Nutcracker syndrome is a rare disease caused by the compression of the renal vein between the aorta and superior mesenteric artery. It is known to cause of venous hypertension, peripelvic and periureteral varicosities. Clinical manifestations include varicocele, hematuria, and flank or abdominal pain. Surgical correction is needed in nutcracker syndrome cases with severe or recurrent hematuria and abdominal or flank pain. Reanastomosis of the renal vein at 5cm below the original insertion site at the inferior vena cava is the one of the most common corrective methods and the transabdominal approach is usually employed. This disease usually appears in healthy young people and in order to decrease postoperative complications such as intestinal obstruction and bowel adhesion by avoiding unnecessary intraperitoneal manipulation, the authors used the extraperitoneal approach through a flank incision. We report because, in selected cases, we consider that this extraperitoneal approach is one of the alternative methods for the usual transperitoneal approach.
Abdominal Pain ; Aorta ; Flank Pain ; Hematuria ; Hypertension ; Intestinal Obstruction ; Mesenteric Artery, Superior ; Postoperative Complications ; Rare Diseases ; Renal Veins ; Varicocele ; Vena Cava, Inferior

Pseudothrombocytopenia is usually associated with anticoagulant ethylene diaminetetraacetic acid (EDTA). The platelet clumping that occurs in EDTA-dependent pseudothrombocytopenia (EDPT) can sometimes be prevented by the use of other anticoagulants such as heparin or sodium citrate. As an alternative, we used kanamycin before or after the withdrawal of EDTA-anticoagulated blood in a 6-year-old boy with EDPT. Kanamycin used supplementarily during the differentiation of EDPT effectively prevented platelet clumping.
Anticoagulants ; Blood Platelets* ; Child ; Citric Acid ; Edetic Acid ; Heparin ; Humans ; Kanamycin* ; Male ; Platelet Aggregation* ; Sodium

No abstract available.
Orthopedic Procedures* ; Orthopedics*

One of the serious and challenging problems confronting orthopaedic surgeons is an open un-united fracture of tibia. Especially, there are some difficulties in getting bone union on the condition of combining soft tissue defect with infection. In the management of infected un-united fracture of tibia with significant soft tissue loss we attempted a two-stage reconstruction : the first stage consisted of radical sequestrectomy, soft tissue reconstruction, and external fixation, and the 2nd stage consisted of various types of bone grafting and bone fixation. Fifteen patients with open infected un-united fractures of tibia treated with staged reconstruction from September 1982 to August 1987 at Department of Orthopaedic Surgery, Dae-Jeon's St. Mary's Hospital, Catholic University Medical College, were analyzed in clinical aspects and the results of treatment obtained were as follows : 1. Satisfactory bone union was obtained in an average of 6 months after bone graft with a range of 4 months to 12 months. 2. The duration from the injury to bone union was 13 months on an average with a range of 8 months to 19 months. 3. The soft tissue rer.onstruction at the first stage were performed with local flap in 11 cases and muscular flap in 2 cases and musculocuteneous flap in 2 cases. 4. The time interval between 1st stage and 2nd stage was from 1.5 months to 3 months. 5. At the 2nd stage, bone graft were performed with autogenous cancellous bone graft in 11 cases, vascularized osteocutaneous fibular graft in 2 cases and ipsilateral vascularized fibular transference in 2 cases. In summary, a two-stage reconstruction for open infected un-united fracture of tibia is a advisable procedure that leads to bone union with satisfactory return of function.
Bone Transplantation ; Fractures, Open ; Humans ; Surgeons ; Tibia ; Transplants ; United Nations

OBJECTIVE: This study was aimed to compare the efficacy and tolerability of milnacipran and sertraline treatment in patients with major depressive disorder and to evaluate the relationships between beta-adrenergic receptor responsiveness and depressive mood states. METHODS: Fifty three patients who had a diagnosis of major depressive disorder according to the DSM-IV and showed scores of 17 or more on the 17-item Hamilton Rating Scale for Depression (HAM-D) were randomly assigned to either milnacipran or sertraline treatment group. Each patient received 8 weeks of antidepressant treatment with one of the two drugs. Efficacy was assessed using the HAM-D, Beck Depression Inventory (BDI), Montgomery and Asberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI). Twenty normal control subjects who had no history of psychiatric and major medical illness and were matched with the depressed patients considering age, sex and body mass index were recruited for the comparison of beta-adrenergic receptor responsiveness between depressed patients and normal control subjects. We measured beta-adrenergic receptor density, lymphocyte cAMP ratio (ratio of isoproterenol-stimulated cAMP/basal cAMP), and receptor affinity (Kd) in all subjects. We also investigated beta-adrenergic receptor responsiveness before and after treatment in depressed patients. RESULTS: Twelve patients in milnacipran group and 15 patients in sertraline group were completed this study. In all assessment scales for depression, we found significant decrease in depression severity in both milnacipran and sertraline groups. Both of the two drugs proved equally effective for reduction of the overall symptoms of depression throughout the treatment period. And there were significant differences in the means of Kd values between control subjects and depressed patients before treatment. We found a significant negative correlation between Kd values and BDI scores. After treatment with either milnacipran or sertraline, cAMP ratio (4.8+/-1.6 vs 5.7+/-2.5, p=0.095) and Kd value (65.6+/-11.9 vs 74.6+/-7.8, p=0.066) tended to increase, but there was no significant difference in beta-adrenergic receptor responsiveness between milnacipran and sertraline group. CONCLUSION: Both milnacipran and sertraline were not different in the clinical efficacy in major depressive disorder. In depressed patients, beta-adrenergic receptor responsiveness is reduced and both milnacipran and sertraline antidepressants tended to increase beta-adrenergic receptor responsiveness.
Antidepressive Agents ; Body Mass Index ; Depression ; Depressive Disorder, Major* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Lymphocytes ; Sertraline* ; Weights and Measures

The involvement of mucosal mast cells (MMC) in the pathophysiology of irritable bowel syndrome (IBS) is still controversial. We aimed to re-evaluate the role of MMC in visceral hypersensitivity associated with IBS using a rat IBS model that develops the IBS symptom after a subsidence of acetic acid-induced colitis. No significant difference in the number of MMC was observed between normal rat colon and IBS rat colon. (61.7 +/-2.9/mm 2 in normal vs. 88.7 +/-13.3/mm 2 in IBS, p >0.29). However, the degranulation rate of MMC was significantly higher in IBS rat colon (49.5 +/-2.4% in normal vs. 68.8 +/-3.4% in IBS, p >0.05). Pretreatment of a mast cell stabilizer, doxantrazole (5 mg/kg, i.p.), reduced the degranulation rate of MMC and significantly attenuated visceral hypersensitivity to rectal distension in IBS rat, whereas it had no effect on the visceral sensory responses in normal rat. These results suggest that, although the number of MMC is not significantly changed in IBS rat colon, the higher degranulation rate of MMC is responsible for visceral hypersensitivity in this model IBS.
Acetic Acid/toxicity ; Animals ; Cell Count ; Colitis/chemically induced/*pathology ; Hypersensitivity/*pathology ; Image Processing, Computer-Assisted ; Intestinal Mucosa/*pathology ; Irritable Bowel Syndrome/*pathology ; Male ; Mast Cells/drug effects/*pathology ; Models, Theoretical ; Phosphodiesterase Inhibitors/pharmacology ; Rats ; Rats, Sprague-Dawley ; Thioxanthenes/pharmacology ; Viscera/immunology ; Xanthones/pharmacology

Congenital dyserythropoietic anemia Type II (herditary erythroblatic multinuclearity with positive acidified serum test; HEMPAS) is characterized by binuclearity, multinuclearity, pluripolar mitoses, karyorrhexis of normoblasts, and the presence of abnormal antigens on the red cells. We experienced a case of HEMPAS in a 2 month old girl patient who had an intermittent fever, abdominal distention with palpable liver & spleen, and generalized jaundice. The blood analysis revealed anemia, and thrombocytopenia. Peripheral blood smear showed an averge of 6 mature normoblast per 100 leukocyte count. The red cells showed moderate anisocytosis, poikilocytosis, irregularly crenated, contracted cells and occasional spherocytes. The leukocytes showed relative lymphocytosis, and there were occasional villous lymphocytes. The marrow smear showed abnormality in erythroid series. About ten percent of the erythroblasts showed 2~7 nuclei or lobulated nuclei. The mitotic forms of the erythroid precursors were also increased in frequency. The M:E ratio was 1:3.2. Blood culture on this patient showed a pure growth of Coxiella burnetti. Medical treatment with Doxycycline and Rifampin was performed. After treatment, she became afebrile showing improved general condition with decreased size of liver & spleen. In spite of clinical improvement, she died suddenly 3 weeks after initial treatment.
Anemia ; Anemia, Dyserythropoietic, Congenital* ; Bone Marrow ; Coxiella ; Doxycycline ; Erythroblasts ; Female ; Fever ; Hempa ; Humans ; Infant ; Jaundice ; Leukocyte Count ; Leukocytes ; Liver ; Lymphocytes ; Lymphocytosis ; Mitosis ; Rifampin ; Spherocytes ; Spleen ; Thrombocytopenia

Purpose: The current treatment option of bimalleolar equivalent fractures is open reduction and internal fixation of lateral malleolus followed by syndesmotic screw fixation of syndesmosis or deltoid ligament augmentation. On the other hand, there is still debate using deltoid ligament augmentation technique. This study compared the clinical results of deltoid ligament augmentation and syndesmosis screw fixation in bimalleolar equivalent fractures. Materials and Methods: From 2007 to 2022, this study retrospectively compared 31 patients who underwent deltoid ligament augmentation with fibula fixation with 12 patients who underwent syndesmosis fixation for bimalleolar equivalent fractures. The clinical results were compared by measuring visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and ankle range of motion 12 months after surgery. The radiological results were compared by measuring medial clear space, tibiofibular overlap, and tibiofibular clear space before and after surgery. The postoperative complications were compared. Results: The post-operative AOFAS score, the VAS score, and the ankle range of motion were similar in the two groups. The radiological results showed a similar medial clear space, tibiofibular overlap, and tibiofibular clear space in the two groups before and after surgery. In addition, there were no postoperative complications in the group that underwent deltoid ligament augmentation, and one screw break and superficial infection were observed in each of the patient groups that had undergone trans-syndesmosis screw fixation. Conclusion Clinically good results could be obtained despite only deltoid ligament augmentation being performed alone after fibular fracture fixation in bimalleolar equivalent fractures. In addition, if only deltoid ligament augmentation is performed alone rather than transsyndesmosis screw fixation, there is little possibility of misalignment and no risk of screw breakage or the need for additional procedures to remove the screws. In conclusion, deltoid ligament repair without syndesmosis screw fixation could be viable for treating bimalleolar equivalent fractures.

Spontaneous gastric perforation is an important but rare cause of gastrointestinal perforation in neonates. Just over 200 cases have been reported in the literatures. In spite of recent surgical advances in its managements, mortality rate has been reported as high as 25~50%. Because of physiologic differences, immature immune mechanisms, variations in gastrointestinal flora and poor localization of perforation, a neonate with gastric perforation is at high risk. The pathogenesis is greatly debated. Five patients with spontaneous neonatal gastric perforation who were operated upon at the Department of Pediatric Surgery, Seoul National University Hospital from 1980 to 1993 were reviewed. Four patients were male and one female. The first indication of perforation was 1 day to 6 days of life. All of 5 perforations were located along the greater curvature of the stomach. The size of perforation ranged from 2 cm to 10 cm. Debridement and primary closure were performed in all patients. The operative mortality was 40%(2 of 5). The cause of perforation was not identified in all cases. Prematurity and necrotizing enterocolitis, synchronous or metachrotlous, were thought to be crucial prognostic factors. Earlier recognition and surgical intervention are necessary to reduce morbidity and mortality.
Debridement ; Enterocolitis, Necrotizing ; Female ; Gastrointestinal Microbiome ; Humans ; Infant, Newborn ; Male ; Mortality ; Seoul ; Stomach

BACKGROUND: The point of this study is focused on the rescuer's fatigue may increase as the ratio of chest compression-ventilation increases. METHODS: 10 students of emergency medical service and resucue had participated in this study. Cardiopulmonary resuscitation (CPR) was carried out with Laerdal's ResusciAnne with 4 types of compression-ventilation ratio (C-V ratio), and the data was recorded. The rescuer's fatigue was subjectively estimated with the visual analogue scale (VAS), objective fatigue was measured by median frequency which was acquired from the electromyography (EMG) signal, heart rate and the serum lactate level was measured. Statistical analysis was accomplished within each C-V ratios. RESULTS: As C-V ratio increased from 15 : 2 to 30 : 2, the quality of chest compression was improved. Subjective fatigue was increased significantly when C-V ratio increased to 30 : 2 from 15 : 2 and to 60 : 2 from 45 : 2. Gradual downward transition of the median frequency on EMG was shown as a result of increments of C-V ratio. Significant serum lactate accumulation had shown on ratio of 60 : 2 compare to other ratios. CONCLUSIONS: Fatigue of the rescuers will be aggravated by increase of C-V ratio. Rapid rescuer change is preferable when C-V ratio is increased.
Cardiopulmonary Resuscitation* ; Electromyography ; Emergency Medical Services ; Fatigue* ; Heart Arrest ; Heart Rate ; Humans ; Lactic Acid ; Manikins* ; Thorax