PURPOSE: Precocious puberty is defined as the development of secondary sexual characteristics in girls younger than 8 years, and boys younger than 9 years. Central precocious puberty (CPP) is gonadotropin releasing hormone (GnRH) dependent process and the result of premature activation of hypothalamic-pituitary-gonadal axis. CPP accelerates the linear growth, skeletal maturation, and premature epiphyseal fusion. So CPP results in decrement of final adult height. The purpose of this study is the analysis of the relationship with chronologic age and bone age at the beginning of treatment. METHODS: We enrolled patients treated with GnRH agonist for CPP from January 2003 to January 2005. Their bone age was examined by the method of Greulich & Pyle. We retrospectively examined medical records for sex, chronologic age, bone age, height and Tanner stage. RESULTS: A total of 56 patients were included, only 4 patients were boys. The mean chronologic age and the mean bone age were 7.8+/-1.6 years, 9.4+/-1.9 years in female, respectively; 7.9+/-2.0 years, 12.4+/-0.9 years in male, respectively. Bone age exceeded chronologic age by 1.6+/-1.1 years in female, by 4.6+/-1.8 years in male. The difference between chronologic age and bone age was greater in boys compared to girls by 3.0 years. Such a difference was prominent in advanced Tanner stage in female. CONCLUSION: This study shows that bone age exceeded chronologic age by 1.6+/-1.1 years when CPP was diagnosed in girls. However, further data were needed to set a standard due to variation heterogeneity in distribution of the chronologic age of the control. Additionally, follow up data on improvement of expected adult height after GnRH agonist treatment are needed in order for 1.6+/-1.1 years, a standard, to have a significant value.
Adult ; Axis, Cervical Vertebra ; Diagnosis* ; Female ; Follow-Up Studies ; Gonadotropin-Releasing Hormone ; Humans ; Male ; Medical Records ; Population Characteristics ; Puberty, Precocious* ; Retrospective Studies

BACKGROUND: Percutaneous mitral commissurotomy(PMC) has been known as an effective therapeutic modality for moderate to severe mitral stenosis. However, long-term results and factors influencing late outcome after PMC remain to be elucidated. MATERIALS AND METHODS: Three hundred and forty-six patients received PMC at Seoul National University Hospital between August, 1988 and March, 1996. We evaluated long-term results of these patients and assessed demographic, clinical, echocardiographic and hemodynamic variables in order to identify predictors of immediate and late outcomes. RESULTS: PMC was completed without major complication or technical failure in 339(98%) out of 346 cases. A good immediate result was obtained in 67% of cases. Multivariate study identified echocardiographic score(P=0.004) and left atrial volume(P=0.009) as independent predictors of immediate outcome. The estimated 3-year and 5-year event-free survival rates were 95.8+/-2.5% and 90.6+/-4.3%, respectively. According to multivariate analysis, the independent predictors of late outcome were pre-PMC left atrial volume(P=0.03), post-PMC mitral valve area(P=0.01), and severity of mitral regurgitation after PMC(P=0.03). CONCLUSION: Percutaneous mitral commissurotomy as a treatment for patients with mitral stenosis is safe, and achives good long-term results. Pre-procedural echocardiographic score, left atrial volume, post-procedural mitral valve area, and severity of mitral regurgitation affect the immediate and late outcomes after PMC.
Disease-Free Survival ; Echocardiography ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Multivariate Analysis ; Seoul

A l9-year-old boy was admitted because of progressive spastic quadriparesis and bulbar palsy which developed from 3 years ago. The results of all performed laboratory tests were normal, but neuroradiologic tests revealed intracerebral calcification and degeneration of oilateral pyramidal tracts. Idiopathic familial intracerebral calcification was rarely occurred and presented usually with various extrapyramidal and cortical symptoms. Mild pyramidal symptoms were also associated in some reported cases, but none of them showed predominant spasticity as well as suspicious pyramidal tract degeneration on magnetic resonance imaging.
Bulbar Palsy, Progressive ; Humans ; Magnetic Resonance Imaging ; Male ; Muscle Spasticity ; Pyramidal Tracts* ; Quadriplegia

BACKGROUND: Ischemia/reperfusion injury is very important issue in the era of thrombolysis and primary coronary angioplasty in acute myocardial infarction. However, the mechanism of ischemia-reperfusion injury is not fully clarified. Estrogen is well known to have protective actions against ischemic heart disease. We tested hypothesis that estrogen may protect myocardium by reducing ischemia/reperfusion-induced apoptosis. METHODS: Sprague-Dawley rats that underwent ovariectomy, female controls, and male rats were subjected to 45minutes of left coronary artery occlusion followed by 4 or 24hours of reperfusion. Coronary artery occlusion was performed 1 week after ovariectomy or sham operation. And sham operation was also performed in each group to confirm the effects of ischemia/reperfusion. RESULTS: Ischemia/reperfusion induced apoptosis in myocardium, especially at border zone, whereas sham operation did not induce apoptosis. After 4 hours of reperfusion the percentages of apoptotic myocytes in border and center zone of reperfused area were 35.7+/-3.7%, 29.0+/-4.2% in ovariectomized rats (n=3), 40.8+/-3.7%, 29.5+/-2.5% in female control rats (n=3), and 39.0+/-1.6% (p=0.10), 32.4+/-1.6% (p=0.43) in male rats (n=3). After 24hours of reperfusion the percentages in border and center zone of reperfused area were 20.6+/-3.1%, 12.9+/-4.8% in ovariectomized rats (n=3), 19.6+/-4.1%, 14.0+/-2.0% in female control rat (n=3), and 21.4+/-6.6% (p=0.93), 15.1+/-2.4% (p=0.85) in male rats (n=3). There is difference of apoptosis neither between male and female rats nor between control and ovariectomized female rats. CONCLUSION: Estrogen did not affect the ischemia/reperfusion-induced apoptosis in rat myocardium.
Angioplasty ; Animals ; Apoptosis* ; Coronary Vessels ; Estrogens* ; Female ; Humans ; Male ; Muscle Cells ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium* ; Ovariectomy ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury

PURPOSE: The purpose of this study is to examine the causes of Pleural effusion (PE) in cancer patients and to compare the clinical characteristics between malignant PE (MPE) and non-MPE. METHODS: All consecutive cancer patients with PE who underwent diagnostic thoracentesis from January 1, 2008 to March 31, 2011 were analyzed retrospectively. RESULTS: A total of 719 patients were included; mean age was 58.4+/-13.6 years and 44.5% were female. The most common cause of PE was MPE (57.7%), followed by parapneumonic or empyema in 16.3%. However, the etiology was significantly different according to primary tumor origin and subtypes of lung cancer. While MPE was most common in lung, breast, and gynecologic cancer, hepatic hydrothorax was the main cause in Hepatocellular carcinoma (HCC). MPE accounted for 85.2% in adenocarcinoma, and 30.2% and 58.8% in squamous cell and small cell carcinomas, respectively. Patients with MPE were younger (57.0 vs. 60.2 years) and female-dominant (55.4% vs. 29.6%) compared to those with non-MPE. MPE had the large size (53.5% vs. 34.9%) and left location of PE (31.3% vs. 19.4%) more frequently than non-MPE, and fewer neutrophils (15.4% vs. 30.6%) and more lymphocytes (32.2% vs. 28.2%), higher levels of pH (7.33 vs. 7.29), and lower levels of glucose (111.5 vs. 129.7 mg/dL) than non-MPE (p<0.001 for all). CONCLUSION: Overall, MPE was the most common cause of PE in cancer patients. However the etiology of PE was significantly different according to primary tumor origin and subtypes of lung cancer. A difference in age, gender, size and location of PE, cell count, pH, and glucose was observed between MPE and non-MPE.
Adenocarcinoma ; Breast ; Carcinoma, Hepatocellular ; Carcinoma, Small Cell ; Cell Count ; Empyema ; Female ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Hydrothorax ; Liver Neoplasms ; Lung ; Lung Neoplasms ; Lymphocytes ; Neutrophils ; Pleural Effusion* ; Retrospective Studies

BACKGROUND: Long-term survival after surgical correction of mitral regurgitation is associated with preservation of left ventricular systolic function after operation. And mitral valve repair has been suggested to provide a better postoperative left ventricular systolic function. Accordingly, we intended to compare the operative results of mitral valve repair with those of mitral valve replacement and search for preoperative predictors of postoperative left ventricular systolic function. METHOD: The clinical features, echocardiographic measurements, and cardiac catheterization results of 75 patients operated between January 1984 and December 1994 for acquired pure mitral regurgitation were analyzed. RESULTS: Of the 75 patients, 39 patients had mitral valve repair, and 36 patients had mitral valve replacement. When the outcomes of mitral valve repair and mitral valve replacement were compared, left ventricular ejection fraction decreased significantly after surgery inboth groups but postoperative left ventricular ejection fraction was greater in valve repair group than in valve replacement group. Data analysis of preoperative variables showed that echocardiographic left ventricular end-diastolic diameter(p<.05), but not other clinical and echocardiographic variables, were predictors of postoperative left ventricular systolic function. CONCLUSION: After surgical correction of chronic organic mitral regurgitation, left ventricular dysfunction is frequent and valve repair decreases the severity of left ventricular dysfunction. And the most powerful predictor of postoperative left ventricular systolic function is preoperative left ventricular end-diastolic diameter measured by echocardiography.
Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Statistics as Topic ; Stroke Volume ; Ventricular Dysfunction, Left

PURPOSE: The aim of this study was to describe clinical, biochemical, and radiologic features in patients with pyogenic liver abscess and to investigate predictors of septic shock. METHODS: We consecutively included subjects who were diagnosed as pyogenic liver abscess in the emergency department (ED) from January 1st, 2010 to June 30th, 2013. Through review of medical records, clinical, biochemical, and radiologic data were collected. The primary endpoint was septic shock during hospitalization. RESULTS: A total of 228 patients were included, with a mean age of 60.8+/-12.8 years, and 63.2% were men. Among them, 198 patients presented with fever and GCS <15 was observed in 15. Klebsiella spp. was most commonly identified in 33.8%, followed by E. coli and Streptococci spp. in 7% for each. Septic shock occurred in 55 (22.4%) and mortality rate was 1.3%. In univariable logistic regression, GCS <15, systolic BP <90 mmHg, pulse rate > or =120/min, respiratory rate > or = 22/min, body temperature (BT) > or =38degrees C, WBC, platelet, BUN, creatinine, albumin, AST, alkaline phosphatase (ALP), Creactive protein (CRP), abscess size > or =5 cm, and bilobal involvement were significantly associated with septic shock (p<0.05). In multivariate analysis, systolic BP <90 mmHg (OR 95.79, 95% CI: 11.16-822.02), BT > or =38degrees C (OR 1.95, 1.36-2.78), BUN (OR 1.03, 1.01-1.06), ALP (OR 1.003, 1.000-1.005), and abscess size > or =5 cm (OR 2.31, 1.08-4.94) were independent predictors of septic shock. CONCLUSION: Low Systolic Bp, High Bt, Elevated Bun And Alp, And Abscess Size > or =5 Cm Were Independently Associated With Septic Shock In Patients With Pyogenic Liver Abscess.
Abscess ; Alkaline Phosphatase ; Blood Platelets ; Body Temperature ; Creatinine ; Emergency Service, Hospital ; Fever ; Heart Rate ; Hospitalization ; Humans ; Klebsiella ; Liver Abscess, Pyogenic* ; Logistic Models ; Male ; Medical Records ; Mortality ; Multivariate Analysis ; Respiratory Rate ; Shock, Septic*

Radiation-induced osteosarcoma is a very rare complication of radiation therapy, with a poor prognosis. We experienced a case of radiation-induced osteosarcoma of the sternum, in a patient who had had breast cancer treated with surgery, adjuvant chemotherapy, and adjuvant radiation therapy 6 years earlier. A 53-year-old woman complained of a painful anterior chest wall mass. The mass was diagnosed as osteosarcoma on biopsy. The radiation-induced osteosarcoma had an aggressive nature.
Biopsy ; Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Female ; Humans ; Middle Aged ; Osteosarcoma ; Prognosis ; Sternum ; Thoracic Wall

This study aimed to investigate whether the demographic variable-adjustment and supplementation of Frontal Assessment Battery (FAB) score can improve the screening ability of Mini-Mental State Examination (MMSE) for dementia and its subtypes. Five hundred forty-one non-demented comparison (NC) and 474 dementia (320 Alzheimer's disease [AD]; 139 non-Alzheimer's disease dementia [NAD]; and 15 mixed AD-NAD dementia) individuals living in the community were included. Education-adjusted MMSE (MMSE-edu) score showed significantly better screening accuracy for overall dementia, AD, and NAD than MMSE raw score. FAB-supplemented MMSE (MMSE-FAB) score had significantly better screening ability for NAD, but not for overall dementia and AD, than MMSE raw score alone. Additional supplementation of FAB to MMSE-edu further increased the ability for overall dementia or NAD screening, but not for AD screening. Further education adjustment of MMSE-FAB also improved its ability for overall dementia, AD, and NAD screening. These results strongly support the usefulness of education-adjustment and supplementation of frontal function assessment to improve screening performance of MMSE for dementia and its subtypes, NAD in particular.
Aged ; Aged, 80 and over ; Alzheimer Disease/complications/diagnosis ; Area Under Curve ; Dementia/complications/*diagnosis ; Demography ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Neuropsychological Tests ; ROC Curve

BACKGROUND/AIMS: Esophageal perforation is a rare but often a life-threatening condition. However, the incidence and clinical features of esophageal perforation caused by ingested foreign body are unknown. This study investigated the incidence of esophageal perforation caused by ingested foreign body and evaluated the clinical features and outcome of patients with esophageal perforation. METHODS: Among a total of 196 adult patients with confirmed esophageal foreign body and complained of at least one of the related symptoms at the emergency department between January 2000 and July 2008, 18 patients with esophageal perforation due to esophageal foreign body ingestion were included in the study. Data were collected by retrospectively reviewing the electric medical records. RESULTS: The incidence of esophageal foreign body and esophageal perforation in adults was 19.4% (196/1,009) and 1.8% (18/1,009), respectively. Chest pain was the most common symptom and fishbone was the most common foreign body causing esophageal perforation. Mediastinitis or mediastinal abscess occurred in 13 patients (13/18, 72.2%). About half (8/18) of the patients were admitted to the intensive care unit but there was no in-hospital mortality. CONCLUSIONS: The incidence of esophageal perforation in patients with foreign body ingestion was low but it increased up to 9.2% in patients with esophageal foreign body. However, prognosis was favorable with timely proper treatment. Chest pain can be an ominous sign indicating the presence of esophageal perforation in patients with esophageal foreign body.
Aged ; Chest Pain/etiology ; Emergency Medical Services ; Esophageal Perforation/*diagnosis/epidemiology/etiology ; Female ; Foreign Bodies/*complications ; Humans ; Incidence ; Intensive Care Units ; Male ; Middle Aged ; Prognosis ; Retrospective Studies