PURPOSE: The purpose of this study was to evaluate the accuracy of Tc-99m DTPA diuretic renal scans in children upper urinary tract. MATERIALS AND METHODS: We reviewed diuretic renal scans of 14 pediatric patients (age range: 3 days to 4 years) with unilateral hydronephrosis diagnosed by ultrasonography. Diuretic renal scan was done using Tc-99m DTPA and standardized protocol. In 3 neonates, diuretic renal scans were performed within 1 week and 3-7 months after birth. RESULTS: Six patients required pyeloplasty and eight were managed conservatively. All 6 patients requiring pyeloplasty were diagnosed as having ureteropelvic junction obstruction in the diuretic renal scan. In these 6 patients, post-operative renal scans at 3-12 months after surgery were converted to nonobstructive pattern in 5 and a nonobstructive patterns in 1. In 3 patients who underwent diuretic renal scan within 1 week after birth., nonobstructive patterns of initial scan were coverted to obstructive patterns in the follow-up scan. However, all patients with nonobstructive diuretic renal scans performed after the neonatal period did well on serial ultrasonography and showed favorable clinical outcome without progression to obstruction. CONCLUSION: Tc-99m DTPA diuretic renal scan with standarized protocol is useful in assessing suspected ureteropelvic junction obstruction in children as an initial diagnostic or post-operative follow-up modality. Nonobstructive or indeterminate scan RESULTS in the neonatal period requires follow-up scan to monitor development of the obstructive pattern.
Child* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Infant, Newborn ; Kidney Pelvis ; Parturition ; Pentetic Acid* ; Radioisotope Renography* ; Ultrasonography ; Urinary Tract*

OBJECTIVE: Progression after operation in traumatic brain injury (TBI) is often correlated with morbidity and poor outcome. We have investigated to characterize the natural course of traumatic intracranial hemorrhage and to identify the risk factors for postoperative progression in TBI. METHODS: 36 patients requiring reoperation due to hemorrhagic progression following surgery for traumatic intracranial hemorrhage were identified in a retrospective review of 335 patients treated at our hospital between 2001 and 2010. We reviewed the age, sex, Glasgow Coma Scale, the amount of hemorrhage, the type of hemorrhage, rebleeding site, coagulation profiles, and so on. Univariate statistics were used to examine the relationship between the risk factors and reoperation. RESULTS: Acute subdural hematoma was the most common initial lesion requiring reoperation. Most patients had a reoperation within 24-48 hours after operation. Peri-lesional edema (p=0.002), and initial volume of hematoma (p=0.013) were the possible factors of hemorrhagic progression requiring reoperation. But preoperative coagulopathy was not risk factor of hemorrhagic progression requiring reoperation. CONCLUSION: Peri-lesional edema and initial volume of hematoma were the statistical significant factors requiring reoperation. Close observation with prompt management is needed to improve the outcome even in patient without coagulopathy.
Brain Injuries ; Edema ; Glasgow Coma Scale ; Hematoma ; Hematoma, Subdural, Acute ; Hemorrhage ; Humans ; Intracranial Hemorrhage, Traumatic* ; Reoperation* ; Retrospective Studies ; Risk Factors*

OBJECTIVE: The aim of this study is to investigate the factors that may be related to bone graft infection and to contribute to lower the infection rate. According to current studies, the rate of bone graft infection after cranioplasty was reported up to 15.9% and this is significantly high. There are many analyses of the factors influencing bone graft infection, but this issue may need to be reconsidered in that the current medical environment is ever-changing. METHODS: We retrospectively reviewed the demographic, clinical data of 130 patients who underwent cranioplasty following decompressive craniectomy from January 2004 to December 2011. We analyzed several factors influencing bone graft infection and divided them into three categories of clinical, operation-related and hematological factors including white blood cell count, erythrocyte sedimentation rate, C-reactive protein and albumin. Statistical significance was done by chi-square test, Fisher's test and Mann-Whitney U test. RESULTS: The infection occurred in 12 patients in 130 cranioplasties (9.2%). There was no difference in infection rate between each group of early and later surgery, graft material, cause of craniectomy. Among many factors, low Glasgow Coma Scale (GCS< or =8) and combined ventriculoperitoneal (VP) shunt were significantly correlated with bone graft infection (p=0.025, p=0.025, respectively). There was no statistically significant difference in hematological analysis between groups. CONCLUSION: Low GCS and combined VP shunt with cranioplasty may increase the risk of bone graft infection.
Blood Sedimentation ; C-Reactive Protein ; Decompressive Craniectomy ; Glasgow Coma Scale ; Humans ; Leukocyte Count ; Retrospective Studies ; Risk Factors* ; Transplants*

OBJECTIVE: Lumbar spine stenosis (LSS) can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Minimally invasive surgery has come to be more commonly used for the treatment of LSS. The current study describes outcomes of bilateral microdecompression by unilateral or bilateral laminotomy (BML) for degenerative LSS after a minimum follow-up period of 3 years and investigates factors that result in a poor outcome. METHODS: Twenty-one patients who were followed-up for at least 3 years were included in this study. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, and disc height. RESULTS: Twenty-one patients (10 men, 11 women) aged 53-82 years (64.1+/-8.9 years) were followed-up for a minimum of 3 years (36-69 months). During follow-up, two patients underwent reoperation. Average preoperative JOA score and clinical symptoms, except persistent low back pain, improved significantly at the latest follow-up. There were no significant differences in radiological findings preoperatively and postoperatively. Thirteen patients (61.9%) had excellent to fair outcomes. CONCLUSION: BML resulted in a favorable and persistent outcome for patients with degenerative LSS without radiological instability over a mid-term follow-up period. Persistent low back pain unrelated to postoperative instability adversely affects mid-term outcomes.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Laminectomy* ; Low Back Pain ; Male ; Orthopedics ; Reoperation ; Spinal Stenosis* ; Spine ; Spondylolisthesis

A myopericytoma is a rare mesenchymal neoplasm composed of oval to spindle-shaped myoid appearing cells with a striking tendency for concentric perivascular growth. The vast majority of lesion is in the dermis and subcutaneous tissue of extremities. Very few cases have been reported in other locations. We hereby present, with a literature review, a case of myopericytoma in the neck.
Dermis ; Extremities ; Neck ; Strikes, Employee ; Subcutaneous Tissue

PURPOSE: To evaluate the efficacy of sagittal fat-suppressed 3D SPGR MR imaging of the osteoarthritic medial femoral condyle in terms of extent and degree of a focal articular cartilage defect of the knee. MATERIALS AND METHODS: The MRI findings (Disler scale) of normal and osteoarthritic medial femoral condyles from 112 knees were prospectively compared with the arthroscopic findings (Jackson staging). The arthroscopic findings were normal in 10 cases, stage I in 26 cases, stage II in 36 cases, stage III in 21 cases and stage IV in 19 cases on arthroscopy. RESULTS: All 10 cases arthroscopy findings were grade 0 in MRI. Among the 26 knees in arthroscopic stage I, only 11 knees (42.3%) showed surface irregularities on MRI that were consistent with grade 1, otherwise grade 2. All cases of arthroscopic stage II showed grade 2 or grade 3. Stage III was grade 3 in all cases on MRI. Among the 19 knees in arthroscopic stage IV, 16 knees (84.2%) with a large defect showed grade 4 on MRI. The sensitivity, specificity and accuracy of the MRI compared with the arthroscopic findings was 97%, 100% and 97.3%, respectively. The weighted kappa index was 0.7194 and the SE (standard error) was 0.053, suggesting significant consistency. CONCLUSION: The sagittal fat-suppressed 3D SPGR MR imaging is valuable for determining the extent and degree of the articular cartilage lesion of the medial femoral condyle in an osteoarthritic knee.
Arthroscopy ; Cartilage, Articular* ; Knee* ; Magnetic Resonance Imaging* ; Prospective Studies ; Sensitivity and Specificity

No abstract available.
Abducens Nerve Diseases* ; Abducens Nerve* ; Headache* ; Intracranial Hypotension*

OBJECTIVE: This study was performed to evaluate the diagnostic accuracy of cytology, colposcopically directed biopsy and conization and to analyze predictive factors for residual tumor after conization in patients with cervical neoplasia. METHODS: We reviewed 167 patients who had undergone cytology, colposcopically directed biopsy and conization followed by subsequent hysterectomy depending on their current disease status at the Department of Obstetrics & Gynecology, Catholic University of Korea Medical College, Holy Family Hospital from January, 1993 to August, 1998. The diagnostic accuracy of cytology, colposcopically directed biopsy and conization were investigated. Also, we investigated the significance of the margin status and the presence of HPV which were used to predict residual tumors in hysterectomy specimens after conization. RESULTS: The results of each methods were analyzed with regard to the histopathologic findings of the surgical specimen. The accuracy rates of cytology, and colposcopically directed biopsy were 59.3% (99 of 167) and 71.3% (119 of 167), respectively. After conization, residual tumors were found in 30.1% of subsequent hysterectomized specimens (51 of 167). Underestimation by conization occurred in 2.0% of cases (1 of 51) and overestimation in 7.8% (4 of 51). Residual tumors were significantly more frequent in patients with positive conization margins than in those with negative margins (P<0.001). But the presence of HPV was not significant. CONCLUSION: These results suggest that diagnostic conization seems to be essential procedure in patients showing abnormal results by cytology and colposcopically directed biopsy, especially in those with CIN III or microinvasion, for the further proper management of cervical neoplastic lesion and margin status is useful in predicting residual tumor after conization.
Biopsy* ; Conization* ; Gynecology ; Humans ; Hysterectomy ; Korea ; Neoplasm, Residual* ; Obstetrics

BACKGROUND: Mycobacterium tuberculosis (Mtb) heparin binding hemagglutinin (HBHA) is an Ag known to evoke effective host immune responses during tuberculosis infection. However, the molecular basis of the host immune response to HBHA has not been fully characterized. In this study, we examined the molecular mechanisms by which HBHA can induce the expression of proinflammatory cytokines in macrophages. METHODS: HBHA-induced mRNA and protein levels of proinflammatory cytokines were determined in bone marrow-derived macrophages (BMDMs) using RT-PCR and ELISA analysis. The roles of intracellular signaling pathways for NF-kappaB, PI3-K/Akt, and MAPKs were investigated in macrophage proinflammatory responses after stimulation with HBHA. RESULTS: HBHA robustly activated the expression of mRNA and protein of both TNF-alpha and IL-6, and induced phosphorylation of NF-kappaB, Akt, and MAPKs in BMDMs. Both TNF-alpha and IL-6 production by HBHA was regulated by the NF-kappaB, PI3-K, and MAPK pathways. Furthermore, PI3-K activity was required for the HBHA-induced activation of ERK1/2 and p38 MAPK, but not JNK, pathways. CONCLUSION: These data suggest that mycobacterial HBHA significantly induces proinflammatory responses through crosstalk between the PI3-K and MAPK pathways in macrophages.
Cytokines ; Enzyme-Linked Immunosorbent Assay ; Hemagglutinins ; Heparin ; Interleukin-6 ; Lectins ; Macrophages ; Mycobacterium tuberculosis ; NF-kappa B ; p38 Mitogen-Activated Protein Kinases ; Phosphorylation ; RNA, Messenger ; Tuberculosis ; Tumor Necrosis Factor-alpha

Pylephlebitis is defined as an inflammation of the portal system, which is a rare but dreaded complication of intra-abdominal inflammatory processes. In the past it was observed as a sequela of neglected or complicated appendicitis. With earlier diagnosis, modern surgical technique and antibiotics, the incidence has declined even further. In addition, thrombosis in portal system (pylethrombosis) can complicate the pylephlebitis, followed by obstruction of the portal system, leading to portal hypertension in the late stage. Proper recognition of early thrombosis and an accompanying intra-abdominal inflammatory process should arouse the suspicion of septic thrombophlebitis and lead to the early institution of adequate therapy to prevent the almost universally fatal outcome. We report the case of woman who had pylephlebitis and presented with fever of unknown origin, probably associated with acute appendicitis.
Anti-Bacterial Agents ; Appendicitis ; Diagnosis ; Fatal Outcome ; Female ; Fever of Unknown Origin* ; Fever* ; Humans ; Hypertension, Portal ; Incidence ; Inflammation ; Portal System ; Portal Vein* ; Thrombophlebitis* ; Thrombosis