Purpose: The purpose of our study was to assess the clinical and radiological results of isolated acetabular revision and the differences in the results between monoblock and modular femoral stems. Materials and Methods: Between October 1991 and June 2002, 39 patients (39 hips) underwent isolated acetabular revisions with use of uncemented cups and bone grafts. The mean period of follow-up was 5 years 3 months (range, 2 years 1 month to 9 years 8 months). The mean age of the patients at the time of the surgery was 51 years old (range, 26 to 75 years old). The monoblock femoral stems were used in 19 hips and the modular femoral stems were used in 20 hips. The monoblock stems were retained without exchange provided that there was no gross scratch on the femoral head and the femoral stem was confirmed to be stable and fixed intraoperatively. In the modular stems, the femoral heads were always exchanged with new ones. Results: The mean Harris hip score improved from 57 to 87 points. Radiologically, all the stems retained at surgery remained well osseointegrated without osteolysis. Re-revisions of the acetabular components were performed in 5 hips using monoblock stems due to periacetabular osteolysis caused by excessive wear of polyethylene and subsequent loosening of the cups in 3 hips and mechanically unstable acetabular cups without osteolysis in 2 hips. The mean wear rate of polyethylene coupled with the monoblock stem was 0.27 mm/year which was greater than the 0.11 mm/year in the cases with modular stems. Conclusion: To prevent failure of acetabular cups that may occur later by excessive wear of polyethylene, we recommend revision of the well-fixed monoblock femoral stems even though there is no gross scratch on the femoral heads of the monoblock stems.
Acetabulum* ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteolysis ; Polyethylene ; Transplants

BACKGROUND: We analyzed the changes in QT dispersion (QTd) in children with Kawasaki disease (KD), and determined the presence of repolarization abnormality in these children even in the absence of coronary artery abnormalities. METHODS: Ninety-one children with KD and 20 healthy controls were enrolled in this retrospective study. Serial echocardiographic and electrocardiographic (ECG) measurements in the beginning of treatment, 2nd month and 6th month after the diagnosis were compared. Fifty-one of 91 children had at least 2 serial ECG data. The number of patients who had 3 consecutive ECG data was 23. RESULTS: Among the 67 KD patients with no coronary artery changes, the consecutive mean QTd values were 41.86 ms, 37.84 ms, and 25.47 ms, respectively (26 ms for controls). In the analysis of changes among KD patients without coronary artery abnormalities, QTd showed a significant decrease with time (p=0.01). Especially, the 1st month and the 6th month QTd values were significantly different (p=0.028). The mean QTd values in KD patients with coronary artery changes were significantly higher than those in KD patients with no coronary artery changes at each time (1st, 2nd, and 6th month exam). CONCLUSION: QTd is significantly increased in children during the early stage of KD. Repolarization abnormality may exist during the acute stage of KD, regardless of the echocardiographic changes.
Child* ; Coronary Vessels ; Diagnosis ; Echocardiography ; Electrocardiography ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies

Turner syndrome with abnormalities of X chromosome is generally characterized by gonadal dysgenesis causing premature ovarian failure, primary and secondary amenorrhea. Premature ovarian failure is often caused by X chromosome aberrations. It has been shown that gross X chromosome abnormalities such as monosomy X usually result in primary amenorrhea and poor pubertal development, whereas mild X chromosome abnormalities such as partial X deletions usually lead to secondary amenorrhea and fairly good pubertal development. Fertility has been reported in several patients with relatively small Xq deletions before the onset of premature ovarian failure, and the X chromosome abnormality is often inherited by offspring. We describe a 46,X,del(X)(q26) female with normal pregnancy, in whom same karyotype was found in the fetus by amniocentesis. We report this case with brief review of related literatures.
Amenorrhea ; Amniocentesis ; Female ; Fertility ; Fetus* ; Gonadal Dysgenesis ; Humans ; Karyotype* ; Pregnancy ; Pregnant Women* ; Primary Ovarian Insufficiency ; Turner Syndrome ; X Chromosome

PURPOSE: To evaluate the prevalence of capsular retraction in malignant hepatic tumors and the factorsinvolved. MATERIALS AND METHODS: Between January 1994 and December 1996, we retrospectively reviewed the CT scansof 152 patients with pathologically-proven, peripherally-located, malignant hepatic tumors. We evaluated size,site, portal and hepatic venous obstruction, bile duct dilatation, and liver atrophy in 18 cases involvingcapsular retraction. RESULTS: The overall prevalence of capsular retraction among malignant hepatic tumors was18/152(12%) ; the prevalence was 9/129(7%) in hepatocellular carcinoma, 6/14(43%) in cholangiocarcinoma and3/9(33%) in metastatic cancer ; among cases of cholangiocarcinoma and metastatic cancer, the prevalence washigh(p <0.05). Portal venous obstruction was seen in six patients with hepatocellular carcinoma (a high incidence ;p=0.041) and one with cholangiocarcinoma. Hepatic venous obstruction was demonstrated in one patient withhepatocellular carcinoma and one with cholangiocarcinoma. Among cholangiocarcinoma patients, bile duct obstructionwas seen in four and liver atrophy in three, but among metastatic cancer cases there were no similar findings. CONCLUSION: The main factors causing capsular retraction were portal venous obstruction in hepatocellularcarcinoma and bile duct obstruction and liver atrophy in cholangiocarcinoma.
Atrophy ; Bile Ducts ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Cholestasis ; Dilatation ; Humans ; Incidence ; Liver ; Prevalence ; Retrospective Studies

BACKGROUND: In Korea, clinical performance examination (CPX) has been included in license examination for medical doctors since 2009 in order to improve clinical performance of medical students. This study aimed to evaluate the contribution of CPX to medical education. METHODS: Clinical competency in the differential diagnosis of secondary headache was compared between the incoming interns in 2009 unexposed to CPX and the incoming interns in 2010 exposed to CPX, using the data of patients who visited the emergency department due to headache (181 patients seen by 60 CPX non-exposed interns and 150 patients seen by 50 CPX-exposed interns). We obtained the data by reviewing electronic medical records and nominal lists of doctors. Clinical competency was assessed by sensitivity and specificity between the diagnostic impression by interns and the final diagnosis. The association between CPX exposure and clinical competency in secondary headache diagnosis was evaluated using multiple logistic regression analysis. RESULTS: When we assessed clinical competency on the basis of all listed diagnostic impressions, sensitivity and specificity were 67.9% and 80.0%, respectively, for headaches seen by CPX-exposed interns, and 51.7%, and 71.7%, respectively, for headaches seen by CPX non-exposed interns. Multivariable adjusted logistic regression analysis showed exposure to CPX was not associated with increased competency for identifying secondary headache. CONCLUSION: Exposure to CPX as a part of the medical license examination was not effective for the improvement of clinical competency of interns in identifying secondary headache.
Competency-Based Education ; Diagnosis ; Diagnosis, Differential* ; Education, Medical ; Electronic Health Records ; Emergency Service, Hospital ; Headache* ; Humans ; Internship and Residency ; Korea ; Licensure ; Logistic Models ; Sensitivity and Specificity ; Students, Medical

OBJECTIVES: To evaluate the patterns of changes in maternal weight and fetal weight discordance in twin pregnancies during consecutive gestational periods. METHODS: A retrospective chart review was done for a total of 148 twin pregnancies taken care of throughout pregnancies between February 2002 and May 2004. They were divided into two groups; group A consisting of 109 cases without postnatal complications and with no more than 25% twin weight discordance at birth, and group B consisting of 39 cases with more than 25% twin weight discordance. Both ultrasound examination and maternal weight measurement were conducted in the three gestational intervals; between prepregnant times to gestational age 18 weeks, between gestational ages 18 to 28 weeks, and from gestational age 28 weeks to delivery. RESULTS: Except for maternal weights, none of the pregnancy factors such as maternal age, parity, gravity, height, prepregnant weight, duration of pregnancy, natural or artificial pregnant status, gender and chorionicity showed any significant difference by means between the two groups. The maternal BMI of the group A vs. the group B at the first, the second, and the third period were 0.53+/-0.10% and 2.01+/-1.28%, 2.97+/-0.11% and 4.84+/-1.23%, and 3.29+/-0.16% and 2.15+/-0.63% respectively. Inter-twin weight discordances between the two groups were 8.29+/-0.67% vs. 11.26+/-1.25 %, 7.79+/-0.05% vs. 11.03+/-1.36%, and 9.07+/-0.55% vs. 32.79+/-1.13%, respectively. CONCLUSIONS: Although several factors that affect twin weight discordance may be considered, we showed that the pattern of maternal weight gain during the gestational period is associated with the estimated values of twin weight discordances in the first gestational period.
Chorion ; Female ; Fetal Weight ; Gestational Age ; Gravitation ; Humans ; Maternal Age ; Parity ; Parturition ; Pregnancy ; Pregnancy, Twin ; Retrospective Studies ; Twins* ; Ultrasonography ; Weight Gain ; Weights and Measures

PURPOSE: To report a case of periorbital infantile capillary hemangioma treated with propranolol. CASE SUMMARY: A 6-month-old girl visited our clinic for a mass on the right upper eyelid, which had been present since birth. A dome-shaped, red-purple colored mass occupying almost the entire right upper eyelid was observed, and overlying branch-shaped telangiectases were also detected. The visual axis of the right eye was partially obscured, due to the ptotic eyelid, and her ability to fix and follow was poor in the right eye. The patient was diagnosed with infantile capillary hemagioma. Because amblyopia in her right eye was suspected, treatment with propranolol was initiated. After 2.5 months of propranolol treatment, the hemangioma decreased in size and volume dramatically, changed from red-purple to light red color, and softened. The ptosis of the right upper eyelid improved, as well as the ability of the right eye to fix and follow. No significant adverse effects (e.g. hypotension, bradycardia, hypoglycemia, bronchospasm, or elevated liver enzymes) were observed, except transient QTc prolongation during cotreatment with ibuprofen, due to an upper respiratory infection. CONCLUSIONS: Propranolol should be considered as a treatment option for periorbital infantile capillary hemangioma. Further clinical studies are required to establish the optimal guidelines and long-term outcome.
Amblyopia ; Axis, Cervical Vertebra ; Bradycardia ; Bronchial Spasm ; Capillaries ; Eye ; Eyelids ; Hemangioma ; Hemangioma, Capillary ; Humans ; Hypoglycemia ; Hypotension ; Ibuprofen ; Infant ; Light ; Liver ; Parturition ; Propranolol ; Telangiectasis

Most of anti-incontinence surgeries bear the risk of postoperative complication such as voiding dysfunction due to urethral obstruction. Fortunately, Tension Free Vaginal Tape(TVT) procedure has much lower incidence of postoperative urethral obstruction than other surgical procedures for stress urinary incontinence. There are many reports about the surgical treatments for short-term urethral obstruction after TVT procedure. However, there are few reports on the effect of surgical releasing of the obstruction lasting for a long period. In our case, the patient had urethral obstruction for 32 months after TVT procedure and she was able to void well after surgical releasing of the tape. We suggest that releasing of the tape will be a treatment of choice for long-term urethral obstruction after TVT procedure.
Humans ; Incidence ; Postoperative Complications ; Suburethral Slings* ; Urethral Obstruction* ; Urinary Incontinence

We describe a 28-year old man in otherwise apparently good health, in whom pain in his left knee joint caused by avascular necrosis led to a diagnosis of polyarteritis nodosa (PAN). The angiogram showed multiple microaneurysmal and thrombotic lesions, notably in the renal, mesenteric and tibial arteries. A skin biopsy of the upper dermis of the left thigh with an erythematous skin rash showed the infiltration of mononuclear leukocytes in the perivascular area. During hospitalization, he was diagnosed with chronic hepatitis B, and was treated with lamivudine, and corticosteroid, azathioprine to control the PAN. The knee joint pain improved progressively, and the patient could walk normally after several months. This case is an unusual presentation because the initial manifestation of PAN was avascular necrosis.
Azathioprine ; Biopsy ; Dermis ; Exanthema ; Hepatitis B, Chronic ; Hospitalization ; Humans ; Knee Joint ; Lamivudine ; Leukocytes, Mononuclear ; Necrosis ; Osteonecrosis ; Polyarteritis Nodosa ; Skin ; Thigh ; Tibial Arteries

BACKGROUND: The relationship between infection of microorganism and atherosclerosis has been studied because the pathophysiology after infection is similar to those of cell injury and/or lipid theory. Although there are many reports which described the relationships between the infection of chalamydia pneumoniae and the atherosclerosis. In Korea, even the prevalence of chlamydia infection has not been studied yet. This study was purposed on the prevalence of chlamydia infection and it's correlation to atherosclerosis. METHODS: 235 subjects were enrolled and age and sex adjusted subjects were divided into two groups, normal controls (n=43), atherosclerosis (AS, n=90) group:coronary artery disease (CAD, n=61) and cerebrovascular disease (CVD, n=29). Serum total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C) were measured, LDL-cholesterol (LDL-C) was calculated. Serum IgG chlamydia antibody were measured by ELISA method. RESULTS: TG was significantly higher in AS (162.51+/-100.04 mg/dL vs 122.91+/-63.31 mg/dL, mean+/-SD, p=0.019), and HDL-C was significantly higher in controls (47.30+/-9.88 mg/dL vs 39.38+/-8.29 mg/dL, p<0A65A>0.01). Levels of LDL-C and TC were not statistical significant. Serum IgG chlamydia antibody was positive in 29.8% (70/235), 30% (27/90) in AS group and 28% in controls and there was no statistical significance between groups (p=0.804). CONCLUSION: In conclusion, there was no significant differences in positivity of IgG chlamydia antibody in AS compared with that of controls. Overall positivity of chlamydia antibody was lower in Korea than in other country. It is still controversial whether Chlamydia pneumoniae is a primary etiologic agent of atherosclerosis or not. This study could not demonstrate the relationship between chlamydia infection and atherosclerosis in Korea. The effectiveness and indications of antichlamydial antibiotics for prevention of cardiovascular complications in atherosclerosis and overall chlamydia infection in general population will be needed in large scale trials.
Anti-Bacterial Agents ; Arteries ; Atherosclerosis* ; Chlamydia Infections ; Chlamydia* ; Chlamydophila pneumoniae* ; Cholesterol ; Coronary Artery Disease ; Enzyme-Linked Immunosorbent Assay ; Immunoglobulin G ; Korea ; Pneumonia ; Prevalence ; Triglycerides