Lumbar hernias are rare posterolateral abdominal wall defects that may be congenital or acquired. There are two types of lumbar hernia, the superior lumbar hernia through Grynfeltt triangle, and the inferior lumbar hernia through Petit triangle. Many techniques have been described for the surgical repair of lumbar hernias including primary repair, local tissue flaps, and conventional mesh repair. But these open techniques require a large skin incision. We report a case of superior lumbar hernia, which was successfully repaired using a laparoscopic approach.
Abdominal Wall ; Hernia ; Skin

PURPOSE: The aim of this study was to assess the outcome of subtotal colectomy on patients with a diagnosis of chronic constipation. METHODS: A retrospective review of 11 consecutive patients who underwent subtotal colectomy between January 1990 and July 1999 was undertaken. Preoperative testings included complete history and physical examination, anorectal manometry, videodefecography, and colonic transit studies. RESULTS: The 11 patients consisted of 5 men and 6 women, with a mean age of 44 (range, 25~62) years. The most common symptom was inability to defecation and mean duration of this symptom was 13.6 (range, 0.75~45) years. Ten patients had slow colon transit and one patient had normal colon transit with anismus. All patients were followed up for mean duration of 33 (range, 5~120) months. Mean bowel frequency was 4 times per day after colectomy. Nine patients were satisfied with the results of surgery and showed improvement in quality of life. One patient was less satisfied due to diarrhea even with several times bowel movement per day. One patient felt that the operation was not so effective due to incontinence for liquid stool and 7 bowel movement per day. Three patients frequently used antidiarrheal medication after surgery. Three patients had postoperative small bowel obstruction and were treated without surgery. CONCLUSION: Subtotal colectomy with ileorectal anastomosis produces a satisfactory functional outcome in the majority of patients with proven slow transit constipation.
Colectomy* ; Colon ; Constipation* ; Defecation ; Diagnosis ; Diarrhea ; Female ; Humans ; Male ; Manometry ; Physical Examination ; Quality of Life ; Retrospective Studies

Behavioral problems are thought to be pervasive and devasting to patients with dementia of the Alzheimer's type and their families. Despite this, little empirical data are available concerning the nature of such impairments, their rate of occurrence or their relationship to the disease process. This study was designed to investigate the nature and the rates of behavioral disturbance among DAT patients. The subjects involved in this study were 72 patients who were hospitalized and had primary diagnosis of dementia of the Alzheimer's type. Severity of the dementia was assessed by MMSE, and abnormal behavior by E-BEHAVE-AD. Pearson correalation was used to analysis data. The subjects were divided into mild/moderate dementia group and severe, and then evaluated significant differences. Independent-samples T-test was used to analysis data. The results were as follows: 1) Wandering and delusional ideation were associated with declining MMSE score 2) Wandering was only differenciated between mild to moderate group. In conclusion, problems found associated with level of impairment such as wandering and delusion are thought to be characteristic of the disease and therefore predictable. Problems found not associated with level of impairment, are likely to be idiosyncratic. The former should probably be incorporated into education and intervention programs, the latter addressed as needed on an individual basis.
Alzheimer Disease* ; Delusions ; Dementia* ; Diagnosis ; Education ; Humans ; Psychopathology*

Behavioral problems are thought to be pervasive and devasting to patients with dementia of the Alzheimer's type and their families. Despite this, little empirical data are available concerning the nature of such impairments, their rate of occurrence or their relationship to the disease process. This study was designed to investigate the nature and the rates of behavioral disturbance among DAT patients. The subjects involved in this study were 72 patients who were hospitalized and had primary diagnosis of dementia of the Alzheimer's type. Severity of the dementia was assessed by MMSE, and abnormal behavior by E-BEHAVE-AD. Pearson correalation was used to analysis data. The subjects were divided into mild/moderate dementia group and severe, and then evaluated significant differences. Independent-samples T-test was used to analysis data. The results were as follows: 1) Wandering and delusional ideation were associated with declining MMSE score 2) Wandering was only differenciated between mild to moderate group. In conclusion, problems found associated with level of impairment such as wandering and delusion are thought to be characteristic of the disease and therefore predictable. Problems found not associated with level of impairment, are likely to be idiosyncratic. The former should probably be incorporated into education and intervention programs, the latter addressed as needed on an individual basis.
Alzheimer Disease* ; Delusions ; Dementia* ; Diagnosis ; Education ; Humans ; Psychopathology*

A clinicostatistical analysis of 683 males with infertility who visited the Pusan National University Hospital between January 1986 and December 1995 was performed. We divided the patients into 5 groups by Shirataki classification as follows, group I, sperm concentration above 20 x 106/ml, group II, oligozoospermia with a sperm concentration above 10 x 100000/ml, but below 20 x 1000000/ml, group III,oligozoospermia with a sperm concentration below 10x 100000/ml, group IV, primary azoospermia, group V, obstructive azoospermia. The mean age was 33.1 years. The mean duration of infertility was 48.2 months. The frequency in each groups were group IV 383 cases (56.1%), group III 127 cases (18.6%), group I 111 cases (16.3%), group II 37 cases (5.4%), and group V 25 cases (3.7%), respectively. Except group V, as decreasing the sperm density, testicular volume tended to reduce (p<0.01). The semen volume in group V was significantly less than that in other groups (p<0.05). As sperm density decreased, the sperm motility tended to reduce (p<0.05). The levels of serum luteinizing hormone (LH) and follicular stimulating hormone (FSH) in group IV were significantly the higher than other groups (p<0.05). As for serum prolactin and testosterone, there were no significant differences between each 5 group. Of etiologic factors of male infertility, idiopathic was the most common cause with 489 cases (71. 6%), and followed by varicocele 71 cases (10.4%), seminal tract obstruction 44 cases (6.4%), chromosome abnormality 30 cases (4.4%), infection 20 cases (2.9%), testicular trauma 13 cases (1.9%), cryptorchidism 10 cases (1.5%), hyperprolactinemia 4 cases (0.6%) and retrograde ejaculation 2 cases (0.3%). A total of 391 cases had a management for male infertility which consisted of medical treatments 291 cases (74.4%), surgical treatments 89 cases (22.8%) and assisted reproductive technologies 11 cases (2.8%). In conclusion, We think the more clear clarification of physiology of male reproductive system, the development of new drugs for the improvement of spermatogenesis and the application of advanced assisted reproductive technique would be needed to handle properly the patients with male infertility.
Azoospermia ; Busan ; Chromosome Aberrations ; Classification ; Cryptorchidism ; Ejaculation ; Humans ; Hyperprolactinemia ; Infertility ; Infertility, Male* ; Luteinizing Hormone ; Male ; Male* ; Oligospermia ; Physiology ; Prolactin ; Reproductive Techniques, Assisted ; Semen ; Sperm Motility ; Spermatogenesis ; Spermatozoa ; Testosterone ; Varicocele

With the exception of accidental perforation during a laparoscopic Cholecystectomy, An Iatrogenic Gallbladder Perforation Is Quite Rare. Several Cases Have Been Reported As A Complication Of Interventional Or Endoscopic Procedures. Although A Case Of Gallbladder And Stomach Perforation During Gastric Endoscopic Mucosal Resection (Emr) Has Been Reported, We Encountered A Case Of Gallbladder Perforation During Gastric Emr Without Evidence Of A Perforation Of The Stomach, Which Has Not Been Reported In The Literature.
Cholecystectomy, Laparoscopic ; Gallbladder ; Stomach

We report on a case of torsion of an accessory spleen occurring in a 19-year-old female. She was admitted with a three-day history of left-upper quadrant pain that became slowly aggravated. On physical examination, left-side abdominal tenderness was observed, most markedly in the left upper quadrant, but no rebound tenderness was noted. Contrast-enhanced computed tomography (CT) scan showed a non-enhancing mass with a tubular vascular pedicle and normal enhancing spleen in the left upper abdomen. Doppler ultrasound showed no vascular flow within the hypoechoic mass in the left upper abdomen. Torsion of an accessory spleen was suspected, and emergent laparoscopic exploration was performed. Laparoscopic exploration showed a large rounded violet mass with a tw isted vascular pedicle, located anterior to the normal spleen. The mass was excised laparoscopically and then removed through a 2.5 cm extended incision of the left-sided trocar incision. Postoperative recovery was normal and she was discharged on the fifth postoperative day.
Abdomen ; Female ; Humans ; Physical Examination ; Spleen* ; Surgical Instruments ; Ultrasonography ; Viola ; Young Adult

We report on a case of torsion of an accessory spleen occurring in a 19-year-old female. She was admitted with a three-day history of left-upper quadrant pain that became slowly aggravated. On physical examination, left-side abdominal tenderness was observed, most markedly in the left upper quadrant, but no rebound tenderness was noted. Contrast-enhanced computed tomography (CT) scan showed a non-enhancing mass with a tubular vascular pedicle and normal enhancing spleen in the left upper abdomen. Doppler ultrasound showed no vascular flow within the hypoechoic mass in the left upper abdomen. Torsion of an accessory spleen was suspected, and emergent laparoscopic exploration was performed. Laparoscopic exploration showed a large rounded violet mass with a tw isted vascular pedicle, located anterior to the normal spleen. The mass was excised laparoscopically and then removed through a 2.5 cm extended incision of the left-sided trocar incision. Postoperative recovery was normal and she was discharged on the fifth postoperative day.
Abdomen ; Female ; Humans ; Physical Examination ; Spleen* ; Surgical Instruments ; Ultrasonography ; Viola ; Young Adult

Adult intussusception is a rare disease and it differs from childhood intussusception in its presentation, cause and treatment. Most of the cases have an underlying lesion within the intussusception that requires surgical resection. Making the diagnosis can be delayed because of the nonspecific and chronic symptoms, and many cases are diagnosed during performance of emergency laparotomy for treating the obstructive symptoms. A computed tomography (CT) scan is most useful for making the diagnosis of adult intussusception and is helpful in revealing the underlying lesion, although a barium enema can help to diagnose colonic intussusceptions. Surgical resection remains the recommended treatment for nearly all cases, but there is controversy about whether or not the intussusception should be initially reduced before resection. Gastrointestinal lipomas are rare benign tumors that can occur anywhere along the gut, and the small bowel is the second most common site for gastrointestinal lipomas after the colon. Intussusception of the ileum by a lipoma is very rare. We report here on a case of ileo-ileal intussusception that was caused by a lipoma of the ileum in a 35-year-old man who complained of abdominal pain of one week duration. The diagnosis of an ileo-ileal intussusception caused by a lipoma of the ileum was suspected preoperatively according to the typical CT findings, so we tried to initially reduce the intussusception during laparotomy. But manual reduction was impossible due to the edema of the lesion, and an ileum of some length had to be resected.
Abdominal Pain ; Adult ; Barium ; Colon ; Edema ; Emergencies ; Enema ; Humans ; Ileum ; Intussusception ; Laparotomy ; Lipoma ; Rare Diseases

Gallbladder torsion is a rare clinical entity and it is a difficult condition to diagnose preoperatively. About 500 cases of gallbladder torsion have been reported since 1898, when Wendel first described gallbladder volvulus. This condition most commonly occurs in elderly women and the symptoms of this disease are largely non-specific and they mimic those of acute cholecystitis. Even with the recent advances of radiologic imaging modalities, making a preoperative diagnosis of gallbladder torsion is difficult and most cases are diagnosed at the time of surgery. An early diagnosis and prompt cholecystectomy for this disease are important in order to avoid the complications of gangrene and perforation, and to reduce mortality. A high index of suspicion of gallbladder torsion on the basis of the clinical situation and the specific findings on the radiologic images, usually ultrasonography and computed tomography (CT) scanning, can make the correct preoperative diagnosis possible. Gallbladder torsion is a rare disease, and gallbladder torsion with accompanying acute appendicitis is extremely rare. We report here on a case of gallbladder torsion with accompanying acute appendicitis in an 89-year-old woman and we review the clinical aspects of gallbladder torsion. Unfortunately, the diagnosis of gallbladder torsion was missed in this case, so we retrospectively reviewed and correlated the CT findings with the surgical findings.
Aged ; Aged, 80 and over ; Appendicitis ; Cholecystectomy ; Cholecystitis, Acute ; Early Diagnosis ; Female ; Gallbladder ; Gangrene ; Humans ; Hydrazines ; Intestinal Volvulus ; Rare Diseases ; Retrospective Studies