No abstract available.
Humans* ; Polymerase Chain Reaction*

Oral cholecystography is one of the most relible and widely used x-ray examination which enables us to observe not only morphological features of the gallbladder (GB) but also its functioning state. It was disclosed that functional evaluation of the GB is mandatory to recognize such kinetic disorders of the viscus as acalculous cholecystitis or dyskinesia. For the purpose of functional evaluation, fat meal has been used traditionally. Recently, cholecystokinin(CCK) and ceruletide were introduced into clinical diagnosis of the GB, the usefulness of which we have confirmed. In the present study we have made an attempt at improving cholecystagogic effect of conventional fat meals(FM) such as whole mild and egg yolk by changing the posture of the examined from sitting up to right decubitus position after the ingestion of fat meal. The hypothesis involved in this study is that the presence of quantitatively more fat meal in the duodenum per unit time may result in more effective cholecystagogic action and such a setting would be created by enhancement of pyloric passage of fat meal by decubitus posturing. Clinical materials consisted of 280 normal oral GB series (136 males and 144 females) andthey were divided into 4 equally numbered groups of mild sitting and mild decubitus and egg sitting and eggdecubitus. Upon confirming satisfactory opacification of the GB 11 hours after the ingestion of 3g of sodiumipodate or iopanoci acid either 2 pieces of medium sized hen's egg yolk were given. The xaminess were then allowed either sitting up comfortably on a bench or lying down on the right flank on a couch. After the ingestion of fat mean, x ray was taken at the end of 30 minutes in all but the mild decubitus group in which x rays were taken serially at the end of 5, 15, 30 and 60 minutes. The frontal area of each opacified GB was measured by using aplanimeter and the contraction rate before and after fat meal stimulation was calculated by the following equation and delineation of the biliary tree was analyzed in each group. Contraction rate (%) = (1
Acalculous Cholecystitis ; Biliary Tract ; Ceruletide ; Cholecystography ; Deception ; Diagnosis ; Duodenum ; Dyskinesias ; Eating ; Egg Yolk ; Gallbladder ; Humans ; Male ; Meals ; Ovum ; Posture

PURPOSE: This study investigated the changes of quality of life after the supplement of testosterone in the aging male partial androgen deficiency(PADAM). MATERIALS AND METHODS: The changes of subjective symptoms were estimated in 56 cases(experimental group: 48 cases, placebo group: 8 cases) with PADAM over 55 year-old, who were treated with transdermal testosterone(Androderm(R)) or a placebo patch by single blind method from September, 1997 to July, 1998. The 12.2mg testosterone patch was attached daily on the lower abdomen, thigh, upper arm and back on a period of three months. Laboratory tests were done on pretreatment and monthly after treatment, which include serum testosterone, PSA, cholesterol, AST and ALT. Changes in the quality of life were evaluated by the PNUH QOL system, which consisted of 21 questions inquiring the following 7 functions: metabolic, cardiopulmonary, musculoskeletal, gastrointestinal, neurologic, psychiatric and sexual function. RESULTS: The 56 cases showed an age distribution of 55-80 year-old(mean 64.3 year-old). During the follow-up period, the drop-out rate after treatment in the experimental group was 18 cases(37.5%) and 7 cases(14.6%) in the posttreatment 1st and 2nd months, respectively. Serum testosterone was significantly increased in the posttreatment 1st, 2nd, 3rd months when compared to pretreatment levels only in the experimental group(r=0.897, p=0.009). Prior to treatment, sexual dysfunction was inquired the most common problem, and followed by psychiatric, musculoskeletal, metabolic, cardiopulmonary, neurologic and gastrointestinal dysfunction in order. After treatment, sexual dysfunction showed the most improvement, and followed by metabolic, musculoskeletal, cardiopulmonary, psychiatric, gastrointestinal and neurologic dysfunction in order. Except for neurologic and gastrointestinal dysfunctions, other subjective symptoms improved in proportion to duration of treatment. The most common complication was a skin rash, which occured in 36 cases(64.2%) and caused the drop out of 14 cases(25%). CONCLUSIONS: According to the above results, it revealed that testosterone supplement therapy induced the improvement of the quality of life in PADAM. Therefore, treatment proctocols including indication, dosage and duration as well as the exact mechanism of the biological role of testosterone should be prepared to popularize hormonal therapy in PADAM.
Abdomen ; Age Distribution ; Aging* ; Arm ; Cholesterol ; Exanthema ; Follow-Up Studies ; Humans ; Male* ; Middle Aged ; Neurologic Manifestations ; Quality of Life* ; Single-Blind Method ; Testosterone* ; Thigh

Even a single brain infarct can cause dementia when it occurs in functionally critical areas of the brain. A 71- year-old female developed sudden cognitive impairment without any other focal neurologic deficits. A brain MRI revealed a bilateral anterior fornix infarction. Neuropsychological evaluation revealed verbal and visual memory deficits, visuospatial dysfunction, and frontal executive dysfunction. The cognitive impairment did not improve for 3 months and the patient showed impairments in daily activities. We report a patient who demonstrated strategic infarct dementia after a bilateral anterior fornix infarction.
Brain ; Dementia* ; Dementia, Vascular ; Female ; Fornix, Brain ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Memory Disorders ; Neurologic Manifestations

Double common bile duct (DCBD) is a rare congenital anomaly among biliary anomalies. The anomaly has an important clinical implication because of its association with anomalous pancreaticobiliary ductal union (APBDU) and upper gastrointestinal cancers. In addition, if one of the two common bile ducts is mistaken for the cystic duct during surgery, bile duct injury is likely to occur. Treatment depends on the coexistence of concomitant cancer and APBDU. A 54-year-old male diagnosed of gastric cancer was referred for surgery. During surgery, we incidentally detected bile leak from the tubular structure around the hepatoduodenal ligament. We performed intraoperative cholangiogram by cannulizing into the tubular structure, and confirmed the tubular duct as the accessory bile duct with an ectopic drainage into the stomach, which was connected to the proximal common bile duct. In this study, we report a rare case of DCBD with an ectopic drainage into the stomach and review the literature.
Bile ; Bile Ducts ; Common Bile Duct* ; Cystic Duct ; Drainage* ; Gallstones ; Gastrointestinal Neoplasms ; Humans ; Ligaments ; Male ; Middle Aged ; Stomach Neoplasms ; Stomach*

Global aphasia without other focal neurologic lateralizing signs (GWLS) is an uncommon stroke syndrome. The pathogenesis of GWLS has been thought as the result of multiple cardioembolism. However, a few cases of GWLS with a single lesion have been reported. We report an unusual case of GWLS with a single left superior temporal infarction. A 73-year-old right handed man was admitted with receptive and expressive language impairment without other focal neurologic lateralizing signs. The patient's global aphasia symptom has being 4 weeks after symptom onset. Brain CT showed only one lesion of left superior temporal lobe. Our case notes that the multiple lesions of the speech area are not only necessary to produce GWLS, and it is not necessarily imply a double lesion or an embolic causes.
Aged ; Aphasia* ; Brain ; Hand ; Humans ; Infarction ; Stroke ; Temporal Lobe

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is very uncommon even in countries with high prevalence of TB. The clinical manifestation of primary hepatic TB is atypical and imaging modalities are unhelpful for differential diagnosis of the liver mass. Image-guided needle biopsy is the best diagnostic method for primary hepatic TB. In the cases presented here, we did not perform liver biopsy because we believed the liver masses were cholangiocarcinoma, but primary hepatic TB was ultimately confirmed by postoperative pathology. Here we report two cases of patients who were diagnosed with primary hepatic TB mimicking mass-forming intrahepatic cholangiocarcinoma.
Biopsy ; Biopsy, Needle ; Cholangiocarcinoma* ; Diagnosis, Differential ; Hepatectomy ; Humans ; Liver ; Pathology ; Prevalence ; Tuberculosis ; Tuberculosis, Hepatic* ; Cholangiocarcinoma

Acute mountain sickness is an illness caused by climbing to a high altitude without prior acclimatization. Neurological consequences, like parkinsonism following acute mountain sickness without lesion of brain MRI have been reported rarely. A healthy 56-year-old man presented with dysarthria and gait disturbance. Neurological examination revealed tremor of hands, limb rigidity, and bradykinesia. The symptoms developed approximately 30 days following a 3,500 m climb of the Annapurna in the Himalayas. Brain MRI did not reveal any abnormalities including globus pallidus. The parkinsonism symptoms persisted for about 3 months before a complete recovered was made. We suggest that parkinsonism can develop after climbing to a high altitude but that the symptoms can be transient if a brain MRI detects no abnormalities.

The tibia is the most commonly fractured bone of all the long bones. In this age of vehicular accidents, the tibia is frequently subjected to high energy trauma. Anatomically the tibia has poor soft tissue coverage and poor blood supply. Therefore severe injury on the tibia can lead to severe complication and major disability. 41 adult patients with comminuted fracture of the tibial shaft were treated by OR/IF with D.C.P. and bone graft at the Department of Orthopedic Surgery, Kyungpook University Hospital from January 1978 to June 1986. These were analysed according to mechanism of injury, degree of comminution, timing of operation, soft tissue injury and operation time. Bone union and end results of treatment were reviewed. The results were as follows Of 41 cases, causes of injury were vehicular accident in 32 cases. 34 cases had associated injury on other part of body and average injury per case was 1.7 injuries. Based on the classification of Johner and Wruhs, the B group with butterfly fragment was 27 cases and C group was 14 cases. Among the B group, B2 was most common as 14 cases. Average union time was 18 weeks and delayed union and nonunion were 6 cases. Degree of comminution of fracture might be important fractor to bone union. According to the end result of Johner and Wruhs, excellent and good were 31, fair and poor were 10. Of the 41 cases, 10 cases had permanent disability. 4 cases had angular and rotational deformity alone and 1 case had shortening of tibia more than 1 cm, 1 case had both of them. Limited R.O.M. of ankle joint (>50%) occured in 4 cases. The post-operative infection occured in 6 cases, 3 were superficial infection but 3 cases were osteomyelitis. OR/IF with D.C.P. on comminuted tibial shaft fracture was a risk operation. Therefore proper method of treatment should be selected according to degree of comminution, timing of operation, presence or abscence of open wound and associated injury.
Adult ; Ankle Joint ; Butterflies ; Classification ; Clinical Study ; Congenital Abnormalities ; Fractures, Comminuted ; Gyeongsangbuk-do ; Humans ; Methods ; Orthopedics ; Osteomyelitis ; Soft Tissue Injuries ; Tibia ; Transplants ; Wounds and Injuries

Soft tissue defect on dorsum of hand requires immediate soft tissue cover to achieve early wound closure and to minimize wound infection and scarring. If the tendon or bone was exposed and the deep structures were absent, flap was required to provide adequate protection and allow proper function of the underlying structures. Small size in skin loss can easily be covered with local flaps but major defects involving the dorsal aspect of the hand should be coverd with distant flaps, free flaps or radial forearm flaps. Techniques in distant flaps require staged procedures and free flap transfer to obtain soft tissue cover in a single stage require microsurgical techniques. The reverse radial forearm flap is a fasciocutaneous flap based on the radial artery which together with its two venae comitantes lies invested in a condensation of the deep fascia known as the lateral intermuscular septum. The authors had treated 5 cases of distally based reverse forearm flap for soft tissue reconstruction on 2 patients of crushing injury with soft tissue defect on hand, a patient with Marjolin's ulcer on dorsum of hand due to previous burn scar and a patient with soft tissue necrosis on dorsum of both hands due to extravasation of adriamycin during chemotherapy. It has proved to be one of the saftest, simple and effective one-stage method of soft tissue reconstruction in hand without long term immobilization. The results of these operation in cover of soft tissue defect have been satisfactory.
Burns ; Cicatrix ; Doxorubicin ; Drug Therapy ; Fascia ; Forearm ; Free Tissue Flaps ; Hand ; Humans ; Immobilization ; Methods ; Necrosis ; Radial Artery ; Skin ; Tendons ; Ulcer ; Wound Infection ; Wounds and Injuries