There are several methods available to check bone masses. One of them is Singhs index which is singlest way with grading trabecular pattern of the proximal femur on anteroposterior X-ray film and the other is recently developed Dual Photon X-ray Absorptiometry which measures bone mineral contents. Some authors proclaim that Singh's index has low accuracy, objectiveness and reproducibility. So we studied for reliability of Singh's index and correlation between Singh's index and bone mineral contents measured by Dual Photon X-ray Absorptiometry in 65 patients. There are significant differences between 3 orthopedic surgeons in interpreting Singh's index (interpersonal difference). There are significant differences between first and second interpretation out of same surgeons (intrapersonal difference). There are significant differences interpretating among interpreted Singh's indices from films of different radiological exposures in the same radiograph. There are fair correlations(0.60-0.66) between Singhs index and bone mineral density. The Singh's index was overestimated in low bone mineral density with under-exposed radiograph, but Singh's index was under-estimated in high bone mineral density with over-exposed radiograph. Singh's index can be useful in clinical application by some modification.
Absorptiometry, Photon ; Bone Density ; Femur ; Humans ; Orthopedics ; Surgeons ; X-Ray Film

BACKGROUND/AIM: The lipo-PGE1, known for being more stable during pulmonary circulation and having more targeting effect, has been reported to inhibit ET-1 induced stellate cell contraction. We assessed the effect of lipo-PGE1 on the change of ET-1 concentration and the relationship between ET-1 concentration and the liver damage. METHODS: Mongrel dogs weighing about 25 kg were divided into a control (n=6) and a lipo-PGE1 (n=6) group. Partial liver allotransplantation was performed. In the lipo-PGE1 group, lipo-PGE1 was slowly infused through splenic venous cannulation during the donor liver harvesting procedure (50 microgram) and continuously infused (60 microgram/day) for 48 hours after reperfusion. The AST, ALP, LDH and ET-1 concentrations were monitored RESULTS: The AST and ALP levels of the lipo-PGE1 group were significantly lower than those of the control group both at 1 hour and 48 hours after reperfusion. The LDH level in the lipo-PGE1 group was lower at 1 hour and 48 hours after reperfusion. But there was no statistical difference between the two groups. The baseline ET-1 concentration of the lipo-PGE1 group was eight times higher than that of the control group. The ET-1 concentration was elevated gradually in the control group. There was no significant difference between the two groups at 48 hours. There was no correlation between ET-1 concentrations and AST, ALP, LDH levels. CONCLUSION: This study demonstrated the hepatoprotective effect of the lipo-PGE1 against ischemia-reperfusion injury in canine partial liver allotransplantation. However, the baseline ET-1 level was eight times higher in the lipo-PGE1 group than that of the control group in spite of the hepatoprotective effects of the lipo-PGE1.
Alprostadil* ; Animals ; Catheterization ; Dogs ; Endothelin-1* ; Humans ; Liver Transplantation* ; Liver* ; Pulmonary Circulation ; Reperfusion ; Reperfusion Injury* ; Tissue Donors

Gastric stump cancer is defined as cancers that develop in the gastric remnant after the gastric resection of nonmalignant lesions or malignant lesions. The interval between gastrectomy and the detection of gastric stump cancer must be over 5 years in nonmaligant lesions and 10 years in malignant lesions. Symptoms of gastric stump cancer are not specific, so, diagnosis is often delayed. Early detection and curative operation is very important in gasric stump cancer and follow-up endoscopic examination is the most importaint diagnostic tool to detect gastric stump cancer. Recently we experienced a case of early gastric stump cancer. We report review of the literature to remind the important of gastric stump cancer and the important of follow-up endoscopic examination.
Diagnosis ; Esophagus* ; Follow-Up Studies ; Gastrectomy* ; Gastric Stump* ; Intestines* ; Stomach*

OBJECTIVES:Long standing observation, which may relate either to the causes or the effects of UC, reveals that there is a pronounced alteration of mucin such as quantitative and qualitative abnormalities of mucin glycoprotein. But recently in situ hybridization technique showed no specific difference in the expression of apomucin mRNA in UC. Therefore we investigated whether abnormality of mucin was originated from defect in glycosylation. And we also tried to find differences in the expression of Tn and sTn antigens between Korean and Jewish patients with UC. METHODS: We performed the immunohistochemical staining using the monoclonal antibody of mucin carbohydrate antigens Tn and sTn in 19 patients with UC. RESULTS: Tn and sTn antigens were not expressed throughout the crypt and surface epithelium in normal colon but both of mucin carbohydrates antigens were well expressed in mild UC, Tn antigen was seen in the surface epithelium with perinuclear pattern and sTn antigen was shown not only in surface but also in crypt epithelium. In severe UC, Tn antigen was well expressed, but sTn antigen was not expressed. Tn antigen seemed to be ex-pressed more frequently than sTn antigen with severity of inflammation. These results were similar in Korean and Jewish patients with UC. CONCLUSION: These results suggest that inflammatory bowel disease has some deterioration in the step of glycosylation in the cytoplasm and there was no racial difference in the expression of Tn and sTn antigen in Korean and Jewish patients with UC.
Carbohydrates ; Colitis, Ulcerative ; Colon ; Cytoplasm ; Epithelium ; Glycoproteins ; Glycosylation ; Humans ; In Situ Hybridization ; Inflammation ; Inflammatory Bowel Diseases ; Mucins* ; RNA, Messenger ; Ulcer*

Gastrointestinal bleeding from small bowel lesions is uncommon but it is the most common cause of obscure gastrointestinal bleeding that can go undiagnosed using traditional upper endoscopy and colonoscopy. Recently, various new methods, including wireless capsule endoscopy and double-balloon enteroscopy have been used to detect and manage small bowel lesions. A 51-year-old man was admitted with hematochezia. The source of bleeding could not be identified using conventional upper endoscopy and colonoscopy. Wireless capsule endoscopy revealed a mass-like lesion with active blood spurting in the proximal jejunum. Finally, a tumor with central ulceration was detected at the proximal jejunum using a clean colonoscope through the oral approach. This lesion was surgically resected, and the histology findings were consistent with a gastrointestinal stromal tumor. We report a case of gastrointestinal bleeding from a proximal jejunal GIST diagnosed by clean colonoscopy through the oral approach with a review of the relevant literature.
Capsule Endoscopy ; Colonoscopes ; Colonoscopy* ; Double-Balloon Enteroscopy ; Endoscopy ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors ; Hemorrhage* ; Humans ; Jejunum ; Middle Aged ; Ulcer

PURPOSE: TPN has been widely used to treat nutritional depletion since the late 1960s. However, many metabolic complications may occur as a result of parenteral feeding. Among these, hepatic complications has received increasing attention. A retrospective review of liver function abnormalities in adult patients who underwent TPN was done to determine the frequency and magnitude of the abnormalities in a liver function test. METHODS: From January 2001 to Jun 2001, 160 adult patient receiving TPN were reviewed. Of these, 111 had a malignant disease and 49 had a benign disease. The duration of TPN therapy ranged from 5 days to 52 days, with a mean duration of 14 days. Abnormalities of liver function test were defined as a value greater than the upper normal limit. Forty cases of gastric cancer were analyzed to determine the risk factors that contribute to abnormal liver function in individual patients receiving TPN. RESULTS: Abnormalities of the liver function test appeared after 6~7 days of therapy. Increases in the ALP levels were noted in 34 out of 93 patients (37.6%), in the AST levels in 42 out of 116 patients (36.2%), in the ALT levels in 54 out of 125 patients (43.2%), in the LDH levels in 20 out of 72 patients (27.8%), in the gamma-GTP levels in 44 out of 81 patients (54.3%), and in the bilirubin levels in 30 out of 126 patients (23.8%). The serum ALP level rose to 1.6 times upper the limit of normal; AST, 1.7 times; ALT, 2.0 times; LDH, 1.2 times; gamma-GTP, 2.4 times; bilirubin, 2.4 times. gamma-GTP value was most sensitive. In 40 gastric cancers, factors as age, the amount of TPN solution, the duration of TPN, intraoperative chemotherapy, transfusion, and postoperative infection were investigated. However, no association with TPN-associated liver function abnormalities was found. CONCLUSION: The incidences of an abnormal liver function during TPN were 23.8~54.3%. However, the liver function abnormalities that developed during short term-TPN were reversible and not serious.
Adult ; Bilirubin ; Drug Therapy ; Humans ; Incidence ; Liver Function Tests ; Liver* ; Parenteral Nutrition ; Parenteral Nutrition, Total* ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms

Giant duodenal ulcer can be defined as a variant of peptic ulceration that exceeds 2 cm at the greatest diameter. The high mortality and morbidity of giant duodenal ulcer are directly related to the resultant perforation, obstruction and massive hemorrhage. The patient usually has a long history of an inadequately treated or neglected peptic ulcer, but this malady is rarely induced by nonsteroidal anti-inflammatory drugs (NSAIDs). A 60-year-old man was referred to us due to epigastric pain. He underwent appendectomy 1 week ago, and he was administered ketorolac (tarasyn(R)) for 5 days to control the postoperative pain. Esophagogastroduodenos copy (EGD) revealed a giant duodenal ulcer encircling the lumen from the pylorus to the postbulbar portion of the duodenum, and he was then treated with proton pump inhibitor. Two weeks later, the follow-up EGD showed complete duodenal obstruction at the bulb. He was treated by laparoscopic gastrojejunostomy. We report here on this case of duodenal obstruction that was induced by the short-term use of NSAIDs.
Anti-Inflammatory Agents, Non-Steroidal ; Appendectomy ; Duodenal Obstruction* ; Duodenal Ulcer ; Duodenum ; Follow-Up Studies ; Gastric Bypass ; Hemorrhage ; Humans ; Ketorolac ; Middle Aged ; Mortality ; Pain, Postoperative ; Peptic Ulcer ; Proton Pumps ; Pylorus

BACKGROUND/AIMS: The clinical significance of serum CA 125 levels in patients with chronic liver disease has not been widely appreciated in relation to the severity of the disease. We examined serum CA 125 levels in patients with chronic liver disease according to the severity of liver disease and the presence of ascites. METHODS: Fasting serum CA 125 levels were measured by a commercial RIA kit in 92 patients with chronic liver disease: 22 with chronic hepatitis and 70 with liver cirrhosis (Child class A, 19; B, 28; C, 23). Forty-one patients (45%) had ascites. RESULTS: The patients with Child class C liver cirrhosis had significantly higher mean serum CA 125 level than those with class A (p<0.05). In Child class B patients, the mean serum CA 125 level was significantly higher in patients with ascites than in those without (p<0.05). A multiple regression analysis showed that the presence of ascites, serum albumin, and prothrombin time were independent factors related to the increase of serum CA 125 levels. CONCLUSIONS: The presence of ascites is more closely related to the increase of CA125 levels in patients with liver cirrhosis than the severity of liver disease.
Adult ; Aged ; Ascites/blood ; CA-125 Antigen/*blood ; Chronic Disease ; Female ; Hepatitis B, Chronic/*blood ; Humans ; Liver Cirrhosis/*blood ; Male ; Middle Aged

Vaccination against hepatitis A virus (HAV) is recommended for patients with chronic liver disease (CLD), but this has been deemed unnecessary in Korea since the immunity against HAV was almost universal in adults. However, this practice has never been reevaluated with respect to the changing incidence of adult acute hepatitis A. We retrospectively reviewed the medical records of 278 patients with acute hepatitis A diagnosed from January 1995 to November 2005 and prospectively tested 419 consecutive CLD patients from July to December 2005 for the presence of IgG anti-HAV. The number of patients with acute hepatitis A has markedly increased recently, and the proportion of adult patients older than 30 yr has been growing from 15.2% during 1995-1999, to 28.4% during 2000-2005 (p=0.019). Among 419 CLD patients, the seroprevalences of IgG anti-HAV were 23.1% for those between 26 and 30 yr, 64% between 31 and 35 yr, and 85.0% between 36 and 40 yr. These data demonstrate that immunity against HAV is no more universal in adult and substantial proportion of adult CLD patients are now at risk of HAV infection in Korea. Therefore, further study on seeking proper strategy of active immunization against HAV is warranted in these populations.
Risk Factors ; Risk Assessment/methods ; Middle Aged ; Male ; Liver Diseases/*epidemiology/*prevention & control ; Korea/epidemiology ; Infant, Newborn ; Infant ; Incidence ; Humans ; Hepatitis A Vaccines/*therapeutic use ; Hepatitis A/*epidemiology/*prevention & control ; Female ; Disease Outbreaks/*prevention & control/*statistics & numerical data ; Comorbidity ; Communicable Diseases, Emerging/epidemiology/prevention & control ; Chronic Disease ; Child, Preschool ; Child ; Aged, 80 and over ; Aged ; Adult ; Adolescent

PURPOSE: To report the results of stereotactic body radiotherapy (SBRT) for unresectable primary or recurrent cholangiocarcinoma. MATERIALS AND METHODS: From January 2005 through August 2013, 58 patients with unresectable primary (n = 28) or recurrent (n = 30) cholangiocarcinoma treated by SBRT were retrospectively analyzed. The median prescribed dose was 45 Gy in 3 fractions (range, 15 to 60 Gy in 1-5 fractions). Patients were treated by SBRT only (n = 53) or EBRT + SBRT boost (n = 5). The median tumor volume was 40 mL (range, 5 to 1,287 mL). RESULTS: The median follow-up duration was 10 months (range, 1 to 97 months). The 1-year, 2-year overall survival rates, and median survival were 45%, 20%, and 10 months, respectively. The median survival for primary group and recurrent group were 5 and 13 months, respectively. Local control rate at 1-year and 2-year were 85% and 72%, respectively. Disease progression-free survival rates at 1-year and 2-year were 26% and 23%, respectively. In univariate analysis, ECOG performance score (0-1 vs. 2-3), treatment volume (<50 vs. > or =50 mL), and pre-SBRT CEA level (<5 vs. > or =5 ng/mL) were significant in overall survival rate. In multivariate analysis, ECOG score (p = 0.037) and tumor volume (p = 0.030) were statistically significant. In the recurrent tumor group, patients with >12 months interval from surgery to recurrence showed statistically significant higher overall survival rate than those with < or =12 months (p = 0.026). Six patients (10%) experienced > or =grade 3 complications. CONCLUSION: SBRT can be considered as an effective local modality for unresectable primary or recurrent cholangiocarcinoma.
Cholangiocarcinoma* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Radiosurgery* ; Recurrence ; Retrospective Studies ; Survival Rate ; Tumor Burden