A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.
Acinetobacter baumannii ; Bronchial Fistula ; Carbon Dioxide* ; Carbon* ; Chest Tubes ; Empyema* ; Fistula ; Humans ; Hydropneumothorax ; Hypercapnia ; Lung ; Lung Neoplasms ; Respiration, Artificial ; Respiratory Insufficiency ; Thoracotomy

No abstract available.
Rupture* ; Subclavian Artery*

STUDY DESIGN: We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication OBJECTIVES: The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. SUMMARY OF LITERATURE REVIEW: Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. MATERIALS AND METHODS: Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination, postmyelography CT and MRI. RESULTS: Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. CONCLUSION: The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.
Adipose Tissue ; Back Pain ; Cauda Equina ; Diagnosis ; Epidural Space ; Humans ; Laminectomy ; Lipomatosis* ; Low Back Pain ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Physical Examination ; Radiculopathy ; Spinal Canal ; Spinal Cord ; Spinal Stenosis ; Spine

No abstract available.
Cartilage* ; Ear*

Serial neurosonographic examinations are routinely performed at frequent intervals during nursery course of all preterm infants of very low-birth-weight who are admitted to the intensive care nursery of Presbyterian Medical Center from November 1, 1990 to July 30, 1992. After discharge, the following survivors who had received periodic, serial scanning by meas of cranial ultrasonography were longitudinally observed in an interdisciplinary neurodevelopmental follow-up program to a mean corrected age of 13 months. Neurodevelopmental outcome was assessed by means of Vojta's postural reaction and other neurological examinations. The results are as follows: 1) The incidence of PV-IVH in the study was 79%. 2) According to Papile's grading system of PV-IVH, gradel was 20%, gradell was 46%, gradelll was 19%, and grade IV was 13%. 3) The risk factors associated with PV-IVH were birth weight, gestational age, apgar score, ventilator care, RDS, and sepsis. 4) The mortality of PV-IVH was 20% for gradel, 19% for gradell, 44% for gradelll, and 67% for grade lV. 5) According to relationship between PV-IVH and neurodevelopmental outcome, in two of the four subjects with grade lll PV-IVH, moderate/severe CCD was developed. 6) According to relationship between PVE with cysts and nuerodevelopmental outcome, moderate/severe PVE with periventricular cysts larger than 3mm in diameter was associated with development of severe CCD.
Apgar Score ; Birth Weight ; Follow-Up Studies ; Gestational Age ; Hemorrhage* ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature* ; Critical Care ; Mortality ; Neurologic Examination ; Nurseries ; Protestantism ; Risk Factors ; Sepsis ; Survivors ; Ultrasonography ; Ventilators, Mechanical

STATEMENT OF PROBLEM: There are two methods of color choice for the esthetic restoration. One is visual shade matching which draws a comparison between shade guide and teeth in dentist's own eye and the other is using a digital shade analysis system recently introduced. Although the visual shade matching has a lot of problems, decision of color by this visual shade matching and the ways of expression for the decided color are still applicable to clinical dentistry. PURPOSE: This study is designed to investigate shade guides used in the dental clinics and laboratories have the same value using ShadeEye-NCC(R). dental chroma meter (Shofu Inc., Kyoto, Japan) using shade guide are evaluated. MATERIAL AND METHODS: At the first experiment, eight Vita Lumin Vacuum shade guides (Vident Inc., California, USA) were collected from the dental clinics. A1 and B1 shade tabs are chosen and the colors are analyzed five times each in both tooth and porcelain modes by digital shade analysis system, ShadeEye-NCC(R). In the second experiment, twelve Vita shade guides using practically in the dental clinics and laboratories were collected and also A1 and B1 shade tabs are chosen and the colors of A1 and B1 are analyzed one time each in both tooth and porcelain modes by ShadeEye-NCC(R). RESULTS AND CONCLUSION: There were significant differences among eight shade guides in terms of shade (chroma), value and hue in both of A1 and B1 (P < .05). Shade guides using in present both dental clinics and laboratories did not show significant differences, except A1 in the porcelain mode, it showed significant differences (P < .05) in the shade even though the shade tab has the same name.
California ; Dental Clinics ; Dental Porcelain ; Dentistry ; Eye ; Quinolinium Compounds ; Tooth ; Vacuum

We investigated whether there was any difference in the extent of cupping reversal after reduction of intraocular pressure(IOP) by trabeculectomy between advanced glaucoma(stage IV of Jonas classification; 6 eyes) and less advanced glaucoma(stage III or less; 5 eyes). Computer-aided morphometry was performed in 11 eyes of 10 adult patients with chronic open-angle glaucoma in whom reversal of glaucomatous cupping was apparent photographically. Mean preoperative IOP, postoperative IOP, and percent reduction of IOP respectively were 42.5+/-8.3mmHg, 12.5+/-3.8mmHg, and 69.1+/-13.2%(range, 40.6 to 81.0%) over a mean period of 22.7+/-14.6 months(range, 5 to 53 months). Mean cup area and cup to disc ratio decreased significantly(P<0.01, Wilcoxon signed rank test). The reversal of rim area/disc area ratio showed a marginally significant correlation with the percent reduction of IOP(Spearman`s correlation coefficient=0.57, P=0.07). The reversal of vertical cup to disc ratio was significaltly lower in eyes with advanced glaucoma than in eyes with less advenced glaucoma(P=0.03, Mann-Whitney U test). Although reversal of other disc parameters tended to be lower in eyes with advanced glaucoma, they were not statistically significant. In eyes with advanced glaucoma, reversal of rim area/disc area ratio was more pronounced in the nasal disc region than in the superior or inferior disc region. Our results suggest that the extent of cupping reversal after reduction of IOP may decrease in the advanced stage of glaucoma than in mild to moderate stages of glaucoma.
Adult ; Classification ; Filtering Surgery* ; Filtration* ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Trabeculectomy

We investigated whether there was any difference in the extent of cupping reversal after reduction of intraocular pressure(IOP) by trabeculectomy between advanced glaucoma(stage IV of Jonas classification; 6 eyes) and less advanced glaucoma(stage III or less; 5 eyes). Computer-aided morphometry was performed in 11 eyes of 10 adult patients with chronic open-angle glaucoma in whom reversal of glaucomatous cupping was apparent photographically. Mean preoperative IOP, postoperative IOP, and percent reduction of IOP respectively were 42.5+/-8.3mmHg, 12.5+/-3.8mmHg, and 69.1+/-13.2%(range, 40.6 to 81.0%) over a mean period of 22.7+/-14.6 months(range, 5 to 53 months). Mean cup area and cup to disc ratio decreased significantly(P<0.01, Wilcoxon signed rank test). The reversal of rim area/disc area ratio showed a marginally significant correlation with the percent reduction of IOP(Spearman`s correlation coefficient=0.57, P=0.07). The reversal of vertical cup to disc ratio was significaltly lower in eyes with advanced glaucoma than in eyes with less advenced glaucoma(P=0.03, Mann-Whitney U test). Although reversal of other disc parameters tended to be lower in eyes with advanced glaucoma, they were not statistically significant. In eyes with advanced glaucoma, reversal of rim area/disc area ratio was more pronounced in the nasal disc region than in the superior or inferior disc region. Our results suggest that the extent of cupping reversal after reduction of IOP may decrease in the advanced stage of glaucoma than in mild to moderate stages of glaucoma.
Adult ; Classification ; Filtering Surgery* ; Filtration* ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Trabeculectomy

No abstract available.
Appendix* ; Carcinoid Tumor*

Since the concept of osseointegration has been introduced, a lot of researches were performed to achieve stronger fixation of the implant. In this study, we tried to find the different pattern of bone ingrowth after implanting pure titanium implant and Hydroxyapatite coated titanium implant in dogs. Four typed of cylindrical titanium implants (diameter 6 mm, length 1 mm) were inserted in the distal femur of adult dogs. The histological examination was done at postoperative 2, 4, 8, and 12 weeks. There was no foreign body reaction at contact site and all implants kept direct contact with bone tissue. In the light microscopic finding, after 2 weeks, the cases with Hydroxyapatite-coated Implant (HAP) showed greater formation of immature woven bone in comparison to Titanium implant. After 4 weeks, Hydroxyapatite-coated Implant (HAP) showed more mature lamellar bone. After 8 and 12 weeks, most of the woven bone was transformed into mature lamellar bone. The fluorescence microscopic finding, after 2 weeks, revealed calcein green fluorescence around implants in all cases and it was more prominent in the cases with Hydroxyapatite-coated Implant (HAP). After 4 weeks, the center of trabecula gave out green fluorescent light, the corner of them showed red fluorescent light, and they were more prominent in the cases with Hydroxyapatite-coated Implant (HAP). After 8 and 12 weeks, green fluorescence disappeared gradually, red fluorescence appeared for the most part, and there was no difference in each cases, especially in 12 weeks. As a result, we support the concept that Hydroxyapatite-coated Implant (HAP) induces faster bone ingrowth in 4 weeks than Titanium implant, and that it may be more profitable for early bone ingrowth and implant stability.
Adult ; Animals ; Bone and Bones ; Dogs* ; Durapatite ; Femur ; Fluorescence ; Foreign-Body Reaction ; Humans ; Osseointegration ; Titanium*