A case of orbital injury with a plastic chopstick accompanied by meningeal irritation signs was presented. A 34-year-old house-wife was admitted to our clinic complaining of vision loss, proptosis and dull ocular pain in right eye on March 11, 1976. 17 days before admission she was stabbed on the right orbital region with a plastic chopstick. The clinical finical findings Were recorded normal in left eye. The right eye showed zero in vision, proptosis, fixed eyeball with total ophthalmoplegia and exposure Keratitis. On the 2nd hospital day a broken plastic chopstick, 9.5 cm in length, was carefully removed from injured site by exploratory eperation. In that afternoon meningeal irritation signs, vomiting and neck stiffness was abruptly developed. The laboratory findings of the cerebrospinalfluid revealed inflammatory signs. After having been administered massive antibiotics (crystalline penicillin, bayrena, and chloramphenicol) systemi-cally for 17 days, she was recovered from meningeal irritation signs containing remission of inflammatory findings of cerebro spinal fluid examination. On the 21st hospital day, 39 days after injury, the optic disc was seen totally pale. On the 25th hospital day she was discharged, at which right eye showed clear in cornea, totally pale disc, and total ophthalmoplegia with ptosis. When she returned about 5 months after discharge, the right eye revealed much regressed ptosis, superficial corneal opacity with loss of corneal sense, ocular motility limited in superolateral direction, fixed and dilated pupil and still pale disc. Authors attempt to evalurate this case throlgh the related literatues.
Adult ; Anti-Bacterial Agents ; Cornea ; Corneal Opacity ; Exophthalmos ; Humans ; Keratitis ; Neck ; Ophthalmoplegia ; Orbit* ; Penicillins ; Plastics* ; Pupil ; Vomiting

No abstract available.
Bacillus* ; Humans ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Despite significant advances in obstetric and pediatric health care, Streptococcus agalactiae(Lancefield group B β-hemolytic Streptococcus, GBS) remains one 91 the most prevalent and devastating pathogens in peripartum women and their newborn infants. It may cause urinary tract infection, chorioamnionitis and endometritis, bacteremia, and cesarean wound infection in the peripartum period. It was Pasteur who first identified microbes in the blood and lorchia of septic women. After that, in 1938 the isolation of S. agalactiae from three mortally ill women was reported, thereby implicating it as another cause of puerperal sepsis. S. agalactiae is now one of the most common causes of neonatal sepsis and meningitis in the United States. However, in Korea there have been only twenty-three cases of neonatal meningitis and/or sepsis due to group B β-hemolytic streptococcus reported. Recent studies have noted other serious infections in adults, including bacteremia, pneumonia, cellulitis, osteomyelitis, meningitis, and endocarditis. In Korean adults no case of pneumonia due to S. agalactiae has been reported till now. As minimal inhibitory concentration of penicillin was reported to be higher for S. agalactiae than for S. pyogenes, minimal inhibitory concentration of penicillin for S. agalactiae should be tested. Herein we describe the course of a case of S. agalactiae pneumonia and bacteremia in a 74-year-old diabetic man, and we review the literatures.
Adult* ; Aged ; Bacteremia ; Cellulitis ; Chorioamnionitis ; Delivery of Health Care ; Endocarditis ; Endometritis ; Female ; Humans ; Infant, Newborn ; Korea ; Meningitis ; Osteomyelitis ; Penicillins ; Peripartum Period ; Pneumonia* ; Pregnancy ; Sepsis ; Streptococcus agalactiae* ; Streptococcus* ; United States ; Urinary Tract Infections ; Wound Infection

Treatment of femoral shaft fractures in children is varying according to age. Satisfactory results have been obtained with longitudinal skin traction, split Russell traction, ordinary Russell traction, 90-90 skeletal traction, and immediate application of a spica cast(2,4,6,11,15). Most authors use one or more techinques routinely. It is safe and convenient to use single treatment protocol to treat all fractures of same type, Distal femoral skeletal traction with the knee and hip flexed 90 degrees and with the thigh hanging free, using the trunk as counter traction, has been used routinely for femoral shaft fractures in children(age 4-12). We reviewed 30 cases of femoral shaft fractures in children treated with 90-90 skeletal traction. 1. The average age of the patients was 6.8 years(range, 4-12 years), and almost all were caused by pedestrian injury. 2. The average time of traction was 48 days(range, 28-75), and 12 cases(40%) were treated without spica cast application. 3. Four among 30 cases developed angular deformity exceeding acceptable range(15° in AP view, 20° in lateral view), and three of them were proximal third fractures. 4. The older the patient, the longer the duration of limited activity and the more tendency of angular deformity. 5. 90-90 skeletal traction is easy, safe and convenient to treat all femoral shaft fractures of the children between four and ten years old.
Child ; Clinical Protocols ; Congenital Abnormalities ; Hip ; Humans ; Knee ; Skin ; Thigh ; Traction

It is well known that the medullary carcinoma of the breast is one of the special types of breast carcinoma with a good prognosis. At present, the medullary carcinoma of the breast is subclassified into 3 types: typical medullary, atypical medullary and nonmedullary carcinoma. Among them, the former has the best prognosis. We reviewed the film mammographic and ultrasonomammographic findings of 13 patients according to the reevaluated histopathologic diagnosis. Typical medullary carcinoma shows a well circumscribed mass with surrounding halo on film mammogram, and well defined mass with central intermediate echogenicity and peripheral low echogenicity and posterior acoustic enhancement on ultrasonomammogram. Atypical medullary carcinoma shows relatively well circumscribed mass with partial marginal obliteration on film mammogram, and irregular bordered mass with inhomogeneous echogenicity due to focal necrosis in the mass and associated findings of thick boundary, asymetrical lateral shadowing on ultrasonomammogram. Nonmedullary carcinoma shows lobulated mass with surrounding parenchymal distortion and skin thickening on film mammogram, and relatively well defined lobulating mass with surrounding parenchymal distortion and marked heterogeneous internal echogenicity on ultrasonomammogram. Therefore, differentiation between typical medullary carcinoma with good prognosis and atypical medulary or nonmedullary carcinoma with poor prognosis, may be possible by various diagnostic imaging modalities preoperatively. But further collective study shall be needed in near future.
Acoustics ; Breast Neoplasms ; Breast* ; Carcinoma, Medullary* ; Classification* ; Diagnosis ; Diagnostic Imaging ; Humans ; Necrosis ; Prognosis ; Shadowing (Histology) ; Skin

Six hundred and fifty one cases of bone tumors diagnosed and operated at Department of Orthopedic Surgery, Seoul National University Hospital, from Jan., 1969 to Apr., 1989. were reviewed and analyzed with respect to the types of tumor, the age and sex distribution of the patients, the location of the lesions and the advances of diagnosis and treatment. 378 benign and 273 malignant bone tumors were identified. Osteochondroma(113 cases, 17.4%) was the most common bone tumor, followed by osteosarcoma(72 cases, 11.1%) and giant cell tumor(50 cases, 7.7%) Second decade was the most common age of bone tumors(216 cases, 33.2%) and male(379 cases, 58%) was more common than female. Femur(222 cases) was the most common site of bone tumors, followed by tibia and vertebra. For simple bone cyst, steroid injection was widely used recently. It was a simple and safe procedure and its results were similar to those of curettage and bone graft. Limb salvage operations were performed for malignant bone tumors increasingly. Neoadjuvant chemotyeraphy and limb salvsge operation using tumor prosthesis were performed in 5 patients of osteosarcoma and their results are so far promising. Of 7 cases of chondrosarcoma, the limb was salvaged by resection arthrodesis or resection arthroplasty. 7 cases of malignant fibrous histiocytoma were treated by radical ablative surgery and/or chemotherapy and radiation, but local recurrence or pulmonary metastasis were detected in all of them. So it was thought to be highly malignant bone tumors.
Arthrodesis ; Arthroplasty ; Bone Cysts ; Chondrosarcoma ; Curettage ; Diagnosis ; Drug Therapy ; Epidemiologic Studies ; Extremities ; Female ; Giant Cells ; Histiocytoma, Malignant Fibrous ; Humans ; Limb Salvage ; Neoplasm Metastasis ; Orthopedics ; Osteosarcoma ; Prostheses and Implants ; Recurrence ; Seoul ; Sex Distribution ; Spine ; Tibia ; Transplants

BACKGROUNDS: In man, adding clonidine to local anesthetics results in an increased duration of spinal, epidural and peripheral nerve blocks such as femoral nerve block. The purpose of this study was to compare the effects of intramuscular or adding clonidine to mepivacaine on the duration of analgesia after brachial plexus block. METHODS: After informed consent, 30 ASA 1 or 2 adults patients scheduled for elective upper limb surgery under brachial plexus anesthesia were included in this study. Brachial plexus block with Supraclavicular approach was performed following paresthesia. 40ml of 1.5% mepivacaine was injected in the brachial plexus sheath in all patients. In group 2, 150 ug of clonidine IM, 30 min before the procedure. In group 3, 150 ug of clonidine added to mepivacaine in brachial plexus sheath. Onset of anestheasia and duration of anesthesia and analgesia were assessed. Blood pressure and sedation score was monitored. Statistical analysis was done with ANOVA. RESULTS: Duration of anesthesia were significantly increased in group 3 (217.0 +/- 56.2 min by pinprick) compared to group 1 (176.0 +/-26.3 min). Duration of analgesia were significantly increased (p<0.05) in group 3. (229.0 +/- 43.3 min) compared to group 1 (186.0 +/- 20.0 min). Blood pressure was not significantly different in the three groups. A sedation was observed in group 3, especially from 20 min to 180 min after injection of drug. CONCLUSION: 150 ug of clonidine added to mepivacaine for brachial plexus block increases duration of anesthesia and analgesia without any significant side effects.
Adult ; Analgesia ; Anesthesia ; Anesthesia and Analgesia ; Anesthetics, Local ; Blood Pressure ; Brachial Plexus* ; Clonidine* ; Femoral Nerve ; Humans ; Informed Consent ; Mepivacaine* ; Paresthesia ; Peripheral Nerves ; Upper Extremity

PURPOSE: The replacement of functional genes into cells that lack genes or mutant genes is the basis of gene therapy. In cancer, where cells often have multiple genetic defects, the replacement of critical genes may suffice to suppress cell growth or induce cell death. In malignant brain tumors, p53 mutation are among the most frequently observed genetic findings and inactivation p53 suggests that p53 plays a critical role in carcinogenesis and tumor progression. Therefore, we study the successful transfer of the wild-type p53 gene using a replicative deficient adenovirus vector into human glioma and medulloblastoma c~ell lines. Meterials and Methods: The human glioma cell line T-98G, U-87MG, U-373MG were used. To determine the efficiency of the adenovirus vector, cell lines were transfected with the Ad-p gal and analysed with X-Gal staining. Cell viability was determined by trypan blue exclusion every day after infection and Westem blot analysis was used to conform the expression of the exogenous p53 protein. RESULTS: Cell growth of the Ad-CMV-p53 infected U-373MG, and U-87MG was significantly suppressed. It appeared that exogenous p53 protein expression had an earlier ad more profound suppressive effect on U-373MG having a mutated p53 gene than on U-87MG having a wild-type p53. The expression of the exogenous p53 was more than 10 times higher than the expression of the endogenous p53. To examine the decreased viability, U-373MG was stained with Hochest 33258 and detected nuclear condensation and apoptic body. Staining results suggest that cells undergo apoptosis. CONCLUSION: The replicative deficient adenoviral vector can transfer and express p53 in human glioma cell lines in vitro, restoring wild-type p53 tumor suppressor functions. The restoration of normal p53-encoded protein in the mutant ceil lines induced cell death. The high expression of the newly transduced protein had different effects on the growth rate of the infected cell lines depending on the p53 status of the cells.
Adenoviridae* ; Apoptosis ; Brain Neoplasms ; Carcinogenesis ; Cell Death ; Cell Line* ; Cell Survival ; Genes, p53 ; Genetic Therapy ; Glioma* ; Humans ; Medulloblastoma ; Trypan Blue

Sex typing may become the start point in investigations that are usually performed through amelogenin typing. In cases involving genotype-phenotype discrepancy, amelogenin typing could yield misleading results. The rare XX male syndrome is characterized by a phenotypic male with a 46, XX female karyotype. In this point, this case report would help understand the importance of genotype-phenotype discrepancy.
Amelogenin ; Female ; Genes, sry ; Humans ; Karyotype ; Klinefelter Syndrome ; Male ; Y Chromosome

Patients with advanced urothelial tumors that relapse or persist following conventional therapy have poor prognosis. Management of the patients with recurrent local or disseminated urothelial tumors presents a difficult clinical problems. In 1985 Sternberg et al reported 71% of significant tumor regression and 50% of complete clinical remission with M-VAC (methotrexate, vinblastine, doxorubicin and Cisplatin) combination chemotherapy for treatment of advanced urothelial transitional cell carcinomas. Herein, we have experienced 13 cases of M-VAC combination chemotherapy in advanced urothelial tumors. Complete and partial remission was in achieved 46.2 per cent of the patients clinically, while 15.4 percent had a minor response and 38.4 per cent had progression with median survivals of 11.5, 8.5 and 7.4 months. Toxicity was significant. 15.4 per cent of the patients having experienced nadir sepsis, 30.8 per cent mucositis and 7.6 per cent cardiac toxicity. Median cycle length varied from 31.6 to 41.7 days for the first and 5th cycle respectively. This regimen has been efficacious in selected patients with advanced urothelial tumors.
Carcinoma, Transitional Cell ; Doxorubicin* ; Drug Therapy, Combination ; Humans ; Mucositis ; Prognosis ; Recurrence ; Sepsis ; Vinblastine*