A case of the traumatic avulsion of the penis in a 18 year-old male, which was resulted by accident while working in a flour mill, is presented.
Adolescent ; Flour ; Humans ; Male ; Penis*

Postoperative bleeding is a common complication in cardiac surgery using cardiopulmonary by- pass(CPB) and thrombocytopenia and platelet dysfunction, as well as inadequate surgical hemostasis are cited as a cause. To evaluate the effect of routine use of platelet to prevent postoperative bleeding, auther compared the patients with and without platelet administration of 1 unit/10kg. Routine coagulation tests(RCT) and Thromboelastographs were compared to evaluate the effects of CPB and platelet administration. Also postoperative bleeding amounts were compared. PT and aPTT of RCT were prolonged and fibrinogen was decreased after CPB with no effect with platelet administration. Platelet count was decreased after CPB and recovered in number reaching the pre-CPB level with platelet. R, K, and a of TEG parameters showed no differences after CBP even with platelet. MA, the index of platelet function, remained in the normal range and became hypercoagulable with platelet administration. There was no difference in bleeding amounts between two groups. According to the results, routine administration of platelet after CPB in cardiac surgery is not recommended.
Blood Platelets* ; Cardiopulmonary Bypass* ; Fibrinogen ; Hemorrhage ; Hemostasis, Surgical ; Humans ; Platelet Count ; Platelet Transfusion ; Reference Values ; Thoracic Surgery* ; Thrombocytopenia

For evaluating the boosting (anamnestic) effects of the most recent commercially produced plasma derived heat-inactivated hepatitis B vaccine (A. Co.), 117 adults with naturally acquired antibody to hepatitis B surface antigen (anti-HBs) were selected at random. In addition, out of case immunized at zero and 1 month, and boosted at 6 months (primary booting) by conventional vaccine (B.Co), inactivated by pepsin digestion and formalin treatment, 11 cases who showed elevated titer after primary boosting were also submitted to the study. The results were as follows: 1) Out of the 117 subjects with naturally acquired anti-HBs, 6(5.1%) showed isolated anti-HBs and the titers were below 10 ratio units (RU). Negative seroconversion was seen in 4 (3.4%) of the 117 cases at 12 months after the screening and, of these cases, 3 showed isolated anti-HBs below 10 RU (increased GMT, 28.04) at one month after primary booster injection with 3 microgram dose of A. Co. Vaccine at all, but 90% of the other subjects responded. 3) The anti-HBs titers of all the 11 cases who showed a rise of more than 10 RU (increased GMT, 28.04) at one month after primary booster injection by 20 microgram dose of B. Co. vaccine decreased at 19 months after the primary booster. And 3 subjects (27.3%) of the 11 reached negative seroconversion. All of the 11 cases, who had secondary booster injection with 3 microgram dose of A. Co. vaccine at 19 months after primary boosting, showed increased anti-HBs titer at least 20 RU or more (increased GMT, 57.72) at one month after the boosting. According to the above results in the anti-HBs screening survey for the purpose of immunization with hepatitis B vaccine, subjects with isolated anti-HBs below 10 RU should be regarded as being in an unimmunized state. In cases who are in risk circumstances, immunized primarily with a 20 microgram dose of B. Co. vaccine, a secondary booster injection should be given within 2 years after initiation of primary immunization and a 3 microgram booster dose of A. Co. vaccine can be reliably used.
Adult ; Digestion ; Formaldehyde ; Hepatitis B Surface Antigens* ; Hepatitis B Vaccines ; Humans ; Immunization* ; Mass Screening ; Pepsin A ; Plasma

Last spring, we experienced a case of frontal sinusitis with ocular deviation to lower lateral direction. This 49 year old male had complained of the ocular deviation with exophthalmos, visual disturbance and diplopia, since 5 months before. This case was recovered by external sinusotomy through superior nasal approach with remarkable results.
Diplopia ; Exophthalmos ; Frontal Sinus* ; Frontal Sinusitis* ; Humans ; Male ; Middle Aged

No abstract available.
Seoul*

The intrachoroidal changes in Harada's disease were studied by indocyanine green(ICG)angiography. ICG angiography using confocal laser scanning ophthalmoscope (Heidelberg Retina Angiograph, HRA)and fluorescein angiography were performed in 12 eyes of 6 patients during the acute stage before the initiation of corticosteroid treatment and recovery stage, and the findings were evaluated retrospectively. During the acute stage, early phase HRA images disclosed a dark background fluorescence in all eyes due to the diffuse filling delay and the vague contour of choroidal vessels. In the midphase, Intrachoroidal hyperfluorescence resulting from vascular leakage and scattered hypofluorescent spots were intermingled, and in some eyes patchy hypofluorescence representing focal filling defect was observed. These choroidal changes could be observed before any visible retinal changes appeared. During the recovery stage, choroidal filling was more rapid and choroidal vessels were more clearly visible. However the scattered hypofluorescent spots due to the blockage by the inflammatory precipitates were still observed in small numbers, and in some eyes focal vascular leakage remained. According to these findings, we hypothesize the pathogenesis of Harada`s disease as follows. Severe inflammatory precipitates and vascular leakage can make the choroid edematous with highly viscous fluid. It adds mechanical damage to choroidal vessels already injured by the inflammatory process, leading to reversible circulatory disturbances. The retinal pigment epithelium and the sensory retina may be damaged secondarily.
Angiography ; Choroid ; Fluorescein Angiography ; Fluorescence ; Humans ; Ophthalmoscopes ; Retina ; Retinal Pigment Epithelium ; Retinaldehyde ; Retrospective Studies

To evaluate the role of capsular polysaccharide (CPS) as a virulence factor, the interaction of V. vulnificus with mouse peritoneal macrophages and serum, which are involved in the clearance of bacteria from blood and other tissues, were examined. In this study, MO6-24/0 (wild strain; hemolysin- and capsule-positive), MO6-24/I' (acapsular spontaneous mutant), CVD 752 (acapsular transposon mutant), and CVD 707 (hemolysin-negative and capsule-positive mutant) were used. The strain with CPS (MO6-24/0 and CVD 707) were more resistant to phagocytosis by mouse peritoneal macrophages compared with acapsular strains (MO6-24/T and CVD 752), and the resistance to phagocytosis was not changed by serum opsonin in the capsular strains. Acapsular strains were more susceptible to serum bactericidal activity than the capsular strains through the classical complement pathway. MO6-24/0 strain were detected in blood, spleen, liver and lung at 4 hours after intraperitoneally infection, whereas CVD 752 were not detected. All tested strains could induced the transcription of inflammatory cytokine gene such as IL-1, IL-6, IL-10 and TNF-u, and their inductions were not decreased by cytochalasin B treatment. This results demonstrate that CPS of V. vulnificus plays an important role in V. vulnificus infection through interfering nonspecific host defense system such as blood clearance and phagocytosis.
Animals ; Bacteria ; Complement Pathway, Classical ; Cytochalasin B ; Interleukin-1 ; Interleukin-10 ; Interleukin-6 ; Liver ; Lung ; Macrophages, Peritoneal ; Mice ; Phagocytosis ; Spleen ; Vibrio vulnificus* ; Vibrio* ; Virulence*

PURPOSE: A gastroduodenostomy after a distal subtotal gastrectomy is known to have several advantage over a gastrojejunostomy. However, recently, anastomotic methods using an EEA stapler during a gastro duodenostomy have been developed and have been reported to be superior to manual anastomosis with respect to operative time and complications. Thus, we investigated the differences between a manual and a stapled gastroduodenostomy by comparing the clinicopatholoic features and clinical course. METHODS: From January to October 1999 at Korea University Guro Hospital, a gastroduodenostomy using an EEA stapler was performed on 30 gastric cancer patients after a distal subtotal gastrectomy. From January 1996 to December 1998, a manual anastomosis had been used on 40 patients at the same hospital. A retrospective analysis of these two groups was made with respect to patients, tumor, operation, post operative complications and clinical course. RESULTS: The mean age of the stapled group was older than that of manual group (62.3+/-8.4 vs 53.0+/-10.7 years), and most of the tumors were located at the antrum and the body. In the stapled group, the operative time was significantly shorter than I was in the manual group (205.0+/-20.0 vs 239.6+/-37.3 minutes, p<0.001), and there was no significant difference in the resection margin between the two groups. The time of nasogastric (NG) tube removal was earlier in the stapled group (4.8+/-0.8 vs 5.9+/-2.2 days, p=0.007), but no significant differences were observed with respect to the oral intake and the complication rate between the two groups. Anastomotic stenosis was observed in one case of manual group, but it was not significant. CONCLUSIONS: A gastroduodeno stomy using an EEA stapler has an advantage over conventional manual anastomosis with respect to operation time and NG tube removal, so this method can be employed safely in aged and generally morbid patients to improve the postoperative course.
Constriction, Pathologic ; Duodenostomy ; Gastrectomy* ; Gastric Bypass ; Humans ; Korea ; Operative Time ; Retrospective Studies ; Stomach Neoplasms*

It had heen emphasized the necessity for upper gastrointestinal endoscopic examinations in patients. Who has had gastrectomy and presents persisting gastrointestinal symptoms. This study was conducted to evaluate endoscopic findings and clinical symptoms in patients following gastrectomy. (continue...)
Gastrectomy* ; Humans

BACKGROUND: The initial history, physical examination, and ECG assessment should focus on identification of potentially serious noncardiac or cardiac disorders, including coronary artery disease, congestive heart failure, and electrical instability at the emergency room. additionally, it is essential to define disease severity, stability and need for emergency therpy. echocardiography is a useful tool for this purppose. especially Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic symptoms. So we evaluate the feasibility of the echocardiographic measurement by emergency physicain after short-term course. METHOD AND RESULTS: Twenty volunteers(10 male, 38.8+/-9.3 years) were included in the study for measurement of myocardial performance index and established parameters of ventricular function using conventional echo-Doppler methods. Myocardial performance index: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The most of mean values of echocardiogrphic parameters were not significantly different between those of cardiologist and those of emergency physicians(p<0.01). The duration for measuring myocardial performance index was shortest among echocardiographic parameters. the validity of echocardiographic parameters measured by emergency physicians was proved relatively good. CONCLUSION: It is proved to be feasible for emergency physician to perform echocardiographic evaluation of ventricular function after short-term course.
Coronary Artery Disease ; Curriculum* ; Echocardiography* ; Echocardiography, Doppler ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Heart Failure ; Humans ; Male ; Physical Examination ; Relaxation ; Ventricular Function*