BACKGROUND : Anomalous pancreaticobiliary ductal union (APBDU) is a congenital defect defined as a union of the pancreatic and the biliary ducts located outside the duodenal wall. Accordingly, this anomalous connection between the choledochus and the pancreatic duct is considered to be a factor in the development of biliary tract diseases such as choledochal cysts, pancreatitis, cholangitis, gallbladder cancer, and bile duct cancer. Our purpose is to analyze combined disease, especially biliary neoplasm, and to evaluate biliary tract microscopic changes in the biliary tract. METHODS : To study the clinical characteristics of APBDU, we reviewed 21 APBDU cases which were treated from June 1994 to January 1998. We studied the associated diseases, the surgical treatment, histological findings and the PCNA expression. We also analyzed the gallbladder epithelium in 10 control patients without APBDU. RESULTS : Among the 21 cases, 12 cases were accompanied by a choledochal cyst. A gallbladder carci noma occurred in 5 cases. Of the 13 operations, 4 involved a cholecystectomy only, and 9 involved a cholecystectomy, bile duct resection and hepaticojejunostomy. The histologic findings were reviewed in 13 cases. Bile duct metaplasia was found in 8 of the 9 cases with a bile duct resection, and gallbladder metaplasia was found in 8 of the 12 cases whereas metaplasia was detected in 1 of the 10 control patients. The PCNA expression was significantly high in APBDU group. CONCLUSIONS : The patients with APBDU showed a high incidence of gallbladder carcinoma and meta plasia in the epithelium of the gallbladder and the bile duct. This metaplasia in the gallbladder and the bile duct was thought to be related to the cancerous change.
Bile Duct Neoplasms ; Bile Ducts* ; Bile* ; Biliary Tract ; Biliary Tract Diseases ; Cholangitis ; Cholecystectomy ; Choledochal Cyst ; Common Bile Duct ; Congenital Abnormalities ; Epithelium ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Incidence ; Metaplasia ; Noma ; Pancreatic Ducts ; Pancreatitis ; Proliferating Cell Nuclear Antigen

Tinnitus-the perception of sound in the absence of an actual external sound-represents a symptom of an underlying condition rather than a single disease. Several theories have been proposed to explain the mechanisms underlying tinnitus. Tinnitus generators are theoretically located in the auditory pathway, and such generators and various mechanisms occurring in the peripheral auditory system have been explained in terms of spontaneous otoacoustic emissions, edge theory, and discordant theory. Those present in the central auditory system have been explained in terms of the dorsal cochlear nucleus, the auditory plasticity theory, the crosstalk theory, the somatosensory system, and the limbic and autonomic nervous systems. Treatments for tinnitus include pharmacotherapy, cognitive and behavioral therapy, sound therapy, music therapy, tinnitus retraining therapy, massage and stretching, and electrical suppression. This paper reviews the characteristics, causes, mechanisms, and treatments of tinnitus.
Auditory Pathways ; Autonomic Nervous System ; Cochlear Nucleus ; Massage ; Music Therapy ; Otoacoustic Emissions, Spontaneous ; Tinnitus

Adult ; Humans ; Malocclusion ; Orthognathic Surgery ; Surveys and Questionnaires

Patients undergoing maintenance dialysis show an increased susceptibility to tuberculosis because host immunity is decreased secondary to malnutrition, impaired cellular immunity, acidosis and etc. Extrapulmonary tuberculosis is more prevalent in patients with end stage renal disease than in normal subjects. Among the extrapulmonary tuberculosis in patients receiving hemodialysis, the diagnosis of tuberculous spondylitis is difficult because the symptoms are non specific and attributable to uremia, and the appearance of plain radiographs is often normal during the early phase of the disease. We experienced a case of tuberculous spondylitis in a hemodialysis patient. A 55 years old female admitted with fever, weight loss and back pain. Conventional radiograph of T-spine showed no definite abnormal finding. However, chest CT revealed heterogeneously enhancing soft tissue around the T8 vertebral body and T-spine MRI showed compatible finding to tuberculous spondylitis. She received radical excision of involved vertebra and confirmed tuberculous spondylitis with histologic finding from a surgical specimen. Following the administration of anti-tuberculosis medication(isoniazid, rifampin, pyraziamide, ethambutol) and radical excision, patient's symptom and sign were improved. The patient is maintaining dialysis with anti-tuberculosis medication for 5 months.
Acidosis ; Back Pain ; Diagnosis ; Dialysis ; Female ; Fever ; Humans ; Immunity, Cellular ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Malnutrition ; Middle Aged ; Renal Dialysis* ; Rifampin ; Spine ; Spondylitis* ; Tomography, X-Ray Computed ; Tuberculosis ; Uremia ; Weight Loss

In this study, we evaluated an edge detector for small-beam dosimetry. We measured the dose linearity, dose rate dependence, output factor, beam profiles, and percentage depth dose using an edge detector (Model 1118 Edge) for 6-MV photon beams at different field sizes and depths. The obtained values were compared with those obtained using a standard volume ionization chamber (CC13) and photon diode detector (PFD). The dose linearity results for the three detectors showed good agreement within 1%. The edge detector had the best linearity of +/-0.08%. The edge detector and PFD showed little dose rate dependency throughout the range of 100~600 MU/min, while CC13 showed a significant discrepancy of approximately -5% at 100 MU/min. The output factors of the three detectors showed good agreement within 1% for the tested field sizes. However, the output factor of CC13 compared to the other two detectors had a maximum difference of 21% for small field sizes (~4x4 cm2). When analyzing the 20~80% penumbra, the penumbra measured using CC13 was approximately two times wider than that using the edge detector for all field sizes. The width measured using PFD was approximately 30% wider for all field sizes. Compared to the edge detector, the 10~90% penumbras measured using the CC13 and PFD were approximately 55% and 19% wider, respectively. The full width at half maximum (FWHM) of the edge detector was close to the real field size, while the other two detectors measured values that were 8~10% greater for all field sizes. Percentage depth doses measured by the three detectors corresponded to each other for small beams. Based on the results, we consider the edge detector as an appropriate small-beam detector, while CC13 and PFD can lead to some errors when used for small beam fields under 4x4 cm2.
Dependency (Psychology)

It is important that the clinical anesthetist pay attention to the interaction of anesthetic induction agents and succinylcholine chloride(S,C,C) on the elctrolyte level especially the plasma potassium ion concentration. For instance succinylcholine chloride has a marked effect upon specific conditions such as severe burns, multiple injury, deabetes insipidus and myopathy. Also secondary plasma changes may bring about non synchronous depolarizing action on the muscle and cause cardiac arrhythmai and even cardiac arrest by the increase of potassium concentration in the plasma. With this in mind the author has randomly selected 30 patients who belong to class l physical status by the classification of the American Society of Anesthesiologist had no abnormal symptoms in respiration, circulation or endocrine and metabolism defects. This paper covers the period from the 10th of April 1979 to the 10th of May 1980 in the Department of Anesthesiology, Hanyang University Hospital. The 30 subjects were divided into 3 groups: a) propanidid with S.C.C. b) thiopental sodium with S.C.C. c) diazepam with S.C.C. The plasma concentration of potassium, sodium and calcium were observed and compared in the pre-induction (control group) and two minute post-induction(study group). The results are follows: 1) The plasma potassium ion concentration showed no any significant changes in the whole group. 2) The plasma sodium and calcium ion concentration also showed no any significant changes in the whole group.
Anesthesiology ; Burns ; Calcium* ; Classification ; Diazepam ; Heart Arrest ; Humans ; Metabolism ; Multiple Trauma ; Muscular Diseases ; Plasma ; Potassium ; Propanidid ; Respiration ; Sodium* ; Succinylcholine* ; Thiopental

PURPOSE: To determine the usefulness of ultrasound-guided core biopsy for the diagnosis of non-palpable beast lesions. MATERIALS AND METHODS: Between April 1996 and December 2000, 932 lesions in 901 patients were the object of ultrasound-guided core biopsy. Of these, 440 non-palpable lesions ranging in size from 0.3 to 3.0 (average, 0.9)cm, and found in 428 patients (all women aged, on average, 43.9 years), were included in this study. The pathologic results of core biopsy were compared with the available surgical data, and clinical and radiologic follow-up data were also reviewed. A 16-gauge needle was used in 197 lesions, and a 14-gauge neadle in the other 243. RESULTS: At core biopsy, 53 lesions were diagnosed as invasive carcinoma, and 45 of these were excised. Forthfour were confirmed as invasive carcinoma, and in one case there was no residual tumor. Seven lesions, diagnosed as ductal carcinoma in situ at core biopsy, were surgically removed, and the final diagnosis was ductal carcinoma in four cases and invasive carcinoma in two. Two of four cases initially diagnosed as atypical ductal hyperplasia were finally diagnosed as invasive carcinoma after surgery. Six lesions diagnosed at core biopsy asbenign were later found to be malignant (false-negative rate, 8.3%). Radiologic imaging suggested that all six lesions-for two of which, a 14-gauge needle was used, and for four, a 16-gauge needle-were malignant. The false-negative rate was 5.1% and 12%, respectively, whithout statistical significance (p=0.26). CONCLUSION: Ultrasound-guided core needle biopsy for non-palpable breast lesions is useful and can replace surgical excision. To avoid false-negative assessment, however, strict radiologic-histopathologic correlation is required.
Biopsy ; Biopsy, Large-Core Needle* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hyperplasia ; Needles ; Neoplasm, Residual

BACKGROUND: Perineal reconstruction following pelvic exenteration is a challenging area in plastic surgery. Its advantages include preventing complications by obliterating the pelvic dead space and minimizing the scar by using the previous abdominal incision and a vertical rectus abdominis musculocutaneous (VRAM) flap. However, only a few studies have compared the complications and the outcomes following pelvic exenteration between cases with and without a VRAM flap. In this study, we aimed to compare the complications and the outcomes following pelvic exenteration with or without VRAM flap coverage. METHODS: We retrospectively reviewed the cases of nine patients for whom transpelvic VRAM flaps were created following pelvic exenteration due to pelvic malignancy. The complications and outcomes in these patients were compared with those of another nine patients who did not undergo such reconstruction. RESULTS: Flap reconstruction was successful in eight cases, with minor complications such as wound infection and dehiscence. In all cases in the reconstructed group (n=9), structural integrity was maintained and major complications including bowel obstruction and infection were prevented by obliterating the pelvic dead space. In contrast, in the control group (n=9), peritonitis and bowel obstruction occurred in 1 case (11%). CONCLUSIONS: Despite the possibility of flap failure and minor complications, a VRAM flap can result in adequate perineal reconstruction to prevent major complications of pelvic exenteration.
Cicatrix ; Humans ; Myocutaneous Flap* ; Pelvic Exenteration* ; Peritonitis ; Rectus Abdominis* ; Retrospective Studies ; Surgery, Plastic ; Wound Infection

Two cases of total anomalous pulmonary venous connection(TAPVC) were diagnosed in 18 years old female and 20 years old male. Both of them complained frequent URI and exertional dyspnea from childhood. The chest films of the two cases showed cardiomegaly and increased pulmonary vascularity. Particulary, the film of female case showed a typical snowman appearance. In both cases, the diagnosis of TAPVC was made preoperately by 2-D echocardiography, cardiac catheterization, and cardiac angiography. The postoperative diagnosis was also TAPVC. The correvtive surgery was performed without complications and postoperative course was uneventful. We report two cases of TAPVC which is very rare in adult.
Adolescent ; Adult* ; Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Diagnosis ; Dyspnea ; Echocardiography ; Female ; Humans ; Male ; Thorax ; Young Adult

Hypovolemia and relative polycythemia is not an uncommon presentation in a child with nephrotic syndrome, but it is seldom mentioned in an adult. We experienced a case of hypovolemic shock and erythrocytosis in a patient with minimal change disease. Hypovolemia and polycythemia was corrected only after infusing isotonic fluid with albumin for 3 days. Hypovolemic shock is attributable to some of the following factors; suddenly decreased capillary oncotic pressure due to massive proteinuria, interstitial edema with tubular collapse, redistribution of renal blood flow, decreased glomerular filtration rate, and use of diuretics without albumin. In summary, 1) Relative polycythemia may occur as a result of hypovolemia in a patient with nephrotic syndrome but can be easily corrected by isotonic fluid and albumin. 2) An early detection of hypovolemia can be made by the measurement of central venous pressure, echocardiography, and the assessement of FeNa, U[k]/(U[Na]+U[K]). 3) Diuretics without albumin may result in transient developement of shock in patients with profound volume depletion.
Adult ; Capillaries ; Central Venous Pressure ; Child ; Diuretics ; Echocardiography ; Edema ; Glomerular Filtration Rate ; Humans ; Hypovolemia ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Polycythemia* ; Proteinuria ; Renal Circulation ; Shock