A 14-year old girl presented with urinary incontinence along with normally secured voluntary voiding. Careful physical examination revealed leakage of urine through a small opening near the vestibule, ventral to the urethral meatus. Cystoscopically, the right ureteral orifice was absent but otherwise normal. Nonfunctioning right kidney was found on excretory urography. A #4 ureteral catheter was inserted into the ectopic opening as high as 10cm, and the retrograde pyelogram showed dilated right ureter ending blindly at the level of lumber vertebra II with stricture at the level of the tip of the catheter. After the right nephroureterectomy, she became dry and was discharged on the 12th postoperative day. The removed kidney weighed only 8 Gm. and pathological diagnosis was congenital hypoplasia of the right kidney with ectopic ureteral opening.
Adolescent ; Catheters ; Constriction, Pathologic ; Diagnosis ; Female ; Humans ; Kidney* ; Physical Examination ; Spine ; Ureter* ; Urinary Catheters ; Urinary Incontinence ; Urography

Trochanteric fractures frequently occur in elderly patients and are associated with other fractures due to increase in severity of accidents. Because of complications in elderly patients, trochanteric fractures are treated with open reduction and internal fixation with increasing frequency. The authors treated 41 cases of trochanteric fractures of the femur in the year 1977 through 1980 at the Department of Orthopedic Surgery, Jeonbug National University. The resuts were as follows: 1. Of 41 cases, 35 cases were males and 6 cases females. In males most occurred at 60's and in females at 70's. 2. The most common cause of the fracture was slipping or fall down. 3. In Tronzo classification, the type I was most commmon. 4. 5 cases were treated conservatively and 36 cases with open reduction and internal fixation. 5. The mean duration of bony union was 16.4 weeks and no differences were noticed in the cases treated with open reduction and internal fixation. 6. Satisfactory results were obtained in 91.7% of operative treatment and in 80% of non-operative treatment. 7. From these results, it was concluded that operative treatment of trochanteric fracture had more advantages of improvement of function and less complication than those of non-operative treatment.
Aged ; Classification ; Clinical Study ; Female ; Femur ; Hip Fractures ; Humans ; Jeollabuk-do ; Male ; Orthopedics

BACKGROUND: The purpose of this study was to compare the time course of the bradycardia and hypotensive effects of esmolol. METHODS: Thirty patients who undergoing gynecologic operation were anesthetized with nitrous oxide and enflurane. After the steady state of anesthesia was achieved, esmolol 500microgram/kg for 1 minute followed by 25, 50, or 100microgram/kg/min for 60minuts infused by intravenous catheter. Heart rate, mean arterial pressure, cardiac index, stroke volume, and systemic vascular resistance was measured by 1, 3, 5, 10, 15, 20, 25, 30, 45, and 60 minutes. RESULTS: Heart rate was changed abruptly within 3 to 5 minutes, and decreased rapidly for 15minutes. Mean arteral pressure was decreased rapidly for 30 minutes, but slower than heart rate. Cardiac index was decreased rapidly for 20 minutes and differed significantly on the dose of 25, 50, 100microgram/kg. Stroke volume was decreased for 30 minutes, and systemic vascular resistance was increased rapidly for 10 minutes. It was decided the onset time that was expressed 90% of ultimate response of esmolol effect, and was calculated in each group. The onset time of heart rate of esmolol 25, 50, 100microgram/kg were 8.0 +/- 4.1, 4.8 +/- 2.3, 8.1 +/- 4.4 minutes, the time of mean arterial pressure were 30.0 +/- 7.5, 21.1 +/- 6.2, 19.9 +/- 7.8 minutes, and the time of cardiac index were 25.1 +/- 4.7, 14.8 +/- 5.0, 14.2 +/- 4.6 minutes. Thus heart rate, mean arterial pressure, cardiac index, stroke volume, and systemic vascular resistance responses of administration of esmolol did not occur with equal rapidity. CONCLUSIONS: Thus although esmolol has an ultrashort kinetic half life, only the heart rate effect can be considered to have an ultrashort onset.
Anesthesia ; Arterial Pressure ; Bradycardia ; Catheters ; Enflurane ; Half-Life ; Heart Rate ; Humans ; Nitrous Oxide ; Stroke Volume ; Vascular Resistance

A case of gouty polyarthropathy accompanied with carpal tunnel syndrom is reporte, in a 70 year old man. The patient was treated by removal of tophaceous materials surgically in both knee and right wrist joints for the relief of pain. There was a relatively good result postoperatively in the aspect of pain free motion of joints, but he was died of the complication of gouty nephropathy 4 months later after discharge.
Arthritis ; Gout ; Humans ; Joints ; Knee ; Wrist ; Wrist Joint

The development of the microvascular surgery revolutionalized the reconstructive surgery of the lower ext tremity. Especially, the defects of the heel and sole, the weight bearing area, were quite difficult and complicate to reconstruct by conventional methods. Many papers reported successful resurfacing the heel pad by free cutaneous or myocutaneous flaps. However, only few reports were conceming the late results of the reconstructed free flaps. The authors studied the histological and histochemical changes of the free flaps under the weight bearing stress in 10 cases. 1. The authors reconstructed 10 cases of the heel pad defects by dorsalis pedis free Aaps (5 cases) and latissimus dorsi myocutaneous flaps(5 cases). 2. Before transfer, the homy layer was very thin(about 0.16–0.2 mm) and had an arrangement of basket-weave pattem in both flaps. Until one year after transfer, this layer was wom out (0.02–0.08mm) However, after one year, this layer became thick (0.05–0.7 mm) and the arrangement was compact in both free flaps. 3. The granular and prickle cell layers were also increased in thickness after one year. 4. In the suprabasilar area, friction blisters were observed before one year, especially in latissimus dorsi myocutaneous flap. However, they slowly disappeared after one year and then the epidermis was stabilized. 5. In the dermis, the contents of the amyloid and acid mucopolysaccharides were increased up to the level of those of the normal heel pad in both flaps. 6. As a conclusion, the transferred free flaps were in distress before one year. But after one year, they began to adapt well histologically and histochemically to the weight bearing stress.
Amyloid ; Blister ; Dermis ; Epidermis ; Follow-Up Studies ; Free Tissue Flaps ; Friction ; Glycosaminoglycans ; Heel ; Myocutaneous Flap ; Superficial Back Muscles ; Weight-Bearing

True cysts of the pancreas are rare, and enterogeous (duplication) cysts are extremely rare. We describe a case of enterogenous cyst of the pancreas located in the retroperitoneum, in which homogenous low attenua-tion, multiloculation, internal septation and cyst wall calcification were noted.
Pancreas*

The femur is the largest long bone in the body which is related to weight bearing. As a result of rapid increase in traffic accidents and industrial injuries, the incidence of femoral shaft fractures has risen also. The methods of treatment in children and adults are different, therefore inadequate treatment can cause permanent disability. The authors have reviewed 211 cases of femoral shaft fractures in 204 persons (children and adults) from September 1967 to September 1976 whe were admitted and treated in Orthopedic Department, Severance Hospital. The results were as follows: 1. The fractures occured commonly in the 6–10 yr. age group (41.2%) in children and in the 21–40 yr. group (54.2%) in adults. Males comprised 138 cases (67.6%). 2. Closed fractures were 185 cases (87.7%) and comminuted fractures were the most common type, 94 cases (44.5%) in all. The fracture site was middle third in 116 cases (55%). 3. Causes were mainly car accidents, 146 cases (71.5%) and industrial injuries. Pedestrian injuries are particularly common in Korea. Many industrial accidents occur due to inadequate working facilities in factories. 4. Associated injuries were common in young adults and in order of frequency these were fractures of the tibia and fibula; skulls; pubic bone. 5. In the early and delayed operation groups, primary bony union rate was better (92%) in the early than the late operation group (78.3%). 6 The period of bony union was 13 weeks with compression plate and screw fixation: 16 weeks with Kuntscher nailing; 17. 5 weeks with plate and screw fixation; and 20 weeks with skeletal traction in adults. 7. Knee joint motion was most limited with skeletal traction (33.5%), less with plate and screw fixation (14.7%) and Kuntscher nailing (1.7%), but none with compression plate and screw fixation. 8. Good results were obtained with conservative treatment in children and operative treatment in adults. 9. Complications were much less frequent in children than in adults and were treated well. 10. Post-operative infection rate was 4.4% and infection was treated well with conservative measures. 11. The 90° – 90° skeletal traction in children and compression plate and screw fixation along with cast brace in adults were recommended.
Accidents, Occupational ; Accidents, Traffic ; Adult ; Braces ; Child ; Clinical Study ; Femur ; Fibula ; Fractures, Closed ; Fractures, Comminuted ; Humans ; Incidence ; Knee Joint ; Korea ; Male ; Orthopedics ; Pubic Bone ; Skull ; Tibia ; Traction ; Weight-Bearing ; Young Adult

Authors observed the antihypertensive effect of debrisoquin sulfate in 35 cases of essential hypertension and following results were obtained. 1) Results of short term control of blood pressure with debrisquin in 35 hypertensive patients revealed good control in 74.3%, fair in 14.3%, poor in 5.7% and failure in 5.7% of cases. Significant reduction of blood pressure was achieved in 7 of 9 cases of hypertension with addition of hydrochlorthiazide to debrisoquin. 2) During long term therapy with debrisoquin (duration of average 3.9 months), good control cases were slightly reduced(good in 58.6%, fair in 24.1%, poor in 6.9%, failure in 10.3%). But average effective dose of debriioquin was not increased significantly. 3) Antihypertensive effect of debrisoquin was slightly reduced in the cases of severe hypertension, hypertension of over 10 years duration and complication of cerebrovascular accident. 4) The side effects during treatment with debrisoquin were dizziness in 31.4%, headache in 11.4%, dry mouth, blurred vision, general weakness, insomnia in 8.6% respectively. There were no side effects in 48.6% of cases.
Blood Pressure ; Debrisoquin* ; Dizziness ; Headache ; Humans ; Hypertension* ; Mouth ; Sleep Initiation and Maintenance Disorders ; Stroke

Twenty-two cases of idiopathic myocardiopathy were observed during the period of 1962 to 1971 and follow up clinical study was made in 5 cases. The criteria of diagnosis was based mainly on exclusive diagnosis in etiology unknown marked cardiomegaly. 1) Male and female ratio of idiopathic myocardiopathy was 1.1:1 and age of onset were distributed from first decade to fifth decade with similar number of cases. 2) Cardinal symptoms were dyspnea, palpitation, chest pain and cough. Common physical findings were protodiastolic gallop (in 2 cases), moist rales (in 3 cases) and hepatomegaly(in 3 cases). 3) Laboratory findings were normal except elevated T.T.T. in one case. 4) Electrocardiogram were abnormal in all cases. There were 3 cases of left ventricular hypertrophy, 3 cases of non-specific ST-T changes and one case of first degree A-V block, intraventricular conduction defect, abnormal Q wave and low valtage, respectively. 5) After medical treatment, symptoms were improved in 4 cases but heart size was reduced in only one case and E.C.G. abnormalities were unchanged in all cases.
Age of Onset ; Cardiomegaly ; Cardiomyopathies* ; Chest Pain ; Cough ; Diagnosis ; Dyspnea ; Electrocardiography ; Female ; Follow-Up Studies ; Heart ; Humans ; Hypertrophy, Left Ventricular ; Male ; Respiratory Sounds

Granulosa cell tumors are uncommon neoplasm of ovary that are characterized by their long natural history and for their tendency to recur years after an aparrent clinical cure. Endometrial cancer occurs in association with these tumor in at least 5% of cases and 25%-50% are associated with endometrial hyperplasia. In this study, we present a case of granulosa cell tumor of right ovary with endometrial cancer after left oophrectomy.
Endometrial Hyperplasia ; Endometrial Neoplasms* ; Female ; Granulosa Cell Tumor* ; Granulosa Cells* ; Natural History ; Ovary*