Poland's syndrome is congenital anomaly which was described first by Alfred Poland in 1841. The clinical features are variable but always include congenital aplasia of fingers and syndactyly. We have experienced a case of Poland's syndrome. This case was male children and revealed thoracic anomaly of right side (absence of pectoral muscles and anterior axillary fold), atrophy of forearm muscles, ipsilateral syndactyly with aplasia of thumb and middle phalanges of 2, 3, 4, 5,th fingers, and ipsilateral congenital radio-ulnar synostosis.
Atrophy ; Child ; Fingers ; Forearm ; Humans ; Male ; Muscles ; Poland ; Syndactyly ; Synostosis ; Thumb

Intraventricular hemorrhage is a common hemorrhagic cerebral disorder in premature, but occurs much less frequently in the full-term newborn. In order to obtain documentation of clinical and ultrasonographic characteristics of intraventricular hemorrhage in full-term, we performed cerebral ultrasonography on 602 newborn infants who had been admitted to neonatal intensive care unit at the Deppartment of Pediatrics, Yonsei University College of Medicine between December 1989 and June 1991. 15 cases (2.5%) of intraventricular hemorrhage were analysed. The results were as follows: 1) Among 15 cases with intraventricular hemorrhage, there was no obstetrical and perinatal complication in 8 cases (53%) and 13 cases (87%) were neurologically normal at birth. 2) Sudden onset of dramatic neurologic abnormalitis inclued seizures, fever, bulging fontanel, irritability, lethargy, vomiting in cases (73%) and the remainder (27%) had no clinical symptoms and signs. 3) The age at diangosis of hemorrhage was before 72 hours in 5 cases (33%), between 4 and 7 days in 2 cases (13%), at 8 to 28 days in 8 cases (53%), 8 of 15 cases (53%) had Grade 1 IVH, four with Grade 2, cases with Grade 3, and 1 case of these infant demonstrated Grade IV IVH. The source of hemorrhage was subependymal germinal matrix in 12 cases (80%) and choroid plaxus in 3 cases (20%). 4) Precipitating factors were cerebral venous infarction in 7 cases, hypoxic injury in 5, and 3 other infants had no identifiable medical risk factors. 5) Among all 15 survivors, 2 of 3 infants with choroid plexus hemorrhage required placement of a ventriculo-peritoneal shunt, in the other case, ventriculomegaly decreased spontaneously.
Choroid ; Choroid Plexus ; Hemorrhage* ; Humans ; Infant ; Infant, Newborn* ; Infarction ; Intensive Care, Neonatal ; Lethargy ; Parturition ; Pediatrics ; Precipitating Factors ; Risk Factors ; Seizures, Febrile ; Survivors ; Ultrasonography ; Ventriculoperitoneal Shunt ; Vomiting

The incidence of diabetes mellitus is in increasing tendency because of expension of medical care, economic development and increasing of the population of the aged person recently. The diabetic foot is one of serious complication of diabetes. With the advancement of the method of treatment of diabetes the other acute metabolic complications are decreased, but the development of diabetic gangrene encounteres at any age of adult life with increasing of incidence according to the duration of diabetes. The most of them requires operation, and its treatment is difficult frequently because of high incidence of wound problem in healing. So it is important to educate and prevent for lowering its incidence. From January 1978 to December 1984, 38 patients with diabetic foot were treated and analysed at Department of Orthopaedic Surgery of Presbyterian Medical Center. The results obtained are as follow. 1. The average of annual incidence of diabetic gangrene was 2.85%. There was increasing tendency of incidence to 1981, thereafter decreasing tendency. 2. 71% of patients with gangrene were in over-50 year age group. 3.72% of patients were in duration of diabetes more than 5 years. 4.79% of patiens were in inadequate treatment before admisson. 5. There was no relationship between fasting blood sugar level and development of gangrence. 6. The most common site of the lesion was big toe. 7. The most common predisposing fector was local pressure (39%), then minor trauma, and burn injury. 8. The primary wound healing rate was 53% after operation. 9. There was no relationship between the lowest palpable artery and primary wound healing. 10. The most common combined complication of diabetes was retinopathy (47%), then neuropathy and hypertension. 11. The rate of bacterial infection was 66%, and the most common organism was staphylococcus aureus (36%).
Adult ; Arteries ; Bacterial Infections ; Blood Glucose ; Burns ; Clinical Study ; Diabetes Mellitus ; Diabetic Foot ; Economic Development ; Fasting ; Gangrene ; Hallux ; Humans ; Hypertension ; Incidence ; Methods ; Protestantism ; Staphylococcus aureus ; Wound Healing ; Wounds and Injuries

PURPOSE: The optimal surgical technique for inguinal hernia repair continues to be debated. This study was designed to investigate optimal surgical procedures in inguinal or femoral hernia. METHOD: We analyzed 153 cases of herniorrhaphy on inguinal or femoral hernias between August 1996 and November 2000. We divided patient into four groups according to the methods of hernia repair, i.e., 1) 78 cases of laparoscopic herniorrhaphy, 2) 42 cases of Lichtenstein herniorrhaphy, 3) 24 cases of Bassini herniorrhaphy and 4) 9 cases of McVay herniorrhaphy. RESULTS: The patient in the laparoscopic and Lichtenstein herniorrhaphy groups needed shorter hospital stays than those in the Bassini or McVay herniorrhaphy groups. The severity of pain was assessed by the total amount and duration of nonsteroidal anti-inflammatory drug injections, which was minimal in the laparoscopic group. There were no differences in complications between the groups. One patient in the laparoscopy group had a hernia recurrence and was reoperated with Lichtenstein herniorrhaphy. We compared two tension-free herniorrhaphies with each other. The numbers of patients not needing analgesic injections were more in the laparoscopic than the Lichtenstein herniorrhaphy group, reflecting less pain in the former group. Hospital stays were also shorter in the laparoscopic than the Lichtenstein herniorrhaphy group. CONCLUSION: We concluded that tension-free herniorrhaphy is superior to tension herniorrhaphy in terms of postoperative pain & recovery. Of the tension-free herniorrhaphies, laparoscopic herniorrhaphy is associated with less postoperative pain and shorter hospital stays than Lichtenstein herniorrhpahy.
Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy* ; Length of Stay ; Pain, Postoperative ; Recurrence

BACKGROUND AND OBJECTIVES: Even short-term treatment with angiotensin converting enzyme inhibitor in essential hypertension has been known to improve left ventricular (LV) diastolic function, LV hypertrophy (LVH), and aortic stiffness. The purpose of this study was to examine the effects of angiotensin II receptor antagonist (Losartan) on LV diastolic function, LVH, and aortic stiffness in essential hypertension. MATERIALS AND METHODS: Twenty-three hypertensive patients who were aged over 50 years, previously untreated, and without cardiac, renal, neurologic disease, or diabetes, were studied. Before and 12 weeks after monotherapy with Losartan 50 mg q.d., (1) supine arterial blood pressure by sphygmomanometry, (2) interventricular septum and LV posterior wall thickness, and LV end-diastolic dimension by M-mode echocardiography, (3) mitral peak E and A wave velocity by doppler echocardiography, (4) pulse wave velocity (PWV) in the descending aorta from aortic arch to the bifurcation by doppler echocardiography, were done. RESULTS: Twelve weeks after treatment, systolic blood pressure was lowered from 168.2+/-3.5 mmHg to 142.9+/-2.9 mmHg (p<0.05), diastolic blood pressure from 98.52.4 mmHg to 87.51.3 mmHg (p<0.05). Peak E/A ratio was increased from 0.75+/-0.04 to 0.82+/-0.04 (p<0.05). LV mass was decreased from 267.5+/-15.8 g to 235.6+/-12.6 g (p<0.05), and LV mass index from 166.8+/-8.0 g/m2 to 146.9+/-6.0 g/m2 (p<0.05). However, there were no significant change in PWV (from 7.18+/-0.10 m/sec to 7.23+/-0.30 m/sec, p>0.05), compliance (from 1.31+/-0.04 to 1.34+/-0.12, p>0.05), and compliance index (from 0.16+/-0.01 to 0.15+/-0.01, p>0.05). CONCLUSION: Short-term treatment with Losartan decreases blood pressure, improves LV diastolic function and LVH, but not aortic stiffness.
Angiotensin II* ; Angiotensins* ; Aorta, Thoracic ; Arterial Pressure ; Blood Pressure ; Compliance ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension ; Hypertrophy ; Losartan* ; Peptidyl-Dipeptidase A ; Pulse Wave Analysis ; Receptors, Angiotensin ; Vascular Stiffness* ; Ventricular Function, Left*

BACKGROUND/AIMS: We studied to evaluate the virological and biochemical responses to lamivudine and to detect YMDD mutants in patients who received long-erm lamivudine therapy. METHODS: We conducted a one-ear trial of lamivudine in 45 Korean patients with chronic liver disease due to hepatitis B virus. The patients were treated with a single oral average dose of 100 mg of lamivudine every day for 12 months. RESULTS: The suppression of serum HBV DNA was sustained in 77.8% of the patients and the normalization of serum ALT in 80%. The proportions of patients with HBeAg seroconversion were 25%. YMDD mutants were detected in 4 of 8 patients who showed sustained HBV DNA and serum ALT response (n=31) and in 3 of 8 patients who showed HBV DNA or serum ALT breakthrough (n=9). The response to lamivudine therapy in HBeAg-egative patients was excellent. CONCLUSION: Lamivudine therapy resulted in a significant virological and biochemical improvements and were well tolerated. But, YMDD mutants were detected during lamivudine therapy.
DNA ; Hepatitis B e Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Lamivudine* ; Liver Diseases* ; Liver*

BACKGROUND AND OBJECTIVES: Congestive heart failure is one of the most frequent problems in cardiovascular patients. However, very little data concerning this syndrome in Korea was available. The objectives of this study were to evaluate the demographic and clinical characteristics of hospitalized Korean patients with congestive heart failure. SUBJECTS AND METHODS: Six university hospitals that fulfilled the protocol for clinical information of the patients with heart failure, were prospectively engaged in this study. Six hundred and ninety patients, admitted between Jan. 1. 1998 and Dec. 31. 1999, were enrolled. RESULTS: Ischemic heart disease was the most frequent underlying disease (33.2%), with the other causes of heart failure being cardiomyopathy (23%), hypertensive heart disease (22%) and valvular heart disease (12.7%). Compared with ischemic cardiomyopathy, the patients with idiopathic dilated cardiomyopathy were younger (61.1+/-16.6 vs. 66.9+/-10.3, p<0.05), had less incidence of diabetes (16.8% vs. 32.2%) and smoked less (13.5+/-21.5 vs. 20.4+/-26.0 pack-year). The common aggravating factors were arrhythmia (22%), myocardial ischemia (21.7%) and infection (18.7%). Thirty nine (5.7%) patients died during the one year follow up period. Ischemic heart disease was the main underlying disease in the fatal cases (46.2%). CONCLUSION: Ischemic heart disease was the major cause of heart failure, and the leading cause of death in Korean patients with congestive heart failure.
Arrhythmias, Cardiac ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cause of Death ; Coronary Disease ; Epidemiology ; Estrogens, Conjugated (USP)* ; Follow-Up Studies ; Heart Diseases ; Heart Failure* ; Heart Valve Diseases ; Hospitals, University ; Humans ; Incidence ; Korea* ; Myocardial Ischemia ; Prospective Studies ; Smoke

BACKGROUND/AIMS: The study proposed to evaluate the efficacy of anticancer drugs of intraarterial chemoinfusion and investigate prognostic factors influencing survival. METHODS: A total of 127 patients diagnosed as having advanced hepatocellular carcinoma(HCC) of same stage (TNM stage IVa) from 1996 to 1998 were examined. Two intraarterial infusion chemotherapeutic regimens were employed: Adriamycin(Group I) and Cisplatin(Group II). RESULTS: Overall survival was significantly diffrent(10.0 vs 5.7months) and favored Group I. By the univariate analysis, significant prognostic factors included: age, portal vein thrombosis(PVT), size(>5cm) and type of tumor, response rate (size & -fetoprotein) at 3 months after therapy, level of albumin, alkaline phosphatase, and total bilirubin. After repeated therapy, Group I showed better survival (14.0 vs 7.9 months), but there was no statistical difference in survival rate between two groups in the case of large size, PVT, and diffuse type. CONCLUSION: Group I showed better survival than Group II in advanced HCC of TNM stage IVa. But, considering prognostic factors, there was no significant difference in survival rate between two groups except small size or nodular type of HCC. TNM classification of stage IVa should be reconsidered to include prognostic factors influencing survival rate such as PVT, size and type of HCC.
Alkaline Phosphatase ; Bilirubin ; Carcinoma, Hepatocellular* ; Classification ; Humans ; Infusions, Intra-Arterial ; Neoplasm Staging ; Portal Vein ; Psychotherapy, Group ; Survival Rate ; Treatment Outcome*

Tuberculosis can involve any part of the gastrointestinal tract but 80~90% of patients present the disease in the ileocecal region. The cases of colon cancer coexisting with colonic tuberculosis are relatively rare and ascending colon is the predominant site of the combined disease. A 46-year-old man, without specific past medical or family history, showed multiple colonic polyps and ulcers on colonoscopic examination. After surgery, the surgical specimen disclosed adenocarcinoma in the ascending colon, eleven adenomatous polyps throughout the colon, and multiple tuberculous ulcers in the entire colon. Tuberculosis of terminal ileum was also accompanied. The association of colonic tuberculosis and colon cancer with multiple polyps in this case may have been coincidental. The preoperative colonoscopic examination and pathologic diagnosis by frozen section during operation are necessary for the adequate treatment.
Adenocarcinoma ; Adenomatous Polyps ; Colon* ; Colon, Ascending ; Colonic Neoplasms* ; Colonic Polyps ; Diagnosis ; Frozen Sections ; Gastrointestinal Tract ; Humans ; Ileum ; Middle Aged ; Polyps ; Tuberculosis* ; Ulcer

With the exception of aneurysms of the aorta and iliac segments, splenic artery aneurysms are the most common form of aneurysm found in the abdomen. The pathogenesis of splenic artery aneurysms may be largely congenital, in women, and atherosclerotic, in men. A blunt trauma may be one of the less common causes of splenic artery aneurysms. Furthermore, to our knowledge, the delayed development of a splenic artery aneurysm, after a blunt trauma, is extremely rare. We report a case of a 35-year-old man with the delayed development of a splenic artery aneurysm on a follow- up computed tomographic scan of the spleen, 2 weeks after injury. Our case showed that a follow-up computed tomographic scan, after a blunt trauma, provided valuable clinical information on the diagnosis and management of splenic injury for documentign the healing or the progression of the injury, even though some studies have suggested this has no particular value.
Abdomen ; Adult ; Aneurysm* ; Aorta ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Male ; Spleen ; Splenic Artery*