No abstract available.
Female ; Hysterectomy, Vaginal*

No abstract available.
Fetal Macrosomia*

BACKGROUND: The large volume of blood products are required during orthotopic liver transplantation. Any preoperative and intraoperative factors may influence the intraoperative blood products usage. METHODS: We retrospectively reviewed the demographic information, coagulation screens, thrombelastographic variables, and intraoperative blood requirements in 952 adult patients, who underwent orthotopic liver transplantation at the University of Pittsburgh Medical Center between January 1992 and December 1995. A preoperative coagulation abnormality score (CAS) was calculated by assigning one point of each abnormal result of the coagulation tests (PT, aPTT, platelet count) and thrombelastographic variables (reaction time, alpha angle, maximal amplitude, clot lysis index). Intraoperatively, blood products and pharmacologic coagulation therapy were administered based on thrombelastographic and hemodynamic data. RESULTS: Underlying liver disease, retransplantation one month after the first transplantation, poor preoperative coagulation profiles were predictive of intraoperative blood usage. Age, preoperative PT >15 sec, and CAS were not predictive of intraoperative blood usage. The severe fibrinolysis during operation occurred. More blood products were required in patients with severe fibrinolysis. CONCLUSIONS: The understanding of preoperative and intraoperative factors affecting blood product requirements can help the management of blood component therapy during liver transplantation.
Adult ; Blood Platelets ; Fibrinolysis ; Hemodynamics ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Retrospective Studies ; Risk Factors*

Differential diagnosis of benign giant tumors includes a circumscribed fibrocystic disease, giant fibroadenoma, juvenile fibroadenoma, lipoma, cystosarcoma phylloides, and hamartoma. Current general surgery textbooks describe excision through an inframammary incision and state that reconstructive procedures with flap rotation and prosthesis are inappropriate because the breast remnant generally returns to a normal configuration and contour following removal of a benign breast tumor. Although we agree with this recommendation for smaller fibroadenomas, the distortion and asymmetric stretching that occur with the larger tumors call for a breast reconstructive technique to achieve symmetry. We report 3 cases of giant benign tumors which were treated by excision and reconstruction using mastopexy technique. It's highly recommended that patients with benign giant tumors of breast should be treated by plastic surgeons with reconstructive techniques.
Breast Neoplasms* ; Breast* ; Diagnosis, Differential ; Fibroadenoma ; Hamartoma ; Humans ; Lipoma ; Phyllodes Tumor ; Prostheses and Implants

OBJECTIVE: The purpose of this study was to investigate the relationship between menarche and cervical vertebral maturation. METHODS: Lateral cephalograms of 67 young korean girls within the range of 1 year before or after their menarche were gathered. The concavity of the cervical vertebrae base and the ratio of the base length to the 3rd and 4th cervical vertebrae anterior height were measured and analyzed. RESULTS: The mean measured values were as follows; concavity of the 3rd cervical vertebrae base: 1.27 (+/- 0.18) mm, concavity of the 4th cervical vertebrae base: 1.06 (+/- 0.15) mm, ratio of the base length to the 3rd cervical vertebrae anterior height: 0.73 (+/- 0.06) and ratio of the base length to the 4th cervical vertebrae anterior height: 0.70 (+/- 0.05). There was a significant increase in the ratio of the base length to the 3rd vertebrae anterior height and the base concavity of the 3rd and 4th cervical vertebrae during the period of 1 year before to 1 year after their menarche. CONCLUSIONS: These characteristics of the 3rd and 4th cervical vertebrae on the lateral cephalogram can provide useful clues on evaluating the growth stage.
Cervical Vertebrae ; Female ; Menarche ; Spine

The receiver operating characteristic (ROC) curve analysis was done to evaluate the effects of digital image processing techniques on the detectability of simulated pulmonary nodules and cysts in chest radiographs. Image processing techniques used were the contrast inversion, unsharp masking, and filtered equalization method. Simulated pulmonary nodules and cysts were generated by the computed program using Turbo-C language for personal computer. Each processed and unprocessed image sets of sixty images with pulmonary nodules and cysts and one hundred and twenty normal images were analyzed by three board-certified radiologists and four senior residents training in diagnostic radiology by five rating category. Area under the ROC curve was calculated using the trapezoidal rule. Mean area under the ROC curve of seven radiologists of the unprocessed image was 0.6360±0.0583, contrast inversion was 0.5660±0.0478, unsharp masking was 0.7534±0.0355 and filtered equalization was 0.6915±0.0472. Unsharp masking(p<0.01) and filtered equalization image(p<0.05) was statistically significant than unprocessed image. Digital chest radiographs processed by the unsharp masking method significantly increased the detectability of simulated pulmonary nodules and cysts overlapped with mediastinum and pulmonary cysts in free lung fields.
Lung ; Masks ; Mediastinum ; Methods ; Microcomputers ; Radiography, Thoracic* ; ROC Curve ; Thorax*

Thoracic outlet syndrome is a relatively common disease. However, costoclavicular syndrome as a condition secondary to nonunion of a displaced fracture of the clavicle is very rare. Most clavicular fractures in adults are united with no or minimal persistent symptoms. Also, symptomatic nonunion of a displaced fracture of the clavicle is rare. A 55-year-old male initially presented with persistent forearm pain after slip-down was initially diagnosed with simple muscle strain. However, he was given a delayed diagnosis of costoclavicular syndrome, caused by compression of the subclavian artery due to trauma in the fibrotic nonunion of the right clavicle without apparent symptoms. We obtained satisfactory results by surgical treatment. Here we report this case with a review of the literature.
Adult ; Clavicle ; Delayed Diagnosis ; Forearm ; Humans ; Male ; Muscles ; Sprains and Strains ; Subclavian Artery ; Thoracic Outlet Syndrome

No abstract available.
Emergencies* ; Emergency Service, Hospital* ; Hospitals, Teaching* ; Korea* ; Medical Records*

PURPOSE: Survival outcome of locally advanced pancreatic cancer has been poor and little is known about prognostic factors of the disease, especially in locally advanced cases treated with concurrent chemoradiation. This study was to analyze overall survival and prognostic factors of patients treated with concurrent chemoradiotherapy (CCRT) in locally advanced pancreatic cancer. MATERIALS AND METHODS: Medical records of 34 patients diagnosed with unresectable pancreatic cancer and treated with definitive CCRT, from December 2003 to December 2012, were reviewed. Median prescribed radiation dose was 50.4 Gy (range, 41.4 to 55.8 Gy), once daily, five times per week, 1.8 to 3 Gy per fraction. RESULTS: With a mean follow-up of 10 months (range, 0 to 49 months), median overall survival was 9 months. The 1- and 2-year survival rates were 40% and 10%, respectively. Median and mean time to progression were 5 and 7 months, respectively. Prognostic parameters related to overall survival were post-CCRT CA19-9 (p = 0.02), the Eastern Cooperative Oncology Group (ECOG) status (p < 0.01), and radiation dose (p = 0.04) according to univariate analysis. In multivariate analysis, post-CCRT CA19-9 value below 180 U/mL and ECOG status 0 or 1 were statistically significant independent prognostic factors associated with improved overall survival (p < 0.01 and p = 0.02, respectively). CONCLUSION: Overall treatment results in locally advanced pancreatic cancer are relatively poor and few improvements have been accomplished in the past decades. Post-treatment CA19-9 below 180 U/mL and ECOG performance status 0 and 1 were significantly associated with an improved overall survival.
Chemoradiotherapy* ; Follow-Up Studies ; Humans ; Medical Records ; Multivariate Analysis ; Pancreatic Neoplasms* ; Survival Rate

BACKGROUND: Left atrial thrombi(LAT) and spontaneous echo contrast(SEC) are known as major risk factors for thromboembolic complication in patients with mitral valvular heartdisease. Recent clinical introduction of transesophageal echocardiography(TEE) makes it possible to improve the diagnostic accuracy of these risk facors compared to conventional transthoracic echocardiography(TTE). The aims of the present study were to evaluate diagnostic accuracy of TEE for detection of LAT and to determine if clinical and echocardiographic variables can predict the presence of LAT and/or SEC at TEE. METHODS: From July 1991 to April 1993, both TTE and TEE were performed in 84 patients with mitral valvular heart disease before open heart surgery. The incidence and diagnostic accuracy of TTE and TEE for LAT detection were confirmed at surgery for mitral valve replacement in all cases. Biplane with 5.0 MHz transducer was used in TEE. The following clinical and transthoracic echocardiographic variables were analyzed:age, totoal or recent embolism, atrial fibrillation, left atrial dimension, ejection fraction, mitral valve area, and mitral regurgitation. RESULT: 1) THe sensitivity of TEE for detection of LAT was 100%, which was significantly higher than that of TTE(60.8%). There was no statistical difference in specificity of both techniques(98.3% vs 93.4%). In eleven patients (11/24,45.8%), LAT was confined to the left atrial appendage and TEE was far superior to TTE(sensitivity : 100% vs 27.2%) in detection of appendegeal thrombi. 2) SEC was found in 43 patients(51.2%). Patients with SEC had higher rates of LAT(p<0.001) and embolic episodes (p=0.001) than patients without SEC. There was no association between the severity of SEC and the embolic episodes. 3) Patients with SEC or LAT were characterized by more frequently associated with recent embolic episodes, smaller mitral valve orifice, abscence of mitral regurgitation than those without SEC and LAT. CONCLUSION: TEE is superior to TTE in detection of LAT and appendegeal thrombi. SEC is frequently noted in TEE and also strongly associated with left atrial blood stasis and left atrial thrombi in mitral valve disease.
Atrial Appendage ; Atrial Fibrillation ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Heart Valve Diseases* ; Humans ; Incidence ; Mitral Valve ; Mitral Valve Insufficiency ; Risk Factors ; Sensitivity and Specificity ; Thoracic Surgery ; Thrombosis* ; Transducers