Wilms' tumor is one of the most common primary malignant tumors of the kidney during infancy and childhood and is known to be originated from the primitive cells of metanephric blastema. It presents difficulties when encountered in deciding the presence of anaplasia or in differentiating it from other renal tumors of childhood with different biologic behavior because of its diverse histologic patterns and varying degrees of differentiation. Evaluation of clinical and histopathologic features in terms of prognostication was done of 32 cases of Wilms' tumor which were surgically resected and diagnosed in the period from January 1979 through June 1992. Immunohistochemical reaction for cytokeratin, vimentin, actin and desmin was also analysed on all cases of Wilms' tumor in conjunction with clear cell sarcoma of the kidney(CCSK), malignant rhabdoid tumor of the kidney(MRTK) and congenital mesoblastic nephroma(CMN) to assess the validity of immunohistochemistry in differentiating Wilms' tumor from these renal tumors. Twenty four(75%) cases were diagnosed before the age of 5 and 40.7% were under 2 years old. Mixed type was most common(62.5%), followed by epithelial, blastemal and stromal predominant type in descending order of frequency. Anaplasia was observed in 3 cases(9.4%), two of which were epithelial predominant type and one blastemal predominant type. Treatment modality and presence of anaplasia were significantly correlated with 5 year survival rate of patients. Immunohistochemical stain revealed that all epithelial component of Wilms' tumor were positive for cytokeratin and 56.3% of Wilms' tumor had blastemal component which were positive for both cytokeratin and vimentin. Twenty cases(62.5%) of Wilms' tumor had blastemal component which were positive for cytokeratin with a proportion of more than 5% of reactive cells. Stromal component of Wilms' tumor generally did not show differentiation into the specialized type of tissue and all revealed positive reactions for vimentin among which some revealed positive reactions for actin. Only 3 out of 6 cases with rhabdomyoblastic differentiation were positive for desmin. CCSK, MRTK and CMN which have different biologic behavior and treatment modality compared to Wilm's tumor showed positivity only for vimentin and/or actin. In summary, treatment modality and presence of anaplasia are significantly correlated with patients' survival and the immunohistochemical stain for cytokeratin is very helpful in confirming the presence of blastemal component and useful in the differential diagnosis of Wilms' tumor from other kinds of pediatric renal tumors.
Child ; Male ; Female ; Humans ; Diagnosis, Differential

No abstract available.
Bursitis*

The authors performed the interfascicular nerve grafting in the gap of injured nerves using the microsurgical technique to obtain the accurate coaptation of the fascicles. The authors experienced the 33 cases(26 patients) of the interfascicular nerve grafting in the median(11), ulnar(9), radial(2), common peroneal(3) and digital(8) nerves at the Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University from Jan. 1980 to June 1984. The patients were followed up from 12 to 26 months (average 20 1/2 months). The following results were obtained; 1. The shorter the length of the donor nerve and the younger the age of the patients are, the better the recovery of the nerve function is. 2. The medial and lateral cutaneous nerves of forearm as donor nerve are suitable as well as the sural and superficial radial nerves. 3. The end result of each patient was evaluated by Seddon's classification. The excellent motor recovery was 72.0% (18/25) and the excellent sensory recovery was 81.8% (27/33). 4. The interfascicular nerve grafting is an excellent method in treating the widely separated,severed peripheral nerve injury.
Classification ; Forearm ; Humans ; Methods ; Peripheral Nerve Injuries ; Peripheral Nerves ; Radial Nerve ; Tissue Donors ; Transplants

We studied two hundread cases of replantations-61 cases of major limb replantation and 139 cases of finger replantation. 53 of 179 patients had multiple amputation. The most common cause of amputation was cutting-machine injury and the next one was belt and roller injury. The patients were followed than 6 months, ranging 6 months to 5 years and 10 months, averaging 36 months. The success rate of replantation is 86.9%(53/61) in the amputated limbs and 80.6%(112/139) in the amputated digits. Main causes of failure were tissue crushing, vessel thrombosis, long ischemic time, and amputation wound infection. Common complications were infection (25 cases), delayed union(7 cases), nonunion(2 cases), bleeding tendency and hematoma formation due to systemic heparinization(5 cases). We used Seddon's classification to assess the recovery of the nerve function of the replanted limbs and digits. 84.6 % of success cases of limb replantation presented the excellent result in the motor fuction recovery and 89.1% also presented the excellent sensory recovery. 89.8% of the success cases of the digit replantation showed the excellent result in the sensory recovery. The factors influencing the functional recovery of the replantation surgery were mechanism of injury, ischemic time, surgical technique, numbers of anastomosed vessels, ratio between anastomosed artery and vein, and wound infection. This analysis demonstrated that strict selection of the indication or the replantation is the first step in the limb and digit replantation surgery.
Amputation ; Arteries ; Classification ; Extremities ; Fingers ; Hematoma ; Hemorrhage ; Humans ; Operative Time ; Replantation ; Thrombosis ; Veins ; Wound Infection

The authors made an attempt to classify the supracondylar extension-valgus fracture according to the direction and location of the fracture line based on the radiographic manifestation. This new classification helps to dictate the model of treatment, possible sequence of reduction and the causes of deformity of the elbow after treatment. During the last 12 years of this study, 200 supracondylar fractures of the humerus were treated in the Kyung Hee University Hospital. Of the cases 82 were extension-valgus fractures. The results were as follows: 1. The supracondylar extension-valgus fracture were classified into 5 types: Type I: fish-tail fracture (14 cases) Type II : obtuse fish-tail fracture (27 cases) Type III: oblique fracture (16 cases) Type IV: oblique fracture with comminution of lateral column (14 cases) Type V: Transverse fracture (11 cases) 2. The displacement of the distal fragment in the fish-tail fracture is severe but it can be reduced easily by manipulation. Once reduction has been obtained, the fracture is stable and maintained by a long arm cast with acute flexion of the elbow alone. There is no need of percutaneous pinning. Among 14 cases of type I fracture there was no cubitus varus deformity. 3. The line of the obtuse fish-tail fracture lies distal to fish-tail fracture. This is unstable so it is necessary to percutaneous pinning. 4. The oblique fracture is produced by the hyperextension of the elbow and degrees of the obliquity of the fracture line were 12 to 20 degrees (Av. 14 degrees). The valgus angles in opposit elbows were 9 to 25 degrees (Av. 16 degrees). The forearm must be pulled into valgus position during the reduction of the fracture. 5. Type IV fracture occures under 4 years old, and more commonly in girls. This is unstable, so it is necessary to percutaneous pinning.
Arm ; Child ; Classification ; Congenital Abnormalities ; Elbow ; Female ; Forearm ; Humans ; Humerus

No abstract available.
Diaphragm* ; Stomach Volvulus*

BACKGROUND AND OBJECTIVES: Many studies have shown that coronary artery bypass graft (CABG) surgery prolongs the life of patients with left main coronary artery disease (LMCD). Recently, percutaneous coronary intervention (PCI) has been applied to treat LMCD, with good clinical results. However, a significant portion of patients decline any revascularization therapy, so receive medical treatment only. The aim of this study was to evaluate the long term clinical outcome in these patients with LMCD, according to the treatment strategies. SUBJECTS AND MEHTODS: The clinical outcomes of 281 consecutive patients, with significant LMCD, between January 1997 and December 2000, were evaluated. The patients were divided into three groups, according to their initial treatment strategies;1) CABG, 2) PCI and 3) medical treatment. The mean follow-up duration was 37.4+/-14.9 months. RESULTS: The 1- and 3-year survival rates in the CABG group (97.4+/-1.5% and 95.6+/-1.9%) were significantly higher than those of the medical group (89.8+/-3.9% and 76.1+/-5.9%;p=0.03). The survival rates in the PCI group (one year and 3-year survival rate, 98.1+/-1.3% and 93.8+/-2.5%) were similar to those of the CABG group (p=0.93). The incidence of 3-year MACE in the medical group (40.7%) was higher than those of the CABG (10.5%, p<0.001) and PCI groups (20.4%, p=0.007). There was no significant difference between the CABG and PCI groups (p=0.06). CONCLUSION: In patients with LMCD, a CABG remains the standard therapy for prolonging survival and lowering the incidence of MACE. PCI offers similar survival benefits in selected patients. Medical treatment is associated with a significantly higher mortality and MACE. Active revascularization therapy should be the treatment of choice for the patients with LMCD.
Angioplasty ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Disease* ; Follow-Up Studies* ; Humans ; Incidence ; Mortality ; Percutaneous Coronary Intervention ; Survival Rate ; Transplants

Two case of a rare from of congenital ichthyosis in infants born to the same parents are presented. Typical features revealed of parchment like skin, ectropion of upper eyelids, and fixed semiflexion attitude of the upper limb. The skin lesion were followed by desquamation and appearance of normal looking skin from the the second day of life to a month. Diagnosis of collodion baby was established by clinical features, histopathological and laboratory studies. A brief feview of literatures were presented.
Collodion* ; Diagnosis ; Ectropion ; Eyelids ; Humans ; Ichthyosis ; Infant ; Parents ; Skin ; Upper Extremity

The Cornelia de Lange syndrome is characterized by severe growth and mental retardations and a cluster of minor malformations, the facial appearance being most characteristic. In the present paper, we shall report I case of this syndrome in Korean male infant and the variability of de Lange syndrome is discussed. The bady showed hirsutism, low forehead coved with lanugo-like hair, bushy eyebrows that meet in the midline, long curely eyelashes as well as low pitched, growling cry and skeletal abnormalities of hand bones. There is no positive family history and the karyotype was normal. Although the de Lange syndrome has received more interest there is no agreement as to the possible cause.
De Lange Syndrome* ; Eyebrows ; Eyelashes ; Forehead ; Hair ; Hand Bones ; Hirsutism ; Humans ; Infant ; Karyotype ; Male

No abstract available.