PURPOSE: To evaluate the effects and complications of self-expandable metallic stent for the treatment of malignant esophagogastric strictures. MATERIALS AND METHODS: From September 1991 to March 1995, 110 stents were placed under fluoroscopic guidance in 103 patients. Of the 103 patients, there were 73 patients with esophageal cancer, 14 patients with gastric cancer, 12 patients with recurrence after surgery, three patients with esophageal compression by metastatic mediastinal lymphadenopathy, and one patient with esophageal invasion by lung cancer. Seventeen patients had esophagorespiratory fistulas. Under fluoroscopic guidance, 113 self-expandable metallic stents (99 Song stents, 14 Strecker stents) were placed in 103 patients. RESULTS: After stent placement, 68 (66%) of the patients could ingest solid food, 26 (25.2%) could ingest soft food, whereas three (2.9%) were not able to have food. Esophagorespiratory fistulas were occluded immediately after stent insertion. All stents were placed without any technical failures or procedural morbidity or mortality. Complications included restenosis in 13, gastroesophageal reflux in 11, stent tube migration in eight, massive bleeding in four, delayed esophageal perforation in one, stent obstruction by food impaction in one patient. CONCLUSION: Self-expandable metallic stent seems to be relatively safe and effective procedure in the palliative treatment of malignant esophagogastric stricture.
Constriction, Pathologic* ; Esophageal Neoplasms ; Esophageal Perforation ; Fistula ; Gastroesophageal Reflux ; Hemorrhage ; Humans ; Lung Neoplasms ; Lymphatic Diseases ; Mortality ; Music ; Palliative Care* ; Recurrence ; Stents* ; Stomach Neoplasms

Actinomycosis is a chronic suppurative and granulomatous bacterial infection characterized by contiguous spread, abscess formation and sinus tract formation. There are four clinical forms according to the lesional site, as 1) cervicofacial, 2) thoracic, 3) abdominal, and 4) disseminated form. Recently, we experienced a case of 54 year-old patient with left mandibular actinomycosis. The pathognomonic findings of actinomycosis is sulfur granule with multiple filaments in Gram-stain and the treatment of actinomycosis is surgical excision of mass or sinus tract with massive antibiotics (esp. Penicillin) therapy for 6 to 12 months.
Abscess ; Actinomycosis* ; Anti-Bacterial Agents ; Bacterial Infections ; Humans ; Penicillins ; Sulfur

No abstract available.
Thumb*

Soft-tissue expansion is a new surgical technique of providing donor tissue in modern reconstructive surgery. This technique provides a quantity of tissue of similar color, texture, and hair-bearing qualities for reconstruction of adjacent defects. It is known that the expanded skin shows several constant histologic changes including the increase in collagen fibers and vascularity within dermis, and thinning of subcutaneous tissue and dermis. In this study, the author observed serial histologic changes of rabbit skin induced by progressive tissue expansion up to excessive expansion of 6 times. The results are as follows: 1. Changes in the thickness of the epidermis was minimal until 3 times of expansion, but slight thinning was observed at excessive expansion state. 2. The thickness of the dermis was progressively decreased, and collagen fibers in the dermis was rapidly increased in early phase of expansion. 3. The vascularity in the dermis was also progressively increased. 4. The skin appendages showed no structural changes even in excessive expansion. 5. The panniculus carnosus showed no atrophic changes and the thickness was maintained in excessive expansion.
Collagen ; Dermis ; Epidermis ; Humans ; Skin* ; Subcutaneous Tissue ; Tissue Donors ; Tissue Expansion*

No abstract available.
Hemolytic-Uremic Syndrome*

Symptomatic neuroepithelial cysts of the lateral ventricles are rare. The CT and MRI findings of the intraventricular neuroepithelial cysts in the surgically proven three cases are reported. On CT, the cysts had density similar to CSF, and the cyst walls were generally not seen. The cyst contents were slightly higher signal than CSF signal in Tl-weighted and proton density MR images. The delicate cyst walls were easily seen in spin echo MR images. MRI was better than CT in the demonstration of the cyst wall and the evaluation of the cyst content in patients with neuroepithelial cysts in the lateral ventricles.
Humans ; Lateral Ventricles* ; Magnetic Resonance Imaging ; Protons

BACKGROUND: It is important for the health care provider, particularly primary care physicians as gatekeepers of health care, to understand the social interests and needs toward health care. This study was done to find ways to deal with public opinion by analyzing the contributions of health care in the newspapers. METHODS: Two hundred twenty four contributions about health care were sorted out in the three national newspapers during one calendar year from January to December, 1996. These contributions were coded by themes and subjects according the content analysis and qualitative text interpretation. RESULTS: The contributions were classified into three categories, medical insurance, and hospital services, and health care policies. Forty four contributions of medical insurance category were coded into 5 themes and 18 subject. Fifty eight contributions of hospital services category were coded into 3 themes and 31 subjects. One hundred twenty two contributions of medical insurance category were coded into 8 themes and 32 subjects. The themes and subjects were listed and findings were described qualitatively. The characteristics of public opinions about health care were diversity, conflicting interests, plentifulness of complaints and discontent, and finally, infrequency of alternative proposals for problem solving. How to deal with public opinions were discussed. CONCLUSIONS: We can recognize the public attitude of health care and complaints of patients and consumers of health care by analyzing the contributions in the newspapers. These data can be used to develop ways of primary care physicians to deal with patients' needs.
Delivery of Health Care* ; Health Personnel ; Humans ; Insurance ; Periodicals* ; Patient Education as Topic ; Physicians, Primary Care ; Problem Solving ; Public Opinion

Tinnitus is one of the most common complaints in the otolaryngology. It can be classified as either as subjective or objective; the former refering to that sensation heard only by the patient and the latter to that sensation heard also by the examiner. Arteriovenous fistula is the most common cause of objective tinnitus due to the trauma. Recently, the authors experienced one case of the pulsatile tinnitus caused by post-traurnatic arteriovenous fistula involving the superficial temporal artery. This was confirmed by selectcd angiography and was treated by percutaneous transarterial embolization which resulted in the disappearance of tinnitus.
Angiography ; Arteriovenous Fistula* ; Humans ; Otolaryngology ; Sensation ; Temporal Arteries* ; Tinnitus*

Trichofolliculoma is a rare skin lesion. It is an adnexal tumor of hair follicles, which was first described by Miescher. Trichofolliculoma is a hamartomatous lesion of hair follicle origin, intermediate in differentiation between a hair follicle nevus and trichoepithelioma as classified by Kligman and Pinkus. It usually manifests clinically as a small, slowly growing, well-demarcated, flesh-colored papule on head and neck. The diagnosis is difficult clinically and is based mainly on histopatholigic appearance. It is commonly misdiagnosed as sebaceous cyst, nevus, and basal cell carcinoma. Treatment is by simple excision and recurrence is rare. We report a case of trichofolliculoma of nasal vestibule with a review of literature.
Carcinoma, Basal Cell ; Diagnosis ; Epidermal Cyst ; Hair Follicle ; Head ; Neck ; Nevus ; Recurrence ; Skin

PURPOSE: The purpose of this study was to evaluate the diagnostic usefulness of scintimammography performed with Tc-99m tetrofosmin in the detection of primary breast cancer. MATERIALS AND METHODS: Sixty-one patients underwent Tc-99m tetrofosmin scintimammography, plain-filrn mammography and ultrasonography. After intravenous injection of Tc-99m tetrofosmin (740 MBq), prone lateral and anterior scintimammograms were obtained. Scintimammogram was visually interpreted as positive, probably positive, probably negative and negative for malignancy. The tumor to background count ratio (T/B) was measured at 5 minutes and 1 hour. Plain-film mammogram was interprcted as one of 5 categories. Final diagnosis was achieved by surgical histology (58/61) or fine needle aspiration (3/61). Of 61 patients, 44 had cancer and 17 had benign lesion. Tumor size of malignant and benign lesions on ultrasonogram were 2.51+/-1.30 cm (range 1-8 cm), 2.50+/-1.35 cm (range 0.96-6 cm), respectively. RESULTS: The sensitivity of plain-film mammography was 88.6%, specificity 58.8%, positive predictive value 84.7%, and negative predictive value 66.7%. The sensitivity of Tc-99m tetrofosmin scintimammography was 90.9%; specificity, 88.2%; positive predictive value, 94.9%; negative predictive value, 78.9%. Of 25 patients with indeterminate degree of suspicion for malignancy on plain-film mammogram, 23 were correctly diagnosed by scintimamography. The T/B at 5 minutes and 1 hour were 3.78+/-2.21, 3.25+/-1.80 respectively. The T/B was decreased significantly at 1 hour (p<0.001). CONCLUSION: Tc-99rn tetrofosrnin scintimammography was useful diagnostic procedure in the detection of primary breast cancer, especially in patients with indeterminate degree of suspicion for malignancy on plain-film mammogram.
Biopsy, Fine-Needle ; Breast Neoplasms* ; Breast* ; Diagnosis ; Humans ; Injections, Intravenous ; Mammography ; Sensitivity and Specificity ; Ultrasonography