Humeral head chondrolysis has been widely reported as a devastating complication after arthroscopic shoulder surgery; however little is known about post-arthroscopic humeral head osteonecrosis. We experienced a 66-year-old female patient with rapidly progressive osteonecrosis of the humeral head only seven months after arthroscopic Bankart and rotator cuff repair. The patient had no systemic risk factors for osteonecrosis. A satisfactory result was achieved with reverse total shoulder arthroplasty for severe humeral head destruction and an irreparable massive rotator cuff tear. Shoulder surgeons should be aware of such severe complication, perform routine radiographs, and pay close attention to the presence of constant pain or loss of motion after arthroscopic shoulder surgery.
Aged ; Arthroplasty ; Female ; Humans ; Humeral Head* ; Osteonecrosis* ; Risk Factors ; Rotator Cuff* ; Shoulder ; Tears

Many researchers report that the measurement of urine calcium concentration during antenatal period is helpful in prediction of having preeclampsia,but some don`t. The purpose of this clinical study is to evaluate the relationship of low calcium level in urine and the develpoment of preeclampsia, and effects of other variables. 24hour urine were collected and measured for the concentration of calcium and creatinine from 769 pregnant women who visited our department of obstetrics at Young-Dong Severeance hospital, Yonsei university medical college for antenatal care from March 1, 1993 to May 31, 1996. One group of 41 women developed preeclampsia and the other didn`t. There were no diffrences in ages and gestational age at urine collection between two groups, but a group with preeclampsia had an increased mean arterial blood pressure. There were signiificant difference in calcium concentration in urine and ratios of concentration of calcium and creatinine from urine collected between gestational ages of 25 weeks and 32 weeks and also in those women younger than 25 years old and their first pregnancy. Our study suggests that the measure ment of calcium level and ratios of urine calcium concentration and creatinine concentration at gestational ages between 25 weeks and 32 weeks in women younger than 25 year old with their first pregnancy is quite helpful inpredicting the develpoment of preeclampsia.
Adult ; Arterial Pressure ; Calcium ; Creatinine ; Female ; Gestational Age ; Humans ; Obstetrics ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women ; Urine Specimen Collection ; Weights and Measures

PURPOSE: Headache is a frequent symptom in pediatric practice, but the prevalence of chronic recurrent headache was estimated in several studies with wide variations, because of inadequate expression and differences in case definition in children. Headache classification of International Headache Society is usually used in adults, but the application of it to children is uncommon, so we tried to diagnosis children with headache by using International Headache Society Classification. METHODS: We analyzed the clinical pictures, physical examinations including neurologic examination, PNS series, EEG and CT or MRI in 53 children with nonprogressing recurrent headache over than one month, who visited to pediatric department of Dong-A University hospital from January, 1995 to Feburary, 1996 and diagnosed them by using International Headache Society Classification. RESULTS: 1) The sex ratio between male and female was 1:1.2. 2) Diagnosed groups consisted of children with migraines in 22 cases(41.5%), tension-type headache in 19 cases(35.9%), coexisting migraine and tension-type headaches in 5 cases(9.4%), miscellaneous headaches not associated with structual lesion in 1 case(1.9%), headache associated with vascular disorders in 2 cases(3.8%), headache associated with nonvascular intracranial disorder in 1 case(1.9%), headache due to facial pain in 3 cases(5.6%). 3) Of 22 migraine cases, 13 cases(59.1%) had migraine with aura, 8 cases(40.9%) have migraine without aura and of 19 tension-type headache cases, 8 cases(42.1%) have episodic type, 11(57.9%) cases have chronic type. 4) Of 53 cases with recurrent headache, 3 cases(6%) had abnormal findings in CT or MRI. 5) Of 53 cases with recurrent headache, 9 cases(17%) had abnormal findings in EEG. CONCLUSIONS: International Headache Society Classifications are useful, but the diagnostic criteria are too strict for children, especially in migraine and tension type headache.
Adult ; Child* ; Classification* ; Diagnosis ; Electroencephalography ; Facial Pain ; Female ; Headache* ; Humans ; Magnetic Resonance Imaging ; Male ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Neurologic Examination ; Physical Examination ; Prevalence ; Sex Ratio ; Tension-Type Headache

Percutaneous endoscopic surgery for the treatment of upper urinary tract stone or stricture has proved less invasive, reliable and safe with results comparable to open surgery. Because this contains many procedures, however, one can expect complications at some extents. Between 1987 and 1994, 410 percutaneous endoscopic procedures - PNL (330 cases), endopyelotomy (40 cases), endoinfundibulotomy (24 cases), endoureterotomy (10 cases), nephropexy (6 cases) - were performed by three operators in one hospital. The incidence of complication was evaluated and compared statistically. Overall complication rates were 23.6% and there was no mortality. Bleeding necessitating transfusion (7.6%) and fever (7.1%) were the most frequent complications. Other complications included renal pelvis or ureteral perforation (6.8%), paralytic ileus (2.9%), sepsis (0.7%), pneumothorax (0.7%), stent migration (0.7%), atelectasis (0.2%), ureteral stricture (0.2%), colon perforation (0.2%). Surgical interventions for the management of complication included nephrectomy (2 cases) for uncontrolled bleeding, and open repair for colon perforation (1 case). Renal artery embolization stopped the delayed bleeding in one case. Data on complications occurring before and after the first 50 cases indicated a statistically significant decrease in complications (p<0.005). These complications could be attributed to inexperience, improper technique, underlying pathologic conditions, and anatomic variants. As might be expected, the complication rate was much lower on later cases according to the increasing experience and improved technique. Based on our accumulated experience, the experience with more than 50 procedures could be needed to minimize complications.
Colon ; Constriction, Pathologic ; Endoscopy ; Fever ; Hemorrhage ; Incidence ; Intestinal Pseudo-Obstruction ; Kidney Pelvis ; Mortality ; Nephrectomy ; Pneumothorax ; Pulmonary Atelectasis ; Renal Artery ; Sepsis ; Stents ; Ureter ; Urinary Calculi

PURPOSE: We applied lateral lithotomy position to the severe ureteral stricture cases supposed to fail with only retrograde approach. MATERIAL AND METHODS: From October 1997 to April 1999, 13 patients with severe ureteral stricture (lenghth>2cm or complete obstruction) supposed to fail with only retrograde approach and one patient with study. The causes of ureteral strictures were pelvic malignancy in 5, tuberculosis in 4, trauma in 2 and others in 2. The patient's ipsilateral shoulder was rotated and fixed like lateral position. And ipsilateral pelvis was elevated with sandbag or pad and rotated about 45 degrees, too. The retrograde approach was tried at first, if fail, antegrade approach was combined. RESULTS: We could insert ureteral stent via retrograde approach only in 3 patients and we needed aid of antegrade approach for passage through ureteral stricture in the other 11 patients (79%). Percutaneous antegrade approaches were combined in those 11 patients and we could pass the guide wire and indwell the stent in 10 of 11 patients (91%) using this position. CONCLUSIONS: The lateral lithotomy position was very helpful to the simultaneous retrograde and antegrade approach in severe fibrotic or malignant ureteral strictures.
Constriction, Pathologic ; Humans ; Pelvis ; Shoulder ; Stents ; Tuberculosis ; Ureter*

Hamartoma of the bladder is quite a rare entity which is composed of a disorderly admixture of mature cellular elements normally present in the urinary bladder. There is a great controversy regarding the pathogenesis of this lesion. Whether it is a true hamartomatous lesion or metaplastic lesion developed secondary to the inflammatory process. Similar or identical lesions has often been given by other names such as florid examples of cystitis glandularis. We prefer to cell florid examples of cystitis glandularis rather than hamartoma when it was occurred in an old age higher then 50th decade. Here we report a case of hamartoma of the urinary bladder in 44 years old man. Cystoscopic examination revealed a papillary polypoid mass which was attached to the fundus of bladder by long stalk. The mass measured 1.5 cm in greatest diameter. It was composed of epithelial nests resembling von Brunn's nest, cystitis glandularis or cystitis cystica dispersed in a stroma rich in smooth muscle and fibrous tissue.
Hamartoma

To evaluate the progress of clinical and histopathological changes of dermat ophytosis caused by M. gypseum, its inoculation study was done in 16 male New Zealand white rabbits(control: 4, innoculation : l2). The results were as follows . Clinically Initial erythema, scales, and crusts developed in 1 week after inoculation. They reached maximum severity on the 14th to 18th day and disappeared on the 25th to 44th day after inoculation. I-Iist,opathologically : The earliest findings were mild focal acanthosis and for al vascular ilatations and cellular infiltrations of the papillary dermis on the 4th day after inoculation. Their severity increased to the moderate degree until the. 8th day when mild hyperkeratosis was notec1, and lasted to the 13th day, Maximum degree of the findings including parakiratosis, intraepidermal microabscesses and middermal changes was seen on the 16th to 22nd day, and disapveared gradually between the 25th day and the 46th day. Hyphae and spores were founil on the PAS stainings until the 22nd clay. M. gypseum was not cultured from the lesions after the 25th day. seven of 10 rabbits injected intradermally with trichophytons became positive in 2 to 4 weeks after inoculation. All these findings suggest that the maximum inflammatory response is the result of immunologic reaction and the increased epidermal turnover rate may play a. major role in the shedding of remained fungi of the horny layer.
Dermis ; Erythema ; Fungi ; Humans ; Hyphae ; Male ; Microsporum* ; New Zealand ; Rabbits* ; Spores ; Trichophyton ; Weights and Measures

OBJECTIVES: To investigate the effects of (-)-3-PPP(0.5, 2, and 10mg/kg, s.c.) and haloperidol(0.1, 0.5, and 2mg/kg, s.c.) on the extracellular dopamine concentrations, and the effect of pretreatment with (-)-3-PPP(2mg/kg) on the haloperidol(2mg/kg)-induced extracellular dopamine concentrations in the nucleus accumbens(NAS) of free moving rats. METHODS: Dopamine levels in dialysate were determined with high pressure liquid chromatography(HPLC) with electrochemical detection(ECD). RESULTS: (1) (-)-3-PPP had dual actions depending on the doses : at 2mg/kg, it decreased and at 10mg/kg, increased extracellular dopamine concentrations ; (2) haloperidol at all doses increased dopamine levels with higher dose having a greater icrease ; and (3) pretreatment of (-)-3-PPP reduced the increase in dopamine levels elicited by acute treatment with haloperidol. CONCLUSIONS: These findings suggest that pretreatment of (-)-3-PPP in low dose could accelerate the onset of therapeutic effect of haloperidol by diminishing the haloperidol-induced dopamine release in the limbic system.
Animals ; Dopamine* ; Haloperidol ; Limbic System ; Nucleus Accumbens* ; Rats*

A randomized, prospective study was conducted between October, 1994 and April, 1996 to compare the efficacy and safety of warfarin (group I) with dextran (group II) for the prevention of DVT after hip arthroplasty. 109 cases in 106 patients were included in the study. There were 60 cases in group I and 49 cases in group IL Risk factor for DVT were analysed before surgery and prophylactic modalities were performed. Color doppler was performed to all patients by one muskuloskeletal radiologist on 5th 8th post operative day and on 6 weeks after operation. DVT occurred in ten ( 16.6% ) of the 60 patients in group I, six ( 12.2% ) of the 49 patients in group II. but, this difference was not significant ( p= 0.582 ). Statistical analysis for the risk factors of age, sex, operation time, anesthetic method and operation method were performed and there were no statistical difference. Only statistical significance was a higher rates of DVT in cemented hip arthroplasty (p=0.028). There were seven proximal thigh DVT and nine calf DVT. We confirmed with sequential color doppler image that all cases of DVT except two complicated cases were resolved within 8 weeks after treatment: one case was expired for the reason of PE, and the other case had thigh hematoma during the treatment with warfarin. We could detect only one case of late onset DVT.
Arthroplasty* ; Dextrans ; Hematoma ; Hip* ; Humans ; Prospective Studies ; Risk Factors ; Thigh ; Venous Thrombosis* ; Warfarin

Purpose: This study aims to investigate the effect of gonadotropin-releasing hormone agonist (GnRHa) on the growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis and to evaluate whether -202 A/C IGF binding protein-3 (IGFBP-3) promoter polymorphism affects growth velocity in females with central precocious puberty (CPP) during treatment. Methods: Data was collected from 97 females younger than 9 years, diagnosed with precocious puberty and treated with GnRHa for at least 1 year at Kangdong Sacred Heart Hospital from 2014 to 2015. Their body height, weight, change in height standard deviation score (∆SDS), serum IGF-1, serum IGFBP-3, bone age, and -202 A/C IGFBP-3 promoter polymorphism were measured before and after GnRHa treatment. The interrelationships between the variables were calculated. Results: During treatment, height SDS, IGF-1 SDS, IGFBP-3 SDS, and IGF-1/IGFBP-3 ratio significantly decreased. A significant correlation was observed between ∆IGF-1 SDS and ∆height SDS (r=0.405, P<0.001). The presence of the C allele was significantly correlated with IGF-1 SDS after treatment (P=0.049) and with IGFBP-3 SDS before and after treatment (P=0.012 and P=0.001), but not with ∆IGF-1 SDS, ∆IGFBP-3 SDS, ∆IGF-1/IGFBP-3 ratio, or ∆height SDS. Conclusion Growth velocity during GnRHa treatment is related to ∆IGF-1 SDS, indicating the apparent impact of GnRHa on the GH-IGF-1 axis. The -202 A/C IGFBP-3 promoter polymorphism does not affect the growth velocity of GnRHa in CPP girls.