The exact etiologies and mechanisms of ischemia in avascular necrosis of femoral head are still under investigation. But this condition seems to be increasing during a few decades with increasing use of steroid and alcohol abuse in Korea. The treatment modalities have been based on the stages of the disease by simple radiographic findings that do not describe the accurate pathological extent or localization. Therefore more sophisticated study is needed to treat the AVN of the femoral head well. Magnetic resonance images, simple radiographs, scintigraphs of 13 patients(22 femoral heads), who were admitted and treated at Seoul National University Hospital from April, 1989 to December, 1989 were correlated, to characterize the type of AVN by extent and location regardless of its stage and reveal the relationship between types and stages. It is the result of this study that the type of AVN as well as stage should be considered in determining the treatment modality.
Alcoholism ; Classification ; Head ; Ischemia ; Korea ; Magnetic Resonance Imaging ; Necrosis ; Seoul

BACKGROUND: There has been a change in the causes of aortic stenosis when comparence of rheumatioc aortic stenosis in recent year. Therefore, we studied the etiology factor of pure aortic stenosis. METHODS: The gross surgical pathologic features of the aortic valves were reviewed in 92 patients with pure aotic stenosis whom underwent aortic valve replacement at Yonsei University, Cardiovascular center between July 1989 and June 1994. RESULTS: The three most frequent causes were 1) calcification of congenital bicuspid valve in 30%, 2) degenerative calcification of aortic valve in 22%, 3) rheumatioc valvular change in 48%. The mean age at the time of aortic valve replacement for the entire series of patients was 54.4 years. The range of age was from 18 years to 77 years. Males predominated for degenerative disease and congenital bicuspid valves, but there were reversed rheumatic origin. One or more complications occured in 17% of patients undergoing operation. The surgical mortality was 3.3%. CONCLUSION: Our data suggest that more common cause of aortic stenosis is non-rheumatic disease rather than rheumatinc origin.
Adult* ; Aortic Valve ; Aortic Valve Stenosis ; Constriction, Pathologic* ; Humans ; Male ; Mitral Valve ; Mortality

OBJECTIVE: The laparoscopic appendectomy was developed as an alternative procedure to be used in acute appendicitis. Some surgeons dispute the advantages of laparoscopic procedures for acute appendicitis. Specifically, there are many controversies associated with perforated appendicitis. We reviewed the results of appendectomies to assess the feasibility of a laparoscopic appendectomy in acute appendicitis that included perforated appendicitis. METHODS: Three hundred thirty-nine consecutive patients with laparoscopic appendectomies, which include 27 patients with perforated appendicitis, were analysed. This study considered the lengths of the operation and the hospital stay. Differences in complications between non-perforated and perforated appendicitis were also evaluated. RESULTS: A total of 388 patients underwent appendectomies, 339 patients with laparoscopy and 49 patients with conventional open appendectomies, from April 1994 to June 1996. The mean duration of laparoscopic appendectomies was 48.9 minutes. This was slightly longer than that of open appendec tomies (44.9 minutes) in the same hospital. The duration of hospital stay was on the average of 4.9 days. Six patients (1.8%) were converted to conventional surgery because of difficult mobilization in 4 patients and uncontrollable bleeding in the remaining two. The surgeries on patients who were converted to conventional surgery were performed by rotating residents without staff supervision. Minor complications developed in eight patients (2.4%). In comparing the results between non-perforated and perforated appendicitis, durations of operation (47.3 vs. 78.3 minutes) and the hospital stay (4.6 vs. 8.6 days) were longer in perforated appendicitis. However, the complication rate (2.6 vs. 0%) was unexpectedly found to be lower in perforated appendicitis. CONCLUSIONS: The laparoscopic appendectomy is a safe, feasible procedure for acute appendicitis. It is an excellent procedure for perforated appendicitis and has minor complications compared to an open appendectomy with its large incision that is followed by a high rate of wound infection and/or post operative adhesion. There aree various reports on prospective randomized studies evaluating the benefits of a laparoscopic appendectomy compared to a conventional open appendectomy. The reports by laparo scopic surgeons in various centers are different with regard to operative time, postoperative recovery, morbidity, and postoperative complications. For complicated appendicitis, most surgeons are not in agree ment with the laparoscopic approach. We obtained excellent results with laparoscopic appendectomies in perforated appendicitis which included periappendiceal abscesses.
Abscess ; Appendectomy* ; Appendicitis ; Dissent and Disputes ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Organization and Administration ; Postoperative Complications ; Prospective Studies ; Wound Infection

Solar urticaria is a fairly uncommon but Well recognized clinical entity characterized by erythema and wheal with itching immediately following exposure to sunlight or artifical radiation. A 33-year-old female had a six-year duration of urticaria, tightness of chest and dizziness that appeared within 15 minutes of exposure to sunlight. The action spectrum of this patient was between 320 and 400nm and the passive and reverse passive transfer test were negative. Solar urticaria of our patient appeared to belong to type g in the classification of Harber et al(1963). The patient was treated with antihistamines and repeated exposure to sunlight for inducing tolerance. After 3 months of the treatment, the symptoms did not appear even after 3 hours of exposure to sunlight.
Adult ; Classification ; Dizziness ; Erythema ; Female ; Histamine Antagonists ; Humans ; Intradermal Tests ; Pruritus ; Sunlight ; Thorax ; Urticaria*

A case of scabies combined with superficial dermatophytosis which was aggravated by application of topical fluorinated steroid for 6 months is presented. One year ago a 60-year-old male began to have pruritic erythematous papules on the lower abdomen which spread slowly to the inguinal and buttock area. He had had onychomycosis for six years and for the last 6 months he had applied a. fluorinated steroid. preparation. After application of steroid, the aggravated skin lesions spread rapidly over the whole body. A KOH mount showed sarcoptes scabiei and fungus. A count of itch mites from scales brushed off and collected from. the overall surface of the patients body showed 263 adults, 169 Iarvae and 534 eggs. T. rubrum from a culture of scales from the trunk and nails was confirmed. On admission FBS and oral GTT test revealed diabetic curve, however it could not be determined whether the diabetes mellitus was primary or secondary to the use of topical steroid application. The patient has been treated with crotamiton cream and antifungal agent with remarkably effective results.
Abdomen ; Adult ; Buttocks ; Diabetes Mellitus ; Eggs ; Fungi ; Humans ; Male ; Middle Aged ; Mites ; Onychomycosis ; Ovum ; Sarcoptes scabiei ; Scabies* ; Skin ; Tinea* ; Weights and Measures

To assess the prognostic factors of the femoral neck fractures in patients with CVA, we compared the survival rates in 12 cases of CVA group with 12 cases of non-CVA group and evaluated the various clinical factors of CVA group affect the mortality. All of the patients both CVA group and non- CVA group were treated hemiarthroplasty for femoral neck fractures between June 1990 and June 1992. The mean age was 68.9 years old in the CVA group and 69.3 years old in the non-CVA group. The mean follow-up periods were 32.8 months in the CVA group and 33.6 months in the non-CVA group. The results were as follows; 1. The incidence of the femoral neck fracture with CVA was 15%(12 cases among SO femoral neck fractures). 2. The survival rates in the CVA group at l-year, 2-year, and 3-year were 83.3%, 66.7%, and 58.3% respectively. In the non-CVA group, the survival rates were 83.3%, 75.0%, and 62.5%. 3. In the CVA group, serum total protein, nutritional index, hypertension, lung disease, and cardiac disease may be valuable prognostic factors. In conclusion, the pretraumatic patient's general physical condition could affect the mortality of femoral neck fracture in the CVA patients rather than CVA itself or postoperative status.
Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Heart Diseases ; Hemiarthroplasty ; Humans ; Hypertension ; Incidence ; Lung Diseases ; Mortality ; Nutrition Assessment ; Stroke ; Survival Rate

To clarify the exact role of endomyocardial biopsy in the diagnosis and monitoring of adriamycin-induced cardiotoxicity and to observe the actual relationship between pathologic changes and cardiac dysfunction, a cross-sectional clinical study was conducted. Echocardiography was used to evaluate cardiac dysfunction in 18 patients who had received chemotherapy including adriamycin(mean dose : 410mg/m2 of B.S.A.) without clinical evidence of congestive heart failure, and in 19 normal controls. Six patients receiving adriamycin underwent 7 transfemoral endomyocardial biopsy procedures, and the specimens were evaluated by light and electron microscopy for evidence of drug-related cardiotoxicity. Indexes of cardiac systolic function obtained by M-mode echocardiography(left ventricular dimension, excursion of interventricular septum and left ventricular posterior wall, shortening fraction and ejection fracton) did not show any statistically significant difference between patients who received adriamycin and normal controls. In transmitral flow-velocity curves recorded by Doppler echocardiography with a 2.25MHz probe, the patients showed less E peak velocity and decreased E/A ratio compared with normal controls, which suggests left ventricular diastolic dysfunction in the patients who received adriamycin. All the specimens of the endomyocardial biopsy showed significant pathologic changes of adriamycin indnced cardiotoxicity which was characterized by myofibrillar loss and vacuolization of the cytoplasm. In 2 specimens, pathologic grade was II, while 5 specimens showed pathologic changes of grade III and further chemotherapy with adriamycine was not done in thse 5 cases. From these results it is suggested that pathologic changes precede the clinical onset of congestive cardiomyopathy in the patients receiving adriamycin and left ventricular diastolic dysfunction occurrs before ejection fraction falls to subnormal levels. We conclude that sequential endomyocardial biopsy is absolutely indicated for exact diagnosis and monitoring of adrinamycin-induced cardiotoxicity to prevent the development of irreversible and often fatal cardiomyopathy.
Biopsy ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cytoplasm ; Diagnosis ; Doxorubicin* ; Drug Therapy ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Humans ; Microscopy, Electron

BACKGROUND: The regular meal pattern with consistent day-to-day calorie and carbohydrate intake is one of the most important determinants of good glycemic control in diabetes. This study was aimed to investigate the meal pattern and their relationships with total energy intake, nutrients intake and glycemic and lipid profile in type 2 diabetes. METHODS: 1,084 subjects were divided according to glycemic status into three groups: the diabetes (DM), dysglycemia (DG) and normal (N). The meal frequency (MF), meal interval (MI) and daily intake of total energy, macronutrient and micronutrient were estimated with the 24 hours dietary recall from the Korean National Health and Nutrition Examination Survey (KNHANES) in 2001 and Eulji hospital. For analysis of meal pattern and it's relations with the nutrients intake, we regrouped into meal skipper (G1), non-meal skipper with unreasonable MI (G2), and non-meal skipper with reasonable MI (G3). RESULTS: 17.5% of DM, 21.8% of DG, 23.3% of N skipped at least one meal a day without significant difference across the groups. 55.9% of non-meal skipper had unreasonable MI. Meal was more regular in older age, lower educated person, employee, and female. G1 took higher fat, and more calories form snack and less micronutrient density, compared with G3 (P < 0.05). HbA1c, total cholesterol and triglyceride values were higher in G1 compared with other two groups (P < 0.05). CONCLUSION: Many type 2 diabetics had the irregular meal patterns, which was associated with poor glycemic control, lipid profiles and less micronutrient density. This suggested that another treatment strategy might be required for those who had irregular lifestyle.
Cholesterol ; Energy Intake ; Female ; Humans ; Life Style ; Meals ; Micronutrients ; Nutrition Surveys ; Snacks

BACKGROUND: The Korean National Health and Nutrition Examination Surveys reported 65% of daily energy intake (EI) as carbohydrate (CHO) in the Korean population and main source of CHO was cooked rice. We used a standardized-small sized rice bowl for diet education and investigated its effectiveness on body weight, glucose and lipid, compared to the conventional food exchange system in type 2 diabetes obese women. METHODS: Type 2 diabetic women with body mass index > or = 23 kg/m2 were randomly assigned to small rice bowl-based meal plan (BM) and food exchange-based meal plan (ExM) group. Both groups were asked to reduce their EI by 500 kcal/day for 12 weeks. The macronutrient composition was instructed: 55 to 60% of EI as CHO, 15 to 20% as protein, and 20 to 25% as fat. BM group received only a simple instruction for application of the rice bowl. Nutrient intake was estimated with the 3-day dietary records. RESULTS: Finally, 44 subjects finished the study. The percent reduction of body weight was significant both BM group (-5.1 +/- 2.6%) and ExM group (-4.8 +/- 2.8%) after 12 weeks (P < 0.001) but there was no difference between the groups. There was no difference in the proportional change of CHO, protein and fat in EI between the groups. Additionally, the change of HbA1c and low density lipoprotein-cholesterol were not significantly different between the two groups. CONCLUSION: The BM group was as effective as ExM for body weight and glucose control in type 2 diabetes obese women.
Body Mass Index ; Body Weight ; Diabetes Mellitus, Type 2 ; Diet, Diabetic ; Diet ; Diet Records ; Energy Intake ; Female ; Glucose ; Humans ; Meals ; Obesity ; Weight Loss

Chondrolipoma is a benign tumor composed of mature adipose tissue and mature chondrocytes, and very rarely found. The patient, a 36-year-old woman, presented with a firm, walnut sized, mild tender mass at her left knee. There had been dull pain after long walking. There were no limitation of motion in physical examination. On plane lateral radiograph, radioopaque calcific densities were seen in elliptical soft tissue shadow below inferior pole of the patella. Magnetic resonance image demonstrated well defined mass of mixed signal intensity consistent with fat tissue and cartilaginous tissue. Gross specimen showed that the tumor appeared to be a round, encapsulated and firm nodule with milky whitish yellow cut surface. Microscopically the tumor consisted of nodular cartilage and mature fat tissue. The cartilage cells did not show mitotic figure and were often arranged in small clusters. But there were no cytologic features of malignancy. Thus the authors diagnosed this tumor as chondrolipoma, and report it with the literature review.
Adipose Tissue ; Adult ; Cartilage ; Chondrocytes ; Female ; Humans ; Juglans ; Knee* ; Patella ; Physical Examination ; Walking