Traditionally, evaluation after ACL reconstruction has been focused on physical characteristics and measures of knee stability. Recently, however, reliance on such criteria has been refuted based on the lack of a strong relationship between these measures and both the patient s perception of knee function and return to sports activity. In present study, preoperative and postoperative physical examinations, isokinetic dynamometer, arthrometer test and functional tests were performed on 17 patients with chronic anterior cruciate ligament tears treated by arthroscopic reconstruction using autogenous bone-patellar tendon-bone graft with at least 1 year of follow-up. Muscle power, joint stability and functional recovery were checked for functional evaluation by specific methods. Lysholm score rating scale and functional tests (single leg hop test, vertical jump test, timed single jump test) were performed preoperatively and 6, 12 months postoperatively. Pivot-shift test, Lachman test, anterior drawer test, thigh circumference index and Cybex II+ isokinetic dynamometer test were done preoperatively and at 3, 6, 12 months postoperatively. KT-2000 arthrometer test was done at last follow-up. Lysholm score has showed increasing tendency at 6, 12 months postoperatively (p < 0.01). In Cybex study, deficit percentage of peak torque and total work of the quadriceps and hamstrings was same or slightly decreased at 3, 6 months, but have decreased at 1 year follow-up (p < 0.01). Functional tests and physical examinations have also showed improving tendency at 12 months (p < 0.01). Arthrometer test revealed no significant laxity of the knee joint at last follow-up. In conclusion, muscle strengh and functional capacity in ACL reconstructed knee showed significant improvement at postoperative one year compared with preoperative status. It was considered that arthroscopic reconstruction using autogenous bone-patellar tendon-bone graft is one of the useful method for chronic anterior cruciate ligament injury.
Anterior Cruciate Ligament ; Autografts* ; Bone-Patellar Tendon-Bone Grafts ; Follow-Up Studies ; Humans ; Humulus ; Joints ; Knee ; Knee Joint ; Leg ; Muscle Strength* ; Patellar Ligament* ; Physical Examination ; Sports ; Thigh ; Torque

OBJECTIVE: To investigate the prognosis of patients with stroke and urinary retention resistant to alpha blockers and cholinergic agents. METHODS: Post-void residual urine volume (PVR) was measured in 33 patients with stroke (14 men and 19 women) who were admitted to the department of rehabilitation medicine of our hospital within 30 days after stroke onset. An alpha-blocker and cholinergic agent were administered to patients with PVR >100 mL. If urinary retention had not improved despite the maximum drug doses, the patient was diagnosed with drug-resistant urinary retention. We retrospectively reviewed patient's charts, including PVR at discharge and prognostic factors for PVR. RESULTS: Ten patients (30.3%) could not void or their PVR was >400 mL at discharge (45.7+/-15.4 days after onset) after rehabilitation. Twelve patients (36.4%) could void, and their PVR was 100-400 mL. PVR was consistently <100 mL in 11 patients (33.3%). These measurements correlated with the Korean version of the Modified Barthel Index score, Functional Ambulation Category, and the presence of a communication disorder. CONCLUSION: The results show that 22 patients (66.7%) had incomplete bladder emptying or required catheterization at discharge. Outcomes correlated with functional status, walking ability, and the presence of a communication disorder. Patients with urinary retention and poor general condition require close observation to prevent complications of urinary retention.
Catheterization ; Catheters ; Cholinergic Agents ; Communication Disorders ; Humans ; Male ; Prognosis ; Rehabilitation ; Retrospective Studies ; Stroke* ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Retention* ; Walking

Although dysphagia in patients with acute leukemia is usually related to reflux esophagitis, infectious esophagitis, chemotherapy1) and leukemic infiltration2), acute esophageal stricture resulting from chemotherapy in the patient with leukemia is very rare. A 40-year-old man with acute myelogenous leukemia was admitted for operation of esophageal stricture which was developed within 1 month of chemotherapy. An esophagectomy and esophagogastrostomy with pyloroplasty was carried out. Histology showed mucosal infiltration of mononuclear cells and transmural fibrosis involving submucosa and the muscle layer.
Adult ; Deglutition Disorders ; Drug Therapy ; Esophageal Stenosis* ; Esophagectomy ; Esophagitis ; Esophagitis, Peptic ; Fibrosis ; Humans ; Induction Chemotherapy* ; Leukemia ; Leukemia, Myeloid, Acute

Gallstone ileus is caused by mechanical obstruction of the gastrointestinal tract by the gallstone and accounts for 1~3% of all intestinal obstructions. Endoscopic sphincterotomy (EST) is the accepted treatment of choice for choledocholithiasis. Recognized complications of EST include bleeding, acute pancreatitis, retroperitoneal perforation. However, gallstone ileus is a rare complication of EST. A 70-year-old woman was admitted to our hospital with right upper quadrant pain. Abdominal ultrasound revealed single common bile duct (CBD) stone. ERCP was performed to remove the large CBD stone without mechanical lithotripsy. Nausea, vomiting and abdominal pain were developed after stone removal. Plain abdomen X-ray and computerized tomography represented marked dilatation of small bowel loops without definite obstructive lesion. Because the mechanical obstruction was sustained, explorolaparotomy was performed. On the operation, single stone was impacted at the distal ileum, narrowed by previous radiotheraphy. We reported a case of gallstone ileus after the removal of CBD stone following EST without lithotripsy.
Abdomen ; Abdominal Pain ; Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Common Bile Duct ; Dilatation ; Female ; Gallstones* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileum ; Ileus* ; Intestinal Obstruction ; Lithotripsy ; Nausea ; Pancreatitis ; Sphincterotomy, Endoscopic* ; Ultrasonography ; Vomiting

Mucosa-associated lymphoid tissue (MALT) is specially adapted component of the immune system protecting the permeable surface of the gastrointestinal mucosa, bronchial mucosa and other mucosa. Chronic infection of the stomach by Helicobacter pylori, Hashimoto's thyroiditis, Sjogren syndrome in the salivary gland and other chronic inflammatory and autoimmune disease lead to the accumulation of MALT in the mucosa and MALT lymphoma arises from this acquired MALT. MALT lymphoma is histologically characterized by proliferation of centrocyte-like cells that invade the epithelium and lymphoepithelial lesion form. Gastrointestinal MALT lymphoma is clinically important because it is a localized, slow progressive disease and has a long survival and favorable clinical course compared with other lymphoma. Esophageal MALT lymphoma is extremely rare, so we report, radiologic, endoscopic and pathological findings and clinical course in a case of esophageal MALT lymphoma with brouchas-associated lymphoid tissue (BALT) lymphoma with a review of literature.
Autoimmune Diseases ; Epithelium ; Esophagus* ; Helicobacter pylori ; Immune System ; Lymphoid Tissue* ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone* ; Mucous Membrane ; Salivary Glands ; Sjogren's Syndrome ; Stomach ; Thyroid Gland ; Thyroiditis

BACKGROUND/AIMS: Although the quality of colonoscopy is considered important to improve screening efficacy, there is little evidence and few statistical reports which properly reflects the colonoscopy quality of clinical practices in Korea. We aimed to investigate the quality indicators of colonoscopy performing in clinical practice. METHODS: We analyzed the computerized photo-documentation files of patients who were transferred to tertiary academic hospital from private clinics or primary and secondary hospitals from January 2012 to October 2012. Quality indicators including cecal intubation rate, withdrawal time, bowel preparation status, colonoscopy report form were analyzed. Bowel preparation was assessed by 4 steps on the preparation scale (excellent, good, fair, poor). RESULTS: A total of 198 patients (134 male, 64 female) were enrolled and analyzed. Cecal intubation rate was 91.4% (181/198) and photo-documentation of appendiceal orifice and ileocecal valve was achieved as 84.3% (167/198) and 71.7% (142/198), relatively. Overall, 83.3% of cases were adequate bowel preparation state (excellent 52%, good 31.3%). Withdrawal time could be estimated at 94.4% (187/198) of cases and mean withdrawal time of diagonostic colonoscopy (n=165) was 8.6 minutes. However, the rate of cases which withdrawal time was more than 6 minutes was 69.7% (115/165). Total of 30 institution's colonoscopy report forms were analyzed and among nearly half enrolled institutions (46.6%, 14/30) were just recording patient's information and colonoscopic diagnosis. CONCLUSIONS: Considerable portion of colonoscopy examination in the primary clinical practice has been performed with low procedure quality. We thus need careful attention to maintain the quality of colonoscopy in daily practice routines.
Cohort Studies ; Colonoscopy ; Humans ; Ileocecal Valve ; Intubation ; Korea ; Male ; Mass Screening ; Quality Indicators, Health Care ; Tertiary Care Centers

Gallbladder (GB) cancer occurs predominately as a biliary tract malignant tumor. It generally has a very poor prognosis, and early detection is often difficult. A variety of carcinogens have been implicated as an important cause for GB cancer. Benzene is a well-known carcinogen for hematologic malignancy, and its casual relationship with GB cancer has been suggested. We report a case of two patients who had operated a laundry cleaning facility together and later simultaneously got GB cancer after prolonged benzene exposure.
Adenocarcinoma/*diagnosis/etiology/ultrasonography ; Benzene/*toxicity ; Female ; Gallbladder Neoplasms/*diagnosis/etiology/ultrasonography ; Humans ; Laundering ; Male ; Middle Aged ; Positron-Emission Tomography and Computed Tomography ; Tomography, X-Ray Computed

Mirizzi syndrome is commonly defined as a common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct. Mirizzi syndrome has traditionally been treated surgically. However, there are several case reports and small series describing endoscopic and percutaneous alternatives to open surgery. We encountered two cases of type I Mirizzi syndrome that was successfully treated endoscopically. We report these cases with a review of the relevant literature.
Cystic Duct ; Hepatic Duct, Common ; Mirizzi Syndrome*

Hypopharyngeal cancers are often diagnosed at an advanced stage and have a poor prognosis. Even when they are diagnosed at an operable stage, surgery often results in substantial morbidity and decreased patients' quality of life. Although the endoscopic diagnosis of early hypopharyngeal cancer is difficult, recent developments in advanced imaging endoscopy have enabled easier diagnosis of these lesions. Endoscopic resection of early hypopharyngeal cancer is a potential minimally invasive treatment that can preserve the function and quality of life of patients. Reports of this procedure are limited, however. We report a case of hypopharygeal cancer treated with endoscopic resection.
Carcinoma, Squamous Cell ; Endoscopy ; Humans ; Hypopharyngeal Neoplasms ; Prognosis ; Quality of Life

The objective of the study was to document practice pattern of gastroenterologists for the management of gastroesophageal reflux disease (GERD) under the minimal influence of the insurance reimbursement guideline. Data on management for 1,197 consecutive patients with typical GERD symptoms were prospectively collected during 16 weeks. In order to minimize the influence of reimbursement guideline on the use of proton pump inhibitors (PPIs), rabeprazole was used for the PPI treatment. A total of 861 patients (72%) underwent endoscopy before the start of treatment. PPIs were most commonly prescribed (87%). At the start of treatment, rabeprazole 20 mg daily was prescribed to 94% of the patients who received PPI treatment and 10 mg daily to the remaining 6%. At the third visits, rabeprazole 20 mg daily was prescribed to 70% of those who were followed and 10 mg daily for the remaining 30%. Continuous PPI treatment during the 16-week period was performed in 63% of the study patients. In conclusion, a full-dose PPI is preferred for the initial and maintenance treatment of GERD under the minimal influence of the insurance reimbursement guideline, which may reflect a high proportion of GERD patients requiring a long-term treatment of a full-dose PPI.
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Enzyme Inhibitors ; Female ; Gastroenterology ; Gastroesophageal Reflux/*diagnosis/*drug therapy ; *Guideline Adherence ; Humans ; Insurance, Health, Reimbursement ; Male ; Middle Aged ; *Physician's Practice Patterns ; Proton Pump Inhibitors/therapeutic use ; Republic of Korea ; Treatment Outcome