Osteosarcoma probably arises from a primitive, undifferentiated mesenchyme, It is highly malignant bone tumor characterized by the invariable formation of neoplastic osteoid and tumor tissue with poor prognosis. Osteosarcoma may involve any bone, but usually arises in the metaphyseal portion of long bones, most frequently at the distal ent of the femur, the proximal end of the tibia, and the proximal end of the humerus. The authors have experienced one case (52 year old male) of osteosarcoma originating from the right patella.
Femur ; Humerus ; Mesoderm ; Osteosarcoma ; Patella ; Prognosis ; Tibia

No abstract available.
Ascites* ; Gallbladder* ; Ultrasonography*

PURPOSE: Perinatal asphyxia occurring in newborn is one of the major causes of acute mortality and chronic neurological disability in survivors. We have studied the relationship between early electroencephalography(EEG) findings and clinical course and neurologic outcome in severe asphyxiated neonates. METHODS: Between the period of July 1999 and June 2002, 25 neonates who were diagnosed with severe perinatal asphyxia(1-minute Apgar score of < or =3 and initial pH is less than 7.2) at NICU in Dongsan Medical Center were enrolled. An EEG was recorded and analyzed within three days of life and divided into two groups - group 1(normal or focal change on EEG) and group 2(generalized abnormal EEG). Between the two groups, clinical courses and neurologic outcomes were compared. RESULTS: Fifteen infants(60%) were group 1 and ten infants(40%) were group 2(polyspikes, burst- suppression, generalized low voltage). Associated maternal disease, days of hospitalization, need for ventilator support, delay of oral feeding and convulsion duration are significantly higher and longer in group 2. Also, poor neurologic outcome(expire, developmental delay) was significantly higher in group 2(60%) than group 1(13.3%). CONCLUSION: Thus, the early neonatal EEG in asphyxiated newborn can be a predictable diagnostic tool in assessment of neurologic outcome.
Apgar Score ; Asphyxia ; Electroencephalography ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn* ; Mortality ; Seizures ; Survivors ; Ventilators, Mechanical

BACKGROUND: It has been known that arterial carbon dioxide tension is 4~5 mmHg higher than end-tidal carbon dioxide tension in healthy adults during general anesthesia. But negative arterial to end-tidal PCO2 difference was reported in pregnant patients undergoing cesarean section. The purpose of this study was to elucidate the difference between arterial and end-tidal PCO2 in anesthetized patients with reduced functional residual capacity. METHODS: 90 patients were divided into 3 groups i.e. control group (n=30), obese group (n=20, body weight more than 20% greater than ideal weight), pregnant group (n=40). All patients had no cardiac or respiratory abnormalities and never smoked. Arterial blood gas analysis and measurement of end-tidal PCO2 were done 20 minutes after induction of anesthesia in control and obese group and just before uterine incision and 20 minutes after fetal delivery in pregnant group. RESULTS: There were significant correlations between arterial and end-tidal PCO2 in all groups. The incidences of negative arterial to end-tidal PCO2 difference were 10% in control group, 40% in obese group, 42.5% in pregnant group (p<0.05). CONCLUSION: From this study, it is concluded that patients with reduced functional residual capacity have more incidences of negativity than normal patients in the values of arterial to end-tidal PCO2 difference during general anesthesia. So when the tight control of PaCO2 is required in patients with reduced FRC, we recommend to measure PaCO2 for better anesthetic management.
Adult ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Body Weight ; Carbon Dioxide* ; Carbon* ; Cesarean Section ; Female ; Functional Residual Capacity* ; Humans ; Incidence ; Pregnancy ; Smoke

No abstract available.
Crohn Disease*

The ability to distinguish between unipolar and bipolar depression and the knowledge to bring the appropriate effective treatment is particularly crucial to psychiatrists. Because the pharmacologic strategies indicated for each disorder differ. Failure to make the correct diagnosis may lead to a lack of response to treatment, or complications such as switches into mania or rapid cycling. Common mood symptoms are melancholy, tearfulness, and irritability; common cognitive and perceptual symptoms are self-deprecatory and self-accusatory thoughts, poor concentration, diminished clarity and speed of thought, and suicidal ideation. Absence of a history of hypomania or mania does not rule out a bipolar diagnosis. Retardation, hypersomnia, hyperphagia, suicide attempts, and psychotic symptoms are more frequently found in these patients than in patients with unipolar depression. Few studies have examined the efficacy of somatic treatments in acute bipolar depression. Less than 20 controlled pharmacological studies have been conducted for the depressive phase of bipolar disorder. In addition, these studies examined small sample sizes and with only a few of the available treatment options. Because there is very little data specific to treatment of bipolar depression, most of the approaches to bipolar depression are derived from experience with unipolar depression. The basic premise of treatment os that these patients frequently respond to mood stabilizing agents without antidepressants, and that antidepressants should be reserved for those cases in which mood stabilizers alone have not worked, because of the well-known risk of triggering manic episodes(switching) and rapid cycling. Antidepressants should not be continued any longer than necessary. Mood stabilizers should be considered as first-line agents in view of the fact that their efficacy is at lease equal to, if not greater than, treatment with antidepressant, and that their use is rarely associated with the complications of cycle acceleration or with manic switch. It is recommended to use bupropion or SSRI because of low risk of manic switch and rapid cycling. In the future, research and pharmaceutical communities will have to focus on the short- and long-term effectiveness of antidepressants, and the development of new drugs for the treatment of bipolar depression. More experience is needed with the anticonvulsant lamotrigine, gabapentin, topiramate. The preliminary studies of lamotrigine suggests the antidepressant effect and mood stabilizing efficacy.
Acceleration ; Antidepressive Agents ; Bipolar Disorder* ; Bupropion ; Depressive Disorder ; Diagnosis ; Disorders of Excessive Somnolence ; Excipients ; Humans ; Hyperphagia ; Psychiatry ; Sample Size ; Suicidal Ideation ; Suicide

Paranasal sinus CT is known as the most effective imaging modality in the evaluation of inflammatory sinonasal diseases and can depict the distribution, causative lesions obstructing main drainge route, and associated findings. Recently, functional endoscopic sinus surgery has been widely used for the evaluation and treatment. Before operation, PNS CT has been routinely used to evaluate the paranasal sinuses and mucociliary drainage route. The authors analyzed the PNS CT findings of 3156 cases in 1578 patients with chronic sinusitis symptoms. Sinonasal inflammatory diseases were categorized into 5 patterns according to the obstruction sites. They were 1) infundibular (10%, 316/3156), 2) ostimeatal unit (41%, 1294/3156), 3) sphenoethmoidal recess (12%, 379/3156), 4) sinonasal polyposis (30%, 946/3156) , and 5) unclassifiable (6%, 190/3156) patterns. The main causes for infundibular obstruction in order of frequency were inflammatory mucosa, enlarged ethmoidal bulla and Haller's cell. With respect to the middle meatus obstruction, is main causes in the order of frequency were polypoid lesion, inflammatory mucosa and medially deviated uncinate process. In particular, sinonasal polyposis showed one or more of the characteristic associated findings of infundibular enlargement, air-fluid level, ethmoidal sinus was bulging and bony deossification or sclerosis as well as sinonasal polypoid change. In conclusion, the inflammatory sinonasal diseases were classified into five patterns, and the causative lesions or anatomic variations were efficiently detected by the PNS CT. Furthermore, it could provide a guidance for proper management of the sinusitis including functional endoscopic sinus surgery.
Drainage ; Humans ; Mucous Membrane ; Paranasal Sinuses ; Sclerosis ; Sinusitis

PURPOSE: In young male patients who suffered several kinds of trauma with subsequent suspicious reflex sympathetic dystrophy syndrome, we performed three-phasic bone scan in order to investigate its usefulness. MATERIALS AND METHODS: Patients with narrow range of age (21-25. mean 22.8+/-1.3, all male) were included with suspicious reflex sympathetic dystrophy syndrome of 12 feet and 5 hands. Only one was bilateral feet case and 16 were ipsilateral (Rt:13, Lt:3). The etiologic traumas were 4 fractures, 4 sprains, 3 blunt trauma, 2 cellulitis, 1 tendon tear, 1 crush injury, 1 overexercise, and 1 unknown. Radiologically 3 showed osteoporotic changes. Three-phasic bone scans were performed 21.2+/-7.3wks after trauma. RESULTS: According to symptom complex, confirmatory reflex sympathetic dystrophy syndrome 4 cases and suspicious 13 were analyzed. All confirmatory cases (100%) showed increased uptake at delay phase with periarticular accentuation. Of confirmatory 4 cases, 2 showed increased uptake in all three phases (perfusion: P, blood pool: B, and delay: D), and other 2 revealed decreased P but, both increased B and D. Of suspicious 13 cases, 9(69.2%) had increased D (4 periarticular and 5 focal), 2 decreased D, and 2 symmetric D. In 12 foot cases, so-called weight bearing patterns - increased contralateral sole at P and B - were revealed in 7(58.3%). CONCLUSION: Diffuse periarticular increased uptake at delay phase of three-phasic bone scan was a compatible finding to reflex sympathetic dystrophy syndrome in young male patients whose symptom complex strongly designated post traumatic reflex sympathetic dystrophy syndrome.
Cellulitis ; Foot ; Hand ; Humans ; Male* ; Reflex Sympathetic Dystrophy* ; Reflex* ; Sprains and Strains ; Tendons ; Weight-Bearing

No abstract available.
Down Syndrome* ; Myeloproliferative Disorders*

Posttraumatic stress disorder (PTSD) is relatively common and chronic illness that causes severe functional impairment. Though many studies have been done, PTSD is still difficult to understand because of heterogeneity of its nature and other psychiatric comorbidities. But the last decades have brought new appreciation for the complexity and the diversity of clinical features and improved treatment approaches. Achieving complete remission from PTSD through pharmacotherapy alone appears out of reach currently. Antidepressants appear to demonstrate the best overall efficacy for the treament of PTSD, especially in patients with combined depression, insomnia, intrusive and hyperarousal symptoms. Though data for different efficacy among antidepressants are not known, tricyclic antidepressants and monoamine oxidase inhibitor appear to be effective in severe war PTSD patients and SSRIs appear to be more effective in avoidance/numbness symptoms. Considering their ease of use and tolerability, it is reasonable to choose SSRIs such as paroxetine and sertraline as a first-line treatment. Mood stabilizers are effective, especially for impulsivity, irritability and unstable mood. More studies are needed to confirm the efficacy of benzodiazepine, though it is used for inosmnia, panic symptoms and anxiety. Though there is little empirical date demonstrating the efficacy of antipsychotics, they may provide effective strategy if psychotics symptoms are combined. The future of therapy for PTSD holds much hope with the rapid development of psychopharmacology and elucidation of pathophysiology of PTSD.
Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Antipsychotic Agents ; Anxiety ; Benzodiazepines ; Chronic Disease ; Comorbidity ; Depression ; Drug Therapy* ; Hope ; Humans ; Impulsive Behavior ; Monoamine Oxidase Inhibitors ; Panic ; Paroxetine ; Population Characteristics ; Psychopharmacology ; Sertraline ; Sleep Initiation and Maintenance Disorders ; Stress Disorders, Post-Traumatic*