No abstract available.
Breast Neoplasms* ; Tamoxifen*

Notch stenosis had been thought to be related with anterior cruciate ligament (ACL) injury. The purpose of this study is to evaluate the possible relationship between notch stenosis and ACL injury. We measured the notch seen on the axial section in MRI at popliteal groove. We have retrospectively analyzed 116 cases of knee MRI. All cases were divided into three groups ; Group I were fifty six normal knee. Group II were thirty knee with contact ACL injuries. Group III were thirty knee with non contact ACL injuries. The result were as follows; 1. Statistically significant difference was found in the notch width index (NWI) between group I and group III but no significant differences was found in the NWI between group I and group II. 2. Statistically significant correlation to non-contact ACL injuries was found in the NWI at both anterior and posterior outlet of the notch. 3. An unique shape of the notch was found in the majority of group III.There seemed to be an obvious relationship between notch stenosis and non-contact ACL injuries.
Anterior Cruciate Ligament* ; Constriction, Pathologic ; Knee ; Magnetic Resonance Imaging* ; Retrospective Studies

Extramammary Pagets disease(EMPD) of the vulva is an uncommon neoplasm which accounting for 2.5% of all vulvar malignancies and 0.02% of all female cancer. Several hundred cases have been reported worldwide since the first description by sir James Paget in 1874, It generally affects postrnenopausal age poup and presents high rate of recurrence but the precise incidence remines unclear, Although Paget's disease of the breast and the vulva are histologically similar, their histogenesis and biological behavior are considered to be significantly different and EMPD has gcnerally perceived rnore benign compared to that of the breast. Four histologic forms of vulvar EMPD have been recognized and treated vulvar EMPD in according to the 4 histologic classification. The high rate of recurtence disease remains a challenge for optimal management. Recently we experienced a case of Paget's disease of the vulva, diagnosed as an intraepithelial Pagets disease preoperatively and underwent radical vulvectomy and superiomedial thigh(SMT) flap, and present with a brief review of literature.
Breast ; Classification ; Female ; Humans ; Incidence ; Paget's Disease, Mammary ; Recurrence ; Vulva*

No abstract available.
Melanosis* ; Tranexamic Acid*

OBJECTIVE: With the increasing popularity of pedicle screw fixation devices for several indications, the safety and reliability of screw insertion in the small pedicle has become a major issue. Many studies have investigated the accuracy of screw placement after pedicle screw fixation using various method. The reported displacement rates have been very different. The purpose of the study is to investigate the proper placement of pedicle screw insertion in the lumbar spine on 26 consecutive patients. METHODS: Between September and December 2003, 26 consecutive patients (16women and 10men) were analyzed after transpedicular screw fixation of the lumbar and lumbosacral spine. After pedicle screw fixation in this study, 2-mm slices of CT scan were performed in all patients to detect caudal and cranial deviation of screw and medial and lateral deviation. Pedcile screw placement related complication was evaluted clinically. RESULTS: A total of 144 inserted pedicle were analyzed in 26patients, and 58pedicle screws (40.3%) were detected to be improper placement. There were 14level (9.0%) of caudal or cranial deviation and 44level (30.6%) of medial or lateral deviation to the pedicle. Extra-pedicle placement was found on 4levels (2.7%) with only 1case of neurologic injury. CONCLUSION: Proper screw placement, though complication rate is low, is important not only for clinical symptom but also for biomechanics. Further study for screw placement related biomechanical changes is needed.
Humans ; Spine ; Tomography, X-Ray Computed

OBJECTIVE: Lumbar lordotic curve on L4 to S1 level is important in maintaining spinal sagittal alignment. Although there has been no definite report in lordotic value, loss of lumbar lordotic curve may lead to pathologic change especially in degenerative lumbar disease. This study examines the changes of lumbar lordotic curve after posterior lumbar interbody fusion with wedge shape cage. METHODS: We studied 45patients who had undergone posterior lumbar interbody fusion with wedge shape cage and screw fixation due to degenerative lumbar disease. Preoperative and postoperative lateral radiographs were taken and one independent observer measured the change of lordotic curve and height of intervertebral space where cages were placed. Segmental lordotic curve angle was measured by Cobb method. Height of intervertebral space was measured by averaging the sum of anterior, posterior, and midpoint interbody distance. Clinical outcome was assessed on Prolo scale at 1month of postoperative period. RESULTS: Nineteen paired wedge shape cages were placed on L4-5 level and 6 paired same cages were inserted on L5-S1 level. Among them, 18patients showed increased segmental lordotic curve angle. Mean increased segmental lordotic curve angle after placing the wedge shape cages was 1.96? Mean increased disc height was 3.21mm. No cases showed retropulsion of cage. The clinical success rate on Prolo's scale was 92.0%. CONCLUSION: Posterior lumbar interbody fusion with wedge shape cage provides increased lordotic curve, increased height of intervertebral space, and satisfactory clinical outcome in a short-term period.
Postoperative Period

The reliability and validity of the Cognitive Impairment Diagnosing Instrument (CIDI) were studied in 67 nursing home elderly subjects and 251 elderly psychiatric patients. Its possible highest score is 77 and covers 10 subscales: short-term memory, long-term memory, concentration/calculation, abstract thinking, judgement, memory registration, higher cortical functions, orientation in time, orientation in place and object naming. Test-retest correlations were between 0.827 and 0.990 for the subscale scores and 0.984 for the total score. Inter-tester kappas for each item ranged from 0.200 to 1.000 with a mean of 0.698. Concordance rates were between 50.0 and 100.0% with a mean of 87.2%. Cronbach's alphas for the items of the individual subscales ranged from 0.702 to 0.915. Inter-subscale and subscale-total correlations ranged from 0.503 to 0.820 with a mean of 0.684 and from 0.721 to 0.883, respectively. Cronbach's alpha of the subscales was 0.934. Sensitivity and specificity were 93.3% and 93.8% at the cut-off point of 57.0/57.5 for dementia. Subscale and total scores were significantly different between the demented and non-demented. The total CIDI score was significantly correlated with scores of the Blessed Dementia Rating Scale and the Korean version of the Mini-Mental State Examination.
Aged ; Aged, 80 and over ; Cognition Disorders/*diagnosis ; Female ; Human ; Male ; Middle Age ; Sensitivity and Specificity ; Support, Non-U.S. Gov't

BACKGROUND: The aim of this study was to clarify to what extent bacterial meningitis could be distinguished from aseptic or tuberculous meningitis through C-reactive protein (CRP) in adults. METHODS: We retrospectively analyzed the medical records of 91 patients aged 15~81 years who had been hospitalized for acute meningitis and underwent lumbar puncture due to suspected central nervous system infection. RESULTS: We included 50 patients with aseptic meningitis, 23 patients with acute bacterial meningitis, and 18 patients with tuberculous meningitis. Blood CRP was higher in bacterial meningitis. None of the patients with bacterial meningitis had a CRP value of under 20 mg/dl. The CRP values were under 20 mg/dl in 92% of the patients with aseptic meningitis and in 73% of those with tuberculous meningitis. Taking a CRP level of above 20 mg/dl as a positive discriminatory factor for bacterial meningitis, the sensitivity and specificity were 1.0, 0.88. To better predict whether a patient has bacterial or nonbacterial meningitis, we developed a canonical discriminant function equation using CRP and CSF parameter, and finally concluded that blood CRP was a good predictive indicator that differentiated bacterial meningitis from aseptic or tuberculous meningitis at admission. CONCLUSIONS: The CRP measurement, is easily performed and inexpensive. We believe it is worth analyzing CRP whenever meningitis is suspected, it can also limit the unnecessary use of antibiotics.
Adult* ; Anti-Bacterial Agents ; C-Reactive Protein* ; Central Nervous System Infections ; Cerebrospinal Fluid ; Diagnosis, Differential* ; Discriminant Analysis ; Humans ; Medical Records ; Meningitis* ; Meningitis, Aseptic ; Meningitis, Bacterial ; Retrospective Studies ; Sensitivity and Specificity ; Spinal Puncture ; Tuberculosis, Meningeal

BACKGROUND AND OBJECTIVES: Recently, the result of total correction in tetralogy of Fallot(TOF) is improved dramatically. But, residual anatomical changes of right ventricular outflow tract(RVOT) and pulmonary artery junctional stenosis result in bad prognosis. Therefore we sought to analyze risk factors for pulmonary artery junctional stenosis after correction of TOF. METHODS: From 1991 to 1998, 146 patients underwent the follow-up catheterizations after total correction of TOF in our institution and were analysed risk factors for pulmonary artery junctional stenosis. Of this patients group [age on operation 20.119.8 months, follow-up duration after operation 13.95.0 months, male(64%)], 20 cases(13.7%) had a PDA and 26 cases(17.8%) had a systemic-to-pulmonary shunt operation before total correction of TOF. RESULTS: 1) Residual PS is correlated significantly with post-operative RVP/LVP(r=.776, p<0.01) and post-operative RVEDP(r=.196, p<0.05). 2) Post-operative RVP/LVP and residual PS increased significantly in grade II of residual PI than grade III~IV. 3) The left pulmonary artery junctional stenosis(LPAJS) was observed in 31 cases, this group decreased significantly in pre-operative LPA diameter(p<0.01), increased in post-operative RVP/LVP(p<0.01), and increased in post-operative RPA diameter(p<0.01), decreased in post-operative LPA diameter(p<0.01) and was more severe in post-operative PI(p<0.01) than the other group respectively. 4) Of the patients group which went patch enlargement of RVOT to LPA junction, the pressure gradient on LPA junction increased significantly in PDA and false aneurysmal change. 5) Factors significantly associated with pulmonary artery junctional stenosis were patch enlargement of RVOT to LPA junction, aneurysmal change of RVOT, PDA, systemic-to-pulmonary shunt and pre-operative LPAJS. 6) LPAJS(P, mmHg) =5.43 +16.24*[false aneurysmal change of RVOT] +14.13*[RVOT patch enlargement to LPA] +16.89*PDA. CONCLUSION: Several factors significantly associated with pulmonary artery junctional stenosis influenced each other. And the LPAJS led to secondary changes (volume overload of RV, increasing diameter of RPA, et. al) therefore more active diagnosis and treatment after total correction is recommended.
Aneurysm ; Aneurysm, False ; Catheterization ; Catheters ; Constriction, Pathologic* ; Diagnosis ; Follow-Up Studies ; Humans ; Prognosis ; Pulmonary Artery* ; Risk Factors* ; Tetralogy of Fallot*

In the rat hippocampal formation, the time-course and dose-response of the expression of enkephalin and dynorphin gene were examined after kainate (KA) treatment with in situ hybridization histochemistry. The KA induced enkephalin and dynorphin mRNA expression in hippocampus occurred mainly in the dentate gyrus. The enkephalin mRNA expression appeared at 3hour after KA injection, increased dramatically at 6hour, and then decreses. At 24hour after KA injection, the expression of enkephalin mRNA disappeared. The dynorphin mRNA expression appeared at once after injection and increased dramatically at 3hour. Unexpectedly at 6hour after injection, the expression was decreased, and then increased less than the 3hour expression. The increased pattern persisted to 24hour after injection. Unexpected result was also encounted in the experiment of KA dose-response of enkephalin mRNA and dynorphin mRNA. In the hippocampal formation, in contrast with other areas, low dosage (8mg/kg) of KA induced more significant expression of both genes than high dosage (16mg/kg) of KA.
Animals ; Dentate Gyrus ; Dynorphins ; Enkephalins ; Gene Expression* ; Hippocampus* ; In Situ Hybridization ; Kainic Acid ; Opioid Peptides* ; Rats* ; RNA, Messenger ; Seizures*