OBJECTIVE: Sixteen cases of blunt diaphragmatic injury were clinically reviewed during 10 years from Oct.1987 to Jun.1996 at the Kangdong sacred heart hospital. The age and sex distribution were ranged from 3 to 67-old-years. The most common age range was between third decades to fifth decades in 10 cases(62.50%) and occurred predominantly in male, the sex ratio was 4.3 : 1.(M:F 4.3:1) The modes of blunt diaphragmatic injury were due to motor vehicle accidents(MVA), motor cycle accidents(MCA), fall down(FD) and others. Most common injuries were responsible for MVA. MVA were pedestrian traffic accidents 5 cases (41.7%), driver 4 cases(33.3%) passenger 3 cases(25.0%). In the blunt diaphragmatic injury sites, the left-sided diaphragmatic injury had predominant[left-sided cases 10(62.50%), right-sided cases 6(37.50%)]. Cost common symptoms and signs were chest pain or chest discomfort(81.25%) and dyspnea(68.75%), abdominal tenderness(50.00%), decreased bowel sound and breath sound(50.00%) and others. All of 16 cases in blunt diaphragmatic injury were associated with other injuries. The associated injuries were hemopneumothorax 14(87.50%), hemoperitoneum 7(43.759o), liver injury 7(43.75%), orthopedics fracture 14(87.50%), head injury 5(31.25%) and others. The diagnostic methods were used with simple x-ray, ultrasonogram and computed tomogram. The preoperative diagnosis of blunt diaphragmatic injury were suggested in 10 cases(62.509o) and others were confirmed during operation. The thirteen cases of all of sixteen cases were performed emergency operation within eight hours. The herniated intraabdominal organs through ruptured diaphragm were presented in 10cases(62.5%) [stomach 7 cases(43.75%), spleen 6 cases(37.50%), colon 3 cases(18.75%), liver 3 cases(18.75%), small bowel and omentum 2 cases(12.50%), respectively]. The mean size of blunt diaphragmatic injury were 7.7cm, right-sided mean size were 9cm, left-sided mean size were 6.9cm. The most common site of blunt diaphragm- atic injury were presented in anteromedial site 7 cases(43.75%). Simple chest x-ray revealed abnormal finding [hemothorax 10cases(62.50%), pneumothorax 4cases(25.00%), herniated organ into thorax8 cases(50.00%), diaphragm elevation 3 cases(18.75%) and others]. The postoperative complication were associated in 10 cases(62.50%) out of 16 cases. Common complications were pleural effusion 6 cases(37.50%) and atelectasis 3 cases(18.75%). Injury severity score(ISS) value of 16 cases in the blunt trauma ranged from 10 to 59. It was presented with mean value of ISS(35.5),mean value of ISS survivors(35) and nonsurvivors(55.5). Revised trauma score(RTS) value ranged also from 4 to 12. There were revealed with mean value of RTS(9.7),mean value of RTS survivors(10) and nonsurvivors(6.5). All of the blunt traumatic injury, mortality rate was related to the values of ISS and RTS.
Accidents, Traffic ; Chest Pain ; Colon ; Craniocerebral Trauma ; Diagnosis ; Diaphragm ; Emergencies ; Heart ; Hemoperitoneum ; Hemopneumothorax ; Humans ; Liver ; Male ; Mortality ; Motor Vehicles ; Omentum ; Orthopedics ; Pleural Effusion ; Pneumothorax ; Postoperative Complications ; Pulmonary Atelectasis ; Sex Distribution ; Sex Ratio ; Spleen ; Thorax ; Ultrasonography

The incidence of ectopic pregnancy is apparently increasing in recent years. In order to gain greater insight into the diagnosis and management of ectopic pregnancies, this study was undertaken on 100 patients with ectopic pregnancy(admitted via ER) who were operated and confirmed by histopathological study at the department of Obstetrics and Gynecology of Hallym University(Kangdong Sacred Heart Hospital) from January, 1996 to June, 1997. The results were as follows; 1. The hospital incidence of ectopic pregnancy was 1 in 11.6 deliveries(168/1954). 2. The most frequent age group was in 25-34 years of ages(58%). 3. Nullipara was 32 cases(32%) and number of cases who had 1, 2 and 3 deliveries were 35(35%), 31(31%) and 2(2%) respectively. 4. The most frequent number of pregnancy was second times(24%) and 65% of cases have been experienced artificial abortion. 5. In the past history, of possible predisposing factors, 65% had at least one abortion, 17% ectopic pregnancy, 17% cesarean section and 13% had previous laparoscopic tubal sterilization, but 19% showed no special distinct. 6. The main clinical symptoms are 96% in lower abdominal pain, 95% in amenorrhea and 65% in vaginal spotting and bleeding. 7. The most frequent interval between LMP and onset of symptoms was 6-8 weeks(49%). 8. Urine hcG test was positive in 94.9% and culdocentesis was positive in 94.3%. 9. In initial hemoglobin level, more than 11.0g% was 55%, however less than 10.0g% was 20%. 10. In initial systolic blood pressure at hospital, most of them were under normal condition, however 30% were under 90mmHg. 11. The amount of intraabdominal hemorrhage under 500cc was 42%(highest rate), 25% under 500cc-1000cc(second rate) and 6 cases overed 200cc. 12. The site of ectopic pregnancy was 88% in fallopian tube, 9% in uterine conus, 2% in intraabdomen and 1% in cervix. 13. The most common surgical procedure was ipsilateral salpingectomy(82%), of which 22 cases were operated by laparoscopy. 14. There was no fatal case in 100 ectopic pregnancy.
Abdominal Pain ; Amenorrhea ; Blood Pressure ; Causality ; Cervix Uteri ; Cesarean Section ; Conus Snail ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Fallopian Tubes ; Female ; Gynecology ; Heart ; Hemorrhage ; Humans ; Incidence ; Laparoscopy ; Metrorrhagia ; Obstetrics ; Pregnancy ; Pregnancy, Ectopic* ; Sterilization, Tubal

There have been increasing interests of diabetes in the realm of plastic surgery due to problems like foot ulcer as a complication, delayed wound healing or higher failure rates of flap surgery. Main pathology in diabetes is microvascular compromise as well as metabolic derangements. The disturbance in microvascular circulation results in ischemic environments in the body and acts as a main factor that determines the limit of reconstructive or aesthetic plastic surgery. A useful method to overcome such problems is the use of hyperbaric oxygen therapy, which is known to be effective in the treatment of ischemic skin ulcer or osteoradionecrosis. However, there have been few studies on the survival of diabetic random skin flap or the effects of hyperbaric oxygenation directed to increase survival of such flap. In our study, we supposed that the survival of diabetic random skin flap was diminished owing to compromised microvascular pathology and blood rheology, and metabolic derangements, so we hypothesized that hyperbaric oxygen therapy has both reversible and irreversible effects on the survival of ischemic random skin flap in Streptozotocin-induced diabetic rats. Increase of local transcutaneous oxygen concentration, O2 affinity in blood and dysmorphogenesis of red blood cells are reversible and relatively short-term effects and promotion of neoangiogenesis is irreversible or long-term effects. We intended to confirm that hyperbaric rats and to compare the effects between preoperative and postoperative hyperbaric oxygenation on the survival of such flap. And we expect the additional effects of hyperbaric oxygenation on metabolism in diabetic rat, such as lowering the blood glucose level and solving the arrested weight gain. We divided Streptozotocin-induced diabetic rats into three groups: the first was non-treatment diabetic group, the second was preoperative hyperbaric oxygen treated diabetic group(100% O2, 2 atm, 90min, 15sessions, twice a day), and the third was postoperative hyperbaric oxygen treated group(100% O2, 2atm, 90min, 15sessions, twice a day). After elevation of random skin flap on dorsum of diabetic rats, we evaluated the extent of flap survival by measuring the necrotic areas at 3rd, 7th, 10th, and 13th postoperative days. At that time, we intended to evaluate both effects on flap survival by preoperative and postoperative hyperbaric oxygen therapy. As a result, flap survival of non-treated diabetic group was 41% at 13th postoperative days. In diabetic groups with preoperative and postoperative hyperbaric oxygen therapy, flap survival were increased to 64.6% and 62.4% respectively. Diabetic groups with hyperbaric oxygen therapy have a tendency of meaningful decrement in blood glucose level. However, there were no meaningful differences between preoperative and postoperative hyperbaric oxygen therapy. Hyperbaric oxygen therapy has no effective correlations with body weight changes. We conclude that hyperbaric oxygen therapy has some useful effects on the survival of diabetic random skin flap.
Animals ; Blood Glucose ; Body Weight Changes ; Erythrocytes ; Foot Ulcer ; Hyperbaric Oxygenation* ; Metabolism ; Osteoradionecrosis ; Oxygen ; Pathology ; Rats* ; Rheology ; Skin Ulcer ; Skin* ; Surgery, Plastic ; Weight Gain ; Wound Healing

No abstract available.

No abstract available.
Blood Flow Velocity* ; Pregnancy* ; Umbilical Arteries*

For evaluating the boosting (anamnestic) effects of the most recent commercially produced plasma derived heat-inactivated hepatitis B vaccine (A. Co.), 117 adults with naturally acquired antibody to hepatitis B surface antigen (anti-HBs) were selected at random. In addition, out of case immunized at zero and 1 month, and boosted at 6 months (primary booting) by conventional vaccine (B.Co), inactivated by pepsin digestion and formalin treatment, 11 cases who showed elevated titer after primary boosting were also submitted to the study. The results were as follows: 1) Out of the 117 subjects with naturally acquired anti-HBs, 6(5.1%) showed isolated anti-HBs and the titers were below 10 ratio units (RU). Negative seroconversion was seen in 4 (3.4%) of the 117 cases at 12 months after the screening and, of these cases, 3 showed isolated anti-HBs below 10 RU (increased GMT, 28.04) at one month after primary booster injection with 3 microgram dose of A. Co. Vaccine at all, but 90% of the other subjects responded. 3) The anti-HBs titers of all the 11 cases who showed a rise of more than 10 RU (increased GMT, 28.04) at one month after primary booster injection by 20 microgram dose of B. Co. vaccine decreased at 19 months after the primary booster. And 3 subjects (27.3%) of the 11 reached negative seroconversion. All of the 11 cases, who had secondary booster injection with 3 microgram dose of A. Co. vaccine at 19 months after primary boosting, showed increased anti-HBs titer at least 20 RU or more (increased GMT, 57.72) at one month after the boosting. According to the above results in the anti-HBs screening survey for the purpose of immunization with hepatitis B vaccine, subjects with isolated anti-HBs below 10 RU should be regarded as being in an unimmunized state. In cases who are in risk circumstances, immunized primarily with a 20 microgram dose of B. Co. vaccine, a secondary booster injection should be given within 2 years after initiation of primary immunization and a 3 microgram booster dose of A. Co. vaccine can be reliably used.
Adult ; Digestion ; Formaldehyde ; Hepatitis B Surface Antigens* ; Hepatitis B Vaccines ; Humans ; Immunization* ; Mass Screening ; Pepsin A ; Plasma

Emphysematous pyelonephritis is rare but freuently fatal complication of renal parenchymal infection, mostcommonly occurs in diabetic patients and is often associated with urinary obstruction, prior urologicalabnormality or infection. From 1898 to 1984 , about 50 cases of empysematous pyelonephritis have been reporteduniversally. The diaignosis of emphysematous pyelonephritis can be made only roentgenographically. In the last 2years, we have had two cases of emphysematous pyelonephritis at our hospital. It is our purpose to report twopatients who have survived wtih a brief review of the previous literature.
Humans ; Pyelonephritis

PURPOSE: To compare the detectability and conspicuity of focal hepatic lesions among conventional spin echo techniqueniques and fast scanning techniqueniques in MR imaging. MATERIALS AND METHOD: 36 patients (24 men and 12 women, mean age of 54 years) with suspected liver mass on CT scan and US underwent MR imaging at 1.5 T system. Conventional spin echo T1, T2 weighted imaging, T2 weighted fast spin echo, T1 weighted fast multiplanar spoiled gradient recalled(FMPSPGR) imaging and Gd-enhanced FMPSPGR(Gd-FMPSPGR) were performed. 16 cases of hepatocellular carcinoma, 13 cases of hemangioma, 3 cases of metastasis, 3 cases of cholangiocarcinoma, and 1 case of lymphoma were included. Lesion conspicuity and number of detected hepatic masses were compared among the MR sequences. RESULTS: Overall 63 hepatic lesions were detected in 36 patients. Lesion detection' was 63(100%) with Gd-FMPSPGR, 62(98%) with non-enhanced FMPSPGR, 58(92%) with SE T2WI, 56(89%) with SE T1WI and 54 (86%)with FSE. For solid tumors, the contrast to noise ratio was greatest on Gd-FMPSPGR which was significantly higher than any other sequences. For hemangiomas it was greatest on SE T2WI and was significantly higher than SE T1WI. In the qualitative assessment, Gd-FMPSPGR was preferred for both solid mass lesion and hemangioma. FSE was inferior to SE T2WI for lesion detection and conspicuity without statistical significance. CONCLUSIONS: For the evaluation of focal hepatic lesions, breath-hold FMPSPGR with and without contrast enhancement may replace the conventional SE T1WI. Because FSE was inferior to SE T2WI when the later is used with respiratory compensation in some cases, it is difficult to replace the SE T2WI with FSE. But FSE, FMPSPGR and Gd-FMPSPGR images, when combined, may replace SE T1WI and SE T2WI.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Compensation and Redress ; Female ; Hemangioma ; Humans ; Liver ; Lymphoma ; Magnetic Resonance Imaging ; Male ; Neoplasm Metastasis ; Noise ; Tomography, X-Ray Computed

Esophageal ulcers induced by doxycycline is a rare complication. These patients usually complain of sudden onset of symptoms, ie acute substernal or chest pain and odynophagia without prior hietory of esophageal syraptoms. On esophagoscopic examination, there are upper or midesophageal ulcers, which heal after diseontinuation of the drug within 2 weeks. A history of ingestion of the doxycycline,with liquid jost before bedtime can be elicited. The exact eause of the xaucosal ulceration is not clear, but a direct irritant effeet on esophageal mucosa seems most likely. We report 5 cases of esophageal uleeration secondary to the ingestion of doxycydine. Esophagoscopy revealed esophageal ulcers in all patients and the patients hecame asymptomatic following stopping of tbe drugs and taking antacids.
Antacids ; Chest Pain ; Doxycycline* ; Eating ; Esophagoscopy ; Humans ; Mucous Membrane ; Ulcer*

We assessed the efficacy of trabeculectomy with mitomycin C in the management of congenital glaucoma of which prognosis is known to be poor. Twelve consecutive eyes of 7 primary congenital glaucoma patients who underwent trabeculectomy with mitomycin C were retrospectively reviewed. The mean age was 3.2 years(ranging from 1 to 10 years) and the mean follow-up period was 31.6 months (ranging from 15 to 42 months). The mean postoperatie intraocular pressure (IOP) at the end of follow-up period was 11.0 +/-3.0mmHg, significantly lower than the mean preoperative IOP which was 25.4 +/-6.3mmHg (P<0.01). The overall success rate was 50% after a single procedure. All the 6 failed eyes underwent the same operation again and the overall success rate was 83%. The complications included hypotony in 4 eyes (33.3%) and shallow anterior chamber in 2 eyes (16.6%), and they were all resolved spontaneously. There was no evidence of hypotonic maculopathy and endophthalmitis. Trabeculectomy with mitomycin C successfully lowered the IOP in congenital glaucoma patients without serious complication and further investigation will be required to determine ling-term effects in terms of successful filtration and possible late complications.
Anterior Chamber ; Endophthalmitis ; Filtration ; Follow-Up Studies ; Glaucoma* ; Humans ; Intraocular Pressure ; Mitomycin* ; Prognosis ; Retrospective Studies ; Trabeculectomy*