BACKGROUND: Periampullary cancer is a relatively common malignancy, and its incidence is increasing. A pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancer. However, leakage of the pancreaticojejunal anastomosis has been a major complication after a pancreaticoduodenectomy, with a frequently reported incidence of 5 percent to 25 percent. The ideal management of the pancreatic stump has not yet been determined. Thus we tried to find a safe and effective pancreatic stump management technique and to monitor the security of the pancreatic stump anastomosis by using the body fluid amylase level. PATIENTS AND METHODS: Forty six (46) consecutive patients who had undergone a pancreaticoduodenectomy, between January 1990 and January 1998, were evaluated retrospectively. Before June 1997, we did 36 pancreaticojejunostomies without long stent insertion into the pancreatic duct (group 2). After that, we did 10 P-Jstomies with long stent insertion (group 1). A long silicone stent was used for intubation of the anastomosis. Also the amount of pancreatic juice drainage from the long pancreatic duct tube was checked daily. We placed two Penrose drains and one Jackson-Pratt drain near the anastomosis. Patients were monitored for clinical evidence of a pancreatic fistula by evaluation of the amylase concentration in serum and the peritoneal drainage at postoperative day 7. The normal range of body fluid amylase was defined to be within five times of the normal serum amylase level. Cholangiography, which was obtained through a T-tube or a percutaneous transhepatic catheter, was performed on postoperative day 7 and was used to assess to leakage from or the obstruction at any of the three reconstructive anastomoses. RESULTS: In group 1, there was no leakage from the P-Jstomy site. The daily mean pancreatic juice amount and body fluid amylase level were 76.6 ml/day (range, 0.4-137.4 ml/day) and 147.4 U/L (range,44-323 U/L). In group 2, there were 4 cases of leakage at the P-Jstomy site (11.1%). CONCLUSION: An external long pancreatic duct stent insertion is an effective and safe method for management of a pancreatic remnant. We could check the amount of the daily pancreatic juice precisely. Effective decompression of the P-Jstomy was achieved by long stent insertion. We could monitor the security of the pancreatic stump anastomosis by the body fluid amylase level. We suggest that our method, which monitors the body fluid amylase level, is effective in early detection and treatment of P-Jstomy site leakage. The effort to find the best method for management of the pancreatic remnant should be continued.
Amylases ; Body Fluids ; Catheters ; Cholangiography ; Decompression ; Drainage ; Humans ; Incidence ; Intubation ; Pancreatic Ducts* ; Pancreatic Fistula ; Pancreatic Juice ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Reference Values ; Retrospective Studies ; Silicones ; Stents*

Acute focal bacterial nephritis is a part of urinary tract infection and a special form of acute pyelonephritis. In most cases, it is treated well by antimicrobial therapy without severe complications. Unusual cases have been reported that renal failure and or chronic granulomatous interstitial nephritis was combined with acute focal bacterial nephritis. We describe a case of acute reanl failure complicated by acute focal bacterial nephritis in 30-year-old male. He was admitted to this hospital owing to fever, chilling, right flank pain. On admission, BUN and creatinine were 29 mg/dl, 1.8 mg/dl. Urinalysis showed leukocyturia, & bactriuria. Urine culture revealed E. coli over us. Abdominal CT and ultrasonography was represented focal hypodense area and diffuse renal enlargement so we could diagnose acute focal bacterial nephritis. The patient was improved with antimicrobial therapy and hydration. In conclusion, this case shows the possibility that unusual complication such as acute reanl failure can be happensed in acute focal bacterial nephritis in continum with acute pyelonephritis
Acute Kidney Injury* ; Adult ; Creatinine ; Fever ; Flank Pain ; Humans ; Male ; Nephritis* ; Nephritis, Interstitial ; Pyelonephritis ; Renal Insufficiency ; Tomography, X-Ray Computed ; Ultrasonography ; Urinalysis ; Urinary Tract Infections

PURPOSE: Anogential distance (AGD) and the 2:4 digit length ratio appear to provide a reliable guide to fetal androgen exposure. We intended to investigate the current status of penile size and the relationship between penile length and AGD or digit length according to birth weight in Korean newborn infants. MATERIALS AND METHODS: Between May 2013 and February 2014, among a total of 78 newborn male infants, 55 infants were prospectively included in this study. Newborn male infants with a gestational age of 38 to 42 weeks and birth weight>2.5 kg were assigned to the NW group (n=24) and those with a gestational age<38 weeks and birth weight<2.5 kg were assigned to the LW group (n=31). Penile size and other variables were compared between the two groups. RESULTS: Stretched penile length of the NW group was 3.3+/-0.2 cm, which did not differ significantly from that reported in 1987. All parameters including height, weight, penile length, testicular size, AGD, and digit length were significantly lower in the LW group than in the NW group. However, there were no significant differences in AGD ratio or 2:4 digit length ratio between the two groups. CONCLUSIONS: The penile length of newborn infants has not changed over the last quarter century in Korea. With normal penile appearance, the AGD ratio and 2:4 digit length ratio are consistent irrespective of birth weight, whereas AGD, digit length, and penile length are significantly smaller in newborns with low birth weight.
Anthropometry ; *Birth Weight ; *Body Weights and Measures ; Cross-Sectional Studies ; Fingers/*anatomy & histology ; Gestational Age ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Male ; Organ Size ; Penis/*anatomy & histology ; Republic of Korea

PURPOSE: To characterize the CT and MR findings in patients with meningioangiomatosis(MA). MATERIALS AND METHODS: Four patients (18 to 53 years old, two females and two males) with MA were retrospectively reviewed. CTwas used in four cases and MR in three. Pathologic specimens were obtained from all four. RESULT: All lesions were located in the cortical and subcortical areas and showed spotty(n=1), popcornlike(n=2), or gyral(n=1) calcification. The mass were associated with surrounding edema and gliosis. In two patients, lesions were multiple and were accompanied by eccentric cysts. CONCLUSION: MA is a surgically correctable benign disease. Its radiologic characteristics are cortical or subcortical mass with various calcifications, associated peripheral edema and gliosis.
Edema ; Female ; Gliosis ; Humans ; Middle Aged ; Retrospective Studies

PURPOSE: This study was designed to determine the embolic effect of PVA particles of various sizes on the cerebral artery of a cat and to determine the appropriate particle size for embolization. MATERIALS AND METHODS: A total of 21 cats were divided into three groups according to the PVA particle size injected: group I(n=7), embolized with 45-150 micrometer PVA; group II(n=7), with 150-250 micrometer PVA; and group III(n=7), with 350-500 micrometer PVA. PVA particles were slowly injected into the left common carotid artery of each cat, and T2-weighted coronal MR images were obtained 24 hours after injection. During histologic examination of brain sections we analyzed the size, number of occluded vessels, and the ischemic changes caused by the particles. RESULTS: On T2 weighted images, areas of high signal intensity (infarction) were observed in four of the seven cats (57%) in group Iand in two of the seven (29%) in group II. High signal intensity was not found in group III. The mean percentage of areas of high signal intensity was 11.86 +/-1 . 37 % in group Iand 5.18 +/-1 . 77% in group II( P <0.05). During histologic examination, occlusion of the distal branches of the anterior cerebral (ACA) and/or the middle cerebral arteries(MCA) by PVA particles was observed in all seven cats (100%) in group I, and in four of the seven cats (57%) in group II. No group IIIcat showed occlusion of the distal branches of the ACA and/or MCA. The mean caliber of occluded vessels was 175 micrometer in Group Iand 258 micrometer in Group II. The mean number of occluded vessels seen on all slide sections was 14 in Group I and 5 in Group II. CONCLUSION: Small PVA particles had a greater cerebral embolic effect than did those which were medium or large. For the induction of embolic infarction in cat brain, PVA particles 45-150 micrometer in size are appropriate.
Animals ; Brain ; Carotid Artery, Common ; Cats* ; Cerebral Arteries* ; Infarction ; Particle Size* ; Polyvinyl Alcohol* ; Polyvinyls*

PURPOSE: This study was designed to determine the embolic effect of PVA particles of various sizes on the cerebral artery of a cat and to determine the appropriate particle size for embolization. MATERIALS AND METHODS: A total of 21 cats were divided into three groups according to the PVA particle size injected: group I(n=7), embolized with 45-150 micrometer PVA; group II(n=7), with 150-250 micrometer PVA; and group III(n=7), with 350-500 micrometer PVA. PVA particles were slowly injected into the left common carotid artery of each cat, and T2-weighted coronal MR images were obtained 24 hours after injection. During histologic examination of brain sections we analyzed the size, number of occluded vessels, and the ischemic changes caused by the particles. RESULTS: On T2 weighted images, areas of high signal intensity (infarction) were observed in four of the seven cats (57%) in group Iand in two of the seven (29%) in group II. High signal intensity was not found in group III. The mean percentage of areas of high signal intensity was 11.86 +/-1 . 37 % in group Iand 5.18 +/-1 . 77% in group II( P <0.05). During histologic examination, occlusion of the distal branches of the anterior cerebral (ACA) and/or the middle cerebral arteries(MCA) by PVA particles was observed in all seven cats (100%) in group I, and in four of the seven cats (57%) in group II. No group IIIcat showed occlusion of the distal branches of the ACA and/or MCA. The mean caliber of occluded vessels was 175 micrometer in Group Iand 258 micrometer in Group II. The mean number of occluded vessels seen on all slide sections was 14 in Group I and 5 in Group II. CONCLUSION: Small PVA particles had a greater cerebral embolic effect than did those which were medium or large. For the induction of embolic infarction in cat brain, PVA particles 45-150 micrometer in size are appropriate.
Animals ; Brain ; Carotid Artery, Common ; Cats* ; Cerebral Arteries* ; Infarction ; Particle Size* ; Polyvinyl Alcohol* ; Polyvinyls*

OBJECTIVE: The purpose of this reports is to describe the influence of continuous external ventricular drainage (EVD) on delayed ischemic neurologic deficit (DIND) after early surgery in ruptured aneurysmal patients. METHODS: The authors reviewed 229 patients with aneurysmal subarachnoid hemorrhage (SAH) who had been treated with clipping at a single institution between 1998 and 2004. Of these, 121 patients underwent continuous EVD (Group A) postoperatively, whereas 108 patients did not (Group B). EVD was performed at ipsilateral Kocher's point and maintained 2 to 14 days postoperatively. RESULTS: DIND occurred in 15.7% (19 cases) of patients in Group A, 25% (27 cases) from Group B (P value=0.112). Compared with Group A, Group B was more likely to suffer acute symptom of DIND and showed poor response to 3- H therapy. Major symptoms of DIND in Group A were mild confusion (36.8%) and mild deterioration of mental state (26.3%), contrary to weakness of extremities (59.2%) in Group B. At discharge, Glasgow Outcome Scales (GOS) of Group A were: good recovery (63.2%), moderately disabled (21%), severely disabled (10.5%), dead (5.3%) and Group B : good recovery (48.1%), moderately disabled (37%), severely disabled (14.8%) and dead (0%). Of 121 patients from group A, 35 patients (28.9%) suffered ventriculitis. CONCLUSION: Continuous EVD after aneurysmal clipping in patients with SAH reduced the risk of DIND and its sequelae, relieved its symptoms, and improved the outcome.
Aneurysm* ; Aneurysm, Ruptured ; Drainage* ; Extremities ; Humans ; Neurologic Manifestations* ; Subarachnoid Hemorrhage* ; Ventriculostomy ; Weights and Measures

Cooperation of the patients in orthodontic treatment is an essential element. This study examines the internal and external restriction factors and level of cooperation for orthodontic treatment of adolescent orthodontic treatment patients, and the factors that impart influence on the level of cooperation for orthodontic treatment. ‘Form for students’ among the indices of internal and external restrictions for orthodontics, which is an adaption of ‘Orthodontic Locus of Control Scale’ was used as survey tool, and ‘Reliability and Stability of the Orthodontic Patient Cooperation Scale’ was used as survey tool for the level of cooperation of orthodontic patients. As the result of examination of the effect of internal and external restriction factors on level of cooperation for orthodontic treatment by compensating the general characteristics in the multiple regression analysis, it was found that the level of cooperation for orthodontic treatment is higher for the patients who believe there is strong influence of external restrictions–patents–on the events that determines orthodontic treatment. In order to enhance the level of cooperation for orthodontic treatment of adolescent orthodontic patients, there is a need to assess the relationship between the patient and parents as well as the attitude or psychological state of the patients on orthodontic treatment.
Adolescent* ; Humans ; Internal-External Control ; Orthodontics ; Parents ; Patient Compliance

BACKGROUND: Even though there have been many case reports on nephrotic syndrome in patients with malignancy, an overall study on malignancy- associated nephrotic syndrome is rare in Korea. The purpose of this study was to explore the clinical and pathologic findings and clinical course of malignancy-associated nephrotic syndrome. METHODS: From January, 1986 to December, 2003, the medical records of patients with nephrotic syndrome and concomitant malignancy were retrospectively reviewed. RESULTS: Forty-eight patients (2.3%) out of 2, 085 patients with nephrotic syndrome had concomitant malignant disease during the study period. The mean age of patients was 57.9+-1.6 years with sex ratio of 2.4: 1. The most common primary origin of malignancy was liver (8 patients, 16.7%) and lungs (8 patients, 16.7%), and adenocarcinoma (17 patients, 35.4 %) was the leading histologic type of malignancy. There was no significant difference in 24-hour urinary protein excretion among patients grouped by TNM stage. Percutaneous renal biopsy was performed in 26 patients (54.2%), renal pathology revealed membranous nephropathy and minimal change disease in 9 patients (34.6%) each, membranoproliferative glomerulonephritis in 6 (23.1%), and IgA nephropathy in 2 patients (7.7%). When the patients were divided into progression and remission group based on the clinical course of underlying malignancy, there were significantly more patients with improved nephrotic syndrome in the remission group than the progression group (55.0% vs. 0%, p<0.05). CONCLUSION: Malignancy should be considered as a cause of nephrotic syndrome in adults, and the treatment of underlying malignancy may affect the outcome of nephrotic syndrome in patients with malignancy.
Adenocarcinoma ; Adult ; Biopsy ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Humans ; Korea ; Liver ; Lung ; Medical Records ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Pathology ; Retrospective Studies ; Sex Ratio

BACKGROUND: Syncope is a sudden and brief loss of consciousness associated with a loss of postural tone, from which recovery is spontaneous. The most frequently identified causes of syncope are neurocardiogenic, cardiac, cerebrovascular and side effects of drugs. However, in many cases, it is not easy to make a diagnosis of syncope. The prevalence rate of syncope also is variable according to the nature of the study. We investigated the prevalence rate, characteristics and triggering factors of syncope in young medical students. METHODS: We contacted 400 medical students of Kyungpook National University, Daegu, Korea, and a questionnaire on the prevalence, triggering factors, and recurrence rate of syncope was handed out. The data from 379 medical student (male 168, female 211, mean age 22.3 years) were included for further analysis. RESULTS: Fifty-eight students (15.3%) experienced syncope and female students reported higher prevalence rate than male students (20.4 versus 8.9%, p=0.002). Among 58 students with syncopal history, 22 students (male 2, female 20) experienced recurrent syncope. The students who experienced recurrent syncope were younger at first syncope than those without recurrent syncope (15.0 versus 17.3 years, p=0.039). The triggering factors of syncope were prolonged standing, warm environment, immediate standing, tiredness, emotional upset, menstruation, and so on. CONCLUSION: The prevalence rate of syncope was 15% in medical student with mean age of 22.3 years. As the syncope in female and early onset syncope showed higher rate of recurrence, more attention may prevent recurrent syncope in these cases.
Daegu ; Diagnosis ; Female ; Gyeongsangbuk-do ; Hand ; Humans ; Korea ; Male ; Menstruation ; Prevalence* ; Recurrence ; Students, Medical* ; Syncope* ; Unconsciousness ; Surveys and Questionnaires