The purpose of this study is to review epidemiological and clinical characteristics of diverticular disease of the colan in Korea and to discuss the difference of the findings from those in other countries. Reviewing all thebarium enema films taken at the Seoul National University Hospital retrospectively for the last 8 years. that is, from January 1, 1980 to December 31, 1987, we observed the annual and overall incidence of the disease, the number and location of the diverticula, and the presenting symptoms of the cases. The results are summarized as follows: 1) Out of the patients examined, 237 cases had one or more diverticula in the colon, the overall incidence being 1.32%, 2) The annual incidence increased progressively for the last 8 years, from 0.25% in 1980 to 2.53% in 1987. 3) The mean age of the patients at the time of diagnosis was 51 years. The male to female ratio was 2.5. 4) The diverticula were located on the right side in 81.0% of the cases, on the left side in 10.6%, and on both sides in 8.4%. 5) In 82 cases (34.6%) single diverticulum was found, whereas 34 cases (14.3%) had more than 10 diverticula. 6) The most frequent symptoms for taking barium enema were abdominal discomfort and pain (34. 2%) and changes in bowel habits (33.8%}, whereas 45 casea (19.0%) had the examination just for a routine health check. In conclusiion, the diverticular disease of the colon is still uncommon in Korea as compared with in western countries, and the right colon type is far more freqtaent than the left colon type. However in recent years the incidence increases quite rapidly and the left colon type is getting more common.
Barium ; Colon* ; Diagnosis ; Diverticulum ; Enema ; Female ; Humans ; Incidence ; Korea* ; Male ; Retrospective Studies ; Seoul

BACKGROUNDS: The high mortality and morbidity rates associated with traumatic rupture of the hollow viscera have been attributed to the clinical difficulty in establishing an early diagnosis. The accuracy of CT in the detection of injuries of the solid visceral organ is well established, but the value of CT in diagnosing small bowel perforation artier blunt abdominal trauma is controversal. This study was conducted to ascertain CT findings of small bowel perforation result from blunt abdominal trauma. METHODS: A retrospective analysis of preoperative abdominal CT findings in 40 patients was performed. Small bowel perforation was confirmed by surgery. Precontrast and postcontrast enhanced CT images were obtained in all patients. RESULTS: Diagnostic findings of small bowel perforation including intraperitoneal or retroperitoneal free air, discontinuity of the bowel wall and extravasation of oral or IV contrast materials were observed in 34 cases(85%). The most common fading of small bowel perforation was intraperitoneal or retroperitoneal free fluid collection(90%), followed by segmental bowel wall thickening(83%), intraperitoneal or retroperitoneal free air(80%) and focal mesenteric fat infiltration(70%). CONCLUSIONS : The CT scan is sensitive and effective modality for evaluation of small bowel perforation after blunt abdominal truauma, because of high detectability of diagnostic antral suggestive CT findings.
Contrast Media ; Diagnosis* ; Early Diagnosis ; Humans ; Mortality ; Retrospective Studies ; Rupture ; Tomography, X-Ray Computed ; Viscera

BACKGROUND: Breast cancer is increasing cause of cancer-related mortality among Korean women. Early detection and treatment are the most important strategy for reducing breast cancer mortality. Despite of its importance as a early detection method, a low percentage of women practice breast self-examination(BSE) regularly. The aim of this study was to describe the effectiveness of patient education on performing BSE regularly and to identify predisposing factors associated with these activities. METHODS: Sixty-six women who did not have experience in BSE in the past were randomly assigned to the experimental group and the control group. We taught BSE knowledge and skill about BSE using breast models and audiovisual equipment for experimental group in patient education class. Women in control group, however, were simply educated by their physician about BSE knowledge and skill with only educational booklet during their outpatient visits. We observed the difference in regular BSE performance proportion between two groups 6, 12 months later and analyzed the predisposing factors affecting on the education effect. Direct and telephone interview methods were used to gather the information. Data were analyzed with t-test, x2analysis and logistic regression using SAS 6.10, EGRET program. RESULTS: There were no differences in sociodemographic characteristics between study groups. They were followed for 12 months. At follow-up after 6 months 44.1% of women performed BSE regularly among experimental group and 18.8% of women did it among control group(OR=3.4, 95% Cl 1.1-10.4, p<0.05). At follow-up after 12 months proportion of women performed BSE regularly in experimental group(28.6%) was slightly higher than that of control group(22.2%), but that difference was not statistically significant. The prevalence of performing BSE regularly was higher among women who had experience in periodic health examination(OR =6.0, 95% Cl 1.9-18.8, p<0.01), who had experience in mammography(OR =4.0, 95% Cl 1.0-15.6, p<0.05). And the prevalence of performing BSE regularly also was higher among women who were older than 40 years old, married, had experience in cervical Pap. smear, had knowledge about BSE before education, have done exercise regularly, had less number of health risk factors, but without statistical significance. CONCLUSIONS: These results showed that of effectiveness of patient education on BSE, if we determine the effectiveness of BSE education with regular performance of BSE, is relatively low among Korean women. We could see, however, that if we use breast models for demonstration in addition to usual educational material, the effectiveness of BSE education can be more effective. We also recognized that effectiveness of BSE education will not be continued for long time without any maintenance strategy. There were lots of predisposing factors which could affect the effectiveness of BSE education positively or negatively. So, family physicians who plan BSE patient education at their clinics must consider these factors.
Adult ; Breast Neoplasms ; Breast Self-Examination* ; Breast* ; Causality ; Education* ; Female ; Follow-Up Studies ; Humans ; Interviews as Topic ; Logistic Models ; Mortality ; Outpatients ; Pamphlets ; Patient Education as Topic ; Physicians, Family ; Prevalence ; Risk Factors

The success and rapid spread of laparoscopic cholecystectomy have prompt the application of laparoscopic approach to abdominal surgical problems. As better in- strumentation is introduced, more complicated surgical procedrues will be performed. In some hematologic disorders, splenectomy was required to cope with these disorders. So laparoscopic splenectomy also has been perfomed inspite of several specific difficulties for handling and mobilization of a parenchymatous organ and the retrieval of the specimen. We experienced a case of idiopathic thrombocytopenic purpura which was treated safely and successfully by laparoscopic splenectomy in 35-year-old female. This technique allows the patient to return to normal activity sooner than with open splenectomy.
Adult ; Cholecystectomy, Laparoscopic ; Female ; Humans ; Purpura, Thrombocytopenic, Idiopathic* ; Splenectomy*

No abstract available.

No abstract available.
Humans ; Stomach Neoplasms*

No abstract available.

PURPOSE: Delirium in the elderly is common in the postoperative period but there are only few reports on detailed studies of this condition. Number of urologic patients with postoperative delirium was increas ed in our hospital for recent 24 months. The clinical characteristics of patients with postoperative delirium was analyzed retrospectively. MATERIALS AND METHODS: We selected the patients with postoperative delirium from 1010 patients who had undergone urological surgery under general or spinal anesthesia in the period from Jan. 1997 to Dec. 1999. Diagnosis of postoperative delirium was established with Diagnostic and Statistical Manual of Mental Disorders(DAM-III-R) by psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric disorder, relationship with anesthesia, drugs, and surgical procedures, concomittant medical conditions, and complications were retrospectively reviewed. RESULTS: Postoperative delirium was observed in 13 patients (1.3%). All patients were male and mean age was 70.4 years (46-86 years). Surgical procedures included TURP(8 patients), cystectomy (3 patients), nephroureterectomy (1 patient), and bladder rupture repair (1 patient). Delirium became apparent between one day and two days after the operation (mean 32.2 hours) and lasted for up to 7 days (mean 53 hours). Several factors such as older age (>65 years), male patient, longterm medication, past history of CVA, memory impairment, hearing difficulty, traumatic brain contusion, and obsessive personality were thought to be risk factors of postoperative delirium. Treatment with Haloperidol(R) intramuscular injection (2.5-5mg, every 30 minutes, 2-4 times until symptom resolution was achieved) with or without Ativan(R) intravenous injection (2mg) were effective. Complete symptom recovery was seen in 92.3% (12/13) of patients. One patient (7.7%) with previous history of dementia had persistent memory disturbance and disorientation during follow-up periods. CONCLUSIONS: Generally, postoperative delirium is an acute transient confusional state without considerable sequeles. Treatment is sedation and prevention of inadvertent accident associated with confusional state. Urologic surgeon must be attentive to the development of this illness especially when high risk factors were present.
Aged ; Anesthesia ; Anesthesia, Spinal ; Brain Injuries ; Cystectomy ; Delirium* ; Dementia ; Diagnosis ; Follow-Up Studies ; Hearing ; Humans ; Injections, Intramuscular ; Injections, Intravenous ; Male ; Memory ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Rupture ; Urinary Bladder

No abstract available.

In an effort to find more comprehensive and general diagnosis of erectile failure, we already have analysed 90 cases and reported the results. After that we added 199 more cases and performed a computer based analysis of total 289 cases in the dynamic changes of penile blood flow during natural physiologic erection after exposure to the audiovisual stimulation. The following results were obtained. 1. In normal volunteers, we were able to achieve uniform penogram findings in all cases with T.T.(Transit Time) ranging 1 to 3 minutes(mean 2.17 minutes), the EPT(Erection Persistent Time) over 30 minutes and no fluctuation phenomena after AVS. 2. Erectile failure group.(2.83 cases) (1) Group I.(108 cases; 38.2%). They demonstrated similar penogram features with the normal volunteers but EPT more than 5 minuets(mean 18.26 minutes) at least. most common causes were psychogenic origin(57 cases). (2) Group II.(175 cases ; 61.8%). Patients were showing abnormal penogram findings, and were divided into following 3 types. a) A type-Impossible type(10 cases ; 3.5%). They failed to show more than 2 fold increase in the maximal radioactivity after AVS when compared to the pre-stimuli level(mean 1.83 times). The underlying causes were identified to be arteriogenic and neurogenic. b) B type-Unstable type(124 cases ; 43.8%). They were unable to sustain erection due to fluctuation(mean 1.83 times). The underlying causes were psychogenic, vasculogenic and neurogenic origins. c) C type-Delayed type(41 cases ; 14.5%). They were showing T.T. more than 15 minutes(mean ; 23.71 minutes), and the underlying causes were arteriogenic, psychogenic and neurogenic origins. Based on these results, we have concluded that AVS-Penogram seems to the most appropriate diagnostic method for screening test and follow-up evaluation after vascular surgery. Through more clinical experience and investigation, and more comparison and analysis with other diagnostic methods, it will be a standard diagnostic approach in the future.
Diagnosis ; Follow-Up Studies ; Healthy Volunteers ; Humans ; Mass Screening ; Radioactivity