Torsion of the gallbladder is a uncommon disease. Since Wendel reported the first case of torsion of the gallbladder in 1898, approximately 400 or more cases have been reported on. A mobile gallbladder with abnormal anatomical fixation to the liver is required for this torsion. Twisting of the mobile gallbladder on its pedicle creates occlusion of the blood supply or bile flow to the organ, and gangrene and necrosis finally occurs. Prompt surgery is required for this condition. Unless cholecystectomy is performed, this condition could cause severe postoperative complications or death to the patient. Torsion of the gallbladder has been known to occur frequently in thin, elderly females. Because of its medical rarity, diagnosis of torsion prior to operative exploration is extremely difficult and the diagnosis is generally maded by laparotomy. We report here on a case of torsion of the gallbladder. The patient was an 82 years old female who complained of severe epigastric pain, nausea, and vomiting. Ultrasonography and computed tomography were performed and these modalities demonstrated a distended gallbladder with wall thickening; the gallbladder didn't contain stones. Explorative laparotomy and cholecystectomy was then performed. We found that the necrotized gallbladder was twisted around its pedicle. We report here on a case of gallbladder torsion and we discuss the clinical features and diagnostic methods for this malady.
Aged ; Aged, 80 and over ; Bile ; Cholecystectomy ; Diagnosis ; Female ; Gallbladder* ; Gangrene ; Humans ; Laparotomy ; Liver ; Nausea ; Necrosis ; Postoperative Complications ; Ultrasonography ; Vomiting

BACKGROUND: The interest of medicine was moved from disease treatment to disease prevention and health promotion. Especially, there has been marked increased interest in health promotion recently. Perception and health behaviors held or acquired during medical training can influence the acceptance and prevention strategies. This exploratory study surveyed medical and non-medical student to assess both preventive health behaviors and perception, to find relations of personal behaviors and corresponding perception. METHODS: This survey were conducted 140 medical students and 131 non-medical students in one big city. Data were obtained by self-reported questionnaire. Weschler survey was adapted to assess perception toward preventive behavior, and Fantastic lifestyle was adapt,ed to assess health behavior. RESULTS: Among the questionnaire of perception of preventive behavior, quitting cigarette smoking ranked highest frequency as very important in medical student. In non-medical student, use seat-belt is ranked highest frequency. Mean score of FANTASTIC lifestyle is 29.98 in medical student, 28.86 in non-medical. The result show significant relationship between st,udent-reported behavior and corresponding perception in 6 qestionnaire that is eat breakfast, moderate or no alcohol use, eliminate smoking, use seat belt, limit coffee, get seven hours sleep. CONCLUSIONS: In comparing medical and non-medical students, health perception and health behavior were no significant difference. Overall, the result indicated that the preponderance of respondents that is engaging in health behaviors are high in health perception.
Breakfast ; Coffee ; Surveys and Questionnaires ; Health Behavior* ; Health Promotion ; Humans ; Life Style ; Seat Belts ; Smoke ; Smoking ; Students, Medical

Changes in the urinary tract associated with prolapse uteri have been known for a long time. However, women who have a prolapse uteri are often free of symptoms. When symptoms are present they are above all, urinary tract infection, difficulties in emptying the bladder, increased frequency of micturition, stress incontinence, and ureteral obstruction. We reviewed 82 patients who had prolapse uteri of grade II and III in order to evaluate the effects of prolapse uteri to the urinary tract. There were 5 patients (6.1%) who had urinary tract infection and urine culture revealed the growth of E. coli in 3 of them. Only 1 patient (1.2%) had high blood urea nitrogen. 51 (62.2%) out of 82 patients showed voiding problems (frequency, voiding difficulty, stress incontinence) and 53 (64.6%) out of 82 patients had cystocele of several degrees, but there was no difference between the degree of prolapse uteri and both voiding problems and cystocele. Vaginal hysterectomy with anterior and posterior colpoperineorraphy was performed in 68 (88. 3%) out of 77 patients who underwent surgical treatment by gynecologists, and in 22 (91.7%) out of 24 patients who showed difficult urination, their symptoms were improved immediately after surgery. Bladder neck suspension was performed simultaneously in 3 patients who showed stress urinary incontinence with prolapse uteri. Intravenous pyelography or abdominal ultrasonography was performed to evaluate accompanied ureteral obstruction in 8 patients who had severe cystocele. In 5 patients, upper tract deteriorations were noted. Bilateral hydroureteronephrosis was found in 3 patient, unilateral lower ureteral dilatation in 1 patient, and severe parenchymal damage in 1 patient. In conclusion, we believe that urologist should participate in managing those patients who have prolapse uteri to improve their voiding problems and prevent upper urinary tract deterioration.
Blood Urea Nitrogen ; Cystocele ; Dilatation ; Female ; Humans ; Hysterectomy, Vaginal ; Neck ; Prolapse* ; Ultrasonography ; Ureter ; Ureteral Obstruction ; Urinary Bladder ; Urinary Incontinence ; Urinary Tract ; Urinary Tract Infections ; Urination ; Urography ; Uterus*

Corticobasal degeneration (CBD) is characterized by asymmetric clinical manifestations including asymmetrical apraxia, alien limb movement and Parkinsonian symptoms. Cognitive function is relatively normal in the early course of illness. We report a 59 years old right-handed male with CBD. He showed asymmetrical ideomotor apraxia, alien limb movement and extrapyramidal symptom, such as cogwheel rigidity and bradykinesia, that were more severe in the right hand. These symptoms have deteriorated progressively for 2 years, but the cognitive function was relatively pre-served. Brain MRI revealed atrophic changes in both parietal lobes. FDG-PET showed an asymmetrical hypometabo-lism in supplementary motor area, parietal lobe, thalamus and basal ganglia, which was more severe in the left than the right hemisphere.
Apraxia, Ideomotor ; Apraxias* ; Basal Ganglia ; Brain ; Emigrants and Immigrants ; Extremities ; Hand ; Humans ; Hypokinesia ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle Rigidity ; Parietal Lobe ; Thalamus

BACKGROUND: Inflammatory bowel disease(IBD) such as ulcerative colitis or Croln's disease is often related with varied diseases including pyoderma gangrenosum, erythema nodosum, ankylosing arthritis and psoriasis. To date, however, a cIinical observation of IBD accompanied by psoriasis has been sparcely accomplished although an immunogenetic mechanism explaining a coexistence of IBD and psoriasis has been proposed. OBJECTIVE: We estimated the prevalence of IBD in patients with psoriasis in Korea and investigated the clinical characteristics of IBD accompanied by psoriasis. METHODS: 92 psoriatic patients and 389 non-psoriatic control subjects were enrolled in this study. Colonoscopic biopsy and barium series were performed in 47 psoriatic patients and 110 control subjects showing irritative intestinal symptoms. RESULTS: 1. The prevalence of IBD in psoriatic patients(14.1%) was significantly greater than in the control group(1.0%). 2. In the temporal relationship, psoriasis developed several years prior to the onset of IBD in 84.6% of psoriatic patients. 3. The frequency of arthropathies in the psoriatic patients possessing IBD(84.6%) was significantly higher than that of non-psariatic counterparts with IBD(25.0%) or that of psoriatics without lBD(2.5%), 4. The psoriatir. patients with IBD demonstrated much more frequently diffuse colonal extension than in non-psoriatic subjects with IBD. CONCLUSION: Our findings of an increased prevalence of IBD in the psoriatic population present further evidence of an association between IBD and psoriasis. In the psoriatic patients showing acute or chronic gastrointestinal symptoms, colonoseopic evaluation might be mandatory for the evaluation of IBD.
Arthritis ; Barium ; Biopsy ; Colitis, Ulcerative ; Colon ; Erythema Nodosum ; Humans ; Immunogenetics ; Inflammatory Bowel Diseases* ; Korea ; Prevalence ; Psoriasis* ; Pyoderma Gangrenosum

One hundred gastric cancer patients who underwent total gastrectomy and Roux-en-Y, end-to-side esophagojejunostomy by using stapling devices were analyzed with regard to their operative results. The median time required for the anastomosis was 18 minutes (range of 15 to 45 minutes). A cartridge of 25 mm in diameter was preferred (85% of 25 mm vs. 15% of 28 mm). In 92 patients, procedures were uneventful. Intraoperative problems happened in 8 patients: Two misfirings of stapler due to mechanical problems, in 6 patients, doughnut tissues were incomplete. Mechanical problems were solved by a change of the stapler and for incomplete doughnut tissues, anastomosis was simply reinforced (2 cases) or reanastomosed with restaplings (4 cases). Anastomotic leakage occurred in 2 patients but it was seen only in radiological studies. During the follow up period, two cases of anastomotic stricture were found and they were treated with endoscopic dilatations. There was no operative mortality nor other complication. In addition, routine use of the Levin tube after total gastrectomy was appraised by comparing postoperative courses. Twenty patients were randomly divided into two groups; for 10 patients the Levin tube was removed at the recovery room and for another 10 patients the Levin tube was indwelled until peristalsis returned. Timing of the tube removal did not affect the duration of the hospital stay and starting day of oral intake. We think that the stapler, when properly used, can facilitate the esophagojejunostomy safely and routine use of the Levin tube after total gastrectomy may be unnecessary.
Adult ; Aged ; *Anastomosis, Roux-en-Y ; *Esophagostomy ; Female ; *Gastrectomy ; Human ; *Jejunostomy ; Male ; Middle Age ; *Surgical Staplers

Extra-adrenal paragangliomas are rare tumors of neural crest origin, usually arising from the carotid bodies, the glomus jugulare, or the retroperitoneum. And, though ten percents of cases are presented with malignancy, it`s prognosis is relatively good. In genitourinary area, there are a few reported cases of extra-adrenal paragangliomas of the urinary bladder and the spermatic cord. Herein, we report a case of paraganglioma arising in the scrotum, which is an extremely rare location.
Carotid Body ; Glomus Jugulare ; Neural Crest ; Paraganglioma ; Paraganglioma, Extra-Adrenal* ; Prognosis ; Scrotum* ; Spermatic Cord ; Urinary Bladder

OBJECTIVE :To evaluate the axonal degeneration after nerve block with phenol and ethanol injection into tibial nerve. METHOD: Tibial nerves of thirty Sprague-Dawley rats were exposed. For the developement of neuropathic pain, the method of intraneural injection was performed. Five percent phenol, 90% ethanol or normal saline were injected into the epineurial sheath of tibial nerve at each group. The mechanical and thermal allodynia were evaluated in post- injection 1, 2, 3, and 4 weeks. The mechanical allodynia was evaluated by withdrawal response to 10 stimulations with von Frey hair. Thermal allodynia was tested by withdrawal response to 5 stimulations with acetone. Motor nerve conduction study was performed in post-injection 1, 2, and 4 weeks. RESULTS: In behavioral test, the experimental group exhibited increased withdrawal response to mechanical and cold stim ulation, but there was no significant difference between two groups, phenol and ethanol groups. In motor nerve conduc tion study, compound motor action potential amplitude loss were observed in experimental group, but there was no significant difference between two groups, phenol and ethanol groups. CONCLUSION: These results suggest that axonal degeneration of ethanol is roughly similar to those of phenol block.
Acetone ; Action Potentials ; Animals ; Axons ; Ethanol* ; Hair ; Hyperalgesia ; Nerve Block* ; Neural Conduction ; Neuralgia ; Phenol* ; Rats ; Rats, Sprague-Dawley ; Tibial Nerve

OBJECTIVE: The purpose of this study was to evaluate the incidence of inability to flex proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint in normal Koreans. The opposition palm ratio and thumb index ratio was also of interest. METHOD: Randomly selected eighty nine normal Korean adults of 48 men and 41 women, with ages 20 to 79 years. The finger flexion was measured using the standard flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) screening tests. Thumb index ratio and opposition palm ratio was also assessed additionally. RESULTS: In the sample population, 2 subjects (2.2%) were unable to bilaterally flex their fifth PIP joints independently. Four subjects (4.4%) were unable to flex one or both of their fourth or fifth DIP joints. These results show far less incidence of FDS dysfunction comparing with 52% of FDS dysfunction rate in Americans. The opposition palm ratio in men were 63.6% and in women 69.9%, indicating lower ratio in men. The thumb index ratio was not different statistically between the men and women. CONCLUSION: These data suggest that the different incidences of FDS and FDP dysfunction should be considered in interpretation. The opposition palm ratio and thumb index ratio might be useful in the hand rehabilitation.
Adult* ; Female ; Fingers ; Hand ; Humans ; Incidence ; Joints ; Male ; Mass Screening ; Rehabilitation ; Thumb*

PURPOSE: Good color match is a key element in facial reconstruction for good aesthetic result. To correct the wide facial soft tissue defect were usually used the tissue expanded cheek flap, deltopectoral flap or radial forearm free flap. This study is aimed to analyse the color difference after flap surgery by using chromameter. METHODS: From August 1995 to December 2006, 30 patients who underwent flap operations were chosen randomly and evaluated color differences between flap site and adjacent skin. Reconstructive procedures included tissue expanded cheek flap(n=10), deltopectoral flap(n= 10), and radial forearm free flap(n=10). The measured sites were flap center within a radius of 1cm and four points of adjacent skin along the flap margin. The colors were quantified in a three dimensional coordinate system composed of L* (brightness), a*(redness), b*(yellowness). RESULTS: There were no significant color differences between the pedicled flaps(tissue expanded cheek flap and deltopectoral flap) and adjacent skin area. On the other hand, color values of the radial forearm free flap were statistically different from those of adjacent skin area. Total color difference(delta E) of tissue expanded cheek flap and deltopectoral flap were 7.45+/-5.78 versus 9.41+/-7.09, and that of radial forearm free flap was 11.74+/-3.85. It suggests that pedicled flaps have a potential of better color match than radial forearm free flap. CONCLUSION: Thus, better esthetic results and satisfaction is more likely to be expected in pedicled flaps as long as it could be applied comparing radial forearm free flap.
Cheek ; Forearm ; Free Tissue Flaps ; Hand ; Humans ; Radius ; Skin ; Surgical Flaps