PURPOSE: The purpose of this study was to evaluate the accuracy of Tc-99m DTPA diuretic renal scans in children upper urinary tract. MATERIALS AND METHODS: We reviewed diuretic renal scans of 14 pediatric patients (age range: 3 days to 4 years) with unilateral hydronephrosis diagnosed by ultrasonography. Diuretic renal scan was done using Tc-99m DTPA and standardized protocol. In 3 neonates, diuretic renal scans were performed within 1 week and 3-7 months after birth. RESULTS: Six patients required pyeloplasty and eight were managed conservatively. All 6 patients requiring pyeloplasty were diagnosed as having ureteropelvic junction obstruction in the diuretic renal scan. In these 6 patients, post-operative renal scans at 3-12 months after surgery were converted to nonobstructive pattern in 5 and a nonobstructive patterns in 1. In 3 patients who underwent diuretic renal scan within 1 week after birth., nonobstructive patterns of initial scan were coverted to obstructive patterns in the follow-up scan. However, all patients with nonobstructive diuretic renal scans performed after the neonatal period did well on serial ultrasonography and showed favorable clinical outcome without progression to obstruction. CONCLUSION: Tc-99m DTPA diuretic renal scan with standarized protocol is useful in assessing suspected ureteropelvic junction obstruction in children as an initial diagnostic or post-operative follow-up modality. Nonobstructive or indeterminate scan RESULTS in the neonatal period requires follow-up scan to monitor development of the obstructive pattern.
Child* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Infant, Newborn ; Kidney Pelvis ; Parturition ; Pentetic Acid* ; Radioisotope Renography* ; Ultrasonography ; Urinary Tract*

Early stage osteonecrosis of femoral head is a major therapeutic dilemma in orthopedics. Many joint preserving treatment modalities have been proposed, but none of them is entirely satisfactory. Among them, core decompression has been widely performed. The results of twenty two core decompression procedures that were performed for osteonecrosis of the femoral head in fifteen patients were retrospectively reviewed to evaluate the effectiveness of the procedure. From January 1990 to December 1993, we had treated twenty two cases of the osteonecrosis of femoral head. The average follow-up was 31 months, ranging from 12 months to 58 months and the average age at operation was 39.6 years, ranging from 21 to 58 years. By Ficat-Arlet stage, the stages I were 1 case,IIa 6 cases, IIb 7 cases and III 8 cases. The functional and radiological evaluation was done preoperatively and at final follow up by the Harris Hip score and Ficat stage. The results were as follows. The improved cases were 10 cases and the progressed were 12. Radiologically, none of 1 hip(0%) with stage I, two of 6 hips(33%) with stage IIa, four of 7 hips(57%) with stage IIb, and six of 8 hips(75%) with stage III have progressed. Mean preoperative Harris Hip score was 57 points and it improves to 69 (the improved 13 cases; 85, the progressed 9; cases; 49)at final follow up. In six of the progressed 9 cases, the arthroplasties were performed. Among them, five cases are being observed. In conclusion, the core decompression is not only highly effective in preventing further change in femoral head, but also relieving pain and delaying time for arthroplasty at late stage osteonecrosis of femoral head.
Arthroplasty ; Decompression ; Follow-Up Studies ; Head ; Hip ; Humans ; Joints ; Orthopedics ; Osteonecrosis ; Retrospective Studies

Tumor and tumor-like lesion of the patella are extremely rare. The following have been reported: giant cell tumor; osteoblastoma; osteoid osteoma; chondroblastoma; solitary osteochon droma; chondroma; ganglion; simple bone cyst; aneurysmal bone cyst; hyperparathyrodism (brown tumor); malignant lymphoma; haemangioendothelioma; haemangima; primary osteosarcoma; plasmocytoma and metastases. Chodroblastoma in patella were very rare and first repoted by Jerone Cohren in 1963. On review of our literatures, we could not find reported case in Korea. The purpose of this paper is to present an unusual case of chondroblastoma of the patella.
Aneurysm ; Bone Cysts ; Chondroblastoma* ; Chondroma ; Ganglion Cysts ; Giant Cell Tumors ; Korea ; Lymphoma ; Neoplasm Metastasis ; Osteoblastoma ; Osteoma, Osteoid ; Osteosarcoma ; Patella* ; Plasmacytoma

PURPOSE: To determine (1) the relationship between the cortical defects seen on 99 mTc-DMSA renal scans and age, and (2) the presence and degree of vesicoureteral reflux, and then to depict the risk factors for cortical defects in children with acute urinary tract infection (UTI). Furthermore, to assess the diagnostic value of VCUG in predicting a defect on 99 mTc-DMSA renal scans. MATERIALS AND METHODS: We studied 134 kidneys in 67 children aged 15 days-10 years (M:F=39:28) in whom symptomatic UTI was present. In all these children, both DMSA renal scans and voiding cystourethrography (VCUG) were performed. Scanning took place within 7 days of diagnosis and VCUG was performed after one month of diagnosis. Scintigraphic findings were graded according to the extent and number of cortical defects. We evaluated the relationships between the cortical defects seen on DMSA scans and age, and the grade of vesicoureteral reflux. The diagnostic value of VCUG in predicting cortical defects was analysed. Results: The prevalence of cortical defects was greater in patients older than two years (38/54, 70%) than in those aged less than two (38/80, 48%). The frequency of cortical defects was related to vesicoureteral reflux (p<0.05) and grade of reflux (p<0.05). As this latter increased, the extent of cortical defects also increased (p<0.05), and DMSA scans revealed the presence of these in 76 of the 134 kidneys (57%) with acute UTI. In 30 of these 76 (39.5%), VCUG demonstrated the presence of vesicoureteral reflex. On the other hand, vesi-coureteral reflex was found in 36 of the 134 kidneys (27%), and in 30 of these 36 (83%), cortical defects were noted. The sensitivity of VCUG in predicting cortical defect was 39.5%, while specificity was 89.7%. The positive predictive value for defects was 83.3%, and the negative predictive value was 53.1%. The relative risk of cortical defect in the presence of vesicoureteral reflux was 1.78. CONCLUSION: Renal cortical defects are significantly related to age and grade of vesicoureteral reflux. Risk factors for developing cortical defects were older age (> or =2yrs) at the time of acute UTI, and high grade of vesicoureteral reflux. The specificity of VCUG in predicting cortical defects is relatively high but the sensitivitiy is low, and a significant proportion of cortical defects therefore occurred in the absence of vesicoureteral reflux.
Child* ; Diagnosis ; Hand ; Humans ; Kidney ; Prevalence ; Radionuclide Imaging* ; Reflex ; Risk Factors* ; Sensitivity and Specificity ; Succimer* ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

OBJECTIVES: Infection and replication of the hepatitis B virus are closely related to the host immunity. Anticancer chemotherapy decreases the immune response of the host, Especially, glucocorticoid can activate the replication of hepatitis B virus directly. It is well known that hepatitis B virus infection and hepatic complications are more common in patients with hematologic malignancies like malignant lymphoma. We studied the incidence of hepatitis B virus infection and hepatic complications following anti-cancer chemotherapy in patients with malignant lymphoma. METHODS: Among 224 cases diagnosed as malignant lymphoma from January 1989 to December 1993 at Yonsei University Medical Center, 77 cases tested for hepatitis B virus serology was studied. RESULTS: 1) Eighteen cases (23%) was HBsAg positive. 2) The results of hepatitis C virus serology in six cases were all negative. 3) Eight (57%) of 14 follow-up cases had hepatic complications, Two patients had fulminant hepatitis, two nonicteric hepatitis and four icteric hepatitis. 4) Interferon-alpha was administered in three cases among the patients with hepatic complications. Loss of HBeAg was observed in one case and loss of HBsAg in another case. CONCLUSION: Serious hepatic complications can be occurred following anticancer chemotherapy in HBsAg-positive patients with malignant lymphoma. Therefore, we recommend that patients being considered as candidates for anticancer chemotherapy should routinely undergo serologic test for Hepatitis B virus. In addition HBsAg-positive patients with anticancer chemotherapy should be regularly monitored for hepatic injury. And with the careful use of steroid and interferon, prolongation of survival might be searched for these patients.
Academic Medical Centers ; Drug Therapy* ; Follow-Up Studies ; Hematologic Neoplasms ; Hepacivirus ; Hepatitis ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Humans ; Incidence ; Interferon-alpha ; Interferons ; Lymphoma* ; Serologic Tests

We retrospectively evaluated postoperative refraction of four patients(five eyes)who received intraocular lens implantation after excimer laser photorefractive keratectomy (PRK).The mean age of the patients was 44.8 years and 3 patients were female and 1 patient was male.The mean interval between PRK and cataract operation was 20.2 months (1 to 45 months)and the mean follow-up time after cataract operation was 16.2 months(2~43months).Phacoemulsification and PMMA-PCL(6.0~6.5 mm)implantation were made in all cases.SRK-II formula,the most popular empirical formula was used in first 3 cases(group I),but Idem-lens formula,a primitive theoretical formula was used in another 2 cases (group II)after occurrence postoperative refraction errors in group I .In group I and II,the mean postoperative refraction error was +3.00 diopters and +0.50 diopters and uncorrected visual acuity at postoperative 2 months was 20/60 and 20/24 respectively.The mean of calculated IOL-power was -3.75 diopter in group I and -0.625 diopter in group II.From these results,the empirical formula is definitely unsuitable for the calculation of IOL power in the cataract operation following excimer laser PRK. Moreover,although a primitive one,Idem-lens theory could be temporally useful for the IOL-power calculation in such cases.In conclusion,new formula is required for the cataract operation following excimer laser PRK.
Cataract* ; Female ; Follow-Up Studies ; Humans ; Lasers, Excimer* ; Lens Implantation, Intraocular ; Lenses, Intraocular* ; Photorefractive Keratectomy ; Retrospective Studies ; Visual Acuity

Penetrating keratoplasty with or without intraocular lens implantation is necessary to restore a vision of an eye with aphakic bullous keratopathy. We analyzed surgical outcomes in eleven aphakic bullous keratopathy patients(11, eyes) who received penetrat-ing keratoplasty with scleral-fixated posterior chamber lens(PCL)at Kangnam St.Mary's hospital from January, 1989 to December 1991 and followed up more than 1 year Eight of eleven eyes showed the postoperative corrected VlSlOn of 0.3 to 0.8 at postoperative one year. The cuases of poor vision below 0.3 were age-related macular degeneration(1 eye), graft failure(I eye) and diabetic retinopathy(1 eye). At one year after surgery, mean spherical equivalent was-1.12, mean astigmatism was 4.21D and percent loss of corneal endothelium was 35.5%. Graft rejection(3 eyes) and secondary glaucoma(1 eye) were occured during the postoplasty with scleral-fixated PCL can be an excellent surgical technique to get visual rehabilitaion of patients with an aphakic bullous keratopathy.
Astigmatism ; Corneal Transplantation ; Endothelium, Corneal ; Humans ; Keratoplasty, Penetrating* ; Lens Implantation, Intraocular ; Transplants

Purpose: Breast volume is an important factor in breast reconstruction; however, the surgeon is expected to deliver the volume expectation with his aesthetic inspiration. Therefore, objective volumetry must be developed. This study aimed to conduct an MRI-based breast volumetric analysis. With periodic analysis of 2-stage breast reconstruction, we suggest the possibility of clinical use of breast volumetry in implant volume prediction. Methods: This retrospective study included 140 patients who underwent unilateral 2-stage breast reconstruction (tissue expander followed by implant insertion) between January 1, 2017 and December 31, 2019. The MRI image was converted into a 3-dimensional image with a reconstruction program (A-VIEW, Coreline Soft). MRI image was obtained before the surgery and then at 1, 3, 6, 12, and 24 months postoperatively. The volume was automatically calculated. Results: Compared with the preoperative volume, maximized volume and differences were noted at 1 month and minimized at 1 year. The correlation between MRI-based preoperative breast volumetry and the mastectomy specimen volume was 0.611. Volume difference between the MRI-based preoperative state and the implant volume showed a minimal difference at 1 year. The final implant size prediction formula was calculated using the 1-year postoperative volume (P < 0.001, R 2= 0.594). Conclusion To avoid breast reconstruction based solely on the surgeon’s subjective assessment, MRI-based breast volumetry could be a useful method to develop more scientific and objective breast reconstruction planning. We suggest a volume prediction formula that describes the relationship between the postoperative breast volume and the final breast implant size.

Torsade de Points is unique polymorphic ventricular tachycardia associated with QT interval prolongation. The mechanism of Torsade de Points was not defined exactly but triggered activity associated with afterdepolarization and/or dispersion of repolarization were known possible explanation. Torsade de points is most often induced by various drugs such as antiarrythmic agents, antipsychotic agents, antibiotis, and antihistamines. Astemizole(Hismanal(R)) and Terfenadine among antihistamines are reported that cause leading to a Torsade de Points. We experienced the case of Torsade de Points which was induced with Piprinhydrinate(Diphenylpyraline, Plokon(R)), antihistamine of ethanolamine derivatives, expressed recurrent syncope and dizziness in a young lady.
Antipsychotic Agents ; Dizziness ; Ethanolamine ; Histamine Antagonists ; Syncope ; Tachycardia, Ventricular* ; Terfenadine

With the increase in international human and material exchanges, contagious and infectious epidemics are occurring. One of the effective methods of epidemic inhibition is the rapid development and supply of vaccines. Considering the safety of the brain during vaccine development is very important. However, manuals for brain safety assays for new vaccines are not uniform or effective globally. Therefore, the aim of this study is to establish a positive-control protocol for an effective brain safety test to enhance rapid vaccine development. The blood-brain barrier's tight junctions provide selective defense of the brain; however, it is possible to destroy these important microstructures by administering lipopolysaccharides (LPSs), thereby artificially increasing the permeability of brain parenchyma. In this study, test conditions are established so that the degree of brain penetration or brain destruction of newly developed vaccines can be quantitatively identified. The most effective conditions were suggested by measuring time-dependent expressions of tight junction biomarkers (zonula occludens-1 [ZO-1] and occludin) in two types of mice (C57BL/6 and ICR) following exposure to two types of LPS (Salmonella and Escherichia). In the future, we hope that use of the developed positive-control protocol will help speed up the determination of brain safety of novel vaccines.
Animals ; Biomarkers ; Blood-Brain Barrier ; Brain* ; Clothing ; Emergencies* ; Hope ; Humans ; Lipopolysaccharides ; Mice ; Permeability ; Tight Junctions ; Vaccines*