There is room for debate in appropriate diagnosis and treatment due to physiological and anatomical differences in pediatric facial bone fractures from that of adult's. The objectives of this article is to analyze for our clinical cases and to suggest the appropriate management of facial bone fracture in children. The study included 56 children who had treatment for the craniofacial fractures form March, 1990 to February, 1998. Their ages ranged from 3 to 15. There were 38 males and 18 females. Physical examination, simple x-rays, ultrasonograms and routine CT scans were used for diagnosis. Materials were classified into 28 nasal bone fractures, 4 nasoethmoidal fractures, 6 orbital fractures, 8 mandible fractures, and 10 zygoma fractures. Patients were treated with conservative treatment in 9 cases, with closed reduction in 28 cases and open reduction only, and 14 patients with open reduction and internal fixation using microplates and screws. 3 patients needed autogenous calvarial bone graft. Plates and screws were removed in postoperative 3-6 months. All patients had successful union of fractured bones without no specific complications, and normal bony growths were noticed during the 7 years follow up. We conclude that surgeons should be careful in diagnosis and management for the pediatric facial fracture due to anatomical variations and differences in fracture aspects. First, it is mandatory for surgeous to get accurate diagnosis and identify children's fracture and displacement through routine CT check up along with physical examination. Second, it is important to perform the minimally invasive technique or conservative treatment for the children with mild displacement so that it reduces the incidence of growth retardation which may be caused by extensive operation. However, application of rigid fixation is necessary in case of extensive bony displacement or bony defects because of poor coorporation in postoperative care. Third, plates and screws which were used for the internal fixation should be removed at 3-6 months after the surgery. Fourth, if bone graft is needed, it is better to use autogenous graft than allogeneous graft. Fifth, care for dentition and follow up for growth are necessary for growing children.
Child ; Dentition ; Diagnosis ; Facial Bones* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mandible ; Nasal Bone ; Orbital Fractures ; Physical Examination ; Postoperative Care ; Tomography, X-Ray Computed ; Transplants ; Ultrasonography ; Zygoma

A case of pineoblastoma in a 28-year-old male is reported. A computerized tomography showed hydrocephalus and a mass in the pineal region. Histologically, the tumor is composed of regular, patternless aggregates of small round undifferentiated cells, resembling medulloblastoma-retinoblastoma group. Immunohistochemical reactivity of the neoplastic cells for neuron specific enolase and synaptophysin demonstrates neuronal differentiation. The patient underwent partial resection of the mass followed by radiotherapy. The patient had no cerebrospinal dissemination at 8 month follow-up. The pineoblastoma is a highly malignant neoplasm, one of the class of primitive neuroectodermnal tumors. The tumor is a very rare pineal parenchymal meoplasms, representing an incidence of less than 0.1% of intracranial tumors. This is the first case of pineoblastoma reported in Korea. In this report the divergent differentiation of the tumor is discussed, along with review of literatures.
Male ; Humans ; Incidence

A case of pineoblastoma in a 28-year-old male is reported. A computerized tomography showed hydrocephalus and a mass in the pineal region. Histologically, the tumor is composed of regular, patternless aggregates of small round undifferentiated cells, resembling medulloblastoma-retinoblastoma group. Immunohistochemical reactivity of the neoplastic cells for neuron specific enolase and synaptophysin demonstrates neuronal differentiation. The patient underwent partial resection of the mass followed by radiotherapy. The patient had no cerebrospinal dissemination at 8 month follow-up. The pineoblastoma is a highly malignant neoplasm, one of the class of primitive neuroectodermnal tumors. The tumor is a very rare pineal parenchymal meoplasms, representing an incidence of less than 0.1% of intracranial tumors. This is the first case of pineoblastoma reported in Korea. In this report the divergent differentiation of the tumor is discussed, along with review of literatures.
Male ; Humans ; Incidence

Gestational trophoblastic disease associated with the tubal pregnancy is uncommon, and the incidence has been described as 1/5000 tubal pregnancy. We have experienced a case of metastatic gestational trophoblastic disease(GTD) in the lung occuring with complete hydatidiform mole arising in tubal pregnancy. The patient was a 39-year-old, G4P2A2L2 woman with amenorrhea for 5 weeks. Ectopic pregnancy in the right fallopian tube was suspected on transvaginal ultrasonogram. A right adnexectomy was performed. The fallopian tube was markedly dilated and ruptured. The right ovary and a round hematoma had adhered to the external surface of the fallopian tube. On gross examination, no molar tissue was identified. On microscopic examination, the lumen of the dilated fallopian tube was filled with blood clots admixed with several chorionic villi showing hydropic swelling and marked proliferation of atypical trophoblasts. Proliferating syncytio-and cytotrophoblasts invaded the wall of the blood vessels of the fallopian tube and sheets of trophoblasts and some villi were identified in the lumen of blood vessels. Multiple pulmonary nodules thought to be metastatic nodules were identified in the chest X-ray and serum beta-HCG had increased 2 weeks later. This case indicates that a careful pathological examination in the ectopic pregnancy is mandatory, because tubal GTD is not clinically distinguishable from ordinary tubal pregnancy.
Pregnancy ; Female ; Humans ; Neoplasm Metastasis

PURPOSE: Recently, it has been reported that Epstein-Barr virus (EBV) is associated with some gastric cancers. But EBVs role in EBV-associated gastric carcinomas (EBVaGCs) has not been fully elucidated. This study was undertaken to evaluate the characteristics of EBVaGCs and to compare those with non-EBVaGCs. MATERIALS AND METHODS: EBV infection was studied using paraffin-embedded tissue blocks of 119 cases of gastric adenocarcinomas by in situ hybridization for EBV-encoded small RNAs (EBERs). In EBVaGCs and non-EBVaGCs, molecular characteristics were evaluated by immunohistochemical staining for latent membrane protein (LMP)-1, p53 protein, and proliferating cell nuclear antigen (PCNA). RESULTS: EBERs were detected in 12 cases (10.1%) of 119 gastric adenocarcinomas. LMP-1 was negative in all carcinomas tested, p53 protein was positive in 7 cases (58.3%) of 12 EBVaGCs and in 51 (47.7%) of 107 non-EBVaGCs, the difference between two groups being not significant. Mean PCNA index was 38.2+-26.1% in EBVaGCs and 22.8 +- 20.0% in non-EBVaGCs. The index was significantly higher in the former than in the latter. CONCLUSION: These results suggested that neoplastic progression in EBVaGCs was implicated with high expression of PCNA, but not consistently with overexpression of p53 protein or LMP-1.
Adenocarcinoma* ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; In Situ Hybridization ; Membrane Proteins ; Proliferating Cell Nuclear Antigen* ; RNA ; Stomach Neoplasms

Microsurgical reconstruction is necessary for children to correct severe trauma and congenital or acuqired deformity. The aim of this study was to evaluate whether or not microsurgical reconstruction is a safe and reliable operation in children and to analyze the differences of microsurgical reconstruction in children compared to adults. The study included 12 children who underwent 13 microsurgical reconstructions among a total of 251 cases of microsurgical reconstruction from May, 1986 to August, 1998. Their ages ranged from 24 months to 14 years and 8 months. There were 7 males and 6 females. The involved sites were 9 legs, 3 hands and 1 face. The causes of microsurgical reconstruction were 9 traumas, 2 congenital anomalies, 1 acquired deformity and 1 cancer. The applied flaps were 4 scapular flaps, 2 rectus abdominis muscle flaps, 1 de-epithelized groin flap, 1 lateral arm flap, 1 forearm tendocutaneous flap, 1 forearm tendocutaneous flap, 1 latissimus dorsi muscle flap, 1 fibula flap, 1 second toe transfer, and 1 wrap-around flap. All patients have had normal growth of the donor and recipient sites without specific complications during an average 2 years follow-up. We concluded that microvascular reconstruction is a very useful and reliable procedure in children if it is performed in consideration of each child's specific characteristics and conditions.
Adult ; Arm ; Child ; Congenital Abnormalities ; Female ; Fibula ; Follow-Up Studies ; Forearm ; Groin ; Hand ; Humans ; Leg ; Male ; Rectus Abdominis ; Superficial Back Muscles ; Tissue Donors ; Toes

Breast cancer is the second leading cause of cancer death in women. Unfortunately, the frequency of breast cancer and mastectomy are increasing in Korea. The purpose of the study is to analyze the results of breast reconstruction using free transverse rectus abdominis myocutaneous(TRAM) flap and to suggest the operative technique for more satisfactory results. 19 patients underwent immediate breast reconstruction from 1990 to 1998, and we experienced 2 cases of bilateral immediate reconstruction of breasts following mastectomy. We have performed the free TRAM flaps based on the deep inferior epigastric vessels using microvascular technique. TRAM flap included very small portion of rectus sheath and muscle-so called muscle sparing technique. So it reduced markedly donor site morbidity. The postoperative course of these cases was uneventful with minor complication. The free TRAM flap was an excellent method of immediate breast reconstruction using autogenous tissue and provided satisfactory outcome. The goals of the immediate breast reconstruction after mastectomy are to restore body image, to achieve near normal shape of breast, and to reduce the complications. This paper represents our experience of immediate breast reconstruction using free TRAM flap, and technical options to get more satisfactory result and reduce the complications. We think this method could be regarded as the first choice for immediate breast reconstruction.
Body Image ; Breast Neoplasms ; Breast* ; Female ; Humans ; Korea ; Mammaplasty* ; Mastectomy ; Rectus Abdominis* ; Tissue Donors

Angiofollicular lymph node hyperplasia(AFLNH) was first described in 1956 by Castleman et al. It was initially reported as a solitary mediastinal mass but multicentric and extranodal disease is now well known. Histologically two distinct variants, e.g. the hyaline vascular type and the plasma cell type, of AFLNH are recognized. And the plasma cell type is typically associated with clinical syndrome consisting of fever, anemia, elevated erythrocyte sedimentation rate and polyclonal hypergammaglobulinemia. Recently, we experineced three cases of AFLNH. Histologically, two cases were hyaline vascular type, that were presented as a right supraclavicular mass of 49-year-old female, and as an anterior mediastinal mass of 53-year-old female. The remaining one case was plasma cell type that was presented as a left axillary mass of 63-year-old male. The former two cases showed typical features of hyaline vascular type but in case 1, exuberant proliferation of hyalinized vessels of capillary size was characteristic feature. The latter case of plasma cell type characteristically showed clinical syndrome consisting of fever, hypoalbuminemia, polyclonal hypergammaglobulinemia. All cases were presented as a single mass and they were well after surgical excision.
Female ; Humans

No abstract available.
Carcinoma, Papillary* ; Thyroid Gland*

PURPOSE: To determine the incidence of avascular necrosis (AVN) of the femoral head after renal transplantation, evaluate plain radiographic and MR findings, and compare known predisposing factors between the AVN group and the control group. MATERIALS AND METHODS: Between August 1990 and June 1998, 256 renal transplantations were carried out at the Maryknoll hospital. The incidence of AVN was determined clinically, and in the AVN group, plain radiographic and MR findings were evaluated. A control group of 29 cases was randomly selected from among the remaining 241 patients, and acute rejection, mean daily steroid dose and osteopenia were compared between the AVN group and the control group. RESULTS: The incidence of AVN of the femoral head was 5.9 %(15/256). Involvement was bilateral in nine cases and unilateral in six and 24 femoral heads were thus affected. The mean period required for diagnosis of this condition was 10.7 months(within 6 months: 2 hips, between 6 -12 months: 10, between 12 -24 months: 9, over 24 months: 3). Plain radiographs showed that three cases were Ficat stage I, five were stage II, seven were stage III, and nine were stage IV. MRI indicated that 15 cases were Mitchell class A, one was class C, and three were class D. Correlation between Ficat stage and the period required for diagnosis showed that the longer the latter, the higher the Ficat stage. A comparison of risk factors between the AVN group and the control group showed that the incidence of acute rejection and osteopenia, and the mean daily steroid dose, were higher in the AVN group than in the rejection group and that the difference was statistically significant. CONCLUSION: The incidence of AVN of the femoral head after renal transplantation was 5.9 %. The longer the period required for diagnosis of AVN, the higher the Ficat stage. A comparison of risk factors between the AVN group and the rejection group showed that the incidence of acute rejection and osteopenia as well as the mean daily steroid dose, were higher in the AVN group than in the rejection group, and these may thus be pre-disposing factors for AVN. In patients with these risk factors, even though plain radiographic findings are normal, MRI is necessary if AVN is to be diagnosed during its early stages.
Bone Diseases, Metabolic ; Causality ; Diagnosis ; Head* ; Hip ; Humans ; Incidence ; Kidney Transplantation* ; Magnetic Resonance Imaging ; Necrosis* ; Risk Factors