Macroamylasemia is a benign condition characterized by abnormally large-sized serum amylase; it has been reported to occur in 1-2% of the population. In macroamylasemia, a macromolecular complex consisting of amylase linked to immunoglobulins circulates in the plasma and usually causes hyperamylasemia with low or normal amylasuria. Macroamylasemia is extremely rare in children. We report a case of a 4-year-old girl with abdominal pain and macroamylasemia, who was initially misdiagnosed as having acute pancreatitis. Failure to immediately identify macroamylase as the cause of the unexplained but benign hyperamylasemia can lead to the misdiagnosis of the condition, necessitating costly analyses for ruling out pancreatic disease and unnecessary prescriptions such as fasting and intravenous replacement therapies, as was observed in our patient.
Abdominal Pain ; Amylases ; Child ; Diagnostic Errors ; Fasting ; Humans ; Hyperamylasemia ; Immunoglobulins ; Pancreatic Diseases ; Pancreatitis ; Plasma ; Preschool Child ; Prescriptions

Macroamylasemia is a benign condition characterized by abnormally large-sized serum amylase; it has been reported to occur in 1-2% of the population. In macroamylasemia, a macromolecular complex consisting of amylase linked to immunoglobulins circulates in the plasma and usually causes hyperamylasemia with low or normal amylasuria. Macroamylasemia is extremely rare in children. We report a case of a 4-year-old girl with abdominal pain and macroamylasemia, who was initially misdiagnosed as having acute pancreatitis. Failure to immediately identify macroamylase as the cause of the unexplained but benign hyperamylasemia can lead to the misdiagnosis of the condition, necessitating costly analyses for ruling out pancreatic disease and unnecessary prescriptions such as fasting and intravenous replacement therapies, as was observed in our patient.
Abdominal Pain ; Amylases ; Child ; Diagnostic Errors ; Fasting ; Humans ; Hyperamylasemia ; Immunoglobulins ; Pancreatic Diseases ; Pancreatitis ; Plasma ; Preschool Child ; Prescriptions

OBJECTIVES: lschemic acute renal failure(ARF) is characterized by an abrupt and sustained decline in GFR within minutes to days after renal ischemia and not immediately reversed on restoration of renal blood flow. The typical delay of a few days to a few weeks suggests reversible parenchymal damage awaiting cell regeneration for functional recovery. Many potentially cell damaging factors, such as ATP depletion, plasma membrane phospholipid degradatian and superoxide-induced membrane damage, play a central part in ischemic injury. More recently, much attention has been focused on the role of calcium, especially ischemic cell injury and the possible therapeutic role of calcium channel blockers emerged from studies conducted several years ago. In the past, it was thought that activation of renin-angiotensin system plays a role in the pathogenesis of ARF. Now the role of angiotensin in human renal ischemia also appears to be controversial. The following study was done in order to investigate the effect of a calcium channel blocker, nifedipine, on gene expression of renin during acute ischemic renal injury. METHODS: The Sprague-Dawley rats were divided into 4 groups, group I(n=3) as the control, group II (n=3) as the sham operation group, group III(n=15) as the ischemic renal injury group without nifedipine pretreatment, and group IV(n=15) as the ischemic renal injury model by right nephrectomy and left renal artery clamping for 40 minutes with systemic nifedipine pretreatment(10mg/kg), 1n ischemic renal injury model(group III and IV), rats were further divided into three subgroups according to reperfusion time of 1,24,72 hours. The non-ischemic right kidney removed at the time of initial procedure served as paired control. Total renal RNA was extracted by Chomczynskis method and electrophoresis was done in a 1% agarose gel containing 2,2M formaldehyde. Northern was performed at 42degrees C with isotope labeled renin probe for 18 hours, Autoradiographs were obtained and quantitated by a densitometer measured at 530nm. RESULTS: 1) The expression of renin gene was markedly decreased after renal ischemia and slowly recovered to one half of the control level after 72 hours of reperfusion. 2) Renin gene expression pattern of ischemic renal injury with prior nifedipine treatment was similar to the ischemic group without nifedipine pretreatment. CONCLUSION: These findings suggest that the renin gene expression was markedly decreased after renal ischemia and slowly recovered. Systemic nifedipine pretreatment does not have a significant effect on gene expression pattern of renin in ischemic renal injury.
Adenosine Triphosphate ; Angiotensins ; Animals ; Calcium Channel Blockers ; Calcium Channels* ; Calcium* ; Cell Membrane ; Constriction ; Electrophoresis ; Formaldehyde ; Gene Expression* ; Humans ; Ischemia ; Kidney ; Membranes ; Nephrectomy ; Nifedipine ; Rats ; Rats, Sprague-Dawley ; Regeneration ; Renal Artery ; Renal Circulation ; Renin* ; Renin-Angiotensin System ; Reperfusion ; RNA ; Sepharose

Screw fixation of the tibial component offers advantages in initial fixation in cementless total knee replacement. But the high incidence of screw related osteolysis was reported. The purpose of this study is to evaluate clinical results of cementless total knee replacement and to look for radiographic changes at the screw-bone interface. From January 1988 to December 1991, primary cementless total knee replacements with Miller Galante I (Zimmer, Warsaw. IN) were performed to 53 knees at Kyung Hee university hospital. Among them, 21 cases which could be followed-up for more than 4 years were studied retrospectively about the clinical and radiographic results. The mean follow-up period was 5.5 years(ranged from 4.2 years to 8 years). At the last follow-up period, knee scores of Hospital for Special Surgery were improved from mean 56 points to 90 points and the range of motion from 72 degrees to 110 degrees. In the last follow-up radiographs, osteolysis around screw was classified as linear(type I ), cystic(type II ) and cavitary(type III ) according to the width of the lucency around screws. Among 21 cases, radiographic findings of osteolysis around screw were detected in 10 cases but not in 11 cases. But clinical results were similar between these two groups. Among the total 84 screws(4 screws in each case), 21 screws(25%) showed screw related osteolysis typed as I in 13 screws(15.4%), II in 4 screws(4.8%) and III in 4 screws(4.8%). Among the 13 cases that followed-up more than 6 years, 20 screws(38%) showed screw related osteolysis typed as in 11 screws(21.2%), I in 5 screws(9.6%) and II in 4 screws(7.8%). The most frequently involved site of screw was anteromedial(33.3%). In conclusion, after mean 5.5 year follow-up, the clinical results were satisfactory but the development of osteolysis around screw might be an indicator of the implant failure.
Arthroplasty, Replacement, Knee* ; Follow-Up Studies ; Incidence ; Knee ; Osteolysis* ; Range of Motion, Articular ; Retrospective Studies

Many previously described nuclear medicine procedures to assess glomerular filtration rate have some problems because numerous blood sample is to be taken and they don't measure each separate renal function. Gates described isotopic method for the measurement of global and unilateral GFR based on the fractional renal uptake of (99m)Tc-DTPA 2 to 3 minutes after its intravenous injection. We evaluated GFR using (99m)Tc-DTPA in 57 people according to Gates method and compared with creatinine clearance. A good correlation was observed between creatinine clearance and GRF calculated by Gates' formula with an r value of 0.9(P<0.05). And also the relationship between parameters of (99m)Tc-DTPA renal scan images and GFR was taken. They were significantly correlated with GFR calculated by Gates' formula : r value 0.66 between relative intensity of peak renal to peak aortic activity(pK/pA) and GFR, -0.42 between time between aortic and kidney peak(A-K) and GFR and -0.48 between parenchymal renal activity at 25 min compared to peak kidney activity(25K/pK) and GRF. In conclusion, the determination of GFR according to Gates' formula shows good and reproducible of GRF with rapidity and simplicity. And the parameters from the renal scan images can use to estimate the renal function.
Creatinine ; Filtration* ; Glomerular Filtration Rate ; Injections, Intravenous ; Kidney ; Methods ; Nuclear Medicine

No abstract available.
Thyroid Dysgenesis*

Considering the relatively good prognosis of papillary thyroid carcinoma, surgical treatment should be conducted with an adequate method and extent of surgery with minimal complications. The optimal indications and extent of central neck dissection in papillary thyroid carcinoma has been introduced by variable guidelines. However, there have been controversies in several aspects regarding central neck dissection (i.e., prophylactic versus therapeutic, unilateral versus bilateral), which will remain until a large prospective study is completed. Successful management of cervical lymph node metastasis in papillary thyroid carcinoma requires thorough preoperative evaluation, knowledge on adequate indications and extent of surgery and considerations on surgical anatomy. In this article, we reviewed the rationales for optimal central neck dissection in papillary thyroid carcinoma based on recent studies and presented the surgical strategy and skills based on personal experience of a single surgeon.
Humans ; Lymph Nodes ; Neck Dissection* ; Neoplasm Metastasis ; Prognosis ; Thyroid Neoplasms*

Femoral neuropathy may be associated with various etiologies and can cause severe walking disability. We present the case of a 25-year-old woman who underwent surgical repair for a patella fracture and complained of lower extremity pain, paresthesia, and weakness postoperatively. Electromyography and magnetic resonance imaging (MRI) revealed partial peripheral neuropathy of the left femoral nerve associated with the patella fracture. To our knowledge, this is the first reported case of femoral neuropathy associated with a patella fracture.
Adult ; Electromyography ; Female ; Femoral Nerve ; Femoral Neuropathy ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle Weakness ; Paralysis ; Paresthesia ; Patella ; Peripheral Nervous System Diseases ; Walking

Hypoparathyroidism is one of the major complications of total thyroidectomy. This complication can occur when the parathyroid tissue is unintentionally removed or the parathyroid vessels is ligated. Early mapping and localization of the parathyroid tissue would be helpful to prevent such unintended complication. The authors introduce the procedures of parathyroid identification with Near-infrared autofluorescence performed in our institution.

Hypoparathyroidism is one of the major complications of total thyroidectomy. This complication can occur when the parathyroid tissue is unintentionally removed or the parathyroid vessels is ligated. Early mapping and localization of the parathyroid tissue would be helpful to prevent such unintended complication. The authors introduce the procedures of parathyroid identification with Near-infrared autofluorescence performed in our institution.