BACKGROUND: The aim of this study was to compare the efficacy of ketorolac, paracetamol, and paracetamol plus morphine on pain relief after thyroidectomy. METHODS: Eighty patients were randomly allocated to one of the 4 groups: normal saline (group C), ketorolac 30 mg (group K), paracetamol 1 g (group P), and paracetamol 700 mg plus morphine 3 mg (group PM). Each regimen was administered intravenously (IV) 30 min. before the end of surgery. If pain was not relieved, patients received an IV bolus of pethidine hydrochloride 25 mg. Pain intensity using a visual analogue scale (VAS) was recorded at 0.5, 1, 2, 4, and 6 hr after the end of surgery. RESULTS: VAS at 0.5 and 1 hr after the end of surgery were significantly lower in group K, group P, and group PM than in group C (P < 0.05). The number of patients receiving pethidine hydrochloride at 0.5 and 1 hr after the end of surgery was significantly lower in group K, group P, and group PM than in group C (P < 0.05). There was no significant difference among the groups in the incidences of adverse events associated with study medications and patient satisfaction (P > 0.05). CONCLUSIONS: Paracetamol 1 g IV possesses a similar analgesic efficacy to ketorolac 30 mg IV after thyroidectomy. Paracetamol may represent an alternative to ketorolac for pain prevention after mildly to moderately painful surgery in situations where the use of NSAIDs is unsuitable.
Acetaminophen ; Analgesics ; Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Incidence ; Ketorolac ; Meperidine ; Morphine ; Patient Satisfaction ; Thyroidectomy

We present 2 cases of invasive extramammary Paget disease occuring in the vulva area of a 60 year old female, and in the scrotal and penile area of a 63 year old male patient. The histologically typical Paget cells were not only seen in the surface epithelium but were also involved in the outer root sheath of the hair follicles. Stromal infiltration of tumor cells into the upper dermis were present in both cases, however, no underlying primary sweat gland carcinoma was present. Metastatic foci of inguinal lymph nodes showed apocrine-type epithelium with abundant eosinophilic granular cytoplasm, which were positive for anti-CEA and GCDFP-15, as well as eccrine-type epithelium containing mucinous secretory materials in the lumen and the cytoplasm. Ultrastructural findings showed interdigitating plasma membranes with prominent desmosomes between the Paget cells, intracytoplasmic tonofibrils, intracellular tubules, lipid vacuoles, and enlarged mitochondria. Histological, immunohistochemical, and ultrastructural findings suggested that Paget cells showed both eccrine and apocrine differentiation.
Female ; Male ; Humans ; Neoplasm Metastasis

No abstract available.
Epidermis* ; Psoriasis

The fractures of tibial shaft are common and open injury are also frequenly accompanied. Since the AO unreamed interlocking nail is solid type compared to present tubular type nail, it has no dead space, and without reaming the intramedullary blood supply can be preserved and the soft tissue trauma can be minimized. Therefore it can be used with minor risk of infection in the treatment of open tibial shaft fractures without secondary operation such as in the cases using external fixaters. Especially in Orientals, whose tibial medullary canal is narrower than Smm, it can be used ideally. From October 1991, we have experienced 14 cases of tibial shaft fractures treated with AO unreamed interlocking nail. Among 14 cases, the open fractures were 8, 4 cases were type 1 and 4 cases were type 2 by Gustilo classification. Among 6 cases of closed fractures, 4 cases had risk of post operative infection due to accompanying soft tissue injuries, such as abrasion or bulla and 2 cases had narrow intramedullary canal less than 8mm. There was no postoperative infection in all cases including open fractures, and the soft tissue defect could be reconstruted by muscle transfer, etc. The AO unreamed interlocking nail is thought to be recommendable in the treatment of open tibial shaft fracture, closed fracture with risk of postoperative infection, and also the fracture with narrow canal diameter less than 8mm.
Classification ; Fractures, Closed ; Fractures, Open ; Soft Tissue Injuries ; Tibia

Recently, tuberculosis of bone and joint is decreased with good nutrition and environment, development of preventive medicine and improvement of treatment regimen. But it is still one of the common inflammatory diseases in Korea, and must be considered in the differential diagnosis of common orthopedic complaints. There are few reports on extraspinal tuberculosis of bone and joint. Forty one cases of extraspinal tuberculosis of bone and joint were studied in our department from January 1988 to August 1993. The results were as follows; l. Extraspinal tuberculosis of bone and joint were 41 cases (39 patients, 27.8% of 147 tuberculosis of bone and joint including spine). 2. The proportion of children and young adults was 56%, hips were involved in 11 cases, knee joints in 8 cases, ankle joints in 6 cases, feet in 6 cases and elbow joints in 5 cases. 3. Coexisting pulmonary tuberculosis was found in 19 patients and active lesion in 15 patients. 4. Confirmative diagnosis could be made by smear and culture of the lesion or pathologic findings or recently available polymerase chain reaction(PCR) method. 5. Various treatment, such as antituberculous medication, external immobilization, synovectomy, curettage and bone graft, arthrodesis, had been carried out. 6. Reactivation of other site was found in 7.3%(3 cases) and resistant tendency was found in 9.7%(4 cases).
Ankle Joint ; Arthrodesis ; Child ; Curettage ; Diagnosis ; Diagnosis, Differential ; Elbow Joint ; Foot ; Hip ; Humans ; Immobilization ; Joints ; Knee Joint ; Korea ; Methods ; Orthopedics ; Preventive Medicine ; Transplants ; Tuberculosis ; Tuberculosis, Pulmonary ; Young Adult

To evaluate the results of anterior decompression and fusion with autogenous bone graft for cervical disc disease, the authors reviewed 18 cases of cervical disc herniation which were treated surgically at Inje Univ. Paik Hosp. from 1990 to 1994 with special interest in the thickness of the bone graft. All cases have been followed for more than 12 months. We try to know the clinical results of anterior decompression and fusion with autogenous bone graft. At this treatment, controversial point is a ideal thickness of graft and the width of distraction. Therefore, we follow up the correlation between thickness of graft on roentgenogram and clinical results. The clinical results were satisfactory as excellent in 11 cases, good in 5 cases according to criteria of Robinson et al. Successful fusion occured in 16 cases within 3 months after their initial procedure, and fusion failure resulted in 2 cases. 3mm distraction from baseline disc height was considered ideal thickness of graft after anterior decompression and all cases healed successfully. We concluded that 3mm distraction from baseline disc height is necessary for successful decompression & fusion.
Decompression ; Follow-Up Studies ; Transplants

The mortality and morbidity of peritrochanteric fractures in the elderly are great due to preexisting diseases, the osteoporosis, and poor general conditions. Since the complications sometimes lead to death, it is utmost important to reduce the complications and to prevent them. Authors had experienced 42 peritrochanteric fractures over 65 years old from January, 1988 to December, 1992. Age incidence was distributed from 65 to 93 years. The sites of fractures were 17 femoral neck, 24 intertrochanteric, 1 subtrochanteric. The mortality at postoperative 6 months was 10.2%. The postoperative complications were 6 cardiovascular diseases, 3 pneunonia, 3 pressure sore etc. The results according to interval between injury and operation were not significant, but reducing risk factors following check-up of general conditions was significant. It was necessary in treatment of elderly peritrochanteric fractures to check the general conditions, to reduce risk factors, to choose appropriate method of operation and anesthesia, and to operate as soon as possible by experienced surgeon. Postoperative early ambulation was also significant at good results. The percutaneous pinning under local anesthesia was an recommendable method in patients with severely poor general conditions.
Aged ; Anesthesia ; Anesthesia, Local ; Cardiovascular Diseases ; Early Ambulation ; Femur Neck ; Humans ; Incidence ; Methods ; Mortality ; Osteoporosis ; Postoperative Complications ; Preexisting Condition Coverage ; Pressure Ulcer ; Risk Factors

Chromosome 18q alteration plays a key role in colorectal tumorigenesis, and loss of heterozygosity at 18q is associated with a poor prognosis in colon cancer. DCC(Deleted in Colorectal Cancer) is a putative tumor- suppressor gene at 18q21 that encodes a transmembrane protein with structural similarity to neural cell adhesion molecule that is involved in both epithelial and neuronal cell differentiation. DCC is implicated in regulation of cell growth, survival and proliferation. Thus, tumor progression in squamous cell carcinoma, stomach cancer, colorectal cancer correlates with downregulation of DCC expression. The mechanism for DCC suppression is associated with hypermethylation of the DCC gene promoter region. Hence, the goal of this study is to identify the promoter methylation responsible for the down-regulation of DCC expression in oral squamous cell carcinoma. 12 of tissue specimens for the study are excised and gathered from 12 patients who are diagnosed as SCC in department of OMS, dental hospital, dankook university. To find expression of DCC in each tissue samples, immunohistochemical staining, RT-PCR gene analysis and methylation specific PCR are processed. The results are as follows. 1. In the DCC gene RT-PCR analysis, 5(41.6%) of 12 specimens of oral squamous cell carcinoma did not expressed DCC gene. 2. In the promoter methylation specific PCR analysis, 5(41.6%) of 12 specimens showed promoter methylation of DCC gene. 3. In the immunohistochemical staining of poor differentiated and invasive oral squamous cell carcinoma, loss of DCC expression was observed. These findings suggest that methylation of the DCC gene may play a role in loss of gene expression in invasive oral squamous cell carcinoma.
Carcinoma, Squamous Cell ; Cell Differentiation ; Cell Transformation, Neoplastic ; Colonic Neoplasms ; Colorectal Neoplasms ; Down-Regulation ; Gene Expression ; Genes, DCC ; Genes, Suppressor ; Humans ; Loss of Heterozygosity ; Methylation ; Neural Cell Adhesion Molecules ; Neurons ; Polymerase Chain Reaction ; Prognosis ; Promoter Regions, Genetic ; Stomach Neoplasms

No abstract available.
Spondylitis*

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*