The purpose of this study is to obtain information of simple and effective methods for the pos-tlaminectomy pain control, and to reduce the consumption of supplemental analgesic drugs and side effects. In a double blind study, 75 patients scheduled for lumbar laminectomy were randomly divided into five groups according to the epidurally instilled drugs, such as, morphine 2mg,Group M2; morphine 3mg,Group M3; methylprednisolone 80 mg, Group D; morphine 2mg plus methylprednisolone 80mg, Group M2D; normal saline as a control Group C. All of the drugs were prepared in 2ml normal saline solution. The following items were recorded in the postoperative period: Pain score using visual analogue scale(VAS) at 6, 12, 24, 48 hours after the operation; the episode of supplemental systemic analgesic; the need for postoperative urethral catheterization; any evidence of respiratory depression; pruritus; nausea and vomiting. The results were as follows. I) VAS score were not significantly different between control group and group M2(p>0.05), but usually less in the group M2 and supplemental analgesic consumption was significantly less in the group M2 than in the control group. 2) VAS score were less in the group M3 than in the group M2 and significantly less than in the control group at 6 hour after operation and also supplemental analgesic consumption was significantly less in the group M3. 3) Group D revealed similar VAS score with group M2 at 6 and 12 hour but significantly lower VAS score at 24 and 48 hour after operation than group M2. 4) VAS score were the most significantly less in the group M2D at 6,12,24,48 hour after operation than in the control group and supplemental analgesic consumption was significantly less in the group M2D. 5) Side effects were not significantly different among all groups. These findings suggest that epidurally instilled morphine 3mg, or methylprednisolone 80mg or both before the closure of the laminectomy wound is effective, simple and safe method for the post-laminectomy pain control and reducing supplemental intramuscular analgesics without specific complication.
Analgesics ; Double-Blind Method ; Humans ; Laminectomy* ; Methylprednisolone* ; Morphine* ; Nausea ; Pain, Postoperative* ; Postoperative Period ; Pruritus ; Respiratory Insufficiency ; Sodium Chloride ; Urinary Catheterization ; Urinary Catheters ; Vomiting ; Wounds and Injuries

A case of esophagopleural fistula after pleuropneumonectomy is reported. A 59 years old male underwent right pleuropneumonectomy due to tuberculous empyema. The postoperative small esophagopleural fistula was confirmed by esophagogram and was initially managed by a conservative treatment. There was a persistent fistula on follow up esophagogram, therefore we planned the next treatment modality for obstruction of the fistula. For poor general conditions and arrhythmia, an esophageal stent was applied as a non-surgical method. At first, a covered-form stent was inserted, but it migrated to the stomach after 3 months. By using an uncovered-form stent, a complete obstruction of the esophagopleural fistula was achieved.
Arrhythmias, Cardiac ; Empyema, Tuberculous ; Esophageal Fistula ; Fistula* ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pneumonectomy ; Stents* ; Stomach

Partial anomalous pulmonary venous connection is frequently found in any ASD(atrial septal defect) patients. These patients are usually symptomatic, therefore, easily diagnosed as just simple ASD. We experienced a case of a 37-year-old female patient with ASD in which the left upper pulmonary vein was connected to SVC by the left inominate vein. The patient was diagnosed as simple ASD previously. During cardiac catheterization, we found a meaningful oxygen saturation step up between the SVC and its upper portion. Angiogram confirmed PAPVC. The surgical correction of anastomosis of PAPVC with left atrial appendage and direct closure of ASD were done. The patient was discharged 15 days later.
Adult ; Atrial Appendage ; Cardiac Catheterization ; Cardiac Catheters ; Female ; Heart Septal Defects, Atrial* ; Humans ; Oxygen ; Pulmonary Veins ; Veins

Spinal fixation using pedicle screws has recently been the focus of increased attention, but the adequate size of pedicle screw and maximum percentage fill as related to the pedicle diameter and are not well known. The objects of this study were to determine the ideal ratio among pedicle, drill and screw diameter, and to determine the maximum percentage fill of the screw without significant decrease of pull-out strength. The materials used for the experiments were 376 thoracic pedicles obtained from the 38 young pigs, and the diameters of pedicles ranged from 3.0 to 8.5mm. After 40% to 100% drilling as compared to pedicle diameter, screws were inserted carefully, and measurements were taken of the outer pedicle changes and pull-out strengths, and adequate drill and screw sizes as related to the diameters of given pedicles were determined. It was found that pull-out strength was the strongest after 60% drill, and the larger the drill diameter, the smaller the holding power, and the larger the screw diameter, the greater the holding power. Maximum pull-out strength was seen at 80-90% fill with 60% drill. After sequentially drilling each pedicle with increasingly larger drill bits, larger screws could be inserted with pedicle changes such as expansion, cutout, split fracture, and comminuted fracture. after larger drilling up to 100%, pedicle screws with diameters smaller than 115% of measured pedicle diameters could be safly inserted without fracture and significant decrease of pull-out strength. It is concluded that effective percentages of drill and screw diameters to the pedicle diameter are 60% and 80-90% respectively, and pedicle screw up to 115% of measured pedicle diameter can be safely inserted into pedicle without significant decrease of pull-out strength. It is thought that fresh pedicle has elasticity and larger screw can be inserted to the pedicle with strong holding after larger drilling.
Elasticity ; Fractures, Comminuted ; Pedicle Screws ; Swine

No abstract available.
Hemangioma* ; Polyhydramnios*

Since Wands et al. reported for the first time in 1975 the reactivation of the hepatitis B virus in hematologic disease patients who had been receiving chemotherapy, the efficacy of chemotherapy and immunosuppressants has improved. As a result, the frequency of the reactivation of hepatitis B is increasing. Reported herein is a case of a non-Hodgkin lymphoma patient in her 70s who was suspected to have had HBsAg negative/anti-HBs negative occult HBV infection. The patient experienced fulminant hepatitis caused by the reactivation of hepatitis B, and died three months after the R-CHOP regimen was completed. In the HBsAg negative plus HBV DNA-negative case, there were few instances of viral activation of HBV. In this case, antiviral therapy was needed when the patient was confirmed to have become HBV DNA positive through regular monitoring, but its necessity is often overlooked, unlike the preemptive antiviral treatment in the HBsAg positive cases.
DNA ; Drug Therapy* ; Hematologic Diseases ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Virus Activation ; Rituximab

PURPOSE: The current TNM staging system for papillary thyroid cancer (PTC), which is based on tumor diameter, may not precisely reflect the true tumor burden. Therefore, we investigated whether preoperative tumor volume might more accurately reflect tumor burden and predict prognosis in patients with T1N0 PTC than preoperative tumor diameter. MATERIALS AND METHODS: We retrospectively reviewed data from 1,659 patients with T1N0 PTC, and after exclusion, a total of 1,081 patients were ultimately included. Tumor volume (V) was calculated for all patients using preoperative ultrasonography, and patients were grouped according to tumor diameter (T1a vs. T1b) and tumor volume (V1a vs. V1b). The recurrence-free survival (RFS) rates were then compared for these groups. RESULTS: The mean follow-up time was 66.12±28.75 months, and 97.2% of the cohort experienced RFS. The optimal volume cut-off was defined as 0.545 cm³. There were no differences in RFS rates between T1a/T1b groups (all ages) and V1a/V1b groups (< 45 years of age). However, ≥ 45-year-old patients in the V1b group had a significantly poorer RFS rate than those in the V1a group. These results were confirmed by multivariate analysis. CONCLUSION: Our results indicate that preoperative tumor volume may be more useful for predicting prognosis than tumor diameter in ≥ 45-year-old patients with T1N0 PTC.
Cohort Studies ; Follow-Up Studies ; Humans ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Tumor Burden* ; Ultrasonography

PURPOSE: We evaluated outcomes of treatment in medial condyle fracture of the distal humerus in children. MATERIALS AND METHODS: Seven patients (4 females, 3 males) who were treated at the Pusan National University Hospital and followed-up until skeletal maturity after treatment were included. The average age at the time of fracture was 4.6 years (range, 2 to 10 years). Treatment was performed from 1 day to 6 months after the fracture: 4 patients underwent a surgical treatment for 17 days, 2 months, 2 months and 6 months after fracture, respectively. All fractures were Milch type 1. Five patients had Kilfoyle type 3, and two patients had type 2 fractures. Final outcomes were evaluated by the Mayo elbow performance score and carrying angle. RESULTS: There were 3 excellent, 3 good and 1 fair result at the final follow-up. There was no elbow pain in any of the patients. One of the four patients who underwent a late surgical treatment received corrective osteotomy due to cubitus varus. All four patients had a limitation of elbow motion. The other three patients who had accurate diagnosis and treatment had a full range of motion. CONCLUSION: Diagnosis of medial condyle fracture of the distal humerus based on plain radiograph is difficult in children due to its cartilaginous structures. When a patient shows pain, tenderness and swelling on the medial side of the elbow, an additional examination with magnetic resonance imaging may be required even if no fracture line is found in the radiograph. Accurate diagnosis and early treatment is important for good results.
Child* ; Elbow ; Female ; Follow-Up Studies ; Humans ; Humerus* ; Lifting ; Magnetic Resonance Imaging ; Osteotomy

Bartter syndrome is a renal tubular defect in electrolyte transport characterized by hypokalemia, metabolic alkalosis, hyperreninemia, hyperaldosteronism, normal blood pressure, and other clinical symptoms. As a clinical and genetical heterogeneous disorder, this syndrome can be classified into two clinical variants, antenatal Bartter syndrome and classic Bartter syndrome according to the onset age. Nephrocalcinosis is common in antenatal Bartter syndrome, but is rare in classic Bartter syndrome. It can also be classified into five genetic subtypes by the underlying mutant gene, all of which are expressed in the tubular epithelial cells of the thick ascending limb of the loop of Henle. Patients with Bartter syndrome type 1, 2 and 4 present at a younger age than classic Bartter syndrome type 3. We have experienced a case of Bartter syndrome with nephrocalcinosis in a 42-year-old woman diagnosed by biochemical and radiologic studies. We had successful response with potassium chloride and spironolactone.
Adult* ; Age of Onset ; Alkalosis ; Bartter Syndrome* ; Blood Pressure ; Epithelial Cells ; Extremities ; Female ; Humans ; Hyperaldosteronism ; Hypokalemia ; Loop of Henle ; Nephrocalcinosis* ; Potassium Chloride ; Spironolactone

A cosmetic incision for minimal invasive cardiac surgery is described. Through a small submammary skin incision combined with partial low sternotomy some kinds of cardiac operations are possible without extra-difficulty but with excellent cosmetic effect, No special instruments nor techniques are required. By this method routine cannulations for cardiopulmonary bypass as well as aortic cross clamping bicaval snaring and venting of cardiac chambers are possible, We performed 5 cases of open heart surgeries using this approach which includes two cases of atrial septal defect closure one case of ventricular septal defect closure one case of pulmonic valvotomy and one case of mitral valve replacement.
Cardiopulmonary Bypass ; Catheterization ; Constriction ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Mitral Valve ; Skin ; SNARE Proteins ; Sternotomy ; Thoracic Surgery*