Percutaneous vertebroplasty is a relatively recent procedure in the treatment of osteoporotic vertebral compression fractures. Bone cement embolism is a severe and potentially life-threatening complication of percutaneous vertebroplasty with cement. The risk for cement pulmonary embolism ranges between 3.5 and 23% for osteoporotic fractures. Bone cement leakage may be usually more frequent with vertebroplasty than with kyphoplasty. We experienced a 69-year-old female patient of an asymptomatic pulmonary embolus (length 8 cm) after kyphoplasty for an osteoporotic vertebral compression fracture
Aged ; Embolism ; Female ; Fractures, Compression ; Humans ; Kyphoplasty ; Osteoporotic Fractures ; Pulmonary Embolism ; Vertebroplasty

Ratio analysis allows a hospital to evaluate its own performance over time and to compare its performance with that of other hospitals. For this study, three types of ratio analysis were conducted based on some data on hospitals in Massachusetts. First, Key ratios influencing financial performance were identified using discriminant analysis. Second, the financial structures of the teaching and the non-teaching hospitals were compared using ratios and multiple comparison method. Third, the effects of the prospective reimbursement law of the state on financial performance were examined using ratios and paired t-test. The purpose of the law is to reduce hospital costs by setting the revenue ceiling prior to the effective budget year. The findings of this study were as follows: 1) When hospitals were divided into three groups, according to their operating income, only profitability ratios showed a consistent difference among the groups. 2) In the discriminant analysis, five ratios were selected: current ratio, operating margin, return on assets, fixed assets turnover, and inventory turnover. They are the key ratios to be monitored periodically for the purpose of evaluating the financial performance of hospitals. 3) When teaching hospitals were compared with non-teaching hospitals, acid ratio, days of cash on hand, and inventory turnover were statistically significant before the law went into effect, whereas only fixed assets turnover and inventory turnover were significant afterward. Contrary to previous studies, profitability ratios of teaching hospitals were higher than those of non-teaching hospitals, although the differences were not statistically significant. 4) When the ratios between the two periods (before and after the law) were compared, three profitability ratios (operating margin, return on assets, and return on equity) were significant for teaching hospitals, whereas three activity ratios (total assets turnover, fixed assets turnover, current assets turnover) were significant for non-teaching hospitals. Furthermore, while both total operating revenue and expenses were decreased, net operating income was increased, due to a greater decrease in total operating expenses. This shows that the law can indeed, simultaneously, achieve both a reduction in costs as well as improvement in the financial situation of hospitals.
Budgets ; Hand ; Hospital Costs ; Hospitals, Teaching ; Jurisprudence ; Massachusetts ; Prospective Payment System

Nodular cystic fat necrosis, first described by Przyjemski and Schuster, is a peculiar form of encapsulated necrosis of subcutaneous fat characterized by totally or near-totally encapsulated necrosis of fatty tissue in which clusters of nonviable adipocytes are surrounded by condensed fibrous tissue. We report two cases of nodular cystic fat necrosis associated with history of trauma about the site of the lesion. Each lesion was a subcutaneous movable nodule on buttock (case 1) and shin (case 2) which has evolved over months. Both cases showed possible relation to multiple intramuscular injection or direct trauma injury. Pathologically, encapsulated nodule showed a characteristic feature of nodular cystic fat necrosis which composed of the ghosts of anucleated adipocytes showing fairly well-preserved outline.
Adipocytes ; Adipose Tissue ; Buttocks ; Fat Necrosis* ; Injections, Intramuscular ; Necrosis ; Subcutaneous Fat

No abstract available.
Mitral Valve* ; Quinidine*

Paragonimiasis caused by Paragonimus westermani is essentially a pulmonary disorder, but it is also known to cause ectopic parasitism at various sites in human host such as the brain, muscle, liver, spinal cord and spleen. Ectopic parasitism of the female genital tract, especially the ovary is relatively rare. We have experienced a case of a 62-year-old Korean woman with asymptomatic ectopic paragonimiasis in the salpinx , ovary, and cul de sac.
Female ; Humans

Amelanotic melanoma comprises only 1.8~8.1% of malignant melanomas, and is difficult to diagnose clinically due to the lack of the diagnostic evidence of clinical pigmentation. To our knowledge, it is rarely reported, and only 10 cases have been reported in the Korean dermatological literature. It presents rather conflicting features such as a pink or red macule, papule, plaque, or nodule mimicking various benign and malignant conditions; therefore, it is difficult to diagnose. We performed a review of six patients with amelanotic melanoma focusing on differential diagnosis, particularly at the time of the initial visit. Clinical impressions included pyogenic granuloma, dermatofibrosarcoma protuberans, eccrine poroma, epidermal cyst, keloid, pilomatricoma, and squamous cell carcinoma in addition to malignant melanoma. The biopsy specimens were consistent with malignant melanoma with little or no melanin pigment on hematoxylin and eosin and Fontana-Masson stains. Four of the six patients were positive for S-100 and HMB-45, but two patients were positive for S-100 only. We report these cases to remind clinicians of the necessity of including malignant melanoma in the differential diagnosis process when patients show poor and unpredictable responses to treatment after a clinical diagnosis of other benign and malignant conditions.
Biopsy ; Carcinoma, Squamous Cell ; Coloring Agents ; Dermatofibrosarcoma ; Diagnosis ; Diagnosis, Differential* ; Eosine Yellowish-(YS) ; Epidermal Cyst ; Granuloma, Pyogenic ; Hematoxylin ; Humans ; Keloid ; Melanins ; Melanoma ; Melanoma, Amelanotic* ; Pigmentation ; Pilomatrixoma ; Poroma

The purpose of this study was to investigate the anatomic and functional changes of submucous cleft palate operated with Furlow palatoplasty. A total of 36 patients with submucous cleft palate underwent Furlow palatoplasty from 1993 to 1998. The mean follow-up period was 5 years 3 months. Midfacial growth was measured using lateral cephalograms in 18 patients, whose age was older than 8 years of age. Speech analyses were performed in 25 patients by the same speech pathologist for the degrees of nasality and articulation. The parameters obtained in the lateral cephalogram were compared with a healthy population in Korea. ANS-PNS was in 61.1% within the clinical normal range for the age group. SNA and SNB were in 55.6% within the normal range. ANB was in 72.2% and Ba-PNS was 50.0% within the range. The postoperative nasality scores of open vowels and round vowels were 24.2% and 25.2%, respectively, which were lower than preoperative scores. The mean articulation accuracy value was 92.9% which was higher than preoperative value. Our results suggest that Furlow palatoplasty is a useful procedure as the initial treatment of the submucous cleft palate and has the advantages in both aspects of speech results and facial growth.
Cleft Palate* ; Follow-Up Studies ; Humans ; Korea ; Reference Values

A sesamoid bone can occasionally be found under the interphalangeal joint of the hallux. These had anatomical variants and usually remain asymptomatic, it is uncommon for symptomatic cases of painful plantar keratoses or irreducible dislocation of interphalangeal joint of the hallux with incarcerated sesamoid. While the latter has a few cases, the former has not reported in Korea. We experienced a rare case of intractable plantar keratoses due to interphalangeal sesamoid bone of the hallux which may reqire excision.
Dislocations ; Hallux ; Joints ; Keratosis ; Korea ; Sesamoid Bones

BACKGROUND: This study evaluates the effectiveness of the target-controlled infusion (TCI) of remifentanil through stepwise increases in the effect-site concentration (Ceff) in preventing coughs. METHODS: In a preliminary study, we randomly selected 140 patients to receive remifentanil through two-step increases in Ceff (1.0 ng/ml to 4.0 ng/ml: Group R1-4; 2.0 ng/ml to 4.0 ng/ml: Group R2-4). Based on the results of the preliminary study, we employed another sample of 140 patients and implemented a three-step increase in TCI (1.0 ng/ml to 2.0 ng/ml to 4.0 ng/ml: Group R1-2-4). We then compared this treatment with direct targeting based on 4.0 ng/ml TCI (Group R4). We recorded the episodes of coughs, rating them as mild (1-2), moderate (3-4), or severe (5 or more). RESULTS: In Group R1-4, one patient (1.5%) coughed during the first step, and five (7.3%) coughed during the second step. In Group R2-4, nine (13.2%) coughed during the first step, but none coughed during the next step. Only one patient had a mild cough during the three-step increase in TCI, that is, patients in Group R1-2-4 were significantly less likely to cough than those in Group R4 (P < 0.001). CONCLUSIONS: Stepwise increases in the TCI of remifentanil reduced the incidence of remifentanil-induced coughing, and the three-step increase in TCI nearly eliminated remifentanil-induced coughing.
Cough ; Humans ; Incidence ; Opioid-Related Disorders ; Piperidines ; Resin Cements

PURPOSE: The study aimed to explore the health consequences that women experienced after miscarriage and the factors related to them. METHODS: A convenience sample consisting of 102 women who had miscarried within 2 years was used. Women were recruited from hospitals and enterprises in Seoul and Gyeong-Gi Province. Participants completed a self-administered questionnaire containing a physical and psychological symptoms checklist developed for this study. RESULTS: More than 40% of the miscarriages occurred after 9 weeks of pregnancy and 35% of women were found to have had a previous miscarriage prior to this study. Psychological symptoms were more prevalent and prolonged than the physical symptoms, furthermore, the frequencies of the symptoms experiencedwere not consistent with the duration of symptoms. Employed women and women with early miscarriages complained of more physical symptoms; however, psychological symptoms were not different according to women's characteristics. Employment was a significant factor affecting physical symptoms. CONCLUSION: Health care professionals need to inform and educate women and the family of the potential health changes during the recovery after the miscarriage. Health consequences due to miscarriages also need to be incorporated in women's reproductive health care. Nursing care should consider factors of maternal age, employment status, and obstetrical conditions upon the apparent social changes.
Abortion, Spontaneous ; Checklist ; Delivery of Health Care ; Employment ; Female ; Humans ; Maternal Age ; Nursing Care ; Pregnancy ; Surveys and Questionnaires ; Reproductive Health ; Social Change