BACKGROUND: Balloon PTCA for the distal, long, eccentric coronary artery stenosis will be at high risk for severe dissection or acute occlusion during or after procedure. METHODS AND RESULTS: High Speed Rotational Atherectomy followd by low pressure balloon angioplasty due to distal, long, eccentric coronary artery stenosis. Rotational coronary atherectomy debulked the lesion quickly without difficulty. Rotational Coronary Atherectomy with adjuctive low pressure balloon inflation was successful without event. CONCLUSIONS: This case illustrates the point that complementary deployment of devices may not only improve success of percutaneous coronary intervention, but also may extend its scope.
Angioplasty, Balloon ; Atherectomy, Coronary* ; Coronary Stenosis ; Inflation, Economic ; Percutaneous Coronary Intervention

No abstract available.
Teratoma*

No abstract available.

The prognostic factors for extrahepatic biliary atresia (EHBA) after Kasai portoenterostomy include the patient's age at portoenterostomy (age), size of bile duct in theporta hepatis (size), clearance of jaundice after operation (clearance) and the surgeon's experience. The aim of this study is to examine the most significant prognostic factor of EHBA after Kasai portoenterostomy. This retrospective study was done in 51 cases of EHBA that received Kasai portoenterostomy by one pediatric surgeon. For the statistical analysis, Kaplan-Meier method, Logrank test and Cox regression test were used. A p value of less than 0.05 was considered to be significant. Fifteen patients were regarded as dead in this study, including nine cases of liver transplantation. There was no significant difference of survival to age. The age is also not a significant risk factor for survival in this study (Cox Regression test; p = 0.63). There was no significant difference in survival in relation to the size of bile duct. However, bile duct size was a significant risk factor for survival (Cox Regression test; p = 0.002). There was a significant difference in relation to survival and clearance (Kaplan-Meier method; p = 0.02). The clearing was also a significant risk factor for survival (Cox Regression test; p = 0.001). The clearance of jaundice is the most significant prognostic factor of EHBA after Kasai portoenterostomy.
Bile Ducts ; Biliary Atresia* ; Humans ; Jaundice ; Kaplan-Meier Estimate ; Liver Transplantation ; Prognosis ; Retrospective Studies ; Risk Factors

Although the management of fractures of the calcaneus still remains controversial, open reduction and internal fixation is gaining in popularity as the method of choice for the treatment of displaced intraarticular calcaneal fractures. However, open methods can make several complications such as neurovascular injury and infection. Thus we have performed the new technique of arthroscopic reduction and minimal internal fixation for displaced intraarticular calcaneal fractures in 5 cases. The results were evaluated between 12 and 16 months after surgery. A Bohler angle was restored to 25degrees-40degrees in all cases. Anatomical reduction of articular surface were obtained from 4 cases out of 5. No complications were found except 1 peroneal tendinitis. The clinical results by Creighton-Nebraska health foundation assessment for fractures of the calcaneus were 3 excellent, 1 good and 1 fair. Even though this was a few case and a short term follow-up study, the arthroscopic assisted management of displaced intraarticular calcaneal fracture induced a little complications and satisfactory results.
Calcaneus ; Follow-Up Studies ; Tendinopathy

To evaluate the sensitivity and specificity of transthoracic fine needle aspiration cytology(TFNAC) in the preoperative diagnosis of pulmonary nodules, a retrospective analysis was carried out on a consecutive series of 200 TFNACs. They included 186 primary malignant tumors, 66 squamous cell carcinomas, 65 adenocarcinomas, 36 small cell carcinomas, 7 large cell carcinomas, 4 carcinoids, 8 others, 9 metastatic tumors, and 5 benign tumors. On cytohistologic correlation of malignant pulmonary tumors, the pro- cedure had a sensitivity of 97.3% and a specificity of 100%. A 86.6% correct correlation between the cytologic and histologic diagnoses was achieved. Five out of the 7 undifferentiated large cell carcinomas, 10 out of the 65 adenocarcinomas, 2 out of the 36 small cell carcinomas, and 2 out of the 66 squamous cell carcinomas were turned out to be mistyped in cytologic diagnosis. We concluded that TFNAC is a highly sensitive and specific preoperative diagnostic procedure in the investigation of patients with discrete pulmonary nodules in whom the specific cell type of the malignant neoplasm has important implications in treatment modality and prognosis.
Adenocarcinoma ; Bezafibrate ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Endometrial Neoplasms ; Female ; Humans ; Hydronephrosis* ; Kidney* ; Natural History* ; Papanicolaou Test ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: There are several ways to treat for recurrent pericardial effussion and cardiac tamponade due to malignancy. They are repeated pericardiocentesis, pericardial instillation of sclerosing and chemotherapeutic agents, surgical creation of a pericardial window and transthoracic pericardiectomy. Surgical techniques are usually effective but bear a significant morbidity and mortality especially in chronic debilitating cancer patients. So percutaneous balloon pericardial window as an alternative to surgery in these patients. METHODS: After pericardiocentesis was performed, a 0.035 inch J-tip guidewire was advanced into the pericardial space. And a pigtail catheter was advanced over the wire. A moderate amount of pericardial fluid were removed. A nd then the pigtail catheter was withdrawn and 8F sheath was inserted. A20mm diameter, 4cm long(Single balloon method) or two 10mm diameter, 4cm long balloon dilating catheter(Double balloon medium) was advanced over the wire to straddle the parietal pericardial border though the sheath. Several inflations of the balloon with a solution containing 50% radiographic contrast medium were performed until disappearance of the balloon waist. After balloon dilation, contrast medium from the pericardial space to subcutaneous tisse suggesting successful PBPWF. Single ballon method was employed in 4 patients and Dould balloon method in 2 patients. RESULT: We performed percutaneous balloon pericardial window formation in 6 patiemts with malignant pericardial effusion. We did percutaneous balloon pericardial window formation successfully in 5 patients and failed due to adhesion of parietal pericardium in 1 patient. One patient developed recurrent pericardial effusion with tamponade at a mean follow-up of 11.49.6 months(1.5-26 months). Conclusion: These results suggest that PBPWF is an alternative method less invasive than subxiphoid surgical windowing, espesially in critically ill patients with recurrent malignant pericardial effussion. It carries less risks and has more constant effect than repeated pericardiocentesis.
Cardiac Tamponade ; Catheters ; Critical Illness ; Follow-Up Studies ; Humans ; Mortality ; Pericardial Effusion* ; Pericardiectomy ; Pericardiocentesis ; Pericardium ; Rabeprazole

OBJECTIVES: This study was performed to investigate the effectiveness of the questionnaire. METHODS: Workers'health examination records, work environment record, and questionnaires of selected industries as samples were analysed using logistic regression analysis and discrimination analysis Results'Cases of bearing impairment (Dl+C) as dependent variables, and age, work duration and level of environmental noise as independent variables were selected for multiple unconditional logistic regression analysis. Odds ratio was 4.04 in hearing difficulty, 2.78 in tlnnitus and 1.08 in age. In the second analysis Noise induced hearing loss is selected as dependent variable. The OR in hearing difficulty was 3.67(95 % C.1. : 1.61 8.61), and was 1.09(95 % C.1. : 1.05-1.14) in age. Conditionnal multlple logistic regression analysis was performed. In hearing impairment as dependent variable, the OR of age was 1.02(95 % C.1. : 1.00-1.04) and other variables were not significant. However, NIHL as dependent, the OR of hearing difficulty was 4.57(95 % C.1. : 1.43-14.67). According to multiple logistic regression adopting each items of questionnaire as dependent variable, the only item of hearing difficulty showed significant difference with hearing ability. The discrimination analysis was performed with the class variable of hearing impairment, and discrimination variables of age, work duration, and environment noise level. The sensitivity of 59 %, and specificity of 88 %, and average error count of 23 % were obtained. When the numbers of items answered in questionnaire were assumed as the parameter of judgement for noise induced hearing loss (NIHL), the highest sensitivity and specificity were 33.5% and 49.0% in cases of more than two items answered. CONCLUSIONS: The development of items that is simple and discriminative mainly consisted of chronic and specific diseases related items is needed. Computerization for newly developed items might be needed to establish effective surveillance system for NIHL in the future.
Discrimination (Psychology) ; Hearing Loss* ; Hearing* ; Logistic Models ; Mass Screening* ; Noise* ; Odds Ratio ; Questionnaires* ; Sensitivity and Specificity

PURPOSE: We assessed the feasibility and efficacy of a laparoscopic approach in surgically managing various conditions of the acute abdomen. METHODS: This report presents preliminary data from our ongoing prospective study. Sixty patients underwent a diagnostic or a therapeutic laparoscopy for acute or subacute abdominal conditions between July 1997 and September 1998. RESULTS: Conditions were classified into trauma (n=8), peritonitis (n=41), and obstruction (n=11). Trauma included 5 blunt (2 small bowel perforations, 1 spleen rupture, 2 mesenteric ruptures) and 3 stab injuries. Peritonitis included 23 duodenal ulcer perforations, 10 acute cholecytitis/empyema, 3 colon perforations, 1 tuberculous peritonitis, 1 ectopic pregnancy, 1 ruptured corpus luteum, 1 appendicitis, and 1 ruptured liver abscess. Obstruction included 5 intussusceptions (4 Children, 1 adult), 2 intestinal adhesions; and 4 congenital hypertropic pyloric stenoses. Among the 54 cases of therapeutic laparoscopy, 9 cases were converted during the procedure (conversion rate: 16.7%). There were 2 intraoperative (bowel perforation) and 4 postoperative (1 subphrenic abscess, 1 incomplete adhesiolysis, 1 port site hernia, 1 port-site seroma) complications. CONCLUSION: Our preliminary data may justify further clinical study to clarify the role of laparoscopy in managing acute or subacute abdominal conditions.
Abdomen, Acute* ; Appendicitis ; Child ; Colon ; Constriction, Pathologic ; Corpus Luteum ; Duodenal Ulcer ; Female ; Hernia ; Humans ; Intussusception ; Laparoscopy* ; Liver Abscess ; Peritonitis ; Peritonitis, Tuberculous ; Pregnancy ; Pregnancy, Ectopic ; Prospective Studies ; Rupture ; Spleen ; Subphrenic Abscess

A collodion baby is born with a tough, inelastic parchment-like membrane covering the whole body surface. As the meinbrane fissures and peels, a more characteristic ichthyosiform change is evident beneath the collodion membrane. Uncommonly, normal skin is found under it. We herein present two cases af collodion baby, which were confirmed as a sporadic case of lamellar ichthyosis and a case of lamellar exfoliation of the newborn, respectively, after long-term clinical observation. It is necessary that detailed genetical and molecular biological studies should be perforrned in order to elucidate the fur:damental, molecular changes that cause these dramatic cutaneous changes.
Collodion* ; Humans ; Ichthyosis, Lamellar ; Infant, Newborn ; Membranes ; Skin