The purpose of this study is to present a novel method of harvesting autogenous bone graft and to analyze the behavior of xenograft used for pelvic osteotomy in young children. Twenty hips of eighteen patients underwent pelvic osteotomies using xenograft (Lubhoc) from Sep. 1993 to Jun. 1996. In fitteen hips, we harvested autogenous bone avoiding damage to the chondroapophysis of iliac crest and t'illed the donor site with the xenograft. It supplemented the autogenous bone at the osteotomy site in eleven hips, and was used as a wedge without autogenous hone in five hips. During the followup, no growth disturbance of iliac crest was found. The xenograft incorporation was satisfactory at the graft donor sites and the osteotomy sites where it supplemented the autogenous bone, however, unsatistactory at the osteotomy sites where it was used alone. Our novel method of harvesting bone graft from young pelvis may help prevent growth disturbance of lilac crest, and Luhhoc is useful as space-filler of donor site and suppiementary to the autograft in pelvic osteotomy of young children.
Autografts ; Child* ; Follow-Up Studies ; Heterografts* ; Hip ; Humans ; Osteotomy* ; Pelvis ; Tissue Donors ; Transplants

Infectious endogenous endophthalmitis is a relatively rare, but seriously devasting disease. To evaluate clinical aspects of this disease, we performed a retreospective study on 7 eyes of 7 patients who had been treated with this diagnosis from July 1994 to January 1998 at Asan Medical Center. The preceding systemic diseases consisted of liver abscess, non-small cell lung cancer, spontaneous bacterial peritonitis, acute cholangitis, cystitis, systemic candidiasis. Microorganisms were recovered in blood culture in 4 of them(3 Klebsiella pneumoniae and one Candida albicans). One among these patients also revealed culture positive for Klebsiella pneumoniae in the vitreous as well as in his blood. All patients received intravitreal vancomycin and amikacin injection following vitreous and aqueous tapping. Four patients underwent pars plana vitrectomy as the second procedure and 2 of them expired. At the final follow up, retina remained attached succesjully in six of 7 eyes, yet the visual outcome was so poor that only two recovered over 5/200 or better. Infectious endogenous endophthalmitis has guarded prognosis since causative microorganisms are often extremely virulent, detection of this disease is likely to be delayed and appropriate management can not be started immediately. High index of suspicion for the diagnosis and the intensive treatment are strongly suggested to achieve the best result.
Amikacin ; Candida ; Candidiasis ; Carcinoma, Non-Small-Cell Lung ; Cholangitis ; Chungcheongnam-do ; Cystitis ; Diagnosis ; Endophthalmitis* ; Follow-Up Studies ; Humans ; Klebsiella pneumoniae ; Liver Abscess ; Peritonitis ; Prognosis ; Retina ; Vancomycin ; Vitrectomy

Osteoid osteoma is a relatively common benign skeletal tumor that usually affects the cortex of the long bone. Despite its common incidence, the diagnosis is often delayed and confused with other entities such as stress fracture, tuberculosis, osteomyelitis and intracortical abscess. Moreover, the diagnosis becomes more difficult when the osteoid osteoma develops in the intra-articular region. Several factors contribute to the difficulty of the diagnosis: First, osteoid osteoma is relatively rare compared to other causes of articular pain. Second, it presents non-specific clinical manifestation in the hip joint much like other intraarticular disorders. Third, plain radiographs sometimes do not represent the characteristic findings. Fourth, MR imaging reveals inconsistent signal intensities, especially in the early stage. Bone scan also lacks specificity for diagnosis. Recently, we experienced four cases of intra-articular osteoid osteoma of the hip joint and presented them with a review of the literatures.
Abscess ; Diagnosis ; Fractures, Stress ; Hip Joint ; Hip* ; Incidence ; Magnetic Resonance Imaging ; Osteoma, Osteoid* ; Osteomyelitis ; Sensitivity and Specificity ; Tuberculosis

Although ERCP is a therapeutic endoscopic procedure in pacreatico-biliary diseases, its rare complications, including pancreatitis, duodenal perforation, and bleeding, can be fatal. An 87-year-old woman with a history of gallbladder cancer presented with jaundice and general weakness. Her skin color was yellowish and epigastric tenderness was confirmed on a physical examination. On abdomen CT, the gallbladder cancer directly invaded the duodenum, common bile duct, and liver parenchyma. Enlarged portocaval lymph nodes obstructed the extrahepatic bile duct. ERCP was performed for bile duct decompression. When shortening of endoscopy was achieved, the duodenal lateral wall was perforated because of the endoscopic tip pressure. After inserting endoscopic retrograde biliary drainage and endoscopic nasobiliary drainage, endoclips were placed evenly around the defect, and a detachable snare was tightened around the endoclips. Three days later, the duodenal wall was not sealed on the abdomen CT scan. Repeat endoscopy was achieved, and the endoscopic nasobiliary drainage, endoscopic retrograde biliary drainage, endoclips, and detachable snare were removed. From the distal margin of the perforation, band ligation was performed, and a detachable snare was applied. The patient's condition improved after the second procedure. A percutaneous biliary stent was inserted, and she was discharged. This case highlights the successful endoscopic management of ERCP-related duodenal perforation.

Phlegmonous gastritis is a disease caused by a bacterial infection of the gastric wall. This condition is rare, but when it does occur, its prognosis appears to be poor. The underlying etiology is largely unknown, but an immunocompromised state is considered an important risk factor. An 85-year-old woman presented with a confused mentality, fever, epigastric pain, and melena. There was no history of alcohol drinking or smoking, nor of previous gastric surgery. On the other hand, there was a history of senile dementia and cognitive impairment. Initial contrast-enhanced abdominal CT revealed gastric wall edema at the antrum with mucosal hyper-enhancement and an abscess in the thickened antrum. Upper gastrointestinal endoscopy on the fourth hospital day showed dark-colored fluid retention in the stomach. The gastric mucosa was inflamed and friable, with several ulcerative lesions showing purulent discharge. A toothpick was found in the process of identifying the base of the ulcerative lesion and was removed. Eventually, phlegmonous gastritis due to the penetration of a toothpick was diagnosed. After endoscopic toothpick removal, the patient's symptoms improved dramatically. Serial endoscopy revealed improvement in the gastric mucosa. This case is an example of phlegmonous gastritis caused by a foreign substance in the gastric wall of a patient with senile dementia. During upper gastrointestinal endoscopy in this case, identification of the base of ulcerative lesion played a critical role in the diagnosis.

Coin batteries are often used in daily life devices and can be easily available. Children can swallow coin batteries, resulting in the need to go to hospital, but this is rare in adults. Adults generally eliminate the swallowed coin battery from the digestive system, unless they have congenital structural abnormalities of the digestive system or complications, such as postoperative stenosis. In this case, a 31-year-old man swallowed three coin batteries, approximately 0.4 cm in diameter emergent endoscopy was unable to find any batteries embedded in the ingested food. An attempt was made to rinse out the batteries by bowel preparation. During the hospital stay, the patient complained of acute abdominal pain and fever. In the abdominal CT scan, impaction of the coin battery into the appendix was confirmed. The patient underwent a laparoscopic appendectomy to prevent appendiceal perforation.
Abdominal Pain ; Adult ; Appendectomy ; Appendix ; Child ; Constriction, Pathologic ; Digestive System ; Endoscopy ; Fever ; Humans ; Length of Stay ; Numismatics ; Tomography, X-Ray Computed

Coin batteries are often used in daily life devices and can be easily available. Children can swallow coin batteries, resulting in the need to go to hospital, but this is rare in adults. Adults generally eliminate the swallowed coin battery from the digestive system, unless they have congenital structural abnormalities of the digestive system or complications, such as postoperative stenosis. In this case, a 31-year-old man swallowed three coin batteries, approximately 0.4 cm in diameter emergent endoscopy was unable to find any batteries embedded in the ingested food. An attempt was made to rinse out the batteries by bowel preparation. During the hospital stay, the patient complained of acute abdominal pain and fever. In the abdominal CT scan, impaction of the coin battery into the appendix was confirmed. The patient underwent a laparoscopic appendectomy to prevent appendiceal perforation.
Abdominal Pain ; Adult ; Appendectomy ; Appendix ; Child ; Constriction, Pathologic ; Digestive System ; Endoscopy ; Fever ; Humans ; Length of Stay ; Numismatics ; Tomography, X-Ray Computed

Polymyalgia rheumatica is characterized by pain and stiffness of the shoulder and pelvic girdles, morning stiffness, constitutional symptoms and an elevated erythrocyte sedimentation rate. We have experienced a 45-year-old female patient with polymyalgia rheumatica who presented with pain and stiffness of the shoulder and pelvic girdle, an elevated erythrocyte sedimentation rate and dramatic response to low-dose steroids. To our knowledge, thes is the second case of polymyalgia rheumatica with a brief review of literature.
Blood Sedimentation ; Female ; Humans ; Middle Aged ; Polymyalgia Rheumatica* ; Shoulder ; Steroids

BACKGROUND: Though many adolescents are suffering from depression in Korea, there have been few studies about the prevalence of it and depressive adolescents are not managed appropriately yet because of ignorance of the society and family. This study was intended to find out college freshmen's prevalence of depression, and the relationship between family function and depression. METHODS: The subjects were college freshmen of one university both in Seoul and Suwon and the study period was from January to February on 1999. Family APGAR was used as a family function index and Beck's Depression Inventory (BDI) was used to measure the degree of depression. Chi square tests and logistic regression were done for analysis using SPSS 8.0/PC program. RESULTS: The prevalence of depression among college freshmen was 1.5%(37 out of 2465) as of BDI score 21 or more. Depression was more common in the families with low Family APGAR score and those in Suwon campus. No significant differences were found in gender, age, blood pressure, blood type, BMI, present illness, number of families, marital status of parents or siblings. Relative risks of depression were 4.5 times for family dysfunction group and 2.6 times for Suwon campus group. CONCLUSION: Depression is not a rare disease among college freshmen. Therefore, family physician as a primary care physician should consider the possibility of depression among adolescence and screen depression using BDI for adolescents in dyfunctional family particularly.
Adolescent ; Apgar Score ; Blood Pressure ; Depression* ; Gyeonggi-do ; Humans ; Korea ; Logistic Models ; Marital Status ; Parents ; Physicians, Family ; Physicians, Primary Care ; Prevalence ; Rare Diseases ; Seoul ; Siblings