Nerve compression syndromes can be caused by compression of the peripheral nerve from interior or exterior of the nerve. In the upper extremities, brachial plexus, ulnar nerve and median nerve can be compressed in thoracic outlet syndrome, cubital tunnel syndrome and carpal tunnel syndrome respectively. Because these syndromes are caused by compression, decompressive management can be expected to be the principle of treatment. From Jan. 1980 to Dec. 1988, 94 patients were admitted and treated for nerve compression syndromes of the upper extremities in Seoul National University Hospital. Among these, 52 patients suffered from carpal tunnel syndrome and operation was performed to 86 hands. Twelve patients suffered from thoracic outlet syndrome and 25 from cubital tunnel syndrome. Ten patients were treated with conservative method and 84 with decompressive surgery. Satisfactory results were obtained in 92.3% of carpal tunnel syndrome and 84% of cubital tunnel syndrome. Of 4 operated cases of thoracic outlet syndrome, 3 cases were satisfactory.
Brachial Plexus ; Carpal Tunnel Syndrome ; Cubital Tunnel Syndrome ; Hand ; Humans ; Median Nerve ; Methods ; Nerve Compression Syndromes ; Peripheral Nerves ; Seoul ; Thoracic Outlet Syndrome ; Ulnar Nerve ; Upper Extremity

During the period from January 1980 to September 1988, 59 patients suffering from brachial plexus injury, have admitted to Seoul National University Hospital. Fifty-four patients were male and 5 patients were female, and age ranged from 6 to 58 years (mean:26.8 years). The most common cause of injury was traffic accident accounting for 66% (39patient), and among them 24 patients(62%) had the motor cycle accident. Birth injury, stab or gun shot wound, fall down and industrial hazard were following causes. Fracture and dislocation of involved limb accompanied in 19 patients(32%) and 2 patients of arterial injury were also found. EMG and cervicsl myelography with or without CT were performed in almost all the patients and MRI was performed in selected patients. Forty-five patients(76%) had supra-clavicular lesion and 14 patients (24%) had infra-clavicular lesion. In supra-clavicular lesion, upper roots or whole roots were involved in most of cases. Forty-nine cases were treated with conservative treatment for more than 8 months and operative procedures were performed in 36 cases. In operative cases, 30 patients were followed up for more than 1 year (average 24.3 months). Signs of root avulsion were found in 25 out of 31 cases of cervical myelography. MRI was performed in 7 cases, but it was inconclusive in diagnosis of root involvement. Infra-clavicular lesion showed better prognosis than supra-clavicular lesion. In supra-clavicular lesion, upper root involvement had the best prognosis. A pseudocyst detected by myelography usually precluded recovery in the root at the level of pseudocyst. Result of reparative treatment was better than that of conservative treatment. Overall satisfactory result in reparative treatment was 36%. However, if we include neurological improvement, positive result was 53%. Complete recovery was gained in half cases of neurolysis and other half showed no recovery, but all the cases of neurotization showed poor result. Reconstructive surgery including arthrodesis or muscle transfer can be effective treatment method, if it is performed properly on a selective patient.
Accidents, Traffic ; Arthrodesis ; Birth Injuries ; Brachial Plexus ; Diagnosis ; Dislocations ; Extremities ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Methods ; Myelography ; Nerve Transfer ; Prognosis ; Seoul ; Surgical Procedures, Operative ; Wounds and Injuries

Authors have reviewed a series of 41 cases of fibrous dysplasia which were treated surgically at the Department of Orthopedic Surgery, College of Medicine, Seoul National University. After mean follow-up of 25 months, we summarized the results as follows; 1. Among the 41 patients, 20 were male patients(M:F= 1:1.05). The average age was 20.2 years old. It was the most common in the 2nd decade(44%). The most common site was femur (53.6%) followed by tibia (28.6%) in monostotic type. Each polyototic patient had 3.8 locations in average. 2. The results were better in skeletally mature patients (86%) than in immature patients (42%). 3. Satisfactory results seemed to be expected in monostotic type (71%) than polyostotic type(33 %) 4. Satisfactory results seemed to be expected in sclerotic type(78%) than cystic type(50%) or ground glass appearance type (62%). 5. Autograft(71%) was superior to xenograft(40%) in our study. However, xenograft only or xenograft with autograft can be a recommendable method of treatment for a very large lesion or for a patient with insufficient graft donor site.
Autografts ; Femur ; Follow-Up Studies ; Glass ; Heterografts ; Humans ; Male ; Methods ; Orthopedics ; Seoul ; Tibia ; Tissue Donors ; Transplants

Accelerated atherosclerosis is not only a frequent complication but also the most common cause of death in patients with chronic renal failure (CRF). Although mechanisms are unclear, disorder of lipid metabolism may be a major factor. Since apolipo-protein (apo) E is known to play a major regulatory role in lipid metabolism, we evaluated apo E genotype in 72 male patients with CRF and compared with that in 194 rnale normal controls. In addition, we measured plasma lipid and apolipoprotein concentrations and evaluated them according to apo E genotype in patients and controls. Apo E genotype was determined with the INNO-LiPA Apo E kit (Innogenetics, Belgium), which is based on reverse hybridization. The results are as follows ; 1) The distribution of the three major apo E alleles in patients with CRF ( e 2: 6.2%, e 3: 80.6%, e 4: 13.2%) was not different from that in controls ( e 2: 4.1%, e 3: 87.6%, e 4: 8.3%). 2) In patients with CRF, total cholesterol, lowdensity lipoprotein (LDL) and high-density lipoprotein (HDL) levels were significantly lower and the triglyceride and lipoprotein (a) levels were significantly higher than those in controls. 3) In controls, E 4/3 group had significantly lower levels of HDL than E 3/3 and E 3/2 groups. In patients with CRF, E 4/3 group had significantly higher levels of total cholesterol and apo B lipoprotein than E3/2 group. In conclusion, although there was no significant difference in the apo E genotype frequencies between male patients with CRF and controls, apo E polymorphism may play an important role in the determination of individual differences in plasma lipids in male patients with CRF.
Alleles ; Apolipoproteins B ; Apolipoproteins E ; Apolipoproteins* ; Atherosclerosis ; Cause of Death ; Cholesterol ; Genotype ; Humans ; Individuality ; Kidney Failure, Chronic* ; Lipid Metabolism ; Lipoprotein(a) ; Lipoproteins ; Male* ; Plasma* ; Triglycerides

The simultaneous occurrence of primary glomerulonephritis in identical twins has been rarely reported previously. It has suggested that genetic factors may play an important role in the pathogenesis of primary glomerulonephritis. We describe a pair of 17-year-old identical twin brothers with asymptomatic proteinuria, one with histologically proven minimal change disease and the other with focal segmental glomerulosclerosis. HLA typing in twin brothers revealed an identical phenotype consisting of A25, A33, B44, B54, Cwl, Cw7, DR7 and DRB1. To our knowledge, this is the first case of glomerulonephritis in identical twins in Korea.
Adolescent ; Glomerulonephritis ; Glomerulosclerosis, Focal Segmental* ; Histocompatibility Testing ; Humans ; Korea ; Nephrosis, Lipoid* ; Phenotype ; Proteinuria ; Siblings* ; Twins, Monozygotic*

The prevalence of obesity and functional gastrointestinal disorders (FGIDs) is increasing worldwide. Obesity has been linked to gastroesophageal reflux disease, irritable bowel syndrome, functional dyspepsia, and various FGIDs. However, the relationship between obesity and FGIDs remains unclear. The purpose of this paper is to evaluate the published studies on this topic and clarify the relationship between obesity and the pathophysiology of various FGIDs.
Dyspepsia ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Irritable Bowel Syndrome ; Obesity ; Prevalence

The prevalence of obesity and functional gastrointestinal disorders (FGIDs) is increasing worldwide. Obesity has been linked to gastroesophageal reflux disease, irritable bowel syndrome, functional dyspepsia, and various FGIDs. However, the relationship between obesity and FGIDs remains unclear. The purpose of this paper is to evaluate the published studies on this topic and clarify the relationship between obesity and the pathophysiology of various FGIDs.

Sarcoidosis is an idiopathic, multisystem disease that rarely involves the genitourinary tract. Here we present an unusual case of testicular sarcoidosis with extensive lymphadenopathy that mimicked a metastatic testicular tumor. A 27-year-old male presented with a palpable right testicular mass accompanied by multiple palpable inguinal lymph nodes. The scrotal ultrasound showed a hypoechoic lesion at the inferior portion of the right testis. Extensive enlarged lymph nodes were noted in multiple areas on the abdominal computed tomography. Preoperative testicular tumor markers were within the normal range. Exploration of the right testis with a frozen section analysis of the right testicular mass and of a palpable right inguinal lymph node showed granulomatous inflammation. The testis was salvaged and the final pathological diagnosis was sarcoidosis. Treatment with high-dose corticosteroids resulted in complete resolution of the intratesticular mass and a significant decrease in the extent of the lymphadenopathy.
Adrenal Cortex Hormones ; Adult ; Frozen Sections ; Humans ; Inflammation ; Lymph Nodes ; Lymphatic Diseases ; Male ; Reference Values ; Sarcoidosis ; Steroids ; Testicular Neoplasms ; Testis ; Biomarkers, Tumor

Diarrea-associated hemolytic uremic syndrome (HUS) is very rare in adults. Few reports are available on clinical features and plasma exchange in adult patients with diarrhea-associated HUS in Korea. We retrospectively examined the records of five adult patients with diarrhea-associated HUS admitted to Samsung Seoul Hospital between January 1995 and December 1997. If the patient had neurologic abnormalities, or there was rapid clinical deterioration, with the hematocrit decreasing below 20%, the platelet count falling below 10,000/mm3, the creatinine concentration increasing above 5.0 mg/dl, plasma exchange was begun. There were 4 females and 1 male. Patients ranged in age from 16 to 61 years. All patients presented with diarrhea and abdominal pain, and 3 patients had bloody diarrhea. The mean time between the onset of diarrhea and thrombocytopenia was 4.4+/-1.9 days (range, 1 to 6). All patients received 7 to 24 plasma exchanges. The mean exchanged plasma volume was 1.1+/-0.2 times of patients own plasma volume. The pattern of clinical response to plasma exchange was initial normalization of platelet count (8.0+/-3.8 days), followed by normalization of LDH level (20.2+/-14.5 days) and creatinine concentration (25.8+/-13.8 days). Metabolic alkalosis developed in two patients undergoing daily plasma exchange. We successfully managed the metabolic alkalosis with continuous venovenous hemofiltration. The mean duration of hospitalization was 28.8+/-11.2days (range, 20 to 42). All patients successfully recovered without any sequale. Although this study is based on small case series, we suggested that plasma exchange may improve the outcome in adult diarrhea-associated HUS.
Abdominal Pain ; Adult* ; Alkalosis ; Creatinine ; Diarrhea ; Female ; Hematocrit ; Hemofiltration ; Hemolytic-Uremic Syndrome* ; Hospitalization ; Humans ; Korea ; Male ; Plasma Exchange* ; Plasma Volume ; Plasma* ; Platelet Count ; Retrospective Studies ; Seoul ; Thrombocytopenia