With the development of antenatal diagnostic tools such as ultrasonography, some congenital anomalies or diseases can be detected in early fetal life. Routine serial antenatal check-ups have made it possible to predict the prognosis of these problems, and a few life-threatening single anatomic malformations have been treated by open fetal surgery. The experience of fetal surgery revealed that the human fetus appears to heal without any scarring. In contrast to adult animals, the response to tissue injury in the fetus is conspiciously devoid of acute inflammation. Indeed, the absence of neutrophils is perhaps the most consistent observation in fetal wounds and seems to be followed by absent or scanty fibroblast infiltration, which results in healing with sparse and well organized collagen deposition. Actually, the amount and quality of the collagen deposition were decided by the fibroblasts which infiltrated the wound. It is well known that fetal wounds have sparse collagen deposition, however, the mechanisms are still unclear. This study was designed to evaluate the role of fibroblast activity in the differences of the scar formation between the fetus and neonate. Fibroblast activity such as the cell growth rate, the amount of collagen synthesis and the synthesized collagen types of fetus(IUP 18-22 weeks) was compared with that of neonate. The amount of collagen synthesis was measured by H-proline uptake and the amount of collagen type III was measured by Western blot using antihuman procollagen type III. The cell growth rate as determined by cell proliferation from the initial cell count of 5x10(5) to cell confluence was 3.6 x 10(6) in the fetal fibroblasts compared to 2.5x10(6) in neonatal fibroblasts. Fetal fibroblast synthesize 16.9 x 10(4) cpm of collagen and neonatal fibroblasts synthesize 2.7 x 10(4) cpm of collagen. The synthesized amount of type III collagen was 2.1x10(4) ug/ml, and 1.5x10(4) ug/ml by fetal and neonatal fibroblasts, respectively. In conclusion, fetal fibroblasts grow faster and synthesize a smaller amount of collagen, but produce more type III collagen than neonatal fibroblasts.
Adult* ; Animals ; Blotting, Western ; Cell Count ; Cell Proliferation ; Cicatrix ; Collagen Type III ; Collagen* ; Fetus* ; Fibroblasts* ; Humans ; Infant, Newborn ; Inflammation ; Neutrophils ; Prognosis ; Ultrasonography ; Wounds and Injuries

PURPOSE: This study was conducted to evaluate success and perforation rates of pneumatic reduction and to find the predictors of reduction failure. METHODS AND MATERIALS: We reviewed 224 cases of pediatric intussusception diagnosed by air-enema between July, 1989 and June, 1992. The mean age was 9.8 months(range, 1 month to 3 years). Logistic regression analysis was used to find predictors of reduction failure. RESULTS: Successful reduction was achieved in 197 cases(87.9% of success rate). Bowel perforation occurred in two cases(0.9% of perforation rate). There were two statistically significant predictors of failure;(1) ileoileocolic intussusception(p<.001), (2) long duration of symptom(p<.001). Surgery was performed in 26 cases (11.6%), of which seven required bowel resection. CONCLUSION: Pneumatic reduction is a useful means in the management of pediatric intussusception with a high success rate and no mortality.
Child* ; Humans ; Insufflation* ; Intussusception* ; Logistic Models ; Mortality

Recurrent disc herniation and postoperative fibrosis are the main disease entities causing failed back surgery syndrome (FBSS) and magnetic resonance (MR) imaging has become a major diagnostic modality in differentiating the two. To observe the variable entities of FBSS and their MR findings, we retrospectively analyzed 15 MR images in 12 patients. The causes of FBSS were as follows; normal (no organic cause), fibrosis, new or recurrent disc herniation, discitis, osteomyelitis, inflammation at operation site, epidural abscess, arachnoiditis, and hematoma. Except a case of hematoma, gadolinium enhancement scan was necessary and informative in the diagnosis of FBSS and MR imaging only was not enough in the diagnosis of arachnoiditis.
Arachnoid ; Arachnoiditis ; Diagnosis ; Discitis ; Epidural Abscess ; Failed Back Surgery Syndrome* ; Fibrosis ; Gadolinium ; Hematoma ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Osteomyelitis ; Retrospective Studies

PURPOSE: To compare the results of total deviation (TD) as measured by standard automated perimetry (SAP) and measured with of Matrix Frequency-doubling Technology (FDT) in patients with preperimetric glaucoma. METHODS: Fifty-two eyes of 52 patients with preperimetric glaucoma were included. Subjects were examined with Matrix FDT and Stratus optical coherence tomography (OCT), and the results of each examination were analyzed. The proportions of abnormal results in SAP TD, Matrix TD, and Matrix pattern deviation (PD) were calculated. Among the results of tests, the following correlations were evaluated: SAP TD and Matrix, and visual fields and OCT. In addition, the differences in peripapillary retinal nerve fiber layer thickness (RNFL) according to the result of SAP TD in preperimetric patients with abnormal Matrix PD were analyzed. RESULTS: A abnormalities in SAP TD, Matrix TD and Matrix PD were found in 22 (42.3%), 34 (65.4%), 41 (78.9%) eyes, respectively. There was marginal correlation between SAP TD and Matrix PD (p=0.07). No significant correlation was found between SAP TD and OCT, although Matrix PD and OCT did show significant correlation (p<0.05). In preperimetric patients with abnormal Matrix PD, RNFL thickness was significantly lower in the abnormal SAP TD group than in the normal SAP TD group on average, in the superior quadrant, and at the 12 o'clock and 5 o'clock positions (p<0.05). CONCLUSIONS: In patients with preperimetric glaucoma, 42.3% and 78.9% had glaucomatous VF defects in SAP TD and Matrix PD, respectively. These results were higher than expected, especially those of SAP TD.
Eye ; Glaucoma ; Humans ; Nerve Fibers ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Field Tests ; Visual Fields

We reviewed MR angiograms to evaluate its efficacy for visualizing the renal arteries and detecting renovascular disease. 41 renal arteries in 19 patients were examined by MR angiography. 3-D time-of-flight technique was used as routine examination method for MR angiography and 2-D time-of-flight technique was added in some particular cases to visualize venous flow. Within two weeks after MR angiography was performed, 23 renal arteries in 10 patients were additionally examined by conventional angiography or intraarterial DSA. The success rates of vessel visualization on MR angiography in normal renal arteries were 100% in main 67.7% in segmental, and 11.8% in intrarenal arteries. As a result of comparative study in normal main renal arteries with MR angiograms and conventional angiograms, overall correspondence in the number and the shape was noted and the caliber discrepancy between two examination did not exceed 3.0 mm. one arteriovenous fistula with aneurysm, one stenotic artery and two occluded arteries were well evaluated One arteriovenous fistula with aneurysm, and two occluded arteries were well evaluated by MR angiography. However three stenotic lesions were misdiagnosed as occlusions on MR angiography. and the overall accuracy was 87%. We conclude that MR angiography has the potential to be a noninvasive and useful screening method for determining the number of renal arteries and for detection of abnormalities of main renal arteries.
Aneurysm ; Angiography* ; Arteries ; Arteriovenous Fistula ; Humans ; Mass Screening ; Methods ; Renal Artery*

Growing skull fracture is a rare complication of injury during infancy and childhood. About 90% of them occur in childhood under the age of 3 years. Growing skull fracture or leptomeningeal cyst was known to be formed through the bony erosion of fractured site by cerebrospinal fluid pulsation of the leptomeninges, impacted into the fractured bone by trauma. Most growing skull fractures are located in the parietal region. A growing fracture commonly presents as a progressive, often pulsatile, scalp mass that appears several months to years after head injury sustained during infancy or early childhood. The authors report a case of acute growing skull fracture in 4-year-old male patient, which developed 3 weeks after fall down injury.
Arachnoid Cysts ; Cerebrospinal Fluid ; Child, Preschool ; Craniocerebral Trauma ; Humans ; Male ; Rabeprazole ; Scalp ; Skull Fractures* ; Skull*

PURPOSE: In evaluation of the limb fracture, MR scan has been used in limited roles as evaluating the associated soft tissue injury not the fracture itself. This study aims at understanding the possible role of MR in fracture. METHODS AND MATERIALS: thirty three sets of MR scans in twenty nine patients were retrospectively analyzed. They included twelve tibial plateau fractures, four pateliar fractures, four distal femur fractures, five epiphyseal fractures and four others. RESULTS: All MRs except two showed better image and more information about the extent of the injury (93.9%). Evaluation of cartilage (which was impossible on other modalities) was possible in 28 MR scans (84.8%). Surrounding marrow change associated with fracture was also able to be evaluated. Associated soft tissue injury or other abnormality could be evaluated-cruciate or collateral ligament injury, meniscus tear, chodromalacia or osteonecrosis. In epiphyseal injury, direct demonstrability of premature bony fusion on MR took a critical role in making a management plan. CONCLUSION: MR scan in fracture has its value in evaluating the extent and degree of the injury and it is especially advantageous in detecting cartilage injury and early complication of growth plate injury.
Bone Marrow ; Cartilage ; Collateral Ligaments ; Extremities* ; Femur ; Growth Plate ; Humans ; Osteonecrosis ; Retrospective Studies ; Soft Tissue Injuries

BACKGROUND AND OBJECTIVES: Submandibular space might be estimated as the most common space of deep neck infection. It may, in certain cases, be treated conservatively with no need for early open surgical drainage. The purpose of this study is to review the clinical course and outcome in treatment of submandibular abscess. SUBJECTS AND METHOD: A retrospective study was peformed for 9 years on 49 cases admitted from June 1994 to January 2003 for deep neck infection limited to the submandibular space. All patients were treated with intravenous antibiotics. The conservative group was treated with antibiotics only or combination therapy with needle aspiration. The surgical group was treated with intraoral or external drainage. Contrast enhanced computed tomography (CT) imaging was conducted for all cases and had confirmed that they all had an abscess in the submandibular space. RESULTS: The mean period of hospitalization was 7.6 days, with 35 patients treated with IV antibiotics only and 3 patients with aspiration in the conservative group. On the other hand, 3 patients were treated with intraoral drainage and 8 patients with external drainage in the surgical group. One patient required tracheotomy because of severe dyspnea. There was no complication observed in any cases. CONCLUSION: SSubmandibular abscess is an infection of deep neck space and is considered as the most common infection. Conservative treatment is a good therapeutic choice in cases with localized submandibular absess.
Abscess* ; Anti-Bacterial Agents ; Drainage ; Dyspnea ; Hand ; Hospitalization ; Humans ; Neck ; Needles ; Retrospective Studies ; Tracheotomy

Saccular aneurysms of the distal anterior cerebral artery are relatively rare, ranging from 1.5 to 9.2% of all intracranial aneurysms. A 61-year old woman presented with headache and nuchal rigidity. Cerebral angiographic image demonstrated multiple aneurysms of the distal anterior cerebral artery. We report a case of multiple aneurysms of the distal anterior cerebral artery without other vascular anomalies.
Aneurysm* ; Anterior Cerebral Artery* ; Female ; Headache ; Humans ; Intracranial Aneurysm ; Middle Aged ; Muscle Rigidity

Suprarenal IVC obstruction occurs rarely but has various causes. Because this obstruction proceed chronically and usually has collateral circulation, if there is no IVC or hepatic vein obstruction symptom such as Budd-Chiari syndrome, operation is usually needless. However, although symptom is not combined, if malignancy can not be ruled out and there is no proper and radiologically visible collateral, mass resection with IVC wall and bypass graft should be done. 58 year-old female patient visit the hospital for IVC mass that is occasionally discovered by routine abdominal ultrasonography examination. After abdominal CT scanning and IVC venography, IVC obstructive mass between renal vein and hepatic vein was found. Patient didn't show any abnormality in hematological examination such as coagulation and platelet counts. There was no IVC obstruction symptom such as lower limb swelling. Inferior hepatic vein was abnormally dilated and this was regarded as collateral vessel for IVC obstruction. Radiologically, primary leiomyosarcoma was not ruled out and so operation was decided. Suprarenal IVC was dissected and mass was exposed. And with the use of femoral vein and right atrium, temporally veno-veno bypass was performed. Mass including IVC wall was excised and upper end of divided IVC was sutured. Lower end of divided IVC was anastomosed with 16 mm Dacron graft and graft was anastomosed with right atrium by end-to-end methods (Cavoatrial shunt). Postoperative pathologic examination revealed the mass to be organized thrombi. After 2 weeks later, follow-up IVC venography was performed and good patency was found from IVC to right atrium through artificial bypass graft and patient was discharged without complications.
Budd-Chiari Syndrome ; Collateral Circulation ; Female ; Femoral Vein ; Follow-Up Studies ; Heart Atria ; Hepatic Veins ; Humans ; Leiomyosarcoma ; Lower Extremity ; Middle Aged ; Phlebography ; Platelet Count ; Polyethylene Terephthalates ; Renal Veins ; Thrombosis* ; Tomography, X-Ray Computed ; Transplants ; Ultrasonography