BACKGROUND AND OBJECTIVES: Computed tomography of the temporal bone can provide otologists precise informations regarding the middle ear diseases. In this study, we aimed to measure the distance of mastoid antrum using the temporal bone CT for predicting the distance of mastoid depth during the mastoid surgery. MAERIALS AND METHODS: We analyzed normal ears of 88 patients who visited the Department of Otolaryngology, Chonnam University Hospital during the period between Aug. 1996 and Aug. 1997. These patients demonstrated unilateral chronic otitis media, temporal bone fracture, and traumatic facial nerve palsy. RESULTS: The mean distance of mastoid antrum was 11.45mm. The distance of mastoid antrum according to age distribution showed 7.75 mm in 0-4 year old group, 10.35 mm in 5-9 year old group, 10.71 mm in 10-14 year old group, 11.50 mm in 15-19 year old group, and 11.93 mm in over 20 year old group. The distance also differed between males and females, with 2.84 mm for male and 11.24 mm for female. CONCLUSION: For the group under 20 years old, the distance of mastoid antrum increased as the patient's age became older. Especially, the group who were between 5 to 9 years old showed marked increase in the distance, and the distance did not differ between male and female. The distance of the mastoid antrum of the Korean adults was 10.1-13.7 mm and it represents some difference when compared with that of Westerners.
Adult ; Age Distribution ; Child ; Ear ; Ear, Middle ; Facial Nerve ; Female ; Humans ; Jeollanam-do ; Male ; Mastoid* ; Otitis Media ; Otolaryngology ; Paralysis ; Temporal Bone* ; Young Adult

OBGECTIVE : The purpose of this study is to evaluate perinatal outcomes according to thyroid function in pregnant women with thyroid disease. METHODS : The retrospective study was made by review of medical records of 42 pregnant women with thyroid disease (hyperthyroidism:22 cases, hypothyroidism:20 cases) who had delivered between Jan 2001 to Oct 2005. Clinical features and thyroid hormone levels were compared between the women who were managed during pregnancy (treating group) and not managed during pregnancy who had been cured (cured group). RESULTS:In pregnant women with hyperthyroidism, treating group showed higher T3 and T4, lower TSH than cured group, but there was no difference in neonatal thyroid hormone levels between two groups. In the women with thyroid storm, all thyroid hormone levels were significantly different from those in women without thyroid storm, but in newborn of women with thyroid storm, only TSH level was significantly lower. In the pregnant women with hypothyroidism who were treated appropriate levothyroxine, almost women maintained euthyroid hormone levels during pregnancy. CONCLUSION:Early diagnosis and treatment for thyroid disease before pregnancy may prevent perinatal complications. Team approach of obstetrician, endocrinologist and neonatalogist may help for maternal and fetal well-being.
Diagnosis ; Female ; Humans ; Hyperthyroidism ; Hypothyroidism ; Infant, Newborn ; Medical Records ; Pregnancy ; Pregnant Women* ; Prognosis* ; Retrospective Studies ; Thyroid Crisis ; Thyroid Diseases* ; Thyroid Gland* ; Thyroxine

Caudal regression syndrome is rare malformative syndrome characterized by lower vertebral agenesis, accompanied by abnormalities of the pelvis, lower extremities and urogenital malformation. Although the cause is not clear, hyperglycemia during the organogenesis may be important teratogen. Strict evaluation of diabetes and its control in preconception and early pregnancy are important to prevent this malformation. And ultrasonography in the first trimester should be recommended for early detection of this syndrome. We report a case of caudal regression syndrome detected by prenatal ultrasonography of the gestational diabetic mother.
Female ; Humans ; Hyperglycemia ; Lower Extremity ; Mothers ; Organogenesis ; Pelvis ; Pregnancy ; Pregnancy Trimester, First ; Ultrasonography ; Ultrasonography, Prenatal*

Recently the incidence of coronary artery diseases in young patients has been increased in Korea, which may be related with the changes in dietary habits, stress and smoking. This report presents an 18-year-old male patient who suffered from acute non-ST elevation myocardial infarction. He had a history of 1.5 pack-years smoking, but no other risk factors. Depression of ST segments more than 3 mm in V1-6, I and aVL was documented on a twelve-lead electrocardiogram. Two-Dimensional echocardiography revealed hypokinetic anteroseptal wall motion, and myocardial SPECT demonstrated severe, reversible perfusion defects in the anteroseptal wall. A diagnostic coronary angiogram and an intravascular ultrasound revealed total occlusion in the proximal left anterior descending coronary artery due to heavy atheromatous plaque. The lesion was treated successfully by a coronary balloon and stent. He has no major adverse cardiovascular event on nine-month clinical follow-up after discharge.
Adolescent ; Coronary Artery Disease ; Coronary Vessels ; Depression ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Food Habits ; Humans ; Incidence ; Korea ; Male* ; Myocardial Infarction* ; Perfusion ; Risk Factors ; Smoke ; Smoking ; Stents ; Tomography, Emission-Computed, Single-Photon ; Ultrasonography

Purpose: Many patients who have an acceptable living- kidney donor do not undergo transplantation because of the presence of antibodies against the donor cells resulting in a positive lymphocyte-crossmatch (LCX). Recently, the combination therapy of plasmapheresis, intravenous gamma- globulin and potent immunosuppression to induce negative conversion of LCX in patients who had positive LCX to their living donors was reported. Our institute gave these patients the combination therapy and reported the results of follow-up done 1~3 years after kidney transplantation. Methods: Eleven patients, who showed positive LCX to their living donors, underwent the conversion trials between January 1, 2002 and March 31, 2004. Combination therapy consisting of plasmapheresis, intravenous gamma globulin injection, tacrolimus, mycophenolate mofetil (MMF) and steroids was used. Plasmapheresis had been done every other day up to 6 times. Kidney transplantations were performed immediately after negative conversion was achieved. Five to ten day-courses of ATG (or OKT3) were used as an induction immunosuppression and tacrolimus, MMF, and steroids as a maintenance immunosuppression. Results: Negative conversions in ten out of eleven patients were achieved. Kidney transplantations in these 10 patients were successfully performed. No hyperacute rejection transpired, although four patients developed acute rejection, whose grafts were all rescued with steroid pulse therapy. Serum creatinine level was 1.57+/-0.12 mg/dL (mean+/-SD) during follow-up periods except for one whose graft was lost to Polyoma virus nephropathy. Conclusion: Nine of the 10 grafts are functioning well for 15~41 months after transplantations. Our results suggest that selected crossmatch positive patients can be transplanted successfully with living donor kidney allograft.
Allografts* ; Antibodies ; Creatinine ; Follow-Up Studies ; gamma-Globulins* ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Living Donors ; Lymphocytes* ; Plasmapheresis* ; Polyomavirus ; Steroids ; Tacrolimus ; Tissue Donors ; Transplants

PURPOSE: The natural history of renal transplant recipients with positive HBs Ag is still unclear and unpredictable. Liver-related morbidity and mortality after long-term immunosuppression need clinical challenges. We retrospectively investigated the clinical outcome of pre-transplant HBs Ag positive renal recipients in a single transplant center located in endemic area. METHODS: After excluding post-transplant de novo HBV infected, and peri-transplant anti-hepatitis C virus positive recipients, the clinical outcome of 1,816 recipients was examined by the nature of pre-transplant HBs Ag positivity. RESULTS: Pre-transplant HBs Ag positivity was documented in 61 recipients (M/F=47/14). During mean follow up of 71.61+/-54.14 months, 24 recipients died (6 by infection, 12 by hepatic failure, 2 by hepatocellular carcinoma, 2 by other malignancies, 1 by suicide, 1 by gastrointestinal bleeding). In 14 recipients (58.3%), death was related to liver-associated reasons. The 10-year patient survival rates in HBs Ag negative and positive groups were 90.0% and 62.6%, respectively (P<0.0001). The 10-year graft survival rates in HBs Ag negative and positive groups were 82.0% and 55.6%, respectively (P<0.0001). When pre-transplant HBV DNA viral load by PCR was positive or when the level of post-transplant HBV-DNA viral load flared up, we started lamivudine therapy since 1997. Seventeen recipients received daily 100 mg lamivudine. The mean duration of patients survival with (n=17) and without (n=44) lamivudine therapy was 104.3+/-45.6 and 59.0+/-51.2 months, respectively (P= 0.003). The 10-year patient survival rates in patients with and without lamivudine therapy were 80.7% and 55.4%, respectively (P=0.0698). CONCLUSION: Overall patient and graft survival in patients with positive pre-transplant HBs Ag was lower than negative recipients. Although, statistically not significant, lamivudine therapy showed a marginally positive impact on the survival of patients with pre-transplant positive HBs Ag.
Carcinoma, Hepatocellular ; DNA ; Follow-Up Studies ; Graft Survival ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunosuppression ; Kidney Transplantation* ; Lamivudine ; Liver Failure ; Mortality ; Natural History ; Polymerase Chain Reaction ; Retrospective Studies ; Suicide ; Survival Rate ; Transplantation ; Viral Load

PURPOSE: The aims of this study were to review the result of kidney re-transplantation in comparison with first kidney transplantation, and to identify the prognostic factors affecting long-term outcome at a single center. METHODS: Between April 1979 and January 2006, the total number of renal allografts was 2,495. Among these, 159 cases received second (155 cases) or third (4 cases) transplantation. Demographic characteristics and clinical outcomes of both groups were compared. And we examined the risk factors affecting long-term outcome in re-transplantation recipients. RESULTS: The mean duration of previous graft survival in re-transplantation group was 86.1+/-51.4 (0~215) months. Major cause of the previous graft failure was chronic rejection (n=88, 55.3%). One-, 5-, and 10-year graft survivals of the re-transplantation group and the first transplantation group were 94.1%, 88.9%, 76.0% and 96.0%, 84.8%, 69.1%, respectively without significant difference (P=0.2203). In uni-variate survival analysis, acute rejection experienced group, elderly recipient more than 50 years old, and female gender group showed significant inferior graft survival rate compared to control group. Previous graft survival duration didn't cause significant graft survival difference. Multivariate survival analysis also confirmed that the episodes of acute rejection within 12 months after transplantation (P=0.035, Odd ratio= 2.514), elderly recipient more than 50 years old (P=0.002, odd ratio=3.734), and female gender (P=0.005, Odd ratio= 3.692) were statistically significant independent risk factors affecting graft survival in kidney re-transplantation. CONCLUSION: Long-term outcomes after kidney re-transplantation were not different from that of first kidney transplantation. Therefore, renal re-transplantation could be the treatment of choice even in recipients with previous failed renal allograft.
Aged ; Allografts ; Female ; Graft Survival ; Humans ; Kidney Transplantation ; Kidney* ; Middle Aged ; Risk Factors* ; Survival Rate ; Transplants

PURPOSE: As increasing overseas kidney transplant recipients, the post-transplantation management of these recipients is not unusual. Shortage of donor information and operative findings is an obstacle to post-transplant evaluation and management of overseas transplant recipients. We retrospectively reviewed the post-transplant clinical manifestation of overseas transplant recipient, and compared with those of domestic deceased donor transplant recipient. METHODS: Sixty overseas transplant recipients and 39 deceased donor transplant recipient in our center from January 2002 to August 2006 were enrolled in this study. Among the post-transplant outcomes, we focused the episodes of post-transplant complication, acute rejection and graft functional status. RESULTS: In comparison of pre-transplant clinical manifestation, overseas transplant recipients were more elderly, male predominant and less retransplantation than domestic deceased transplant cases. Remarkable surgical complications (35%, 21/60) were observed in overseas transplant recipients which was significantly higher than those of domestic transplant recipients (5.1%, 2/39 cases)(P=0.03). The urologic complication was major (14 cases) complication, and intraoperative hematoma (5 cases) and vascular complication (2 cases) succeed. Interventional procedure or surgical correction was performed in six recipients with urinary leakage obstruction. Excluding post-transplant acute tubular necrosis, the post-transplant outcomes, such as incidence of acute rejection, graft survival rate and graft function within post-transplant 3 year, of overseas transplant recipient were statistically similar with these of domestic deceased donor recipients. CONCLUSION: Considering that overseas transplant recipient had high incidence of surgical or urologic complication, the initial evaluation of post-transplant recipient was focused on completion of surgical procedure by using radiologic imaging study.
Aged ; Graft Rejection ; Hematoma ; Humans ; Incidence ; Kidney Transplantation* ; Kidney* ; Male ; Necrosis ; Retrospective Studies ; Survival Rate ; Tissue Donors* ; Transplantation ; Transplants

PURPOSE: Occurrence of renal failure and its related complications such as hypertension are long-term problems after donor nephrectomy for living donor kidney transplantation. We retrospectively reviewed renal function of unilateral kidney donor. METHODS: From 669 living donors for kidney transplantation from December 1998 to October 2006, laboratory data related to renal function are collected from hospital medical record retrospectively in 251 (37.5%) donors who were followed-up after discharge. The selection criteria of donors were: 1) pre-nephrectomy serum creatinine level below 1.5 mg/dL, 2) no radiologic abnormality in bilateral kidney. The donor nephrectomy was performed by conventional open nephrectomy or video assisted minilaparotomy surgery. The estimated glomerular filtration rate (e-GFR) by Modification of Diet in Renal Disease (MDRD) study was used as renal function monitoring parameter. RESULTS: In immediate post-nephrectomy period, e-GFR was decreased to 67.8+/-4.6% of pre-nephrectomy level (93.8+/-9.9 mL/min/1.73 m2). The urinary protein excretion for 24 hours was increased to 255% of pre-nephrectomy level (76.4+/-4.6 mg/day), but cases with proteinuria more than 300 mg per day were only 4 cases (1.7%, 4/251). After 14.0+/-5.2 months follow-up (range: 1~80 months), two cases (0.8%, 2/251) of renal failure (chronic kidney disease stage 5) were found. Relative renal function (post-nephrectomy e-GFR ratio versus pre-nephrectomy e-GFR, %) was increased by post-nephrectomy duration. The mean scores of e-GFR ratio within post-nephrectomy 2 months, 3~11 months, 12~23 months and after 24 months were 64.8+/-10.4%, 66.4+/-9.7%, 69.5+/-10.9% and 75.8+/-17.6% respectively. The relative e-GFR ratio after 24 months was significantly different from those of within 24 months (P<0.0001 by ANOVA). In linear regression analysis, mean increment of e-GFR ratio per post-nephrectomy year was 2.88%. CONCLUSION: In spite of possibility of renal failure, our study shows the long-term compensation of residual renal function after nephrectomy.
Compensation and Redress ; Creatinine ; Diet ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Hypertension ; Kidney Diseases ; Kidney Transplantation* ; Kidney* ; Laparotomy ; Linear Models ; Living Donors ; Medical Records ; Nephrectomy* ; Patient Selection ; Proteinuria ; Renal Insufficiency ; Retrospective Studies ; Tissue Donors*

PURPOSE: Serum level of soluble form CD30 (sCD30), a marker for T helper 2-type cytokine-producing T cells, is used as a marker of immunologic status of pre-transplant recipient that can predict graft rejection and graft survival. This study compared pre-transplant serum sCD30 levels with conventional pre-transplant immunologic parameter, such as panel- reactive antibodies (PRA) and lymphocyte cross matching (LCM). METHODS: Adult seventy two patients were enrolled this study. The blood for tests was sampled simultaneously. Measurement of serum sCD30 level was performed using enzyme-linked immunosorbent assay kit (Bender MedSystems, Co. CA, USA). We tested PRA using a commercial ELISA kit (Lambda Cell Tray Lymphocytotoxicity assay)(One Lambda Inc. CA, USA). We established LCM tests for T cells by Modified NIH (National institute center of health)/Johnson's Method/AHG (Anti human globulin), and for B cells by warm test. RESULTS: Mean score of sCD30 was 90.3+/-6.4 U/mL, ranged from 12.2 to 244.4 U/mL. There was no significant correlation between patient's age or sex and sCD30 level. The correlation between sCD30 and mode or duration of dialysis was not statistically significant clinical situation. The result of LCM didn't show significant correlation with sCD30 level (87.3+/-55.7 U/mL in LCM positive group versus 91.9+/-1.3 U/mL in LCM negative group, P=0.696). And sCD30 level equal to or more than 86 U/mL could not predict the positive result of LCM. The positive and negative predictive value of sCD30 to LCM was merely 27.8% and 58.3% (P=0.322). Also the correlation between sCD30 level and PRA was not significant (P=1.0). CONCLUCION: There was no significant correlation between serum sCD30 level and conventional immunologic parameter such as PRA or LCM. That means the pre-transplant monitoring of the sCD30 level can be used as an independent immunologic parameter.
Adult ; Antibodies* ; B-Lymphocytes ; Dialysis ; Enzyme-Linked Immunosorbent Assay ; Graft Rejection ; Graft Survival ; Humans ; Lymphocytes* ; T-Lymphocytes