No abstract available.
Gastrectomy* ; Stomach Neoplasms*

Cecal Diverticulitis(CD) is a rare condition with a higher incidence in Oriental populations, which symptoms and signs are closely simulate acute appendicitis. The present study was designed to resume the optimal therapeutic modalities. A retrospective review was conducted between 1991 and 1996 on 28 surgically treated patients(18 men, 10 women ; mean age 45 years) with documented CD in Kon-Kuk University Hospital. Most patients presented with right lower quadrant pain and tenderness. Acute appendicitis was the preoperative diagnosis in 89.2%(25/28) of the patients. The CD patients were divided into three groups : CD-RC(right hemicolectomy group; n=4), CD-DV(diverticulectomy group; n=5), and CD-AP(appendectomy only group; n=19) by operative options. Information on patient demographics, duration of symptom, white blood cell count, radiologic studies, operative procedure, operation time, hospital days, duration of intravenous antibiotics administration, complications and recurrent symptoms were reviewed and analyzed. CD-RC and CD-DV patients required more hospital days than CD-AP(mean 20.6 days, 9.6 days versus 8.4 days, respectively) and more complications(50%, 60% versus 26%). There was no recurrent patient in this series and also there were no reoperated cases. But there was one death in CD-RC group. Of the 4 patients who had right hemicolectomy, one was expired by sepsis and one had minor wound infection. Minor wound infections are the most common complications : 5 in CD-AP, 3 in CD-DV group. Conclusively, if CD could be diagnosed preoperatively, surgical management should be reserved and initial medical treatment with intravenous antibiotics should be considered, and in those patient who underwent emergency operation presumed acute appendicitis, right hemicolectomy with primary ileocolic anastomosis is recommended with acceptable low morbidity. But alternatively appendectomy only is a safe and effective procedure for the treatment of CD if there is no evidence of free perforation, abscess formation or strongly suggested cecal carcinoma.
Abscess ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Demography ; Diagnosis ; Diverticulitis* ; Emergencies ; Female ; Humans ; Incidence ; Leukocyte Count ; Male ; Retrospective Studies ; Sepsis ; Surgical Procedures, Operative ; Wound Infection

The purpose of this study was to analyse the magnetic resonance (MR) appearance of the patellar tendon autograft for anterior cruciate ligament injury. Among 35 patients of ACL reconstructions with central 1/3 of the patellar tendon autograft and interference screw fixation, 13 patients underwent MRI examination. All examination were performed on 1.5 T magnet(Signa;GE medical system). T1WI, PDI, T2WI Sagittal and coronal images were obtained together with T2WI MPGR and oblique sagittal images. A four-level grading system based on the MR appearance of the ACL graft was developed. A grade I was indiscernible in graft course, Grade II; incomplete in its course, grade III; complete but thin and grade IV; complete and thick. 2 out of 13 patients showed grade I, 3; grade II, 4; grade III and 4 grade IV. Five patients of grade I and II had a finding of roof impingement. However, only one out of 8 grade III and IV revealed such finding. In summary reconstructed ACL had various appearance in MRI, which was considered to be closely related with roof impingement.
Anterior Cruciate Ligament ; Autografts ; Humans ; Magnetic Resonance Imaging ; Patellar Ligament ; Transplants

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that occurs once in 3,000 live births. Patients with NF1 are prone to develop malignancies, particularly neural tumors, that is, malignant schwannoma and glioma in adults. For non-neural tumors, the NF1 incidence is increased in rhabdomyosarcomas, leukemia, malignant melanomas, breast cancer, lung cancer, thyroid cancer, and other organ cancers. The NF1 gene seems to increase the risk for carcinogenesis. A case of NF1 associated with metachronous cancers, such as breast cancer (1991) and small-bowel leiomyosarcoma (1997), in the same patient is reported. Investigation of the patient's family revealed four further cases (offsprings) of multiple neurofibromatosis. The relevant literature on the subject is reviewed.
Adult ; Breast Neoplasms ; Carcinogenesis ; Genes, Neurofibromatosis 1 ; Glioma ; Humans ; Incidence ; Leiomyosarcoma ; Leukemia ; Live Birth ; Lung Neoplasms ; Melanoma ; Neurilemmoma ; Neurofibromatoses ; Neurofibromatosis 1* ; Rhabdomyosarcoma ; Thyroid Neoplasms

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is a well-recognized cause of vomiting in infancy and is easily cured by a Ramstedt pyloromyotomy. However there have been no reports on the postoperative appearance of a pyloric mass in Korea. METHODS: Twenty infants with IHPS and 20 control infants were studied ultrasonographically during the first year of life at a regular interval. According to examination intervals, the IHPS infants (n=20) were divided into three groups: Group A (3 months, n=6), B (6 months, n=7), and C (12 months, n=7). At each examination, measurements were obtained concerning the length of the pyloric canal and the muscular thickness. RESULTS: The mean preoperative length of the pylorus of the IHPS group was 19.4+/-3.64 mm, ranging from 17 to 30 mm (control: 7.73+/-2.67 mm) (p<0.0001). The mean pyloric muscle thickness of the IHPS group was 5.08+/-0.67 mm, ranging from 3.5 to 6 mm (control: 2.37+/-0.58 mm) (p<0.0001). The preoperative and postoperative measurements were subsequently compared. Postoperatively, the length of the pylorus averaged 22.0+/-2.66 mm, and the muscular thickness was 6.53+/-1.68 mm (p<0.0001). The reduction rates in pyloric length were 23.5%, 46.3%, and 53.4% for the respective groups. Also, the muscle-thickness reduction rates were 31.8%, 48.9%, and 57.8% respectively. At 6 months after the operation, the pyloric muscular thickness was in the normal control range, and the pyloric length was reduced to the normal range after 12 months. CONCLUSIONS: This prospective study suggests that the pyloric mass undergoes a rapid reduction in size in the first 6 months, followed by a more gradual reduction to a normal value by 12 months after a pyloromyotomy.
Humans ; Infant ; Korea ; Prospective Studies ; Pyloric Stenosis, Hypertrophic* ; Pylorus ; Reference Values ; Ultrasonography ; Vomiting

Hydrogen peroxide solution is commonly used for irrigating and cleaning wounds. When it is applied to tissues, catalase causes its rapid molecular degeneration with the release of oxygen bubbles. We present case report illustrating two hazards ; chemical colitis and oxygen embolus. A 29-year-old previously healthy woman presented to the bloody diarrhea and anal pain after hydrogen peroxide enema. In the colonoscopic examination, severe mucosal edema and ulceration with bleeding was noted from anus to sigmoid colon. With use of anal endosonography, multiple high level echo were noted in the internal and external anal sphincter of the upper anal canal. Microscopically, mononuclear cells were infiltrated in lamina propria and congestion. She had treatment with IV fluid, IV antibiotics and NPO. At 3rd hospital day, anal pain was disappeared. Bloody stool was disappeared next day. At 8th hospital day, mucosal edema and ulceration were disappeared on colonoscopic examination. Recovery was full and the patient was discharged at nine days after the episode.
Adult ; Anal Canal ; Anti-Bacterial Agents ; Catalase ; Colitis* ; Colon, Sigmoid ; Diarrhea ; Edema ; Embolism ; Endosonography ; Enema* ; Estrogens, Conjugated (USP) ; Female ; Hemorrhage ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Mucous Membrane ; Oxygen ; Ulcer ; Wounds and Injuries

Carotid sinus syndrome is the most commonly reported cause of falls and syncope in elderly adults. However, it has been rarely reported in Koreans, and the reason of this ethnic difference is unknown. We report here on an Korean unusual case of carotid sinus syncope and this was induced by carotid sinus massage.
Adult ; Aged ; Carotid Sinus ; Humans ; Massage ; Syncope

BACKGROUND: A large amount of attention in anorectal physiologic studies has been devoted to the diagnosis of fecal incontinence. The current study was designed firstly to assess the physiologic characteristics of fecal incontinence and secondly to analyze how the physiologic findings correlate with each other. METHODS: The physiologic findings of 47 patients (24 men and 23 women) were analyzed, retrospectively. Studies included anal manometry (n=38), anal electromyography/pudendal nerve terminal motor latency (PNTML) (n=30), and endoanal ultrasound (n=37). The degrees of continence were estimated by using continence grading scores (CGS) that ranged from 0 to 20 points based on the type and the frequency of incontinence. Control data were obtained from volunteers (n=23). RESULTS: The patients were categorized as having neurogenic (group I, n=25) or myogenic (group II, n=17) incontinence. Despite intensive investigations, unknown etiology was noted in 5 patients (10.4%). The CGS was not different between groups I and II. Pudendal neuropathy was found in 96% of group I and 37.5% of group II patients. Group I showed a higher value of PNTML than that of group II (2.96 1.0 msec vs. 2.07 0.48 msec, p=0.003). The CGS was proportional to the value of the PNTML in group I (r=0.476, p=0.01). However, no correlation was found between the mean PNTML and the CGS in group II. In the manometric parameters, there were no statistical differences between the values of the mean resting pressure (RP), the maximum RP, and the maximum voluntary contraction (MVC) between groups I and II. The MVC was inversely proportional to the CGS in group I (r= 0.616, p=0.02) and in group II (r= 0.664, p=0.02). No correlation was found between the PNTML and the manometric parameters. When we consider the presence of a defect or a scar as an abnormal anal ultrasound finding, such findings were more frequent in group II than in group I (group I, 20% vs. group II, 88%, p<0.001, Fisher's exact test). CONCLUSIONS: The value of the PNTML had relevance to the degree of symptoms in the patients with neurogenic incontinence. Specifically, the squeeze profiles of the manometric parameters were inversely related to the grade of incontinence. No correlation between the PNTML and the manometric parameters could be independently specified based on the etiology. Complementary examination by using the PNTML and anal ultrasound provided the only useful information to discriminate the etiology of incontinence.
Cicatrix ; Diagnosis ; Fecal Incontinence* ; Humans ; Male ; Manometry ; Physiology* ; Pudendal Neuralgia ; Retrospective Studies ; Ultrasonography ; Volunteers

In patients with myotonic dystrophy (MD), impairment of the conduction system is a common and progressive finding. However, only a few cases of MD with cardiomyopathy have been reported. Herein we report a case of MD with progressive non-ischemic cardiomyopathy and severe electrocardiographic abnormalities.
Adult ; Cardiomyopathies ; Electrocardiography ; Humans ; Myotonic Dystrophy

Ampullary adenoma is rare but clinically important because it is a premalignant lesion. Use of endoscopic gastroduodenoscopy has increased detection of adenoma of the major duodenal papilla. Endoscopic papillectomy is a promising technique to supplant surgical ampullectomy, because it is less aggressive and more stable. However, various complications include bleeding, perforation, pancreatitis and cholangitis. We describe pancreatic and biliary strictures associated with cholangitis, and bile reflux through the pancreatic duct to the minor duodenal papilla after endoscopic papillectomy. Pancreatic and biliary strictures have not been hitherto reported complications. We performed endoscopic papillary balloon dilatation, minor papilla papillotomy and inserted a drain tube through the accessory pancreatic duct.
Adenoma ; Ampulla of Vater ; Bile ; Bile Reflux ; Cholangitis ; Constriction, Pathologic ; Dilatation ; Hemorrhage ; Pancreatic Ducts ; Pancreatitis