The veins of the lower limb are subdivided into deep veins, superficial veins, and comminucating veins. The deep veins accompany the arteries, while the superficial veins course under the superficial fascia just beneath the skin and they have great, small saphenous veins, and their tributaries. The superficial and deep veins are connected by the commincating veins, which are usually located along the intermuscular septum. There are many reports about the venous system of the lower limb in foreign countries but a few in Korea. It is considerably valuable in the vascular surgery of the lower limb and the surgical management of the varicose veins. This study deals with the Korean cadavers, the authors observed the location of the saphenofemoral junction, medial and lateral femoral circumflex veins, and deep femoral veins, and the termination modes between the superficial veins and great saphenous veins and the femoral circumflex veins to the deep femoral veins or femoral veins. The following results were: 1. Any noticeable anomalies of the femoral vein proper were not present. 2. The saphenofemoral junctions were located at 3.78±0.91cm below the inguinal ligaments, 2.22±1.18cm below the pubic tubercles, 3.99±0.99cm lateral to the pubic tubercles. 3. The termination modes of superficial veins to the great saphenous veins around the fossa ovalis were classified into 3 types, Type I: Superficial epigastric vein, superficial iliac circumflex vein, external pudendal vein emptied into the upper end of the great saphenous vein(45.1%). Type II: One or more veins among above mentioned 3 veins emptied into the lateral accessory saphenous vein (48.8%). Type III: One or more veins among above mentioned 3 veins emptied into the medial accessory saphenous vein(4.9%). One cadaver(1.2%) was not belonged to the above classification, in which above mentioned 3 veins were emptied directly into the femoral vein. 4. The termination level of deep femoral veins into the femoral veins was 8.68±1.92cm below the inguinal ligaments, 6.60±1.98cm below the pubic tubercles, 5.28±51.46cm lateral to the pubic tubercles. 5. The termination level of medial femoral circumflex veins into the femoral veins or deep femoral veins was 5.10±1.73cm below the inguinal ligaments, 3.65±1.92cm below the pubic tubercles, 4.62±1.41cm lateral to the pubic tubercles, and the termination level of the lateral femoral circumflex veins into the femoral veins or deep femoral veins was 7.00±1.48cm below the inguinal ligaments, 5. 05±1. 67 cm below the pubic tubercles, 5. 41±1.21 cm, lateral to the pubic tubercles. 6. The termination modes of femoral circumflex veins were classified into 4 types in male cadavers, Type A: Medial and lateral femoral circumflex veins emptied into the femoral vein. Type B: Medial femoral circumflex vein emptied into the femoral vein and lateral femoralcircumflex vein emptied into the deep femoral vein. Type C: Medial femoral circumflex vein emptied into the deep femoral vein and lateral femoral circumflex vein emptied into the femoral vein. Type D: Medial and lateral femoral circumflex veins emptied into the deep femoral vein. In the right sides, type A was 94.1% and type C was 5.9% while in the left sides, type A was 79.4%, type B was 5.9% and type C was 14.7%. 7. The collateral circulations were identified in 67 observations (81.7%) and venous circles were identified in 46 observations (56.1%).
Adult ; Arteries ; Cadaver ; Classification ; Collateral Circulation ; Femoral Vein ; Femur ; Humans ; Korea ; Ligaments ; Lower Extremity ; Male ; Saphenous Vein ; Skin ; Subcutaneous Tissue ; Varicose Veins ; Veins

After the discovery of penicillin by Fleming, a great improvement in the treatment of osteomyelitis was obtained and the mortality rate in the acute stage was markedly decreased. But, because of abuse of the antibiotics and resulting resistant organisms to antibiotics, the incidence of acute hematogenous osteomyelitis tends to increase recently. During the period of 6 years extending from 1979 to 1984, we have treated 45 cases of acute hematogenous osteomyelitis in children and clinical analysis was made about the causes of the development of chronic osteomyelitis with particular emphasis on the time interval from onset to treatment, and on the operative methods in the surgical treatments. The following results were obtained; 1. The incidence in males was 1.5 times greater than females. 2. Age incidence showed that it was most prevalent in the age group of 6 to 15 with 66.2% of the total cases. 3. The most common sites of the involvement was femur and tibia in orders. 4. Most of cases showed pain, local tenderness, pyrexia, loss of motion, swelling, and heat of the involved limbs. 5. Among the causative organisms, staphylococcus aureus was most prevalent one. 6. Cephalosporin, methicillin, gentamicin showed the highest sensitivity while penicillin showed marked resistancy (80%). 7. Time interval from onset to treatment was persistently an important factor in the development of chronicity. 8. Bone fenestration was the best method in the surgical treatments of acute hematogenous osteomyelitis in children. 9. Early diagnosis, adequate antibiotics, and early surgical decompression and drainage (esp. bone fenestration) were considered to be the essential part of management of acute hematogenous osteomyelitis in preventing its chronicity.
Anti-Bacterial Agents ; Child ; Decompression, Surgical ; Drainage ; Early Diagnosis ; Extremities ; Female ; Femur ; Fever ; Gentamicins ; Hot Temperature ; Humans ; Incidence ; Male ; Methicillin ; Methods ; Mortality ; Osteomyelitis ; Penicillins ; Staphylococcus aureus ; Tibia

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is a choice of surgical procedure for cervical degenerative diseases associated with radiculopathy or myelopathy. However, the patients undergoing ACDF still have problems. The purpose of the present study is to evaluate the radiologic results of 3 different methods in single-level ACDF. METHODS: We conducted a retrospective collection of radiological data from January 2011 to December 2014. A total of 67 patients were included in this study. The patients were divided into 3 groups by operation procedure: using stand-alone cage (group cage, n=20); polyether-ether-ketone (PEEK)-titanium combined anchored cage (group AC, n=21); and anterior cervical cage-plate (group CP, n=26). Global cervical lordosis (C2-C7 Cobb angle), fused segment height, fusion rate, and cervical range of motion (ROM) were measured and analyzed at serial preoperative, postoperative, 6-month, and final 1-year follow-up. RESULTS: Successful bone fusion was achieved in all patients at the final follow-up examination; however, the loss of disc height over 3 mm at the surgical level was observed in 6 patients in group cage. Groups AC and CP yielded significantly better outcomes than group cage in fused segment height and cervical ROM(p=0.01 and p=0.02, respectively). Furthermore, group AC had similar radiologic outcomes to those of group CP. CONCLUSION: The PEEK-titanium combined anchored cage may be a good alternative procedure in terms of reducing complications induced by plate after ACDF.
Animals ; Cervical Vertebrae ; Diskectomy* ; Female ; Follow-Up Studies ; Humans ; Lordosis ; Methods* ; Postoperative Complications ; Radiculopathy ; Radiography ; Range of Motion, Articular ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Fusion

A 57-year-old man complained of severe lower back pain and radicular pain in both legs for 1 week after falling from a ladder. Magnetic resonance imaging (MRI) of the spine showed a subdural hematoma (SDH), which was surgically removed. The patient had no back pain or the radicular leg pain at 2 weeks post-surgery. However, he complained of diffuse headaches upon follow-up. Brain computed tomography (CT) and MRI revealed an intracranial SDH, which was immediately removed by surgery. During his 1-year follow-up, he reported that the pain had resolved without recurrence. Simultaneous spinal and intracranial SDH are rare and no standard treatment exists for this condition. This case suggests that it is possible that an intracranial SDH can migrate into the cerebrospinal fluid (CSF) space through an arachnoid tear. CSF circulation allows the intracranial SDH to enter subarachnoid spaces encasing the spinal cord. In order to prevent irreversible damage, surgical intervention should be considered for case of spinal SDH with progressive neurological deficits.
Arachnoid ; Back Pain ; Brain ; Cerebrospinal Fluid ; Follow-Up Studies ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Intracranial* ; Hematoma, Subdural, Spinal ; Humans ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Middle Aged ; Recurrence ; Spinal Cord ; Spinal Injuries ; Spine ; Subarachnoid Space ; Subdural Space* ; Tears

PURPOSE: Laparoscopic liver resection has gained much popularity in recent years, but relatively few centers have performed hepatectomies in hepatocellular carcinoma (HCC) patients due to the technical difficulties faced with underlying liver cirrhosis. We now present our early experience with laparoscopic liver resection in HCC performed in a single institution. METHODS: From October 2003 until March 2009, 39 laparoscopic liver resections were performed on HCC patients among whom 26 had underlying liver cirrhosis. RESULTS: The location of the tumor was in the left lateral section in 15, segment 5 or 6 in 20, segment 4 in 3 and caudate lobe in 1. Resection involving less than a monosegment was done in 26 and more than 2 segments in 13. Tumor size ranged from 0.8 cm to 6.6 cm (median 2.35) and the resection margin from 0.1 to 6 cm (median 1.5 cm). All patients were either stage I (29) or II (10). There was no difference between cirrhotic and non-cirrhotic patients in operation time (median 210 minutes, range 60~637), change of hematocrit value (4.8%, -1~19.6%), or hospital stay (8 days, 3~67 days). The median follow up duration was 15.1 months, and the 2-year recurrence free survival rate was 48.3%. CONCLUSION: Laparoscopic liver resection in HCC with or without underlying cirrhosis seems to be feasible with minimal morbidity, especially in well selected cases with early stage HCC.
Carcinoma, Hepatocellular ; Fibrosis ; Follow-Up Studies ; Hematocrit ; Hepatectomy ; Humans ; Laparoscopy ; Length of Stay ; Liver ; Liver Cirrhosis ; Recurrence ; Survival Rate

Primary biliary cirrhosis (PBC) is a chronic progressive disease, more often affecting women, characterised by progressive destruction of the small intrahepatic bile ducts with portal inflammation leading to fibrosis and cirrhosis. There is a close association between PBC and antibodies to antimitochondrial antibodies (AMA). The pathogenesis of PBC remains uncertain. The disease has been considered as an example of autoimmunity. Estimates of disease prevalence vary between 20 and 240 cases per milion per year. PBC is a extremely rare liver disease in Asia. There is no definitive drug treatment, liver transplantation is indicated for patients with intractable symptoms and for end-stage disease. The authors have experienced a case of PBC in 66 year-old female who suffered from lethargy, pruritus and dry mouth since 2 years ago. We report a case of PBC with a review of literatures.
Aged ; Antibodies ; Asia ; Autoimmunity ; Bile Ducts, Intrahepatic ; Female ; Fibrosis ; Humans ; Inflammation ; Lethargy ; Liver Cirrhosis, Biliary* ; Liver Diseases ; Liver Transplantation ; Mouth ; Prevalence ; Pruritus

A 50-year-old male, renal transplant recipient, was admitted with fever and chest discomfort. At admission, chest radiologic finding was negative and echocardiography showed minimal pericardial effusion. After 2 days of admission, chest pain worsened and blood pressure fell to 60/40 mmHg. Emergency echocardiography showed a large amount of pericardial effusion compressing the entire heart. Pericardiocentesis was performed immediately. Mycobacterium tuberculosis was isolated from pericardial fluid. Tuberculosis pericarditis should be considered as the cause of cardiac tamponade in renal transplant recipients, even with the absence of pericardial effusion in the initial study or suggestive history.
Blood Pressure ; Cardiac Tamponade ; Chest Pain ; Echocardiography ; Emergencies ; Fever ; Heart ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; Mycobacterium tuberculosis ; Pericardial Effusion ; Pericardiocentesis ; Pericarditis ; Thorax ; Transplants ; Tuberculosis

In patients with tumors and spinal cord lesions, inflammation and tissue infection can result in mass effect detection on imaging. As a result, surgical biopsy procedures are often performed on the lesions. We report a rare case in which the thickening ligamentum flavum (LF) appeared to be a tumor in the epidural space of the cervical spine based on imaging findings. A 52-year-old man visited our outpatient clinic with severe shoulder pain and radicular pain in his right arm that had developed gradually after a traffic accident two months earlier. Magnetic resonance imaging of the cervical spine revealed an extradural mass at the cervicothoracic junction level. Suspecting a tumor, spinal decompression surgery was performed and a biopsy of the mass was obtained. At the time of surgery, the LF was thick and compressed the spinal cord. After successful removal of the LF, the spinal cord appeared normal. Histopathological examination confirmed the mass as the LF. The patient was discharged without pain or weakness two weeks postoperatively. This case demonstrated that when the LF of the cervicothoracic junction is thickened, it may be misdiagnosed as a cervical spine tumor compressing the spinal cord.
Accidents, Traffic ; Ambulatory Care Facilities ; Arm ; Biopsy ; Cervical Vertebrae ; Decompression ; Epidural Space* ; Female ; Humans ; Inflammation ; Ligamentum Flavum* ; Magnetic Resonance Imaging ; Middle Aged ; Radiculopathy ; Shoulder Pain ; Spinal Cord ; Spinal Cord Compression ; Spine*

To investigate fragile sites induced by aphidicolin which is a specific inhibitor of eukaryotic DNA polymerase a which is primarily associated with chromosomal DNA replication in human lymphocytes, HaCat cells (human keratinocytes) and MRC-5 cells (human embryonic lung fibroblast), we cultured each cells in RPMI 1640 with 10% fetal calf serum and 2% PHA. Treatment of the cells with aphidicolin was generally carried out for the last 24 hours of culturing. The drug was dissolved in DMSO and used at final concentrations of 0.05~0.15 mg/ml, corresponding to a maximum DMSO concentration of 0.028%. Karyotypes of each cells were performed by routine method, and 50 metaphases were scored for each culture for analysis of breakage rate. Experimental cells treated with APC showed a dose dependent sensitivity and the amounts of chromosome breakage induced by APC are the highest in concentration of 0.15 mg/ml. The frequency of fragile sites on each cells appeared in MRC-5 cells, lymphocytes and HaCat cells in order. The common fragile sites on all experiments was 16q23, and the common fragile sites on embryonic cells was 1p31. It can be concluded that gene or nucleic acid which is located on 16q23 is the most important factor to induce chromosomal breakage with sensitivity to aphidicolin and 1p31 is important site to induce chromosomal breakage in embryonal cells.
Aphidicolin* ; Chromosome Breakage ; Dimethyl Sulfoxide ; DNA ; DNA Replication ; Humans ; Karyotype ; Lung ; Lymphocytes* ; Metaphase

This study was conducted to observe effects of two methods of setting positive endexpiratory pressure (PEEP) based on the pressure-volume (PV) curve. After lung injury was induced by oleic acid in six mongrel adult dogs, the inflation PV curve was traced and the lower inflection point (LIP) was measured. The 'PEEP(INF)' was defined as LIP+2 cmH2O. After recruitment maneuver to move the lung physiology to the deflation limb of PV curve, decremental PEEP was applied. The lowest level of PEEP that did not result in a significant drop in PaO2 was defined as the 'PEEP(DEF)'. Arterial blood gases, lung mechanics, hemodynamics, and lung volumes (measured on computed tomography during end-expiratory pause) were measured at PEEP of 0 cmH2O, PEEP(INF) and PEEP(DEF) sequentially. The median PEEP(INF) was 13.4 cm H2O (interquartile range, 12.5-14.3) and median PEEP(DEF) was 12.0 cm H2O (10.0-16.5) (p=0.813). PEEP(DEF) was associated with significantly higher PaO2 and lung volumes, and significantly lower shunt fraction and cardiac index when compared to PEEP(INF) (p<0.05). Setting the PEEP based on the deflation limb of the PV curve was useful in improving oxygenation and lung volumes in a canine lung injury model.
Animals ; Dogs ; Lung/pathology ; *Lung Injury ; Lung Volume Measurements/*methods ; Male ; Oxygen/metabolism ; Positive-Pressure Respiration/*methods ; Pressure ; Pulmonary Gas Exchange ; Radiography, Thoracic/methods ; Tomography, X-Ray Computed/*methods