PURPOSE: To evaluate the early clinical results of lumbar microdiscectomy using minimally invasive tubular retractor (METRx-MD system, Medtronic Sofamor Danek, Memphis, TN), and to validate the merits of minimally invasive spinal surgery. MATERIALS AND METHODS: From April, 2003 to April 2004 we retrospectively studied a consecutive series of 45 patients who underwent lumbar microdiscectomy using minimally invasive tubular retractor. In all cases, minimally invasive approach using the tubular retractor were performed with a 2 cm sized paramedian incision. The following data were collected: clinical outcomes, operative time, intraoperative blood loss, need for blood replacement, time needed before ambulation, length of hospital stay, and complications. The clinical outcomes were assessed by the modified MacNab criteria. RESULTS: Minimally invasive tubular microdiscectomy was performed in 45 patients over a 12-month period with an average follow-up of approximately 8 months. The clinical outcomes assessed by MacNab criteria were excellent in 33 patients (73%), good in 10 patients (22%). The average operative time was 63 minutes (range, 35 to 95 minutes). The average blood loss was 62 mL (range, 50 to 110 mL). None of the patients needed blood replacement. With the exception of 2 patients, all patients could walk at the day of surgery. The average hospital stay was 2.3 days. None of the patients had dural tear, wound problem, or other complications. CONCLUSION: Lumbar microdiscectomy using tubular retractor can offer a useful modality for the treatment of lumbar herniated disc with the merits of minimally invasive spinal surgery. Further long-term, randomized, prospective investigations are needed to fully evaluate the impact of this technique.
Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Length of Stay ; Operative Time ; Wounds and Injuries

We report a case of sevoflurane anesthesia. Sevoflurane is a halogenated methyl isopropyl ether which was synthesized first in the early 1970s. In 1975, Wallin RF and his colleagues first reported on physicochemical, pharmacologic, and toxicologic properties of sevoflurane. They noted that frequent exposures of dogs and rats to sevoflurane over a period of 2 weeks did not result in any significant toxicologic changes and did not sensitize the heart to epinephrine. It has a blood: gas partition coefficient of 0.60 which is lower than that of other currently used inhalational volatile agents. Its MAC value has been reported to vary between 1.71 and 2.5%. From reports of studies in adult valunteers and Japanese children it is clear that induction of anesthesia by sevoflurane is rapid and smooth as predicted by a blood: gas partition coefficient of about 0.6 and acceptable odour which allows the use of overpressure concentrations of up to 10%. Other animal investigations indicate that sevoflurane provides no organotoxicity. In this study we observed induction-emergence time, hemodynamic changes and postoperative hepatorenal effects in healthy surgical patients receiving sevoflurane anesthesia.
Adult ; Anesthesia* ; Animals ; Asian Continental Ancestry Group ; Child ; Dogs ; Epinephrine ; Ether ; Heart ; Hemodynamics ; Humans ; Rats

Clinical electrophysilogical study(EPS) was done in 5 patients with chronic bifascicular block of completa RBBB and left anterior fascicular block. The results were as follows. 1) In 2 patients who needed permenent pacemaker therapy, EPS disclosed prolonged HV interval(>70msec) and block distal to his bundle by atrial with cycle length of longer than 545msec. 2) In 3 patients who didn't need permenent pacemaker therapy, AV conduction and to choose the therapeutic measures in the patients with chronic bifascicular block and unexplained dizziness and/or syncope.
Bundle of His ; Bundle-Branch Block ; Dizziness ; Humans ; Syncope

BACKGROUND AND OBJECTIVES: Diabetes is associated with a unique form of cardiomyopathy in the absence of atherosclerosis. The mechanisms of diabetic cardiomyopathy have not been defined, but is associated with early left ventricular (LV) diastolic dysfunction following an altered LV contractile performance. However, less attention has been paid to the right ventricular (RV) diastolic function in diabetes. Therefore, the changes in the RV ans LV filling dynamics, in patients with early type 2 diabetes, were investigated. SUBJECTS AND METHODS: The transtricuspid and trans-mitral flows were assessed by transthoracic Doppler echocardiography, at maximal inspiration and expiration, in 48 subjects (mean age: 62+/-9 years, M:F=16:32) with type 2 diabetes (Type 2 DM group) and 34 normal subjects (control group ; mean age:59+/-9 years, M:F=15:19, ranging from 45-75 years of age) with normal LV systolic function and ECG at rest. Subjects with diabetic complication, nephropathy (Cr >1.5 mg/dL), LVH and COPD were excluded. RESULTS: The mitral E/A ratio and DT (deceleration time) showed no significant difference between the type 2 DM and control groups. The LV and RV systolic functions also showed no significant difference between the two groups. However, the type 2 DM group had a lower tricuspid E/A ratio (0.98+/-0.25 vs. 1.17+/-0.21, p<0.001) and a longer tricuspid DT (241+/-65 msec vs. 208+/-51 msec, p=0.016) than the control group. CONCLUSION: The right ventricular diastolic function is frequently abnormal in early type 2 diabetes. This suggests that right ventricular diastolic dysfunction may be an important predictor for the early detection of diabetic cardiomyopathy.
Atherosclerosis ; Cardiomyopathies ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Cardiomyopathies ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Heart Ventricles ; Humans ; Pulmonary Disease, Chronic Obstructive

Noninvasive prediction of pulmonary arterial pressure is of paramount importance in heart disease. To estimate pulmonary arterial pressure, several echocardiographic techniques, including abnormal pulmonary valve motion, prolongation of RV preejection period/RV ejection time ratio and contrast echocardiography have been proposed. Recently Doppler echocardiography has been known to detect intracardiac blood quantitatively. For assessment of the benefit of several indices by Pulsed Doppler echocardiography for mean pulmonary arterial pressure, 22 patients(mean pulmonary pressure> or =20mmHg; 11, <20mmHg; 11) were compared with the mean pulmonary arterial pressure by cardiac catheterization. In comparison of mean pulmonary arterial pressure(MPAP); 1) Right preejection period / RV ejection time RPEP/RVET;r=0.278 2) Right preejection period / Acceleration time RPEP/AT : r=0.654 3) Acceleration time(AT) AT=-1.55(MPAP)+154.37(r=-0.763) AT=-92.99(log MPAP)+239.41(r=-0.752) AT is less than 105 msec in 9 or 11 pulmonary hypertension and one of 11 normal individual. 4) Acceleration time/ RV ejection time AT/RVET=-136.36(MPAP)+83.31(r=-0.817) AT/RVET=-0.29(log MPAP)+0.81(r=-0.803) 5) (Right preejection period+Decceleration time) / AT (RPEP+DT)/AT=9.6(MPAP)-0.16(r=0.806) (RPEP+DT)/AT=3.86(log MPAP)-2.46(r=0.789) In conclusion AT/RVET, (RPEP+DT)/AT and Acceleration time of 105 msec are valuable indices to estimate mean pulmonary arterial pressure by Pulsed Doppler echocardiogram.
Acceleration ; Arterial Pressure* ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Echocardiography, Doppler ; Echocardiography, Doppler, Pulsed* ; Heart Diseases ; Hypertension, Pulmonary ; Pulmonary Valve

PURPOSE: Animal and clinical experiments have recently shown that TUEIP resulted in a reduction of the prostate volume and an increase of the lumen of the prostatic urethra. We assessed the clinical efficacy of TUEIP for BPH. MATERIALS AND METHODS: Between February 2001 and December 2001, 27 patients diagnosed with BPH, and had undergone surgical management, were evaluated. With endoscopic injection set, 99% alcohol was injected into the inferior portion of the bladder neck and around the verumontanum, depending on the individual endoscopic findings. Pre-operatively, immediately after removal of the Foley catheter and at 3 months post-operatively, all the patients were evaluated with uroflowmetry and PVR, with 15 patients receiving transrectal ultrasound at 3 months post-operatively. RESULTS: The pre-operative Qmax was 8.1ml/sec, which increased to 11.8ml/sec (p<0.05) after removal of the Foley catheter, and was further increased to 13.0ml/sec (p<0.05) at 3 months post-operatively. The pre-operative PVR was 14.2ml, which increased to 15.8ml and 16.5ml after removal of the Foley catheter and at 3 months post- operatively, respectively. The pre-operative prostate volume was 39.7cc, which was reduced to 25.9cc (p<0.05) at 3 months post-operatively. There was no systematic adverse effect from alcohol absorption. CONCLUSIONS: TUEIP is considered as an effective alternative treatment of symptomatic bladder outlet obstruction caused by BPH, showing a significant increase in Qmax and reduction of the prostate volume.
Absorption ; Animals ; Catheters ; Ethanol* ; Humans ; Neck ; Prostate* ; Prostatic Hyperplasia* ; Ultrasonography ; Urethra ; Urinary Bladder ; Urinary Bladder Neck Obstruction

Primary vesicoureteric reflux is regarded as a congenital condition resulting from a short submucosal ureteral segment and an absence of adequate detrusor support behind the intravesical ureter. Several antireflux operations have been devised, all of which entail opening the bladder and performing a variety of procedures on the ureter. Polytef paste is a sterile, relatively inert, injectable paste, containing polytef, glycerine and polysorbate and polytef is Teflon that has been pyrolysed. Subureteric injection of Teflon is a good substitute for open operation which eliminate vesicoureteric reflux because it is well tolerated, avoids open operation and shortens Hospital day. Herein we report two case of vesicoureteric reflux treated by endoscopic injection of Teflon and review the literatures.
Endoscopy ; Glycerol ; Polytetrafluoroethylene* ; Ureter ; Urinary Bladder

Authors have experienced with a rare case of marginal blepharitis caused by pubic lice, which was confirmed by slit-lamp and light microscopic examinations and resulted with a good outcome with appropriate treatment. Patient was a 11 year-old Korean male who has been complaining of itching sensation on the upper lid margin, conjunctival congestion, eye wax and foreign body sensation in both eyes for more than three months. Authors speculate that the possible contact or source of this invader probably is his mother since we have found same ova and worms from the pubic region of his mother. It is recommended that if a patient complains of a blepharitis witli stubborn itching sensation which is not controlled by a ordinary treatment, the therapist should be kept in mind of this parasitic intruder.
Blepharitis* ; Child ; Estrogens, Conjugated (USP) ; Foreign Bodies ; Humans ; Male ; Mothers ; Ovum ; Phthiraptera* ; Pruritus ; Sensation

PURPOSE: To compare the detectability and conspicuity of focal hepatic lesions among conventional spin echo techniqueniques and fast scanning techniqueniques in MR imaging. MATERIALS AND METHOD: 36 patients (24 men and 12 women, mean age of 54 years) with suspected liver mass on CT scan and US underwent MR imaging at 1.5 T system. Conventional spin echo T1, T2 weighted imaging, T2 weighted fast spin echo, T1 weighted fast multiplanar spoiled gradient recalled(FMPSPGR) imaging and Gd-enhanced FMPSPGR(Gd-FMPSPGR) were performed. 16 cases of hepatocellular carcinoma, 13 cases of hemangioma, 3 cases of metastasis, 3 cases of cholangiocarcinoma, and 1 case of lymphoma were included. Lesion conspicuity and number of detected hepatic masses were compared among the MR sequences. RESULTS: Overall 63 hepatic lesions were detected in 36 patients. Lesion detection' was 63(100%) with Gd-FMPSPGR, 62(98%) with non-enhanced FMPSPGR, 58(92%) with SE T2WI, 56(89%) with SE T1WI and 54 (86%)with FSE. For solid tumors, the contrast to noise ratio was greatest on Gd-FMPSPGR which was significantly higher than any other sequences. For hemangiomas it was greatest on SE T2WI and was significantly higher than SE T1WI. In the qualitative assessment, Gd-FMPSPGR was preferred for both solid mass lesion and hemangioma. FSE was inferior to SE T2WI for lesion detection and conspicuity without statistical significance. CONCLUSIONS: For the evaluation of focal hepatic lesions, breath-hold FMPSPGR with and without contrast enhancement may replace the conventional SE T1WI. Because FSE was inferior to SE T2WI when the later is used with respiratory compensation in some cases, it is difficult to replace the SE T2WI with FSE. But FSE, FMPSPGR and Gd-FMPSPGR images, when combined, may replace SE T1WI and SE T2WI.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Compensation and Redress ; Female ; Hemangioma ; Humans ; Liver ; Lymphoma ; Magnetic Resonance Imaging ; Male ; Neoplasm Metastasis ; Noise ; Tomography, X-Ray Computed

A 33-year-old woman was presented with dyspnea and chest discomfort after indigesting approximately 500ml of oil paint brush washing fluid. Hypoxic symptoms and radiographic infiltrates rapidly progressed. The patient was intubated and received mechanical ventilation. Bronchoalveolar lavage and transbronchial lung biopsies were performed. The CT scan of the lung showed bilateral extensive pneumonitis with necrosis and the lung tissue pathologic findings showed diffuse alveolar damage with extensive necrosis and numerous lipidladen macrophages. After intensive medical care with mechanical ventilation, her symptoms and radiological findings improved.
Adult ; Biopsy ; Bronchoalveolar Lavage ; Dyspnea ; Eating* ; Female ; Humans ; Lung ; Macrophages ; Necrosis ; Paint ; Pneumonia* ; Respiration, Artificial ; Thorax ; Tomography, X-Ray Computed