PURPOSE: Kawasaki disease is notorious for coronary arterial complication which is usually developed as a febrile disease in early childhood. Increased polymorphonucleus(PMN) cell levels in acute phases may be associated with the pathophysiology of Kawasaki disease. We studied the relationship between coronary arterial dilatation and elastase activity which was excreted from PMN cell and roles as an important factor for vasculitis. METHODS: Ten patients diagnosed with Kawasaki disease in Yonsei University Medical Center were examined between November, 2001 and January, 2002. In addition, 15 patients with other febrile diseases were also examined. Echocardiography was done in patients with Kawasaki disease on the first day of admission and four weeks after the onset of the disease. At each time, venous samples were drawn and separated into plasma and leukocytes. In patients with other febrile disease, samples were drawn on admission. Elastase activities in plasma and neutrophil extracts were measured. RESULTS: The significant increased plasma elastase activity, 6.19+/-0.74 U/mL, found in Kawasaki disease patients compared with the other febrile disease patients, 4.86+/-1.17 U/mL(P<0.05). And there was no significance between the above two diseases in terms of the elastase activity in neutrophil extracts. The relationship between initial elastase activity and the coronary arterial complication which was shown in subacute phase wasn't significant. CONCLUSION: Plasma elastase activity was increased in Kawasaki disease significantly, but the initial plasma elastase activity in the acute phase could not reflect the range of coronary arterial complication.
Academic Medical Centers ; Dilatation* ; Echocardiography ; Humans* ; Leukocyte Elastase* ; Leukocytes ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils* ; Pancreatic Elastase ; Plasma ; Vasculitis

A total of 37 randomized patients with left sided varicocele were investigated for the past 5 years to evaluate the effects of varicocelectomy on semen quality and fecundity. They were 14% of infertile males who hospitalized for surgical treatment except vasectomy reversal cases. According to severity of varicocele, patients were divided into three grades such as Grade I (Valsalva positive, consisted of 8 cases). Grade II (palpable, consisted of 18 cases) and Grade III (visible, consisted of 11 cases). Their, mean age was 29 years(20-40 years) (Table 1), and duration of marital life, 3 years(1-15 years). Mean levels of plasma FSH(6. 39 IU/l), LH(6. 25 IU/I) and testosterone (6. 97 ng/ml) were within normal ranges. There were no significant differences in hormonal levels among the grades of varicocele (Table 2), Oligospermias and normospermias were distributed in these grades of varicoceles almost the same extent. This means that the size or grade of varicocele was not closely correlated with degree of spermatogenic failure. Spermiogram of total patients was as follows: mean volume. 2. 9 ml; motility, 34%; normal shape, 68%; and azoospermia in 3 cases; counts of less than 20 X 10`/ml in 21 cases; and more than 20 x 10 6/ml in 13 cases with mean count of 26 x 10 6/ml(Tables 3 and 4). Of these, 6 subjects with sperm counts of more than 41 x10 6/ml were submitted to control series without surgery and the remaining 31 patients with sperm counts of less than 40 x 10 6/ml underwent varicocelectomy by high ligation of internal spermatic vein. After the operation, sperm appeared in 1 of the 3 azoospermia. Numbers of patients with sperm counts of less than 20 x 10 6/ml decreased from 21 to 19 cases, and those with more than 21 x 10 6/ml increased from 7 to 10 cases following the surgery. No significant changes in volume, motility and morphology could be demonstrated after varicocelectomy(Tables 5. 6 and 7). When judging by tentative criteria of fertility unit (total sperm counts( 10 6) x motility(%) x morphology(%) / 10 6) of more than 1 unit, improvement was observed in only 9 patients(29%) after the operation(Table 5). Three conceptions (10%) occurred in those submitted to varicocelectomy in 1 to 36 months after the operation and 1 pregnancy(17%) resulted in control series. In the present series of patients with varicocele, no significant beneficial effects were observed on semen quality and pregnancy rate after varicocelectomy(Tables 5 and 6).
Azoospermia ; Fertility ; Fertilization ; Humans ; Ligation ; Male ; Oligospermia ; Plasma ; Pregnancy Rate ; Reference Values ; Semen Analysis ; Sperm Count ; Spermatogenesis* ; Spermatozoa ; Testosterone ; Varicocele ; Vasovasostomy ; Veins

BACKGROUND: The purpose of our study was to evaluate the functional and radiologic outcomes of additive augmentation sutures through rotator cuff for proximal humeral fractures stabilized locking plate in elderly patients. METHODS: We enrolled 74 patients over the age of 60 years who received internal fixation using locking plates for proximal humeral fractures. Of these, 50 patients had additive augmentation sutures through rotator cuff. The mean age at the time of surgery was 72.1 years (range, 60-89 years), and the mean follow-up period was 17.5 months (range, 12-62 months). The humeral neck-shaft angle and humeral head height were used as radiological markers to assess the effect of additive augmentation sutures through rotator cuff. We allocated the patients who received additive augmentation sutures into group A and those who did not into group B. RESULTS: At the final follow-up, the mean Korean Showlder Society score and Constant scores were 88.96 +/- 12.1 and 86.6 +/- 11.9, respectively, in group A and 86.21 +/- 11.8 and 85.3 +/- 11.7, respectively, in group B (p=0.368, 0.271). At the final follow-up, the mean loss in humeral neck-shaft angle from the time of immediate postoperative measurement was 1.6degrees in group A and 4.8degrees in group B, whereas the mean loss in humeral head height was 0.82 mm in group A and 0.52 mm in group B (p=0.029, 0.178). CONCLUSIONS: The surgical outcomes of internal fixation using locking plates for proximal humeral fractures were clinically and radiologically good in elderly patients over the age of 60 years without any observable complications. Further, the loss of humeral head shaft angle at the final follow-up from its initial postoperative measurement was significantly smaller in patients who received an additive augmentation suture than in those who did not. Thus, we conclude that augmentation sutures are a beneficial option for elderly patients that clinicians can consider at the time of surgical decision making.
Aged* ; Decision Making ; Follow-Up Studies ; Humans ; Humeral Head ; Rotator Cuff ; Shoulder Fractures* ; Sutures*

Klinefelter's syndrome was described in 1942 as a syndrome of hypogonadal men with small testes, gynecomastia and elevated urinary gonadotropin by Klinefelter et al. for the first time. As the pathogenesis has become better understood the original description has been expanded to include additional features. The presence of supernumerary X chromosome is considered to be the fundamental underlying etiological factor. The clinical triad of the Klinefelter`s syndrome are sterility, male phenotype, and small firm testes. Clinical observation and plasma testosterone, FSH(follicle stimulating hormone), LH(luteinizing hormones measurement were made on the 11 Klinefelter`s syndromes in the Department of Urology, Seoul National University Hospital as follows: 1. The age distribution was from l9 years old to 33 years old and the average span was 28 years old. 2. A11 of the patients had small and firm testes, and showed decreased pubic hair and sparse body hair. Gynecomastia occurred in 5 patients(48%). 3. The average height was 169.3cm and average span was 170. 1 cm and average lower leg length 96.3 cm 4. The chromosomal study showed 47 XXY in the all patients and sex chromatin was positive in the all patients. 5. All of the patients was azoospermia on the semen analysis. 6. Histological structures of the testes were hyalinization with fibrosis of the seminiferous tubule and psuedoadenomatous clumping of the Leydig cell. 7. The average level of plasma testosterone, FSH, LH were 184 ng/d1(range 80-349 ng/d1) 35.25 mI U/ml(range 27-43.3mI U/ml), 14.5mI U/ml(range 7.6-26.52mI U/ ml). 8. Treatment of the patients was hormonal therapy with testosterone.
Adult ; Age Distribution ; Azoospermia ; Fibrosis ; Gonadotropins ; Gynecomastia ; Hair ; Humans ; Hyalin ; Infertility, Male ; Klinefelter Syndrome* ; Leg ; Male ; Phenotype ; Plasma ; Semen Analysis ; Seminiferous Tubules ; Seoul ; Sex Chromatin ; Testis ; Testosterone ; Urology ; X Chromosome

BACKGROUND: A novel technique for the repair of tears of the upper subscapularis tendon—intraarticular knotless fixation—has been introduced recently. The purpose of this study was to evaluate the clinical and structural outcomes of arthroscopic intraarticular knotless fixation for the treatment of upper subscapularis tendon tears. METHODS: We retrospectively analyzed the clinical and radiological outcomes of 27 patients who underwent arthroscopic intraarticular knotless fixation for upper subscapularis tendon tears. Finally, a total of 10 patients who could participate in at least a 6 month follow-up of magnetic resonance imaging evaluation and in a least 1-year follow-up on an outpatient basis were enrolled in our study. The mean age at the time of operation was 60.7 years, and the mean duration of follow-up was 14.7 months. Two patients had concomitant tears of the supraspinatus tendon and 8 patients had concomitant tears of the supraspinatus and the infraspinatus tendons. RESULTS: The clinical and radiological outcomes improved after the patients had undertaken arthroscopic intraarticular knotless fixation. The mean visual analogue scale score for pain during motion improved from 6.7 preoperatively to 1.4 at the final follow-up (p<0.001). The mean Constant score improved from 59.3 preoperatively to 79.6 at the final follow-up, and the mean the University of California at Los Angeles score, from 21.7 to 30.2, respectively (p<0.001 and p<0.001). The upper subscapularis tendon tear was healed in every patient except one (90%), for the patient had suffered from a postoperative trauma that resulted in a retear. CONCLUSIONS: We found that arthroscopic intraarticular knotless fixation gives good clinical and structural outcomes for the repair of upper subscapularis tendon tears. Arthroscopic intraarticular knotless fixation provided such a reliable and efficient restoration of the subscapularis tendon footprint that we anticipate it will become a widely-used procedure for upper subscapularis tendon tears.
Arthroscopy ; California ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Outpatients ; Retrospective Studies ; Shoulder ; Tears* ; Tendons* ; Treatment Outcome

BACKGROUND: Management of massive rotator cuff tears can be challenging because of the less satisfactory results and a higher retear rate regardless of the use of open or arthroscopic repair technique. METHODS: We retrospectively analyzed 102 cases of massive rotator cuff tear treated with either open or arthroscopic repair. Open repair was performed in 38 patients; and arthroscopic repair, in 64 patients. The mean age at the time of surgery was 59.7 years in the open group and 57.6 years in the arthroscopic group. RESULTS: The Constant score increased from the preoperative mean of 55.9 to 73.2 at the last follow-up in the open repair group and from 53.8 to 67.6 in the arthroscopic repair group (p<0.001 and <0.001, respectively). The University of California at Los Angeles (UCLA) score increased from a preoperative mean of 17.7 to 30.8 at the last follow-up in the open group and from 17.5 to 28.7 in the arthroscopic group (p<0.001 and <0.001, respectively). No statistically significant difference in the Constant and UCLA scores was observed between the two groups at the last follow-up (p=0.128 and 0.087, respectively). Retear was found in 14 patients (36.8%) in the open group and 39 patients (60.9%) in the arthroscopic group (p=0.024). CONCLUSIONS: Open and arthroscopic repairs of massive rotator cuff tears may provide satisfactory clinical results with no significant difference. However, a significantly lower retear rate was observed for the open repair group compared with the arthroscopic repair group.
Arthroscopy ; California ; Follow-Up Studies ; Humans ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Tears* ; Tendon Injuries

We reported a case of atypical thymic carcinoid tumor with ectopic ACTH syndrome which was proved by the presence of intracytoplasmic ACTH in the tumor cells using PAP method and electron microscopy. The patient was a 43-year-old housewife who was referred with Cushing's syndrome of unknown origin, and subsequantly followed by many disabling symptoms including, diabetes mellitus and electrolyte imbalance for which bilateral adrenalectomy was carried out. Thereafter, rapid rise in serum ACTH level and hyperpigmentation were followed. Pituitary irradiation was done under the impression of Nelson's syndrome despite of lacking evidence of pituitary tumor, but high serum ACTH persisted. Seven months after pituitary irradiation, two anterior mediastinal masses were first noticed and removed. Immunohistochemical and ultrastructural studies confirmed this neoplasm as a ACTH producing spindle cell variant of atypical thymic carcinoid tumor. When dealing with a patient who developed Nelson's syndrome-like phenomenon without apparent pituitary tumor, the possibility of ectopic ACTH syndrome caused by thymic carcinoid should be considered.

No abstract available.
Noise* ; Organ of Corti*

BACKGROUND: Atracurium is a benzylisoquinolium nondepolarizing neuromuscular blocking drug. It releases histamine upon the rapid administration of more than 2 x ED95. Cisatracurium is about three to four times more potent than atracurium, less likely to release histamine, and has weaker cardiovascular or autonomic effects. Mivacurium releases histamine to about the same degree as atracurium at the same dose. This study was undertaken to reevaluate the experimental model for the evaluation of effects on the autonomic nervous system, and to determine the neuromuscular blocking profiles and the vagolytic effects of atracurium, cisatracurium and mivacurium in cats. METHODS: Cats, either sex, anesthetized with pentobarbital, were used. Neuromuscular blocking effects were assessed using the effects on the anterior tibialis muscle twitch evoked with supramaximal stimuli (0.2 ms-duration, 0.1 Hz). Inhibition of the parasympathetic nervous system was assessed in response to bradycardia to vagal nerve stimulation with ten-second trains of square-waves (0.5 ms-duration, 20 Hz). The dose-response curves for both neuromuscular blocking and vagolytic actions were determined for each animal. The dose-response curves were constructed in cumulative fashion. The response for vagal stimuli was measured two minute after each dosing. Vagal ID50 (The doses that produced 50% inhibition of the response to vagus nerve stimulation) were determined. RESULTS: NMB ED95 and NMB ED50, respectively, were 102.0 +/- 28.3 and 143.7 +/- 40.5 microgram/kg for atracurium, 81.4 +/- 13.3 and 110.7 +/- 18.8 microgram/kg for cisatracurium, and 56.8 +/- 17.4 and 74.2 +/- 25.0 microgram/kg for mivacurium. Vagal ID50 was 2,654 +/- 1,651 microgram/kg for atracurium, 655 +/- 389 microgram/kg for cisatracurium, and 606 +/- 182 microgram/kg for mivacurium. The vagal ID50/NMB ED95 and vagal ID50/NMB ED50 were 18.5 and 26.0 for atracurium, 5.9 and 8.1 for cisatracurium, and 8.2 and 10.7 for mivacurium. CONCLUSIONS: Atracurium has a wider margin of safety only for vagal stimulation as compared with cisatracurium and mivacurium. However, we couldn't exclude that either sympathetic stimulation or histamine release might contribute to heart rate.
Animals ; Atracurium* ; Autonomic Agents ; Autonomic Nervous System ; Bradycardia ; Cats* ; Heart Rate ; Histamine ; Histamine Release ; Models, Theoretical ; Neuromuscular Blockade* ; Parasympathetic Nervous System ; Pentobarbital ; Vagus Nerve ; Vagus Nerve Stimulation

BACKGROUND: Community-acquired pneumonia (CAP) is a common respiratory disorder in children, which necessitates hospitalization. Bacterial pneumonia, especially lobar pneumonia and parapneumonic effusions, is associated with considerably severe clinical course and extensive alveolar infiltrates. Serum procalcitonin (PCT) level has been used to distinguish bacterial from viral infections, but its usefulness is disputed. The diagnostic accuracy and usefulness of PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count were determined by comparing their values in the patients with CAP with those in healthy controls. METHODS: The serum PCT levels, as well as CRP level, ESR, and WBC counts, were measured in 76 hospitalized patients with CAP (lobar pneumonia, 16; bronchopneumonia, 60) and 18 healthy controls. Serum PCT level was measured using VIDAS(R) BRAHMS PCT (Biomerieux, France), and ROC curve analysis was performed to evaluate its diagnostic accuracy. RESULTS: Serum PCT levels were higher in the patients with CAP than in healthy controls, especially in the patients with lobar pneumonia than in those with bronchopneumonia. Serum CRP level was also significantly elevated in the patients with CAP, especially in those with lobar pneumonia. The diagnostic accuracy of serum PCT level for the diagnosis of lobar pneumonia was better than those of serum CRP level and ESR. The serum PCT level was significantly correlated with the CRP level, ESR, and WBC count. CONCLUSIONS: Serum PCT level was a better marker than CRP level or ESR for the diagnosis of lobar pneumonia in children with CAP.
Adolescent ; Biological Markers/blood ; Blood Sedimentation ; Bronchopneumonia/complications ; C-Reactive Protein/analysis ; Calcitonin/*blood ; Child ; Child, Preschool ; Community-Acquired Infections/complications/*diagnosis ; Female ; Humans ; Infant ; Infant, Newborn ; Leukocyte Count ; Male ; Pneumonia/complications/*diagnosis ; Protein Precursors/*blood ; ROC Curve