PURPOSE:The incidence of congenital adrenal hyperplasia(CAH) is 1/5,000- 1/20,000 births and thus the importance of the neonatal screening test is being emphasized. However, the reference value for the term and preterm infants has not yet been established and false positive values are frequent due the immature hypothalamic-adrenal axis of the preterm infants or the stress-induced adrenal dysfunction. Therefore, we analyzed the 17-hydroxyprogesterone(17-OHP) concentration in terms of gestational age, birth weight, and postnatal state to establish the reference range for the Korean term and preterm infants. METHODS:We analyzed the results of the CAH screening test retrospectively, which was performed on 737 neonates(624 fullterm neonates, 113 premature neonates) born between January 1998 through July 1998 in Inje University College of Medicine Sanggye Paik Hospital. Mean gestational age and birth weight of infants were 38.2+/-2.6 weeks and 3,116+/-674kg respectively. 17-OHP screening test was performed on 4.9+/-3.8days after birth by obtaining blood samples from the heelstick of neonates. 17-OHP concentration was measured by the ELISA kit(ICN Co.) and repeated the procedure if the result was higher than 35ng/ml. RESULTS: 1) 17-OHP concentration of the preterm infants was significantly higher than that of the fullterm infants(19.1+/-12.3ng/ml vs 11.7+/-7.8ng/ml, P=0.001). 17-OHP concentration was inversely proportional to gestational age. 2)17-OHP concentration was inversely proportional to birth weight(r=0.22, P>0.01). 17-OHP concentration according to birth weight was as follows.:below 1,500g was 26.7+/-11.7ng/ml, 1,500 to 2,000g was 18.0+/-13.9ng/ml, 2,001 to 2,500g was 17.9+/-10.5ng/ml, 2,501 to 3,000g was 12.1+/-7.9ng/ml, 3,001 to 3,500g was 11.5+/-8.1ng/ml, above 3,500g was 11.4+/-7.5ng/ml. There was a significant decline in the 17-OHP concentration as the birth weight increased. 3) 17-OHP concentration was gradually decreased as sampling date increased. 4) The gender of the infants did not influence the 17-OHP concentration(male 13.0+/-9.1 vs female 12.7+/-9.0). 5)17-OHP concentration were significantly higher in sick preterm infants than healthy preterm infants. 6)Six cases, whose 17-OHP concentration were greater than 35ng/ml, were all preterm and low birth weight infants. Reexamination after one week showed the value within normal range. No CAH cases were diagnosed in the study. CONCLUSION: 17-OHP concentration was inversely proportional to gestational age and birth weight. Therefore, reference ranges of 17-OHP concentration should be subdivided according to gestational age and birth weight. Further research about perinatal risk factors affecting the 17-OHP concentration will be required.
17-alpha-Hydroxyprogesterone* ; Axis, Cervical Vertebra ; Birth Weight ; Enzyme-Linked Immunosorbent Assay ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature* ; Mass Screening ; Neonatal Screening ; Parturition ; Reference Values ; Retrospective Studies ; Risk Factors

The UGI studies had been performed to 238 patients below the age of 15 years during the period from Jan. 1979to Jul. 1983 in SCH hospital. The results are as follows; 1. Among 238 cases, 48 cases revealed peptic ulcers ofstomach or duodenum (20.2%). The ulcer was in 31/37 cases of male patients(22.6%), and in 17/101 cases of female(16.8). Below the age of 5 years, ulcer was noted in 9 cases among 61 cases (14.8%), whereas above 5 years, in 39cases among 177 patients (22.0%). 2. In the age group below 5 years, mostly the objective symptoms were discovered(8/9), but above 5 years, complained of subjective symtoms (30/39). 3. The predominant site of peptic ulcer wasgastric antrum in the age group below 5 years (7/9), whereas duodenal bulb above 5 years(33/43). 4. Gastric antrumor duodenal bulb deformity was revealed in 13 cases and most of them were in the age group above 5 years. 5. Alllesion so peptic ulcers in this study were benign in nature. 6. In follow up study after 1 or 2 months, ulcer wasdecreased in size strikingly(9/11).
Congenital Abnormalities ; Duodenum ; Follow-Up Studies ; Humans ; Male ; Peptic Ulcer ; Ulcer

Gastritis cystica polyposa(GCP) is a polypoid cystic lesion showing all the histological features of the hyperplastic polyps and the cysts penetrating through the mucularis mucosae. Most reported GCP lesions were developed at gastraenterostomy stomas. It is rare that GCP develops without history of previous gastroenterostomy. In 1990, however, Kim et al reported a GCP presenting as a submucosal tume-like lesion in a 69-year-old man. Recently, we had experienced two consecutive cases of GCP diagnosed by endoscopic polypectomy. The first case was 49-year-old housewife without history of previous gastric surgery. Esophagogastroduodenoscopy(EGD) showed a 2.0x1.5x1.5cm sized lobulated polypoid lesion with a broad stalk on the anterior wall of the distal antrum. The second case was 45-year-old woman without history of previous gastric surgery. EGD revealed a 1.0 x 1.0 x l.0 cm sized polypoid lesion with a pedicle on the greater curvature aspect of the upper body and two duodenal ulcers with pseudodiverticulum formation. These lesions were endoscopically polypectomized and diagnosed as GCP by the histologic examination.
Aged ; Duodenal Ulcer ; Female ; Gastritis* ; Gastroenterostomy ; Humans ; Middle Aged ; Mucous Membrane ; Polyps

Klippel-Feil syndrome is characterized by congenital fusion of cervical vertebrae with a wide range of associated anomaly. The authors present a 50-year-old Klippel-Feil syndrome patient with a minor trauma followed progressive quadriparesis. He had typical radiologic findings of type II Klippel-Feil syndrome and presented progressive myelopathy due to cord compression at foramen magnum level with cervical instability. The patient underwent craniocervical decompression and fusion. The authors reviewed the pertinent literatures and discussed this rare syndrome.
Cervical Vertebrae ; Decompression ; Female ; Foramen Magnum ; Humans ; Klippel-Feil Syndrome* ; Middle Aged ; Quadriplegia* ; Spinal Cord Diseases

Bone scan using 99m Tc-MDP is the most accurate and reliable method for the early detection of fracture, andgive the most accurate in formation about the healing process of fractured bone. Recent days, the medicolegalproblem about the injured time is frequently provoked in vertebral fracture patient by trauma. The authorsanalyzed the bone scan of vertebral fracture patients from March to Dec. 1983. The authors obtained results asfollows: 1. The minimum time for a fracture to return to normal on a bone scan was 4 month in cervical spine. 2.It was 12 month in thoracic spine. 3. It was 6 month in lumbar spine. 4. Surrounding soft tissue injury was healedwithin 10 days after trauma in our cases. 5. Focal hot uptake is persisted in case of callus deposition on plainfilm, although very small in amount. 6. Healing time is delayed in case of severely compressed vertebral body,belowed the half than normal height. 7. With bone scan it is possible to differentiate the fresh fracture from oldhealed, impossible by plain film. 8. Healing time is delayed in old age.
Bony Callus ; Humans ; Methods ; Soft Tissue Injuries ; Spine

PURPOSE: The purpose of the study was to evaluate serum magnesium(Mg) concentration in very low birth weight(VLBW) infants during the first three weeks of life and to assess its relation to diseases of prematurity. METHODS: We measured serum Mg level at 0, 1, 2, and 3weeks of life in VLBW infants and analyzed its correlations with diseases of prematurity. Ninety-five VLBW infants(mean gestational age 30.4wks, birth wt 1304gm) who survived 30days were selected. Seven infants who had been treated with magnesium sulfate prenatally were excluded. RESULTS: Serum Mg level decreased linearly during the first three weeks of life(P=0.03). Serum Mg level at birth had no significant relation to gestational age, birth weight and serum calcium concentration. Serum Mg level at birth were higher within normal range in infants with respiratory distress syndrome(n=20, 2.6mg/dl vs. n=68, 2.2mg/dl, P=0.036), patent ductus arteriosus (n= 19, 2.5mg/dl vs. n=69, 2.2mg/dl, P=0.035) and bronchopulmonary dysplasia(BPD)(n=15, 2.6mg/dl. vs. n=73, 2.2mg/dl, P=0.01) than in infants without them. Serum Mg level at first week of life were similar(2.3mg/dl. vs. 2.2mg/dl, P=0.51) and serum Mg level at second and third weeks of life were significantly lower in infants with BPD than in control(1.9mg/dl vs. 2.2mg/dl, P=0.002 and 1.6mg/dl vs. 2.2mg/dl, P=0.001, respectively). CONCLUSION: Serum Mg level during the first three weeks of life decreased linearly. Serum Mg level of infants with BPD at birth was higher within normal variation than in infants without BPD. And serum Mg level of infants with BPD at second and third weeks of life were lower than control. Thus, we suggest that Mg deficiency during the first three weeks of life might play a role in the pathogenesis of BPD.
Birth Weight ; Bronchopulmonary Dysplasia ; Calcium ; Ductus Arteriosus, Patent ; Gestational Age ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Magnesium Sulfate ; Magnesium* ; Parturition ; Reference Values

PURPOSE: Vasodilator therapy in infants with persistent pulmonary hypertension of the newborn(PPHN) frequently causes systemic hypotension due to non-selectivity for pulmonary vessels. Blood pressure(BP) cuffs can increase systemic vascular resistance around which they are applied without affecting pulmonary vessels. We studied the effects of BP cuffs on the circulatory and respiratory status of infants with PPHN receiving vasodilator therapy. METHODS: Mechanically ventilated 16 term infants(gestational age of 39.9+ 1.3 weeks and birth weight of 3,533+/-318 gm with PPHN who had right to left shunt on echocardiogram and survived over 5 days were included for the study. All infants received vasodilator(tolazoline)therapy. We applied BP cuffs for neonatal use to four extremities of study infants(n=8) and inflated them to systolic pressure. Those who received vasodilator therapy alone served as control(n=8). We analyzed systolic and mean BP, respiratory parameters, presence of right to left shunt an clinical outcome at 1, 2, 6, 12, 24, 48, 72hr after initiation of vasodilator therapy. RESULTS: Systolic BP increased significantly in study group(from 37+/-11 to 46+/-13 mmHg) from 6 hours after BP cuff application compared to control group(from 39+/-8 to 40+/-13 mmHg), and this effect persisted up to 72 hour(52+/-18 vs. 46+/-16 mmHg)(P<0.05). Mean BP also increased significantly in study group(30 +/-10 to 38+/-12 mmHg) from 6 hours compared to control group(32+/-11 to 33 15 mmHg) and maintained up to 72 hour occurred(43+17 vs. 3715 mmHg)(P<0.05). Reversal of right to left shunt occurred significantly earlier in study group than control group(30+/-10 vs. 52+/-18 hr)(P<0.01). Respiratory parameters such as mean airway pressure, oxygenation index and duration of ventilator care and hospitalization were not different. Four of five infants in the study group and five of eight in control group survived. CONCLUSION: Application of BP cuffs to the infants with PPHN treated with vasodilator resulted in increase innd mean BP and early reversal of right to left shunt. We suggest that application of BP cuffs can play a useful role in the management of infants with PPHN.
Birth Weight ; Blood Pressure* ; Extremities ; Hospitalization ; Humans ; Hypertension* ; Hypertension, Pulmonary ; Hypotension ; Infant* ; Infant, Newborn* ; Oxygen ; Vascular Resistance ; Ventilators, Mechanical

During the period from January, 1975, to June, 1989, one hundred patients with histopathologically proven polymorphic reticulosis in the upper respiratory tract were treated with radiation therapy and the analysis of treatment results was undertaken. One hundred patients (69 males, 31 females) with a mean age of 46 years (range 12-79 years) were presented. Nasal cavity was the most frequent site of involvement(56%), and 44 cases had multifocal sites of involvement. The incidence of cervical lymph node metastasis at initial diagnosis was 24%. Staging was determined by Ann-Arbor classification, retrospectively. The number of patients of stage IE, IIE, IIIE and IVE were 35, 60, 1, and 4, respectively. The overall 5 year actuarial survival rates were 38.4%. The difference in 5 year survival rates between patients with stage IE and IIE, with solitary and multiple, with CR and PR after irradiation were significant statistically. For the analysis of failure patterns, failure sites include the following: local failure alone(30/55=54.6%), systemic failure alone(9/55=16.4%), both local and systemic failure(16/55=29.0%). Retrograde slide review was available in 29 cases of PMR with respect to histopathologic bases, and immunohistochemical studies were performed using MTI and DACO-UCHL-1 as T-cell markers, MB2 as a B-cell marker and alpha-1-antichymotrypsin as a histiocytic markers. All that 29 cases showed characteristic histologic features similar to those of peripheral T-cell lymphoma and showed positive reactio to the T-cell marker. These findings suggest strongly that quite a significant portion of PMR may be in fact T-cell lymphoma.
B-Lymphocytes ; Classification ; Diagnosis ; Granuloma, Lethal Midline* ; Humans ; Incidence ; Lymph Nodes ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral ; Male ; Nasal Cavity ; Neoplasm Metastasis ; Respiratory System ; Retrospective Studies ; Survival Rate ; T-Lymphocytes

Erythropoietic protoporphyria is a genetic disorder due to a deficiency of ferrochelatase resulting in excessive accumulation and excretion of protoporphyrin. The predominant clinical feature is photosensitivity. Severe hepatic failure occurs in a small percentage of patients, and neurological symptoms are very rare. We report a case of erythropoietic protoporphyria associated with severe hepatic dysfunction and neurological symptoms. A 9-year-old girl presented with severe abdominal pain, nausea, weakness and pain of extremities, and urinary retention. Ultrasonogram and abdominal CT scanning revealed a diffuse infiltrated and enlarged liver. Liver biopsy showed deposition of dense dark brown pigment within the bile, hepatocytes and Kupffer cells. Plus, dense dark brown deposits gave a red birefringent under polarize light. Porphyrin studies demonstrated markedly elevated serum free erythrocyte protoporphyrin. This girl was diagnosed as erythropoietic protoporphyria with severe liver dysfunction and neurological symptoms.
Abdominal Pain ; Bile ; Biopsy ; Child ; Erythrocytes ; Extremities ; Female ; Ferrochelatase ; Hepatocytes ; Hepatomegaly ; Humans ; Kupffer Cells ; Liver Diseases* ; Liver Failure ; Liver* ; Nausea ; Protoporphyria, Erythropoietic* ; Tomography, X-Ray Computed ; Ultrasonography ; Urinary Retention

Purpose: To determine if it is feasible and safe for a surgeon to transition from using the posterolateral approach to direct anterior approach (DAA) by evaluating the first 53 cases of total hip arthroplasty using a DAA. Materials and Methods: A retrospective review of 52 patients who underwent THA using a DAA between July 2017 and December 2018. Reasons for THA were: femoral neck fracture (n=34), avascular necrosis (n=13), and arthritis (n=6). The mean age was 70 years old. An assessment of feasibility was made by analyzing mean operative time and blood loss. Cup inclination, anteversion, and leg length discrepancy (LLD) were measured using postoperative radiology. Safety of the DAA was judged using the incidence and nature of all complications. Results: The mean operative time was 112 minutes. 135 minutes for the 1st 10 cases, 100 minutes for 2nd 10 cases, 113 minutes for 3rd 10 cases, 119 minutes for 4th 10 cases, and 91 minutes for the final 13 cases. The mean blood loss was 724 mL. Average cup inclination was 40.27。; 2 cases were out of safety angle. Mean anteversion was 16.18。. No intraoperative fractures or infections were observed. LLD was detected in 3 cases, one of which underwent revision due to walking difficulty. Dislocation occurred in 3 cases, all within the first 20 cases, however, there was no recurrent dislocation. Conclusion DAA for THA was deemed to be feasible and safe based on an assessment of operative time, blood loss and complications.