No abstract available.
Mass Screening*

PURPOSE: The purpose of this study was to evaluate the accuracy of Tc-99m DTPA diuretic renal scans in children upper urinary tract. MATERIALS AND METHODS: We reviewed diuretic renal scans of 14 pediatric patients (age range: 3 days to 4 years) with unilateral hydronephrosis diagnosed by ultrasonography. Diuretic renal scan was done using Tc-99m DTPA and standardized protocol. In 3 neonates, diuretic renal scans were performed within 1 week and 3-7 months after birth. RESULTS: Six patients required pyeloplasty and eight were managed conservatively. All 6 patients requiring pyeloplasty were diagnosed as having ureteropelvic junction obstruction in the diuretic renal scan. In these 6 patients, post-operative renal scans at 3-12 months after surgery were converted to nonobstructive pattern in 5 and a nonobstructive patterns in 1. In 3 patients who underwent diuretic renal scan within 1 week after birth., nonobstructive patterns of initial scan were coverted to obstructive patterns in the follow-up scan. However, all patients with nonobstructive diuretic renal scans performed after the neonatal period did well on serial ultrasonography and showed favorable clinical outcome without progression to obstruction. CONCLUSION: Tc-99m DTPA diuretic renal scan with standarized protocol is useful in assessing suspected ureteropelvic junction obstruction in children as an initial diagnostic or post-operative follow-up modality. Nonobstructive or indeterminate scan RESULTS in the neonatal period requires follow-up scan to monitor development of the obstructive pattern.
Child* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Infant, Newborn ; Kidney Pelvis ; Parturition ; Pentetic Acid* ; Radioisotope Renography* ; Ultrasonography ; Urinary Tract*

Myasthenia gravis is a neuromuscular disorder manifested by fatigability and weakness of the skeletal muscles. The basic defect in the myasthenia is the reduction of available acetylchopline receptors at neuromuscular junctions by an autoimmune mechanism. The thymus gland seems intimately involved in the disease process and removal of the thymus gland plays an important role in the management of this disease. In this article, we had three cases of thymectomies for myasthenia gravis. The first two were females, 17 and 26 year old. They were anesthetized for thymectomies using succinylcholine, pancuronium, sodium pentothal and. N2O-Halothane. The third case, a 40 year old female was not given any muscle relaxants because of the severity of the disease and her respiration was controlled for a month postoperatively. For the cases, the preoperative, intraoperative and postoperative management of anesthesia and the use of muscle relaxants are described.
Adult ; Anesthesia* ; Female ; Humans ; Muscle, Skeletal ; Myasthenia Gravis* ; Neuromuscular Junction ; Pancuronium ; Respiration ; Sodium ; Succinylcholine ; Thiopental ; Thymectomy* ; Thymus Gland

Porcelain is considered to be one of the materials of choice for restoration where esthetics is of concern. But porcelain surface without final glazing treatment may induce undesirable results such as inflammatory respones on adjacent soft tissues due to plaque accumulation and increased wear of opposing teeth. Therefore, rough porcelain surface must be smoothened by final glazing treatment or chairside polishing procedure. The purpose of this study was to compare the surface roughness among self-glazed, overglazed and polished porcelain with various polishing kit, and to detect which phase of polishing is optimal in clinic. Specimens were fabricated with Vita VMK porcelain. The surface treatment of each group was performed as follows. Group 1 : overglazing treatment Group 2 : self-glazing treatment Group 3 : polishing with the Truluster Polishing System for Porcelain(Brasseler, U.S.A.) Group 4 : polishing with the Exa Cerapol Adjustment kit (Edenta dental products, Switzerland) followed by finishing with diamond-filled polishing paste Group 5 : polishing with the Shofu Porcelain Adjustment kit (Shofu inc., Japan) followed by finishing with diamond-filled polishing paste. At each polishing steps, the measurement of Ra and Rq values were performed, and the surface was examined by scanning electron microscope. The results were as follows: 1. Overglazing treatment brought smoother surface than self-glazing treatment. 2. Polishing systems without porcelain polishing paste did not make better result than self-glazing treatment. 3. Polishing system with porcelain polishing paste made similar result to overglazing treatment. 4. Applying diamond-filled polishing paste after using polishing system which has porcelain polishing paste produced surface as smooth as overglazing treatment does.
Dental Porcelain* ; Esthetics ; Tooth

OBJECTIVE: This study was performed to determine the anatomical landmarks and optimal dissection points of the facial nerve (FN) and the hypoglossal nerve (HGN) in the submandibular region to provide guidance for hypoglossal-facial nerve anastomosis (HFNA). METHODS: Twenty-nine specimens were obtained from 15 formalin-fixed adult cadavers. Distances were measured based on the mastoid process tip (MPT), common carotid artery bifurcation (CCAB), and the digastric muscle posterior belly (DMPB). RESULTS: The shortest distance from the MPT to the stylomastoid foramen was 14.1+/-2.9 mm. The distance from the MPT to the FN origin was 8.6+/-2.8 mm anteriorly and 5.9+/-2.8 mm superiorly. The distance from the CCAB to the crossing point of the HGN and the internal carotid artery was 18.5+/-6.7 mm, and that to the crossing point of the HGN and the external carotid artery was 15.1+/-5.7 mm. The distance from the CCAB to the HGN bifurcation was 26.6+/-7.5 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, was about 35.8+/-5.7 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, corresponded to about 65.5% of the whole length of the DMPB. CONCLUSION: This study provides useful information regarding the morphometric anatomy of the submandibular region, and the presented morphological data on the nerves and surrounding structures will aid in understanding the anatomical structures more accurately to prevent complications of HFNA.
Adult ; Cadaver ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Facial Nerve ; Humans ; Hypoglossal Nerve ; Mastoid ; Muscles

OBJECTIVE: Progression after operation in traumatic brain injury (TBI) is often correlated with morbidity and poor outcome. We have investigated to characterize the natural course of traumatic intracranial hemorrhage and to identify the risk factors for postoperative progression in TBI. METHODS: 36 patients requiring reoperation due to hemorrhagic progression following surgery for traumatic intracranial hemorrhage were identified in a retrospective review of 335 patients treated at our hospital between 2001 and 2010. We reviewed the age, sex, Glasgow Coma Scale, the amount of hemorrhage, the type of hemorrhage, rebleeding site, coagulation profiles, and so on. Univariate statistics were used to examine the relationship between the risk factors and reoperation. RESULTS: Acute subdural hematoma was the most common initial lesion requiring reoperation. Most patients had a reoperation within 24-48 hours after operation. Peri-lesional edema (p=0.002), and initial volume of hematoma (p=0.013) were the possible factors of hemorrhagic progression requiring reoperation. But preoperative coagulopathy was not risk factor of hemorrhagic progression requiring reoperation. CONCLUSION: Peri-lesional edema and initial volume of hematoma were the statistical significant factors requiring reoperation. Close observation with prompt management is needed to improve the outcome even in patient without coagulopathy.
Brain Injuries ; Edema ; Glasgow Coma Scale ; Hematoma ; Hematoma, Subdural, Acute ; Hemorrhage ; Humans ; Intracranial Hemorrhage, Traumatic* ; Reoperation* ; Retrospective Studies ; Risk Factors*

OBJECTIVE: The aim of this study is to investigate the factors that may be related to bone graft infection and to contribute to lower the infection rate. According to current studies, the rate of bone graft infection after cranioplasty was reported up to 15.9% and this is significantly high. There are many analyses of the factors influencing bone graft infection, but this issue may need to be reconsidered in that the current medical environment is ever-changing. METHODS: We retrospectively reviewed the demographic, clinical data of 130 patients who underwent cranioplasty following decompressive craniectomy from January 2004 to December 2011. We analyzed several factors influencing bone graft infection and divided them into three categories of clinical, operation-related and hematological factors including white blood cell count, erythrocyte sedimentation rate, C-reactive protein and albumin. Statistical significance was done by chi-square test, Fisher's test and Mann-Whitney U test. RESULTS: The infection occurred in 12 patients in 130 cranioplasties (9.2%). There was no difference in infection rate between each group of early and later surgery, graft material, cause of craniectomy. Among many factors, low Glasgow Coma Scale (GCS< or =8) and combined ventriculoperitoneal (VP) shunt were significantly correlated with bone graft infection (p=0.025, p=0.025, respectively). There was no statistically significant difference in hematological analysis between groups. CONCLUSION: Low GCS and combined VP shunt with cranioplasty may increase the risk of bone graft infection.
Blood Sedimentation ; C-Reactive Protein ; Decompressive Craniectomy ; Glasgow Coma Scale ; Humans ; Leukocyte Count ; Retrospective Studies ; Risk Factors* ; Transplants*

PURPOSE: In order to assess the usefulness of serum ferritin as a marker of disease activity and prognostic factor in pediatric malignancy, serum ferritin levels were measured. METHODS: Peripheral blood samplings for ferritin level were made at presentation, in remission following therapy, and in relapse in 95 children with malignancy admitted to the Department of Pediatrics, Kosin University Gospel Hospital between January, 1986 and August, 1995. The patients were comprised of 35 acute lymphoblastic leukemia(ALL), 17 acute myelogenous leukemia(AML), 20 non- Hodgkin's lymphoma(NHL) and 23 neuroblastoma(NB). RESULTS: The mean values of serum ferritin at presentation were 465.3+/-53.9 ng/mL in ALL, 468.9+/-69.4 ng/mL in AML, 274.1+/-69.2 ng/mL in NHL and 337.3+/-64.4 ng/mL in NB. Those values were increased significantly compared to the mean of 20 control children(69.5+/-12.9 ng/mL). The mean values of serum ferritin concentration in remission stage(first, second, and third remission) tend to be lower compared to those in the active stage(at presentation, first relapse and second relapse). But these differences reached a statistical significance only in patients with ALL when the mean values of the active stage were compared to those checked in the remission stage over 12 months(P= 0.0002). Comparison of overall survival according to initial serum ferritin levels(below and above 200 ng/mL) did not show any significant difference in ALL, AML and NHL. However, there was a borderline relationship in NB(relative risk 3.12, P=0.06). CONCLUSION: The study showed that normalization of serum ferritin levels were found in ALL who had continuous, complete remission for more than 12 months. And patients with lower serum ferritin levels were not associated with better survival except in patients with NB in which the lower ferritin group showed borderline significance.
Child ; Ferritins* ; Humans ; Leukemia ; Lymphoma ; Neuroblastoma ; Pediatrics ; Prognosis ; Recurrence

OBJECTIVE: Lumbar spine stenosis (LSS) can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Minimally invasive surgery has come to be more commonly used for the treatment of LSS. The current study describes outcomes of bilateral microdecompression by unilateral or bilateral laminotomy (BML) for degenerative LSS after a minimum follow-up period of 3 years and investigates factors that result in a poor outcome. METHODS: Twenty-one patients who were followed-up for at least 3 years were included in this study. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, and disc height. RESULTS: Twenty-one patients (10 men, 11 women) aged 53-82 years (64.1+/-8.9 years) were followed-up for a minimum of 3 years (36-69 months). During follow-up, two patients underwent reoperation. Average preoperative JOA score and clinical symptoms, except persistent low back pain, improved significantly at the latest follow-up. There were no significant differences in radiological findings preoperatively and postoperatively. Thirteen patients (61.9%) had excellent to fair outcomes. CONCLUSION: BML resulted in a favorable and persistent outcome for patients with degenerative LSS without radiological instability over a mid-term follow-up period. Persistent low back pain unrelated to postoperative instability adversely affects mid-term outcomes.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Laminectomy* ; Low Back Pain ; Male ; Orthopedics ; Reoperation ; Spinal Stenosis* ; Spine ; Spondylolisthesis

OBJECTIVE: Distal middle cerebral artery (MCA) aneurysms are the least frequent aneurysms of the MCA, and they represent about 1.1 to 5% of all MCA aneurysms. Patients with ruptured distal MCA aneurysms generally have a poor clinical outcome. The purpose of this article is to review the characteristics of distal MCA aneurysms to avoid the complications of microsurgical dissection and clipping of distal MCA aneurysms. METHODS: A total of 1187 patients with ruptured aneurysms were treated at our hospital between January 1997 and May 2008. All patients underwent surgical procedures. Computed tomography (CT) revealed rupture of distal MCA aneurysms in 15 (1.26%) patients. The location of the aneurysm were the M2 (insular) segment in seven patients, the M2-3 junction in three and the M3 (opercular) segment in five. Brain CT images revealed the presence of both subarachnoid hemorrhage (SAH) and intracranial hemorrhage (ICH) in 11 of 15 (77.3%) patients, with a mean ICH volume of 14.5 cc (range : 5 to 32 cc). Rebleeding occurred in 7 out of the 15 (46.7%) patients. RESULTS: All the patients underwent early surgical procedures, including clipping in seven, trapping in two, bypass surgery in four, Guglielmi detachable coil embolization in one and exploratory craniotomy in one patient. The aneurysm had a fusiform appearance in 9 out of 15 cases (60%), and the mean size of the aneurysm was 10.4 mm (range : 2 to 35 mm). Three patients died due to severe brain swelling (20%). CONCLUSION: In this study, distal MCA aneurysms had a relatively fusiform shape as well as high rates of rebleeding and ICH. A good clinical outcome was associated with early surgery for adequately controlling brain swelling and preventing rebleeding.
Aneurysm ; Aneurysm, Ruptured ; Brain ; Brain Edema ; Cerebral Hemorrhage ; Craniotomy ; Humans ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Middle Cerebral Artery ; Rupture ; Subarachnoid Hemorrhage