Pacemaker twiddler's syndrome is reported as a very rare complication of permanent pacemaker implantation. There was a recent report suggesting that the incidence of pacemaker twiddler's syndrome increase recently presumably as a result of the implantation of thinner and smaller pacemaker system than before. We experienced a case of pacemaker twiddler's syndrome complicated 3 times with the conventional method of implantation or replacement during 14 months after the first implantation(Optims MP 158C and Pacing lead 400, Telectronic)on June 13th 1987. This case was an 18 year-old high school girl who had suffered frequent syncope for 2 years and extertionl dyspnea for 5 years due to congenital complete heart block, of which block site was proved to be AV nodal by His bundle electrogram. Pacemaker twiddler's syndrome developed 3 times;firstly 6 weeks after the first implantation in the right subclavicular fossa, secondly 10 weeks after the replacement of the twisted pacing lead, thirdly 10 months after the change of implantation site to the left subcalvicular fossa with the replacement of the twisted and fractured lead. Finally, the pacemaker generator was anchored to the clavicular periostium and pectoralis fascia at several points by using Dacron pouch.
Adolescent ; Dyspnea ; Electrophysiologic Techniques, Cardiac ; Fascia ; Female ; Heart Block ; Humans ; Incidence ; Polyethylene Terephthalates ; Syncope

The only clinically avilable levo-isomer type of beta-recepter blocker is penbutolol sulfate, and it is already accepted as one of beta-receptor blockers for initial antihypertensive drug therapy according to the report of 1988 Joint National Committee on Detection, Evaluation, and Tratment of High Blood Pressure. To evaluate the antihypertensive efficacy, effect on the quqlity of life, and side effects of penbutolol recently introduced into Korea, penbutolol was administered to 29 essential hypertensive(mild 9, moderate10, and severe 10) patients for 12 weeks or longer. The result of the clinical analysis are as follows; 1) The mean age was 50.0+/-10.9(M+/-SD), and the sex distribution between male and female was16:13. 2) The blood pressure lowering effects of penbutolol as a monotherapy were marked in 16, moderate in 6, and insignificant in 2 cases. The systolic blood pressure was significantly decreased from 179.1+/-20.2 to 135.4+/-16.5mmHg(P<0.005), and the diastolic blood pressure from 112.6+/-13.5 to 84.0+/-11.9mmHg(P<0.005)after 12 weeks' penbutolol therapy. 3) The heart rate was significantly decreased from70.3+/-13.3 to 65.5+/-9.1 per minute(P<0.05). 4) The quality of life was improved markely in 5(17.2%) and slightly in 8 cases(29.6%). 5) There were no significant laboratory changes after 12 weeks' penbutolol therapy. 6) Two out of three cases with non-specific ST segment and T wave changes in EKG and two out of 9 cases with EKG were normalized, 2 cases of LAH with strain were improved. 7) The side effects of penbutolol were dizziness in 4, sexual dysfunction in 2, and skin rash in 1 case. 8) Final multifarious assessment of penbutolol therapy showed that it was very useful in 11(37.9%), useful in 4(13.8%) and slightly useful in 7 cases(24.1%). These reult suggest that penbutolol is a first-line antihypertensive agent with an effective antihypertensive action, improving quality of life, with no significant laboratory changes and few side effects.
Blood Pressure ; Dizziness ; Drug Therapy ; Electrocardiography ; Exanthema ; Female ; Heart Rate ; Humans ; Hypertension ; Joints ; Korea ; Male ; Penbutolol ; Pheniramine ; Quality of Life ; Sex Distribution

PURPOSE: To investigate the prevalences of anatomical variations regarding prostate and its surrounding structures, and also the intra- and postoperative effects of such anatomical variations in performing radical retropubic prostatectomy (RRP). MATERIALS AND METHODS: A retrospective analysis of 156 patients who received RRP for prostate cancer was performed. Patients' records including the results preoperative radiologic evaluations were reviewed. For our analysis, patients were grouped according to the anatomical variations relevant to prostate and surrounding structures shown on preoperative radiographs. Also, patients were interviewed via telephone as needed. RESULTS: Prostate volume (mean: 41.4ml) measured from preoperative transrectal ultrasound correlated with estimated blood loss (EBL) during RRP (p=0.029). Interspinous diameter (mean: 1.69cm) measured on axial image of preoperative magnetic resonance imaging (MRI) was observed to be inversely correlated with operative time (p=0.010). And, patients with box-shaped deep dorsal vein (as demonstrated on axial view of MRI; 15.3%) were observed to have significantly less EBL during RRP (p=0.030). Also, EBL was significantly higher (p=0.013) for patients in which anterior portion of prostatic apex appeared to overlap and obscure membranous urethra (62.8%). Meanwhile, absence of the distal protrusion of apical region (21.8%) was observed to be associated with early (within 3 postoperative months) recovery of urinary continence (p=0.014). CONCLUSIONS: Our results suggest that various anatomical variations regarding prostate and its surrounding structure may exist as herein presented, and also that they may indeed have significant effects on both intra- and postoperative course regarding RRPs. Variations in the shape of prostatic apex may be significantly associated with recovery of continence after RRPs.
Humans ; Magnetic Resonance Imaging ; Operative Time ; Prevalence ; Prostate* ; Prostatectomy* ; Prostatic Neoplasms ; Retrospective Studies ; Telephone ; Ultrasonography ; Urethra ; Veins

A case of aneurysmal bone cyst(ABC) secondary to eosinophilic granuloma of the skull is reported. In the skull, the presence of ABC secondary to eosinophilic granuloma is rare. We reviewed the clinicopathological- and radiological features of this type of eocinophilic granuloma at the cranium.
Aneurysm* ; Eosinophilic Granuloma* ; Eosinophils* ; Granuloma ; Skull*