The sella turcica is often the key to intracranial diseases and some endocrine disorders. It is significanly enlarged in hypothyroidism, pituitary tumors, some types of increased intracranial pressure and decreased in size in hypopituitarism. Estimation of the sellar size by naked eye is not scientific and moreover very difficult, especially in the borderline sella, an everyday problem of radiologist and pediatrician. It would be very convenient in evaluating the size of the sellar turcica if there are reliable standards. However normal values of the sella turcica for children have not been published in Korea yet. Means+/-2 S.D. of the area and volume of the sella turcica were obtained from skull films taken antero-posterior and lateral projections with focus-film distance of 36 inches in 517 Korean children(Boys, 293; Girls, 224). The area was calculated using the formula : A=LxD, and the volume was studied using the formula : V=1/2 (LxDxW) where A is area ; V, volume ; L, length ; D, depth and W, width of the sella turcica (Fig. 1,2,3). The results obtained are presented in Tables 2~5 and Figures 4~7. By the data, sella turcica area above 70mm2 in infants (0~1 year of age), 90mm2 in preschool children(2~5 years of age), 100mm2 in schoolchildren (6~11 years of age) and 140mm2 in adolescents(12~14 years of age) and/or sellar turcica volume above 450mm2 in infants, 600mm2 in preschool children, 700mm2 in school children and 1,000mm2 in adolescents can be regarded abnormally large sella whereas sella turcica area below 10mm2 in infants, 30mm2 in preschool children, 40mm2 in school children and 50mm2 in adolescents and/or sella turcica volume below 60mm2 in infants, 150mm2 in preschool children, 300mm2 in schoolchildren and 450mm2 in adolescents can be said abnormally small sella. Separate plottings of the volume of the sella turcica for boys and girls show a rapid increase in size during the first two years of life, gradual deceleration in growth rate thereafter and pre-pubertal acceleration of growth in girls by 12 years of age and in boys by 14 years of age. The sella turcica of boys tends to be larger than that of girls from the infancy to 10 years and girls tend to be larger than that of boys between the ages of 11 and 14 years because of the earlier pre-adolescent growth acceleration in girls compared with boys(Fig. 8). An application of these normal values for the sella turcica should help the pediatrician, radiologist, neurologist and neurosurgeon in judging the size of the sellar turcica for children.
Acceleration ; Adolescent ; Child* ; Child, Preschool ; Deceleration ; Female ; Humans ; Hypopituitarism ; Hypothyroidism ; Infant ; Intracranial Pressure ; Korea ; Pituitary Neoplasms ; Reference Values ; Sella Turcica* ; Skull

No abstract available.
Humans ; Neurogenic Bowel* ; Spinal Cord Injuries*

Hereditary fructose intolerance (HFI) is a carbohydrate metabolic disease of autosomal recessive inheritance. The basic deficit is deficiency of aldolase B, the enzyme catalyzing catabolism of fructose-1-phosphate, which is found only in intestinal mucosa, liver and kidney. Its main symptoms are abdominal pain, vomiting, hypoglycemia, and severe liver disease following the ingestion of fructose. Neurologic impairment is not typical in HFI, but it can occur in the acute phase of the disease. Neurologic impairment is related to the acute hepatic toxicity of fructose (hypoglycemia, abnormal coagulation, cardiovascular collapse). The 7 year-old German girl admitted because of generalized tonic clonic seizure. She had the first seizure at the age of 2, and was diagnosed as Lennox-Gastaut syndrome. Thereafter, frequent morning and midnight seizures were developed following indigestion of milk, sweety cake and cookies. Her family history was unknown because she was adopted from India at the 4 months of age. She showed developmental delay. After the ingestion of fructose, the patient experienced hypoglycemic episode within 60-90 minutes of the intake. Based on this finding, she was diagnosed as HFI. With fructose free diet, the patient became free of seizure even without the anticonvulsant, and improved in growth and development.
Abdominal Pain ; Child ; Diet ; Dyspepsia ; Eating ; Female ; Fructose ; Fructose Intolerance* ; Fructose-Bisphosphate Aldolase ; Growth and Development ; Humans ; Hypoglycemia ; India ; Intestinal Mucosa ; Kidney ; Liver ; Liver Diseases ; Metabolic Diseases ; Metabolism ; Milk ; Seizures ; Vomiting ; Wills

Fifteen patients, 15 eyes with medically uncontrollable glaucomas and poor surgical prognoses underwent one-stage, single plate Molteno implatation without postoperative adjunctive systemic antifibrosis therapy. The Molteno implant procedures were successful in 12 (80%) of the 15 eyes. The visual acuity was improved in 2 eyes (13%), but worsened in 2 eyes (13%). Complications included hyphema in 5 eyes (33%), choroidal detachment in 4 eyes (26%), shallow anterior chamber in 3 eyes (20%), tube-iris touch in one eye (6%).
Anterior Chamber ; Choroid ; Glaucoma* ; Humans ; Hyphema ; Prognosis ; Visual Acuity

Thyroid hormones are crucial for development of the central nervous system. Congenital hypothyroidism (CH) is the most common preventable disease resulting in mental retardation. A neonatal screening test (NST) can detect a mild form of CH that can be treated at an early age. Generally after 3 years of age, when most of the brain has matured, clinicians consider reevaluation of thyroid function for CH patients that have been identified with a normal thyroid gland at a normal position. This report presents three CH patients that developed normally, with persistent goiter despite thyroid hormone supplements. The patients’ initial thyroid-stimulating hormone (TSH) level after NST was 47, 157, and 57 mIU/L, respectively. Levothyroxine administration began at 1 or 2 months of age and was terminated after reevaluation at the age of 3, 15, and 5 years, respectively. However, 1 or 2 years later, they all resumed their medication due to increased TSH level coupled with newly developed or enlarged goiter. They all showed dual oxidase maturation factor 2 (DUOXA2) gene mutation: a homozygous mutation with DUOXA2 (c.413dupA; p.Tyr138*) in case 1, a presumed compound heterozygotic mutation with DUOXA2 (p.Tyr138*/p.Tyr246*) in case 2, and heterozygous mutations with DUOXA2 (c.738C>G; p.Tyr246*) and TPO (c.2268dupT; p.Glu757*) in case 3. When goiter persists or is newly developed despite a maintained euthyroid status, for those with transient CH history, follow-up to assess the thyroid function is recommended for at least 1 or 2 years, and genetic testing would be helpful. This study presents the first clinical cases of DUOXA2 mutation in Korea.

PURPOSE: We evaluated restoration of range of motion(ROM) after manipulation under intravenous anesthesia in patients whose maximum flexion was less than 90 degrees at 2 weeks after total knee arthroplasty(TKA). MATERIALS AND METHODS: 136 knees of 108 patients who received TKA between January 1996 and December 2000 and followed up for more than 2 years were analyzed. The forceful manipulation underwent for 16 knees because whose maximum flexion was less than 90 degrees after 2 weeks of TKA. Manipulation were done for 12 of 16 cases at 2 weeks after TKA and 4 cases after more than 3 months. RESULTS: 12 knees which were manipulated 2 weeks after TKA had a mean flexion 103+/-10.2 degrees , 111+/-9.6 degrees and 116+/-11.4 degrees at immediate post-operation, 3 months and 2 years after TKA. In 4 knees manipulated more than 3 months after TKA, a mean flexion was 100+/-10.4 degrees , 102+/-11.5 degrees and 96+/-11.4 degrees at immediate post-operation, 3 months after manipulation and 2 years after TKA. 120 knees with no manipulation had a mean flexion 115+/-13.7 degrees at last follow-up. There was no difference of a mean flexion at last follow-up between group manipulation within 2weeks after TKA and group with no manipulation. CONCLUSION: Manipulation under intravenous anesthesia performed 2 weeks after TKA if patients had less than 90 degrees of flexion increased flexion of the operated knee without any serious complication.
Anesthesia, Intravenous ; Arthroplasty* ; Follow-Up Studies ; Humans ; Knee*

OBJECTIVE: The purpose of our study is to evaluate the success rate and feasibility of intraoperative neuromonitoring (IONM) focusing on transcranial motor evoked potential (TcMEP) monitoring for patients with preoperative motor weakness in spine surgery. METHODS: Between November 2011 and December 2013, TcMEP and somatosensory evoked potential (SSEP) monitoring were attempted in 130 consecutive patients undergoing spine surgeries for cervical or thoracic cord lesions. Patients ranged in age from 14 to 81 years (mean±standard deviation, 56.7±14.8 years), and 84 patients were male. The success rates of both SSEP and MEPs monitoring were assessed according to the preoperative Medical Research Council (MRC) and Nurick grades. RESULTS: TcMEP was recorded successfully in 0%, 28.6%, 72.3%, and 100% of patients with MRC grades 1, 2, 3, 4, and 5, respectively. SSEP was obtained from 0%, 37.5%, 21.5%, 61.4%, and 85.4% of patients with MRC grades 1, 2, 3, 4, and 5, respectively. TcMEP was recorded successfully in 84% of patients with Nurick grades 1-3 and 26% of patients with Nurick grades 4-5. SSEPs were recorded successfully in 76.3% of patients with Nurick grades 1-3 and 24% of patients with grades 4-5. CONCLUSION: IONM during spine surgery may be useless in patients with MRC grades 1-2, applicable MRC grade 3, and useful MRC grades 4-5. MRC grade 3 is a critical point of indication for application of MEPs. In unmonitorable cases with MRC grade 3, increasing stimulus intensity or facilitation techniques may be considered to improve the usefulness of TcMEP.
Evoked Potentials, Motor ; Evoked Potentials, Somatosensory ; Humans ; Male ; Spine*

Urethral stricture is one of the most serious disease in Urology and must be treated vigorously, but the best method of treatment is not established. Our aim is to evaluate a policy of treatment which had developed in favor of urethroplasty for all but minor stricture. A total of 123 patients who had suffered from urethral stricture and undergone urethroplasty in the Department of Urology. Catholic Medical College, were studied during the period from January, 1970 to December, 1982. Of 123 patients,112 primary operations were interlocking, resection and end-to-end anastomosis, Turner-Warwick urethroplasty and transpubic urethroplasty. The results were as follows: 1. In age distribution of the 123 cases of urethral stricture, age of 80 cases ranged from 20 to 49 years. 2. The most common cause of urethral stricture was traumatic urethral injury(traffic accident, industrial accident and staddle injury)comprising 117(95.1%)our of 123cases and the remainders were inflammatory in 3(2.4%),iatrogenic in 3(2.4%). 3. In 41 cases(36.6%)repair was done by interlocking,57(50.9%)by resection and end-to-end anastomosis,3 (2.7%)by Turner-warwick urethroplasty,1(0.9%)by transpubic urethroplasty, 10(8.9%)by suprapubic cystostomy alone. 4. Of the 41 cases of interlocking,6(14.6%) were developed stricture and they required a secondary operation due to persistent stricture in spite of urethral dilatation. 5. Of the 57 cases of resection and end-to-end anastomosis, 5(8.8%)were developed stricture and they required a secondary operation. 6. The methods of secondary operation were resection and end-to-end anastomosis in 6, Turner-Warwick urethroplasty in 2, transpubic urethroplasty in 2.9 of the 10 had good results but 1 required a tertiary operation. 7. In 11 cases transferred from other hospital, methods of secondary operation were resection and end-to- end anastomosis in 8,Turner-Warwick urethroplasty in 2, transpubic urethroplasty in 1 but 3 of the 11 cases required a tertiary operation(Turner-Warwick urethroplasty.) 8. Impotence was developed in 17(13.8%) and the incidence of impotence associated with pelvic bone fracture was 11 cases(64.7%) In total 123 urethral stricture patients,55cases have been followed up by interview and questionnaire from 2 to 10 years. 68 were lost to follow-up. 2 of the 55 vases died of unrelated disease within the period of follow-up. In long term follow-up survey of 53 cases, 7(13.2%) were complicated of urethral stricture and impotence in 9 (17.0%).
Accidents, Occupational ; Age Distribution ; Constriction, Pathologic ; Cystostomy ; Dilatation ; Erectile Dysfunction ; Follow-Up Studies* ; Humans ; Incidence ; Lost to Follow-Up ; Male ; Pelvic Bones ; Surveys and Questionnaires ; Urethral Stricture* ; Urology

The subconjuctival sparganosis is rare tissue helminthiasis which develops frequently in. orbital, abdominal, urethral, ureteral and vertebral cases. Authors reported a case of sparganosis which complained conjuntival hyperemia, chemosis, subconjuntival mass in the right eye for 10 months. The patient was a 37 years old male who had a history of having eaten raw snake in the So-Re Gun. Gyeonggi Do for the purpose of tonics 3 years ago. In the winter of 1977, he had experienced edematous changes in the right cheek intermittently. A few months later, he noticed the apperence of the congestion and a mass on the right eye. On surgical exploration, one larvae (5.8 cm in length and 5 m min width) was extracted from the right upper temporal subconjunctiva. It was actively motile in the bottle filled with saline, so this larvae was consulted to parasitology department of Korea University from our clinic under the impression of subconjunctival sparganosis. The sources of infection of some formely reported sparganosis in Korea were discussed. It is most probable that human sparganosis is acquired by consuming of raw snakes and frogs in this country.
Adult ; Cheek ; Estrogens, Conjugated (USP) ; Gyeonggi-do ; Helminthiasis ; Humans ; Hyperemia ; Korea ; Larva ; Male ; Orbit ; Parasitology ; Snakes ; Sparganosis* ; Ureter

We evaluated the complications of intravesical and extravesical ureteroneocystostomy in 125 renal transplantations performed in the Department of Urology, Catholic Medical College between March 1969 and July 1982. The following results were obtained: 1. Of 125 cases of the recipient 105 cases were male and 20 cases were female. 2. Intravesical ureteroneocystostomy was performed by Politano-Leadbetter method in 66 cases and extravesical ureteroneocystostomy by the similar ones reported by MacKinnon in 59 cases. 3. Our incidence of urological complications in the 125 renal transplantations was 9.7% (12 cases). 4. Postoperative complications developed in 11 of the 66 who underwent intravesical ureteroneocystostomy and in 1 of the 59 who underwent extravesical ureteroneocystostomy. 5. The details of the complications were as follows: 6 were ureteral obstruction, 4 ureteral leakage, 1 bleeding from anastomosis site and 1 was urine leakage from anastomosis site. 6. Operative methods for urological complications were ureteroureterostomy in ureteral obstruction 161 and ureteral leakage (3), ureteroneocystostomy in ureteral leakage (1), simple suture in bleeding (1) and urine leakage (1) from anastomosis site. 7. This method of extravesical ureteroneocystostomy in renal transplantation was easy and fast and has a low complication.
Female ; Hemorrhage ; Humans ; Incidence ; Kidney Transplantation* ; Male ; Postoperative Complications ; Sutures ; Ureter ; Ureteral Obstruction ; Urology