We have experienced 11 cases of large bony defect that were treated using microsurgery since 1981. Free vascularized bone transplantation was performed in 8 of them, vascularized bone transposition in 2 cases, and free vascularized joint transplantation in the remaining 1 case. The causes of the large bony defect were primary bone tumor (4 cases), congenital pseudoarthrosis (3 cases), open comminuted fracture (2 cases), sequela of osteomyelitis (1 case), and post-traumatic ankylosis of PIP joint of second finger (1 case). As a donor, fibula was used in 8 cases, iliac crest in 1 case, rib in 1 case and in the remaining 1 case, the second M-P joint of foot was transplanted. In 9 of 11 cases, successful result was obtained and 2 cases were failed because of vascular damage following tibial lengthening in one case and infection on the grafted area in the other one. From the above data and review of articles, following conclusions were obtained. 1. Fibula is thought to be the most appropriate donor for the large bony defect in the extremity, especially in lower extremity, but the donor site must be determined according to the anatomical and physilogical condition of the patient. 2. After mechanical lengthening of the extremity, it is recommened to perform the microvascular surgery after sufficient time for the recovery of vascular damage. But further studies are required for the identification of the change in the vascular tissue following stretching and its recovery time. 3. Progression of the ossification in the epiphysis of transplanted iliac crest was observed and this finding proposed us the idea that the epiphyseal plate injury or leg length discrepancy will be able to be treated with free vascularized epiphyseal plate transplantation and the reconstruction of the destroyed joint of growing children will be possible using free vascularized joint transplantation. 4. As the technique become more popular, the free vascularized bone transplantation is being used for the reconstruction of the extremity more frequently, but it seems to be wise to restrict its indication to cases which are impossible to be treated with more simple methods such as vascularized bone transposition or pedicled bone graft.
Ankylosis ; Bone Transplantation ; Child ; Epiphyses ; Extremities ; Fibula ; Fingers ; Foot ; Fractures, Comminuted ; Growth Plate ; Humans ; Joints ; Leg ; Lower Extremity ; Microsurgery ; Osteomyelitis ; Pseudarthrosis ; Ribs ; Tissue Donors ; Transplants

Peri-vater divertieula may interfere with the normal flow of biliary and pancreatic secretion, thus leading to pancreatobiliary diseasa and the very presence of juxtapapillary diverticulum makes cannulation technically difficult and contributes to the low success rate. In this present series, the relationship between duodenal diverticula and age, sex, and biliary-pancreatic pathology was stud.ied in 1400 patients examined with ERCP. The results are as follows. 1) Duodenal diverticula was demonstrated in 73 of 1400 patients(5, 2%). 2) The incidence of duodenal divertieular increased with age and they were more frequent in men. 3) The cannulation of one or both duct system was suecessful in 69 of the 73 patients, the success rate was 94. 5%. 4) The biliary pathology was found in 41 of the 73 patients and the pancreatic pathology in 6 of the 73 patients. The rnost common finding was biliary calculi which were demonstrated in 35 patients(47. 9%).
Catheterization ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis* ; Diverticulum* ; Gallstones ; Humans ; Incidence ; Male ; Pathology

Primary cancer af the duodenum is rare. An extensive experience with fiberoptic eaophag-ogastro-duodenoscopy in our institution has indicated that duodenal cancer may be more frequent thsn suspeeted and readily diagnesed by this modality, With this in mied, clinical, pathological, diagnostic and therapeetie aspects of the 26 patients with primary duodenal cancer which had been endoscopically diugnosed were reviewed. The results obtained were as follows: 1) Ages ranged from 16 to 75, with the mean of 55.2 years. Seventeen patients were men and nine patients women being l. 9:1 of male-female ratio. 2) Hndoscoyic findings were 46. 1 percent ulcerative anld 34. 8 per cent ulcerative-infiltrative, 3) The diatribution within the duodenum was 50 per cent suprapapillary, 42. 4 per cent peri- papillary aecl 7. 6 per cent infrapapillary. 4) The twenty-three patients had adenocarcinoma, two patients leiomyosarcoma and 1 patient lymphoma. 5) Twenty patients were confirmed by duodenoseopic biipsies and six patients by operations. 6) The mast common presenting mmyliiints were abdominal pain, chronic blood lais leading anemia, jaundice, anorexia, indigestion, weight lass and palpable abdominal mass. 7) Of the 26 patients, eight patients underwent attempted curative resection, six patients underwent palliative bypasa procedures or exploratory laparotomy.
Abdominal Pain ; Adenocarcinoma ; Anemia ; Anorexia ; Diagnosis* ; Duodenal Neoplasms ; Duodenum ; Dyspepsia ; Female ; Humans ; Jaundice ; Laparotomy ; Leiomyosarcoma ; Lymphoma ; Male ; Ulcer

Hyperglycemia has been noted to occur in pediatric patients undergoing cardiac surgery with hypothermia. Because even moderate hyperglycemia during cerebral ischemia may predispose patients to an increased risk of neurologic deficit, the authors wished to determine whether the large dosage of fentanyl might contribute significantly to the decrease in blood glucose, The authors examined 20 infants who underwent cardiac surgery with small dosage of fentanyl(Group I, n= l0) or large dosage of fentanyl (Group II, n=10), none of whom received dextrose in the clear cardiopulmonary bypass pump prime, maintenance iv fluids, or cardioplegic solution. Blood samples were obtained after induction, during cardiopulmonary by-pass, after cardiopulmonary bypass and after operation. There was no hypoglycemia during the entire surgical periods in all patients. During cardio-pulmonary bypass in group I and group II, after cardiopulmonary bypass, after operation in group II, blood glucose levels were significantly decreased compared with after induction values(p<0.05). Compared with group L the rates of changes from the values after induction were significant during cardiopulmonary bypass and after operation in group II(p<0.05). In conclusion, large dosage of fentanyl is valuable in control the hyperglycemia during open heart surgery in infants.
Blood Glucose* ; Brain Ischemia ; Cardioplegic Solutions ; Cardiopulmonary Bypass ; Fentanyl ; Glucose ; Heart* ; Humans ; Hyperglycemia ; Hypoglycemia ; Hypothermia ; Infant* ; Neurologic Manifestations ; Thoracic Surgery*

Postcholecystectomy syndrome is the persistence or recurrence of symytom complex following cholecystectomy, The majority of the patients have mild symptoms. However, the cause of recurrent symptoms is often obscure and as a consequence, a plan of management is difficult to formulate. Recently ERCP has proved to be increasingly helpful in the investigation of postcholecystectomy patients. The purpose of this study was to test the effectiveness of the ERCP in the evaluation of patients with postcbiolecystectomy syndrorae. The results are as follows 1) 102 postcholecystectomy patients were studied by endoscopic retrograde cholangiopancreatography and successful cannulation with demonstration of at least one duct was achieved in 49 of 50 jaundiced patients and in 49 of 52 non-jaundiced patients. The overall success rate was 96. 1%. 2) The results of ERCP were normal in 26 patients(26.5%) and abnormal in 72 patients (73.5%), Only 3 of 50 jaundiced patients were normal, but 23 of 52 non-jaundiced patients showed no abnormal findings. 3) The most common abnormality was biliary stone in common bile duct and intrahepatic duct which were present in 51 patients(50%). Cholangitis without stone was next common finding which was in 13 patients(13%). Of the remaining patients have air biligram, 2 CBD stricture, 1 CBD aseariasis & 1 chronic pancreatitis. 4) Time lapse between onset of symptoms and cholecystectomy was variable. 31 patients were studied less than 2 years after cholecystectomy. 18 of these patients had jaundice and 13 had no jaundice. Within 2 years afte chklecystectomy, the biliary stone was most common finding which were present in 14 out of 31 patients.
Catheterization ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Cholecystectomy ; Common Bile Duct ; Constriction, Pathologic ; Humans ; Jaundice ; Pancreatitis, Chronic ; Postcholecystectomy Syndrome ; Recurrence

No abstract available.
Contrast Media* ; Magnetic Resonance Imaging*

PURPOSE: It is important to know for transurethral resection of prostate (TURP) affecting the serum prostate specific antigen (PSA) value how long one should wait before being able to ~ obtain an accurate and meaningful serum PSA level. We evaluated the change of serum PSA concentration in patients with benign prostate hypertrophy(BPH) before and after TURP in association with time course and resected prostatic weight. MATERIALS AND METHOD: The effect of TURP was examined in 27 patients with BPH (mean age: 64 years; range: 55-79 years). The serum PSA levels were measured serially (before and 1, 3, 5, 7, 14, 30, 60, 90 days after TURP) by Abott IMX assay. RESULTS: The level of serum PSA appeared to be consistent with prostatic volume by transrectal ultrasonography(TRUS) and was elevated by about 0.16 ng/mL for each gram of hyperplastic tissue present (p=0.375, p=0.058). TURP caused an immediate elevation in the serum PSA concentration, with a median increase of 19 ng/mL (p=0.0001). The larger resected group showed a dramatic and statistically significant PSA rise immediately after TURP than the smaller resected group (p=0.023). From the 15 post-operative day, the PSA concentrations continued slightly lower than that of pre-operative day (p=0.0001), and was still decreased on 30 days (p=0.0001). The median time to return to a baseline level of PSA was 30 days (range: 1460 days) after TURP. CONCLUSION: These findings indicate that TURP caused an immediate increase in the serum PSA level, which generally return to stable, baseline level within 30 days. However, because in some patients the serum PSA still remained elevated than upper normal limit after 30 days, it is recommended that a serum PSA determination should be obtained for at least 60 days after TURP.
Humans ; Hypertrophy* ; Prostate* ; Prostate-Specific Antigen* ; Transurethral Resection of Prostate*

PURPOSE: It is important to know for transurethral resection of prostate (TURP) affecting the serum prostate specific antigen (PSA) value how long one should wait before being able to ~ obtain an accurate and meaningful serum PSA level. We evaluated the change of serum PSA concentration in patients with benign prostate hypertrophy(BPH) before and after TURP in association with time course and resected prostatic weight. MATERIALS AND METHOD: The effect of TURP was examined in 27 patients with BPH (mean age: 64 years; range: 55-79 years). The serum PSA levels were measured serially (before and 1, 3, 5, 7, 14, 30, 60, 90 days after TURP) by Abott IMX assay. RESULTS: The level of serum PSA appeared to be consistent with prostatic volume by transrectal ultrasonography(TRUS) and was elevated by about 0.16 ng/mL for each gram of hyperplastic tissue present (p=0.375, p=0.058). TURP caused an immediate elevation in the serum PSA concentration, with a median increase of 19 ng/mL (p=0.0001). The larger resected group showed a dramatic and statistically significant PSA rise immediately after TURP than the smaller resected group (p=0.023). From the 15 post-operative day, the PSA concentrations continued slightly lower than that of pre-operative day (p=0.0001), and was still decreased on 30 days (p=0.0001). The median time to return to a baseline level of PSA was 30 days (range: 1460 days) after TURP. CONCLUSION: These findings indicate that TURP caused an immediate increase in the serum PSA level, which generally return to stable, baseline level within 30 days. However, because in some patients the serum PSA still remained elevated than upper normal limit after 30 days, it is recommended that a serum PSA determination should be obtained for at least 60 days after TURP.
Humans ; Hypertrophy* ; Prostate* ; Prostate-Specific Antigen* ; Transurethral Resection of Prostate*

PURPOSE: The purpose of this experimental study was to evaluate early CT and MRI findings of cerebral sparganosis, to correlate the imaging findings with histopathologic findings, and to determine capability of CT and MRI to differentiate live worm from the dead. MATERIALS AND METHODS: After scolices of three to four spargana, which were obtained from naturally infected snakes, were introduced into cerebral hemispheres of 21 mongrel cats, sequential brain CT and MRI were performed at the 2nd, 4th, 8th and 12th week, and the imaging findings were analyzed and compared with the histopathologic findings. RESULTS: Spargana were found in 16 sites of 10 cat brains(48%);they were located in basal ganglia(5 cases), periventricular white matter and centrum semiovale(4 cases), subdural(2 cases) or subarachnoid spaces(1 case), and lateral ventricle(2 cases). The larvae were also observed in the contralateral hemisphere(3 cases). The lesions without larvae(presumably tracts) were found in 22 sites of 14 cat brains(67%) ;they were located in periventricular white matter and centrum semiovale(11 cases), basal ganglia(5 cases), midbrain(3 cases) and frontal 10be(2 cases). The lesions without larvae were also found in the contralateral hemi- sphere (7 cases). On CT, the lesions with larvae showed high density in 75%(9/12) and were enhanced in 38%(3/8) as a nodular pattern. On MRI they showed iso-(7/11) or low signal intensity(4/11) on Tl-weighted images, mainly isosignal intensity on proton density- weighted images, and variable signal intensity on T2-weighted images. Contrast enhancement of variable shapes was seen in 50%(4/8). The lesions without larvae showed iso-(14/22) or low density(6/22) on CT and were rarely enhanced(2/17). On MRI they mostly showed isosignal intensity on both T1-weighted and proton density- weighted images, and variable signal intensity on T2- weighted images. They were enhanced in 29%(5/17) on contrast-enhanced MRI. Dilatation of ipsilateral ventricle was found in 43% (9/21) ;it was seen as early as the second week in 5 cats. On histopathologic examinations, there was only mild degree of inflammation and edema around both the larvae and the lesions without larvae in most cases. Granulation tissues, small calcifications, and small morrhages were observed nearby the larvae in six, one and two cases, respectively. At the lesions without larvae, small calcifications and hemorrhages were found in three and nine cases, respectively. It was not possible to determine the viability of the larvae by using CT or MRI findings and even by histopathologic findings. CONCLUSION: The results indicate that the spargana actively move within brain tissue in early stage, cause mild degree of inflammation and edema around the larvae and the tracts, but presumably produce early degeneration of cerebral white matter, resulting in dilatation of ipsilateral ventricle. Additionally, CT may differ. entiate the lesions with worms from tracts(the lesions without worms), but viability of the larvae can not be determined by either CT or MRI.
Animals ; Brain ; Cats ; Cerebrum ; Diagnosis* ; Dilatation ; Edema ; Granulation Tissue ; Hemorrhage ; Inflammation ; Larva ; Magnetic Resonance Imaging ; Protons ; Snakes ; Sparganosis*

BACKGROUND: Carcinoma of the uterine cervix is a theoretically preventable disease because its precursor lesions can be detected by cervical Papanicolau smears and appropriately treated, Although cervical cytology screening programmes have resulted in the redution of cervical cancer incidence and mortality, Pap smear have been subjected to intense scrutiny and criticism in recent years. The focus of criticism has been the false-negative Pap smear, and the false-negative Pap smear is the major quality issue currently facing the physicians. To reduce the false-negative rate of Pap smear, it is essential to improve the accuracy of Pap smear. But false-negative rate of Pap smear has been reported variously. OBJECTIVE: This study was undertaken to evaluate accuracy of Pap smear by study false-negative and false-positive rate of Pap smear and to determine whether false-negative and false-positive rate had any correlations with clinical factors. STUDY DESIGN: The study population was comprised of 346 women, who were undertaken gynecologic operation at the Department of Obstetrics & Gynecology at Hanyang University hospital between March, 1997 and April, 1998. All patients were taken Pap smear before operation. In 93 women of these, preoperative diagnosis were cervical intraepithelial neoplasia and carcinoma in situ of uterine cervix, and in 253 women of these, preoperative diagnosis were benign disease as uterine myoma or adenomyosis, etc. All of their surgical specimen were examined. Pap smear, pathology, medical charts of all patients were reviewed retrospectively, and false-negative rate and false-positive rate were calculated. Clinical factors that associated with false-negative and false-positive rate were evaluated. Fishers exact test and Pearson chi-square test were used of statistical analysis, RESULTS: False-negative rate of Pap smear was 7.2%, false-positive rate was 4.6%, corresponding rate with histology was 88.2%. Sensitivity and specificity of PAP smear were 87.0% and 97.0% respctively. According to gross finding of uterine cervix, erosion was 46.6% in cervical intraepithelial neoplasia, 67.8% in carcinoma in situ, 66.6% in microinvasive carcinoma of uterine cervix and 55.3% of 103 erosion findings was cervical intraepithelial neoplasia, carcinoma in situ or microinvasive carcinoma. 23.1% of cervical lesion were normal gross finding. Menopause was associated with false-negative rate and previous vaginal infection history, previous cervical minor operation, delivery mode, contraception method, pelvic inflammatory disease history, vaginal bleeding at Pap smear and gross finding of cerbix were not associated. There were no clinical factors that were associated with false-positive rate. CONCLUSION: Compared with other reports, false-negative rate(7.2%) and false-positive rate(4.6%) of Pap smear was lower and corresponding rate(88.2%) was higher in Hanyand university hospital. Because of higher false-negative rate in menopausal women, it need more careful to take and interpretate Pap smear in these group.
Adenomyosis ; Carcinoma in Situ ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Contraception ; Diagnosis ; Female ; Gynecology ; Humans ; Incidence ; Leiomyoma ; Mass Screening ; Menopause ; Mortality ; Obstetrics ; Pathology ; Pelvic Inflammatory Disease ; Retrospective Studies ; Sensitivity and Specificity ; Uterine Cervical Neoplasms ; Uterine Hemorrhage