PURPOSE: We performed this study to evaluate the changes of gallbladder ejection fraction (GBEF) in diabetic patients with or without autonomic neuropathy. MATERIALS AND METHODS: This study included 37 diabetic patients (25 women, 12 men, mean age 51 years) and 24 normal controls (10 women, 14 men, mean age 38 years). After intravenous injection of 185 MBq of 99mTc-DISIDA, serial anterior abdominal images were acquired before and after fatty meal. Regions of interest were applied on gallbladder and right hepatic lobe on 60 and 90 minute images to calculate GBEF. RESULTS: GBEF was significantly reduced in diabetes with autonomic neuropathy (43+/-12.3%) and without autonomic neuropathy (57.5+/-13.2%) compared with normal controls (68+/-11.6%, p <0.05). And also, GBEF was significantly reduced in diabetes with autonomic neuropathy compared with diabetes without autonomic neuropathy (p <0.05). Fasting blood glucose level, age, sex, hemoglobin A1c, body mass index, serum lipid level were not different in these two diabetic patient groups (p>0.05). When 50.2% of GBEF was used as the criteria for diabetic autonomic neuropathy, the sensitivity and specificity were 80%, 76.5%, respectively. The area under receiver operating characteristic curve was 0.846. CONCLUSION: GBEF of diabetic patients with autonomic neuropathy was significantly reduced than that of diabetic patients without autonomic neuropathy.
Blood Glucose ; Body Mass Index ; Diabetic Neuropathies* ; Fasting ; Female ; Gallbladder* ; Humans ; Injections, Intravenous ; Male ; Meals ; ROC Curve ; Sensitivity and Specificity ; Technetium Tc 99m Disofenin*

The hand is frequently affected area in high voltage electrical burn injury as an input or output sites. Therefore, proper treatment method should be applied in order to achive aesthetic and funtioning hand. To reconstruction of soft tissue defect in hand, a variety of treatment have been, but most are associated with drawbacks, such as limited range, limited application, long time surgery, 2nd stage surgery, large donor defect. The reverse dorsal digital and metacarpal island flaps use the dorsal skin of the digital or metacarpal areas, and they are based on the arterial branches anastomosing the volar and dorsal arterial networks. The series of 15 cases of reconstruction for soft tissue defect due to electrical burn in hand were reviewed. Most cases survived completely and we could gain satisfactory results. Advantages of these flaps are minimal defect in donor site, good reliability, short time and easy technique, versatile variation, usefulness in secondary reconstruction. In conclusion, our result suggested that the reverse dorsal digital and metacarpal artery island flap are very useful methods for reconstruction of soft tissue defect due to electrical burn in hand, functionally and aetheticallly.
Arteries* ; Burns* ; Hand* ; Humans ; Skin ; Surgical Flaps ; Tissue Donors

Split-thickness skin graft is a frequent, necessary method of treatment in burn patients. After harvesting a split thickness skin graft, there is a variety of options in the post-operative management of the donor site created. Dressing materials provide an occlusive and wet environment and aids in superior wound healing. Of the commercially available dressing materials, Medifoam(R), Allevin(R) and Polymem(R) are the most commonly used materials during the early phases of epithelization. Medifoam-B(R) is a more absorbant dressing material compared to other dressing materials. Its swelling ratio is 1200% and it contains a layer of wound promoters and antibiotics. The purpose of this study is to compare medifoam-B(R), Allevyn(R) and Polymem(R) in the healing time, infection rate, absorption ratio and pain degree. This study is based on 30 patient who underwent split-thickness skin graft in Hanil General Hospital from March 2002 to July 2002. All skin grafts were harvested with an electric dermatome, with a thickness depth of 0.012 to 0.016 inches. Three divisions of each donor site was managed separately with each different materials through postoperative days 0 to 1. Absorption property, infection rate, pain degree, time to complete epithelization were assessed. Medifoam-B(R) performed superior to Allevyn(R), Polymem(R). In conclusion, We suggest Medifoam-B(R) as a useful alternative in the management of the split-thickness donor site wound in the early phases.
Absorption ; Anti-Bacterial Agents ; Bandages* ; Burns ; Hospitals, General ; Humans ; Skin ; Tissue Donors* ; Transplants ; Wound Healing ; Wounds and Injuries

OBJECTIVES: This study was performed to investigate the incidence and the clinical significance of inlet patch of heterotopic gastric mucosa in Koreans. This lesion can be found by close observation around the upper esophageal sphincter during upper gastrointestinal endoscopy. METHODS: From March 1, 1996 to July 8, 1996, at Kwak's hospital, randomly selected 271 patients undergoing routine diagnostic upper gastrointestinal endoscopy were included in this study. Patients with the inlet patch were confirmed by histology. Clinical symptoms observed through medical history were recorded. RESULTS: Twenty-six cases(9.6%) of the 271 patients studied had heterotopic gastric mucosa which was found at or just below the upper esophageal sphincter, varing from 3 to 30mm in diameter. It was velvety red in color and distinct from the surrounding normal squamous esophageal mucosa, resembling the Z-line at the esophagogastric junction. Parietal cells were identified in all 18 cases in which biopsy specimen contained deep glands, and chief cells were found in 14 cases. Histologically, fundic gland type was most frequent. The symptoms were relatively mild, 5 out of 6 patients who complained of throat discomfort were relieved by H2 antagonists. CONCLUSION: In Koreans the incidence of heterotopic gastric mucosa in the upper esophagus was similar to the reports from western countries unlike Barrett's esophagus. The etiology of these patches appeared to be congenital rather than acquired from reflux of gastric acid. This was supported by its location in the proximal esophagus and lack of correlation with reflux esophagitis. It must be considered as one of the differential diagnosis of a patient who complains of throat discomfort during diagnostic upper gastrointestinal endoscopy. Attention needs to be paid to find possible development of complications such as stricture and adenocarcinoma in patients with the inlet patch of heterotopic gastric mucosa.
Adenocarcinoma ; Barrett Esophagus ; Bays* ; Biopsy ; Constriction, Pathologic ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Esophageal Sphincter, Upper ; Esophagitis, Peptic ; Esophagogastric Junction ; Esophagus ; Gastric Acid ; Gastric Mucosa* ; Humans ; Incidence* ; Mucous Membrane ; Pharynx ; Rabeprazole

The Peutz-Jeghers syndrome is an autosomal dominant disease characterized by hamartomatous polyps in the gastrointestinal tract and mucocutaneous melanin pigmentation. Although these polyps are believed to have little potential for malignancy, and the disease was believed to have a relatively benign course, it recently has been recognized that patients with this syndrome are at increased risk for the development of cancer at gastrointestinal and nongastrointestinal sites. A 33-year-old male patient was admitted because of vomiting and abdominal pain for 3 months duration. A diagnosis of Peutz-Jeghers syndrome was made 3 years ago by multiple hamartomatous polyps confined to the colon and mucocutaneous pigmentation. A barium study showed abrupt string like luminal narrowing at the 4th portion of the duodenum. On laparotomy, there was an annular constricting mass involving the serosa of duodenum with multiple metastasis to liver, so a segmental resection of small bowel followed by chemotherapy was performed. The histologic finding was adenocarcinoma.
Abdominal Pain ; Adenocarcinoma* ; Adult ; Barium ; Colon ; Diagnosis ; Drug Therapy ; Duodenum ; Gastrointestinal Tract ; Humans ; Laparotomy ; Liver ; Male ; Melanins ; Neoplasm Metastasis ; Peutz-Jeghers Syndrome* ; Phenobarbital ; Pigmentation ; Polyps ; Serous Membrane ; Vomiting

We experienced a case of ruptured aneurysm of the sinus of Valsalva, and this resulted in simultaneous aortic and tricuspid valve endocarditis through a shunt. The echocardiography showed a ruptured sinus of Valsalva aneurysm to the right atrium with a shunt. The aortic non-coronary cusp was fibro-thickened with vegetation. Vegetations of the septal leaflet and the anterior leaflet of the tricuspid valve were also found. The blood culture grew Enterococcus garllinarum. We replaced both tricuspid and aortic valve with successful surgical result.
Aneurysm ; Aneurysm, Ruptured ; Aortic Valve ; Echocardiography ; Endocarditis ; Enterococcus ; Heart Atria ; Rupture ; Sinus of Valsalva ; Tricuspid Valve

We have experienced a case of aortic dissecting aneurysm in pregnant woman. She felt initially severe chest pain which was radiated to the neck on the 3days before delivery. Thereafter dyspnea and generalized edema were developed for 1 month after delivery. She was diagnosed as aortic dissectLn, Debakey type-II. During cardiopulmonary bypass, the selective cerebral perfusion was done through the right and left commom carotid arteries. Aortic replacement with Hemashield vascular graft and reimplantation of innominate artery, resuspension of aortic valve, repair of intimal tear were performed. The postoperative course was uneventful.
Aneurysm, Dissecting ; Aortic Valve ; Brachiocephalic Trunk ; Cardiopulmonary Bypass ; Carotid Arteries ; Chest Pain ; Dyspnea ; Edema ; Female ; Humans ; Neck ; Perfusion ; Pregnant Women* ; Replantation ; Tears ; Transplants

OBJECTIVE: The purpose of this study was to investigate the incidence, cause, and influence of the adverse drug reactions (ADRs) associated with long-term intravenous antibiotics in patients with pyogenic spondylitis (PS). METHODS: We retrospectively reviewed the medical records of 84 patients with PS who underwent intravenous antibiotic therapy in our hospital from January 2001 to December 2012. ADRs were categorized to drug eruption, acute renal failure (ARF), hematologic toxicity, toxic hepatitis, pseudomembranous colitis (PMC), drug fever, and neuronal toxicity. Incidence and onset time of each ADR after antibiotic therapy were analyzed with the incidence of ADRs according to types of antibiotics. RESULTS: ADRs occurred in 38 of the 84 patients (incidence: 45.2%). The use of antibiotics was longer in the patients with ADRs (62.7 days) than in the patients without ADRs (44.3 day). The incidence of drug eruption, ARF, hematologic toxicity, toxic hepatitis, PMC, drug fever, and neuronal toxicity were 22.6, 11.9, 11.9, 10.7, 7.1, 3.6%, and 1.2%, respectively. The duration of antibiotics administration was related to the occurrence of PMC (p=0.001). ADRs were more common in patients treated by glycopeptides including vacomycin and teicoplanin. CONCLUSION: The incidence of ADRs due to long-term intravenous antibiotics was as high as 45.2% in patients with PS. Therefore, we speculate that the possibility of delayed ADRs should be considered after long-term use of the antibiotics. Furthermore, close observation is mandatory to identify and treat ADRs promptly, even though PS revealed the improvement after antibiotic therapy.
Acute Kidney Injury ; Anti-Bacterial Agents* ; Drug Eruptions ; Drug-Induced Liver Injury ; Drug-Related Side Effects and Adverse Reactions* ; Enterocolitis, Pseudomembranous ; Epidural Abscess ; Fever ; Glycopeptides ; Humans ; Incidence ; Medical Records ; Neurons ; Retrospective Studies ; Spondylitis* ; Teicoplanin

Bacterial endocarditis has been well recognized as an important complication of congenital heart disease, such as ventricular septal defect, patent ductus arteriosus or pulmonary stenosis. The incidence of right sided bacterial endocarditis is lesser than left sided bacterial endocarditis. Also, pulmonic valve vegetation has been thought to be relatively uncommon. So in a patient with fever and evidence of recurrent pulmonary infarction, changing heart murmurs and scattered pneumonic infiltrates, one should direct attention to the heart as a possible source of the infection. Echocardiography with M-mode, 2-D and Doppler mode represents the only noninvasive technic available for detecting vegetations in bacterial endocarditis. In fact, the technic is more sensitive in identifying these lesions than angiography. We experienced a case of ventricular septal defect with bacterial endocarditis, pulmonic valve vegetation and multiple pulmonary embolism diagnosed with Echocardiogram and lung scan, and confirmed by operation. Patch repair of ventricular septal defect, resection of pulmonic valve and vegetation and artificial valve formation with pericardium were done.
Angiography ; Ductus Arteriosus, Patent ; Echocardiography ; Endocarditis, Bacterial* ; Fever ; Heart ; Heart Defects, Congenital ; Heart Murmurs ; Heart Septal Defects, Ventricular* ; Humans ; Incidence ; Lung ; Pericardium ; Pulmonary Embolism ; Pulmonary Infarction ; Pulmonary Valve Stenosis

Intussusception in adults is not common unlike in pediatrics. It also differs from the pediatric intussusception in its origins, symptoms, and treatment. Since more than half of intussusception cases come from malignancy, laparotomy is considered to be the treatment of choice in most cases. This report deals with a patient who visited our hospital complaining of abdominal pain after colonoscopic polypectomy. The patient was diagnosed with colonic intussusception. After a conservative treatment regimen including antibiotics and fluid therapy, the intussusception was spontaneously reduced.
Abdominal Pain ; Adult ; Anti-Bacterial Agents ; Colon ; Colonoscopy ; Fluid Therapy ; Humans ; Intussusception ; Laparotomy ; Pediatrics