BACKGROUND: Laparoscopic cholecystectomy has become the standard treatment of benign gallbladder disease. It requires the skill of a trained surgeon, and its safe performance. The advantages of laparoscopy are less postoperative pain, absence of cosmetic damage, shorter recovery times, and decreased length of hospital stays compared with conventional open surgery. METHODS: We reviewed 500 consecutive laparoscopic cholecystectomies retrospectively at the department of general surgery of Maryknoll Hospital from February 1992 to May 1999. RESULTS: There were 175 males and 325 females(M:F=1:1.86) with ages ranged from 21 to 78 years (mean: 50.0 year). Preoperatively, 72 patients underwent endoscopic retrograde cholagiography and 7 patients underwent endoscopic sphincterotomy due to common bile duct stone. Mean operation time was 73.7 minutes. Operative cholangiogram was attempted in 8 patients. Conversion to open cholecystectomy during operation was done in 8 cases(1.6%) and leading causes were severe adhesion, uncontrolled bleeding, suspected malignancy, bile duct injury. Operative Complications occured in 18 patients(3.6%): bile duct injury 1, postoperative bleeding 1, bile leakage 4,subcutaneous emphysema 1, abdominal wall hematoma 3, wound infection 8. There was no operative mortality. The length of hospital stay ranged from 2 to 15 day with average of 4.7 day. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective operation in patients with benign gallbladder diseases.
Abdominal Wall ; Bile ; Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Common Bile Duct ; Emphysema ; Gallbladder Diseases ; Hematoma ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Male ; Mortality ; Pain, Postoperative ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Wound Infection

STATEMENT OF PROBLEM: Unlike screw-retention type, fixture-abutment retention in Locking taper connection depends on frictional force so it has possibility of abutment to sink. PURPOSE: In this study, Bicon(R) Implant System, one of the conical internal connection implant system, was used with applying loading force to the abutments connected to the fixture. Then the amount of sinking was measured. MATERIAL AND METHODS: 10 Bicon(R) implant fixtures were used. First, the abutment was connected to the fixture with finger force. Then it was tapped with a mallet for 3 times and loads of 20 kg corresponding to masticatory force using loading application instrument were applied successively. The abutment state, slightly connected to the fixture without pressure was considered as a reference length, and every new abutment length was measured after each load's step was added. The amount of abutment sinking (mm) was gained by subtracting the length of abutment-fixture under each loading condition from reference length. RESULTS: It was evident, that the amount of abutment sinking in Bicon(R) Implant System increased as loads were added. When loads of 20 kg were applied more than 5 - 7 times, sinking stopped at 0.45 +/- 0.09 mm. CONCLUSION: Even though locking taper connection type implant shows good adaption to occlusal force, it has potential for abutment sinking as loads are given. When locking taper connection type implant is used, satisfactory loads are recommended for precise abutment location.
Bite Force ; Fingers ; Friction ; Retention (Psychology)

Angiosarcoma is a rare malignant vascular tumor of endothelial cell origin. Most lesions of cutaneous angiosarcoma occur over the face and scalp. We experienced a case of angiosarcoma of the scalp in a 63-year-old man. Multiple pea-sized erythematous papules and nodules developed on the forehead 6 months ago. Thereafter, the lesions have extended to make violaceous, compressible and hemorrhagic plaques. On histologic examination, there were irregular, often anastomosing vascular channels lined by the atypical endothelial cells in the dermis.
Dermis ; Endothelial Cells ; Forehead ; Hemangiosarcoma* ; Humans ; Middle Aged ; Scalp*

The bleeding duodenal varices are a rare complication in patients with portal hypertension, but present a difficult diagnostic problem. If there is no bleeding esophageal, gastric fundal varices or ulcer in a patient with upper gastrointestinal bleeding and portal hypertension, the possibility of bleeding duodenal varices should be kept in mind. Thorough endoscopic examination of the entire duodenal mucosa is essential to document bleeding from duodenal varices. As an initial treatment, endoscopic sclerotherapy has had limited success in controlling active duodenal variceal bleeding. However, rebleeding rate is high, surgical treatment including shunt operation may be required for permanent control of bleeding and portal decompression. We report three cases of duodenal varices causing massive hemorrhage. All the patients had portal hypertension caused by liver cirrhosis of various etiologies and had varices in their esophagus. The second portion of the duodenum was the site of duodenal varices in all cases. The management was tailored to the condition of each patient, but only one patient among three survived.
Decompression ; Duodenum ; Esophageal and Gastric Varices ; Esophagus ; Gastrointestinal Hemorrhage* ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Mucous Membrane ; Sclerotherapy ; Ulcer ; Varicose Veins*

The antihypertensive effect and side reactions of perdipine were evaluated in 30 patients with essential hypertension. The results were as follows; 1) Before medication and after 2, 4, 5 and 8 weeks of medication, the over all average systolic and diastolic blood pressure were 170+/-13/104+/-7, 152+/-13/93+/-6, 146+/-11/91+/-6, 143+/-9/90+/-7, and 141+/-10/89+/-7mmHg, respectively. In 89% of all cases, marked or moderate degree of antihypertensive effect was observed. 2) There were no significant changes in heart rates before and after treatment. 3) In 83% of all cases, improvement of symptoms were observed. 4) The side reactions of oral perdipine were mild constipation, anorexia, facial flushing, dizziness, and headache, respectively one case. but there were no side reactions which required discontinuing the treatment, except 1 case which discontinued the medication because of severe bradycardia and dizziness.
Anorexia ; Blood Pressure ; Bradycardia ; Constipation ; Dizziness ; Flushing ; Headache ; Heart Rate ; Humans ; Hypertension ; Nicardipine*

STATEMENT OF PROBLEM: Accurate fit between the implant components is important because the misfit of the implant components results in frequent screw loosening, irreversible screw fracture, plaque accumulation, poor soft tissue reaction, and destruction of osseointegration. PURPOSE: This study is to evaluate the machining accuracy and consistency of the implant fixture/abutment/screw interfaces of the internal connection system by using a Stereoscopic Zoom microscope and FE-SEM(field emission scanning electron microscope) MATERIALS AND METHODS: The implant systems selected in this study were internal connection type implants from AVANA(Osstem(R)), Bioplant(Cowell-Medi(R)), Dio(DIO(R)), Neoplant(Neobiotech (R)), Implantium(Dentium(R))systems. Each group was acquired 2 fixtures at random. Two piece type abutment and one piece type abutment for use with each implant system were acquired. Screw were respectively used to hold a two piece type abutment to a implant fixture. The implant fixtures were perpendiculary mounted in acrylic resin block. Each two piece abutment was secured to the implant fixture by screw and one piece abutment also secured to the implant fixture. Abutment/fixture assembly were mounted in liquid unsaturated polyester. All samples were cross-sectioned with grinder-polisher unit. Finally all specimens were analysed the fit between implant fixture/abutment/screw interfaces Results and CONCLUSIONS: 1. Implant fixture/abutment/screw connection interfaces of internal connection systems made in Korea were in good condition. 2. The results of the above study showed that materials and mechanical properties and quality of milling differed depending on their manufacturing companies.
Korea ; Osseointegration ; Polyesters

Serum HBsAg, AntiHBs, HBeAg, AntiHBe, and AntiHBc were detected by radioimmunoassay in 39 patients with acute viral hepatitis, 79 patients with chronic hepatitis, 30 patients with liver cirrhosis, 16 patients with primary hepatocellular carcinoma, 14 patients of HBsAg carriers and 129 cases of controls: 78 cases of normal level of SGOT, SGPT, and 51 cases of elevated level of SGOT, SGPT. Following results were obtained: 1. HBsAg was detected in 66.7% of acute viral hepatitis, 63.3% of chronic hepatitis, 36.7% of liver cirrhosis, 81.3% of primary hepatocellular carcinoma and 27.1% of controls. 2. AntiHBs was positive in 0% of acute viral hepatitis, 21.5% of chronic hepatitis, 36.7% of liver cirrhosis, 31.3% of primary hepatocellular carcinoma, 0% of carrier and 44.2% of controls. 3. HBeAg was detected in 45.6% of chronic hepatitis, 23.3% of liver cirrhosis and 31.3% of primary hepatocellular carcinoma. 4. Among chronic liver diseases, antiHBe was positive in 56.3% of primary hepatocellular carcinoma, 23.3% of liver cirrhosis and 20.3% of chronic hepatitis. 5. AntiHBc was detected in most of all examinees and the significance of presence of AntiHBc does not seem to represent liver disease itself but the evidence of infection of HBV. 6. Among 14 HBV carriers, 6 cases presented with abnormal SGOT, SGPT. 7. All HBV markers were negative in 5.1% of acute viral hepatitis, 5.1% of chronic hepatitis and 14.7% of controls: 17.6% of subjects with abnormal SGOT, SGPT and 12.8% of subjects with normal SGOT, SGPT. 8. Beside of HBV, other causes, such as non A, non B virus, Delta-agent, other viruses or related factors should be excluded among the patients with evidence of HBV infection associated with elevation of SGOT & SGPT.
Alanine Transaminase ; Aspartate Aminotransferases ; Carcinoma, Hepatocellular ; Clinical Study* ; Hepatitis ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis, Chronic ; Herpesvirus 1, Cercopithecine ; Humans ; Liver Cirrhosis ; Liver Diseases* ; Liver* ; Radioimmunoassay

PURPOSE: The present study was performed to determine the optimum conditions(RPM, load, sharpness of drill) for drilling human cortical bone with standard drill, and to evaluate the histological changes occuring in bone after drilling. MATERIALS AND METHODS: in experiment I, we measured temperature elevations and the durations of temperature elevation in cadaveric femoral cortices at specific distances from the drill hole wall while drilling. The effects of drilling force, speed and new versus worn drill on the termperature were determined. In experiment II, we also measured temperature elevations in the same manner in porcine femoral cortices and evaluated the histological changes occuring in bone after drilling. RESULTS: In experiment I, the most significant temperature elevation(68.4degrees C ) was found when worn drill was used. The lower drilling force and faster speed resulted in 55.1degrees C and 45.8degrees C temperature elevation, respectively. However, drill diameter was not a significant factor for temperature elevation. In experiment II, greater heat production was measured with worn drill, at lower drilling forces, at faster drill speed. The acute histologic reactions in bone were hyperemia, degeneration of osteocytes, change in bone stainability, tears, and fragmentation of the bone edges around the drill holes. The observed histological changes were proportional to the amount of trauma produced, that is, the greater the degree of thermal irritation, the greater the degree of histologic activity. CONCLUSION: In cortical drilling, greater heat production was measured with worn drill, at lower drilling forces, at faster drill speed and the greater the degree of thermal irritation, the greater the degree of histologic activity. A further study of the reaction of bone to drilling at longer intervals of time at different conditions may possibly show whether aseptic thermal necrosis could be prevented.
Cadaver ; Hot Temperature* ; Humans ; Hyperemia ; Necrosis* ; Osteocytes ; Thermogenesis*

PURPOSE: This study examined the wear pattern of the articular cartilage of the medial tibial plateau with or without a functional ACL in patients with degenerative osteoarthritis of the knee. MATERIALS AND METHODS: Between July 2003 and May 2004, 71 cases (52 patients) of total knee arthroplasty due to degenerative osteoarthritis of the knee were enrolled in this study. The intraoperative evaluations such as a test for the functional status of the ACL and the wear pattern of medial tibial plateau were performed, and the associations with the physical examinations such as, range of motion (ROM), Lachman test and pivot shift test, and tibio-femoral angle (TFA), were analyzed. RESULTS: There were 43 cases with a functional ACL, and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 8 cases (18.6%), central in 30 cases (69.8%), and central and posteromedial in 5 cases (11.6%). There were 28 cases with a non- functional ACL and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 1 case (3.6%), central in 2 cases (7.2%), and central and posteromedial in 25 cases (89.2%). In the group with the non-functional ACL, the most prevalent wear pattern was central and posteromedial (p<0.001). CONCLUSION: In patients with degenerative osteoarthritis of the knee without a functional ACL, the wear pattern of the articular cartilage of the medial tibial plateau was more posteromedially than patients with a functional ACL.
Arthroplasty ; Cartilage, Articular* ; Humans ; Knee* ; Osteoarthritis* ; Physical Examination ; Range of Motion, Articular

Background: One of the challenges neurosurgeons are facing in the global public health crisis caused by the coronavirus disease 2019 (COVID-19) pandemic is to balance COVID-19 screening with timely surgery. We described a clinical pathway for patients who needed emergency brain surgery and determined whether differences in the surgery preparation process caused by COVID-19 screening affected clinical outcomes. Methods: During the COVID-19 period, patients in need of emergency brain surgery in our institution were managed using a novel standardized pathway designed for COVID-19 screening. We conducted a retrospective review of patients who were hospitalized through the emergency room and underwent emergency brain surgery. A total of 32 patients who underwent emergency brain surgery from February 1 to June 30, 2020 were included in the COVID-19 group, and 65 patients who underwent surgery from February 1 to June 30, 2019 were included in the pre-COVID-19 group. The baseline characteristics, disease severity indicators, time intervals of emergency processes, and clinical outcomes of the two groups were compared. Subgroup analysis was performed between the immediate surgery group and the semi-elective surgery group during the COVID-19 period. Results: There were no significant differences in baseline characteristics and severity indicators between the pre-COVID-19 group and COVID-19 group. The time interval to skin incision was significantly increased in the COVID-19 group (P = 0.027). However, there were no significant differences in the clinical outcomes between the two groups. In subgroup comparison, the time interval to skin incision was shorter in the immediate surgery group during the COVID-19 period compared with the pre-COVID-19 group (P = 0.040). The screening process did not significantly increase the time interval to classification and admission for immediate surgery.The time interval to surgery initiation was longer in the COVID-19 period due to the increased time interval in the semi-elective surgery group (P < 0.001). Conclusion We proposed a clinical pathway for the preoperative screening of COVID-19 in patients requiring emergency brain surgery. No significant differences were observed in the clinical outcomes before and after the COVID-19 pandemic. The protocol we described showed acceptable results during this pandemic.