BACKGROUND: Infantile Hypertrophic Pyloric Stenosis (IHPS) is one of the most common surgical problems of early infancy and one for which an eminently successful surgical treatment has been available since the work of Ramstedt in 1912. A clinical study was begun to access further the accuracy of ultrasonography in identifying hypertrophic pylorus. METHODS: This study is a retrospective clinical analysis of 31 cases of IHPS treated at the Department of Surgery of Pohang St. Mary's Hospital from Jan. 1990 to Dec. 1997. RESULTS: (1) The most prevalent age group was between 3 weeks and 8 weeks in 24 cases (77.4%), and the ratio of males to females was 5.2:1. (2) Among the 31 cases, new born babies were 21 cases (67.7%). (3) In 30 cases (96.8%), the gestational age was between 37 weeks and 42 weeks, and the birth weight was more than 3.5 kg in 21 cases (67.7%). The body weight percentile at admission was lower than the 50 percentile in 31 cases. (4) Among the 31 cases, breast-fed infants were 15 cases (48.4%), milk-fed 13 cases (41.9%), and mixed-fed 3 cases (9.7%). B type blood group was 23 cases (74.2%), and O type was 4 cases (12.9%). (5) In 4 cases (12.9%), an inguinal hernia was noted as an associated anomaly. (6) The onset of symptoms was neonatal (1 week-12 weeks) in all 31 cases, and the duration of the symptoms was between 1 week and 2 weeks in 18 cases (58.1%). (7) Non-bile stained, projectile vomiting was noted in all 31 cases (100.0%), an olive-shaped mass in right upper quadrant of the abdomen was felt in 27 cases (87.1%), and visible peristalsis on the epigastrium was noted in 25 cases (80.6%). (8) On laboratory tests, 17 patients had leukocytosis, and anemia was observed in 2 cases. Hypokalemia was observed in 9 cases (29.0%), hypochloremia in 4 cases (12.9%), and moderate to severe alkalosis (CO2 content > 25 mEq) in 7 cases. (9) Among the 25 cases, for which an the ultrasonographic evaluation was performed, the length of the stenotic canal was from 16 mm to 20 mm in 23 cases (92.0%), and the thickness of the stenotic portion was from 5 mm to 6 mm in 21 cases (84.0%). (10) All 31 cases were surgically treated by using a Fredet-Ramstedt pyloromyotomy, and the mortality was nil. The average hospitalization was 9.4 days. (11) There was 1 case of duodenal perforation and 1 case of intermittent non-projectile vomiting after the operation. CONCLUSIONS: We conclude that early accurate diagnosis, adequate preoperative preparation of the fluid & electrolyte imbalance, immediate surgical correction, and scheduled careful oral feeding are important in treatment of IHPS. Ultrasonographic determination of pyloric muscle length and thickness is the most accurate of the currently available techniques. A Fredet-Ramstedt pyloromyotomy is a safe and successful surgical procedure.
Abdomen ; Alkalosis ; Anemia ; Birth Weight ; Body Weight ; Diagnosis ; Female ; Gestational Age ; Gyeongsangbuk-do ; Hernia, Inguinal ; Hospitalization ; Humans ; Hypokalemia ; Infant ; Leukocytosis ; Male ; Mortality ; Peristalsis ; Pyloric Stenosis, Hypertrophic* ; Pylorus ; Retrospective Studies ; Ultrasonography ; Vomiting

This study was carried out to observe and evaluate the middle ear pressure(MEP) change by nitrous oxide(N2O) and end tidal PCO2 during general anesthesia with halothane or enflurane. MEP was measured during general anesthesia by impedance audiometer(GSI 28 Auto tymp model) in 50 patients who were relatively healthy without upper respiratory tract infection and otologic problems from August 1987 at Chonbuk National University Hospital. The results were as follows: 1) During general anesthesia with 100% O2 and halothane or enflurane, MEP was decreased progressively under the preinduction level with time. 2) The decrease in MEP during general anesthesia with 100% O2 and halothane or enflurane was reversed by relative hypoventilation, but MEP showed negative values in all patients. 3) End tidal PCO2 was increased progressively by relative hypoventilation and returned gradually to pre-hypoventilation level by normoventilation. 4) MEP was increased during general anesthesia using N2O, which is propotional to the concentration of N2O by 20 minutes. Thereafter, MEP remained increased until termination of N2O administration. From the above results, it is concluded that MEP is increased during anesthesia using N2O. MEP can also be affected by end tidal PCO2 even though physiologic range. Therefore, it is prudent to avoid N2O especially when hyperventilation is not adequately permitted during general anesthesia for middle ear surgery and patient with middle ear disease.
Anesthesia ; Anesthesia, General* ; Ear, Middle* ; Electric Impedance ; Enflurane ; Halothane ; Humans ; Hyperventilation ; Hypoventilation ; Jeollabuk-do ; Nitrous Oxide ; Respiratory Tract Infections

Peripheral nervous system dysfunction is a rare complication in Henoch-Schonlein purpura, but it tends to recover spontaneously without treatment. A 78-year-old man who had ankylosing spondylitis presented with Henoch-Schonlein purpura associated with progressive sensorimotor polyneuropathy. He was diagnosed with chronic inflammatory demyelinating polyneuropathy, which did not improve despite intravenous immunoglobulin therapy. We describe a case of Henoch-Schonlein purpura, accompanied by chronic inflammatory demyelinating polyneuropathy in a patient with ankylosing spondylitis.
Aged ; Humans ; Immunization, Passive ; Peripheral Nervous System ; Polyneuropathies ; Polyradiculoneuropathy ; Purpura, Schoenlein-Henoch ; Spondylitis, Ankylosing

Pneumatosis cystoides intestinalis, which is characterized by multiple air-filled cysts in the intestinal mucosa, submucosa, and subserosa, is associated with autoimmune disorders, including systemic sclerosis, inflammatory myopathy and, rarely, systemic lupus erythematosus (SLE). Here, we report the case of a 57-year-old female with a 2-year history of SLE who developed pneumatosis cystoides intestinalis. The patient's symptoms were improved with conservative management. Although pneumatosis cystoides intestinalis is an uncommon manifestation of SLE, and follows a mainly benign course, it can be associated with vasculitis, which has a poor prognosis.
Female ; Humans ; Intestinal Mucosa ; Lupus Erythematosus, Systemic ; Middle Aged ; Myositis ; Pneumatosis Cystoides Intestinalis ; Prednisolone ; Prognosis ; Scleroderma, Systemic ; Vasculitis

No abstract available.
Scrub Typhus* ; Seoul*

PURPOSE: To evaluate the effectiveness of magnetic resonance imaging (MRI) for the diagnosis and usefulness of vertebroplasty in osteoporotic occult vertebral fractures. MATERIALS AND METHODS: Of 472 osteoporotic vertebral fractures treated from May 2003 to July 2009, 45 patients were diagnosed with occult osteoporotic vertebral fracture. Their medical charts and radiographs were reviewed. The degree of vertebral body collapse was graded by a semiquantitative method. In order to increase the reliability, interpretation was based on radiographic diagnoses from 3 orthopedic surgeons. Vertebroplasty was performed at 31 of the 45 patients, for whom conservative treatment failed. Pre-operatively and post-operatively, pain was evaluated using a visual analog scale (VAS). RESULTS: We observed 55 occult fractures in 45 patients. Forty vertebrae (72.7%) among the 55 vertebrae were just adjacent to an old vertebral fracture with deformation of the vertebral body. The rediagnosis rate of occult fracture attempted without MRI was only 21.8%. The average pre-operative VAS score of 8.07 (6~9) was improved to 2.43 after surgery and showed no delayed vertebral body collapse. CONCLUSION: Gadolinium enhancement of MRI is critical to the diagnosis of occult vertebral fractures, which are 9% of whole osteoporotic vertebral fractures. Seventy-two point seven percent of occult vertebral fractures were just adjacent to an old vertebral fracture with collapse of the vertebral body. This means that if vertebroplasty is performed without thorough MRI examination, it may fail.
Fractures, Closed ; Gadolinium ; Humans ; Magnetic Resonance Imaging ; Orthopedics ; Osteoporosis ; Spine ; Vertebroplasty

PURPOSE: To evaluate the radiological and clinical outcomes of the standard total knee arthroplasty without internal fixation or extended long stem in tibial bone defect with severe varus deformity. MATERIALS AND METHODS: Between July 2012 and April 2014, 32 patients (45 cases; 4 men and 41 women with a mean age of 74.2 years) who underwent total knee arthroplasty with autologous bone grafting were enrolled for analysis. The mean follow-up period was 34.4 months. The cancellous bone defect site was exposed, and a longitudinal sulcus was made. Subsequently, a premolded bone graft was inserted in the sulcus at 45°. The defect size was measured, and the radiological and clinical results were evaluated. RESULTS: The mean defect size according to the radiograph was found to be 15.31×30.36 mm in the frontal view and 15.46×45.98 mm in the sagittal view. The mean defect size of depth during the operation was found to be 8.38 mm. The preoperative mean varus angle was 14.1° (4.0°–26.9°), and the follow-up mean valgus angle was 5.4° (0.5°–10.5°). The implant position was α=95.7°, β=90.4°, γ=2.1°, δ=89.1° on the follow-up. No implant loosening was observed, and the mean bone union period was 4.3 months. The Hospital for Special Surgery score was improved from a preoperative mean of 50.1 to a postoperative mean of 90.4. CONCLUSION: Standard total knee arthroplasty using autologous structural bone grafting without internal fixation in a tibial bone defect demonstrated a rapid, stable bone healing and excellent radiological and clinical results. Thus the index procedure was considered to be simple, and effective for bone grafting.
Arthroplasty, Replacement, Knee* ; Bone Transplantation ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Male ; Transplants*

PURPOSE: To compare the hematologic changes and the rates of transfusion of patients using rivaroxaban or aspirin for venous thromboembolism prophylaxis after a total knee arthroplasty. MATERIALS AND METHODS: Among patients with total knee arthroplasty from July 2010 to March 2011, two groups of 100 consecutive cases were enrolled in this study, 50 patients with Rivaroxaban group and 50 patients with Aspirin group for venous thromboembolism prophylaxis after a total knee arthoplasty. Hematologic changes and transfusion rates were calculated in each group. RESULTS: The mean of decreased hemoglobin was 4.7 (3.1-6.6) in the Rivaroxaban group and 3.6 (2.0-5.1) in the Aspirin group (p<0.05). The number of patients with decreased hemoglobin of less than 8 g/dl was observed in 23 cases (46%) in the Rivaroxaban group, and 9 cases (18%) in the Aspirin group. The numbers of patients who needed transfusion were 12 in the Rivaroxaban group, and 2 in the Aspirin group (p<0.05). CONCLUSION: Rivaroxaban group revealed more significant decrease of hemoglobin and needed more transfusion than the Aspirin group did. For the prevention of venous thromboembolism after total knee arthroplasty, we should be careful using Rivaroxaban for the standard risk patients of venous thromboembolism.
Arthroplasty ; Aspirin ; Hemoglobins ; Humans ; Knee ; Morpholines ; Thiophenes ; Venous Thromboembolism ; Rivaroxaban

In this study, hydroxyapatite (HAp) was coated on titanium using electrochemical deposition (ECD) method at body fluid temperature. The titanium specimens for ECD were prepared by chemically etching treatment using 5M NaOH solution. The electrolyte mixed with 5 mM Ca(NO³)² and 2 mM NH⁴H²PO⁴ which has pH 5 (E2) was adjusted to pH 3 (E1) and pH 6 (E3). The different electric pulses of −10, −15, −30 mA were applied to each specimen. The temperature of electrolytes was kept at 37℃. E1-10, E1-15, E1-30, E2-10, E2-15, E2-30, E3-10, E3-15, and E3-30 groups were prepared for this study. Scanning electron microscope (SEM) images showed that E1-10 and E1-15 groups were not coated and the powder-shaped compounds were formed on E3-15 and E3-30 groups. The cracks were observed on the surface of E1-30 and E2-30 groups. The evenly and stable coated layer was deposited on E2-10, E2-15 and E3-10 groups. The layer coated on titanium surface had an HAp crystalline structure. E1-30 and E2-30 groups had low crystallinity, even though they had thick layer. HAp layer on for E2-10 group was well deposited on the surface because it more aligned to c-axis compared with other groups.
Body Fluids ; Crystallins ; Durapatite ; Electrolytes ; Hydrogen-Ion Concentration ; Methods ; Titanium

PURPOSE: The purpose of this study was to determine the extent of safety of medial dissection of the thyroid gland along the trachea. Medial to lateral dissection of the thyroid gland along the trachea after early division of the isthmus has been known to be a useful technique in thyroid surgery, especially for difficult cases, but the risk of injury of the recurrent laryngeal nerve (RLN) has constrained thyroid surgeons from utilizing this technique to its full extent. METHODS: Distances of the laryngeal entry point (LEP) of 134 RLNs of 71 patients from the midline of the trachea, and some other anatomical distances, were measured intraoperatively. The relationships of the intraoperatively measured data with circumferences of the cartilaginous portion of the trachea (CCT) around LEP measured preoperatively by CT scan were evaluated. RESULTS: LEP was always located within 2 mm vertically from the horizontally extended line of the inferior border of the cricoid cartilage and was the closest point from the midline in the whole course of the RLN. The distance between LEP and the midline was very closely correlated with CCT measured on preoperative CT scan, and it can be accurately calculated with a regression equation; Distance between LEP and the midline = (0.42 × CCT) + (1.2 × sex) + 3.2 (mm) (sex: female=0, male=1; R2 = 0.85). CONCLUSION: Early division of the isthmus and dissecting the thyroid off the trachea to the calculated extent is a safe and effective procedure.
Cricoid Cartilage ; Humans ; Recurrent Laryngeal Nerve* ; Surgeons ; Thyroid Gland* ; Thyroidectomy ; Tomography, X-Ray Computed ; Trachea*