There are many kinds of instrumentation systems for posterior operation in the treatment of scoliosis. Cotrel-Dubousset (C-D) system is most widly used for its excellent correction potential and stability. However there were some problems in C-D hook system such as hook dislodgement and correction loss. So, in order to reduce these problems we use transpedicular screw system and compare the results between two systems. We studied 44 cases of scoliosis ( hook 19 cases, screw 25 cases) who were operated with C-D instrumentation from February 1988 to August 1995. The average follow-up period was 54 months in hook group and 23 months in screw group. 1. Operation time was 241 minutes in hook group and 223 minutes in screw group. Average amount of transfusion was 5.0 pints in hook group and 4.6 pints in screw group. 2. Involved segments of main curvature were 7.0 in hook group and 6.6 in screw group. 3. Scoliotic curve was changed from 49degrees to 13degrees (73%) in hook group and from 47degrees to 12degrees (74%) in screw group. Loss of correction during follow up period was 7degrees in hook group and 3 in screw group. 4. Thoracic kyphosis was changed from 24degrees to 26degrees in hook group and from 27degrees to 30degrees in screw group. Lumbar lordosis was changed from 26degrees to 29degrees in hook group and from 26degrees to 31degrees in screw group. 5. Correction rate of rotation of apex vertebrae by Pedriolle method was 43% (from 20degrees to 12degrees) in hook group and 50% (from 22degrees to 11degrees) in screw group. 6. Complications were two cases of hook dislodgement, one delayed deep infection and four cases of progression of curvature in hook group and one case of malinsertion of screw and two cases of progression of curvature in screw group. In conclusion, these results suggested that screw system is more effective than hook system on rotational correction of apex vertebra and prevention of loss of correction.
Animals ; Follow-Up Studies ; Kyphosis ; Lordosis ; Scoliosis* ; Spine

PURPOSE: Islet cell tumors are a rare disease that can be cured by surgical management if they are early diagnosed. However, diagnosis and localization are difficult due to their small size and varied clinical manifestations. We analyzed the clinicopathologic features, the diagnosis and the surgical management of islet cell tumors. METHODS: We retrospectively analyzed the case histories of 30 patients had undergone pancreatic surgery for islet cell tumors between April 1990 and December 1999. RESULTS: The islet-cell tumors included 16 insulinomas, 4 gastrinomas, 1 glucagonoma, one insulin-gastrin secreting tumor, and 8 nonfunctioning tumors. The major clinical manifestations were neuroglycopenic (94%) and adrenergic (75%) symptoms in cases of an insulinoma, abdominal ulcer symptoms (100%) in the cases of a gastrinoma, diabetis mellitus (100%) in the cases of a glucagonoma, and abdominal pain (63%) and a mass (25%) in nonfunctioning tumor. The preoperative tumor localization tools were angiography, transhepatic portal vein sampling, endoscopic ultrasonography, computed tomography, and octreotide scans which had sensitivities of 56%, 71%, 55.5%, 43.3%, and, 25% respectively. The surgical treatments were enucleation (38%) or segmental resection (25%) for insulinomas, pancreaticoduodenectomy with total gastrectomy (25%) or total pancreatectomy (25%) for gastrinomas, and pylorus preserving pancre aticoduodenectomy (38%) or regional pancreatectomy (26%) for nonfunctioning tumors. Malignant islet cell tumors were presenting cases (30%). Two patients died with postoperative complications on post operative day 3 and 35; the others survived during the follow-up period (1 month-10 years). Islet cell tumors with multiple endocrine neoplasm type I occurred in five (17%) cases; in three cases, the tumors were malignant. CONCLUSION: The early diagnosis and vigorous attempt to resect the lesion in islet cell tumors of the pancreas should be carried out for the long-term survival.
Abdominal Pain ; Adenoma, Islet Cell* ; Angiography ; Diagnosis ; Early Diagnosis ; Endosonography ; Follow-Up Studies ; Gastrectomy ; Gastrinoma ; Glucagonoma ; Humans ; Insulinoma ; Islets of Langerhans* ; Octreotide ; Pancreas* ; Pancreatectomy ; Pancreaticoduodenectomy ; Portal Vein ; Postoperative Complications ; Pylorus ; Rare Diseases ; Retrospective Studies ; Ulcer

OBJECTIVE: This study was to compare the characteristics between parthenogenetic mES (P-mES) cells and in vitro fertilization mES cells. MATERIAL AND METHODS: Mouse oocytes were recovered from superovulated 4 wks hybrid F1 (C57BL/6xCBA/N) female mice. For parthenogenetic activation, oocytes were treated with 7% ethanol for 5 min and 5microgram/ml cytochalasin-B for 4 h. For IVF, oocytes were inseminated with epididymal perm of hybrid F1 male mice(1x106/ml). IVF and parthenogenetic embryos were cultured in M16 medium for 4 days. Cell number count of blastocysts in those two groups was taken by differential labelling using propidium iodide (red) and bisbenzimide (blue). To establish ES cells, blastocysts in IVF and parthenogenetic groups were treated by immunosurgery and recovered inner cell mass (ICM) cells were cultured in LIF added ES culture medium. To identity ES cells, the surface markers alkaline phosphatase, SSEA-1, 3, 4 and Oct4 staining were examined in replated ICM colonies. Chromosome numbers in P-mES and mES were checked. Also, in vitro differentiation potential of P-mES and mES was examined. RESULTS: Although the cleavage rate (> or =2-cell) was not different between IVF (76.3%) and parthenogenetic group (67.0%), in vitro development rate was significantly low in parthenogenetic group (24.0%) than IVF group (68.4%) (p<0.05). Cell number count of ICM and total cell in parthenogenetic blastocysts (9.6+/-3.1, 35.1+/-5.2) were significantly lower than those of IVF blastocysts (19.5+/-4.7, 63.2+/-13.0) (p<0.05). Through the serial treatment procedure such as immunosurgery, plating of ICM and colony formation, two ICM colonies in IVF group (mES, 10.0%) and three ICM colonies (P-mES, 42.9%) in parthenogenetic group were able to culture for extended duration (25 and 20 passages, respectively). Using surface markers, alkaline phosphatase, SSEA-1 and Oct4 in P-mES and mES colony were positively stained. The number of chromosome was normal in ES colony from two groups. Also, in vitro neural and cardiac differentiation derived from mES or P-mES cells was confirmed. CONCLUSION: This study suggested that P-mES cells can be successfully established and that those cell lines have similar characteristics to mES cells.
Alkaline Phosphatase ; Animals ; Antigens, CD15 ; Bisbenzimidazole ; Blastocyst ; Cell Count ; Cell Line ; Embryonic Stem Cells* ; Embryonic Structures ; Ethanol ; Female ; Fertilization in Vitro* ; Humans ; Male ; Mice* ; Oocytes ; Propidium

OBJECTIVE: This study was to investigate the generation of the functional neuron derived from human embryonic stem(hES,MB03) cells on in vitro neural cell differentiation system. METHODS: For neural progenitor cell formation derived from hES cells, we produced embryoid bodies (EB: for 5 days, without mitogen) from hES cells and then neurospheres (for 7~10 days, 20 ng/ml of bFGF added N2 medium) from EB. And then finally for the differentiation into mature neuron, neural progenitor cells were cultured in i) N2 medium only (without bFGF),ii) N2 supplemented with 20 ng/ml platelet derived growth factor-bb (PDGF-bb) or iii) N2 supplemented with 5 ng/ml brain derived neurotrophic factor (BDNF) for 2 weeks. Identification of neural cell differentiation was carried out by immunocytochemistry using betaIII-tubulin (1:100) and GFAP (1:500). Also, generation of functional neuron was identified using anti-glutamate (Sigma, 1:1000), anti-GABA (Sigma, 1:1000), anti-serotonin (Sigma, 1:1000) and anti-tyrosine hydroxylase (Sigma, 1:1000). RESULTS: In vitro neural cell differentiation, neurotrophic factors (PDGF and BDNF) treated cell groups were high expressed MAP-2 and GFAP than non-treated cell group. The highest expression pattern of MAP-2 and betaIII-tubulin was indicated in BDNF treated group. Also, in the presence of PDGF-bb or BDNF, mostof the neural cells derived from hES cells were differentiated into gultamate and GABA neuron in vitro. Furthermore, we confirmed that there were a few serotonin and tyrosine hydroxylase positive neuron in the same culture environment. CONCLUSION: This results suggested that the generation of functional neuron derived from hES cells was increased by addition of neurotrophic factors such as PDGF-bb or BDNF in b-FGF induced neural cell differentiation system and especially gultamate and GABA neurons were mainly produced in the system.
Blood Platelets ; Brain-Derived Neurotrophic Factor* ; Cell Differentiation* ; Embryoid Bodies ; Embryonic Stem Cells* ; gamma-Aminobutyric Acid ; Humans* ; Immunohistochemistry ; Nerve Growth Factors ; Neurons* ; Serotonin ; Stem Cells ; Tyrosine 3-Monooxygenase

159 histologically proved cases of lung cancer have been reviewed at the Department of Internal Medicine, Yeungnam University Medical School for the past two years and six months from January, 1984 to July 1986. 1. The age distribution ranged from 27 to 87 years and 69.2% of the patient were distributed between the ages of 51 and 70. 2. The ratio of male and female was 4.6 : 1 (131 males, 28 females) 3. Chief complains were in order of dyspnea, chest pain, cough, hemoptysis and weight loss. 4. Localization on chest film. Right was more than left (right 58.6%, left 36.2%) and the most frequent site is right upper lung field (33 cases, 21.7%) 6. 76.8% of case was diagnosed histologically under the bronchoscopic biopsy. 8. The most common treatment was conservative therapy In general. However chemotherapy was most common treatment of the small cell type carcinoma.
Age Distribution ; Biopsy ; Chest Pain ; Clinical Study* ; Cough ; Drug Therapy ; Dyspnea ; Female ; Hemoptysis ; Humans ; Internal Medicine ; Lung Neoplasms* ; Lung* ; Male ; Schools, Medical ; Thorax ; Weight Loss

Infection of both native and prosthetic vessels in the groin is a very serious disease because of recurrent arterial rupture and sepsis, which can cause death. The successful treatment of groin infection, including infection of the femoral artery, requires extensive excision of the infected tissues and restoration of the circulation where the infected area is isolated. Here we describe a case of obturator bypass in a patient with infected femoral artery rupture that occurred after extracorporeal membrane oxygenation for myocarditis and severe heart failure.
Extracorporeal Membrane Oxygenation ; Femoral Artery ; Groin ; Heart Failure ; Humans ; Myocarditis ; Rupture ; Sepsis

BACKGROUND: Primary cardiac tumors are extremely rare. The most common type are benign myxomas, and these are almost completely curable with early surgery. Malignant tumors, however, such as sarcomas, are difficult to remove surgically, and their prognosis is known to be poor. In this study, data on patients who had undergone surgical treatment of cardiac tumor in the authors' hospital were collected and analyzed. MATERIAL AND METHOD: The subjects included 28 patients who had undergone surgical treatment of cardiac tumor from August 1993 to December 2008. Their medical records were reviewed and retrospectively analyzed. RESULT: The patients were aged from 20 to 76 years (mean age: 54.2+/-15.6), and 11 were male (39%) and 17 female (61%). Fifteen of them (54%) underwent emergency surgery to improve heart failure symptoms. The most common preoperative symptom was dyspnea (15 cases, 54%). Preoperative echocardiography was performed on all the patients. The average size of the tumor as measured during the operation was 7.0+/-6.9 cm (the average length of the long axis was 2~40 cm), and the sites of tumor attachment were the interatrial septum (18 cases, 64%), the left atrium (9 cases, 32%), the mitral valve annulus (2 cases, 7%), and the left ventricle (2 cases, 7%). The operation was performed with an incision through both atria in all the patients, and a complete excision was made in 25 cases (89%). According to the biopsy results, there were 4 cases of sarcoma (14%), 1 case of lipoma (4%), and 23 cases of myxoma (82%). The three cases in which the tumors were not completely excised were sarcomas. No operative deaths occurred after the operations. Outpatient follow-up was possible for 24 cases (86%), with a mean follow-up period of 46.8+/-42.7 months. Late death occurred in 3 of the 24 patients; each of these patients had sarcomas. Of these patients, the first had undergone two repeat surgeries, the second had metastatic sites removed, and the last had only chemotherapy. The average recurrence time was 12.7+/-10.8 months, and the average metastasis time was 20.5+/-16.8 months. CONCLUSION: Most cardiac tumors are benign myxomas. In principle, they should be surgically treated because they can create risks such as embolism, and can be radically treated when surgically removed. In most cases, however, malignant sarcomas are already considerably advanced with severe infiltration into the neighboring tissues at the time of diagnosis. The surgical removal of malignant sarcomas is known to be difficult because of the advanced stage and degree of infiltration. We suggest that excision of the removable portion of the tumor sites to alleviate symptoms such as heart failure can improve quality of life.
Aged ; Axis, Cervical Vertebra ; Biopsy ; Dyspnea ; Echocardiography ; Embolism ; Emergencies ; Female ; Follow-Up Studies ; Heart Atria ; Heart Failure ; Heart Neoplasms ; Heart Ventricles ; Humans ; Lipoma ; Male ; Medical Records ; Mitral Valve ; Myxoma ; Neoplasm Metastasis ; Outpatients ; Prognosis ; Quality of Life ; Recurrence ; Retrospective Studies ; Sarcoma

OBJECTIVE: Despite increased survival in patients with cardiac arrest, it remains difficult to determine patient prognosis at the early stage. This study evaluated the prognosis of cardiac arrest patients using brain injury, inflammation, cardiovascular ischemic events, and coagulation/fibrinolysis markers collected 24, 48, and 72 hours after return of spontaneous circulation (ROSC).METHODS: From January 2011 to December 2016, we retrospectively observed patients who underwent therapeutic hypothermia. Blood samples were collected immediately and 24, 48, and 72 hours after ROSC. Neuron-specific enolase (NSE), S100-B protein, procalcitonin, troponin I, creatine kinase-MB, pro-brain natriuretic protein, D-dimer, fibrin degradation product, antithrombin-III, fibrinogen, and lactate levels were measured. Prognosis was evaluated using Glasgow-Pittsburgh cerebral performance categories and the predictive accuracy of each marker was evaluated. The secondary outcome was whether the presence of multiple markers improved prediction accuracy.RESULTS: A total of 102 patients were included in the study: 39 with good neurologic outcomes and 63 with poor neurologic outcomes. The mean NSE level of good outcomes measured 72 hours after ROSC was 18.50 ng/mL. The area under the curve calculated on receiver operating characteristic analysis was 0.92, which showed the best predictive power among all markers included in the study analysis. The relative integrated discrimination improvement and category-free net reclassification improvement models showed no improvement in prognostic value when combined with all other markers and NSE (72 hours).CONCLUSION: Although biomarker combinations did not improve prognostic accuracy, NSE (72 hours) showed the best predictive power for neurological prognosis in patients who received therapeutic hypothermia.
Biomarkers ; Brain Injuries ; Creatine ; Discrimination (Psychology) ; Fibrin ; Fibrinogen ; Heart Arrest ; Humans ; Hypothermia, Induced ; Inflammation ; Lactic Acid ; Phosphopyruvate Hydratase ; Prognosis ; Retrospective Studies ; ROC Curve ; Troponin I

Objective: Tsutsugamushi disease is a febrile illness caused by tick bites. Delay in making the diagnosis and treatment cause an increase of the frequency of complications and mortality. The aim of this study was to determine quick sequential organ failure assessment (qSOFA) to predict the clinical outcome of scrub typhus patients in emergency departments. Methods: This was a retrospective, observational study of patients with tsutsugamushi disease and who presented to the emergency department of an urban hospital and a rural tertiary hospital between January 2013 and December 2018. The demographic and laboratory data was collected through a chart review. Statistical analysis was performed by dividing the patients into the general ward admission group (general ward) and the intensive care unit admission group (ICU). Results: Age, Acute Physiology and Chronic Health Evaluation II (APACHE) II score and laboratory tests such as pH, leukocyte count, C-reactive protein, and procalcitonin also showed significant differences between the general ward and ICU groups on the univariable logistic regression analysis, but only the qSOFA score among the variables showed a significant difference on the multivariate logistic regression analysis (P=0.014). Conclusion The qSOFA score will be a prompt and useful tool for predicting the prognosis of patients with tsutsugamushi disease in the emergency department.

A 47-year-old man presented with complaints of chest pain and dyspnea caused by deceleration injury due to an automobile accident. Systolic cardiac murmur was audible at the right sternal border. An electrocardiogram showed sinus tachycardia. Transthoracic echocardiography revealed a flailing anterior leaflet of the tricuspid valve, papillary muscle rupture, and severe valve insufficiency. Rupture of papillary muscle of the anterior leaflet and chordae tendineae of the posterior leaflet were confirmed by right atrial incision under routine cardiopulmonary bypass. Artificial chordae tendineaes were implanted between the anterior and posterior leaflet and papillary muscles in the right ventricles. De-Vega annuloplasty was also added. This is a very rare case in which a surgery was done for tricuspid valve regurgitation caused by post-traumatic papillary muscle rupture.
Automobiles ; Cardiopulmonary Bypass ; Chest Pain ; Chordae Tendineae ; Deceleration ; Dyspnea ; Echocardiography ; Electrocardiography ; Heart Murmurs ; Heart Ventricles ; Humans ; Middle Aged ; Papillary Muscles ; Rupture ; Tachycardia, Sinus ; Thorax ; Tricuspid Valve ; Tricuspid Valve Insufficiency