The common bile duct and the duct of Wirsung cojoin at the level of the duodenum, forming the major. papilla of Vater. Existence of a double major papilla, i.e., two neighboring independent papillary structure:, is infrequent. In our endoscopy unit we have experienced one case of double papilla of Vater wherein canulation of the common bile duct and pancreatic duct could be accom plished through either orifice independently.
Common Bile Duct ; Duodenum ; Endoscopy ; Pancreatic Ducts

Urachal carcinoma is an uncommon neoplasm associated with a poor prognosis. We have encountered two another cases of urachal adenocarcinoma recently 5 years after our first report. The common sign of urachal cancer was painless hematuria. We diagnosed the specific site of origin preoperatively by means of computerized tomography. One patient was performed partial cystectomy and another was total cystectomy with double barrel ureterocutaneostomy. A brief review of the literature of urachal adenocarcinoma was also made.
Adenocarcinoma* ; Cystectomy ; Hematuria ; Humans ; Prognosis

Three cases of orbital rhabomyosarcoma are reported here. Histological studies comfirmed the lesion 1:0 be the alveolar type in all cases. This tumor is a rare disease entity in Orient than Europe and America and accordingly, rarely encountered in our ophthalmologic practice, although it is the commonest primary malignant orbital tumor in children. Of the three cases reported here one occurred in adu1t and the other two in children. Case I. This 15 month old male showed a swelling of the left upper lid toward the medial side for 2 months and visited to our hospital on March 10, '69 with complaints of progressive swelling on the region with ptosis. The eye ball was slightly displaced toward the lower temporal side and ocular movement is limitted to upward. On palpation, the childthumb sized tumor was palpable in the upper nasal portion of the orbit. On excision of the tumor, the mass was found to be originated from the superior oblique muscle. The mass round measuring 2.5 X 2.5 X 1.5 cm in size. Histological diagnosis was alveolar rhabdomyosarcoma without cross-striation. No follow-up could be done. Case II. This patient of 15 month old male showed a swelling on the right lower lid existed 6 months and visited to our hospital on September 8, '69. The physical examination revealed that the left eye and the other routine examinations were within normal limits. The right eye showed the swelling of the lower lid, congestion of the palpebral conjunctiva, limitted movement of the eye ball toward the lower side and a palpable bean-sized mass on the region. The excision of tumor was performed under the general anesthesia. This mass was attached with the inferior oblique muscle with no other recognizable adhesion seemingly originating from that muscle. The mass was round and oval in shape, measuring 2 X 2 X 1 cm in size, diagnosis was alveolar rhabdomyosarcoma. The post-operative follow-up studies were unavailable. Case III. This case in one of adult alveolar rhabdomyosarcoma. At the age of 25 years, this man showed a proptosis of the right eye associated with migrain like headache, ocular pain and visual disturbance. This symptoms existed 6 months and gradually increased in intensity. On the physical examination, the left eye was found to be normal. The skull and orbit x-ray and c.b.c. were with in normal limits. The right eye revealed about 5mm proptosis compared with left eye and the adult thumb sized tumor was palpated on the inner side of the lower orbital rim. The visual acuity was in zero. The right optic disc was edematous and elevated about 4.0 D. The pupil showed marked dilatation and the light reflex was abscent and ocular movement was markedly limitted and eye ball is deviated toward the upper side. Under the general anesthesia, the exenteration of the orbit associated with the removal of tumor was carried out with no untoward complications. Origin of the mass was the inferior oblique muscle penetrating to the deeper part of the optic foraman and optic nerve was surrounded by the tumor completely Histology confirmed alveolar rhabdomyosarcoma. Follow-up study was impossible.
Adult ; Americas ; Anesthesia, General ; Child ; Conjunctiva ; Diagnosis ; Dilatation ; Estrogens, Conjugated (USP) ; Europe ; Exophthalmos ; Headache ; Humans ; Infant ; Male ; Optic Nerve ; Orbit* ; Palpation ; Physical Examination ; Pupil ; Rare Diseases ; Reflex ; Rhabdomyosarcoma* ; Rhabdomyosarcoma, Alveolar ; Skull ; Thumb ; Visual Acuity

No abstract available.
Cell Adhesion* ; Ischemia* ; Microscopy, Video* ; Reperfusion*

The management of supracondylar fractures of the femur remains controversial. Most studies over the past twenty years have attempted to compare the results of non-surgical with those of surgical methods. Until a few years ago, conservative treatment was considered superior to internal fixation of supracondylar fractures of the femur. However, the development of new fixation devices and techniques have, according to several investigations, improved the results of the treatment of these fractures. The following clinical results were shown by analysis of 96 cases of supracondylar fractures of the femur treated in the Department of Orthopedic Surgery, Yonsei University, College of Medicine during the past 10 years from Jan. 1971 to Dec. 1980. 1. The prevalent age distribution was between 21 and 50 years of age (79.1%), and the ratio between males and females was 3.4:1. The most common cause of injury was car accidents (51.0%). 2. A classification of supracondylar fractures was unicondylar, simple supracondylar and intercondylar. Intercondylar which was subdivided into Type I, II-A, II-B, III according to Neer's classification. 3. Fifty nine patients (61.4%) were associated with injuries of other parts and the most frequent associated fracture was tibial fracture and the most common associated soft tissue injury was cerebral concussion or contusion. 4. The methods of treatment: conservative management by using skeletal traction for 34 cases, surgical treatment by open reduction and internal fixation for 58 cases and A-K amputation for 4 cases due to populiteral artery injury. 5. Fifty nine cases were suitable for result analysis. The satisfactory result of surgical treatment was 63.4% and conservative treatment was 50.0% respectively. The factors affecting the final results were Type of fracture, severity of injury, and rigid internal fixation. 6. The main complications of the supracondylar fractures of the femur were delayed union (10.2%), infection (10.2%), and traumatic arthritis (13.3%). 7. Finally, the results of treatment depend largely on anatomical reduction, rigid fixation, early joint motion.
Age Distribution ; Amputation ; Arteries ; Arthritis ; Brain Concussion ; Classification ; Clinical Study ; Contusions ; Female ; Femur ; Humans ; Joints ; Male ; Orthopedics ; Soft Tissue Injuries ; Tibial Fractures ; Traction

No abstract available in English.
Osteosarcoma

Congenital adrenal hyperplasia, especially due to steroid-12-hydroxylase(P450c21) deficiency, is one of the most common autosomal recessive inborn errors at adrenal steroidogenesis in Korean. Molecular genetic analysis has demonstrated that there are two steroid 21-hydroxylase genes, CYP21A1P and CYP21A2. The CYP21A2 gene encodes P450c21, whereas the CYP21A1P gene is a pseudogene. Since there is 98 percent homology between the CYP21A1P and CYP21A2 gene in nucleotide sequences, it has hampered the characterization of molecular defects in the CYP21A2 gene.In this study, efforts have been made to selectively PCR amplify the CYP21A2 gene and test feasibility of DNA microextraction from Guthrie card for prospective use of molecular screening. This study was also aimed at investigating deletion mutations in P450c21 deficient patients, as well as allele frequencies and average heterozygosity of exon 1 A/C polymorphism in Korean newborns. Genomic DNAs were obtained from Guthrie cards of 50 Korean newborns by microextraction method and these DNAs were analyzed by PCR-allele specific oligonucleotide(ASO) hybridization. First part of the CYP21A2 gene has been successfully amplified and digested by restriction enzyme using Taq I or Kpn I, subsequently run on 1.5% agarose gel to confirm its specificity. The anterior 1141 bp PCR product was utilized to examine the frequency and average heterozygosity of exon 1 A/C polymorphism in 100 alleles by ASO dot blot hybridization. Amplified genomic DNAs from four P450c21 deficient patients out of three families were screened by PCR to see if any one has complete deletion of the CYP21A2 gene.The results were as follows;1) The average 1230ng of genomic DNA was obtained form single semi-circled Guthrie card of 1/2 inch diameter by microextraction method, which has been successfully used for DNA analysis.2) The PCR amplified anterior 1141 bp product from the CYP21A2 gene was digested by Kpn I, generating 309 bp, 832 bp fragments, not by Taq I, indicating its specificity.3) The frequencies of exon 1 nucleotide 138 A/C polymorphism in Korean population were 0.81, 0.91 respectively, and average heterozygosity was 0.31.4) None of four P450c21 deficient patients turned out to carry complete deletion of the CYP21A2 gene based on selective PCR amplification of the CYP21A2 gene.In conclusion, dried blood spots from Guthrie card can be sued for DNA analysis because of easy sample collection, bandling, shipment, and DNA extraction feasibility. The selective PCR amplification of the CYP 21A2 gene will pave the way for molecular characterization in P450c21 deficient patients. The exon 1 A/C polymorphism can by efficiently used for molecular diagnosis of P450c21 deficiency in informative families, though it has a drawback of handling radioactive material.
Adrenal Hyperplasia, Congenital ; Alleles ; Base Sequence ; Diagnosis ; DNA ; Exons ; Gene Frequency ; Humans ; Infant, Newborn ; Mass Screening ; Methods ; Molecular Biology ; Polymerase Chain Reaction ; Prospective Studies ; Pseudogenes ; Sensitivity and Specificity ; Sepharose ; Sequence Deletion ; Steroid 21-Hydroxylase

Many procedures of quadricepsplasty were reported by Thompson (1944), Judet (1959), van Nes (1962), Nicoll (1963) and Hesketh (1963) in confining the indication of them for the strictly extra-articular origin of their causes. During the period of January 1979 to August 1979, 5 cases of stiff knee joints were surgically treated by means of arthrolysis and quadriceps release. The result were gratifying. The average gain of flexion was 119 degrees, and extension lag was absent except a case which had compression fracture of femoral condyle.
Fractures, Compression ; Knee Joint ; Knee

Mirizzi syndrom is a rare disorder characterized by obstruction of common hepatic duct due to impacted gallbladder neck or dystic duct stone and is an uncommon cause of obstructive jaundice. Authors experienced one case of Mirizzi syndrome mimicked lobulated intraductal tumor.
Gallbladder ; Hepatic Duct, Common ; Jaundice, Obstructive ; Mirizzi Syndrome ; Neck

No abstract available.
Biomarkers* ; Carcinoma, Hepatocellular* ; Hepatitis B* ; Hepatitis* ; Humans ; Korea* ; Prevalence*