No abstract available.
Drug Therapy* ; Fistula*

The patient was a 51 year-old woman suffering fraen dysphagia due to upper esoyhageal lye stricutue whieh had developed as a result of a suicide attempt 21 years ago. Shortly after that, she underwent feeding gastrostomy and has lived in the gastrostomy state for 2l years. After admission, she underwent a barium esophagoram which revealed a near total obstruction at the cricoid cartilage level. Bougie dilatation with American Dilation System was tried on day 3. But the spring tip marked guide wire which was to be used with the American Dilation System could not be passed through the stricuture. Therefore, we performed a bougie dilatation using angiographic guide wire M(H-AG-35in-150 cm) with success. On day 14, she underwent a barium esophagogram which revealed her improved condition, and she was discharged on day 16.
Barium ; Constriction, Pathologic* ; Cricoid Cartilage ; Deglutition Disorders ; Dilatation* ; Female ; Gastrostomy* ; Humans ; Lye* ; Middle Aged ; Suicide

An endodermal sinus tumor is a malignant germ cell tumor that usually arises in the gonads, but on rare occasion occurs in extragonadal locations. Our case was that of a 3 year old girl who complained of a rapid growing orbital mass. On histologic examination it revealed the typical picture of an endodermal sinus tumor and it also disclosed a positive reaction for alphafetoprotein using an immunoperoxidase technique. An orbital exenteration was performed followed by chemotheraphy, but the patient died 5 months after the onset of the disease.

Nine surgically proven congenital absence of gallbladder (CAGB) cases were reviewed. All of them had one or more kinds of biliary symptom. Tests such as abdominal ultrasonography, intravenous or oral cholecystography and even endoscopic retrograde cholangiography not only failed to predict CAGB but misleadingly indicated other similar conditions. Only the abdominal computed tomography (CT), performed on one patient, enabled the accurate diagnosis of CAGB. All the patients underwent abdominal exploration, and CAGB was confirmed by the meticulous dissection of the entire extrahepatic biliary tree and the operative cholangiography. Five patients had concomitant biliary pathologies responsible for their symptoms, but four patients had isolated CAGB. CAGB is a rarely encountered condition for a clinician, but extensive diagnostic work-ups including abdominal CT should be performed in all situations where CAGB is suspected. Thus unnecessary exploration can be avoided in the isolated CAGB case.
Bile Duct Diseases/etiology/surgery ; Diagnostic Techniques, Surgical ; Gallbladder/*abnormalities ; Human ; Radiography, Abdominal ; Tomography, X-Ray Computed

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

PURPOSE: To evaluate factors that predict prognosis of colon perforation, we review the hospital records of 37 patients who underwent emergency operation for colon perforation. METHODS: Information of clinical findings, Acute Physiology and Chronic Health Evaluation (APACHE II score), perforation sites and causes, operation methods, and postoperative complications were obtained. RESULTS: The causes of perforation were traumatic 11 (29.7%), iatrogenic 10 (27.0%), diverticular 6 (16.2%), cancerous process 6 (16.2%), strangulated hernia 2 (5.4%), ischemic colitis 1 (2.7%) and stercoral 1 (2.7%). The longer duration from colon perforation to operation, the more severe intra-abdominal fecal contamination was seen. The complication rate was increased as the intra-abdominal fecal contamination increased or APACHE II score increased (p<0.05). But there were no correlation between the complication rate and perforation sites and causes. In according to operative managements, one-stage operation (simple closure or resection with anastomosis) group had more lower complication rate than two-stage operation (formation of colostomy) group, unexpectedly (31.3% vs. 52.4%, p>0.05). Also former group had lower complication rate compared to latter group in left colon (40% vs 50%). CONCLUSIONS: The factors that predict of mortality and morbidity are not perforation site, causes, and operation method, but preoperative physiologic status (APACHE II score) and intra-abdominal fecal contamination. So preoperative proper and vigorous treatment for improvement of physiologic status and shortening of interval to operation are important for better results. And primary closure and resection with anastomosis is useful for colon perforation in selected circumstance regardless of its site and cause.
APACHE ; Colitis, Ischemic ; Colon* ; Colostomy ; Emergencies ; Hernia ; Hospital Records ; Humans ; Mortality ; Postoperative Complications ; Prognosis

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

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the efficiency of titanium mesh cylinder as an anterior strut in reconstructive spinal surgery. SUMMARY OF LITERATURE REVIEW: Biomechanically, 80 to 85% of the axial forces on the upright spine are distributed through the anterior column. Reconstruction of the anterior column using load sharing construct is essential for normal spinal biomechanics in various anterior column deficiency conditions. Titanium mesh cylinder as an anterior strut has advantages in these surgical conditions, and may be an effective alternative to strut bone graft. MATERIALS AND METHODS: From October 1993 to May 1998, 22 patients received reconstructive spinal surgery using titanium mesh cylinder-bone graft composite. Average follow up period was 3(1/2)years(range: 1(1/2)to 6 years). 20 of them were male and 2 were female and average age was 45 years(range: 21 to 69 years). The diagnoses were kyphosis/kyphoscoliosis, burst fracture/ fracture-dislocation, revision surgery, tumor, and multiple thoracic HNP. Radiographs were taken preoperatively, postoper-atively at 2 weeks, 4, 6, 9, 12, 18, 24 months, and yearly thereafter, these were read for change of sagittal angle correction, anterior bony fusion, settling of the titanium mesh cylinder-bone graft composite, or instrument failure. RESULTS: Radiologic union between titanium mesh cylinder & vertebra appeared at (1/2)to 1 (1/2)years follow-up period. 81.8%(18 of 22 cases) showed definite bony trabeculation, and 18.2%(4 of 22 cases) showed immature bony trabeculation. Sagittal angle correction loss was measured by average 7.6 .(range: 5 .to 9 .) in 8 of 22 cases, all of which appeared at 4 months to 1 year follow-up period. Correction loss was associated with penetration of spikes of titanium mesh cylinder into endplates of adjacent vertebral bodies until internal rings contact endplates, but was not accompanied with implant failures, dislodgement or migration of titanium mesh cylinder. CONCLUSIONS: Titanium mesh cylinder can be used as a good substitute of anterior strut in combination with rigid spinal fixa-tion in reconstructive spinal surgery.
Diagnosis ; Female ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Spine ; Titanium* ; Transplants

Primary papillary serous carcinoma of the peritoneum is a rare primary tumor involving the peritoneum. Histologically, it is indistinguishable from serous ovarian papillary carcinoma, although it either spares the o-varies or only microscopically involves their surface. The characteristic features of this tumor are extensive peritoneal and omental masses or implants with psammomatous calcification, and ascites. In addition, it can occur focally in the pelvic peritoneum. We report the CT findings, with histopathologic correlation of primary papillary serous carcinoma of the peritoneum occurring in the upper mesorectum.
Ascites ; Carcinoma, Papillary ; Peritoneum*

PURPOSE: To analyze the efficacy of iliac tricortical allograft (Tutoplast (r) ) as an anterior load sharing construct in global fusion consisting of interbody fusion, transpedicular screw fixation and posterolateral fusion. MATERIALS METHODS: We followed up 40 levels in 27 patients who had undergone interbody fusion using iliac tricortical allograft (Tutoplast (r) ) and added transpedicular screw fixation and poterolateral fusion from Dec. 1995 to Dec. 1996. They were followed up for more than 2 years. The disease entities included 11 patients with spondylolisthesis, 8 patients with spinal stenosis with lumbar intervertebral discs herniation, 6 patients with degenerative lumbar kyphoscoliosis and 2 patients with pseudoarthrosis. Anterior interbody fusion was performed in 11 cases and posterior lumbar interbody fusion in 16 cases. RESULTS: The radiological union rate of interbody fusion was 90% (36/40) , and collapsed union was 7.5% (3/40) ranging from 11% to 28% collapses of initial graft height. The non-union occurred at level 1, which showed radiolucent line on host-graft interface but did not reveal instability on stress views. The radiologic union rate of the posterolateral fusion was 100%. Complications such as metal failure and infection were not noted. Satisfactory clinical results were 88.9%. CONCLUSION: Iliac tricortical allograft was a good substitute for an anterior load sharing construct in interbody fusion combined with transpedicular screw fixation and posterolateral fusion.
Allografts* ; Humans ; Intervertebral Disc ; Pseudarthrosis ; Spinal Fusion* ; Spinal Stenosis ; Spondylolisthesis ; Transplants