No abstract available.
Fontan Procedure*

BACKGROUND: the prediction on changes in the lung function after lung surgery would be an important indicator in terms of the operability and postoperative complications. In order to predict the postoperative FEV1 - the commonly used method for measuring changes in lung function- a comparison between the quantitative CT and the perfusion lung scan was made and proved its usefulness. MATERIAL AND METHOD: The subjects included 22 patients who received perfusion lung scan and quantitative CT preoperatively and with whom the follow-up of PFT were possibles out of the pool of patients who underwent right lobectomy or right pneumonectomy between June of 1997 and December of 1999. The FEV1 and FVC were calibrated by performing the PFT on each patient and then the predicted FEV1 and FVC were calculated after performing perfusion lung scan and quantitative CT postoperatively. The FEV1 and FVC were calibrated by performing the PFT after 1 week and after 3 momths following the surgery. RESULTS: There was a significant mutual scan and the actual postoperative FEV1 and FVC at 1 week and 3 months. The predicted FEV1 and FVC(pneumonectomy group : r=0.962 and r=0.938 lobectomy group ; r=0.921 and r=913) using quantitative CT at 1 week postoperatively showed a higher mutual relationship than that predicted by perfusion lung scan(pneumonectomy group : r=0.927 and r=0.890 lobectomy group : r=0.910 and r=0.905) The result was likewise at 3 months postoperatively(CT -pneumonectomy group : r=0.799 and r=0.882 lobectomy group : r=0.934 and r=0.932) CONCLUSION: In comparison to perfusion lung scan quantitative CT is more accurate in predicting lung function postoperatively and is cost-effective as well. Therefore it can be concluded that the quantitative CT is an effective method of replacing the perfusion lung scan in predicting lung function post-operatively. However it is noted that further comparative analysis using more data and follow-up studies of the patients is required.
Follow-Up Studies ; Humans ; Lung* ; Perfusion* ; Pneumonectomy ; Postoperative Complications

STUDY DESIGN: The authors is to report the clinical and radiological results of proximal half corpectomy with one motion segment fusion in Denis type B burst fracture. OBJECTIVES: To evaluate the efficacy of proximal half corpectomy in Denis type B burst fracture of thethoracolumbar and lumbar spine. SUMMARY OF LITERATURE REVIEW: For the operative management of burst fracture, various mothods including posterior ligamentotaxis, posterolateral decompression, anterior decompression or combined were reported. Among the methods, anterior decompression by the corpectomy of fractured vertebral body and fusion with or without instrumentation is the one of the widely accepted method of treatment. However, anterior decompression by excision of whole vertebral body has the disadvantage of high complication rate due to the instability from the large defect and long length of bone graft. Moreover, two motion segments have to be sacrified, which is very important especially in thoracolumbar and lumbar area. Material and METHODS: 43 cases operated from 1989 to 1996 and the minimum follow up period was two years and compared with that of 48 cases who were treated by total corpectomy and two motion segment fashion from 1986 to 1989. RESULTS: Solid bony union was obtained in 43 cases within 6 months and no back pain was complained in 39 cases (93%) at last follow up. There was no significant difference between two groups in correction of anterior vertebral height and kyphotic angle. Length of bone graft was 3.0cm in half corpectomy group and was 6.3cm in total corpectomy group. Hardward breakage or graft collapse was not observed in proximal half corpectomy, while there were 5 cases in total corpectomy. CONCLUSION: Proximal half corpectomy and fusion of one motion segment in Denis type B burst fracture is believed to be a successful method which can minimize the fused level, increase the stability, preserve motion segment and reduce the complication.
Back Pain ; Decompression ; Follow-Up Studies ; Spine* ; Transplants

STUDY DESIGN: Sixteen patients with congenital kyphoscoliosis were evaluated the clinical and radiological results according to the treatment method. OBJECTIVES: To provide a guideline for surgical treatment of congenital kyphoscoliosis SUMMARY OF LITERATURE REVIEW: Congenital kyphoscoliosis is an abnormal coronal and sagittal curvature of spine that is caused by the presence of vertebral anomalies, which causes a significant deformity and disability. Correction of the deformity is challenging and accompanied by high risk of complications. Many methods of operative treatment were recommended with various results. MATERIALS & METHODS: We reviewed 16 patients of congenital kyphoscoliosis who were operated from 1984 to 1997, and follow-up periods were over 12 months in all. The average age of surgery was 12 years (ranged from 4 to 20 years). Nine cases were operated by excision of quadrant hemivertebra through combined anterior & posterior approach and 6 cases were treated only by posterior instrumentation and one underwent posterior on bloc spondylectomy. RESULTS: The type of curves were thoracic in 5, thoracolumbar in 9, lumbar area in 2 patients. Average angle of kyphosis was 55 degree preoperatively, 25 degree postoperatively, and 39 degree at the follow up study. Average angle of scoliosis was 48 degree, 22 degree, and 27 degree, respectively. In 9 cases corrected by excision of quadrant hemivertebra; kyphotic angle was changed from 62degrees preoperatively, to 22degrees postoperatively and to 36 degree at the end of follow up study, while scoliotic angle was changed from 47degrees, to 12degrees and to 21degrees, respectively. In 6 cases corrected by posterior instrumentation kyphotic angle was changed from 52degrees preoperatively, to 33degrees postoperatively and to 48degrees degree at the follow up study, while scoliotic angle was changed from 53degrees, to 33degrees and to 37degrees, respectively. CONCLUSION: Excision of quadrant hemivertebra through combined anterior and posterior approach or posterior instrumentation were resulted in significant loss of correction during the remaining growth period due to the secondary change of adjacent vertebrae. So, to obtain better correction and to reduce the recurrence of deformity, more aggressive approach including the concept of three dimentional osteotomy involving the upper and lower adjacent curve may be considered.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Osteotomy ; Recurrence ; Scoliosis ; Spine

BACKGROUND: During the last few years, the in vivo study of the physiological parameters of the skin by non-invasive methods has been considerably developed. So far, there have been some reports on the skin characteristics only in parts, but there has not been any criteria to classify those of normal subjects. OBJECTIVE: The aim of the present study was to investigate the skin characteristics of healthy Korean subjects according to sex and sites using non-invasive methods. METHODS: To determine normal levels of sebum, skin hydration, transepidermal water loss (TEWL), skin elasticity and skin color according to sex, 163 subjects (male; 124, female; 39) were used to investigate 5 different anatomical sites. 6 different instruments were used: The Sebummeter SM 410, Corneometer CM 820, Evaporimeter EP1, Cutometer SEM 474, Chromameter CR-121, and Mexameter MX 16, for evaluating sebum excretion rate, capacitance, TEWL, mechanical property and skin color respectively. RESULTS: Differences were noticed depending on the anatomical sites and sex. Most of the measuring parameters were significantly different according to sites and sex. The values of sebum levels, capacitance and TEWL were higher in the males on the cheek, forehead and crows foot, whereas in the females, higher values were observed on the dorsum of the hand. The skin elasticity varied considerably among the nine-parameters but, for the elastic ratio (R2, R5), the females showed significantly higher values than the males in all sites except the forehead. Skin lightness (L* value) was higher in the females, whereas the males showed lugher values in the category of redness (a* value) and yellowness (b* value). The values of the eqrthema index (EI) and melanin index (MI) were also higher in the males on all sites. Correlations between the skin parameters mentioned above were calculated. A negative, correlation between capacitance and TEWL was observed only on the cheek (male/female, r =-0.2/ r =-0.4, p<0.05). The L* value correlated negatively with MI. Mioreover the values between a* and El also showed sipificant correlations in the male (cheek and dorsum of hand, y =0.2, forehead and crows foot, r =0.3, p<0.05). There were considerably significant correlations between the visual pigmentation score and instrumental skin parameters in the males (visual pigmentation score vs. L* value measured by Chromameter ; cheek/crows foot, r = -0.3/y =-0.4, visual pigmentation score vs. MI by Mexameter ; cheek/crows foot, r =0.2/ r =0.4, viisual winkle score vs. sebum excretion rate measured by Sebumeter ; cheek, r=0.2, visual winkle score vs. elasticity parameters measured by Cutometer ; cheek, R2/R5/R7, r =-0.3/ r =-0.2/ r =-0.3, p<0.05). CONCLUSION: Skin physiological parameters can be evaluated by non-invasive skin bioengineering methods which show quantitative modifications in physiological conditions in relation to sites and sex.
Bioengineering* ; Cheek ; Crows ; Elasticity ; Female ; Foot ; Forehead ; Hand ; Humans ; Male ; Melanins ; Pigmentation ; Sebum ; Skin*

No abstract available.
Metallothionein*

No abstract available.
Exostoses*

Chordoma is relatively rare and slowly growing tumor arising from notochordal remnant. The tumor is locally infiltrative rather than metastatic. Distant metastasis occured in 5% of Gentil & Coley's cases and 43% of Higinbotham et als cases. Usual sites of metastasis sites were lung, liver adrenal gland and lymph nodes. In 1922, Stewart reported first case of extrapulmonary metastatic chordoma in muscle & subcutaneous layer, which was extremely rare. We have experienced a case of wide spread multiple metastasis to muscle & subcutaneous tissue from primary sacrococcygeal chordoma. The case was 26 years old man, who have had multiple metastatic lesions in trunk, upper & lower extremities. They located in muscle and subcutaneous fat layer. In some lesions neurovascular structure was involved. We have treated the metastatic lesions by complete surgical excision, and they were confirmed as soft tissue chordoma by histologic examination.
Adrenal Glands ; Chordoma ; Liver ; Lower Extremity ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Notochord ; Subcutaneous Fat ; Subcutaneous Tissue

The trachea is a cartilagenous and membranous tubular midline structure with parallel walls. Tracheal deviation may be caused either by traction toward the diseased hemithorax or by compression toward the normal side. Unless an obvious mass is observed radiographically, occasionally it can be difficult to decide whether the trachea has been pushed or pulled from its normal position in the mediastinum. We studied the differences between tracheal deviation patterns in 23 patients with fibroatelectatic pulmonary tuberculosis and 35 patients with elongated and dilated aortas. In cases of retraction of the trachea by fibroatelectatic pulmonary tuberculosis, the diameter of the deviated segment was greater than that of the normal segment and deviation of the wall adjacent to the fibroatelectasis from its normal position was greater than that of the opposite wall. In cases of compression of the trachea by the elongated and dilated aorta, the diameter of the diviated segment was smaller than that of the normal segment and deviation of the wall adjacent to the aortic arch from its normal position was greater than that of the opposite wall. We conclude that these differences between tracheal deviation patterns are useful signs for discriminating retraction from compression. Thus when the trachea is retracted, the deviation of the juxtalesional wall is greater than that of the lesion-free wall, and vice versa.
Aorta ; Aorta, Thoracic ; Diagnosis, Differential* ; Humans ; Mediastinum ; Trachea* ; Traction* ; Tuberculosis, Pulmonary

The tracheostomy is increasingly being performed. In most cases, the tracheostomy sites are left to heal by secondary intention, so it leaves a depressed and wide scar that is cosmetically disfigured. Another problem os that the scar is also attached directly to the trachea itself and will move vertically with the trachea during the act of swallowing. Even though the tracheostomy scar is cosmetically acceptable, the mobility and retraction of the scar is a continual nuisance to the patient. We performed a retrospective study on 9 patients who had undergone revision of the depressed thracheostomy scar by the Renner Method from June, 1997 to February, 1999. The method includes transverse fusiform incision of the original scar and excision of the depressed portion of the scar to the level of the trachea itself. To prevent attachment of the skin and trachea, a bilateral subcutaneous flap and muscle flap were simply advanced to the midline and overlapped. Then the rest of scar that was not depressed was deepithelized and flipped to augment the soft tissue volume in the central depressed area. Satisfactory results were achieved in all patients without hematoma, infection, hypertrophic scar, and keloid formation. We believe this simple Renner method is one of the best ways of performing posttracheostomy scar revision.
Cicatrix* ; Cicatrix, Hypertrophic ; Deglutition ; Hematoma ; Humans ; Intention ; Keloid ; Retrospective Studies ; Skin ; Trachea ; Tracheostomy