PURPOSE: To establish the interobserver and intraobserver reliability of the Coonrad classification for an idiopathic coronal curve pattern. MATERIALS AND METHODS: Radiographs of 257 idiopathic scoliosis patients that had a rib humping of more than 1 cm and a Cobb angle of more than 10 were reviewed. The interobserver and intraobserver reliability was assessed by a comparison of the classification of the curves between four observers. RESULTS: In the Coonrad classification, a 1A type-curve occurred in 37 cases, the 1B type-curve occurred in 27 cases, the 2A type-curve occurred in 70 cases, a 2B type-curve occurred in 22 cases, a 3 type-curve occurred in 44 cases, a 4 type-curve occurred in 6 cases, a 5 type-curve occurred in 15 cases, a 6 type-curve occurred in 22 cases, a 7 type-curve occurred in 13 cases and a 8 type curve occurre in 1 case. The interobserver reliability for the Coonrad classification was 0.60 and the intraobserver reliability was 0.71. CONCLUSION: The Coonrad classification proved to be relatively reliable, but revealed some confusion, particularly between type 2A and type 3. Also, there seemed to be no advantage in using this method of determining the treatment modality compared with the conventional scoliosis classification system.
Adolescent* ; Classification* ; Humans ; Ribs ; Scoliosis*

The metal ceramic crown is currently the most popular complete veneer restoration in dentistry, but in many cases, the metal cervical collar at the facial margin is unesthetic and unacceptable. Facial porcelain margin has been used in place of it. But this dose not solve the problems, such as dark gingival discoloration and cervical opaque reflection of porcelain veneer. Recently, metal copings which were designed to terminate its labio-cervical end on the axial walls coronal to the shoulder have been clinically used to solve the esthetic problem of metal ceramic crown. But in this design, porcelain veneer of labio-cervical area which is not supported by metal may not be able to resist the stress during cementation and mastication. The purpose of this study was to evaluate fracture strength and fractured appearance of crowns according to different coping designs. A resin maxillary left central incisor analogue was prepared for a metal ceramic crown, and metal dies were made with duplication mold. Metal copings were made and assigned to one of four groups based on facial framework designs: group 1, coping with 0.5mm metal collar; group 2, metal extended to the shoulder; group 3, metal extended to 1 mm coronal to the shoulder; group 4, metal extended to 2mm coronal to the shoulder. Copings and crowns were adjusted to be same size and thickness, and cemented to metal dies with zinc phosphate cement by finger pressure. Fracture strength was measured with Instron Universal Testing Machine. Metaldies were anchored in Three-way-vice at 3mm below finish line and at 130degree inclined to the lone axis of the crown. Load was directed lingually at 2mm below midincisal edge. Load value at initial crack and at catastrophic fracture was recorded. The results obtained were as follows: 1. Fracture strength values at initial crack were higher in groups 1, 2 than in groups 3, 4 but this difference was not statistically significant(P<0.05). 2. Conventional metal collared crown had greater catastrophic fracture strength than any other collarless crowns. 3. The greater the labial metal coping reduction, the lower the catastrophic fracture strength of crowns but when more than 1mm of labial metal reduction was done, the difference in strengths was not statistically significant(p<0.05). 4. The strongest collarless coping design was group 2.
Axis, Cervical Vertebra ; Cementation ; Ceramics* ; Crowns* ; Dental Porcelain ; Dentistry ; Fingers ; Fungi ; Incisor ; Mastication ; Shoulder ; Zinc Phosphate Cement

A 19-year-old man had a good neurologic recovery from a severe hypothermia(19 degrees C) and a prolonged coma following active infernal rewarming. From inhaling hydrocarbons, he was left unconscious on the cold floor for 24 hours. As soon as the patient was brought into the emergency medical center, he was early evaluated arid treated aggressively. ECG showed Osborn(J) wave on all leads. The temperature o( patient was increased by 2-3 degrees C per hour through active external rewarming (by heating blankets and warm bag) and active infernal rewarming (by airway rewarming, warmed IV fluids, gastrointestinal tract irrigation, and bladder irrigation). The temperature reached 36 degrees C after 6 hours. Active infernal rewarming provides rapid core rewarming with the additional benefit of circulatory support during the period of cardiac instability.
Coma ; Electrocardiography ; Emergencies ; Gastrointestinal Tract ; Heating ; Hot Temperature ; Humans ; Hydrocarbons* ; Hypothermia* ; Inhalation ; Rewarming ; Unconsciousness* ; Urinary Bladder ; Young Adult

OBJECTIVES: E-cadherin is a transmembrane protein that is one of the key players involved in cell to cell adhesion. Loss of E-cadherin expression is suggested to promote tumor invasion and distant metastasis in tumor development. Recently, it has been proposed E-cadherin function requires its linkage to the cytoskeleton through catenins. So defects in catenins may cause defective E-cadherin function and promote tumor invasion. We intend to evaluate the expression of E-cadherin and alpha-, beta-, gamma- catenin in tissues of human endometrial carcinoma to analyze the patterns of cell adhesion molecules' expression in endometrial carcinoma and to investigate the relationship between status of cell adhesion molecules and various clinicopathological factors. MATERIALS AND METHODS: The present study investigated the immunohistochemical expression of E-cadherin and alpha-, beta-, gamma- catenin in 33 paraffin embedded formalin fixed tissues of endometrial carcinomas. RESULTS: Aberrant E-cadherin, alpha-, beta-, gamma- catenin expression was observed in 33.3(11 of 33), 27.3(9 of 33), 18.2 (6 of 33), and 51.5(17 of 33) % of the specimens, respectively. Statistically significant correlation was found between aberrant expression of E-cadherin and lymph node metastasis and cell types other than endometrioid adenocarcinoma. Aberrant pattern of gamma- catenin expression also correlated with deep myometrial invasion. But alpha-, beta- catenin expression were not correlated with any clinicopathological parameters. Using Kaplan-Meier curves, abnormal expression of E-cadherin correlated closely with poor survival (p<0.05). CONCLUSION: We revealed aberrant expression of these cell adhesion molecules in part of patients with endometrial carcinoma. Aberrant expression of E-cadherin was correlated with lymph node metastasis and cell types other than endometrioid adenocarcinoma and aberrant expression of gamma-catenin was related with deep myometrial invasion.
Cadherins* ; Carcinoma, Endometrioid ; Catenins* ; Cell Adhesion ; Cell Adhesion Molecules ; Cytoskeleton ; Endometrial Neoplasms* ; Female ; Formaldehyde ; gamma Catenin ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin

Soft-tissue sarcomas account for 1% of all solid tumors. Of these, less than 15% will occur in the retroperitoneum. Late diagnosis and large tumor size make retroperitoneal sarcomas difficult to resect. Resection with wide margins in all directions is rarely possible owing to proximity to vital structures. Radiation therapy is limited in dosage and, as with chemotherapy, has only been successful in a limited number of cases. These problems result in a poor prognosis. A series of patients with retroperitoneal sarcoma was reviewed with a focus on issues of surgical management and prognostic factors. A retrospective analysis of 12 patients with retroperitoneal sarcomas who had undergone operations at the Department of Surgery, Inje University Paik Hospital, Seoul, from 1980 through 1996 was performed. The mean age of the 10 adult patients was 51 years; the male-to-female ratio was 2:1. Eighty-three percent of the patients presented with an abdominal mass. The mean diameter of the tumors was 18.3 cm. Leimyosarcomas(33%) and liposarcomas(25%) comprised the majority of the histologic types. The tumor grades were I, II, and III in 3 cases each. Resection of the tumor was possible in 75%(9/12) of the cases, although 17% of the resections were incomplete. Resection of adjacent organs was required in 66% of the cases. The resectability rose from 60% in 80s to 86% in 90s, with no statistical significance, possibly due to the small number of cases in this series. There was no postoperative morbidity or mortality. Actuarial 1-, 3-, and 5-year survival rates after resection were 75%, 60%, and 30%, respectively. Four of the 7(57%) patients who underwent complete resections had recurrence 3 to 33 months after surgery; this was notable for grade II or III tumors only. Two patients with grade I tumors are alive 65 and 102 months respectively after complete resection and show no evidence of the disease. One patient who underwent an incomplete resection of the tumor died 50 months after the operation. Only the tumor grade was a significant prognostic factor(p=0.0207). In conclusion, a wide en-bloc resection of a retroperitoneal sarcoma with a clear margin in all directions is a prerequisite for long-term survival. Aggressive follow-up for the first 3 years after a complete resection of a high-grade tumor is justified.
Adult ; Delayed Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Mortality ; Prognosis ; Recurrence ; Retrospective Studies ; Sarcoma* ; Seoul ; Survival Rate

STUDY OBJECTIVE: determine the level of medical care required for mass gatherings and describe the types of medical problems encountered in a religious mass gathered ceremony. DESIGN: Standard charts and a four-tiered triage system(minor, moderate, urgent, and emergent) were developed before the event. The triage system was applied to each chart retrospectively by a single emergency physician. SETTING: Medical staff(10 physicians,13 nurses,1 pharmacist, and 54 first-aid attendants) were based in 8 advanced life support (ALS) clinics. INTERVENTIONS: First-aid attendants referred patients to the clinics, where nurses conducted initial assessments and referred patients to physicians at the venue. Three ambulances were stationed at the venues. RESULT: 22 trauma patients were developed and 183 medical complaints were encountered. Only 7 urgent medical problems were encountered.
Ambulances ; Emergencies* ; Humans ; Pharmacists ; Retrospective Studies ; Triage

No abstract available.
Endometrial Neoplasms* ; Female

Hydatidiform moles are generally separated into two clasifications. Complete hydatidiform moles are characterized by cystic swlling of all villi, often pronounced trophoblastic hyperplasia, lack of fetal parts, all 46 chromosomes of paternal origin(androgenesis), and a major risk for persistent trophoblastic tumor. Partial hydatidiform moles appear to be a milder version of complete moles with both normal and cystic villi, focal trophoblastic hyperplasia, a fetus or indications of previous fetal existence, 69 chromosomes with a maternal contribution, and a malignant potential less than described for complete moles. Hydatidiform mole with coexistent fetus is a very rare phenomenon, with an estimated incidence of 0.005 to 0.01 percent of all pregnancies. The rarity of live-born, surviving children may in part be due to termination of pregnancies, when molar parts are observed and without access to current advanced diagnostic procedures. Progress in techniques for first trimester prenatal diagnosis and improved surveillance of first trimester pregnancies through prenatal chromosomal analysis, ultrasound scan, maternal serum-hCG and serum- AFP screening has created complex situation, allowing confirmation of hydatidiform mole with coexisitng fetus. We recently experienced one case of unusual pregnancy with complete hydatidiform mole and coexisiting live fetus.
Child ; Female ; Fetus* ; Humans ; Hydatidiform Mole* ; Hyperplasia ; Incidence ; Mass Screening ; Molar ; Pregnancy ; Pregnancy Trimester, First ; Prenatal Diagnosis ; Trophoblastic Neoplasms ; Trophoblasts ; Ultrasonography

This study was done on a case of chronic otitis media in both ears of a 47-year-old woman who received tympanization in the left middle ear in a local hospital three years ago. Ossiculoplasty was not tried in this case due to fixation of the stapes. However, conductive hearing loss of the left ear continued after tympanization, necessitating middle ear exploration. After the exposure of middle ear cavity, we found the absence of malleus and incus, and the fixation of stapes. Stapedectomy was carried out and total ossicular replacement prosthesis was also performed for the protection of the oval window by using perichondrium, cartilage and fascia. Postoperative bone conduction showed improvement of 15 dB, and air conduction showed improvement of 22 dB. After the operation, an average air-bone gap was improved within 10 dB. We experienced good hearing improvement without significant complications during the follow up period.
Bone Conduction ; Cartilage ; Ear ; Ear, Middle ; Fascia ; Female ; Follow-Up Studies ; Hearing ; Hearing Loss, Conductive ; Humans ; Incus* ; Malleus* ; Middle Aged ; Ossicular Prosthesis* ; Ossicular Replacement* ; Otitis Media ; Stapes Surgery* ; Stapes*

Intralabyrinthine schwannomas are rare benign tumors that arise from the terminal ends of the eighth cranial nerve. These may involve the cochlea, vestibule, or semicircular canals. These tumors are uncommon, and were diagnosed incidentally either during labyrinthectomy or at autopsy. The increasing use of the MRI in the diagnostic assessment of patients with unilateral sensorineural hearing loss or tinnitus has led to the diagnosis of intralabyrinthine schwannomas. Because the clinical symptoms of intralabyrinthine schwannomas and other otologic disorders, particularly Meniere's disease, are so similar, diagnosis of intralabyrinthine schwannomas is challenging. We report a patient with intralabyrinthine schwannoma, who had been misdiagnosed as having Meniere's disease. With the aid of MRI, intralabyrinthine schwannoma was detected and removed successfully by translabyrinthine approach.
Autopsy ; Cochlea ; Diagnosis ; Hearing Loss, Sensorineural ; Humans ; Magnetic Resonance Imaging ; Meniere Disease* ; Neurilemmoma* ; Semicircular Canals ; Tinnitus ; Vestibulocochlear Nerve