Mayer-Rokitansky-Kuster-Hauser Syndrom is characterized by the absence of the vagina and the uterus, the presence of apparently normal tubes and ovaries, feminine appearance, normal female secondary sexual characteristics, a normal 46, XX karyotypes, and a feminine psychosexual orientation. Absence of the vagina results from an embryological arrest in the development of the lower portion of the Mullerian system. Various methods of surgical treatment for the vaginal absence in this syndrom have been introduced but the ideal method to restore the original dimension and function of the normal vagina was not found. The two cases reviewed in this paper were all treated with modified McIndoe operation using full thickness skin grafts. Postoperatively both women were satisfied without complications, i,e. lack of skin graft, bleeding, urethrovaginal fistula, perforation of the rectum, rectovaginal fistula and significant vaginal stricture. This paper reveals the satisfactory results that were uniformly good.
Constriction, Pathologic ; Female ; Fistula ; Hemorrhage ; Humans ; Karyotype ; Ovary ; Rectovaginal Fistula ; Rectum ; Skin* ; Transplants* ; Uterus ; Vagina

Although bimaxillary surgery enhances patients' self-esteem and mood by improving their facial appearance, surgical outcome assessments for this procedure are limited. This preliminary study investigated differences in brain activity on functional magnetic resonance imaging (fMRI) during self-face evaluation before and after bimaxillary surgery. Three patients (1 man and 2 women, age range: 20–27 years) underwent fMRI while viewing self-face images before and after bimaxillary surgery for maxillofacial deformity. The activation in the left postcentral gyrus, and medial orbital frontal cortex was significantly great in response to after-surgery self-face images compared to before-surgery images. Our preliminary results may facilitate the development of an objective measure for patient satisfaction after orthognathic surgery including bimaxillary surgery.

OBJECTIVE: To investigate whether the serum levels of IL-10 in patients with rheumatoid arthritis are different from those of normal controls and SLE patients and to find out any correlation with disease activity parameters of rheumatoid arthritis. METHODS: Sera from 20 healthy normal persons, 16 rheumatoid arthritis patients and 16 patients with systemic lupus erythematosus were collected and measured for IL-10 and IL-6. Various disease activity parameters were measured in RA patients. RESULTS: The serum level of IL-10 in RA patients was significantly elevated compared to normal controls but lower than those of SLE patients. In RA patients there was no definite correlation between the disease activity parameters and serum IL-10 levels. Despite significant improvements in terms of various disease activity parameters, there was no significant change of serum IL-10 levels after treatment in RA patients. In seropositive RA patients, positive correlation was found between serun IL-10 and rheumatoid factor levels. CONCLUSION: Our findings show that the serum IL-10 levels in patietns with RA are elevated compared to normal controls but lower than those of SLE patients. There was no correlation between serum IL-10 levels and disease acivity parameters of RA.
Arthritis, Rheumatoid* ; Humans ; Interleukin-10* ; Interleukin-6 ; Lupus Erythematosus, Systemic ; Rheumatoid Factor

Spondylolisthesis is the slippage of all or part of one vertebra onto another. The term is derived from the Greek words spondylos and olisthesis. Wiltse, Macnab, and Newman combined their concepts in what remains the most widely accepted classification. Wiltse and Rothman in 1989 suggested a common congenital component in the etiology of dysplastic and isthmic types and added the postsurgical group to the original classification. The precise anatomy of the pars lesion is extremely important in understanding the pathogenesis. The pars interarticularis is the connecting link between pedicles, transverse processes, laminae, and the two articular facets acting as the pivot center. The L5-S1 articulation, being in the coronal plane, is more stable than the sagittal placement of the L4-5 facet joint. The fifth lumbar vertebra is stabilized by a large L5 transverse process, which supports strong muscular and ligamentous(iliolumbar) attachment. An increased lumbar lordosis increases the shear stress at the L4-5 level. Both congenital and isthmic types are often associated with spina bifida of the L5 or S1 segments. There seems to be a definite sex and racial difference, with black women (1.1%) having the lowest prevalence and white men(6.4%) the highest. The increased prevalence is in Alaskan natives and young sportsmen, ranging from 11% to 35%. Repetitive flexion, combined flexion-extension and both forcible hyperextension and rotation of the lumbar spine predispose to a pars stress fracture. Most of isthmic type develops during the first year of school, and by age 7 the prevalence is 4%. A further 1.4% of cases occur during adolescence, most between 11 and 15 years of age. In patients under 25 years of age with low back pain and isthmic spondylolisthesis, this lesion is most probably the cause of the symptoms(18.9%). In patients older than 40 years, it is seldom the only cause of low back pain (5.2%). The radicular pain is found in 14% of patients with isthmic spondylolisthesis. Degenerative spondylolisthesis results from long standing intersegmental instability. 10% of women over 60 years had a 1st or 2nd degree. It occurs 6 times more often at the L4-5 level and 5 times more often in women, mostly in those older than 40 years. The patient may have back pain (5.6%) with or without leg pain and/or may have intermittent claudication (80%). In traumatic spondylolisthesis, acute fractures of the pars interarticularis are rare and are always due to fracture of the other part of the posterior elements caused by severe trauma. In pathological spondylolisthesis, the bony strength is insuffient to resist forward motion of the proximal vertebra on the one below. In postsurgical spondylolisthesis, the most common etiology is extensive decompression with sacrifice of the facet joints.
Adolescent ; Animals ; Back Pain ; Classification* ; Decompression ; Female ; Fractures, Stress ; Humans ; Intermittent Claudication ; Leg ; Lordosis ; Low Back Pain ; Natural History* ; Population Groups ; Prevalence ; Spinal Dysraphism ; Spine ; Spondylolisthesis* ; Zygapophyseal Joint

BACKGROUND AND OBJECTIVES: The goal of this study was to examine the safety and feasibility of a primary (direct) stenting in acute myocardial infarction (AMI). In the treatment of AMI, Percutaneous transluminal coronary angioplasty (PTCA) has documented superior reperfusion rate and improved clinical outcomes than thrombolytic therapy. However, there are several limitations of PTCA, such as recurrent ischemia in 10 to 15%, reinfarction in 3 to 5% and restenosis in 30 to 50% of patients. There are several reports that, compared with PTCA, the implantation of coronary stent has been shown to reduce angiographic restenosis and improve late clinical outcomes. But in general, stenting has been contraindicated in thrombus containing lesion due to the risk of subacute thrombosis. With advance in technique and the recognition of the importance of adequate platelet inhibition, the incidence of subacute thrombosis has fallen in patients with acute coronary syndrome and thrombus laden lesion. Methods and Results: In our study, primary stenting was performed in 42 patients of AMI. There are 6 cases (22.5%) target lesion restenosis during the follow up coronary angiography (150+/-86day) and no in-hospital death. Three cases (7.1%) of them require revascularization including two re-PCTA and a coronary artery bypass graft for the recurrent ischemic symptoms. There were no reinfarction and death after discharge. Six-months event free survival reate was 85.7%. CONCLUSION: Primary stenting is safe and feasible in the majority of patients with AMI and results in excellent mid-term outcomes compared with PTCA.
Acute Coronary Syndrome ; Angioplasty, Balloon, Coronary ; Blood Platelets ; Coronary Angiography ; Coronary Artery Bypass ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Ischemia ; Myocardial Infarction* ; Reperfusion ; Stents* ; Thrombolytic Therapy ; Thrombosis ; Transplants

Subungual exostosis are not uncommon, however, they are infrequently mentioned in the dermatologic literature. We report herein a rase of subungual exostosis in the great toe of 16-year-old female student which was confirmed by histopathologic and radiologic findings. Histopathologic examination showed that the mass was ooeered by a dense fibrous tissue which merged into a fibrocartilage cap and bone. Computed tomography showed a well defined, oval shaped, radiopacity of bony density capped by a radiolucency.
Adolescent ; Exostoses* ; Female ; Fibrocartilage ; Humans ; Toes

No abstract available.
Polycystic Kidney Diseases* ; Tuberous Sclerosis*

OBJECTIVE: The aim of this study was to evaluate the relationship between sustained attention deficits in Attention-Deficit/Hyperactivity Disorder(ADHD) children and short-term Heart Rate Variability(HRV) parameters. In addition, we evaluate the relationship between The ADHD rating scale(ARS), the computerized ADHD diagnostic system(ADS) and Parenting stress index-short form(PSI-SF). METHODS: This study was performed in the department of children and Adolescent psychiatry, Korea university Guro hospital from august 2008 to January 2009. We evaluated HRV parameters by short-term recordings of 5 minutes. K-ARS and ADS are used for screening and identifying ADHD children. Intelligence was measured using Korean educational Developmental Institute-wechsler Intelligence Scale for Children. The caregivers Complete Parenting Stress Index scale for evaluation parent stress. RESULTS: The low frequency(LF) was significantly correlated with response variability of ADS. However, the other variables of ARS and ADS were not significantly correlated with LF. Hyperactivity subscale of ARS was significantly correlated with parental distress subscale and difficult child subscale of PSI-SF and inattention subscale of ARS was also significantly correlated with dysfunctional interaction and difficult child subscale of PSI-SF. CONCLUSION: The LF, 0.10-Hz component of HRV is known to measure effort allocation. This study shows that the LF component of HRV is significantly correlated with the response variability of ADS. This means that more severe symptoms of ADHD were correlated with the increase in the LF that means decreased effort allocation. These results also support the clinical usability of HRV in the assessment of ADHD. Furthermore, PSI-SF is correlated with hyperactivity and inattention variables of ARS.
Adolescent ; Adolescent Psychiatry ; Caregivers ; Child ; Heart ; Heart Rate ; Humans ; Intelligence ; Korea ; Mass Screening ; Parenting ; Parents

No abstract available.
Gonadal Dysgenesis, Mixed*

We report herein a case of subcutaneous granuloma annulare occured in a 3-year-old girl who had 7 subcutaneous nodules on the scalp, lumbar area, buttock, right tibial area and both ankles. liistopathologically, multiple foci of complete and incomplete collagen degeneration surrounded by histiocytes in a palisading arrangement were seen in the subcutaneous layer. Some vessel walls were thickened and infiltrated with inflammatory cells and many eosinophils were scattered among the inflamrnatory cell infiltrate around the palisaiing granuloma. Five of the lesions disappeared spontaneously and other s decreased in size without specific treatment in 2 months.
Ankle ; Buttocks ; Child, Preschool ; Collagen ; Eosinophils ; Female ; Granuloma Annulare* ; Granuloma* ; Histiocytes ; Humans ; Scalp