A clinical study was made on 52 patients (55 organs) with renal injuries in Capital Armed Forces General Hospital during the period from January, 1980 to May, 1982. Emphasis was placed on comparison of the expectant and early surgical management. Following results were obtained: 1. The nonpenetrating injuries were 45 cases (86.5%), penetrating, 7 cases (13.5%) and the most common cause of nonpenetrating injuries was traffic accident in 23 cases (44.2%) and the most common cause of penetrating injuries was gunshot in 6 cases (11.6%). 2. As to the management of nonpenetrating injuries, the expectant management was performed in 32 cases (71.1%) and early surgical management in 13 cases (28.9%). 3. All cases of penetrating injuries were managed with early surgical intervention. 4. As to the early surgical management in nonpenetrating injuries, nephrectomy was performed in 6 cases (46.2%), simple closure in 6 cases (46.2%) and partial nephrectomy in I case. 5. As to the early surgical management in penetrating injuries, nephrectomy was performed in 5 cases (71.4%), simple closure in 1 case and partial nephrectomy in I case. 6. In group of expectant management, gross hematuria disappeared at 2.7 days on an average. 7. In nonpenetrating injuries, complication were 6 cases (18.8%) after expectant management, while none, after early surgical management. 8. In penetrating injuries, complication were 2 cases (28.6%) after early surgical management. 9 As to the management of complication in nonpenetrating injuries, nephrectomy was performed in 4 cases (66.7%), deroofing of cyst in 1 case and expectant management in 1 case. 10. As to the management of complication in penetrating injuries, incision and drainage was performed in 1 case and colostomy in 1 case.
Accidents, Traffic ; Arm ; Colostomy ; Drainage ; Hematuria ; Hospitals, General ; Humans ; Nephrectomy ; Wounds, Nonpenetrating

A 47-year-old male with hypertension, diabetes mellitus and heavy smoking, but no anginal symptoms, presented with claudication of the lower extremities. Extremity angiography with coronary angiography revealed peripheral arterial lesions including a left subclavian artery occlusion with coronary artery disease. The patient underwent an initial off-pump coronary artery bypass with an ascending aorto-axillary bypass. The right internal mammary artery was anastomosed to the left anterior descending coronary artery. The greater saphenous vein graft was connected from the ascending aorto-axillary bypass graft to the diagonal branch. At postoperative day 18, femorofemoral and bilateral femoropopliteal bypasses were performed. We report a case of the combined repair of coronary artery disease and a left subclavian artery occlusion.
Angiography ; Coronary Angiography ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease* ; Coronary Vessels* ; Diabetes Mellitus ; Extremities ; Humans ; Hypertension ; Lower Extremity ; Male ; Mammary Arteries ; Middle Aged ; Peripheral Vascular Diseases ; Saphenous Vein ; Smoke ; Smoking ; Subclavian Artery* ; Transplants

A 76-year-old woman with a history of chest pain and palpitation, was diagnosed with bilateral coronary to pulmonary artery fistulae with a concomitant saccular aneurysm, which is quite rare. Suture closure of the fistular vessels around the pulmonary artery root, the removal of a saccular aneurysm, and the transpulmonary closure of coronary to pulmonary artery fistulae were performed. The patient was well at 4 months after surgery.
Aged ; Aneurysm* ; Chest Pain ; Female ; Fistula* ; Humans ; Pulmonary Artery* ; Sutures

The tibia is the most commonly fractured bone of all the long bones. In this age of vehicular accidents, the tibia is frequently subjected to high energy trauma. Anatomically the tibia has poor soft tissue coverage and poor blood supply. Therefore severe injury on the tibia can lead to severe complication and major disability. 41 adult patients with comminuted fracture of the tibial shaft were treated by OR/IF with D.C.P. and bone graft at the Department of Orthopedic Surgery, Kyungpook University Hospital from January 1978 to June 1986. These were analysed according to mechanism of injury, degree of comminution, timing of operation, soft tissue injury and operation time. Bone union and end results of treatment were reviewed. The results were as follows Of 41 cases, causes of injury were vehicular accident in 32 cases. 34 cases had associated injury on other part of body and average injury per case was 1.7 injuries. Based on the classification of Johner and Wruhs, the B group with butterfly fragment was 27 cases and C group was 14 cases. Among the B group, B2 was most common as 14 cases. Average union time was 18 weeks and delayed union and nonunion were 6 cases. Degree of comminution of fracture might be important fractor to bone union. According to the end result of Johner and Wruhs, excellent and good were 31, fair and poor were 10. Of the 41 cases, 10 cases had permanent disability. 4 cases had angular and rotational deformity alone and 1 case had shortening of tibia more than 1 cm, 1 case had both of them. Limited R.O.M. of ankle joint (>50%) occured in 4 cases. The post-operative infection occured in 6 cases, 3 were superficial infection but 3 cases were osteomyelitis. OR/IF with D.C.P. on comminuted tibial shaft fracture was a risk operation. Therefore proper method of treatment should be selected according to degree of comminution, timing of operation, presence or abscence of open wound and associated injury.
Adult ; Ankle Joint ; Butterflies ; Classification ; Clinical Study ; Congenital Abnormalities ; Fractures, Comminuted ; Gyeongsangbuk-do ; Humans ; Methods ; Orthopedics ; Osteomyelitis ; Soft Tissue Injuries ; Tibia ; Transplants ; Wounds and Injuries

Soft tissue defect on dorsum of hand requires immediate soft tissue cover to achieve early wound closure and to minimize wound infection and scarring. If the tendon or bone was exposed and the deep structures were absent, flap was required to provide adequate protection and allow proper function of the underlying structures. Small size in skin loss can easily be covered with local flaps but major defects involving the dorsal aspect of the hand should be coverd with distant flaps, free flaps or radial forearm flaps. Techniques in distant flaps require staged procedures and free flap transfer to obtain soft tissue cover in a single stage require microsurgical techniques. The reverse radial forearm flap is a fasciocutaneous flap based on the radial artery which together with its two venae comitantes lies invested in a condensation of the deep fascia known as the lateral intermuscular septum. The authors had treated 5 cases of distally based reverse forearm flap for soft tissue reconstruction on 2 patients of crushing injury with soft tissue defect on hand, a patient with Marjolin's ulcer on dorsum of hand due to previous burn scar and a patient with soft tissue necrosis on dorsum of both hands due to extravasation of adriamycin during chemotherapy. It has proved to be one of the saftest, simple and effective one-stage method of soft tissue reconstruction in hand without long term immobilization. The results of these operation in cover of soft tissue defect have been satisfactory.
Burns ; Cicatrix ; Doxorubicin ; Drug Therapy ; Fascia ; Forearm ; Free Tissue Flaps ; Hand ; Humans ; Immobilization ; Methods ; Necrosis ; Radial Artery ; Skin ; Tendons ; Ulcer ; Wound Infection ; Wounds and Injuries

The mortality and morbidity of peritrochanteric fractures in the elderly are great due to preexisting diseases, the osteoporosis, and poor general conditions. Since the complications sometimes lead to death, it is utmost important to reduce the complications and to prevent them. Authors had experienced 42 peritrochanteric fractures over 65 years old from January, 1988 to December, 1992. Age incidence was distributed from 65 to 93 years. The sites of fractures were 17 femoral neck, 24 intertrochanteric, 1 subtrochanteric. The mortality at postoperative 6 months was 10.2%. The postoperative complications were 6 cardiovascular diseases, 3 pneunonia, 3 pressure sore etc. The results according to interval between injury and operation were not significant, but reducing risk factors following check-up of general conditions was significant. It was necessary in treatment of elderly peritrochanteric fractures to check the general conditions, to reduce risk factors, to choose appropriate method of operation and anesthesia, and to operate as soon as possible by experienced surgeon. Postoperative early ambulation was also significant at good results. The percutaneous pinning under local anesthesia was an recommendable method in patients with severely poor general conditions.
Aged ; Anesthesia ; Anesthesia, Local ; Cardiovascular Diseases ; Early Ambulation ; Femur Neck ; Humans ; Incidence ; Methods ; Mortality ; Osteoporosis ; Postoperative Complications ; Preexisting Condition Coverage ; Pressure Ulcer ; Risk Factors

Capsule endoscope is self-contained videoendoscopy device that transmit images of the gastrointestinal tract to an external receiver. Capsule endoscopy has become a very important tool for diagnosing of small bowel disorders. Upcoming capsule endoscopy techniques for the investigation of esophageal, stomach, and colon may render it promising technique for these organs as well. This document is intended to provide the principles by which credentialing organizations may create practical guidelines for granting privileges to perform capsule endoscopy. KSGE recommends that the use of capsule endoscopy be limited to practitioners already competent and privileged to perform standard upper and lower endoscopy and who have extensive experience viewing gastrointestinal mucosa. KSGE recommends additional specific training in capsule endoscopy as well as review of the 20 procedures to verify competence. KSGE also admitted formal fellowship training having a familiarity with the hardware and software systems and interpretation of the at least 10 cases under the supervision of professor in capsule endoscopy during GI fellowship.
Capsule Endoscopes ; Capsule Endoscopy ; Colon ; Credentialing ; Endoscopy ; Endoscopy, Gastrointestinal ; Fellowships and Scholarships ; Financing, Organized ; Gastrointestinal Tract ; Mental Competency ; Mucous Membrane ; Organization and Administration ; Recognition (Psychology) ; Stomach

PURPOSE: Objective of this study is to determine changes in the levels of type I and III collagen in women with stress urinary incontinence (SUI). MATERIALS AND METHODS: Forty-nine women were enrolled to this study and e divided into two groups. Forty-four patients with SUI and 5 patients with without SUI for control. All the women were underwent a pre-operative evaluation. The presence of collagen type I and III was determined by immunohistochemical technique. Analysis of staining was studied with help of specialist of pathology with Image Pro computerized program. The student t-test was used for statistical analysis. RESULTS: Collagen type I and III was significantly reduced (p<0.05) in patients with SUI in anterior vaginal wall tissue. compared to patients in control. Both collagen type I and III were marked reduced in the patient of severe grade of stress urinary incontinence. However there were no significant relation between quantity of collagen and other etiological factors including age, parity, grade, and menopausal. CONCLUSION: In this study, women with SUI have less collagen type I and III around the urethra regardless of the degree of pelvic relaxation, SUI grade, parity, menopausal, age. It appears that collagen has a significant role in the maintenance of urinary continence.
Collagen Type I ; Collagen* ; Female* ; Humans ; Parity ; Pathology ; Relaxation ; Specialization ; Urethra ; Urinary Incontinence*

PURPOSE: The goal of this study was the early diagnosis of ABCB11 spectrum liver disorders, especially those focused on benign recurrent intrahepatic cholestasis and progressive familial intrahepatic cholestasis. METHODS: Fifty patients presenting neonatal cholestasis were evaluated to identify underlying etiologies. Genetic analysis was performed on patients suspected to have syndromic diseases or ABCB11 spectrum liver disorders. Two families with proven ABCB11 spectrum liver disorders were subjected to genetic analyses to confirm the diagnosis and were provided genetic counseling. Whole exome sequencing and Sanger sequencing were performed on the patients and the family members. RESULTS: Idiopathic or viral hepatitis was diagnosed in 34%, metabolic disease in 20%, total parenteral nutrition induced cholestasis in 16%, extrahepatic biliary atresia in 14%, genetic disease in 10%, neonatal lupus in 2%, congenital syphilis in 2%, and choledochal cyst in 2% of the patients. The patient with progressive familial intrahepatic cholestasis had novel heterozygous mutations of ABCB11 c.11C>G (p.Ser4*) and c.1543A>G (p.Asn515Asp). The patient with benign recurrent intrahepatic cholestasis had homozygous mutations of ABCB11 c.1331T>C (p.Val444Ala) and heterozygous, c.3084A>G (p.Ala1028Ala). Genetic confirmation of ABCB11 spectrum liver disorder led to early liver transplantation in the progressive familial intrahepatic cholestasis patient. In addition, the atypically severe benign recurrent intrahepatic cholestasis patient was able to avoid unnecessary liver transplantation after genetic analysis. CONCLUSION: ABCB11 spectrum liver disorders can be clinically indistinguishable as they share similar characteristics related to acute episodes. A comprehensive genetic analysis will facilitate optimal diagnosis and treatment.
Biliary Atresia ; Choledochal Cyst ; Cholestasis ; Cholestasis, Intrahepatic ; Diagnosis ; Early Diagnosis* ; Exome ; Genetic Counseling ; Hepatitis ; High-Throughput Nucleotide Sequencing ; Humans ; Hyperbilirubinemia ; Jaundice ; Liver Transplantation ; Liver* ; Metabolic Diseases ; Parenteral Nutrition, Total ; Syphilis, Congenital

BACKGROUND: When it comes to wasting blood components, it usually means wastage before transfusion due to several reasons such as improvement of the patient's condition, death of the patient, delay of blood returning, etc. Yet blood components can sometimes can be wasted after a transfusion is started and this is referred as residual blood wastage. In this study, we analyzed the rate and causes of discarded blood components that are not used and the residual blood wastage in order to help reduce the rate of blood component wastage. METHODS: From January 2009 to December 2010, the number of and the reasons for discarded blood components without use and residual blood wastage were analyzed by reviewing the laboratory information system and wastage statements at Soonchunhyang University Seoul Hospital. RESULTS: The number of blood components issued during the study period was 24,001 units. Among them, the number of units discarded without use was 162 units (0.7%) and the number of units of residual blood wastage was 115 units (0.5%). Among the reasons for the discarded blood component without use, improvement of the patient's conditions ranked as 1st with 80 units (49.5%) and death of the patient ranked as 2nd with 42 units (25.9%). The biggest reason for the residual blood wastage was transfusion-related side effects with as many as 52 units (45.2%). Other than side effects, the wastage of residue from pediatric transfusion were 48 units (41.7%), followed by delay of surgery with 5 units (4.3%) and patients' refusal with 4 units (3.5%). CONCLUSION: The wastage of residue from pediatric transfusion was the second most common cause of residual blood wastage in our hospital. According to this, we should evaluate the routine use of pediatric transfusion bags and their cost-effectiveness in our hospital.
Clinical Laboratory Information Systems ; Disulfiram ; Humans ; Korea