No abstract available.
Ligaments* ; Pelvic Organ Prolapse*

PURPOSE: This is a retrospective study to analyze the functional results of closed reduction and external fixation of unstable fractures of the proximal humerus. MATERIALS AND METHODS: Ten unstable proximal humerus fractures were managed with closed reduction and external fixation in which other operative methods are not proper due to comminution, osteoporosis or poor general condition of patients. 4 cases of 2-part and 6 cases of 3-part fracture were included. Radiologically union of fracture, malunion and the evdence of avascular necrosis of humeral head were assessed and the functional results were analyzed with Neer scoring system. RESULTS: Radiologically all fractures were healed but in 2 cases malunion was resulted because of reduction loss in proximal fragment. Pin site infection was developed in 7 cases and oral antibiotics were needed. The functional results were excellent in 4, satisfactory in 3 and unsatisfactory in 3 cases. 2 cases with malunion and one case with lack of postoperative cooperation resulted in functionally unsatisfactory. CONCLUSION: External fixation is an alternative method in the treatment of unstable proximal humerus fractures in which open reduction or percutaneous pinning are not proper due to comminution, osteoporosis or poor general condition of patient.
Anti-Bacterial Agents ; Humans ; Humeral Head ; Humerus* ; Necrosis ; Osteoporosis ; Retrospective Studies

OBJECTIVE: To determine the dincal significance of placenta previa totalis. METHODS: Maternal and neonatal medical rerords were reviewed retrospectively. Between March 1990 and June 1997, sixty-nine pregnant women with placenta previa totalis delivered at Asan Medical Center. Diagnosis of placenta previa totalis was confirmed during cesarean section. RESULTS: Mean maternal age at diagnosis was 31.7+ 3.9 years and 3 patients(4.3%) were nullipara. Fifty two patients(75%) had the history of vaginal bleeding during their index pregnancy and seventeen of 52 patients were admitted more than once. Median gestational age at the time of initial bleeding episode was 33.2 weeks(range 23.5-41. 1) and median interval from the first admission to delivery was 11 days(range 1-63), Major placental implantation site was posterior uterine wall(64%, 44/69). Six cases(8%) were complicated with placenta accreta or increta and no case was combined with abruptio placentae. Estimated blood loss at the time of cesarean section was 1,510+/-952ml(mean+/-SD) and 43 patients(62%) were transfused. No case was complicated with disseminated intravascular coagulation. Eight patients(11.6%, 8/69) underwent cesarean hysterectomy because of uncontrollable bleeding. Thirty four patients(49.3%) delivered their babies before 37 weeks of gestation. The mean gestational age at delivery was 36.4+/-3.0 weeks(mean+/-SD). Major neonatal morbidity was respiratory distress syndrome(20.3%, 14/69). Perinatal death rate was 4.3%(3/70). CONCLUSION: Because pregnant women complicated with placenta previa totalis have high probability for transfusion and cesarean hysterectomy, these patients should be managed cautiously and thoroughly. The most frequent neonatal morbidity was respiratory distress syndrome due to preterm delivery.
Abruptio Placentae ; Cesarean Section ; Chungcheongnam-do ; Diagnosis ; Disseminated Intravascular Coagulation ; Female ; Gestational Age ; Hemorrhage ; Humans ; Hysterectomy ; Maternal Age ; Mortality ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy* ; Pregnant Women ; Retrospective Studies ; Uterine Hemorrhage

STUDY DESIGN: Eighteen patients undergoing bone cement augmentation of pedicular screwing for osteoporotic lumbar spine were reviewed retropectively. OBJECTIVES: To assess the effectiveness of bone cement augmentation of pedicular screwing for osteoporotic lumbar spine. SUMMARY OF LITERATURE REVIEW: For the technical limit obtaining the dynamic stability in the bone-screw interface for osteoporotic lumbar spine, the additional device to enhance pedicular screw fixation strength needs. MATERIALS AND METHODS: We reviewed 18 cases undergoing pedicular screwing and fusion for the osteoporotic (Jikei grade I, II, III/III) lumbar spine from Feb. 2000 to Mar. 2001 with an average follow-up of 1.5 years. Mean age was 69.5 years with 6 male and 12 female. Inclusion criteria was 9 degenerative spinal stenosis, 5 spinal stenosis associated with compression fracture, 2 Kummel's disease, 1 spondylolisthesis and 1 internal disc disruption. We performed bone cement injection around the screws showing significantly low insertion torque, screw pullout or cut-up during surgery. We asssessed the radiographic results of sagittal angle correction (SAC) of the fused segment and disc height restoration (DHR) on the preoperative, postoperative and last follow up lumbar lateral views. Clinical results were evaluated according to the Kumano's criteria. RESULTS: Mean sagittal angle at preoperative, postoperative and last follow-up was 11.6-21.6-19.6 degrees with mean SAC gain 10 degrees (p<0.05) and gain loss 2 degrees (p>0.05). Mean disc height of each period was 33.3-49.8-43.5% with mean DHR gain 16.5% (p<0.05) and gain loss 6.3% (p>0.05). The clinical result was analyzed as 14 good, 3 fair and 1 poor. Fusion success was achieved in all. There were 2 perioperative complications of 1 superficial surgical site infection and 1 incomplete L4 root injury, and 6 complications during follow up of 3 compression fractures above fused segment, 1 screw pullout, 1 screw cut-up, and 1 bone cement extrava-sation into canal. CONCLUSIONS: The bone cement augmentation of pedicular screwing for osteoporotic lumbar spine can be an alternative to enhance screw fixation strength.
Female ; Follow-Up Studies ; Fractures, Compression ; Humans ; Male ; Osteoporosis ; Spinal Stenosis ; Spine* ; Spondylolisthesis ; Torque

A 3-month-old female presented with anuria and abdominal distention for 1 day. The patient was twin and was delivered at 30 week-term with low birth weight. Emergent ultrasonography revealed both hydronephrosis and hyperechogenic mass within the both renal pelves. Urinoma around left kidney was also found. Computed tomography showed high density material filled dilated pelvises. Urinoma measured 3x4cm in the left prerenal space and urinary ascites in the right abdomen were found. Candida albicans was cultured from catheter drained urine. We started the care with percutaneous nephrostomy with amphotericin B irrigation, coupled with systemic antifungal therapy. And this management had a major role in the successful outcome.
Abdomen ; Amphotericin B ; Anuria* ; Ascites* ; Bezoars* ; Candida albicans ; Catheters ; Female ; Humans ; Hydronephrosis ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature* ; Kidney ; Nephrostomy, Percutaneous ; Pelvis ; Twins ; Ultrasonography ; Urinoma

STUDY DESIGN: A prospective study of the reproducibility of F-18 FDG-PET. OBJECTIVES: The purpose of this study was to determine whether F-18 FDG-PET had value in distinguishing between vertebral pathologic fractures and osteoporotic compression fractures. SUMMARY OF LITERATURE REVIEW: There were many reports in the literature about vertebral pathologic disease studied with F-18 FDG-PET, but few about the distinction between pathologic and benign causes in fractured vertebrae. MATERIALS AND METHODS: Twenty-nine patients with vertebral fractures that did not result from major trauma, who were admitted to our hospital from December 2002 to May 2004, were included in this study; and all of them were evaluated with MRI and F-18 FDG-PET. Their final diagnoses were confirmed by biopsy (n=12) or clinical follow-up (n=17). There were 18 cases of vertebral compression fractures, 11 cases of pathologic fractures (4 cases of tumor lesions and 7 cases of pyogenic spondylitis). F-18 FDG-PET images of those patients were interpreted as vertebral compression fractures or pathologic fractures by one nuclear medicine specialist and one radiology specialist without any clinical or radiologic information. The sensitivity and specificity of MRI and F-18 FDG-PET for the diagnosis of vertebral pathologic fractures were calculated and compared. RESULTS: Twenty-four (82.8 %) of 29 cases demonstrated a coincidence between MRI and F-18 FDG-PET interpretations. The sensitivity of F-18 FDG-PET for the diagnosis of vertebral pathologic fractures was 90.9 % and the specificity was 88.9 %. The sensitivity of MRI was 81.8% and the specificity was 83.3%. F-18 FDG-PET demonstrated a higher sensitivity and specificity, and these were statistically insignificant differences. CONCLUSIONS: F-18 FDG-PET is a useful method for determining the differential diagnosis of vertebral pathologic fractures, with high sensitivity and specificity.
Biopsy ; Diagnosis* ; Diagnosis, Differential ; Follow-Up Studies ; Fractures, Compression ; Fractures, Spontaneous* ; Humans ; Magnetic Resonance Imaging ; Nuclear Medicine ; Prospective Studies ; Sensitivity and Specificity ; Specialization ; Spine

PURPOSE: We evaluated brain perfusion SPECT findings of MELAS syndrome and mitochondrial myopathy in correlation with MR imaging in search of specific imaging features. MATERIALS AND METHODS: Subjects were five patients (four females and one male; age range, 1 to 25 year) who presented with repeated stroke-like episodes, seizures or developmental delay or asymptomatic but had elevated lactic acid in CSF and serum. Conventional non-contrast MR imaging and Tc-99m-ethyl cysteinate dimer (ECD) brain perfusion SPECT were performed and imaging features were analyzed. RESULTS: MRI demonstrated increased T2 signal intensities in the affected areas of gray and white matters mainly in the parietal (4/5) and occipital lobes (4/5) and in the basal ganglia (1/5), which were not restricted to a specific vascular territory. SPECT demonstrated decreased perfusion in the corresponding regions of MRI lesions. In addition, there were perfusion defects in parietal (1 patient), temporal (2), and frontal (1) lobes and basal ganglia (1) and thalami (2). In a patient with mitochondrial myopathy who had normal MRI, decreased perfusion was noted in left parietal area and bilateral thalami. CONCLUSION: Tc-99m ECD SPECT imaging in patients with MELAS syndrome and mitochondrial myopathy showed hypoperfusion of parieto-occipital cortex, basal ganglia, thalamus and temporal cortex, which were not restricted to a specific vascular territory. There were no specific imaging features on SPECT. The significance of abnormal perfusion on SPECT without corresponding MR abnormalities needs to be evaluated further in larger number of patients.
Basal Ganglia ; Brain* ; Female ; Humans ; Lactic Acid ; Magnetic Resonance Imaging ; Male ; MELAS Syndrome* ; Mitochondrial Encephalomyopathies ; Mitochondrial Myopathies* ; Occipital Lobe ; Perfusion ; Rabeprazole ; Seizures ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

H2-receptor blockers are widely used for therapy of peptic ulcer disease and gastroesophageal reflux disease. H2-receptor blockers infrequently cause adverse hepatic effects, and when they occur they are usually asymptomatic. There are several previous reports of liver injury related to ranitidine. Until now, only two cases of acute hepatitis associated with the use of famotidine were reported in the world. We report three cases of clinical hepatitis that followed administration of famotidine (2 cases) and ranitidine (1 case). First, a 54-year-old woman received famotidine, 40mg, daily for treatment of erosive gastritis. After 6 weeks of treatment with famotidine, jaundice and itching sense developed. Second, a 45-year-old man was hospitalized for jaundice. He had a long history of duodenal ulcer and had been intermittently treated with famotidine. He had 6 weeks of treatment with famotidine prior to admission. Third, a 19-year-old woman was hospitalized for nausea, vomiting and urticaria. She had a history of acute hepatitis B virus infection and was discharged 4 weeks prior to readmission. She had been received ranitidine, 300 mg, daily for treatment of gastritis. After 17 days of drug ingestion, whenever she had taken her medication, she developed these symptoms of nausea, vomiting and urticaria. Other causes of hepatitis were ruled out and all patients recovered after discontinuation of drug ingestion.
Duodenal Ulcer ; Eating ; Famotidine* ; Female ; Gastritis ; Gastroesophageal Reflux ; Hepatitis B virus ; Hepatitis* ; Humans ; Jaundice ; Liver ; Middle Aged ; Nausea ; Peptic Ulcer ; Pruritus ; Ranitidine* ; Urticaria ; Vomiting ; Young Adult

H2-receptor blockers are widely used for therapy of peptic ulcer disease and gastroesophageal reflux disease. H2-receptor blockers infrequently cause adverse hepatic effects, and when they occur they are usually asymptomatic. There are several previous reports of liver injury related to ranitidine. Until now, only two cases of acute hepatitis associated with the use of famotidine were reported in the world. We report three cases of clinical hepatitis that followed administration of famotidine (2 cases) and ranitidine (1 case). First, a 54-year-old woman received famotidine, 40mg, daily for treatment of erosive gastritis. After 6 weeks of treatment with famotidine, jaundice and itching sense developed. Second, a 45-year-old man was hospitalized for jaundice. He had a long history of duodenal ulcer and had been intermittently treated with famotidine. He had 6 weeks of treatment with famotidine prior to admission. Third, a 19-year-old woman was hospitalized for nausea, vomiting and urticaria. She had a history of acute hepatitis B virus infection and was discharged 4 weeks prior to readmission. She had been received ranitidine, 300 mg, daily for treatment of gastritis. After 17 days of drug ingestion, whenever she had taken her medication, she developed these symptoms of nausea, vomiting and urticaria. Other causes of hepatitis were ruled out and all patients recovered after discontinuation of drug ingestion.
Duodenal Ulcer ; Eating ; Famotidine* ; Female ; Gastritis ; Gastroesophageal Reflux ; Hepatitis B virus ; Hepatitis* ; Humans ; Jaundice ; Liver ; Middle Aged ; Nausea ; Peptic Ulcer ; Pruritus ; Ranitidine* ; Urticaria ; Vomiting ; Young Adult

Toxic epidermal necrolysis(TEN) is a severe drug induced life-threatening disease and an acute illness. This disease is characterized by rapid onset of widespread necrosis resulting in sloughing of epidermis. The incidence of TEN is very rare, with approximately 0.5 to 1.4 cases per million per year. but TEN has a high mortality rate of 25-40 percent. Therapy for TEN is primarily aimed at supportive care. Treatment with systemic corticosteroid, immunosuppresive agent such as cyclosporine, cyclophosphamide, pentoxifyllin or plasmapheresis have not been shown to improve outcome. Recently, administration of high dose intravenous immunoglobulin(IVIG) has been shown to result in rapid improvement in patients with TEN. There have been several reports of the benefit of IVIG in adult patients with TEN. However we could not find using IVIG in pediatric patient with TEN in Korea. We have experienced improvement in a 2 years old boy with TEN after using high dose IVIG.
Adult ; Child ; Child, Preschool* ; Cyclophosphamide ; Cyclosporine ; Epidermis ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Incidence ; Korea ; Male* ; Mortality ; Necrosis ; Plasmapheresis ; Stevens-Johnson Syndrome*