Spontaneous fistula formation between the kidney and the colon is uncommon. The underlying cause is usually a pyonephrotic kidney which becomes adherent to a portion of the colon and then ruptures spontaneously, thus creating a fistula. Herein we present a case of renocolonic fistula which occurred in a 36-year old man with review of the literature.
Adult ; Colon ; Fistula* ; Humans ; Kidney ; Rupture

BACKGROUND: Cardiovascular disease (CVD) is the major cause of death in type 2 diabetic patients. The purpose of this study was to investigate the characteristics of Korean type 2 diabetes mellitus (DM) patients according to plasma high density lipoprotein (HDL) cholesterol level and to document the effect of diet on HDL-cholesterol. METHODS: The subjects were 252 (male: 134, female: 118) Korean type 2 DM patients recruited from a general hospital's DM clinic and divided into low HDL-cholesterol group (male < 40 mg/dL, female < 50 mg/dL) and control group (male > or = 40 mg/dL, female > or = 50 mg/dL). Anthropometric and hematological variables and dietary intake were assessed by the groups. RESULTS: The subject's mean age was 60.2 +/- 1.1 years and duration of diabetes was 9.5 +/- 1.0 years. Anthropometric measurements (body fat mass, % body fat, WHR, fat free mass, and muscle mass) and BMI were not significantly different between two groups. The male subjects with low HDL-cholesterolemia showed higher Atherogenic Index (AI, P < 0.001) and higher % carbohydrate from energy than control group (P < 0.01). The female subjects with low HDL-cholesterolemia showed higher AI (P < 0.001) and a tendency of higher triglyceride level and lower intake of energy, protein, lipid, vitamin B1 and vitamin E (P < 0.05) than control group. CONCLUSION: The subject with low HDL-cholesterolemia showed significantly higher AI. Male subject with low HDL-cholesterolemia consumed higher carbohydrate and female subject with low HDL-cholesterolemia showed lower intakes of many nutrients. This result suggests the importance of an adequate and balanced diet to manage type 2 DM patients to prevent CVD complications.
Adipose Tissue ; Cardiovascular Diseases ; Cause of Death ; Cholesterol ; Diabetes Mellitus, Type 2 ; Diet ; Female ; Humans ; Lipoproteins ; Male ; Muscles ; Plasma ; Thiamine ; Vitamin E ; Vitamins

The sacral area is the most frequent site of pressure sore. Because bony prominence is broad and flat along with little soft tissue padding. Between many muscle flaps, the gluteus maximus myocutaneous flap is the most reliable one for surgery of sacral pressure sores. After complete resection of ulcer, the gluteus maximus muscle detached from its original site including posterior iliac crest. After adequate dissection proceeded and bony prominence removed, flap repair is done at the central line. When performing this flap, most surgeon use elliptical design and incision. In the past, we also used elliptical incision and sometimes experienced some drawbacks especially when wound extended close to anus. There are difficulties on repair of perianal skin, central tension of long vertical scar, perianal skin adhesion and natal cleft distortion and resulting asymmetry of gluteal contour and contamination of operation site by defication. After review of the photographs in the references dealing with pressure sores, we had an impression that there are skin adhesion near the anus in some cases and actually experienced such cases in other surgeon's operations. This time, we applicate new design called the "Bomb-shape" design when performing this flap to patients who have a broad wound extent close to anus or perianal skin. The "Bomb-shape" design is a concept of adding bilateral subcutaneous incisions to lower part of classic elliptical incision and we named as such because it resembles the military bomb in shape. We expect the effect of preserving the perianal skin and preventing the skin adhesion or natal cleft distortion and performed this procedure in 15 patients whose defect close to anus. Consequently, benefits of this method are spreading tension of vertical scar, decreased contamination in wound care, earn skin stability without perianal skin adhesion or natal cleft distortion, so maintain the symmetry of gluteal contour and get better cosmetic result. There is no significant increase in operation time in that no need of handling the "dog-ear", and all 15 patients have good results and are satisfied, so we introduce this flap design carefully with concurrent review of literature.
Anal Canal ; Bombs ; Cicatrix ; Concurrent Review ; Humans ; Military Personnel ; Myocutaneous Flap ; Pressure Ulcer* ; Skin ; Ulcer ; Wounds and Injuries

BACKGROUND: Goal of the initial treatment of primary spontaneous pneumothorax is re-expansion of the lung by evacuation of air from pleural space. Authors thought small caliber catheter could reach to this goal instead of conventional large bore chest tube. This retrospective study was undertaken to assess the effectiveness of 7-French (Fr) catheter for the initial treatment of primary spontaneous pneumothorax. MATERIAL AND METHOD: Between May 2003 and April 2005, 111 patients with primary spontaneous pneumothorax were managed with tube drainage; 7 Fr catheter for 86 patients and 24-French chest tube for 25 patients. We analyzed catheter indwelling time, use of analgesics, re-expansion of the lung, and catheter related problems by medical records. RESULT: Mean catheter indwelling time was 2.4+/-1.1 days in 7 Fr group and 2.3+/-1.3 days in chest tube group (p>0.05). All patients with 24 Fr catheter needed analgesics injection but never in 7Fr group. Complete re-expansion of the lung based on plane chest radiograph was obtained in 77% of 7 Fr group. The problem related with 7 Fr catheter was kinking, which showed in 5.6%. CONCLUSION: Application of the 7 Fr catheter for initial management of primary spontaneous pneumothorax was as effective as 24 Fr catheter.
Analgesics ; Catheters* ; Chest Tubes ; Drainage ; Humans ; Lung ; Medical Records ; Pneumothorax* ; Radiography, Thoracic ; Retrospective Studies

Solitary plasmacytoma of bone is a rare disease that accounts for only about 3~5% of all plasma cell tumors. Especially, no case of solitary plasmacytoma of a rib origin has been described in the Korean literature. A 54 year old Korean man was referred to our hospital for further evaluation of a lung mass that had been detected on a screening chest radiograph. A tumor with a left 6th rib origin was revealed by the computed tomography (CT) and positive emission tomography (PET-CT); therefore, surgical resection was performed. The histopathological findings of the tumor revealed plasmacytoma of a rib origin. The postoperative screening test revealed no evidence of multiple myeloma. Postoperative radiation therapy was not performed, and no new lesion has been noted during the 2 years of follow up.
Lung ; Mass Screening ; Multiple Myeloma ; Plasmacytoma ; Rare Diseases ; Ribs ; Thorax

The purpose of this study was to investigate the impact DM duration on cardiovascular disease risk factors in Korean Type 2 diabetes mellitus patients. The subject were 250 (male: 134, female: 118) Korean Type 2 DM patients recruited from a general hospital's DM clinic. Anthropometric and hematological variables and dietary intake were assessed. The subject's mean age was 60.2 years and duration of diabetes was 9.5 years. As far as DM duration was concerned, male subjects with long duration (> or = 5 years and longer) showed significantly lower weight, fat free mass, skeletal muscle mass, BMI (p < 0.05) and higher 2hrs-postprandial plasma glucose (p < 0.05) and concentration of Hemoglobin A1c (p < 0.01) compared to those with less 5years of duration. In female subjects, same trend was found. Female subjects with long duration (> or = 5 years and longer) showed significantly higher fat free mass (p < 0.05) and skeletal muscle mass (p < 0.05), Hemoglobin A1c (p < 0.01), HDL-cholesterol (p < 0.01) and triglyceride (p < 0.05), dietary intakes of protein (p < 0.05) and fat (p < 0.05) compared to those with less 5years of duration. In conclusion, Type II DM patients of long duration had higher blood lipid concentrations and higher carbohydrates intakes. Subjects followed diet prescription strictly showed lower blood lipid concentration, suggesting the effectiveness of diet to manage Type 2 DM patients.
Blood Glucose ; Carbohydrates ; Cardiovascular Diseases* ; Diabetes Mellitus, Type 2 ; Diet ; Female ; Humans ; Korea* ; Male ; Muscle, Skeletal ; Prescriptions ; Risk Factors* ; Triglycerides

BACKGROUND: Medical doctors who perform C-arm fluoroscopy-guided procedures are exposed to X-ray radiation. Therefore, radiation-protective shields are recommended to protect these doctors from radiation. For the past several years, these protective shields have sometimes been used without regular inspection. The aim of this study was to investigate the degree of damage to radiation-protective shields in the operating room. METHODS: This study investigated 98 radiation-protective shields in the operation rooms of Konkuk University Medical Center and Jeju National University Hospital. We examined whether these shields were damaged or not with the unaided eye and by fluoroscopy. RESULTS: There were seventy-one aprons and twenty-seven thyroid protectors in the two university hospitals. Fourteen aprons (19.7%) were damaged, whereas no thyroid protectors (0%) were. Of the twenty-six aprons, which have been used since 2005, eleven (42.3%) were damaged. Of the ten aprons, which have been used since 2008, none (0%) was damaged. Of the twenty-three aprons that have been used since 2009, two (8.7%) of them were damaged. Of the eight aprons used since 2010, one (12.3%) was damaged. Of the four aprons used since 2011, none (0%) of them were damaged. The most common site of damage to the radiation-protective shields was at the waist of the aprons (51%). CONCLUSIONS: As a result, aprons that have been used for a long period of time can have a higher risk of damage. Radiation-protective shields should be inspected regularly and exchanged for new products for the safety of medical workers.
Academic Medical Centers ; Eye ; Fluoroscopy ; Hospitals, University ; Thyroid Gland

OBJECTIVE: Survivin is a novel inhibitor of apoptosis. Suppression of apoptosis is important for carcinogenesis and tumor growth. The purpose of this study was to investigate whether survivin is expressed in the tissues of normal uterine cervix, cervical intraepithelial neoplasia grade III (CIN III) and squamous cell carsinoma of the uterine cervix, as a first step for evaluation of the clinical significance of survivin in uterine cervical cancer. METHODS: We investigated the expression of survivin in the tissues of 11 cases of normal uterine cervix and 14 cases of CIN III and 20 cases of uterine cervical cancer, using Immunohistochemistry at department of obstetrics and gynecology of Ajou university hospital from Jan. 2000 to Jan. 2001 and then compared with the results of three groups. RESULTS: The expression of survivin is increased significantly in cases of CIN III and uterine cervical cancer compared with controls. (p<0.05, One way ANOVA test) CONCLUSION: This study shows survivin could play an important role in the carcinogenesis mechanism of uterine cervix. And further study will be followed to evaluate the clinical relationship of survivin in uterine cervical cancer and whether to act a prognostic factor or not.
Apoptosis ; Carcinogenesis ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Female ; Gynecology ; Immunohistochemistry ; Obstetrics ; Uterine Cervical Neoplasms

BACKGROUND: beta-catenin plays a pivotal role in hair follicle development and hair growth cycle. OBJECTIVE: The aim of this study was to identify beta-catenin-regulated genes in cultured human hair outer root sheath (ORS) cells. METHODS: Primary cultured ORS cells were transduced with recombinant adenovirus expressing N-terminal truncated beta-catenin (constitutive active form), and beta-catenin-regulated genes were identified. RESULTS: Overexpression of the constitutively active form of beta-catenin led to induction of Sox9 expression at both mRNA and protein levels. To investigate the potential role of Sox9, we made the recombinant adenovirus expressing green fluorescent protein-tagged Sox9, and then transduced into cultured ORS cells. Interestingly, Sox9 induced the expression of keratin 15, increased the proliferation of ORS cells in vitro, and enhanced colony-forming activity. CONCLUSION: Our results suggest that Sox9 is a beta-catenin-regulated gene in ORS cells, and has potential importance in the regulation of hair follicle homeostasis.
Adenoviridae ; beta Catenin ; Electrolytes ; Hair ; Hair Follicle ; Homeostasis ; Humans ; Keratin-15 ; RNA, Messenger

"Purple toe" syndrome is an extremely rare complication of warfarin therapy. The occurrence of purple toe syndrome is characterized by a sudden appearance of purplish discoloration of toes and the sides of feet. The skin lesions usually develop 3-8 weeks after beginning anticoagulation. The pathogenesis was not clearly defined but the presence of atherosclerosis in most of patients led to suggest that the mechanism was related to cholesterol emboli from the atherosclerotic plaques and warfarin- induced bleeding into the plaques. These microemboli are commonly associated with irreversible organ dysfunction such as renal failure, distal gangrene, pancreatitis, and multifocal myocardial necrosis. Therefore purple toe syndrome may be considered as a sentinel of cholesterol crystal embolism. Once established, anticoagulation and thrombolysis are contraindicated. Necrosis and gangrenous changes may result in loss of limb and occasional mortality has been reported. We report a case of purple toe syndrome associated with acute renal failure after warfarin therapy with a review of literatures.
Acute Kidney Injury* ; Atherosclerosis ; Cholesterol ; Embolism ; Embolism, Cholesterol ; Extremities ; Foot ; Gangrene ; Hemorrhage ; Humans ; Mortality ; Necrosis ; Pancreatitis ; Plaque, Atherosclerotic ; Renal Insufficiency ; Skin ; Toes* ; Warfarin*