PURPOSE: The postoperative morbidity and mortality for acute gangrenous cholecystitis (AGC) are higher than for acute nongangrenous cholecystitis (ANGC). However, preoperative predictive factors for the outcome of gangrenous cholecystitis have not been identified. The goal of this study was to determine the preoperative clinical predictive factors for the outcome of surgical treatment for acute gangrenous cholecystitis. METHODS: From January 2005 to December 2006, the medical records of 173 patients who underwent laparoscopic cholecystectomy for acute cholecystitis were reviewed and analyzed retrospectively. RESULTS: Among 173 patients with acute cholecystits, 57 (32.9%) had pathologically confirmed gangrenous cholecystits. Six variables were found to be associated with gangrenous cholecystits by univariate analysis: an age > or = 55 years, the presence of associated diseases, hypertension, fever (> or =37 degrees), an increased white blood cell count (> or = 15,450/mm3) and glucose. Four variables were identified that were associated with gangrenous cholecystits by multivariate analysis: an age > or = 55 years, the presence of associated diseases, hypertension, and an increased white blood cell count (> or =15450/mm3). CONCLUSION: The results of this study suggest that patients with an age > or = 55 years, the presence of associated diseases, hypertension, and an increased white blood cell count (> or =15450/mm3) have an increased risk of gangrenous cholecystitis and require immediate surgery.
Cholecystectomy, Laparoscopic ; Cholecystitis* ; Cholecystitis, Acute ; Fever ; Glucose ; Humans ; Hypertension ; Leukocyte Count ; Medical Records ; Mortality ; Multivariate Analysis ; Retrospective Studies

In an attempt to investigate the pattern of the urinary acidification process in the Korean, the urinary excretion of phosphate, ammonia, and the titratable acid were measured in 20 medical students (A group) and in 15 psychiatric patients (B group) under regular Korean diets, while the effects of high protein diets on them were studied in 4 subjects. In addition, TmPO4 was also determined in 11 subjects. The urinary excretions of phosphate, titratable acid, and ammonia under regular Korean diets were markedly lower as compared to those of the Europeans. However, there was no difference in the plasma concentration of phosphate between the Korean and the European. Upon administration of high protein diets, the urinary excretions of phosphate and titratable acid increased while the urine pH and the ammonia excretion were little affected. Thus, the correlations between urinary nitrogen and titratable acidity were 0.50 and 0.65, respective1y, showing a linear relationship. However, the correlation between urinary nitrogen and ammonia excretion was slight. The value of TmPO4 ranged from 74 to 355 muM/min with the mean of 193 muM/min, which is considerably higher than that of the European. On the basis of these findings, the overall pattern of the urinary acidification processes in the Korean is discussed.
Acids/*urine ; Adult ; Ammonia/*urine ; Asian Continental Ancestry Group ; Dietary Proteins ; Human ; Kidney Function Tests ; Korea ; Male ; Phosphates/*urine ; Protein Deficiency/metabolism

Visual internal urethrotomy may be a reasonable initial procedure of complete and incomplete urethral stricture before planning more extensive urethroplasty. We reviewed our experience with 62 complete urethral strictures for 10 years. The outcomes of the treatment of 28 patients who were managed by visual internal urethrotomy were compared with those of 34 patients managed urethroplasty, The overall successful results were 32.1% in visual internal urethrotomy and 85.3% in urethroplasty. When stricture length was less than 1 cm, success rate was 40% in spite of several recurrences in visual internal urethrotomy, comparable to the success rate of 12.5% in case of stricture length more than 1 cm. We recommended that visual infernal urethrotomy as an applicable initial method before urethroplasty, when stricture is less than 1 cm in cases of complete urethral stricture
Constriction, Pathologic ; Humans ; Recurrence ; Urethral Stricture*

Local invasion or distant metastasis is frequently seen in patients with anaplastic carcinoma at the time of presentation, and this is unlike the usual cases of pancreatic carcinoma. So most cases of anaplastic carcinoma are confirmed by autopsy. We report here on our experiences of two cases of the anaplastic pancreatic carcinoma that were confirmed by the postoperative pathology. From January 2006 to December 2006, two patients at Chung-Nam National University Hospital were postoperatively diagnosed as having anaplastic carcinoma of the pancreas. The clinicopathologic data of these patients was reviewed. Case 1) A seventy-years-old male was admitted to our hospital due to his left abdominal pain. On physical examination, there was ill-defined palpable mass on the left upper abdomen. The CA 19-9 level was 4.8 (U/ml). On the abdominal CT scans, a 14.8 cm sized cystic mass with a mild enhancing internal solid portion was detected. He underwent distal pancreatectomy, total gastrectomy and segmental resection of the transverse colon due to direct invasion. The mass was pathologically confirmed as anaplastic pancreatic carcinoma. Postoperatively 3 months later, multiple liver and lymph node metastases were detected on the follow-up CT scan. Case 2) A sixty-five years-old female was referred to our department for a splenic hilar mass that involved the distal pancreas. The CA19-9 level was 3.18 (U/ml). On the preoperative CT scan, an 8.0 cm sized irregular mass with heterogenous contrast enhancement was detected on the tail of the pancreas. She underwent distal pancreatectomy with splenectomy and segmental resection of the transverse colon due to direct invasion. On the pathology report, the pancreatic mass was revealed to be anaplastic carcinoma of the pancreas. One month later, a recurred pancreatic mass and multiple liver and peritoneal metastases were detected on the follow-up CT scan. Anaplastic pancreatic carcinomas show distinctive aggressive behavior and a dismal prognosis.
Abdomen ; Abdominal Pain ; Autopsy ; Carcinoma ; Colon, Transverse ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Liver ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms ; Physical Examination ; Splenectomy

The Clinical analysis of 130 spontaneous intracebral & cerebellar hematoma confirmed by brain CT & admitted to this neurosurgical clinic past years & 5 months were made with literature review. 1) The age incidence showed increase over fourth decade and male to female ratio was 56.1:43.9. 2) 50.4% of total patients showed hypertension but 40.3% did not checked their B.P. & 9.3% had normal B.P. before cerebral hemorrhage. Among 50.4% of hypertension cases, 72% received antihypertensive treatment intermittently, 2.9% regularly and the rest 24.3% did not. 3) 69.7% of hematoma located in basal ganglia & thalamus. In nonoperated patients, the morbidity & mortality showed no marked difference in their location except pontine & cerebellar hematomas. In operated patients the morbidity & mortality was prominent in putaminal hemorrhage than in thalamus and cerebellum. Most of putaminal hematoma had semicomatose or comatose mental state and ventricular hemorrhage in 87.5%. 4) The morbidity & mortality increased in proportion to size of hematomas, grade of unconsciousness in admisson and state of intraventricular hemorrhage. 5) About time interval from ictus to operation, the patients within first 24 hours are 29 cases(51.1%) and the next 24 hours are 13 cases(26.5%). The mortality rate of two groups were 55.1% & 53.8% respectively but no death in the patients with operation performed after 48 hours. 6) The morbidity & mortality rate were as follows. In the non operated patients (90 patients), no or mild neurological deficits:22.2% moderate:21.1% severe:20% and moribund or death:36.6%. In the operated patients no or mild neurological deficits:16.3% moderate:18.4% severe:18.4% and moribund or death:46.9%. The results of total patients showed no or mild neurological deficits:20.1%, moderate:20.1%, severe:19.4% and moribund or death:40.2%.
Basal Ganglia ; Brain ; Cerebellum ; Cerebral Hemorrhage ; Coma ; Female ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Male ; Mortality ; Putaminal Hemorrhage ; Thalamus ; Unconsciousness

PURPOSE: To evaluate the results between open reduction and internal fixation with the plate and percutaneous reduction by towel clip and intramedullary fixation with Steinmann pin for clavicle shaft fractures in adult. MATERIALS AND METHODS: We have studied the results in 33 cases with the plate, 35 cases with the Steinmann pin among total 68 cases of clavicle shaft fracture. The patients were followed up over a period of at least 12 months. The final postoperative outcome was analyzed with the clinical outcomes using Kang's criteria, radiological union time and operation time. RESULTS: The clinical outcome that was good or excellent according to the Kang's criteria showed a distribution of 88% in the group using the plate with 29 cases out of total 33 cases, 91% in the group using the Steinmann pin with 32 cases out of total 35 cases. The mean radiological union time was 8.9 weeks in the group using the plate, 9.1 weeks in the group using Steinmann pin. The mean operation time was 72 minutes in the group using the plate, whereas was 18 minutes in the group using Steinmann pin. CONCLUSION: In the treatment of adult clavicle shaft fracture, two groups did not show a significant statistical difference in clinical and radiological outcomes. However, the operation time and postoperative functional recovery was significantly shorter and faster in the group using Steinmann pin. Additionally economic and cosmetic aspect was more satisfactory in the group using Steinmann pin.
Adult* ; Clavicle* ; Humans

PURPOSE: Postoperative hyperamylasemia and pancreatitis may sometimes follow abdominal surgery but the significance and cause of hyperamylasemia after colorectal surgery were not studied enoughly. Our study was designed to identify the incidence of hyperamylasemia after colorectal surgery, to investigate the effect of hyperamylasemia on postoperative hospital course, and to clarify the causes such as extent of colorectal resection or intraoperative events. METHODS: The serum amylase was determined in post operative first day in random sampled 72 patient among whom underwent elective colorectal resection from March 2000 to July 2001. If a hyperamylasemia was evident, repeated check the level till it returned to within normal range. Other factors that seemed to affect serum amylase such as traction of pancreas during operative manupulation, intraoperative hypotensive episode or infused drug and volume expanders etc. were reviewed and analysed. RESULTS: Hyperamylasemia occurred in 25 patients (34.7%) after colorectal surgery. Serum amylse level returned to normal in all but nine patients (12.4%) by third postoperative day, two patients (2.8%) by the fifth postoperative day. Pancreas manupulation and intraoperative use of volume expander, amylopectin were found to be significantly associated with postoperative hyperamylasemia by 2-test and pearson correlation analysis. The developement of hyperamylasemia did not adversely influence the postoperative hospital course. CONCLUSIONS: Twenty-five (34.7%) in seventy-two patients who underwent colorectal surgery developed hyperamylasemia after operation. The incidence was significantly high in a group who underwent surgical procedure with more pancreas manupulation and infused hydroxyethyl starch (amylopectin) containing volume expander. The development of postoperative hyperamylasemia did not seem to influence adversely the postoperative hospital course in this study.
Amylases ; Amylopectin ; Colorectal Surgery* ; Humans ; Hyperamylasemia* ; Incidence ; Pancreas ; Pancreatitis ; Reference Values ; Starch ; Traction

PURPOSE: Laparoscopic common bile duct exploration (LCBDE) has more advantages than conventional common bile duct surgery, but the use of this route for stone removal and biliary drainage remains controversial. The goal of this study was to investigate the usefulness of LCBDE in patients who had been failed in the endoscopic stone extraction. METHODS: From November 2005 to August 2008, 52 patients underwent LCBDE due to failure of endoscopic stone extraction in Chungnam National University Hospital. Clinical data were collected and analyzed retrospectively. RESULTS: Duodenal diverticulum (23 cases, 44.2%) was the most common cause in failure of endoscopic stone extraction and large common bile duct stone 12 cases (23.1%), previous upper gastrointestinal operation 10 cases (19.2%) were followed. Twenty four patients did not have preoperative biliary drainage, such as PTBD, ENBD, PTGBD. Forty-five patients (86.5%) of the 52 participating patients underwent LCBDE successfully, but 7 cases resulted in open surgery for the following reasons: 3 cases of severe intraabdominal adhesions, 3 cases of stone impaction in ampulla portion, and 1 case of a remnant stone. External biliary drainage was performed in 41 cases with T-tube (31 cases, 68.9%), PTBD (7 cases, 15.6%), ENBD (3 cases, 6.7%). The stone clearance of LCBDE was 95.6%. Remnant stone weredetected in 2 cases (4.4%) and removed with choledochoscope via external biliary drain. Postoperative complications happened in 5 cases (9.5%). Procedure related complications happened in 2 cases (3.8%). CONCLUSION: LCBDE is useful technique in patients with failed endoscopic stone extraction, and biliary drainage may be necessary for detection and removal of latent remnant CBD stones.
Common Bile Duct ; Dioxolanes ; Diverticulum ; Drainage ; Fluorocarbons ; Humans ; Postoperative Complications

PURPOSE: To evaluate the clinical and radiographic results of treatment of trochanteric fracture with ITST (Intertrochanteric/ Subtrochanteric) nail. MATERIALS AND METHODS: We reviewed the results of 40 cases of trochanteric fracture treated with ITST from January 2006 to May 2007, which could be followed up for more than 12 months. The cases include 13 males and 27 females, and the mean age is 75.6 years old. The clinical results were evaluated by Ceder mobility assessment, and the radiographic results were evaluated by the change of femoral neck-shaft angle and sliding of lag screw. RESULTS: The mean bone union time is 13.5 weeks. Thirty four cases (85%) were recovered to pre-injury state of walking ability. The change of neck-shaft angle was an average of 5.21degrees and the sliding distance of lag screw was an average of 5.78 mm. Complications were occurred in 4 patients (10%). CONCLUSION: The ITST nail were seen good results in treatment of trochanteric fracture and has relatively less complications than other internal fixator.
Female ; Femur ; Humans ; Male ; Nails ; Walking

PURPOSE: Serum levels of G-CSF and GM-CSF were measured and CFU-GM assay using G- CSF, GM-CSF and SCF was conducted to evaluate the influence of hematopoietic growth factor on the precursor cells of cyclic neutropenia. METHODS: A 7-year-old male with cyclic neutropenia was studied. Marrow mononuclear cells were isolated at neutrophil nadir and recovery and cultured in methylcellulose media with or without G-CSF, GM- CSF and SCF. CD34 positive cells were evaluated using flow cytometry. Serum levels of G-CSF and GM-CSF were measured by ELISA. RESULTS: The Numbers of CFU-GM without growth factors were 50 at neutrophil nadir and 33 at the recovery phase in the patient and show increased colony forming capacity. CD34 positive cells were 9.32% at nadir and 14.17% at recovery. Increasement of CFU-GM with G-CSF at nadir and recovery were 46% and 118% and those with GM-CSF were 70% and 78% respectively, compared with 54.4% and 78.2% in control groups. In contrast, the presence of SCF did not enhance CFU-GM number in the patient, but in the control group, increasement with SCF was 28.9 %. There an was inverse relationship between serum G-CSF levels and peripheral neutrophil count whereas those of GM-CSF were constant. CONCLUSION: Serum G-CSF level showed inverse relationship with neutrophil counts. The response of progenitor cells to G-CSF and GM-CSF was not impaired. The presence of SCF did not enhance CFU-GM number in the patient. This result suggests that the abnormality in hematopoiesis in cyclic neutropenia may involve more immature progenitor cells responsive to SCF.
Bone Marrow ; Child ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Granulocyte Colony-Stimulating Factor* ; Granulocyte-Macrophage Colony-Stimulating Factor* ; Granulocyte-Macrophage Progenitor Cells* ; Hematopoiesis ; Humans ; Intercellular Signaling Peptides and Proteins* ; Male ; Methylcellulose ; Neutropenia* ; Neutrophils ; Stem Cells