The proposed factors that affect the prognosis of osteosarcoma are the patient's age, site and size of the primary lesion, pathologic features(type and grade), duration of symptoms, spread of disease (local or regional extension, distant metastasis) at diagnosis, the patient's sex, serum alkaline phos- phatase(ALP) and lactic dehydrogenase(LDH) levels, chromosomal number or DNA index, response to initial chemotherapy, location of the lesion on the bone, presence or absence of pathologic fracture, and mode of therapy. The purpose of this study is to analyze the factors that affect the 5-year survival rates of osteosarcoma. Total 25 patients were included in this study who had treated form Jan. 1988 to Apr. 1994. The overall 5-year survival rate of 25 patients was 65.43%, and the 5-year survival rates were sig- nificantly higher(P < 0.1) in the groups in which limb salvage operation with neoadjuvant chemothera- py were performed(66.67%), with longer duration of symptoms(>2 months; 83.33%), with lower serum level of LDH( < 300 U/L; 100%), and with smaller mass size( < 10cm; 72.92%). However there were no significant differences in the 5-year survival rates according to age and sex of the patients. We also suggest that the better prognosis will be observed in the patients with the favorable radiologic response to the preoperative chemotherapy.
Diagnosis ; DNA ; Drug Therapy ; Fractures, Spontaneous ; Humans ; Limb Salvage ; Osteosarcoma ; Prognosis ; Survival Rate

The aims of treatment of children with CDH untreated until walking age should be to reestablish the mechanics of the hip joint and avoid complications, especially avascular necosis, thus delaying the devlopment of osteoarthritis. In the child who is first seen between the ages of one and three years, considerable controversy still exists as to the merit of closed versus operative management. The average 29.3 months follow-up results in fifty congenitally dislocated hips in forty-five children with were between six and thirty-six months old when treatment was begun have been reviewed at the Department of Orthopaedic Surgery, In Je University, College of Medicine, Paik Hospital from June, 1979 to Aug, 1989. The results of this study were as follows: 1. Factors affecting method of treatment were age, degree of dislocation and acetabular index; A. Age 1) The children below ages of 18 months were treatment by closed reduction. 2) The children below ages of 18 months were treatment by open reduction with concomittant procedures. B. Degree of dislocation: Open reduction was more frequently reguired in higher degree of dislocation. C. Acetabular index: It was little influenced on method of treatment. 2. The complications were persisten subuxation (3 cases), temporary irregular ossification (16 cases) and avascular necrosis (1 cases).
Acetabulum ; Child ; Dislocations ; Follow-Up Studies ; Hip ; Hip Joint ; Humans ; Mechanics ; Methods ; Necrosis ; Osteoarthritis ; Walking

Thoracic disc herniation is an uncommon cause of thoracic cord compression. Herniation in this region is of particular importance because of the serious disorders of nervous function which result from anterior compresstion of the spinal cord. Early diagnosis and prompt surgical treatment are imperative because of the progressive and serious neurological deficit which results from delay. Numerous problems remain as to the safest surgical approach to the prolapsed thoracic intervertebral disc. We treated a case of herniated intervertebral disc occuring at Tll–T12 using the anterior approach. The result was favourable.
Early Diagnosis ; Intervertebral Disc ; Spinal Cord

Indocyanine green (ICG) could be applied for multiple functions such as fluorescent tumor localization, fluorescence lymph node mapping (FLNM), and intraoperative angiography in colorectal cancer surgery. With the near-infrared (NIR) systems, colonoscopic ICG tattooing can be used to define the early colorectal cancer that cannot be easily distinguished through the serosal surface. The lymphatic pathways can be visualized under the NIR system when ICG is injected through the submucosal or subserosal layer around the tumor. Intraoperative ICG angiography can be applied to find a favorable perfusion segment before the colon transection. Although all fluorescence functions are considered essential steps in image-guided surgery, it is difficult to perform multifunctional ICG applications in a single surgical procedure at once because complex protocols could interfere with each other. Therefore, we review the multifunctional ICG applications for fluorescent tumor localization, FLNM, and ICG angiography. We also discuss the optimal protocol for fluorescence-guided colorectal surgery.

Indocyanine green (ICG) could be applied for multiple functions such as fluorescent tumor localization, fluorescence lymph node mapping (FLNM), and intraoperative angiography in colorectal cancer surgery. With the near-infrared (NIR) systems, colonoscopic ICG tattooing can be used to define the early colorectal cancer that cannot be easily distinguished through the serosal surface. The lymphatic pathways can be visualized under the NIR system when ICG is injected through the submucosal or subserosal layer around the tumor. Intraoperative ICG angiography can be applied to find a favorable perfusion segment before the colon transection. Although all fluorescence functions are considered essential steps in image-guided surgery, it is difficult to perform multifunctional ICG applications in a single surgical procedure at once because complex protocols could interfere with each other. Therefore, we review the multifunctional ICG applications for fluorescent tumor localization, FLNM, and ICG angiography. We also discuss the optimal protocol for fluorescence-guided colorectal surgery.

BACKGROUND: Laryngoscopy and endotracheal intubation are potent stimuli that increase heart rate and blood pressure. Especially, hypertensive patients are more prone to have significant increase in heart rate and blood pressure and cardiac complications such as arrythmia, myocardial ischemia and infarction can lead to fatal situation. This study was designed to evaluate the effectiveness of different dosage of propofol on cardiovascular responses to tracheal intubation in hypertensive patients. METHODS: Sixty hypertensive patients, ASA PS 1 or 2, scheduled for elective surgery were selected randomly. They were divided into three groups(Group 1: propofol 2.0 mg/kg, Group 2: propofol 2.5 mg/kg, Group 3: propofol 3.0 mg/kg, n=20 in each group). Induction of Anesthesia was started with propofol 2.0 mg/kg(Group 1), 2.5 mg/kg(Group 2), 3.0 mg/kg(Group 3) and succinylcholine(1 mg/kg). After tracheal intubation, pancuronium bromide 0.08 mg/kg was injected, 50 % nitrous oxide in oxygen and 2 % enflurane were inhaled. Using noninvasive automatic blood pressure monitor(CRITIKON DINAMAP TM 1846SX, USA), blood pressure(systolic, diastolic, and mean arterial pressure) and heart rate were measured at 4 points; 1) as the control value, on arrival to operating room, 2) 1 minute after tracheal intubation, 3) 3 minutes after intubation, 4) 5 minutes after intubation. RESULTS:In group 3, systolic, diastolic pressure and mean arterial pressure at 1 minutes, 3 minutes, 5 minutes after intubation were less increased than group 1, 2 and blood pressure response was more effectively blunted than heart rate response CONCLUSIONS: we suggested that 3.0 mg/kg of propofol for the induction of anesthesia could blunt hemodynamic changes caused by laryngoscopy and endotracheal intubation in hypertensive patients, but we had to give attention to the side effect until postoperative period.
Anesthesia ; Anesthetics ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Pressure ; Enflurane ; Heart Rate ; Hemodynamics ; Humans ; Infarction ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Myocardial Ischemia ; Nitrous Oxide ; Operating Rooms ; Oxygen ; Pancuronium ; Postoperative Period ; Propofol*

PURPOSE: Dexamethasone is a well-known treatment for preterm infants with bronchopulmonary dysplasia. However, serious side effects have been identified, including hypertension, and cardiac hypertrophy. This study was undertaken to examine whether dexamethasone induced cardiac hypertrophy in preterm infants with bronchopulmonary dysplasia. METHODS: We retrospectively reviewed 12 infants with bronchopulmonary dysplasia treated with dexamethasone at Korea University Hospital from August 1995 to February 1999. Serial two-dimensional and M-mode echocardiographic measurements were taken before treatment and at 1,2,3,4,5 weeks after the start of dexamethasone therapy. RESULTS: Patients receiving dexamethasone had a significantly increase in interventricular septal thickness and left ventricular posterior wall thickness. These effects were transient, reached their maximal degree by the third week of treatment, and approached pretreatment conditions by the fifth week of treatment. Heart rate was increased but statistically not significant. The fractional shortening, systolic and diastolic arterial pressure were transiently increased during dexamethasone therapy. CONCLUSION: We conclude that a transient myocardial hypertrophy is associated with dexamethasone therapy in infants with bronchopulmonary dysplasia. Follow up of careful echocardiac monitoring should be considered in infants with dexamethasone therapy.
Arterial Pressure ; Bronchopulmonary Dysplasia ; Cardiomegaly* ; Cardiomyopathy, Hypertrophic* ; Dexamethasone* ; Echocardiography ; Follow-Up Studies ; Heart Rate ; Humans ; Hypertension ; Hypertrophy* ; Infant ; Infant, Newborn ; Infant, Premature* ; Korea ; Retrospective Studies

PURPOSE: Transcatheter closure of the patent ductus arteriosus (PDA) is a well established alternative to surgical treatment. The aim of this study was to analyze safety, efficacy and follow up results of percutaneous closure of a moderate-to-large sized PDA. METHODS: Between November 1999 and October 2004, eighty-two patients underwent attempted transcatheter closure of a moderate to-large sized PDA. Age at intervention ranged from 9 months to 68 years (18.4+/-18.3 years). Body weight ranged from 7.8 kg to 74 kg (34.0+/-21.3 kg). RESULTS: The mean PDA diameter was 4.5+/-1.3 mm. The type of PDA was conical (72 patients), tubular (9 patients), other (1 patient, dumbbell shape). The devices used were Amplatzer Ductal Occluder (ADO(R), 64 cases), Detachable Coil (14 cases), and Duct Occlud (3 cases). Total complete closure rate was 93%. Complete closure was achieved in 58 patients (78%) at the end of procedure, 8 patients (11%) at 1week, 4 patients (5%) at 1 month, and 4 patients (5%) at 1 year, respectively. A residual shunt was present in three patients (4%). Complications occurred in eight patients: stenosis of left pulmonary artery (4 patients), hemolytic anemia (2 patients), infective endocarditis (1 patient), and device embolization (1 patient). CONCLUSION: Transcatheter closure of a moderate to-large sized PDA using the device is a safe and effective treatment with a favorable short and mid-term results. For optimal results, appropriate devices should be selected in relevance to PDA morphology and diameter, age, body weight, and +++economical factor.
Anemia, Hemolytic ; Body Weight ; Constriction, Pathologic ; Ductus Arteriosus, Patent* ; Endocarditis ; Follow-Up Studies ; Humans ; Pulmonary Artery

OBJECTIVE: The purpose of this study is to identify correlations between diffusion tensor imaging(DTI) and motor improvement by quantifying and visualizing the corticospinal tract on DTI to predict motor impairment in patients with hypertensive intracerebral hemorrhage(ICH). METHODS: Fifteen normal subjects and 7 patients with hypertensive ICH were examined and the latter were treated surgically. DTI was performed with a 3.0 T MRI. The region of interest(ROI) from the posterior limbs of both internal capsules was measured on a fractional anisotropy(FA) map, and the ratios of ROIs were calculated. Tractography, 3-dimensional DTI was then constructed. Motor impairment was assessed on admission and 2weeks after stroke by the Motricity Index(MI). The FA ratio, tractography and score on MI were analyzed for correlations. RESULTS: The FA ratio from the initial DTI did not show a linear correlation with motor impairment. However, after 2weeks, patients with high FA ratios showed high degrees of motor recovery, regardless of the initial severity, and patients with low FA ratios showed low recovery rates. Otherwise, a relationship between the amount of hematoma and the degree of motor recovery could not be determined. On tractography, injury of the corticospinal tract could be visualized and estimated 3-dimensionally. CONCLUSION: FA ratio analysis and tractography constructed from DTI may be useful in understanding corticospinal tract injury and in predicting the recovery from motor impairment in patients.
Diffusion Tensor Imaging* ; Diffusion* ; Extremities ; Hematoma ; Humans ; Internal Capsule ; Intracranial Hemorrhage, Hypertensive* ; Magnetic Resonance Imaging ; Pyramidal Tracts* ; Stroke

OBJECTIVE: To assess the clinical usefulness of ultrasonography for the diagnosis of mild and very mild carpal tunnel syndrome. METHOD: Ultrasonographic evaluation was performed in 39 hands of 29 patients with mild and very mild carpal tunnel syndrome according to Bland's neurophysiologic grading scale. Controls included 41 hands of 34 subjects without electrophysiologic evidence of carpal tunnel syndrome. Ultrasonographic findings were evaluated quantitatively with regard to the cross-sectional area, the flattening ratio, the swelling ratio of the median nerve, and palmar displacement of the flexor retinaculum. The analysis of differences between controls and patients group were done by independent t-test. Cut-off values using receiver operation characteristic, were calculated. RESULTS: Patients had significantly increased cross sectional area and flattening ratio of the median nerve at proximal carpal area, palmar displacement of the flexor retinaculum at proximal carpal area. A critical value of equal or higher to 8.5 mm(2) for cross-sectional area at the pisiform level showed a sensitivity 79.5%, a specificity of 95.1%, which had most diagnostic value compared with the value of cross-sectional area at the distal radius level, flattening ratio at the pisiform level and palmar displacement. CONCLUSION: Ultrasonography was useful in the diagnosis of mild and very mild carpal tunnel syndrome.
Carpal Tunnel Syndrome ; Displacement (Psychology) ; Hand ; Humans ; Median Nerve ; Radius ; Sensitivity and Specificity