Hereditary theory was first proposed by Joachimsthal in 1905. However, a family history of congenital muscular torticollis is uncommon. This is a report of two female children who are interrelated and have congenital muscular torticollis. They are sisters. No environmental factor could be identified that would predispose the the children to congenital muscular torticollis. In this family, it is apparent that genetic factors are influencing the development of this condition. The cause of congenital muscular torticollis is unknown, but heredity may play a more important role than has previously been supected.
Child ; Female ; Heredity ; Humans ; Siblings ; Torticollis

PURPOSE:Chronic autoimmune thyroiditis is the most common thyroid disease in children and adolescents, and also is the most common cause of hypothyroidism in children and adolescents. We studied the clinical manifestations and natural courses of chronic autoimmune thyroiditis in children and adolescents. METHODS:We analyzed retrospectively twenty one children and adolescents who were diagnosed as chronic autoimmune thyroiditis before 15 years of age. The diagnoses were made from July 1997 to February 2004 at Ajou Univesity Hospital. We reviewed the clinical manifestations and thyroid functions of these patients. RESULTS:Nineteen patients were female and two were male. The mean age at diagnosis was 9.95+/-3.1 years, the mean duration of follow up was 23.52+/-22.98 months. At diagnosis, the most common chief complaint was goiter (15 patients/21 patients) and the others were short stature, easy fatigue, cardiac murmur and weight loss. Eighteen patients had goiters at diagnosis. Four had familial history of thyroid disease, Three of them had maternal history of thyroid disease and one had paternal history of thyroid disease. At diagnosis, Seven patients were euthyroid and four patients were hyperthyroid, eighteen patients had antithyroglobulin antibody, seventeen patients had antimicrosomal antibody, fourteen patients had both of them. At last follow-up, eight patients were euthyroid and ten patients were hypothyroid, three patients were hyperthyroid. CONCLUSION: Chronic autoimmune thyroiditis in children and adolescents can have the various important influences on the metabolism including the growth. The clinical manifestations and thyroid functions should be monitored in children and adolescents with chronic autoimmune thyroiditis.
Adolescent* ; Child* ; Diagnosis ; Fatigue ; Female ; Follow-Up Studies ; Goiter ; Heart Murmurs ; Humans ; Hypothyroidism ; Male ; Metabolism ; Retrospective Studies ; Thyroid Diseases ; Thyroid Gland ; Thyroiditis, Autoimmune* ; Weight Loss

Ipsilateral fractures of the femoral neck and shaft represent many difficulties in diagnosis and treatment. The femoral neck fracture of this injury is commonly missed on initial evaluation. The overlooked femoral neck fracture may lead to higher risk of complications such as avascular necrosis of the femoral head, nonunion and coax vara. The authors reviewed nine cases of ipsilateral femoral neck and shaft fracture treated in our clinic from September 1989 to May 1995, and average follow-up period was 33 months(range, 12 to 101 months). The results obtained were as follows : 1. The most common cause of injury was traffic accident, and three femoral neck fractures were missed initially. 2. The most common site of femoral neck fractures was basicervical in 7 cases, and that of shaft fracture was middle 1/3 shaft in 5 cases. 3. The most common associated injury was ipsilateral knee injury(6 cases). 4. Five cases were treated with femoral reconstruction nail, two with multiple neck-pinning and retrograde interlocking IM nail, one with multiple screws for neck fracture and long dynamic compression plate for shaft fracture, and the other, multiple neck-pinning and antegrade interlocking IM nail. 5. The complications were a refracture of the shaft after removal of interlocking nail and a delayed union of shaft fracture which had been treated by reconstruction nailing. Coxa vara, delayed union and metal loosening were found in femoral neck fracture site, but all that were clinically acceptable. In conclusion, the fracture of femoral neck should be kept in mind not to be lost in case of high velocity-femoral shaft fracture, and if found, it should be treated with anatomical and rigid internal fixation in femoral neck fracture having first priority. Recently reconstruction nail for the treatment of these fractures was widely used, but that is technically difficult and might destroy the neck fracture during shaft fracture fixation. We recommend retrograde interlocking nail followed by multiple neckpinning might be safe and stable fixation for the ipsilateral neck and shaft fracture.
Accidents, Traffic ; Coxa Vara ; Diagnosis ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Fracture Fixation ; Head ; Knee ; Neck ; Necrosis

Efforts to improve end-of-life (EOL) care have generally been focused on cancer patients, but high-quality EOL care is also important for patients with other serious medical illnesses including heart failure (HF). Recent HF guidelines offer more clinical considerations for palliative care including EOL care than ever before. Because HF patients can experience rapid, unexpected clinical deterioration or sudden death throughout the disease trajectory, choosing an appropriate time to discuss issues such as advance directives or hospice can be challenging in real clinical situations. Therefore, EOL issues should be discussed early. Conversations are important for understanding patient and family expectations and developing mutually agreed goals of care. In particular, high-quality communication with patient and family through a multidisciplinary team is necessary to define patient-centered goals of care and establish treatment based on goals. Control of symptoms such as dyspnea, pain, anxiety/ depression, fatigue, nausea, anorexia, and altered mental status throughout the dying process is an important issue that is often overlooked. When quality-of-life outweighs expanding quantity-of-life, the transition to EOL care should be considered. Advanced care planning including resuscitation (i.e., do-not resuscitate order), device deactivation, site for last days and bereavement support for the family should focus on ensuring a good death and be reviewed regularly. It is essential to ensure that treatment for all HF patients incorporates discussions about the overall goals of care and individual patient preferences at both the EOL and sudden changes in health status. In this review, we focus on EOL care for end-stage HF patients.

Leiomyoma is a benign tumor, which usually occur at the smooth muscle of the gastrointestinal tract and uterus but rarely occurs on the corpus cavernosum of the penis. We experienced a patient with leiomyomas on the bilateral corpus cavernosa of the penis accompanied with impotence in a 60-year-old man. The patient was treated with complete local excision and has remained well without recurrence for l year, So we report this case with review of literatures.
Erectile Dysfunction ; Gastrointestinal Tract ; Humans ; Leiomyoma* ; Male ; Middle Aged ; Muscle, Smooth ; Penis* ; Recurrence ; Uterus

BACKGROUND & OBJECTIVE: It has not been clear that the correlation between individual ictal scalp/sphenoidal EEG patterns and MRI findings or surgical outcome. So we investigated the correlation between the differences in individual ictal EEG patterns, MRI findings and surgical outcome. METHOD: Twenty nine temporal lobe epilepsy patients undergoing anterior temporal lobectomy with hippocampectomy in AMC since 1993 were evaluated. Ictal EEGs were classified as A(focal ictal onset) and B(lateralizing pattern) MRI findings were grouped as hippocampal atrophy (HA) with or without lateral temporal atrophy (LTA). RESULT: In group A(19), 7(37%) had HA with LTA on MRI and 12(63%) showed HA only. In group B(10), 8(80%) had HA with LTA and 2(20%) showed HA only. Among the 20 patients whose postoperative follow up period were more than 1 year, 11 cases(73%) of group A(IS) had seizure free outcome, whereas all (100%) of group B (5) had seizure free outcome. Eight (72.7%) out of 11 cases with HA only on MRI were seizure free outcome, whereas 8(89%) out of 9 cases with HA with LTA were seizure free after surgery. CONCLUSION: Focal ictal EEG pattern was more commonly noticed in HA only and lateralized Ictal EEG pattern was more commonly noticed in HA with LTA on MRI. Surgical outcome seems not to be directly correlated with the ictal EEG patterns or accompanied LTA on MRI in temporal lobe epilepsy.
Anterior Temporal Lobectomy ; Atrophy ; Electroencephalography* ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Seizures ; Temporal Lobe*

Sixty diabetic cystopathy patients (symptomatic DCP, 4.9%) among 1236 patients of diabetes mellitus (DM) from May, 1995 to June, 1996 were analyzed to ascertain the usefulness of urodynamic study in the diagnosis of DCP. The mean age was 58 (24--80) years and mean duration of DM was 9 (1~30) years. 36 (60%) patients had diabetic neuropathy, 31 (52%) had diabetic retinopathy and 4 (7%) had diabetic nephropathy. DM was managed by insulin pump (DIABECARETM, 52%) and subcutaneous insulin injection (42%). In residual urine and voiding diaries, residual urine volume more than 40ml was 83%, voiding interval less than 2 or more than 5 hours was 67% and voiding amount less than 200ml or more than 400ml was 48%. According to urodynamic findings, patients were classified as detrusor areflexia (63%), impaired detrusor contractility (18%), detrusor instability (15%) and normal detrusor contraction (3%). There were no significant differences of age, semm-HbA1C, treatment method and duration of diabetes mellitus among above groups. Mean duration of DM in irritative symptom group (32%), combined symptom group (23%) and obstructive symptom group (45%) were 2 years, 8 years and 15 years respectively (p<0.001). The shape of the cystometrographic curve was not influenced by the rate of bladder filling (40ml/min versus 100ml/min). In conclusion, because DCP is marked by insidious onset and progression with minimal symptoms, DCP can be early diagnosed using urodynamic study especially in patients with voiding symptoms and 1ong.DM duration.
Diabetes Mellitus ; Diabetic Nephropathies ; Diabetic Neuropathies ; Diabetic Retinopathy ; Diagnosis ; Humans ; Insulin ; Urinary Bladder ; Urodynamics*

To evaluate the clinical correlation between the penile size and benign prostatic hyperplasia (BPH) we measured the penile circumference(PC) and length(PL) as the flaccid state in 416 male cases more than 50 old years. PC was measured on the penile groove and PL from upper margin of symphysis pubis to the tip of penile glans. We compared PC and PL with prostatic volume, IPSS symptom score, uroflow and BPH defined by Garraway (1993)(BPH-G). All cases were classified as group I(below 9.0cm : 231 cases), II(above 9.0cm : 185 cases) in PC and A(below 8.0cm . 206 cases), B(above 8.0cm 210 cases) in PL. The ranges of PC and PL value were 6.0- 13.0cm(ave. 9.2) and 5.0-13.0cm(ave. 8.2), respectively. PC and PL values according to presence and absence of BPH-G were 9.3+/-0.8cm, 8.4+/-2.6cm and 8.6+/-1.5cm, 7.6+/-2.6cm, respectively (P<0.05), and PC values in prostatic volume below 30gm and more than 30gm, 8.8+/-l.0cm, 9.5+/-0.7cm, respectively (p<0.05). Among BPH associated factors, only prostatic volume has a correlation with penile size according to regression analysis(<0.05). Prevalence of BPH in group I, II and A, B was 10.4%, 27.09& and 0.49&, 31.4%, respectively(p<0.05). As higher PL or PC, as higher prevalence of BPH. We suggest that prominently large penile size, especially PC may be a possible sign of BPH.
Humans ; Male ; Prevalence ; Prostatic Hyperplasia*

Auditory brainstem potentials were.recorded from scalp electrodes in neonates ranging in gestational age from 33 to 43 weeks, The latencies of the various potential component decreased with maturation, Wave V, evoked by 90-100dB sensation level clicks, changed in latency from 7.18 msec at 33 weeks of gestation to 6.93 msce at 43 weeks of gestation. Central condcuction times( I-V interpeak latency) in the auditory pathway also decreased with maturation from 5.65 msec at 3,3 weeks to 5,35 msec at 43 weeks, Several kinds of patholgic condition including hyperbilirubinemia, bacterial meningitis and respiratory difficulty syndrome were also evaluated with auditory brainstem potentials, the application of all of these techniques could permit an objective definition of normal and will be helpful in abnormal infants.
Auditory Pathways ; Brain Stem* ; Electrodes ; Evoked Potentials, Auditory* ; Gestational Age ; Humans ; Hyperbilirubinemia ; Infant ; Infant, Newborn* ; Meningitis, Bacterial ; Pregnancy ; Scalp ; Sensation