STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To discuss the iatrogenic intradural-extramedullary epidermoid cyst and review the literatures. SUMMARY OF LITERATURE REVIEW: Intradural epidermoid cyst has two types of lesions, congenital and iatrogenic. The former is fre-quently associated with bone or skin malformations(spina bifida. etc) and the latter resulting from lumbar puncture, due to direct implantation of epithelial cell by puncture needle. MATERIALS AND METHODS: A 13-year-old boy had pain radiating down to the right lower extremity and hypoesthesia on the anterolateral aspect of right thigh. Straight leg raising was markedly limited. T1 weighted image reveals round intradural mass on L3-4, which was not enhanced by gadolinium. He had the history of spinal tapping two and a half years ago for the work-up of headache. RESULTS: The mass was excised through posterior approach and midline durotomy. It was whitish ovoid mass, measuring 2x1.5x1.5cm in size and histologically diagnosed as epidermoid cyst consisting of keratinous material and cholesterol. All the symptoms were completely relieved at 16 months follow-up. CONCLUSIONS: A case of iatrogenic epidermoid cyst was successfully treated by excision. Epidermoid cyst must be ruled out if space occupying lesion exists in lumbar spine and patients complaining of lower back pain.
Adolescent ; Cholesterol ; Epidermal Cyst* ; Epithelial Cells ; Follow-Up Studies ; Gadolinium ; Headache ; Humans ; Hypesthesia ; Leg ; Low Back Pain ; Lower Extremity ; Male ; Needles ; Punctures ; Skin ; Spinal Puncture ; Spine ; Thigh

PURPOSE: In a retrospective study for the pediatric patients who underwent liver transplantation in the past 6 years at Samsung Medical Center, the clinical features of 5 patients with posttransplant lymphoproliferative disorder (PTLD) were analyzed. METHODS: Between June 1996 and June 2002, 41 pediatric patients underwent liver transplantation. Seven of them died in the postoperative period. Thirty-five including one patient who died of PTLD were finally reviewed. Patients were divided into two groups: high risk group, EBV naive recipients of EBV-positive grafts; low risk group, the patients other than those in high risk group. The authors reviewed age at operation, immunosuppressive agent, postoperative duration until diagnosis, postoperative duration until EBV seroconversion, presence of treatment against rejection, and presenting symptoms of PTLD. RESULTS: Five of 41 patients (12.2%) developed PTLD. All of them belonged to high risk group, and the incidence of PTLD in high risk group was 31.3% (5/16). The mean age at operation was 10.8 months old and the mean duration between operation and diagnosis for PTLD was 9.8 months. Primary EBV infection developed after a median of 6 months after transplantation. One patient was diagnosed as laryngeal and gastrointestinal PTLD and the other four, gastrointestinal PTLD. The following symptoms and signs were seen in the patients: anemia (100%), hypoalbuminemia (100%), fever (80%), diarrhea (80%), gastrointestinal bleeding (80%), and anorexia (60%). CONCLUSION: PTLD is one of the major complications after pediatric liver transplantation, especially in the group of high-risk recipients. Anemia, hypoalbuminemia, fever, diarrhea and gastrointestinal bleeding were features that are characteristic of PTLD. The common features of PTLD development were: (i) EBV-positive donors placed into EBV naive recipients, (ii) primary EBV infection about 6 months after transplantation, (iii) young age, about 1 year old at operation, and (iv) the requirement for intensive posttransplant immunosuppression.
Anemia ; Anorexia ; Diagnosis ; Diarrhea ; Epstein-Barr Virus Infections ; Fever ; Hemorrhage ; Herpesvirus 4, Human ; Humans ; Hypoalbuminemia ; Immunosuppression ; Incidence ; Liver Transplantation* ; Liver* ; Lymphoproliferative Disorders* ; Postoperative Period ; Retrospective Studies ; Tissue Donors ; Transplants

PURPOSE: To report a case of corneal ulcer caused by Paecilomyces lilacinus after penetrating keratoplasty. CASE SUMMARY: A 67-year-old male with a history of penetrating keratoplasty in the left eye 7 years prior and re-penetrating keratoplasty in the left eye due to graft failure in June 2013, visited our clinic for ocular pain and conjunctival injection in the left eye 3 days in duration. Corneal scrapings were performed for Gram and fungal stains and cultures. The patient was admitted to the hospital for hourly topical fortified ceftazidime and amphotericin B. Despite intensive topical therapy, no improvement was observed. Three days later, fungal culture confirmed Paecilomyces lilacinus and topical voriconazole was prepared from the intravenous formulation and was administered topically and intravenously. Despite medical therapy with voriconazole, perforation occurred requiring a tectonic keratoplasty. CONCLUSIONS: Keratitis caused by Paecilomyces lilacinus is difficult to eradicate and refractory to amphotericin B. We suggest early use of topical eyedrops, intracameral, and intravitreal injections of voriconazole may be an appropriate treatment for patients with Paecilomyces lilacinus keratitis.
Aged ; Amphotericin B ; Ceftazidime ; Coloring Agents ; Corneal Transplantation ; Corneal Ulcer ; Humans ; Intravitreal Injections ; Keratitis* ; Keratoplasty, Penetrating* ; Male ; Ophthalmic Solutions ; Paecilomyces* ; Transplants

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the clinical features and prognosis of intraoperative incidental durotomy during posterior surgery for degenerative lumbar disease. In addition, we tried to evaluate clinical outcome and safety of skillful neglect of pin point dural tear. SUMMARY OF LITERATURE REVIEW : Incidental durotomy is one of the most common complications during the operation of degenerative lumbar disease. It may cause signs and symptoms of cerebrospinal fluid leakage and complications such as meningitis, wound infection, pseudomeningocele and fistula. From the literature review, primary repair is mandatory even in the case of pin point dural tear. MATERIALS AND METHODS: Seven hundred fifty-five patients with degenerative lumbar disease, who were operated posteriorly from Jan. 1990 to Feb. 2002, were reviewed retrospectively. Primary operations were 378 cases of laminectomy without instrumentation and 377 cases of decompression and instrumented fusion. Of these patients, 44 (6 percent) sustained an incidental dural tear. We analyzed the mechanisms of dural tear, intraoperative treatment, postoperative management and clinical outcome. RESULTS: Eight cases (2.1%) of dural tears occurred during discectomy, 36 (9.5%) during instrumentation and fusion, and 12 (20%) during revision surgery. Dural tears were treated intraoperatively by primary repair in 20 cases, by fascial graft in 2 and without repair (skillful neglect) in 22. There were no cases of persistent cerebrospinal fluid leakage or fistula formation, and the symptoms of cerebrospinal fluid leakage were transient. Of 36 patients followed for more than one year, 82% had good or excellent result. CONCLUSION: Incidental durotomy occurred in 5.8 percent of lower back surgery patients, and more frequently in revision surgery. Very small dural tears did not have significant influence on the clinical outcome, whether they were repaired or not. Skillful neglect of pin point dural tear may be a reasonable treatment option.
Cerebrospinal Fluid ; Decompression ; Diskectomy ; Fistula ; Humans ; Laminectomy ; Meningitis ; Prognosis ; Retrospective Studies ; Transplants ; Wound Infection

PURPOSE: The aim of this study was to evaluated biphasic calcium phosphate applied in surgically created 1-wall periodontal intrabony defects in dogs by histometrical analysis. MATERIAL AND METHOD: Critical sized(4 mm x 4 mm), one wall periodontal intrabony defects were surgically produced at the proximal aspect of mandibular premolars in either right and left jaw quadrants in four canines. The control group was treated with debridement alone, and experimental group was treated with debridement and biphasic calcium phosphate application. The healing processes were histologically and histometrically observed after 8 weeks. RESULTS: In biphasic calcium phosphate group, more new bone and cementum formation, less epithelium and connective tissue attachment were observed compared to other groups. But there was no statistical significance. CONCLUSION: Though the statistically significant difference could not be found, it seemed that there was more new bone and cementum formation with applying biphasic calcium phosphate in 1 wall intrabony defects in dogs by preventing junctional epithelium migration.
Animals ; Bicuspid ; Calcium ; Connective Tissue ; Debridement ; Dental Cementum ; Dogs ; Epithelial Attachment ; Epithelium ; Hydroxyapatites ; Jaw

OBJECTIVE: We studied the use of smartphone technology in stroke rehabilitation in Korea and gathered opinions on how it would best be utilized it in a clinical setting. METHOD: Physiatrists, occupational therapists, physical therapists, and rehabilitation ward nurses were surveyed to examine smartphone propagation among the rehabilitation team, current therapeutic knowledge, the use of smartphone technology, and perceptions regarding the potential therapeutic use of smartphones in rehabilitation. The respondents were also asked to specify the applications considered to be the most appropriate for rehabilitation. We also examined applications available for stroke rehabilitation at Android and Apple stores. RESULTS: Of the respondents, 92% had never using smartphone technology in rehabilitation with their clients. The greatest barrier to use was that "smartphone technology and appropriate applications were not available for rehabilitation settings" (71.4%). Areas identified as most appropriate for smartphone use in therapy included provision of information (82.4%) and cognitive (72.5%) and language training (68.1%). We found only a few applications in android and Apple application stores. Of the respondents, 89% intended to use smartphone applications in rehabilitation in the future. CONCLUSION: Smartphone applications developed for stroke rehabilitation are promising. Further research and the development of new therapeutic applications for use in rehabilitation and across health care are needed.
Surveys and Questionnaires ; Delivery of Health Care ; Humans ; Korea ; Language Therapy ; Physical Therapists ; Stroke ; Smartphone

OBJECTIVE: We studied the use of smartphone technology in stroke rehabilitation in Korea and gathered opinions on how it would best be utilized it in a clinical setting. METHOD: Physiatrists, occupational therapists, physical therapists, and rehabilitation ward nurses were surveyed to examine smartphone propagation among the rehabilitation team, current therapeutic knowledge, the use of smartphone technology, and perceptions regarding the potential therapeutic use of smartphones in rehabilitation. The respondents were also asked to specify the applications considered to be the most appropriate for rehabilitation. We also examined applications available for stroke rehabilitation at Android and Apple stores. RESULTS: Of the respondents, 92% had never using smartphone technology in rehabilitation with their clients. The greatest barrier to use was that "smartphone technology and appropriate applications were not available for rehabilitation settings" (71.4%). Areas identified as most appropriate for smartphone use in therapy included provision of information (82.4%) and cognitive (72.5%) and language training (68.1%). We found only a few applications in android and Apple application stores. Of the respondents, 89% intended to use smartphone applications in rehabilitation in the future. CONCLUSION: Smartphone applications developed for stroke rehabilitation are promising. Further research and the development of new therapeutic applications for use in rehabilitation and across health care are needed.
Surveys and Questionnaires ; Delivery of Health Care ; Humans ; Korea ; Language Therapy ; Physical Therapists ; Stroke ; Smartphone

PURPOSE: Various bone graft materials are being used for periodontal tissue regeneration.Th materials are being developed continuously for ideal clinical effects. Therefore, it is necessary to identify the clinical characteristics of each bone graft material through comparing the various bone graft materials statistically and in doing so, proposing a more efficient bone graft material. In this study, the following results were attained through comparing the clinical effects among the bone graft materials, using the statistical method based on the clinical studies published at the department of periodontology of Yonsei hospital. MATERIALS AND METHOD: 6 selected studies of department of Periodontology at Yonsei University Hospital were based on clinical study of bone grafting in intrabony defects. It was compared the clinical parameters among the 6 clinical studies, using the statistical META analysis. RESULT: When comparing the probing depth reduction, there was a relatively great amount of decrease when using the xenograft, Anorganic Bovine Derived Hydroxapatite Bone Matrix/Cell Binding Peptide(ABM/P-15: PepGen P-15(R)) and the autogenous bone and absorbable membrane, d,l-alctide/glycolide copolymer(GC: Biomesh(R)). The allogfrafts showed a relatively low decrease in the probing depth and clinical attachment change. It also showed a slight decrease in the bone probing depth. The allografts showed various results according to different bone graft materials. When comparing the ABM/P-15 and bovine bone powder(BBP(R)), ABM/P-15 showed a relatively high clinical attachment level and the bovine bone powder showed a relatively high clinical attachment level. The probing depth change and gingival recession change showed a lower value than the mean value between the two bone graft materials. The synthetic bone showed a relatively high decrease in clinical attachment level and periodontal probing depth change. There was a relatively larger amount of gingival recession when using Bioactive Glass(BG) but a relatively low bone regeneration effect was seen. CONCLUSION: Good restorative results of the periodontal tissue can be attained by applying the various bone graft materials being used today after identifying the accurate clinical effects.
Allografts ; Alveolar Bone Loss ; Bone Regeneration ; Bone Transplantation ; Gingival Recession ; Heterografts ; Membranes ; Transplants*

Between 1997 May and 2007 May, One hundred and seventeen patients were treated. There were 129 cases of sinus elevation using a lateral window opening procedure and 258 implants placed simultaneously or delayed. The cumulative survival rate of the implants calculated. The implants were evaluated according to surgical site, quality and quantity of bone, graft material, membrane used, the length and diameter of the implant and complications. 1. The 10-year cumulative survival rate of the implants by sinus augmentation using lateral window approach was 96.90%. 2. There was no difference in the survival rate between the implant placed simultaneously with sinus elevation (one stage) and the procedure performed in the delayed procedure (two stage). 3. There was no difference in the survival rate according to the type and amount of graft materials. 4. There was no difference in the survival rate according to the implant site, bone quality and quantity. 5. There was no difference in the survival rate when the CollaTape(R) or Gore-Tex was placed in the window of the lateral wall. 6. There was no difference in the survival rate of the implant length and diameter. 7. The survival rate was as low as 75.00% when there were more than two complications. Implant placement with sinus augmentation using the lateral window approach is a predictable treatment method. Although the vertical height of residual ridge is insufficient and the quality of bone is poor, the normal survival rate of the implants would be expected if an appropriate graft material and membrane is used with greater effort to prevent complications.
Humans ; Maxillary Sinus* ; Membranes ; Polytetrafluoroethylene ; Retrospective Studies* ; Survival Rate ; Transplants

STUDY DESIGN: A case report and literature review. OBJECTIVES: To discuss pyogenic infections of the facet joints and paraspinal intramuscular abscess that developed after a steroid injection into the facet joint of the lower back. MATERIAL AND METHODS: A 39-year-old man who received a steroid injection to the facet joint, 3 weeks prior to admission, experienced increasing lower back pain and a high fever. RESULTS: Plain radiographs of the lumbar spine showed osteolytic erosion of the articular process at the L3-4 facet joint. On a CT scan, the destructed facet joint was connected to a paraspinal intramuscular abscess. MR images also showed a paraspinal intramuscular abscess on multiplane views. In the operative field, the paraspinal abscess, which extended from 2nd to 5th lumbar vertebrae, was found on the right side, with the L3-4 facet destructed and directly connected to the abscess. Some chalky material, considered to be steroid crystals, was found at the L3-4 facet joint. Drainage, debridement and irrigation were performed. Staphylococcus aureus was isolated from the culture. After surgery, intravenous antibiotics were administered, and the patients' symptoms quickly resolved. CONCLUSIONS: A posterior facet joint injection has its own risks of developing a pyogenic infection of the facet joint. Pyogenic facet joint infections may progress to a paraspinal intramuscular abscess. Surgical drainage is mandatory in cases resistant to antibiotic treatment, with evidence of pus formation on imaging studies.
Abscess* ; Adult ; Anti-Bacterial Agents ; Arthritis* ; Debridement ; Drainage ; Fever ; Humans ; Low Back Pain ; Lumbar Vertebrae ; Spine ; Staphylococcus aureus ; Suppuration ; Tomography, X-Ray Computed ; Zygapophyseal Joint*