PURPOSE: The purpose of this study was to evaluate the accuracy of Tc-99m DTPA diuretic renal scans in children upper urinary tract. MATERIALS AND METHODS: We reviewed diuretic renal scans of 14 pediatric patients (age range: 3 days to 4 years) with unilateral hydronephrosis diagnosed by ultrasonography. Diuretic renal scan was done using Tc-99m DTPA and standardized protocol. In 3 neonates, diuretic renal scans were performed within 1 week and 3-7 months after birth. RESULTS: Six patients required pyeloplasty and eight were managed conservatively. All 6 patients requiring pyeloplasty were diagnosed as having ureteropelvic junction obstruction in the diuretic renal scan. In these 6 patients, post-operative renal scans at 3-12 months after surgery were converted to nonobstructive pattern in 5 and a nonobstructive patterns in 1. In 3 patients who underwent diuretic renal scan within 1 week after birth., nonobstructive patterns of initial scan were coverted to obstructive patterns in the follow-up scan. However, all patients with nonobstructive diuretic renal scans performed after the neonatal period did well on serial ultrasonography and showed favorable clinical outcome without progression to obstruction. CONCLUSION: Tc-99m DTPA diuretic renal scan with standarized protocol is useful in assessing suspected ureteropelvic junction obstruction in children as an initial diagnostic or post-operative follow-up modality. Nonobstructive or indeterminate scan RESULTS in the neonatal period requires follow-up scan to monitor development of the obstructive pattern.
Child* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Infant, Newborn ; Kidney Pelvis ; Parturition ; Pentetic Acid* ; Radioisotope Renography* ; Ultrasonography ; Urinary Tract*

No abstract available.
Mass Screening*

Myasthenia gravis is a neuromuscular disorder manifested by fatigability and weakness of the skeletal muscles. The basic defect in the myasthenia is the reduction of available acetylchopline receptors at neuromuscular junctions by an autoimmune mechanism. The thymus gland seems intimately involved in the disease process and removal of the thymus gland plays an important role in the management of this disease. In this article, we had three cases of thymectomies for myasthenia gravis. The first two were females, 17 and 26 year old. They were anesthetized for thymectomies using succinylcholine, pancuronium, sodium pentothal and. N2O-Halothane. The third case, a 40 year old female was not given any muscle relaxants because of the severity of the disease and her respiration was controlled for a month postoperatively. For the cases, the preoperative, intraoperative and postoperative management of anesthesia and the use of muscle relaxants are described.
Adult ; Anesthesia* ; Female ; Humans ; Muscle, Skeletal ; Myasthenia Gravis* ; Neuromuscular Junction ; Pancuronium ; Respiration ; Sodium ; Succinylcholine ; Thiopental ; Thymectomy* ; Thymus Gland

Porcelain is considered to be one of the materials of choice for restoration where esthetics is of concern. But porcelain surface without final glazing treatment may induce undesirable results such as inflammatory respones on adjacent soft tissues due to plaque accumulation and increased wear of opposing teeth. Therefore, rough porcelain surface must be smoothened by final glazing treatment or chairside polishing procedure. The purpose of this study was to compare the surface roughness among self-glazed, overglazed and polished porcelain with various polishing kit, and to detect which phase of polishing is optimal in clinic. Specimens were fabricated with Vita VMK porcelain. The surface treatment of each group was performed as follows. Group 1 : overglazing treatment Group 2 : self-glazing treatment Group 3 : polishing with the Truluster Polishing System for Porcelain(Brasseler, U.S.A.) Group 4 : polishing with the Exa Cerapol Adjustment kit (Edenta dental products, Switzerland) followed by finishing with diamond-filled polishing paste Group 5 : polishing with the Shofu Porcelain Adjustment kit (Shofu inc., Japan) followed by finishing with diamond-filled polishing paste. At each polishing steps, the measurement of Ra and Rq values were performed, and the surface was examined by scanning electron microscope. The results were as follows: 1. Overglazing treatment brought smoother surface than self-glazing treatment. 2. Polishing systems without porcelain polishing paste did not make better result than self-glazing treatment. 3. Polishing system with porcelain polishing paste made similar result to overglazing treatment. 4. Applying diamond-filled polishing paste after using polishing system which has porcelain polishing paste produced surface as smooth as overglazing treatment does.
Dental Porcelain* ; Esthetics ; Tooth

OBJECTIVE: This study was performed to determine the anatomical landmarks and optimal dissection points of the facial nerve (FN) and the hypoglossal nerve (HGN) in the submandibular region to provide guidance for hypoglossal-facial nerve anastomosis (HFNA). METHODS: Twenty-nine specimens were obtained from 15 formalin-fixed adult cadavers. Distances were measured based on the mastoid process tip (MPT), common carotid artery bifurcation (CCAB), and the digastric muscle posterior belly (DMPB). RESULTS: The shortest distance from the MPT to the stylomastoid foramen was 14.1+/-2.9 mm. The distance from the MPT to the FN origin was 8.6+/-2.8 mm anteriorly and 5.9+/-2.8 mm superiorly. The distance from the CCAB to the crossing point of the HGN and the internal carotid artery was 18.5+/-6.7 mm, and that to the crossing point of the HGN and the external carotid artery was 15.1+/-5.7 mm. The distance from the CCAB to the HGN bifurcation was 26.6+/-7.5 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, was about 35.8+/-5.7 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, corresponded to about 65.5% of the whole length of the DMPB. CONCLUSION: This study provides useful information regarding the morphometric anatomy of the submandibular region, and the presented morphological data on the nerves and surrounding structures will aid in understanding the anatomical structures more accurately to prevent complications of HFNA.
Adult ; Cadaver ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Facial Nerve ; Humans ; Hypoglossal Nerve ; Mastoid ; Muscles

PURPOSE: In order to assess the usefulness of serum ferritin as a marker of disease activity and prognostic factor in pediatric malignancy, serum ferritin levels were measured. METHODS: Peripheral blood samplings for ferritin level were made at presentation, in remission following therapy, and in relapse in 95 children with malignancy admitted to the Department of Pediatrics, Kosin University Gospel Hospital between January, 1986 and August, 1995. The patients were comprised of 35 acute lymphoblastic leukemia(ALL), 17 acute myelogenous leukemia(AML), 20 non- Hodgkin's lymphoma(NHL) and 23 neuroblastoma(NB). RESULTS: The mean values of serum ferritin at presentation were 465.3+/-53.9 ng/mL in ALL, 468.9+/-69.4 ng/mL in AML, 274.1+/-69.2 ng/mL in NHL and 337.3+/-64.4 ng/mL in NB. Those values were increased significantly compared to the mean of 20 control children(69.5+/-12.9 ng/mL). The mean values of serum ferritin concentration in remission stage(first, second, and third remission) tend to be lower compared to those in the active stage(at presentation, first relapse and second relapse). But these differences reached a statistical significance only in patients with ALL when the mean values of the active stage were compared to those checked in the remission stage over 12 months(P= 0.0002). Comparison of overall survival according to initial serum ferritin levels(below and above 200 ng/mL) did not show any significant difference in ALL, AML and NHL. However, there was a borderline relationship in NB(relative risk 3.12, P=0.06). CONCLUSION: The study showed that normalization of serum ferritin levels were found in ALL who had continuous, complete remission for more than 12 months. And patients with lower serum ferritin levels were not associated with better survival except in patients with NB in which the lower ferritin group showed borderline significance.
Child ; Ferritins* ; Humans ; Leukemia ; Lymphoma ; Neuroblastoma ; Pediatrics ; Prognosis ; Recurrence

OBJECTIVE: Lumbar spine stenosis (LSS) can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Minimally invasive surgery has come to be more commonly used for the treatment of LSS. The current study describes outcomes of bilateral microdecompression by unilateral or bilateral laminotomy (BML) for degenerative LSS after a minimum follow-up period of 3 years and investigates factors that result in a poor outcome. METHODS: Twenty-one patients who were followed-up for at least 3 years were included in this study. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, and disc height. RESULTS: Twenty-one patients (10 men, 11 women) aged 53-82 years (64.1+/-8.9 years) were followed-up for a minimum of 3 years (36-69 months). During follow-up, two patients underwent reoperation. Average preoperative JOA score and clinical symptoms, except persistent low back pain, improved significantly at the latest follow-up. There were no significant differences in radiological findings preoperatively and postoperatively. Thirteen patients (61.9%) had excellent to fair outcomes. CONCLUSION: BML resulted in a favorable and persistent outcome for patients with degenerative LSS without radiological instability over a mid-term follow-up period. Persistent low back pain unrelated to postoperative instability adversely affects mid-term outcomes.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Laminectomy* ; Low Back Pain ; Male ; Orthopedics ; Reoperation ; Spinal Stenosis* ; Spine ; Spondylolisthesis

We report here on a case of a ruptured left posterior communicating artery (P-com) aneurysm that was treated by clipping in a patient with idiopathic thrombocytopenic purpura (ITP) and steroids were used to control the platelet count during the perioperative period. A 34-year-old female who had been suffering from ITP for four years experienced the sudden onset of a headache and vomiting while showering. She was referred to our hospital as a case of subarachnoid hemorrhage (SAH) due to a ruptured P-com aneurysm. Aneurysmal neck clipping was performed via the left pterional approach 6 hours after the ictus. The aneurysmal clipping was successful without an increased bleeding tendency during the operation. Intravenous steroid injection was given after aneurysmal clipping for 7 days and then it was tapered off. It is important to maintain an adequate platelet count in SAH patients with chronic ITP in order to avoid hemorrhagic diathesis during surgery. Intravenous steroid injection is a helpful method for maintaining an adequate platelet count in these patients during surgery.
Adult ; Aneurysm ; Arteries ; Female ; Headache ; Hemorrhage ; Hemorrhagic Disorders ; Humans ; Intracranial Aneurysm ; Neck ; Perioperative Period ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; Steroids ; Stress, Psychological ; Subarachnoid Hemorrhage ; Vomiting

OBJECTIVE: The purpose of this study is to investigate the significance of an early clinical course during the external ventricular drainage(EVD) in patients with thal amic hemorrhage. METHODS: During the last 11 years(1990-2000), a hundred patients with thalamic hemorrhage who underwent EVD were studied. Thirty-four patients underwent temporary closing of EVD at the mean interval of 4.5 days after EVD. The clinical course was divided into 3 groups according to change of Glasgow Coma Scale(GCS) scores of 2 or more within 3 days after EVD compared with those just before EVD: deteriorated, unchanged, and improved. RESULTS: The factors affecting mortality were unchanged(odds ratio [OR] 0.05, 95% confidence interval [CI]0.01-0.38, p=0.0028) and deteriorated clinical course(OR 0.06, 95% CI 0.01-0.38, p=0.0033), GCS scores at the time of admission(OR 1.3, 95% CI 1.02-1.66, p=0.0346), amount of hematoma(OR 0.91, 95% CI 0.83-1.00, p=0.0461) and hematoma enlargement(OR 0.06, 95% CI 0.01-0.65, p=0.0198). The factor affecting the early clinical deterioration was the hematoma enlargement(OR 0.11, 95% CI 0.03-0.38, p=0.0005). The shunt operation was predicted in patients who showed the clinical improvement after EVD followed by the clinical deterioration within 48 hours after temporary closing of EVD. CONCLUSION: It is suggested that an early clinical course during the maintenance of EVD is important to predict mortality and necessity of shunt operation.
Coma ; Drainage* ; Hematoma ; Hemorrhage* ; Humans ; Mortality

The crowned dens syndrome (CDS), also known as periodontoid calcium pyrophosphate dehydrate crystal deposition disease, is typified clinically by severe cervical pain, neck stiffness and atlantoaxial synovial calcification which could be misdiagnosed as meningitis, epidural abscess, polymyalgia rheumatica, giant cell arthritis, rheumatoid arthritis, cervical spondylitis or metastatic spinal tumor. Crystalline deposition on cervical vertebrae is less well known disease entity and only a limited number of cases have been reported to date. Authors report a case of CDS and describe the clinical feature.
Arthritis ; Arthritis, Rheumatoid ; Axis, Cervical Vertebra ; Calcium Pyrophosphate ; Cervical Vertebrae ; Crowns* ; Crystallins ; Epidural Abscess ; Female ; Giant Cells ; Meningitis ; Neck ; Neck Pain ; Polymyalgia Rheumatica ; Spondylitis