Breast carcinoma has been infrequently reported in children. About 25 cases have been reported in world literatures since first description in 1913, by Bryan. We present a case of juvenile breast carcinoma in a 17 months old girl with brief review of literatures. Grossly, the submitted specimen is grayish white and measured by 1.3x1.0x0.8 cm in size. It is not encapsulated and its cut surfaces are homogeneous. Microscopic examination showed a neoplastic proliferation of duct cells forming mainly glandular spaces with focal papillary pattern, solid sheets or cribriform pattern. The glandular spaces were filled with collections of PAS-positive eosinophilic secretory materials. The individual cell varied from columnar to polygonal and showed moderate hyperchromatism and variation of nuclear size. Mitoses and necrosis are not found. Tumor cell invasion into the stroma was found.
Child ; Male ; Female ; Humans

No abstract available in English.
Drainage* ; Lung Abscess* ; Lung*

Although embryonal rhabdomyosarcoma has been frequently reported in genitourinary tract, head and neck, embryonal rhabdomyosarcoma of the biliary tree is an extremely rarte. It must be considered in differential diagnosis of jaundice in childhood. About 35 cases have been reported in world literatures, since first description on 1875, by Moxon and Wilks. We present a case of embryonal rhabdomyosarcoma of the biliary tree in a 25 months old boy with brief review of literatures. Since chief complaints of this case were jaundice and loss of appetite, the first clinical diagnosis was infectious hepatitis. On ultrasound examination, there is a space occupying lesion in right lobe of liver and it was diagnosed as hepatoma. Choledochoduodenostomy with biopsy was done. The operation revealed dilated common bile dut and both hepatic ducts which were filled with light brown jelly like materials and diagnosed as embryonal rhabdomyosarcoma on frozen and permanent senions. In gross and histologic characteristics, this tumor resembles embryonal rhabdomyosarcoma(sarcoma botryoides) in other locations. In spite of chemo-and radiotherapy after operation, the boy was died.
Child ; Male ; Female ; Humans ; Diagnosis, Differential ; Biopsy

A relationship between preceding acute paralytic poliomyelitis and the later development of motor neuron disease has only occasionally been suggested since it was first postulated by Charcot in 1875. The authors recently experienced a 20-year-old male who was considered to have postpoliomyelitis muscular atrophy. We report this case in view of its rarity and necessity of differential diagnosis from other neuromuscular disorders. Clinical presentation included slowly progressive muscle wasting of left thigh for 4 years, mild weakness of left arm and both thigh, intermittent fasciculation, and previous history of acute paralytic poliomyelitis. Electromyographic findings showed fibrillation potentials, positive sharp waves, fasciculations, giant motor unit potentials and reduced interference patterns. Muscle biopsy revealed scattered small angulated fibers, individual myofiber degeneration and mild inflammatory cell infiltration.
Arm ; Biopsy ; Diagnosis, Differential ; Fasciculation ; Humans ; Male ; Motor Neuron Disease ; Poliomyelitis ; Postpoliomyelitis Syndrome* ; Thigh ; Young Adult

Vaginitis is one of the most common disease in gynecologic field in recent days. About 90% of these patients suffer from the infection of the vagina caused by Gardnerella vaginalis, Candida, or Trichomonas, either alone or in combination. For the effective diagnosis and management, it is essential to get an accurate identification of the causative agent. Applying simple and easy diagnostic methods such as pH of vaginal discharge, amine test and microscopic examination of wet mount preparation of normal saline and 10% KOH to 549 cases of randomly selected patients visiting Out-patient Department of Obstetrics and Gynecology of Yeungnam University Hospital through May 1st to Sept. 31st, 1987, the following results were obtained. 1. In the Gardnerella vaginitis vaginal pH was more than 5.0 in 81.0% of total cases, positive amine test in 62.8%, decreased lactobacilli in 77.4% & decreased WBC counts in 70.1%, In the Trichomonas vaginitis vaginal pH more than 5.0 was noted in 93.3% of the cases, negative amine test in 90%, decreased showed vaginal pH of 3.0~4.0 in 83.2%, negative amine test in 90%, decreased lactobacilli in 90% & increased WBC counts in 93.3%, whereas Candida vaginitis and normal groups showed vaginal pH of 3.0~4.0 in 83.2%, negative amine test in 100%, normal distribution of lactobacilli in 89.7%, normal WBC counts in 72.4%. 2. The accuracy rates of physical diagnosis by wet mount preparation of normal saline and 10% KOH revealed 26.3%, 47.5%, 70.0% in Gardnerella vaginitis, Candida vaginitis, and Trichomonas vaginitis, respectively. The vaginal pH and amine test showed 83.2% of accuracy rate in Candida vaginitis group, 60.6% in Gardnerella vaginitis group and 83.3% in Trichomonas vaginitis group. 3. In 23 cases of Gardnerella vaginitis showing vaginal pH of 3.0 or 4.0 and positive amine test, the clue cells were observed in 10% or less in 12 cases, 30% in 5 cases, 50% in 4 cases and 50% or more in 2 cases. In summary vaginal pH and amine test could be useful in screening and differentiating the different types of infectious vaginitis. Furthermore by adding microscopic examination of normal saline and 10% KOH wet mount preparation to them, they not only could obtain higher diagnostic accuracy rate but would be more valuable in selecting the patients requiring cultures to confirm the diagnoses.
Candida ; Diagnosis ; Gardnerella ; Gardnerella vaginalis ; Gynecology ; Humans ; Hydrogen-Ion Concentration* ; Mass Screening ; Obstetrics ; Outpatients ; Trichomonas ; Trichomonas Vaginitis ; Vagina ; Vaginal Discharge* ; Vaginitis*

Spinal stenosis is a localized narrowing of the spinal canal due to structural abnormalities. It may be caused by diminution of the sagittal diameter, volume changes of the lateral recesses and the intervertebral foramena. Its symptoms are somewhat different from those of classical herniated intervertebral disc and are characterised by a chronic, less localized and usually bilateral nerve root compression syndrome. During the period of 5 years and 8 months, from January 1973 when the concept of spinal stenosis was adopted to August 1978, we saw at Seoul National University Hospital 65 cases of spinal stenosis and operated on 58. 60 of the cases were reviewed and following observations were made: 1. There were 30 males and 30 females. The youngest age was 9 years and the oldest 62 years, the average being 41.5 years. 80% of the patients were between 30 and 60 years of age. 2. The etiology of spinal stenosis was as follows: Congenital/developmental 5, Degenerative 11, Combined 19, Spondylolitic/spondylolisthetic 19, Iatrogenic 1, Miscellaneous 5. 3. Chief complaints on admission were as follows: Back pain only 17, back pain and sciatica 22. intermittent claudication 11, numbness 5, weakness 4, and bladder incontinence 1. 4. Lasegue test was positive in only 11 cases, 7 of which being bilateral. 5. Myelogram was performed on 44 patients, yielding following findings: Hourglass bilateral defects 13, complete block 12, unilateral focal defect 7, multiple defects 6, almost complete block 2, uniformly narrow canal 2, and negative 2. 6. Decompressive surgery was carred out on 58 patients as in the following One level 21. two levels 21, and more than three levels 16. The longest follow-up was 4 years and the shortest 1 month, the average being one year and six months. Results were as follows: excellent 31.4%. good: 53%. fair 13.7% and poor 1.9%.
Back Pain ; Female ; Follow-Up Studies ; Humans ; Hypesthesia ; Intermittent Claudication ; Intervertebral Disc ; Male ; Radiculopathy ; Sciatica ; Seoul ; Spinal Canal ; Spinal Stenosis ; Urinary Bladder

The precise diagnosis of internal derangement of the knee is difficult, since the signs and symptoms are frequently obscure. For this reason, diagnostic aids have long been sought, and arthrogrphy has been widely used as a means to improve diagnostic accuracy. Recently, post-arthrographic high resolution computed tomogrphy has been added to the diagnostic techniques for the evaluation of the knee. Arthrography and post-arthrographic high resolution computed tomography were carried out in 97 cases of clinically suspicious meniscal tear from January 1986 to October 1987. Among them, 40 cases were confirmed by arthroscopic surgery and following results were obtained. l. Arthorgraphy resulted in a diagnostic accuracy of 92.5% and 72.5% for medial and lateral meniscal lesion. Post-arthrographic high resolution computed tomography resulted in that of 95.0% and 90.0% for each meniscal lesion. 2. 16 cases of them were discoid meniscus. 13 cases(92.5%) were detected by arthrography and 16 cases(100%) by post-arthrographic high resolution computed tomography. 3. The sensitivity of arthrography was proved to be 100% and 65.4% for medial and lateral meniscal lesion, and thst of post-arthrographic high resolution computed tomography to be 100% snd 88.5% for each meniscal lesion. The specificity of arthrography was 90.0 and 85.7% in each meniscal lesion and that of post-arthrographic high resolution computed tomography was 93.3% and 92.9% in each meniscal lesion. 4. Post-arthrogrsphic high resolution computed tomography was proved to show better diagnostic accuracy, and good visualization of the relationship and extent of torn meniscal lesions. The meniscal anatomy that was displayed by high resolution computed tomography more accurately depicted the anatomical findings that were seen at arthroscopy. With this additional information, arthroscopists could plan more appropriate surgical approach.
Arthrography ; Arthroscopy ; Diagnosis ; Knee ; Sensitivity and Specificity ; Tears

With the advent of improyed external fixation device, femoral lengthening has gained renewed popularity in recent years in the treatment of unequal leg length. Wagner(1971) and De Bastiani et al(1987), among others, have made epochal contribution in this field. During the period from May 1984 to May 1987, 25 patients with leg length discrepancy underwent femoral lengthening using Wagner's or De Bastianis distractable external fixators at the Department of Orthopedic Surgery, Seoul National University Hospital. There were 6 patients below 16 years of age admitted to the Children's Hospital, and 19 patients were 16 years or older. The mean age was 18.2 years, ranging from 3 years to 36 years. The underlying etiology included residual poliomyelitis in 20 patients, epiphyseal injury in 2 patients, congenital short femur in 1 patient, septic hip residua in 1 patient, and cerebral palsy in 1 patient. The mean leg length discrepancy was 4.5cm, ranging from 1.3cm to 7.4cm. The mean length gained was 4.1cm, ranging from 1.8cm to 6.4cm. All except two patients had two stage procedures with iliac crest strut bone graft. The mean time required for radiological consolidation of bone graft was 4.8 months. The plate and screws used for osteosynthesis was removed after the medullary canal has been re-established. Six patients had removal of the plate and screws between 8 months and 25 months after the second stage osteosynthesis. Technical errors included 1 case of incomplete osteotomy which required manual clasis, and another case of faulty insertion of Schanz screws that required reinsertion. Five cases (33.3%) had the minor pin tract infection. Schanz screw breakage occurred in a case of one stage femoral lengthening. Loosening of plate and screws was seen in three cases. One case had delayed union requiring augmentation bone graft. Stiff knee with less than 90°of flexion was encountered in one case. One case sustained fracture of patella during physiotherapy. Despite of a long list of complication, the ultimate goal of leg length equalization was successfully achieved in all the cases.
Cerebral Palsy ; External Fixators ; Femur ; Hip ; Humans ; Knee ; Leg ; Orthopedics ; Osteotomy ; Patella ; Poliomyelitis ; Seoul ; Transplants

Grice extra-articular subtalar arthrodesis has been performed as either a temporizing or a definite procedure in young children to correct the dynamic hindfoot valgus deformity without affecting subsequent growth of the foot. Fifty eight extra-articular subtalar arthrodesis in thirty patients, performed at Seoul National University Children's Hospital from setpember 1985 to June 1989, were retrospectively reviewed to evaluate the clinical and radiographic results. There were 52 valgus feet in 26 patients and 6 varus feet in 4 patients secondary to cerebral palsy, meningomyelocele, congenital snomalies, and other neuromuscular diseases. In many instances, additional tendon surgeries were also required to correct deformities or achieve the muscle balance. The review consisted of personal interview, physical examination, and radiological assessment. On physical examination, preoperative hindfoot valgus deformty(mean: 14.3°clinically) was well corrected, postoperative hindfoot valgus ranging from neutral to valgus 5°clinically in 35 of 52 cases(67.3%). Correction of the lateral talocalcaneal angle on standing lateral radiographic view averaged 8.5 degrees(from 57.3 degrees preoperatively to 37.6 degrees postoperatively). In valgus feet, there were 3 cases with mild pain around the ankle joint. There were 5 cases of graft resorption and 2 cases of nonunion. Graft failure was more frequent when the proximal end of the graft was directed anterior to the weight bearing axis. With original Grice subtalar arthrodesis, satisfactory results were obtained in 34 of 52(65.4%) hindfoot valgus feet. In 6 varus feet, there were 1 undercorrection and 2 recurrence of varus deformity. We re-emphasize the importance of strict operative technique to obtain satisfactory results. We also believe that Grice procedure may be used for the correction of subtalar instability in selected cases of varus foot before muscle baancing procedures.
Ankle Joint ; Arthrodesis ; Cerebral Palsy ; Child ; Congenital Abnormalities ; Foot ; Humans ; Meningomyelocele ; Neuromuscular Diseases ; Physical Examination ; Recurrence ; Retrospective Studies ; Seoul ; Tendons ; Transplants ; Weight-Bearing

Background. Ultimate goal for the treatment of the deformities in the lower extremities is to minimize the energy requirement and conserve the energy on walking and daily living. The normal energy saving mechanism is usually broken down in the patients with the deformities in the lower extremity, and they need more energy consumption. This is the reason why they feel fatigue frequently. It is well known that the deformity in the lower extremity cause excessive energy consumption. Objectives. There is no report that compared the energy consumption according to the deformities of the lower extremity. When we decide the priority of the treatment in cases of multiple deformities, it will be important to understand the energy demand according to each deformity. Therefore, it is the purpose of this study that assess the energy consumption according to the various types of lower extremity deformities. Method. We induced the multiple deformities in ten normal adults with the brace artificially. The induced deformities are as follows: Equinus deformity; mild (10degrees), moderate (20degrees), severe (30degrees), Knee flexion deformity; mild (10degrees), moderate (20degrees), severe (30degrees), Hip flexion deformity; mild (10degrees), moderate (20degrees), severe (30degrees). For the control group, same braces were applied without any deformity. Oxygen consumption was measured for the energy consumption with the Oxygen Consumption Meter (Morgan Oxylog II, Morgan Ltd. England). Heart rate was checked with the Telemonitor (Dynascope, Fukuda Ltd, Japan). We evaluated the inspired volume, oxygen rate, oxygen cost, and heart rate in each group and compared the data among the groups. Result. Energy consumption was higher in the hip deformity group, in the knee deformity group, and in the ankle deformity group in that order. Conclusion. When there are concomitant deformities in hip, knee and ankle, the priority of treatment may be hip, knee and ankle, in that order in terms of energy consumption.
Adult ; Ankle ; Braces ; Congenital Abnormalities* ; Equinus Deformity ; Fatigue ; Heart Rate ; Hip ; Humans ; Joints* ; Knee ; Lower Extremity* ; Oxygen ; Oxygen Consumption ; Walking