No abstract available.
Mass Screening* ; Stomach Neoplasms* ; Stomach*

No abstract available.
Anemia, Aplastic*

PURPOSE: To evaluate the clinical feature and the results of the treatment of Lisfranc joint fracture/dislocation with limited open reduction, pin fixation and Ilizarov external fixation. MATERIALS AND METHODS: From June 2001 to May 2003, six patients with Lisfranc fracture/dislocation were treated. The average periods of follow-up was 23 months. After limited open reduction on the second tarso-metatarsal joint, we performed pin fixation of the above joint. On the other Lisfranc joint fracture/dislocation, closed reduction and the application of Ilizarov external fixator was done. This rigid system produced the early partial weight bearing and joint motion of the injured foot and ankle joint. The parameters used were radiographic evaluation, patient's clinical assesment and the AOFAS midfoot score. RESULTS: We used the Myerson's criterier to evaluate the radiographic result. All cases could be achieved more than nearly anatomical reduction. Three cases of excellent and 3 cases of good result could be obtained in the evaluation of the patient's clinical assesment. The average AOFAS midfoot score was 87.2 (76~95) points. CONCLUSION: The treatment using Ilizarov external fixation on Lisfranc joint fracture/dislocation can be another useful method.
Ankle Joint ; Dislocations* ; Equidae ; External Fixators ; Follow-Up Studies ; Foot ; Humans ; Joints* ; Weight-Bearing

We report a case of 70-year-old woman who had bilateral coronary arteriovenous fistula(CAVF) and treated with percutaneous transcatheter coil embolization. Enlarged LV and reduced global LV systolic function were demonstrated on transthoracic echocardiography. Coronary angiography revealed a large coronary arteriovenous fistula from the right coronary artery to the main pulmonary artery and a small fistula from the left coronary artery to the main pulmonary artery. Percutaneous transcatheter coil embolization for CAVF from the right coronary artery to the main pulmonary artery was successfully performed with symptomatic improvement.
Aged ; Arteriovenous Fistula* ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Embolization, Therapeutic* ; Female ; Fistula ; Humans ; Pulmonary Artery

To dtermine the optimal timing for Aortic Valve Replacement in patients of aortic insufficiency is very important, because irreversible myocardial damage can result before symtoms such as dyspnea, syncope and chest pain, appear for the first time. Henry suggested that the echocardiographic index of left ventricular end systolic dimension 55mm could be useful as an indicator of whether to operate or not. But Fioretti, et al., insisted that there was no significant difference postoperatively between those below 55mm and those over 55mm. To determine whether a left ventricular end systolic dimension greater than 55mm is one of the risk factors for AVR in patients with aortic insufficiency, we analyzed the serial echocardiographic examinations of 23 patients who underwent AVR for isolated AI. Group I patients (n=17) had a preoperative left ventricular end systolic dimension less than or equal to 55mm and Group II patients (n=6) had a preoperative left ventricular end systolic dimension greater than than 55mm. 1) left ventricular end systolic dimension decreased in both groups significantly, and there was a statistically significant difference between Group I and Group II at 12 modths after operation. 2) Left ventricular end diastolic dimension also decreased in both groups significantly, and there was a statistically significant difference between Group I and Group II at 12 months after operation. 3) Ejection Fraction was decreased markedly just postoperatively, but it was recovered soon in both groups, and there was no statistically significant differences of the ejection fractions between the two groups postoperatively. 4) SV1+/-RV6 in EKG, as an indicator of LV mass, was also analzed and it revealed significant reduction in both groups postoperatively, but we could not observe statistically significant differences between the two groups from 6 months after the operation. We concluded that the preoperative left ventricular end systolic dimension 55mm could be useful as an index to predict postoperative prognosis and to determine the timing of aortic valve replacement.
Aortic Valve* ; Chest Pain ; Dyspnea ; Echocardiography* ; Electrocardiography ; Humans ; Prognosis ; Risk Factors ; Syncope

Acute necrotizing pancreatitis (ANP) is a disease with high morbidity and mortality despite the progress made in intensive medical care. This study was conducted to clarify the strategy and the prognostic factors in its surgical management.We reviewed retrospectively 26 patients who had operative treatment for ANP from March 1990 to February 1995 at Wallace Memorial Baptist Hospital. The results were as follows:1) The most common cause of the ANP was alcohol (38.5%) and the next most common cause was gallstone (23.1%). 2) The operative indications were an acute surgical abdomen (15 cases), sepsis (6 cases), organ failure (3 cases), and shock (2 cases). 3) The culture results for the specimens which were obtained from the necrotic lesions or from fluid collections showed bacterially positive patients in 78.9% of the cases and polymicrobial infection in 31.6% of the cases. 4) Of the operative methods, a necrosectomy with open drainage and delayed lavage was applied to 17 cases (65.4%), and the mortality of this procedure was 23.5%. 5) During the postoperative course, reoperation was required in 3 cases (11.5%) and diabetes was seen in 6 cases of 22 cases (27.3%). 6) We analyzed prognostic factors like the Ranson score, infection, inadequate necrosectomy with drainage, and preoperative organ failure with statistical methods (Student's t-test and Chi-square test). The Ranson score and infection showed little correlation with the postoperative mortality, but an inadequate necrosectomy with drainage and preoperative organ failure showed a statistically significant correlation (p=0.006, p=0.009, respectively). In conclusion, we applied a necrosectomy with open drainage and delayed lavage to most of the ANP patients. An inadequate necrosectomy with drainage and preoperative organ failure had important meanings as prognostic factors and affected the postoperative mortality. Hence we think that necrotic lesions and fluid collections require early radical debridement and wide drainage, especially in infected necrotizing pancrectitis, and that multiple, well-positioned drains are important for decreased morbidity and mortality.
Abdomen ; Atrial Natriuretic Factor ; Coinfection ; Debridement ; Drainage ; Gallstones ; Humans ; Mortality ; Pancreatitis, Acute Necrotizing* ; Protestantism ; Reoperation ; Retrospective Studies ; Sepsis ; Shock ; Therapeutic Irrigation

Consideration of the nutritional status of patients with acute respiratory failure and mechanical ventilation is important for effective patient assessment and management. Patients with acute respiratory failure are at a high risk for developing malnutrition. High glucose intakes given during the administration of total parenteral nutrition (TPN) have been demonstrated to increase CO2 production. The workload imposed by the high CO2 production may precipitate respiratory distress in patients experiencing compromised pulmonary function. The authors report a case of successful weaning from mechanical ventilation in patient with post-operative ARDS by proper nutritional support and by changing the proportion of calories derived from carbohydrates and fats. Substitution of fat calories for carbohydrate in TNA solutions can reduce CO2 production and help wean patients from mechanical ventilation. Conclusively, the TNA (total nutrients admixture) system is more beneficial to patients with acute respiratory failure due to less CO2 production and surfactant production than TPN. For patients with hypercapnia, providing 25% to 30% of calories as carbohydrate and 50% to 55% of calories from fat may be beneficial.
Carbohydrates ; Fats ; Glucose ; Humans ; Hypercapnia ; Malnutrition ; Nutritional Status ; Nutritional Support* ; Parenteral Nutrition, Total ; Respiration, Artificial ; Respiratory Insufficiency* ; Ventilator Weaning* ; Ventilators, Mechanical* ; Weaning

The adrenal gland is the second most common site of metastasis from a hepatocellular carcinoma (HCC). Radiofrequency ablation (RFA) for these tumors has been reported to be a potentially effective alternative to an adrenalectomy, especially for inoperable patients. However, for intermediate or large adrenal tumors, combination therapy of transarterial chemoembolization (TACE) and RFA can be attempted as it may reduce the heat sink effect. A 74-year-old patient presented with abdominal discomfort. Abdominal CT images revealed a 5.0 cm sized right adrenal mass. A percutaneous biopsy of the adrenal mass revealed a metastatic hepatocellular carcinoma. TACE was performed on the adrenal mass. However, a one-month follow-up CT image revealed a residual viable tumor. RFA was performed for the adrenal tumor six weeks after the TACE. No procedure-related major complications were noted. The serum alpha-fetoprotein level had also been normalized after the treatment, and 10-month follow-up CT images showed no definite evidence of viable adrenal tumor.
Adrenal Glands ; Adrenalectomy ; Aged ; alpha-Fetoproteins ; Biopsy ; Carcinoma, Hepatocellular* ; Catheter Ablation* ; Follow-Up Studies ; Hot Temperature ; Humans ; Neoplasm Metastasis ; Tomography, X-Ray Computed

BACKGROUND: Little is known concerning hair diameter variation within the safe donor area for hair transplantation surgery. Thicker or thinner hair may be needed, depending on the recipient area, hairline design, and the purpose of surgery. METHODS: Twenty-seven patients (7 men and 20 women; mean age, 28 years; range, 20–47 years) were included in this study. The midoccipital point was used as the reference point on the horizontal plane at the upper border of the helical rim. The target area width was 15 cm (7.5 cm to the right and left of the reference point) and the height was 8 cm (2 cm above and 6 cm below the reference point). The study area was divided horizontally into 3 5-cm sections (A, B, C) and vertically into 4 2-cm sections (1–4), creating a total of 12 zones. Ten anagen hairs were randomly obtained from each zone and their diameters were measured. RESULTS: Hair diameter in the 4 vertical sections varied significantly, gradually decreasing from sections 1 (superior) to 4 (inferior) in all 3 horizontal sections (A, B, and C). CONCLUSIONS: Our results suggest that sections 1 and 2 of the occipital safe donor area would be useful for obtaining thicker hair, such as in procedures to treat male- and female-pattern hair loss, whereas hair from zones 3 and 4 could be useful for transplantation surgery requiring thinner hair, such as eyebrows, eyelashes, and female hairline correction. Our results may be clinically valuable for planning hair transplant surgery and choosing the optimal donor region.
Eyebrows ; Eyelashes ; Female ; Hair Follicle ; Hair* ; Humans ; Male ; Tissue Donors* ; Transplant Donor Site ; Transplantation

PURPOSE: Laparoscopic cholecystectomy (LC) has been the treatment of choice for acute and chronic disease of the gallbladder. We have performed 621 cases of LC from January 02 2001 to April 30 2008. This study aims to clinically analyze 621 cases of LC that were performed by a single surgeon over a 7 year period and to evaluate the effectiveness and safety of laparoscopic treatment for gallbladder disease. METHODS: From January 02 2001 to April 30 2008, 621 patients underwent LC at the Department of Surgery by a single surgeon. We retrospectively analyzed the patients' ages, gender distribution and chief complaints, the operation times, the duration of hospitalization, the conversion rate to open cholecystectomy and the causes, the diagnostic methods and the postoperative complications through a review of the patients' charts. RESULTS: The mean age was 46 years and the ratio of males to females was 1:1.4. The most common chief complaint was right upper quadrant pain (52.97%). The mean operative time was 67.37 minutes and the duration of hospitalization was 5.12 days and the duration of postoperative hospitalization was 3.86 days. The conversion rate was 3.29% and the most common cause of conversion was anatomic uncertainty due to inflammatory adhesion. Abdominal sonography was the most common diagnostic method and this was performed in 73.27% of the patients. The postoperative complication rate was 1.93%. CONCLUSION: LC has become the gold standard for the treatment of benign gallbladder diseases. We think that LC is effective and safe, and even at a secondary care hospital, if the surgeon has accumulated operative experience and improved operative skill.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Chronic Disease ; Female ; Gallbladder ; Gallbladder Diseases ; Hospitalization ; Humans ; Male ; Operative Time ; Polyenes ; Postoperative Complications ; Retrospective Studies ; Secondary Care ; Uncertainty