Atrial flutter is and infrequent, but potentially unstable tachyarrythmia that occurs in pediatric ages. Transesophageal atrial pacing was used for treatment of 10 episodes of atrial flutter in 7 patients. At the time of atrial flutter conversion, patients were 6 days to 14 years old. 6 patients had associated with congenital heart disease. The atrial cycle length of atrial flutter ranged from 140 to 280 msec with variable atrioventricular conduction. Transesophageal atrial pacing was performed using a bipolar 4 F transesophageal electrode catheter. Atrial flutter conversion was accomplished with stimulation bursts using about 5 seconds of stimuli, 10 msec in duration at 20 to 27 mA. Pacing cycle length was 45 to 110 msec less than the atrial cycle length of tachycardia in 6 episodes. But in a neonate, underdrive pacing converted atrial flutter to sinus rhythm. Conversion attempts were unsuccessful on 2 occasions. Transesophageal atrial pacing is a safe and effective, minimally invasive technique for treatment of atrial flutter in infants and children.
Adolescent ; Atrial Flutter* ; Catheters ; Child* ; Electrodes ; Heart Defects, Congenital ; Humans ; Infant* ; Infant, Newborn ; Tachycardia

The incidence of pulmonary tuberculosis decreased from 5.1% in 1965 to 1.0% in 1995 in Korea but no statistics about the incidence of urinary tuberculosis have been reported yet. The urinary tuberculosis in childhood is known to be a rare disease because of its long latent period. We report a case of urinary tuberculosis in a 9 year old girl.
Child ; Female ; Humans ; Incidence ; Korea ; Rare Diseases ; Tuberculosis* ; Tuberculosis, Pulmonary ; Urinary Tract*

After portal vein occlusion, portal to portal collaterals (hepatopetal) develop from preexisting periportal vessels or recanalization of the thrombosed portal vein, undergo compensatory enlargement, bypass the obstructed extrahepatic occlusion and reconstitute the intrahepatic portal branches. Angiographically, collateral veins are seen as multiple tortous winding veins in the porta hepatis and are described as a cavemous transformation of the portal vein. When the common bile duct or gall bladder is compressed by collateral veins, a cholangiogram demonstrates multiple smooth intramural defects and jaundice can develop due to the partial obstruction of the bile duct. Demonstration of the cavernous transformation of the portal vein can be done by ultrasonography, abdominal computed tomography and nuclear magnetic resonance, but Doppler ultrasonography and direct or indirect portography are needed to evaluate its hemodynamic change. We present a 35-year-old female patient complaining repeated jaundice, in whom common bile duct and gall bladder varices accompanied by cavernous transformation of the portal vein and intrahepatic stones were diagnosed by ultrasonography, abdominal computed tomography, ERCP, and Doppler ultrasonograpy and confirmed by surgery. ERCP demonstrated the irregular contour of the common bile duct and gall bladder due to multiple smooth intramural defects. Doppler utrasongraphy revealed the unique flow signal of portal vasculature from the tortous vessls in the porta hepatis and from the vascular structures on the wall of the gall bladder.
Adult ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct* ; Female ; Hemodynamics ; Humans ; Jaundice ; Magnetic Resonance Spectroscopy ; Portal Vein ; Portography ; Ultrasonography ; Ultrasonography, Doppler* ; Urinary Bladder* ; Varicose Veins* ; Veins ; Wind

The congenital esophageal atresia with proximal tracheoesophageal fistula is a developmental defect with incomplete septation of the foregut of embryonic period and is often associated with other congenital anomaly. We experienced a case of the esophageal atresia with proximal tracheoesophageal fistula in a 1-day old male patient who was transferred from an obstetric clinic due to respiratory distress soon after birth. The baby was treated not by primary anastomosis but by operation of ligation of proximal part of fistula and gastrostomy because of too long distance of 4cm between proximal and distal pouches of esophageal atresia. His weight gain has been good in the treatment of reverse gastric tube interposition for 9 months after birth. We presented the case with brief review of the related literatures.
Esophageal Atresia* ; Fistula ; Gastrostomy ; Humans ; Ligation ; Male ; Parturition ; Tracheoesophageal Fistula* ; Weight Gain

Purpose: The goal of this study was to retrospectively compare systematic ultrasound-guided prostate biopsy (US-PB) and multiparametric magnetic resonance imaging-ultrasound fusion prostate biopsy (MRI-PB) in men undergoing primary or repeated biopsies. Methods: A population of 2,200 patients with a prostate-specific antigen (PSA) level >4.0 ng/ dL and/or an abnormal rectal examination was divided into two groups. All patients underwent US-PB (n=1,021) or MRI-PB (n=1,179) between April 2015 and April 2019. Population demographics, including age, PSA level, digital rectal examination results, prostate volume, number of previous negative biopsies, Prostate Imaging Reporting and Data System (PI-RADS) version 2 (V2) score, and biopsy results, were acquired and compared with respect to these variables. Univariate regression analysis of the risk factors for a higher Gleason score (GS) was performed. Results: The cancer detection rate (CDR) was 23.8% (243 of 1,021) in the US-PB group and 31.3% (399 of 1,179) in the MRI-PB group. Of those, 225 patients (22.0%) in the US-PB group and 374 patients (31.7%) in the MRI-PB group had clinically significant prostate cancer (csPCa). The patients with csPCa in the MRI-PB group included 10 (40%), 50 (62.5%), 184 (94.8%), and 32 (94.1%) patients with PI-RADS V2 scores of 2, 3, 4, and 5, respectively. Of the patients with csPCa, 155 (91.7%) in the US-PB group were diagnosed on the basis of the primary biopsy, compared to 308 (94.4%) in the MRI-PB group. We found the PI-RADS V2 score to be the best predictor of a higher GS. Conclusion MRI-PB showed a high CDR for csPCa. MRI-PB could be a reasonable approach in patients with high PI-RADS V2 scores at primary biopsy.

Primary malignant melanoma arising from the leptomeninges is a rare entity. We report two cases of primary intracranial melanoma developed in one aged 65 years female and the other 70 years male. One case died 2 years after the operation, and the other case is still living more than 1 year after operation. Both cases seems to have a relatively long survival. The literature on this subject is briefly reviewed.
Female ; Humans ; Male ; Melanoma*

No abstract available.
Erythropoietin* ; Humans* ; Kidney Failure, Chronic*

PURPOSE: We retrospectively reviewed the cases of ureteroscopic stone removal at our institution to define the efficiency of ureteroscopy for treatment of ureteral calculi. MATERIALS AND METHODS: Ureteroscopic stone removal was performed in 376 cases of ureteral stone from August, 1989 to December, 1997. There are 241 males and 135 females, and mean age was 45.6 years. Nine stones were located in the upper ureter, 27 in the mid ureter, 340 in the lower ureter. The stone size was less than 5mm in 125 cases, from 5 to 10mm in 185 cases and more than 10mm in 66 cases. Ureteroscopy was performed with 9.5Fr, 10Fr or 12.5Fr rigid ureteroscope under spinal, general or epidural anesthesia. RESULTS: Overall success rate of ureteroscopic stone removal was 95.1 percent. The success rates of upper, mid and lower ureteral stones were 55.6, 88.9 and 97.1 percents, respectively. According to the stone size, the success rates was 97.6 percent in stones less than 5mm, 94.6 percent in stones of 5 to 10mm and 92.4 percent in stones more than 10mm. Over all complication rate was 9.6 percent. Complications consisted of severe ureteral mucosal tearing(20 cases), ureteral perforation(8 cases), gross hematuria(3 cases), infection(3 cases) and urethral stricture(2 cases). All complications were treated successfully with conservative treatment except 2 cases of urethral stricture that required visual urethrotomies. CONCLUSIONS: Ureteroscopic stone removal could offer rapid relief of obstruction and colic due to mid and lower ureteral calculi with high success rate and minimal complications.
Anesthesia, Epidural ; Calculi ; Colic ; Female ; Humans ; Lithotripsy ; Male ; Retrospective Studies ; Ureter ; Ureteral Calculi ; Ureteroscopes ; Ureteroscopy ; Urethral Stricture

PURPOSE: To describe the MRI and CT findings of temporal bone Langerhans cell histiocytosis. MATERIALS AND METHODS: The MRI (n=8) and CT (n=7) findings of nine lesions of temporal bone Langerhans cell histiocytosis in six children were retrospectively reviewed. Eight lesions were pathologically confirmed and one was clinically diagnosed. The findings were analyzed for bilaterality, location, lesion extent, signal intensity, the attenuation of soft tissue lesions seen at MRI or precontrast CT, enhancement pattern at MRI or CT, and the pattern of bony destruction at CT. RESULTS: Bilateral involvement was present in three of six patients (50%). Lesions were most frequently located in the mastoid (n=8, 89%), followed by the petrous ridge (n=6, 67%), and the squamous portion (n=3, 33%). Seven (78%) lesions extended to the ipsilateral cavernous sinus (n=3), sphenoid bone (n=3), orbit (n=2), or epidural space (n=2). The signals of the soft tissue lesions were isointense in five cases (63%) on T1-weighted images and hyperintense in six (75%) on T2-weighted images. Five lesions (71%) were isodense on precontrast CT scans. The enhancement patterns were inhomogeneous in six cases (75%) at MRI, and homogeneous in five (71%) at CT. All lesions demonstrated bony destruction without periosteal reaction and five (71%) showed ill-defined destruction, with crossing sutures. CONCLUSION: Familiarity with findings of predominant mastoid involvement, isointense or isodense soft tissue lesions seen on T1-weighted images or at precontrast CT, with relatively homogeneous enhancement at CT, and irregular bony destruction with crossing sutures may be helpful in narrowing the diagnosis of temporal bone Langerhans cell histiocytosis.
Cavernous Sinus ; Child ; Diagnosis ; Epidural Space ; Histiocytosis ; Histiocytosis, Langerhans-Cell* ; Humans ; Magnetic Resonance Imaging ; Mastoid ; Orbit ; Recognition (Psychology) ; Retrospective Studies ; Sphenoid Bone ; Sutures ; Temporal Bone* ; Tomography, X-Ray Computed

A 31-year-old woman was referred to our pain clinic department under the diagnosis of an adult onset Still's disease. She had been suffering from high fever, skin rash, multiple arthralgia, morning stiffness and lymph node enlargement for 16 months. She had taken conventional medication with steroid and NSAIDs, but the symptoms were a remittent nature. And also, she complained of systemic side effects of corticosteroids. Stellate ganglion block with 0.25% bupivacaine was performed 67 times for the treatment of adult onset Still's disease and then, her symptoms were improved eventually. We could discontinue steroid and NSAIDs, laboratory data were satisfactory. As we experienced an adult onset still's disease improved with stellate ganglion block, we report this case with a review of the literature.
Adrenal Cortex Hormones ; Adult* ; Anti-Inflammatory Agents, Non-Steroidal ; Arthralgia ; Bupivacaine ; Diagnosis ; Exanthema ; Female ; Fever ; Humans ; Lymph Nodes ; Pain Clinics ; Stellate Ganglion* ; Still's Disease, Adult-Onset*