No abstract available.

Meconium peritonitis is a rare disease in neonates, characterized by intraperitoneal calcification, numerous fibrosis with or without pseudocyst formation due to antenatal extravasation of meconium. Meconium peritonitis may result in a number of genital manifestations, including inguinal and scrotal or labial hydrocele containing meconium or calcifications. Recently, increased numbers of fetuses with meconium peritonitis have been prenatally diagnosed by ultrasonography. We report a case of meconium peritonitis in a neonate with ascites and hydrocele which was diagnosed by antenatal ultrasonography.
Ascites ; Fetus ; Fibrosis ; Humans ; Infant, Newborn ; Meconium* ; Peritonitis* ; Rare Diseases ; Ultrasonography

PURPOSE: To classify the type of transient synovitis and determine a treatment plan using MRI. MATERIALS AND METHODS: From March 1985 to October 1998, 37 hips in 33 children with clinical symptoms of transient synovitis were evaluated with MRI. The average age of the patients was 7.5 years (range, 3.5-15 years) . The mean follow-up period was 18 months (range, 12-36 months) . The 37 hips were classified as grade l, ll, lll, or lV according to the amount of accumulated joint fluid on MRI. RESULTS: Of 37 hips with transient synovitis, 36 hips had no involvement of epiphysis and metaphysis and one hip had a cyst and bone marrow edema in the metaphysis on MRI scans. The amount of joint fluid was classified as seen on MRI scans: grade 1 in 2 hips, grade 2 in 14 hips, grade 3 in 5 hips, and grade 4 in 16 hips. CONCLUSION: MRI is a very useful diagnostic tool to classify and determine the treatment plan for transient synovitis. In patients with grade 3 and 4 joint fluid, the risk of vascular compromise of the femoral epiphysis could be higher. These patients should be hospitalized and immobilized in flexed position of the hip. Patients with grade 1 and 2 joint fluid can be treated at home with immobilization.
Bone Marrow ; Child ; Classification* ; Edema ; Epiphyses ; Follow-Up Studies ; Hip ; Humans ; Immobilization ; Joints ; Magnetic Resonance Imaging* ; Synovitis*

PURPOSE: The most common cause of failure after Steindler flexorplasty has been known insufficient power of the transferred muscles. We develop "effective muscle index" which is calculated from the actual strength of each muscle to predict postoperative flexion power of the elbow for preventing the failure of the surgery. MATERIALS AND METHODS: We reviewed 10 patients who received Steindler flexorplasty from Aug. 1983 to Jan. 1997. We calculated "effective muscle index" with power of each transferred muscle, tension fraction2) by Brand, 1981, correction index of the magnitude of transferring muscle and correlated the "effective muscle index" with postoperative elbow flexion power. RESULTS: Excluding 4 out of total 10 patients who had grade 1 or 2 power of biceps and brachialis, "effective muscle index" has borderline significance with the postoperative flexion power of the elbow (p=0.123) . CONCLUSION: The authors concluded that the "effective muscle index" is maybe considered as a useful index for predicting the postoperative flexion power of the elbow after Steindler flexorplasty.
Elbow* ; Humans ; Muscles

BACKGROUND: Tricuspid regurgitation (TR) is a common finding that can be detected with use of Doppler echocardiographic technique in patients with right ventricular dysfunction as well as in normal children, adolescents and adult. It is difficult to evaluate the right ventricular function by conventional method, including echocardiography, especially in case with TR. METHOD: To determine the degree and relationship of right ventricular function and duration of TR, we examined the 41 patients with TR associated with heart disease, group 2 (n=19) with no definitive evidence of right ventricular dysfunction nor significant pulmonary hypertension, and group 3 (n=22) with right ventricular dilatation or wall motion abnormality, or history of longstanding pulmonary hypertension or moderate or severe TR, and compared 59 normal subjects (group 1) with trivial or mild TR without definitive heart disease. Using Doppler echocardiography, duration of TR (TRD) and pulmonary ejection period (ET) is measured, and calculated the TR time interval (RTI) by the difference of TRD and ET divided by ET. RESULT: Pre-ejection period (PEP), ET and systolic time interval (STI, PEP/ET) of right ventricle are significantly prolonged in group 2 and 3 compare to those of group 1 (p<0.001 respectively), TRD is significantly prolonged in group 3 compare to those of group 1 and 2, and isovolumic contraction time (IRT), isovolumic relaxation time (IRT) and RTI are significantly different in each group and prolonged in group 2 and 3. RTI is significantly correlated to STI (r=0.56), ICT (r=0.75) and IRT (r=0.94), but independent to heart rate. CONCLUSION: We conclude that Doppler measurement of RTI (TRD-ET)/ET{=(ICT+IRT)/ET} is a simple and useful new index for the evaluation of RV function including systolic and diastolic function.
Adolescent ; Adult ; Child ; Dilatation ; Echocardiography ; Echocardiography, Doppler ; Evaluation Studies as Topic* ; Heart Diseases ; Heart Rate ; Heart Ventricles ; Humans ; Hypertension, Pulmonary ; Relaxation ; Systole ; Tricuspid Valve Insufficiency* ; Ventricular Dysfunction, Right ; Ventricular Function, Right

PURPOSE: To evaluate the risk period of osteonecrosis of the femoral head following steroid therapy. MATERIALS AND METHODS: Medical records data were reviewed and studied the duration and dosage of steroid therapy for 22 patients who were diagnosed as in the early stage osteonecrosis by MRI but were without positive findings on plain radiographs. RESULTS: The period from the onset of steroid therapy to the time of diagnosis by MRI ranged from one to 16 months (mean, 5.3 months). Twenty-one of the 22 patients were diagnosed within 12 months. The total dosage of steroid ranged from 1,800 to 15,505 mg of prednisolone or its equivalent (mean, 5,928 mg). CONCLUSION: The current study revealed that the risk period for developing femoral head osteonecrosis in patients receiving long-term steroid therapy is 12 months. Periodical follow-up and intensive screening are recommended within the first year of long-term steroid therapy to detect osteonecrosis of the femoral head at an early stage.
Diagnosis ; Follow-Up Studies ; Head* ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Medical Records ; Osteonecrosis* ; Prednisolone

BACKGROUND: Hip pain is a common musculoskeletal complaint in general practice. Although comprehensive diagnostic approach on hip pain is mandatory for adequate treatment, un- or mis-diagnosis is not rare in primary care. The aim of this study was to analyze descriptively un- or mis-diagnosed hip pain cases referred from primary care to a tertiary hospital, especially in young adults ≤ 50 years old. METHODS: We retrospectively analyzed a consecutive cohort of 150 patients (≤ 50 years old) with chronic hip pain (≥ 6 weeks), which was not diagnosed or misdiagnosed based on the information provided on the referral form. RESULTS: Overall an average 32 cases/month were referred due to hip pain without a diagnosis or with an incorrect diagnosis. Among them, 150 patients were enrolled in this study and 146 (97.3%) could be allocated to a specific disease by using data from routine clinical practice. Four common final diagnoses were femoroacetabular impingement (FAI) syndrome (55.3%), hip dysplasia (HD, 13.3%), referred pain from the lumbar spine (9.3%), and spondyloarthritis (SpA, 7.3%). In patients with FAI syndrome, 37 (44.0%) had pincer-type FAI and 33 (39.8%) had combined-type. Although the pain site or gender was not tightly clustered, the distribution of final diagnosis was significantly different according to hip pain location or gender. Especially, SpA or HD was not observed in younger women subgroup or elder men subgroup, respectively, when stratified by the mean age of participants. CONCLUSION: Most (> 80%) young patients with hip pain, a difficult issue to diagnosis for many primary physicians, had FAI syndrome, HD, spine lesions, and SpA. This study could give a chance to feedback information about cases with un- or mis-diagnosed hip pain, and it suggests that primary physicians need to be familiar with the diagnostic approach for these 4 diseases.
Cohort Studies ; Diagnosis ; Female ; Femoracetabular Impingement ; General Practice ; Hip Dislocation ; Hip* ; Humans ; Male ; Pain, Referred ; Primary Health Care ; Referral and Consultation ; Retrospective Studies* ; Spine ; Tertiary Care Centers ; Young Adult*

STUDY DESIGN: A retrospective study was designed to evaluate the clinical result and difference between short segment and long segment fixation, which was undertaken by posterior approach for thoracic and lumbar spine fractures. OBJECTIVE: To determine and compare the mechanical maintenance and ability of correction, and clinical and neurologic recov-ery between short segment and long segment fusion group. SUMMARY OF BACKGROUND DATA: The long segment instrumentation is a cause of decrease of motion segment in thoracic and lumbar spine. In short segment fusion, screw failures were reported. MATERIALS AND METHODS: From 1989 thorough 1997, 54 patients who had been operated on by the posterior approach with transpedicular screw fixation for spine injuries were divided into two groups. The authors applied the short segment transpedic-ular instrumentation including fractured vertebra. Short segment group included 35 cases, and long segment group, 19 cases. The mean follow-up period was one year and eight months for short segment group, two years and seven months for long segment one. The results were evaluated by comparing the anterior vertebral height, sagittal index in simple roentgenogram and neurologic recovery. RESULTS: The average of anterior vertebral height which was 50.7% at preoperation, became 78.7% after the operation and measured 74.9% at final follow-up in long segment fusion group, while in short segment fusion group it was 59.7%, 79.3% and 77.7%, respectively. The average of sagittal index of 17.5degreeat preoperation became 6.7degreeafter the operation, and measured 8degreeat final follow-up in long segment fusion group, while in short segment fusion group it was 19.9degree, 10.4degree, and 12.1degree, respectively. Overall clinical results had no statistical significant difference between two groups. Of the thirty-six patients with neurologic deficits, twenty-two improved by over the one Frankel grade. CONCLUSIONS: The authors conclude that the short segment transpedicular instrumentation including fractured vertebra is a successful method of thoracolumbar and lumbar burst fractures.
Follow-Up Studies ; Humans ; Neurologic Manifestations ; Retrospective Studies ; Spine

Traumatic anterior dislocation of the hip is rare. Bilateral traumatic anterior dislocation is an even rarer injury; indeed, only 5 cases have been reported in the English literature. We describe a case of a bilateral traumatic anterior dislocation of the hip and a concomitant unstable lumbar burst fracture following a mechanism of injury distinctly different from other reports.
*Accidents, Occupational ; Acetabulum/injuries ; Buttocks/*injuries ; Fractures, Bone/complications/etiology/radiography ; Hip Dislocation/etiology/*radiography ; Humans ; Lumbar Vertebrae/*injuries ; Lumbosacral Region/*injuries ; Male ; Middle Aged ; Spinal Fractures/etiology/*radiography

BACKGROUND: It is important to differentiate Graves' disease from that of painless thyroiditis in patients with thyrotoxicosis. In this study, we evaluated the usefulness of total T3 to free T4 ratio in making a differential diagnosis between Graves' disease and painless thyroiditis. METHODS: We reviewed medical records of thyrotoxic patients, who had been diagnosed with Graves' disease or painless thyroiditis, from October 2009 to July 2011. We assessed clinical characteristics, serum levels of total T3, free T4, thyroid stimulating hormone, thyrotropin-binding inhibitory immunoglobulin, and findings of 99mTechnetium thyroid scan. We analyzed the total T3/free T4 ratios between Graves' disease and painless thyroiditis patients. RESULTS: A total of 76 untreated thyrotoxic patients "49 Graves' disease and 27 painless thyroiditis" were examined. The total T3, free T4 levels and the total T3/free T4 ratios were significantly higher in patients with Graves' disease than in those with painless thyroiditis (P < 0.001). In the total T3/free T4 ratio > 73, the possibility of Graves' disease was significantly higher than in painless thyroiditis (sensitivity, 75.5%; specificity, 70.3%). The sensitivity and specificity of the total T3/free T4 ratio in patients with free T4 < 3.6 ng/dL have been increased (sensitivity, 100%; specificity, 71.4%). CONCLUSION: The total T3/free T4 ratios was useful for making a differential diagnosis between Graves' disease and painless thyroiditis.
Diagnosis, Differential ; Graves Disease ; Humans ; Immunoglobulins ; Immunoglobulins, Thyroid-Stimulating ; Medical Records ; Sensitivity and Specificity ; Thyroid Gland ; Thyroiditis ; Thyrotoxicosis ; Thyrotropin