Laparoscopic cholecystectomy can be performed safely in most patients with symptomatic cholelithiasis. Preoperative evaluation should assess the potential problems that affect the performance of laparoscopic cholecystectomy. Hepatobiliary scintigraphy or oral cholecystography can assess the gallbladder function and nonvisualization of gall bladder usually indicates acute or severe chronic cholecystitis. The purpose of this study was to evaluate the role of preoperative hepatobiliary scintigraphy or oral cholecystography in predicting the performance of laparoscopic cholecystectomy. The study group consists of 176 patients who underwent both hepatobiliary scintigraphy with Tc-99m DISIDA and oral cholecystography within one month before laparoscopic cholecystectomy. Nonvisualization of gallbladder was defined as persistent nonvisualization of gall- bladder until 4 hours on hepatobiliary scintigraphy or 12 hours on oral cholecystography. Among 176 patients, gallbladder was not visualized in 38 patients on hepatobiliary scintigraphy and 41 patients on oral cholecystography, Concordance rate between hepatobiliary scintigraphy and oral cholecystography was 89.2%. The conversion rate to open cholocystectomy was significantly higher in patients with nonvisualization of gallbladder than in patients with gallbladder visualization(15.8% vs 2.9% on hepatobiliary scintigraphy, 12.2% vs 3.7% on oral cholecystography: p<0.01 and p<0.05 respectively). The operative complication rate was also significantly higher in patients with nonvisualization of gallbladder (13.2% vs 2.9% on hepatobiliary scintigraphy, 14.6% vs 2.2% on. oral cholecystography : p<0.0l and p<0.001, respectively). Similarly, operation time was significantly prolonged in patients with nonvisualization of gall bladder (88.8+/-41.9min vs 62.5+/-23.6min on hepatobiliary scintigraphy : p<0.001, 89.4+/-41.3 min vs 61.8+/-22.8 min on oral cholecystography : p<0.001). It is concluded that nonvisualization of gallblader on hepato biliary scintigraphy or oral cholecystography is a valuable preoperative clincal risk factor in predicting increased conversion rate to open cholecystectomy, increased operative complication and prolonged operation time.
Adosterol* ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystography ; Cholelithiasis ; Cushing Syndrome ; Gallbladder ; Humans ; Radionuclide Imaging* ; Risk Factors ; Urinary Bladder

Cutaneous polyarteritis nodosa(CPAN) is a benign form of rare vasculitis of small and medium-size arteries with a recurrent but benign course without systemic involvement. We experienced a 61-year-old male who had two months history of multiple deep-purpurish livedo reticularis on both lower legs. Noncutaneous manifestations including malaise, fever, myalgia, and arthritis were absent. A skin biopsy specimen from the livedo reticularis on the leg showed perivascular and trans-mural neutrophilic and lymphocytic infiltration of medium-sized arteries in the dermal-subcutaneous junction and fibrinoid necrosis of the vessel walls. The patient was treated with colchicine for 2months and showed markded improvement.
Arteries ; Arthritis ; Biopsy ; Colchicine ; Fever ; Humans ; Leg ; Livedo Reticularis ; Male ; Middle Aged ; Myalgia ; Necrosis ; Neutrophils ; Polyarteritis Nodosa* ; Skin ; Vasculitis

No abstract available.
Growth Hormone*

We report a case of pigmented spindle cell nevus occurred in a 4-year-old girl. The lesion was well-demarcated, 2.5 x 3mm sized black macule on the left thenar area. The histopathologic findings of excisional biopsy specimen revealed the prociferation of uniform spindle-shaped pigmented melanocytes at the dermoepidermal junction and sharply definded lateral margins.
Biopsy ; Child, Preschool ; Female ; Humans ; Melanocytes ; Nevus, Spindle Cell*

No abstract available.
Arginine ; Growth Hormone* ; Growth Hormone-Releasing Hormone ; Somatostatin

No abstract available.
Hazardous Substances* ; Occupations* ; Skin*

No abstract available.
Congenital Hypothyroidism*

Fixed pelvic obliquity refers to a composite deformity induced by contractures both above and below the pelvis and the elements of this deformity are frequently interrelated during the period of growth. From the functional standpoint, leg length discrepancy is caused by deformities of the pelvis and lower extremities, such as pelvic obliquity and acetabular dysplasia, as well as by inequality of true limb bone length, and these deformities either aggravate or compensate functional discrepancy. During fhe fourteen years period, from August 1968 to August 1982, at the Department of Orthopaedic Surgery, Seoul National University Hospital, we treated 35 cases of fixed pelvic obliquity and acetabular dysplasia associated with true or functional limb length discrepancy by means of lumbodorsal fasciotomy or pelvic osteotomies such as Salters innominate osteotomy or Steels triple osteotomy, combined, if necessary, with contralateral abductor fasciotomy to gain functional limb length as well as to improve posture and balance. In many cases of residual poliomyelitis, epiphysiodesis was also performed when indicated. These cases were reviewed and following observations were made: 1. Of the 35 cases, residual poliomyelitis with 29 cases (83%) was by far the main cause of leg length discrepancy. Cerebral palsy (2cases), Legg-Perthes disease (2 cases), and fibrous ankylosis secondary to septic hip (2 cases) comprised the remainder. 2. The male-to-female ratio was about equal, being 17 to 18. 3. The average age at the time of operation was 17.9 years, the youngest being 7 years and the oldest being 30 years. The average age at the time of current follow-up was 18.8 years. 67% of those followed was skeletally mature. 4. An average of 1.35cm of bone length was gained radiographically by pelvic osteotomies. Steels triple osteotomy was more effective in gain than Salters innominate osteotomy. 5. An average of 2.43cm of functional length when standing was gained radiographically by lumbodorsal fasciotomy alone. 6. An average of 2.61cm of functional length when standing was gained radiographically by lumbodorsal fasciotomy and combined contralateral Soutters or Campbells fasciotomy. 7. An average of 3.57cm of functional length when standing was gained radiographically by lumbodorsal fasciotomy and combined ipsilateral Steel's triple osteotomy. 8. An average of 1.73cm of functional lengthening when standing was corrected radiographically by ipsilateral Soutter's fasciotomy. 9. When lumbodorsal fasciotomy and Steel's triple osteotomy were combined with contralateral Soutter's or Campbell's fasciotomy, the average radiographic gain in standing length was 3.77cm. 10. Leg length discrepancy in terms of true bone length is conventionally corrected either by epiphysiodesis or bone shortening on the longer limb, or by bone lengthening on the shorter limb. We believe that when leg length discrepancy is associated with fixed pelvic obliquity, frequently aggravating the disability functionally, lumbodorsal fasciotomy and/or pelvic osteotomies on the shorter side and, combined if necessary, Soutters or Campbells fasciotomy on the longer side, can, in many instances, successfully correct or reduce functional limb discrepancy and improve balance, posture and function. Any residual discrepancy, true or functional, may then be corrected by conventional methods.
Acetabulum ; Ankylosis ; Bone Lengthening ; Cerebral Palsy ; Congenital Abnormalities ; Contracture ; Extremities ; Follow-Up Studies ; Hip ; Leg ; Legg-Calve-Perthes Disease ; Lower Extremity ; Osteotomy ; Pelvis ; Poliomyelitis ; Posture ; Seoul ; Socioeconomic Factors ; Steel

No abstract available.
Blattellidae* ; Child* ; Humans

We described a case of well differentiated papillary mesothelioma (WDPM) of the peritoneum in a 68-year-old man because of its rarity. It was incidentally found during operation for renal cell carcinoma. Grossly, the tumor appeared as multiple small granules or nodules on the entire peritoneal surface, including serosa of the intestine, omentum and mesentery. Microscopically, characteristic features are papillary, tubulopapillary or solid architecture lined by single layer of uniform, cytologically bland, cuboidal or polygonal mesothelial cells. The tumor cells were positive for EMA, cytokeratin and vimentin, but negative for CEA on immunohistochemical staining. Ultrastructural study showed characteristic long slender microvilli on the surface and intercellular junctions.
Male ; Humans