PURPOSE: The usual technique of temporomandibular joint (TMJ) reduction, recommended by most emergency medicine textbooks, consists of downward forces applied to the mandible. However, it has been the authors' experience that conscious sedation and significant force is required to achieve reduction. For that reason, we designed a new method of TMJ reduction. The purpose of our study is to introduce the new method of TMJ reduction and to compare the traditional method with the new method. METHODS: We performed a prospective, randomized trial with 52 patients who were diagnosed as having a TMJ dislocation. The patients were divided into two groups: the group treated with the traditional method (25 cases) and treated with the new method (27cases). Patients with histories of trauma or inflammatory signs were excluded from this study. The new method is an extraoral approach in which the operator applies the coronoid process on the face in the posteroinferior direction. RESULTS: Age, sex, and history of TMJ dislocation showed no statistical differences between the two groups. Reduction of the TMJ dislocation was achieved in 15 (60.0%) of the traditional method group and in 25 (92.6%) of the new method group (p=0.005). The means of the reduction time were 11.8+/-6.2 sec in the traditional method group and 6.6 +/- 3.3 sec in the new method group (p=0.007). CONCLUSION: The new method was an effective treatment for TMJ dislocation without any sedations. I had a higher success rate and a shorter reduction time than traditional method.
Conscious Sedation ; Dislocations ; Emergency Medicine ; Humans ; Mandible ; Prospective Studies* ; Temporomandibular Joint*

All of the methicillin-resistant Staphylococcus aureus (MRSA) strains exhibit resistance to oxacillin by producing PBP2a encoded by mecA, whereas methicllin-susceptible Staphylococcus aureus (MSSA) strains do not. To investigate phenotypic differences other than oxacillin resistance level in responses to oxacillin between MSSA and MRSA, we compared alterations of viability and ultrastructure of MSSA by oxacillin treatment with those of MRSA. When MSSA and MRSA strains were exposed to oxacillin of their respective MICs, and then were assayed for viability and observed by transmission electron microscope, increase in thickness of cell wall was more prominent in MRSA strains than in MSSA strains, while decrease in number of surviving cells was more evident and change in morphology of growing cross wall was greater in MSSA strains than in MRSA strains. It is assumed that these different responses to oxacillin between MSSA and MRSA strains may be due to activation of some PBP2a unbound to oxacillin. In conclusion, MSSA and MRSA showed different functional and morphological responses to oxacillin, although they were treated with oxacillin of concentrations that respectively inhibit their proliferation.
Adenosine ; Cell Wall ; Electrons ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Staphylococcus aureus

Coincidental occurrence of the renal cell carcinoma and renal angiomyolipoma in the same kidney is exceedingly rare, and it is usually presented as separated masses or nodules in cage of its occurrence. However, our case which has occurred in a 37-year-old-man without any stigmata of tuberous sclerosis is different because the angiomyolipoma and renal cell carcinoma are admixed in the same mass. To our knowledge, only 2 cases or combination of this tumors have been reported previously.
Angiomyolipoma* ; Carcinoma, Renal Cell* ; Christianity ; Kidney* ; Tuberous Sclerosis

For over a half centry, physicians have suspected that patients with duodenal ulcer are offered an insurance policy against gastric carcinoma. This may be used clinically so that gastric lesion in the presence of duodenal ulcer, are considered benign. However, the duodenal ulcer may coexit with gastric cancer, Although rare in incidence of coexistence of duodenal ulcer and gastric cancer, physician always should be alert in diagnosing of gastric lesion in the presence of the duodenal ulcer. Here, we present 60 years old woman with coexitence of duodenal ulcer and gastric cancer, diagnosed by endoscopy and treated surgically.
Duodenal Ulcer* ; Endoscopy ; Female ; Humans ; Incidence ; Insurance ; Middle Aged ; Stomach Neoplasms*

For many years, the histogenesis of the granular cell tumor was controversial and this resulted in the tumor being given more than 20 synonyms. Abrikossoff, reporting on the fiist granular cell tomor, favored a muscle origin, but other authora have postulated a fibroblastic or a histiocytic origin. Recently, the concept of Schwann cell origin, supported by electron microscopic studies and immunohistochemistry of S-100 protein, has gained wider recognition. Approximately 90 cases of esophageal granular cell tumor have been reported in the literature, representing about 2% incidence of all reported granular cell tumor, In Korea, only four cases of granular cell tumors were reported in the literatures including the cases occuring in the cecum, colon, and anus until now. Recently we experienced 46-years old women with granular cell tumor of the esophagus, which might be the second case in Korean literature.
Anal Canal ; Cecum ; Colon ; Esophagus* ; Female ; Fibroblasts ; Granular Cell Tumor* ; Humans ; Immunohistochemistry ; Incidence ; Korea ; Middle Aged ; S100 Proteins

PURPOSE: To analyse and interpret different sonographic findings in acute nonperforated and appendicitis. MATERIALS AND METHODS: In 46 cases of acute appendicitis in children(26 girls, 20 boys) proven by surgery, sonographic findings were reviewed retrospectively. The findings of nonperforated and perforated appendicitis were analysed, focusing on the size, shape and echogenicity of the appendix, echo patterns of periappendiceal abscesses, mesenteric lymphadenopathy, and the prevalence of appendicolith. RESULTS: A noncompressible distended appendix was present in 18 of 21 patients with nonperforated appendicitis and in 13 of 25 patients with perforation. In 18 patients with nonperforated appendicitis, the average diameter of distended appendix was 8.6mm;target appearance was noted in 16 patients and loss of echogenic submucosa in two. In 13 patients with perforated appendicitis, the average diameter of appendix was 9.1 mm;target appearance was noted in four patientsand loss of echogenic submucosa in nine. periappendiceal abscesses were present in 21 of 25 cases of perforated appendicitis, and the echogenicity of abscesses was mixed in 12 patients, hypoechogenic in eight, and hyperechogenic in one. Mesenteric lymphadenopathy was present in two of 21 patients with nonperforated appendicitis and in four of 25 with perforation. Appendicolith was detected on sonography in three of 25 patients with perforated appendicitis, but was found in seven patients during surgery. One patients with perforated appendicitis also had right side hydronephrosis. Sonographically false-negative results were obtained in sixcases. CONCLUSION: A sonographic examination was useful to differenciate perforated and nonperforated appendicitis in children. Loss of echogenic submucosa in the distended appendix and periappendiceal abscess formation were important findings in diagnosis of perforated appendicitis.
Abscess ; Appendicitis* ; Appendix ; Child* ; Diagnosis ; Female ; Humans ; Hydronephrosis ; Lymphatic Diseases ; Prevalence ; Retrospective Studies ; Ultrasonography

PURPOSE: Obesity is a well known risk factorfor erectile dysfunction, and metformin normalizes androgen levels in patients with polycystic ovary syndrome and decreases body fat and leptin concentration in normal weight men. Thus, we hypothesized that metformin may restore the neuroendocrine abnormalities associated with obesity and improve erectile dysfunction. MATERIALS AND METHODS: Obesity was induced by a high fat(HF) diet fed for 4 months, and then metformin(300 mg/kg/day) was administered for 4 weeks. Penile nitric oxide synthase(NOS) expression and luteinizing hormone (LH), follicle stimulating hormone(FSH), testosterone, leptin, corticotropin releasing factor(CRF), adrenocorticotropin (ACTH), and proopiomelanocortin(POMC) were evaluated in control and HF obese rats. RESULTS: Penile nNOS and eNOS were suppressed markedly, and serum leptin and FSH were increased in HF rats compared to controls. However, POMCexpression in the hypothalamus was decreased in HF rats compared to controls,despite slightly elevated cerebrospinal fluid(CSF) leptin concentration. Metformin treatment for 4 weeks restored penile nNOS and eNOS expression, decreased serum leptin, increased POMC expression in the hypothalamus, and decreased serum concentration of FSH and CRF in HF rats. Surprisingly, metformin increased CSF leptin concentration in both control and HF rats. CONCLUSIONS: These results suggested that NOS expression was suppressed by the HF diet, but restored by metformin treatment. The effect of metformin on NOS expression resulted from not only a leptin sensitizing effect but also through a normalizing effect on levels of endocrine factors.
Adipose Tissue ; Adrenocorticotropic Hormone ; Animals ; Diet ; Erectile Dysfunction ; Humans ; Hypothalamus ; Leptin ; Luteinizing Hormone ; Male ; Metformin* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Obesity ; Polycystic Ovary Syndrome ; Pro-Opiomelanocortin ; Rats* ; Testosterone

Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.
Adrenal Insufficiency/diagnosis/etiology ; Adult ; Brain/diagnostic imaging ; Depression/etiology ; Female ; Hepatolenticular Degeneration/*complications ; Humans ; Hypopituitarism/complications/*diagnosis/drug therapy ; Hypothyroidism/diagnosis/etiology ; Liver Cirrhosis/complications/diagnostic imaging ; Magnetic Resonance Imaging ; Steroids/therapeutic use ; Thyrotropin-Releasing Hormone/therapeutic use

Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.
Adrenal Insufficiency/diagnosis/etiology ; Adult ; Brain/diagnostic imaging ; Depression/etiology ; Female ; Hepatolenticular Degeneration/*complications ; Humans ; Hypopituitarism/complications/*diagnosis/drug therapy ; Hypothyroidism/diagnosis/etiology ; Liver Cirrhosis/complications/diagnostic imaging ; Magnetic Resonance Imaging ; Steroids/therapeutic use ; Thyrotropin-Releasing Hormone/therapeutic use

The authors analyzed 105 cases of spinal cord tumor in regarding to the age, sex, location and distribution, clinical presentation and postoperative outcome. They were confirmed by pathologic study at the Kyung Hee Medical Cented from 1981 to 1991. The incidence of spinal cord tumors was slightly predominant in males. The most commom tumor was neurogenic tumor. The neurogenic tumor composed 43.8%(46 cases), and the rests were meningioma 15.2%(16 case), metstasis 10.5%(11 cases) and others. The tumor were located most frequently in the thoracic area(31.4%) and in the intradural extramedullary space(56.1%). Most common initial symptom of spinal cord tumors were pain and it's mean duration was 8.3 month. The patients were assigned to one of four groups according to their neurologic deficit. About 66.6%(70 cases) of the patients were included in Groups I and II(mild neurologic deficit), and others were classified in Groups III and IV(significant to severe neurologic deficit). Complete tumor removal was achieved in 70.4%(4 cases) of the patients, and subtotal removal was performed in 26.7%(28 cases), and biopsy was performed in 2.9%(3 cases). Among the 105 patients, the postoperative outcomes on dischage were recovery in 36 cases(34.3%), improved in 45 cases(42.9%), stationary state in 12 cases(11.4%), and progression in 12 cases(11.4%).
Biopsy ; Hospital Distribution Systems ; Humans ; Incidence ; Male ; Meningioma ; Neurologic Manifestations ; Spinal Cord Neoplasms ; Spinal Cord*