We performed 75 cases of daryocystorhinostomy from Jan. 1988 to Dec. 1990. A routine dacryocystography was performed prior to operation in all cases. A modified T oti's method was applied as a surgical technique "H" shaped incision was done. Both anterior and posterior flaps were sutured adequately and vaseline guaze was used as a plugging agent for 7 to 10 days Success was achieved in 72(96.0%) of 75 cases. The causes of 3-failures were organized granulation tissue and trauma.

Recently, NAG activity has gained increasing importance as and aid in the diagnosis of renoparenchymal diseases. Elevation of urine NAG activity has been found to be an indicator of renoparenchymnal diseases. To evaluate the diagnostic value of the NAG activity test in the renal disease, we carried out clinical study on 31 cases of renal disease patients who had been admitted to the Department of Pediatrics, Chung-Ang University Hospital between March 1992 and February 1993. We analyese by two data: (1) Stastical Package for the Social Science. (2) Students'T test. The results were as follows 1) The urine NAG activity significantly increased (p<0.05) to 69.9+/-5165.69U/hr/mg Creatinine (U/hr/mg Cr) in the renal disease group compared to 3.6+/-1.91U/hr/mg Cr in the control group. 2) The serum NAG activity was 11.69+/-5.18U/L in the renal disease group and 10.58+/-4.04U/L in the control group. There was no significant difference in the serum NAG sctivity between two groups. 3) In the renal disease group, the serum NAG activity was 10.78+/-3.32U/L in male 12.53+/-6.47U/L in female. There was no significant difference between both sexes. In the renal disease, the urine NAG activity was 33.62+/-30.67U/hr/mg Cr in male and 114.05+/-241.62U/hr/mg Cr female. There was no significant difference between both sexes (p<0.05). 4) In the renal disease group, the urine NAG activity increased 314.73+/-420.39U/hr/mg Cr in the 2 years old group but there was no significant difference of urine NAG activity compared to above 2 years old group . 5) The urine NAG activities were 93.1+/-0193.04U/hr/mg Cr in the poteinuria subgroup and 13.3+/-47.62U/hr/mg Cr in the nonproteinuria subgroup and 3.66+/-1.91U/hr/mg Cr in the control group. There was no significant difference between the proteinuria subgroup and the nonproteinuria subgroup. but there was significant difference between nonproteinuria subgroup and control grouop(p<0.005).
Child, Preschool ; Creatinine ; Diagnosis ; Female ; Humans ; Male ; Pediatrics ; Proteinuria ; Social Sciences

Removal of blunt esophageal foreign bodies using Foley catheter under a fluoroscopic guidance is a well-recognized procedure. However, since this procedure is rather cumbersome and uncomfortable to the patient, the authors tried to find an easier and more convenient modified technique. For 10 patients with esophageal foreign body, we tried the method to the patients who is lying in the right lateral decubitus position and 3 assistants hold head. arms, trunk and legs of the patients without tilting the table and without using immobilizer. Foley catheter is inserted through nostril, nasal cavity and pharynx to esophagus. In order to identify the Foley catheter in esophagus, 0.025 inch short wire was inserted in the Foley catheter. The balloon of a Foley catheter was inflated by 10cc of air, and the syringe was kept attached to the Foley catheter during the procedure. After passage of the foreign body through the upper esophageal sphincter, the balloon was deflated immediately and the foreign body was removed through the mouth. We successfully removed in removing all the blunt esophageal foreign body with ease. This modified method is also fast, safe and efficient.
Arm ; Catheters* ; Deception ; Esophageal Sphincter, Upper ; Esophagus ; Foreign Bodies* ; Head ; Humans ; Leg ; Methods* ; Mouth ; Nasal Cavity ; Pharynx ; Syringes

Trichoblastic fibroma is a benign trichogenic tumor that has both epithelial and mesenchymal components and exhibits partial follicular induction. We studied 4 cases of trichoblastic fibroma and reviewed their clinical and histologic features. Two tumors were present in the face. The remaining two were in the vulva and perianal area, respectively. The age of the patients ranged from 53 to 68 years, with an average age of 62. All were female. Histologically, the lesions showed a well circumscribed mass, located at dermo-subcutaneous junction in three patients and subcutaneous in one. They demonstrated mesenchymal induction evidenced by hair germ-like structure and perifollicular sheath. There was no connection between the tumor and epidermis. Differentiation toward hair structure led to the formation of the infundibulum through inner root sheath. Trichoblastic fibroma may be confused clinically and/or histologically with basal cell carcinoma. Identification of the mixed epithelial and mesenchymal components, and the absence of epidermal connection and cleft within the stroma are important in differentiating this benign neoplasm from basal cell carcinoma.
Carcinoma, Basal Cell ; Epidermis ; Female ; Fibroma* ; Hair ; Humans ; Vulva

BACKGROUND: The claudins are a family of transmembrane proteins associated with tight junctions and they are critical for maintaining cell-to-cell adhesion in sheets of epithelial cells. However, their role in the progression of cancer remains largely unexplored. The aims of this study were to evaluate the expression patterns of claudin-1 and -4 in benign lesions and invasive ductal carcinomas (IDC) of the breast, and relationships between the expression of these markers and the clinicopathological characteristics in IDC patients. METHODS: We examined the claudin-1 and -4 protein expressions by performing immunohistochemical stainings in 54 benign lesions and 120 IDCs via the tissue microarray method. We evaluated the correlation between the expression of these markers and the clinicopathological characteristics of IDC. RESULTS: The expressions of claudin-1 (p=0.099) and -4 (p=0.000) were up-regulated in IDCs as compared with benign lesions. The claudin-1 expression correlated with the loss of estrogen receptor (p=0.036) and progesterone receptor (p=0.011). The claudin-4 expression correlated with lymph node metastasis (p=0.043), the nuclear grade (p=0.030), the histologic grade (p=0.007), and the loss of estrogen receptor (p=0.001) and progesterone receptor (p= 0.029). CONCLUSIONS: These results suggest that claudin-1 and -4 may play a significant role in the carcinogenesis of IDC of the breast and these may represent novel markers for this disease.
Breast* ; Carcinogenesis ; Carcinoma, Ductal* ; Claudin-1* ; Claudin-4 ; Claudins ; Epithelial Cells ; Estrogens ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Receptors, Progesterone ; Tight Junctions

Infection in primary total hip arthroplasty may cause catastrophic results and is the major reason for implant failure. The purpose of this study was to evaluate the utility of the hip joint fluid culture as a method of predicting the possibility of a hip joint infection by calculating the sensitivity, specificity and accuracy. We performed 628 primary total hip arthroplasty and aerobic and anaerobic bacterial cultures for hip joint fluid between January 1989 and June 1996. The hip joint fluid culture was routinely performed to evaluate the utility of the femoral head for bone banking. Thirty-two cases out of the 628 hips showed positive intraoperative culture and 596 cases showed negative intraoperative culture. The isolated organisms from 32 positive cultures were 11 for Staphylococcus aureus, eight for Staphylococcus coagulase negative, seven for Enterococcus, three for E.coli and one each for Enterobacter, Acinetobacter and Pseudomonas. Anaerobic culture was negative in all cases. In the positive intraoperative culture cases, none had delayed infection during the follow-up period. But in the negative intraoperative culture cases, one case had acute infection and two cases had delayed infection. In the case with acute infection, Staphylococcus aureus was isolated and on two cases with delayed infection, Enterococcus and Staphylococcus coagulase negative were isolated, respectively. All 32 positive culture cases were fa~lse positive and 595 negative culture cases were true negative and one negative culture case was fa~lse negative. The sensitivity of the hip joint culture was 0%, the specificity was 94.9% and the accuracy was 0%. The specificity of hip joint fluid culture in primary total hip arthroplasty was high, hut the sensitivity score was zero. Therefore, the hip joint fluid culture should not be used for a routine check of infection status in primary total hip arthroplasty. We recommend the hip joint fluid culture in revision arthroplasty or hips in which infection is clinically suspected.
Acinetobacter ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Bone Banks ; Coagulase ; Enterobacter ; Enterococcus ; Follow-Up Studies ; Head ; Hip Joint* ; Hip* ; Pseudomonas ; Sensitivity and Specificity ; Staphylococcus ; Staphylococcus aureus

Most proximal humeral fractures respond satisfactorily to simple conservative treatment, but operative treatment is recommended in cases where poor results are anticipated by prolonged immobilization, or because of severe displacement and comminution. We used a minimal internal fixation and tension band technique in severely displaced and comminuted cases to achieve firm fixation and avoid subacromial impingement. Passive range of motion of the involved shoulder began within the first postoperative day and active range of motion exercise was encouraged as soon as possible within the first postoperative week. Between February 1996 and November 1997, we operated using this technique on 15 patients ranging in age from 16 to 71 years (average 52). Follow-up averaged 13 months. During the follow-up period, all patients except one patient, had a active full range of motion on the affected limb. According to the evaluation on the 10 patients who had follow- up periods over 12 months by Hawkins rating scale of shoulder function, 6 patients had achieved a good result and 4 patients had achieved a fair result at the last follow up. In conclusion, tension band technique with minimal internal fixation could afford sufficient fracture stability to allow early, aggressive rehabilitation. As a method of internal fixation on a proximal humerus fracture, this technique may have particular advantages in elderly osteoporotic patients.
Aged ; Extremities ; Follow-Up Studies ; Humans ; Humerus ; Immobilization ; Range of Motion, Articular ; Rehabilitation ; Shoulder ; Shoulder Fractures*

PURPOSE: Due to the increasing number of early gastric cancer (EGC) cases, laparoscopic procedures have focused on in the quality of life. Although several studies have compared the surgical results of laparoscopic and open gastric resections, these are only the early initial experiences of the laparoscopic procedure. However, there has been no study following the overcoming of the learning curve. Between October 1998 and April 2003, we performed 83 laparoscopic radical gastrectomies, and compared the laparoscopy-assisted distal gastrectomy (LADG) with the conventional open subtotal gastrectomy after obtaining the learning curve. METHODS: Between May 2003 and February 2004, 35 patients who diagnosed with EGC by gastroscopy underwent LADG with lymph node dissection. Conventional open gastrectomy were performed in 14 patients preoperatively diagnosed advanced gastric cancer, but confirmed to EGC inform the pathology. Various clinicopathological parameters were retrospectively evaluated from the medical records. RESULTS: Statistically significant differences (P<0.05) were present between the laparoscopy-assisted and conventional open gastrectomies; white blood cell count on day 2 (10687 vs. 13053, P=0.033), liquid diet start day (4.0 vs. 6.0, P<0.001) and days of hospital stay (7.6 vs 12.1, P=0.005). For the LADG without complication, the group with more than a 7 day hospital stay had a delayed liquid diet start day (4.19 vs. 3.18, P=0.006). A strong positive correlation was found between the day of hospital stay and the start of a liquid diet for LADG without complication there is strong poitive correlation (correlation coefficient=0.77). CONCLUSION: A LADG with lymph node dissection for EGC has several advantage compared with a conventional open gastrectomy; less inflammatory reactions, a rapid return of gastrointestinal function, and a shorter hospital stay with no decrease in operative curability.
Diet ; Gastrectomy* ; Gastroscopy ; Humans ; Learning Curve* ; Learning* ; Length of Stay ; Leukocyte Count ; Lymph Node Excision ; Medical Records ; Pathology ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms*

BACKGROUND AND OBJECTIVE: Several recent studies have demonstrated that cognitive function is impaired in non-insulin dependent diabetes mellitus (NIDDM) patients compared with age-matched non-diabetic controls. However, the underlying pathophysiological mechanism of this diabetic central nervous involvement remains obscure. The present study was designed to explore further whether cognitive deficits are present in NIIDDM patients who do not show apparent symptoms and signs of central nervous system damage and to evaluate the influence of clinical parameters and diabetic complications on cognitive function. METHODS: Thirty patients over 50 years of age with NIDDM and 30 age-, sex- and education-matched normal controls were recruited for the study. P300 event-related potential test and neuropsychological tests (Mini-Mental State Examination, MMSE; Benton Visual Retention test; Digit Span Forward and Backward) were perfomed. P300 latencies were recorded according to the conventional technique using Counterpointer MK2. RESULTS: Compared with controls, NIDDM patients showed significant impairment in MMSE (P<0.05), Benton Visual Retention (P<0.05), and Digit Span Backward (P Blood Glucose ; Central Nervous System ; Diabetes Complications ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Event-Related Potentials, P300* ; Fasting ; Humans ; Neuropsychological Tests* ; Peripheral Nervous System Diseases ; Reference Values ; Triglycerides

BACKGROUND: It is well known that when macrophages are stimulated with endotoxin, they produce a wide variety of cytokine mediators, including TNF-α and IL-1β. However, there is an alterationnin the macrophages responsiveness when they are challenged with repeated bouts of endotoxin, termed 'endotoxin tolerance' which is regarded as a self-protective phenomenon from continuous stimulation. In this study, endotoxin tolerance in the peripheral blood monocytes of sepsis patients was evaluated. METHODS: Fourteen patients with organism-documented sepsis were included. The severity of illness was evaluated by APACHE IIscore. Peripheral blood monocytes were isolated from the patients and diluted to 1×105/well. After stimulation with endotoxin(LPS of E. coli O114:B4, 100 ng/ml), they were incubated at 37℃ in 5% CO2 incubator for 24 hours. Supernatant was collected for the measurement of TNF-αand IL-1β with ELISA method. Peripheral blood monocytes of seven healthy volunteers were used as control. RESULTS: The APACHE IIscore(mean±SD) of the patients at the time of blood sampling was 12.2±5.7. The primary infection foci were urinary tract infection, pneumonia, subacute bacterial endocarditis, and catheter related infection, etc. The causative organisms were gram negative rods(10 cases), gram positive cocci(6 cases) with two cases of mixed infection. Serum TNF-α could be measured in 4 cases with 29.9±27.7 pg/ml. Serum IL-1β was measureable in only one patient. The TNF-α level of supernatant of cultured peripheral blood monocytes was 2,703±2,066 pg/ml in patients and 2,102±1,914 pg/ml in controls. The IL-1β level of supernatant was 884±1,050 pg/ml in patients and 575±558 pg/ml in controls. There was no difference of TNF-α and IL-1β level between patients and controls. CONCLUSION: We cannot prove the phenomenon of endotoxin tolerance in this study. Future study needs to be focused on the more severe sepsis patients who were taken for sampling earlier. Addition of serum to the culture medium could be an another valuable option for the success of this study.
APACHE ; Catheters ; Coinfection ; Endocarditis, Subacute Bacterial ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Humans ; Incubators ; Macrophages ; Monocytes ; Pneumonia ; Sepsis* ; Tumor Necrosis Factor-alpha* ; Urinary Tract Infections