From January 1988 to January 1996, 42 infants and children (44 renal units) had undergone surgical management to correct ureteropelvic junction obstruction. Median patient age was 8.5 years (range from 2 months to 17 years) and 11 patients were less than 1 year old at operation. Of 44 renal units surgically managed, 30 were on the left side and 10 were right side. 2 patients had undergone bilateral surgical management. Presenting symptoms were febrile urinary tract infection in 14 cases, abdominal pain in 14 cases, abdominal mass in 5 cases, gross hematuria in 3 cases and 3 cases were detected prenatally. We used imaging antegrade pyelography (AGP) in 15 cases, additional retrograde pyelography (RGP) in 12 cases and both AGP and RGP were performed in 1 case. To correct ureteropelvic junction obstruction, we performed dismembered pyeloplasty in 33 renal units, ureterolysis in 2 renal units, ureterocalycostomy in 1 renal unit, endopyelotomy in 1 renal unit and nephrectomy in 7 renal units. To diverge the urinary flow, we used nephrostomy in 19 renal units, ureteral stenting in 6 renal units and both nephrostomy and ureteral stenting were used in 10 renal units. As postoperative complications, restenosis was developed in 5 renal units, delayed open in 5 renal units, urinary tract infection in 2 renal units and wound infection, prolonged urine leakage, ureteral stone in each 1 renal unit. Postoperative success rate in followed-up patients, who had undergone pyeloplasty, was 91.6%. The success rate in children, who was less than 1 year old, was 100% and in children, who was more than 1 year old, was 88.4%. Finally we suggest that the surgical correction is safe and proper method for ureteropelvic junction obstruction in children. Additionally early operation of ureteropelvic junction obstruction is recommendable.
Abdominal Pain ; Child* ; Hematuria ; Humans ; Infant ; Nephrectomy ; Postoperative Complications ; Stents ; Ureter ; Urinary Tract Infections ; Urography ; Wound Infection

No abstract available.
Chondromatosis, Synovial* ; Knee Joint* ; Knee* ; Osteoarthritis*

OBJECTIVE: It is not unusual to decompress two consecutive disc levels in treating patients with multiple radiculopathy or uncertain level diagnosis. However, the controversy over whether to use corpectomy or bisegmental diskectomy for anterior cervical fusion is still largely unsettled. The aim of this study is to define the properties of these two surgical options. PATIENTS AND METHODS: We performed a retrospective review of radiological data and clinical records only in patients whom the follow up period is longer than 12 months. Functional outcome, fusion rate, complication rate, and duration of anesthesia were analyzed in both groups. RESULTS: In total of 61 cases, corpectomy was performed in 34 and the bisegmental diskectomy in 27 patients. Mean follow-up periods were over 24 months in both groups. Anesthesia time was shorter in corpectomy patients(280 minutes vs. 300 minutes in segmental diskectomy). However, the bisegmental diskectomy group was better in achieving good clinical outcome(92.6% vs. 82%). Overall fusion rate in bisegmental diskectomy was 100%. Hardware failure rate was lower in bisegmental diskectomy group(11% vs. 18%). Revision was needed in 6% of corpectomy group. CONCLUSIONS: In conclusion, although the anesthesia time is slightly longer in bisegmental fusion, we believe the method of bisegmental diskectomy is better in accomplishing higher fusion rate and lower complication rate.
Anesthesia ; Diagnosis ; Diskectomy* ; Follow-Up Studies ; Humans ; Radiculopathy ; Retrospective Studies

No abstract available.
Myelitis, Transverse* ; Retrospective Studies*

Many plastic surgeons have been tried to attain ultimate goal lies in restoring the original shape and function of the facial aesthetics, in reconstruction of deformities resulting from facial hypertrophic scar and skin defects. This would require consideration in terms of hanmony in color match, skin texture and thickness. Various forms of skin graft, local flap, distant flaps, free flap and tissue expander have been employed in restoring skin defects and deformities of the cheek and submental area, and the use of large local flaps utilizing the cervicofacial skin flaps or tissue expander have brought about improved aesthetic results. the authers have obtained satisfactory results in treating 2 cases of wide hypertrophic scar of the cheek and submental area with combination of wide cervical flap and intraoperative tissue expansion using foley catheter. the merits of this combined operative methods are as follows : 1. It is not necessory to keep tissue expander for a long period. 2. This technique is able to diminish the cost of multistage operation and using of tissue expander. 3. There is no psychologic problems due to undesirable facial appearance during tissue expansion period. 4. Rapid intraoperative tissue expansion by foley catheter during elevating wide cervical flap can allow to dissect one, preserving the perforators without bleeding in a short time. 5. Wide cervical flap and additional expanded tissue by means of intraoperative tissue expansion could brought into suturing avoiding tension of oral commissure and lip eversion. 6. Preservation of perforators of cervical flap above the platysma muscle raised flap's survival rate and then this result could prevent distal ischemic necrosis after flap coverage.
Catheters ; Cheek ; Cicatrix, Hypertrophic* ; Congenital Abnormalities ; Esthetics ; Free Tissue Flaps ; Hemorrhage ; Lip ; Necrosis ; Skin ; Survival Rate ; Tissue Expansion Devices ; Tissue Expansion* ; Transplants

OBJECTIVES: This study was performed to estimate the prevalence and possible risk factors of the metabolic syndrome in steel-mill workers, and to evaluate the relation between gamma-glutamyltransferase (gamma-GTP) and the metabolic syndrome. METHODS: The study subjects comprised 1,604 male steel-mill workers. The indices of metabolic syndrome, such as BMI, triglyceride, HDL-cholesterol, blood pressure, fasting glucose, and gamma-GTP were analyzed in each subject. We collected information about demographic characteristics, behavioral patterns, such as alcohol drinking, smoking, and exercise, and family medical history through a self-administered questionnaire. Statistical analysis was done by using the chi-square test, Mantel-Haenszel trend test and logistic regression model. RESULTS: The crude and age-adjusted prevalences of the metabolic syndrome were 21.3% and 15.5%, respectively, in the steel-mill workers. Age (OR: 1.063, 95% CI: 1.033-1.094), alcohol drinking (OR: 1.657, 95% CI: 1.175-2.337) and smoking (OR: 1.359, 95% CI: 1.017-1.816) were risk factors for the metabolic syndrome. Meanwhile, shift work showed a significant relation with hypertension (OR: 1.329, 95% CI: 1.038-1.700), but not with other metabolic syndrome components. However, tenure, exercise and family medical history were not significant factors for the metabolic syndrome in this study. The risk ratio of the metabolic syndrome (OR: 3.345, 95 % CI: 2.534-4.416) and its components, such as obesity, hypertriglyceridemia, hypertension and hyperglycemia, were higher in the high gamma-GTP group (> or =63 IU/ liter) than in the controls (<63 IU/liter). CONCLUSIONS: These results confirm the need for health education to control the metabolic syndrome by improving behavioral patterns, such as alcohol drinking and smoking, in factory workers. In addition, it is suggested that gamma-GTP might be a useful candidate in screening for the metabolic syndrome.
Alcohol Drinking ; Blood Pressure ; Fasting ; gamma-Glutamyltransferase ; Glucose ; Health Education ; Humans ; Hyperglycemia ; Hypertension ; Hypertriglyceridemia ; Logistic Models ; Male ; Mass Screening ; Obesity ; Odds Ratio ; Prevalence ; Questionnaires ; Risk Factors* ; Smoke ; Smoking ; Triglycerides

Two cases of vertex epidural hematomas are described to illustrate their unique diagnostic and treatment problems. Due to its specific location, a correct diagnosis of the intracranial hematoma was delayed in the first case. Quantitative analysis of the hematoma volume was performed in the second case. We would like to emphasize the usefulness of the magnetic resonance imaging and quantitative analysis of vertex epidural hematoma in choosing treatment options in such patients.
Adult ; Case Report ; Hematoma, Epidural/*diagnosis/surgery ; Human ; Magnetic Resonance Imaging ; Male

PURPOSE: In most patients of Kawasaki disease(KD), fever subsides within 48 hours after infusion of intravenous immunoglobulin(IVIG), but in some cases, retreatment of IVIG is needed because of prolonged fever. This study was performed to findout the factors associated with the retreatment of IVIG in KD. METHODS: Patients with KD, treated with IVIG were classified into two groups : single IVIG treatment group(defeverescence within 48 hours after starting IVIG : group B) and IVIG retreatment group(retreatment with IVIG for fever over 48 hours despite the 1st infusion of IVIG; group A). We compared the clinical symptoms, laboratory findings, clinical signs and echocardiogram findings between group A and B. RESULTS: The mean CRP level of group A was higher than that of group B(P= 0.001), and the mean cholesterol level of group A was lower than that of group B(P=0.002). In CRP level is above 10 mg/dL, odds ratio for retreatment of IVIG is higher than that of level below 10 mg/dL. As cholesterol level decreased, the odds ratio for retreatment with IVIG increased. CONCLUSION: When readministration of IVIG in KD patients for prolonged fever over 48 hours, the consideration of the initial levels of relatively low serum cholesterol and high CRP is recommended.
Cholesterol ; Fever ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Mucocutaneous Lymph Node Syndrome* ; Odds Ratio ; Retreatment*

Cranial mononeuropathies, manifesting particulary as opthalmoplegia or facial palsy, are common entities in the dia-betic population. However, sequential multiple cranial neuropathies due to diabetes are much less common. It is often associated with other conditions such as a brain tumor or head trauma. A 61-year-old diabetic man presented with ptosis, opthalmoplegia, and facial palsy which were manifestations of multiple cranial neuropathies involving the left 3rd, 4th, 6th, and 7th cranial nerves throughout five weeks. The pupils were not involved. The neurologic evaluation included a CSF study and a brain MRI with MRA. None of them produced any significant results. Blink reflexes revealed evidence of a left facial nerve lesion. The blood glucose was strictly controlled and steroid therapy was administered. The ptosis of the patientanjx left eyelid improved during treatment and he was discharged after 13 days. In a follow-up examination 3 months after onset, focal neurological deficits including opthalmoplegia and facial palsy on the left side were greatly improved and barely noticeable.
Blinking ; Blood Glucose ; Brain ; Brain Neoplasms ; Cranial Nerve Diseases* ; Cranial Nerves ; Craniocerebral Trauma ; Diabetes Mellitus* ; Eyelids ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mononeuropathies ; Pupil

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a rare case of dislodgement of two intracoronary stents. On withdrawal of two balloon catheters, one with a guide wire was mechanically distorted from the left main (LM) to the proximal left anterior descending artery (LAD) while the other was dislodged from the LM to the ostial left circumflex artery. The stent in the LAD could not be retrieved into the guide catheter using a Goose neck snare, because it was caught on a previously deployed stent at the mid LAD. A new stent was quickly deployed from the LM to the proximal LAD, because the patient developed cardiogenic shock. Both stents, including a distorted and elongated stent, were crushed to the LM wall. Stent deployment and crushing may be a good alternative technique to retrieving a dislodged stent.
Angioplasty, Balloon, Coronary/adverse effects/*instrumentation ; Cardiac Catheterization/adverse effects/*instrumentation ; Coronary Angiography ; Coronary Stenosis/diagnosis/*therapy ; Female ; Humans ; Middle Aged ; Prosthesis Failure ; Shock, Cardiogenic/etiology/therapy ; *Stents ; Treatment Outcome