Freibergs disease is avascular necrosis of the second or third metatarsal bone. Since 1914, numerous causes and treatments have been proposed but no definite single cause and treatment method were developed. The simple method, joint debridement could not recover the pathophysiologic condition of Freibergs disease and the destructive method, metatarsal head resection and prosthetic replacement arthroplasty had many postoperative problems. Recently, dorsiflexion osteotomy, which was described by Gauthier and Elbaz for the first time, and joint debridement and reshaping of the metatarsal head, which was described by Mann, were very effective method to manage Freibergs disease. This paper was aimed to evaluate the result of joint debridement and reshaping of the metatarsal head which were relatively simple, less destructive and safe method in treatment of the advanced Freibergs disease. We treated 7 cases of Freibergs disease from August 1993 to March 1997. The results were as follows: 1. All the patients of the last follow-up improved pain. 2. The passive range of motion was increased from 39.1 preoperatively to 57.6 postoperatively. 3. Follow-up X-rays showed no loose body and further metatarsal head destruction. The above results suggested that the joint debridement and reshaping of metatarsal head provided good result in the treatment of advanced Freibergs disease.
Arthroplasty, Replacement ; Debridement* ; Follow-Up Studies ; Head* ; Humans ; Joints* ; Metatarsal Bones* ; Necrosis ; Osteotomy ; Range of Motion, Articular

PURPOSE: This study aimed to compare the results of laparoscopic resection with those of open resection for consecutive colorectal cancer patients who underwent surgery at a single center. METHODS: During the thirty-month period between January 2003 and August 2005, patients with a colorectal adenocarcinoma admitted to our hospital were assessed. Cancers related with FAP or HNPCC, cancers treated with endoscopy or local excision, and recurrent cancers were excluded from the study. Three hundred two laparoscopic resection patients were matched to 302 open resection patients. RESULTS: The mean age of the laparoscopic resection group was 59.5 years while that of the open resection group was 59.4 years. Patients in two groups were similar in terms of gender distribution, level of CEA and ASA, and location and size of tumor. The modified Dukes' stages showed 51 patients in stage A, 33 in stage B1, 62 in stage B2, 17 in stage C1, and 139 in stage C2 for the laparoscopic resection group and 33 in stage A, 52 in stage B1, 82 in stage B2, 18 in stage C1, and 117 in stage C2 for the open resection group (P=0.024). The operative time averaged 9.6 minutes longer in the laparoscopic group (188.9 vs. 179.3 min, P<0.0001). The rate of stoma formation for protection of anastomosis in the laparoscopic group was 4.9% (5.8% in open group). There were significant differences in blood loss (556.2 vs. 952.8 ml, P<0.0001), the amount of intraoperative blood transfusion (1.6 vs. 2.3 unit, P=0.004), the number of harvested lymph nodes (21.1 vs. 16.9, P<0.0001), and the rate of high ligation of IMA (91.7 vs. 75.5%, P<0.0001). The length of the distal resection margins from cancer was longer in the open group (2.9 vs. 3.5 cm, P=0.037). Patients in the laparoscopic group had a faster recovery of bowel function (P<0.0001) and a significant reduction in the mean length of hospital stay (11.5 vs. 16.8 days, P<0.0001). There was no mortality in either group. Early and late complications were comparable. The conversion rate was 1.6 percent. CONSLUSIONS: The benefits of a laparoscopic resection for colorectal cancers are less blood loss and transfusion, faster postoperative bowel motion, a shorter hospital stay, low morbidity, and a large number of harvested lymph nodes. In conclusion, a laparoscopic resection for colorectal cancers can be done safely and effectively and is an acceptable alternative to a conventional open resection.
Adenocarcinoma ; Blood Transfusion ; Colorectal Neoplasms* ; Endoscopy ; Humans ; Length of Stay ; Ligation ; Lymph Nodes ; Mortality ; Operative Time

Primary cutaneous CD30-positive, anaplastic large cell lymphoma (ALCL) is a rare cutaneous peripheral T cell lymphoma with a favorable prognosis. ALCL is characterized by a solitary or localized skin tumor composed of sheets of atypical lymphoid cells with pleomorphic or anaplastic nuclei. Herein we report a 67-year-old woman presented with tender nodules and severely pruritic numerous eruptive papules. Histopathologic examination revealed dense non-epidermotrophic infiltrates of atypical large cells with round, oval or irregularly shaped nuclei and abundant cytoplasm. Immunohistochemical studies demonstrated that most lymphoid cells in the dermis and subcutis were positive for CD30 and CD45RO, and negative for CD20 and CD56.
Aged ; Cytoplasm ; Dermis ; Female ; Humans ; Lymphocytes ; Lymphoma, Large-Cell, Anaplastic* ; Lymphoma, T-Cell, Peripheral ; Prognosis ; Skin

Good's syndrome (GS) is a rare cause of acquired combined B- and T-cell immunodeficiency in adults. GS is also known as a rare form of paraneoplastic syndrome of thymoma that may persist after thymectomy. Some reported GS cases have been related to various diseases as a result of humoral immunodeficiency, but no report to date has related GS to cytomegalovirus (CMV) retinitis in Korea. We report two cases of CMV retinitis as a manifestation of GS with severe cellular immunodeficiency. In the first case, a 61-year-old woman was diagnosed with GS manifesting as CMV retinitis combined with coincident pulmonary tuberculosis and soft-tissue tuberculosis. In the second case, a 56-year-old man had CMV retinitis and CMV pneumonia. Both patients had a history of thymoma and had received total thymectomies, and were diagnosed with GS a few years thereafter.
Adult ; Cytomegalovirus ; Cytomegalovirus Retinitis ; Female ; Humans ; Immunologic Deficiency Syndromes ; Korea ; Middle Aged ; Paraneoplastic Syndromes ; Pneumonia ; Retinitis ; T-Lymphocytes ; Thymectomy ; Thymoma ; Tuberculosis ; Tuberculosis, Pulmonary

OBJECTIVE: To compare the diagnostic accuracy and acceptability of saline infusion sonohysterography (SIS), and hysteroscopy for detecting intracavitary abnormalities in women with abnormal uterine bleeding. METHODS: Seventy-eight patients with abnormal uterine bleeding were selected from the Department of Obstetrics and Gynecology in Chonnam University Hospital. The findings at SIS were compared with the hysteroscopic and histologic findings. The agreement of diagnosis between SIS and hysteroscopy was calculated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: SIS had a sensitivity of 84% and a specificity of 85% for a diagnosis of endometrial polyp. Hysteroscopy had a sensitivity of 86% and a specificity of 96% for diagnosis of endometrial polyp. SIS had a sensitivity of 75% and a specificity of 86% for a diagnosis of submucosal myoma. Hysteroscopy had a sensitivity of 100% and a specificity 99% for a diagnosis of submucosal myoma. SIS had a sensitivity of 91% and a specificity of 96% for a diagnosis of submucosal myoma. Hysteroscopy had a sensitivity of 100% and a specificity 91% for a diagnosis of endometrial hyperplasia. CONCLUSIONS: The diagnostic accuracy of SIS was significant to that of hysteroscopy in diagnosing intracavitary abnormalities, Moreover, SIS in a safe, convenient, cost effective, easily accessible and acceptable investigative modality.
Female ; Gynecology ; Humans ; Hysteroscopy ; Myoma ; Obstetrics ; Polyps ; Sensitivity and Specificity ; Uterine Hemorrhage

Staphylococcus aureus is a well-known pathogen involved inright-sided endocarditis with predisposing factors, and the clinical course may be acute and rapidly progressive. Intravenous drug abuse, pacemakers or central vascular catheters, and congenital heart diseases are well-known predisposing factors. However, right-sided endocarditis as a result of S. aureus infection is very rare in patients without these predisposing factors. Here, we report the case of a previously healthy 25-year-old male with native tricuspid valve infective endocarditis by methicillin-sensitive Staphylococcus aureus, complicating multiple septic pneumonia and septic pulmonary artery thrombosis. The patient was treated with antibiotics and surgical thromboembolectomy with tricuspid valve repair.
Adult ; Anti-Bacterial Agents ; Endocarditis ; Heart Diseases ; Humans ; Male ; Pneumonia ; Pulmonary Artery ; Staphylococcus ; Staphylococcus aureus ; Substance Abuse, Intravenous ; Thrombosis ; Tricuspid Valve ; Vascular Access Devices

PURPOSE: Acute cholecystitis has been a general contraindication of laparoscopic cholecystectomy, and complicated cholecystitis is a challenging disease even in open surgery. The purpose of this study is to evaluate the effectiveness and safety of laparoscopic cholecystectomy in acute and complicated cholecystitis. METHODS: We retrospectively reviewed the medical records of 233 cases treated with laparoscopic cholecystectomy for acute and complicated cholecystitis at Ewha Mokdong hospital from March 1997 to February 2001. Postoperative outcomes were compared between simple acute cholecystitis and complicated cases. The uncomplicated simple acute cholecystitis group (simple acute group) comprised 161 cases (69%) and the complicated cholecystitis group, which included hydrops, empyema, and pericholecystic abscess (complicated group), included 72 cases (31%). RESULTS: In the acute and complicated cholecystitis groups, the length of postoperative diet was 2.19 days and 2.46 days, the conversion rate was 8.07% and 8.3%, and the complication rate was 4.97% and 12.5%, respectively. There was no statistical difference for these three factors (p>0.05). The hospital stay was 6.19 days and 7.57 days, and the mean time of operation was 97.09 minute and 116.5 minute, respectively. These two factors were significantly different (p<0.05). CONCLUSION: Laparoscopic cholecystectomy was shown to be a safe and effective treatment for simple acute cholecystitis and complicated acute cholecystitis. Even in severecomplicated cholecystitis, laparoscopic cholecystectomy can be a primary treatment modality.
Abscess ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Diet ; Edema ; Empyema ; Length of Stay ; Medical Records ; Retrospective Studies

OBJECTIVE: The aim of this study was to evaluate the clinical effectiveness and safety of vaginal myomectomy via colpotomy with analyzing clinical course and postoperative complication. METHODS: A retrospective study was performed in 59 patients, who underwent vaginal myomectomy between November 1997 and July 2006 in department of gynecology, Chonnam National University Hospital. Operating time, hemoglobin change, postoperative pain, perioperative complication, and days of hospital stay were recorded. RESULTS: Fifty-nine patients were evaluated, mean age of patients was 41.54+/-5.8 years. Mean diameter of the uterine myoma was 6.79+/-1.75 cm. Mean operating time was 66.69+/-34.49 minute. Mean hemoglobin loss was 2.67+/-1.26 g/dL, and mean days of hospital stay was 4.91+/-1.25 days. One patient had febrile morbidity. Only one patient had suffered from retroperitoneal bleeding enough to get on operation. CONCLUSION: Vaginal myomectomy seems to be a feasible and safe surgical procedure. Further randomised studies are needed to compare this procedure with laparotomy and laparoscopy, and vaginal myomectomy is expected to be more effective and generalized surgical procedure.
Colpotomy ; Gynecology ; Hemoglobins ; Hemorrhage ; Humans ; Laparoscopy ; Laparotomy ; Leiomyoma ; Length of Stay ; Myoma ; Pain, Postoperative ; Retrospective Studies

Gastric variceal bleeding has relatively low incidence rate compared to esophageal variceal bleeding. However, gastric variceal bleeding tends to lead to a massive bleeding and rebleeding which in turn leads to high mortality rate. In cases where endoscopic approach is limited, Ballon-occluded retrograde transvenous obliteration (BRTO) could be considered as a next modality of seizing acute bleeding. Venous catheterization should be preceded to perform venous embolization, however, in cases of hypovolemic shock status, alternative approaches are required. We are reporting a case of 60-year old female with hypovolemic status due to a massive hematemesis, who went through a percutaneous transhepatic glue embolization to control gastric variceal bleeding.
Adhesives* ; Catheterization ; Catheters ; Esophageal and Gastric Varices* ; Female ; Hematemesis ; Hemorrhage ; Humans ; Hypovolemia ; Incidence ; Mortality ; Shock

BACKGROUND/AIMS: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are predominantly known as medication-induced diseases. However, at our institution, we have experienced more cases of non-drug-related SJS and TEN than expected. Therefore, we studied the difference between non-drug-related and drug-related SJS and TEN in terms of clinical characteristics and prognoses. METHODS: The etiologies, clinical characteristics, and treatment outcomes for 82 adult patients with SJS and TEN were retrospectively reviewed. RESULTS: A total of 71 patients (86.6%) were classified as having SJS, and the other 11 patients (13.4%) were classified as having TEN. Drug-related cases were more common (43, 52.4%) than non-drug-related cases (39, 47.6%). Anticonvulsants (12/82, 14.6%) and antibiotics (9/82, 11%) were the most common causative medications. Anemia (p = 0.017) and C-reactive protein of > or = 5 mg/dL (p = 0.026) were more common in the drug-related cases than in the non-drug-related cases. Intravenous steroid therapy was used as the main treatment regimen (70/82, 85.4%). Of the 82 patients, 8 (9.8%) died during the clinical course. A univariate analysis for mortality showed statistical significance for the following: kidney function abnormality, pneumonia, hemoglobin of < 10 g/dL, and combined underlying diseases. In a multivariate analysis, only pneumonia was statistically significant (odds ratio, 25.79; p = 0.009). CONCLUSIONS: Drugs were the most frequent cause of these diseases. However, non-drug-related causes also contributed to a significant proportion of cases. Physicians should keep this in mind when documenting patient history. In addition, early recognition and treatment may be important for better outcomes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Epidermal Necrolysis, Toxic/diagnosis/*etiology/mortality/*therapy ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Republic of Korea ; Risk Assessment ; Risk Factors ; Stevens-Johnson Syndrome/chemically induced/diagnosis/*etiology/mortality/*therapy ; Survival Analysis ; Treatment Outcome ; Young Adult