Anomalous origin of coronary artery is a relatively rare disordes which is often associated with hypertension and valvular geart desease and in some instances lead to sudden death.Among 1,100 patients who underwent diagnosis coronary angiography at Yonsei Uiversity Medical Center, severance hospital, we found 2 patients with anomalous aortic origin of coronary arteries.In one patient, single coronary artery originated from ascending aorta 1.5cm above the left aortic sinus and in another patient, the origin of the orifice of the right coronary artery separately from the left aortic sinus.
Aorta ; Coronary Angiography ; Coronary Vessels* ; Diagnosis ; Humans ; Hypertension ; Sinus of Valsalva

No abstract available.
Thyroid Gland* ; Thyroid Nodule*

BACKGROUND: Morphine for the intravenous patient controlled analgesia (IV-PCA) provides effective postoperative pain control, but it has side effects such as itching, nausea and vomiting. Meanwhile, butorphanol, a synthetic potent agonist-antagonist narcotic with low incidence of adverse side effects and minimal addiction, produce adequate analgesia for postoperative pain. The purpose of this study was to compare the suitability of butorphanol combining with or without morphine with that of morphine in terms of relieving postoperative pain and incidence of side effects. METHODS: Sixty ASA physical status I or II female patients undergoing total abdominal hysterectomy were randomly allocated into one of three groups according to type of drug used (n=20 for each group). The groups were divided to group M (morphine 100 mg), group M B (morphine 50 mg+butorphanol 10 mg) and group B (butorphanol 20 mg). Drugs for each group mixed with 90 ml of normal saline (total amount: 100 ml) for infusion. Loading dose, PCA dose, lockout interval, mode of infusion was 0.05 ml/kg, 0.02 ml/kg, 8 minute, and PCA only, respectively. In each group, visual analog scale (VAS), pain score, sedation score, degree of satisfaction, total amount of drug used, history of attempt/injetion and incidence of side effects were checked. RESULTS: There were no significant differences in analgesic effects and degree of satisfaction among three groups, but incidence of side effects (especially pruritis) were less in group M+B and B compared with group M (p<0.05). CONCLUSIONS: Butorphanol showed comparable postoperative pain relief and marked less side effects compared with morphine. Butorphanol was considered as a useful drug for postoperative pain relief using IV-PCA.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics ; Butorphanol* ; Female ; Humans ; Hysterectomy ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Pruritus ; Visual Analog Scale ; Vomiting

Renal allograft rupture is an uncommon but life-threatening complication. The most common cause of the spontaneous rupture of the renal graft is acute rejection but other causes including acute tubular necrosis, renal vein thrombosis and urinary tract obstruction have been reported. Here we report a case of spontaneous rupture of renal graft caused by arteriovenous fistula in the patient being managed by plasmapheresis due to hemolytic uremic syndrome developed in the renal graft 3 years late after transplantation.
Allografts* ; Arteriovenous Fistula* ; Hemolytic-Uremic Syndrome ; Humans ; Necrosis ; Plasmapheresis ; Renal Veins ; Rupture* ; Rupture, Spontaneous ; Thrombosis ; Transplants ; Urinary Tract

PURPOSE: At present renal transplantation, the most frequent surgical complications may be occurred on ureterovesical anastomosis site (i.e. leakage, stenosis and reflux). The results of ureteroureterostomy using recipient's own ureter in these complications, will be presented. METHODS: From 1983 to 2004, 410 renal transplantations were performed at our institution. In all cases, external ureteroneocystostomy technique was used. Complications involving the anastomosis site occurred in 23 cases (5.4%), with 15 stenosis (3.4%) and 8 cases of leakage (1.9%). All of them were living donor cases. The mean recipient's age was 47.2 years. Corrective surgery were performed as soon as complication confirmed radiologically (ultrasonography), 16.1+/-22.3 days after transplantaion for leakage and 86.8+/-87.6 days for stenosis. If the length of graft ureter was long enough, ureteroneocys tostomy was performed again and if not, end to side ureteroureterostomy was performed in 12 cases, end to end ureteroureterostomy in 1 case and end to end pyeloureterostomy in one case. A double J ureteral stent was used in every case. RESULTS: There were one graft loss due to stone formation nephropathy, one mortality due to herpetic infection with functioning graft and one failure of recovery of graft function because of too late patients visit. Others had good graft function until last follow up with 3.8+/-2.5years of mean follow-up without further ureteral complications. CONCLUSION: Ureteroureterostomy is a safe and permanent treatment for complications of ureterovesical anastomosis site and gives good results.
Constriction, Pathologic ; Follow-Up Studies ; Humans ; Kidney Transplantation* ; Living Donors ; Mortality ; Stents ; Transplants ; Ureter

A basal cell carcinoma developed in the forehead of a 57-year-old man at the scar site from a blunt trauma that happened 10 months previously. The patient had never been noted to have premalignant or other malignant skin lesions. The significance of injury in the etiology of basal cell carcinoma is discussed.
Carcinoma, Basal Cell* ; Cicatrix* ; Forehead ; Humans ; Middle Aged ; Skin

Sex steroid hormones play a major role in bone homeostasis. Therefore, the use of sex hormones or drugs may increase the risk of osteonecrosis of the jaw (ONJ), a complication caused by damaged bone homeostasis. However, few are known the impact of medications changing sex hormone levels on ONJ. The pathophysiology of ONJ is not clearly understood and many hypotheses exist: cessation of bone remodeling caused by its anti-resorptive effect on osteoclasts; compromised microcirculation due to medication affecting angiogenesis, including bisphosphonate; and impairment of defense mechanism toward local infection.The use of high-dose intravenous bisphosphonate in cancer patients is associated with a high prevalence of ONJ. Exogenous estrogen or androgen replacement was reported to be associated with ONJ. Polycystic ovarian syndrome (PCOS) patients demonstrate an androgen excess status, and androgen overproduction serves as a protective factor in the bone mineral density of young women. To date, there are no reports of ONJ occurrence due to androgen overproduction. In contrast, few reports on the occurrence of ONJ due to estrogen deficiency induced by drugs, such as selective estrogen receptor modulator (SERM), aromatase inhibitors, and gonadotropin-releasing hormone (GnRH) agonists, are available.Thus, the role of sex steroids in the development of ONJ is not known. Further studies are required to demonstrate the exact role of sex steroids in bone homeostasis and ONJ progression. In this review, we will discuss the relationship between medication associated with sex steroids and ONJ.

STUDY DESIGN: The preoperative and postoperative lateral radiograms and clinical results were analyzed in 22 cases of lumbar spinal stenosis with osteoporosis treated by posterior decompression and posterior lumbar interbody fusion. OBJECTIVES: To assess the efficiency of the cage-instrumented posterior lumbar interbody fusion in lumbar spinal stenosis with osteoporosis. SUMMARY OF LITERATURE REVIEW: Problems in surgical treatment of osteoporotic spinal stenosis were early screw loosening and early reversal to the original deformity because of insufficient mechanical stability in the bone-screw interface, and special strategy is essential for transpedicle screwing to sustain axial and screw cut-up load applied by flexion-extension motion in vivo. MATERIALS AND METHODS: We reviewed 22 cases of lumbar spinal stenosis with osteoporosis(Jikei grade I, II/III) from June 1996 to July 1998 with an average follow up period of 1.4 years. Inclusion criteria was combined segmental instability, deformity, spondylolisthesis and herniated nucleus pulposus with significant disc space narrowing. We asssessed the radiographic results of sagittal angle correction(SAC) of the instrumented segment and disc height restoration(DHR) on the preoperative, postoperative and last follow up lumbar lateral views, and clinical results according to the Kirkaldy-Willis criteria. RESULTS: Postoperative mean SAC gain was 10degree(p<0.05) and mean SAC loss at last follow up was 1.1degree(p>0.05). Postoperative mean DHR gain was 21.3%(p<0.05) and mean SAC loss at last follow up was 3.9%(p>0.05). The clinical result was analyzed as 2 excellent(9.1%), 16 good(72.7%), 4 fair(18.2%) and no poor. There were 2 intraoperative complications of a dural tear and a nerve root injury and 2 postoperative complications of a transient radiculopathy and a pseudoarthrosis. CONCLUSIONS: Cage-instrumented posterior lumbar interbody fusion can be an option for the lumbar spinal stenosis with osteoporosis requiring instrumentation because of instability, deformity or postdiscectomy anterior column deficiency.
Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Intraoperative Complications ; Osteoporosis* ; Postoperative Complications ; Pseudarthrosis ; Radiculopathy ; Spinal Stenosis* ; Spondylolisthesis ; Tears