PURPOSE: This study was undertaken to increase the knowledge of the intra- and extra-spinal alignments and to help recovery of sagittal alignment in operation by measuring the normal values of the spinal alignment in relation to hip axis as well as those of the thoracic, thoracolumbar junction, lumbar and lumbosacral junction of sagittal alignment and their correlation. MATERIALS AND METHODS: Whole spine standing lateral radiographs were taken in young 100 adults without spinal abnormalities clinically and radiographically. Intraspinal alignment was measured with angles of thoracic kyphosis, lumbar lordosis, maximum thoracic kyphosis, maximum lumbar lordosis, angle of the thoracolumbar junction, sacral inclination, segmental angles and disc angles respectively with special emphasis on lumbar lordosis. Extraspinal alignment was measured with sacropelvic angle, spinopelvic balance and spinal balance in relation to hip axis. Correlations among these parameters were analyzed. RESULTS: Lumbar lordosis and thoracic kyphosis were measured -49 degree(-22 - -79 degree) and 32 degree(6 degree-56 degree), respectively. Slight amount of kyphosis in thoracolumbar junctional area was considered normal. Lumbar lordosis had significant correlation with thoracic kyphosis and sacral inclination. However, there was no correlation between thoracic kyphosis and sacral inclination. Lowest two lumbar segments comprised 71% of total lordosis. Lumbar lordosis usually started at L1-2 and gradually increased at each level caudally to the sacrum. Sacropelvic angle, spinopevlic balance and spinal balance were measured -11 degree(-6 degree - 24 degree), -4 cm (-10 - 2 cm), and -2 cm (-7 - 4 cm) respectively with C7 positioned posterior to hip axis mostly. CONCLUSIONS: There was a wide range of normal sagittal alignment of the thoracic and lumbar spines, and normal values of these alignments were not easily defined. Therefore, normal patterns of sagittal curvature and sagittal balance should be more emphasized.
Adult ; Animals ; Axis, Cervical Vertebra ; Hip ; Humans ; Kyphosis ; Lordosis ; Reference Values ; Sacrum ; Spine*

Background: Hyperglycemia during cardiopulmonary bypass may increase the incidence and severity of neurologic deficits that may result from cerebral ischemia. Moderate hyperglycemia has been noted to occur in pediatric patients undergoing cardiac surgery despite measures such as eliminating dextrose from the CPB clear pump priming solution and from the intra-operative iv fluids. To ameliorate the hormonal and hemodynamic stress responses during cardiac surgery in neonates, infants and children, high dose fentanyl anesthesia is widely used. The authors wished to determine prospectively whether fentanyl dosage is associated with reduced blood glucose or not in pediatric patients undergoing cardiac surgery. METHODS: Twenty four pediatric patients undergoing cardiac surgery were allocated randomly into 3 groups who received 25 g/kg fentanyl, 50 g/kg fentanyl or 75 g/kg fentanyl before CPB. The changes of plasma glucose and insulin levels were observed after sternotomy, on bypass, 30 min after bypass, off bypass, and the end of the operation. RESULTS: Blood glucose levels were not increased after sternotomy, but significantly increased at bypass to the end of the operation in all fentanyl dosage groups. Plasma insulin level increased, but statistically not significant. Different fentanyl dosage (25~75 g/kg) is not associated with differences in blood glucose level. CONCLUSION: At a dosage of 25~75 g/kg fentanyl anesthesia during pediatric open heart surgery were associated with no differences and below 250 mg/dl of blood glucose level and no significant changes in insulin level.
Anesthesia ; Blood Glucose* ; Brain Ischemia ; Cardiopulmonary Bypass ; Child ; Fentanyl* ; Glucose ; Heart* ; Hemodynamics ; Humans ; Hyperglycemia ; Incidence ; Infant* ; Infant, Newborn* ; Insulin* ; Neurologic Manifestations ; Plasma ; Prospective Studies ; Sternotomy ; Thoracic Surgery*

PURPOSE: To present the enhancement pattern of acute cerebral or cerebellar cortical infarctions aged 1-3 days on MR. MATERIALS AND METHODS: Contrast-enhanced MR images of 26 patients with acute cerebral or cerebellar ischemic events were retrospectively reviewed. MR was performed within 3 days after ictus. RESULTS: Contrast enhancement in the area of infarction was observed in 61.5% (16/26) on MR. Of these 50% (13/26) showed non-parenchymal enhancement (NPE) representing either vascular or leptomeningeal enhancement, 7.7% (2/26) showed parenchymal enhancement (PE), and 2.8% (1/26) showed both NPE and PE. The earliest enhancement was seen in images obtained 12 hours after the onset of symptoms and appeared as NPE. One patient showed NPE without apparent high signal intensity at the corresponding area on T2-weighted images. In 38. 5% (10/26), there was no enhancement. CONCLUSION: Contrast-enhanced MR imaging may be needed in acute ischemic infarction, because NPE may be seen as the earliest MR finding of acute cortical infarction aged 1-3 days.
Cerebral Infarction* ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Retrospective Studies

Tracheal gaenesis is an extremely rare congenital anomaly and is characterized by totally or partially undeveloped trachea. In many instances, the lesion has been associated with malformations in other organ systems. This anomaly is classified into 3 types based on developmental period of the respiratory tract. We report a case of tracheal agenesis with tracheoesophageal fistula in a 2-hour-old male. Postmortem examination revealed that the upper and mid portion of the trachea was absent but 1 cm segment of the trachea above the carina was present. The proximal end to this trachea opened to the esophagus by a fistula, 1 cm in diameter. The well-formed larynx ended blindly in a fibrous sac at which thyroids and cartilage islands are noted. Associated anomalies were bilobed right lung and single umbilical artery.

We tried to evaluate the possibility that the radionuclide imaging of the knee with 99mTc-pyrophosphate be the diagnostic tool for the patients with the suspected tear of the meniscus of the knee. Among the 142 cases in which 99mTc-pyrophosphate scan was performed, both arthrogram and knee scintigraphy were performed in 60 cases, but only 25 cases were done arthroscopy & arthrotomy for identification to intraarticular legion. We observed 4 types of abnormally increased uptake in the scintigraphy from 16 cases of 19 cases that identified to the meniscus tear. These patterns were seen with 1) diffuse increased uptake, 2) focal increased uptake, 3) plate-like increased uptake in or near the joint space, 4) diffuse increased uptake with plate-like accentuation. Among the 25 cases, 18 cases were found to have consistent scintigraphy & operative findings, 3 cases were observed not tear of meniscus but other legions in the knee joint. And only 4 cases were seen differented to findings of arthrotomy & scintigraphy. We could conclude that the knee scintigraphy with 99mTc-pyrophosphate could be used as a helpful method of the initial evaluation of the internal derangement of the knee in the patients with the suspected tear of the meniscus of the knee.
Arthroscopy ; Humans ; Joints ; Knee Joint ; Knee ; Methods ; Radionuclide Imaging ; Tears ; Technetium Tc 99m Pyrophosphate

Aneurysms of the superior mesenteric artery are rare, accounting for 8% of visceral artery aneurysms. About 60% of all superior mesenteric artery aneurysms have a mycotic origin. The only helpful clinical manifestations are episodes of previous abdominal pain and a history of valvular heart disease. In this case, a 66-year-old female patient with mitral regurgitation and aortic regurgitation presented with pain in the upper abdominal area. A superior mesenteric artery aneurysm was diagnosed at the time of impending rupture. Since excellent collateral circulation was present, an aneurysmectomy without revascularization was performed, and no ischemic symptom occurred. The patient presented no major complications during the postoperative course.
Abdominal Pain ; Aged ; Aneurysm ; Aneurysm, Infected* ; Aortic Valve Insufficiency ; Arteries ; Collateral Circulation ; Endocarditis* ; Female ; Heart Valve Diseases ; Humans ; Mesenteric Artery, Superior* ; Mitral Valve Insufficiency ; Rupture

A 3-years-old girl, diagnosed as infantile spasm and 5-years-old boy, diagnosed as akinetic seizure were subjected to ketogenic diet trial because of their poor responses anticonyulsant treatment After adding ketogenic diet trial, in the former infantile spasm case, her seizures were controlled satisfactorily and in the latter akinetic seizure case, the frequency of seizures decreasd fairly. It seemed to be beneficial to add kotogenic diet the anticonvulsant therapy for the treatment of minor motor seizure children. We report these results with some discussion and a brief review of related literature
Child ; Diet ; Female ; Humans ; Infant ; Infant, Newborn ; Ketogenic Diet* ; Male ; Seizures* ; Spasms, Infantile

PURPOSE: To analyze clinical, radiological and pathological features as well as clinical outcome after surgical treatment of patients with secondary chondrosarcoma arising from osteochondroma(tosis). MATERIALS AND METHODS: We retrospectively reviewed clinical records, radiographs, pathologic slides of 14 patients. Nine patients were male and five were female. The mean age was 34 years. The mean follow-up period was 54 months. RESULTS: All patients had a history of previous mass since childhood or puberty. Preexisted osteochondroma was single in 3 patients and multiple in 10. Remaining 1 patient had multiple osteochondromatosis with enchondromatosis. MRI clearly provided thickness of cartilage cap, which was over 2 cm except in 2 cases. Chondrosarcoma was grade 1 in all except 1 case, which was grade 2. Wide excision was performed in 10 patients, marginal excision in 3 and amputation in 1. Twelve patients were doing very well without evidence of disease. Among 3 patients with marginal excision, 1 patient had local recurrence and 1 patient died of disease. CONCLUSION: Comprehensive understanding of clinical, radiological and pathological features of secondary chondrosarcoma is warranted for accurate diagnosis. The best result can be expected with early recognition of malignant change of osteohcondroma(tosis) and wide excision.
Amputation ; Cartilage ; Chondrosarcoma ; Enchondromatosis ; Female ; Follow-Up Studies ; Humans ; Male ; Osteochondroma ; Osteochondromatosis ; Puberty ; Recurrence ; Retrospective Studies

PURPOSE: To investigate prognostic factors influencing on local recurrence, distant metastasis and event-free survival of liposarcomas. MATERIALS AND METHODS: Fifty-two patients managed for liposarcomas since 1993 were analyzed respectively in the view of prognostic influence of patient age, tumor size, location, histologic type, histologic grade, resection type, surgical margin, chemotherapy and radiation therapy on local recurrence, distant metastasis and event-free survival. The mean follow up period was 39 months. The univariate and multivariate regression analysis were performed for statistical evaluation. RESULTS: The local recurrences occurred in 11 patients (21.2%) and distant metastasis in 4 patients (8%), Event-free survival rate at 4 year follow up was 67%. In univariate analysis, histologic grade, surgical margin, chemotherapy and radiation therapy were significant prognostic factors on local recurrence (p<0.05). However, histologic grade lost its significance in muitivariate analysis. Trunk location revealed higher rate of distant metastasis than extremity location. In univariate analysis on event-free survival. histologic grade and chemotherapy were significant factors (p<0.05). No factor remained significant in multivariate analysis. CONCLUSION: Considering selection bias, positive surgical margin was negative prognostic factor on local recurrence. Liposarcomas arisen in trunk revealed higher rate of distant metastasis. There was no independent prognostic factor on event-free survival of patients with liposarcomas.
Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Liposarcoma ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Selection Bias

Numerous studies have revealed the similarities and discrepancies in two divisions of class II malocclusion, since these malocclusion groups have been postulated to be disparate criterion, much as classified under one diagnostic umbrella. This study was undertaken to describe the craniofacial configurations of class II division 1 and 2, and consequently to discriminate the morphologic differences between the two malocclusion groups in Korean sample. Lateral headfilms of 34 class II division 1 and 29 division 2 were employed, while those of 142 adults of normal occlusion served as a control. The landmarks were digitized and 26 variables were statistically analyzed for one way: 1. There manifested no statistically significant difference in maxillary position anteroposteriorly. Normal occlusion group exhibited most anteriorly positioned mandible, whereas class II division 1 showed the most retroposition. Class II division 1 disclosed clockwise rotation tendency of mandible, which resulted in position of the chin posteriorly. 2. Class II division 1 showed greater in SN to MP, SN to PP significantly than other groups. 3. Class II division 2 showed smaller gonial angle and larger mandibular body length than other groups. 4. Class II division 1 revealed greater anterior lower face height than other groups, whereas division 2 dictated significantly greater posterior face height. 5. Class II division 2 expressed the most retroclined lower incisor, while division 1 manifested the most proclination. The largest interincisal angle resided in Class II division 2 group. There were no significant differences in upper molar position anteroposteriorly.
Adult ; Chin ; Humans ; Incisor ; Malocclusion ; Mandible ; Molar