Discrete subaortic stenos is one of the subtype of congenital left ventricular outflow obstruction and frequently associated with other defect such as ventricular septal defect, coarctation of the aorta, inturrupted aortic arch, double-chambered right ventricle and atrioventricular canal. It is progressive disease from the neonatal period and can be a cause of secondary endocarditis or aortic regurgitation. The authors have experienced a case of discrete subaortic stenosis without other associated lesions in 8 years old male patient who has complained chest discomfort. The diagnosis was established by the findings of echocardiography and cardiac catheterization. We report this case with a brief review of related literatures.
Aorta, Thoracic ; Aortic Coarctation ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Child ; Diagnosis ; Discrete Subaortic Stenosis* ; Echocardiography ; Endocarditis ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Male ; Thorax ; Ventricular Outflow Obstruction

PURPOSE: The chest radiograph is useful and reliable in assessing the severity and progression of neonatal respiratory distress syndrome. To evaluate the effect of exogenous surfactant r eplacement therapy, we performed sequential observation of chest radiogratphic findings in neonates with respiratory distress syndrome. METHODS: Two groups of infant with RDS in mechanical ventilation therapy were studied. Surfactant(S-Tx) group(n=36) was treated with Surfactant-TA and control group(n=19) was without use of surfactant. Observation of gestational age, birth weight, clinical severity by ventilatory index, sequential change of radiographic findings and radiological complications in RDS patients were performed. RESULTS: In RDS patients, there was correlation in the radiologic grading and clinical severity. In surfactant treated infants, change of chest radiographic finding was significantly improved than control group. Incidence of pneumothorax and or pulmonary interstial emphysema in S-Tx group was less than that of control group. CONCLUSIONS: Exogenous pulmonary surfactant replacement therapy may contribute the improvement of the clinical and radiological severity and reduction of the incidence of clinical complications. We suggest that surfactant replacement therapy is effective and important useful therapeutic method in neonates with respiratory distress syndrome.
Birth Weight ; Emphysema ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn* ; Pneumothorax ; Pulmonary Surfactants ; Radiography, Thoracic* ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn ; Thorax*

We report a rare case of the idiopathic membranous glomerulonephritis (IMGN) in association with the thin glomerular basement membrane nephropathy (TGBMN) in a 63-year-old female with hematuria. This is the first case reported in Korea. In renal biopsy of this case, direct immunofluorescence demonstrated anti-IgG Ab along the glomerular capillary wall with granular pattern. The basement membrane was thin, about 170-220 nm and small epimembranous electron dense deposits were observed by electron microscopy. As this case, the combination of TGBMN and IMGN is very uncommon because the IMGN is characterized morphologically by diffuse global thickening of the glomerular capillary wall, while the TGBMN is defined as an extreme thinning of the glomerular basement membrane, less than 200 nm. Our case showed no renal function deterioration and benign prognosis as other reports showed.
Basement Membrane ; Biopsy ; Capillaries ; Female ; Fluorescent Antibody Technique, Direct ; Glomerular Basement Membrane* ; Glomerulonephritis, Membranous* ; Hematuria ; Humans ; Korea ; Microscopy, Electron ; Middle Aged ; Prognosis

OBJECTIVE: Our purpose was to assess the efficacy of routine ultrasonographic prediction of macrosomic fetal weight, to determine its influences on subsequent delivery type and to assess perinatal outcome by delivery type. METHODS: The hospital records of 177 patients delivered infants weighing > or =4000gm between January 1997 and December 1998 were reviewed. Statistical comparisons were made between patients in whom fetal macrosomia was predicted before delivery(n=71) and those in whom it was not(n=106) and between the perinatal outcomes for macrosomic fetuses delivered vaginally and by cesarean section. The statistical analysis was performed by student-t test, and Chi-square test and Fisher's exact test. RESULTS: The fetuses were consecutive singleton fetuses in vertex presentation delivered at a single institute. The sensitivity for identifying macrosomic fetus(birth weight >4000gm) with an estimated weight of > or =4000gm was 40%, Overall 60% of the infants had birth weights within 10% of the ultrasonographic estimates and 29% had birth weights within 5% of the ultrasonographic estimates. Cesarean sections were performed in 69% of the 'predicted' group and in 35% of the 'not predicted' group(69% vs 35%, p<0.0001, Fisher's exact test). Predicated group were more likely to be performed by elective cesarean section(48% vs 19%, p<0.0001, Fisher's exact test) and more like due to failed progress at<4cm cervical dilatation(27% vs 7%, p<0.05, Fisher's exact test). The proportion of patients delivered by cesarean section for failed progress at > or =4cm cervical dilatation was similar in the predicted and not predicted groups(19% vs 12%, NS). There was no significant difference in the incidences of the occurrence of birth trauma. CONCLUSION: There appears to be a limitation to obtain estimation of fetal weight by ultrasonography. The antenatal prediction of fetal macrosomia is associated with a marked increase in cesarean deliveries without a significant reduction in the incidence of fetal injury
Birth Weight ; Cesarean Section ; Female ; Fetal Macrosomia ; Fetal Weight* ; Fetus ; Hospital Records ; Humans ; Incidence ; Infant ; Labor Stage, First ; Parturition ; Pregnancy ; Ultrasonography*

OBJECTIVE: Our purpose was to evaluate the effect of epidural anesthesia on labor course. METHODS: Between January 1998 and December 1998, we evaluated pregnant women at term with singleton fetus in vertex presentation and with spontaneous onset of labor at our hospital. Comparison of 120 women (100 cases of primiparous women, 20 cases of multiparous women) who received epidural anesthesia in labor with 120 women (100 cases of primiparous women, 20 cases of multiparous women) who did not receive epidural anesthesia was performed. Adverse pregnancy outcomes were obtained from hospital delivery records and neonatal records. Statistical analysis were performed by Student's t-test and Chi square test. RESULTS: The results of this study were as followings; 1. There was no significant difference in mean age, body weight, height, and gestational age between epidural anesthesia group and control group (P>0.05). 2. The frequency of oxytocin augmentation was significantly greater in the primiparous epidural anesthetic group than in primiparous control group (p<0.05). 3. The effect of epidural anesthesia on the first stage of labor revealed no significant difference in both group. 4. Prolongation of second stage of labor was noticed in nullipara of epidural anesthesia group compared to control group (p<0.05). 5. The incidence of instrumental delivery was significantly increased in the primiparous epidural group than in the primiparous control group(p<0.05). 6. The meconium-stained amnionic fluid, Apgar score and birth weight were similar in both groups. 7. The maternal blood loss was similar in both groups. CONCLUSION: Epidural anesthesia, significantly prolongs second stage of labor in induced patients. While instrumental delivery was more prevalent in these parturients, C-section rate and intra-partum complications were not increased in these patients.
Amnion ; Anesthesia, Epidural* ; Apgar Score ; Birth Weight ; Body Weight ; Female ; Fetus ; Gestational Age ; Humans ; Incidence ; Oxytocin ; Pregnancy ; Pregnancy Outcome ; Pregnant Women

PURPOSE: This study was performed to compare the postoperative maximal flexion angle (MFA) of standard PCL-substituting (PS) prosthesis with that of high-flexion PS prosthesis after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 81 patients (133 knees) were enrolled in this study. Sixty-eight primary bilateral TKAs were performed in 34 consecutive patients. The bilateral TKAs were performed in a staged sequential manner, with a standard PS prosthesis in one knee and a high-flexion PS prosthesis in the contralateral knee. We also analyzed the results of another 47 patients as several control groups, and this consisted of standard or high-flexion PS total knee prostheses in the bilateral TKAs, and standard or high-flexion PS total knee prostheses in the unilateral TKAs. The patients were clinically assessed with the Knee Society scoring system and the MFA was measured with a goniometer. RESULTS: At the last follow up, the mean postoperative MFA of the 34 patients operated with the combination of different prostheses was 131.6+/-10.4degrees for high-flexion prosthesis side and 131.6+/-9.5degrees for standard prosthesis side respectively. There was no statistically significant difference. On comparing with the results of the 47 patients in the control group, no statistically significant difference in the mean postoperative MFA was found between the groups. CONCLUSION: We found no significant differences between the high-flexion PS prosthesis and the standard PS prosthesis in the postoperative MFA.
Arthroplasty ; Follow-Up Studies ; Humans ; Knee ; Knee Prosthesis ; Prostheses and Implants

PURPOSE: This study examined the wear pattern of the articular cartilage of the medial tibial plateau with or without a functional ACL in patients with degenerative osteoarthritis of the knee. MATERIALS AND METHODS: Between July 2003 and May 2004, 71 cases (52 patients) of total knee arthroplasty due to degenerative osteoarthritis of the knee were enrolled in this study. The intraoperative evaluations such as a test for the functional status of the ACL and the wear pattern of medial tibial plateau were performed, and the associations with the physical examinations such as, range of motion (ROM), Lachman test and pivot shift test, and tibio-femoral angle (TFA), were analyzed. RESULTS: There were 43 cases with a functional ACL, and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 8 cases (18.6%), central in 30 cases (69.8%), and central and posteromedial in 5 cases (11.6%). There were 28 cases with a non- functional ACL and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 1 case (3.6%), central in 2 cases (7.2%), and central and posteromedial in 25 cases (89.2%). In the group with the non-functional ACL, the most prevalent wear pattern was central and posteromedial (p<0.001). CONCLUSION: In patients with degenerative osteoarthritis of the knee without a functional ACL, the wear pattern of the articular cartilage of the medial tibial plateau was more posteromedially than patients with a functional ACL.
Arthroplasty ; Cartilage, Articular* ; Humans ; Knee* ; Osteoarthritis* ; Physical Examination ; Range of Motion, Articular

A case of vaginal and cervical adenocarcinoma, mostly of clear cell type, in young women have been associated with intrauterine exposure to diethystillbestrol(DES) or other nonsteroidal estrogenic substances and vaginal adenosis. We have encountered a case of clear-cell adenocarcinoma of the cervix uteri of 27years young house wife, in which there was a history of intrauterine exposure to DES. We presented a case with a brief review of related literature.
Adenocarcinoma ; Adenocarcinoma, Clear Cell* ; Cervix Uteri* ; Estrogens ; Female ; Humans ; Spouses

BACKGROUNDS/AIMS: Traumatic pancreatic injury is rare and various surgical procedures can be applied according to the severity of injury. We reviewed our experience of pancreatic injury and investigated the clinical outcome. METHODS: Fifty-six patients were treated conservatively or with surgery for pancreatic injury at the Department of Surgery, Korea University Medical Center of Korea University College of Medicine from January 2001 to February 2012. RESULTS: Forty-one men and 15 women were included (mean age, 32 years; range, 5-66 years). Twelve patients were hypotensive at admission. According to the American Association for the Surgery of Trauma grade, 15 patients were grade I, 16 were grade II, 10 were grade III, 13 were grade IV, and one patient was grade V. A total of 41 patients underwent exploratory surgery. Complications developed in 35 patients, and 19 patients demonstrated intra-abdominal abscesses associated with pancreatic leakage. Four mortalities occurred. More adult patients (n=42) required intensive care than that of pediatric patients (n=14) (p=0.03). However, more pediatric patients had hyperamylasemia at admission (p=0.023). A significantly higher proportion of patients in the hypotensive group had blunt abdominal injuries, associated extra-abdominal injuries, combined intra-abdominal injuries, longer ICU stays, and a higher mortality rate. CONCLUSIONS: Associated intra-abdominal and extra-abdominal injuries are frequent in patients with traumatic pancreatic injury. Despite the complication rate, most patients recovered. Mortalities were associated with combined injuries being placed into bleeding, hypovolemic shock, and multiorgan failure.
Abdominal Abscess ; Abdominal Injuries ; Academic Medical Centers ; Adult ; Female ; Hemorrhage ; Humans ; Hyperamylasemia ; Critical Care ; Korea ; Male ; Pancreatic Fistula ; Shock

PURPOSE: The aim of this study was to determine the anatomic proximal tibial posterior slope angle by measuring the true posterior slope angle of the proximal tibia and the meniscal slope angle by MRI. MATERIALS AND METHODS: We measures 102 meniscal and tibial plateau slope angles, including 39 medial and 63 lateral sides. The average age of the patients was 33.3 years (8-66). We measured the meniscal slope angle form MRIs of the patients, with confirmed no pathologic abnormality of the meniscus by arthroscopy. We traced the line between the upper margins of the anterior and posterior horn of the medial and lateral menisci, and the proximal tibial plateau line. The angle between the two lines was considered as the meniscal slope angle. RESULTS: The medial meniscal slope angle between the medial meniscal slope and the medial tibial bony slope averaged 6.2 degrees (2.5-9) and 5.3 degrees (1-15) in the lateral, side, an overall average angle of 5.8 degrees. CONCLUSION: This results suggests that the proximal tibial meniscal slope is less oblique than the usually measured bony slope at about 5.8 degrees. The authors suggest the proximal tibial cutting slope with 5.8 degrees less posterior tilt than bony slope angle.
Animals ; Arthroscopy ; Horns ; Humans ; Knee ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Tibia*