As the average life expectancy in Korea continues to rise, the number of elderly patients with pancreatobiliary disease is also expected to increase. Thus, it has been important to perform safe and quality-controlled endoscopic retrograde cholangiopancreatography in nowadays. However, there has been no standard educational programs of endoscopic retrograde cholangiopancreatography and quality control system, so Korean Pancreatobiliary Association has a plan to make credentialing organizations especially for pancreatobiliary certification. In this article, we would like to discuss the suitable framework and practical problems about the process and renewal of pancreatobiliary certification system.

No abstract available.
Glomerulonephritis, IGA* ; Immunoglobulin A*

PURPOSE: Carcinoembryonic antigen (CEA) is the most widely used tumor marker for detecting colorectal cancer. This study was designed to evaluate the level of serum CEA that is associated with recurrence after potentially curative surgery for colorectal cancer. METHODS: We retrospectively investigated the pre- and post-operative levels of serum CEA in 246 patients with colorectal cancer and they had undergone potentially curative surgery from 1996 through 2005. RESULTS: The pre-operative CEA level was significantly associated with the number of metastatic lymph nodes, the tumor size and the recurrence rate. The feature that was associated with recurrent disease on multivariate analysis was the pre-operative level of serum CEA. CONCLUSION: In order to detect the recurrence of colorectal cancer, we should closely follow up with frequent checks of the CEA level after surgery for those patients who had a high preoperative CEA level.
Carcinoembryonic Antigen ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Recurrence ; Retrospective Studies

PURPOSE: In a previous report, it took several days for white matter lesions to regress in hypoglycemic encephalopathy. We present a case of rapid diffusion-weighted image (DWI) changes in hypoglycemic encephalopathy. CASE REPORT: A 58-year-old male patient was found semi-comatous with the only abnormality in his laboratory tests showing hypoglycemia (44 mg/dL). After rapid correction of glucose level, immediate brain DWI showed bilateral subcortical white matter lesions. After about 5 hours, follow-up DWI showed resolved subcortical white matter lesions, with newly-appeared bilateral fronto-temporo-parietal cortical lesions. CONCLUSION: Both white matter and cortex involvement in hypoglycemic encephalopathy has been shown in several reports, but rapid regression of white matter changes in hypoglycemic encephalopathy has been rarely reported. It is important to know that MR imaging changes in hypoglycemic encephalopathy can be made as quick as just a few-hour-long.
Brain ; Follow-Up Studies ; Glucose ; Humans ; Hypoglycemia ; Magnetic Resonance Imaging ; Male ; Middle Aged

We report a case of thoracic post-herpetic neuralgia which was improved by dorsal root ganglionectomy. The patient had failed to obtain adequate pain relief from conservative therapy such as carbamazepine, amitriptyline, thioridazine, gabapentin, and transcutaneous lidocaine infiltration. Thoracic dorsal root ganglionectomy from T5 to T7 on left side was performed and satisfactory pain relief without significant postoperative neurologic deficit was achieved. Although dorsal root entry zone operation for refractory pain was the most commonly performed procedure in past, dorsal root ganglionectomy is an alternative anatomically and technically safe procedure for the pain in the thoracic lesion. The clinical feature, operative technique and clinical result are presented with review of the literatures.
Amitriptyline ; Carbamazepine ; Ganglionectomy* ; Humans ; Lidocaine ; Neuralgia* ; Neurologic Manifestations ; Pain, Intractable ; Spinal Nerve Roots ; Thioridazine

Primary intramedullary oligodendroglioma is very rare, accounting for only about 1% of all intramedullary spinal cord tumor. We present a case of intramedullary oligodendroglioma in a 30-year-old women. Magnetic resonance image showed an intramedullary mass in the T11-L1 region. Decompressive laminectomy and partial mass removal was performed, however, neurologic state became worse. The histological examination revealed oligodendroglioma. The intramedullary oligodendroglioma, although it is a rare entity, must be considered in the differential diagnosis of spinal cord tumors.
Adult ; Diagnosis, Differential ; Female ; Humans ; Laminectomy ; Oligodendroglioma* ; Spinal Cord Neoplasms

PURPOSE: The aims of this study were to evaluate risk factors for knee stiffness after the fixation of distal femoral fractures, and to analyze the clinical and radiologic outcomes. MATERIALS AND METHODS: This is a retrospective case control study of 104 consecutive patients who have a distal femoral fracture and were treated with a submuscular locking plate. The case group comprised of patients with 12-month postoperative range of motion (ROM) ≤90° or a history of manipulation under anesthesia. The case group was compared with the control group of patients with a 12-month postoperative ROM >90°. The possible risk factors were evaluated by univariate and logistic regression analysis. The postoperative ROM and Knee Society clinical rating system was evaluated for the clinical assessment and the distal femoral angle on a whole-extremity scanogram was measured for radiologic assessments. RESULTS: Fifty-four patients were included in the study (14 in the case group, 40 in the control group). Univariate analysis showed that comminuted fracture, intra-articular fracture, open fracture, temporary external fixation, severe osteoarthritis, and prolonged immobilization placed patients at an increased risk for knee stiffness. On the other hand, multivariate logistic regression showed that an extensor mechanism injury was the only significant predictor (p=0.001; odds ratio, 42.0; 95% confidence interval, 5.0–350.7). The ROM and Knee Society score were significantly lower in the case group; however, the coronal alignment was similar in the case and control group. CONCLUSION: Various factors that delay postoperative knee motion place patients at increased risk of knee stiffness. Understanding these risk factors may help surgeons prevent postoperative knee stiffness after distal femoral fractures. In particular, extensor mechanism injury, such as patella fracture or open quadriceps injury, was found to be an independent predictable factor associated with knee stiffness.
Anesthesia ; Bone Plates ; Case-Control Studies ; Femoral Fractures ; Fractures, Comminuted ; Fractures, Open ; Hand ; Humans ; Immobilization ; Intra-Articular Fractures ; Knee ; Logistic Models ; Odds Ratio ; Osteoarthritis ; Patella ; Range of Motion, Articular ; Retrospective Studies ; Risk Factors ; Surgeons

PURPOSE: To evaluate postoperative knee joint function, activity, stability and complications of the patients who had taken PCL reconstruction with tibial inlay method which has the advantages of firm tibial fixation and no killer turn. METHODS: From August 1998 to September 2000, tibial inlay method of PCL reconstruction was used in 20 patients who could be followed over 15 months. The Lysholm score and Tegner activity score was applied for the function and activity of the patients, KT-2000 arthrometer and posterior stress X-ray was used for the stability of the knee joint. RESULTS: 1) Lysholm score: the mean value of the preoperative score was 40.7 and the postoperative score was 83.8(Excellent 3, Good 9, Fair 7, Poor 1). 2) Tegner activity score: 1.9 of preoperative score was improved to 3.8. 3) The posterior displacement on the preoperative stress X-ray to compare with normal side showed 17 cases of grade III, 3 of grade IV(mean 13.6 mm). The postoperative posterior displacement showed 16 cases of grade I, 4 of grade II( mean 3.6 mm). 4) The side to side difference of KT -2000 arthrometer between affected and normal side was 2.4 mm under loading of 20 lb. 5) The difference of Quadriceps circumference between normal and affected side was 2.2cm and post-operative range of motion revealed slight extension limitation (10 degrees) in reconstruction group. CONCLUSION: Although disadvantages of inlay method are technical difficulty and risk of neurovascular injury and intraoperative positioning, tibial inlay method is thought to be an excellent option for PCL reconstuction with its advantages no killer turn and firm tibial fixation.
Humans ; Inlays* ; Knee Joint ; Posterior Cruciate Ligament ; Range of Motion, Articular

BACKGROUND: Helicobacter pylori (H. pylori) can now be eradicated in the majority of patients with 7 days of treatment with OAC (omeprazole+amoxicillin+clarithromycin) regimen. It is unclear if additional acid-suppressing treatment should be continued beyond 7 days in patients with active gastric or duodenal ulcers. METHODS: Ninety two patients with endoscopically proven active peptic ulcers who were H. pylori positive were randomized to receive either omeprazole 20 mg plus amoxicillin 1.0g plus clarithromycin 500mg ; twice daily for 1 week alone (OAC group) or same regimen followed by 3 weeks of omeprazole (OACP group). Endoscopy and UBT (urea breath test) were performed 8 weeks after the initiation of treatment. RESULTS: Forty four of forty five (97.8%) of OAC group and forty four of forty seven (93.6%) of OACP group were noted to have healed ulcer at week 8. CONCLUSION: In patients with H. pylori infection and peptic ulcers, one week of OAC therapy without further need for PPI may heal the ulcers. Following an l week course of H. pylori eradication therapy by OAC for peptic ulcers, further 3 weeks of acid-suppressing therapy with PPI was not proven to promote ulcer healing rate.
Amoxicillin ; Clarithromycin ; Duodenal Ulcer ; Endoscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Omeprazole ; Peptic Ulcer* ; Ulcer