One case of congenital cutis aplasia is presented. The defect involved includes full-thickness skin defect of scalp and cranium. The patient was treated with debridement of dirty necrosed crust which covered exposed dura mater and with double opposing rotation flap including pericranium for bone regeneration. The donor site was covered with skin graft from right thigh. During operation, the superficial temporal artery was found to be short and weak. And after operation, the margin of flap were congested and finally necrotized. The necrotic wound was treated with conservative management. The vascular impairment is thought to be main course of congenital cutis aplasia. So we conclude that the treatment of choice is conservative management or careful flap surgery for coverage of defect area.
Bone Regeneration ; Debridement ; Dura Mater ; Estrogens, Conjugated (USP) ; Humans ; Scalp ; Skin ; Skull ; Temporal Arteries ; Thigh ; Tissue Donors ; Transplants ; Wounds and Injuries

No abstract available.
Adult* ; Humans

No abstract available.
Adult* ; Humans

Nonunion is extremely rare in children, Weber et al. concluded that considerable skill is required to induce nonunion in a child and its occurrence always results from a serious error in management. Twenty-six cases of delayed union and nonunion examined and treated at department of Orthopedic Surgery, Yonsei University, Wonju College of Medicine during the period of 1970 to 1988 was observed and analysed. 1. Of the 26 cases, there was 18 male and 8 female patients. The results showed more predominence of male over female patients. 2. Delayed union and nonunions commonly occurred over 5 year of age. 3. The causes of the fractures consisted of 12 Fell from heights, 5 Traffic accidents and others. 4. Of the 26 cases, there were 21 closed fractures and 5 open fractures. 5. Prior to admission to this hospital, 15 were treated conservatively and 10 treated operatively, and one received no treatment at all. 6. The sites of delayed union and nonunion were 10 phalanges, 6 tibia, and 3 ulna in order. 7. Probably causes of the delayed union and nonunion were unsatisfactory immobilization in 13 cases, infections in 6 cases, operative complications in 6 cases, interposition of the soft tissues in 2 cases in 2 cases, persistent seperation of the fragments in 1 case. 8. We are considered that the treatment of the nonunion must be individualizd but usually requires eradication of any infection, excision of the intervening fibrous tissue, bone grafting, and internal fixation.
Accidents, Traffic ; Bone and Bones ; Child ; Female ; Fractures, Closed ; Fractures, Open ; Gangwon-do ; Humans ; Immobilization ; Male ; Orthopedics ; Tibia ; Transplants ; Ulna

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women, which is characterized by the oligo/ anovulation, hyperandrogenism (HA) and polycystic ovarian morphology which are diagnostic criteria. PCOS has diverse clinical aspects in addition to those diagnostic criteria including increased risk for cardiovascular diseases, metabolic syndrome, dyslipidemia, type 2 diabetes and impaired fertility. Because of the heterogeneity of the disease, the pathogenesis of the disease has not been elucidated yet. Therefore, there is no cure for the endocrinopathy. HA and insulin resistance (IR) has been considered two major pillars of the pathogenesis of PCOS. Recent advances in animal studies revealed the critical role of neuroendocrine abnormalities in developing PCOS. Several pathways related to neuroendocrine origin have been investigated such as hypothalamus pituitary ovarian axis, hypothalamus pituitary adrenal axis and hypothalamus pituitary adipose axis. This review summarizes the current knowledge about the role of HA and IR in developing PCOS. In addition, we review the results of recent genome wide association studies for PCOS. This new perspective improves our understanding of the role of neuroendocrine origins in PCOS and suggest a novel potential therapeutic target for the treatment of PCOS.

No abstract available.
Thumb*

A putative polypeptide hormone identified as amylin[islet amyloid polypeptide] is synthesized and co-localized with insulin in B cells of pancreatic islets in several animal species including man. However, there is growing evidence that somatostatin cells are also expressed and contained amylin in the pancreatic islets of the rat The aim of the present study was to investigate the immunocytochemical expression of the amylin within the endocrine pancreas of the man, rabbit and guinea pig, with special reference to the possible ability of islet cells other than insulin cells to synthesize amylin. For this purpose serial sections of the pancreatic islets were stainedimmunocytochemically using anti-amylin, anti-insulin, anti-glucagon, anti-somatostatin antisera. In serial sections of pancreatic islets of the man and rabbit, it was shown that amylin immunoreactivity occurred in insulin-reactive B cells predominantly located in interior of the islets. In contrast, amylin immunoreacivity appeared in glucagon-reactive A cells peripherally located in the islets of the guinea pig. These results suggest that in both the man and rabbit, amylin is synthesized by B cells for subsequent co-secretion with insulin, and that in guinea pig, amylin is synthesized by A cells for co-secretion with glucagon. It thus appears that amylin release may be mediated by different secretory mechanisms according to animal species.
Amyloid ; Animals ; B-Lymphocytes ; Glucagon ; Guinea Pigs* ; Guinea* ; Immune Sera ; Immunohistochemistry ; Insulin ; Islet Amyloid Polypeptide* ; Islets of Langerhans* ; Rats ; Somatostatin-Secreting Cells

PURPOSE: We investigated whether C-reactive protein (CRP) levels, urine protein-creatinine ratio (uProt/Cr), and urine electrolytes can be useful for discriminating acute pyelonephritis (APN) from other febrile illnesses or the presence of a cortical defect on 99mTc dimercaptosuccinic acid (DMSA) scanning (true APN) from its absence in infants with febrile urinary tract infection (UTI). MATERIALS AND METHODS: We examined 150 infants experiencing their first febrile UTI and 100 controls with other febrile illnesses consecutively admitted to our hospital from January 2010 to December 2012. Blood (CRP, electrolytes, Cr) and urine tests [uProt/Cr, electrolytes, and sodium-potassium ratio (uNa/K)] were performed upon admission. All infants with UTI underwent DMSA scans during admission. All data were compared between infants with UTI and controls and between infants with or without a cortical defect on DMSA scans. Using multiple logistic regression analysis, the ability of the parameters to predict true APN was analyzed. RESULTS: CRP levels and uProt/Cr were significantly higher in infants with true APN than in controls. uNa levels and uNa/K were significantly lower in infants with true APN than in controls. CRP levels and uNa/K were relevant factors for predicting true APN. The method using CRP levels, u-Prot/Cr, u-Na levels, and uNa/K had a sensitivity of 94%, specificity of 65%, positive predictive value of 60%, and negative predictive value of 95% for predicting true APN. CONCLUSION: We conclude that these parameters are useful for discriminating APN from other febrile illnesses or discriminating true APN in infants with febrile UTI.
Acute Disease ; C-Reactive Protein/*analysis ; Case-Control Studies ; Fever/microbiology ; Humans ; Infant ; Male ; Potassium/*urine ; Predictive Value of Tests ; Prospective Studies ; Proteinuria/diagnosis ; Pyelonephritis/*diagnosis/radionuclide imaging ; Sensitivity and Specificity ; Sodium/*urine ; *Technetium Tc 99m Dimercaptosuccinic Acid ; Urinary Tract Infections/drug therapy/microbiology/*radionuclide imaging

Patients with moderate to severe degrees of Henoch-Schonlein purpura (HSP) nephritis receive high-dose intravenous methylprednisolone pulse therapy (IMPT). Although the regimen is generally safe and effective, various complications occasionally develop. administration of excessive corticosteroid can induce urinary potassium wasting leading to hypokalemia. Polyuria, one of the complications of hypokalemia, is related to both increased thirst and mild nephrogenic diabetes insipidus. And hypokalemia itself also impairs the maximal renal urinary concentration ability. Although polyuria or nocturia after IMPT is not common, it is correctable immediately by oral potassium supplementation. Therefore, during IMPT, careful history taking of nocturia as well as monitoring urine volume, serum and urine potassium level at regular follow-up are necessary because even mild hypokalemia can provoke urine concentrating ability defect. We experienced a case of 11 year-old boy with HSP nephritis who suffered from hypokalemia-induced polyuria with nocturia right after IMPT.
Attention ; Diabetes Insipidus, Nephrogenic ; Humans ; Hypokalemia ; Kidney Concentrating Ability ; Methylprednisolone ; Nephritis ; Nocturia ; Polyuria ; Potassium ; Purpura, Schoenlein-Henoch ; Thirst

PURPOSE: The aim of this study was to evaluate the incidence of febrile urinary tract infection (UTI) according to clinical characteristics in patients with congenital hydronephrosis (CH) and hydronephrotic patients first diagnosed with hydronephrosis during treatment of febrile UTII. METHODS: In this study, 200 patients with congenital hydronephrosis were enrolled in group 1 and 252 patients first diagnosed with hydronephrosis during treatment of febrile UTI were enrolled in group 2. We counted the episodes of UTI in the two groups according to clinical characteristics, the presence of VUR, type of feeding, and clinical outcomes since 2000. And we compared those results between the two groups. and compared two groups as well. RESULTS: The incidence of recurrent UTI was 10%, 0.028 per person-year in group 1 and 16.7%, 0.051 per person-year in group 2, respectively (P <0.05). Group 2 had more VUR (3% vs. 27%, P <0.05) and higher incidence of UTI than group 1. The incidence of UTI in patients with CH of Society of Fetal Urology (SFU) grade 4 or grade 4-5 VUR was 80% and 44.4%, respectively. No significant differences were found in incidence of UTI between BMF (breast milk feeding) and artificial milk feeding group in both groups (P 1= 0.274, P 2=0.4). The time of resolution of CH had no correlation with either number of UTI episodes or the presence of VUR. CONCLUSION: The overall incidence of UTI is low in patients with CH as well as patients patients first diagnosed with hydronephrosis during treatment of febrile UTI except patients with SFU grade 4 or grade 4-5 VUR. BMF has no protective effect against UTI.
Humans ; Hydronephrosis ; Incidence ; Milk ; Urinary Tract ; Urinary Tract Infections ; Urology ; Vesico-Ureteral Reflux