We experienced one case of severe pituitary dwarfism in a 10 years old female girl. Magnetic resonance image (MRI) revealed transection of the pituitary stalk stalk with the formation of high intensity ectopic posterior lobe located at the median eminence and agenesis of an anterior lobe of pituitary gland. The serum growth Hormone (GH) response to clonidine and L-dopa revealed severe GH deficiency. The patient had responses to TRH, normal TSH and partial prolactin response, respectively. There was not response LH and FSH to GnRH. The morning cortisol concentration and serum T4 concentration were decreased below the normal range. These findings and no hyperprolactinemia suggested the presence of a vascular connection between the pituitary gland and hypothalamus, which is not visible on MRI. Sofar, the primary cause of idiopathic pituitary dwarfism in many patients is injury to hypothalamus by perinatal insults. In this patient, there was no history of perinatal insults and postnatal head trauma but transection of the pituitary stalk. We report a case of severe pituitary dwarfism due to agenesis with brief review of related litereature.
Child ; Clonidine ; Craniocerebral Trauma ; Dwarfism, Pituitary* ; Female ; Gonadotropin-Releasing Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hyperprolactinemia ; Hypothalamus ; Levodopa ; Magnetic Resonance Imaging ; Median Eminence ; Pituitary Gland* ; Pituitary Gland, Anterior* ; Prolactin ; Reference Values

BACKGROUND AND OBJECTIVES: The incidence of inflammatory heart diseases is not yet as high as those of other cardiovascular diseases; however, inflammatory heart diseases do have relatively high mortality rate. Therefore, update information on the economic burden of inflammatory heart diseases are necessary in order to appropriate policy making on these diseases. MATERIALS AND METHODS: This study used a number of resources to obtain data, national health insurance statistics, the Korean Health Panel, and the causes of death report by the Korean National Statistical Office. The total costs of inflammatory heart diseases were estimated as the sum of direct medical care costs, direct non-medical care and indirect costs. RESULTS: The total direct cost of inflammatory heart disease was higher in Korean men than that of Korean women and cost due to inpatient was higher than that of outpatients cost. The costs to cover premature death were highest among all of the components used to determine the total costs for inflammatory heart disease, representing 66.3% of these costs in Korea. CONCLUSION: Inflammatory heart disease has a relatively high mortality rate, and the costs that are associated with premature deaths consume the greatest proportion of the costs associated with this disease. In spite of some limitations of study, this could be a reliable evidence of economic burden of inflammatory heart disease.
Cause of Death ; Cost of Illness ; Endocarditis ; Female ; Health Care Costs ; Heart ; Heart Diseases ; Humans ; Incidence ; Inflammation ; Inpatients ; Korea ; Male ; Mortality, Premature ; National Health Programs ; Outpatients ; Policy Making

PURPOSE: To analyze the patterns of and risk factors for fixation failure after hip nailing in intertrochanteric (IT) hip fractures. MATERIALS AND METHODS: Fourteen patients who sustained a fixation failure after hip nailing for IT hip fractures were enrolled in this study. The mean age at the index surgery was 74.5 years and the mean time to the fixation failure was 6.6 weeks. All of the serial radiographs up to the fixation failure and pre-operative 3-D computed tomography were analyzed. RESULTS: According to AO classification, there were 7 stable fractures and 7 unstable ones. Of the total of 14 cases, 10 showed a comminution of the greater trochanter tip and incomplete anatomical reduction of the medial and anterior cortex at the fracture site. Of the 10 cases with appropriate position of the lag screw within the femoral head, 9 showed a high pertrochanteric fracture (HPF) pattern. The mechanism of the fixation failure was rotation of the femoral head in 7 of 9 cases with HPF and varus collapse of the proximal fragment in 4 of the other 5 cases. CONCLUSION: The HPF pattern, the comminution of the greater trochanter tip, and incomplete reduction of the medial and anterior cortex may be additional risk factors of fixation failure after treating IT hip fractures with hip nailing in.
Femur ; Head ; Hip ; Hip Fractures ; Humans ; Nails ; Risk Factors

BACKGROUND AND PURPOSE: Vascular shear stress is essential for maintaining the morphology and function of endothelial cells. We hypothesized that shear stress in the internal carotid artery (ICA) may differ between patients with ischemic stroke and healthy control subjects. METHODS: ICA shear stress was calculated in 143 controls and 122 patients with ischemic stroke who had a normal ICA or an ICA with <50% stenosis. The stroke group included patients who presented with a first-ever or recurrent ischemic stroke but excluded cardioembolic stroke and uncertain etiologies. Of the 122 patients, 107 (87.7%) and 15 (12.3%) patients were categorized as first-ever and recurrent stroke, respectively. RESULTS: Carotid diameters were significantly larger, and both peak-systolic and end-diastolic velocities were significantly lower in patients with ischemic stroke than in controls (all p values <0.05). Mean values of peak-systolic and end-diastolic shear stress in both ICAs were significantly lower in patients with ischemic stroke in models that adjusted for age, sex, and vascular risk factors (p for trend <0.05). The ICA shear stress was lowest in patients with recurrent stroke or the subtype of small-vessel occlusion. Higher peak-systolic and end-diastolic shear stresses in both ICAs were independently and negatively associated with ischemic stroke after adjusting for potential confounders (all p values <0.05). CONCLUSIONS: ICA shear stresses were significantly lower in patients with ischemic stroke than in control subjects. Future studies should attempt to define the causal relationship between carotid arterial shear stress and ischemic stroke.
Carotid Arteries* ; Carotid Artery, Internal ; Constriction, Pathologic ; Endothelial Cells ; Hemodynamics ; Humans ; Risk Factors ; Stroke*

Ospemifene—a third-generation selective estrogen receptor modulator approved by the Food and Drug Administration in 2013—is an oral medication for the treatment of dyspareunia. In postmenopausal women with vulvovaginal atrophy, ospemifene significantly improves the structure and pH levels of the vagina, reducing dyspareunia. It is available as a 60-mg tablet; hence, women who may have had prior difficulty with vaginal administration or on-demand use of nonprescription lubricants and moisturizers would likely prefer this form of treatment. Preclinical studies demonstrated that ospemifene has an estrogen agonist action on the bone, reducing the cell proliferation of ductal carcinoma in an in situ model. Studies evaluating the safety of treatment for up to 52 weeks have shown that ospemifene is a safe medication with minimal impact on the endometrium. Further studies with larger number of subjects are necessary to better conclude its effects and long-term safety.
Administration, Intravaginal ; Atrophy* ; Carcinoma, Ductal ; Cell Proliferation ; Dyspareunia ; Endometrium ; Estrogens ; Female ; Humans ; Hydrogen-Ion Concentration ; Lubricants ; Menopause ; Selective Estrogen Receptor Modulators ; Tamoxifen ; United States Food and Drug Administration ; Vagina ; Vulva

The purpose of this study was to analyze the structure form of the head and face using 3-dimensional computerized tomography in Korean adults. We examined CT images of 100 Koreans (50 males and 50 females) between 22 and 46 years of age. The data of the 2-dimensional CT images were sent to the personal computer in the form of DICOM (Digital Image Communication in Medicine) files and transformed to the 3-dimensional CT images using V-worksTM 4.0 program (Cybermed, Korea). The authors could have 50 soft and 50 bony tissue 3-D images of the female patients by changing the contrast from same data. We could also have 50 soft and 50 bony tissue 3-D images of the male patients by the same method. To define the structural elements, we identified the key points of upper face (eurion, frontotemporale), mid face (zygion, malar eminence), and lower face (anterior mandible, posterior mandible) in the soft tissue and skeletal images, respectively. We measured the distance between the key points and evaluated the angular relationships in construction a geometric form corresponding to these points. We were able to get the quantitative data of facial form variants and the characteristics of facial structure of Korean adults. The cranium of the male Korean is wider and higher than that of female. The facial contour is also more projected than female. Application of these concepts to surgery may be helpful in determining the plan of the intervention and evaluation of the results of procedures.
Adult ; Anthropometry* ; Female ; Head ; Humans ; Imaging, Three-Dimensional ; Male ; Mandible ; Microcomputers ; Skull

Acquired defects involving exposed bone on the forehead is challenging to reconstruct. Skin expansion provides an ideal thin flap for forehead aesthetic unit, but it takes long time and high cost, and many patients are dissatisfied at their figures. Free flap can provide enough tissue immediately, but it takes long time and has the risk of mismatches of color and texture. This report details our experiences with two patients who had soft tissue defect on their forehead that was covered with remnant forehead flap unit. This method uses one-unit-forehead island flap based on supratrochlear and supraorbital vessel. We obtained satisfactory results in terms of aesthetic and functional consideration.
Forehead* ; Free Tissue Flaps ; Humans ; Skin

PURPOSE: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. METHODS: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turned over flap is fixed on the upper portion of the chest wall of the mastectomy site. RESULTS: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and in natural shape. CONCLUSION: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than those of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.
Arteries ; Breast ; Equipment and Supplies ; Female ; Humans ; Mammaplasty ; Mastectomy ; Thoracic Wall

BACKGROUND: The purpose of this study was to elucidate the effects of fluid on the acid-base and electrolytes status and renal function after kidney transplantation (KT). METHODS: We retrospectively analyzed 103 patients who underwent KT. Analyses were performed separately according to the donor type (living, 52; deceased, 51). In the living donor KT group, 28 patients received normal saline solution (NS) and 24 patients received Hartmann's solution (HS). In the deceased donor KT group, 27 patients received NS, and 24 received HS. The acid-base and electrolyte status, urine volume, and renal function between patients receiving NS and patients receiving HS were compared in each group. RESULTS: Regardless of donor type, there were no differences in potassium, pH, base excess, PCO2 and HCO3 between HS and NS on immediate postoperative and postoperative day 1. However, changes to neutral acid-base balance in terms of pH, HCO3, and base excess were significantly higher in HS than in NS. In living donor KT, NS increased serum potassium and chloride significantly during fluid therapy. On postoperative day 7, renal function showed no difference between two groups but urine volume was significantly larger in NS than in HS. CONCLUSIONS: HS does not increase the incidence of hyperkalemia after KT. The use of HS resulted in less metabolic acidosis than the use of NS. Renal function was similar but polyuria was more severe in patients who received NS than in those who received HS.
Acid-Base Equilibrium ; Acidosis ; Electrolytes* ; Fluid Therapy ; Humans ; Hydrogen-Ion Concentration ; Hyperkalemia ; Incidence ; Kidney Transplantation* ; Kidney* ; Living Donors ; Polyuria ; Potassium ; Retrospective Studies ; Sodium Chloride* ; Tissue Donors

Estlander's method was popular for lower lip reconstruction after wide excision of malignant tumor of lower lip. This operative method is safe, easy and has good result, but it is necessary to perform a secondary commissuroplasty because of round and small commissure. Several methods have been suggested for secondary commissuroplasty. We have performed commissuroplasty with three triangular flaps according to Ichiro's report.5 This method uses two opposing triangular mucosal flaps in the vermilion area and one small triangular skin flap on the commissure. We can obtain satisfactory results in terms of aesthetic and functional consideration. Thus, we report the usefulness of three triangular flaps as a secondary commissuroplasty after reconstruction of the lip by Estlander's method.
Lip* ; Skin ; Surgical Procedures, Operative*