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

No abstract available.
Spine*

The methods of treatment of spondylolisthesis range from posterior fusion to instrumentation, and circumferential fusion. Combined anterior and posterior fusion with instrumentation had been carried out in one or two stages and satisfactory results were obtained in nighteen cases with follow-up period of one year to four years at department of orthopedic surgery of Ewha Womans University Hospital from 1987 to 1991. The results were as follows: 1. Of 19 patients, 7 patients were male and 12 patients were famale. 2. The isthmic type was 12 cases (63.1%) and the 5th lumbar vertebral involvement is common (12 cases, 63.1%). 3. The operative treatment was as follows: Posterior fusion with instrumentation was 8 cases, and anterior fusion with instrumentation was 11 cases. 4. The combined anterior and posterior fusion with instrumentation had been carried out in one stage operation at 8 cases, and two stage operation was done at 11 cases. 5. The average operation time was 3.0 hrs in one stage operation, 3.1 hrs in two stage operation, and the average amount of blood loss was 22cc/Kg in one stage, 17cc/Kg in two stage. 6. The satisfactory results were obtained in 19 cases, but there was no specific difference between one stage and two stage operation.
Female ; Follow-Up Studies ; Humans ; Male ; Orthopedics ; Spondylolisthesis

Background: Studies on prevalence and social variables affecting postpartum depression appear to be inconsistent. This study aimed to examine the prevalence of postpartum depression, as well as the correlation between education, offspring, age, and risk of the postpartum depression. Methods: This study included 144 mothers living in Chungju who appeared to experience postpartum depression based on a score of >10 marks on the Korean version of the Edinburgh Postnatal Depression Scale (EPDS). Correlation and logistic regression analyses were used to calculate correlation coefficients and odds ratios (OR) for postpartum depression based on the education level of mothers and number of offspring. Results: Prevalence of postpartum depression was found to be 29.17%. Age was not significantly correlated with EPDS score. EPDS scores tended to decrease with the increase in the number of education years (OR, 0.66); however, EPDS scores tended to increase with the increase in the number of offspring increased (OR, 1.65). Conclusion The result of this study demonstrates that education acts as a protective factor and number of offspring acts as a risk factor for postpartum depression. It also suggests that proper intervention in the mothers’ educational level and number of offspring is necessary.

Myopathy due to hypothyroidism can be detected in its early stage, but as the symptom is mild, complications such as rhabdomyolysis are rare. Thrombotic thrombocytopenic purpura in hypothyroidism is not yet clearly defined, and rare cases of it are reported. Reported herein is a case of thrombotic thrombocytopenic purpura and rhabdomyolysis associated with acute renal failure in hypothyroidism. A 70-year-old male was admitted to the hospital due to general weakness and muscle pain. Later, based on the laboratory findings, he was diagnosed with rhabdomyolysis associated with acute renal failure and thrombotic thrombocytopenic purpura combined with hypothyroidism. Initially, he was treated with fluid resuscitation due to rhabdomyolysis combined with acute renal failure but eventually, the levothyroxine supplement lowered the thyrotropin-stimulating hormone level. As a result, the patient recovered from rhabdomyolysis and thrombotic thrombocytopenic purpura without receiving plasmapheresis treatment.
Acute Kidney Injury* ; Aged ; Humans ; Hypothyroidism* ; Male ; Muscular Diseases ; Myalgia ; Plasmapheresis ; Purpura, Thrombotic Thrombocytopenic* ; Resuscitation ; Rhabdomyolysis* ; Thyroxine

No abstract available.
Nevus, Blue*

No abstract available.

Inability to synthetize adequate amounts of IL-2 has been suggested to be the basis of defective T-cell function following anesthesia with the operation. The present study was designed to examine the effect of anesthesia and operation on host defence mechenism. serum soluble IL-2R(sIL-2R) levels and hemo-dynamic parameters were measured in 30 patients. Patients were divided into two groups (G: general anesthesia with isoflurane, E:epidural anesthesia with bupivacaine) according to the method of anesthesia. Venous blood samples were taken before anesthesia(T1), 10 mins after induction of anesthesia(T2), 10 mins after injection of bupivacaine in epidural anesthesia(T2), 1 hour after skin incision(T3), 30 mins after completion of operation(T4), and 24 hours after completion of operation(T5). Simultaneously arterial blood pressure and heart rate were measured. Six mililiter of perip-heral blood was obtained for sIL-2R studies in plain tubes. Serum concentration of sIL-2R was measured by human IL-2 receptor ELISA kit(Boehringer Mannheim Biochemica, Mannheim, Germany). Any significant change in IL-2R level was not seen in patients under general anesthesia with isoflurane and operation. Also any significant change in IL-2R level was not seen in patients who had an epidural anesthesia with bupivacaine and operation. The results suggest that suppression of T-lymphocyte function and decrease in lymphocyte counts induced by anesthesia and operation is not due to alteration of intracellular metabolism, but due to extracellular immune depressor. And general anesthesia operation with isoflurane as well as epidural anesthesia with bupivgcaine is safe and can be selected for immunosuppressive patients.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General* ; Arterial Pressure ; Bupivacaine* ; Enzyme-Linked Immunosorbent Assay ; Heart Rate ; Humans ; Interleukin-2* ; Isoflurane* ; Lymphocyte Count ; Metabolism ; Receptors, Interleukin-2 ; Skin ; T-Lymphocytes