Slipped femoral capital epiphysis is a rare entity in Korea and only three cases have been reported so far1,2,3). One of our cases was a unilateral mild chronic slip in a 14 year old boy with Frohlich body type. It was treated by gentle closed reduction followed by knowles' pin fixation. The other case, a 20 year old female, presented chondrolysis of the left hip. Scrutinization of roentgenograms revealed typical features of an unrecognized slipped femoral capital epiphysis. It was treated by Wagner resurfacing replacement arthroplasty.
Arthroplasty, Replacement ; Epiphyses ; Female ; Hip ; Humans ; Korea ; Male ; Somatotypes

No abstract available.
Humans*

No abstract available.
Mucocele* ; Sphenoid Sinus*

As craniopharyngioma is histologically benign, recent trend of managing this tumor has been complete surgical removal without adding any adjuvant therapy. But because of its close relation with surrounding vital structures, total removal sometimes results in unacceptable neurologic sequelae. To avoid these serious complications various management options have been suggested. Among these, bleomycin injections into the cystic cavity have been sporadically reported with satisfactory results. The authors report a 50-year-old woman presented with visual symptoms, who was found to have a largely cystic craniopharyngioma. Because the boarder between the tumor and hypothalamus was ill defined, intracystic bleomycin injection followed by delayed surgery was scheduled. A total of 80mg bleomycin was given over the 8 days. After the treatment high fever, skin rash and mental change developed but these symptoms were gradually subsided and the cysts were shrunken with surrounding infarction. During the follow-up period, visual symptoms became rapidly worse for which surgery was undertaken. Optic nerve was severely compressed by the underlying solid tumor and overlying A1 portion of the anterior cerebral artery. The tumor was near totally removed without any vascular insult. After the operation, the patient remained drowsy and lapsed into coma 6 days later and died. CT scan just before her death showed an infarct in the right ACA and MCA territories suggesting ICA occlusion. The cause of ICA occlusion remained to be unsolved.
Anterior Cerebral Artery ; Bleomycin* ; Coma ; Craniopharyngioma* ; Exanthema ; Female ; Fever ; Follow-Up Studies ; Humans ; Hypothalamus ; Infarction ; Middle Aged ; Optic Nerve ; Tomography, X-Ray Computed

A retrospective review was undertaken of 19 patients with occult papillary carcinoma of thyroid (lesions<1.5 cm in diameter) who were operated on at National Medical Center between 1980 and 1993. The prevalence of occult thyroid cancer was 11.7 %(19/162) of papillary cancer and 3.5 %(19/535) of all cases operated for thyroid disease. All patients were female and the mean age of patients was 45 years. Four out of 19 patients (21%) had cervical lymph node metastasis. The mean age for the group of patients with nodal metastasis was 37 years, which was more than a decade younger than the age for those without nodal metastasis, 47 years. The mean maximum diameter of the tumors was 0.72 cm with the range of 0.2 to 1.4 cm. Histologically all lesions were densely fibrotic, unencapsulated and composed of a predominantly follicular pattern. Operations were conservative. For patients with nodal metastasis, lymphadenectomy generally involved a selective node excision or a modified radical neck dissection. The mean follow-up period was 6.5 years. All patients were alive without evidence of recurrent disease and distant metastasis. Thus, radical surgical or medical extirpation of all thyroid tissue is unnecessary in the treatment of this disease.
Carcinoma, Papillary* ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Prevalence ; Retrospective Studies ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Neoplasms

BACKGROUND: An initiating time of renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD) has great influence on prognosis of the patients, however, there are currently no accurate guidelines for initiation of renal replacement therapy. Traditionally, nephrologists usually initiate RRT on the basis of observation of uremic symptoms and changes of laboratory parameters, such as serum creatinine concentration and/or glomerular filtration rate (GFR). DOQI guidelines suggest weekly Kt/Vurea < 2.0 or nPNA < 0.8 g/kg/day for an objective index of the initiation of dialysis. Then, we designed to formulate KP index {(weekly Kt/Vurea + 2.5 X nPNA) X 1/2} using two indices above as a clinically useful objective index to determine the initiation of RRT for patients with ESRD. METHODS: Patients with ESRD having the weekly Kt/Vurea index below 3.0 were selected from 186 patients who came to renal unit of Soonchunhyang Bucheon hospital. The patients having the weekly Kt/Vurea index between 1.0 and 2.0 were classified into two groups, KP index > 2.0 and KP index < 2.0. The groups were compared and analyzed via renal function, biochemical index and the number of patients starting a first RRT. Further, the correlations between KP index and other indices were analyzed over all patients. Then, the numbers per group of patients starting RRT were compared after all patients were divided into two groups, one of which is between 1.5 and 2.0 and the other is between 2.0 and 2.5 by weekly Kt/Vurea index and KP index. RESULTS: The group of KP index < 2.0 indicated significantly lower indices in weekly Kt/Vurea, nPNA (B2) and % LBM (%) than those of the group of KP index > 2.0, while no significant differences between the groups were in serum albumin concentration, serum creatinine concentration, FFEFBM and RRF. And the frequency of patients starting RRT was significantly higher in the group of KP index < 2.0 rather than the group of KP index > 2.0 in statistics. There was a significant correlation between KP index and other indices in all patients. In comparing and analyzing the number of patients starting RRT, weekly Kt/Vurea index did not demonstrate significant differences between two groups of 1.5 < weekly Kt/Vurea < 2.0 and 2.0 < weekly Kt/Vurea < 2.5, but the frequency of patients in the group of 1.5 < KP index < 2.0 was significantly higher than that in the group of 2.0 < KP index < 2.5. CONCLUSION: It is considered that KP index is an index clinically useful for ESRD patients to determine an appropriate timing for the initiation of RRT, and that the timing should be fixed with regard for other various indices and clinical features for advisable prognosis of the patients. In addition, accurate guideline to determine such an appropriate time needs to be suggested by further new studies.
Creatinine ; Dialysis* ; Glomerular Filtration Rate ; Gyeonggi-do ; Humans ; Kidney Failure, Chronic* ; Prognosis ; Renal Replacement Therapy ; Serum Albumin

We report a case of rhabdomyolysis in a 29-year-old man, presenting pain on neck and shoulder and dark urine, which developed after taking Bear's gall and swimming. Laboratory studies revealed serum creatinine 0.9 mg/dL, creatinine kinase 83,045 IU/L, serum myoglobin 794.6 ng/mL, urine myoglobin 220.2 ng/mL. Tc-99m MDP whole bone scan showed diffuse increased uptake confined to the soft tissue of upper chest. The condition resolved spontaneously when consumption of the product ceased, he was recovered with normal creatine kinase. Generally, the Bear's gall is termed gall bladder of bear dried under the air-flow, which has been applied as versatile treatment in oriental medcine. Rhabdomyolysis is a well known complication of HMG-CoA inhibitor therapy, the Bear's gall has not yet been reported as a cause of rhabdomyolysis. We postulate that the Bear's gall may result in muscle injury.
Adult ; Creatine Kinase ; Creatinine ; Humans ; Myoglobin ; Neck ; Phosphotransferases ; Rhabdomyolysis* ; Shoulder ; Swimming ; Technetium Tc 99m Medronate ; Thorax ; Urinary Bladder

BACKGROUND: The time at which renal replacement therapy (RRT) is initiated in patients with end-stage renal disease (ESRD) has a great influence on the prognosis of the patient; however, there are currently no accurate guidelines for the initiation of RRT. Traditionally, nephrologists usually initiate RRT on the basis of the observation of the uremic symptoms and changes in the laboratory parameters, such as the serum creatinine concentration and/or glomerular filtration rate (GFR). DOQI guidelines suggest a weekly Kt/Vurea < 2.0 or an nPNA < 0.8 g/kg/day as objective indices for the initiation of dialysis. Thus, a KP index was formulated (weekly Kt/Vurea+2.5 X nPNA) X (1/2) using the above two clinically useful and objective indices to determine the adeguate time to initiate RRT in patients with ESRD. METHODS: Of 186 patients admitted to the renal unit of Soonchunhyang Bucheon hospital, those with ESRD and a weekly Kt/Vurea below 3.0 were selected. The patients with a weekly Kt/Vurea index between 1.0 and 2.0 were classified into one of two groups; KP index > 2.0 and KP index < 2.0. The groups were compared and analyzed in relation to their renal function, biochemical indices and the numbers of patients per group starting RRT. Further, the correlations between the KP and other indices were analyzed in all the patients. The patients were then further divided into another two groups according to their weekly Kt/Vurea and KP index: group one; between 1.5 and 2.0 and group 2; between 2.0 and 2.5. The numbers of patients per group starting RRT were compared. RESULTS: The KP index < 2.0 group showed significantly lower indices for weekly Kt/Vurea, nPNA and %LBM (%) than those of the KP index > 2.0 group, while there were no significant differences between the groups in the serum albumin concentration, serum creatinine concentration, FFEFBM and RRF. Also, there was a statistically significant higher rate of incidence of patients starting RRT in the KP index < 2.0 group than in the KP index > 2.0 group. There was a significant correlation between the KP and other indices in all patients. When comparing the number of patients starting RRT, the weekly Kt/Vurea index demonstrated no significant differences between the 1.5 < weekly Kt/Vurea < 2.0 and 2.0 < weekly Kt/Vurea < 2.5 groups, but the number of patients starting RRT in the 1.5 < KP index < 2.0 group was significantly higher than that in the 2.0 < KP index < 2.5 group. CONCLUSION: The KP index is considered a clinically useful index in ESRD patients for determining an appropriate time for the initiation of RRT. Also, the timing of the initiation of RRT should be fixed with regard to the various other indices and clinical features for a desirable prognosis of the patients. In addition, further studies will be required to determine accurate guidelines for an appropriate time for RRT initiation.
Adult ; Aged ; Blood Urea Nitrogen ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Humans ; Kidney/metabolism ; Kidney Failure, Chronic/epidemiology/*metabolism/physiopathology/*therapy ; Korea/epidemiology ; Male ; Middle Aged ; Nutritional Status ; *Renal Dialysis ; Serum Albumin/metabolism ; Severity of Illness Index ; Urea/blood

PURPOSE: Airways eosinophilia and increased IgE, characteristic features of asthma, result from a predominant Th2 response. In this study, we investigated the effect of CpG oligodeoxynucleotides (ODNs) on the inhibition of airways eosinophilia in mice with established airway inflammation. We also investigated the immunological mechanisms involved. METHODS: Groups of BALB/c mice were sensitized intradermally with ovalbumin(OVA). At week 10, airway inflammation was induced by intranasal challenge of the mice with OVA. At week 14, the mice were challenged intranasally again with OVA in the presence and without the presence of CpG ODNs. Mice with saline administration served as negative controls. Bronchoalveolar lavage fluids(BALF) were obtained and eosinophils were counted. Th1 and Th2 cytokines in the spleen cell cultures were measured by ELISA. Serum OVA-specific IgE and IgG2a antibodies were also measured by ELISA. RESULTS: BALF eosinophils were significantly inhibited in the CpG ODNs-treated mice(P<0.01). IgE and IgG2a levels increased significantly in both CpG ODNs-treated and untreated groups as compared to the negative control group; there was, however, no significant difference between the two groups four days after intranasal administration of CpG ODNs. Cytokine analysis revealed decreased production of IL-4, IL-5, and IL-13 and increased production of IL-12 in the CpG ODNs-treated group as compared to the untreated group. Interestingly, IFN-gamma levels were not upregulated in the CpG ODNs-treated group. CONCLUSION: CpG ODNs vaccination is a potentially useful approach for reversing airways eosinophilia in mice with established airways inflammation.
Administration, Intranasal ; Animals ; Antibodies ; Asthma ; Bronchoalveolar Lavage ; Cell Culture Techniques ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Immunoglobulin E ; Immunoglobulin G ; Inflammation* ; Interleukin-12 ; Interleukin-13 ; Interleukin-4 ; Interleukin-5 ; Mice* ; Oligodeoxyribonucleotides* ; Ovum ; Spleen ; Vaccination

PURPOSE: The purpose of this study is to assess the periopertive morbidity and mortality rates in relation to the principal variables in aged patients who undergo laparoscopic colorectal resection. METHODS: From March 2001 to March 2006, the prospective laparoscopic colorectal resection database was used to identify 233 patients. Among them, 132 were 70 years of age or older and they were classified as the aged group. 101 were younger than 70 years of age and they were classified as the younger group. RESULTS: Comorbidity was more common in the aged group than in the younger group (67.4% and 53.5%, respectively) (P=0.030). There were higher ASA scores in the aged group (I: 2.3% II: 68.2% III: 29.5%) than in the younger group (I: 27.7% II: 56.4% III: 15.8%) (P<0.0001). There was a higher postoperative complication rate for the aged group than for the younger group (25.0% and 8.9%, respectively) (P=0.002). Only one case of mortality (0.8%) was found in the aged group. The period of the postoperative hospital stay was longer for the aged group than that for the younger group (21.9+/-3/416.3 days and 16.3+/-3/48.1days, respectively) (P= 0.002). For the aged group, univariate analysis revealed that the operative procedure, disease, the T stage and the operation time were significant variables for the postoperative complications, and multivariate analysis identified the operation time as an independent variable faor the postoperative complications. CONCLUSION: More prudent care is needed to prevent postoperative complications for the aged patients who undergo laparoscopic colorectal resection, and particularly for those who can be expected to have a longer operation time.
Comorbidity ; Humans ; Length of Stay ; Mortality ; Multivariate Analysis ; Postoperative Complications ; Prospective Studies ; Surgical Procedures, Operative