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

No abstract available.
Crohn Disease*

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

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

As the advantages of atypical antipsychotics in bipolar disorder have been known, the approval of indications of these drugs is expanding. According to APA practice guidelines, in addition to lithium and valproate, atypical antipsychotics are recommended as the first-line agent in treating acute manic or mixed episode with mild severity. Quetiapine like other atypical antipsychotics such as risperidone or olanzapine is an effective antipsychotic drug in treating bipolar disorder. Based on currently available clinical evidences, quetiapine was approved in Korea and United States as a monotherapy or combination therapy in treating bipolar disorder. It is expecting that the use of quetiapine in patients with bipolar is increasing considering the efficacy and favorable side effect profiles. But more studies are needed to investigate the long-term efficacy and tolerability of mono-therapy or combination therapy in the maintenance period.
Antipsychotic Agents ; Bipolar Disorder ; Humans ; Korea ; Lithium ; Risperidone ; United States ; Valproic Acid

We report a case of atrophoderma of Pasini and Pierini in which the characteristic soft atrophic patch with cliffdrop border developed on the neck and two well-demarcated indurated atrophic patches were on both shoulders. We took biopsies from centers and margins of each lesion. Histipathologic findings from atrophic center showed marked dermal atrophy comparing to that from margin of the lesion on the neck, but the atrophic center and margin of the lesion on the shoulder showed morphea-like features without, distinct differences between two.
Atrophy ; Biopsy ; Neck ; Shoulder

BACKGROUND: Pancreatoduodenectomy is a standard operation for benign and malignant lesions of the periampullary area. Even though the complication and the mortality rates have markedly decreased owing to recent developments in surgical techniques and postoperative care, the complication rates still remain high. Especially, pancreatic leakage is the main cause of death today in a pancreatoduodenectomy, so surgical techniques dealing with this problem have emerged as a major issue. The usual techniques used have been the duct ligation method, the duct occlusion method, a pancreatojejunostomy, and a pancreatogastrostomy. However, a recent trend has been to maintain pancreato-enteric continuity. Thus, the authors used a pancreatojejunostomy with the duct-to-mucosa method to decrease the complications. METHODS: The authors retrospectively reviewed the medical records of 56 patients who had undergone a pancreatoduodenectomy between January 1987 and July 1997 by one surgeon. RESULTS: The male-to-female ratio was 1.4:1 and the mean age was 55.5 years (ranging from 25 to 77). A Whipple's operation was done in 44 cases, and a pylorus-preserving pancreatoduodenectomy was done in 12 cases. All the cases used a pancreatojejunostomy with the duct-to-mucosa method. No pancreatic leakage was observed in any of the 56 cases. The immediate postoperative complication rate was 28.6%, and there was one (1.8%) postoperative mortality due to adult respiratory distress syndrome. Six patients complained of minimal exocrine functional abnormality, but only one patient, who had suffered severe chronic pancreatitis preoperatively, routinely now takes a pancreatic enzyme. However, even after long-term follow up, no endocrine insufficiency has been detected. CONCLUSIONS: Through our experience, a pancreatojejunostomy with the duct-to-mucosa method is a secure and reasonable method and can be used for all patients undergoing a pancreatoduodenectomy.
Cause of Death ; Follow-Up Studies ; Humans ; Ligation ; Medical Records ; Mortality ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Pancreatitis, Chronic ; Postoperative Care ; Postoperative Complications ; Respiratory Distress Syndrome, Adult ; Retrospective Studies

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