Chylothorax is the most common cause of pleural effusion in the neonatal period and is defined as an effusion of lymph in the pleural cavity. We report a case of chylothorax in a 13-day-old male who was admitted due to respiratory difficulty. Chest AP showed pleural effusion of the left lung and milky yellow fluid was aspirated via thoracentesis upon which laboratory and lipoprotein electrophoresis of pleural fluid revealed findings compatible with that of chylothorax. Due to reaccumulation of chyle after daily thoracentesis, chest tube was inserted at the 4th hospital day, and MCT containing diet was given. He was discharged on the 21st hospital day in good health, and revealed no recurrence for 3 months during outpatient follow up visits.
Chest Tubes ; Chyle ; Chylothorax* ; Diet* ; Electrophoresis ; Follow-Up Studies ; Humans ; Infant, Newborn ; Lipoproteins ; Lung ; Male ; Outpatients ; Pleural Cavity ; Pleural Effusion ; Recurrence ; Thoracostomy* ; Thorax ; Triglycerides*

We had experienced 2 cases of acute subdural hematoma due to vitaimin K(vit. K) deficiency. They were 44-and 42-day-old. After the adminstration of vit.K1, prolonged prothrombin time(PT) and activated partial thromboplastin time(APTT) were corrected, so the surgical treatment ws performed. We supposed the predisposing factors were breast feeding and unknown hepatic pathology. No complication remained to one infant but the other multiple cerebral infarctions. The etiology, pathogenesis, diagnosis, prevention are discussed. We insist on neonatal administration of vit. K1 for the prevention of bleeding tendency. If intracranial hemorrhage develops, we must keep in mind that the early neurosurgical intervention may be needed.
Breast Feeding ; Causality ; Cerebral Infarction ; Diagnosis ; Hematoma, Subdural, Acute* ; Hemorrhage ; Humans ; Infant* ; Intracranial Hemorrhages ; Partial Thromboplastin Time ; Pathology ; Prothrombin ; Prothrombin Time ; Thromboplastin ; Vitamin K Deficiency ; Vitamins*

ICAM-l(Intercellular adhesion molecule-1) is an important early marker of immune activation and response. ICAM-1 is expressed on varous cell types and observed in a variety of diseases, including patients with asthma, melanoma, prostatic cancer, ovarian and colon cancer. Some authors demonstrated the expression of ICAM-1 protein in high-grade intraepithelial squamous neoplasia of cervix by immunohistochemistry and suggested that the expression was related to human papillomavirus infection. The aim of this study was to determine the serum levels of soluble intercellular adhesion molecule-1(sICAM-1) in patients with squamous cell carcinoma of the cervix, Serum levels of sICAM-1 were measured by enzyme-linked immunosorbent assay(ELISA), We evaluate invasive squamous cell carcinoma of the cervix (40), carcinoma in situ (16) and control (15) patients. Serum levels of sICAM-1 in healthy volunteers, in parients with carcinoma in situ and invasive cervical cancer were 150.1+/-41.3, 182.7+/-105.9, 189.8+/-60.0 ng/ml, respectively. Although the serum levels of sICAM-1 in patients with carcinoma in situ did not increase, serum levels of ICAM-1 in patients with invasive cervical cancer were significantly increased (control vs invasive cervical cancer, p < 0,05). From the above results, sICAM-1 is shed from the cancerous tissue in patients with squamous cell carcinoma of the cervix.
Asthma ; Carcinoma in Situ ; Carcinoma, Squamous Cell ; Cervix Uteri ; Colonic Neoplasms ; Enzyme-Linked Immunosorbent Assay ; Female ; Healthy Volunteers ; Humans ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Melanoma ; Papillomavirus Infections ; Prostatic Neoplasms ; Uterine Cervical Neoplasms*

No abstract available.
Diabetes Mellitus* ; Hearing* ; Humans

No abstract available.
Spine*

Acromioclavicular joint injuries are recently increased, but there are still controversies as to the proper choice of treatment. We treated thirty cases of acromioclavicular injuries, among these, twenty five cases were done by operative method and five cases conservatively from August 1979 to June 1988. The results were as follows, 1. The injuries were composed of one case of Type 1, 7 cases of Type 2 and 22 cases of Type 3. 2. The result of conservative treatment consisted of 2 cases of good, 1 case of fair and 2 cases of poor. 3. The final outcome of operative method was better than that of conservative one, which consisted of 16 cases of good and 9 cases of fair. 4. The cause of fair results in operative method was thought to residual lexity of the repaired coracoclavicular ligament. 5. The key point of operative treatment in acromioclavicular separation was firm and strong reconstruction of the coracoclavicular ligament. 6. Modified method of coracoclavicular ligament reconstruction using coracoacromial ligament with bone block has been tried.
Acromioclavicular Joint ; Ligaments ; Methods

In order to identify the risk factors for shunt dependency and to select the optimal treatment modality of hydrocephalus in medulloblastoma patient, fifty two patients with medulloblastoma, who were treated at Seoul National University Hospital from 1982 to 1992, were reviewed. Retrospectively the authors analyzed the types of treatment and the results in the fifty patients of hydrocephalus associated with medulloblastoma. Two cases of perioperative death were excluded from the statistical analysis. The initial management of hydrocephalus in 50 patients included:1) ventriculoperitoneal shunt(VPS) before the removal of tumor in 6, 2) external ventricular drainage(EVD) bfore the removal of tumor in 4, 3) intraoperative ventricular puncture and placement of EVD or internalized reservoir(IVD, internalized ventricular drainage) for continuous or intermittent cerebrospinal fluid(CSF) drainage postoperatively in 29, 4) no procedures of CSF drainage before or during the operation for tumor removal in 11. Among the 44patients in whom preoperative VPS was not inserted, 16 finally required permenent VPS after tumor removal and 28 remained shunt-free. Factors which might predict the need for permanent VPS were analyzed and tested statistically. The presence of symptoms and signs of increased intracranial pressure, the severity of hydrocephalus on computerized tomography(CT), T and M stage, and the type of initial management of hydrocephalus were not statistically significant factors influencing the shunt dependency. The only two statistically significant features predicting the need for a subsequent permanent shunt were:1) incomplete tumor removal(p=0.025) and 2) postoperative hematoma in the fourth ventricle(p=0.004) Among the 11 patients without preoperative or intraoperative EVD, 4 required shunt placement after tumor removal, of which 3needed urgent placement of EVD. Preoperative or intraoperative EVD could have played a role as a safety mechanism in those patients. On the other hand, the preoperative or intraoperative EVD did not enhance the rate of infection or shunt dependency. In the cases of ventricular installations for CSF drainage, simple externalization of ventricular catheter and postoperative continuous CSF drainage(EVD) seemed to be associated with a lower rate of infection compared with the method of postoperative intermittent puncture and drainage through the internalized reservoir(IVD), but the difference of infection rates between the two groups were statistically insignificant(p=0.557). The average duration of CSF drainage in the externalized EVD roup was shorter than that of internalized reservoir group(5.4 versus 10.7 days). In conclusion, 1) the preoperative or intraoperative EVD is useful as a safety mechanism while it dose not enhance the possibilities of shunt dependency and infection, 2) for the patients in whom the placement of subsequent permanent shunt is highly expected, the EVD with the internalized reservoir can be a good choice. An algorithm for the management of hydrocephalus was suggested.
Catheters ; Drainage ; Hand ; Hematoma ; Humans ; Hydrocephalus* ; Intracranial Pressure ; Medulloblastoma* ; Punctures ; Retrospective Studies ; Risk Factors ; Seoul ; Ventriculoperitoneal Shunt

Spinal cord tumors usually present themselves with severe pain without neurologic deficits during early stages. Cervical or thoracic spinal tumors can evoke anterior neck pain or chest pain without neurologic symptoms. As a result, when chest pain or anterior neck pain occurs initially, many physicians think its origin is a cardiac disorder such as angina. Eventually, during cardiac evaluation and treatment, myelopathy or radiculopathy develops to reveal spinal cord tumor. Even though it is rare, when anterior neck or chest pain is the presenting complaint, the possibility of spinal cord tumors should be considered. We report a case of spinal cord tumor with initial presentations of anginal chest pain and electrocardiographic myocardial ischemic changes (ST segment depression and T-wave inversion) in a 45 year old male patient who had no history of hypertension. It was later discovered that the cause was due to an A-V malformation.
Chest Pain* ; Depression ; Electrocardiography ; Humans ; Hypertension ; Male ; Neck ; Neck Pain ; Neurologic Manifestations ; Radiculopathy ; Spinal Cord Diseases ; Spinal Cord Neoplasms*

Two factors of the ventricular function, systolic contractile and diastolic relaxing functions, cooporate in pumping the adequate blood volumes to suffice bodily demands. In some hypertensive patients with marked left ventricular hypertrophy, the intact systolic function of the ventricle associated with clinical symptom of congestive heart failure(CHF), which is considered to be a consequence of diastolic dysfunction. In this study 10 hypertensive patients(group A) complaining of exertional dyspnea or chest pain with increased left ventricular mass index and normal systolic function and 6 normotensive controls(group B) were examined by cardiac catheterization and echocardiography to assess the left ventricular systolic and diastolic function and ventricular responses to constant infusion of nitroprusside. Various systolic and diastolic function indices were measured by cardiac catheterization and echocardiography. 1) The ejection fraction(EF), fractional fiber shortening, mean velocity of circumferential fiber shortening, left ventricular(LV) peak+dp/dt, change of slope of LV peak systolic pressure-volume and pressure-dimension relations in group A were not different from those of group B in the resting states. 2) Diastolic dysfunction was evidenced by prolonged A2D time, decreased OR slope, decreased peak negative dp/dt and increased diastolic time constant 'T' in group A. 3) Cardiac index by thermodilution method was negatively related to left ventricular mass index(LVMI) measured by echocardiography, whereas time constant T was positively related to LVMI. 4) With constant infusion of nitroprusside, LV systolic pressure, LV end-diastolic pressure and pulmonary arterial pressure were decreased, and left ventricular end-systolic stress and stroke work index(SWI) derived from left ventricular pressure-volume loop area were decreased, EF was increased, but time constant T was prolonged and cardiac output(CO) by thermodilution method was decreased in group A. 5) In group B, with constant infusion of nitroprusside, EF, SWI and CO were pratically unaffected and time constant T was not prolonged significantly. These reults suggest that patients with hypertensive hypertrophic left ventricle is associated with diastolic dysfunction, which could further be exacerbated by a vasodilator such as nitroprusside.
Arterial Pressure ; Blood Pressure ; Blood Volume ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Dyspnea ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart Diseases* ; Heart Ventricles* ; Heart* ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Nitroprusside* ; Stroke ; Theophylline ; Thermodilution ; Ventricular Function

We report a case of focal dermal hypoplasia associated with ichthyosis in an 18-year-old Korean female. The patient showed a yellowish atrophic patch on the left side of her abdomen, abnormal skin pigmentation, nail dystrophy and ichthyosis since birth.We could also find skeletal and dental deformities. The biopsy specimen obtained from the yellowish atrophic patch showed marked attenuation of collagen fibers and ectopic fatty tissue nearly reaching up to the upper dermis.
Abdomen ; Adipose Tissue ; Adolescent ; Biopsy ; Collagen ; Congenital Abnormalities ; Dermis ; Female ; Focal Dermal Hypoplasia* ; Humans ; Ichthyosis* ; Skin Pigmentation