Acetabular fractures are usually caused by violent external force such as car clash and commonly accompany injuries of the other parts of the body. And there has been long controversy between conservative and operative treatments. A clinical analysis was performed on the 29 patients with acetabular fractures, who had been treated at seoul National University Hospital from 1973 to 1982, mainly focussed on the result of treatment. Followings are the summary of the result. 1. Conservative treatment was done in 52% and operative treatment in 48%. 2. Mean follow-up period was 1 year and 8 months. 3. The result of treatment was good or fair in 53% of conservative treatment group comparedto 71 in operative treatment group. 4. Primary total hip replacement was done in one case of bursting fracture combined with fracture of femur neck and the result was good. 5. Superior and bursting fractures showed the worst result(poor in 83%). 6. Degenerative arthritis with or without avascular necrosis was the most common complication (45 %) and it was more common in conservative treatment group (60 vs. 29%). 7. From above results it could be said that operative treatment in acetabular fractures, if carefully done with reasonable indications, would improve the result and decrease the rate of degenerative arthritis.
Acetabulum ; Arthroplasty, Replacement, Hip ; Femur Neck ; Follow-Up Studies ; Humans ; Necrosis ; Osteoarthritis ; Seoul

Anticancer effect and complications were evaluated after transcatheter arterial embolization(TAE) in 12patients with hepatocellular carcinoma until 2 weeks and 4 weeks after TAE, respectively. The results were asfollows: 1. Serum alpha-fetoprotein value decreased in 7 out of 9 patients wih high value prior to TAE. 2. Loss ofenhancement and better definition on enhanced CT were seen in the tumors in all cases, and low-density areas in9/10 . Gas bubbles were seen in low-density areas in 4/10 and highdensity area caused by lipiodol in 6/10. 3.Post-embolization syndrome was develped in most patients but improved clinically within a week after TAE. 4. Onlaboratory examination, impairment of liver function was developed in most patients but improved within 4 weeksafter TAE. 5. Complications on CT included splenic infarction and thickening of wall of the gallbladder, whichdidn't require specific treatment. The authors conclude that TAE for hepatocellular carcinoma reveals apparentanticancer effect on shortterm evaluation, and resultant complications are transient and improved by conservativetreatment.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Ethiodized Oil ; Gallbladder ; Humans ; Liver ; Splenic Infarction

No abstract available in English.
Osteotomy

CT and portographic findings of 63 patients with hepatoma, undergone hepatic angiography and superiormesenteric portography for evaluation of tumor and thrombosis of portal vein and determination of indication oftranscatheter arterial embolization for palliative treatment of hepatoma from April,85 to June, 86 in Hanyanguniversity hospital, were reviewed. The results were as follows: 1. In 36 cases, portal vein thrombosis wasdetected during portography. Nineteen of 37 cases which revealed localized hepatoma in the right lobe of the livershowed portal vein thrombosis; 9 of 11 cases of the left lobe; 8 of 14 cases which were involved in entire liverrevealed thrombosis. One case localized in the caudate lobe showed no evidence of invasion to portal vein. 2.Twenty-four of 34 cases with diffuse infiltrative hepatoma revealed portal vein thrombosis and the incidence ofportal vein thrombosis in this type were higher than in the cases of the nodular type. 3. The portal veinthrombosis appeared as filling defects of low density in the lumen of the portal veins in CT and they did notreveal contrast enhancement. 4. CT revealed well the evidences of obstructions in the cases of portal veinthrombosis and the findings were well-corresponded to the findings of the superior mesenteric portography. 5. Fiveof the cases of the portal vein thrombosis were missed in the CT and the casuses were considered as due to partialvolume effect of enhanced portal vein with partial occlusion or arterioportal shunts. 6. Six of 13 cases withocclusion of main portal vein showed cavernous transformation and they were noted as multiple small enhancedvascularities around the porta hepatis in the CT. According to the results, we conclude that CT is a usefulmodality to detect the changes of the portal veins in the patients of the hepatoma.
Angiography ; Carcinoma, Hepatocellular ; Humans ; Incidence ; Palliative Care ; Portal Vein ; Portography ; Thrombosis ; Veins ; Venous Thrombosis

Tuberculous peritonitis is mainly transmitted via hematogenous spreading of tuberculous bacilli. But sometimes this disease is occured, as the abdominal lymph node infected by the localized tuberculous enteritis was ruptured We pressent the report and the brief review of related literatures, who experienced a case of tuberculous peritonitis confirmed by paracentiesis and peritoneoscopic examination in a 9 years old male patient who was suspected toa malignant tumor because of the recent unexplained abdominal distension.
Child ; Enteritis ; Humans ; Laparoscopy* ; Lymph Nodes ; Male ; Peritonitis, Tuberculous*

BACKGROUND: It is well known that the inferior parathyroids are more difficult to preserved than the superior parathyroid glands because the inferior parathyroid glands have more anatomical variations. METHODS: The authors analysed the gross surgical findings of a total of 411 inferior parathyroid glands in 314 total thyroidectomy cases. The inferior parathyroid glands were grouped according to patterns based on their location and arterial blood supply. RESULTS: Type 1 (location: posterior surface of the lower thyroid pole; artery: inferior branch of the inferior thyroid artery): incidence 51% and presevation rate 62%. Type 2 (location: thyrothymic ligament or in the thymus; artery: inferior branch of the inferior thyroid artery): incidence 27% and preservation rate 86%. Type 3 (location: apart from the lower thyroid pole; artery: inferior branch of the inferior thyroid artery): incidence 6.1% and preservation rate 92%. Type 4 (location: anteriorly on the lower thyroid pole; artery: inferior branch of the inferior thyroid artery): incidence 4.1% and preservation rate 33%. Type 5 (location: lower thyroid pole; artery: comes out from the thyroid gland): incidence 4.1% and preservation rate 0%. Type 6 (location: lower thyroid pole; artery: branch of the superior thyroid artery): incidence 3.6% and preservation rate 80%. Type 7 (location: lower thyroid pole; artery: embedded in the thyroid gland): incidence 2.9% and preservation rate 36%. Type 8 (location: more superior than usual; artery: superior branch of the inferior thyroid artery): incidence 0.7% and preservation rate 67%. Type 9 (location: lower thyroid pole; artery: thyroid ima artery): incidence 0.5% and preservation rate 100%. CONCLUSIONS: The most identified inferior parathyroids belonged to the usual types, and their pre-servation rate were relatively high. However there were some unusual types though their incidence was low. Thus, accurate anatomical knowledge of variations in the location and the blood supply of the inferior parathyroids is needed to enhance the preservation rate.
Arteries ; Incidence ; Ligaments ; Parathyroid Glands* ; Thymus Gland ; Thyroid Gland ; Thyroidectomy*

Graft-versus-host disease (GVHD) is a rare complication after kidney transplantation. We describe a 62-year-old female with end-stage renal disease due to hypertension. She received a kidney with 4 mismatched human leukocyte antigen (HLA) out of 6 HLA - A, B, DR from a deceased donor. After the procedure, the patient showed watery diarrhea on postoperative day (POD) 45. An endoscopic biopsy of the colon revealed some apoptotic cells consistent with GVHD. Thrombocytopenia was gradually developed on POD 54. She received steroid pulse therapy, and thrombocytopenia did not progress. However, pneumonia, renal failure, and cardiac failure occurred. She died due to multiple organ failure. We must consider GVHD in renal transplant recipients without homozygous or identical HLA, who had only watery diarrhea without other typical GVHD symptoms such as skin rash and fever, although GVHD is rare in renal transplant recipients.
Biopsy ; Colon ; Diarrhea ; Exanthema ; Female ; Fever ; Graft vs Host Disease ; Heart Failure ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Leukocytes ; Middle Aged ; Multiple Organ Failure ; Pneumonia ; Renal Insufficiency ; Thrombocytopenia ; Tissue Donors

BACKGROUND: Chronic graft-versus-host disease(GVHD) is a major cause of morbidity and mortality in long-term survivors of bone marrow transplantation, an increasingly used therapeutic option for hematological disorders. Cutaneous manifestations are frequently the presenting feature; therefore, the dermatologist needs to be aware of the wide spectrum of chronic cutaneous GVHD, enabling early diagnosis and management. OBJECTIVE: We investigated the clinical and histological features of chronic cutaneous GVHD in recipients receiving allogenic BMT. METHODS: On the basis of the patients' charts, photographs and biopsy specimens, we investigated the occurring interval, clinical manifestations and histological characteristics of chronic cutaneous GVHD in 37 patients from January 1, 1996 through December 31, 2000. RESULTS AND CONCLUSION: 1. The chronic cutaneous GVHD was preceded by the acute form of GVHD in 56.7% of patients, and occurred as an extension(18.9%) of acute GVHD, after a disease-free interval(37.8%), or with no precedent(43.2%). The disease usually developed at a mean 251days after transplant. 2. The chronic cutaneous GVHD mainly presented as maculopapular(37.8%), lichenoid(37.8%), or sclerodermoid(13.5%) patterns. 3. Histologically, 35.1% of biopsy specimens showed characteristic acute GVHR-like change, 40.5% showed lichen planus-like, and 13.5% was scleroderma-like histology. Lichen planus-like feature mixed with scleroderma-like was 2.7%, and 8.1 % was non-specific. 4. Appearing after day 100, the acute GVHD other than chronic GVHD was detected in some cases, and the lichenoid rash of chronic GVHD in one case was observed as early as day 60. 6. Our opinions are that the time of occurrence is not a reliable parameter for the clinical picture of GVHD and histologic parameters do not absolutely separate between acute and chronic GVHD as defined by days after BMT. 7. Mortality rate was 21 % in our cases.
Biopsy ; Bone Marrow Transplantation ; Early Diagnosis ; Exanthema ; Graft vs Host Disease* ; Humans ; Lichens ; Mortality ; Survivors ; Transplants*

PURPOSE: D-lactate, optical isomer of L-lactate is not a human metabolite. Once the D-lactate enters the human body, it is mainly metabolized in liver. The metabolism of D-lactate can be changed in patients with decompensated liver cirrhosis with the exposure of antibiotics and the frequent trial of lactulose, if neccessory. The aim of this study is to analyze blood D-lactate level in cirrhotic patients and it's relationship with the degree of hepatic insufficiency and acid-base imbalance. METHODS: Plasma L-lactate and D-lactate levels were measured in 40 cirrhotic patients classified by Child-Pugh system with L-LDH and D-LDH with comparison of their changes before and after the use of antibiotics and lactulose(n=14). Also, acid-base disorders were analyzed in 35 cirrhotic patients, and plasma L, D-lactate levels were determined in each acid-base disorder. RESULTS: Plasma D-lactate level was not significantly elevated in cirrhotic patients compared to the control group(2.34+/-.48 mmol/L vs. 1.63+/-.26 mmol/ L, p=NS), but some patients(n=4, 10%) revealed abnormally elevated D-lactate level. The plasma L, D- lactate levels were not different in subgroups classified by Child-Pugh system as well as by underlying causes of liver cirrhosis, and plasma D-lactate level was not sugnificnatly different before and after the exposure of antibiotics and lactulose. Plasma D-lactate level was significantly increased in 3 patients with respiratory alkalosis and metabolic acidosis(12+/-.98 mmol/L) compared to others(p<0.05). CONCLUSION: These results suggest that, regardless of its decompensated degree and exposure to drugs, a subset of patients with liver cirrhosis can develop elevation of D-lactate in blood, particularly when metabolic acidosis is accompanied.
Acid-Base Imbalance* ; Acidosis ; Alkalosis, Respiratory ; Anti-Bacterial Agents ; Hepatic Insufficiency ; Human Body ; Humans ; Lactic Acid ; Lactulose ; Liver ; Liver Cirrhosis ; Metabolism ; Plasma*

The hepatic hemangioma is the most common benign tumor in the liver. Most hemangiomas are asymptomatic and treatment is not required. Rarely, complications occur due to a hepatic arterioportal shunt through a large high-flow hemangioma. We report a case of recurrent esophageal variceal bleeding despite repeated esophageal variceal ligation (EVL) due to a hepatic arterioportal shunt through a large high-flow hemangioma that was successfully treated with hepatic arterial embolization, in a patient with cirrhosis and end stage renal disease.
Esophageal and Gastric Varices* ; Fibrosis* ; Hemangioma* ; Hematemesis ; Humans ; Hypertension, Portal ; Kidney Failure, Chronic ; Ligation ; Liver ; Liver Cirrhosis