No abstract available.
Glycogen Storage Disease Type II* ; Wolff-Parkinson-White Syndrome*

In many cases the breast reconstruction surpasses the goal of a normal breast mound appearance in clothing and achieves a result that, in time, may look almost normal in the unclothe state. Breast reconstructions with autologous transverse rectus abdominis myocutaneous (TRAM) flaps are well known to produce the most aesthetically excellent results. the pedicled to TRAM flap cannot be used in high risk patient such as obese or smoking patients due to partial flap necrosis. But, the free TRAM flap have more robust blood supply and less donor site morbidity than the pedicled TRAM flap and is therefore the currently preferred technique in western. However, the free TRAM flaps has a problem related to the anastomotic failure which has been reported as high as 6% to 10%. Moreover many Korean women have smaller sized breast than western women and have no risk factors compromising flap circulation. So the single pedicled TRAM flap can be safely used for breast reconstruction without any flap necrosis. 60% of the elevated flap area has a sufficient volume to mold a new breast that matches with the contralateral breast and the unneccessary distal portion of the flap that has the marginal circulation can be resected. In this study we review our 20 consecutive cases of breast reconstruction using the pedicled TRAM flap and have a conclusion that the pedicled TRAM flap produce an aesthetically acceptable new breast in Korean mastecotmy patients without any flap necrosis or donor site morbidity.
Breast* ; Clothing ; Female ; Fungi ; Humans ; Mammaplasty* ; Necrosis ; Rectus Abdominis* ; Risk Factors ; Smoke ; Smoking ; Tissue Donors

We had replaced 159 hips in 130 patients with cementless porous-coated AML porsthesis at Kwang Ju Christian Hospital between April 1987 and Feb. 1992. Among them, 100 cases(80 patients) could be analyzed clinically and radiologically with an average follow-up of 38.5 months(range 10 months to 74 months). The purpose of this study was to evaluate the relationships of initial fit, follow up stability and clinical results. The results were as follows. 1. The average postoperative Harris hip score was 90 points(preop. 42) at the follow-up of 1 year or more, the pain score 41 points(preop. 15). 2. When the surgical fit of stem was achieved properly, fixation by bone ingrowth could be expected. Simultaneously adequate fit of acetabular cup provided stable fixation. 3. The incidence of thigh pain was high in patients with an unstable implant of stem and the hip pain was more common in group of a definitely unstable cup. 4. Stress shielding was seen in 44 cases(44%). Of the 44 cases, 38 cases(86%) revealed in bone ingrowth. In conclusion, this study showed good clinical result of THR using AML prosthesis at the average follow-up of 38.5 months and it seemed to be influenced by initial fit significantly. But long-term follow-up is needed for accurate clinical and radiological evaluation.
Acetabulum ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Gwangju ; Hip ; Humans ; Incidence ; Prostheses and Implants ; Thigh

Eosinophilic granulomatosis with polyangiitis (EGPA), previously called Churg-Strauss syndrome, is an anti-neutrophil cytoplasmic antibody associated vasculitis, accompanied by asthma, hypereosinophilia, nonfixed pulmonary infiltrates, and sinusitis. Peripheral neuropathy is common in patients with EGPA; however, a few cases of EGPA with central nervous system (CNS) involvement have been reported. A 45-year-old female referred for right side weakness and posterior neck pain was diagnosed as EGPA with subarachnoid hemorrhage and mononeuritis multiplex. She was effectively treated with a high dose glucocorticoid, cyclophosphamide, and intravenous immunoglobulin. EGPA with CNS involvement is uncommon and causes significant morbidity and mortality. Therefore more rapid and accurate diagnostic evaluation may be required. EGPA should be considered in patients with neurological symptoms and hypereosinophilia.
Antibodies, Antineutrophil Cytoplasmic ; Asthma ; Central Nervous System ; Churg-Strauss Syndrome ; Cyclophosphamide ; Eosinophils* ; Female ; Humans ; Immunoglobulins ; Middle Aged ; Mononeuropathies* ; Mortality ; Neck Pain ; Peripheral Nervous System Diseases ; Sinusitis ; Subarachnoid Hemorrhage* ; Vasculitis

PURPOSE: To evaluate useful findings and diagnostic value of TI-201 thyroid scan in differentiating benign from malignant nodules. MATERIAL AND METHOD: We studied 77 cold thyroid nodules proven histologically(27 malignat and 50 benign). Early (5--15rain) and delayed images(3--5hours) were obtained after intravenous injection of thallium 201. In these nodules, we retrospectively analyzed the degree of TI-201 uptake in early and delayed images, histopathologic type, size, and presence or absence of cystic change in the sonograms of 22 malignant nodules. RESULTS: Useful finding for diagnosis of malignant nodules was strong uptake of TI-201 in early and delayed images(specificity:98%, sensitivity:63%, positive predictive value:94.4%). Useful finding for benign nodules was no uptake of TI-201 in delayed image(specificity :88.9%, sensitivity :68%, positive predictive value :91.9%). The accuracy of TI-201 thyroid scan in differentiating benign from malignant nodules was 66.2%. The nodules with strong TI-201 uptake in early image and low TI-201 uptake in delayed image were malignant in 29.4%. Cystic changes were found in 40% of malignant nodules with atypical TI-201 uptake. TI-201 thyroid scan showed high specificity in follicutar neoplasm and adenomatous goiter in which differentiation of benignancy and malignancy is difficult with only cytologic examination. CONCLUSION: We consider that TI-201 thyroid scan is valuable in differentiating benign from malignant nodules and when combined with fine needle aspiration and ultrasound examination, it will enable more accurate differential diagnosis between benign and malignant thyroid nodules.
Biopsy, Fine-Needle ; Diagnosis ; Diagnosis, Differential* ; Goiter ; Injections, Intravenous ; Retrospective Studies ; Sensitivity and Specificity ; Thallium* ; Thyroid Gland* ; Thyroid Nodule ; Ultrasonography

The reconstruction of the cheek area is a complex problem because the cheek is the most broad area of the face and is close to the aesthetically important region such as eyelids, nose, and mouth. The ultimate purpose of the cheek reconstruction is the restoration of the original shape and function, and establishment of the harmony with the adjacent structure in terms of color, nature and thickness. Various procedures such as skin graft, local flap, free flap, and local flap using skin expansion have been performed for cheek reconstruction. However, no golden principal or indication has been clarified to be imperative. Analyzing our clinical experiences of the cheek reconstruction, we intend to present a general guide of the cheek reconstruction and to assess the advantages and/or disadvantages of the operative methods. Between march of 1989 and August of 1999, we have experienced 154 cases of the cheek reconstruction. There were 52 males and 73 females, and their ages ranged from 3 to 89 years (mean 28.1 years). Preoperative diagnosis were post-burn deformity(n=74), Romberg disease (n=9), post-traumatic deformity(n=7), hemangioma(n=7), nevus(n=7), neurofibroma(n=5), hemifacial microsomia (n=3), lymphangioma(n=3), cancer(n=6), post-hemimandibulectomy(n=1), radical maxillectomy(n=1). The procedures were one stage cervicofacial flap(49 cases), cervicofacial flap following skin expansion(42 cases), local cheek flap (14 cases), deltocervicopectoral flap(2 cases), skin graft(29 cases), free flap(18 cases). Follow up period ranged from 3 to 72 months(mean 11.8 months). Advantages and disadvantages of each procedures were explained. The satisfaction rate was higher in one stage cervicofacial flap and free flap when assessed by both patients and surgeon. There were 3 cases of the ectropion of lower eylids, 4 cases of partial flap necrosis, and 1 case of exposure of tissue expander. The local flap is always the preferred method for the cheek reconstruction and the free flap is the treatment of choice for the cheek contour reconstruction. Selection of the most suitable flap is mandatory depending on the location and size of the defects.
Cheek* ; Diagnosis ; Ectropion ; Eyelids ; Facial Hemiatrophy ; Female ; Follow-Up Studies ; Free Tissue Flaps ; Goldenhar Syndrome ; Humans ; Male ; Mouth ; Necrosis ; Nose ; Skin ; Tissue Expansion Devices ; Transplants

BACKGROUND: Postoperative myalgia after administration of succinylcholine is a frequent complication after surgery. This study was designed to determine whether there was any association between postoperative myalgia and muscle relaxants. METHODS: Sixty patients were assigned to three groups of equal size. Group 1, the patients received succinylcholine, 1.0 mg/kg for tracheal intubation. Group 2, received pancuronium 0.01 mg/kg, 4 minutes before administration of succinylcholine 1.5 mg/kg. Group 3, received pancuronium 0.01 mg/kg, 4 minutes before administration of pancuronium 0.09 mg/kg. Blood samples for determination of serum potassium concentration were taken before the induction of anesthesia and 3 minutes after tracheal intubation. The incidence and severity of muscle fasciculation and myalgia were assessed in a double-blind manner. RESULTS: Serum potassium concentration was significantly increased in group 1. In group 2, incidence and severity of muscle fasciculation were significantly less than groups 1. Postoperative myalgia was significantly less in group 3 when compared with group 1 and 2. CONCLUSIONS: There was no significant correlation between succinylcholine induced fasciculation and postoperative myalgia. Pretreatment with pancuronium decreased the incidence of fasciculation and the changes of serum potassium concentration by succinylcholine, but has little effects on the succinylcholine induced postoperative myalgia.
Anesthesia ; Fasciculation ; Humans ; Incidence ; Intubation ; Myalgia* ; Pancuronium* ; Potassium ; Succinylcholine*

OBJECTIVE: This study was aimed to identify the incidence and risk factors of vancomycin-resistant enterococcus (VRE) colonization in neurosurgical practice of field, with particular attention to intensive care unit (ICU). METHODS: This retrospective study was carried out on the Neurosurgical ICU (NICU), during the period from January. 2005 to December. 2007, in 414 consecutive patients who had been admitted to the NICU. Demographics and known risk factors were retrieved and assessed by statistical methods. RESULTS: A total of 52 patients had VRE colonization among 414 patients enrolled, with an overall prevalence rate of 6.1%. E. faecium was the most frequently isolated pathogen, and 92.3% of all VRE were isolated from urine specimen. Active infection was noticed only in 2 patients with bacteremia and meningitis. Relative antibiotic agents were third-generation cephalosporin in 40%, and vancomycin in 23%, and multiple antibiotic usages were also identified in 13% of all cases. Multivariate analyses showed Glasgow coma scale (GCS) score less than 8, placement of Foley catheter longer than 2 weeks, ICU stay over 2 weeks and presence of nearby VRE-positive patients had a significantly independent association with VRE infection. CONCLUSION: When managing the high-risk patients being prone to be infected VRE in the NICU, extreme caution should be paid upon. Because prevention and outbreak control is of ultimate importance, clinicians should be alert the possibility of impending colonization and infection by all means available. The most crucial interventions are careful hand washing, strict glove handling, meticulous and active screening, and complete segregation.
Bacteremia ; Catheters ; Colon ; Demography ; Enterococcus ; Glasgow Coma Scale ; Hand Disinfection ; Handling (Psychology) ; Humans ; Incidence ; Critical Care ; Intensive Care Units ; Mass Screening ; Meningitis ; Multivariate Analysis ; Neurosurgery ; Prevalence ; Retrospective Studies ; Risk Factors ; Vancomycin

Wilson's disease is a treatable autosomal recessive inherited disorder of copper metabolism due to mutation of the copper transporting gene. The basic strategy of treatment is to reduce the amount of copper in the liver and other tissues by administering both a low copper diet and copper-chelating agents. D-penicillamine is the first choice as a copper-chelating agent. Some serious side effects could occur in 3~5% of all patients following D-penicillamine therapy. We report a 19 year-old male with Wilson's disease who developed nephrotic syndrome 6 months after the initiation of D-penicillamine therapy. Prednisolone was administered to control nephrotic syndrome and D-penicillamine was switched to trientine. Urinary remission was achieved within a week and maintained thereafter. Nephrotic syndrome was proven to be MCNS by kidney biopsy.
Biopsy ; Copper ; Diet ; Hepatolenticular Degeneration* ; Humans ; Kidney ; Liver ; Male ; Metabolism ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Penicillamine* ; Prednisolone ; Trientine ; Young Adult

PURPOSE: The purpose of this study was to evaluate the CT features of second branchial cleft cysts. MATERIALS AND METHODS: We retrospectively analyzed the computed tomographic images in nine cases of second branchial cleft cyst which was confirmed pathologically. Emphasis was on localization of the masses to fascial spaces as defined by the deep cervical fasica. RESULTS: In all nine cases, the lerions were located in the submandibular and carotid spaces. Among these cases, six(67%) had simultaneous involvement of the other contiguous spaces, such as anterior and posterior cervical spaces. All cases had round or oval, unilocular, cystic masses with partial or complete rim enhancement. In eight cases(89%), smooth and thin walls were observed. In one case, thick wall and septations were noted. No definite calcifications were noted in all cases. The internal contents of cystic masses showed relatively homogeneous appearance, and CT number ranged from 20 to 35.2 Hounsfield unit(HU)(mean, 28.4HU). CONCLUSION: CT diagnosis of second branchial cleft cyst would be easily obtained from recognition of frequent simultaneous involvement of the other contiguous spaces, along with a typical location and characteristic morphology.
Branchial Region* ; Branchioma* ; Diagnosis ; Retrospective Studies