No abstract available.
Anemia, Megaloblastic* ; Humans ; Megaloblasts* ; Methotrexate*

OBJECTIVE: Here we describe a microsurgical method for decompression and the radiological findings of the extraforaminal entrapment of the L5 spinal nerve. METHODS: The authors reviewed the clinical and neurodiagnostic findings, surgical management, and outcomes in 53 patients with extraforaminal entrapment of L5 who had been successfully decompressed via a microsurgical paramedian tangential approach. A total of 28 women and 25men ranging in age from 54 to 73(mean age 65 years). All patients had uni- or bilateral leg pain due to extraforaminal entrapment of L5 in the lumbosacral spine. The mean follow-up period was 9 months (range 3-15 months). RESULTS: Pain was measured by the Numerical Rating Scale. The function of back was assessed by the Oswestry Disability Index score, and the patient satisfaction was evaluated by the North American Spine Society Outcome Questionnaire. Relief of back pain was obtained for all patients immediately after surgery. The mean Numerical Rating Scale improved from 8.2 before the surgery to 1.7 after the surgery (P<0.0001). The mean ODI score improved from 74.6 before the surgery to 15.3 after the surgery (P<0.0001). Overall, excellent and good result were achieved in 27(51%) and 23(43%) at the last follow-up examination. There was no complications related to the surgery, nor was any spinal instability was detected. The parasagittal T-1 weighted magnetic resonance images showed foraminal stenosis with the circumferential loss of the perineural fat signal at L5-1 level in 23 of 53(43%) patients. Radiological and operating finding showed narrowing of the extraforaminal tunnel that resulted from the annulus bulging in 36 patients(68%), disc protrusion or rupture in 17 patients(30%) and osteophytes of the vertebral body in 39 patients(74%). CONCLUSION: The paramedian tangential approach is a safe, effective procedure that avoids the risk of secondary spinal instability. This study showed that the major causes of the extraforaminal nerve root entrapment in the lumbosacral spine are the bulged annulus, the disc protrusion and osteophytes. The major pathognomonic cause of the extraforaminal L5 nerve entrapment was the bulged annulus fibrosus with the osteophytes.
Back Pain ; Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Leg ; Nerve Compression Syndromes ; Osteophyte ; Patient Satisfaction ; Surveys and Questionnaires ; Radiculopathy ; Rupture ; Spinal Nerves ; Spine*

No abstract available.
Child* ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Tendons*

BACKGROUND: Vascular endothelial dysfunction (VED) plays a pivotal role in the pathogenesis of atherosclerosis and is associated with insulin resistance and with visceral obesity. Therefore, in this study the predicting factor of vascular endothelial dysfunction was investigated in healthy premenopausal obese women by pulse-wave analysis (PWA) combined with provocative pharmacological testing. METHODS: Thirty three obese women (BMI> or =25), aged 20~45 y and 25 age-matched control subjects (BMI; 18.5~22.9) were examined. All women were sedentary (<1 hr/wk of physical activity), non-smoker and were excluded if they had type 2 diabetes melitus, hypertension, hyperlipidemia, cardiovascular disease, or acute inflammatory disease and were studied in folicullar phase of the cycle, within the first week after cessation of menstrual bleeding. They underwent determination of anthropometric measurements, metabolic variables, adipose tissue regional distribution, and endothelial function by performing pulse-wave analysis (PWA) combined with provocative pharmacological testing. RESULTS: Augmentation Index (AIx) fell significantly after the administration of salbutamol, which causes endothelium-dependent vasodilatation, but response was significantly reduced in obese women compared with controls (10.28 6.72% vs 17.2 6.84%, P=0.0003). The change in after Nitroglycerin, which causes endothelium-independent vasodilatation, did not differ significantly (30.86 9.67% vs 30.6 10.11%, P=0.9172). In our obese subjects, visceral adipose tissue area was independently a significant predictor of vascular endothelial dysfunction (beta= 0.1381, P=0.0038, Adj-R2=0.348). CONCLUSION: Increased abdominal adiposity is a powerful independent predictor of VED in obese healthy women. Future studies of vascular endothelial function should account for the independent effects of abdominal fat.
Abdominal Fat ; Adipose Tissue ; Adiposity ; Albuterol ; Atherosclerosis ; Cardiovascular Diseases ; Female ; Hemorrhage ; Humans ; Hyperlipidemias ; Hypertension ; Insulin Resistance ; Intra-Abdominal Fat ; Nitroglycerin ; Obesity, Abdominal ; Vasodilation

OBJECTIVE: The measurement of liver size can be used for the diagnosis of the fetal growth abnormality (FGR, macrosomia etc.). The purpose of this study was to evaluate a mathematical relationship between the fetal liver size(liver length or volume) and the gestational age in the normal pregnancies. Brief comparisons were also tried on the base of the degree of the correlation between liver length and its volume. METHODS: We collected 54 singleton pregnancies of 20 to 36weeks of gestation for measuring fetal liver length and 57 singleton pregnancies for measuring fetal liver volume. We used Combison 530 utrasonic machine(Kreztechnik AG, Zipf, Austria). RESULTS: There was significant correlation between liver size( length and volume) and gestation age. And the liver volume better correlated with gestational age than liver length(r=0.93 : r=0.78, p<0.0001, p<0.0001). CONCLUSION: Ultrasonic measurement of fetal liver size is a reliable indicator of fetal growth, especially liver volume. Therefore these data may have a potential value for the prediction of abnormal fetal growth(FGR, macrosomia).
Diagnosis ; Fetal Development ; Gestational Age* ; Liver* ; Pregnancy* ; Ultrasonics

A 45-year-old woman was admitted with the diagnosis of diabetic ketoacidosis (DKA). During the hospital course, fluctuation of blood pressure accompanying with headache and palpitation was noted. The diagnosis of pheochromocytoma was proven by elevated urinary catecholamine and its metabolite, and confirmed histologically after right adrenalectomy. Mild glucose intolerance is known to be associated with pheochromocytoma in many cases. However, acute diabetic complication such as DKA has been reported in only 4 cases, mainly in Japanese. We think this is the first case of pheochromocytoma manifested DKA in Korea, so we report this with literature review.
Adrenalectomy ; Asian Continental Ancestry Group ; Blood Pressure ; Diabetes Complications ; Diabetic Ketoacidosis* ; Diagnosis ; Female ; Glucose Intolerance ; Headache ; Humans ; Korea ; Middle Aged ; Pheochromocytoma*

Primary extracranial and extraspinal meningiomas are rare. Cases involving the orbit, skin, nasal cavity, paranasal sinuses, oral cavity and parotid gland have been reported. The histogenesis of primary extracranial meningioma is still nucertain, but it has been thought that this tumor originates from arachnoid cell rests in displaced during embryonal development. The authors observed a case of primary meningioma of the nasal cavity and paranasal sinuses occurring in a thirty-eight year old male patient in Feb. 1989. He suffered from bulging in the medio-superior portion of left orbit for 15 years, and left nasal obstruction and headache for 5 years, A head CT scan revealed numberous polypoid masses filling the left frontal sinus left ethmoidal sinus, left maxillary sinus and left nasal cavity. During the operation, a connection to the dura was not found. Microscopically, there were discrete lobules or netst of meningothelial cells, beneath the nasal mucosa. They showed an occasional whorling pattern and psammoma bodies. Therefore, this case was diagnosed as primary meningioma, meningotheliomatous type involving the left nasal cavity and paranasal sinuses.
Male ; Humans ; Meningioma

The purpose of this study is to present an actual example for procedures for developing a PBL package based on philosophical backgrounds derived from Problem-based learning. To perform a systemic study on the operations of an intergrated curricula under multi-disciplines, a research team made up of several professors with different academic backgrounds was formed. Among the four situations for the patients with perception-adjustment disorder, especially a procedure for the development of PBL package which can be used in the emergency room situation has been proposed. The little(2000)'s PBL package model has been applied for this study. Tha package includes course objectives, learning objectives, concept map, situation scenario, tutor guide, and evaluation method. It is believed that learning objectives achievement procedures designed as a part of a problem-based learning package development procedures for the nursing of patients with perception-adjustment can be achieved at the same level as the learning objectives for the science of nursing founded by the Korean Nurses Association.
Curriculum ; Emergency Service, Hospital ; Humans ; Learning ; Nursing ; Problem-Based Learning*

Although spontaneous bacterial peritonitis is a frequent complication in the childhood nephrotic syndrome, it is very rare in adults with nephrotic syndrome. It frequently develops when the patients are either in relapse or receiving steroid therapy at the time peritonitis is diagnosed. We report an unusual case of a spontaneous bacterial peritonitis as the presenting feature in a 15-year-old male patient with nephrotic syndrome. He presented with diffuse abdominal pain and distension for 15 days. Abdominal paracentesis revealed the diagnostic laboratory findings of peritonitis, and the bacterial culture of the ascites showed a mixed growth of Escherichia coli and Pseudomonas aeruzinosa. His serum albu- min level was 1.6gldL and the amount of 24 hours proteinuria was 21.0g/day. Although he was treated with adequate antibiotics for 3 weeks, the peritonitis was more aggravated. We decided to insert a catheter into the peritoneal cavity for continuous drainage of the intractable ascites. Two weeks after drainage, the peritonitis improved as the peritonitis subsided, the proteinuria disappeared completely without a steroid therapy. Six months after spontaneous remission, the proteinuria have recurred, and the kidney biopsy then showed focal segmental glomerulorsclerosis.
Abdominal Pain ; Adolescent ; Adult ; Anti-Bacterial Agents ; Ascites ; Biopsy ; Catheters ; Drainage ; Escherichia coli ; Humans ; Kidney ; Male ; Nephrotic Syndrome* ; Paracentesis ; Peritoneal Cavity ; Peritonitis* ; Proteinuria ; Pseudomonas ; Recurrence ; Remission, Spontaneous

Iodinated contrast-induced acute renal failure is estimated to occur in 0.15 to 2% of all patients undergoing contrast imaging studies. Incidence is higher in patients with renal insufficiency, diabetes mellitus, dehydration, multiple myeloma, congestive heart failure, advanced age. We here report successful vascular interventional procedure by using gadopentetate dimeglumine(Gd-DTPA) as a contrast agent in a patient with chronic renal insufficiency and right superficial femoral artery stenosis. The patient had a history of iodinated contrast-induced acute renal failure. Gd-DTPA(0.17mmoVkg) diluted 1: 1 with 0.9% norrnal saline was used as contrast agent for the interventional procedure. Percutaneous transluminal angioplasty was successfully performed and there was no evidence of contrast material- induced acute renal failure after the procedure. Gd- DTPA is an alternative contrast agent for patients with chronic renal insufficiency.
Acute Kidney Injury ; Angioplasty* ; Constriction, Pathologic ; Dehydration ; Diabetes Mellitus ; Femoral Artery ; Gadolinium DTPA* ; Heart Failure ; Humans ; Incidence ; Multiple Myeloma ; Pentetic Acid ; Renal Insufficiency ; Renal Insufficiency, Chronic*