Five patients with obstruction of the hepatic portion of the inferior vena cava diagnosed by digital subtraction inferior vena cavography were reported. All of these patients, aged from 38 to 52, were female who had never used the oral contraceptives. Main collateral pathway of these patients was the central channels through ascending lumbar veins, internal and external vertebral plexuses, azygos-hemiazygos complex, and inferior vena cava itself above the obstructed segment.
Contraceptives, Oral ; Female ; Humans ; Veins ; Vena Cava, Inferior

No abstract available.
Adolescent* ; Dislocations* ; Hip* ; Humans

We carried out animal experiment in order to determine the effect of resection of nerves, muscles and tendons on the induction of osteoporosis. One hundred and forty rats, weighing approximately 250 gm, were divided into seven groups. In Group I, as a control group, the three skin incisions, one on the anterior aspect of the knee, one on the anteromedial aspect of proximal thigh, and one on the posterior aspect of proximal thigh were made and wounds were sutured. In Group II, the patellar tendon and the extensor digitorum longus tendon were divided to disable knee extension. In Group III, all the knee flexors were divided. In Group IV, all the knee extensors and flexors were divided. In Group V, the femoral nerve was divided to disable knee extension. In Group VI, the sciatic and obturator nerves were divided to diable knee flexion. In Group VII, the sciatic, and obtrator nerves were all divided. Before the procedures, bone density was measured by photon absorptiometry and postoperatively, the measurement was repeated every two weeks until the eighth week. At the time of each measurement, two rats were sacrificed out of each group and were submitted to microphotographic measurement of the tibial cortices. The results were as follows. l. In the muscle and tendon resection groups (Group II, Group III, Group IV), the bone density significantly decreased two weeks after operation and then, gradually increased four, six and eight weeks. 2. In the nerve resection groups (Group V, Group VI, and Group VII), the bone density decreased significantly two and four weeks after operation and then gradually increased six, and eight weeks after operation. 3. In both motor resection and denervation, the paralysis of both flexors and extensors of the knee, caused more decrease in bone density than the paralysis of either flexor or extensor. 4. In the muscle and tendon resection groups, the bone density was significantly more decrease two weeks after operation when the flexors were resected, but thereafter there was no significant difference between the flexors and extensors resection. In the nerve resection group, the paralysis of knee flexors caused more decrease in bone density than the paralysis of knee extensors throughout the entire experimental period. 5. The nerve resection groups demonstrated significantly more severe loss of bone density than muscle and tendon resection groups throughout the entire experimental period. 6. The values of bone density measured by photon absorptiometry correlated well with the cortical thickness indices. Bssed upon these observations, we came to the following conclusions. 1. The osteoporosis following injuries of the nerve, muscle, and tendon is most significant at two weeks after injury. 2. Denervation causes more severe osteoporosis than muscle and tendon injuries. 3. It is suggested that the photon absorptiometry is a reliable means in the evaluation of the osteoporosis.
Absorptiometry, Photon ; Animal Experimentation ; Animals ; Bone Density ; Denervation ; Femoral Nerve ; Knee ; Muscles ; Obturator Nerve ; Osteoporosis ; Paralysis ; Patellar Ligament ; Rats ; Skin ; Tendon Injuries ; Tendons ; Thigh ; Tibia ; Wounds and Injuries

Ilizarov device is a circular external skeletal fixator with crossed transfixation wires and connecting rods. Its stability depends on the tension in the wire and the spatial orientation of the fixator frame. It provides extreme versatility for correction of three dimensional complex deformities including angulation, rotation, shortening and translation. In an attempt to identify the various factors that contributed to the outcome and the complications of lengthening, we reviewed the first 19 cases of leg lengthening by the Ilizarov technique in 17 patients with leg length inequality or dwarfism. Simultaneous correction of the three dimensional deformities was also aimed at in 13 patients, and osteosynthesis of congenital pseudarthrosis of the tibia in 2 patients. Follow-up periods averaged 1.6 years, ranging from 1 year to 2.8 years. The results were summarized as follows : 1. The amount of lengthening averaged 5.2cm, ranging from 2.0cm to 9.8cm. 2. The percentage increase was 27%, ranging from 9% to 58%. 3. The average healing index (month/cm) was 1.3months/cm and it was higher in the groups that had premature consolidation, complete osteotomy, single level corticotomy and neurologic compromise as compared with the groups that had adequate corticotomy, double level corticotomy and no neurologic complication. 4. The desired lengthening was obtained in 14 cases. Simultaneous correction of the deformities and osteosynthesis for nonunion were also achieved satisfactorily during lengthening. 5. There were sixteen cases of problems (84%), which were pin tract inflammation (7 cases), Transient senrory change (3 cases), knee joint flexion contracture (2 cases), nut breakage (2 cases). There were thirteen cases of obstacles (68%), which were equinus deformity(5 cases), premature consolidation (3 cases), pathologic fracture (3 cases), and delayed consolidation (2 cases). There was only one ture complication case. In conclusion, the Ilizarov technique was very effective for leg lengthening in children, particularly when three dimensional deformities were combined with leg length shortening. But a thorough knowledge of the Ilizarov technique and meticulous care during lengthening are mandatory to prevent the pitfalls and complications.
Child ; Congenital Abnormalities ; Contracture ; Dwarfism ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Ilizarov Technique ; Inflammation ; Knee Joint ; Leg Length Inequality ; Leg ; Nuts ; Osteotomy ; Pseudarthrosis ; Tibia

Hereditary sensory motor neuropathy type V (HAMN V) is very rare disease entity. The authors experienced a patient who had the findings of peroneal muscular atrophy and pyramidal tract feature. A 20 year-old man was admitted to our hospital due to gait disturbance. Scissoring gait and peroneal muscular atrophy were observed. The findings of electrophysiologic studies were compatible with axonal type peripheral neuropathy. The results of other evaluations were compatible with HAMN V. To our knowledge, it is the first report in Korea.
Axons ; Charcot-Marie-Tooth Disease ; Gait ; Humans ; Korea ; Peripheral Nervous System Diseases ; Pyramidal Tracts ; Rare Diseases

Two cases of spontaneous kidney rupture with literatural review was presented at first in Korea. 1) 56 years male patient and 25 years male patient admitted to our department of Urology through Emergency Room after onset of 2 and 1 day. after treatment at local clinic. 2) Chief complaints were one side flank pain which was followed by total gross hematuria. 3) Preoperative diagnoses were kidney rupture due to necrotic pelvic tumor in 56 years male and hypernephroma in 25 years male patient. 4) Operation was procedured at 8 days and 4 days after admission respectively. 5) The operative procedure were nephrectomy in both cases. 6) The pathological diagnoses were pelvis rupture due to renal stone and parenchymal rupture due to renal infarction in each case.
Carcinoma, Renal Cell ; Diagnosis ; Emergency Service, Hospital ; Flank Pain ; Hematuria ; Humans ; Infarction ; Kidney* ; Korea ; Male ; Nephrectomy ; Pelvis ; Rupture ; Rupture, Spontaneous* ; Surgical Procedures, Operative ; Urology

PURPOSE: The objectives of this study were to clarify the efficacy of the calcaneal lengthening procedure for flatfoot deformity in spastic conditions, and to identify factors affecting results after calcaneal lengthening. MATERIALS AND METHODS: Ninety-eight feet in sixty patients were included in this study. The average age was 9.5 years and mean follow-up was 2.4 years. The following comparisons were made pre- and post-operatively: clinical, radiographic, kinematic, kinetic changes, and type of bone graft. RESULTS: Seventy five feet (77%) showed excellent or good clinical results. Decreased longitudinal arch was the most resistant component after calcaneal lengthening. All of the radiological indices improved significantly, and were within the normal range, except calcaneal pitch post-operatively. Pre-operative calcaneal pitch was the most sensitive index for predicting the end result. According to 3-D gait analysis, peak knee flexion during early swing increased from 56.2degrees to 61.9degrees on average, and exaggerated dorsiflexion of the ankle in the stance phase improved to the normal range with restoration of first rocker action post-operatively. Foot progression angle, which averaged 16.7degrees of external progression pre-operatively, improved to 7.4degrees of external progression post-operatively. Peak and A2 power generation of the ankle increased post-operatively. CONCLUSION: Calcaneal lengthening proved an effective procedure for improving foot function, foot progression angle and knee flexion, and for increasing ankle power generation by increasing the foot lever arm.
Ankle ; Arm ; Congenital Abnormalities ; Flatfoot* ; Follow-Up Studies ; Foot ; Gait ; Humans ; Knee ; Muscle Spasticity* ; Reference Values ; Transplants

BACKGROUND: For the treatment of peptic ulcer diseases infected with Helicobacter pylori (H. pylori), amoxicillin, clarithromycin, and metronidazole are most commonly used. Recently the resistant rates against these antibiotics have been increased and this has become one of the major causes of treatment failure. It was recently demonstrated that metronidazole resistance is associated with mutation in rdxA gene that encodes an oxygen-insensitive NADPH nitroreductase. The aim of this study was to investigate the mutations of the rdxA gene for the metronidazoleresistant H. pylori isolates from Guri City, Korea. METHODS: H. pylori strains were isolated from gastric biopsy specimens from patients diagnosed as having peptic ulcer or gastric carcinoma in Hanyang University Guri Hospital. Antimicrobial susceptibility testing was performed by the modified broth microdilution method. Resistance was defined as metronidazole minimum inhibitory concentration (MIC) being more than 16 ug/mL Three metronidazole-sensitive and 10 metronidazole-resistant strains were selected to detect mutations in the rdxA genes by direct sequencing of PCR products. RESULTS: Of the 266 clinical isolates of H. pylori that were isolated from 1996 through 2001, 90 isolates (33.8%) showed metronidazole resistance. The frequency of nucleotide substitutions of the rdxA gene of 10 metronidazole-resistant strains (25-33/strain) was not so different from that of the three metronidazole-sensitive strains (22-26/strain). Stop signals generated by nucleotide substitution, insertion, or deletion, were found in 5 metronidazole-resistant strains (50%), but not in 3 metronidazole- susceptible strains. CONCLUSION: The present study confirms that the presence of mutations on the rdxA gene causing a premature stopping of the inferred RdxA protein is associated with metronidazole resistance. But other genes or mechanisms might be implicated in the generation of metronidazole resistance and further investigations are needed.
Amoxicillin ; Anti-Bacterial Agents ; Biopsy ; Clarithromycin ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea* ; Metronidazole* ; Microbial Sensitivity Tests ; NADP ; Peptic Ulcer ; Polymerase Chain Reaction ; Treatment Failure

PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.
Bacteriuria ; Child* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Ureter* ; Ureteral Obstruction ; Ureterocele* ; Urinary Bladder

PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.
Bacteriuria ; Child* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Ureter* ; Ureteral Obstruction ; Ureterocele* ; Urinary Bladder