PURPOSE: The purpose of this study is to evaluate the clinical and radiologic results of using Acutrak screws for treating ankle medial malleolar fracture. MATERIALS AND METHODS: We reviewed 38 cases of ankle medial malleolar fracture treated with Acutrak screws from February 2005 to May 2008. RESULTS: In clinical result, there were 30 exellent cases, 7 good cases, 1 fair case. In radiologic result, there is no case with reduction loss. Average union time is 10.5 weeks. CONCLUSION: We conclude that Acutrak screw fixation is a useful method for ankle medial malleolar fracture, there are many advantages in accurate anatomical reduction, small incision, short operative time.
Animals ; Ankle ; Operative Time

BACKGROUND: Tuberculosis (TB) remains an important cause of morbidity and mortality throughout the world. The surge of TB has been accompanied by an increase in multi-drug-resistant tuberculosis (MDR-TB). In this study, we developed a denaturing HPLC (DHPLC) method for detecting rpoB gene mutation as a rifampin resistance based on sequence. METHODS: In this study, we used 99 mycobacterial isolates grown in Ogawa media. At first, we used a PCR method that can amplify the 235 bp and 136 bp rpoB DNAs of Mycobacterium tuberculosis complex (MTB) and Non-tuberculous mycobacteria (NTM). And then, PCR-restriction fragment length polymorphism (RFLP) of rpoB DNA (342 bp), which comprises the Rif(T) region, was used for the differential identification of Mycobacteria. Finally, we detected these amplicons by DHPLC, compared to PCR-RFLP results, and performed sequencing. RESULTS: Among 99 mycobacterial isolates, 80 (81%) were MTB and 19 (19%) were NTM. NTM were identified to 7 different species by DHPLC and PCR-RFLP. rpoB mutation was detected in 9 (11%) of the MTB specimens. These results were confirmed by using sequencing. CONCLUSIONS: DHPLC provided a rapid, simple, and automatable performance for detection of rifampin resistant Mycobacterium tuberculosis complex and would be helpful as a supplemental method in high-throughput clinical laboratories.
Antibiotics, Antitubercular/*pharmacology ; Bacterial Typing Techniques ; Chromatography, High Pressure Liquid/*methods ; DNA, Bacterial ; Drug Resistance, Bacterial/genetics ; Humans ; Mutation ; Mycobacterium tuberculosis/*drug effects/genetics/*isolation & purification ; Rifampin/*pharmacology ; Tuberculosis/*microbiology

Although the adrenal gland is a common site of metastasis from hepatocellular carcinoma (HCC), adrenal metastases are rarely seen in clinical practice because of its lower metastatic potential compared to the other malignancies. Adrenal metastases usually were detected at the time of diagnosis of primary HCC or simultaneously with intrahepatic recurrence after curative management of HCC. It is very rare that only metastatic HCC is detected without evidence of intrahepatic recurrence. Hereby, we report two cases of adrenal metastasis from HCC without intrahepatic recurrence after hepatic resection.
Adrenal Gland Neoplasms/*diagnosis/radionuclide imaging/secondary ; Aged, 80 and over ; Carcinoma, Hepatocellular/*pathology/surgery ; Humans ; Liver Neoplasms/*pathology/surgery ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

Acute mesenteric venous thrombosis (MVT) is an uncommon form of intestinal ischemia with high mortality and usually occurs in the setting of preexisting comorbidities including thrombophilia and abdominal inflammatory conditions. Hyperhomocysteinemia has been known to be a risk factor for thromboembolism, often located on an unusual site. Considering that homocysteine metabolism is determined genetically to a high degree, a mutant of methylenetetrahydrofolate reductase (MTHFR) C677T causes hyperhomocysteinemia, leading to thrombophilia. Until now, there have been few reports of MVT associated with MTHFR gene mutation. We, herein, report a case of small bowel infarction associated with MVT by MTHFR gene mutation in an adult without any other risk factors of thrombophilia.
Adult ; Comorbidity ; Homocysteine ; Humans ; Hyperhomocysteinemia ; Infarction* ; Ischemia ; Mesenteric Veins ; Metabolism ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Mortality ; Risk Factors ; Thromboembolism ; Thrombophilia ; Thrombosis ; Venous Thrombosis*

C1q nephropathy is an immune complex glomerulonephritis defined by predominant mesangial C1q deposition and has no evidence of systemic lupus erythematosus. Patients are usually between the ages of 15 and 30 when diagnosed and have a nephrotic range proteinuria. C1q nephropathy in adult has not been reported yet in Korea. Also it may be accompanied by hematuria, but it is uncommonly manifested hematuria without proteinuria. We experienced a case of C1q mediated glomerulonephritis that manifested by asymptomatic hematuria in adult. A 47-years-old man visited our hospital complaining general weakness and fatigue. Microscopic hematuria was detected on routine examination of urinary sediment so that renal biopsy was carried out. Renal biopsy showed C1q mediated glomerulonephritis. We report a case of C1q mediated glomerulonephritis manifested by asymptomatic hematuria without proteinuria. C1q nephropathy should be added to the differential diagnosis of glomerulonephritis in patients with asymptomatic hematuria.
Adult ; Antigen-Antibody Complex ; Biopsy ; Diagnosis, Differential ; Fatigue ; Glomerulonephritis* ; Hematuria* ; Humans ; Korea ; Lupus Erythematosus, Systemic ; Proteinuria

Adrenal gland is an uncommon primary site in non-Hodgkin's malignant lymphoma and reports of primary bilateral adrenal lymphoma with its functional impairment are extremely rare. Only 15 cases were reported during past 50 years, and 11 of them expired within 6 months after diagnosis.A woman came to emergency room with lethargy, abdominal pain and diarrhea. Bilateral adrenal enlargement was found on a previous abdominal sonogram. Under the impression of acute adrenal insufficiency, intravenous hydrocortisone and vigorous saline infusion were given immediately. Later, the endocrine function tests revealed primary hypoadrenalism. The 1st CHOP chemotherapy was administered after tissue diagnosis. This report describes the clinical, radiologic, and pathologic findings in a 58-year-old woman with adrenal insufficiency due to primary bilateral adrenal lymphoma with the review of previous literatures.
Abdominal Pain ; Addison Disease ; Adrenal Glands ; Adrenal Insufficiency* ; Diagnosis ; Diarrhea ; Drug Therapy ; Emergency Service, Hospital ; Female ; Humans ; Hydrocortisone ; Lethargy ; Lymphoma* ; Middle Aged

Pancreatic tumor has a wide range of differential diagnosis, from the benign inflammatory diseases, to the malignant disease such as pancreatic cancer. Here, we report a case of extrapulmonary paragonimiasis involving pancreas which was difficult to differentiate from primary neoplasm of pancreas. A 44 year old man was presented with a pancreatic tumor having inhomogenous enhancement and cystic nature in part, and conglomerated mass with rim enhancement and central hypodensity along both anterior and posterior side of pancreas on CT. No diagnostic clue was obtained from those conventional procedures and then the surgical exploration was perfomed to confirm the histology. The pathologic finding revealed the Paragonimus eggs in the granulomatous inflammation with necrosis.
Adult ; Diagnosis, Differential ; Eggs ; Humans ; Inflammation ; Necrosis ; Ovum ; Pancreas ; Pancreatic Neoplasms ; Paragonimiasis* ; Paragonimus

PURPOSE: Bronchopulmonary dysplasia (BPD) is characterized by arrested vascular and alveolar growth in the premature lung. Considering the consequences of arrested lung growth, the idea of administering bone marrow cells to enhance the inborn repair mechanism is promising as this may reduce the morbidity and mortality of BPD. We followed enhanced green fluorescent protein (EGFP)-labeled bone marrow cells (BMC) injected intraperitoneally into non-EGFP mice in order to determine their fate after transplantation. METHODS: An angiogenesis inhibitor, SU1498, was injected subcutaneously on day 3 in non-EGFP C57BL/6 newborn mice to create a model of arrested alveolar development. On the following day, 1x10(6) BMCs isolated from major histocompatibility complex (MHC)- matched syngenic EGFP mice were injected intraperitoneally to non-EGFP BPD mice. Morphometric analysis, immunostaining, and confocal microscopy were performed to determine the fate of EGFP-positive stem cells in the injured lung. RESULTS: SU1498 injection reduced alveolar surface area and mean alveolar volume in newborn mice. BMC injection resulted in recovery of lung structure comparable to controls. EGFP-positive BMCs were identified in the lungs of the recipient mice after intraperitoneal injection. The injected EGFP cells were co-stained with endothelial and epithelial cells of the developing lung as determined by confocal microscopy. CONCLUSION: Our results illustrated that EGFP-positive BMCs engrafted and trans- differentiated into epithelial and endothelial cells after intraperitoneal injection in a mouse model of arrested alveolar development.
Animals ; Bone Marrow ; Bone Marrow Cells ; Bronchopulmonary Dysplasia ; Cinnamates ; Endothelial Cells ; Epithelial Cells ; Green Fluorescent Proteins ; Humans ; Infant, Newborn ; Injections, Intraperitoneal ; Lung ; Major Histocompatibility Complex ; Mice ; Microscopy, Confocal ; Stem Cells

BACKGROUND: 'Eight drugs in a day' was one of the widely used regimen in medulloblastoma. Result of treatment of this regimen and comparison between pre-RT chemotherapy and post-RT chemotherapy were presented. METHODS: Medical records of children who were diagnosed as medulloblastoma and treated with 8 in 1 therapy in Seoul National University Children's Hospital from January 1986 to June 1997 were reviewed. RESULTS: 1) Forty nine cases(male: 30, female: 19) were analyzed. The age at diagnosis was between 3 months and 15 years 3 months and median age was 7 years 10 months. 2) The T stage by Chang classification revealed T1(2%), T2(26%), T3a(9%), T3b(56%), and T4(7%) in 43 cases. M stage revealed M0(46%), M1(15%), M3(37%), and M4(2%) in 41 cases. The surgical results revealed gross total resection(36%), near total resection(18%), subtotal resection(38%), and partial resection(9%). 3) The 5-yr disease free survival(DFS) rate of all tumors was 53%. There was no difference in DFS about sex, age, pathology, T stage, M stage, and surgical result. 4) Difference of 5-year DFS between pre-RT chemotherapy group(53%) and post-RT chemotherapy group(83%) was significant[-2Log(LR), P=0.023], excluding the patient relapsed or too young(below 18 month, who had more chemotherapy to delay radiation) to be received radiation therapy. CONCLUSIONS: DFS in post-RT chemotherapy was better than pre-RT chemotherapy. As medulloblastoma has the property to confine in CNS system, prior treatment with radiation as a intensive local therapy may be more effective than the systemic chemotherapy. Progression or relapse were the main causes of treatment failure. Result of treatment may be improved by more intensive therapy.
Child ; Classification ; Diagnosis ; Drug Therapy* ; Female ; Humans ; Medical Records ; Medulloblastoma* ; Pathology ; Recurrence ; Seoul ; Treatment Failure

PURPOSE: Germ cell tumors have variable clinical characteristics according to the age, sex, primary site, and pathologic diagnosis. To provide the therapeutic principle, the clinical characteristics, response to the treatment, and prognostic factors were analyzed. METHODS: Medical records of 57 children who were diagnosed as malignant germ cell tumor in Seoul National University Children's Hospital from January 1986 till June 1996 were reviewed. RESULTS: 1) Fifty seven cases (male : 22, female : 43, true hermaphrodite : 1) were analyzed. The age of diagnosis was between 2 months and 15 years and median age was 4 year 7 month. 2) The primary sites were sacrococcygeal area (28%), intracranial area (25%), ovary (18%), testis (11%), retroperitoneum (7%), and mediastinum (4%) in order of frequency. Another cases were in liver, spinal cord, skull base, tongue, and ovary & testis in hermaphrodite. 3) Pathologic diagnosis was possible in 53 cases. Mixed germ cell tumor (37%), endodermal sinus tumor (23%), germinoma (13%), immature teratoma (8%), embryonal carcinoma (4%), and choriocarcinoma (2%) were included in order of frequency. 4) The stage by CCG/POG classification revealed that 6% of stage I, 19% of stage II, 43% of stage III, and 32% of stage IV in 53 cases. 5) After the initial surgery or needle biopsy, radiation therapy was done in the intracranial tumor with EP induction or modified CCG 8891, etc. and cis-VAB, EP, VAB-3, VAC, or CCG 8891, etc. was done in the extracranial tumor with/without radiation therapy. 6) The response rate revealed that 71% of complete response, 22% of partial response, and 7% of progressive disease in 45 cases. 7) The response rate was related to the primary site but not pathology and stage. All the gonadal tumors had complete response. 8) The 5 year-survival rate of all malignant germ cell tumors was 73%. Stage 4 or sacrococcygeal tumor had poor survival rate. CONCLUSIONS: Stage 4 and sacrococcygeal area were thought as the poor prognostic factors affecting survival. Survival rate of tumors at sacrococcygeal area were poor owing to the relatively younger age of onset, and poor response rate. The 5 year-survival rate of tumors treated with cis-VAB were 74% but shown complications frequently. So BEP will be preferred.
Age of Onset ; Biopsy, Needle ; Carcinoma, Embryonal ; Child ; Choriocarcinoma ; Classification ; Diagnosis ; Drug Therapy ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Germinoma ; Gonads ; Humans ; Liver ; Mediastinum ; Medical Records ; Neoplasms, Germ Cell and Embryonal* ; Ovary ; Pathology ; Pregnancy ; Seoul ; Skull Base ; Spinal Cord ; Survival Rate ; Teratoma ; Testis ; Tongue