No abstract available.
Foreign Bodies*

Primary peptic ulcer disease in not known to be the result of underlying illness or trauma. These are most frequently duodenal or prepyloric. Since clinical features of peptic ulcer in children can easily be confused with many other disorders, the diagnosis is usually made when one of the more dramatic presentations, such as perforation, bleeding and obstruction. Recently, we experienced 2 cases of duodenal obstruction due to peptic ulcer in children. So, we report it with review of references.
Child* ; Diagnosis ; Duodenal Obstruction* ; Hemorrhage ; Humans ; Peptic Ulcer*

No abstract available.
Bone Regeneration* ; Bone Substitutes*

While the microbiology of cellulitis in the pediatric population and systemic diseases(DM, Cirrhosis, etc) is well known,the causative bacteria and clinical aspect of cellulitis in young adults are less descrihed. this study was undertaken to identify the causative organisms and clinical aspect of adult cellulits. We analysed 121 medical records of 115 young adult patients with cellulitis who had been admitted at the department of orthopaedic surgery, National Police hospital from Jan. 1994. to Dec. 1996. The results were as follows. 1. The age of patient was between 21 yrs and 25 yrs, and the sex of all patients was male. 2. The lower leg and foot were the most frequently involved site of cellulitis as 92 cases(74.2%). 3. The potals were suspected in 65 cases(56.5%),of them, traumas were detected in 43 cases(66.1%), non-traumatic skin lesions in 23 cases(33.9%). 4. In most cases, initial systemic symptoms (fever, chill, headache, etc.) and local symptoms (local heating, tenderness, etc.) were found. 5. The laboratory findings revealed leukocytosis in 19%, elevated ESR in 94%, positive CRP in 80%. 6. Microorganism were detected in 16 of 38 pus cultures. Gram positive microorganisms were detected in 15 of 16 cases culture positive. 7. 6.7% of patients with cellulitis experienced recurrence in same lesions. In conclusion, the retrospective analysis of 115 young adult patients with cellulitis showed that primary cause of young adult cellulit was circulatory disturbance and lymphatic obstruction of the lower extremities most often involved by trauma. therefore, supportive treatments such as rest,elevation,ice packs are considered prior to antibiotic treatment.antibiotic treatment aimed at gram-positive cocci appears to be sufficient.
Adult ; Bacteria ; Cellulitis* ; Fibrosis ; Foot ; Gram-Positive Cocci ; Headache ; Heating ; Hot Temperature ; Humans ; Leg ; Leukocytosis ; Lower Extremity ; Male ; Medical Records ; Police ; Recurrence ; Retrospective Studies ; Skin ; Suppuration ; Young Adult*

PURPOSE: Whereas cyclosporine is increasingly used not only in transplantation but also in autoimmune disorders, it may be associated with several side effects. Gingival hyperpalsia is one of the most frequent side effects and has been estimated to occur in 21-30% of all patients receiving the drug and may require surgical correction. Azithromycin is a macrolide antibiotics reported to coincidentally reduce gingival hyperplasia in renal transplant recipients treated for respiratory infections. To confirm the effect of azithromycin in cyclosporine induced gingival hyperplasia we tried clinical use of azithromycin in renal transplant patients with severe gingival hyperplasia. METHODS: Patients (n=9) with cyclosporine induced gingival hyperplasia were selected and took azithromycin for 5 days. Follow-up visits were conducted at week 4 and week 8. Changes in gingival hyperplasia were evaluated by measuring the ratio of clinical crown height and width in each of the four central incisors. RESULTS: Significant improvements were observed in periodontal measurement. The pre-treatment ratio of clinical crown height and width was 1.04+/-0.14 and it was increased to 1.17+/-0.16 in 4 weeks and 1.22+/-0.15 in 8 weeks. 88.9% (8/9) of patients reported an improvement in clinical symptoms. Azithromycin was tolerated and 77.8% (7/9) of patients reported that the treatment was at least somewhat useful. CONCLUSION: Azithromycin treatment for cyclosporine induced gingival hyperplasia is efficacious, cost effective, and has less morbidity compared with gingivectomy.
Anti-Bacterial Agents ; Azithromycin* ; Crowns ; Cyclosporine ; Follow-Up Studies ; Gingival Hyperplasia* ; Gingivectomy ; Humans ; Incisor ; Respiratory Tract Infections ; Transplantation*

PURPOSE: Iliac vein compression syndrome (IVCS), first characterized by Cockett and Thomas in 1965, is the development of iliofemoral deep venous thrombosis due to compression of the left common iliac vein against the spine and pelvic brim by the right common iliac artery. Thrombectomy treatment of the underlying compression is essential if significant long-term sequelae are to be avoided. Surgical treatment options include venous reconstruction or venous bypass, but treatment using endovascular techniques have recently been described. This study was conducted to evaluate the usability of endovascular treatment (esp. thrombolysis with stent insertion) in a venous outflow obstruction resulting from IVCS. METHOD: During a 2-year period, 20 patients (17 women, 3 men; mean age, 60 years) presented with clinical and imaging findings consistent with IVCS. All patients presented with leg edema or pain. The mean duration of symptom onset was 6.6+/-4.4 days, ranging from 1 to 15 days. All patients were evaluated using a Duplex scan, computerized tomography and venography. After the ascending venography had been performed, an infusion catheter system was placed, and urokinase infused locally into the thrombus burden. After near complete clot dissolution, the residual left common iliac vein stenosis was treated by means of angioplasty and the placement of a Wallstent. All patients continued to receive oral warfarin. Patients were followed-up by means of clinical visits, and the stent patency was assessed by means of a Duplex scan or computerized tomography. RESULT: The total dose of urokinase used and the duration of infusion were 2.28+/-0.93 million unit, ranging from 1.00 to 5.20 and 46.8+/-14.8 hours, ranging from 14 to 72 hours, respectively. Grade III (complete lysis) thrombolysis was achieved in 17 patients. All 17 patients successfully received a Wallstent. The initial clinical success was 100%, with complete resolution of symptoms in all patients. One patient, with combined ovarian cancer, had a recurrent symptomatic deep vein thrombosis and complete occlusion of the stent due to thrombosis 2 months after treatment. However, no other patients showed evidence of deep vein thrombosis after treatment. The overall patency rate of the stenting at 18 months was 94.1%. There were no deaths, pulmonary embolism, cerebral hemorrhage or major bleeding complications. CONCLUSION: These results suggested that the treatment of iliac vein compression syndrome, using catheter directed thrombolytic therapy and venous stent insertion, was a safe and effective method at the mid term evaluation. These patients will continue to be followed up with screening tests to further define the long-term patency.
Angioplasty ; Catheters ; Cerebral Hemorrhage ; Constriction, Pathologic ; Edema ; Endovascular Procedures ; Female ; Hemorrhage ; Humans ; Iliac Artery ; Iliac Vein* ; Leg ; Male ; Mass Screening ; May-Thurner Syndrome* ; Ovarian Neoplasms ; Phlebography ; Pulmonary Embolism ; Spine ; Stents ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis ; Warfarin

PURPOSE: The main object of treatment in chronic occlusive arterial disease is to increase blood flow and to prevent progress of ischemic ulcer. In case of the symptoms and signs such as rest pain, ischemic ulcer and gangrene with poor angiographic distal run-off, conservative medical treatment is recommended. Argatroban (Novastan(R) ) has an arginine structure, is the first selective antithrombin in the world, showing the inhibitory effect of thrombin-induced fibrin formation, platelet aggregation and vasoconstriction. METHOD: From September 1995 to January 1999, 39 patients with chronic arterial occlusion as subjects, ulcers, resting pain and feelings of coldness participated in Novastan treatment in 3 institutions (Department of Surgery, Yeungnam University College of Medicine, Department of Surgery Vascular Division, Ulsan University College of Medicine and Asan Medical Center, Department of Surgery, Gachon Medical School) and 30 patients completed the study:thromboangitis obliterance (TAO) in 19 and atherosclerosis obliterans (ASO) in 11 cases. Administration dose was 20 mg (2 amples, q.d or b.i.d) and medicated for consecutive 4 weeks. To detect the changes of symptoms, ulcer size and occurrence of side effects, inquiries, photography and laboratory tests were checked at prior to medication and 2, 3 and 4 weeks after medication. RESULT: There were 29 men and 1 women, ranging in age from 18 to 80 years old with mean of 50 years old and in body weight from 44 to 86 kg with mean of 64 kg. Improvement rate on ulcer size and granulation appearance was 73.3% (22 cases/30) and 86.7% (26 cases/30) respectively. General improvement rates were 76.7% (23 cases/30), general safety rates were 97.4% (38 cases/39), and utility rates were 70.0% (21 cases/30). Side effects were observed in 3 cases (7.7%), and abnormal changes in laboratory tests were observed for 15 items in 9 cases. But there noted no significant side effects and abnormalities in laboratory tests. CONCLUSION: Argatroban had a beneficial effect in improving such clinical symptoms as ischemic ulcer, resting pain and the feeling of coldness, accompanying chronic arterial occlusion, it causes no serious side effects and it shows high clinical utility.
Aged, 80 and over ; Arginine ; Atherosclerosis ; Body Weight ; Chungcheongnam-do ; Female ; Fibrin ; Gangrene ; Humans ; Male ; Middle Aged ; Photography ; Platelet Aggregation ; Ulcer ; Ulsan ; Vasoconstriction

PURPOSE: This study was designed to determine the clinical factors affecting the long-term graft patency of leg arterial bypass for the patients with chronic lower limb arterial occlusion. METHOD: The clinical data of 81 femoro-distal bypasses performed at Yeungnam University Hospital from January 1996 to December 2002 were included for this retrospective study. A Log-Rank test of Kaplan-Meier method and Cox proportional hazard analysis were performed to identify those main effects that were predictive of graft patency. The patients, 79 males and 2 females, ranged from 37 to 81 years of age, with a mean age of 64. The highest incidence occurred among those in their 60s and 70s. Associated diseases were hypertension in 42 cases (51.8%), diabetes mellitus in 15 (18.8%), cardiac disease in 26 (32.1%) and cerebrovascular disease in 6 (7.4%). A history of smoking was noted in 76.5% of the cases. As for the clinical grades of chronic limb ischemia according to SVS/ISCVS classification, 21 limbs (25.9%) were classified as grade I (category 3), 40 (49.4%) as grade II, and 20 (24.7%) as grade III. The site of distal anastomosis was above the knee popliteal artery in 53 limbs (65.4%), below the knee popliteal artery in 8 (9.9%) and tibial artery in 20 (24.7%). As bypass conduit, autologous vein graft was used in 67 limbs (82.7%) and polytetrafluoroethylene (PTFE) graft in 14 (17.3%). There were no hospital mortalities or major perioperative complications. RESULT: From the univariate analysis of 21 clinical variables (age, sex, smoking, hypertension, diabetes mellitus, coronary arterial disease, congestive heart failure, chronic pulmonary disease, cerebrovascular disease, malignancy, hypercholesterolemia, clinical grade of chronic limb ischemia by SVS/ISCVS, level of occlusion, preoperative ankle-brachial index, type of graft, site of distal anastomosis, operation time, status of inflow artery, postoperative ankle-brachial index, clinical outcome criteria by SVS/ISCVS, postoperative anticoagulation therapy), 5 factors were identified as being associated with long-term graft patency: preoperative clinical grade (P=0.03), preoperative ankle-brachial index (P=0.00), level of occlusion (P=0.03), type of graft (P=0.00) and clinical outcome criteria (P=0.00). In multivariate analysis, type of graft, PTFE graft (vs. autologous vein graft, P=0.002), and clinical outcome criteria, minimally improved (vs. moderately, and markedly improved, P=0.029), showed a lower graft patency rate. CONCLUSION: These results suggest that autogenous vein is more acceptable for leg arterial bypass and poor early clinical outcome predicts poor long term graft patency rate.
Ankle Brachial Index ; Arteries ; Classification ; Diabetes Mellitus ; Extremities ; Female ; Heart Diseases ; Heart Failure ; Hospital Mortality ; Humans ; Hypercholesterolemia ; Hypertension ; Incidence ; Ischemia ; Knee ; Leg ; Lower Extremity ; Lung Diseases ; Male ; Multivariate Analysis ; Polytetrafluoroethylene ; Popliteal Artery ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Tibial Arteries ; Transplants* ; Vascular Patency ; Veins

In 40 patients with aortic regurgitation(AR), the incidence of reverse doming of anterior mitral leaflet was studied by 2-D echocardiography. Reverse doming could be indentified in 17 of 18 patients(94.4%)with severe AR, in 6 of 15 patients(14.3%)with mild AR. And in relation to the direction of regurgitant jet, reverse doming was noticed in 9 of 11 patients(82%) toward the center of left ventricular cavity. In conclusion, the appearance of reverse doming of anterior mitral leaflet is thought to be related to the degree of AR and the direction of regurgitant jet. And reverse doming by 2-D echocardiography is a helpful parameter for the diagnosis of moderate to severe AR.
Aortic Valve Insufficiency* ; Diagnosis ; Echocardiography ; Humans ; Incidence

BACKGROUND: We investigated the interactions between spontaneous apoptosis-induced neutrophils and autoantibodies with attention to the reactivities of each autoantibody against intracellular antigenssuch as the antinuclear antibody (ANA) and the anti-neutrophil cytoplasmic antibody (ANCA) and the applicability as a conventional test for autoantibody detection. METHODS: The 127 serum samples from patients with autoimmune disease were mixed with whole blood from healthy donors and incubated for 20 hours. The bound antibody against substrate neutrophils was detected with anti-IgG-FITC by flow cytometry. The results of this anti-long incubated neutrophil antibody (ALINA) testing were compared with ANA, ANCA and clinical manifestations. RESULTS: The positivity rate was significantly higher in the 20 hour incubation than that of a 30 minute incubation (100% and 18%, respectively; P<0.000005). Agreement analyses between ANCA and ALINA (k=0.34) and between ANA and ALINA (k=0.39) were poor. In comparison, among the autoimmune diseases, systemic lupus erythematosus had a significantly higher ALINA positivity rate than did other diseases (P<0.000005). In patients with SLE, higher mean fluorescence intensity was significantly associated with the presence of lupus nephritis (11/12 cases vs. 2/10 cases, P<0.005). CONCLUSIONS: We detected antibodies against neutrophil antigens expressed by long incubation with patient sera. Those detected autoantibodies were significantly associated with SLE, especially lupus nephritis. Therefore, further studies are necessary to devise optimal protocols and to clarify specificities for detected autoantibodies or their target antigens.
Antibodies* ; Antibodies, Antineutrophil Cytoplasmic ; Antibodies, Antinuclear ; Autoantibodies ; Autoimmune Diseases ; Flow Cytometry* ; Fluorescence ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Neutrophils* ; Tissue Donors