Carotid bruit is a physical sign derived from the turbulence of carotid blood flow and has been rgarded as one of the imponant risk factor of ischemic stroke. To estimate a crude prevalence of carotid bruit in ischemic stroke in Korea at present time, and evaluate the correlation of carotid bruit with carotid stenosis and site of ischemic lesion, we investigated the brain imaging studies (computed tomography and / or magnetic resonance imaging)and cerebral angiographict finding of fifty patiens with caoti bruit.Thirty-nine (3.9 %) ot of nine hundred and ninety-six ischemic stroke patients had bruit around the carotid bifurcation. And the other eleven cases who did not have ischemic stroke were detected to have carotid bruit during the routine neurological examination at the bedside.Th presence of infarction in one side of carotid territory was not significantly differentwhether the bruit was heard or not in that side, but the presece of carotid stenosis in angiographY had a tendency to be significantly different by the audible bruit on that side. Carotid bruit does not necessarily reflect the infarction of that side, but can only be used as a predictor of ipsilateral extracranial carotid occlusive disease in this preliminary study. Further extensive prospective study is needed for the exact prevalence of rate and the clinical usefulss of the carotid bruit in Korea.
Angiography ; Carotid Stenosis ; Humans ; Infarction ; Korea ; Neuroimaging ; Neurologic Examination ; Prevalence ; Risk Factors ; Stroke

PURPOSE: An adequate pain control is one of important factors for obtaining good outcomes in the ambulatory basis of hemorrhoidectomy. There have been many methods for pain control after hemorrhoidectomy such as narcotics, various kinds of analgesics, etc. The aim of this study is to compare intraoperative internal anal sphincter injection of Ketorolac tromethamine and other two conventional methods for pain control. METHODS: A total of 56 patients with hemorrhoid grade III or IV underwent surgery between May and October 1999, and prospectively assigned to three groups in the consecutive order. The group was divided in Group 1: [Ketorolac tromethamine (Tarasyn) 60 mg intrasphincteric injection intraoperatively and 30 mg IM/prn?10 mg po/6hrs], Group 2: [No intraoperative injection and maintain pain control with Tarasyn 30 mg IM/prn/10 mg po/6hrs], and Group 3: [No intraoperative injection and maintain pain control with Pethidine (Demerol) 50 mg IM/prn and Ibuprofen 400 mg/Paracetamol 500 mg/Codeine 20 mg (Myprodol) po/8hrs]. The post operative data and pain scoring was performed on the questionnaire with Point box scale (BS-11) and Behavioral rating scale (BRS-6) each 24 hours during 5 days after surgery. RESULTS: There are 22 patients in the Group 1, 16 in the Group 2 and 18 patients in the Group 3. The median age of the Group 1 is 42.5, Group 2, 44.5 and Group 3, 45 years. The pain score on the first day after surgery in group 1 was significantly lower than group 2 (p<0.05) in the both pain scoring scale but was no differences between group 1 and 3. On the fifth day after surgery group 3 was significantly lower than both group 1 and 2 in the point box scale (p<0.05). The urinary retention rate and the day of first bowel movement after surgery show no differences among three groups (p>0.05). CONCLUSIONS: Intraoperative internal anal sphincter injection of Ketorolac tromethamine shows a better pain control than conventional methods in early postoperative period. Therefore it might be helpful for patients to go home on the day after surgery, and strong pain killer to control pain after discharge will be needed.
Anal Canal* ; Analgesics ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Ibuprofen ; Ketorolac Tromethamine* ; Ketorolac* ; Meperidine ; Narcotics ; Postoperative Period ; Prospective Studies ; Surveys and Questionnaires ; Tromethamine ; Urinary Retention

INTRODUCTION: This study was to assess the effectiveness of new bone formation and regeneration by using a rhBMP-2 and beta-TCP as a carrier in rabbits' mandible. MATERIALS AND METHODS: The mandibles of 36 rabbits were exposed and cortical bone was penetrated for this study. The experimental subjects were divided into 3 groups each 12 rabbits; control group, experimental group 1, and experimental group 2. Control group had the defect itself without any treatment, in the experimental group 1, beta-TCP only was grafted, and in the experimental group 2, rhBMP-2 soaked in beta-TCP was grafted. The rabbits were sacrificed after 1, 2, 3, 4, 6, and 8weeks, and new bone formation area was examined and measured for bone quantitative and qualitative analysis with light, fluorescent and polarized microscopy. RESULTS: In the experimental group 1, new bone formation from the adjacent host bone was made by osteoconduction, and in the experimental group 2, direct new bone formation by osteoinduction of rhBMP-2 as well as new bone formation by osteoconduction of beta-TCP were observed. CONCLUSION: rhBMP-2 of experimental group 2 is very effective in the bone formation in early 2weeks and bone remodelling from 3weeks.
Bone Morphogenetic Proteins ; Bone Regeneration ; Calcium Phosphates ; Light ; Mandible ; Microscopy ; Osteogenesis ; Rabbits ; Regeneration ; Transplants

Study design. This retrospective study analyzes the influence of lumber rotation on fusion extent in King type III AIS treatment by CD instrumentation. Objectives. To establish a guideline for fusion in King type III AIS Summary Study of background data. Rotational characteristics of the lumber curve may significantly affect the postoperativ e behavior of uninstrumented lumbar curve thus calling for a different lumbar rotation. Methods. Sixteen King type III AIS treated with CD were divided into two groups by the direction of lumbar curve rotation. It was opposite direction (OD) to the rotation of the major curve in 9 and same direction (SD) in 7. In OD, 6 were treated by selective thoracic fusion (TF) and 3 were fused to the stable vertebra (SV). In SD, 6 were treated by TF and 1 was fused to the SV. They were evaluated for balance, major and fractional curve correction after a minimum follow up of 2 years. Result. In OD, all curves were balanced regardless of the fusion extent with satisfactory curve correction. In SD-TF, all were clinically balanced with major curve correction of 75%, but all the fractional curve were overcorrected, adding on the major curve. In SD-SV, the curve was balanced with stable lumbar curve. Conclusion. In King type III curve with lumbar curve rotated to the opposite direction, selective thoracic fusion is sufficient. However, when the fractional curve is rotated in the same direction, fusion to the stable vertebra may be a safer choice.
Adolescent* ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis* ; Spine

The authors analysed 2,653 cases of transthoracic fine needle aspiration cytology of the lung to evaluate the diagnostic accuracy and its limitation. A comparison was made between the original cytologic and the final histologic diagnoses on 1,149 cases from 1,074 patients. A diagnosis of malignancy was established in 38.3% benign in 48.1%, atypical lesion in 2.3%, and inadequate one in 11.9% of the cases. Statistical data on cytologic diagnoses were as follows; specificity 98.9%: sensitivity of procedure, 76.8%: sensitivity of diagnosis, 95.5%: false positive 5 cases: false negative 18 cases: predictive value for malignancy, 98.8%: predictive value for benign lesion, 79.5%: overall diagnostic efficiency, 87.5%: typing accuracy in malignant tumor, 80%.
Biopsy, Fine-Needle ; Diagnosis ; Diarrhea* ; Hemolytic-Uremic Syndrome* ; Humans ; Lung ; Sensitivity and Specificity

PURPOSE: The treatment of colorecatal cancer depends primarily upon the stage, and whether or not the regimen of adjuvant therapy can also be decided through this staging. In fact, the clinicopathologic prognostic factors are well known. In addition to these prognostic factors, the importance of molecular biological prognostic factors has also come to light. METHODS: This study was devised to analyze the recurrence pattern and the survival rate and correlate them with the prognostic factors in a group of surgically treated colorectal cancer patients, who were recruited from 1989 to 1998 at the Severance Hospital, Yonsei Uinversity College of Medicine. The survival curves were analyzed according to the Kaplan-Meier method, and the Cox regression hazard model was used to analyze the prognostic factors influencing the survival rates. RESULTS: A total of 1973 patients were recruited, and among them 1848 (93.7%) had undergone a resection with 1643 (89.1%) having a curative resection. The overall follow-up time after surgery was 60.5+/-35.4 months and 1945 (98.6%) patients were confirmed to have either survived or died. The overall recurrence rate was 386/1643 (23.5%). Of these, the local recurrence rate was 86/386 (22.2%), the systemic recurrence rate was 236/386 (61.1%), and both local and systemic recurrence rates were 50/386 (12.9%). The overall 5 year survival rate was 61.5%, and according to the TNM stage, the survival rate was 84.3% for stage 1, 79.2% for stage 2, 61.5% for stage 3, and 31.5% for stage 4. Multivariate analysis indicated that the TNM stage, the number of lymph nodes involved, the gross appearance of the tumor, the positive lateral margin, vascular invasion, the preoperative CEA level (higher than 5ng/ml), and rectal cancer were significant prognostic factors for the 5 year survival rate. CONCLUSION: Patient with ulceroinfiltrative, poorly differentiated, rectal cancer and the positive lateral resection margin, vascular invasion etc. had a poor survival rate after a curative resection for colorectal cancer. In addition to these clinicopathologic prognostic factors, an investigation into the molecular biological prognostic factors is also needed.
Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Proportional Hazards Models ; Rectal Neoplasms ; Recurrence* ; Survival Rate*

The purpose of this study is to assess the usefulness of digital infrared thermographic image(DITI) in patients with surgically treated lumbar disc disease. A series of 480 patients with lumbar herniated disc was studied. The mean age of the patients was 37 years, with a range of 18 to 64 years. Of which 126 cases of chemonucleolysis. 18 cases of percutaneous endoscopic laser discectomy, and 336 cases of laminectomy with discectomy were performed. Among these patients, 336 cases of laminectomy were assessed by DITI preoperatively. The thermal differences(delta T) between the symptomatic and asymptomatic limbs were evaluated. We have categorized the types of herniations into 3 classes: 200 protruded, 99 extruded, and 37 sequestered. The thermal differences were classified into 3 groups: 177 patients had delta T < 0.5 degrees C, 74 patients had 0.5 degrees C < or = delta T < 0.8 degrees C and 85 patients had delta T > or = 0.8 degrees C. Among the group of patients with the sequestered disc, 30(i.e. 80%) had delta T > or = 0.8 degrees C. Among the surgically treated 336 patients, non-visualization of a part of the sciatic limb on preoperative DITI was the condition used to coin the term amputation sign by the authors. In the sequestered group, the "amputation sign" was observed in 28 cases(75%). We conclude that DITI can predict a sequestered disc disease, and it allows more precise indication regarding open surgery.
Amputation ; Diskectomy ; Extremities ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc Displacement ; Laminectomy ; Numismatics

PURPOSE: The restorative proctocolectomy has been accepted as the operation of choice for chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess the operative safety and the functional outcome after a total proctocolectomy and ileal-pouch anal anastomosis. METHODS: The medical records of 16 patients who had undergone a total proctocolectomy and ileal-pouch anal anastomosis for ulcerative colitis (n=9) and familial adenomatous polyposis (n=7) from January 1996 to December 1999 were reviewed. The mean length of follow-up was 19.9 months, and we evaluated functional outcome using a prepared questionnaire. RESULTS: A hand-sewn anastomosis with diverting ileostomy was performed in 9 patients, and a double stapled anastomosis was done in 7 patients. Postoperative complications occurred in 8 cases (50%): intestinal obstructions in 4 patients and anastomosis related complications in 4 patients, i.e. stenosis (n=2), leak (n=1) and perianal abscess (n=1). The defecation frequency and the, day and night continence were improved in the first period (one year after surgery) compared to the second period (3 months after surgery). The need for anti-diarrheal medication, and for the use of a pad was also decreased in the second period compared to the first period. Postoperative urinary function was satisfactory in 13 of 14 patients. Postoperative sexual function was assessed in 8 patients (5 males, 3 females) and showed in good erection (5/5), ejaculation (5/5), and satisfactory sexual life (8/8). CONCLUSION: Satisfactory functional outcomes regarding the frequency of bowel movement and fecal incontinence and operative safety can be achieved after a restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis.
Abscess ; Adenomatous Polyposis Coli ; Colitis, Ulcerative ; Constriction, Pathologic ; Defecation ; Ejaculation ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Ileostomy ; Intestinal Obstruction ; Male ; Medical Records ; Postoperative Complications ; Proctocolectomy, Restorative* ; Surveys and Questionnaires

PURPOSE: The management of local recurrence after curative surgery of the rectal cancer remains difficult clinical problems to surgeons. This study was performed to analyze the outcomes of patients with local pelvic recurrence according to its recurrence type. METHODS: A total 109 patients with local recurrence were evaluated. Among the 109 patients 62 were local recurrence alone and 47 were both local and systemic recurrence. The recurrence type was classified as Central, Anterior, Posterior, Lateral and Perineal recurrence according to the relation of the tumor location and either intra pelvic organ and/or fixed pelvic structure. RESULTS: Only 26 (23.9%) of the 109 patients had curative resection and the remaining 83 (76.1%) patients had palliative exploration or nonsurgical procedure. The resectability according to the recurrence type showed that the Central and Anterior type was higher than other type of recurrences (P=0.001). When the primary operation was Abdominoperineal Resection (APR) the resectability was poorer than Low Anterior Resection (LAR) (P=0.0001). When comparing the patients with local recurrence alone, the 5 year survival rate was significantly higher patients treated by curative resection than palliative or non-resection group (P=0.002). Mean follow up period was 44.2+/-30.0 months and mean recurrence time between primary operation and recurrence was 26.0+/-22.7 months. CONCLUSIONS: Resection for central type of the recurrent is potentially curative, however treatment failure was common when the recurrence invaded fixed pelvic structure. Our data suggest that local pelvic recurrence should be treated with radical resection as can as possible.
Classification* ; Follow-Up Studies ; Humans ; Prognosis* ; Rectal Neoplasms* ; Recurrence* ; Survival Rate ; Treatment Failure

PURPOSE: Intravenous 5-Fluorouracil (5-FU) and oral doxifluridine were compared with respect to therapeutic efficacy, drug toxicity, and quality of life to clarify the efficiency of oral doxifluridine. METHODS: One hundred sixty-six (166) patients who underwent a curative resection for TNM stage II and III rectal cancer between Oct. 1997 and Feb. 1999 were randomized to receive intravenous 5-FU (450 mg/m2/day) or oral doxifluridine (700 mg/m2/day) in combination with leucovorin (20 mg/m2/day). 5-FU was infused intravenously 5 consecutive days per month for a total of 12 cycles (IV arm, N=74) in one group, and doxifluridine was given orally daily for 3 weeks with a rest of 1 week for a total of 12 cycles (Oral arm, N=92). Drug toxicity and quality of life were observed. Quality of life was scored according to twenty-two daily activity items (good,>71, fair,53< or =and<70, poor,< or =52). RESULTS: There was no significant difference in the mean age, sex, TNM stage distribution, or type of operation between the two groups (>0.05). Mean number of chemotherapy cycles was 6.5+/-3.7 (IV arm) vs 7.2+/-4.3 (Oral arm). The recurrence rate was 9/74 (12.1%) in IV arm and 6/92 (6.5%) in oral arm (P=0.937). Local recurrence was 2/74 (stage III; 2.7%) in IV arm and 1/92 (stage II; 1.1%) in oral arm. Systemic recurrence was 7/74 (Stage III; 9.4%) in IV arm and 5/92 (Stage III; 5.4%) in oral arm. Toxicity pro-files are as follows: Leukopenia (30/74, 17/92) and alopecia (21/74, 13/92) were more common in IV arm than in oral arm, and the difference was statistically significant. Diarrhea was more common in oral arm. The quality of life score was better at 1 month (19.5%, 49%) and at 2 months (47%, 72%) in the oral arm group (<0.05). CONCLUSION: Oral Doxifluridine with leucovorin as a postoperative adjuvant therapy shows a therapeutic efficacy comparable to the intravenous 5-FU regimen and has a high quality of life. The oral regimen also can be safely given with an appropriate toxicity and tolerability.
Alopecia ; Arm ; Diarrhea ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; Fluorouracil* ; Humans ; Leucovorin ; Leukopenia ; Prospective Studies* ; Quality of Life ; Rectal Neoplasms* ; Recurrence