No abstract available.
Cholecystectomy, Laparoscopic*

We report a patient who developed a Barrett,s esophageal ulcer 10 years after esophagomyotomy for achalasia. A-59-year-old female was admitted to the hospital with dysphagia for 2 months. In 1982, she had undergone a modified Heller esophagomyotomy for achalsia. After esophagogram, esophageal manometry, 24hr esophageal pH monitoring, esophagoscophy achalasia and Barrett,s esophageal ulcer was diagnosed. So, she had been treated with omeprazole and sucralfate and has been followed up in a asymtomatic state currently. In Barrett,s esophagus, there is a metaplasia of the normal stratified squamous mucosa to columnar epithelium, caused by the reflux of acid. It appears in approximately 10% of patients with chronic gastroesophageal reflux and is associated with increased probability of adenocarcinoma of the esophagus. Among the predis- posing factors of gastroesophageal reflux, there is treatment of esophageal achalsia by forceful dilatation or by the esophagomyotomy. The resultant ralaxation of lower esophageal sphinter, combined with deficient propulsive esophageal peristalsis, predisposed to gastroesophageal reflux. Actually an increased incidence of gastroesophageal reflux, esophagitis and stricture are well-known complications after esophagomyotomy. But in spite of higher risk of gastroesophageal reflux after esophagomyotomy the development of Barrett,s mucosa has been rarely reported and only recently recognized. Diagnosis of Barrett,s esophagus in such patients is difficult and the cumulative effects of achalasia and Barrett's esophagus predispose these patient to higher risk of developing esophageal carcinoma. So, high index of awareness and regular endoscopic surveillance are required.
Adenocarcinoma ; Barrett Esophagus ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis ; Dilatation ; Epithelium ; Esophageal Achalasia* ; Esophageal pH Monitoring ; Esophagitis ; Esophagus ; Female ; Gastroesophageal Reflux ; Humans ; Incidence ; Manometry ; Metaplasia ; Mucous Membrane ; Omeprazole ; Peristalsis ; Sucralfate ; Ulcer*

A retrospective analysis was performed on 461 pediatric patients under one year of age who had received operation from 1983 to 1990 in department of anesthesiology of Ewha Womans University Hospital. Total number of operation showed incresing tendency, annually, 37 in 1983, 36 in 1984, 43 in 1985, 41 in 1986, 54 in l987, 89 in 1989, 81 in 1989, and 80 in 1990. The eletive and emergency operation com- prised 79% and 21%, respectively. The distribution of the patients by department was general surgery 217, plastic surgery l09, orthopedic surgery 23, neurosurgery l6, cardiothoracic surgery l6, urology 14, and otolaryngology 6. The average age distribution was 149 in 6.to l2 months, l00 in 1 to 3 months, 81 in 1 week to 1 month, 81 in 3 to 6 months, and 50 under 1 week of age. The male to female ratio was 2.7: l. The distribution of induction agents of general anesthesia was ketamine and succinylcholine (SCC) 317, without induction agent(awake intubation) 84, thiopental or diazepam and SCC 23, ketamine and pancronium or vecuronium l2. The most common technique of maintenence anesthesia was the balaced anesthesia. The distribution of disease entity by department was the following inguinal hernia was the most frequent in general surgery, cleft lip in palstic surgery, and hydrocephalus in neurosurgery. The postoperative complication developed in 31 of 461. The most common complications were the respiratory problems, the others were sepsis, heart failures, and convulsions. The motality rate was 1.73%.
Age Distribution ; Anesthesia ; Anesthesia, General ; Anesthesiology ; Cleft Lip ; Diazepam ; Emergencies ; Female ; Heart ; Hernia, Inguinal ; Humans ; Hydrocephalus ; Ketamine ; Male ; Neurosurgery ; Orthopedics ; Otolaryngology ; Postoperative Complications ; Retrospective Studies ; Seizures ; Sepsis ; Succinylcholine ; Surgery, Plastic ; Thiopental ; Urology ; Vecuronium Bromide

BACKGROUND: CSF can be leaked from the nose or ear due to fractures, tumors or surgical procedures in the skull base region, and the threat of impending meningitis necessitates early identification of it. Since 2-transferrin occurs practically in cerebrospinal fluid (CSF) and not in other body fluid, its detection from the rhinorrhea or otorrhea can be used for the diagnosis of CSF leakage. We carried out immunofixation-silver stain (IF-SS) method for detection of 2-transferrin in the CSF in order to know optimal identification condition of specific cerebrogenic marker. METHODS: The fresh CSF sample was collected by spinal tapping. 2-Transferrin was estimated by quantifying the total transferrin by nephelomertry (Behring, Germany). 2-Transferrin of CSF was identified by electrophoresis using Titan gel high resolution protein system (Beckman, USA), immunofixation with anti-human transferrin antibody (Dako, Denmark) and then stained with silver nitrate. Serial dilutions of CSF were performed to know the detection limit of 2-transferrin. To know the influence of blood mixing, tests for mixed specimen of serum and hemolysate in CSF were performed. To evaluate the specimen storage condition, tests for different temperature and storage time were performed . RESULTS: By IF-SS method, identification limit of 2-transferrin was 0.5 mg/dL in 1:4 diluted CSF with distilled water. And 2-transferrin could be detected in condition of mixing serum protein (7.5 g/dL) or hemoglobin (13 g/dL) with CSF up to 6 : 4. At various sample storage condition, such as 37degrees C, room temperature, and 4degrees C, band intensity decreased abruptly after 1 day, and it was not detected 5 days later. Mean while, in -20degrees C and -70degrees C, 2-transferin band was detected after 10 days. CONCLUSIONS: IF-SS method was sufficiently sensitive and specific for invalidation by blood contamination, and seems to be used as effective identification of 2-transferrin in the CSF without sample concentration, less diagnostic test for CSF leakage.
Body Fluids ; Cerebrospinal Fluid* ; Diagnosis* ; Diagnostic Tests, Routine ; Ear ; Electrophoresis ; Limit of Detection ; Meningitis ; Nose ; Saturn ; Silver Nitrate ; Skull Base ; Spinal Puncture ; Transferrin* ; Water

With advancement of endoscopical instruments and technique, gallstone diseases can be managed with laparoscopic cholecystectomy which has rapidly and radically changed the surgical treatment of gallstone diseases. The ideas of laparoscopic surgery was introduced by Germany gynecologist Semm, in 1967 and was first performed by French surgeon Mouret, Dubois in 1987. Although many reports of early laparoscopic cholecystectomy were excellent, many surgeons want to know the surgical results of laparoscopic cholecystectomy are enough good to perform comparing with the conventional cholecystectomy, especially in early complications and late complications. (continue...)
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Gallstones ; Germany ; Laparoscopy

The authors performed percutaneous antegrade pyelography guided by ultrasound on 33 patients, from J une 1982 to October 1984, at the department of radiology, Busan National University Hospital. The results obtained were as follows: 1. Of the 31 cases,17 cases (5 1.5%) were female and 16 cases (48.5 %)were male,and age distribution was nearly even, but most prevalent age group was third decade. 2. Comparing intravenous pyelographic findings with ultrasonographic findings, pyelographically non. visualized kidney 15 cases (45 .5%) were hydronephrosis 12 cases, multiple cysts 2 cases, and intrarenal cystic mass 1 case, ultrasonographically. Pyelographically hydronephrosis 9 cases (27.3%) were all hydronephrosis, ultrasonographically. Intrarenal mass 5 cases (15.2%) were all intrarenal cystic mass, NVK with air in kidney 1 case (3.0%) was air in perirenal space, partial NVK 1 case (3.0%) was per. irenal fluid , suprarenal mass 1 case (3 .0%) was suprarenal intrarenal and huge perirenal cystic masses, ultraso nograp h ically. 3. On technical reliability of antegrade pyelography under ultrasound gUide, 31 cases (93 .9%) could be done fluid aspiration and visualization, and 2 cases (6.1 %) could be only done fluid aspiration but failed visualization . 31 successful cases were visualization of collecting systems 23 cases, visualization of cyst 6 cases, i!nd visualization of perirenal space 2 cases. 2 partial successful cases were perirenal injection 1 case and parenchymal injection 1 case. 4. On fluid aspiration, 22 cases (66.7%) were clear, but 11 cases (33.3%) were not clear, which were pus 7 cases, turbid urine 2 cases, bloody urine 1 case, and bloody pus and air 1 case. 5. Comparing ultrasonographic findings with antegrade pyelographic findings, ultrasonographically hydronephrosis 21 cases revealed obstruction in 16 cases, antegrade pyelographically, which were consisted of ureteral stricture 14 cases, ureteral stone 1 case, and ureteral mass 1 case, non-obstruction in 4 cases, which were consisted of pyonephrosis 2 cases, posterior urethral valve 1 case, and megaureter 1 case, and other 1 case was visualization failure. Ultrasonographically intrarenal cystic mass 6 cases were simple renal cyst 4 cases, and infected renal cyst 2 cases, antegrade pyelographically. Multiple cysts 2 cases were lobulated huge renal cyst 1 case, and visualization failure 1 case, which was multi.cystic kidney. Air in perirenal space 1 case was emphysematous pyelone. phritis, suprarenal cystic mass 1 case was complete duplication with ectopic ureteral orifice, perirenal fluid 1 case due to kidney fracture was perirenal fluid , and intrarenal and perirenal cystic mass was per irenal abscess, antegrade pyelographically. 6. On ana lysis of anteg rade pyelography result as next diagnostic step of ultrasound, 31 successful cases were 27 conclusive diagnostic cases (87.1%), and 4 heplful diagnostic cases (12.9%) with percutaneous antegrade pyelography guided by ultrasound . 7. Antegrade pyelography provides significant diagnostic information on the nature of the obstructive lesion and can be performed as an adjunct to retrograde study or as an alterative to a pyelogram. 8. Ultrasonographic examination could be performed easiJy in diagnosis of renal and perirenal diseases as non.invasive method without risk of radiation hazard , and was not influenced by renal function. 9. Ultrasound is considered a most advantageous aid to the performance of antegrade pyelography and has yie lded valuab le diagnostic information in patients with obstructive hydronephrosis.
Abscess ; Age Distribution ; Busan ; Constriction, Pathologic ; Diagnosis ; Female ; Humans ; Hydronephrosis ; Kidney ; Methods ; Pyonephrosis ; Suppuration ; Ultrasonography ; United Nations ; Ureter ; Urography

Ultrasonographic and radiographic findings in 72 cases of pelvic masses which have been provedhistopathologically were analyzed. The results were as follows; 1. Among 72 cases, 28 cases were uterine massesand 44 cases were adnexal masses. 2. Pathologic accuracies of ultrasonographic diagnosis were 64.3% in uterinemasses, 70.5% in adnexal masses, and 68.1% in all pelvic masses. 3. Plain or IVP findings were not specific indiagnosis and showed secondary mass effects or functional disturbances. 4. Because of its high accuracy ofpathologic diagnosis and safety, ultrasonography can be regared as the most valuable and preferential study. Butin cases of cystic myomas, endometrioses, cystic missed abortions and huge masses, the accurate diagnoses weredifficult.
Abortion, Missed ; Diagnosis ; Endometriosis ; Female ; Myoma ; Pregnancy ; Ultrasonography

We report a case of polycythemia vera combined with coagulation disorder. The patient was 54 years old man who complained of continuous bleeding after incision of skin abscess 20days ago. Laboratory tests were revealed prolonged aPTT and slightly prolonged PT. Coagulation factor, I, VIII, IX, XI and fibrinogen decreased, however FDP did not increased. It appears that patient with polycythemia vera have chronic activation of coagulation system, probably initiated by activation of factor XII. Platelet aggregation test to ADP, collagen, epinephrine was also revealed poor response.
Abscess ; Adenosine Diphosphate ; Blood Coagulation Factors ; Collagen ; Epinephrine ; Factor XII ; Fibrinogen ; Hemorrhage ; Humans ; Platelet Aggregation ; Polycythemia Vera* ; Polycythemia* ; Skin

PURPOSE: We evaluated both the patients and the normal volunteers to determine the diagnostic criteria of subacromial impingement syndrome. MATERIALS AND METHODS: We analyzed the radiologic finding of Thirty degree of caudal tilt view (TCTV) and Supraspinatus outlet view (SOV) of 100 shoulders from 85 patients with clinically proved subacromial impingement syndrome and normal 100 shoulders from 60 volunteers. RESULT: In TCTV, the protrusion of acromion below the line of extension from inferior surface of clavicle was shown in 94% of the patient group and 48% in normal group. Sharp tip of acromial protrusion was detectable in 55.3% of the patient group and 10.4% in normal group. In SOV, curved type of acromion was seen in 53% of the normal and 50% in patient group. Hooked type of acromion was detected in 3% and 31% of the normal and patient group, respectively. CONCLUSION: Protrusion of acromion at TCTV itself was not a criteria of subacromial impingement syndrome, but more than 7 mm below the line of extension from inferior surface of clavicle was meanigful. In SOV, hooked type of acromion was a criteria of subacromial impingement syndrome but curved type is was not a finding of diagnostic significence. Acromial spur formation on TCTV and SOV was important criteria of subacromial impingement syndrome.
Acromion ; Clavicle ; Healthy Volunteers ; Humans ; Shoulder ; Shoulder Impingement Syndrome* ; Volunteers

PURPOSE: We evaluated both the patients and the normal volunteers to determine the diagnostic criteria of subacromial impingement syndrome. MATERIALS AND METHODS: We analyzed the radiologic finding of Thirty degree of caudal tilt view (TCTV) and Supraspinatus outlet view (SOV) of 100 shoulders from 85 patients with clinically proved subacromial impingement syndrome and normal 100 shoulders from 60 volunteers. RESULT: In TCTV, the protrusion of acromion below the line of extension from inferior surface of clavicle was shown in 94% of the patient group and 48% in normal group. Sharp tip of acromial protrusion was detectable in 55.3% of the patient group and 10.4% in normal group. In SOV, curved type of acromion was seen in 53% of the normal and 50% in patient group. Hooked type of acromion was detected in 3% and 31% of the normal and patient group, respectively. CONCLUSION: Protrusion of acromion at TCTV itself was not a criteria of subacromial impingement syndrome, but more than 7 mm below the line of extension from inferior surface of clavicle was meanigful. In SOV, hooked type of acromion was a criteria of subacromial impingement syndrome but curved type is was not a finding of diagnostic significence. Acromial spur formation on TCTV and SOV was important criteria of subacromial impingement syndrome.
Acromion ; Clavicle ; Healthy Volunteers ; Humans ; Shoulder ; Shoulder Impingement Syndrome* ; Volunteers