We have reviewed 22 cases of acute rupture of the achilles tenden seen at Naticnal Seoul Ho pital during a seven-year peiod (1974.1 to 1980. 12), 17 treated surgically, and 5 treared cons ervatively, The results of a follow-up review are as follows: 1. Males predominated by a ratio of 21: 1. The mean age for the 22 patients was 29.8 years. Fourteen cases (63.6%.) were in the third decade. 2. The sites of rupture were 13 cases(58.4%.) on the left side and the level of rupture was at the tendon itself on 15 Cases (68.2%). 3. The cause of injury was indirect trauma in 14 cases (63.6%) and the most ccmmon mechanim of injury was a sudden push-off of the foot from the plantar flexed position: seven (50%) of 14 cases. 4. Positive Thompson test was noted in 19(86.3%) of 22 cases. 5. The average period of cast immobilization was 6 weeks in surgically treated cases and 10 weeks in conservatively treated cases. 6. The most common complication was wound infection, which developed in three cases(17.6%) postoperatively. One case of re-rupture (20%) developed after conservative treatment.
Follow-Up Studies ; Foot ; Humans ; Immobilization ; Male ; Rupture ; Seoul ; Tendons ; Wound Infection

A clinical study of traumatic amputation by railroad accidents was made an 124 patients with 154 amputee, who had been treated at Department of Orthopaedic Surgery, National Seoul Hospital, during the 4 years period from January 1976 to December 1979. The results of this study are as follows: 1. The ratio of male to female was 9 to 1. The 3rd decade of age group showed the hightest number of accident causalties, as much as 37.1%. 2. Causalties showes a maximum during the sprlng (37.1%) and a minimum during winter. 3. The most common injured sites of the amputee were B–K in 44 cases among 154 cases of the amputee. 4. Considering the number of the multiple amputee in 26 casee among 124 cases, frequently they developed in 2 sites with 22 cases, 3 sites with 4 cases. 5. The frequent fracture sites with combined amputation were 18 cases of the pelvic bone, 12 cases of femur in amputation of the lower extremity. 6. Our methods of treatment were debridement, debridement and primary skin closure, debridement with open amputation, circular amputation, closed amputation with skin graft, and closed amputation. 7. The major complications were phantom limb in 108 cases (70.1%), infection in 44 cases (28.6%). 8. The most frequent infectious agent was pseudomonas (16 cases).
Amputation ; Amputation, Traumatic ; Amputees ; Clinical Study ; Debridement ; Female ; Femur ; Humans ; Lower Extremity ; Male ; Pelvic Bones ; Phantom Limb ; Pseudomonas ; Railroads ; Seoul ; Skin ; Transplants

An esophageal foreign body has clinical significance because it may cause serious complications such as esophageal perforation, mediastinitis and/or aorto-esophageal fistula. A prompt attempt to remove an esophageal foreign body via flexible endoscopy should be made when the shape of the foreign body is especially sharp and long as it can easily lead to esophageal perforation. We report here on a case of endoscopic removal of an impacted esophageal foreign body, a fishhook, that hade been present in the esophagus for two months, and there were no serious complications from the procedure.
Endoscopy ; Epoxy Compounds ; Esophageal Perforation ; Esophagus ; Fistula ; Foreign Bodies ; Hydroxybenzoate Ethers ; Mediastinitis

Linear focal elastosis is characterized clinically by horizontal yellowish palpable striae on the lower back and histologically fragmentation or aggregation of elastic fibers. We herein report four cases of linear focal elastosis in male patients. They were 12 to 17 years old and the disease duration was 1 to 3 years. We suggest linear focal elastosis is a variant of striae distensae affecting elastic fibers.
Adolescent ; Elastic Tissue ; Humans ; Male ; Striae Distensae

BACKGROUND/AIMS: A diagnosis of gastroesophageal reflux disease (GERD) is based on the typical symptoms, such as acid regurgitation and heartburn. However, there is a very high inter-observer variation in the evaluation of GERD patients. METHODS: The endoscopic images of forty-two cases with reflux symptoms (2 still images and 15-second video images per case) were analyzed by 18 experienced endoscopists and 22 trainees. The findings were classified into the following: (1) 6 groups (modified LA classification: 4 LA groups, minimal, and normal), (2) erosinve and non-erosive, and (3) confluent erosive and others. The level of inter-observer variation is expressed as a kappa value. RESULTS: The level of inter-observer agreement of the 18 experienced endoscopists for classifying the patients into 6 groups was fairly low (kappa=0.364). However, when the findings were classified into the 2 groups suggested in the Genval workshop (NERD, A, or B versus C or D), the level of inter- observer agreement increased substantially (kappa=0.710). The kappa value of the 22 trainees for classifying the patients into 6 groups was 0.402. CONCLUSIONS: Modified LA classification with minimal change lesions showed a fairly low level of agreement. The problem caused by inter-observer variations decreased significantly when the findings were classified into two groups.
Classification ; Diagnosis* ; Education ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Observer Variation*

BACKGROUND: To determine the benefits of laparoscopic surgery compared with exploration, the clinical outcomes of open and laparoscopic distal pancreatectomy were compared. METHOD: From March 2005 to June2007, we studied 95 patients at Asan Medical Center. These patients had benign pancreatic disease in the distal pancreas, e.g. a cystic neoplasm. These patients underwent a distal pancreatectomy with or without spleen-preservation using laparoscopic or exploration surgery. We divided these patients into two groups i.e. laparoscopy (n=60) and exploration (n=35), and compared the outcomes of the two groups retrospectively. RESULT: There was no difference in demographic features between the two groups. Laparoscopic resection required a median time of 208 mins, compared with 190 mins for the open resection. (p>0.05) The laparoscopic patients started a liquiddiet on postoperative day three, and required a median hospital stay of 11 days, compared with 4.5 days and 16 days for the open resection surgery, respectively. (p<0.001) The overall postoperative complication rate was 28.3% for the laparoscopic group compared with 22.9% for the open group. (p>0.05) The pancreatic fistula rate was lower in the laparoscopic patient group than in the open group. (8.3% vs. 14.3%) (p>0.05) The rate of spleen-preservation was higher in the laparoscopy group than the open group. (25% vs. 5.7%), (p>0.05) CONCLUSION: The results of this study showed that the laparoscopic distal pancreatectomy had a similar surgical time, an early start of the diet, a shorter hospital stay, and a higher spleensaving rate, compared to exploration surgery. Therefore, considering the benefits of laparoscopic surgery, it appears to be the preferred approach, with or without spleen-preservation, for treating benign distal pancreatic disease.
Chungcheongnam-do ; Diet ; Humans ; Laparoscopy* ; Length of Stay ; Operative Time ; Pancreas ; Pancreatectomy* ; Pancreatic Diseases ; Pancreatic Fistula ; Postoperative Complications ; Retrospective Studies

Bezoars are the most common foreign bodies in the stomach as seen endoscopically with a frequency of approximately 0.4%. They consist of persistent concretions or hard accumulations of non-digestible vegetable matter, hair or more unusual materials. Gastric bezoars develop in patients with previous gastric surgery, gastric outlet obstruction, or poor gastric emptying such as gastroparesis due to hypothyroidism, diabetes mellitus or mixed connective tissue disease. The clinical presentations of gastric bezoars include epigastric pain, a palpable mass, a gastrointestinal obstruction and peptic ulceration. The treatment options include surgery, enzymatic dissolution or endoscopic mechanical fragmentation and/or removal. Recently, the efficacy of the administration or lavage of 'Coca-Cola' for the effective dissolution of gastric bezoars has been reported. We report a case of a 27-year-old woman with a large gastric bezoar that was successfully removed by the direct endoscopic injection of a carbonated beverage ('Coca-Cola light', a sugar free product; Coca cola Co., Seoul, South Korea) into the bezoar, which led to fragmentatio
Adult ; Bezoars* ; Carbonated Beverages ; Coca ; Cola ; Diabetes Mellitus ; Endoscopy ; Female ; Foreign Bodies ; Gastric Emptying ; Gastric Outlet Obstruction ; Gastroparesis ; Hair ; Humans ; Hypothyroidism ; Mixed Connective Tissue Disease ; Peptic Ulcer ; Seoul ; Stomach ; Therapeutic Irrigation ; Vegetables

BACKGROUND/AIMS: The incidence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study was to evaluate the relationship between GERD symptoms and dietary factors in Korea. METHODS: From January 2007 to April 2008, 162 subjects were enrolled (81 in GERD group and 81 in control group). They were asked to complete the questionnaires about GERD symptoms and dietary habits. The symptom severity score was recorded by visual analogue scale. RESULTS: Subjects with overweight or obesity had an increased risk for GERD (OR, 2.52; 95% CI, 1.18-5.39). Irregular dietary intake was one of the risk factors for GERD (OR, 2.33; 95% CI, 1.11-4.89). Acid regurgitation was the most suffering (2.85 +/- 2.95 by visual analogue scale) and frequent reflux-related symptom (57.5%) in GERD. Noodles (OR, 1.22; 95% CI, 1.12-1.34), spicy foods (OR, 1.09; 95% CI, 1.02-1.16), fatty meals (OR, 1.20; 95% CI, 1.09-1.33), sweets (OR, 1.42; 95% CI, 1.00-2.02), alcohol (OR, 1.16; 95% CI, 1.03-1.31), breads (OR, 1.17; 95% CI, 1.01-1.34), carbonated drinks (OR, 1.69; 95% CI, 1.04-2.74) and caffeinated drinks (OR,1.41; 95% CI, 1.15-1.73) were associated with symptom aggravation in GERD. Among the investigated noodles, ramen (instant noodle) caused reflux-related symptoms most frequently (52.4%). CONCLUSIONS: We found that noodles, spicy foods, fatty meals, sweets, alcohol, breads, carbonated drinks and caffeinated drinks were associated with reflux-related symptoms.
Bread ; Carbonated Beverages ; Diet ; Food Habits ; Gastroesophageal Reflux ; Incidence ; Korea ; Meals ; Obesity ; Overweight ; Surveys and Questionnaires ; Risk Factors ; Stress, Psychological

BACKGROUND: Although there have been some reports on microsatellite alterations in gastric cancer, findings are inconsistent regarding the associations between histological classification and microsatellite instability (MSI). In the present study, we attempted to determine whether Lauren's histological subtypes are related with MSI status. METHODS: Paraffin-embedded tissue samples from 14 diffuse-type and 14 intestinal-type gastric adenocarcinomas were matched up according to patient gender and age. Mononucleotide markers (BAT25 and BAT26) and dinucleotide markers (D2S123, D5S346, and D17S250) were used for MSI analyses. Microsatellite genotypes were categorized in terms of high MSI incidence (MSI-H, > 30% positive marker) or low MSI incidence (MSI-L, < 30% positive marker). Losses of hMLH1 and hMSH2 protein expression were immunohistochemically studied. RESULTS: MSI-H was observed in 11 cases (78%) of the 14 intestinal-type cases as compared to 3 (21%) of the 14 diffuse-type cases (p=0.007). In MSI-H tumors, 10 cases (71%) showed losses of hMLH1 protein expression, while 2 cases (14%) in MSI-L tumors showed losses of hMLH1 protein expression (p=0.006). CONCLUSION: MSI-H tumors are more frequently found in intestinal-type gastric cancer, which suggests the possibility that there are different pathogenic pathways in gastric carcinogenesis according to histologic type.
Adenocarcinoma/epidemiology/*genetics/pathology ; Aged ; Base Pair Mismatch/*genetics ; Comparative Study ; Female ; Gene Expression Regulation, Neoplastic ; Genotype ; Humans ; Incidence ; Korea/epidemiology ; Male ; Microsatellite Repeats/*genetics ; Neoplasm Proteins/genetics ; Nuclear Proteins/genetics ; Polymerase Chain Reaction ; RNA, Messenger/genetics ; Retrospective Studies ; Stomach Neoplasms/epidemiology/*genetics/pathology

BACKGROUND/AIMS: Safety of endoscopic procedures has been a major issue over the last 10 years. Most endoscopy units use 2% glutaraldehyde and automated endoscope reprocessors (AERs) for disinfecting gastrointestinal endoscopes. We attempted an in-use evaluation of the current reprocessing procedures. METHODS: Thirty flexible endoscopes were randomly collected just after upper endoscopic examinations and were disinfected using 2% glutaraldehyde in an AER. Cultures were taken from biopsy channels (S-1), tip of the insertion tubes (S-2), umbilical cords (S-3), and angulation knobs (S-4). RESULTS: In 63.3% (19/30) of endoscopes, there was no microbial contamination after disinfection procedures. The culture positive rates of S-1, S-2, S-3, and S-4 samples were 20.0%, 0.0%, 3.3%, and 20.0%, respectively. Microorganisms of 13 species were identified, but there was no pathogen related with reported infectious complications after endoscopic procedures. CONCLUSIONS: Current disinfection procedure using 2% glutaraldehyde and an AER appears to be very effective in decontaminating patient-used endoscopes. Low level microbial contamination of endoscopes after conventional reprocessing methods may not impose great risk on patients.
Biopsy ; Disinfection* ; Endoscopes* ; Endoscopes, Gastrointestinal ; Endoscopy ; Glutaral* ; Humans ; Umbilical Cord