We designed this study to analyze the causes of repeat surgery in the low back disorder after primary procedure, to evaluate the risk factors and to suggest the rational approachs can prevent and solve the problems related with repeat surgery. We retrospectively reviewed the medical record and radiographs of 24 patients who had sustained persistent or recurrent pain, failed to extended conservative therapy, showing abnormal myelogram and/or CT scan with nerve root compression, and with segmental instability consistent with patients symptom and sign after the primary procedures. We evaluated the functional outcome according to Kims(1986) criteria. The causes of remained or recurrent pain with neurologic symptom were persistent or aggravated lumbar spinal stenosis in 10 cases(42%), recurrent disc herniation in 4 cases(17%), infection in 3 cases(12%), instability in 2 cases(8%) and others in 5 cases(20%). Satisfactory outcome was recorded in 79%(19/24) of patients. The characteristics of the patients associated with satisfactory outcome were those who operated by recurrent disc herniation, instability, retained disc, metal malposition, and nerve root compression by bone chip. But the characteristics of the patients associated with unsatisfactory outcome were those who operated by infection, lumbar spinal stenosis aggravated by degenerative spondylosis and multiple herniated disc, inadequate decompression of lateral and/or foraminal stenosis in aged patients. The most common lesion site was on L4-5 disc, and unsatisfactory result was expected at the upper lumbar spine involvement. Favorable outcome could be expected in the presence of a pain-free interval more than 1 year from the date of the previous operation or persistent symptoms immediately after the initial operaion. We were expected the risk factors leading to repeat surgery were old aged(more than 60) patients, upper lumbar spine involvement and multiple lumbar disc herniation. Postoperative diskitis or osteomyelitis, pain free interval more than 1 month or less than 1 year, and those who had a revision on the lumbar spine previously could be considered as a poor prognostic indicators. When surgery is indicated for degenerative lumbar spinal disorders, adequate diagnostic tests and the execution of appropriate procedures based upon this information should be carried out to prevent the repeat surgery in the low back disorders. Adequate postoperative management can reduce the occurrence of failed back surgery syndrome and in cases necessitating repeat surgery, thorough analysis of causes following proper surgical stabilization can reduce the operative morbidity with early return to daily life.
Constriction, Pathologic ; Decompression ; Diagnostic Tests, Routine ; Discitis ; Failed Back Surgery Syndrome ; Humans ; Intervertebral Disc Displacement ; Medical Records ; Neurologic Manifestations ; Osteomyelitis ; Radiculopathy ; Reoperation* ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Spine ; Spondylosis ; Tomography, X-Ray Computed

Any type of urticaria may affect as many as 20% person during their lifetimes, yet the causes of this disorder is established in no more than 20% of cases. So, 308 patients with urticaria(acute ; 73, factitial; 120, chronic;115) were evaluated for results of historical and laboratory tests. The results were summerized as follows,' 1. The disesse primarily affected 2nd % 3rd decade(46.2%) with predominance of woman than man (M: F=1: 1.4). 2. Ninety-seven(31.5%) had at least one abnormal finding in the laboratory tests but, may be twenty-three(7.5%) would have causal relationship. 3. We sought serologic markers of Hepatitis B virus infection in serum from 8(14%) of 57 patients with urticaria. Of these, 4 were found to have abnormal liver function. 4. Sixty-five had taken at least one sort of drug previously or just before urticaria developed, but, may be forty-six(14.9%) would have a causal relationship and the predisposing drugs were analgesics, antibiotics, common cold medication & vitamin etc. 5. The predisposing conditions were as follows ; pulmory tuberculosis, viral hepatitis, hyperthyroidism, tonsillitis & ascariasis, etc. Of these, eleven(3.6%) of this patients were newly found to have underlying diseases. 6. This study showed inciting factors of urticaria in 27.2%(84/308).
Analgesics ; Anti-Bacterial Agents ; Ascariasis ; Common Cold ; Female ; Hepatitis ; Hepatitis B virus ; Humans ; Hyperthyroidism ; Liver ; Palatine Tonsil ; Tonsillitis ; Tuberculosis ; Urticaria* ; Vitamins

A 16-year-old girl developed pyoderma gangrenosum without underlying disease at first. She was treated with local cutaneous dressing and systemic oral prednisolone and minocycline for 10 months, imtermittently. After that, acute leukemia, which was undeterminated type, was developed 4 years after first onset. Since pyoderma gangrenosum may be a preindication of underlying disease, continual follow up check for systemic disease is required.
Adolescent ; Bandages ; Female ; Follow-Up Studies ; Humans ; Leukemia* ; Minocycline ; Prednisolone ; Pyoderma Gangrenosum* ; Pyoderma*

The autogenous fascia graft has been used for various surgical purposes because it has good durability, a gliding capacity, elasticity and a high survival rate. However, few studies have reported histological changes of the graft in various situations. This study attempted to determine histomorphologic changes after autogenous fascia graft in various surgical conditions. The results revealed were as follows: 1. The tension applied to grafts plays the key role in the survival rate of autogenous fascia grafts. 2. Rolling the fascia reduced the volume and weight after autogenous graft due to fibrosis and central fatty degeneration. 3. Autogenous fascia graft covering silicone blocks showed its fascial structure and reduction of the formation of fibrous capsule around the silicone.
Elasticity ; Fascia ; Fibrosis ; Silicones ; Survival Rate ; Transplants*

No abstract available.
Incidence* ; Nurseries* ; Parenteral Nutrition, Total* ; Pharmacy* ; Sepsis*

Endoscopic ACL reconstruction using bone-patellar tendon-bone has been considered the gold standard in the field of reconstructive ACL surgery. Technically, graft must be placed at isometric point. But it is difficult to evaluate the placement of graft postoperatively. The purpose of this study is to determine the radiological ideal position of graft by comparing postoperative results with the graft placement. Seventy cases of endoscopic ACL reconstruction were reviewed and classified according to the femoral and tibial graft position on radiologic imaging. The femoral graft position was classified in relation to angle of graft on anterior position view and distance from posterior margin of graft to the inner surface of posterior cortex on lateral view. The tibial graft position was classified in relation to intercondylar eminence on anterior posterior view and lateral view. Knee score (modified Marshall, Lysholum), manual anterior instability test (Lachman test, Pivot shift test) and arthrometer measurement were checked to evaluate postoperative results in each case. The results of this study implicate that knee joint in which femoral graft was oriented at direction of 11 o clock centring around 68 degree respect to tibial joint and placed within 3mm from posterior cortex showed higher knee score and lesser laxity. In cases of tibial side, the graft oriented to intercondylar eminence (AP view) and placed anterior to intercondylar eminence (lateral view) showed higher knee score and lesser laxity.
Joints ; Knee ; Knee Joint ; Patellar Ligament* ; Transplants

The hemodynamic changes during the induction and maintenance of anesthesia, the rapidity of postanesthetic recovery, and side effects were measured and compared in 60 patients receiving either morphine, meperidine, or fentanyl as supplements to balanced anesthesia. Blood pressure, measured through an indwelling arterial catheter, was recorded continuously, as were electrocardiogram and heart rates. The narcotics, made up in equipotent concentration, were given as indicated by hemodynamic and clinical signs. After induction, hemodynamic reponses to laryngoscopy and intubation were more suppressed in patients receiving fentanyl than in patients receiving morphine or meperidine. Meperidine, unilke morphine or fentanyl, significantly increased heart rates. Intraoperatively, mean arterial blood pressure and rate-pressure product were lowest in patients receiving fentanyl. Because of the increase in blood pressure, hart rate, or both to greater than 20% above preanesthetic values, supplementation with a potent inhalatinal agent was necessary, in 25%, 10%, and 10% of the patients given meperidine, morphine, and fentanyl, respectively. Side effects, including histamine release accompanied by tachycardia and hypotension, were most frequent and most severe in patients who received meperidine. Postoperatively, there was more rapid recovery of consciousness with fentanyl than meperidine and morphine and the incidence of postoperative respiratory depression was least with fentanyl. The authors concluded that a moderate dose of fentanyl was a better supplement to balanced anesthesia than morphine or meperidine.
Anesthesia ; Arterial Pressure ; Balanced Anesthesia* ; Blood Pressure ; Catheters ; Consciousness ; Electrocardiography ; Fentanyl* ; Heart Rate ; Hemodynamics ; Histamine Release ; Humans ; Hypotension ; Incidence ; Intubation ; Laryngoscopy ; Meperidine* ; Morphine* ; Narcotics ; Respiratory Insufficiency ; Tachycardia

We report a case of giant cell tumor of the tendon sheath involving the foot, in a 21-year-old female patient, who presented with an asymptomatic tumor on the dorsum of her right foot. Histopathologically the tumor is surrounded by thin fibrous connective tissue. The characteristic findings of the excised specimen revealed a typical mixture of abundunt round or polygonal histocyte-like cells with varying portions of spindle-shaped fibroblast-like cells and multinucleated giant cells. Variable amounts of hyalinized fibrous stromal tissue were also present. After excision, local recurrence has not been observed for 3 months.
Connective Tissue ; Female ; Foot* ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Hyalin ; Recurrence ; Tendons* ; Young Adult

BACKGROUND: Both atrophic gastritis and intestinal metaplasia may progress to gastric dysplasia. This study aimed to analyze the factors influencing progression of atrophic gastritis and intestinal metaplasia to dysplasia. METHODS: People diagnosed with atrophic gastritis and intestinal metaplasia for the first time received a follow-up endoscopy and were investigated for the cumulative incidence rate of gastric dysplasia by age, gender, smoking habit, alcohol intake, rice consumption and family history of stomach cancer. RESULTS: The cumulative incidence rate increased with age, consuming > or =3 bowls of rice per day and family history of stomach cancer. Multivariate analysis showed that the cumulative incidence rate of gastric dysplasia increased in subjects >61 years (RR=2.54, P=0.014), in those consuming > or =3 bowls of rice per day (RR=1.46, P=0.021) and in those with a family history of stomach cancer (RR=1.31, P=0.037). CONCLUSIONS: More active management, such as intensive endoscopic follow-up examinations, lifestyle change and education regarding gastric dysplasia, are required in those older than 61 years, having a higher intake of grain or with a family history of stomach cancer.
Edible Grain ; Endoscopy ; Follow-Up Studies ; Gastritis, Atrophic ; Humans ; Incidence ; Life Style ; Metaplasia ; Multivariate Analysis ; Risk Factors ; Smoke ; Smoking ; Stomach ; Stomach Neoplasms

PURPOSE: The criteria for Suspected hereditary nonpolyposis colorectal cancer(Suspected HNPCC) has been devised by the Korean Hereditary Tumor Registry for families who do not fulfill Amsterdam criteria, but hereditary background is strongly suggested. This study was performed to define the clinical characteristics of 'Suspected HNPCC'. METHODS: The 'Suspected HNPCC' criteria include the followings: a) vertical transmission of colorectal cancer or at least two siblings affected with colorectal cancer in a family and b) development of multiple colorectal tumors (including adenoma) or at least one colorectal cancer case diagnosed before the age of 50 years or development of extracolonic cancers (endometrium, urinary tract, small intestine, stomach, hepatobiliary system, ovary) in family members. We analysed the clinical characteristics of 93 patients from 39 Suspected HNPCC families and compared these characteristics with 176 HNPCC familes and with 1,204 non-hereditary colorectal cancer patients. RESULTS: The mean age of Suspected HNPCC patients at the time of diagnosis (49.0 years) was significantly lower than that of non-hereditary colorectal cancer patients (56.1 years), but higher than that of the HNPCC patients (44.5 years). Tumors were more frequently located in the right colon (34%) in Suspected HNPCC compared to non-hereditary colorectal cancer (23%). Dukes' A and B cancers were more frequent in the Suspected HNPCC as compared to non-hereditary colorectal cancer (55% vs. 48%, p<0.05), but tumor differentiation was not statistically different between the two groups. Among the Suspected HNPCC, 24.0% of the patients had synchronous adenomatous polyps and 20.0% had synchronous colorectal cancers and 15.6% had metachronous polyps or cancers. These findings were similar to HNPCC, but significantly higher than non-hereditary colorectal cancers (p<0.05). In Suspected HNPCC families, 42 patients had extracolonic malignancies with the stomach cancer being the most common (n=22). CONCLUSION: These data indicate that the clinical characteristics of Suspected HNPCC are similar to those of HNPCC and may suggest that the management principles of the HNPCC should also be applied to the Suspected HNPCC.
Adenomatous Polyps ; Colon ; Colorectal Neoplasms ; Diagnosis ; Humans ; Intestine, Small ; Korea* ; Polyps ; Siblings ; Stomach ; Stomach Neoplasms ; Urinary Tract