Prophylactic treatment of varices is an appealing concept because 50% of patients who experience variceal bleeding will die within the first 6 weeks of the first bleeding. However, the majority of trials which have evaluated prophylactic therapy gave failed to demonstrate advantage, We tried prophylactic endoscopic variceal ligation(EVL) in 10 patients, to evaluate the safety and effect of prophylactic EVL for esophageal varices with high-risk of hemorrhage. The eradication rate was 100% without bleeding and mortality, the mean session for eradication of varices 1.9, the number of bands per person 16.9 and the number of bands per session 8.9. Although mild chest pain(5.3%) and chest discomfortness(31.6%) were observed, no serious complication related with EVL resulted from 19 EVL sessions. The patients were followed for a mean of 327.0 days(85-708), during which recurrent esophagea1 varices were found in a case at 260 days from last session, but no bleeding nor death was occured. No late complication of EVL was documented. In conclusion, prophylactic EVL is safe and may be effective for esophageal varices with high-risk of hemorrhage. But, the large controlled-trial should be required.
Esophageal and Gastric Varices* ; Hemorrhage* ; Humans ; Ligation* ; Mortality ; Thorax ; Varicose Veins

BACKGROUND: Definite criteria for the diagnosis and treatment evaluation for different clinical stags of syphilis are not yet present dute to the inability to dultivate Treponema pallidum in vitro. However, as the staining methods and the serological tests currently used have their limitations, a more definite method for its confirmation is needed. Polymerase chain reaction (PCR), due to its high sensitivity and specificity, is currently being applied to the detection of T. pallidum. OBJECTIVE: We have used PCR for the detection of T. pallidum DNA in various clinical specimens in orber to evaluate its potenital as a diagnostic tool. METHOD: Clinical specimens were collected from patients with different stages of syphilis who visited ithe Deparment of Dermatology of Yonsei medical Center for 1 year beginning from May, 1991. Sera from 63 patients, cerebrospinal fluids from 24 patients, amniotic fluids from 3 patients, and 21 tissues from 19 patients were subjected to PCR and the results were analyzed to evaluate its usefulness as a diagnostic and treatment evaluation tool. A portion of the T. pallidum-specific chromosomal DNA, tpp47, which encodes the 47 kDa surface protein, was used as the template DNA to amplify the 658 bp DNA fragment, and the following results were obtained. PCR using primers 47-1 and 47-2 were applied to amplify 658 bp DNA fragments from the T. pallidum-specific tpp47 gene encoding 47 kDa surface protein. RESULT: 1. To evaluate the sensitivity of the PCR, T. pallida and their chromosomal DNA were diluted. The diluents contataining a single organism and 1 fg of the chromosomal DNA showed positive reactions by the amplification. 2. Specificity of the PCR was determined by using T. pallidum, 4 species beloging to genus Treponema, and 9 species of nonpathogenic or pathogenic organisms. A positive reaction was obtained only when T. pallidum chromosomal DNA was used. 3. PCR was positive in 5 of 9 (55%) sera in primary syphilis, 22 of 26(84%) in secondary syphilis, 3 to 15(20%) in early latent syphilis, 1 of 19 (11%0 in late latent syphilis, 2 of 2 (100%) in neurosyphlis, and 0 of 2 (0%) in congenital syphilis. The differences in the positive rates were statistically significant (P<0.01) in all stages except neurosyphilis and congenital syphilis, as their numbers were too smalll to deduce any significant meaning. Despite their high VDRL titers, the positive rate in early latent syphilis was relatively low when compared to the rate in secondary syphilis. 4. Follw-up PCR of sera in some patients showed positive results 9 months after treatment. However, some with negative PCR before treatment showed positive results after treatment. 5. PCR was positive in 1 of 1 (50%) cerebrospinal fluid in primary syphilis, 3 of 14 (21%) in secondary syphilis, 2 of 7 (29%) in early latent syphilis, and 1 of 1(100%) in neurosyphlis. The differences in the positive rates showed no statistical significance in relation to the clinical stages. Cerebrospinal fluid VDRL test, white blood cell count, and protein content showed no correlation to the PCR results in early syphilis patients. 6. Amniotic fluid showed a positive PCR result only in a pregnant woman whose serum showed a high VDRL titer and a positive PCR. 7. PCR positive rates were 90% in frozed tissues and 50% in paraffin embedded tissues. CONCLUSION: From the results, it is suggested that PCR is not suitable for treatment evaluation but is useful for the detection of T. pallidum in sera of secondary syphilis patients and syphilitic lesions, and for the confirmation of the diagnosis the diagnosis in these cases.
Amniotic Fluid ; Cerebrospinal Fluid ; Dermatology ; Diagnosis ; DNA ; Female ; Humans ; Leukocyte Count ; Neurosyphilis ; Paraffin ; Polymerase Chain Reaction* ; Pregnant Women ; Sensitivity and Specificity ; Serologic Tests ; Syphilis ; Syphilis, Congenital ; Syphilis, Latent ; Treponema pallidum* ; Treponema*

The fractures of the ankle in children are differ from those of adults in terms of the fracture pattern and the possibilities of influence to growth. The injuries of the ankle in children occur mostly at the bony structure rather than ligamentous structure, and some injuries of the growth plate may result in the arrest of entire growth plate or parts of growth plate and these may lead to leg length discrepancy or deformity. Many authors agree that the prognosis of injuries of the growth plate is dependent on the fracture type, the age of the patient at the onset of injuries, the degree of displacement of the fracture fragments, whether the injuries open or closed, and the efficacy of reduction. But the authors can not postulate one uniformed method of classification and treatment of the children's ankle fracture because of the variability of injuries. We have reviewed 35 cases of children's ankle fracture treated at our clinics from Dec. 1979 to Feb. 1984. The results obtained are as follows: l. Over half of the patients were between the ages of 13 and 16 years (54.3%). 2. The incidence of each type as Salter-Harris classification was that of type II(48.6%), type I(20.0%),type III(14.3%),type IV (8.6%). 3. The traffic accidents were the main causes of injury (68.5%). 4. The type I fractures occured mostly under 10 years of age and the type II fractures in adolescents. 5. All the type I fractures were treated conservatively without any complication, and the type II fractures were treated conservatively in 13 cases (76.5%) and operatively in 4 cases (23.5%) with variable results. 6. Overall incidence of complication was 20.0%, consisted with two cases of conservatively treated but not accurately reduced type II fractures, a conservatively treated type III fracture, a triplane fracture, and the others.
Accidents, Traffic ; Adolescent ; Adult ; Ankle Fractures ; Ankle ; Child ; Classification ; Clinical Study ; Clothing ; Congenital Abnormalities ; Growth Plate ; Humans ; Incidence ; Leg ; Ligaments ; Methods ; Prognosis

No abstract available.
Humans ; Interferon-alpha* ; Interferons* ; Melanoma* ; Ulcer*

Using the FTA-ABS complernent test, 32 skin speciruens from 27 patients with primary and secondary syphilis and a stomach specimen from a patient with suspected gastric syphilis which were confirmed by clinical history, physical examination, VDRL, FTA-ABS, and 19S(IgM)-FTA test, were tested. The following results were obtained. 1. In the darkfield examination, 7 of the 9 specimens(78%) were positive and in the FTA-ABS complernent test, 20 of the 33 specimens(61%) were positive. 2. The ratio of agreement between the darkfield examination and the FTA-ABS complement test was 89%. 3. In the chancres, macular syphilids, and condyloma lata, T. pallida were diffusely scattered in the epidermis, dermoepidermal junction, connective tiasue, and vascular walls, whereas in the papular syphilid T. pallida were mainly aggregated in the the epidermis, dermoepidermal junction, papillary dermis as well as the blood vessel walls in the papillary dermis. From these results, the FTA-ABS complement test can be considered to be a useful method for both the diagnosis and research of syphilis. It is especially helpful in cases where serological or histopathological study can not confirrn the diagnosis as when internal organs are involved.
Blood Vessels ; Chancre ; Complement System Proteins* ; Dermis ; Diagnosis ; Epidermis ; Humans ; Physical Examination ; Skin ; Stomach ; Syphilis ; Syphilis, Cutaneous ; Treponema pallidum* ; Treponema*

Only several stages of conventional operation have been able to treat the open fracture of the limb with extensive bone and soft tissue loss. So we, authors, reviewed 25 cases of vascularized osteocutaneous fibulat transfer which were performed to the extensive bone defect of the limb and associated soft tissue injury(from May 13, 1982 to September 30, 1988). In 25 cases, one case was a chronic osteomyelitis combined pseudocarcinomatous epithelial hyperplasia of surrounding soft tissue, the other(24 cases) were the open comminuted fractures with the extensive bone and soft tissue loss of the limbs. The average size of the skin flap was 12.33 × 5.83cm, the average length of vascularized fibula was 16.5cm in length. The complications were fractures of grafted fibula, partial necrosis of both ends of the skin flap and uncontrolled infection of proximal end of grafted fibula. During postoperative period, the patency of the anastomoses were monitored by observing the color of the skin of buoy skin flap. The average amounts hypertrophied fibula at 12 months after operation were 20.6cm. And the following remarkable result were obtained. 1. With the uncontrolled bone infection, the vascularized osteocutaneous fibular transfer was able to be performed. 2. During the follow up period, the grafted fibula had been hypertrophied. 3. In roentgenogram, as compared with conventional bone graft, grafted bone was not resorbed and early united. 4. In adult, free fibula can be obtained and grafted as 23cm as long and the skin flap with fibula can be obtained and grafted as 21 × 7cm as large in or experience. 5. In the vascularized osteocutaneous fibula transfer, the patency of anastomoses was monitored indirectly by confirming skin flap. 6. The fractured fibula was united early by cast immobilization, and it was hypertrophied at the fracture site. 7. The vascularized osteocutaneous fibula transfer is also useful in application of the other long bones.
Adult ; Extremities ; Fibula ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Humans ; Hyperplasia ; Immobilization ; Microsurgery ; Necrosis ; Osteomyelitis ; Postoperative Period ; Skin ; Transplants

PURPOSE: We performed a retrospective study to determine the comparative characteristics of vesicoureteral reflux (VUR) between the infants less than 1 year and children more than 1 year old and whether early treatment in infantile VUR may be of benefit to preserve the renal function and to prevent the new renal scar. MATERIALS AND METHODS: All of 62 cases (infant group 19 and children group 43) with primary VUR were managed as the ureteral reimplantation from January 1991 to December 1996. RESULTS: The average age of patients was 7.1 months in infant group and 6.0 years in children group. The sex ratio of male to female showed no difference between infant and children group (1.7:1 Vs 1.5:1). The average follow up periods were 20.5 and 23.7 months in infant and children groups, respectively. The high grade reflux and renal scarring in infant group were significantly more frequent than those in children group (P<0.05), but the prevalence of urinary tract infection in children group was significantly higher than that in infant group (P<0.05). There was no significant difference in the rates of bilaterality and in the sex ratio between infant and children group. The success rate of operation was 100 percent in both groups. CONCLUSION: We suggest that the early surgical treatment in infants with bilateral and higher grade VUR may be of benefit to the preservation of renal function and the decrease of renal parenchymal change.
Child* ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Infant* ; Male ; Prevalence ; Replantation ; Retrospective Studies ; Sex Ratio ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

No abstract available.
Reference Values*

No abstract available.
Catheters*

The clinical studies were performen on 304 patients with heart disease who had been received corrective heart surgery at Kosin Medical Center from July, 1984 to December, 1991. The results were as follows: 1) Out of 304 patients, 162 cases (53.3%) were male and 142 cases (46.7%) were female and sex ratio was 1.15:1. 35 cases (11.5%) had clinical cyanosis and 269 cases (88.5%) had no evidence of cyanosis. 2) As age distribution of patients, under 2 years, 3~5 years, 6~10 years, 11~15 years, 16~18 years consist of 22.0%, 26.0%, 29.0%, 16.1% and 6.9%, respectively. 3) As disease distribution, out 304 patients, ventricular septal defect (57.9% of all) was the most common disease, and then atrial septal defect (13.2%), tetralogy of Fallot (11.2%), patent ductus arteriosus (9.9%) and pulmonic stenosis (5.3%), in their order. 4) As sex distribution of each disease, ventricular septal defect, atrial septal defect and tetralogy of Fallot were more common in male and patent ductus arteriosus and pulmonic stenosis were more common in female. 5) The most frequent cardiac anomaly associated with ventricular septal defect and atrial septal defect was pulmonic stenosis. In the case of subarterial ventricular septal defect, aortic insufficiency was associated in 13.3%. 6) Respiratory problems (11.3%), tricuspid regurgitation (9.5%), arrhythmia (6.2%) and congestive heart failure (5.8%) were the major complications after surgery. 7) Case fatality reat was 4.4%. Mortality rate in ventricular septal defect, tetralogy of Fallot and tricuspid atresia were 1.7%, 20.6% and 100%, respectively, Majority (75.0%) of expired patients were died within 24 hours after sugery and the cause of death was hypoxia due to low cardiac output syndrome.
Age Distribution ; Anoxia ; Arrhythmias, Cardiac ; Cardiac Output, Low ; Cause of Death ; Cyanosis ; Ductus Arteriosus, Patent ; Female ; Heart Diseases* ; Heart Failure ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Male ; Mortality ; Pulmonary Valve Stenosis ; Sex Distribution ; Sex Ratio ; Tetralogy of Fallot ; Thoracic Surgery ; Tricuspid Atresia ; Tricuspid Valve Insufficiency