The authors report two cases of successful reconstruction in infected nonunion of the femur involving marked shortening by compression and gradual distraction at the nonunion site using Ilizarov external fixator. At first, infection was controlled by radical excision & the administration of systemic antibiotics for four weeks and we also started compression at the nonunion site 3 days after operation. Autogenous iliac bone graft was added to strengthen the site of new bone formation lastly. In this report, the role of the compression seems to provide a good environment for distraction osteogenesis by focal necrosis and triggering inflammation. Compression and gradual distraction may be one of the treatment mordalities for nonunion of a long bone with massive bone loss or shortening, even infected.
Anti-Bacterial Agents ; External Fixators ; Femur* ; Inflammation ; Necrosis ; Osteogenesis ; Osteogenesis, Distraction ; Transplants

Malignant growth of the small bowel accounts for approximately 1 to 3 percent of malignant tumors of the gastrointestinal tract. Leiomyosarcomas are the second most common primary tumor of the small bowel, their frequency being one-third to one-half of adenocarcinoma. The common clinical symptoms of leiomyosarcoma of the small intestine are hemorrhage and abdominal pain. Accurate diagnosis cannot be based on solely on the roentgenographic finding, although in certain situations the dignosis of leiomyosarcoma may be suggested strongly. We report a case of bleeding leiomyosarcoma located in the second portion of the duodenum which was first recognized by endoscopic examination and confirmed by explolaparotomy.
Abdominal Pain ; Adenocarcinoma ; Diagnosis ; Duodenum* ; Gastrointestinal Tract ; Hemorrhage ; Intestine, Small ; Leiomyosarcoma*

PURPOSE: Ventricular repolarization is assessed using the QT interval corrected by the heart rate (QTc) via an electrocardiogram (ECG). Prolonged QTc is associated with an increased risk of arrhythmias and cardiac mortality. As there have been few reports regarding the effects of hyperthyroidism on ventricular repolarization, we studied the association between serum free thyroxine (free T4 [fT4]) and thyroid stimulating hormone (TSH) levels and the QTc interval. METHODS: Thirty-eight patients with hyperthyroidism (<30 years old) were included, and we used their clinical records and available ECGs (between August 2003 and August 2011) to evaluate the association between their fT4 and TSH levels and their QTc interval. In addition, we studied the ECGs of 72 age-matched patients with no hyperthyroidism (control group) and compared their data with that from the patients group. RESULTS: The QTc duration in patients with hyperthyroidism was significantly prolonged compared to that in the control subjects (P<0.001). In addition, the number of hyperthyroid patients with abnormal prolonged QTc was significantly higher than that in the control group (P<0.001). Among the patients with hyperthyroidism, patients with prolonged QTc and borderline QTc had higher fT4 levels and there was positive correlation between their fT4 levels and their QTc interval (P<0.05). However, no correlation was observed between their TSH levels and their QTc interval. CONCLUSION: We report that hyperthyroidism is associated with QTc prolongation. The correlation between the fT4 levels and the QTc interval suggests that thyroid status is associated with QTc values and the risk of cardiac mortality.
Arrhythmias, Cardiac ; Electrocardiography ; Heart Rate ; Humans ; Hyperthyroidism* ; Long QT Syndrome ; Mortality ; Thyroid Gland* ; Thyrotropin ; Thyroxine

No abstract available.
Lymphangioleiomyomatosis*

Carcinoid tumors of the intestinal tract are uncommon neoplasms thought to arise from argentaffin cells in the base of the intestinal crypts. Carcinoid tumors of other sites have since been reported with increasing frequency. We experienced one case of rectal carcinoid tumor and the other case of stomach carcinoid turnor. A 52-year-old male patient was admitted to the hospital because of right upper abdominal discomfort. On the CT scan, multiple low density masses were noticed. Sigmoidoscopy revealed the whitish yellow ulcerofungating mass which had vague margin. And a 31-year-old male patient was admitted to the haspital because of hematemesis. On the gastrofiberscopic examination, an ovoid shallow ulcer crater which had elevated margin, smooth tapered fold and vissible vessel was noticed on the anterior wall side of the high body. The biopsy specimen in both these cases showed carcinoid cells. 24h urine 5-HIAA of these cases was negative. Awareness of carcinoid tumor in differential diagnosis of hepatic metastasis and of gastric ulcer is necessary.
Adult ; Biopsy ; Carcinoid Tumor* ; Diagnosis, Differential ; Enterochromaffin Cells ; Hematemesis ; Humans ; Hydroxyindoleacetic Acid ; Male ; Middle Aged ; Neoplasm Metastasis ; Rectum* ; Sigmoidoscopy ; Stomach Ulcer ; Stomach* ; Tomography, X-Ray Computed ; Ulcer

BACKGROUND: Reticulocyte counts provide clinically useful informations and the most widely used method for counting reticulocytes is a manual microscopic procedure. Although manual method is inexpensive and relatively simple to perform, it is labor intensive and imprecise. So, more rapid and more reproducible methods are needed. METHODS: Reticulocyte counts on 96 blood samples were performed by conventional manual method, H*3 RTX(TM)(Bayer, U.S.A.), and FACScan(TM)(Beckon Dickinson, U.S.A.). The changes of reticulocyte count after storage of samples and certain time intervals after preparation were also examined. RESULTS: Reticulocyte counts(%) by manual method, H*3 RTX(TM), and FACScanM were 2.05+/-2.16, 1.95+/-2.24 and 2.51+/-1.94, respectively. There was no statistically significant differences between manual counting and H*3 RTX(TM)(P>0.05). However, there were significant differences between H*3 RTX(TM) and FACScan(TM), manual counting and FACScan(TM)(P<0.05). Correlation coefficients of three comparisons were all above 0.920. Statistically not confirmed the reticulocytosis sample showed decreasing tendency of reticuocyte count by H*3 RTX(TM) after storage of the sample and prepared sample and others were relatively stable in H*3 RTX(TM)and FACScan(TM). CONCLUSIONS: The result of the mean difference between H*3 RTX(TM) and manual counting is statistically insignificant. So, the H*3 RTX(TM)can be used interchangeably with manual counting atter consideration of cost-effectiveness.
Reticulocyte Count ; Reticulocytes* ; Reticulocytosis

Echocardiographic study was performed in 31 cases with dilated cardiomyopathy and 31 normal persons. measurement values of the aortic valve and root echocardiogram were compared with those in normal. The resuts were followings. 1. There were 22 males and 9 females of 31 cases with dilated cardiomyopathy whose average ages were 53 years. 2. LAD 3.86+/-0.76cm, AoD/LAD ratio 0.74+/-0.21 in dilated cardiomyopathy were significantly changed with those in normal(p<0.01). 3. C-E slope 2.14+/-0.68 cm in dilated cardiomyopathy was significantly decreased with that in normal(p<0.01). 4. cAoD 3.24+/-0.50 cm, AoPWT 0.46+/-0.14 cm in dilated cardiomyopathy were significantly decreased with those in normal(p<0.01). 5. cAVD 1.56+/-0.29cm, cAvD/mAvD ratio 0.79+/-0.10 in dilated cardiomyopathy were significantly decreased with those in normal(p<0.01). 6. AvOT or ET 0.24+/-0.03 sec. in dilated cardiomyopathy was significantly shortened with that in normal(p<0.01).
Aortic Valve ; Cardiomyopathy, Dilated* ; Echocardiography* ; Female ; Humans ; Male

BACKGROUND AND OBJECTIVES: There is little data to indicate that hypertrophy of adenoid and tonsil may cause short stature. However, there is no data relating short stature to allergic rhinitis in the Korean population. The aim of this study was to investigate the effect of hypertrophy of adenoid and tonsil and allergic rhinitis on children with short stature. SUBJECTS AND METHOD: One hundred and ninety-one children were included in the disease group, which consisted of three groups, allergic rhinitis only (n=83), hypertrophy of adenoid and tonsil only (n=67), and combintorial of allergic rhinitis and hypertrophy of adenoid and tonsil (n=41). There were 174 pediatric patients in the control group. Growth hormone levels, thyroid function and both wrist X-rays were checked on the children with short stature in order to exclude other chief medical problems causing short stature. For the purpose of evaluating the relationship between short stature and clinical factors, allergy parameters, eosinophil partition rate and total IgE levels were checked in the allergic rhinitis group, and the size of the adenoid and tonsil were checked in the adenoid and tonsil hypertrophy group. The relationship between the incidence of short stature and above clinical factors was evaluated. RESULTS: The incidence of short stature was significantly higher in each disease group than in the control. However, there was no statistically significant differences between each disease group. The above clinical factors were not associated with short stature. CONCLUSION: Hypertrophy in adenoid and tonsil and allergic rhinitis might be an independent cause of short stature.
Adenoids* ; Body Height ; Child* ; Eosinophils ; Growth Hormone ; Humans ; Hypersensitivity ; Hypertrophy* ; Immunoglobulin E ; Incidence ; Palatine Tonsil* ; Rhinitis* ; Thyroid Gland ; Wrist

PURPOSE: Epinephrine is a key drug for treating anaphylaxis; however, its underuse is still a significant issue worldwide. The objective of this study was to compare epinephrine use between pediatric and adult patients who were treated with anaphylaxis in the emergency department (ED). METHODS: The data were retrieved from the National Sample Cohort of South Korea, which contains claim data from the National Health Insurance Service. We included patients who visited the ED with a discharge code of anaphylaxis between 2004 and 2013. We assessed prescription information of epinephrine, antihistamine and systemic steroid, previous medical history and discharge disposition from the ED. The study population was categorized based on age at the visit. RESULTS: A total of 175 pediatric and 1,605 adult patients with anaphylaxis were identified. Only 42 (24%) of the pediatric patients were treated with epinephrine, while 592 (36.9%) of the adult patients were treated with epinephrine (P = 0.001). Furthermore, the pediatric patients were less likely to be treated with systemic steroid than the adult patients (6.9% vs. 12.3%, P = 0.047). The odds ratios for the administration of epinephrine relative to the baseline in the 19-65 age group were 0.34 (95% confidence interval [CI], 0.15–0.67), 0.56 (95% CI, 0.28–1.03) and 0.79 (95% CI, 0.45–1.33) in the < 7, 7–12 and 13–18 age groups, respectively. CONCLUSIONS: The pediatric patients with anaphylaxis experienced a lower rate of epinephrine injection use than the adult patients and the injection use decreased as age decreased.
Adult ; Anaphylaxis ; Cohort Studies ; Emergencies ; Emergency Service, Hospital ; Epinephrine ; Humans ; Korea ; National Health Programs ; Odds Ratio ; Prescriptions

Hip subluxation and dislocation are common orthopaedic problems in children with cerebral palsy. Selective posterior rhizotomy(SPR) is a neurologic procedure aimed in reducing spasticity. Several recent studies have indicated a decrease in spasticity and functional improvement after SPR, and also decrease the tendency toward hip subluxation in children with cerebral palsy. This is a retrospective study to examine whether SPR halts hip subluxation. Between May 1994 and July 1996, 22 children below age of 5 underwent SPR. Twenty children were spastic diplegic types and 2 were mixed type and quadriplegic type respectively. Approximately 50-80% of L2-Sl level dorsal roots was cut, and 13 children had 50% of both Ll roots cut. Migration percentage score (MP) was used to determine progression of hip subluxation during the follow up period (12 36 mos.; Average 15 mos.). Of the total 44 hips in 22 patients, 45.5% (20 hips) improved, 34% (15 hips) remained unchanged, and 20.5% (9 hips) were worsened after SPR. Radiographic stability was achieved in 79.5%. Ll root cut rate (Ll SPR) was 55.5% for improved hips, 67% for unchanged hips, and 50% for worsened hips. Two patients had undergone orthopaedic procedure for progressive hip migration. Most patients experienced postoperative hip stability after SPR, but 20.5% were worsened and 2 patients had orthopaedic procedure. Also it is unlikely that Ll root involvement prevents progression of hip migration.
Cerebral Palsy* ; Child ; Dislocations ; Follow-Up Studies ; Hip* ; Humans ; Muscle Spasticity ; Retrospective Studies ; Rhizotomy* ; Spinal Nerve Roots