Malignant fibrous histiocytoma has recently become an established diagnosis for some tumors that arise in the musculo-skeletal tissue. But it contains areas that resemble with osteosarcoma, fibrosarcoma, the microscopic lesions are composed of interlacing bands of fibroblast, bizzare histiocytes and multinucleated giant cells, arranged in storiform pattern. At present, the treatment advocated for malignant fibrous histiocytoma has been total surgical removal and radiation therapy. A case of malignant fibrous histiocytoma affecting the proximal tibia is reported with brief review of literature.
Diagnosis ; Fibroblasts ; Fibrosarcoma ; Giant Cells ; Histiocytes ; Histiocytoma, Malignant Fibrous ; Osteosarcoma ; Tibia

No abstract available.

This treatise summarizes the medical facts about the persistent vegetative state(PVS) and the associated issues. In August 1998, the opinions of the 380 neurologists and the 1007 neurosurgeons are inquired about the diagnostic criteria of PVS, the degree and the withdrawal of treatment on PVS patients. The response rate is 18.8%. The diagnostic criteria of PVS is determined by the items approved above 5007o of responses. (1) no evidence of cerebral function and an inability to interact with visual, auditory stimuli and follow commands. (2) maintaining the respiratory function with spontaneous respiration and normal respiratory pattern. (3) spontaneous eye opening and eye ball movements without sustained tracking. (4) variably preserved brain stem reflexes. (5) presence of sleep-wake cycles. (6) (1)-(5) symptoms should be persist for 6 months after the development of vegetative state. (7) the diagnostic criteria of PVS should be applied more than 3 times during the minimum observation period. (8) this diagnostic criteria of PVS could be applied to adults over 7 ages. As to the degree of treatment, nasogastric tube feeding and air-way keeping through the tracheostomy are approved over 9007b. Also antibiotics can be used in infection. As to the withdrawal of treatment, do not resuscitate order of patient s family is accepted by 46.1% in an emergency condition like cardiac arrest. But discharge against medical advice by the patient s family is accepted by 73.107o in non-emergency condition. In the case of neonates, parents decision is more determinative than any other thing.
Adult ; Anti-Bacterial Agents ; Brain Stem ; Emergencies ; Enteral Nutrition ; Heart Arrest ; Humans ; Infant, Newborn ; Korea* ; Parents ; Persistent Vegetative State* ; Reflex ; Respiration ; Tracheostomy

The study consisted of all patients over 35yerars old undergoing surgical repair of atrial septal defect for the period from June 1985, to August 1992. The following results were observed. 1. ASD was closed with patch in 11 (73%) patients. 2. The relationship of pulmonary artery systolic pressure to Qp/Qs ratio was not significant. 3. Before operation 6 patients were in NYHA functional class II. 8 were in class III, After operation 8 patients were in class I, 6 were in class II. 4. Atrial fibrillation has persisted in 3 patients and returned regular rhythm in 1 patient after surgery. 5. There was no operative mortality and we had good surgical results regardless of patient's age.
Adult* ; Atrial Fibrillation ; Blood Pressure ; Heart Septal Defects, Atrial* ; Humans ; Mortality ; Pulmonary Artery

Neurilemoma is benign never-sheath tumor which has been described as painless mass and is usually discovered incidentally. It is the most common tumor of peripheral nerve origin and may arise in any nerve where Schwann cells occur. There are few domestic reports which were clinically evaluated in tens of cases of neurilemoma so far. We evaluated on the 56 cases of neurilemoma confined to the trunk and extremities, in the aspect of clinical characteristics, radiology, pathology, EMG, surgical treatment and postoperative results, who were surgically treated at the Department of Orthopedic Surgery of Seoul National University from 1984 to 1994. Among 56 patients, male were 29 and female were 27, and there was no sexual difference. The average age at surgical intervention was 46.4 years (16–83yrs) and 46.4% of patients were in the age of fourties and fifties. The anatomical locations of the tumors were as followed: upper extremities in 22(39%) cases, neck and supraclavicular area in 15(27%) cases, sacrum and lower extremities in 14(25%) cases and trunk in 5(9%) cases. Symptoms were palpable mass in 55 cases, local tenderness in 14, radiating pain in 11, pain in 10, paresthesia in 11, motor weakness in 2 cases. The average follow up period was 19.1 months(13–56 month). Median nerve was involved most frequently(14%), then ulnar nerve(11%). There was no cases which occurred in multiplicity or associated with neurofibromatosis. Marginal excision was done in 51 cases(91%), incisional biopsy only in 4 cases(7%), wide excision in 1 case. The size of the tumors in the longest axis was smaller than 2cm in 9 cases, between 2 and 4cm in 31 cases, between 4 and 6cm in 13 cases and more than 6cm in 3 cases. Malignant change or recurrence was not found in all cases.
Biopsy ; Extremities ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Male ; Median Nerve ; Neck ; Neurilemmoma ; Neurofibromatoses ; Orthopedics ; Paresthesia ; Pathology ; Peripheral Nerves ; Recurrence ; Sacrum ; Schwann Cells ; Seoul ; Transcutaneous Electric Nerve Stimulation ; Upper Extremity

An epidemiologic investigation was conducted to identify the source of infection and the mode of transmission of typhoid fever outbreak occurred in Ohchun middle and high schools located in Young il Gun, Kyungpook Province from May 21 to Jun 4, 1994. Four out of 13 hospitalized students in three general hospitals in Pohang City were culture positive typhoid fever (Salmonella typhi Group D). Review of the in and outpatient logbooks of the three general hospitals in Pohang City, county health center and local clinics in the vicinity of the Ohchun middle and high schools suggested that the outbreak was confined to the schools. Drinking water source of the schools was two underground water pumps that had no treatment facilities; one in northern end and the other in southern end of the main school building. However, the southern water pump was closed on April 28, 1994 because a recent test for the water revealed E-coli suggesting a possible fecal contamination. Two hundred twenty students stated that they had experienced symptoms related to typhoid fever since April l, 1994 in a self administered questionaire survey of all of the 2, 226 students. Personal interviews with these 220 students were performed to confirm the clinical history together with a rectal swab culture for typhoid fever and Widal test. A total of 39 patients were detected; 15 confirmed cases (culture-positive) and 24 suspected cases (symptom positive with equal to or greater than 1:160 titer of Salmonella O-antibody or 1:320 titer of H-antibody titer in Widal test). The epidemic curve showed a unimodal curve with a peak on the second week(17 May, 1994) and tailed down to the 5th week (22 28 May, 1994). The overall incidence rate of typhoid fever was 1.8 per 100 students; 1.5 (1.6 for male, 1.5 for female) in the middle school and 2. 4 (6. 2 for male, 0. 4 for female) in the high school. When contrasted with the students who did not drink water at all in the school, the relative risks of incidence rate of typhoid fever for the students who drank the underground water of the school, both underground water and water brought from home, or water brought from home only were 55.5, 19.0, and 3.0 respectively. Three classes which had especially high incidence rates of typhoid fever were located in the southern part of the main school building, where the contaminated underground water pump is located. These findings suggested that the source of infection was the contaminated underground water of the school. Both of the two underground water pumps were closed permanently and the public running water was supplied to the schools.
Drinking Water ; Groundwater ; Gyeongsangbuk-do* ; Hospitals, General ; Humans ; Incidence ; Male ; Outpatients ; Running ; Salmonella ; Typhoid Fever* ; Water

When the non-union gap in a long bone is more than half of the diameter of the bone at that level, it presents a significant challenge to traditional bone grafting technique. Even if there are several good ways for this problem, such as shortening, traditional various bone grafting, electrical stimulation and free vascularized bone graft, most of these techniques have some difficulties to maintain the stability of fracture post-operatively, and we have to keep their extremities into a cast or external fixator so long. So we have attempted to treat the large osseus gap non-union in long bone with fixation of heavy duty or condylar plate on one side of fracture for fracture stability, a long tibial corticocancellous strut graft on the other side of fracture for fracture stability and rapid bony union, and extensive cancellous chip bone graft between the plate and tibial graft to enhance the bony union. We have experienced 9 cases of large osseus gap non-union in long bone with this technique from March 1981 to September 1986 at the department of orthopaedic surgery, St. Mary's hospital, Catholic University Medical College. 1. Their, 7 males and 2 females, average age was 38 years old, with a range of 24 to 53 years old. The distribution of the involved bone was 6 femur, 2 humerus, 1 radius and ulna with 1.4 years of average duration of non-union, ranged from 7 months to 2.4 years. The average gap from normal bone to normal bone was 4.8cm, with a range of 2.7cm to 7.4cm. The average number of previous surgical procedures was 4, with a range of 2 to 7. Four of the nine patients had quiescent osteomyelitis. 2. Post-operative immobilization with splint or cast was applied for 6 weeks for upper extremity and 8 weeks for lower extremity followed by active R.O.M. exercise and non-weight bearing crutch walking. 3. Five of the nine cases(55.6%) had completely bony union. This occured on an average 8 months post-operatively and was faster in the forearm bones and femur than in the humerus. An additional cancellous bone graft was done in two. But other two of the patients had subsequent amputation because of recurrent and uneontrollable osteomyelitis stirred up by the surgery. 4. This procedures was proved to be one of valuable adjuvant method in treatmqnt of large osseous gap non-union of long bones.
Amputation ; Bone Transplantation ; Electric Stimulation ; External Fixators ; Extremities ; Female ; Femur ; Forearm ; Humans ; Humerus ; Immobilization ; Lower Extremity ; Male ; Methods ; Osteomyelitis ; Radius ; Splints ; Transplants ; Ulna ; Upper Extremity ; Walking

BACKGROUND: Cardiopulmonary bypass during open heart surgery causes systemic inflammatory respose. IL-10 is an anti-inflammatory cytokine that inhibits inflammatory process and protects organ function by down regulation of pro-inflammatory cytokine release and maintenance of blood level balance with pro-inflammatory cytokines. MATERIAL ateial and Method: Plasma IL-10 levels were measured and analyzed in 22 patients who underwent open heart surgery (11 cases of coronary artery bypass graft, 11 cases of valve replacement) under cardiopulmonary bypass since 1988 January to July at Department of Thoracic and Czardiovascular surgery, Yeungnam University Hospital. 1g of methylprednisolone was administrated to thirteen patients randomly. Blood samp.es were taken and collected at the time of induction of anesthesia, 10 min before cardiopulmonary bypass, 10 min after starting of CPB, 10 min aftr aortic cross clamping, 10 min after ACC release, and 10 min, 2 hours, and 5 hours after CPB respectively. The plasma levels of IL-10 were determined by enzyme-linked immunosorbent assays (ELISA). Wilcoxon-Raule Sum test was used for statistical analysis. In all 22 patients, cardiopulmonary bypass time was used for statistical analysis. In all 22 patients, cardiopulmonary bypass time was 171+/-41.4 min and aortic cross clamp time was 118+/-36.5 min. Peak IL-10 level was achieved at 10 min after ACC (361.0+/-52.81pg/ml) and was decreased sharply at 2 hours after CPB. Peak IL-10 level was correlated positively with aortic cross clamp time (p=0.011); however, it did not correlated with bypass time (p=0.181). In valve replacement group, mean IL-10 level at peak point was 567.89+/-107.69 pg/ml and was significantly higher than that of coronary artery bypass group (205.67+/-192.70 pg/ml) (p<0.001). ACC time in valve replacement group was significantly longer than that of coronary artery bypass group (p<0.01), however, bypass time was not (p=0.212). Thirteen patients with steroid pretreatment before starting of CPB showed relatively higher plasma IL-10 level than in control group, however, no statistical significance was noted (p=0.19). CONCLUSION: plasma level of IL-10 was increased in association with cardiopulmonary bypass and revealed peak at 10 min after ACC release. IL-10 level was correlated positively with ACC time. Therefore, systemic inflammatory respeonse in association with cardiopulmonary bypass could be decreased by reducing ACC time during cardiac surgery.
Anesthesia ; Cardiopulmonary Bypass* ; Constriction ; Coronary Artery Bypass ; Cytokines ; Down-Regulation ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-10* ; Methylprednisolone ; Plasma ; Thoracic Surgery ; Transplants

Congenital bronchobiliary fistual is a rare disease with unclear etiology. An abnormal tract communicates the tracheobronchial junction to a hepatic segment, usually the left lobe. Billous sputum, a positive HIDA(o-Dimethyliminodiacetic acid) scan, and a trification at the level of the carina lead to the diagnosis, which can be confirmed by bronchoscopic contrast injection. We experienced a case of congenital bronchobiliary fistual in a 27-day-old girl. Our case is reported with literature reviews.
Diagnosis ; Female ; Fistula* ; Humans ; Rare Diseases ; Sputum

BACKGROUND: This study was performed to evaluate the incidences, the risk factors, and the clinical course of the hyperamylasemia in patients who underwent open heart surgery under cardiopulmonary bypass. MATERIAL AND METHOD: Thirty seven patients who underwent cardiopulmonary bypass were studied at Department of Thoracic & Cardiovascular Surgery, Yeungnam University Hospital, from July 1997 to June 1998. The thirty seven patients were divided into two groups, 13 patients in group I had normal serum amylase levels and 24 patients in group II had hyperamylasemia. Mean serum amylase(IU/l) levels and 24 patients in group II had hyperamylasemia. Mean serum amylase(IU/l) levels of gorup II showed 54.3+/-4.6, 78.0+/-9.2, 372.0+/-103.4, 460.5+/-80.4, 280.4+/-46.6, and 131.0+/-15.6, preoperative, immediate postoperative, at postoperative 1, 2, 3, and 7 days, respectively. In group II, serum amylase level of the postoperative day 2 was the highest and was significantly higher than that of the preoperative day (p<0.001). Serum amylase level started to decreased at postoperative day 3 and returned to the normal level at postoperative day 7. Significant clinical symtoms of overt pancreatitis were not shown in patients in group II. The following perioperative variable such as diagnosis, cardiopulmonary bypass time, aortic cross clamping time, mean systemic pressure during bypass, and administration of steroid were compared between groups. There were no significant differences between groups. In all patients, Serum amylase level of postoperative day 2 and aortic cross clamping time were correlated significantly (p=0.047). CONCLUSION: Serum amylase level after cardiopulmonary bypass could be elevated postoperatively and serum amylase level of POD 2 was considered to have significant correlation with aortic cross clamping time. Shortening of aortic cross clamping time will help in reducing the hyperamylsemia. In this study, although significant clinical symptoms and overt pancreatitis were not seen from hyperamylsemic patients, careful clinical observation of hyperamylasemia would be necessary.
Amylases ; Cardiopulmonary Bypass* ; Constriction ; Diagnosis ; Humans ; Hyperamylasemia* ; Incidence ; Pancreatitis ; Risk Factors ; Thoracic Surgery