Minoxidil is a potent direct-acting peripheral vasodilator indicated in the management of severe or refractory hypertension. Well-known adverse effects include reflex tachycardia, fluid retention and hypertrichosis. This drug has also been reported to cause pericardial effusion in about three percent of nondialyzed patients with compromised renal function and to cause cardiac tamponade less frequently. Many studies have reported that the mean duration of therapy that caused pericardial effusion was about 8 months (range 1 month-53 months). We report a case of cardiac tamponade in nondialyzed patient with chronic renal failure receiving minoxidil for 10 years. A 58-year-old female was admitted to our hospital with dyspnea of NYHA III. She was a chronic renal failure patient without dialysis treatment and received kidney transplantation from cadaver donor and was dignosed chronic rejection in 1994. Minoxidil 10mg has been used for past 10 years. Lasix has been used for past 2 years, with dosage of 40mg to 240mg. On admission, blood pressure was 90/60mm Hg. Cardiomegaly was seen on chest radiograph. The two-dimensional echocardiogram showed a large amount of pericardial effusion. Emergency treatment with pericardiocentesis removed 2500ml of straw- colored pericardial fluid and resulted in marked improvement of dyspnea and stabilized blood pressure. The minoxidil was discontinued. The evidence of pericardial effusion was not seen for 12 months after minoxidil had been discontinued.
Blood Pressure ; Cadaver ; Cardiac Tamponade* ; Cardiomegaly ; Dialysis ; Dyspnea ; Emergency Treatment ; Female ; Furosemide ; Humans ; Hypertension ; Hypertrichosis ; Kidney Failure, Chronic* ; Kidney Transplantation ; Middle Aged ; Minoxidil* ; Pericardial Effusion ; Pericardiocentesis ; Radiography, Thoracic ; Reflex ; Tachycardia ; Tissue Donors

45,X/47,XYY mosaicism is a rare sex chromosomal disorder with clinical information limited to 25 cases in the literature. We report an unusual mosaic Turner syndrome case in a 35-year old Korean woman with a phenotypic female, primary amenorrhea, short stature, immature secondary sexual characteristics. Cytogenetic analysis including G- and Q-banding revealed 45,X/47,XYY mosaicism, and SRY gene was demonstrated by polymerase chain reaction(PCR). Prophylactic bilateral gonadectomy was performed because the presence of Y-chromosomal sequences in Turner stigmata may predispose this patient to gonadoblastoma formation.
Adult ; Amenorrhea ; Christianity ; Chromosome Disorders ; Cytogenetic Analysis ; Female ; Genes, sry ; Gonadoblastoma ; Humans ; Mosaicism ; Turner Syndrome*

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

A wide variety of cancers metastasize to the ovaries. In a majority of instances the primary site is the gastrointestinal tract, breast, or other gynecologic organs. The best known tumor of this type is signet-ring cell adenocarcinoma. The gallbladder and bile duct are rare sources of these metastases. The authors have had an experience of a case that was presented of Krukenberg tumor metastatic from the gallbladder and report the case with brief review of literature.
Adenocarcinoma ; Bile Ducts ; Breast ; Female ; Gallbladder* ; Gastrointestinal Tract ; Krukenberg Tumor* ; Neoplasm Metastasis* ; Ovary

The authors underwent the serum lipid study, involving the lipoprotein fraction, and the HDL-cholesterol mean values in normal Korean adults visited to Hanyang University Hospital, and also compared with the previously reported serum lipid studies. The results are as follows; 1) The mean values of triglyceride, total cholesterol, and phospholipid were 103.3+/-17.1mg%, 188.9+/-18.2mg%, and 196.7+/-19.8mg%, respectively. 2) Compared with the past 7 years triglyceride showed increasing tendency with significance, and cholesterol and phospholipid showed slightly increasing tendency. 3) In the serum lipoprotein fraction, the mean values of alpha-lipoprotein, pre-beta-lipoprotein, and beta-lipoprotein were 37.2+/-5.9%, 16.0+/-4.2%, and 48.6+/-5.2%, respectively. 4) Compared with the past 10 years, the alpha-, and pre-beta-lipoprotein showed increasing tendency, meanwhile, beta-lipoprotein revealed decreasing tendency. 5) The mean value of HDL-cholesterol was 52.3+/-14.6mg%, and the ratio of HDL-cholesterol to total cholesterol(HDL-cholesterol/total cholesterol) was 28.2+/-7.9. 6) Compared with the past 2 years, HDL-cholesterol level showed slightly increasing tendency.
Adult ; Cholesterol ; Humans ; Lipoproteins ; Triglycerides

The pseudomonas spinal epidural abscess is a extremely rare disease. It is well known that early diagnosis and surgical evacuations of the lesions are very important for better treatment results. Two cases of cervical epidural abscess were admitted to our hospital with neck pain, chillness and quadriparesis. One month prior to admission, the two patients underwent stellate ganglion block at an same institution on the same day, to releive the pain in the neck and the scapular area. Antibiotic therapy was initiated immediately and surgical decompression was performed through a posterior approach. Total laminectomy of C4-C7 was done and greenish pus and granulation tissue from anterior epidural space were evacuated. Culture of the pus revealed pseudomonas aeruginosa. In both of these cases, stellate ganglion block was suspected causes of infection. First patient patient recovered completely, but second had severe neurological deficit with quadriparesis.
Decompression, Surgical ; Early Diagnosis ; Epidural Abscess* ; Epidural Space ; Granulation Tissue ; Humans ; Laminectomy ; Neck ; Neck Pain ; Pseudomonas aeruginosa ; Pseudomonas* ; Quadriplegia ; Rare Diseases ; Stellate Ganglion* ; Suppuration

A corticocancellous core was removed from both femurs and tibias in 5 skeletally immature pigs. The cavity was treated with 5%, 25% phenol cautery, cryosurgery, and normal saline irrigation (control). The animals were sacrified after 7days. The extent of the bone necrosis was assessed by gross examination, simple radiography, MRI evaluation and histological examination with tissue mapping. After cryosurgery, the extent of necrosis was most profound in the depth of 2.0-9.0mm beyond the cavity wall. The effect of 25%-phenol was next to cryosurgery, with a depth of 1.0-3.0mm of necrosis. 5%-phenol made necrosis with the depth of 1.0-2.5mm. Very mild degree of necrosis with the width of 0.5-1.0mm was found along the cavity wall even in control group. On MRI, signal change was well visualized on T2 weighted coronal section and it was quite coincided with the extent of bone necrosis proved by histological tissue mapping to all cases. When the epiphyseal plate was open or very close to the cavity, curettage itself, 5%- and 25%-phenol cautery and cryosurgery all produced mild ischemic necrosis along the provisional calcification zone of physeal plate. These findings suggest that cryosurgery made more profound necrosis beyond cavity than phenol cautery and MRI is very sensitive and specific to find osteonecrosis along the cavity wall after phenol cautery or cryosurgery. When epiphyseal plate is open or very close to the cavity, phenol cautery, or cryosurgery, or even curettage itself could produce an ischemic necrosis to the physeal plate itself.
Animals ; Cautery* ; Cryosurgery* ; Curettage ; Femur* ; Growth Plate ; Magnetic Resonance Imaging ; Necrosis* ; Osteonecrosis ; Phenol* ; Radiography ; Swine ; Tibia*

We measured normal range and mean value of the posterior laxity of normal knee which might be reference for objective and accurate diagnosis, decision of operative indication and position of knee during fixation of ligament, and role of quadriceps building in posterior cruciate ligament injury patients. These results were obtained by measurement and analysis of posterior laxity of normal knee by means of KT-2000 Knee Ligament Arthrometer. We measured 184 Korean adults (100 males, 84 females), and their average age, height, weight, and thigh circumference were 29.8 years, 165.8cm, 59.8kg, 41.2cm, respectively. At 25 degrees of knee flexion, mean posterior displacement of normal knee was 21.2mm with 15lb posterior tibial loading, 2.41mm with 20lb posterior tibial loading. And when quadriceps were tense, laxity was 0.79mm and 0.95mm at the same degree of knee flexion. At 75 degrees of knee flexion, the results were 0.57mm, 0.58mm, 0.26mm, and 0.28mm respectively. Right to left difference of posterior displacement with 20lb posterior tibial loading was 0.07mm at 25 degrees of knee flexion and 0.06mm at 75 degrees of knee flexion. We thought that above 75 degrees of knee flexion is suitable for knee position at the time of graft fixation because 75 degrees of knee flexion markedly decreased(75%) posterior displacement compare to 25 degrees of knee flexion. When quadriceps were tense, remarkable decrease of posterior laxity of normal knee was checked(58%), so we noticed quadriceps building is important to management of posterior cruciate ligament injury patients.
Adult ; Diagnosis ; Humans ; Knee ; Ligaments ; Male ; Posterior Cruciate Ligament ; Reference Values ; Thigh ; Transcutaneous Electric Nerve Stimulation ; Transplants

Gelastic epilepsy characterized by paroxysmal involuntary laughing episodes is a relatively rare type of seizure which may occur singly or, more frequently, with other types of convulsions. Gelastic seizures have been observed in many different conditions, mainly hypothalamic hamartomas. We report a 21-year-old woman whose uncontrollable laughter was the only neurologic disturbance since 20 years of age. Physical and neurological examination did not reveal any abnormality. Neuropsychologic test was also normal. Brain magnetic resonance imaging was normal. During video-EEG monitoring, the clinical events usually consisted of aura of undescriable sensation lasting 1-2seconds followed by ictal laughter, without loss of consciousness and postictal manifestation. Ictal EEG showed bilateral interruption of background activity lasting 2-3seconds, followed by semirhythmic theta frequency activities over right frontotemporal region. Interictal EEG showed intermittent sharp waves or spike activities at right anterior temporal area. After Oxcarbamazepine treatment, she has never experienced the laughing seizures.
Brain ; Electroencephalography ; Epilepsies, Partial* ; Epilepsy ; Female ; Hamartoma ; Humans ; Laughter ; Magnetic Resonance Imaging ; Neurologic Examination ; Neuropsychological Tests ; Seizures ; Sensation ; Unconsciousness ; Young Adult

Radiation therapy is an effective cancer treatment modality as a primary treatment in early cancer and as an adjuvant treatment in advanced cancer, especially in head and neck lesions, but it also causes irreversible chronic damages to overlying normal tissues that may lead to wound complications. As well, at the microscopic level, radiation injury causes both stasis and occlusion of small vessels. Therefore, surgical reconstruction of previously-irradiated lesions in the head and neck poses a great problem. Fifth-six patients with head and neck lesions underwent 57 microsurgical reconstructions between 1990-1998. Thirteen patients were irradiated before surgery. The previous radiation dose was 30-75.6 Gy. The free tissue transfer was successful in 52 of the 57 microsurgical reconstructions(91.2%). The success rate was 92.3%(12/13) in previously-irradiated patients and 90.9%(40/44) in nonirradiated patients. Postoperative complications, such as flap loss, fistula, and infection, developed in 4 irradiated patients and 8 nonirradiated patients. Overall complication rate was 30.8%(4/13) in previously-irradiated patients and 18.2%(8/44) in nonirradiated patients. Although the failure rate of previously-irradiated patients was higher than that of nonirradiated patients, there was no statistically significant difference between them. Thus, free tissue transfers in patients with previously-irradiated head and neck lesions are suitable for one-stage reconstruction.
Fistula ; Head* ; Humans ; Neck* ; Postoperative Complications ; Radiation Injuries ; Wounds and Injuries