Subcutaneous emphysema is a complication of the pneumoperitoneum necessary to perform laparoscopy and will be seen more often as laparoscopic techniques are applied to a growing number of intraabdominal procedures. We report a case of subcutaneous emphysema and hypercarbia without pneumothorax or pneumomediastinum during laparoscopic cholecystectomy, which was treated by multiple puncture with 18G needle on emphysematous site. The suspected cause is inadvertent subcutaneous insufflation of carbon dioxide through the trocar sites by increased intra-abdominal pressure for the establishment of pneumoperitoneum. Immediate recognition, evaluation, and treatment of subcutaneous emphysema is necessary since this can be life-threatening complication.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Insufflation ; Laparoscopy ; Mediastinal Emphysema ; Needles ; Pneumoperitoneum ; Pneumothorax ; Punctures ; Subcutaneous Emphysema* ; Surgical Instruments

Sudden hearing deterioration may occur in our population, but it is difficult to explain the exact pathophysiology and the cause. Magnetic resonance imaging (MRI) in sudden sensorineural hearing loss (SSNHL) is usually useful to evaluate neural lesions such as acoustic schwannoma and hemorrhage in labyrinth. Recently some cases of SSNHL caused by intralabyrintine hemorrhage were reported by the advance of MRI. In the case of intralabyrintine hemorrhage, MRI showed a hyperintense signal in the labyrinth on the pre-contrast and contrast enhanced T1-weighted image and relatively weak intensity on T2-weighted image. The prognosis SSNHL by intralabyrintine hemorrhage is generally known to be poor. We report a case of sudden deafness with intralabyrintine hemorrhage who has a history of anticoagulant administration, with a review of literature.
Ear, Inner ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Hemorrhage* ; Magnetic Resonance Imaging ; Neuroma, Acoustic ; Prognosis

BACKGROUND: It is well known that non-rapid eye movement(NREM) sleep activates the occurrence of interictal epileptiform discharges(IED) in many epileptic syndromes. We performed this study to assess the effect of NREM sleep on IED in epileptic patients with organic brain lesions. MATERIALS AND METHODS: We analyzed awake and sleep electroencephalopathy(EEG) recorded simultaneously after partial sleep deprivation in 50 patients. We calculated the awake and sleep spike index (ASI and SSI, spikes/epoch), and the percentage increase of ASI and SSI during sleep. RESULTS: In the 50 patients, the IEDs were recorded exclusively during the awake state in 1 (2%) patient, and during the sleep state in 13(26%) patients. The SSI was higher in 44 (88%) patients, and the ASI was higher in 5 (10%) patients. The mean ASI and the SSI in patients with organic brain lesions were 0.058+/-0.121 and 0.148+/-0.187, and it was 0.081+/-0.150 and 0.174 +/-0.226 in patients without organic brain lesions. There were significant increases in the spike index (P<0.05) during NREM sleep in both groups (n=36), but no significant difference in the percent increase of spike index (P>0.05). CONCLUSION: The IEDs were activated significantly during NREM sleep both in patients with and without organic brain lesions, but there were no differences in the degree of activation in both groups. The activating effect of NREM sleep was not correlated with clinical factors such as, frequent nocturnal seizures, frequent generalized tonic clonic seizures, type of epilepsy and taking anticonvulsants. We conclude that the routine EEG used to evaluate epileptiform discharges in epileptic patients should include sleep recordings after partial sleep deprivation.
Anticonvulsants ; Brain ; Electroencephalography* ; Epilepsy ; Humans ; Seizures ; Sleep Deprivation

BACKGROUND: To evaluate the clinical and functional outcomes of arthroscopic-assisted reduction and percutaneous screw fixation for glenoid fractures with scapular extension, and investigate the radiologic and clinical benefits from the results. METHODS: We evaluated patients treated with arthroscopic-assisted reduction and percutaneous screw fixation for glenoid fractures with scapular extension from November 2008 to September 2015. Fractures with displacement exceeding one-fourth of the anterior-articular surface or more than one-third of the posterior-articular surface in radiographic images were treated by surgery. Clinical assessment was conducted based on range of motion, Rowe score, and Constant score of injured arm and uninjured arm at last follow-up. RESULTS: Fifteen patients with Ideberg classification grade III, IV, and V glenoid fracture who underwent arthroscopic-assisted reduction using percutaneous screw fixation were retrospectively enrolled. There were no differences in clinical outcomes at final follow-up compared to uninjured arm. Bone union was seen in all cases within five months, and the average time to bone union was 15.2 weeks. Ankylosis in one case was observed as a postoperative complication, but the symptoms improved in response to physical therapy for six months. There was no failure of fixation and neurovascular complication. CONCLUSIONS: We identified acceptable results upon radiological and clinical assessment for the arthroscopic-assisted reduction and percutaneous fixation. For this reason, we believe the method is favorable for the treatment of Ideberg type III, IV, and V glenoid fractures. Restoration of the articular surface is considered to be more important than reduction of fractures reduction of the scapula body.
Ankylosis ; Arm ; Arthroscopy ; Classification ; Follow-Up Studies ; Fracture Fixation ; Glenoid Cavity ; Humans ; Methods ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies ; Scapula

No abstract available.
Ulcer*

No abstract available.
Chondrosarcoma* ; Sternum*

STUDY DESIGN: Authors experienced three cases of malignant schwannoma arising from multiple neurofibromatosis and invading the vertebrae. OBJECTIVE: To report treatment results and preventive idea in three cases of malignant schwannoma transformed from neurofibromatosis within the retroperifoneal area and invading the vertebrae. SUMMARY OF BACKGROUND DATA: The patients with neurofibromatosis are clearly at increased risk to develop the malignant schwannoma. A review of Korean literature revealed no such cases. RESULTS: The first case presented in the L4 body and was treated by surgical excision and chemotherapy, but she expired due to secondary metastasis in six months after diagnosis. The second case was treated by diagnostic biopsy and chemotherapy with adriamycin, ifosfamide, DTIC, mesna. He eventually lived for 14 months. After a diagnostic biopsy, the third case died due to lung metastasis before we could begin the treatment. CONCLUSION: We recommend that neurofibromatsis patients be regularly followed-up and if necessary, CT examination of spine or abdomen should be done. If a malignant schwannoma is detected, then early treatment can be started.
Abdomen ; Biopsy ; Dacarbazine ; Diagnosis ; Doxorubicin ; Drug Therapy ; Humans ; Ifosfamide ; Lung ; Mesna ; Neoplasm Metastasis ; Neurilemmoma* ; Neurofibromatoses ; Spine*

Early gastric cancer (EGC) is a "curable" disease with a high cure rate made possible through proper surgical treatment; nonetheless, some patients sustain a disease recurrence after curative resection. The aim of this study was to identify the clinicopathological characteristics of recurrent EGC and determine predictable immunohistochemical markers for recurrence. We investigated the clinicopathological features of 1,786 EGC cases, and using tissue microarray, the expression of c-erbB-2, EGFR, MLH1, MSH2, p53, and AQP1 was examined in group with recurrence and control group without recerrence. In the clinical analysis, 32 of 1,786 (1.79%) patients showed recurrence, with a 2.04% five-year cumulative recurrence rate. Age, submucosal invasion, and lymph node metastasis significantly correlated with tumor recurrence (P=0.044, 0.019, and <0.001, respectively). Multivariate analysis showed lymph node status and old age (> or =57 yr) as independent risk factors of recurrence. In a case-control study, immunopositivity for c-erbB-2 was significantly associated with disease recurrence (P=0.024). There is the probability that EGC patients with old age (> or =57 yr), lymph node metastasis, submucosal invasion, and c-erbB-2 immunopositivity will experience recurrence; therefore, it is critical that patients with these risk factors be followed-up closely and considered candidates for adjuvant treatment.
Adult ; Aged ; Animals ; Female ; Genes, erbB-2 ; Humans ; Immunohistochemistry/methods ; Male ; Microarray Analysis/methods ; Middle Aged ; Multivariate Analysis ; *Neoplasm Recurrence, Local/metabolism/pathology ; Prognosis ; Risk Factors ; *Stomach Neoplasms/metabolism/pathology ; Tumor Markers, Biological/*metabolism

For young children with scoliosis before growth spurt, suhcutaneous lengthening without fusion was designed by Harrington and modified by Moe and Luque. However, many problems including spontaneous fusion, rod breakage, and hook disloclgement have been ohserved. CotrelDubousset(CD) instrumentation was sometimes used, but it usually resulted in failure due to soft tissue adhesion around the rough surface of ordinary CD rod. We tried to use the smooth CD rod, transvcrse-pedicle clawing on the upper part, and pedicle screw inscrtion on upper and lower part of the curve to reduce the hardware failures. Among 8 patients in whom suhcutaneous lengthening with smooth CD rod was carried out hetween October l992 and Suly 1996. 4 cases perfomed with final spinal fusion were analysed. There were I central core disease, 1 multicore disease and 2 idiopathic scoliosis(infantile and juvenile type). Mean age at the first operation was l0.0(8.8-11.8) years, and the Risser sign was all grade 0 except one with grade 1. Suhcutaneous lengthening was performed every 5 or 6 months Mean lengthening duration was 22(9-39) months and mean age at spinal fusion was 11.7(9.6-13.8) years. Mean Cobb angle decreased from 7ldegrees (55degrees-88degrees) at preoperative stage to 32 (10degrees-59degrees) at the last follow-up. There were 5 complications during 21 operations, and three hardware failures comprised 2 hook dislodgcment and 1 screw pull-out. Crankshaft phenomenon happened in I case who had had a posterior fusion in young age(9.6 years) due to laminar fracture. The suhcutaneous lengthening with smooth CD rod can he another option of treatment for young children with severe scoliosis. prescrving the powth potential of involved vertebrae with few complications.
Animals ; Child* ; Follow-Up Studies ; Hoof and Claw ; Humans ; Myopathy, Central Core ; Scoliosis* ; Spinal Fusion ; Spine ; Tissue Adhesions

High tibial osteotomy has been widely accepted as a method of treatments for middle-aged varus osteoarthritides with uncompartmental involvements. There have been several reports regarding the managements of fibula and their complications during the valgization procedure of tibia. They are, for example, osteotomy of fibular diaphysis or neck and excision of fibular head. Each level of fibular management is often complicated by nonunison, peroneal nerve palsy and lateral instability respectively. We have reviewed 20 cases of cases of high tibial osteotomy using proximal tibiofibular arthrolysis performed between March 1987 and February 1993. This method has proved excellent exposure of upper lateral tibia for the wedge removal, internal fixation and relief of the tethering effect of fibula. There was no peroneal nerve palsy relate to this degenerative change of the proximal tibiofibular was 3.4mm(range 1-11mm) and there was neither degenerative change of the proximal tibiofibular joint nor varus instability. In conclusion the arthrolysis of proximal tibiofibular joint can be highly recommended in high tibial osteotomy.
Diaphyses ; Fibula ; Head ; Joints ; Methods ; Neck ; Osteoarthritis ; Osteotomy ; Paralysis ; Peroneal Nerve ; Tibia