanced computed tomography (CT) scan showed a non-enhancing mass with a tubular vascular pedicle and normal enhancing spleen in the left upper abdomen. Doppler ultrasound showed no vascular flow within the hypoechoic mass in the left upper abdomen. Torsion of an accessory spleen was suspected, and emergent laparoscopic exploration was performed. Laparoscopic exploration showed a large rounded violet mass with a tw isted vascular pedicle, located anterior to the normal spleen. The mass was excised laparoscopically and then removed through a 2.5 cm extended incision of the left-sided trocar incision. Postoperative recovery was normal and she was discharged on the fifth postoperative day.
Abdomen ; Female ; Humans ; Physical Examination ; Spleen* ; Surgical Instruments ; Ultrasonography ; Viola ; Young Adult

We report on a case of torsion of an accessory spleen occurring in a 19-year-old female. She was admitted with a three-day history of left-upper quadrant pain that became slowly aggravated. On physical examination, left-side abdominal tenderness was observed, most markedly in the left upper quadrant, but no rebound tenderness was noted. Contrast-enhanced computed tomography (CT) scan showed a non-enhancing mass with a tubular vascular pedicle and normal enhancing spleen in the left upper abdomen. Doppler ultrasound showed no vascular flow within the hypoechoic mass in the left upper abdomen. Torsion of an accessory spleen was suspected, and emergent laparoscopic exploration was performed. Laparoscopic exploration showed a large rounded violet mass with a tw isted vascular pedicle, located anterior to the normal spleen. The mass was excised laparoscopically and then removed through a 2.5 cm extended incision of the left-sided trocar incision. Postoperative recovery was normal and she was discharged on the fifth postoperative day.
Abdomen ; Female ; Humans ; Physical Examination ; Spleen* ; Surgical Instruments ; Ultrasonography ; Viola ; Young Adult