PURPOSE: Nocturnal enuresis is one of the most common disorders of childhood, occurring in 15% of 5 year-old children. Although usually self-limiting, justification for early treatment has been founded in psyc hological impact on the child. Many investigators have reported upon the effectiveness of prospectively studied to compare the therapeutic effect between imipramine (Tofranil) and desmopressin (Minirin/1-Desamino-8-D-Arginine Vasopressin: DDAVP) on the monosymptomatic enuretic patients. MATERIALS AND METHODS: 83 enuretic patients (primary enuresis 64 cases, secondary enuresis 19 cases) were randomized th one of two groups: imipramine group(44 cases) or desmopressin group (39 cases). They were free of other abnormalities in the screening tests. In addition to drug therapy, all of cases were performed motivational counselling, reduction of fluid in take prior to bedtime and voiding diary. The efficacy of drug was measured in reduction of the number of wet nights per week. During the treatment period, 83 cases were classified as excellent (0 to 1 wet night per week), good (over 59% reduction of wet night)and failed responder(less than 50% reduction of wet night). RESULTS: Average age of imipramine group and desmopressin group was 9.3 years (range 5-17) and 9.6 years (range 5-17), respectively. The number of wet nights per week decreased respectively from a mean of 6.1 to 3.4 in imipramine group are from a mean of 6.4 to 2.3 in desmopressin group. Average therapeutic duration and overall response rate in the imipeamine group and desmopressin group was 9.1 weeks, 6.7 weeks (p<0.05) and 90.9%, 95.9%, respectively (p<0.05). The overall relapse rate of imipramine group and desmopressin group was 40.0% and 40.8% during the follow-up period of 3 months after cessation of medication in excellent responders. There was no difference in the therapeutic effects between primary and secondary enuresis on each drug therapy. There was also on no difference in the therapeutic response according to constipation. No serious side effects were observed in both groups. CONCLUSIONS: These data suggest that the overall effects of imipramine and desmopressin are excellent. But desmopressin has more effective therapeutic response and more shorter therapeutic duration as compared with imipramine.
Child ; Child, Preschool ; Constipation ; Deamino Arginine Vasopressin* ; Drug Therapy ; Enuresis ; Follow-Up Studies ; Humans ; Imipramine* ; Mass Screening ; Nocturnal Enuresis ; Prospective Studies ; Recurrence ; Research Personnel ; Vasopressins

The goal of reduction mammaplasty is a breast with natural contour and volume, aesthetically situated scars, and a well-placed, sensate nipple and areola. The most successful techniques achieve this through the excision of tissue from the lower part of the breast based on some variation. However, the Mckissock's vertical bipedicle technique is the popular method for reduction mammaplasty. As an alternative modified Mckissock's method, we have found the use of only an inferior dermal flap with a keyhole pattern to be a simple and safe method for obtaining satisfactory aesthetic results. We have used inferior dermal flap for 4 patients recently and obtained the advantages as below compare to the Mckissock's method. 1. Rich blood supply to the broad based inferior flap. 2. More easy transposition of the nipple and areola. 3. More good operation field for resection of breast tissue. 4. Short operation time. 5. Can applied to the gigantomastia.
Breast ; Cicatrix ; Female ; Humans ; Mammaplasty* ; Methods ; Nipples

'Marjolin' ulcer' is used to describe the malignant transformation of a chronic ulcer which has developed in a burn scar. Clinically, although the lesions is slowly progressive, it comes to be more aggressive when the scar barrier is disrupted. We reviewed 24 cases in patients who complained of chronic burn wounds suspected to be Marjolin's ulcer. The mean latent period for developing pathologic lesions was 31 years. Histologically, chronic ulcer and pseudoepitheliomatous hyperplasia were 21% respectively, while malignancy including squamous cell carcinoma and leiomyosarcoma was 56%. The mean elapsed time to diagnose squamous cell carcinogma was 33.2 years. In pseudoepitheliomatous hyperplasia which is considered as a transitional state to malignant tumor, wide excision and reconstruction with free muscle flap was a better procedure than skin graft for the prevention of recurrence and malignant transformation. As well, the same modality of treatment was also applied in malignant tumors.
Burns* ; Carcinoma, Squamous Cell ; Cicatrix ; Humans ; Hyperplasia ; Leiomyosarcoma ; Recurrence ; Skin ; Transplants ; Ulcer ; Wounds and Injuries*

A retrospective study was conducted to investigate the effects of CNS prophylaxis with 1,800 cGy cranial irradiation on standing height growth of children with acute lymphoblastic leukemia (ALL). Seventeen longterm survivors (DFS over 5 years ) of ALL and Non-Hodgkins Lymphoma who had been admitted at pediatric department of Inje University Seoul Paik Hospital from January 1982 to September 1988 were studied. The long term survivors were divided into two groups by prophylactic treatment modality; intrathecal chemotherapy alone (Group I, 7 cases), intrathecal chemotherapy with cranial irradiation (Group II, 10 cases). The heights of each groups were compared normal standard growth of the sane aged children by mean SD score (The SD score was calculated with the use of the following formula). SD score=(x-x)/SD (x; height measurement, x; mean height for age of the normal population SD; standard deviation). The results were as follows; 1) The mean SD scores of Group I and Group II at diagnosis were -0.30 and -0.17, which were smaller than height of normal child. 2) In Group 1, the mean SD scores after the end of treatment were -0.14 of 1 year, 0.03 at 2 years and 0.01 at 5 years, which suggests that were normal height velocity and catch-up growth in these patients (P<0.05). The height of 1 year after the beginning of treatment were particularly smaller than that of the normal children (P<0.05). 3) The mean SD scores 5 years after the end of treatment were 0.10 in Group I and -0.17 in Group II, which shows strong tendency to statistical difference among these two groups. If larger numbers of patients are evaluated, it, however, may turn significant. In conclusion, 1,800 cGy cranial irradiation in ALL children significantly affects on height growth. We recommend to evaluate growth hormone for patient with 1,800 cGy cranial irradiation and to treat them with growth hormone.
Child* ; Cranial Irradiation* ; Diagnosis ; Drug Therapy ; Growth Hormone ; Humans ; Lymphoma, Non-Hodgkin ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Seoul ; Survivors

No abstract available.
Facial Bones*

Reflex sympathetic dystrophy(RSD) defines as a chronic pain syndrome with sympathetic manifestations that afflicts individuals who haute suffered a trauma to the hand. Persistent pain and dysfunctions of the hand are frequently overlooked by the surgeons. The exact pathophysiology of RSD is not known but severity of injury and prolonged immobilization of the joints are considered as resonable causes on the retrospective studies. The diagnosis of reflex sympathetic dystrophy is based on clinical manifestations, simple X-ray and three-phase bone scan. Confirmative diagnosis absolutely depends on the presence of a diffusely abnormal pattern of uptake in phase III in a patient haying pain with underlying cause and strong clinical signs of sympathetic overactivities. As with most disease processes, early diagnosis and treatment is a goal of management of RSD. Surgical restoration of anatomical structures such as tendon, nerve and joint goes ahead of any kind of procedures and it made the VAS pain score decrease from 7.8 to 3.4 in 16 patients. Also, decrease of pain could be achievable with sympathetic or stellate ganglion block with steroid medication. Active physical therapy after surgery is also verb helpful to functional recovery of the hands. Once the appropriate diagnosis is made, combined therapy composed of surgical restoration of anatomical structure, physiotherapy and steroid medication with sympathetic block will be free from pain and produce early functional recovery.
Chronic Pain ; Diagnosis ; Early Diagnosis ; Hand Injuries* ; Hand* ; Humans ; Immobilization ; Joints ; Reflex Sympathetic Dystrophy* ; Reflex* ; Retrospective Studies ; Stellate Ganglion ; Tendons

No abstract available.
Thumb* ; Toes*

To evaluate the relationships among the c-erbB-2 oncogene expression, DNA ploidy and other prognostic factors, an immunohistochemical study of the c-erbB-2 oncogene product and flow cytometric analysis of DNA ploidy were performed in paraffin sections of 42 cases of ovarian carcinomas. The results were as follows: 1) The positive reaction for c-erbB-2 oncogene product was observed mainly along the cytoplasmic membrane, and occasionally within the cytoplasm of the tumor cells. 2) Overall the positivity of c-erbB-2 oncogene expression was 45.2% of the ovarian carcinomas. By the histological types, the positivity was 35.7% in serous carcinoma, 80.0% in mucinous carcinoma, and 45.2% in endometrioid carcinoma; by the degree of differentiation, 57.1% in well differentiated carcinoma, 40.0% in moderately differentiated, and 27.3% in poorly differentiated; by the nuclear grading, 58.3% in grade I, 52.6% in grade II, and 18.2 % in grade III; and by the clinical staging, 57.1% in stage I, 42.8% in stage II, and 35.0% in stage III. The expression of the c-erbB-2 oncogene in the ovarian carcinomas was higher in the tumors of good differentiation, of the lower nuclear grade and of the lower clinical stage. 3) The incidence of DNA aneuploidy in the cases positive for the c-erbB-2 oncogene expression(47.3%) was higher than that in the negative cases(31.4%). From the above results, therefore, it is suggested that the c-erbB-2 oncogene may be involved in the early stage of ovarian carcinogenesis. Also suggested is that ovarian carcinomas positive for the c-erbB-2 oncogene in the early stages may have higher probability of having a DNA aneuploid cell line during the progress of the tumors.
Adenocarcinoma, Mucinous ; Aneuploidy ; Carcinogenesis ; Carcinoma, Endometrioid ; Cell Membrane ; Cytoplasm ; DNA* ; Incidence ; Oncogene Proteins ; Oncogenes ; Paraffin ; Ploidies*

A 42-year-old woman with systemic lupus erythematosus (SLE) has had wide-spread erythemas with some purpuric patches on her trunk and upper extremities during exacerbation of her disease. Biopsy findings from erythematous lesions and purpuric areas revealed the pathology of lupus erythematosus and leukocytoclastic vasculitis (LCV) with immune deposits, respectively. A feature of wide-spread symmetrical erythemas with foci of LCV occurring in this patient is considered to be an unusual presentation.
Adult ; Biopsy ; Erythema* ; Female ; Glycogen Storage Disease Type VI ; Humans ; Lupus Erythematosus, Systemic* ; Pathology ; Upper Extremity ; Vasculitis*

No abstract available.
Pneumonia*