PURPOSE: To evaluate the predictability of amount of hemothorax in the patients with blunt chest trauma, supine chest AP radiographs of 66 patients were reviewed and statistically analyzed. MATERIALS AND METHODS: In 66 patients, rib fractures were present in 53 patients, hemothorax in 46 patients, pneumothorax in 25 patients, and pulmonary contusions in 18 patients. Width and length of hemothorax were measured on supine chest AP radiograph, and were correlated with known drained amount of hemothorax. The presence and number of rib fracture, pulmonary contusion, subcutaneous emphysema, fracture of scapula and clavicle, and total opacification of hemithorax were also correlated with the drained amount of hemothorax. RESULTS: In multiple logistic regression analysis, width of hemothorax had the highest correlation with drained amount of hemothorax(regression coefficient 0.718, p value 0.00005). The presence and number of rib fracture, scapular fracture, subcutaneous emphysema were also correlated with drained amount of hemothorax. But length of hemothorax, pulmonary contusion, clavicular fracture, total opacification of hemithorax were not correlated with drained amount of hemothorax. CONCLUSION: Measured width of hemothorax in supine chest AP radiograph is the most reliable predictor for estimation of the amount of hemothorax, and may also be used as an indication for the application of closed thoracostomy in the treatment of hemothorax.
Clavicle ; Contusions ; Hemothorax* ; Humans ; Logistic Models ; Pneumothorax ; Rib Fractures ; Scapula ; Subcutaneous Emphysema ; Thoracostomy ; Thorax*

OBJECTIVE: There is a lack of knowledge regarding whether decompression is necessary in treating patients with epidural spinal cord compression (ESCC) grade 2. The purpose of this study was to compare the outcomes of minimally invasive surgery (MIS) without decompression and conventional open surgery (palliative laminectomy) for patients with hepatocellular carcinoma (HCC) spinal metastasis of ESCC grade 2.METHODS: Patients with HCC spinal metastasis requiring surgery were retrospectively reviewed. Patients with ESCC grade 2, medically intractable mechanical back pain, a Nurick grade better than 3, 3–6 months of life expectancy, Tomita score ≥5, and Spinal Instability Neoplastic Score ≥7 were included. Patients with neurological deficits, other systemic illnesses and less than 1 month of life expectancy were excluded. Thirty patients were included in the study, including 17 in the open surgery group (until 2008) and 13 in the MIS group (since 2009).RESULTS: The MIS group had a significantly shorter operative time (94.2±48.2 minutes vs. 162.9±52.3 minutes, p=0.001), less blood loss (140.0±182.9 mL vs. 1534.4±1484.2 mL, p=0.002), and less post-operative intensive care unit transfer (one patient vs. eight patients, p=0.042) than the open surgery group. The visual analogue scale for back pain at 3 months post-operation was significantly improved in the MIS group than in the open surgery group (3.0±1.2 vs. 4.3±1.2, p=0.042). The MIS group had longer ambulation time (183±33 days vs. 166±36 days) and survival time (216±38 days vs. 204±43 days) than the open surgery group without significant difference (p=0.814 and 0.959, respectively).CONCLUSION: MIS without decompression would be a good choice for patients with HCC spinal metastasis of ESCC grade 2, especially those with limited prognosis, mechanical instability and no neurologic deficit.
Back Pain ; Carcinoma, Hepatocellular ; Decompression ; Decompression, Surgical ; Humans ; Intensive Care Units ; Life Expectancy ; Minimally Invasive Surgical Procedures ; Neoplasm Metastasis ; Neurologic Manifestations ; Operative Time ; Prognosis ; Retrospective Studies ; Spinal Cord Compression ; Spinal Cord ; Spine ; Walking

Purpose: This study evaluated the clinical results of surgical treatment with minimally invasive plate osteosynthesis for treating displaced intra-articular fractures of the calcaneus in comparison with conventional lateral extensile approach plate osteosynthesis. Materials and Methods: Of 79 cases of Sanders type II or III calcaneus fractures, 15 cases treated with the minimally invasive calcaneal plate (group M) and 64 cases treated with lateral extensile approach calcaneal plate (group E) were identified. After successful propensity score matching considering age, sex, diabetes mellitus history, and Sanders type (1:3 ratio), 15 cases (group M) and 45 cases (group E) were matched and the demographic, radiologic, and clinical outcomes were compared between the two groups. Results: The median time of surgery from injury was 2.0 days in group M and 6.0 days in group E (p=0.014). At the six months followup, group M showed results comparable with those of group E in radiographic outcomes. In the clinical outcomes, group M showed better postoperative American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores than did group E (p=0.001, p=0.008). A greater range of subtalar motion was achieved at the six months follow-up in group M (inversion 20.0° vs. 10.0°, p=0.002; eversion 10.0° vs. 5.0°, p=0.025). Although there were no significant differences in complications between the two groups (1 [6.7%] vs. 7 [15.6%], group M vs. group E; p=0.661), there was only one sural nerve injury and no wound dehiscence and deep infection in group M. Conclusion Minimally invasive plate osteosynthesis showed superior clinical outcomes compared with that of the conventional lateral extensile approach plate osteosynthesis in Sanders type II or III calcaneus fractures. We suggest applying minimally invasive plate osteosynthesis in Sanders type II or III calcaneus fractures.

We developed a user-friendly program to independently verify monitor units (MUs) calculated by radiation treatment planning systems (RTPS), as well as to manage beam database in clinic. The off-axis factor, beam hardening effect, inhomogeneity correction, and the different depth correction were incorporated into the program algorithm to improve the accuracy in calculated MUs. A beam database in the program was supposed to use measured data from routine quality assurance (QA) processes for timely update. To enhance user's convenience, a graphic user interface (GUI) was developed by using Visual Basic for Application. In order to evaluate the accuracy of the program for various treatment conditions, the MU comparisons were made for 213 cases of phantom and for 108 cases of 17 patients treated by 3D conformal radiation therapy. The MUs calculated by the program and calculated by the RTPS showed a fair agreement within +/-3% for the phantom and +/-5% for the patient, except for the cases of extreme inhomogeneity. By using Visual Basic for Application and Microsoft Excel worksheet interface, the program can automatically generate beam data book for clinical reference and the comparison template for the beam data management. The program developed in this study can be used to verify the accuracy of RTPS for various treatment conditions and thus can be used as a tool of routine RTPS QA, as well as independent MU checks. In addition, its beam database management interface can update beam data periodically and thus can be used to monitor multiple beam databases efficiently.
Animals ; Humans ; Mice ; Organothiophosphorus Compounds ; Software

Taeniasis has been known as one of the prevalent parasitic infections in Korea. Until recently, Taenia saginata had long been considered a dominant, and widely distributed species but epidemiological profiles of human Taenia species in Korea still remain unclear. In order to better understand distribution patterns of human Taenia tapeworms in Korea, partial nucleotide sequences of mitochondrial cox1 and ITS2 (internal transcribed spacer 2) were determined, along with morphological examinations, on 68 Taenia specimens obtained from university museum collections deposited since 1935. Genomic DNA was extracted from formalin-preserved specimens. Phylogenetic relationships among the genotypes (cox1 haplotype) detected in this study were inferred using the neighbor-joining method as a tree building method. Morphological and genetic analyses identified 3 specimens as T. solium, 51 specimens as T. asiatica, and 14 specimens as T. saginata. Our results indicate that all 3 Taenia tapeworms are sympatrically distributed in Korea with T. asiatica dominating over T. saginata and T. solium.
Animals ; Base Sequence ; Cestode Infections/epidemiology/parasitology ; Cyclooxygenase 1/genetics/metabolism ; DNA, Ribosomal Spacer/genetics ; Gene Expression Regulation ; Humans ; Korea/epidemiology ; Mitochondria/enzymology ; Molecular Sequence Data ; Phylogeny ; Taenia/*classification/*genetics ; Time Factors

Spermatogenesis in liver flukes, C. sinensis, was investigated by using light and electron microscopes. The epithelium of the testis was composed of a basement membrane, numerous lamellae protuded from the membrance and large number of spermatogonia supported by the lamellae. The lumen of the testis was filled with numerous 8, 16 and 32-cell groups representing primary spermatocytes, secondary spermatocytes and spermatids respectively. None of cell groups with over 32 or under 8 cells was noticed. The process of spermatogenesis is presumably as follows; A cell group of 8 spermatogonia, attached together by a cytophore, is separated from the testis epithelium during the growth period, thus becoming primary spermatocytes. The primary spermatocytes divide to form a cell group of 16 secondary spermatocytes giving rise to a cell group of 32 spermatids through meiotic germ cell division. The spermatids begin to undergo a spermiogenesis. The newly formed sperms remain attached together in the lumen for a while before migrating through the vasa efferentia.
parasitology-helminth-trematoda ; Clonorchis sinensis ; spermatogenesis ; morphology ; electronmicroscopy

A 65-year-old woman visited our hospital with a complaint of acute onset dyspnea and radiological manifestations of pulmonary thromboembolism. The patient underwent an exploratory surgery to find a whitish-blue colored mass occupying almost the whole lumen of the main pulmonary arteries. Based on the pathological and radiological findings, the patient was diagnosed to have a pulmonary arterial intramural hematoma. Intramural hematomas are usually observed in the walls of the aorta, and we believe that an isolated intramural hematoma in the pulmonary artery has not been described previously.
Aged ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Female ; Hematoma/*diagnosis/*surgery ; Humans ; Magnetic Resonance Imaging ; *Pulmonary Artery ; Thromboembolism/diagnosis ; Tomography, X-Ray Computed

The management of petroclival tumors has been improved by the techniques of cranial base surgery. However, these tumors are still among the most difficult cranial base lesions to treat. The t ranspetrosal approach is a routine procedure for petroclival tumors, but there are some disadvantages such as the time-consuming craniotomy during surgery. CSF leakage due to incomplete dural closure, postoperative infection, epidural hematoma and depressed deformity of the mastoid area after surgery. To solve these disadvantages, we modified the transpetrosal approach to mini-pet rosal technique involving total petrosectomy without temporal or suboccipital craniotomy. 11 petroclival tumors were operated on using this technique between August 1994 and August 1997. Gross total removal was achieved in tumors of up to 4cm diameter by this technique. The advantages of this approach are smaller skin incision, shorter operation time, and less postoperative complications such as epidural hematoma, CSF leakage infection, and headache. This technique can be indicated for medium to large petroclival tumors which do not extend to cavernous sinus and Jugular foramen.
Cavernous Sinus ; Congenital Abnormalities ; Craniotomy ; Headache ; Hematoma ; Mastoid ; Postoperative Complications ; Skin ; Skull Base

A morphological study on the ultrastructures of the alimentary tract and the excretory system of Clonorchis sinensis was conducted. The liver flukes were collected from rabbit liver six months after the experimental infection The worms were washed with 0.85 percent saline solution and immediately moved to cold 2.5 percent glutaraldehyde in 0.1 M phosphate buffer pH 7.4. The materials were dissected and fixed for two hours. The blocks were post-fixed in 1 percent osmium tetroxide. The blocks were embedded in Epon 812. Ultra thin sections were cut with Sovall MT-2 ultramicrotome and stained with uranyl acetate and lead citrate. Sections were then observed with Hitachi HS-7S electron microscope. The following results were obtained in a series of observations. The walls of oral cavity and esophagus comprised tegumental syncytium, basement membrane, loose connective tissue, muscular layer and parenchymal cells. The apical surface and the base of the syncytium were covered with a protoplasmic membrane for each forming numerous invaginations. Granular endoplasmic reticulum was developed in the epithelium of the oesophagus. The gastrodermis of Clonorchis sinensis comprised two types of cells in general. The first cell type was numerous one forming a single continuous layer of epithelial cells. Each of the cells had outfolded cytoplasm into the caecal lumen and lamellae along the cell surface. Among the above epithelial cells, no considerable differences in structure reflecting their functional states were identified. The second cell type was less differentiated in nature and lay within the gastrodermis above the basement membrane but not in contact with the caecal lumen, being overlapped by neighboring gastrodermal cells of the type described above. At this portion the gastrodermis seemed to be a pseudostratified epithelium. There were well-developed lamellae along the surface of epithelia of all canals or duct concerning evacuation. The excretory pore was 7.5 micrometer in diameter and dorso-terminally opended. The epithelium of the excretory pore, a syncytial layer, contained many microtubules unlike the other part of tegumental layer of this worm. The epithelium thickness of the excretory pore was very irregular(1.3-5.5 micrometer).
parasitology-helminth-trematoda ; Clonorchis sinensis ; electron microscopy ; alimentary tract ; liver ; rabbit

Inflammatory pseudotumors are tumor-like benign lesions of uncertain pathogenesis and have most commonly been reported in the lungs. In the pancreas they are rare. We describe a case of inflammatory pseudotumor of the pancreas which was seen to be isoattenuating at non-contrast CT, and as a well-defined nodule with homogeneous enhancement in the pancreatic tail at contrast-enhanced CT. After a preoperative diagnosis of islet cell tumor, partial pancreatectomy of the pancreatic tail, with splenectomy, was performed. The gross specimen was a yellowish-white, solid mass and the lesion was histopathologically confirmed as inflammatory pseudotumor with an extensive area of sparse cellular fibrosis and collagen deposition.
Adenoma, Islet Cell ; Collagen ; Diagnosis ; Fibrosis ; Granuloma, Plasma Cell* ; Lung ; Pancreas* ; Pancreatectomy ; Splenectomy ; Tomography, X-Ray Computed