Spondylolisthesis has been become of considerable causative disease for low back pain in orthopedic field recently. Twenty-seven patients with spondylolisthesis, who were taken operation during a 7-year period from Jan. 1978 to Dec. 1984 at Department of Orthopedic Surgery of Presbyterian Medical Center, were studied and analized on clinical and radiological aspects and the results of obtained were as follows: 1. The averake age was 41.7 years with a range of 20 to 63 years, and the incidence was more common in female than male in all types. 2. By Wiltse's classification, isthmic type was most common and 19 patients were included and level of spondylolisthesis was common at fourth lumbar vertebra in degenerative type and fifth lumbar vertebra in isthmic type. 3. By Meyerding's grading, 14 patients (52%) were Grade 1, which was most common and the slipping measured by Taillard's method was most common with a range 10% to 19%, which included 13 patients (48%) and average slipping was 21.4%. 4. Meschan's angle was ranged from 5° to 19° with an average of 13.3°. 5. Myelogram was done in 13 patients and 9 of them showed positive findings. 6. Spina bifida was most common developmental abnormal finding and 11 patients (41%) were included. 7. Posterolateral fusion was done in 24 patients and anterior interbody fusion was done in 3 patients. 8. 24 patients who had taken posterolateral fusion were permitted to ambulate early at 2 weeks with Norton-Brown back brace. 9. After over a year follow-up, 23(85%) of 27 patients had satisfactory result. 10. After follow-up, 21(88%) of 24 patients who had taken posterolateral fusion had successful fusion.
Braces ; Classification ; Clinical Study ; Female ; Follow-Up Studies ; Humans ; Incidence ; Low Back Pain ; Male ; Methods ; Orthopedics ; Protestantism ; Spinal Dysraphism ; Spine ; Spondylolisthesis

The Ehlers-Danlos syndrome is a familial disorder of connective tissue, and seven distinct clinical forms are reported. Author experienced two cases of the type 3 Ehlers-Danlos syndrome which present hypermobility of the joints, asymmetry of the thorax, anomalies of the thoracic spine, and flatfoot. So, we report these patients with references.
Connective Tissue ; Ehlers-Danlos Syndrome ; Flatfoot ; Humans ; Joints ; Spine ; Thorax

Chronic hypophosphatemia caused by decreased intestinal absorption or increased renal clearance, may lead to rickets or osteomalacia independently of other predisposing abnormalities. The conditions commonly associated with increased renal clearance of phosphate are X-linked hypophosphatemic rickets, tumor associated rickets/osteomalacia, RTA and Fanconi syndrome. Recently we experienced 3 men with adult-onset, histologically proven osteomalacia associated with increased renal clearance of phosphate. None of them had a family history of bone disease, tumors or other tubular defects. All of these had remarkable biochemical and clinical improvement with medical treatment such as 1, 25-dihydroxyvitamin D and phosphate supplementation. Although we did not find tumors yet, we could not rule out the possibility of tumor-associated osteomalcia since it often takes several years to make a diagnosis because of small size, benign nature and unusual location of tumors. Thus, careful long-term follow up for tumor occurrence will be maintained in these patients with sporadic nonfamilial hypophosphatemic osteomalacia.
Bone Diseases ; Diagnosis ; Familial Hypophosphatemic Rickets ; Fanconi Syndrome ; Follow-Up Studies ; Humans ; Hypophosphatemia ; Intestinal Absorption ; Male ; Osteomalacia ; Rickets

Laminar flow within large vessels or organs can cause artifact that may simulate thrombus during computed tomographic study. The degree of venous enhancement depends on the size of blood pool and cardiac output in relation to the time of scanning. When venous structures are scanned too fast after injection of contrast material, poor mixing of enhanced and unenhanced blood creates flow artifact that gives an appearance of deep venous thrombosis. As compared with dynamic computed tomography (CT), because of a shorter acquisition time of spiral CT, vascular and organ enhancement on spiral CT scan are more dependent on factor that affect delivery of contrast material into the blood stream. Differentiation from true thrombus can be made by use of delayed scan as well as increased density and finding of relatively poor margination of artifact. In addition, both angiography and echocardiography could complement CT to assure that false-positive results are minimized. We experienced a case of artifact mistaken for intracardiac mass on spiral CT, but it was not noted on echocardiography.
Angiography ; Artifacts* ; Cardiac Output ; Complement System Proteins ; Echocardiography ; Heart Neoplasms* ; Rivers ; Thrombosis ; Tomography, Spiral Computed ; Venous Thrombosis

BACKGROUND: Left atrial thrombi(LAT) and spontaneous echo contrast(SEC) are known as major risk factors for thromboembolic complication in patients with mitral valvular heartdisease. Recent clinical introduction of transesophageal echocardiography(TEE) makes it possible to improve the diagnostic accuracy of these risk facors compared to conventional transthoracic echocardiography(TTE). The aims of the present study were to evaluate diagnostic accuracy of TEE for detection of LAT and to determine if clinical and echocardiographic variables can predict the presence of LAT and/or SEC at TEE. METHODS: From July 1991 to April 1993, both TTE and TEE were performed in 84 patients with mitral valvular heart disease before open heart surgery. The incidence and diagnostic accuracy of TTE and TEE for LAT detection were confirmed at surgery for mitral valve replacement in all cases. Biplane with 5.0 MHz transducer was used in TEE. The following clinical and transthoracic echocardiographic variables were analyzed:age, totoal or recent embolism, atrial fibrillation, left atrial dimension, ejection fraction, mitral valve area, and mitral regurgitation. RESULT: 1) THe sensitivity of TEE for detection of LAT was 100%, which was significantly higher than that of TTE(60.8%). There was no statistical difference in specificity of both techniques(98.3% vs 93.4%). In eleven patients (11/24,45.8%), LAT was confined to the left atrial appendage and TEE was far superior to TTE(sensitivity : 100% vs 27.2%) in detection of appendegeal thrombi. 2) SEC was found in 43 patients(51.2%). Patients with SEC had higher rates of LAT(p<0.001) and embolic episodes (p=0.001) than patients without SEC. There was no association between the severity of SEC and the embolic episodes. 3) Patients with SEC or LAT were characterized by more frequently associated with recent embolic episodes, smaller mitral valve orifice, abscence of mitral regurgitation than those without SEC and LAT. CONCLUSION: TEE is superior to TTE in detection of LAT and appendegeal thrombi. SEC is frequently noted in TEE and also strongly associated with left atrial blood stasis and left atrial thrombi in mitral valve disease.
Atrial Appendage ; Atrial Fibrillation ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Heart Valve Diseases* ; Humans ; Incidence ; Mitral Valve ; Mitral Valve Insufficiency ; Risk Factors ; Sensitivity and Specificity ; Thoracic Surgery ; Thrombosis* ; Transducers

The residual tense false lumen following surgical repair of aortic dissection remains one of the most difficult and challenging postsurgical problems. Percutaneous fenestration of the dissecting membrane under the guidance of intravascular ultrasound has been recently introduced to depressurize the tense false lumen. A 63-year-old woman who underwent repair of acute type I dissection was readmitted because of claudication and numbness of the left lower extremity. Angiography, computed tomography, and magnetic resonance imaging clearly showed a dissection flap starting from the thoracic aorta distal to the left subclavian artery. Compressed true lumen by the markedly enlarged tense false lumen was also noted in the double-channeled descending thoracoabdominal aorta. Under intravascular ultrasound guidance, the intimal flap was punctured with a Brockenbrough needle advanced to the true lumen through a femoral artery, and then, a balloon catheter was introduced over the guidewire which was placed across the dissection flap. Desired fenestration was obtained successfully by inflation of the balloon without complications. After procedure, symptoms resolved promptly and she is currently(clinical follow-up of 12 months postfenestration) ambulating without claudication. In conclusion, percutaneous fenestration of the intimal flap is a technically feasible and an effective alternative procedure to surgical repair for restoration of perfusion to an ischemic extremity in selected patients complicated with aortic dissection.
Angiography ; Aorta ; Aorta, Thoracic ; Catheters ; Extremities* ; Female ; Femoral Artery ; Follow-Up Studies ; Humans ; Hypesthesia ; Inflation, Economic ; Ischemia* ; Lower Extremity ; Magnetic Resonance Imaging ; Membranes ; Middle Aged ; Needles ; Perfusion ; Subclavian Artery ; Transcutaneous Electric Nerve Stimulation ; Ultrasonography

Adult ; Animals ; Dogs ; Electric Stimulation ; Humans ; Latency Period (Psychology) ; Osteogenesis ; Osteogenesis, Distraction ; Osteopontin ; Osteotomy

Stress cardiomyopathy (SCMP) is characterized by a transient left ventricular dysfunction associated with apical ballooning and compensatory hyperkinesias of the basal segments after emotional or physical stress, but inverted or mid-ventricular variants of SCMP have also been described. Although catecholamine excess has been suggested as a possible pathophysiologic mechanism of SCMP, the etiology of SCMP is still unknown. Here, we report a case of inverted type of SCMP with clinical presentation mimicking acute coronary syndromes. The cause or precipitating stressor was unclear initially, but pheochromocytoma has been demonstrated as a cause of SCMP during clinical follow-up at out-patient clinic in the present case. Catecholamine-producing tumors should be included in the evaluation or management of SCMP, even though initial clinical manifestations are not suggestive for pheochromocytoma.
Acute Coronary Syndrome ; Cardiomyopathies ; Follow-Up Studies ; Humans ; Hyperkinesis ; Outpatients ; Pheochromocytoma* ; Takotsubo Cardiomyopathy* ; Ventricular Dysfunction, Left

OBJECTIVE: The presence of Y Chromosome in patients with gonadal dysgenesis is related to the risk of gonadoblastoma. Since the patients with abnormal sexual differentiation may have cryptic Y mosaicism, it is important to detect the presence of Y material in these patients. But sometimes it is difficult to detect Y material only with karyotyping. This study was performed to evaluate the usefulness of the SRY gene screening in blood and gonad by using PCR in detecting the presence of Y material and possible tissue mosaicism in patients with gonadal dysgenesis as Tumer syndrome and 46, XY pure gonadal dysgenesis (PGD, Swyer syndrome). METHOD: In 26 patients with gonadal dysgenesis, we screened for Y material by using PCR for SRY gene in peripheral leukocytes and in gonadal tissues of some patients. They were 22 cases of Tumer syndrome (7 45,XO, 2 46,Xi(Xq), 3 45,XO/46,XX, 5 45,XO/46Xi(Xq), 1 45,XO/46,XY, 1 45,XO/46,Xi(Yq), 1 45,XO/47,XYY, 1 46,XX,del(X)(q24) and 1 46,X,+mar) and 4 cases of 46,XY pure gonadal dysgenesis. PCR for SRY gene in the gonadal tissue was performed in 5 Turner syndrome and 2 PGD to determine the cryptic Y mosaicism between blood and gonad. RESULTS: By using PCR analysis for SRY, Y chromosome material was detected in the blood of 4 of 22 Turner syndrome patients (45,XO/46,Xi(Xq), 45,XO/46,Xi(Yq), 45,XO/46,XY, and 45,XO/47,XYY), 3 of 4 46,XY pure gonadal dysgenesis. Discrepancy between karyotyping and blood PCR for SRY was noted in 1 Turner syndrome (45,XO/46,Xi(Xq)) and 1 PGD. Laparoscopic gonadectomy was performed in Y containing or SRY positive cases. In addition, PCR analysis for SRY in the gonads of 5 Turner syndrome and 2 PGD showed discrepancy between blood and gonad or between both gonads in 3 Turner syndrome (45,XO/46,Xi(Xq), 45,XO/46,Xi(Yq), 45,XO/46,XY) and 2 PGD patients. CONCLUSION: In gonadal dysgenesis, PCR analysis for SRY gene is useful to detect the cryptic Y mosaicism that is sometimes undetected by karyotyping. And since there may be tissue mosaicism, it is necessary to evaluate Y mosaicism in various tissues even in the case without Y chromosome on karyotyping.
Genes, sry ; Gonadal Dysgenesis* ; Gonadal Dysgenesis, 46,XY ; Gonadoblastoma ; Gonads* ; Humans ; Karyotyping ; Leukocytes ; Mass Screening ; Mosaicism* ; Polymerase Chain Reaction ; Prostaglandins D ; Sex Differentiation ; Turner Syndrome ; Y Chromosome

BACKGROUND: We studied the association of sagittal abdominal diameter (SAD) and metabolic syndrome and insulin resistance in Korean adults. METHODS: This is a cross-sectional study by 190 patients who visited a Health Promotion Center of National University of Pusan from 11 November to 14 November, 2008. We analyzed the association of anthropometry (waist circumference, BMI, SAD), insulin resistance (homeostatic model assessment-insulin resistance, HOMA-IR), insulin sensitivity (quantitative insulin sensitivity check index, QUICKI), and plasma concentrations of glucose, insulin, total cholesterol, LDL, HDL, triglyceride. SAD was categorized into quartiles and assessed odds ratio of metabolic syndrome adjusted for age, sex, lifestyle factors. RESULTS: SAD showed significance correlation to HOMA-IR than BMI. Quartiles of SAD showed a positive trend with metabolic risk factors including abdominal obesity, high blood pressure, HOMA-IR and obesity but hypertriglyceridemia, low HDL-cholesterolemia did not show significant association. In men QUICKI was significantly high. A multivariate model, adjusted for age, sex, smoking status, physical activity, heavy drinking, HOMA-IR and QUICKI, revealed a progressively increased odds ratio of metabolic syndrome, 3rd quartile (odds ratio [OR]; 9.467; 95% confidence interval [CI], 3.225 to 27.789; P < 0.001) and 4th quartile (OR, 7.253; 95% CI, 2.437 to 21.586; P < 0.001), with increasing SAD. CONCLUSION: As shown above, SAD was a strong anthropometric marker of insulin resistance, risk of metabolic syndrome and decreased insulin sensitivity in Korean adults.
Adult ; Anthropometry ; Cholesterol, LDL ; Cross-Sectional Studies ; Drinking ; Glucose ; Health Promotion ; Humans ; Hypertension ; Hypertriglyceridemia ; Insulin ; Insulin Resistance ; Life Style ; Male ; Motor Activity ; Obesity ; Obesity, Abdominal ; Odds Ratio ; Plasma ; Risk Factors ; Smoke ; Smoking