It is generally considered that enteral feeding is superior to parenteral nutritional support. Thus enteral meal should be given whenever patients have proper gastrointestinal function to take enteral feeding. Because the morbidity and mortality for surgical jejunostomy have been reported as high as 50% and 10% respectively, direct percutaneous endoscopic jejunostomy has been developed to reduce the morbidity and mortality. A 55-year-old male patient, who was suffering from dysphagia and oropharyngeal aspiration, was transferred to the division of gastroenterology to be done permanent enteral feeding. His stomach was resected (subtotal gastrectomy with billroth II anastomosis) due to peptic ulcer hemorrhage 10 years before. We performed direct percutaneous endoscopic jejunostomy without any complication. Herein, we report a successful case.
Deglutition Disorders ; Enteral Nutrition ; Gastrectomy* ; Gastroenterology ; Gastroenterostomy ; Humans ; Jejunostomy* ; Male ; Meals ; Middle Aged ; Mortality ; Nutritional Support ; Peptic Ulcer Hemorrhage ; Stomach

The most common severe cervical spine injury involving the posterior elements is subluxation or dislocation in which the posterior ligamentus complex is completely torn. Late instability is more common than previously realizaed, because ligamentous structures do not reconstitute normally, even with prolonged external rigid fixation. Subluxation of the cervical vertebrae in a flexion injury can be reduced by skeletal traction;however, they usually require posterior stabilization. Unilateral and bilateral facet dislocation frequently require open reduction and posterior stabilization. The authors have used interlaminar clamps for the stabilization of thirty cases of unstable cervical spine. Advantages of this method are 1) immediate and rigid stabilization without cord injury, 2) early ambulation and prevention of respiratory complication and pressure sore. And also, posterior cervical stabilization with Halifax clamps is an easier, safer and faster technology in treatment of unstable spine.
Cervical Vertebrae ; Dislocations ; Early Ambulation ; Female ; Ligaments ; Pressure Ulcer ; Spine*

OBJECTIVES: Psychiatric patients report higher rates of interpersonal trauma, and they present with more symptoms and behavioral problems. However, less is known about other anxiety disorders, except for posttraumatic stress disorder. In this study, we investigated symptomatic correlates of interpersonal trauma (i.e., physical or sexual assaults) in patients with heterogeneous anxiety disorders. METHODS: We surveyed a consecutive sample of 90 outpatients with DSM-IV anxiety disorders (panic disorder, generalized anxiety disorder, obsessive compulsive disorder, social phobia, anxiety disorder not otherwise specified) at the psychiatric department of a university-affiliated hospital. The questionnaire was comprised of the Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory, State and Trait Anxiety Inventory, and Impact of Events Scale-Revised. RESULTS: Patients with interpersonal trauma (n=51) demonstrated a significantly higher level of interpersonal sensitivity, paranoid ideation, and obsessive-compulsive subscale of the SCL-90-R. However, logistic regression analysis suggested that interpersonal sensitivity alone was suggested as the best fitting model. CONCLUSION: Anxiety disorder patients with interpersonal trauma demonstrated difficulty in domains of interpersonal relationship. Clinicians treating this population should consider this finding for better engagement and management.
Anxiety ; Anxiety Disorders ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Logistic Models ; Obsessive-Compulsive Disorder ; Outpatients ; Phobic Disorders ; Surveys and Questionnaires ; Stress Disorders, Post-Traumatic

OBJECTIVE: To analyze 543 cases of amniocentesis with indications, cytogenetic results. METHOD: This study includes 543 cases cytogenetic study results which amniocentesis to detect fetal chromosomal abnormality in the Cytogenetic Laboratory at Eun Hospital in Kwang-Ju from August 1996 to December 2000, as gestational ages, indications of amniocentesis, maternal age distributions, chromosome aberrations with cytogenetic results. The cytogenetic results of chromosome aberration was identified by parents inheritance and de novo karyotypes as parents periperal blood cytogenetic study. RESULTS: Amniocentesis performed mostly from 15 weeks to 20 weeks of gestaional ages. Requested indication of amniocentesis presents abnormal maternal serum screening (37%), infertility (23%) and maternal old age (> or =35) (17%). Chromosome aberration according to amniocentesis indication was suspected fetal anomaly by ultrasonogram (8.6%), previous family history (5.7%). Chormosome aberration following maternal ages, more 40 years old women were found highly 7.9%. The frequency of chromosome aberration was 5.5% but de novo chromosome aberration was 2.2%. Numerical aberration was overall new karyotypes (1.3%). Structural aberration was inheritance karyotypes (3.3%) and de novo karyotypes (0.9%). CONCLUSION: Amniocentesis is a effective diagnostic tools in fetal chromosome aberration. Indication of fetal chromosomal anormality by ultrasonography and advanced maternal ages is an important diagnostic method with chromosome aberrations. Prenatal fetal chromosome aberrations included inheritance and de novo karyotypes. Especially, identification of de novo chromosome aberrations may predict fetal anomaly and counsel the fetus for pregnant parents.
Adult ; Amniocentesis* ; Chromosome Aberrations ; Cytogenetic Analysis* ; Cytogenetics* ; Female ; Fetus ; Gestational Age ; Gwangju ; Humans ; Infertility ; Karyotype ; Mass Screening ; Maternal Age ; Parents ; Ultrasonography ; Wills

Hyperbaric oxygen therapy (HBO), which in Korea is used chiefly for CO poisoning, can be used in many disorders in orthopaedic field through the action of increasing oxygen tension of peripheral tissue, Since June 1986, when the multiplace hyperbaric chamber was built in our hospital, we have experienced 197 cases of HBO in orthopaedic field and we are to analyze the result of treatment and suggest reasonable indications. The outline of results are as follows ;1. Crushing injuries and wounds caused or accompanied by circulatory disturbance were most frequent among the 197 cases we've experienced, and received 17.5 times of HBO on average. 2. Discernible effectiveness was found in split thickness skin graft, diabetic ulcer and Buerger's disease as compared to the control group. 3. Otalgia was the most common side effect, but not severe. 4. From the above results, it is thought that HBO has fair range of indications in orthopaedic field and is worth using as an adjuvant means to surgery.
Earache ; Hyperbaric Oxygenation ; Korea ; Oxygen ; Poisoning ; Skin ; Thromboangiitis Obliterans ; Transplants ; Ulcer ; Wounds and Injuries

No abstract available.
Rhabdomyolysis*

The major causes of small bowel obstruction are postoperative adhesion, hernia, intussusception and malignancies. However, in cases of uncommon causes of small bowel obstruction, surgeons are in a dilemma because the preoperative diagnosis and making a decision to operate are frequently difficult and delayed. Phytobezoars are unusual cause of small bowel obstruction. They are mostly due to ingestion of stringent immature fruits following gastric surgery. They are usually formed in stomach and do not migrate to the other intestinal tract, but can lead to the serious complication of acute small bowel obstruction. We are reporting a case of acute small bowel obstruction due to phytobezoar about 2x2x3 cm3 size in a 90 year old female.
Aged* ; Aged, 80 and over ; Bezoars ; Diagnosis ; Eating ; Female ; Fruit ; Hernia ; Humans ; Intestinal Obstruction* ; Intussusception ; Stomach

Background: Treatment remains a challenge in massive and irreparable rotator cuff tears (RCTs), and superior capsular reconstruction (SCR) has become an increasingly popular choice. The objective of this study was to evaluate clinical and radiological outcomes after SCR using an Achilles tendon allograft in irreparable massive RCTs. Methods: From December 2015 to March 2018, 11 patients (mean age, 66.3 ± 5.8 years) with irreparable massive RCTs who underwent SCR using an Achilles tendon allograft were enrolled in this study. The range of motion (ROM), visual analog scale (VAS), clinical scores, muscle strength, and acromiohumeral distance (AHD) were measured preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively. Magnetic resonance imaging (MRI) was performed preoperatively and at 6 months postoperatively to assess the global fatty degeneration index and graft failure. Ultrasonography was also conducted preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively to assess graft continuity. Results: The mean follow-up period was 27.6 months (range, 24–32 months). The shoulder ROM at final follow-up increased significantly in forward flexion (p = 0.023), external rotation (p = 0.018), internal rotation (p = 0.016), and abduction (p = 0.011). All patients showed improvement in VAS score (p = 0.005) and clinical scores (p < 0.001) compared with the preoperative state. Pseudoparalysis improved in all patients. The AHD was 3.88 mm (± 1.21 mm) preoperatively, 7.75 mm (± 1.52 mm, p = 0.014) at 6 months postoperatively, and 6.37 mm (± 1.72 mm, p = 0.031) at final follow-up. Graft removal and synovectomy were performed in 1 patient who developed postoperative infections. Radiological failure on follow-up MRI occurred in 2 patients at 6 and 12 months postoperatively, respectively. Conclusions SCR using an Achilles tendon allograft in irreparable massive RCTs achieved functional and clinical improvement. The use of Achilles tendon allograft also has the advantages of short operation time without donor site morbidity, sufficient thickness, and robustness; therefore, this allograft can be a useful graft for SCR.

Background: Treatment remains a challenge in massive and irreparable rotator cuff tears (RCTs), and superior capsular reconstruction (SCR) has become an increasingly popular choice. The objective of this study was to evaluate clinical and radiological outcomes after SCR using an Achilles tendon allograft in irreparable massive RCTs. Methods: From December 2015 to March 2018, 11 patients (mean age, 66.3 ± 5.8 years) with irreparable massive RCTs who underwent SCR using an Achilles tendon allograft were enrolled in this study. The range of motion (ROM), visual analog scale (VAS), clinical scores, muscle strength, and acromiohumeral distance (AHD) were measured preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively. Magnetic resonance imaging (MRI) was performed preoperatively and at 6 months postoperatively to assess the global fatty degeneration index and graft failure. Ultrasonography was also conducted preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively to assess graft continuity. Results: The mean follow-up period was 27.6 months (range, 24–32 months). The shoulder ROM at final follow-up increased significantly in forward flexion (p = 0.023), external rotation (p = 0.018), internal rotation (p = 0.016), and abduction (p = 0.011). All patients showed improvement in VAS score (p = 0.005) and clinical scores (p < 0.001) compared with the preoperative state. Pseudoparalysis improved in all patients. The AHD was 3.88 mm (± 1.21 mm) preoperatively, 7.75 mm (± 1.52 mm, p = 0.014) at 6 months postoperatively, and 6.37 mm (± 1.72 mm, p = 0.031) at final follow-up. Graft removal and synovectomy were performed in 1 patient who developed postoperative infections. Radiological failure on follow-up MRI occurred in 2 patients at 6 and 12 months postoperatively, respectively. Conclusions SCR using an Achilles tendon allograft in irreparable massive RCTs achieved functional and clinical improvement. The use of Achilles tendon allograft also has the advantages of short operation time without donor site morbidity, sufficient thickness, and robustness; therefore, this allograft can be a useful graft for SCR.

BACKGROUND/AIM: Gastric outlet obstruction due to malignancy causes various symptoms and malnutrition and so decreases the quality of life and shortens the survival. The aim of this study was to assess the feasibility, effectiveness, safety, and outcome of a self-expandable metal stent as a palliative methods. METHODS: From January, 2000 to August, 2002, 29 consecutive patients (36 cases of stent insertion) with inoperable gastric outlet obstruction were treated palliatively with through-the scope stents (Nitis Taewoong, Korea, 29 uncovered, 7 covered). All patients had malignancy. We reviewed the success rate, complications and clinical outcome. RESULTS: There were 21 cases with advanced gastric cancer, 5 with pancreatic head cancer and 2 with cholangiocarcinoma. The other one had primary duodenal carcinoma. Technical success was achieved in thirty four cases (94.4%). After successful placement, 26 patients could eat soft or solid foods with careful education about foods impaction. During the follow-up (mean: 2.6 months, range: 1~9 months), there were no procedure related early complication. Seven stent occlusion occurred due to tumor in-growth (6 case) and over-growth (1 case). CONCLUSIONS: Endoscopic self-expandable metal stent placement in patients with inoperable gastric outlet obstruction is a highly successful, safe and effective palliative method.
Cholangiocarcinoma ; Education ; Follow-Up Studies ; Gastric Outlet Obstruction* ; Head and Neck Neoplasms ; Humans ; Korea ; Malnutrition ; Quality of Life ; Stents* ; Stomach Neoplasms