No abstract available.
Osteotomy*

Epispadias is an extremely rare malformation that urethral opening is located on the dorsum of the penis. Depending upon its location epispadias is classified as balanic, penile, or penopubic, the latter being by far the most common condition. Most patients of epispadias will have severe urinary incontinence and vesicoureteral reflux. The objects of management in epispadias are to achieve continence, to facilitate normal sexual activity, and to preserve renal function. Recently we have experienced two cases of epispadias without incontinence.
Epispadias* ; Humans ; Male ; Penis ; Sexual Behavior ; Urinary Incontinence ; Vesico-Ureteral Reflux

In the anesthesia for Cesarean section, the anesthetists should select the agent and technique which is safe for both the morther and baby. It seems to be a general tendency that delivery by Cesarean section has been increasing because of the development of anesthetic techniques and agents with which one can give a safter anesthesia than before and in turn, has led to increased anesthetic dependence. A small dose of ketamine with nitrous oxide was tried for the induction of anesthesia for Cesarean section in the first group. In the second group, thiopental was given intravenously and anesthesia was maintained with 2% halothane in 100% oxygen for the delivery. After delivery, morphine, diazepam, and muscle relaxant were added to 0.5~1.0% halothane if necessary. These two groups were compared with conventional thiopental N2O-O2 anesthesia and the results were as follws: 1) Changes in blood pressure were similar aspect in each group, but in the hypertensive mother, the ketamine caused a higher blood pressure than the other agents. 2) Changes in pulse rate also had a similar pattern in each group. 3) I-D and U-D interval was the shortest in the halothane group. 4) The Apgar score at 1 min after delivery wasrelatively higher in the ketamine and halothane group than in the thiopental group, while the score at 5 min was almost the same in each group. 5) The analgesic effect of ketamine was superior to that of other agents. The above data suggest that halothane seems to be superior when the fetal position is abnormal or in case when complicated intrauterine manipulation is expected. A small dose of ketamine with nitrous oxide is better in the hypertensive mother or when fetal distress exists.
Anesthesia* ; Apgar Score ; Blood Pressure ; Cesarean Section* ; Diazepam ; Female ; Fetal Distress ; Halothane ; Heart Rate ; Humans ; Ketamine ; Morphine ; Mothers ; Nitrous Oxide ; Oxygen ; Pregnancy ; Thiopental

PURPOSE: The purpose of this study is to compare the growth pattern of breast fed and formula fed infants in the first 1 year of life. METHODS: Anthropometric data (weight, length, head circumference) of at birth, 1, 3, 6, 9 and 12 months were collected by chart review and characteristics of subjects were collected by questionnaires. Among 358 infants, breast fed infants were 161 (84 males, 77 females) and formula fed infants were 90 (42 males, 48 females). Neither group was given solid foods before 4 months. The weight for age, length for age and head circumference for age were calculated. Breast fed infants were separated into 2 groups (breast fed for 4-11 months and breast fed for more than 12 months). RESULTS: Characteristics of infants and mothers were similar in both groups except for maternal age. Mean weight of breast fed group was lower than that of formula fed group at 12 months of age (male: P=0.004, female: P=0.004). However, mean weight of 12 months breast fed group was below formula fed groups weight at 9 and 12 months (P< 0.05). Mean length and head circumference were similar between groups. CONCLUSION: The growth indices of breast fed and formula fed infants are similar at birth, but weight curves of two groups differ in the first 1 year.
Breast Feeding ; Breast* ; Female ; Head ; Humans ; Infant* ; Male ; Maternal Age ; Mothers ; Parturition ; Surveys and Questionnaires

PURPOSE: To analyze angiearchitecture of arteriovenous malformations(AV malformation) in order to clarify the angiegraphic risk factors for intracerebral hemorrhage and other nonhemorrhagic symptoms. MATERIALS AND METHODS: Eighty-five patients with angiegraphically-proved brain arteriovenous malformation were included in this study. Retrospective review of clinical history and angiography was done. Topographic analysis and evaluation of 17 angiearchitectural characteristics were conducted. RESULTS: Deep-seated and cortico-callosal type, small nidus size, intranidal pouch, one draining vein, deep venous drainage only venous stenosis and venous aneurysm were the most discriminating or predictive characteristics of hemorrhage in brain arteriovenous malformation. And those with large nidus size, dural supply and venous hypertension were correlated with nonhemorrhagic symptoms such as seizure, headache and neurologic deficit. CONCLUSION: Detailed analysis of the angiearchitecture of brain arteriovenous malformations is needed to identify the features that are correlated with prognostic implications for the treatment of patients with ^V malformations.
Aneurysm ; Angiography ; Arteriovenous Malformations* ; Brain* ; Cerebral Hemorrhage ; Constriction, Pathologic ; Drainage ; Headache ; Hemorrhage ; Humans ; Hypertension ; Neurologic Manifestations ; Retrospective Studies ; Risk Factors ; Seizures ; Veins

Aneurysm was the first disease of the renal artery to be recognized by Rouppe on 1770, and until selective renal angiography came into vogue, it was considered a rare occurrence. We had experienced 2 cases of renal artery aneurysm that one case was found intraoperatively by chance and the other was confirmed with selective renal angiography. We report 2 cases with review of the literature.
Aneurysm* ; Angiography ; Renal Artery*

OBJECTIVES: The distributive pattern of atherosclerotic vascular disease is known to be different among the races. In Caucasian population, renal artery stenosis (RAS) was reported to be a frequent finding in the patients with ischemic heart disease (IHD), ranging from 5% to 29%. We investigated the prevalence of RAS and the risk factors in Korean patients. METHODS: Over a 12-month period, 574 patients (M:F, 407:167) with clinical IHD underwent cardiac catheteriza tion. Before the procedure, demographic data, medical history, physical findings, and blood chemistries were ob tained. During the procedure, selective renal arteriogram was also obtained. The degree of renal artery stenosis was quantitated with automatic edge detection technique, and narrowing of diameter greater than 50% was considered to be significant. RESULTS: RAS was identified in 42 patients (7%), of whom 5 patients (1%) had bilateral disease. Angiographi cally significant coronary artery disease was present in 473 patients. The prevalence of RAS in patients with single, double and triple vessel disease of coronary artery were 4% (9/235), 13% (20/154), and 12% (10/84), respec tively. Among the 101 patients with normal coronary arteries, 3 (3%) had RAS. By univariate analysis, there was significant difference between RAS and non-RAS in age (66+/-8 yrs vs 59+/-10 yrs, p<0.0001), duration of hypertension (7.3+/-1.3 yrs vs 3.40.3 yrs, p=0.0002), and the frequency of double or triple +/-coronary artery disease (p=0.004). However, no association was found between RAS and serum lipids, lipoprotein(a), creatinine, sex, smoking, diabetes mellitus, or peripheral vascular disease. By multivariate logistic regression analysis, the following parameters were independent risk factors for RAS: age over 65 years (p<0.001), duration of hypertension (p=0.003), and coronary artery disease involving double or triple vessels (p=0.004). CONCLUSION: The prevalence of RAS in Koreans is somewhat lower than in western population. However, in patients with high degree coronary heart disease, old age over 65 years, or long history of hypertension, the possibility of combined RAS should be considered.
Arteries ; Cardiac Catheterization ; Continental Population Groups ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Disease ; Coronary Vessels ; Creatinine ; Diabetes Mellitus ; Humans ; Hypertension ; Lipoprotein(a) ; Logistic Models ; Myocardial Ischemia ; Peripheral Vascular Diseases ; Prevalence* ; Renal Artery Obstruction* ; Renal Artery* ; Risk Factors* ; Smoke ; Smoking ; Vascular Diseases

PURPOSE: Infective endocarditis (IE) is a serious complication in children with structural heart disease. We reviewed 35 cases of IE to identify the recent changes in the pattern of preexisting heart diseases, the spectrum of causative organisms and prognosis. METHODS: The clinical records of children diagnosed as IE at the Seoul National University Children's Hospital from January 1987 through December 1997, were reviewed retrospectively. Duke criteria was used for diagnosis. Cases were categorized into primary group(PG) IE in an unoperated heart and post operative group(POG), and the latter further into early POG(within 2 months after operation) and late POG. RESULTS: There were 35 cases of IE developed in 34 patients; 18 cases in the PG, 6 cases in the early POG, and 11 cases in the late POG. Male to female ratio was 16 : 19. Mean age of POG, especially early POG was less than that of PG (early POG : late POG : PG=1.65 years : 6.5 years : 8.34 years, P=0.0267). Preexisting heart diseases were identified in 30 cases; rheumatic heart disease 1 case and congenital heart disease (CHD) 29 cases. Causative organisms were identified in 80%; viridans streptococci, 10 cases (33.3%); pneumococci, 2 cases; Group-D streptococci, 3 cases; staphylococci, 8 cases; Gram (-) organisms, 5 cases and Candida albicans, 2 cases. Vegetation was detected in 88.9% of PG and 64.7% of POG. The most common indication for surgery was uncontrolled infection, which were required in 9 cases. The overall mortality rate was 12.1%. Mortality in POG was higher than that of PG (23.5% versus 0%, P=0.033). CONCLUSION: The discrepancy of mean age among patient groups and the high proportion of patients belonging to POG, were consistent with the increase in the number of newly risky population that survived after cardiac surgery. A more aggressive consideration for operative management may improve the treatment results.
Candida albicans ; Child* ; Diagnosis ; Endocarditis* ; Female ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Male ; Mortality ; Prognosis ; Retrospective Studies ; Rheumatic Heart Disease ; Seoul ; Thoracic Surgery ; Viridans Streptococci

PURPOSE: Though acute pyogenic infections of musculoskeletal system are infrequent in children, delayed diagnosis or inadequate management may cause serious chronic sequelae. We analysed 40 cases of children who were affected by acute septic osteomyelitis and/or septic arthritis to find etiologic agents and to establish proper initial antimicrobial therapy. METHODS: Medical records of 40 cases of microbiologically confirmed acute pyogenic osteomyelitis and/or septic arthritis diagnosed at the Seoul National University Children's Hospital from January 1985 to September 1998 were reviewed. RESULTS: There were 12 cases of acute osteomyelitis, 28 of acute septic arthritis, and 4 of concurrent cases of two diseases. Of 12 cases of acute pyogenic osteomyelitis, there were 7 boys and 5 girls whose average age was 75.4 months. Calcaneus was infected in 4 cases and it was the most common site. Ten cases (83.3%) of them were attributable to Staphylococcus aureus, 1 to Streptococcus viridans and 1 to Pseudomonas aeruginosa. Among the 28 cases of acute septic arthritis, male to female ratio was 16 : 12. The hip joint was the most frequent site involved in 13 cases (46.3%), followed by the ankle joint, which was involved in 6 cases (21.4%). The majority of the children were infected by S. aureus (20 cases, 71.4%). Two cases were infected by S. viridans or Salmonella (group D) species, and 1 by Haemophilus influenzae. CONCLUSION: S. aureus was the most common pathogen of acute pyogenic osteoarthritis, and H. influenzae was an infrequent cause of septic arthritis. Regarding initial empirical anibiotic therapy, anti-staphylococcal agent should be included.
Ankle Joint ; Arthritis ; Arthritis, Infectious ; Calcaneus ; Child* ; Delayed Diagnosis ; Female ; Haemophilus influenzae ; Hip Joint ; Humans ; Influenza, Human ; Male ; Medical Records ; Musculoskeletal System ; Osteoarthritis* ; Osteomyelitis ; Pseudomonas aeruginosa ; Salmonella ; Seoul ; Staphylococcus aureus ; Viridans Streptococci

BACKGROUND AND OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) is one of the surgical methods used to cure obstructive sleep apnea (OSA). It is designed to relieve of oropharyngeal obstruction and to enlarge the potential air space in the oropharynx by removing the excessive soft tissues involved in the free margin of the soft palate, uvula, tonsils and the pharyngeal wall. Although laser-assisted uvulopalatoplasty (LAUP) has been recently popular for the treatment of snoring and some OSA, UPPP remains the best choice of treatment for moderate to severe OSA. The criteria for selecting patients for this procedure, however, are obscure and factors that can predict successful responses are not well established. The purpose of this study was to evaluate the success rate of UPPP and to determine the factors that can predict the response to UPPP. MATERIALS AND METHODS: We report our experience on 27 OSA patients who underwent UPPP. We evaluated their preoperative cephalometric radiograph readings as well as body mass index (BMI). Each patient also underwent polysomnography before and after UPPP. RESULTS: Defining surgery to be successful when the postoperative apnea index (AI) was reduced by more than 50%, the success rate of the surgery was 74%. The mean AI decreased from 32 to 4, and the mean lowest oxygen saturation increased from 79% to 89% in good responders. Snoring was reduced in 67% of the patients. However, no single parameter could be used to predict good responses to UPPP. CONCLUSION: We found that UPPP is an effective treatment for OSA, but we could not identify a single parameter which can invariably predict the success of the operation.
Apnea ; Body Mass Index ; Humans ; Oropharynx ; Oxygen ; Palate, Soft ; Palatine Tonsil ; Polysomnography ; Reading ; Sleep Apnea, Obstructive* ; Snoring ; Uvula