Pseudohypoparathyroidism(PHP) is a genetic disorder characterized by target cell resistance to the effect of parathyroid hormone(PTH). The disorder is classified into type I a, I b, I c and II depending on the phenotype and biochemical findings. In type I a, urinary cyclic AMP and urinary phosphate excretion are not increased after PTH stimulation because of deficient G unit activity in target cells. Deficiency of the G unit is a generalized cellular defect and accounts for the association of other endocrine disorders with type I a PHP. Type I b PHP shows resistance to PTH but not to other hormones and normal phenotypic appearance. In type I c PHP affected children have defect in catalytic unit of adenylate cyclase and in addition to resistance to PTH, resistance to the metabolic effects of TSH, gonadotropins, and glucagon may be detected. Typical appearance of Albright's hereditary osteodystrophy is common in PHP type Ia and Ic. In type II PHP, urinary cyclic AMP response is generated but this does not lead to phosphaturia. We experienced two patients with PHP. One is a 11-year-old girl diagnosed type I a PHP and the other is a 11-year-old boy suspected type I b PHP. They visited emergency room because of tetanic movement. Both patients had no previous history of tetany and showed low serum calcium level, high phosphorus level and high PTH level. The girl had typical features of Albright's hereditary osteodystrophy such as round face, short neck, obese feature, brachydactyly and mental retardation but didn't have basal ganglia calcification on brain CT. The boy showed normal appearance and no mental retardation.
Adenylyl Cyclases ; Basal Ganglia ; Brachydactyly ; Brain ; Calcium ; Child ; Cyclic AMP ; Emergency Service, Hospital ; Female ; Glucagon ; Gonadotropins ; Humans ; Hypophosphatemia, Familial ; Intellectual Disability ; Male ; Neck ; Phenotype ; Phosphorus ; Pseudohypoparathyroidism* ; Tetany

The surgical approach to the lower cervical lesions, especially in traumatic injuries, has been controversial. Some authors advocated posterior fusion for such lesions, while others disagreed and reported good operative results with anterior approach using several types of cervical plates. We analysed 28 patients with lower cervical spine traumatic as well as pathological lesions who underwent 32 anterior surgical interventions with cervical plates during the period of August, 1991 and December, 1993. A successful postoperative vertebral stability was obtained in 5 patients(89.3%) and in 19 patients(87.5%) who had predominent posterior ligamentous injuries. Serious complications such as esophageal perforation and postoperative angulation were seen in 5 patients(17.3%) that were related to the process of reduction. With our clinical experiences, we support anterior fusion with cervical plates particularly for lower cervical lesions even though posterior fusion has ben preferred for traumatic posterior ligamentous complex injuries.
Esophageal Perforation ; Humans ; Ligaments ; Spine

In the literature, Terson's syndrome most commonly co-occurs with subarachnoid hemorrhage(SAH) secondary to rupture of an A-com or ICA aneurysm. It is usually observed bilaterally and the prognosis is poor. The authors report two rare cases of unilateral Terson's syndrome after rupture of MCA bifurcation aneurysm rupture. In both cases, retinal hemorrhage was noticed after early aneurysmal clipping ; after these were conservatively treated, the visual acuity of one patient improved slightly and that of the other showed no change. For early detection and proper management of retinal hemorrhage after subarachnoid hemorrhage, early and periodic fundoscopic examination appears to be important.
Aneurysm* ; Humans ; Prognosis ; Retinal Hemorrhage ; Rupture* ; Subarachnoid Hemorrhage* ; Visual Acuity

PURPOSE: The aim of this study was to evaluate the effectiveness of our retraction method for achieving a good operative field for the adequate lymph node dissection during laparoscopic gastrectomy in view of short term surgical outcome. MATERIALS AND METHODS: This study prospectively enrolled 19 patients who underwent laparoscopic gastrectomy for early gastric cancer. The procedure was simply performed by putting the laparoscopic sigle suture in the phrenoesophageal ligament, and then the string was pulling and tying over the sternum. Surgical outcomes of these patients were evaluated. RESULTS: Under V-shaped liver retraction, the mean operating time and mean number of retrieved lymph nodes was 166.3 minute and 31.37, respectively. And the results were satisfactory compared to open or conventional laparoscopic gastric surgery. CONCLUSIONS: V-shaped liver retraction requires no extra port or assistant's hands, and prevents additional injury to any intra-abdominal organ. And this method can easily, efficiently and safely enable to achieve a good operative field for the lymph node dissection near the lesser curvature of the stomach.
Gastrectomy ; Hand ; Humans ; Laparoscopy ; Ligaments ; Liver ; Lymph Node Excision ; Lymph Nodes ; Prospective Studies ; Sternum ; Stomach ; Stomach Neoplasms ; Sutures

This retrospective analysis describes the clinical characteristics, treatment, and long-term outcome of 30 patients with axis fracture admitted to our institution between January 1991 and December 1995. The incidence of axis fracture was 27.2% in the 110 cervical spine fractures. Among these, odontoid process fracture was the most common type, 19 cases(63%) followed by 8 hangmans fractures(27%), 3 miscellaneous fractures(10%). Hangman's fractures, odontoid type III fractures and miscellaneous fractures were treated with external immobilization devices. Remaining 11 odontoid type II fractures, and six patients with dens dislocation of 6 mm or greater were initially treated by early surgical stabilization. Individuals with dens dislocated less than 6 mm were treated by external immobilization only. Among the nonoperative group of acute axis fractures, there was no fusion failure. In the early operated group, all patients were stable clinically or radiologically. But three patients with posterior wiring and bone graft complained of their neck motion limitation.
Axis, Cervical Vertebra* ; Dislocations ; Humans ; Immobilization ; Incidence ; Neck ; Odontoid Process ; Retrospective Studies ; Spine ; Transplants

Natural orifice transluminal endoscopic surgery (NOTES) is the new therapeutic technique. This procedure stands on the cutting edge of minimal invasive surgery that accesses the abdominal cavity through a natural orifice under the endoscopic image. There have been many animal experiments, and clinical trials of NOTES. We performed a transgastric endoscopic cholecystectomy of a pig using conventional endoscopic instruments through a natural orifice and the assistance of a 5mm laparoscopic trocar.
Abdominal Cavity ; Animal Experimentation ; Cholecystectomy

OBJECTIVE: To investigate what factors are associated with a failed arterial embolization for postpartum hemorrhage (PPH) and to attempt to estimate efficacy of arterial embolization. METHODS: Between 2004 and 2008, 60 patients at Korea University Medical Cencter underwent arterial embolization to control obstetrical hemorrhage. In all cases, arterial embolization was performed because of intractable hemorrhage unresponsive to conservative management. Medical records and angiographic results were reviewed. Arterial embolization failure was defined as the requirement for subsequent surgical procedure to control PPH with the procedure, and its results. RESULTS: Arterial embolization was attempted in 60 of deliveries. Failures occurred in 7 of 60 cases (11.7%) and in 4 of 7 cases (57.1%) of abnormal placentation (placenta previa totalis with or without placenta accrete or increta). Comparison of the failed and successful arterial embolization groups showed no differences in maternal characteristics, clinical status, and angiographic finding. Amount of total transfusion in failed arterial embolization group were larger than successful group although hemoglobin before embolization was not different. CONCLUSION: The only factor significantly associated with failed arterial embolization was an abnormal placentation. Arterial embolization is a safe and highly effective method to control PPH.
Hemoglobins ; Hemorrhage ; Humans ; Korea ; Medical Records ; Placenta ; Placentation ; Postpartum Hemorrhage ; Postpartum Period

Gouty ulcer can be caused by the accumulation of clumps of uric acid in body tissues that lead to acute or chronic inflammation at sites of accumulation. Furthermore, tophi-inhibiting granulation tissue may form a canal that channels microbial infection from the underlying involved joint space, and thus, presents the risk of osteomyelitis development. Accordingly, gouty ulcer must be treated appropriately. In this case, refractory wounds on gouty ulcers at the left shin and left radial ankle were treated by surgical debridement. Negative-pressure wound therapy was used successfully to prevent post-operative delayed wound healing.
Ankle ; Debridement ; Gout ; Granulation Tissue ; Inflammation ; Joints ; Negative-Pressure Wound Therapy* ; Osteomyelitis ; Ulcer* ; Uric Acid ; Wound Healing ; Wounds and Injuries

OBJECTIVE: This study was designed to evaluate the patterns of menstruation including menorrhagia using menstrual index, to find out correlations between patient's own judgement and actual patterns of menstruation in Korean women, and to develop the menstrual diary using menstrual index as a screening of menstrual disorders. METHODS: Seventy-seven women teachers of elementary school undergoing routine health screening test were asked to complete a pictorial blood loss assessment chart and a set of interview sheets regarding menstrual history and their subjective judgement on their amount of menstruation. Spearman correlation test was used to assess the correlation between menstrual index which was obtained from pictorial chart and serum hemoglobin concentration. RESULTS: The mean menstrual intervals were 29.8 days (SD+/-5.1), the mean menstrual duration was 5.6 days (SD+/-1.3), the mean value of menstrual index was 170.3 (SD+/-89.2) which varied from 12 to 411, the mean serum hemoglobin concentration was 12.3 g/dL. Significant correlation was found between the serum hemoglobin concentration and the menstrual index (r=-0.29, p=0.01). Seventeen of 20 women who had anemia (serum hemoglobin concentration below 12.0 g/dL) and 25 of 26 women who had menorrhagia (menstrual index above 200) considered her menstruation as 'normal'. CONCLUSION: Many women who have anemia due to menorrhagia are not aware of the serious consequences of menorrhagia. Writing a 'menstrual diary' using menstrual index would be easier and more practical method in predicting menorrhagia.
Anemia ; Female ; Humans ; Mass Screening ; Menorrhagia ; Menstruation ; Writing

Clear cell carcinoma of the endometrium is a relatively rare malignancy that is considered to be one of the most aggressive types of endometrial carcinoma. It is an infrequent variant sharing a common Mullerian origin, accounting for 1 to 5 percent of all endometrial cancers. Histologically, these tumors consists of hobnail cells which have translucent or slightly eosinophilic cytoplasm and protrude to lumen of gland. These tumors occur predominantly in postmenopausal women and carry a relatively unfavorable prognosis comparing with other histologic types of endometrial cancer. We experienced a case of clear cell carcinoma of endometrium in a 81-year old women and this case is presented with a brief review of the literaturs.
Aged, 80 and over ; Cytoplasm ; Endometrial Neoplasms* ; Endometrium ; Eosinophils ; Female ; Humans ; Prognosis