Calvarium protects the brain, the most important organ. The defect of calvarium results in not only deformity but also fatal injury from the trauma. The cranial bone defects result from 1) removal of bone flap for intracranial decompression or infection 2) fracture 3) excision of tumor 4) craniectomy for craniosynostosis. The goals of cranioplasty are to protect the brain from trauma and make the aesthetically acceptable contour. From 1990 to 1995, we experienced twelve cases of cranioplasty using autogenous bone graft; 5 cases with rib bone, 3 cases with iliac bone, 2 cases with calvarial bone, and 2 cases with rib and calvarial bones. The result was very excellent without any significant complications.
Brain ; Congenital Abnormalities ; Craniosynostoses ; Decompression ; Ribs ; Skull ; Transplants*

No abstract available.
Adolescent* ; Ecthyma* ; Humans ; Pseudomonas aeruginosa

Diagnosis and management of abdominal pain in old age is considered a challenge to emergency physicians. Stercoral perforation is an infrequent event, which most commonly develops in old age. We report on a case of stercoral perforation in an elderly woman, which, to the best of our knowledge, is one of a few reported cases in the medical literature. A 74-year-old woman who presented at our emergency department complaining of lower abdominal pain was found to have a perforation of the colon. Examination revealed a stercoral perforation by fecaloma. She underwent Hartman's operation and colostomy. Stercoral perforation is rare; however, emergency physicians should consider this disease entity in elderly patients with abdominal pain.
Abdominal Pain ; Aged ; Colon ; Colostomy ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Female ; Humans ; Intestinal Perforation ; Peritonitis

Corticobasal degeneration (CBD) is characterized by asymmetric clinical manifestations including asymmetrical apraxia, alien limb movement and Parkinsonian symptoms. Cognitive function is relatively normal in the early course of illness. We report a 59 years old right-handed male with CBD. He showed asymmetrical ideomotor apraxia, alien limb movement and extrapyramidal symptom, such as cogwheel rigidity and bradykinesia, that were more severe in the right hand. These symptoms have deteriorated progressively for 2 years, but the cognitive function was relatively pre-served. Brain MRI revealed atrophic changes in both parietal lobes. FDG-PET showed an asymmetrical hypometabo-lism in supplementary motor area, parietal lobe, thalamus and basal ganglia, which was more severe in the left than the right hemisphere.
Apraxia, Ideomotor ; Apraxias* ; Basal Ganglia ; Brain ; Emigrants and Immigrants ; Extremities ; Hand ; Humans ; Hypokinesia ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle Rigidity ; Parietal Lobe ; Thalamus

Adhesive capsulitis of the shoulder joint is a common disease characterized by pain at the insertional area of the deltoid muscle and decreased range of motion. The pathophysiological process involves fibrous inflammation of the capsule and intraarticular adhesion of synovial folds leading to capsular thickening and contracture. Regarding the multidirectional limitation of motion, a limitation in external rotation is especially prominent, which is related to not only global fibrosis but also to a localized tightness of the anterior capsule. Ultrasound and magnetic resonance imaging studies can be applied to rule out other structural lesions in the diagnosis of adhesive capsulitis. Hydraulic distension of the shoulder joint capsule provides pain relief and an immediate improvement in range of motion by directly expanding the capsule along with the infusion of steroids. However, the optimal technique for hydraulic distension is still a matter of controversy, with regards to the infusion volume and rupture of the capsule. By monitoring the real-time pressure-volume profile during hydraulic distension, the largest possible fluid volume can be infused without rupturing the capsule. The improvement in clinical outcomes is shown to be greater in capsule-preserved hydraulic distension than in capsule-ruptured distension. Moreover, repeated distension is possible, which provides additional clinical improvement. Capsule-preserved hydraulic distension with maximal volume is suggested to be an efficacious treatment option for persistent adhesive capsulitis.

Adhesive capsulitis of the shoulder joint is a common disorder characterized by a gradual increase of pain and limitation in range of motion of the shoulder joint. The pathophysiological process involves fibrous inflammation of the capsule leading to capsular thickening and contracture. Intra-articular corticosteroid injection is commonly performed in patients with adhesive capsulitis. However, there is no consensus as to the best injection site. Corticosteroid injection sites for the treatment include posterior capsule approach, rotator interval approach, multi-site, and subacromial injection. All injection methods lead to improvement in adhesive capsulitis cases. In this review article, we provide an overview of current corticosteroid injection methods for adhesive capsulitis.

PURPOSE: Acute thrombosis of arteriovenous graft (AVG) has been treated by surgical thrombectomy; however, endovascular treatment became an alternative treatment option recently. The purpose of this study is to evaluate the effectiveness of endovascular treatment for acute thrombosis of AVG (EndoAVG) by primary endovascular treatment strategy. METHODS: This is a retrospective study of patients who underwent EndoAVG from January 2003 to December 2010 in Inha University Hospital. The patients' clinical characteristics and EndoAVG procedures were reviewed by electronic charts and X-ray films. Clinical success was defined as the residual stenosis below 30% or success of hemodialysis. RESULTS: Thirty-eight patients were enrolled. The mean age was 64+/-15.4 years in the success group and 58+/-17.2 years in the failed group. The mean duration from AVG formation to endovascular thrombectomy was 19.2+/-29.5 months. The success rate of EndoAVG was 84.2% (32/38). There were three complications after EndoAVG: two brachial artery thromboses and one rupture of a vein at the ballooning site. Six months, twelve months and twenty-four months secondary patency rate were 77.5%, 65.5%, and 42.5%, respectively. CONCLUSION: The success rate of EndoAVG was 84.2%. Its result is compatible with open thrombectomy and can be a good alternative option for the treatment of acute thrombosis of AVG. Larger number of cases is required for stronger study.
Arteriovenous Fistula ; Brachial Artery ; Constriction, Pathologic ; Electronics ; Electrons ; Humans ; Renal Dialysis ; Retrospective Studies ; Rupture ; Thrombectomy ; Thrombosis ; Transplants ; Veins ; X-Ray Film

Hypercalcemia is a common complication in CAPD patients treated with calcium-containing phosphate binders and using the standard dialysate(Ca++ : 3.5 mEq/L). Furthermore, the high calcium concentration in standard dialysate may have a suppressive effect on parathyroid hormone(iPTH) level, contributing to the high prevalence of low-urnover bone disease. We studied the effect of low calcium dialysate(Ca++ : 2.5 mEq/L) for those patients with high risk of low- turnover bone disease. Among 386 patients(1996. 1.- 1999. 12.) who had been stable on CAPD for at least 3 months, 46 patients were included in this study. The patients were divided into 3 groups on the basis of the iPTH levels(<150 pg/mL) and/or corrected serum calcium levels(>10 mg/dL) before the conversion to low calcium dialysate. Group 1(n=29), iPTH <150 pg/mL and Ca++>10 mg/dL; Group 2 (n=14), iPTH <150 pg/mL and Ca++<10 mg/dL; Group 3(n=3), iPTH >150 pg/mL and Ca++ >10 mg/ dL. During a 2-month run-in period, those patients were treated with standard dialysate. After that, a 12-month therapy with low calcium dialysate was followed. Biochemical data including calcium, phosphorus, iPTH and alkaline phosphatase were measured regularly and daily phosphate binder and calcitriol intake(pill counting) were assessed during the run-in and therapy period. We obtained the following result: the prevalence of hypercalcemia(Ca++>10.5 mg/dL) was 5.7%(22/ 386 patients). Serum calcium levels decreased during the therapy period(12 months)(10.5+/-1.4 vs 9.4+/-1.3 mg/dL, p<0.05). Serum phosphorus levels remained unchanged. Mean serum alkaline phosphatase level increased(203.0+/-92.9 vs 257.2+/-103.4 U/L, p<0.05). Serum iPTH levels increased (92.7+/-128.8 vs 225.3+/-237.3 pg/mL,p<0.05). The mean intake of oral phosphate binders was not significantly different between run-in period and therapy period. But calcitriol doses increased 0.038+/-0.087 at run-in period to 0.158+/-0.288 tablets/person/day at therapy period(p<0.05). In the six patients, low calcium dialysate was converted to standard dialysate due to high iPTH level (n=3), symptomatic hypo calcemia(n=2), and uncontrolled edema(n=1). In conclusion, in the study of 46 patients over 12 month period, the usage of 2.5 mEq/L calcium dialysate resulted in a significant decrement in calcium levels and increased iPTH levels. Therefore, we propose that dialysis with a low calcium dialysate is an acceptable form of therapy for the patients with high risk of low-turnover bone disease showing hypercalcemia and low iPTH level. However, further study will be needed for evaluating the effect of low calcium dialysate in low-turnover bone disease.
Alkaline Phosphatase ; Bone Diseases* ; Calcitriol ; Calcium* ; Dialysis ; Humans ; Hypercalcemia ; Peritoneal Dialysis, Continuous Ambulatory* ; Phosphorus ; Prevalence

BACKGROUND: Therapy-related AML (t-AML) occurs as a late complication of chemotherapy administered to treat a prior disorder. Prognostic factors affecting the clinical outcome in t-AML have not yet been clearly defined; therefore, we evaluated these factors in this study. METHODS: Forty-eight patients diagnosed with t-AML within the past 10 years were enrolled, and their chemotherapy regimens categorized into 4 groups: alkylating agents (AK) only, topoisomerase II inhibitors (TI) and AK, TI only, and others. The prognostic factors affecting clinical outcome were evaluated. RESULTS: Five (10.4%), 21 (43.8%), 9 (18.8%), and 13 (27.0%) patients were treated with AK only, AK and TI, TI only, and others, respectively. Patients with an AML M3 phenotype showed significantly longer overall survival (OS; 55.1 vs. 14.3 months, P=0.040) and disease-free survival (DFS; 61.2 vs. 17.5 months, P=0.049) than other phenotypes. In contrast, patients with a complex karyotype showed significantly shorter OS (7.9 vs. 31.3 months, P=0.008) and DFS (9.5 vs. 38.6 months, P=0.046); additionally, patients with chromosome 5 or 7 abnormalities showed significantly shorter OS (9.1 vs. 30.7 months, P=0.011) than other phenotypes. Only the presence of a complex karyotype or AML M3 phenotype retained prognostic impact in a multivariate analysis. CONCLUSION: Only the AML M3 phenotype was identified as having a good prognosis, and this might suggest that it exhibits unique clinical features in t-AML patients. Moreover, our findings indicated that karyotype was the strongest prognostic indicator and predicted a poor prognosis for t-AML patients with a complex karyotype.
Alkylating Agents ; Chromosomes, Human, Pair 5 ; Disease-Free Survival ; Humans ; Karyotype ; Leukemia, Myeloid, Acute ; Phenotype ; Prognosis ; Topoisomerase II Inhibitors

No abstract available.
Dendritic Cells*