No abstract available.
Adult* ; Epiglottitis* ; Humans

Giant cell tumor is a predominantly benign condition but often the tumor is locally aggressive and tends to have high rate of recurrence and it can evolve into a malignant tumor. Thus the lesions have a practically difficult therapeutic problem for the orthopaedic surgeon and any method of treatment has not been satisfied. Between March 1984 and March 1993, clinical observation was carried out on 22 cases of giant cell tumor of bone to analyse the recurrence rate and functional evaluation of the joint according to the treatment methods, pathological grade and cortical destruction. The mean follow-up time was 75. 2 months. The recurrence rate of the intralesional excision group was 54.5% and that of the wide excision group was 9%, There was no relationship between the pathologic grade and recurrence rate. There was no recurrent case in the grade I cortical destruction but almost all of recurrence was occurred in the grade I or II cortical destruction. The functional result of the giant cell tumor occurred around the knee joint was that the mean ratings in the intralesional excision group were 79% and in the wide excision group were 51%. In conclusion, to achieve better joint function and less recurrence rate, intralesional or marginal excision with heat using bone cement or with chemical cauterization using phenol and alcohol can be used for cases of radiological grade I or II, and wide excision for grade III.
Cautery ; Follow-Up Studies ; Giant Cell Tumor of Bone ; Giant Cell Tumors ; Giant Cells ; Hot Temperature ; Joints ; Knee Joint ; Methods ; Phenol ; Recurrence

No abstract available.
Facial Nerve* ; Paralysis*

Five medical students in the fourth-year took anatomy as their elective courses for 1 month. They dissected one cadaver, and investigated Digital Report, under the course subjects as follows; (1) the shape of thyroid gland and the location of its isthmus, (2) the branches of left and right coronary arteries, (3) the number of blood vessels and bronchi on the hilum of lung, (4) topographical relationship of the renal vessels and ureter, and the shape of the renal pelvis, (5) the location and attachment of the appendix, (6) the penetration of median nerve through the pronator teres, (7) the sensory nerves and the extensor tendons on the dorsum of hand, (8) the branches of deep femoral artery. The pancreatic and live samples were processed and stained with H&E, for LM observation, since the individual had suffered from pancreatic cancer and got a Pylorus preserving pancreatico-duodenectomy (PPPD). At the last step of the elective course, students wrote small articles following the conventional method for writing manuscript. From the viewpoint of professor, the anatomy course for the fourth-year students were definitely different from that for first-year students, and had many positive effects in terms of anatomy education.
Appendix ; Blood Vessels ; Bronchi ; Cadaver ; Coronary Vessels ; Education ; Femoral Artery ; Hand ; Humans ; Kidney Pelvis ; Lung ; Median Nerve ; Pancreatic Neoplasms ; Pylorus ; Students, Medical* ; Tendons ; Thyroid Gland ; Ureter ; Writing

Necrotizing fasciitis is an uncommon infection of the subcutaneous soft tissue and fascia. The infection is expands rapidly and is highly lethal, so an early diagnosis and a radical debridement of all affected tissues until healthy tissue is encountered is imperative. There are many diagnostic methods such as simple X-ray study, ultrsonography, computerized tomography and diagnostic multiple incisions, but nothing can disclose the extent of affected tissue definitely. Recently someone advocated that magnetic resonance imaging(MRI) is useful to diagnose necrotizing fasciitis. We could determine the extent of underlying infection in a patient with perineal necrotizing fasciitis by using preoperative MRI, and treat it by one surgical resection. We propose that MRI can be used to diagnose the necrotizing fasciitis early and to disclose the extent of affected tissue, to help determine the extent of resection.
Debridement ; Early Diagnosis* ; Fascia ; Fasciitis, Necrotizing* ; Humans ; Magnetic Resonance Imaging*

STUDY DESIGN: Genetic screening of the estrogen receptor 2 (ESR2) genes in patients with ossification of the posterior longitudinal ligament (OPLL). OBJECTIVE: We studied the relationships between ESR2 gene polymorphisms and OPLL to understand the pathophysiology of OPLL. SUMMARY OF LITERATURE REVIEW: The OPLL has a strong genetic component. Several familial surveys and human leukocyte antigen (HLA) haplotype studies reveal that genetic background is an important component in the occurrence of OPLL and a large number of gene analysis studies were utilized to clarify the susceptible gene for OPLL, including COL11A2, BMP-2, TNF-alpha, NPPS, leptin receptor, transforming growth factor (TGF)-beta, Retinoic X receptor, ER, IL-1, PTH, and VDR have been performed. MATERIALS AND METHOD: Genomic deoxyribonucleic acid (DNA) samples obtained from 164 patients (93 men and 71 women) with OPLL and 219 control subjects, without the disease (105 men and 114 women) were amplified by polymerase chain reaction, and polymorphism genotypes were determined by the restriction endonuclease digestion. The distribution of genotypes was compared between the patients with the disease and the control subjects. RESULTS: The polymorphism of ESR2 [rs1256049, exon6, Val328Val, p=0.018, odd ratio (OR)=2.41, 95 confidence interval (CI)=1.15-5.02 in the recessive model] only showed statistically significant association between the control and the OPLL groups. The rest SNPs of ESR2 did not show any significant differences between the control and the OPLL groups. CONCLUSIONS: Estrogen receptor 2 (ESR2) gene polymorphisms (rs 1256049) was associated with OPLL. In future studies, we will perform target SNP chip between OPLL and candidate gene.
Digestion ; DNA ; DNA Restriction Enzymes ; Estrogen Receptor beta ; Estrogens ; Genetic Testing ; Genotype ; Haplotypes ; Humans ; Interleukin-1 ; Leukocytes ; Longitudinal Ligaments ; Male ; Ossification of Posterior Longitudinal Ligament ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Receptors, Leptin ; Spine ; Succinimides ; Transforming Growth Factors ; Tumor Necrosis Factor-alpha

BACKGROUND: Montelukast is a type 1 cysteinyl-leukotrienes receptor antagonist that has been widely used in allergic disease. However, the effect of combination of leukotriene receptor antagonist and antihistamine is controversial. The aim of this study was to compare the effect of combination treatment of montelukast and antihistamine, fexofenadine, over antihistamine alone in patients with allergic rhinitis (AR). SUBJECTS AND METHODS: Retrospective chart review of 60 patients with AR was undertaken. Patients were classified into combination group (montelukast and fexofenadine, n=28) and antihistamine only group (fexofenadine, n=32) according to treatment modalities. Questionnaire survey was performed and allergic symptoms (VAS scale, 5pointscale), and SNOT (sinonasal outcome test)-20 score were obtained before and after the treatment. RESULTS: Mean follow-up duration was 6.7+/-4.6weeks. There was no significant difference in demographic data between two groups. Allergic symptoms and SNOT-20 score(nasal, QOL domain) were improved significantly in both groups after the treatment (all p < 0.001). Combination treatment group showed better improvement in nasal obstruction than antihistamine treatment group(p = 0.03). However, there were no significant differences in other allergic symptoms (rhinorrhea and sneezing) and SNOT-20 between two groups (all p > 0.05, respectively). CONCLUSION: A combination treatment of montelukast and fexofenadine showed more efficacies in nasal obstruction than single fexofenadine treatment in patients with AR. Therefore, montelukast could be used effectively with antihistamine in patients with AR complaining nasal congestion.
Acetates ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Humans ; Nasal Obstruction ; Quinolines ; Receptors, Leukotriene ; Retrospective Studies ; Rhinitis* ; Rhinitis, Allergic, Perennial ; Terfenadine ; Surveys and Questionnaires

Rupture of the major airway by blunt chest trauma is uncommon. It can potentially cause serious complications, such as tension pneumothorax or cardiovascular injuries, with an overall mortality rate reaching up to 30%. The etiology of trauma includes fall-down, traffic accidents, cycling and child abuse. Dyspnea was the most common feature, followed by hemoptysis, air leak and chest pain. It is well known that dyspnea after chest trauma is due to accumulation of secretions in the airway, mucosal and cartilaginous injuries and associated parenchymal injuries. In cases of recurrent dyspnea in children irrespective of trauma, we should consider asthma, foreign body aspiration, tracheal stenosis, bronchial tumor, mediastinal tumor, gastroesophageal reflux disease and vascular ring. In this case, we found granulation tissue repeatedly causing obstruction of the airway at the site of rupture after traffic accident. Dyspnea resolved after surgical resection of the granulation tissue. We report a case of recurrent granulation tissue showing dyspnea after bronchial rupture.
Accidents, Traffic ; Asthma ; Chest Pain ; Child ; Child Abuse ; Dyspnea ; Foreign Bodies ; Gastroesophageal Reflux ; Granulation Tissue ; Hemoptysis ; Humans ; Pneumothorax ; Rupture ; Thorax ; Tracheal Stenosis

BACKGROUND: The monitoring of end-tidal carbon dioxide tension (PETCO2) and oxygen supply may be required in spontaneously breathing patients during spinal anesthesia, particulary in cases involving high spinal block, underlying pulmonary disease, and use of a sedative drug. We investigated changes in PETCO2 and arterial oxygen tension versus oxygen flow rate via a nasal cannula, and the correlation between arterial carbon dioxide tension (PaCO2) and PETCO2 in spontaneously breathing patients during spinal anesthesia. METHODS: Thirty adult patients participated in this study. We performed spinal anesthesia with an optimal dose of heavy marcaine. After determining the sensory blockade level, PETCO2 was sampled from hub of a 14-gauge central catheter piercing one of the two nasal oxygen prongs, and oxygen flow rates (2, 3, 4 or 5 L/min) were measured by on-line capnography. The oxygen flow rates were varied every 5 minutes, and PETCO2 values and arterial samples for PaCO2 and arterial oxygen tension (PaO2) analysis were obtained at the end of each 5-minute period. RESULTS: No significant difference in PETCO2 was observed at the different oxygen flow rates. The results show that PETCO2 correlates closely with PaCO2 irrespective of oxygen flow rate. The PaO2 values were; 155.7 +/- 26.3, 192.7 +/- 36.6, 217.0 +/- 40.6 and 241.4 +/- 51.3 mmHg at nasal oxygen flow rates of 2, 3, 4 and 5 L/min, respectively. CONCLUSIONS: The measurement of PETCO2 via this nasal cannula was useful for continuous, noninvasive monitoring during spinal anesthesia irrespective of oxygen flow rate.
Adult ; Anesthesia, Spinal* ; Bupivacaine ; Capnography ; Carbon Dioxide ; Catheters* ; Humans ; Lung Diseases ; Oxygen* ; Respiration

PURPOSE: To analyze the pattern of posterior column injury in unstable burst fractures and to predict the possibility of dural injury. MATERIALS AND METHODS: Retrospective review was carried out on 22 patients of unstable burst fracture from Nov. 1996 to Sep. 2003. The pattern posterior column injury was analyzed by simple x-ray, CT and MRI findings. In simple x-ray, authors analyzed laminar fracture, posterior facet injury, inter-spinous widening and inter-spinous malalignment, posterior bony injury by CT, posterior inter-spinous ligament injury and dural tear by MRI. The statistical analysis was performed using Mann-Whitney test and Chi-square test. RESULTS: There were 13 men and 9 women, and mean age was 41 years-old (18~65). The level of injury showed 15 cases in T12-L2, 6 in L3, 3 L4. In simple x-ray, findings were showed 13 cases (59.1%) in laminar fracture, 7 (31.8%) in posterior facet injury, 16 (72.7%) in inter-spinous widening and 8 (36.4%) in inter-spinous malalignment. In CT, findings were showed 13 (59.1%) in laminar fracture, 10 (45.5%) in posterior facet injury, 9 (40.9%) in transverse process fracture. In MRI, findings were showed 18 (81.8%) in posterior inter-spinous ligament injury and were not showed dural tear. The combined cases of posterior bony and ligamentous injury was 6 (27%) and 5 of 6 showed dural tear and the analysis of dural tear and radiologic findings was showed positive correlation (p=0.004). CONCLUSION: Posterior ligament injury was more frequent than bony injury in unstable burst fracture. Among the posterior bony injuries, dural tear was more frequent in facet injury. Authors confirmed all dural tear with operation. In cases of posterior bony injury combined with ligamentous injuries, the possibility of dural tear was significantly higher than that of single structural injury (p=0.004).
Adult ; Female ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Male ; Retrospective Studies