There are many established roentgen signs of ascites such as hepatic angle sign, generalized graying of the abdomen, frog belly appearance and Hellmer's sign. These signs are easily recognized in the standard flat abdomen film. It is however hardly possible to recognize such signs in small films of double contrasted upper GI series. By a retrospectroscopical observation we were able to find some interesting signs of massive ascites in small size films of double contrasted stomach and duodenum of upper GI series. The clinical materials consisted of 27patients with massive ascites and 30 normal subjects. The signs we observed were ;(1) Constriction deformity of the junction of the fundus and body of the stomach. We named this "waist" sign. This constriction was attended by convergence of mucosal folds. We called this "converging folds" sign. (2) The fundus assumed electric bulbappearance with its long axis directed vertically. We called this "electric bulb" sign. In normal subjects the fundus assumed beret-cap like appearance. These signs were only appreciated in the supine and RAO views and not in other views. Of these new signs of massive ascites where fundic view was obtained in supine or RAO position.
Abdomen ; Ascites ; Congenital Abnormalities ; Constriction ; Duodenum ; Stomach

Helicobacter pylori (H. pylori) has been recognized as a main cause of gastritis and most cases of peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. An immunological response to H. pylori infection has been suggested to play a major role in determining gastroduodenal damage through the production of cytokines and the autoantibody against gastric epithelial cell. H. pylori has been implicated in the pathogenesis of some autoimmune disease, such as Sjogren disease, Henoch-Schnlein purpura, rheumatoid arthritis, autoimmune thyroid disease, and idiopathic thrombocytopenic purpura (ITP). Serveral studies recently showed a high prevalence of H. pylori infection in patients with ITP and reported a platelet recovery after bacterial eradication therapy. We report a case of a 54-year-old man with chronic ITP who was resolved after eradication of H. pylori.
Adenocarcinoma ; Arthritis ; Autoimmune Diseases ; Blood Platelets ; Cytokines ; Epithelial Cells ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Lymphoma, B-Cell, Marginal Zone ; Middle Aged ; Peptic Ulcer ; Prevalence ; Purpura, Schoenlein-Henoch ; Purpura, Thrombocytopenic, Idiopathic* ; Thyroid Diseases

In an effort to characterize the trend of renal injury of recent years, we reviewed the charts and x-ray films of 50 patients with renal trauma which occurred in the last 6 years. They were 42 males and 8 females with a mean age of 26.4 years (range: 5 to 66) and most of them are younger generation. The main causes of injury were related to falling down in 21 cases (42%) and traffic accident in 17 cases (34%), followed by stab injury in 7 cases and assault in 5 cases. The severity of renal injury was classified using the renal injury scale which was published by the Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) in 1989. According to radiologic and operative findings, they were classified as follows; Grade I, 4 cases; Grade II, 7 cases; Grade III, 12 cases; Grade IV, 23 cases; and Grade V, 4 cases. Of the 50 patients, 39 had gross hematuria and remaining 11 patients had microscopic hematuria. There was no correlation between the degree of hematuria and the severity of renal injury (p=0.098). The major combined other organ injuries were hemoperitoneum in 12 cases, fracture of extremities in 8 cases, liver laceration in 5 cases, hemopneumothorax in 4 cases and intestinal perforation in 2 cases. Surgical treatment was performed in 27 cases (54%) and the remaining 23 cases (46%) which were renal laceration of various degrees without intraperitoneal injuries were managed conservatively.
Accidents, Traffic ; Extremities ; Female ; Hematuria ; Hemoperitoneum ; Hemopneumothorax ; Humans ; Intestinal Perforation ; Kidney ; Lacerations ; Liver ; Male ; X-Ray Film

Oral cholecystography is one of the most relible and widely used x-ray examination which enables us to observe not only morphological features of the gallbladder (GB) but also its functioning state. It was disclosed that functional evaluation of the GB is mandatory to recognize such kinetic disorders of the viscus as acalculous cholecystitis or dyskinesia. For the purpose of functional evaluation, fat meal has been used traditionally. Recently, cholecystokinin(CCK) and ceruletide were introduced into clinical diagnosis of the GB, the usefulness of which we have confirmed. In the present study we have made an attempt at improving cholecystagogic effect of conventional fat meals(FM) such as whole mild and egg yolk by changing the posture of the examined from sitting up to right decubitus position after the ingestion of fat meal. The hypothesis involved in this study is that the presence of quantitatively more fat meal in the duodenum per unit time may result in more effective cholecystagogic action and such a setting would be created by enhancement of pyloric passage of fat meal by decubitus posturing. Clinical materials consisted of 280 normal oral GB series (136 males and 144 females) andthey were divided into 4 equally numbered groups of mild sitting and mild decubitus and egg sitting and eggdecubitus. Upon confirming satisfactory opacification of the GB 11 hours after the ingestion of 3g of sodiumipodate or iopanoci acid either 2 pieces of medium sized hen's egg yolk were given. The xaminess were then allowed either sitting up comfortably on a bench or lying down on the right flank on a couch. After the ingestion of fat mean, x ray was taken at the end of 30 minutes in all but the mild decubitus group in which x rays were taken serially at the end of 5, 15, 30 and 60 minutes. The frontal area of each opacified GB was measured by using aplanimeter and the contraction rate before and after fat meal stimulation was calculated by the following equation and delineation of the biliary tree was analyzed in each group. Contraction rate (%) = (1
Acalculous Cholecystitis ; Biliary Tract ; Ceruletide ; Cholecystography ; Deception ; Diagnosis ; Duodenum ; Dyskinesias ; Eating ; Egg Yolk ; Gallbladder ; Humans ; Male ; Meals ; Ovum ; Posture

A case of congenital periureteral bladder diverticulum is described. Bladder outflow obstruction and urinary tract infection were the presenting symptoms of a 2 year old boy. There were two diverticula in the bladder. The one was small (1 x 2cm) and located just above the right ureteral orifice and the other was large (8 x 10cm) and located at the left trigone. There was no hydronephrosis, and vesicoureteral reflux, neither. A simple diverticulectomy was performed. The left ureteral orifice was found at the medial side of the diverticulum's neck during operation. During follow up, bilateral high grade vesicoureteral reflux were discovered and urinary tract infections developed frequently. Eventually, ureteral reimplantation was done one year after the diverticulectomy.
Child, Preschool ; Diverticulum ; Follow-Up Studies ; Humans ; Hydronephrosis ; Male ; Neck ; Replantation ; Ureter ; Urinary Bladder ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

We report an unusual case of clitoral hypertrophy due to neurofibromatosis of external genitalia. The patient also had definite skin lesions and family history. The patient was treated successfully by clitorectomy. The patient seems to be the first case of clitoral neurofibromatosis reported in Korean literature.
Circumcision, Female ; Clitoris ; Female ; Genitalia ; Humans ; Hypertrophy ; Male ; Neurofibromatoses* ; Skin

BACKGROUND: Hepatocellular carcinoma remains a highly chemoresistant neoplasm and is a common malignancy with poor prognosis in Korea. We performed a phase II study to evaluate the efficacy and toxicities of topotecan and cisplatin combination chemotherapy for advanced hepatocellular carcinoma. METHODS: Between November 1999 and May 2001, ten patients with histologically proven hepatocellular carcinoma were enrolled in this study. The median age was 54 (range: 53~74) years and all were male. Six patients demonstrated stage IV, 1 stage IIIC, 2 stage IIIB and 1 stage IIIA. Six patients showed a ECOG performance status of 1. The treatment regimen consisted of topotecan 1.25 mg/m2 and cisplatin 20 mg/m2 for 5 days. The treatment was repeated every 4 weeks. Toxicities were evaluated according to WHO toxicity criteria. RESULTS: All ten patients were evaluable for response and toxicity. There was only one patient who achieved partial response. The overall response rate was 10% (95% C.I.) and the response duration was 46 weeks. The median survival of all patients was 21 (range: 17~54+) weeks. During a total of 24 cycles, neutropenia of WHO grade 3 and 4 occurred in 33%, thrombocytopenia in 33% and anemia in 21%. In non-hematologic toxicity, diarrhea and hepatoxicity of grade 3 occurred in 1 and 2 patients, respectively. But there was no treatment-related death. CONCLUSION: When used in this dose and schedule, topotecan and cisplatin combination chemotherapy does not seem to be effective for patients with advanced hepatocellular carcinoma.
Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Carcinoma, Hepatocellular/*drug therapy ; Cisplatin/*administration & dosage ; Human ; Liver Neoplasms/*drug therapy ; Male ; Middle Aged ; Topotecan/*administration & dosage ; Treatment Outcome

BACKGROUND: To evaluate the efficacy and safety of paclitaxel and cisplatin against advanced non-small cell lung cancer (NSCLC) as a second-line chemotherapy. SUBJECTS AND METHODS: Twenty-five patients were enrolled. The patients received 200 mg/m2 paclitaxel as a 3-hour intravenous infusion and 60 mg/m2 cisplatin as 30-minute intravenous infusion with vigorous hydration on day 1 every 28 days. The response was assessed every 2 cycles. RESULTS: All 25 patients were assessed for their response and toxicity. Partial responses were observed in 5 patients. The overall response rate was 20% (95% confidence interval, 4%~36%) and the median response duration was 4.5 (range, 2-11) months. The median time to progression was 3.3 (range, 0-14) months. The median overall survival of all patients was 7.4 (range, 1.3-39) months. The hematologic toxicities were minor and easily controlled. CONCLUSION: The combination chemotherapy of paclitaxel and cisplatin as a second-line treatment has a moderate efficacy with an acceptable toxicity in patients with advanced NSCLC.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy* ; Drug Therapy, Combination ; Humans ; Infusions, Intravenous ; Paclitaxel*

Until now, we do not have specific Korean data on the age related prostatic volume and voiding symptoms associated with prostatic volume among randomized aged population. Due to this problem, we studied the correlations on the age, prostatic volume and voiding symptom among random sampled 255 people over the age 60 from the 11 Myun in Chinyang Gun, Kyungsangnam-do from the July 12th to July 26th, 1993. The mean age of the examined people was 71.5 years. 244 people answered on questionaire for voiding symptom scoring and 224 people agreed on the transrectal ultrasonic measurement of the prostatic volume. The prolate spheroid method and elliptical method were used for the measurement of the prostatic volume with the major transverse diameter, major anteroposterior diameter and cephalocaudal diameter of each prostates as Terris. The volume of the prostate ranged from 6.2cc to 54.5cc ( Prolate spheroid method ) and 4.7cc to 44.1cc(Elliptical method ). The prostate volumes measured by the elliptical method were smaller than that measured by prolate spheroid method in each age group. The average prostatic volume measured by the elliptical volume and prolate spheroid method were 17.7/22.5cc(E/P) in age 61 to 65 group(n=17), 19.9/22.8cc in age 66 to 70 group(n= 88), 21.6/ 26.0cc in age 71 to 75 group(n=71), 24.4/27.7cc in age 76 to 80 group(n=34) and 18.1/23.7cc in age over 80 group(n =14) and the pattern of the changes in the prostatic volume related with aging was significant(p <0.05 ). The voiding symptom scores were measured and divided according to the prostate volume into 3 groups, below 20cc, 20.1 to 30 and over 30cc groups. The voiding symptom scores ranged from 0 to 35 and the mean symptom scores were 10.9, 11.7 and 14.1 in each group and these changes were not statistically significant(p>0.05).
Aging ; Humans ; Phosmet ; Prostate ; Ultrasonics

BACKGROUND/AIMS: Immune thrombocytopenic purpura (ITP) is an autoimmune disease that is mediated by anti-platelet antibodies. Based on the pathogenesis of ITP we evaluated the efficacy of intravenous anti-D immunoglobulin for adult chronic ITP. METHODS: Fourteen patients (4 without splenectomy and 10 with splenectomy) with refractory chronic ITP were treated with 50-70 microgram/kg of intravenous anti-D immunoglobulin only once. Treatment effects were evaluated by measuring the platelet counts and hemoglobin levels. RESULTS: Five patients (36%) showed a response; improvement in the platelet count lasted for on average 7 days (range: 2~24 days). There were no serious adverse effects. CONCLUSION: Anti-D immunoglobulin, which is associated with an Fc receptor blockade, appeared to be safe and effective for the treatment of adults with chronic ITP. Further studies are needed to confirm these findings and define further potentially effective treatment protocols with intravenous anti-D immunoglobulin.
Adult ; Antibodies ; Autoimmune Diseases ; Clinical Protocols ; Hemoglobins ; Humans ; Immunoglobulins ; Isoantibodies ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; Receptors, Fc ; Rho(D) Immune Globulin ; Splenectomy