No abstract available.
Angiomyolipoma* ; Tuberous Sclerosis*

PURPOSE: To evaluate the long-term results of treatment of epiphyseal fractures of the distal radius in children. MATERIALS AND METHODS: 23 cases of distal radial epiphyseal fracture, treated by two methods: group 1, closed reduction (CR) plus cast (6 cases); group 2, CR and K-wire fixation (under anesthesia due to marked translation of the distal fragment and swelling) plus cast (17 cases), were selected for this study. All patients were followed up for more than 1 year (average: 3.2 years). Postoperatively, epiphyseal displacement and epiphyseal angulation were measured on anteroposterior and lateral radiographs. At follow-up, the affected and normal sides were compared. Final results were classified by radiologic (radial inclination, volar tilting and radial shortening) and clinical (limitation of ROM, wrist pain, grip strength and wrist deformity) criteria. RESULTS: Group 1 had 5 good, 1 fair result; group 2 had 14 good, 2 fair and 1 poor - there was no statistically significant difference between two groups. All cases where the epiphyseal displacement was less than 30% had good results. A poor case showed a radial shortening, wrist deformity and pain due to premature epiphyseal closure. Premature epiphyseal closure was treated by bar resection and free fat, along with corrective osteotomy when necessary and lengthening of radius with or without epiphysiodesis of the ulna. CONCLUSION: Remodeling can be expected in epiphyseal fractures of the distal radius. Repeated forceful attempts to achieve accurate reduction should be avoided to prevent secondary physeal injury.
Anesthesia ; Child ; Congenital Abnormalities ; Displacement (Psychology) ; Follow-Up Studies ; Hand Strength ; Humans ; Osteotomy ; Radius ; Wrist

PURPOSE: At cystoscopy, bladder cancer shows various presentations; these are papillary, flat, elevated and ulcerated. Erythematous lesions could be carcinoma in situ (CIS), cancer or benign lesion, so biopsy should be done to exclude malignancy. However, this might cause many problems such as bleeding, inflammation and the added cost. The objectives of this study were to evaluate the significance of erythematous lesion biopsy at cystoscopy and to identify the factors related to the detection of bladder cancer. MATERIALS AND METHODS: From January 1999 to June 2006, 337 biopsies were taken from the erythematous lesions seen at cystoscopy. We reviewed the pathologic results of the erythematous lesions. We also investigated the patients' histories of bladder cancer, the urine cytology performed at cystoscopy, the intravesical therapy for bladder cancer and the complications after biopsy. A logistic regression analysis was performed to determine the factors associated with the diagnosis of bladder cancer. RESULTS: In 337 erythematous lesion biopsies, malignancy was found in 36 (10.9%), and 19 of 36 (52.8%) were CIS. Among the benign lesions, chronic cystitis was most common. Bladder cancer was detected more often in patient with a history of transitional cell carcinoma (TCC) and in patients over the age of 65 years. Especially, a history of TCC was an independent risk factor for bladder cancer [odds ratio: 2.974, 95% confidence interval (CI): 1.163-7.604]. After biopsy, hematuria that was needed management occurred in 3.6% of the lesions. CONCLUSIONS: Erythematous lesion biopsy yields a positive finding of malignancy in 10.9% of the lesions and could be a valuable exam, particularly for the follow-up for TCC, and for patients over the age of 65 years.
Biopsy* ; Carcinoma in Situ ; Carcinoma, Transitional Cell ; Cystitis ; Cystoscopy* ; Diagnosis ; Follow-Up Studies ; Hematuria ; Hemorrhage ; Humans ; Inflammation ; Logistic Models ; Risk Factors ; Ulcer ; Urinary Bladder Neoplasms

Liposarcoma in esophagus is rare, moreover the pedunculated form is very rare. We experienced a case of liposarcoma in a 36-year-old man who had intermittent swallowing difficulty for 7 months. Endoscopy and esophagography revealed that a smooth longitudinal tumor mass occupied the esophageal lumen. Esophagotomy and surgical excision was done. The tumor was 4 cm in length and 3 cm in average diameter with an obvious stalk measuring 3.5 cm in length and 1.5 cm in diameter. Microscopic examination disclosed a lipoma with focal ulceration and liposarcomatous change infiltrating into interstitial fibrous tissue at its distal end.
Adult ; Deglutition ; Endoscopy ; Esophagus* ; Humans ; Intestines* ; Lipoma ; Liposarcoma* ; Stomach* ; Ulcer

OBJECTIVE: Notochordal cells in the intervertebral disc interact with nucleus pulposus (NP) cells and support the maintenance of disc homeostasis by regulation of matrix production. However, the influence of notochordal cells has not been evaluated in the annulus fibrosus (AF), which is the primary pain generator in the disc. We hypothesized that the notochordal cell has the capacity to modulate inflammatory mediators secreted by AF cells secondary to stimulation. METHODS: Notochordal and AF cells were isolated from adult New Zealand white rabbits. AF pellets were cultured with notochordal cell clusters or in notochordal cell-conditioned media (NCCM) for 24 or 48 hours with proinflammatory cytokines at varying concentrations. Gene expression in AF pellets were assayed for nitric oxide synthase (iNOS), cyclo-oxygenase (COX)-2, and interleukin (IL)-6 by real time reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: AF pellet in NCCM significantly decreased the iNOS and COX-2 messenger ribonucleic acid (mRNA) levels compared to AF pellets alone and AF pellets with notochordal cells (p < 0.05). AF pellet resulted in dose-dependent iNOS and COX-2 expression in response to IL-1beta, stimulation, demonstrating that 1 ng/ml for 24 hours yielded a maximal response. AF pellet in NCCM significantly decreased the expression of iNOS and COX-2 in response to 1ng/ml IL-1beta, stimulation at 24 hours (p < 0.05). There was no difference in IL-6 expression compared to AF pellets alone or AF pellets with notochordal cell clusters. CONCLUSION: We conclude that soluble factors from notochordal cells mitigate the gene expression of inflammatory mediators in stimulated AF, as expected after annular injury, suggesting that notochordal cells could serve as a novel therapeutic approach in symptomatic disc development.
Adult ; Cytokines ; Gene Expression ; Homeostasis ; Humans ; Interleukin-6 ; Interleukins ; Intervertebral Disc ; Nitric Oxide Synthase ; Notochord ; Prostaglandin-Endoperoxide Synthases ; Rabbits ; Reverse Transcriptase Polymerase Chain Reaction ; RNA

PURPOSE: The incidence of retinopathy of prematurity(ROP) which is one of the most common cause of childhood blindness has not decreased despite the restricted use of oxygen. There may be other factors responsible for ROP which could not be explained solely by improved survival of very low birth weight infants. We tried to clarify perinatal risk factors that are nrelated to the occurrence of ROP. METHODS: We enrolled 239 infants with gestational ages less than 33 wks or with birth weight less than 1,800 gm who had received ophthalrnologic examination between Jan. 1995 and Dec. 1997. The patients were categorized into two groups,' "No ROP" group as control(n=185) and ROP group as study population(n=54), and we compared the perinatal risk factors between the two. RESULTS: 54(22.6%) out of 239 infants were diagnosed as having ROP. The annual incidence of ROP decreased but the incidence of treated ROP increased. The incidence of ROP decreased with longer gestation and higher birth weight. Mean gestational age was 30.3 weeks in the study group vs 31.0 weeks in the control group, and mean birth weight was 1,390 gm and 1,586 gm, respectively. Significant factors contributing to increased incidence of ROP included: duration of oxygen therapy, ventilator therapy, total parenteral nutrition and hospitalization, frequency of hyperoxia, hypercarbia, and transfusion and respiratory distress syndrome, umbilical artery catheterization, intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, use of dexamethasone and aminophylline, pneumonia, air leak syndrome, and hyperglycemia. The incidence of ROP and treated ROP was not influenced by the mode of surfactant treatment(prophylactic vs rescue) in RDS patients and the mode of dexamethasone treatment(short vs long) in BPD patients. CONCLUSION: The risk factors for retinopathy of prematurity included gestational age, birth weight and duration of oxygen, as well as other aforementioned perinatal factors. The occurrence of ROP can be decreased by preventing preterm birth, minimizing the use of oxygen, and further morbidity can be prevented by performing proper ophthalmologic examination and doing an appropriate follow-up.
Aminophylline ; Birth Weight ; Blindness ; Bronchopulmonary Dysplasia ; Catheterization ; Catheters ; Dexamethasone ; Gestational Age ; Hemorrhage ; Hospitalization ; Humans ; Hyperglycemia ; Hyperoxia ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Oxygen ; Parenteral Nutrition, Total ; Pneumonia ; Pregnancy ; Premature Birth ; Retinopathy of Prematurity* ; Risk Factors* ; Sepsis ; Umbilical Arteries ; Ventilators, Mechanical

PURPOSE: The association between iron deficiency anemia and febrile convulsion in infants has been examined in several studies with conflicting results. Therefore, the authors aimed to evaluate the precise relationship involved. METHODS: In this case-control study, the authors assessed 100 children with a diagnosis of febrile convulsion, aged between 9 months and 2 years, during January 2007 to July 2009. The control group consisted of 100 febrile children without convulsion; controls were closely matched to the cases by age, gender, and underlying disease. RESULTS: The mean ages of the febrile convulsion and control group were 16.3+/-7.4 and 15.8+/-6.1 months, respectively, and the two groups had no differences in clinical features. Iron deficiency anemia (Hb <10.5 gm/dL) was more frequent in the febrile convulsion group than in the control group, although there was no statistical significance. Unexpectably, the RDW (red blood cell distribution width) was significantly lower and the MCNC (mean corpuscular hemoglobin concentration) was significantly higher among seizure cases than among the controls (P<0.05). There is no statistical difference between simple and complex febrile groups in the clinical and laboratory profiles. On multiple logistic regression analysis, iron deficiency anemia was more frequent, but the RDW was lower, among the cases with febrile convulsion, compared with the controls. Conclusions: Our study suggests that the iron deficiency anemia is associated with febrile convulsion, and screening for iron deficiency anemia should be considered in children with febrile convulsions.
Aged ; Anemia, Iron-Deficiency ; Blood Cells ; Case-Control Studies ; Child ; Hemoglobins ; Humans ; Infant ; Iron ; Logistic Models ; Mass Screening ; Seizures ; Seizures, Febrile

PURPOSE: Recurrent groin hernias are a significant problem with high recurrence rates. There is a great deal of controversy regarding their management. This study examined the outcome of patients who had undergone a repair of recurrent groin hernias. METHODS: This study examined retrospectively the medical records of all patients who underwent repairs of recurrent groin hernias (a total 239 cases) between January 1998 and December 2006. The repair was tailored to the previous operation and the patients' medical condition. The types of previous operations, present operation, complications and re-recurrence rate were analyzed. RESULTS: Of the 2,542 groin hernias operated on, 239 cases (9.4%) were treated for recurrent groin hernias. The types of previous surgery were conventional open tissue repair in 199 cases (83.3%), Lichtenstein repair in 28 cases (11.7%), open mesh repair (PHS, Perfix plug) in 6 cases (2.5%) and laparoscopic repair in 6 cases (2.5%). The recurrent groin hernias were repaired using a laparoscopic method in 123 cases (51.4%), open mesh repair in 92 cases (38.4%), Lichtenstein repair in 18 cases (7.5%) and a conventional open tissue repair in 6 cases (2.5%). Postoperative complications occurred in 40 cases (16.7%), which included 10 seromas, 4 wound infections, 3 hematomas, 2 wound swellings, 8 scrotal swelling, 5 dysurias, 2 chronic neuralgias. There were 6 cases of re-recurrence in the 239 cases of recurrent groin hernias (2.5%). CONCLUSION: A tailored approach based on the previous repair and the medical condition of the patients with recurrent groin hernias is associated with a decrease in the incidence of major postoperative complications and a low recurrence rate (2.5%).
Dysuria ; Groin ; Hematoma ; Hernia ; Humans ; Incidence ; Medical Records ; Neuralgia ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Seroma ; Wound Infection

BACKGROUND: Isobaric bupivacaine has same baricity as cerebrospinal fluid and therefore, so it remains at the level of injection. But, the risk of high spinal anesthesia exist, because increased intrathecal pressure is possible in prone position as isobaric bupivacaine has mild hypobaricity at body temperature but is isobaric at room temperature. So, we studied the influence of the position of the blockade of spinal anesthesia in isobaric spinal anesthesia. METHODS: We studied 26 patients undergoing elective surgery for which spinal anesthesia was considered appropriate. One group (the P group) were scheduled for surgery in the prone position with a frame (n = 13), the second group (the S group) were scheduled for surgery in the supine position (n = 13). Patients were injected with 12 mg of 0.5% isobaric bupivacaine at L3-4 in the lateral decubitus position with a 22 G spinal needle at the rate of 0.2 ml/sec. We then assessed anesthetic blockade level, heart rate, and blood pressure. RESULTS: The height of the sensory block in the prone position group was at the 10th thoracic dermatome, whereas in the supine position this was at the 8th thoracic dermatome at 15 minutes. There was a little difference between the two groups, but this was insignificant statistically. CONCLUSIONS: Both the supine and the prone positions are suitable for isobaric spinal anesthesia with bupivacaine. Isobaric spinal anesthesia in the prone position with a frame is as safe as in the supine position. Spinal anesthesia with isobaric bupivacaine is considered to have a low risk of high spinal anesthesia and a low complication level in the prone position with a frame, as for the supine position.
Anesthesia, Spinal* ; Blood Pressure ; Body Temperature ; Bupivacaine* ; Cerebrospinal Fluid ; Heart Rate ; Humans ; Needles ; Prone Position* ; Supine Position

Trigeminal neuralgia is a disease of intermittent short lasting facial pain but most severe pain from which mankind suffers. It's treatment usually depends on medication, microvascular decompression surgery, and nerve block such as trigeminal nerve block, retrogasserrian ganglion block and radiofrequency destruction of gasserian ganglion. Here we report two cases performed radiofrequency(RF) thermocoagulation with TEW-TC cannular in a recurred trigeminal neuralgia patient after microvascular decompression and an inoperable patient due to hypertensive cerebral infarction. After the paresthesia and masseter muscle contracture test at 50 Hz - 0.2 volt and 2 Hz - 0.6 volt respectively, RF lesionings were performed for 60 sec at 60oC and 60 sec at 65oC. One patient got relief of pain completely and has been achieved over 8 months with mild hypoesthesia on face and the other patient got incomplete pain relief without hypoesthesia even though has satisfied over 7 months. Radiofrequency thermocogulation is a safe procedure that can be well controlled and less invasive even though inoperable or recurred trigeminal neuralgia patient.
Cerebral Infarction ; Contracture ; Electrocoagulation* ; Facial Pain ; Ganglion Cysts ; Humans ; Hypesthesia ; Masseter Muscle ; Microvascular Decompression Surgery ; Nerve Block ; Paresthesia ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia*