No abstract available.
Craniocerebral Trauma* ; Head*

There is much controversy concerning the method of treatment on the tibial fracture because of frequent complications, such as non-union, delayed union and infection. Authors reviewed and analyzed 110 tibial fractures which had been treated at the Department of Orthopedic Surgery, Sung Ae General Hospital from June 1983 to March 1987 by the groups, conservative treatment, open reduction and internal fixation with compression plate and closed flexible intramedullary nailing. The results were as follows :1. In regard to the fracture location, there was no difference in the healing time among the treatment methods. The I.M. nailing group healed 1.5 weeks earlier than other groups in each location. 2. In minor and moderate severity by Ellis, the I.M. nailing group revealed better result, and in major one, the compression plate group showed better result. More complications occured in major severity. 3. Union time among the trestment methods was not affected by the fibular fractures, but most of the complications occured in the concomitant fibular fracture case. 4. In open fracture, the healing time showed no difference among the groups, and was prolonged about 2 weeks than closed fracture. In closed case, the I.M. nailing group showed good result. 5. The cases, which were reduced earlier in the conservative group, and treated within 3 days in the I.M. nailing group revesled better result. 6. The radiological union time from the definite treatment was 15.80 weeks in the conservative treatment group, 15.18 weeks in the compression plate group and 13.92 weeks in the I.M. nailing group.
Clinical Study ; Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Open ; Hospitals, General ; Methods ; Orthopedics ; Tibia ; Tibial Fractures

PURPOSE: To investigate the chemical stability of papaverine/phentolamine/alprostadil (Standro(R)) used for intracaver nous injection in patients with erectile dysfunction. MATERIALS AND METHODS: Samples of lyophilized Standro(R) were stored at room temperature (25+/-2 degrees C) or in the refrigerator (4+/-2 degrees C). The pH and concentration of papaverine HCl, phentolamine mesylate, and alprostadil were measured at intervals by high-performance liquid chromatography. RESULTS: At 24 months, the concentrations of papaverine, phentolamine, and alprostadil stored in the refrigerator and at room temperature were 99.7%, 98.9%, and 98.7% and 98.4%, 96.3%, and 93.3% of the original concentrations, respectively. When the product was stored in solution in the refrigerator for 19 weeks, the concentrations of the three drugs were 98.7%, 97.2%, and 88.0%, respectively. In 5 days at room temperature, the concentration of alprostadil dropped to 86.4%, which is below the minimum concentration for the product specified by the Korean Food and Drug Administration, although the concentrations of papaverine and phentolamine remained stable (99.6%, 98.4%). The pH of the three agents did not change significantly regardless of the storage conditions (temperature, duration, lyophilized or dissolved). CONCLUSIONS: Lyophilized papaverine/phentolamine/alprostadil (Standro(R)) is chemically stable for at least 2 years at room temperature, although solutions need to be kept in the refrigerator and become less effective with prolongation of storage.
Alprostadil ; Chromatography, Liquid ; Erectile Dysfunction ; Humans ; Hydrogen-Ion Concentration ; Male ; Papaverine ; Phentolamine ; United States Food and Drug Administration

Gastritis cystica profunda is an uncommon benign mass that usually occurs on the gastric side of the site of a gastroenterostomy, but has also been known to develop in which has not been operated on. We report the case of stomach a 51-years-old man with pathologically proven gastritis cystica profunda. This patient had not undergone gastric surgery and CT showed a well-defined, 3 cm sized, cystic mass at the gastric antrum.
Gastritis* ; Gastroenterostomy ; Humans ; Pyloric Antrum ; Stomach

PURPOSE: The angiographic demonstration of absent cerebral blood flow is presently considered to be the most reliable method of confirming brain death. The purpose of this study is to determine whether CT angiography (CTA) with spiral CT can rapidly and specifically establish a diagnosis of brain death. MATERIALS AND METHODS: A total of fifteen CT angiograms (brain death, n=9;severe coma, n=6 within 24 hours of the study) were obtained prospectively in 12 patients with an established clinical diagnosis; Two patients underwent repeated CTA. Twenty seconds after beginning the injection of contrast media (100 mL at a rate of 3 mL/sec), CT scanning (30 -second continuous exposure and 60 -mm length) was performed with a table speed of 2 mm/sec and a section thickness of 2 mm. For each case, the presence or absence of opacification of inter-nal carotid arteries (ICA), vertebral and basilar arteries (VBA), anterior cerebral arteries (ACA), middle cerebral arteries (MCA), posterior cerebral arteries (PCA), distal branches of cerebral arteries, and superficial temporal arteries (STA) was ascertained. RESULTS: Except in one clinically brain-dead patient, whose EEG was difficult to interpret due to excessive arti-facts, the distal branches of cerebral arteries did not opacify. STA, on the other hand, was always visible on both sides. In all brain-dead patients but three, the ICA and proximal ACA, MCA, or PCA escaped visualiza-tion. In the remaining three cases with large skull defect or skull fracture, however, CT angiography showed faint opacification of the ICA and proximal segments of cerebral arteries. Cerebral arterial flow was preserved in all six patients in whom there was no clinical evidence of brain death. CONCLUSION: CTA may be used as a confirmatory test for the determination of brain death.
Angiography* ; Anterior Cerebral Artery ; Basilar Artery ; Brain Death* ; Brain* ; Carotid Arteries ; Cerebral Arteries ; Coma ; Contrast Media ; Diagnosis ; Electroencephalography ; Hand ; Humans ; Middle Cerebral Artery ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery ; Prospective Studies ; Skull ; Skull Fractures ; Temporal Arteries ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; United Nations

PURPOSE: To determine the value of magnetic resonance imaging(MR) and magnetic resonance angiography(MRA) inassessing collateral vessels of moyamoya disease. MATERIALS AND METHODS: Twenty-four patients with moyamoyadisease who underwent MR, 3D TOF MRA, and conventional angiography participated in this study. Two radiologistsworking independently and with no knowledge of the angiographic findings, interpreted the MR and MRA images. Todetermine the presence of parenchymal and leptomeningeal collaterals(48 hemispheres) and transdural collaterals(38hemispheres in 19 patients were depicted by angiography of the external carotid), the findings were compared withthose of angiography. RESULTS: Parenchymal, leptomeningeal, and transdural collaterals were depicted byconventional angiography in 34(71%), 32(67%), and 11(29%) hemispheres respectively. The sensitivity andspecificity of MR/MRA for collateral vessels were 79.1/ 88.1% for parenchymal collaterals, 72.1/ 88.1% forleptomeningeal collaterals, and 0.1/18.1% for transdural collaterals, respectively. Respective sensitivity andspecificity of MR/MRA were 88.94/94.1% for leptomeningeal collaterals, and 18.93/55.1% for transdural collaterals,when the prominent posterior cerebral and external carotid artery were regarded as secondary signs ofleptomeningeal and transdural collateral vessels. CONCLUSION: In moyamoya disease, MR and MRA are useful imagingmodalities for the assessment of collateral vessels. The prominent posterior cerebral artery and external carotidartery can be useful secondary signs of leptomeningeal and transdural collateral vessels.
Angiography* ; Carotid Artery, External ; Cerebral Angiography ; Humans ; Moyamoya Disease* ; Posterior Cerebral Artery

PURPOSE: The purpose of this study was to assess the usefulness of CT angiography(CTA) in patients withintracerebral hematoma. MATERIALS AND METHODS: Eighteen patients with spontaneous intracerebral hematoma underwentCTA ; 20-30 seconds after the onset of an injection of contrast media(100mL, with the use of a power injector, ata rate of 3 mL/sec), Scanning(30-second continuous exposure and 60-90mm length) was performed with a table speedof 2-3 mm/sec and section thickness of 2mm. The starting point selected was the floor of the sella turcica. Theresulting data were reformatted by maximum intensity projection(MIP) after reconstruction at 1-mm intervals, andCTA findings were compared with those of conventional angiography(n=17), surgery(n=6), and postcontrast CT(n=10). RESULTS: The diagnostic findings of CTA included five arteriovenous malformations, two aneurysms, one venousangioma, and one venous sinus occlusion, while the remaining nine patients had no vascular lesion. In all cases,CTA findings correlated well with those of conventional angiography and surgery ; in four cases, they weresuperior to those of postcontrast CT. In one cases of arteriovenous malformation, however, the feeding artery anddraining vein were not definite on CTA, and in one case of sinus occlusion, the full length of the superiorsagittal sinus could not be delineated. CONCLUSION: In patients with spontaneous intracerebral hematoma, CTA is avaluable screening method.
Aneurysm ; Angiography* ; Arteries ; Arteriovenous Malformations ; Hematoma* ; Humans ; Mass Screening ; Sella Turcica ; Veins

We experienced a case of spontaneous rupture of renal angiomyolipoma appeared unilateral and solitary tumor without stigma of tuberous sclerosis in 49 years old women. Renal angiomyolipoma which are not associated with tuberous sclerosis appear at an average of 48 years and are more common in women with a ratio of 6:1 and is a benign tumor. Angiography may be helpful in the differentiation of an angiomyolipoma from renal cell carcinoma. The first symptoms are often due to sudden spontaneous perineal hemorrhage. The patient was managed by left total nephrectomy with good result.
Angiography ; Angiomyolipoma* ; Carcinoma, Renal Cell ; Female ; Hemorrhage ; Humans ; Middle Aged ; Nephrectomy ; Rupture, Spontaneous* ; Tuberous Sclerosis

BACKGROUND: Medical decisions concerning the prolongation of life, the right to die and euthanasia are among the most extensively discussed issues within medicine and law today. The purpose of this study was to evaluate the attitudes of medical students and housestaff toward euthanasia. METHODS: From July 15 to September 15 of the 1998, the responses of 180 medical students and 132 housestaff to a self-administered questionnaire were analyzed to identify attitudes toward euthanasia. Over 312 respondents about attitudes toward euthanasia, the analysis of differences between proportions was made by the Chi-square test. RESULTS: About 69.9% of the respondents thought euthanasia should be legalized. The findings suggest that Buddhists (77.5%) and non-religious groups (88.1%) tend to support euthanasia more than Christians. Futhermore, medical students (74.4%) support euthanasia more than housestaffs(63.6%), male(75.1%) more often than female(57.9%). About 73.1% of the respondents said that active euthanasia is not justifiable, and 79.2% said that they do not like performing active euthanasia. In respect to passive euthanasia, 69.0% said that it is not ethically justifiable, but 63.0% would perform this as if it were legal. Housestaffs of internal medicine (76.9%) were more willing to do euthanasia than pediatrics (70.0%), surgery (63.6%), family practice (53.8%) and Ob/Gyn (33.3%). CONCLUSION: Respondents have positive attitudes toward legalization of euthanasia.. Most considered that passive euthanasia is not morally justifiable. But if it were legalized, they would be willing to do euthanasia, while they would still be disturbed by active euthanasia. The opinions of physician and medical students directly affect patient care and their attitudes must be considered if clear policies are to be developed concerning euthanasia.
Surveys and Questionnaires ; Euthanasia* ; Euthanasia, Active ; Euthanasia, Passive ; Family Practice ; Humans ; Internal Medicine ; Jurisprudence ; Life Support Care ; Patient Care ; Pediatrics ; Right to Die ; Students, Medical*

Xanthoma is characterized by collections in the lamina propria of lipid-laden macrophages or foam cells containing cholesterol land neutral fat, forming plagues or nodules in all regions of the gastrointestinal tract. But it is most common in the stomach. Once thought to be a rare entity, gastric xantoma has been reported with increasing frequency with the advent of increasing utilization of gastrofiberscopy. Because gastric xanthoma appear to be more common in patients with gasritis, gastric ulcer, and with duodenogastric reflux after gastric surgery, mucosal damage has been presumed to play a major role in their pathogenesis. Altough cholesterol and neutral fat are the major constituents of the foam cells, there is no documented relationship between degree of hyperlipidemia or hypercholesterolmia and presence of gastric xanthoma. Gastric xanthoma may be found in any portion of the stomach, and is single or multiple, usually 1 or 2 mm in diameter, rounded or oval, circumscribed, yellow or yeallow-white, and macular or nodular. We report a case of gastric xanthomatosis diagnosed by gastrofibroscopy with forceps biopsy. There are numerous, flat or slightly raised, white or yellow white lesions that range from pinpoint size to several milimeters in diameter and that are scattered through whole gastric mucosa.
Biopsy ; Cholesterol ; Duodenogastric Reflux ; Foam Cells ; Gastric Mucosa* ; Gastrointestinal Tract ; Humans ; Hyperlipidemias ; Macrophages ; Mucous Membrane ; Stomach ; Stomach Ulcer ; Surgical Instruments ; Xanthomatosis*