Tumors of umbilical cord, especially angiomyxoma, are extremely rare lesions. To our knowledge, five cases of angiomyxoma have been reported previously in the umbilical cord. Sonography two weeks after the finding of an elevated serum alpha-fetoprotein, detected a mass of the umbilical cord in a 27-year-old multiparous woman at 18(+3) weeks gestation. Previous sonogram was normal (11 weeks gestational age). At 26 weeks, a premature female infant was delivered by induction and a mass was located in the region of placental insertion of the cord. Section through the mass revealed rubbery myxoid appearance. Microcopically, numerous small vascular channels with thin walls were embedded in loose myxoid matrix. A case of angiomyxoma of umbilical cord with elevation of serum alpha-fetoprotein is presented together with a review of the literature. We hope that this case will help define the natural history of primary angiomyxoma of umbilical cord.
Infant ; Male ; Female ; Humans

PURPOSE: Objective measurements of knee of flexor and extensor strength using isokinetic equipment and function after total knee arthroplasty (TKA) were evaluated until postoperative 12 months. MATERIALS AND METHODS: The control group constituted of 15 persons who were of same age and weight without knee problems. Most of the patients (70%) were operated on both knees simultaneously. The patient group consisted of constituted with 20 patients (34 cases). Isokinetic testing (Cybex) of knee flexor and extensor strength of knee and functional evaluation by HSS score was performed preoperatively and at 3, 6, 12 months postoperatively. RESULTS: The peak torque of the knee extensor and flexor muscle in the patient group was decreased by 17-41% compared to the control group. Especially, the peak torque of extensor was more decreased than flexor muscles. At postoperative 12 months, the peak-torque values of hamstring and quadriceps were able to attain the same strength levels of the preoperative knee. According to the grade of the Hospital for Special Surgery knee rating scales by Insall, 28 cases (82 %) in the patient group could obtain good result at postoperative one year. CONCLUSIONS: Exercises to increase the strength of extensor should be emphasized in the rehabilitation programs after TKA
Arthroplasty* ; Exercise ; Humans ; Knee* ; Muscle Strength* ; Muscles ; Rehabilitation ; Torque ; Weights and Measures

PURPOSE: The accuracy of CT in the detection of injuries of the solid visceral organ is well established, but the value of CT in diagnosing small bowel rupture after abdominal trauma is controversal. This study was conducted to ascertain CT finding of small bowel rupture result from abdominal trauma. MATERIALS AND METHODS: A retrospective analysis of preoperative abdominal CT findings in 40 patients was performed. Small bowel rupture was confirmed by surgery. Precontrast and postcontrast enhanced CT images were obtained in all patients. RESULTS: Diagnostic findings of small bowel rupture including pneumoperitoneum or retroperitoneal air, discontinuity of the bowel wall and extravasation of oral contrast materials were observed in 33 cases(83%). Intraperitoneal or retroperitoneal free air was seen in 31 cases(78%) and intraperitoneal or retroperitoneal free fluid collection was seen in 38 patients(95%). Small bowel wall was thickened in 31 cases(78%), bowel wall was enhanced in 12 cases(30%) and bowel wall discontinuity and extravasation of oral contrast material was seen in 5 cases, respectively. CONCLUSION: The CT scan is sensitive and effective modality for evaluation of small bowel rupture after abdominal trauma, because of high detectability of diagnostic and suggestive CT findings.
Contrast Media ; Humans ; Pneumoperitoneum ; Retrospective Studies ; Rupture* ; Tomography, X-Ray Computed

Obstruction on the urinary tract eventually results in damage to the kidneys and loss of function. The questions that concern the clinician are the degree of nephron loss in that kidney and the potential for recovery following the relief of obstruction. 99mTc DMSA accumulates in tubule cells and has been proposed as a marker of the tubular mass. The authors estimated the renal uptake ratio of 99mTc DMSA for the degree of nephron loss corresponding to duration of hydronephrosis following left ureteral ligation in 5 NewZealand white rabbits and the potential for recovery following percutaneous nephrostomy of hydronephrosis in 24 rabbits. While the renal uptake ratio of 99mTc DMSA of the kidney with unilateral hydronephrosis following ureteral ligation reduced dramatically within 24 hour, that of the opposite healthy kidney increased, and the total renal uptake ratio was same as normal functioning kidneys before ureteral ligation. Upon ureteral release, there was no evidence of definite recovery or impairment in the experimental kidneys for 5 days. The authors conclude that a combination of ureteral release and administration of some drugs such as renal vasodilator or diuretics is an appropriate treatment for the recovery of function in unilateral hydronephrosis.
Diuretics ; Hydronephrosis* ; Kidney ; Ligation ; Nephrons ; Nephrostomy, Percutaneous* ; Rabbits ; Recovery of Function ; Technetium Tc 99m Dimercaptosuccinic Acid* ; Ureter ; Urinary Tract

The aim of this video is to present the procedural details of laparoscopic right hemicolectomy with aortocaval (infrarenal aortic bifurcation) lymphadenectomy, partial resection of the pelvic peritoneum (peritoneal carcinomatosis index, 3), and hyperthermic intraperitoneal chemotherapy in a patient who received neoadjuvant chemotherapy for stage IVc colorectal cancer. The total operation time was 290 minutes, and the patient was discharged on a postoperative day 13 without any complications. No postoperative complications occurred until postoperative day 60. The pathological stage of the tumor was determined to be T3N2bM1c. The pelvic peritoneal nodule was pathologically confirmed as a metastatic lesion. Among the 12 harvested aortocaval lymph nodes, 6 were metastatic lymph nodes. The minimally invasive approach was safe and feasible in this highly selected patient with colon cancer, aortocaval lymph nodes, and peritoneal metastases.

Twenty-eight patients with 20 tibia fractures and 8 femur fractures were treated with external fixation. The average age at fracture was 10 years 10 months ranging from 5 years to 17 years 6 months. Of 28 fractures, 6 were closed fractures and 22 were open fractures. The average follow-up of these children was 23 months. Monofixators were used in 12 fractures and Ilizarov fixators in 16 fractures. The average time to healing of the fractures was 14.6 weeks(range, 6 to 44 weeks). Seven segmental bone defects(range, 2 to 17cm) were treated with the Ilizarov method of internal bone transport using the transport ring and bone grafting at the docking site. The average healing index for callus distraction was 25 days per centimeter. Seven patients had 10 major complications that necessitated additional operative procedures. There were 4 nonunions. Three patients had an infected nonunion, which was treated with the Ilizarov fixator and polymethyl-methacrylate antibiotic beads. One patient had a hypertrophic nonunion which was treated with plate fixation. Three patients who had an epiphyseal injury had shortening with angular deformity, which was treated by callus distraction. Three patients had a joint contracture, which was treated by the percutaneous tenotomy and Ilizarov fixator. The selection of the type of external fixator depends on the fracture pattern and the Ilizarov fixator is recommended for complicated fracture with severe comminution or segmental bone loss.
Bone Transplantation ; Bony Callus ; Child ; Congenital Abnormalities ; Contracture ; External Fixators ; Femur ; Follow-Up Studies ; Fractures, Bone ; Fractures, Closed ; Fractures, Open ; Humans ; Ilizarov Technique ; Joints ; Surgical Procedures, Operative ; Tenotomy ; Tibia

BACKGROUND: Scabies outbreaks have been reported in long-term care facilities, but less commonly in acute care facilities. We experienced an outbreak of scabies that occurred in neurosurgery-intensive care unit of a general hospital, Seoul, Korea. METHODS: An outbreak of scabies was noticed on September 2006 when hospital staffs of NICU were diagnosed with scabies. The infection control nurse reviewed medical records and interviewed all of patient in NICU and health care workers. The epidemic spread of scabies from a patient to other patient, hospital employees and their families and associates was identified from historical, clinical, and microbiologic skin preparation data. RESULTS: Forty-three NICU patients and 22 health care workers were investigated. Five scabies cases were identified in total of 42 cases who are exposed to index case with attack rate of 11.9%. The attack rate of scabies in health care workers and NICU patients were 10% and 13.6%, respectively. Tertiary cases also occurred among the family members of workers, with a tertiary attack rate of 44%. CONCLUSION: The patient of acute care facilities also have chances of being exposed to scabies outbreak, since sensorimotor deficits or cognitive disorders make it difficult for individuals to communicate and understand the implication of risky contacts.
Delivery of Health Care ; Disease Outbreaks ; Hospitals, General ; Humans ; Infection Control ; Long-Term Care ; Medical Records ; Scabies ; Skin

If hypertensive emergencies are left untreated, multiple damages on heart, brain and kindney can develop. So rapid control of blood pressure within safty with effective antihypertensive agents is mandatory. For the comparison of antihypertensive effects among hydralazine (IV or IM), clonidine (IV), and nifedipine (sublingual) in hypertensive emergency, which were frequently used in our hospital, we performed propective study with hypertensive emergency patients(243 cases) who visited emergency room from Oct. 1986 until Aug. 1987. The results are as follows ; 1) For 58 patients who recieved hydralazine (IV or IM), initial mean arterial blood pressure(MAP) was 167.2+/-21.5mmHg and 15 minutes later 138.9+/-24.4mmHg, 45 minutes later 141.7+/-21.1mmHg, 90 minutes later, 133.9+/-26.6mmHg and, respectively. For 55patients who recived clonidine(IV), initial MAP was 164+/-21.9mmHg and 15minytes later 137.4+/-18.9mmHg, 45 minutes later 127.5+/-34.9mmHg, respectively. For 130 patients who recived nifedipine(sublingual), initial MAP was 159.8+/-21.4mmHg and 15 minutes later 143.0+/-22.8mmHg, 45 minutes later 127.5+/-21.1mmHg, 90 minutes later 119.3+/-20.0mmHg, respectibely. 2) Pulse rate showed 12.9% increase afer administration of hydralazine, 15.8% decrease in clonidine, 5.6% increase in nifedipine, respectively. 3)Severe reduction of blood pressure(systolic BP<130mmHG) after administration of following antihypertensive agents was found. i.e., hydralazine 5.2%, clonidine 1.8%, nifedipine 1.5%, respectively. 4) In 4 cases(6.9%) out of the 58 cases using hydralazine, 3 cases(5.5%) out of the 55 cases using clonidine, 9 cases(6.9%) out of the 130 cases using nifedipine, acute paradoxic hyertensive effects were observed.
Antihypertensive Agents ; Blood Pressure ; Brain ; Clonidine* ; Emergencies* ; Emergency Service, Hospital ; Heart ; Heart Rate ; Humans ; Hydralazine* ; Nifedipine*

PURPOSE: Despite withdrawal of RotaShield® and the development of second generation live attenuated rotavirus vaccines, concerns remain regarding the relationship between rotavirus vaccine and intussusception. Nevertheless, since there is no study in Korea, we reviewed data from cases at Severance Children's Hospital to determine the association between rotavirus vaccine and intussusception. MATERIALS AND METHODS: Patients coded as intussusception and following a prescription of RotaTeq® from 2007 to 2013 were reviewed. We calculated comparative incidence figures (CIFs) and 95% confidence intervals (CIs) to compare the risk of intussusception in Korea with the risk in the United States. Expected cases within the four-week post-vaccination window were calculated by applying rates of intussusception from data compiled by the Health Insurance Review and Assessment Service (for a five-year period) to numbers of vaccinations. RESULTS: In total, 10530 doses of pentavalent rotavirus vaccine were administered. A total of 65 intussusception cases were diagnosed, although only two cases occurred within four weeks after vaccination. This was compared to six cases within 999123 doses in United States from April 2008 to March 2013 (CIF, 31.63; CI, 31.33–31.93). When we adjusted incidence rate differences for both countries, the CIF decreased to 7.05 (CI, 6.72–7.40). When we compared our identified cases with the expected cases from our hospital, there was no increased intussusception occurring within four weeks of vaccination. CONCLUSION: We found no association between pentavalent rotavirus vaccine and intussusception. Therefore, rotavirus vaccination should be considered due to its benefits of preventing rotavirus-associated diseases.
Humans ; Incidence ; Insurance, Health ; Intussusception* ; Korea* ; Prescriptions ; Retrospective Studies* ; Rotavirus Vaccines ; Rotavirus* ; United States ; Vaccination

Apert syndrome is characterized by a hyperacrobrachycephalic skull with a flattened occiput, and malformations of the midface, hands and feet, as well as complicated multiple craniosynostosis and dysmorphism of the skull. Several authors have recently reported in the treatment of complicated skull anomalies that simple x-ray and axial/coronal CT imaging cannot provide sufficiently precise information, and presurgical planning cannot be based on the findings of these procedures ; three-dimensional(3D) reconstruction of CT images is, instead, needed. By means of a computerized simulation, the authors reformatted skull contour on a monitor using the method of splitting and remodeling a 3D skull image. Surgery was performed and the result was good. Presurgical computerized simulation was thus shown to be very helpful for the surgical correction of complicated craniosynostosis.
Acrocephalosyndactylia ; Craniosynostoses ; Foot ; Hand ; Skull*