Intractable pain was controlled in 5 cases using dorsal root entry zone lesions. All patients had failed to conservative therapy. Dorsal root entry zone lesions were made to include the involved dermatomes added one half of the dermatomes above and below the painful areas. Four patient noticed good pain relief with follow up period ranging from 6 to 24 months. Patient whose lesions were performed using a CO2 laser mas suffered no complicated deficit. Dorsal root entry zone lesions appeared to be a satisfactory treatment for intractable pain in patients, who have failed to respond to more conservative mode of therapy.
Evoked Potentials ; Follow-Up Studies ; Humans ; Lasers, Gas ; Pain, Intractable* ; Spinal Nerve Roots*

PURPOSE: To investigate short term clinical outcomes of the open surgical repair for triangular fibrocartilage complex (TFCC) foveal detachment. METHODS: We retrospectively reviewed 8 patients (5 men, 3 women) who had been treated with open surgical repair of the TFCC type 1B injury, from 2005 to 2013 and who were followed up for more than one year after surgery. Mean age at time of surgery was 34 years. The right side was involved in 3 patients, and the left in 5. The clinical results of surgery were assessed with modified Mayo wrist score (MMWS), disabilities of the arm, shoulder and hand (DASH) score and pain-visual analogue scale (VAS). Physical examination was performed to evaluate the prescence of distal radioulnar instability, preoperatively and at the latest follow-up. RESULTS: The mean follow up period were 36.5 months (range, 12-64 months). The mean MMWS improved from 52.5 (range, 25-85) preoperatively to 82.5 (range, 75-100) postoperatively (p=0.02). The mean DASH score improved from 39.6 (range, 65-13.5) preoperatively to 13.4 (range, 2.5-33.3) postoperatively (p=0.012). The preoperative mean pain-VAS was 4.6 (range, 6-3); these value was reduced to mean 2 (range, 0-3) at the latest follow-up (p=0.016). There were no patients remaining instability after the surgery, although four patients showed distal radioulnar joint (DRUJ) instability before surgery. CONCLUSION: The surgical outcomes of open repair for TFCC foveal detachment (type 1B) was contentable. Also, in cases of type 1B injury associated with DRUJ instability were managed sucessfully without additional procedure.
Arm ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Physical Examination ; Retrospective Studies ; Shoulder ; Triangular Fibrocartilage* ; Wrist

Traumatic aortic transection after blunt chest injury is highly lethal and has high operative mortality. Recently, the diagnostic and therapeutic method of this injury is advanced, especially in spinal cord protection during aortic cross-clamping. We have experienced two cases of traumatic aortic transection with left hemothorax after blunt chest injury, which was diagnosed in operative field. The transected aorta was primarily repaired with clamp and sew method and postoperative paraplegia had not occured. The patients were dischraged without any significant complications. We report these cases with a review of literature.
Aorta ; Hemothorax ; Humans ; Mortality ; Paraplegia ; Spinal Cord ; Thoracic Injuries

BACKGROUND: Nuss et al introduced a less invasive method for inserting a stainless steel bar through the small incision on the lateral chest wall into the pectus excavatum. This study was undertaken to assess the effect of the Nuss operation on lung mechanics, CT-Index and hemodynamics. METHODS: Twenty patients (age 4 to 17 years) with severe pectus excavatum underwent the Nuss operation. CT-Index (the internal transverse distance of the thorax/the vertebral-sternal distance at greatest depression) was evaluated before operation. Lung mechanics (dynamic compliance [Cdyn], static compliance [Cstat] and airway resistance [Raw]), hemodynamic changes (heart rate [HR], systolic blood pressure [SBP], and diastolic blood pressure [DBP]), and gas exchange (arterial oxygen tension [PaO2], arterial carbon dioxide tension [PaCO2], pulse oximeter saturation [SPO2] and end-tidal carbon dioxide tension[PETCO2]) were measured before and after the operation. RESULTS: Cdyn and Cstat decreased significantly (P < 0.05), but Raw did not change. PaCO2 and PETCO2 decreased significantly (P < 0.05), and SBP and DBP increased significantly (P < 0.05) postoperatively. CONCLUSIONS: It is concluded that decreased compliance after the Nuss operation may result from reduced thoracic elastance, not to a change of lung parenchyma.
Airway Resistance ; Blood Pressure ; Carbon Dioxide ; Compliance ; Funnel Chest* ; Hemodynamics ; Humans ; Lung* ; Mechanics* ; Oxygen ; Stainless Steel ; Thoracic Wall

Emery-Dreifuss muscular dystrophy is characterized by 1) early contractures of the elbows, Achilles tendons, and postcervical muscles, 2) slowly progressive muscle wasting and weakness with a humeroperoneal distribution in the early stages, and 3) cardiomyopathy with conduction defects and risk of sudden death. The inheritance is usually X-linked recessive but can be autosomal dominant and recessive. We report a case of 28-year old woman who presented with dizziness, palpitation, and progressive muscular weakness. Her ECG revealed high degree AV block and muscle biopsy demonstrated diffuse degenerative change consistent with Emery-Dreifuss muscular dystrophy. She was diagnosed as autosomal dominant Emery-Dreifuss muscular dystrophy by characteristic clinical features, and findings of ECG, nerve conduction test, electromyography and muscle biopsy findings. A VVI-type permanent pacemaker was implanted.
Achilles Tendon ; Adult ; Atrioventricular Block* ; Biopsy ; Cardiomyopathies ; Contracture ; Death, Sudden ; Dizziness ; Elbow ; Electrocardiography ; Electromyography ; Female ; Humans ; Muscle Weakness ; Muscles ; Muscular Dystrophy, Emery-Dreifuss* ; Neural Conduction ; Wills

We report a case of pulmonary fungal ball of Pseudallescheria boydii (Scedosporium apiospermum, the anamorph) and the result of LSU rDNA D2 region sequencing of the clinical isolate. An immunocompetent 58-year-old female suffered 2-year history of hemoptysis. Her symptom persisted despite the administration of oral itraconazole, even though the clinical, radiological, and histological findings suggested Aspergilloma. In the fungal culture, the typical morphology of S. apiospermum was observed. Even though the sequencing using LSU rDNA D2 region identified the organism as Pseudallescheria ellipsoidea, one of the P. boydii complex, the further investigation of ours suggested that the species in P. boydii complex could not be differentiated from each other by the sequencing of LSU rDNA D2 region.
DNA, Ribosomal ; Female ; Hemoptysis ; Humans ; Itraconazole ; Middle Aged ; Pseudallescheria ; Scedosporium

BACKGROUND: Thymic carcinoma is a very rare disease and treatment modality is not standardized. So, we report our experience of management of thymic carcinoma. MATERIAL AND METHOD: Between 1984 and 1998, eight patients with thymic carcinoma were treated at Keimyung University Dongsan Medical center. RESULT: The median age was 46 years with a range of 23 to 67 years. Chief complaint was a anterior chest pain. Histologic subtypes included two lymphoepithelioma-like carcinoma, two squamous cell carcinoma, one basaloid carcinoma, and three mixed type. Clinical staging was classified to stage I in 2, stage II in 4, stage III in 1, and stage IVA in 1 according to the modified Masaoka staging system. Four patients underwent complete resection and three patients were found to have incomplete resection by histologic evaluation. One patient underwent only biopsy due to pericardial dissemination and invasion of adjacent organ. All patients had adjuvant chemotherapy, radiation therapy was administered to five patients for positive resection margin and above stage III. The median follow up period was 55.3+/-64.6 months, three patiants died and four patients are alive without recurrence. One patient in recurrence had two times re-operations and adjuvant chemoradiotherapy. He is still alive. CONCLUSION: We concluded that completely surgical resection and adequate adjuvant chemoradiotherapy after early diagnosis are useful to management of thymic carcinoma.
Biopsy ; Carcinoma, Squamous Cell ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Chest Pain ; Early Diagnosis ; Follow-Up Studies ; Humans ; Rare Diseases ; Recurrence ; Thymoma* ; Thymus Gland ; Thymus Neoplasms

BACKGROUND: Mitral valve repair has been suggested to provide better postoperative outcome than valve replacement for mitral regurgita tion. MATERIAL AND METHOD: From Janu ary 1996 to May 2000, 87 patients had mitral valve repair(59 patients) or replac ement(28 patients) for mitral regurgitation. RESULT: The two groups were si milar in age, sex, and functional class. The cause of mitral regurgitation in th e repair group was degenerative in 45 patients, rheumatic in 12 patients, endoca rditis in 1, and ischemic in 1, and in the replacement group was degenerative in 12 patients, rheumatic in 11 patients, endocarditis in 4 and traumatic in 1 pat ient. A Carpentier ring was used in 51 patients and the most common size was 30 mm. The aortic cross-clamp time was 88.3+/-24.7 minutes in the repair group and 7 0.3+/-23.8 minutes in the replacement group(p<0.05), and total pump time was 13 9.6+/-30.5 minutes and 110.4+/-34.3 minutes(p<0.05) respectively. There was no hos pital death in both groups. Four-year actuarial survival was 97.9% for the repai r group and 100% for the replacement group(p = not significant). Postoperative c ardiothoracic ratio and ejection fraction decreased, and postoperative functiona l class improved in both groups(p = not significant). CONCLUSION: Mitral valve repai r for patients with mitral regurgitation can be performed with the satisfactory results as valve replacement.
Endocarditis ; Humans ; Mitral Valve ; Mitral Valve Insufficiency

A 54-year-old woman visited Gangnam Severance Hospital for left side flank pain. She had a history of total removal of malignant melanoma on the left eye ball 20 years prior. No evaluation had been performed since then. A paravertebral mass at thoracic ninth level (T9) was discovered on spinal magnetic resonance imaging, and pathology confirmed malignant melanoma. Following positron emission tomography-computed tomography, no other metastasis was discovered. After removal of the paravertebral mass, palliative chemotherapy (dacabarzine + tamoxifene) was administered in 3 cycles over 2 months. Radiotherapy with simultaneous integrated boost technique was performed at 4,350 cGy total over 15 days, 290 cGy per delivery, and was administered with the first cycle of palliative chemotherapy. Despite this treatment, multiple metastases developed throughout her body 7 months later, and the patient is continuing chemotherapy.
Choroid* ; Drug Therapy ; Electrons ; Female ; Flank Pain ; Humans ; Magnetic Resonance Imaging ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Pathology ; Radiotherapy ; Spine*

PURPOSE: To evaluate the CT findings of peritonitis associated with continuous ambulatory peritonealdialysis(CAPD). MATERIALS AND METHODS: We retrospectively analyzed CT scans of 14 symptomatic patients withperitonitis after CAPD. Diffuse abdominal pain was present in 11, fever in two, and abdominal mass with vomitingin one. The mean duration of CAPD ranged from 10 months to 5 years(mean : 3.9 years). On abdominal CT, weevaluated the presence and location of ascites, bowel wall thickening, cocoon formation, the pattern ofenhancement of peritoneal thickening, the presence of calcifications in the peritoneum, and mesenteric and omentalchange. RESULTS: On enhanced CT, multiloculated ascites was observed in all cases(n=14) ; it was located mainlyin the pelvic cavity with small multi-loculated fluid collections in the peritoneal cavity (n=13), including thelesser sac(n=3). In one patient, ascites was located in the space between the greater omentum and anteriorperitoneal surface. CT showed ileus in 12 cases, small bowel wall thickening in 11, and cocoon formation in five.Uneven but smooth thickening of the peritoneum, with contrast enhancement, was seen in eight cases, and in five ofthese, peritoneal thickening was more prominent in the anterior peritoneum. Other findings included reticularopacity in two cases, hematoma of the rectus muscle in one, and umbilical hernia in one. CONCLUSION:Multiloculated fluid collection, ileus, small bowel wall thickening, uneven but smooth peritoneal thickening, andcocoon formation appear to be CT features of CAPD peritonitis.
Abdominal Pain ; Ascites ; Dialysis ; Fever ; Hematoma ; Hernia, Umbilical ; Humans ; Ileus ; Omentum ; Peritoneal Cavity ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritoneum ; Peritonitis* ; Retrospective Studies ; Tomography, X-Ray Computed