The age of puberty represents a very critical time in the life history of every young woman. The menarche stands as primary indicator of the onset of sexual maturation in females. According to several studies, menarcheal age in Korean girls has dropped from about 15 years of age in 1960s to 13.5 years of age in 1980s. This findings show a pronounced secular trend to earlier maturation. The purpose of this study is to determine (1) the average age at menarche in Korea in present time, (2) the secular trend of menarcheal age, and (3) the geographic regional influence on menarche. The data sampling was obtained from the physical examination cards of women students in Yonsei University who entered from 1983 to 1991. The data which was obtained from the number of 7761 was analysed by dBase III plus and SAS program. The results are as follows: 1) The mean menarcheal age of the subjects was 13.7+/-1.2 years. 2) Age at menarche has been getting earlier by some 7.4 months during the period of recent II years. 3) Comparing to the decreasing secular trend of menarcheal age, the height and weight showed increasing trend. 4) There were significant differences in menarcheal age, height, weight among geographic regions. We conclude that the results indicate an accelerating secular trend in age of menarche in Korea.
Adolescent ; Female ; Humans ; Korea* ; Menarche ; Physical Examination ; Puberty ; Sexual Maturation

Among two groups of navy recruits undergoing training, one consisting of 500 enlisted men and another 100 newly enrolled midshipmen, 18 reported to Chinhae Naval Hospital with fatigue fractures during the period from February though September 1969. Following observations were made on these cases: 1. The incidence of fatigue facture was 1.4 percent among the enlisted men and 11 per cent among the midshipmen. 2. There were 6 cases of complete fraeture and 2 cases of incomplete fracture. In the remaining 10 cases, only periosteal reaction was evdent roentgenographically with no visible fracture line initially: fracture lines, however, became apparent on subsequent examinations in all the cases. 3. The fractures involved the femur in 4 cases and the tibia in 14 cases, a ratio of 1:3. 5 in latter s favor. 4. The site of predirection in the femur was the distal one third of the shaft, occurring in 3 of the cases. In the tibia the junction of the upper and middle thirds was most frequently affected, occurring in 10 of the cases. 5. All the cases in our series healed without any complications.
Fatigue ; Femur ; Fractures, Stress ; Humans ; Incidence ; Male ; Tibia

STUDY DESIGN: This study assessed the final functional results after treatment of thoracolumbar burst fractures and compared the relationship between the results and the parameters of reduction and state of the fractures. OBJECTIVES: To define prognostic factors affecting the final results and to present some precautions to minimize the treatment failure. SUMMARY OF LITERATURE REVIEW: In the treatment of the thoracolumbar burst fractures in which flexion loads are predominant, the sagittal contour is crucial to achieve permanent pain-free stability, but definitive therapeutic guidelines have remained a controversal topic. MATERIALS AND METHODS: We reviewed 37 thoracolumbar burst fractures with an average follow up period of 1.8 years: group 1 consisting of 20 cases treated conservatively and group 2 consisting of 17 cases treated surgically with posterior instrumentation. Finally functional results were analysed with the Denis'pain and work scores, and were compared between groups on anterior body height and local kyphosis. RESULTS: A satisfactory pain score less than or equal to P3 was in 15(75%) in group 1 and 15(88.2%) in group 2(p>0.05), but satisfactory work score less than or equal to W3 was in 12(60%) in group 1 and in 14(82.4%) in group 2(p<0.05). But, some loss of body height and local kyphosis in group 1 was not reversely related with functional outcomes. Eight cases in group 1 showing unsatisfactory result in work scores were analyzed as 4 osteoporosis(Jikei grade I, II/III), 3 associated compression fracture of the contiguous vertebra and one combined osteoporosis and compression fracture, showing significant loss of vertebral height and increase of kyphosis(p<0.01). CONCLUSIONS: Functional results of group 1 showing loss of vertebral height less than 50% and increased kyphosis less than 200 were comparable to those of group 2. The osteoporosis and associated compression fracture of adjacent vertebra were the risk group to develop posttraumatic kyphosis and might be added to the surgical indication of the thoracolumbar burst fractures.
Body Height ; Follow-Up Studies ; Fractures, Compression ; Kyphosis ; Osteoporosis ; Spine ; Treatment Failure

Adult intussusception is rare involving of only 1% of the causes of bowel obstruction. We report a case of a 39-year-old female with intussusceptions due to inverted Meckel's diverticulum. She visited our hospital for diffuse abdominal pain during 1 week and aggravated abdominal pain for 2 days. Vital signs were stable, and there was periumbilical tenderness. She had no history of abdominal operation. CT scan showed a 3.7x2.1 cm of fatty mass with focal intussusception in the distal ileum. When the emergency operation was performed, the patient was found to be suffering from ileocolic intussusception. A manual reduction of intussusception showed inverted Meckel's deverticulum at 65 cm proximal to the ileocecal valve, and the segmental resection of small bowel including a Meckel's diverticulum was performed. Pathologic examination revealed a Meckel's diverticulum containing a 0.6x0.6 cm sized aberrant pancreas.
Abdominal Pain ; Adult ; Emergencies ; Female ; Humans ; Ileocecal Valve ; Ileum ; Intussusception ; Meckel Diverticulum ; Pancreas ; Stress, Psychological ; Vital Signs

Kimura's disease is an uncommon, chronic inflammatory disease of unknown etiology. It is an important category of reactive lymphadenopathy in the oriental population. The most common sites are the subcutis of the head and neck, and parotid gland. It's clinical course is benign nature. The treatment modalities for this disease are steroid therapy, radiation therapy and surgical excision. We experienced a case of soft tissue mass in the left arm. It was slightly tender and relatively movable. We excised the mass, which was turned out to be Kimura's disease on microscopic examination.
Arm ; Head ; Lymphatic Diseases ; Neck ; Parotid Gland

The lack of familiarity with vertebral actinomycosis by both clinicians and radiologists, may contribute to its frequent omission from the differential diagnosis of suspicious lesions, therefore the condition can be difficult to diagnose. We now present the first report of two cases of thoracic and lumbar vertebral actinomycosis resulting in a paraparesis due to epidural abscess which necessifated surgery.
Actinomycosis* ; Diagnosis, Differential ; Epidural Abscess ; Paraparesis ; Recognition (Psychology) ; Spine

STUDY DESIGN: In this study, 18 patients undergoing posterior lumbar interbody fusion for multilevel lumbar spinal stenosis associated with degenerative scoliosis were reviewed retrospectively. OBJECTIVES: To assess the effectiveness of the cage-instrumented posterior lumbar interbody fusion in multilevel lumbar spinal stenosis associated with degenerative scoliosis. SUMMARY OF LITERATURE REVIEW: Degenerative lumbar scoliosis with the problems of neurogenic claudication, mechanical back pain and spinal deformity present a challenge for treatment. MATERIALS AND METHODS: We reviewed 18 surgical cases of multilevel lumbar spinal stenosis with degenerative scoliosis from March 1995 to April 2000 with an average follow up period of 2.9 years. We assessed the radiographic results of scoliotic angle correction and sagittal angle correction of the maximum curve and fused segment and disc height restoration. Clinical results were evaluated according to the Kirkaldy-Willis criteria. RESULTS: Mean scoliotic angle at preoperative, postoperative and final follow-up (maximum curve/fused segment) was 17.7-6.1-7.3degree /15.0-5.8-6.1degree respectively. Mean sagittal angle corresponding to each period was 12.1-34.1-32.7degree /8.3-27.0-26.0degree respectively. Mean disc height corresponding to each period was 22.9-42.4-40.5% respectively. The clinical result was analyzed as 15 satisfactory (83.3%), 3 fair (16.7%) and no poor. Fusion success was achieved in all patients. There were no serious complications except one case of fusion extension distally and no significant curve progression within follow-up period. CONCLUSIONS: The cage-posterior lumbar interbody fusion in multilevel lumbar spinal stenosis with degenerative scoliosis was effective for correction of scoliotic and sagittal deformity and restoration of disc height with resultant foraminal patency, provided relatively high clinical success and in situ fusion success in all cases even over multiple fusion levels, and can be an alternative among surgical treatments of this complex disease.
Back Pain ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis* ; Spinal Stenosis*

PURPOSE: Restaging after neoadjuvant treatment is done for planning the surgical approach and, increasingly, to determine whether additional therapy or resection can be avoided for selected patients. MATERIALS AND METHODS: Local restaging after neoadjuvant chemoradiation therapy (nCRT) was performed in 270 patients with locally advanced (cT3or4 or N+) rectal cancer. Abdomen and pelvic computed tomography (APCT) was used in all 270 patients, transrectal ultrasound (TRUS) in 121 patients, and rectal magnetic resonance imaging (MRI) in 65 patients. Findings according to imaging modalities were correlated with pathologic stage using Cohen's kappa (κ) to test agreement and intra-class correlation coefficient α to test reliability. RESULTS: Accuracy for prediction of ypT stage according to three imaging modalities was 45.2% (κ=0.136, α=0.380) in APCT, 49.2% (κ=0.259, α=0.514) in rectal MRI, and 57.9% (κ=0.266, α=0.520) in TRUS. Accuracy for prediction of ypN stage was 66.0% (κ=0.274, α=0.441) in APCT, 71.8% (κ=0.401, α=0.549) in rectal MRI, and 66.1% (κ=0.147, α=0.272) in TRUS. Of 270 patients, 37 (13.7%) were diagnosed as pathologic complete responder after nCRT. Rectal MRI for restaging did not predict complete response. On the other hand, TRUS did predict three complete responders (κ=0.238, α=0.401). CONCLUSION: APCT, rectal MRI, and TRUS are unreliable in restaging rectal cancer after nCRT. We think that multimodal assessment with rectal MRI and TRUS may be the best option for local restaging of locally advanced rectal cancer after nCRT.
Abdomen ; Hand ; Humans ; Magnetic Resonance Imaging ; Neoadjuvant Therapy ; Neoplasm Staging ; Rectal Neoplasms* ; Ultrasonography

BACKGROUND: Chronic cough is commonly defined as a persistent or recurrent cough exceeding 3 weeks duration and the prevalence of chronic cough is reported to range from 14-23% among non-smoking adults. Irwin et al previously reported that common causes of chronic cough are postnasal drip syndrome asthma, and gastroesophageal reflux using the anatomic and diagnostic protocol. OBJECTIVE: To determine the spectrum and frequency of chronic cough and to aid establishing algorithmic approach for chronic cough. MATERIALS AND METHOD: We prospectively evaluated 105 consecutive and unselected immunocompetent patients complaining of chronic cough utilizing modified anatomic and diagnostic protocol proposed by Irwin et al. Initial diagnosis was made by history, physical examination and laboratory test including spirometry, methacholine provocation test, and 24 hour pH monitoring. Specific treatment was done based upon initial diagnosis and cough score was compared before and after treatment. Reassessment was done in case of treatment failure. RESULT: The causes of cough were determined in 100 of 105 patients(95% ). Cough was due to one condition in 94.8% and two in 15.2%. 121 causes of cough were identified and their spectrum and frequency were found to be postnasal drip syndrome (39.3% ), asthma (32.2% ), gasteroesophageal reflux (14.1%), chronic bronchitis (5.0%), others (4.1%: drug-induced, bronchiolitis, endobronchial tuberculosis, and lung cancer). History about nasal symptoms was useful, but history about gastroesophageal reflux were not useful for the diagnosis. CONCLUSION: The results suggest that anatomic and diagnostic approach for evaluating chronic cough is also useful in Korea and the most common causes of chronic cough are postnasal drip syndrome, asthma and gastroesophageal reflux.
Adult ; Asthma ; Bronchiolitis ; Bronchitis, Chronic ; Cough* ; Diagnosis ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Korea ; Lung ; Methacholine Chloride ; Outpatients* ; Physical Examination ; Prevalence ; Prospective Studies* ; Spirometry ; Treatment Failure ; Tuberculosis

STUDY DESIGN: The preoperative and postoperative lateral radiograms and clinical results were analyzed in 22 cases of lumbar spinal stenosis with osteoporosis treated by posterior decompression and posterior lumbar interbody fusion. OBJECTIVES: To assess the efficiency of the cage-instrumented posterior lumbar interbody fusion in lumbar spinal stenosis with osteoporosis. SUMMARY OF LITERATURE REVIEW: Problems in surgical treatment of osteoporotic spinal stenosis were early screw loosening and early reversal to the original deformity because of insufficient mechanical stability in the bone-screw interface, and special strategy is essential for transpedicle screwing to sustain axial and screw cut-up load applied by flexion-extension motion in vivo. MATERIALS AND METHODS: We reviewed 22 cases of lumbar spinal stenosis with osteoporosis(Jikei grade I, II/III) from June 1996 to July 1998 with an average follow up period of 1.4 years. Inclusion criteria was combined segmental instability, deformity, spondylolisthesis and herniated nucleus pulposus with significant disc space narrowing. We asssessed the radiographic results of sagittal angle correction(SAC) of the instrumented segment and disc height restoration(DHR) on the preoperative, postoperative and last follow up lumbar lateral views, and clinical results according to the Kirkaldy-Willis criteria. RESULTS: Postoperative mean SAC gain was 10degree(p<0.05) and mean SAC loss at last follow up was 1.1degree(p>0.05). Postoperative mean DHR gain was 21.3%(p<0.05) and mean SAC loss at last follow up was 3.9%(p>0.05). The clinical result was analyzed as 2 excellent(9.1%), 16 good(72.7%), 4 fair(18.2%) and no poor. There were 2 intraoperative complications of a dural tear and a nerve root injury and 2 postoperative complications of a transient radiculopathy and a pseudoarthrosis. CONCLUSIONS: Cage-instrumented posterior lumbar interbody fusion can be an option for the lumbar spinal stenosis with osteoporosis requiring instrumentation because of instability, deformity or postdiscectomy anterior column deficiency.
Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Intraoperative Complications ; Osteoporosis* ; Postoperative Complications ; Pseudarthrosis ; Radiculopathy ; Spinal Stenosis* ; Spondylolisthesis ; Tears