We report one case of bilateral naviculo-medial cuneiform coalition in ten year old girl. She complained of pain in the medial aspect of the mid-foot related to long periods of standing and activity. Routine roentgenographs, specifically lateral views showed a bony bridge between the navicular bone and medial cuneiform. A biopsy revealed as fibrocartilaginous tissue. The bony bridge consists about one third in lateral view and 30 degree cephalad tilting in the antero-posterior view. Bilateral resection arthroplasty, with interposing flesh muscle fibers of the abductor hallucis, was performed for restoration of motion in the naviculo-medial cuneiform joint and relief of localized pain. Four months after surgery, pain around the mid-foot had almost complete subsided. One year postoperative, neither recurrence nor disability was observed. We will discuss the diagnosis and treatment of this rare case of bilateral naviculo-medial cuneiform coalition.
Arthroplasty ; Biopsy ; Diagnosis ; Female ; Humans ; Joints ; Recurrence

The introduction of microdiscectomy in lumbar spine surgery has resulted in a significant decrease in postoperative pain and length of hospital stay. Intraoperative application of long-acting local anesthetic agents and corticosteroids during lumbar discectomy have been used for the management of postoperative pain. However, the efficacy of local anesthetic agents and corticosteroids has not been reported. This study evaluated 30 patients undergoing lumbar microdiscectomy. These patients were divided into three groups. Group I(10 patients) received intramuscular Depomedrol and intravenous Solumedrol at the start of the operation. A gelfoam soaked with Depomedrol was placed over the affected nerve root following discectomy. In addition, bupivacaine was infiltrated into the paraspinal musculature at the skin incision and during closure. Group II(10 patients) received intramuscular bupivacaine and used a saline-soaked gelfoam. Group III(10 patients) acted as a control group without corticosteroids and bupivacaine. Patients in Group I had a statistically significantly shorter hospital stay(8.9 days) compared to the control group(14.9 days). Patients in Group I required less postoperative narcotic analgesia than the other groups. A larger percentage of patients in Group I reported reduction of lower back pain and radicular pain until #POD 3 compared to other groups. These results indicate that the combination of long-acting local anesthetic agents and corticosteroids can reduce postoperative discomfort and hospital stay.
Adrenal Cortex Hormones* ; Analgesia ; Anesthetics ; Bupivacaine* ; Diskectomy ; Gelatin Sponge, Absorbable ; Humans ; Length of Stay ; Low Back Pain ; Methylprednisolone Hemisuccinate ; Pain Management* ; Pain, Postoperative ; Skin ; Spine

The authers describe a case of huge tentorial meningioma in 32 year old female patient. Her clinical complaints were bifrontal headache and visual impairment. CT scan revealed huge supratentorial and infratentorial enhanced tumor mass. The tumor mass was removed in one stage.
Adult ; Female ; Headache ; Humans ; Meningioma* ; Tomography, X-Ray Computed ; Vision Disorders

BACKGROUND: Ambulatory surgery has become popular because patients believe it allows them greater control over their business and personal lives and because third party payers find it reduces cost. This study was designed to compare the characteristics of induction and recovery as well as the safety of propofol with those of midazolam used for intravenous anesthesia in outpatient cystoscopy. METHODS: 56 healthy consenting outpatients were randomly assigned to receive either bolus of propofol (2 mg/kg, n=29) or midazolam (0.1 mg/kg, n=27) for anesthesia in outpatients cystoscopic procedure. All patients also received bolus of fentanyl 1ug/kg before induction and N-M blocking agent was not injected for maintenance of spontaneous respiration. Mean arterial pressure, HR and SpO2 were recorded and induction time (time to spontaneous eye closure), recovery time (time to response, time to orientation, time to ambulation) and adverse effects were evaluated. RESULTS: The results were as follows; 1) Both propofol and midazolam produced smooth induction, but caused significant respiratory depression. 2) The time of induction and postoperative recovery (time to ambulation) was faster in propofol than in midazolam. 3) There were less postoperative side effects (nausea, vomiting, dizziness) in propofol than in midazolam. 4) There were more cardiovascular depression in propofol than in midazolam. CONCLUSION: These results suggest 1) that propofol has significant advantage over midazolam in outpatient surgery, where early ambulation and discharge is desirable and 2) that both propofol and midazolam should be administered by expert anesthesiologist only when ventilatory assistant device with oxygen is immediately available.
Ambulatory Surgical Procedures ; Anesthesia* ; Anesthesia, Intravenous ; Arterial Pressure ; Commerce ; Cystoscopy* ; Depression ; Early Ambulation ; Fentanyl ; Humans ; Insurance, Health, Reimbursement ; Midazolam* ; Outpatients* ; Oxygen ; Propofol* ; Respiration ; Respiratory Insufficiency ; Vomiting

A 51-year-old Korean woman presented with a non-tender, well-demarcated, reddish, edematous patch on the right anterior chest where a previous mastectomy and radiation therapy had been performed. She had been diagnosed as having infiltrating ductal carcinoma of the right breast about 1 year ago. Histopathological findings of the skin lesions were consistent with inflammatory metastatic carcinoma of the breast. Inflammatory carcinoma or carcinoma erysipeloides is a well-established entity most frequently associated with carcinoma of the breast. It is characterized by dermal lymphatic invasion by malignancy and clinically should be distinguished from erysipelas or cellulitis. We describe a case of inflammatory metastatic carcinoma derived from an infiltrating ductal carcinoma of the breast which can be clinically confused with radiation dermatitis.
Breast* ; Carcinoma, Ductal ; Cellulitis ; Dermatitis ; Erysipelas ; Erysipeloid ; Female ; Humans ; Mastectomy ; Middle Aged ; Skin ; Thorax

No abstract available.

OBJECTIVES: The purpose of this study was to compare the differences of parental rearing attitude between incarcerated delinqent adolescents and adolescents attending school, in order to identifying the relationships between delinquent behavior and personality factors. METHODS: The subjects were composed of 94 incarcerated delinqent adolescents and 112 adolescents attending school. Subjects were required to complete self-report questionnare including PBI and 16 PF. RESULTS: In incarcerated delinqent adolescents, maternal care(MC) was significantly lower than in adolescents attending school and paternal overprotection(PO) was significantly higher than in adolescents attending school. Of the scores of 16 PF, incarcerated delinqent adolescents showed lower scores in intelligence(B), guilt-proneness(O), liberalism(Q1), self-control(Q3), tension(Q4), anxiety(ANX), superego(SUP) and creativity(CRE) than adolescents attending school. Of the correlation between the scores of PBI and 16PF in incarerated delinqent adolescents, each of superego(G), liberalism(Q1), and supergo(SUP) was negatively correlated with maternal overprotection. Liberalism(Q1) was negatively correlated with paternal overprotection. Stableness(C) was positively correlated with paternal care. Each of gulit-proneness(O), liberalism(Q1), self sufficiency(Q2), tension(Q4), and anxiety(ANX) was negatively correlated with paternal care. In adolescents attending school, groups classified by parental bonding pattern indicated that optimal bonding group(Group l) was correlated with more positive aspects of personality factors, and the affectionless control(Group lV) was correlated with more negative aspects of personality factors. In delinquent adolescents, however, results didn't match the above findings. CONCLUSION: The parent-child bonding patterns of incarcerated delinqent adolescents were related to multiple personality factors. In parental rearing of incarcerated delinqent adolescents, maternal care(MC) was lower and paternal overprotection(PO) was higher than in adolescents attending school. We suggest that personality factors of incarcerated delinqent adolescents are correlated with delinquent behaviors. However, early parent-child bonding patterns do not seem to be correlated with later personality development.
Adolescent* ; Humans ; Multiple Personality Disorder ; Parents* ; Personality Development

No abstract available.
Gallium* ; Neoplasm, Residual* ; Wounds and Injuries*

PURPOSE: Bone bruises of patients with acute traumatic knee injuries, that are not found on simple radiograph, can be found on magnetic resonance imaging (MRI). The purpose of this study is to evaluate the frequency and locations of bone bruises on MRI in acute traumatic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injury. MATERIALS AND METHODS: 25 and 19 MRls, in which acute traumatic ACL and PCL injury was pre sent and there was no abnormality in simple radiograph, were reviewed. MRI was taken within 51 days of injury. A bone bruise was determined as a geographic and nonlinear area of signal loss on T1 images and increased signal intensity on T2 images involving the subcortical bone. RESULTS: In 16 patients with bone bruises and acute ACL injury, bone bruises were found in the lateral compartment of the knee in 15 (93.8%) patients. The most common area was the lateral tibial plateau (11 cases, 68.8%) and the second was lateral femoral condyle (9 cases, 56.3%). In 5 patients with bone bruises and acute PCL injury, bone bruises were found in the lateral compartment of the knee in all 5 (100%) patients. The most common area was lateral tibial plateau (4 cases, 80%) and the second was lateral femoral condyle (2 cases, 40%). CONCLUSIONS: In patients with acute traumatic ACL or PCL injuries the bone bruises are often found on the lateral compartment of the knee, especially lateral tibial plateau and lateral femoral condyle on MRI.
Anterior Cruciate Ligament ; Contusions* ; Humans ; Knee ; Knee Injuries ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament

Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.
Acute Disease ; Aged ; Aneurysm, Dissecting/complications/*therapy ; *Angioplasty, Balloon ; Female ; Humans ; Ischemia/etiology ; *Mesenteric Artery, Superior ; Mesenteric Vascular Occlusion/etiology ; *Stents