No abstract available.
Endoderm* ; Endodermal Sinus Tumor*

No abstract available.

PURPOSE: To compare clinical outcomes of the tumor prosthetic replacement and osteosynthetic fixation for pathologic fracture of skeletal metastatic lesion of the proximal femur. MATERIALS AND METHODS: From 1994 May to 2009 May, medical records of 22 patients who underwent tumor prosthetic replacement with tumor resection (group 1) and 15 others (16 hips) who underwent osteosynthetic fixation without tumor resection (group 2) were reviewed. The mean age of overall patients were 59 (group 1) and 60 (group 2). Mean follow up periods were 23 and 11 months. The oncological and functional results were evaluated with Kaplan-Meier methods and Musculoskeletal Tumor Society (MSTS) scoring system, 1993. The statistical evaluation was assessed with Log rank test and t-test. RESULTS: The mean survival periods were 24 months in group 1 and 11months in group 2. The 1 year survival rates were 86% in group 1 and 50 % in group 2, and 2 year survival rates were 29.7% in group 1 and 9.4% in group 2. The mean MSTS functional score were 26.4 (19-30), 87.9% in group 1 and 15.3 (10-23), 51.0% in group 2. CONCLUSION: The results of tumor resection and prosthetic replacement in selected cases was better than osteosynthetic fixation without tumor resection for metastatic bone tumors around proximal femur in oncological and functional aspects.
Femur ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Joints ; Medical Records ; Survival Rate

No abstract available.
Otitis Media* ; Otitis*

BACKGROUND: Increasing coronary perfusion pressure with phenylephrine is important treatment strategies for right ventricular dysfunction caused by pulmonary hypertension. We compared the effects of phenylephrine on systemic and pulmonary hemondynamics in patients with and without pulmonary hypertension. METHODS: Twenty patients undergoing a valvular replacement were divided into two groups according to pulmonary artery pressure (PAP): control group (mean PAP < 25 mmHg, n = 9) or pulmonary hypertension group (mean PAP > 25 mmHg, n = 11). When systolic blood pressure decreased below 100 mmHg after the induction of anesthesia, phenylephrine was infused to raise systolic blood pressure up to 30% and 50% over baseline. Hemodynamic variables were measured at each time. RESULTS: Phenylephrine failed to raise systolic blood pressure up to 50% above baseline in more than half of the patients with pulmonary hypertension in contrast to successful increases in all patients without pulmonary hypertension. However, the ratio of PAP to systolic blood pressure was significantly reduced in patients whose systolic blood pressure was successfully increased up to 50% over baseline in the pulmonary hypertension group whereas the PAP concomitantly increased as systolic blood pressure was increased in the control group. CONCLUSIONS: Phenylephrine couldn't increase systolic blood pressure in some patients with pulmonary hypertension unlike in control group and it seemed to occur more often in patients with greater the ratio of PAP to systolic blood pressure. The baseline systemic vascular resistance index was high and cardiacoutput was low in the pulmonary hypertension group and these conditions seemed to restrict the effect of phenylephrine.
Anesthesia ; Blood Pressure ; Hemodynamics* ; Humans ; Hypertension, Pulmonary* ; Perfusion ; Phenylephrine* ; Pulmonary Artery ; Vascular Resistance ; Ventricular Dysfunction, Right

The term Down's syndrome is preferred to mongolism. The most constant characteristic of disease is mental retardation. The incidence of Down's syndrome is about 1/600 in the general population, being roughly the same in various parts of world and in all races. The patient's mother's age at the same time of conception as well as the nature of chromosomalmalformation are in genetic counseling. We reported a case of Down's syndrome in 5 year old female who was bone in 38 year old mother, and she was noted epicanthus, nystagmus, esotropia, Brush-field spots. Other systemic manifestation-, Simian crease, short extrimites, inward curved 5th finger, Sandal gap foot, congenital heart disease, prominent abdomen-, was also noted.
Adult ; Child, Preschool ; Continental Population Groups ; Down Syndrome* ; Esotropia ; Female ; Fertilization ; Fingers ; Foot ; Genetic Counseling ; Heart Defects, Congenital ; Humans ; Incidence ; Intellectual Disability ; Mothers

Xanthogranulomatous pyelonephritis in childhood is a rare chronic pyelonephritis often assodiated with calculi of urinary tract obstruction, with a clinical presentation of renal mass. A 3-year old boy was admitted to Korea University Hospital complaining of intermittent fever and palpable mass at right upper quadrant of the abdomen. The CBC revealed increased ESR and the finding of iron deficientcy anemia. Proteus mirabilis was cultured from the urine. We found the idiopathic hypercalciuria was affected also. Intravenous pyelogram. ultrasonogram and abdominal computerized tomogrhapy demonstrated a multiple cystic lesion with renal calculi at upper and lower pole of right kidney. Right nephrectomy was performed under the suspicion of the renal abscess with renal stone. Postoperatively microscopic examination revealed parenchymal destruction with infiltration of foamy phagocytes, giant cells, and plasma cells. In conclusion, we experienced a case of xanthogranulomatous pyelonephritis with idiopathic hypercalciuria in a child. So, we report it with a review of literature.
Abdomen ; Abscess ; Anemia ; Calculi ; Child* ; Child, Preschool ; Fever ; Giant Cells ; Humans ; Hypercalciuria* ; Iron ; Kidney ; Kidney Calculi ; Korea ; Male ; Nephrectomy ; Phagocytes ; Plasma Cells ; Proteus mirabilis ; Pyelonephritis ; Pyelonephritis, Xanthogranulomatous ; Ultrasonography ; Urinary Tract

OBJECTIVES: Dopamine dysregulation has been regarded as one of the core pathologies in patients with schizophrenia. Since dopamine synthesis capacity has found to be inconsistent in patients with schizophrenia, current classification of patients based on clinical symptoms cannot reflect the neurochemical heterogeneity of the disease. Here we performed new subtyping of patients with first-episode psychosis (FEP) through biotype-based cluster analysis. We specifically suggested basal ganglia structural changes as a biotype, which deeply involves in the dopaminergic circuit. METHODS: Forty FEP and 40 demographically matched healthy participants underwent 3T T1 MRI. Whole brain parcellation was conducted, and volumes of total 6 regions of basal ganglia have been extracted as features for cluster analysis. We used K-means clustering, and external validation was conducted with Positive and Negative Syndrome Scale (PANSS). ResultsZZK-means clustering divided 40 FEP subjects into 2 clusters. Cluster 1 (n = 25) showed substantial volume decrease in 4 regions of basal ganglia compared to Cluster 2 (n = 15). Cluster 1 showed higher positive scales of PANSS compared with Cluster 2 (F = 2.333, p = 0.025). Compared to healthy controls, Cluster 1 showed smaller volumes in 4 regions, whereas Cluster 2 showed larger volumes in 3 regions. RESULTS: K-means clustering divided 40 FEP subjects into 2 clusters. Cluster 1 (n = 25) showed substantial volume decrease in 4 regions of basal ganglia compared to Cluster 2 (n = 15). Cluster 1 showed higher positive scales of PANSS compared with Cluster 2 (F = 2.333, p = 0.025). Compared to healthy controls, Cluster 1 showed smaller volumes in 4 regions, whereas Cluster 2 showed larger volumes in 3 regions. CONCLUSIONS: Two subgroups have been found by cluster analysis, which showed a distinct difference in volume patterns of basal ganglia structures and positive symptom severity. The result possibly reflects the neurobiological heterogeneity of schizophrenia. Thus, the current study supports the importance of paradigm shift toward biotype-based diagnosis, instead of phenotype, for future precision psychiatry.
Basal Ganglia* ; Brain ; Classification ; Cluster Analysis ; Diagnosis ; Dopamine ; Healthy Volunteers ; Humans ; Magnetic Resonance Imaging ; Pathology ; Phenotype ; Polytetrafluoroethylene ; Population Characteristics ; Psychotic Disorders* ; Schizophrenia ; Weights and Measures

In this case, a successful mitral valve repair was confirmed by transesophageal echocardiography (TEE) at the end of a cardiopulmonary bypass. The left ventricular vent was placed through the mitral valve to remove the air after the TEE examination, and on its way out, the left ventricular vent damaged the anterior mitral leaflet (AML). Re-examination of the valve with TEE detected the new mitral valve insufficiency. The CPB was reinstituted, and tearing of the lateral third part of the anterior mitral leaflet was found. This case emphasizes the importance of TEE in the operating room as a continuous monitor, not only to evaluate the result of the cardiac surgery, but also to detect any unpredictable events during the surgery.
Mitral Valve Insufficiency/*surgery/*ultrasonography ; Mitral Valve/*injuries/surgery ; Middle Aged ; Intraoperative Complications/surgery ; Humans ; Female ; *Echocardiography, Transesophageal ; Cardiopulmonary Bypass/*adverse effects

BACKGROUND: There has been no report about the effects of blood pressure (BP) on the change of blood flow (BF) to major organs when pump flow is maintained during cardiopulmonary bypass (CPB). We evaluated the changes of the BF and oxygen consumption of major organs when BP was controlled by vasopressors or vasodilators during CPB. METHODS: Carotid, femoral, hepatic and renal arteries and veins were exposed and arteries were cannulated for pressure monitoring, except the hepatic artery and arteries on the opposite side were exposed for the measurement of BF in 7 dogs. Temperature was lowered to 30oC after initiation of CPB and phenylephrine or sodium nitroprusside was infused to increase or decrease BP about 30% under the same pump flow. BP and BF were measured before CPB, before the infusion of drugs and when BP was changed by vasoactive drugs. Blood gas analyses were performed from the artery and each vein while the BF was measured. RESULTS: The change of BP didn't affect carotid and renal BF. However, hepatic BF decreased about 50% when BP was reduced and femoral BF changed in the opposite way of BP change. Oxygen consumption of each organ wasn't influenced by BP. CONCLSIONS: When pump flow was constantly maintained, changes in BP redistributed BF to major organs but didn't affect oxygen consumption. The brain and kidney have the ability of autoregulation of BF unlike the liver or legs. Hepatic BF was dependent on perfusion pressure and a decrease in BP by vasodilators during CPB may be not good for the liver.
Animals ; Arteries ; Blood Gas Analysis ; Blood Pressure ; Brain ; Cardiopulmonary Bypass* ; Dogs ; Hepatic Artery ; Homeostasis ; Kidney ; Leg ; Liver ; Nitroprusside ; Oxygen Consumption ; Perfusion* ; Phenylephrine ; Renal Artery ; Vasodilator Agents ; Veins