No abstract available.
Funnel Chest*

PURPOSE: Cerebral palsy or hearing disability of hyperbilirubinemic complication was reduced by blood exchange transfusion(BET) and phototherapy(PT). But in spite of these treatment, abnormal Auditory Brainstem evoked Response(ABR) finding after BET or PT and neurodevelopmental defect due to chronic bilirubin encephalopathy were observed. So we have studied risk factors and outcome of chronic bilirubin encephalopathy after BET, and treatment of hyperbilirubinemia. METHODS: We have analyzed clinical characteristics, the finding and change of ABR after BET in 17 hyperbilirubinemic neonates, and in 8 hyperbilirubinemic neonates who were treated by phototherapy and 15 normal control neonates. RESULTS: 1) Mean bilirubin concentraion were 27.5+/-4.1mg/dL in BET group and 22.1+/-2.3 mg/dL in PT group. There were no difference of clinical findings between BET and PT group. 2) Change of ABR (1) Wave I loss resulted in 4 neonates, wave III loss in 3 neonates, and wave V loss in 2 neonates in BET group(P<0.05). (2) Wave I peak latency and hearing threshold in BET group were significantly increased more than normal control group(P<0.01). 3) In 10 neonates(58.8%) among 17 BET group, 4 neonates(50%) in 8 PT group were observed abnormal initial ABR finding after jaundice treatment. Age at treatment and duration of jaundice(interval between onset of jaundice and treatment) in abnormal ABR group were significant prolongation compared with normal ABR group(P<0.05). 4) Chronic bilirubin encephalopathy(CBE) was observed in 3 neonates(17.6%) among 17 BET group and showed higher of bilirubin level than normalized group after BET (31.1mg/dL vs 26.6mg/dL), other clinical findings showed no significant differences. CONCLUSION: Bilirubin level was significantly elevated in CBE more than in BET group and duration of jaundice, age at treatment were longer in abnormal ABR group than in normal ABR group. So not only bilirubin level but also duration of jaundice shoud be considered at jaundice treatment, and ABR has a potential utility in detection of acute brain toxicity of bilirubin and follow up evaluation of bilirubin encephalopathy.
Bilirubin ; Brain ; Brain Stem ; Cerebral Palsy ; Follow-Up Studies* ; Hearing ; Humans ; Hyperbilirubinemia ; Infant, Newborn* ; Jaundice ; Kernicterus ; Phototherapy* ; Risk Factors

No abstract available.

In order to investigate the risk factors of retinopathy of prematurity, we retrospectively reviewed the medical records of 153 premature badies alive and born in our hospital between October 1994 and January 1997. We performed analysis on birth weight, gestational age, duration of oxygen therapy, duration of oxygen therapy more than 40 percent, maxinmum and mean value of oxygen pressute and mean value of carbon dioxide pressure from arterial blood gas analysis in the first 2 weeks, the presence of multiple birth, surfactant therapy, corticosteroid therapy, and intraventricular hemorrhage. In univatiate analysis, birth weight, duration of oxygen therapy, value of oxygen pressure and mean value of carbon dioxide pressure from arterial blood gas analysis in the first 2 weeks, surfactant therapy, and corticosteroid therapy were statistically significant(p<0.05). Howeverm, in stepwise logistic regression analysis to correct the correlations in multiple variables, only birth weight and duration of oxygen therapy were significant risk factors in 95% confidence interval( 0.05, p<0.05). Birth weight, duration of oxygen therapy, and maximum value of oxygen pressure from arterial blood gas analysis in the first 2 weeks were significant risk factors in 90% confidence interval( 0.1, p<0.1).
Birth Weight ; Blood Gas Analysis ; Carbon Dioxide ; Gestational Age ; Hemorrhage ; Humans ; Logistic Models ; Medical Records ; Multiple Birth Offspring ; Oxygen ; Retinopathy of Prematurity* ; Retrospective Studies ; Risk Factors*

No abstract available.
Humans ; Infant, Newborn*

There has been so much controversies about the position of upper and lower jaws, and their first permanent molars in normal occlusion and Angle's class I,II,III malocclusions. So, the purpose of this study is to compare the position of upper and lower jaws, and their first molars in normal occlusion and Angle's class IIIIII malocclusions by lateral cephalometric analysis. The sample consisted of one hundred and twenty girls(thirty in each group) who had completed growth. The findings of this study were as follows: 1. In class I malocclusion, both maxilla and mandible were slightly posterior position than normal occlusion, but they showed harmonious relationship. 2. In class II malocclusion, the mandible was greatly retruded, and the maxilla was also slightly retruded to the cranial base as compared with normal occlusion. 3. In class III malocclusion, the maxilla was significantly retruded to the cranial base, but no significant difference was found in mandibular position as compared with normal occlusion. 4. The maxillary first molar was located at posterior position in class II malocclusion, and anterior position in class III malocclusion to the cranium, so that the rotation of mandible was influenced by that. 5. The mandibular first molar showed constant relationship to the mandible in all four groups, but different position to the cranial base in direct proportion to the mandibular position. 6. On the treatment planning of class II malocclusion, it seems to be better to promote the mandibular horizontal growth by inhibiting the vertical growth of maxillary molar area, and on the treatment planning of class III malocclusion, it seems to be better to promote the antero-inferior growth of maxilla and to promote the mandibular vertical growth by inducing the vertical growth of maxillary molar area.
Jaw* ; Malocclusion* ; Mandible ; Maxilla ; Molar* ; Skull ; Skull Base

BACKGROUND: One of major weakness in medical education in Korea is clinical skills has not been uniformly well taught during undergraduate period. To reinforce the basic clinical skill education, we developed introduction to clinical medicine(ICM) course In this study, we described the ICM course development process and the experience. METHODS: We performed comprehensive literature review related to ICM and doctoring curriculum. ICM/OSCE sub-commitee members discussed several time to develop the course. To assess the level of accomplishment of this course, we got feedback from 115 third year medical students by questionnaires. RESULTS: ICM was composed of 9 topics which covers the basic clinical skills. For each topic, three hours per week was allocated, one hour for didactic session and the other 2 hours for practical exercise. Standardized patients were used to teach interview skill. Most of students revealed history taking, abdominal examination, musculo-skeletal system, and interview skill session were valuable learning experience. However, for Gynecology and Pediatric session which were taught by mainly lectures, students evaluated them negatively. INTERPRETATION: This year, we focused on teaching basic clinical skills at ICM. However, our ultimate goal is to develop the ICM course which can allow the students to learn both the art and the science of Medicine.
Clinical Competence* ; Clinical Medicine* ; Curriculum ; Education ; Education, Medical ; Gynecology ; Humans ; Korea ; Learning ; Lectures ; Students, Medical ; Surveys and Questionnaires

The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension.
Aortic Aneurysm/*complications/diagnosis ; Aortic Rupture/*complications/diagnosis ; Constriction, Pathologic ; Female ; Hematoma/*complications ; Human ; Hypertension, Pulmonary/*etiology ; Middle Aged ; Pulmonary Artery/pathology/radiography ; Tomography, X-Ray Computed

In 1947, Liver described adenoid squamous cell carcinoma under the title of "adenoacanthoma of sweat gland". This tumor is not rare, but reported cases in literatures were relatively few. The tumor were frequently found in the sun-exposed skin; such as face, ear, neck etc.. The cases involving non-sun-exposed area, such as oral and labial mucosa, nosopharynx and vulva etc., were also reported. Therefore, the relation between the pathogenesis of adenoid squamous cell carcinoma and sun damage has been still debated. Immunohistochemical studies have recently suggested that this tumor is squamous cell carcinoma undergoing acantholysis. The authors experienced a case of adenoid squamous cell carcinoma of the vulva in a seventy-one year old female patient. She had suffered from itching sensation on vulva for 10 years, and palpable mass on vulva for 1 month. On gross examination, a pale gray pigmentation and erosion, was noted at the right labia major, the minor extending left labia major and minor. On microscopic examination, nests of atypical epithelial cells extending into the cornium showed an adenoid architecture. These were composed of a peripheral layers of cuboidal cell in a lacy pattern. And the glandular spaces contained dyskeratotic acantholytic tumor cells in central portion. Therefore we diagnosed this case as adenoid squamous cell carcinoma of the vulva.
Female ; Humans

Pulmonary artery sling is a rare congenital cardiovascular anomaly which presents clinical obstructive symptoms and signs of trachea, right main bronchus and esophagus due to left pulmonary artery abnormaly arises from proximal part of right pulmonary artery. Aberrant left pulmonary artery courses to the right above right main bronchus and then turns to the left, and courses to between the anterior of the esophagus and the posterior aspect of trachea. One of important clinical significances of the pulmonary artery sling is associated with intracardiac anomalies, and with tracheal stenosis and bronchomalacia due to press tracheobronchial tree by the aberrant pulmonary artery. It has been thought that embryological malconnection between the pulmonary artery bud from left sixth arch and the pulmonary posterior branchial plexus in the left lung bud. We had experienced 21 months old male infant with left pulmonary artery sling associated with persistent left superior vena cava and dextropostioned heart. The heart seems to move to right hemithorax due to hypoplasia or segmental atelectasis of right lung.
Bronchi ; Bronchomalacia ; Esophagus ; Heart* ; Humans ; Infant ; Lung ; Male ; Pulmonary Artery* ; Pulmonary Atelectasis ; Trachea ; Tracheal Stenosis ; Vena Cava, Superior*