BACKGROUND: Although surgical angioplasty for isolated coronary ostial stenosis is assumend as an alternative approach to CABG, the clinical features of isolated coronary ostial stenosis, postoperative complications and follow-up angiographic results would have not been well studied. METHODS: We retrospectively studied 24 patients (female : male = 20 : 4, mean age 50.0 +/- 12.3 yr) who underwent surgical angioplasty for isolated coronary ostial stenosis using patch ( 22 fresh autologous pericardium, 2 saphenous vein) during the period of March 1990 through February 1998. Repeat coronary angiography (16 patients) and echocardiography (24 patients) were performed. Aortic regurgitation was evaluated semiquantitatively (Grade I - Grade IV). RESULTS: There were 3 deaths after surgical angioplasty. One death was due to acute coronary dissection perioperatively, the second due to low cardiac output syndrome 2 weeks post-surgery, and the third due to traumatic panperitonitis 10 months post-procedure. Angina recurred in 4 patients and the remaning 18 patients were symptom-free. Repeat angiography (19.3 +/- 20.7 Mo) showed widely patent ostium with excellent run-off except 2 patients (1 distal patch stenosis, 1 ostial restenosis in Takayasu's arteritis). The third symptomatic patient was proven to have coronary spasm by ergonovine test. AR increased in the fourth patient (Grade II -> III) with patent ostium. CONCLUSION: Surgical angioplasty may be feasible and alternative operative method to CABG for isolated coronary ostial stenosis. It should however be noted that postop AR can develop and/or increase. Further investigation is needed to evaluate the clinical significance of the AR.
Angiography ; Angioplasty* ; Aortic Valve Insufficiency ; Cardiac Output, Low ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Echocardiography ; Ergonovine ; Follow-Up Studies ; Humans ; Male ; Pericardium ; Postoperative Complications ; Retrospective Studies ; Spasm

Ten children were selected out of 21 cases diagnosed as ureteropelvic junction obstruction between March, 1989 and March, 1992. The children were evaluated quantitatively using the renal cortical labeling agent, 99m technetium dimercaptosuccinic acid (Tc-DMSA), before and following pyeloplasty. The preoperative residual renal function and the extent of functional recovery were investigated. The children ranged from 15 months to 13 years old (average 6.8 years) and consisted of 8 boys and 2 girls. The obstruction was on the left in 7 cases and the right in 3. Symptoms on admission included pain in 5 cases, abdominal mass in 3 cases, and fever and chill in 2. The subjects divided into two groups. The first group consisted of children who did not have complications or other coexisting diseases, while the second consisted of who had pyonephrosis or vesicoureteral reflux. All patients underwent dismembered pyeloplasty and the results were satisfactory in all. 1. The preoperative differential renal function by Tc-DMSA renal scintigraphy ranged from 0.5% to 46.0% (mean 19.1%) and increased to 3.5% to 46.9% (mean 28.8%) postoperatively. 2. In five of the seven cases with uncomplicated ureteropelvic junction obstruction, differential renal function increased more than 1096 following pyeloplasty. In the two other cases which showed preserved renal function of up to 4096 preoperatively, noticeable changes not observed. 3. In the three cases with complicated ureteropelvic junction obstruction, (two cases associated with pyonephrosis and one case with vesicoureteral reflux) only slight increased differential renal function. In conclusion, we suggest that severely obstructed kidneys in infants and children spare nephrectomy and encourage pyeloplasty, even in cases of non-visualization on excretory urography in hopes of improving relative renal function.
Adolescent ; Child* ; Female ; Fever ; Hope ; Humans ; Infant ; Kidney* ; Nephrectomy ; Pyonephrosis ; Radionuclide Imaging ; Succimer ; Technetium ; Technetium Tc 99m Dimercaptosuccinic Acid* ; Urography ; Vesico-Ureteral Reflux

It is well known that proper gender assignment and treatment to a neonate born with ambiguous genitalia are extremely important. We reviewed seven patients with ambiguous genitalia who were surgically managed at our department during recent 5 years. The median age was 12.1 years (from 3 to 24 years) and patients consist of three female pseudohermaphroditism (adrenogenital syndrome), one true hermaphroditism, one male pseudohermaphroditism and two mixed gonadal dysgenesis. Three patients were managed with clitoral recession and vaginoplasty, each of them with clitoral recession vaginoplasty and gonadectomy, with clitoral recession and gonadectomy, with clitoral recession, with gonadectomy and bilateral mastectomy. One patient with adrenogenital syndrome was raised as male, but re-assigned and surgically corrected as female at her age of 16 years. Another one patient with true hermaphroditism was raised as male who underwent excision of female internal genitalia, gonadectomy and bilateral mastectomy in considering of patient's gender identity, appearance of external genitalia and parent's proposal although the karyotype was 46 XX. We suggest that gender assignment and surgical correction must be done as early as possible after full evaluation of fertility feasibility, karyotype, sex ability and patient and parent's proposal.
46, XX Disorders of Sex Development ; 46, XY Disorders of Sex Development ; Adrenogenital Syndrome ; Disorders of Sex Development* ; Female ; Fertility ; Gender Identity ; Genitalia ; Gonadal Dysgenesis, Mixed ; Humans ; Infant, Newborn ; Karyotype ; Male ; Mastectomy ; Ovotesticular Disorders of Sex Development

Between July 1988 and June 1993, nine patients with renal and perirenal abscess were treated using the percutaneous management. Percutaneous abscess drainage was done under ultra- sound guidance and local anesthesia. Among the nine patients, two patients were managed by percutaneous aspiration only and the other seven patients were managed by continuous drainage using the 8.3F pig-tail or 14F Malecot catheter. The catheters were placed in the abscess cavity during the period from 4 days to 19 days (average 8 days). On the abscess culture, the organisms were identified in 9 cases ( 100%) ; E.coli was in 4 cases, S. aureus was in 2 cases, Proteus, Enterobacter, unidentified gram negative bacilli in 1 case, respectively. After catheter removal, all patients have remained free of symptoms during followup from 2 months to 32 months (average 20 months). We suggest that proper antibiotic therapy combined with ultrasound guided percutaneous drainage of renal and perirenal abscess is a choice of reasonable, safe and effective management in selected patients.
Abscess* ; Anesthesia, Local ; Catheters ; Drainage ; Enterobacter ; Follow-Up Studies ; Humans ; Proteus ; Ultrasonography

Multilocular cystic nephroma of the kidney is an infrequent lesion and has been reported in the literature under several names. These various denominations reflect the controversy about its nature. Some authors include the lesion among renal dysplasia, while others consider it to be a benign neoplasm that might be related to nephrtblastoms(Wilms` tumor). We present a case of 52 year old male with multilocular cystic nephroma of the left kidney which was composed of highly cellular spindle shaped stromal cells and locally recurred as sarcoma after nephrectomy.
Humans ; Kidney ; Male ; Middle Aged ; Nephrectomy ; Sarcoma* ; Stromal Cells

Uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are very rare tumors that occur mainly in the uterine fundus of women in reproductive age. These tumors can be classified into group 1 and group 2 by histological results. In group 1, epithelial-like differentiation is partially observed in the tumors. In group 2, sex-cord elements are predominant in uterine mural mass. We experienced UTROSCT group 1 in a 29-year-old woman who complained of severe abdominal pain that started one week after delivery and UTROSCT group 2 case in a 49-year-old woman who complained of dysfunctional uterine bleeding. We report two different types of UTROSCT cases that we experienced.
Abdominal Pain ; Adult ; Female ; Humans ; Metrorrhagia ; Middle Aged ; Sex Cord-Gonadal Stromal Tumors ; Uterine Diseases ; Uterine Neoplasms

Among 13 patients with pemphigus : 8 of pemphigus vulgaris(PV), 4 of pemphigus foliaceus(PF), l of pemphigus erythematosus(PE), we have examined the sites of early lesions and the clinical appearances of the skin lesions. The most common site of the early lesions in PV was the oral mucosa, however, in PF and PE the face was affected first. The clinical appearances of the early lesions were flaccid bullae, erythematous papules and eczematoid patches. Clinicians should be aware of these clinical features of pemphigus for a more precise diagnosis and better management.
Diagnosis ; Humans ; Mouth Mucosa ; Pemphigus* ; Skin

OBJECTIVES: Previous studies have shown that the endogenous opioid system, which plays an important role in drinking behavior, might be related to the genetic etiology of alcohol dependence. And a recent study reported that the affinity of micro opioid receptor, which is closely related to the endogenous opioid system activity, is affected by the genotype of micro opioid receptor gene (OPRM1) A118G. To investigate the gender difference in genetic etiology of alcohol dependence, this study examined the association of the genotype of OPRM1 A118G with female alcohol dependence in Koreans. METHODS: The author studied the genotype of OPRM1 A118G in 106 male and 35 female Korean with alcohol dependence and 80 male and 60 female healthy Koreans as control. RESULTS: 1) A statistically significant increase in A/G or G/G (G+) genotype of OPRM1 A118G was observed in women with alcohol dependence compared to the controls. 2) Among men with alcohol dependence, no significant difference in OPRM1 A118G polymorphism was observed relative to the age at which drinking started, age of onset of alcohol-related problems, age of first admission to psychiatric hospital for alcohol-related problems, drinking days per month, drinks per drinking day, family history of alcohol dependence in the first-degree relatives or history of severe alcohol withdrawal symptoms. But the drinking days per month is significantly less in those who have A/G or G/G genotypes of OPRM1 A118G. CONCLUSION: These results suggest that G+ genotypes of micro opioid receptor gene A118G are important genetic factors in the etiology of female alcohol dependence.
Age of Onset ; Alcoholics* ; Alcoholism ; Drinking ; Drinking Behavior ; Female* ; Genotype* ; Hospitals, Psychiatric ; Humans ; Male ; Receptors, Opioid* ; Substance Withdrawal Syndrome

PURPOSE: Population-based studies have shown positive associations between migraine and irritable bowel syndrome, colitis and peptic ulcer and migraine prevalence was higher among patients with dysmotility-like dyspepsia or nausea/vomiting. The aim of this study was to investigate clinical manifestation between primary headache with epigastric pain or tenderness(EPT) and primary headache without EPT. METHODS: We retrospectively reviewed the medical records of 58 patients who were diagnosed primary headache[by ICHD-II(2004)] at Incheon St. Mary Hospital from January, 2006 to December, 2007. Their clinical characteristics such as age, sex, frequency & severity of headache and associated symptoms & signs were analysed. RESULTS: The rate of headache associated with EPT were 36% of migraine cases, 50% of tension-type headache cases, and 100% of unclassified headache cases. Headache with EPT were at a high rate in female. Headache with EPT were more severe than one without EPT. Regulation of behavior, diet and sleep pattern had improved severity of headache in 71% of migraine without EPT and 94% of tension-type headache without EPT, but in 12% of migraine with EPT and 18% of tension-type headache with EPT. Headache disappeared in 64% of migraine with EPT and 53% of tension-type headache by additional regular antiacid medication. CONCLUSION: Our study supports any specific correlation between headache and EPT, but further studies are needed.
Abdominal Pain ; Child ; Colitis ; Diet ; Dyspepsia ; Female ; Gastrointestinal Diseases ; Headache ; Humans ; Irritable Bowel Syndrome ; Medical Records ; Migraine Disorders ; Nausea ; Peptic Ulcer ; Prevalence ; Retrospective Studies ; Tension-Type Headache ; Vomiting

Isolated fetal ascites may be different from general category of nonimmune hydrops in both prenatal course and prognosis. We experienced one case of isolated fetal ascites of unknown origin treated by in utero ultrasound-directed paracentesis and so present it with brief review of literature.
Ascites* ; Edema ; Paracentesis* ; Prognosis