BACKGROUND: The APACHE scoring system of the Health Care Financing Administration (HCFA) has been being used for serious patients. The scoring system is composed of acute physiologic variables and chronic disease. METHODS: Among patients who underwent emergency operations from 1992 to 1997 because of gastrointestinal perforation, we analyzed 110 cases with five kinds of diseases: duodenal ulcer perforation, small bowel perforation, perforated appendicitis, gastric ulcer perforation and colon perforation. RESULTS: The results were as follows: 1) The preoperative APACHE II scores ranged from 0 to 21. The scores of 64 cases (60.9%) were from 0 to 5. 2) There were no death in case for which pre-peration APACHE II score was from 0 to 10, 25% of the mortality occurred in cases with scores from 11 to 15, 50% in those with scores from 16 to 20, and 100% in those with scores above 21. 3) The APACHE II score decreased continuously from the 3rd to the 7th postoperative day. 4) The preoperative APACHE II scores in gastric ulcer perforation patients were significantly higher than those in duodenal ulcer perforation patients. In the cases of gastric and duodenal ulcer perforations, the APACHE II scores in patients who underwent primary closure were higher than the scores in those who underwent a more definitive operation. 5) In death cases, all of their APACHE II scores were higher at the 3rd postoperative than at the 7th postoperative day, but their APACHE III scores continuously increased postoperatively. CONCLUSIONS: It is thought that the APACHE scoring system is more reliable than clinical experience in the classification of patients by operative risk and in estinating the result and giving a prognosis. Thus, the principle of treatment should be established by estinating patient's score before the operation. Careful preoperative management is necessary for patients with scores more than 10. Because patientswith scores more than 21 have very a high mortality, operative time and method must be carefully decided. The APACHE III scoring system seems to be more sensitive than the APACHE II scoring system in predicting deaths and further investigations and clinical applications should be performed.
APACHE* ; Appendicitis ; Centers for Medicare and Medicaid Services (U.S.) ; Chronic Disease ; Classification ; Colon ; Duodenal Ulcer ; Emergencies ; Humans ; Mortality ; Operative Time ; Prognosis ; Stomach Ulcer

Leiomyosarcoma is a malignant tumor showing smooth muscle differentiation, and it accounts for 2% to 8% of soft tissue sarcoma. Clinically, substantial mortality and morbidity are related to the propensity for distant metastasis and local recurrence, respectively. Microscopic findings characteristically reveal intersecting bundles of spindle-shaped cells having fibrillar cytoplasm and blunt-ended nuclei. Immunohistochemistry for intermediate filaments is helpful in establishing a definitive diagnosis. We experienced a case of large protruding leiomyosarcoma that developed on an old burn scar of the medial calf of a 45-year-old man. On preoperative evaluation, we recommended amputation due to a distant metastasis to the lung(stage IV). As the patient refused amputation of his lower leg, the tumor was radically excised and immediate reconstruction was done using free latissimus dorsi muscle flap and skin graft. Four months after excision despite adjuvant chemotherapy, amputation was performed due to local recurrence.
Amputation ; Burns ; Chemotherapy, Adjuvant ; Cicatrix ; Cytoplasm ; Diagnosis ; Humans ; Immunohistochemistry ; Intermediate Filaments ; Leg ; Leiomyosarcoma* ; Middle Aged ; Mortality ; Muscle, Smooth ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Skin ; Superficial Back Muscles ; Transplants ; Ulcer*

BACKGROUND: Hand-foot-mouth disease (HFMD) is mainly caused by the infection of coxsackievirus A16. But recently several epidemics of HFMD with meningitis or myocarditis due to enterovirus 71 have been reported in Southeast Asia. It was necessary that the possibility of enterovirus 71 epidemic in Korea should be ruled out. This study was designed for the determination of causative agents of HFMD in Cheju province in the spring of 1998. METHODS: Serum specimens were collected from 45 pediatric patients with HFMD at Cheju Hankook Hospital in March and April,1998. Virus isolation was performed with RD cell culture through up to three passages. Reverse transcription-PCR and nucleotide sequencing were performed by the method of Oberste et al.(J Clin Microbiol 1999;37:1288-93). The serotypes of viral isolates were determined by BLAST program of National Center for Biotechnology Information, U.S.A. RESULTS: Virus could be isolates from 4 patients, whose age was ranged from 11 months to 3 years. All of 4 viral isolates showed about 430-bp product of RT-PCR using primers 011 and 012. The serotype showing the highest similarity with the nucleotide sequences of all of these viral isolates was coxsackievirus A16. CONCLUSIONS: The causative enteroviral agent of HFMD in Cheju province in the spring of 1998 was coxsackievirus A16. We could not detect enterovirus 71 from the patients' sera in Cheju Province in the spring of 1998.
Asia, Southeastern ; Base Sequence ; Biotechnology ; Cell Culture Techniques ; Enterovirus ; Humans ; Jeju-do* ; Korea ; Meningitis ; Myocarditis ; Polymerase Chain Reaction

No abstract available.
Pregnancy*

To evaluate the effect of shortening the latent period for distraction osteogenesis, the authors experimented with distraction osteogenesis for a 24-hour latent period in the mandibles of rabbits. This study was carried out on 32 New Zealand white rabbits, each weighting 2000 to 2500 gm. Twenty animals were used for the control group and 12 for the experimental group. A unilateral external fixation device was applied to the left mandible. The mandibles were lengthened at 1 mm per 24 hours for 10 days. Five rabbits from the control group and three from the experimental group by random selection were sacrificed on the first day, and at the second, fourth and eighth week of the consolidation period. After lengthening bone densities at the site of the left mandibular bony lengthening were measured by quantitative computer tomography (QCT) and dual energy x-ray absorptiometry (DXA). As a result, the DXA value showed no difference compared to the control group after two week's consolidation. The trabeculae were thicker and had begun to be surrounded by lamellar bone both in the control and experimental groups histologically. In conclusion, the results of this study indicate that the osteogenetic effect in the experimental group was nearly the same as in the control group. If stable fixation and minimal periosteal dissection were performed during the procedure, the latent period would not be an important factor in distraction osteogenesis of membranous bone.
Absorptiometry, Photon ; Animals ; Bone Density ; External Fixators ; Mandible* ; Osteogenesis* ; Osteogenesis, Distraction ; Rabbits*

No abstract available.
Orbit*

No abstract available.
Dermoid Cyst*

A 24-year-old woman was seen for evaluation of an skin lesion on thiright nipple. Examination revealed a solitary 1.5 x 1cm-sized, erythematous, oozing, eroded andruted, verrucous nodule on the right nipple. A small amount of serous discharge was found but there was no pain or tenderness. Histopathologic findings showed cystic invaginations extending down vard from the epidermis and papillary projections extending into the lumina of the invagination. Pupiae were lined by two rows of cells. In stroma, there were marked inflammatory infiltrates containing any plasma cells. The overlying dermis showed an adenomatous growth pattern with a prolifertion of round, oval or irregular shaped ducts and fibrotic stroma.
Adenoma* ; Cytochrome P-450 CYP1A1 ; Dermis ; Epidermis ; Female ; Humans ; Nipples* ; Plasma Cells ; Skin ; Young Adult

This study was undertaken to evaluate the status of human paragonimiasis in Kang Hwa Gun, Kyunggi Do, Korea from March 1973 to October 1975 by the use of intradermal screening test with Veronal buffered saline antigen. A total number of 7,352 (male 3,936; female 3,4l6) consisting of 3,447 primary school children, 2,689 middle school students, l,008 high school students of 9 Myuns out of 13 Myuns of this County and 208 residents of all age group in Kilgeong-Ri, Yangdo Myun were examined by the intradermal test with Paragonimus antigen. In order to detect Paragonimus egg, the sputum and the stool examinations were undertaken on the residents in Kilgeong-Ri. The infestation rate of crayfish with Paragonimus metacercaria was also examined in Konneung and Jeongha village in Kilgeong-Ri. The following results were obtained in this survey: As a whole, 16.6 per cent of the examiners showed positive reaction with sexual difference of 16.1% in male and 14.8 per cent in female. In age groups, the highest positive rate showed in middle school age group (17.1 per cent) than primary school (14.0 per cent) and high school age group (11.4 per cent). In regional differences of positive rates, the highest rate (28.4 per cent) showed at Yangdo Myun followed by Kilsang Myun (27.0 per cent), Hwado Myun (25.0 per cent), and Naega Myun(20.8 per cent). In the result of 208 residents Kilgeong-Ri, the positive of 36.1 per cent in male and 20.2 per cent in female. The highest positive rate showed in 10 to 19 age group (41.5 per cent). Among the residents in Kilgeong-Ri, Paragonimus eggs were detected in 11 residents by the sputum and the stool examinations. The infestation rate of crayfsh with Paragonimus metacercariae was 100 per cent (41 out of 41 crayfishes) in Konneung village, and 84.6 per cent (9 out of 13 crayfishes) in Jeongha village, Kilgeong-Ri The fluctuation of the infection rate of crayfish with Paragonimus metacercariae was decreased in Konneung village in 2 years after the treatment with Bilevon against 10 paragonimiasis patients.
parasitology-helminth-trematoda ; epidemiology-paragonimiasis ; Paragonimus westermani ; crayfish-Cambaroides similis

Parathyroid hyperplasia is a pathologic finding that can be found in hyperparathyroidism. Unlike parathyroid adenoma, treatment of parathyroid hyperplasia is still quite controversial. In addition, the relative merits of two alternative surgical approaches-subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation have not been clearyly elucidated. The records of 10 patients who had parathyroid hyperplaisa and who underwent parathyroid surgery at the Department of Surgery, Hanyang University Hospital, between April 1992 and April 2003 were retrospectively reviewed. The 10 patients were comprised of 3 males and 7 females. The age distribution was between 29 and 73 years. The presenting clinical manifestations were associated with bone pain in 8 patients, muscle weakness in 4, headache in 4, gastrointestinal symptoms in 3, renal symptoms in 3 and psychologic symptoms in 2. The serum parathyroid hormone level was elevated in all patients. The serum alkaline phosphatase level was elevated in seven among the ten patients. Histopathologic findings revealed chief cell hyperplasia in all patients. Postoperative transient hypocalcemia occurred in 5 patients and they were supplied with oral calcium and calcitriol for several months. There were no major complications. The results indicate that a subtotal parathyroidectomy can be performed without mortality or morbidity and provides good control of primary parathyroid hyperplasia, A total prathyroidectomy with autotransplantation can be performed without mortality or morbidity and provides good contril of secondary and tertiary parathyroid hyperplaisa.
Age Distribution ; Alkaline Phosphatase ; Autografts ; Calcitriol ; Calcium ; Female ; Headache ; Humans ; Hyperparathyroidism ; Hyperplasia* ; Hypocalcemia ; Male ; Mortality ; Muscle Weakness ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Retrospective Studies ; Transplantation, Autologous