No abstract available.
Neck*

Authors performed Ilizarov treatment for 9 cases of severse knee flexion contracture. The causes of knee flexion contracture were 2 cases of rheumatoid arthritis, 2 cases of malunion of tibia and femur, 2 cases of infection sequelae, and 3 cases of hemophilic arthritis. The preoperative flexion contracture was av. 65.6 degrees(40-90 degrees). We started the correction at postoperative av. 3.88th day(2-12th day) after postoperative pain was controlled. After the deformity was corrected, the frame was left in place for av. 16.6 days(6-42 days). But in 2 cases of malunion of tibia and femur and 1 case of infection sequela, angular deformity and leg length discrepancy were managed after the correction of knee flexion contracture. The postcorrection flexion contracture was av. 2.6 degrees(0-10 degrees). The correction rate was av. 1.71 degrees/day(0.57-4.16 degrees/day) and the duration for correction was av. 51.1 days(12-85 days). After the follow-up period of av. 7.6 months from removal of Ilizarov, flexion contracture was av. 10.0 degrees(0-25 degrees). We conclude that the severe flexion contracture of the knee can be treated successfully with the Ilizarov correction. Limb shortening and neurovascular injuries can be avoided or minimized with the Ilizarov correction for flexion contracture of the knee as apposed to the other method. The recurrence of the flexion contracture of the knee may be prevented with the sufficient maintenance period.
Arthritis ; Arthritis, Rheumatoid ; Congenital Abnormalities ; Contracture ; Extremities ; Femur ; Follow-Up Studies ; Knee ; Leg ; Methods ; Pain, Postoperative ; Recurrence ; Tibia

BACKGROUND: Stunned myocardium may be mediated by intracellular Ca2+ overloading or oxygen derived-free radicals. Halothane and propofol have been shown to block Ca2+ channels. Propofol is also known to have antioxidant properties. The present study was aimed to investigate the effects of anesthetics on recovery of postischemic, reperfused myocardium in open-chest dogs. Incidence of ventricular arrhythmia upon ischemia and reperfusion was also determined. METHODS: Forty dogs were subjected to 15 min occlusion of left anterior descending coronary artery (LAD) followed by 3 hr reperfusion during halothane (n=10), fentanyl (n=12), or propofol plus fentanyl (n=11) anesthesia. Regional contractile function was assessed using percent systolic shortening (%SS), the preload recruitable stroke work slope (Mw), and peak systolic intramyocardial pressure (IMPs). Diastolic function was evaluated using time constant for isovolumic intramyocardial pressure decline of left ventricle (IMP-tau) and percent post-systolic shortening (%PSS). RESULTS: %SS in the halothane, fentanyl, and propofol-fentanyl groups was similar at 3 hours of reperfusion (58%, 60%, and 55% of baseline value, respectively). Moreover, Mw recovered to the baseline values in the early reperfusion period in all three groups. However, IMP-tau was significantly prolonged in the halothane group throughout the 3 hour reperfusion period, whereas it remained unchanged in the fentanyl and propofol-fentanyl groups. Coronary occlusion was associated with 9, 33, and 0% mortality rate due to ventricular fibrillation upon ischemia and reperfusion in the halothane, fentanyl, and propofol-fentanyl groups, respectively. CONCLUSION: These findings indicate that halothane, but not fentanyl and propofol- fentanyl, impairs myocardial relaxation, while recovery pattern of contractile function do not differ among three groups, and that halothane and propofol reduce reperfusion arrhythmia in the canine model of myocardial stunning.
Anesthesia* ; Anesthetics ; Animals ; Arrhythmias, Cardiac ; Coronary Occlusion ; Coronary Vessels ; Dogs* ; Fentanyl* ; Halothane* ; Heart Ventricles ; Incidence ; Ischemia ; Mortality ; Myocardial Stunning* ; Myocardium ; Oxygen ; Propofol ; Relaxation ; Reperfusion ; Stroke ; Ventricular Fibrillation

OBJECTIVE: We retrospectively analyzed survival, local control rate, and incidence of radiation toxicities after radiosurgery for recurrent metastatic brain lesions whose initial metastases were treated with whole-brain radiotherapy. Various radiotherapeutical indices were examined to suggest predictors of radiation-related neurological dysfunction. METHODS: In 46 patients, total 100 of recurrent metastases (mean 2.2, ranged 1-10) were treated by CyberKnife radiosurgery at average dose of 23.1 Gy in 1 to 3 fractions. The median prior radiation dose was 32.7 Gy, the median time since radiation was 5.0 months, and the mean tumor volume was 12.4 cm3. Side effects were expressed in terms of radiation therapy oncology group (RTOG) neurotoxicity criteria. RESULTS: Mass reduction was observed in 30 patients (65%) on MRI. After the salvage treatment, one-year progression-free survival rate was 57% and median survival was 10 months. Age (<60 years) and tumor volume affected survival rate (p=0.03, each). Acute (< or =1 month) toxicity was observed in 22% of patients, subacute and chronic (>6 months) toxicity occurred in 21%, respectively. Less acute toxicity was observed with small tumors (<10 cm3, p=0.03), and less chronic toxicity occurred at lower cumulative doses (<100 Gy, p=0.004). "Radiation toxicity factor" (cumulative dose times tumor volume of <1,000 Gyxcm3) was a significant predictor of both acute and chronic CNS toxicities. CONCLUSION: Salvage CyberKnife radiosurgery is effective for recurrent brain metastases in previously irradiated patients, but careful evaluation is advised in patients with large tumors and high cumulative radiation doses to avoid toxicity.
Brain ; Disease-Free Survival ; Humans ; Incidence ; Neoplasm Metastasis ; Radiosurgery ; Recurrence ; Retrospective Studies ; Survival Rate ; Tumor Burden

OBJECTIVE: The Histoculture Drug Response Assay (HDRA), which measures chemosensitivity using minced tumor tissue on drug-soaked gelfoam, has been expected to overcome the limitations of in vitro chemosensitivity test in part. We analyzed interim results of HDRA in malignant gliomas to see if the test can deserve further clinical trials. METHODS: Thirty-three patients with malignant gliomas were operated and their tumor samples were examined for the chemosensitivity to 10 chosen drugs by HDRA. The most sensitive chemotherapy regimen among those pre-established was chosen based on the number of sensitive drugs or total inhibition rate (IR) of the regimen. The response was evaluated by 3 month magnetic resonance image. RESULTS: Among 13 patients who underwent total resection of the tumor, 12 showed no evidence of disease and one patient revealed progression. The response rate in 20 patients with residual tumors was 55% (3 complete and 8 partial responses). HDRA sensitivity at the cut-off value of more than one sensitive drug in the applied regimen showed a sensitivity of 100%, specificity of 60% and predictability of 70%. Another cut-off value of >80% of total IR revealed a sensitivity of 100%, specificity of 69%, and predictability of 80%. For 12 newly diagnosed glioblastoma patients, median progression-free survival of the HDRA sensitive group was 21 months, while that of the non-sensitive group was 6 months (p=0.07). CONCLUSION: HDRA for malignant glioma was inferred as a feasible method to predict the chemotherapy response. We are encouraged to launch phase 2 clinical trial with chemosensitivity on HDRA.
Disease-Free Survival ; Gelatin Sponge, Absorbable ; Glioblastoma ; Glioma ; Humans ; Magnetic Resonance Spectroscopy ; Neoplasm, Residual ; Pilot Projects ; Sensitivity and Specificity

Patients with pain syndromes resulting from recurrent or metastatic cancer should be evaluated carefully to determine the cause of their pain and the need for appropriate antitumor treatment. The most effective ablative pain control procedure at the current time is cordotomy, which is indicated in patients with unilateral pain. The authors results of 12 antero-lateral thoracic cordotomies performed for intractable cancer pain between 1996-1998. The follow-up of these patients was continued for at least 12 months or until death to determine the late success of this procedure. Excellent surgical results were obtained in 100% after one week and in 50% in 6 months after operation. The operation was considered to be successful for patients with malignant disease of short life expectancy.
Cordotomy* ; Follow-Up Studies ; Humans ; Life Expectancy

BACKGROUND: The interpretation of electrocardiographic change in treadmill exercise test is difficult when the test is performed in patients with abnormal resting electrocardiography. In patients with primary nagative T wave, normalization of primary negative T wave(pseudonormalization)is not uncommon finding during treadmill exercise test. The mechanism of pseudonormalization is uncertain and the interpretation is difficult. Thus this study was performed to evaluate the diagnostic significance of pseudonormalization during treadmill exercise test. METHODS: 200 cases who showed primary negative T wave at rest were included in this study. The results were classified as positive, borderline positive, borderline negative, negative, non-diagnostic and pseudonormalization. RESULTS: Pseudonormalization during treadmill exercise test was oberved in 78(39%) of the 200 cases who had primary negative T wave at rest. Coronary angiography and left ventriculography were performed in 13(mean age 56+/-7 year, male vs. female 1:2.25) of 78 cases who showed pseudonormalization during exercise. They had no history of acute myocardial infarction and no abnormalities such as abnormal Q wave, left ventricular hypertrophy,bundle branch block,right ventricular hypertrophy and QRS widening above 0.1ms in resting electrocardiography. There were significant stenosis in only 3 cases; 2 cases in left anterior descending coronary artery and 1 case in right coronary artery. CONCLUSION: In treadmill exercise tests, pseudonormalization appears as non-specific finding for the diagnosis of ischemic heart disease becuase it is observed in either patients with or without coronary artery stenosis.
Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Exercise Test* ; Female ; Humans ; Hypertrophy ; Male ; Myocardial Infarction ; Myocardial Ischemia*

The authors present a series of 35 patients who underwent operation for metastatic spinal tumor. Patients were operated via anterior, posterior or posterolateral and combined anterior-posterior approach. The anterior approach was used in cases where there was no involvement of the posterior column, tolerable of a thoracotomy and involvement of three or less adjacent vertebral bodies. The posterior or posterolateral approach was used in cases with involvement of the posterior column, disease at two seperated locations, intolerable of a thoracotomy and involvement of three columns. The combined anterior-posterior approach was used when it was not enough to obtain stabilization with anterior or posterior approach alone and expected greater than 1 year life expectancy. Twenty-five(89%) of the 28 patients improved neurologically following surgery. Average neurologic improvement was 1.3 Frankel grade. Pain relief was obtained in twenty-six(93%) of the 28 patients. Recovery of spincter change was obtained twelve(80%) of the 15 patients. Two patients died postoperatively due to DIC and pneumonia. Prior to operation, selective spinal angiography and embolization were performed in nine patients with metastases from renal carcinoma, thyroid cancer and hepatoma to reduce intraoperative bleeding. The authors believe that the choice of surgical approach has to be individualized for each patient depending on extent and location of the tumor, general condition of patient, goal of therapy and life expectancy.
Angiography ; Carcinoma, Hepatocellular ; Dacarbazine ; Hemorrhage ; Humans ; Life Expectancy ; Neoplasm Metastasis ; Pneumonia ; Thoracotomy ; Thyroid Neoplasms

The authors present a series of 12 patients who underwent one-stage spondylectomy, vertebral reconstruction, posterior segmental stabilization for malignant metastatic disease. Major indication for this approach includes three column involvement or untolerable thoracotomy. This operative method involved the spondylectomy via a bilateral transpedicular or unilateral extracavitary approach, vertebral body reconstruction with methlymethacrylate (MMA), and posterior stabilization with sublaminar wiring in one stage. Postoperatively, all patients improved neurologically. Average neurologic improvement was 1.5 Frankel grade. Pain relief was obtained in all patients. Recovery of sphincter change was obtained 7(88%) of the 8 patients. One patient died postoperatively due to pneumonia. Spinal alignment was maintained in all. The major advantage of this approach is that circumferential decompression of the spine and stabilization can be obtained safely by one stage.
Decompression ; Humans ; Neoplasm Metastasis* ; Pneumonia ; Spine ; Thoracotomy

PURPOSE: To examine the danger zone of mesial root of mandibular first molar of patient without extraction using CBCT(cone -beam computed tomography) to avoid the risk of root perforation. MATERIALS AND METHODS: 20 mandibular first molars without caries and restorations were collected. CT images were obtained by CBCT(PSR9000N TM, Asahi Roentgen Co., Japan), reformed and analyzed by V-work 5.0 (CyberMed Inc., Korea). Distance between canal orifice and furcation was measured. In cross sectional images at 3, 4 and 5 mm below the canal orifice, distal wall thickness of mesiobuccal canal (MB-D), distal wall thickness of mesiolingual canal (ML-D), distal wall thickness of central part (C-D), mesial wall thickness of mesiobuccal canal (MB-M) and mesial wall thickness of mesiolingual canal (ML-M) were measured. RESULTS: The mean distance between the canal orifice and the furcation of the roots is 2.40 mm. Distal wall is found to be thinner than mesial wall. Mean dentinal wall thickness of distal wall is about 1 mm. The wall thickness is thinner as the distance from the canal orifice is farther. But significant differences are not noted between 4 mm and 5 mm in MB-D and C-D. MB-D is thinner than ML-D although the differences is not significant. CONCLUSION: The present study confirmed the anatomical weakness of distal surface of the coronal part of the mesial roots of mandibular first molar by CBCT and provided an anatomical guide line of wall thickness during endodontic treatment.
Cone-Beam Computed Tomography* ; Dentin ; Humans ; Molar*