From January 1988 to December 1994, endoscopic sphincterotomy with stone extraction was attempted in 395 patients with common duct stones at Yeungnam University Hospital. Endoscopic sphincterotomy was successful in 389 patients(98.5 %), and clearance of the duct was achieved in 364 patients with an overall success rate of 92.2%. After sphincterotomy, stone extraction by basket or balloon was undertaken in 298 patients without lithotripsy, and stones could be extracted after fragmentation of stones in 19 patients. In 47 patients, stones were passed into duo denum spontaneously. There were 6 cases of sphincterotomy failure due to large periampullary diverticulum or previous gastrojejunostomy. In patients with success ful sphincterotomy, endoscopic stone extraction was failed in 25 cases due to 14 large stones, 5 bile duct strictures, 4 impacted stones, and 2 cases of technical fail ure. Complications were developed in 13 patients(3.3%); 8 pancreatitis and 5 bleedings. All of them were improved with medical therapy only. Despite relatively high success rate and low complications of the endoscopic management of choledocholithiasis, there were significant difficulties in removing large stones. Developement of more effective and inexpensive methods of lithotripsy, and the search for rapidly effective solvent dissolving stones were needed.
Bile Ducts* ; Bile* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Constriction, Pathologic ; Diverticulum ; Gastric Bypass ; Humans ; Lithotripsy ; Pancreatitis ; Sphincterotomy, Endoscopic

Background: The aim of this study was to evaluate results of osteoperiosteal decortication and autogenous cancellous bone graft combined with a bridge plating technique in atrophic and oligotrophic femoral and tibial diaphyseal nonunion. Methods: We retrospectively reviewed 31 patients with atrophic or oligotrophic femoral and tibial diaphyseal nonunion treated with osteoperiosteal decortication and autogenous cancellous bone graft between January 2008 and December 2018. Patients with hypertrophic nonunion, infected nonunion, and nonunion treated with autogenous cancellous bone graft alone were excluded.The nonunion site was exposed by using the Judet technique of osteoperiosteal decortication. Nonunion with a lack of stability was stabilized with a new plate using a bridge plating technique or augmented by supplemental fixation with a plate. Nonunion with malalignment was stabilized with a new plate after deformity correction. Autogenous cancellous bone graft was harvested from the posterior iliac crest and placed within the area of decortication. A basic demographic survey was conducted, and the type of existing implants, mechanical stability of the implants, the type of implants used for stabilization, the operation time, the time to bone union, and postoperative complications were investigated. Results: The average follow-up period was 33.3 months (range, 8–108 months). The operation time was 207 minutes (range, 100– 351 minutes). All but 1 nonunion (96.7%) were healed at an average of 4.2 months (range, 3–8 months). In 1 patient, bone union failed due to implant loosening with absorbed bone graft, and solid union was achieved by an additional surgery for stable fixation with a new plate, osteoperiosteal decortication, and autogenous cancellous bone graft. There were no other major complications such as neurovascular injuries, infection, loss of fixation, and malunion. Conclusions Osteoperiosteal decortication and autogenous cancellous bone graft combined with stable fixation by bridge plating showed reliable outcomes in atrophic and oligotrophic diaphyseal nonunion. This treatment modality can be effective for treating atrophic and oligotrophic diaphyseal nonunion because it is very helpful stimulating bone union.

Background: The aim of this study was to evaluate results of osteoperiosteal decortication and autogenous cancellous bone graft combined with a bridge plating technique in atrophic and oligotrophic femoral and tibial diaphyseal nonunion. Methods: We retrospectively reviewed 31 patients with atrophic or oligotrophic femoral and tibial diaphyseal nonunion treated with osteoperiosteal decortication and autogenous cancellous bone graft between January 2008 and December 2018. Patients with hypertrophic nonunion, infected nonunion, and nonunion treated with autogenous cancellous bone graft alone were excluded.The nonunion site was exposed by using the Judet technique of osteoperiosteal decortication. Nonunion with a lack of stability was stabilized with a new plate using a bridge plating technique or augmented by supplemental fixation with a plate. Nonunion with malalignment was stabilized with a new plate after deformity correction. Autogenous cancellous bone graft was harvested from the posterior iliac crest and placed within the area of decortication. A basic demographic survey was conducted, and the type of existing implants, mechanical stability of the implants, the type of implants used for stabilization, the operation time, the time to bone union, and postoperative complications were investigated. Results: The average follow-up period was 33.3 months (range, 8–108 months). The operation time was 207 minutes (range, 100– 351 minutes). All but 1 nonunion (96.7%) were healed at an average of 4.2 months (range, 3–8 months). In 1 patient, bone union failed due to implant loosening with absorbed bone graft, and solid union was achieved by an additional surgery for stable fixation with a new plate, osteoperiosteal decortication, and autogenous cancellous bone graft. There were no other major complications such as neurovascular injuries, infection, loss of fixation, and malunion. Conclusions Osteoperiosteal decortication and autogenous cancellous bone graft combined with stable fixation by bridge plating showed reliable outcomes in atrophic and oligotrophic diaphyseal nonunion. This treatment modality can be effective for treating atrophic and oligotrophic diaphyseal nonunion because it is very helpful stimulating bone union.

Rotor syndrome is a rare benign familial disorder characterized by chronic, fluctuating, nonhemolytic and predominantly conjugated hyperbilirubinemia with normal liver tissue. In contrast to Dubin-Johnson syndrome, there is no liver hyperpigmentation in Rotor syndrome, and BSP clearance does not show a secondary retention peak. The serum bilirubin in patients with Gilbert's syndrome is almost all unconjugated in contrast to Rotor syndrome. A 29-year-old male was admitted due to persistent jaundice. Physical examination revealed icteric sclera without hepatosplenomegaly. Laboratory findings showed increased serum bilirubin with indirect bilirubin predominance. Urinary excretion of total coproporphyrin was markedly elevated, and coproporphyrin I was 66% of total urinary coproporphyrin. Oral cholecystography showed well visualized the gallbladder, but 99mTc-DISIDA scan showed markedly decreased hepatic uptake and poor visualization of the gallbladder and biliary tract. Histology of the liver showed no abnormal finding. We report the case with the review of literature.
Adult ; Biliary Tract ; Bilirubin ; Cholecystography ; Gallbladder ; Gilbert Disease ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Hereditary* ; Hyperpigmentation ; Jaundice ; Jaundice, Chronic Idiopathic ; Liver ; Lymphoma ; Male ; Physical Examination ; Sclera ; Skin Neoplasms ; Survival Rate ; Technetium Tc 99m Disofenin

Meningiomas are common brain tumors that show a predilection for females and become more aggressive during pregnancy and menses. Clinical and epidemiological observations regarding meningiomas suggest a sex hormone dependency of these tumors. We reviewed the 47 intracranial meningiomas to examine the presence of the progesterone receptor(PR) by immunohistochemical methods and the relationships between the PR immunostaining status and other parameters, such as age, sex, tumor grade, mitotic index, and Ki-67 staining index. The PR staining status in these tumors was analyzed by immunohistochemistry on formalin-fixed paraffinembedded archival tissue sections utilizing the monoclonal antibody. The results are summarized as follows: 1) fifteen tumors(31.9%) tested were positive for the PR, 2) patients age and sex had no significant relationship with the PR positive rate of meningiomas(p=0.680, and 0.968, respectively), 3) although the positive immunostaining rate for the PR in benign meningiomas(37%) was higher than that in atypical and malignant meningiomas(25%), there was no statistically significant difference between these two groups(p=0.381), and 4) proliferative potentials such as the Ki-67 staining index and the mitotic index were not correlated with the PR staining status(p=0.4578 and 0.1981. respectively). We believe that further studies using large series of patients are needed to elucidate the role of the PR in meningiomas.
Brain Neoplasms ; Female ; Humans ; Immunohistochemistry ; Meningioma* ; Mitotic Index ; Pregnancy ; Progesterone* ; Receptors, Progesterone*

BACKGROUND: There is increasing evidence that inflammation is an important determinant of the development of atherosclerosis and that oxidation of low-density lipoprotein (LDL) obviously plays an important role in the pathogenesis of atherosclerosis. We assessed the levels of oxidized LDL and inflammatory markers in patients with ischemic heart disease and normal group who has normal coronary angiograms. METHODS: Coronary angiography was performed in 142 patients. 107 patients of ischemic heart disease (stable angina pectoris 58, unstable angina pectoris 30, acute myocardial infarction 19) and 38 normal control subjects. We assessed the level of oxidized LDL and inflammatory markers, such as CRP, ESR, fibrinogen and leukocyte. RESULTS: CRP was 3.88+/-2.05 mg/dL in acute myocardial infarction group, and 0.29+/-0.15 mg/dL in normal control subject group (p<0.05). Fibrinogen was 541.6+/-45.1 mg/dL in acute myocardial infarction group, 321.4+/-25.6 mg/dL in normal control subject group (p<0.05). Leukocyte was 10942.1+/-737.6/mm3 in acute myocardial infarction group, 6394.3+/-235.1/mm3 in normal control subject group (p<0.05). Oxidized LDL was 23.0+/-4.0 EU/mL in acute myocardial infarction group, and 16.2+/-1.5 EU/mL in normal control subject group (p<0.05). CRP, ESR and fibrinogen values of the patients with stable angina pectoris and unstable angina pectoris were higher than that of normal control group, but there were no statistical significance. Oxidized LDL (ox-LDL) and Leukocyte value of the patients with unstable angina pectoris, acute myocardial infarction was significantly higher than that of the patients with stable angina pectoris and normal control subjects (p<0.05). CRP, ESR and fibrinogen values of the patients with acute myocardial infarction were also higher than that of normal control subjects. CONCLUSION: This study demonstrate that CRP, fibrinogen and oxidized LDL, leukocyte values of acute myocardial infarction group were significantly higher than that of control group and stable, unstable angina pectoris group. Oxidized LDL and Leucokyte values were also significantly elevated in unstable angina group, but CRP values were not in unstable angina group.
Angina Pectoris ; Angina, Stable ; Angina, Unstable ; Atherosclerosis ; Coronary Angiography ; Fibrinogen ; Humans ; Inflammation ; Leukocytes ; Lipoproteins ; Myocardial Infarction ; Myocardial Ischemia*

BACKGROUND: we have evaluated the association of age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases with postoperative pulmonary complications and identified which parameter of preoperative spirometry was a predictor of postoperative pulmonary complications. METHOD: In 270 patients older than 60 years, the postoperative pulmonary complications were evaluated according to age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases and the parameters of preoperative spirometry were analyzed. RESULTS: The postoperative pulmonary complications rates were significant higher among patients older than 70 years, and among those with previous chronic pulmonary diseases or their smoking history. The pulmonary complications were increased among patients with general anesthesia or duration of surgery more than 2 hours. The pulmonary complications rates did not differ according to sex, type of operation. The patients with hypercarbia(PaCO2> 45mmHg) have more increased postoperative complications. The preoperative FEVl less than 1 liter, FVC, MMEFR & MVV less than 50% of predicted respectively were predictive of complications. CONCLUSION: Age 70, history of smoking,duration of operation more than 2 hours, general anesthesia, previous chronic pulmonary disease and hypercarbia (> or=45mmHg) on preoperative arterial blood gas analysis were predictivd of pulmonary complications. Among the parameters of spirometry, FEV1, FVC, MMEFR and MVV were indicator of predicting postoperative pulmonary complications.
Aged* ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Humans ; Lung Diseases ; Postoperative Complications ; Smoke ; Smoking ; Spirometry

Eight cases of chondroblastoma were studied by analyzing the clinical and pathologic findings. The age of eight cases ranged from 17 to 38 years old(median age, 22.7 years old). The tumors developed in the femur (3 cases), patella (2 cases), tibia( 1 case), fibula (1 case), and ulna (1 case). The mean diameter of tumors was 4.0 cm (range, 1.5 to 8.0 cm). Grossly, tumors showed grayish brown solid area with foci of secondary aneurysmal bone cyst. Histologically, the tumor cells were round or polygonal in shape with nuclear groove. And there were chondroid differentiation(7 cases), mitosis(3 cases), calcific deposits(3 cases), secondary aneurysmal bone cyst(4 cases), hemosiderin deposits(4 cases), necrosis(3 cases), vascular invasion(1 caes) and foamy histiocytes and cholesterol cleft(1 cases). All cases showed no metastasis to lymph node and distant organ. Seven cases (87.5 %) were immunoreactive for S-100 protein. None were immunoreactive for cytokeratin.
Aneurysm ; Bone Cysts ; Cholesterol ; Chondroblastoma* ; Femur ; Fibula ; Hemosiderin ; Histiocytes ; Keratins ; Lymph Nodes ; Neoplasm Metastasis ; Patella ; S100 Proteins ; Ulna

Soft tissue filler injection has been a very common procedure worldwide since filler injection was first introduced for soft tissue augmentation. Currently, filler is used in various medical fields with satisfactory results, but the number of complications is increasing due to the increased use of filler. The complications after filler injection can occur at any time after the procedure, early and delayed, and they range from minor to severe. In this review, based on our experience and previously published other articles, we suggest a treatment algorithm to help wound healing and tissue regeneration and generate good aesthetic results with early treatment in response to the side effects of filler. Familiarity with the treatment of these rare complications is essential for achieving the best possible outcome.
Algorithms ; Biocompatible Materials/*therapeutic use ; Connective Tissue/*surgery ; Face/surgery ; Guided Tissue Regeneration/*methods ; Humans ; Hyaluronic Acid/administration & dosage ; Injections ; Skin Aging ; Surgery, Plastic/*methods ; Tissue Engineering/*methods ; Wound Healing

In recent studies there have been various attempts at replacing a damaged retina with an artificial one. This paper outlines the assembly of an artificial retina membrane by incorporating a photorective protein bacteriorhodopsin into an electrochemically syntheszed conducting polymer polypyrrole. An electrophysiologic test was conducted to evaluate the photoresponsiveness of the bacteriorhodopsin and rabbit eyes were used to examine the biocompatibility of the artificial retina. The electrophysiologic test analyzed both wave forms and amplitudes obtained by photostimulating the artificial retina membrane with various light intensites(0.2, 2, 20J). In the biocompatibility test, the artificial membrane was inserted into the anterior chambers(4 eyes) and vitreous cavities(8 eyes) of rabbits. The condition of the eyes was then observed for one month. At the end of the first moonth, the eyes were enucleated and a histological examination was carried out. The electrophysiologic study displayed negative reflection waves, which are characteristic in rhodpsin, and their amplitudes showed a correspondign increase with stronger light intensities. The results of the biocompatibility test demonstrated that inflammatory reactions were not prominent in either the anterior chambers or the vitreous cavities during the first month and the histological examinations revealed no specific findings. In conclusion, a membrane assembled utilizing an electroactive polymer and a phocial retina.
Anterior Chamber ; Bacteriorhodopsins ; Membranes ; Membranes, Artificial ; Polymers ; Rabbits ; Retina*