Ultrasongraphy is a safe, noninvasive examination which should be the first procedure in the workup of apatient with a definite or suspected pelvic masses. The diagnostic schemes were derived from correlating the sonographic features with histomorphology in 230 surgically proven pelvic masses. Besides separating pelvic masses into the conventional categories of cystic, complex and solid, grayscale sonographic features of a pelvic mass canbe used to subcategorized these masses into a more useful differential diagnosis. The results are as follows; 1.The most characteristic finding of uterine myoma was midly to mederately echogenic uterine enlargement (90.7%)with a lobulated uterine margin (62.8%), and often less echogenic than the normal uterine echoes. 2. The typical ultrasonographic finding of H-mole was uterine enlargement with multiple small vesicular patterns of intrauterincontents(93%). 3. The most frequent finding of cystic teratoma was cystic mass with echogenic foci(48%), but the echogenic appearance of the lesions was extremely variable. 4. The ultrasonographic findings of ectopic pregnancywere adnexal mass(comlex or cystic), decidual proliferation of the uterus, enlargement of uterine size, fluid incul-de-sac, deveiation of uterus by adnexal mass, and psuedointrauterine appearance. 5. Ultrasound provided information leading to the correct diagnosis in 57% of cases, contributory data in 21.3%, and non-specific information in 10.4%. Errors occured in 3.9% and false-negative in 7.4%.
Diagnosis ; Diagnosis, Differential ; Leiomyoma ; Teratoma ; Ultrasonography ; Uterus

Between January 1994 and February 1996 lumbar fusion was carried out in eight patients who had degenerative lumbar disease by a technique of translaminar facet screw fixation. The goal of instrumentation is to confer immediate stability to unstable segments and lower the pseudarthrosis rate. However, transpedicular systems can carry a risk of neural damage and require a high standard surgical skills. Therefore, the purpose of this study was to determine the efficacy and safety, and to introduce the simple fusion technique. We usually used this technique for the patients who had been planned single level fusion without definite preoperative instability. Preoperative diagnosis were isthmic spondylolisthesis in one, spinal stenosis in three and laterally herniated lumbar discs in four in which postoperative instability was expected without performing fusion. A single-level fusion was perfomed in all patients. Fusion levels were L2-3 in two, L3-4 in one, L4-5 in four and L5-Sl in one. The average follow-up period was 20 months, ranging from 12 to 36 months. Overall clinical satisfaction including excellent and good result was obtained in all cases. The fusion rate was evaluated radiographically and all were solidly fused. The time to fusion ranged from 3 to 10 months at an average of 5.4 months. There were no significant complications including nerve root injury, and screw loosening or breakage. Although this study was retrospective and the number of cases were small, translaminar facet screw fixation for degenerative lumbar disease is simple and readily available, and provides sufficient rigid stabilization.
Diagnosis ; Follow-Up Studies ; Humans ; Pseudarthrosis ; Retrospective Studies ; Spinal Stenosis ; Spine* ; Spondylolisthesis

BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.
Anesthesia, Epidural* ; Bupivacaine ; Humans ; Injections, Epidural ; Lower Extremity* ; Needles

No abstract available.
Classification* ; Tibia*

We reviewed four patients who underwent posterior C-D occipitocervical loop and autogenous bone graft. The mean postoperative follow-up period was 16 months. The indications for surgery were progressive neurological deficit, atlantoaxial instability and intractable pain. Of the four patients, one had os odontoideum, two rheumatoid arthritis and suboccipital dislocation combined fractures of C1 and C2. Bong union was confirmed in all cases at approximately 4 months postoperatively. Final outcome result was satisfactory in three patients and unsatisfactory in one patient. The cause of unsatisfactory result was recurrent neck pain secondary to swan neck deformity. The neurologic deficit were improved or remained same as preoperative status. Three patient were out of bed on average of the 14th day postoperatively. One patient could not ambulate due to tetraplegia who needed an artificial ventilator. There was no complication related to instrumentation.
Arthritis, Rheumatoid ; Congenital Abnormalities ; Dislocations ; Follow-Up Studies ; Humans ; Neck ; Neck Pain ; Neurologic Manifestations ; Pain, Intractable ; Quadriplegia ; Transplants ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Vascular stenosis after surgical repair frequently occurs in congenital heart disease. Although conventional balloon dilation is a useful option for stenotic lesions, restenosis may occur. Consequently, balloon expandable stents have been used; however, there are a limited number of balloon expandable stents in our country. Here, we report the early and intermediate-term outcomes of self-expandable stents in vascular stenosis of moderate to large-sized vessels in congenital heart disease. METHODS: Twelve self-expandable stents were implanted in 9 patients between February 2012 and January 2019. The median age and weight were 12 years (range, 4–39 years) and 38 kg (range, 19–69 kg), respectively. The patients were followed-up for a median duration of 43 months (range, 1–83 months) after stent implantation. RESULTS: Nine self-expandable stents were implanted in the pulmonary artery, 2 stents in the right ventricle to the pulmonary artery conduit, and 1 stent in the coarctation. The narrowest diameter of the stented vessel increased from 5.7±3.2 mm to 12.6±3.4 mm (p<0.05). The mean pressure gradient across the stenotic lesion decreased from 23.0±28.2 mmHg to 3.2±3.6 mmHg (p<0.05). Distal migration of the stent occurred in 1 patient, and significant neointimal ingrowth was noted in 1 patient. CONCLUSIONS: The self-expandable stent may be a useful option to relieve vascular stenosis in moderate to large-sized vessels with acceptable intermediate-term outcomes.
Catheterization ; Constriction, Pathologic ; Heart ; Heart Defects, Congenital ; Heart Ventricles ; Humans ; Pulmonary Artery ; Stents

The etiology of congenital dislocation of the hip is still the subject of much discussion. Genetic growth disturbance, intrauterine and postnatal mechanical influences are considered as possible factors. According to Hass, typical congenital dislocation of the hip is not primarily a congenital disease. The occurance rate of C.D.H in sister or brother has been reported higher than others. But there have been no report about this cases. Two cases of C.D.H. in sister have been treated at Kang-Nam St. Mary's Hospital. Both of them were treated by traction and closed reduction under arthrography. Pavlik harness was applied in younger case after removel of hip spica cast. Clinically and radiologically the results were good during the follow-up period.
Arthrography ; Dislocations ; Follow-Up Studies ; Hip Dislocation ; Hip ; Humans ; Siblings ; Traction

BACKGROUND AND OBJECTIVES: Vascular stenosis after surgical repair frequently occurs in congenital heart disease. Although conventional balloon dilation is a useful option for stenotic lesions, restenosis may occur. Consequently, balloon expandable stents have been used; however, there are a limited number of balloon expandable stents in our country. Here, we report the early and intermediate-term outcomes of self-expandable stents in vascular stenosis of moderate to large-sized vessels in congenital heart disease. METHODS: Twelve self-expandable stents were implanted in 9 patients between February 2012 and January 2019. The median age and weight were 12 years (range, 4–39 years) and 38 kg (range, 19–69 kg), respectively. The patients were followed-up for a median duration of 43 months (range, 1–83 months) after stent implantation. RESULTS: Nine self-expandable stents were implanted in the pulmonary artery, 2 stents in the right ventricle to the pulmonary artery conduit, and 1 stent in the coarctation. The narrowest diameter of the stented vessel increased from 5.7±3.2 mm to 12.6±3.4 mm (p<0.05). The mean pressure gradient across the stenotic lesion decreased from 23.0±28.2 mmHg to 3.2±3.6 mmHg (p<0.05). Distal migration of the stent occurred in 1 patient, and significant neointimal ingrowth was noted in 1 patient. CONCLUSIONS The self-expandable stent may be a useful option to relieve vascular stenosis in moderate to large-sized vessels with acceptable intermediate-term outcomes.

PURPOSE: Childhood obesity is global public health issue and early intervention is essential because the long-term consequences of childhood obesity are well documented. We studied the effects of community-based intervention program for obese children in regard to regulating excess body weight and improving their lifestyle. METHODS: The study population were 101 obese children (age 6-12) who lived in Ansan during year 2003. The Program consists of exercise and nutritional education, and was conducted for 20 weeks (during the first 8 weeks program was performed once every week and once every month after that). We evaluated the changes of weight, body mass index, obesity index, lipid profiles and their lifestyle during the program. RESULTS: After the intensive course during 8 weeks, body mass index, obesity index, LDL-cholesterol decreased significantly. However, those results increased again after 20 weeks program comparable to initial levels. There are no significant differences in total cholesterol, triglyceride and HDL-cholesterol during program. The lifestyle for exercise and eating improved after initial 8 weeks intensive course, but returned to previous state after 20 weeks program finished. CONCLUSION: Our 20 weeks obesity program did not influence body mass index significantly although it showed transient improvement during early intensive course. These results suggest that the importance of long-term intensive programs to maintain educated healthy lifestyle. Hereafter, well-controlled and long term followed clinical researches in larger group will be necessary.
Body Mass Index ; Body Weight ; Child* ; Cholesterol ; Early Intervention (Education) ; Eating ; Education ; Gyeonggi-do ; Humans ; Life Style ; Obesity ; Pediatric Obesity ; Public Health ; Triglycerides

Acute rejection in renal transplantation is a major risk factor threatening the longterm graft survival. Acute rejections refractory to conventional anti-rejection therapy using steroid pulse or antilymphocyte preparations occur in minority, preceding to progressive deterioration of renal function and graft loss. Recent reports showed that tacrolimus rescue therapy in this refractory rejections has converted rejection process. In order to evaluate the clinical outcome of tacrolimus rescue therapy in refractory rejections, we performed a retrospective study. Since April 1997, we performed tacrolimus rescue therapy intent-to-treat for steroid- or OKT3- resistant rejections in 5 patients. All rejections were histologically confirmed according to Banff criteria. As conventional antirejection therapy, steroid pulse therapy (solumedrol 500~1000 mg iv for 3 days) or OKT3 therapy (5 mg/day for 14 days) was performed. The outcome of the rescue therapy is classified into three categories by the change of serum creatinine level or the histologic findings; Improvement-return of serum creatinine level (sCr) to or below the prerejection baseline (nadir) level, Stabilization-arrested sCr increase, Failure-progressive deterioration of renal function, or graft loss. All were men and the mean age was 38 years. Living related- & unrelated-donor transplantation were 2 and 3 cases respectively. Immunosuppression were done with CsA Pd+ (3) or CsA+ Pd+ AZA (2). Acute rejection grades according to Banff criteria were mild (2) or moderate (3). The mean interval between transplantation and tacrolimus conversion was 54.4 days. The outcome was as follows; improvement 2 cases, stabilization 1 case and failure 2 cases. During 3~10 months followup PTLD occured in 1 case, treated with graft nephrectomy and no other complications in other 4 cases. In conclusion, we can convert ongoing refractory rejections to steroid and OKT3 therapy by tacrolimus rescue therapy in 60% (3/5) successfully. Although longterm followup result is necessary to confirm the efficacy and safety of the tacrolimus rescue therapy, the result of this early trial is so good that we may try tacrolimus in refractory rejections for rejection reversal.
Creatinine ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation* ; Male ; Muromonab-CD3 ; Nephrectomy ; Retrospective Studies ; Risk Factors ; Tacrolimus* ; Transplants