46,XX male is a rare abnormality of sex determination with an incidence of 1 in 20,000 male neonates. The clinical manifestations of 46,XX males are usually hypogonadism, gynecomastia, azoospermia, and hyalinations of seminiferous tubules, with altered hormonal levels at puberty. Less frequently, some sexual ambiguities are found, always with sterility owing to reduced testicular development. The origin of male phenotype in 46,XX male could be the results of at least three different mechanisms:translocations of Y sequence, including the SRY gene, to an X chromosome or to an autosome(about 90% of cases); a mutation in a yet unknown X-linked or autosomal gene in the testis-determinating pathway, and cryptic Y chromosome mosacism. We experienced a case of SRY-positive 46,XX male in a 21-year-old man with small testes. (J Korean Soc Pediatr Endocrinol 2003;8:184-188)
Adolescent ; Azoospermia ; Genes, sry ; Gynecomastia ; Humans ; Hyalin ; Hypogonadism ; Incidence ; Infant, Newborn ; Infertility ; Male* ; Phenotype ; Puberty ; Seminiferous Tubules ; Testis ; X Chromosome ; Y Chromosome ; Young Adult

46,XX male is a rare abnormality of sex determination with an incidence of 1 in 20,000 male neonates. The clinical manifestations of 46,XX males are usually hypogonadism, gynecomastia, azoospermia, and hyalinations of seminiferous tubules, with altered hormonal levels at puberty. Less frequently, some sexual ambiguities are found, always with sterility owing to reduced testicular development. The origin of male phenotype in 46,XX male could be the results of at least three different mechanisms:translocations of Y sequence, including the SRY gene, to an X chromosome or to an autosome(about 90% of cases); a mutation in a yet unknown X-linked or autosomal gene in the testis-determinating pathway, and cryptic Y chromosome mosacism. We experienced a case of SRY-positive 46,XX male in a 21-year-old man with small testes. (J Korean Soc Pediatr Endocrinol 2003;8:184-188)
Adolescent ; Azoospermia ; Genes, sry ; Gynecomastia ; Humans ; Hyalin ; Hypogonadism ; Incidence ; Infant, Newborn ; Infertility ; Male* ; Phenotype ; Puberty ; Seminiferous Tubules ; Testis ; X Chromosome ; Y Chromosome ; Young Adult

PURPOSE: To described the MR findings in the periodic changes of the size and signal intensity ofreconstructed anterior cruciate ligament (ACL) of the knee and the efficacy of oblique axial imaging in patientswho underwent arthroscopic ACL reconstruction using autogenous patellar tendon. MATERIALS AND METHODS: Twenty-onepatients who had undergone ACL reconstruction were evaluated by follow-up MRI at postoperative 1 week, 1, 2, 3 and6 months, and 1 year, Conventional Fast-Spin-Echo (FSE) sagittal and coronal images and oblique axial images(proton density and T2-WI; VEMP TR/TE, 2000/20/70) were obtained perpendicular to the ligament, and using an ROIcurve in the intra-articular area, periodic changes in the cross-sectional area were evaluated by proton densityimaging and signal intensity by T2WI imaging. Cross-sectional morphology was categorized as either smooth, andround or notch-shaped and periodic changes in configuration were observed. In three cases, we evaluated the retearof reconstructed ACL by comparing the oblique axizl image obtained by conventional sagittal and coronal imaging. RESULTS: The cross-sectional area and signal intensity of grafted ACL increased significantly (p<0.05) after 3months and at 1 year, respectively. Cross-sectional morphology was smooth and round in 86% of cases, and notchedin 14%, and during follow-up MR studies, no periodic changes were seen. Notch-shaped ACL and decreased perigraftsignal intensity, as seen on sagittal images, could lead to a misdiagnosis of partial tear ; on oblique axialimages, ACL and perigraft signal intensity were found to be normal. CONCLUSION: During the natural evolution ofgrafted ACL, cross-sectional area and signal intensity increased significantly after 3 months and at 1 year,respectively ; on follow-up MR studies, cross-sectional morphology did not change, however. Oblique axial imagingprovides important information for evaluating whether the reconstructed ACL is torn or not.
Anterior Cruciate Ligament* ; Cross-Sectional Studies ; Diagnostic Errors ; Follow-Up Studies* ; Knee* ; Ligaments ; Magnetic Resonance Imaging ; Patellar Ligament ; Prospective Studies* ; Protons ; Transplants*

One lung ventilation for thoracic surgery may reduce arterial oxygen saturation by ventilation-perfusion mismatching and by increasing intrapulmonary shunting. We experienced a 52 year old male patient with a lung abscess, who showed arterial desaturation after one-lung ventilation. The authors tried to increase arterial oxygen saturation by applying positive end-expiratory pressure (PEEP) and continuous positive airway pressure (CPAP) to dependent and nondependent lung, respectively. However, arterial oxygen saturation did not increase. So, we applied partial differential lung ventilation using an open-close valve designed by the authors, and arterial oxygen saturation increased rapidly. The advantages of the open-close valve are its straightforward use and ease of manipulation. We report a case involving the use of this open-close valve in a desaturated patient during one lung ventilation.
Continuous Positive Airway Pressure ; Humans ; Lung ; Lung Abscess ; Male ; Middle Aged ; One-Lung Ventilation* ; Oxygen ; Positive-Pressure Respiration ; Thoracic Surgery ; Ventilation

OBJECTIVE: To evaluate the accuracy of the swallowing kinematic analysis. METHODS: To evaluate the accuracy at various velocities of movement, we developed an instrumental model of linear and rotational movement, representing the physiologic movement of the hyoid and epiglottis, respectively. A still image of 8 objects was also used for measuring the length of the objects as a basic screening, and 18 movie files of the instrumental model, taken from videofluoroscopy with different velocities. The images and movie files were digitized and analyzed by an experienced examiner, who was blinded to the study. RESULTS: The Pearson correlation coefficients between the measured and instrumental reference values were over 0.99 (p<0.001) for all of the analyses. Bland-Altman plots showed narrow ranges of the 95% confidence interval of agreement between the measured and reference values as follows: 0.14 to 0.94 mm for distances in a still image, -0.14 to 1.09 mm/s for linear velocities, and -1.02 to 3.81 degree/s for angular velocities. CONCLUSION: Our findings demonstrate that the distance and velocity measurements obtained by swallowing kinematic analysis are highly valid in a wide range of movement velocity.
Biomechanics ; Deglutition ; Epiglottis ; Mass Screening ; Reference Values ; Reproducibility of Results

BACKGROUND: Endoscopic surgical procedure has recently been applied to not only intraabdominal or intrathoracic surgery but also saphenous vein harvesting, because it is less invasive and more cosmetically advantageous. Carbon dioxide insufflation during an endoscopic saphenous vein harvesting may cause an adverse effects on arterial blood gas and hemodynamic variables. This study was conducted to evaluate the safety of carbon dioxide insufflation during endoscopic saphenous vein harvesting. METHODS: Patients in ASA physical status III or IV, scheduled for an endoscopic saphenous vein harvesting (n=30) were gathered for the evaluation. Until the end of the procedure, controlled mechanical ventilation (tidal volume: 10 ml/kg, respiratory rate: 10 rates/min) and ventilator mode was fixed in this tidal volume and respiratory rate. Arterial blood gas analysis, end-tidal carbon dioxide, blood pressure and heart rate were measured before and at 10, 20, 30, 40 minutes after carbon dioxide insufflation. RESULTS: Preinsufflation values of PaCO2 (partial pressure of arterial carbon dioxide) and PETCO2 (partial pressure of end-tidal carbon dioxide) were 33.4 +/- 3.6 mmHg and 24.1 +/- 4.1 mmHg, respectively. PaCO2 was significantly increased at 30 and 40 minutes after carbon dioxide insufflation (40.1 +/- 7.4 mmHg and 41.4 +/- 8.6 mmHg). PETCO2 was significantly increased at 20, 30 and 40 minutes after carbon dioxide insufflation(27.6 +/- 5.5 mmHg, 28.9 +/- 7.0 mmHg and 29.6 +/- 7.8 mmHg). But, the magnitude of difference between PaCO2 and PETCO2 was not significantly different. CONCLUSIONS: During endoscopic saphenous vein harvesting, PaCO2 was significantly increased compared with preinsufflation values. Careful monitoring of PaCO2 is mandatory during the procedure.
Blood Gas Analysis ; Blood Pressure ; Carbon ; Carbon Dioxide ; Coronary Artery Bypass* ; Coronary Vessels* ; Endoscopy ; Heart Rate ; Hemodynamics ; Humans ; Insufflation ; Respiration, Artificial ; Respiratory Rate ; Saphenous Vein* ; Tidal Volume ; Ventilators, Mechanical

BACKGROUND: This study was designed to assess whether pre-anesthetic administration of dexmedetomidine reduces the postoperative consumption of opioids, in patients receiving patient-controlled fentanyl after gynecological laparotomy. METHODS: This was a prospective, randomized, double-blind, controlled study. Ten minutes before induction of anesthesia, 36 patients scheduled for elective gynecological laparotomy were assigned to receive either normal saline (group N) or dexmedetomidine 1 µg/kg (group D). A patient-controlled analgesia (PCA) device was used to administer fentanyl for the postoperative 24 h period. Cumulative fentanyl consumption and pain score were assessed at postoperative 30 min, 6 h and 24 h. Patient's satisfaction for pain control and other side effects (nausea, sedation score) were recorded for all corresponding time points. RESULTS: There was no significant difference between the groups in cumulative fentanyl consumption (Group N: 11.1 ± 3.2 µg/kg, Group D: 10.3 ± 2.9 µg/kg, P value: 0.706). The incidence of side-effects did not differ between the groups. Both groups showed similar blood pressure after anesthesia induction. However, 10 min after anesthesia induction, the heart rates in group D were significantly lower than group N (P = 0.0002). CONCLUSIONS: In patients undergoing gynecological laparotomy, the pre-anesthetic administration of single loading dose dexmedetomidine (1 µg/kg) given 10 min before anesthesia induction did not reduce the PCA consumption of postoperative fentanyl or the pain score.
Adrenergic alpha-2 Receptor Agonists ; Analgesia, Patient-Controlled ; Analgesics, Opioid* ; Anesthesia ; Blood Pressure ; Dexmedetomidine* ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Laparotomy ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Prospective Studies

BACKGROUND: The development of total intravenous anesthesia in coronary artery bypass graft (CABG) surgery has led to increased interest in the use of combination of propofol and remifentanil. Early extubation in post-cardiac surgery reduces the length of stay in intensive care unit and hospital and costs. The purpose of this study is to evaluate which anesthetic factors affect awakening time after anesthesia. METHODS: We enrolled twenty patients of ASA physical status II or III, scheduled for CABG in this study. All patients received a standardized propofol/remifentanil anesthesia as an effect site target controlled infusion. We recorded times to awakening and tracheal extubation, duration of cardiopulmonary bypass (CPB) period, total time of anesthesia and operation. Also, we recorded dose of propofol, remifentanil, fentanyl and minimum body temperature during CPB. To predict the factors that affect awakening time as a dependent variable, we considered all measured parameters as independent variables, and analyzed multiple linear regressions. RESULTS: The mean time responded to verbal command was 216.5 +/- 124.8 minutes after end of surgery. Among several parameters, minimum body temperature during CPB (P = 0.001) and total time of anesthesia (P = 0.003) were considered as significant factors that influence awakening time after CABG. CONCLUSIONS: Minimum body temperature during CPB and the duration of anesthesia influence awakening time after CABG, significantly.
Airway Extubation ; Anesthesia ; Anesthesia, Intravenous ; Body Temperature ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels ; Fentanyl ; Humans ; Intensive Care Units ; Length of Stay ; Linear Models ; Piperidines ; Propofol ; Transplants

We found an error in our published article.

Background: The long term prognostic factors of aortic valve replacement (AVR) in patients with severe aortic stenosis (AS) with normal and low left ventricular function are not well known in Korean population METHODS: Between 1990 and 1999 , 73 patients (52 male, 21 female, mean age: 58+/-10.7) with severe AS underwent AVR in Yonsei cardiovascular hospital. Patients were excluded if they had concomitant valvular operations other than AVR, previous AVR, or more than moderate amount aortic valve regurgitation, and under 18 years old. Overall survival was estimated by the Kaplan-Meier method, and the Cox proportional hazards model analyzed the predictors that influence long-term survival. RESULTS: The causes of aortic stenosis were degenerative (44 case, 60%), congenital (26 case, 36%), and rheumatic (3 case, 4%). The preoperative characteristics (mean+/-SD) included ejection fraction (EF), 58+/-16.5%: mean aortic pressure gradient, 63+/-20 mmHg: aortic valve area, 0.62+/-0.13cm2. Simultaneous coronary artery bypass surgery and percutaneous transluminal coronary angioplasty were performed in 8 cases and 2 cases, respectively. The comparative results of the pre/post operative echocardiography of the total patients showed a significant improvement: EF of 58+/-17/64+/-12%, aortic valve area(AVA) of 0.64+/-0.15/1.54+/-0.63 cm2, mean pressure gradient (MPG) of 63+/-21/23+/-13mmHg, left ventricular end-diastolic dimension (LEEDD) of 54+/-9/50+/-9mmHg, left ventricular posterior wall thickness in systole (LV-PW) of 18+/-2/16+/-2mm. The comparative results of the pre/post operative echocardiography of low EF patients (<35%) also showed a significant improvement: EF of 30+/-4/55+/-15%, AVA of 0.59+/-0.14/ 1.67+/-0.85 cm2, MPG of 52+/-20/ 21+/-12 mmHg, LVEDD of 58+/-8/ 51+/-6 mm. Operative (30-day) mortality was 2.7% (2 of 73 patients). Six additional patients died during follow-up. The survival of patients group was 86% at 5 years and 78% at 10 years. The predictors of long-term postoperative survival were preop-EF (p<0.05,R=0.26) and presence of significant coronary artery disease (CAD) (p<0.01,R=0.35). CONCLUSION: Postoperative long-term survival of the severe AS after AVR was negatively related to reduced preop-EF and presence of significant CAD. Therefore, the early operative treatment before the occurrence of irreversible left ventricular dysfunction and concomitant appropriate management of coronary artery disease is necessary for the improvement of the survival after AVR.
Adolescent ; Angioplasty, Balloon, Coronary ; Aortic Valve Stenosis* ; Aortic Valve* ; Arterial Pressure ; Coronary Artery Bypass ; Coronary Artery Disease ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Mortality ; Prognosis ; Proportional Hazards Models ; Systole ; Ventricular Dysfunction, Left ; Ventricular Function, Left