No abstract available.
Reference Values*

A 12 years old Korean girl was seen on 10 Oct. 1969 with chief complaint of a large fleshy mass extruded out of the orbit associated with ocular pain of mild degree for several months. Her parents were first noticed that the girl's right eye had a peculiar reflex from the pupillary zone in 2 years of her age. She was advised by a local clinician to correct surgicaIly someday later in her childhood. At the age of four, the pupillary margin of the affected eye had become distorted and they became aware of the eyeball was a little protruded and the grade of protrusion had slowly advanced as she had grown up. About a year ago the patient suffered from sudden attack of severe ocular pain associated with vomiting. Having experienced the recurrences of similar attack several times, she at last in Sept. 1969 met a spontaneous outburst of the extruded mass from which the purulent and bloody contents flowed out. It was to be regretted that the history could not reveal when and how the globe had been disorganized as completely as such that no trace of configuration of the anterior segment could be recognized. Familial and past history were not contributory except measle with good recovery at 2 years of age. On examination, the left eye had good vision and no structural changes, wherease the right side showed a marked extrurusion of fleshy mass out of the lid aperture. The mass had a relatively smooth and congested coverage of the conjunctiva except it had the fistulae through which a small amount of the purulent and bloody discharge flowed out under the digital pressure. It was felt somewhat elastic and movable with a broad base into the orbit. On its surface no trace of the cornea or the other global structures could be found. Physical examinations of the whole body including regional lymphnodes revealed normal X-ray Was of chest, skuIl and optic foramina were normal. On 14 Oct. 1969 under general anesthesia an orbital exentration was undertaken because of either probability of a malignant tumor or a long standing intraocular inflammation. In the way of procedure necrotic contents bursted out by mechanical pressure through the weak point, i.e. the fistulae, and correspondingly the tumorous mass became softened. Confirming no hard mass palpable into the orbit, the operating procedure shifted to do partial exentration. The extirpated mass was subjected to the histological study. Grossly, the dissected area revealed that it contained a well preserved structure of sclera on the one side and completly necrotised material on the other, but it did not contain any remnants of the ordinary global structures such as cornea, iris, lens, vitreous and choroid. The hollowed space partially surrounded by scleral structure was filled with the dark and gelatinous materia. The mass was as a whole rather soft Histological examination showed numerous gland like proliferations composed of poorly differentiated and unpigment columner cells having relatively large nuclei, some of which showed a mitotic figure. These were conceivable to be of an embryonic retina. The lumina of the gland like structures with the various sizes and shapes were filled with a pink staining coagulum and an extremly delicate and regularly arranged fibrillar structure. In some parts the tumor consisted of solid cellular conglomeration with rosett like arrangement and in the other necrotic masses containing tumor cells in all stages of degeneration. For the most part and the surrounding structure of the tumor cells, the picture showed likely to be a diffuse inflammation with an infiltration of polymorphonuclear cells, partly vessels being mostly of capillaries and recent hemorrhages, but the cartilage was not found.
Anesthesia, General ; Capillaries ; Cartilage ; Child ; Choroid ; Conjunctiva ; Cornea ; Estrogens, Conjugated (USP) ; Female ; Fistula ; Gelatin ; Hemorrhage ; Humans ; Inflammation ; Iris ; Orbit ; Parents ; Physical Examination ; Recurrence ; Reflex ; Retina ; Sclera ; Thorax ; Vomiting

Choriocarcinoma associated with a normal pregnancy is rare. Futhermore, choriocarcinoma coexistent with a viable pregnancy is even rarer and associated with a greater risk of hepatic and cerebral involvement. So timely diagnosis of the disease is important for successful treatment and aggressive diagnostic procedures may therefore warranted. The patient should be treated with primary intensive combination chemotherapy(EMA-CO) and the selective use of irradiation and surgical therapy. We experienced a case of metastatic choriocarcinoma of lung and kidney following preterm delivery at 34th week of pregnancy and so present it with brief review of literature.
Choriocarcinoma* ; Diagnosis ; Female ; Humans ; Kidney ; Lung ; Pregnancy ; Pregnancy*

STUDY DESIGN: Case report.OBJECTIVES: We report a case of 3-column fracture caused by low-energy trauma in a patient with Baastrup disease who complained of acute radiating pain and motor weakness in the lower limbs after 3 weeks of conservative treatment. Subsequently, posterior fusion surgery was performed.SUMMARY OF LITERATURE REVIEW: Baastrup disease is characterized by enlargement and close approximation of adjacent spinous processes, and it mostly affects the L4-5 level of the spine. In patients with Baastrup disease affecting multiple levels of the lumbar spine, low-energy trauma can cause an unstable 3-column fracture with neurological compromise. Early recognition and surgical treatment prior to the emergence of a neurological deficit are required.MATERIALS AND METHODS: An 84-year-old woman presented with back pain after falling down backward and colliding with the edge of a shelf at ground level. Considering the patient's general condition and age, she was initially treated with close observation and placement of a spinal brace with serial radiographic follow-up.RESULTS: Computed tomography found 3-column fracture at the T11 level, which is quite rare in cases of minor trauma. At a 3-week follow-up, she complained of gradual lower extremity weakness, and her general lower extremity motor function decreased to grade 1–2. The patient underwent posterior fusion 2 levels above and below the affected vertebral body (T9-10-12-L1). Surgery was uneventful and the patient's motor function recovered.CONCLUSIONS: In patients with Baastrup disease affecting multiple levels of the lumbar spine, based on our experience, low-energy trauma can cause an unstable 3-column fracture with neurological compromise. We highly recommend scrutiny of the interspinous space in elderly patients, especially those with a spinal fracture caused by low-energy trauma.
Accidental Falls ; Aged ; Aged, 80 and over ; Back Pain ; Braces ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Spinal Fractures ; Spine

42 knees with degenerative arthritis underwent arthroscopic lavage and 7 knees underwent arthroscopic lavage combined with multiple bone drilling in between 1994 and 1995 and followed average 12 months. Clinical evaluation using the hospita1 for specia] surgery knee scores (HSS scores) was done at last follow up and classified into 4 groups: excellent (90-99), good (80-89), fair (70-79) and poor (less than 70). The results were as follows: l. Of the 42 knees of the lavage group, 6 knees (16%) was excellent, 14 knees (33%) good, ]7 knees (40%) fair and 5 (11%) knees poor. Success group (Excellent & Good) were achived in 20 knees (49%). 2. Of 17 knees treated with arthroscopic lavage comhined with multiple bone drillig resulted in excellent in 9 knees (53%), good in 4 knees (23%), fair in 2 knees (12%) and poor in 2 knees (12%). Success group were achived in 13 knees (76%). 1n conclusion, we helieve that multiple bone drilling in conjunction with arthroscopic lavage has more favorable effect on the pain relief for degenerative osteoarthritis of the knee than arthroscopic lavage only.
Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis* ; Therapeutic Irrigation*

K+ -selective ion channels were studied in excised inside-out membrane patches from human osteoblast-like cells(G292). There classes of K+ channels were present and could be distinguished on the basis of conductance. Conductances were 270+/-27 pS, 113+/-12 pS, 48+/-8 pS according to their approximate conductances in symmetrical 140 mM KCI saline at holding potential of -80 mV. It was found that the small conductance (48 pS) K+ channel activation was dependent on membrane voltage. In current-voltage relationship, small conductance K+ channel showed outward rectification, and it was activated by the positive potential inside the membrane. In recordings, single channel currents were activayed by a negative pressure outside the membrane. The membrane pressure increased P(open) of the K+ channel in a pressure-dependent manner. In the excised-patch clamp recordings, G292 osteoblast-like cells have been shown to contain three types of K+ channels. Only the small conductance (48 pS) K+ channel is sensitive to the membrane stretch. These findings suggest that a hyperpolarzing current, mediated in part by this channel, may be associated with early events during the mechanical loading of the osteoblast. In G292 osteoblast-like cells, K+ channel is sensitive to membrane tension, and may represent a unique adaptation of the bone cell membrane to mechanical stress.
Cell Membrane ; Humans ; Ion Channels ; Membranes ; Osteoblasts ; Stress, Mechanical

OBJECTIVES: We report a case of 3-column fracture caused by low-energy trauma in a patient with Baastrup disease who complained of acute radiating pain and motor weakness in the lower limbs after 3 weeks of conservative treatment. Subsequently, posterior fusion surgery was performed.SUMMARY OF LITERATURE REVIEW: Baastrup disease is characterized by enlargement and close approximation of adjacent spinous processes, and it mostly affects the L4-5 level of the spine. In patients with Baastrup disease affecting multiple levels of the lumbar spine, low-energy trauma can cause an unstable 3-column fracture with neurological compromise. Early recognition and surgical treatment prior to the emergence of a neurological deficit are required. MATERIALS AND METHODS: An 84-year-old woman presented with back pain after falling down backward and colliding with the edge of a shelf at ground level. Considering the patient's general condition and age, she was initially treated with close observation and placement of a spinal brace with serial radiographic follow-up. RESULTS: Computed tomography found 3-column fracture at the T11 level, which is quite rare in cases of minor trauma. At a 3-week follow-up, she complained of gradual lower extremity weakness, and her general lower extremity motor function decreased to grade 1–2. The patient underwent posterior fusion 2 levels above and below the affected vertebral body (T9-10-12-L1). Surgery was uneventful and the patient's motor function recovered. CONCLUSIONS In patients with Baastrup disease affecting multiple levels of the lumbar spine, based on our experience, low-energy trauma can cause an unstable 3-column fracture with neurological compromise. We highly recommend scrutiny of the interspinous space in elderly patients, especially those with a spinal fracture caused by low-energy trauma.

This is a report on the clinical outcome and hemodynamic profile of the ATS(R) cardiac valve prosthesis, which is a recently introduced pyrolytic carbon bileaflet prosthesis. We retrospectively reviewed the early outcome of 100 consecutive patients who underwent isolated cardiac valve replacement with the ATS(R) prosthesis from October 1994 through June 1996 at our hospital. All patients were evaluated with Doppler echocardiography before discharge from the hospital. The mean age of the patients was 48.6 years(range: 2 to 74). A total of 124 prosthesis were implanted; 71 mitral, 46 aortic, and 7 tricuspid. The two most frequently used sizes were 27 mm(40.8%) and 29 mm(35.2%) in the mitral position, and 23 mm(30.4%) and 21 mm(28.3%) in the aortic position. There was no early or late death. The total follow-up period was 950 patient-months with 99% follow-up rate. Serious late morbidity occurred in three patients; reoperation in two patients for late rupture of Sinus of Valsava in one and for endocarditis with prosthetic dehiscence in the other, and intracranial hemorrhage due to hypertension in one patient. There has been no thromboembolic complication or structural valve deterioration. In the mitral position, the average values of peak and mean transprosthetic pressure gradients and valve area calculated from pressure half time were 6.9+/-2.8 mmHg, 2.6+/-1.5 mmHg, and 2.7+/-0.8 cm2 respectively. In the aortic position, the peak and mean pressure gradients were 26.4+/-15.9 mmHg and 14.2+/-7.9 mmHg. For the mitral prostheses larger than 25-mm size, there was no significant difference among prosthetic sizes in terms of transprosthetic gradients, whereas there was a significant negative correlation between the prosthesis size and the transprosthetic gradients for the aortic valves. The peak and mean pressure gradients were 52.2+/-17.6 mmHg and 26.9+/-7.4 mmHg across the 19-mm aortic prostheses, and 27.1+/-11.9 mmHg and 13.3+/-6.6 mmHg across the 21-mm size. Above results can lead to the conclusion that the early clinical outcome of the ATS valve prosthesis is quite satisfactory. And the hemodynamic characteristics are comparable, if not better, with other bileaflet prostheses.
Aortic Valve ; Carbon ; Echocardiography* ; Echocardiography, Doppler ; Endocarditis ; Follow-Up Studies ; Heart Valve Prosthesis ; Heart Valves* ; Hemodynamics ; Humans ; Hypertension ; Intracranial Hemorrhages ; Prostheses and Implants* ; Reoperation ; Retrospective Studies ; Rupture

BACKGROUND AND OBJECTIVES: Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and ventricular assist device has always been the optimal choice for treating the majority of medically intractable low cardiac output case. We retrospectively investigated our institution's outcomes and variables associated with a high risk of mortality. SUBJECTS AND METHODS: From 1999 to 2014, 86 patients who were of pediatric age or had grown-up congenital heart disease underwent mechanical circulatory support for medically intractable low cardiac output in our pediatric intensive care unit. Of these, 9 grown-up congenital heart disease patients were over 18 years of age, and the median age of the subject group was 5.82 years (range: 1 day to 41.6 years). A review of all demographic, clinical, and surgical data and survival analysis were performed. RESULTS: A total of 45 (52.3%) patients were successfully weaned from the mechanical assist device, and 25 (29.1%) survivors were able to be discharged. There was no significant difference in results between patients over 18 years and under 18 years of age. Risk factors for mortality were younger age (<30 days), functional single ventricle anatomy, support after cardiac operations, longer support duration, and deteriorated pre-ECMO status (severe metabolic acidosis and increased levels of lactate, creatinine, bilirubin, or liver enzyme). The survival rate has improved since 2010 (from 25% before 2010 to 35% after 2010), when we introduced an upgraded oxygenator, activated heart transplantation, and also began to apply ECMO before the end-stage of cardiac dysfunction, even though we could not reveal significant correlations between survival rate and changed strategies associated with ECMO. CONCLUSION: Mechanical circulatory support has played a critical role and has had a dramatic effect on survival in patients with medically intractable heart failure, particularly in recent years. Meticulous monitoring of acid-base status, laboratory findings, and early and liberal applications are recommended to improve outcomes without critical complication rates, particularly in neonates with single ventricle physiology.
Acidosis ; Bilirubin ; Cardiac Output, Low* ; Creatinine ; Critical Care* ; Extracorporeal Membrane Oxygenation ; Heart Defects, Congenital ; Heart Failure ; Heart Transplantation ; Heart-Assist Devices ; Humans ; Infant, Newborn ; Intensive Care Units* ; Lactic Acid ; Liver ; Mortality ; Oxygen ; Oxygenators ; Physiology ; Resuscitation ; Retrospective Studies ; Risk Factors ; Survival Rate ; Survivors

PURPOSE: Postoperative thyroid remnant radioablation therapy is necessary to reduce the recurrence and mortality rates as well as to prepare the patients for a proper long term surveillance of well-differentiated thyroid cancers. The radiation safety rules of the government require the patient to be isolated in a hospital if the expected radiation exposure to the family members would be greater than 5 mSv (500 mRem). The purpose was to measure the radiation received by the family members of patients who received large doses of NaI-131. MATERIAL AND METHODS: We have administered 12 therapy doses ranging from 3.70-5.55 GBq (100 to 150 mCi) to 11 patients, and released them immediately if they met the radiation safety criteria. Informed consent was obtained from the subjects prior to the therapy, and each of them agreed to follow written radiation safety instructions. TLD badges were used to measure the radiation dose received by the family members and the room adjacent to the patient's bed room during the first 72 hours. RESULTS: The average dose received by the family members who spent the most time in the closest distance with the patients was 0.04 mSv with a range of 0.01-0.17 mSv. Even the highest dose was only about 3% of the limit set by the government. The average radiation dose to the outer wall of the patient's room was 0.15 mSv. CONCLUSION: It is concluded that I-131 ablation therapy can be administered to outpatients safely to thyroid cancer patients who meet the established radiation safety criteria and follow the instructions.
Humans ; Informed Consent ; Mortality ; Outpatients* ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms*