A case of dysplasia eplphyseaalis hemlmelica (Fairbank, 1956) in a 8 years old boy, showlng typical clinical and roentgenographical appearance, is reported together wlth a brief review of literature in this paper. This condition is a rare developmental disorder of childhood in which there is a asymmetrical cartilaginous overgrowth of one or more than one epiphysis, or of a tarsal or carpal bone. Thls disorder is usually Iimited to elther the medial or lateral half of a single extremity. The disease is characterised radiographically by delay in the appearance of the epiphyseal nucleus, which is mottied and of irregular density. The most common deformities were genu valgum or varum and valgus or equinus deformity of the ankle. These deformities tended to increased wlth growth but the size of the lesion increased in proportion to the growth of the normal bone. Concomitant involvement of the knee and ankle is the rule, and in those cases the affected limb Is usually longer than Its mate. The lesion Is often microscopically indistingulshable from an osteochondroma.
Ankle ; Carpal Bones ; Congenital Abnormalities ; Epiphyses ; Equinus Deformity ; Extremities ; Genu Valgum ; Humans ; Knee ; Male ; Osteochondroma

No abstract available.
Constriction, Pathologic*

Our aim was to identify histologic changes in cervical carcinoma tumor cells due to chemotherapy,by electron microscopic examination. Cisplatin and 5-fluorouracil were used between March 1, 1994 and February 28, 1995 on a total of 16 patients. The treatment schedule consisted of 75 mg/m2 cisplatin via iv with hyperhydration on Day 1, in combination with 1000 mg/m2 5-fluorouracil via continuous iv on Day 1 to 5. The treatment was repeated every 4 weeks with a maxinum of 3 courses. Ultrastructurally, chemotherapy induced apoptosis,indicated by condensation of nucleus and cytoplasm,fragmentation of nuclei, and apoptotic bodies. Due to repeat chemotherapy, increased levels of desmosomes were noted and parts of tumor nests were replaced by mature squamous cells. Tumor nests were reduced in size, mitochondria exhibited swelling, the endoplasmic reticulum was dilated, and infiltration of inflammatory cells increased after chemotherapy. These results suggest that chemotherapy induces apoptosis and injury to the cytoplasm and nuclei of tumor cells. However, the exact selection mechanism of the biochemical pathway of cell death is not fuUy understood. Further study of the molecular biologic actions of cell death after chemotherapy is warranted.
Apoptosis ; Appointments and Schedules ; Cell Death ; Cisplatin ; Cytoplasm ; Desmosomes ; Drug Therapy* ; Endoplasmic Reticulum ; Fluorouracil ; Humans ; Mitochondrial Size

The Clinical analysis of 130 spontaneous intracebral & cerebellar hematoma confirmed by brain CT & admitted to this neurosurgical clinic past years & 5 months were made with literature review. 1) The age incidence showed increase over fourth decade and male to female ratio was 56.1:43.9. 2) 50.4% of total patients showed hypertension but 40.3% did not checked their B.P. & 9.3% had normal B.P. before cerebral hemorrhage. Among 50.4% of hypertension cases, 72% received antihypertensive treatment intermittently, 2.9% regularly and the rest 24.3% did not. 3) 69.7% of hematoma located in basal ganglia & thalamus. In nonoperated patients, the morbidity & mortality showed no marked difference in their location except pontine & cerebellar hematomas. In operated patients the morbidity & mortality was prominent in putaminal hemorrhage than in thalamus and cerebellum. Most of putaminal hematoma had semicomatose or comatose mental state and ventricular hemorrhage in 87.5%. 4) The morbidity & mortality increased in proportion to size of hematomas, grade of unconsciousness in admisson and state of intraventricular hemorrhage. 5) About time interval from ictus to operation, the patients within first 24 hours are 29 cases(51.1%) and the next 24 hours are 13 cases(26.5%). The mortality rate of two groups were 55.1% & 53.8% respectively but no death in the patients with operation performed after 48 hours. 6) The morbidity & mortality rate were as follows. In the non operated patients (90 patients), no or mild neurological deficits:22.2% moderate:21.1% severe:20% and moribund or death:36.6%. In the operated patients no or mild neurological deficits:16.3% moderate:18.4% severe:18.4% and moribund or death:46.9%. The results of total patients showed no or mild neurological deficits:20.1%, moderate:20.1%, severe:19.4% and moribund or death:40.2%.
Basal Ganglia ; Brain ; Cerebellum ; Cerebral Hemorrhage ; Coma ; Female ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Male ; Mortality ; Putaminal Hemorrhage ; Thalamus ; Unconsciousness

BACKGROUND: Epidural anesthesia became most popular for a cesarean section, but it is more time consuming and involves a higher incidence of insufficient or superficial blockade, especially of the motor root, despite large doses of local anesthesia. Combined spinal epidural anesthesia has gained an increasing interest as it combines the reliability of the spinal block and the flexibility of an epidural block. A dural puncture using the combined spinal epidural technique making an early sacral blockade might be a solution to disadvantages in epidural anesthesia. We investigated the efficacy of combined spinal epidural anesthesia and epidural anesthesia with prior dural puncture for a cesarean section. METHODS: Sixty pregnant women at full term were divided into three groups. Group I (EPI, n = 20) received epidural anesthesia with 100 mg of 0.5% bupivacaine. Group II (CSE, n = 20) received combined spinal epidural anesthesia with 1.2 1.4 ml of 0.5% hyperbaric bupivacaine intrathecally, followed by sensory block at T10 after by 7 8 ml of 0.5% bupivacaine through the epidural catheter. Group III (DP, n = 20) received epidural anesthesia with prior dural puncture. A dural puncture with a 27 G whitacre needle was done before an infusion of 20 ml of 0.5% bupivacaine through the epidural catheter. The quality and side effects of surgical anesthesia were compared between the three groups. RESULTS: Time to T10 (P< 0.001) and surgical onset time (P< 0.001) were significantly shorter in the CSE group. Maximal sensory block level (P< 0.001) was significantly higher in the CSE group. Muscle relaxation (P< 0.05) and motor block (P< 0.001) were much better in the CSE group. Hypotension occurred in 25% (EPI group), 40% (CSE group) and 20% (DP group) of the patients. While 65% of the EPI group and 50% of the DP group complained of intraoperative pain, only 25% of CSE group did (P< 0.05). CONCLUSIONS: We can conclude that combined spinal epidural anesthesia has great efficacy and less side effects for a cesarean section than epidural anesthesia and epidural anesthesia with prior dural pucture.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, Local ; Anesthetics ; Bupivacaine ; Catheters ; Cesarean Section* ; Female ; Humans ; Hypotension ; Incidence ; Muscle Relaxation ; Needles ; Pliability ; Pregnancy ; Pregnant Women ; Punctures*

Background: Definitive knowledge of the 24-hour cardiac autonomic activity in patients with allergic rhinitis (AR) is lacking. Thus, we aimed to evaluate heart rate variability (HRV), which is used to measure cardiac autonomic activity by 24-hour Holter monitoring in patients with AR. Methods: We enrolled 32 patients who visited our clinic and were diagnosed with AR. The control group was selected four-fold (n = 128) by matching (age, sex, hypertension, and diabetes) in the AR group from a Holter registry in the cardiology department. The HRV results, which were measured using 24-hour Holter monitoring, were compared between the AR and control groups. Results: All time-domain parameters of HRV revealed no differences between the groups.However, among the frequency domain parameters of HRV, the low-frequency to highfrequency ratio and low-frequency power in normalized units were significantly lower in the AR group. Conversely, high-frequency power in normalized units was significantly higher in the AR group. In the multiple regression analysis, AR was independently associated with sympathetic withdrawal (adjusted odds ratio = 3.393, P = 0.020) after adjusting for age, sex, hypertension, diabetes mellitus, and hyperlipidemia. Conclusions The present findings suggest differences in cardiac autonomic activity which are related with sympathetic withdrawal in patients with AR compared with that in the normal population over 24 hours.

Laminar flow within large vessels or organs can cause artifact that may simulate thrombus during computed tomographic study. The degree of venous enhancement depends on the size of blood pool and cardiac output in relation to the time of scanning. When venous structures are scanned too fast after injection of contrast material, poor mixing of enhanced and unenhanced blood creates flow artifact that gives an appearance of deep venous thrombosis. As compared with dynamic computed tomography (CT), because of a shorter acquisition time of spiral CT, vascular and organ enhancement on spiral CT scan are more dependent on factor that affect delivery of contrast material into the blood stream. Differentiation from true thrombus can be made by use of delayed scan as well as increased density and finding of relatively poor margination of artifact. In addition, both angiography and echocardiography could complement CT to assure that false-positive results are minimized. We experienced a case of artifact mistaken for intracardiac mass on spiral CT, but it was not noted on echocardiography.
Angiography ; Artifacts* ; Cardiac Output ; Complement System Proteins ; Echocardiography ; Heart Neoplasms* ; Rivers ; Thrombosis ; Tomography, Spiral Computed ; Venous Thrombosis

BACKGROUND: Although actinic keratoses is the most common precancerous cutaneous lesion, there has been no clinical and histopathological study about actinic keratoses in Korea. OBJECTIVE: Our purpose was to carry out a clinical and histopathological study about actinic keratoses in Korea. METHODS: 158 patients, diagnosed with actinic keratoses from 1987 to 1995 in Korea, were analyzed clinically and histopathologically. RESULTS: 1. The ratio of males to females was 1:2.4 and the most frequent age groups were the 6th(29.1%) and 7th decade(33.5%). 2. The duration of the lesions was more than 1 year in most cases. 3. The most commonly involved sites were the face, in which the cheek, nose and forehead were the most common sites. 4. Clinically, the size of the lesions was less than 1cm in many cases(66.8%). The color was erythematous in 57.9%, brownish in 26.7%, and dark brownish in 15.3%. Crust and scale were noted in 28.7% and 25.2%, respectively. In 4% of patients, cutaneous horn also was noted. 5. Squamous cell carcinoma was associated with actinic keratoses in 5.7%, basal cell carcinoma in 3.2%, and keratoacanthoma in 1.3%. 6. Histopathologically, hypertrophic types of actinic keratoses were noted in 25.0%, atrophic types in 21.3%, hypertrophic and atrophic types in 18.1%, bowenoid types in 17.6%, acantholytic types in 13.3%, and pigmented types in 4.7%. 7. The most commonly used methods of treatment for actinic keratoses were cryotherapy, surgical excision, 5 FU ointment, and electrodesiccation with good effect. CONCLUSION: Actinic keratoses in Koreans was present on the face most commonly over 50 years of age. It showed a more frequent incidence in females than males. The clinical course of the lesions was chronic and the association with other cutaneous malignancies was noted to be less than 6%. The various histopathological types were noted, including hypertrophic, atrophic, hypertrophic and atrophic, bowenoid, acantholytic, and pigmented. The most commonly used methods of treatment. for actinic keratoses were cryotherapy, surgical excision, 5-FU ointment, and electrodesiccation.
Actins* ; Animals ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cheek ; Cryotherapy ; Female ; Fluorouracil ; Forehead ; Horns ; Humans ; Incidence ; Keratoacanthoma ; Keratosis, Actinic* ; Korea* ; Male ; Nose

BACKGROUND: One of most important mechanisms of coronary stent restenosis is neointimal hyperplasia. Although the process of neointima formation is not fully understood, a special role has been advocated for adherent platelets. Previous studies have shown a clear benefit with combined antiplatelet therapy such as aspirin plus ticlopidine in reducing the rate of thrombotic occlusions of stented vessels. The purpose of this study was to evaluate the effects of duration of antiplatelet regimens on coronary stent restenosis. METHODS: After successful placement of coronary artery stents in 222 patients, we performed follow-up coronary angiograms in 99 patients (42.3%). Forty-six patients were randomly assi-gned to receive aspirin and ticlopidine for four weeks (Group I: 54+/-9 years: M 38, F 8) and 48 patients for 6 months (Group II: 58+/-8 years: M 38, F 10). RESULTS: There were no significant differences in clinical and procedural variables or coronary lesion characteristics before and after stenting. At 6 months after stenting, minimal luminal diameter was 2.16+/-0.93mm in Group I and 2.04+/-1.07mm in Group II (p-0.57). Late lumen loss was 0.80+/-1.07mm in Group I and 0.92+/-1.11mm (p-0.58) in Group II. The stent restenosis rate of Group I at 28.3% and that of Group II at 29.2% were not statistically significant between the two groups (p-0.92). CONCLUSIONS: The therapeutic duration of combined antiplatelet regimen with aspirin and ticlopidine after coronary stent does not affect stent restenosis rate.
Aspirin* ; Coronary Vessels ; Follow-Up Studies ; Humans ; Hyperplasia ; Neointima ; Phenobarbital ; Stents* ; Ticlopidine*

PURPOSE: At many institutes in Korea, preliminary interpretations of after-hours CT and MR images are performed by radiology residents, with the attending radiologist's reviewing the interpretations the next day. The purpose of this study was to assess the rate of discrepancy between residents' interpretations and the final interpretations performed by attending radiologists. METHODS: We reviewed the interpretations of 1381 CT and 404 MRI scans that were obtained at the emergency department of our institute over three months. Any discrepancies between the preliminary and final interpretations were categorized as either major or minor discrepancies with a major discrepancy defined as one resulting in a change in diagnosis and treatment plans. We conducted patient follow-up via a retrospective review of the medical records to evaluate the clinical outcomes of the discrepancies. RESULTS: The rate of major discrepancies was 2.5%, and the rate of minor discrepancies was 11.4%. Major discrepancies led to a change in diagnosis or patient treatment plans, but did not lead to any increase in patient morbidity. CONCLUSION: The discrepancy rate at our institution was relatively insignificant, and patient care at the emergency department was not adversely affected by having radiology residents interpret CT and MRI scans after-hours and the attending radiologist review the interpretations the next morning. Still, further efforts are needed in order to reduce the frequency of major discrepancies.
Academies and Institutes ; Emergencies ; Emergency Medicine ; Follow-Up Studies ; Humans ; Internship and Residency ; Korea ; Magnetic Resonance Imaging ; Medical Records ; Patient Care ; Retrospective Studies