To assess prophylatic antibiotic usage and the value of an intraoperative bile culture in biliary tract surgery, intraoperative bile cultures were taken in 276 biliary surgical patients during the period from Jan. 1991 to Dec. 1995. The results of bile culture, the isolation of organisms, susceptibility of the microorganisms to antibiotics, and the relationship between a positive culture and postoperative complications were analyzed. The positive culture rate was 56.5%, and the highest culture rate(100%) was seen in patients with combined stones in the gallbladder, the common bile duct and the intrahepatic duct. The most common gram negative microorganism was E. coli(44%), and Enterococcus was the most common among the gram positive microorganisms. The effective antibiotics for gram negative organisms were Amikacin, Gentamicin, Tobramycin, and Chloramphenicol; for gram positive organisms, they were Amikacin, Tetracycline, Gentamicin, and Tobramycin in order of effectiveness. The frequency of wound infection was larger in positive cultures(11.5%) than in negative cultures (2.5%), and the risk factors for positive cultures were old age, obstructive jaundice, a high serum SGOT/SGPT level, and previous biliary tract surgery. In conclusion, we recommend that prophylactic antibiotic treatment be done during the perioperative period for old patients with leukocytosis, obstructive jaundice, cholangitis, or a history previous biliary tract surgery. Antibiotic prophylaxis in biliary tract surgery reduces postoperative infectious complications.
Amikacin ; Anti-Bacterial Agents ; Antibiotic Prophylaxis* ; Bile* ; Biliary Tract* ; Chloramphenicol ; Cholangitis ; Common Bile Duct ; Enterococcus ; Gallbladder ; Gentamicins ; Humans ; Jaundice, Obstructive ; Leukocytosis ; Perioperative Period ; Postoperative Complications ; Risk Factors ; Tetracycline ; Tobramycin ; Wound Infection

Primary omental torsion is a rare condition and its etiology and pathogenesis remain unknown. It is very difficult even for general surgeon to differentiate this from other acute abdominal diseases, and so the most common preoperative diagnosis is acute appendicitis and the treatment of choice is resection of the affected organ. The authors experienced 7 cases of primary omental torsion at Holy Family Hospital since 1990 and review them retrospectively with other literatures. We conclude that omental torsion must be tried to find if there is serosanguious fluid or undescended omentum without pathology in peritoneal cavity during the emergency operation.
Appendicitis ; Diagnosis ; Emergencies ; Humans ; Omentum ; Pathology ; Peritoneal Cavity ; Retrospective Studies

Linear and whorled nevoid hypermelanosis(LWNH) is characterized by macules in streaks and whorls along Blaschko's lines, that are not preceded by inflammation. LWNH can present with various findings such as neurologic, musculoskeletal, ophthalmologic, facial and cardiac abnormalities. Intracranial lipoma is very rare condition, with an incidence of less than 1% of all intracranial tumors. We recently experienced a case of LWNH with intracranial lipoma of corpus callosum. We report this case with a brief review of the related literature.
Corpus Callosum ; Hyperpigmentation* ; Incidence ; Inflammation ; Lipoma*

Ovarian pregnancy is a rare form of ectopic pregnancy that is often difficult to diagnose. The diagnostic criteria were described in 1878 by Spiegelberg, which comprise that the pregnancy is in the ovary and does not involve the tube. Ovarian pregnancy occurs in the corpus luteum, and is usually accompanied with the rupture of the ovary and massive hemoperitoneum. It presents as a hemorrhagic ovary and frequently misdiagnosed as a ruptured corpus luteum. We have experienced a case of ovarian pregnancy and reviewed it briefly.
Corpus Luteum ; Female ; Hemoperitoneum ; Ovary ; Pregnancy ; Pregnancy, Ectopic* ; Rupture

PURPOSE: We wanted to estimate the prevalence and risk factors of overactive bladder(OAB) in Korean children who were 5-13 years of age, according to the definition of OAB. MATERIALS AND METHODS: A randomly selected cross-sectional study was conducted on 26 kindergartens and 27 elementary schools nationwide in Korea. There were 19,240 children; a parent was asked to complete the questionnaires, which included items about OAB and the children's voiding and defecating habits. OAB was defined as urgency with or without urge incontinence, and usually with an increased daytime frequency and nocturia(ICCS 2006, group A) or an increased daytime frequency(>8 times/day) and/or urge urinary incontinence with or without urgency (group B); its prevalence and associated factors were investigated. RESULTS: The response rate for the questionnaires was 85.84%. The overall prevalence of OAB was 16.59%(group A) and 18.79%(group B). For groups A and B, the prevalence of OAB decreased with age from 22.89% to 12.16% and from 40.44% to 9.60%, respectively(p=0.0001). The overall rate of wet and dry OAB was 26.97% and 73.03%, respectively. Compared to the normal group, the children with OAB had a higher prevalence of nocturnal enuresis(NE), constipation, fecal incontinence, a history of urinary tract infection and delayed bladder control in both groups A and B(p<0.05). The rate of increased daytime frequency and urge incontinence were 3.69% and 2.31%(p=0.009), and 26.97% and 14.78%(p=0.0001) in group A and for the non-OAB children, respectively; their prevalence in group A decreased with age from 5.04% to 3.06% and from 45.74% to 18.50%, respectively(p=0.0001). CONCLUSIONS: The overall prevalence of OAB in group A for Korean children 5-13 years of age was similar to that in group B. However, the range of prevalence in group B was much more variable than that in group A. NE, constipation, fecal incontinence, a history of urinary tract infection and delayed bladder control may be risk factors for OAB in children.
Child ; Constipation ; Cross-Sectional Studies ; Fecal Incontinence ; Humans ; Korea ; Parents ; Prevalence ; Risk Factors ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence ; Urinary Incontinence, Urge ; Urinary Tract Infections

Carcinoid tumor primarily affects the intestinal tract, which arise from the Kulchitsky cells found at the base of the crypts of Lieberk hn. Rectal carcinoids are relatively uncommon lesions, representing only 1.3 percent of all rectal tumors. Rectal carcinoids have benign course and are usually asymptomatic. While their prognosis is generally favorable, it is known that about 15% of these tumors metastasize. Rectal carcinoid tumors should be treated appropriately and aggressively when indicated. Present-day treatment programs call for radical cancer resection only for lesions larger than 2 cm in diameter and local resection for all others. We have experienced a case of carcinoid tumor of the rectum treated by endoscopic polypectomy.
Carcinoid Tumor* ; Prognosis ; Rectal Neoplasms ; Rectum*

BACKGROUND: Autologous peripheral hematopoietic stem cell transplantation (APBSCT) has been widely used to treat various types of hematological disorders, metabolic diseases and congenital immunodeficiency. Hematopoietic recovery is important because prolonged duration of neutropenia and thrombocytopenia is associated with a higher risk of infection, bleeding and treatment related mortality. Many investigators have studied the factors that affect hematopoietic recovery after stem cell transplantation. METHODS: We retrospectively investigated the factors influencing hematopoietic engraftment in 112 patients with hematological malignancies and solid tumors who received APBSCT. We evaluated the gender, age, CD34+ cell number, conditioning regimens, and the type of tumor and their association with neutrophil and platelet engraftment. RESULTS: Post-transplant neutrophil engraftment (>500/microL) required a median of 11 days (range 6~50) and platelet engraftment 12 (range 1~78) days (>20,000/microL). The univariate analysis showed that the factors that positively affected hematopoietic recovery were: the type of conditioning regimens such as BEAM (BCNU, etoposide, cytosine arabinoside, melphalan) and BEAC (BCNU, etoposide, cytosine arabinoside, cyclophosphamide) versus BC (busulfan, cyclophosphamide), the CD34+ cell number and the disease diagnosis such as multiple myeloma versus acute myelogenous leukemia. The multivariate analysis showed only the CD34+ cell number (5~10 x 10(6)/kg) to be significantly associated with early neutrophil and platelet engraftment (P<.001). CONCLUSION: These findings suggest that measurement of the CD34+ cell count may be sufficient to predict the time to engraftment after APBSCT.
Blood Platelets ; Cell Count ; Cytarabine ; Diagnosis ; Etoposide ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Hemorrhage ; Humans ; Leukemia, Myeloid, Acute ; Metabolic Diseases ; Mortality ; Multiple Myeloma ; Multivariate Analysis ; Neutropenia ; Neutrophils ; Research Personnel ; Retrospective Studies ; Stem Cell Transplantation ; Thrombocytopenia

BACKGROUND: Since 2001, the Ministry of Health and Welfare in Korea has designated muscular dystrophy (MD) to be a rare and intractable disease, and has ensured that patients with this condition obtain support from the National Health Insurance Corporation for their medical expenditure. However, the health-related and socioeconomic status of Korean patients with MD has yet to be established. METHODS: We selected 441 patients with MD who received medical services at 17 neuromuscular centers during 2005. The medical records of selected patients were analyzed, and the subtype of MD was classified by its clinical course and diagnostic tests. A total of 95 patients or their family members participated in this health-related and socioeconomic status survey. RESULTS: Medical record analysis showed similar clinical and diagnostic characteristic data to those published previously in other countries: male predominance, being young at onset, and muscular weakness of the extremities as a predominant symptom in most patients. The diagnostic tests for MD were based on laboratory and electrophysiological studies. The most frequent form of MD among our cohort was Duchenne/Becker muscular dystrophy (42%). Our survey revealed the effect of the patients' profound disability on their activities of daily living. One-half of the patients were dissatisfied with the medical expenditure support service that was made available to them, and most patients suffered from a financial burden. The most important medical services to be developed in the future are expansion of the public health service or development of a rehabilitation hospital. CONCLUSIONS: This is the first multicenter-based epidemiologic study on the health-related and socioeconomic status of patients with MD in Korea. The findings indicate that medical coverage and public health service are currently inadequate and hence should be expanded in the future.
Activities of Daily Living ; Cohort Studies ; Diagnostic Tests, Routine ; Epidemiologic Studies ; Extremities ; Health Expenditures ; Humans ; Korea ; Male ; Medical Records ; Morphinans ; Muscle Weakness ; Muscular Dystrophies ; National Health Programs ; Social Class ; United States Public Health Service