There are many procedures for treatment of injuries of acromioclavicular separation but there are still con- roversies concerning the best management of these injuries. With this in mind, we treated surgically 22 cases of acromioclavicular separation of which 3 cases were old type 2 and 19 cases were type 3 in the department of orthopaedic surgery, Eul Ji General Hospital from March 1977 to darch 1982. The results were as follows: l. Of 22 cases, 21 cases (95.5%) were male with peak incidence in the 3rd and 5th decades (90.9%). 2. The most common causes of the injuries were traffic accidents (63.6%) and followed by falling from height (22.7%). 3. The diagnosis in type 2 and type 3 injuries is based on the clavicular displacement and instability at the acromioclavicular joint. 4. Operative treatment consists of Weaver and Dunn method (54.5%), modified Phemister method (18.2%), Neviaser method (13.0%), Stewart method (9.1%) and modified Henry method (4.5%). 5. The operative procedure in old type 2 and typc 3 injuries is good treatment of acromioclavicular separation.
Accidental Falls ; Accidents, Traffic ; Acromioclavicular Joint ; Diagnosis ; Hospitals, General ; Humans ; Incidence ; Male ; Methods ; Surgical Procedures, Operative

Ectopic ureteroceles have a broad spectrum of presentation, anatomy and pathophysiology and the management is controversial. Herein, we report our experience of the management in 7 children with 8 ectopic ureteroceles associated with complete duplicated systems. Two functioning upper renal segments were able to be salvaged with ureteropyeIostomy and common sheath ureteral reimplantation. Four small ureteroceles not associated with reflux managed successfully with upper tract correction only(3 heminephrectomy and 1 ureteropyelostomy). Three children with ectopic ureteroceles associated with reflux and/or outlet obstruction underwent successful one stage total reconstruction which included heminephrectomy, ureterectomy, ureterocelectomy and lower pole ureter reimplantation. In summary, the management of ectopic ureterocele must be individualized taking into considerations the salvageability of renal segments, presence of reflux and/or outlet obstruction.
Child* ; Humans ; Replantation ; Ureter ; Ureterocele*

Xanthoma tendinosum is a hereditary lipid storage disease marked by formation of papules or nodules in the tendon, especially the extensor tendon of the hand and feet and the Achilles tendon. Xanthoma of the Achilles tendon is a rather rare, interesting orthopaedic condition that has important ramification in internal medicine and dermatology because the lesion is associated with a specific disturbance of lipid metabolism with elevated blood cholesterol level. Author present a case of bilaterally involved Achilles tendon Xanthoma. We performed subtotal resection with gastrocnemius fascial transfer on one side and total resection with peroneus brevis tendon transfer on the other side.
Achilles Tendon ; Cholesterol ; Dermatology ; Foot ; Hand ; Internal Medicine ; Lipid Metabolism ; Tendon Transfer ; Tendons ; Xanthomatosis

Between January 1987 and February 1990, records of 5Z patients with 60 impalpable testes who had surgery were reviewed retrospectively regarding localization and management of the testes. Seven out of 60 testes turned out to be palpable by careful examination under anesthesia. Ultrasonogram detected 8 testes (5 intracanalicular and 3 preperitoneal) out of 25 testes. Laparoscopy provided and in planning the appropriate surgical approach in all 8 testes. Of the 47 testes found at surgery 19 were intraabdominal, 14 intracanalicular, 12 in preperitoneal and 1 located in superficial inguinal area. Also 13 vanished testes were confirmed during surgery examining blind end of spermatic vessels and vasa. Two patients with intersex ( true hermaphroditism and hernia uteri inguinalis) were presented as unilateral impalpable testes. 42 testes were brought down surgically utilizing regular orchiopexy in 26 testes, transabdominal orchiopexy in 8 testes, Fowler-Stephens orchiopexy in 7 testes and staged orchiopexy in 1 testis were done with acceptable results. transabdominal approach is recommended in cases of suspecting intraabdominal testis or intersex.
Anesthesia ; Hernia ; Humans ; Laparoscopy ; Orchiopexy ; Ovotesticular Disorders of Sex Development ; Retrospective Studies ; Testis* ; Ultrasonography ; Uterus

Unilateral renal cystic disease (URCD) is a multicystic disease, characterized by varying sized cysts localized in a diffusely enlarged kidney without forming a distinct encapsulated mass. Except for its unilaterality, gross and histological findings of URCD are indistinguishable from those of autosomal dominant polycystic kidney disease (ADPKD). However, unlike ADPKD, URCD patients show neither a genetic background nor progressive deterioration in renal function; thus, the differential diagnosis of URCD from ADPKD is important, especially from the genetic and prognostic standpoint. Usually, URCD patients have no cardiac valvular abnormalities and no cystic diseases in other intraperitoneal organ, except simple cyst. Intracranial aneurysm can be found in 5-10% of ADPKD patients, but not in previous reported fourteen URCD cases yet. We report a 41- year-old patient with URCD and cerebral artery aneurysm. Careful family history taking and ultrasonographic examination of his parents and siblings revealed that they have no renal cystic disease. We followed the patient for 13 months and his renal function did not deteriorate.
Aneurysm* ; Cerebral Arteries* ; Diagnosis, Differential ; Humans ; Intracranial Aneurysm ; Kidney ; Parents ; Polycystic Kidney, Autosomal Dominant ; Siblings

Various clinical and histopathologic characteristics are currently used to obtain prognostic information about cervical carcinoma, but they do not predict accurately the outcome for any individual patients. Thus, there is a need to identify additional tumor characteristics that are able to predict more accurately the outcome for an individual patient with cervical cancer. In this study, we explored the relationship between cathepsin-D expression and progression of the cervical neoplasia, the correlation between response to neoadjuvant chemotherapy and cathepsin-D expression, and we investigated if tumor cell cathepsin-D expression could serve as a prognostic factor in cervical carcinoma. Tumor tissues were obtained from 14 patients with cervical intraepithelial neoplasia and 52 patients with squamous cell carcinoma of the cervix. Cathepsin-D expression was identified by immunohistochemical methods using monoclonal antibody cathepsin-D (BioGene). Positive cathepsin-D immunoreaction in greater than 30% of carcinoma cells was scored as high expression High cathepsin-D expression was seen in 15 of 52 invasive cervical cancer but was absent in cervical intraepithelial neoplasia. It was shown that cathepsin-D expression was independent of the tumor grade, tumor size, lymph node involvement, depth of invasion, parametrial invasion, and response to chemotherapy. In disease free survival analysis by log-rank test, cathepsin-D expression was not significantly associated with survival. These results show that cathepsin-D expression is not a clinically useful adjunct to assessment of prognosis in invasive squamous cell carcinoma of the cervix.
Carcinoma, Squamous Cell ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Disease-Free Survival ; Drug Therapy ; Female ; Humans ; Lymph Nodes ; Prognosis ; Uterine Cervical Neoplasms

BACKGROUND: The goal of this study is to evaluate the differences of the rate and the ratio of heart rate changes, which is well known to reflect the vagal reactivation, after peak exercise between ischemic heart disease and normal during treadmill exercise test. Additionally R-wave amplitude changes are evaluated to have the discriminal power between ischemic heart disease and normal. METHODS: We have studied 253 human (196 control, 57 patients) who took the symptom-limited exercise test using Marquette case 8000 model. The 57 patients who showed the positive result by exercise test have confirmed by coronary angiography. The rate of heart rate changes was defined as the absolute difference of the heart rate subtracted by the just-previous stage heart rate. The ratio of heart rate changes was defined as the percentile of the rate of heart rate changes comparing to the just-previous stage heart rate. The changes of R-wave amplitude at lead V5 and aVF were obtained by the subtraction of R-wave amplitude at the peak exercise stage from that at the standing rest stage respectively. Additively heart rate recovery was defined as the rate of heart rate change which was obtained at 1 minute later after peak exercise. RESULTS: In patients and control, the resting heart rate were 70 +/- 13 bpm and 69 +/- 11 bpm (p>0.05), and the peak heart rate were 136 +/- 22 bpm and 155 +/- 18 bpm respectively (p<0.001). The rate of heart rate changes in patients group were significantly lower than that in control at 1 minute, 3 minute, and 5 minute respectively (p<0.001, p=0.008, p=0.002). The ratio of heart rate changes in patients group were also significantly lower than that in control at 1 minute, 3 minute, and 5 minute respectively (p=0.017, p=0.027, p=0.002). With comparing both groups, the incidences of ventricular ectopy were not different during exercise and recovery stages, and the difference in the changes of R-wave amplitude at lead V5 and aVF were not observed respectively. CONCLUSION: The rate and ratio of heart rate changes are significantly lower in iscemic heart disease than in normal, and these are resulted from the depression of vagal reactivation. These findings are supplemental to make a diagnosis and a arrhythmic risk stratification of ischemic heart disease.
Coronary Angiography ; Depression ; Diagnosis ; Exercise Test ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Incidence ; Myocardial Ischemia*

V. fluvialis is a gram-negative, oxidase-producing, halophilic bacterium. It is normally found in coastal waters and seafoods. There have been a few reports on Vibrio fluvialis gastroenteritis in other countries, whereas there has been no previous report of V. fluvialis infections in Korea. Reports from other countries showed that V. fluvialis was isolated mostly from infants and children. We experienced a rare case of gastroenteritis due to V. fluvialis in a 55-year-old man with liver cirrhosis who ate an ark shell. He was admitted due to mild abdominal pain and severe watery diarrhea followed by rapidly progressive dehydration, electrolyte imbalance, and hepatorenal syndrome for a week. This patient was not improved by intensive care and antibiotic therapy.
Abdominal Pain ; Arcidae ; Child ; Dehydration ; Diarrhea ; Gastroenteritis* ; Hepatorenal Syndrome ; Humans ; Infant ; Critical Care ; Korea ; Liver Cirrhosis ; Middle Aged ; Seafood ; Vibrio*

PURPOSE: The aim of this study was to investigate the effects of new herbal formula (KBMSI-1) on erectile dysfunction in streptozotocin-induced diabetic rat model. MATERIALS AND METHODS: We used male Sprague-Dawley rats aged 12 weeks and divided into three groups; control (n=8), diabetes (DM) (n=8), DM+KBMSI-1 200 mg/kg treatment (n=8) groups. The DM groups received a single intraperitoneal injection of streptozotocin (STZ). Distilled water was administered in the control and DM group. To investigate the penile erection, intracavernosal pressure (ICP) and intracavernosal pressure/mean arterial pressure (ICP/MAP) were recorded in all groups. Serial sections of the penis were used to perform Masson's trichrome stain. We analyzed the expression of nNOS and eNOS concentration in the isolated corpus cavernosum by western blotting. RESULTS: Peak ICP/MAP ratio was markedly increased in the treatment group with KBMSI-1 compared with DM group (p<0.05). Masson's trichrome staining of corpus cavernosum showed increase in smooth muscle volume and the regular arrangement of collagen fibers in KBMSI-1 treatment group compared with DM group. Western blot analysis revealed that the penile expressions of nNOS and eNOS protein were significantly higher in KBMSI-1-treated group than in DM group. CONCLUSIONS: This study showed that herbal formulation of KBMSI-1 enhances the penile erection and the level of eNOS and nNOS expression of penile corpus cavernosum in streptozotocin-induced diabetic rat model.
Aged ; Animals ; Arterial Pressure ; Azo Compounds ; Blotting, Western ; Collagen ; Diabetes Mellitus ; Eosine Yellowish-(YS) ; Erectile Dysfunction ; Humans ; Injections, Intraperitoneal ; Male ; Methyl Green ; Muscle, Smooth ; Penile Erection ; Penis ; Rats ; Rats, Sprague-Dawley ; Streptozocin ; Water

Amlodipine, a calcium channel blocker (CCB) belonging to the group of dihydropyridines, is characterized by a slower onset of action (6-8h), a longer duration of action (24-72h), a greater vascular, cardiac effect, and hyperglycemia. Case of intoxication with 300 mg of amlodipine in a 69-year-old female patient and with 450 mg of amlodipine and 120 mg of glimepride in a 64-year-old female patient caused severe hypotension and hyperglycemia. They were initially treated with fluids, dopamine and norepinephrine, but these therapy were ineffective. Then, the patients were given a bolus injection of insulin and continuous infusion of insulin. The former patient's hyperglycemia was not controlled. She expired in 47 hours. The latter one's hyperglycemia was controlled and then her hypotension improved. In conclusion, it is suggested that hyperinsulinemia-euglycemia therapy be considered as a first-line therapy in calcium channel blocker intoxication.
Aged ; Amlodipine* ; Calcium Channels ; Dihydropyridines ; Dopamine ; Female ; Humans ; Hyperglycemia* ; Hypotension ; Insulin ; Middle Aged ; Norepinephrine