PURPOSE: Although breast reconstruction provides some advantages for women following mastectomy, few Korean breast cancer patients currently receive such reconstruction. Routine provision of breast reconstruction requires simplicity and easy availability for the procedure. This paper reports the possibility of performing breast reconstruction by insertion of a tissue expander by the breast surgeon. METHODS: We studied 22 cases of breast cancer patients who were treated in the Breast service of KangNam Cha Hospital. Nine cases were the group of immediate expander insertion and 13 were the group of MRM only. We evaluated age, histopathologic stage, starting time of chemotherapy, operation time, drainage amounts and periods, medication periods, time of discharge and depression score. RESULTS: The mean age of the expander insertion group was 41, which was younger than that of the MRM only group by 3 years. Histopathologic state was better in the expander insertion group and the time for chemotherapy start was almost the same between the two groups. Mean operation time in the expander insertion group was 2 hours and 41 minutes, and it was longer than the MRM only group by 1 hour, but it included additional wasting time to check the results of frozen biopsy. Periods for drainage were longer and amounts were larger, but this only delayed the medication period and time for discharge by two days. There were no other complications and mental suffering was alleviated. CONCLUSION: Tissue expander insertion for breast reconstruction could be offered on a routine basis by breast surgeons without problems. Breast reconstruction will become a more essential process for breast cancer patients to improve the quality of life. It is ideal if the same surgeon participates in both oncology and reconstruction surgery.
Biopsy ; Breast Neoplasms* ; Breast* ; Depression ; Drainage ; Drug Therapy ; Female ; Humans ; Mammaplasty* ; Mastectomy* ; Quality of Life ; Stress, Psychological ; Tissue Expansion Devices*

Thirty seven patients with acute scrotal pain were evaluated by color doppler ultrasonography. The diagnosis was made by clinical finding in 26 cases and surgical finding in 11 cases. There were inflammatory diseases in 22 cases, testicular torsion in 5 cases, other diseases in 10 cases. 20 cases of inflammatory disease showed increased blood flow in color doppler ultrasonography and 4 cases of testicular torsion showed absent blood flow. Thus, color doppler ultrasonographic evaluation had diagnostic value that was 80% in sensitivity and 96% specificity in differentiation of testicular torsion from other acute scrotal diseases. We think that color doppler ultrasonography in acute scrotum is a valuable diagnostic method for differentiation of testicular torsion from other acute scrotal diseases.
Diagnosis ; Humans ; Scrotum* ; Sensitivity and Specificity ; Spermatic Cord Torsion ; Ultrasonography, Doppler, Color*

PURPOSE: Cellular biology of response to hyperthermia was understood and localizing hyperthermic equipments were developed recently. It was known that hyperthermia suppressed renal cell carcinoma cell growth in vitro and increased the sensitivity of chemotherapeutic agents in malignant melanoma. We investigated the effect of hyperthermia on chemosensitivity of renal cell carcinoma cell lines in vitro. MATERIALS AND METHODS: Human renal cell carcinoma cell lines, Caki-1(negative multidrug-resistance) and A-498(positive multidrug-resistance) were used. Chemotherapeutic agent(cisplatin or adriamycin) was added to media with appropriate cell counts and hyperthermia(43oC) was applied in 2 and 4 hours duration. The cell growth was measured by MTT colorimetric assay and each experiment was repeated eight times. The effects of hyperthermia on chemosensitivity of renal cell carcinoma cell lines were compared using dose modification factor(DMF) of IC50 of chemotherapeutic agents. RESULTS: In 2-hour treatment at 43oC, the cell growth suppression of Caki-1 and A-498 were 15% and 16% respectively and in 4-hour treatment, the suppression percentage was increased to 36% and 46% respectively. In Caki-1 cell lines, DMFs of cisplatin treated groups in 2 and 4 hour hyperthermia were 0.9 and 0.8 respectively and DMFs of adriamycin treated groups were 0.9 and 0.9 respectively. There was no change of chemosensitivity in Caki-1. In A-498 cell lines, DMFs of cisplatin with 2 and 4 hour hyperthermia groups were 0.7 and 0.4 respectively and DMFs of adriamycin treated groups were 0.9 and 0.5 respectively. Thus, 4 hours hyperthermia increased the chemosensitivity in A-498 cell lines. CONCLUSIONS: These results suggest that hyperthermia increased the chemosensitivity of renal cell carcinoma cell lines in vitro but there was some difference in each cell line. It is necessary to investigate what the mechanism of increasing chemosensitivity is and what affects a difference of chemosensitivity in each cell line.
Carcinoma, Renal Cell* ; Cell Count ; Cell Line* ; Cisplatin ; Doxorubicin ; Fever* ; Humans ; Inhibitory Concentration 50 ; Melanoma

PURPOSE: Leptin is a hormone, encoded by ob gene in adipocytes and regulates food intake and energy expenditure. The serum concentration of leptin is known to be proportional to the amount of body fat but the regulation of leptin for growth and development in childhood is not clear. The purpose of this study is to evaluate the correlation of serum leptin levels to gender, pubertal development and sex steroid in children. METHODS: Serum leptin levels were measured by RIA in 145 Korean children of both sexes, age 8-16yr, and were compared according to body mass index, gender and pubertal stage. The correlations of leptin with testosterone and estradiol were also analized. RESULTS: A positive relationship was observed for leptin levels with body mass index(in male:r=0.63, P<0.001, in female:r=0.80, P<0.001). The mean leptin level of girls was higher than that of boys(7.50+/-.83ng/mL vs 4.11+/-.72ng/mL, P<0.05) in lean children but there was no significant difference in obese group. An analysis according to the pubertal development showed an increase of leptin level in girls while leptin decreased in boys at overt puberty. Serum leptin levels of boys in puberty correlated inversely with testosterone(r=-0.52, P<0.001) but leptin of girls did not have significant correlation with estradiol. CONCLUSION: Serum leptin level increases in girls and decreases in boys as the pubertal development proceeds. The relationships between leptin level and pubertal developement show gender difference and it might be explained in part by suppressive effects of androgen in male.
Adipocytes ; Adipose Tissue ; Adolescent ; Body Mass Index ; Child* ; Eating ; Energy Metabolism ; Estradiol ; Female ; Growth and Development ; Humans ; Leptin* ; Male ; Puberty ; Testosterone

PURPOSE:It is well known that childhood obesity associated with high morbidity of hyperlipidemia, hypertension, fatty liver and type 2 diabetes mellitus. Recently investigators have revealed that hyperinsulinemia in obese children is related with not only insulin resistance but also hyperlipidemia and fatty liver. We investigated the relationship between fasting insulin level and comorbidities of childhood obesity. Also we determined the prevalence of asymptomatic fatty liver and presumed nonalcoholic steatohepatitis and to assess the correlation of fatty liver with degree of obesity and serum insulin level. METHODS:We measured fasting serum insulin in 300 obese children (obesity index greater than 20 percent), from 8 to 15 years old age and blood pressure, fasting serum glucose and lipid profiles were also checked. Fatty liver was diagnosed by liver function test and abdominal ultrasonography. The correlations of insulin with BMI, blood pressure and lipid profiles were analyzed by linear regression. The prevalences of hypertension, hyperlipidemia and fatty liver were compared according to fasting insulin level. RESULTS:Mean obesity index of obese children was 35.26 (37.01 in male, 31.61 in female). Mean body mass index of obese children was 26.15 kg/m2 (26.72 kg/m2 in male, 24.98 kg/m2 in female). Among obese children, 87 children had hypercholesterolemia (>or=200 mg/dL, 28.9%), 60 children had hypertriglyceridemia (>or=150 mg/dL, 20.0%), 128 children had fatty liver (42.7%) and 139 children had hyperinsulinemia (46.6%). Serum insulin level had positive correlation with body mass index (r=0.274, P>0.01), systolic blood pressure (r=0.291, P<0.01), serum triglyceride (r=0.339, P<0.01) and not with serum total cholesterol. The prevalences of hypertriglyceridemia and fatty liver were higher in obese children with hyperinsulinemia than with normal insulin level (P<0.01). The severity of fatty liver was positively related to BMI, obesity index, triglyceride, insulin, HOMA. Fatty liver with elevated ALT was found in 40 subjects (13.3%). CONCLUSION: In this study, fasting insulin level had closely related with dyslipidemia and fatty liver in obese children. Our results suggest that monitoring of insulin level is helpful to assess the morbidities and should become a part of routine care of obese children.
Adolescent ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Child* ; Cholesterol ; Comorbidity* ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Fasting* ; Fatty Liver ; Humans ; Hypercholesterolemia ; Hyperinsulinism ; Hyperlipidemias ; Hypertension ; Hypertriglyceridemia ; Insulin Resistance ; Insulin* ; Linear Models ; Liver Function Tests ; Male ; Obesity ; Pediatric Obesity* ; Prevalence ; Research Personnel ; Triglycerides ; Ultrasonography

Trisomy 9p syndrome was first described by Rethore et al in 1970 and about 100 cases have been reported since. The phenotypic spectrum of this syndrome is characterized by craniofacial malformation, facial deformity, skeletal and dermatoglyphic anomalies with variable degrees of mental retardation. We experienced a case of partial trisomy 9 syndrome in a 15-month-old female who had multiple congenital anomalies of frontal bossing, oblique antimongoloid palpebral fissures, enophthalmos, hypertelorism, globular prominent nose, down-turned mouth, prominent low-set ears, simian creases of both hands, clinodactyly and single crease of 5th finger, congenital dislocation of both knees and mental retardation. In cytogenetic studies using G banding technique and fluorescent in situ hybridization(FISH), she presented with an extra derivative chromosome No. 9. The karyotype of the patient was confirmed as 47,XX,+der (9),t (6:9) (q27;q21.2) mat. We report the case with the review of the associated literatures.
Congenital Abnormalities ; Cytogenetics ; Dermatoglyphics ; Dislocations ; Ear ; Enophthalmos ; Female ; Fingers ; Hand ; Humans ; Hypertelorism ; Infant ; Intellectual Disability ; Karyotype ; Knee ; Mouth ; Nose ; Trisomy*

Clean intermittent catheterization(CIC) is known as a safe, acceptable method in patient with neurogenic bladder due to spinal cord injury. We studied retrospectively the long term results of CIC in spinal cord injury patients. A total of 34 patients(12 upper. motor neuron lesion and 22 lower motor neuron lesion) was followed for 7 months to 82 months (average followup 31.5 months). Sixteen of 34 patient with high intravesical pressure improved after CIC. Two of 3 with abnormal BUN/Cr level, 13 of 14 with hydronephrosis, and all 12 with vesicoureteral reflux improved after CIC. But one patient with abnormal BUN/Cr was worsen. Before CIC period symptomatic bacteriuria developed in 29 patients, epididymitis in 8 patients and bladder stone in 3 patients. But after CIC, each of them was changed to 15, 1 and 1. In conclusion, We think that CIC is a good method for preservation of renal function and to decrease the urologic complications. But patients should be well motivated, cooperative and able to use their hands for continuous CIC.
Bacteriuria ; Epididymitis ; Follow-Up Studies* ; Hand ; Humans ; Hydronephrosis ; Intermittent Urethral Catheterization* ; Male ; Motor Neurons ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder Calculi ; Urinary Bladder, Neurogenic ; Vesico-Ureteral Reflux

Clean intermittent catheterization(CIC) is known as a safe, acceptable method in patient with neurogenic bladder due to spinal cord injury. We studied retrospectively the long term results of CIC in spinal cord injury patients. A total of 34 patients(12 upper. motor neuron lesion and 22 lower motor neuron lesion) was followed for 7 months to 82 months (average followup 31.5 months). Sixteen of 34 patient with high intravesical pressure improved after CIC. Two of 3 with abnormal BUN/Cr level, 13 of 14 with hydronephrosis, and all 12 with vesicoureteral reflux improved after CIC. But one patient with abnormal BUN/Cr was worsen. Before CIC period symptomatic bacteriuria developed in 29 patients, epididymitis in 8 patients and bladder stone in 3 patients. But after CIC, each of them was changed to 15, 1 and 1. In conclusion, We think that CIC is a good method for preservation of renal function and to decrease the urologic complications. But patients should be well motivated, cooperative and able to use their hands for continuous CIC.
Bacteriuria ; Epididymitis ; Follow-Up Studies* ; Hand ; Humans ; Hydronephrosis ; Intermittent Urethral Catheterization* ; Male ; Motor Neurons ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder Calculi ; Urinary Bladder, Neurogenic ; Vesico-Ureteral Reflux

Epidermal nevus syndrome is a rare congenital malformation clinically characterized by the association of epidermal nevi with multiple abnormalities of the skin, skeletal system, central nervous system, eyes, cardiovascular system, urogenital system, as well as with malignant conditions. We describe a 4-month-old male with an extensive epidermal nevus involving the left side of the body (nevus unius lateris) and associated with lymphedema of the left lower extremity, diffuse alopecia and focal cicatrical alopecia of the scalp, atrial septal defect, multicystic dysplastic kidney and infantile spasm. We report this case with brief review of related literatures.
Abnormalities, Multiple ; Alopecia ; Cardiovascular System ; Central Nervous System ; Heart Septal Defects, Atrial ; Humans ; Infant ; Infant, Newborn ; Lower Extremity ; Lymphedema ; Male ; Multicystic Dysplastic Kidney ; Nevus* ; Scalp ; Skin ; Spasms, Infantile* ; Urogenital System

PURPOSE: We investigated if there are some differences in characteristic of recent renal infection from the past one and evaluated the need of ultrasonography in acute renal infection and the efficiency of antibiotics that have been used primarily in treatment of past renal infection. MATERIALS AND METHODS: We reviewed charts of 232 patients with acute renal infection retrospectively, who took admission treatment from 1991 to 1995 at our hospital. The laboratory tests such as complete blood count, urinalysis and urine culture with sensitivity and radiologic evaluations such as abdominal ultrasonography, excretory urography or voiding cystourethrography were performed. RESULTS: The most common age groups were 3rd decade(26.7%) and 4th decade(24.1%). Female was predominant in all age groups(M:F=1:8.7) except 1st decade(M:F=1.6:1). Acute pyelonephritis was the most common disease (87.1%) and then followed by acute focal bacterial nephritis(8.2%), renal abscess(4.3%) and perirenal abscess(0.4%). Five cases(2.2%) were accompanied by vesicoureteral reflux. Abdominal ultrasonography was done in 90.5%, but 74.8% of them were completely normal and most of abnormal findings at abdominal ultrasonography were clinically insignificant. Result of ultrasonography did not affect the outcome of the disease or the treatment plan. The significant bacterial isolation(more than 10(5)CFU/ml) in urine culture was 46.6%. Among them, E. coli was the most common organism(92.6%) and others were Enterobacter, Klebsiella or Pseudomonas. Causative agents were resistant to some drugs such as ampicillin or bactrim which have been usually used for urinary tract infection. CONCLUSIONS: Routine ultrasonography in renal infections without urinary tract obstruction was not helpful in treatment plan or outcome of this disease and selection of antibiotics in treatment of recent renal infection should be changed from the past one.
Ampicillin ; Anti-Bacterial Agents ; Blood Cell Count ; Enterobacter ; Female ; Humans ; Klebsiella ; Pseudomonas ; Pyelonephritis ; Retrospective Studies ; Trimethoprim, Sulfamethoxazole Drug Combination ; Ultrasonography* ; Urinalysis ; Urinary Tract ; Urinary Tract Infections ; Urography ; Vesico-Ureteral Reflux