Grice extra-articular subtalar arthrodesis has been performed as either a temporizing or a definite procedure in young children to correct the dynamic hindfoot valgus deformity without affecting subsequent growth of the foot. Fifty eight extra-articular subtalar arthrodesis in thirty patients, performed at Seoul National University Children's Hospital from setpember 1985 to June 1989, were retrospectively reviewed to evaluate the clinical and radiographic results. There were 52 valgus feet in 26 patients and 6 varus feet in 4 patients secondary to cerebral palsy, meningomyelocele, congenital snomalies, and other neuromuscular diseases. In many instances, additional tendon surgeries were also required to correct deformities or achieve the muscle balance. The review consisted of personal interview, physical examination, and radiological assessment. On physical examination, preoperative hindfoot valgus deformty(mean: 14.3°clinically) was well corrected, postoperative hindfoot valgus ranging from neutral to valgus 5°clinically in 35 of 52 cases(67.3%). Correction of the lateral talocalcaneal angle on standing lateral radiographic view averaged 8.5 degrees(from 57.3 degrees preoperatively to 37.6 degrees postoperatively). In valgus feet, there were 3 cases with mild pain around the ankle joint. There were 5 cases of graft resorption and 2 cases of nonunion. Graft failure was more frequent when the proximal end of the graft was directed anterior to the weight bearing axis. With original Grice subtalar arthrodesis, satisfactory results were obtained in 34 of 52(65.4%) hindfoot valgus feet. In 6 varus feet, there were 1 undercorrection and 2 recurrence of varus deformity. We re-emphasize the importance of strict operative technique to obtain satisfactory results. We also believe that Grice procedure may be used for the correction of subtalar instability in selected cases of varus foot before muscle baancing procedures.
Ankle Joint ; Arthrodesis ; Cerebral Palsy ; Child ; Congenital Abnormalities ; Foot ; Humans ; Meningomyelocele ; Neuromuscular Diseases ; Physical Examination ; Recurrence ; Retrospective Studies ; Seoul ; Tendons ; Transplants ; Weight-Bearing

Two rare cases of human infection with parvum (dwarf) type of Diphyllobothrium latum [syn. D parvum (Stephens,1908)], were discovered in Korea. The first case was a 46-year old houseife, from whom a kind of pseudophyllidean tapeworm eggs was detected in the feces. She was treated with praziquantel and purged, and a complete strobila with scolex, 120 cm in total length, was recovered. She recalled that she had eaten raw trouts at a raw-fish restaurant near the Chungju Lake. Another patient was a 22-year old medical student (male), who used to eat raw sea-foods. He discovered a chain of tapeworm proglottids, 15 cm in length, discharged spontaneously in his stool and brought it for identification. The worms from the two cases were compatible with D. parvum (Stephens, 1908) of which the taxonomic significance has long been questioned. After a detailed morphological study and review of literature, we designated the worms as D. latum parvum type. This is the first report on the occurrence of this rare type of D. latum infection in Korea.
parasitology-helminth-cestoda ; Diphyllobothrium latum parvum type ; sea-food ; human ; case report

PURPOSE: To report a case of delayed sealing of full-thickness macular hole associated with diabetic retinopathy after vitrectomy with silicone oil tamponade. CASE SUMMARY: A 63-year-old woman visited our clinic complaining of decreased visual acuity in her left eye. Fundoscopy showed a full-thickness macular hole with vitreomacular traction in the left eye and bilateral proliferative diabetic retinopathy. The patient underwent uncomplicated phacoemulsification and pars plana vitrectomy with silicone oil tamponade because her vision in the contralateral eye was only light perception. She was unable to maintain a prone position postoperatively due to anterior chamber hyphema. At 1.5 months after surgery, vitreomacular traction was removed but the hole was not sealed as observed on optical coherence tomography. Approximately 3 months after vitrectomy, the macular hole was sealed with minimal subfoveal fluid. At 6 months after vitrectomy, the macular hole was closed completely with no subfoveal fluid.
Anterior Chamber ; Diabetic Retinopathy ; Eye ; Female ; Humans ; Hyphema ; Light ; Phacoemulsification ; Prone Position ; Retinal Perforations ; Silicone Oils ; Tomography, Optical Coherence ; Traction ; Vision, Ocular ; Visual Acuity ; Vitrectomy

Objective: Electroconvulsive seizure (ECS) is a potent treatment modality for various neuropsychiatric diseases, including Parkinson disease (PD). Recent animal studies showed that repeated ECS activates autophagy signaling, the impairment of which is known to be involved in PD. However, the effectiveness of ECS on PD and its therapeutic mechanisms have not yet been investigated in detail. Methods: Systemic injection of a neurotoxin 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride (MPTP), which destroys dopaminergic neurons in the substantia nigra compacta (SNc), in mice was utilized to induce an animal model of PD. Mice were treated with ECS 3 times per week for 2 weeks. Behavioral changes were measured with a rotarod test. Molecular changes related to autophagy signaling in midbrain including SNc, striatum, and prefrontal cortex were analyzed with immunohistochemistry and immunoblot analyses. Results: Repeated ECS treatments normalized the motor deficits and the loss of dopamiergic neurons in SNc of the MPTP PD mouse model. In the mouse model, LC3-II, an autophagy marker, was increased in midbrain while decreased in prefrontal cortex, both of which were reversed by repeated ECS treatments. In the prefrontal cortex, ECS-induced LC3-II increase was accompanied with AMP-activated protein kinase (AMPK)-Unc-51-like kinase 1-Beclin1 pathway activation and inhibition of mamalian target of rapamycin signaling which promotes autophagy initiation. Conclusion The findings revealed the therapeutic effects of repeated ECS treatments on PD, which could be attributed to the neuroprotective effect of ECS mediated by AMPK-autophagy signaling.

Acute antibody-mediated rejection (AMR) developing simultaneously with acute cellular rejection has been rarely reported as a long-term complication of renal transplantation, and it can present on top of another chronic pathology affecting the graft. A 51-year-old female patient with chronic kidney disease of unknown etiology received renal transplantation 12 years ago from a living unrelated donor with 3 HLA mismatches. She received induction therapy with methylprednisolone and was maintained on steroids, mycophenolate mofetil and cyclosporine A (CsA). For a period of twelve years post-transplantation, she was clinically and biochemically stable. She presented with a rise in serum creatinine (SCr.) from 1.3 mg/dL to 2.4 mg/dL but did not have proteinuria. Graft biopsy revealed findings suggestive of acute cellular rejection on top of antibody-mediated rejection (type II) and chronic calcineurin inhibitor toxicity. Panel reactive antibody (PRA) test levels were 3.6%, 91.7% for class I and II respectively. The patient was treated with high-dose methylprednisolone for 3 days but serum creatinine was not fully normalised. After 2 weeks from initial methyl-PDS pulse therapy, she received intravenous immunoglobulin, plasma exchange and anti-CD20 (rituximab). Cyclosporine was changed to tacrolimus. She achieved a complete response, and SCr. was maintained at 1.3 mg/dL without proteinuria. Follow-up PRA test levels were 0%, 75% for class I and II. Current therapies have had considerable success in reversing mixed, acute humoral and cellular rejection since it is being identified quickly and treated aggressively. The best use of rituximab to treat AMR should be evaluated in controlled trials using dosing strategies that include longer courses or retreatment schedules.
Antibodies, Monoclonal, Murine-Derived ; Appointments and Schedules ; Biopsy ; Calcineurin ; Creatinine ; Cyclosporine ; Female ; Follow-Up Studies ; Graft Rejection ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Kidney Transplantation ; Methylprednisolone ; Middle Aged ; Mycophenolic Acid ; Plasma Exchange ; Plasmapheresis ; Proteinuria ; Rejection (Psychology) ; Renal Insufficiency, Chronic ; Retreatment ; Rituximab ; Steroids ; Tacrolimus ; Transplants ; Unrelated Donors

PURPOSE: Despite recent advances in the surgical and postoperative management of infants with congenital heart disease, nutritional support for this population is often suboptimal. The purpose of this study was to develop a nutritional program for the postoperative period for infants who have had cardiac surgery and to evaluate effects of the program. METHODS: A quasi-experimental design with pretest and posttest measures was used. A newly developed nutritional program including a feeding protocol and feeding flow was provided to the study group (n=19) and usual feeding care to the control group (n=19). The effects of the feeding program were analyzed in terms of total feed intake, total calorie intake, gastric residual volume, and frequency of diarrhea. RESULTS: Calorie intake and feeding amount in the study group were significantly increased compared to the control group. However, the two groups showed no significant differences in gastric residual volume and frequency of diarrhea. CONCLUSION: The results indicate that the nutritional program used in the study is an effective nursing intervention program in increasing feeding amount and calorie intake in infants postoperative to cardiac surgery and does not cause feeding-related complications.
Diarrhea/complications/etiology ; Enteral Nutrition/*methods/standards ; Female ; Heart Diseases/*surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Nutritional Requirements ; *Postoperative Care/methods ; Postoperative Complications ; Program Development ; Program Evaluation

The aim of the study was to evaluate the frequency of needed shunt surgeries in 514 patients who underwent surgery for a ruptured intracranial aneurysms. The patients were consisted of 207 patients who were treated from 1986 to 1988(historical control group) and 307 patients treated from 1994 to 1996(study group). In the study group, an earlier aneurysm surgery and more frequent use of adjunctive procedures applied(lumbar and cisternal drainage, and opening of the lamina terminalis and the Liliequist membrane) compared to the control group(p<0.005). Twent-one patients(6.8%) required shunt operations in the study group, while it was necessary in 32 patients(15.5%) of the control group(p<0.005). However, occurrence of a hydrocephalus in both groups were similar. It is concluded that the frequency of a shunt operation has been decreased in the study group presumably due to an earlier surgical intervention, and an aggressive drainage of the bloody cerebrospinal fluid from the cisterns and the ventricles during or after an aneurysm surgery.
Aneurysm* ; Cerebrospinal Fluid ; Drainage ; Humans ; Hydrocephalus ; Hypothalamus ; Intracranial Aneurysm* ; Subarachnoid Hemorrhage

No abstract available.
Peripheral Nerves*

OBJECTIVE: We wanted to assess the role of the popliteal lymph nodes for differentiating rheumatoid arthritis (RA) from osteoarthritis (OA), and we also wanted to investigate the relationship between the popliteal lymph nodes and the inflamed synovial volume (ISV) by using contrast enhanced (CE), fat suppressed, three dimensional-fast spoiled gradient echo (3D-FSPGR) MR imaging. MATERIALS AND METHODS: Contrast enhanced 3D-FSGPR MR imaging of 94 knees (21 with RA and 73 with OA) was analyzed. A lymph node was defined as being 'observed' if it could be seen in at least two planes of the three orthogonal reformatted planes. The number of observed lymph nodes, the mean of the smallest dimension of each lymph node and the existence of central fatty change were recorded. The OA group was graded according to the ISV calculated by a segmentation method: grade I was < 20 cm3; grade II ranged from 20 cm3 to 40 cm3; and grade III was > 40 cm3. Statistical analysis of the number and the mean size of the popliteal lymph nodes among the four groups (the RA group and the grade I-III OA groups) was performed. RESULTS: The prevalence of the observed popliteal lymph nodes was significantly different between all the OA groups or between the grade III OA group and the RA group (p < 0.0001, 0.0001, respectively). The popliteal lymph node was observed in 32 out of 73 OA cases, whereas it was visible in all of the 21 RA cases. The number (mean+/-standard deviation) of lymph nodes in the grade I OA group, the grade II OA group, the grade III OA group and the RA group was 1.2+/-0.4, 1.2+/-0.4, 1.3+/-0.5, and 2.7+/-1.1, respectively. The mean size (mean+/-standard deviation) of the lymph nodes was 3.8+/-1.0 mm, 3.6+/-1.1 mm, 4.1+/-0.8 mm, and 5.4+/-1.3 mm, respectively. The incidence of central fatty changes was significantly lower in the RA group than in all the OA groups and the grade III OA group. When differentiating RA from OA, and when the differentiation was confined to the RA group and grade III OA group, respectively, the criteria of the number of lymph nodes, their size, their central fatty change and a combination of all these three criteria showed statistical significance (Az values for the former were 0.869, 0.847, 0.776, and 0.942; Az values for the latter were 0.855, 0.799, 0.712, and 0.916). The number and mean size of the lymph nodes correlated with the ISVs (r = 0.49, p < 0.001; 0.50, 0.001, respectively). CONCLUSION: The number, size and central fatty changes in the popliteal lymph nodes observed on the MR images might serve as simple and useful markers in differentiating RA disease from OA disease. These markers would be particular helpful in cases of severe synovial enhancement where the ISVs of both RA and OA overlap. The number and mean size of the lymph nodes also correlated well with the ISV.
Adult ; Aged ; Arthritis, Rheumatoid/*diagnosis ; Diagnosis, Differential ; Female ; Humans ; Inflammation ; Knee ; *Lymph Nodes ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Osteoarthritis/*diagnosis ; Research Support, Non-U.S. Gov't ; Retrospective Studies ; Synovial Membrane/*pathology

PURPOSE: Cardiac disease has been known as the most common cause of early and late postoperative mortality following elective arterial surgery. We attempted to investigate the prevalence of concomitant cardiac disease and predictor of postoperative cardiac events in the patients undergoing elective arterial surgery. METHOD: We retrospectively reviewed 300 patients who underwent elective arterial operations at the Department of Surgery, Kyungpook National University Hospital. For preoperative cardiac screening, history taking and physical examination were done with ECG and CK-MB enzyme (OPUS CK-MB, Behring Diagnostic) measurement. Transthoracic echocardiography (145), myocardial perfusion scanning (81, adenosine Tc-99m MIBI or thallium-201 SPECT), and coronary angiography (5) were performed in selective basis. IHD was defined by perfusion defect on myocardial scan and clinical criteria consisting of chest pain, ECG abnormality and serum CK-MB>5%. Possible risk factors including age(> or= 70 years), previous cardiac symptom, aortic clamping, abnormal cardiac function tests, and comorbidities were analyzed to determine the predictor of cardiac events after arterial surgery. RESULT: IHD was associated with in 20.2% of the patients with chronic arterial occlusive disease and 12.8% of patients with abdominal aortic aneurysm. IHD were more commonly associated with diabetes (30.3% vs 15.8%, p=0.014) and hypertension (28.2% vs 11.8%, p=0.0003). After 340 arterial operations for 300 patients, 11 (3.7%) cardiac events (1 congestive heart failure, 10 myocardial infarction or anginal attack and 1 cardiac deaths) were followed. By univariate statistical analysis, postoperative cardiac events occurred more frequently in the patients with prior history of cardiac symptom (9.5% vs 2.7%, p=0.052) and higher CK-MB titer (11.8% vs 3.0%, p=0.038). CONCLUSION: In determining the indications for more detailed preoperative cardiac evaluation, presence of diabetes or hypertension should be considered. To reduce the risk of postoperative cardiac events after elective arterial surgery, more intensive cardiac monitoring is required for the patients with previous cardiac symptoms and/or elevated serum CK-MB.
Adenosine ; Aortic Aneurysm, Abdominal ; Arterial Occlusive Diseases ; Chest Pain ; Comorbidity ; Constriction ; Coronary Angiography ; Echocardiography ; Electrocardiography ; Gyeongsangbuk-do ; Heart Diseases* ; Heart Failure ; Heart Function Tests ; Humans ; Hypertension ; Mass Screening ; Mortality ; Myocardial Infarction ; Myocardial Ischemia* ; Perfusion ; Physical Examination ; Prevalence ; Retrospective Studies ; Risk Factors