A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte* ; Pneumonia ; Pneumonia, Aspiration* ; Shock, Septic ; Spine ; Vomiting

A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte ; Pneumonia ; Pneumonia, Aspiration ; Shock, Septic ; Spine ; Vomiting

No abstract available.
Ear Cartilage ; Ectropion ; Eyelids ; Transplants

In order to investigate the feasibility of a modified tension band combined with anti-gliding loop augmentation technique for the treatment of comminuted patellar fracture, 21 patients with comminuted patellar fracture were enrolled in this study. After the modified tension band wiring of patellar fracture, a cerclage wire was passed around the patella. Anti-gliding loops were made on the bending sites of Kirshner-wires. A knot was tied using both ends of the anti-gliding loops, and the cerclage wire was tightened using proximal knots. Bone union was achieved at 4.5+/-1.5 months postoperatively without nonunion. The Lysholm score was 87.1+/-2.8, and the range of motion of the knee was 2.1degrees+/-3.4degrees to 132.2degrees+/-6.5degrees at the last follow-up. The modified tension band combined with anti-gliding loop augmentation technique might be considered an alternative modification of modified tension band wiring for the treatment of comminuted patellar fracture.
Follow-Up Studies ; Fractures, Comminuted ; Humans ; Knee ; Patella ; Range of Motion, Articular

Various remedies have been developed for broad damage to soft tissue in limbs by traffic accidents and mechanical mishaps that have greatly increased in modern society. If the damaged part is trivial, it may be generally treated with local flap or skin graft. However, this has been limited by the ability to choose the flap available depending on the condition of the wounded part, so that, if it is rather large or severly inflamed, or if it occurred with a bone-fracture, it is inevitable to practice the free flap. In the past, the focus was on whether the free flap would survive or not. However, the function of donor the and recipient, as well as the problem of aesthetic appearance, gas become a matter of increqsing interest and concern as the survival rate of the flap has greatly improved due to the development of precise operations. In thes study, therefore, some complications were analyzed which may develop in a donor by a variety of free flaps. Preoperative plans, as well as intraoperative and postoperati-ve treatment were also studied to minimize the cause of complications. To investigate these questions, we undertook a clinical analysis of 91 followed patients from 1990 to 1997. There were 68 male and 23 female patients ranging in age from 6 to 67 years, with an average of 34.7 years. The length of follow-up ranged from 8 months to 6 years. The results of this study were as follows: Sufficient plans must be made on the donor before operation, single textures like muscle or fascia should be used if possible, and incision should be arranged along Langer`s line. Some measures to reduce wound tension should be pursued, and plans must be made to immobilize the site for an ample period after the operation. Some precautious should also be considered during the operation, such as avoiding traction surrounding nerves and vessels, preserving paratenon, practicing osteotomy with great care and properly stopping any bleeding. In addition, formation of a hematoma or seroma should be preventcd and the donor must be sutur-ed as soon as possible to reduce infection. With the application of the basic operational principles on the treatment of donors, the complications which might be caused by each free flap can be reduced, and furthermore, be protected against.
Accidents, Traffic ; Extremities ; Fascia ; Female ; Follow-Up Studies ; Free Tissue Flaps* ; Hematoma ; Hemorrhage ; Humans ; Male ; Osteotomy ; Seroma ; Skin ; Survival Rate ; Tissue Donors* ; Traction ; Transplants ; Wounds and Injuries

Perioperative hypothermia can occur frequently and lead to various complications. Laparoscopic procedures do not require a large incision or exposure of the viscera, but a prolonged and high pressure procedure can lead to unexpected hypothermia. Hypothermia prolongs the time-course of non-depolarizing neuromuscular blocking agents by reducing the plasma clearance significantly. Rocuronium, a new aminosteroidal neuromuscular blocking agent, can be influenced by reductions in plasma clearance and prolong the duration of action. Therefore, patients must receive ventilator care in the ICU. Aggressive measures were taken for hypothermia, and the patient was discharged without any complications. We report a case of delayed of neuromuscular blockade by rocuronium in a hypothermic patient during a laparoscopic procedure with a brief review of literatures.
Androstanols ; Humans ; Hypothermia ; Laparoscopy ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Plasma ; Ventilators, Mechanical ; Viscera

PURPOSE: Balloon valvuloplasty(BVP) is the treatment of choice for valvular pulmonary stenosis (PS). However, this procedure was usually performed in children older than 2 years. The purpose of the present study was to assess the safety and efficacy of BVP in young infants. METHODS: Retrospective analysis of the medical records of 25 infants younger than 6 months of age who received BVP for PS including critical PS between July 1991 and September 1997 were evaluated. RESULTS: The arterial oxygen saturation before and after procedure was 76.7% and 90.0%, respectively(P<0.001). Transvalvar pressure gradients measured with continuous wave Doppler echocardiography changed from 103.2+/-27.1mmHg to 34.8+/-14.4mmHg(P<0.001) and 29.3+/-15.9 mmHg after 6 months(P=0.075). The systolic pressure ratio of right and left ventricle before and after procedure was decreased from 1.40+/-0.4 to 0.74+/-0.3(P<0.001). Successful gradient relief was achieved with initial BVP in 21 out of 25 infants. There was one procedural death and one emergency surgery after BVP. Four of the 23 remaining patients required repeated BVP. CONCLUSION: Balloon valvuloplasty in young infants is a safe and effective procedure. In patients with symptomatic severe PS, balloon valvuloplasty should be recommended at an early age.
Balloon Valvuloplasty* ; Blood Pressure ; Child ; Echocardiography, Doppler ; Emergencies ; Heart Ventricles ; Humans ; Infant ; Medical Records ; Oxygen ; Pulmonary Valve Stenosis* ; Retrospective Studies

PURPOSE: We evaluated oncologic outcomes of chondrosarcomas and analyzed the disease-free survival rate of chondrosarcomas according to the various factors. MATERIALS AND METHODS: We performed a retrospective study for the disease-free survival rate of 48 chondrosarcomas, 44 of which underwent surgical treatment and followed up more than 18 months since 1993, and in the remaining 4 cases, the patients died before 18 months after surgery. The vsariables were location, tumor volume, histologic grade, stage, age at presentation and treatment performed. The mean follow up period was 43.8 months (1-196 months). RESULTS: The overall disease-free survival rate was 77.1% at mean 43.8 month follow up. The 5 year- and 10 year disease-free survival rates were 64% and 58% respectively. The histologic grade, stage, age at presentation revealed statistical significance on disease-free survival. All 9 patients treated with extended curettage for grade 1 central chondrosarcomas revealed disease-free survival with excellent functional outcome. CONCLUSION: The disease-free survival rate of chondrosarcomas mainly depended on histologic grade, stage and age at presentation. Local recurrence and distant metastasis also revealed statistically significant differences of disease-free survival rate. Comparing to wide resection, extended curettage for low-grade central chondrosarcomas in extremities were efficient methods with similar survival rate and less functional losses and complications.
Chondrosarcoma ; Curettage ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Survival Rate ; Tumor Burden

A total of 150women with singleton pregnancies who were delivered between 37 and 42weeks gestation had ultrasound scans on elective cesarean section day. The biparietal diameter(BPD), head circumference(HC), abdominal circumference(AC) and femur length(FL) were measured in all cases. Equations of estimated fetal body weight(BWT) for Korean term fetuses using AC alone, BPD/AC, AC/FL, HC/AC/FL, BPD/AC/FL, BPD/HC/AC/FL were made by stepwise multiple regression analysis and were compared with foreign equations such as Campbell(AC), Shepard(BPD/AC), Hadlock I(AC/FL), Hadlock II(HC/AC/FL), Hadlock III(BPD/AC/FL), and Hadlock IV(BPD/HC/AC/FL). The results were as follows. 1. The equations of BWT by sonographic measurement were Equation1 (AC) logeBWT=6.105936+0.005957X(AC) (R=0.876) Equation2 (BPD,AC)logeBWT=6.53614548+0.00004963X(ACXBPD) (R=0.929) Equation3 (AC,FL) logeBWT=6.25336442+0.00751602X(FL)+0.00005155X(ACXFL) (R=0.950) Equation4(HC,AC,FL) logeBWT=6.39631346+0.00004823X(ACXFL)+0.00002023X(FLXHC) (R=0.953) Equation5(BPD,AC,FL) logeBWT=5.99934074+0.00871394X(BPD)+0.00005132X(ACXFL) (R=0.960) 2. When BPD, AC and FL were measured, the addition of HC didn,t affected to accuracy of EFW 3. The best results of all equations were obtained with our equation 5(Mean error=2.36gm, Mean absolute error=96.39gm, Mean deviation + SD(%)=0.07+0.37) and among foreign equations, the best results were with Hadlock III equation(Mean error=18.35gm, Mean absolute error=107.82gm, Mean deviation + SD(%)=-0.46+0.42) 4. The equations using AC/FL (our equation 3, Hadlock I) are more accurate than those using BPD/AC (our equatione 2, Shepard) when utilizing two parameters. Therefore, equation using AC/FL is recommended when the BPD is unobtainable at term or labor 5. The percentage of cases in which the EFW was within +5% and +200gm of the actual birth weight was highest at our equation 5 for 82% and 89%, Hadlock IV equation for 79%, 88%. 6. Our equations had relatively an equal tendency to under- and overestimate fetal weight, but foreign equations, especially Campbell and Hadlock II equations tended to underestimate. 7. Analysing according to actual birth weight, our all equations gave the most accurate estimates of fetal weigh for birth weight group between 3000-3499gm, but for birth weight group above 3500gm, that was not. At birthweight group above 3500gm, the equations depend on femur length are more accurate than the equations independ on fumr length.
Birth Weight ; Cesarean Section ; Female ; Femur ; Fetal Weight* ; Fetus ; Head ; Pregnancy ; Ultrasonography

Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases. A rare complication occurring after its surgical treatment is the development of an aneurysm, and we report the radiologic findings in a case in which this occurred after surgical ligation.
Aneurysm* ; Ductus Arteriosus, Patent* ; Heart Diseases ; Ligation*