Six thumb reconstructions and one index reconstruction were performed by use of the wrap-around technique. All successful digital reconstructions were reviewed at an average of 37 months after surgery. There were complications related to the digits in three patients ; these included pin site infection (1), malrotation (1), and nail deformity (1). But we considered that function and cosmesis were excellent with a 100% viability rate. All patients regained protective sensation and sttained two-point discrimination (average 10mm). The wrap-around technique represents an esthetically and functionally excellent procedure of digit reconstruction for amputation at the level of metacarpo-phalangeal joint or distal to it.
Amputation ; Congenital Abnormalities ; Discrimination (Psychology) ; Fingers ; Humans ; Joints ; Sensation ; Thumb

Uterine choriocarcinoma metastatic to kidney and brain is rare. We experienced a 55-year-old woman with complaints of right flank pain and gross hematuria. On admission urine HCG was positive and serum HCG was elevated to 42,250 mIU/ml. Intravenous pyelography revealed delayed visualization of the right kidney. Ultrasonography and computed tomography of the abdomen showed the irregular, multiloculated, mixed density lesion in the posterolateral parenchyme and a subcapsular hematoma of the right kidney. Three days after admission, the patient suffered a seizure. Computed tomography of brain revealed the mass which was the same density as the right kidney in the midbrain and medial occipital lobe of cerebrum. Cerebrospinal HCG was also elevated Under the impression or choriocarcinoma metastatic to kidney and brain, chemotheraphy (EMA- CO : etoposide, methotrexate, actinomycin D, cyclophosphamide and oncovin) was started.
Abdomen ; Brain* ; Cerebrum ; Choriocarcinoma* ; Cyclophosphamide ; Dactinomycin ; Etoposide ; Female ; Flank Pain ; Hematoma ; Hematuria ; Humans ; Kidney* ; Mesencephalon ; Methotrexate ; Middle Aged ; Occipital Lobe ; Pregnancy ; Seizures ; Ultrasonography ; Urography

PURPOSE: To evaluate the significance of color Doppler ultrasonography in patients of chronic prostatitis. MATERIALS AND METHODS: We analysed the pattern of color Doppler images and quantitative changes of vascular flow and flow velocity parameters(FVP) using a 7.0 MHz transrectal probe with findings of expressed prostatic secretion (EPS) from 22 patients with clinically suspected chronic prostatitis and 12 controls with clinically suspected prostatodynia retrospectively. RESULTS: Compared with 2 groups according to color Doppler flow grade, higher grades(grade 2 or 3) of flow increase were more frequently seen in prostatitis group(54.5%) than in control group(33.3%)(p <0.05). But no significant difference was found in flow velocity parameter(FVP: maximal flow velocity, minimal flow velocity, resistive index, and pulsatility index) between control and prostatitis group. Two months later follow up ultrasonography of 5 cases in the prostatitis group after treatment, all of 5 cases showed decrease the color Doppler flow compared with the initial color Doppler image grade. CONCLUSIONS: Grading of the amount of color flow with Doppler ultrasonography is of limited significance at efficacy decision after treatment in chronic prostatitis. But precaution should be taken to use color Doppler ultrasonography as objective diagnostic tool, although higher grades of flow increase were more frequently seen in prostatitis group than control group.
Follow-Up Studies ; Humans ; Prostatitis* ; Retrospective Studies ; Ultrasonography ; Ultrasonography, Doppler ; Ultrasonography, Doppler, Color*

Tissue welding is a potentially expectable surgical application in the field of medical laser technology. We investigated to establish the technology of laser welding and its efficacy with auxiliary stent and solder in the anastomosis of urological tubular organs including ureter and urethra of rabbits and vas of human using CO2, laser(Shaplan 1100 System). The objects consist of four groups including control group of the conventional microsuture anastomosis and three experimental groups that included group I of laser welding only, group II of laser welding with stent and group III of laser welding with solder. The overall success rate in control group was 90.7 % and in experimental groups were lower with 58.3% and 73.3% in group I and II , respectively, but higher with 95.5% group III. According to each tubular organ in experimental groups, the overall success rates in ureter, urethra and vas were 83.3%, 75.0% and 76.9% respectively, so that the thinner in the wall thickness of tubular organ revealed the higher success rate. Also, time of procedures was significantly shorter in laser groups than control group. Histological findings of laser welding showed the only localized adventitial reactions with intact subserosal layer. In conclusion, laser welding in the urological tubular organ anastomosis with auxiliary solder is not only a more simple and fast technique but also has higher success rate than conventional microsuture anastomosis.
Humans ; Rabbits ; Stents ; Ureter ; Urethra ; Welding*

A granular cell tumor (GCT) is a relatively rare benign tumor that has been seldom reported since Abrikossoff first described it as a granular cell myoblastoma in 1926. While GCTs can occur anywhere in the human body, they are very rarely observed in the gastrointestinal tract and are especially rare in the large intestine. Most GCTs are small and asymptomatic and are often found by endoscopy, upper gastrointestinal series, and autopsy. We report two cases in which a submucosal tumor in the cecum was accidentally discovered by colonoscopy and was subsequently removed by colon polypectomy and endoscopic mucosal resection. Immunohistochemical analysis of the samples confirmed both cases as GCT. The literature review and reports of other growths in the gastrointestinal tracts support the necessity for proper identification of GCTs within the body to differentiate them from more malignant tumors.

Cholecystocolic fistula (CCF) is a rare and late complication of gallbladder disease. The cause of CCF is known to be peptic ulcer, gallbladder disease, malignant tumor, trauma, and postoperative complications. The proper treatment method is to perform cholecystectomy and to identify and alleviate the CCF. However, cholecystectomy is not always possible owing to technical difficulties and disease severity. CCF is difficult to diagnose preoperatively, and CCF operation without an accurate preoperative diagnosis can lead to a more complicated surgery and cause surgeons to face more difficult situations or to endanger patients' lives. We report a case of asymptomatic CCF successfully treated with laparoscopic surgery after accurate diagnosis before surgery.
Cholecystectomy ; Diagnosis ; Fistula ; Gallbladder Diseases ; Laparoscopy ; Methods ; Peptic Ulcer ; Postoperative Complications ; Surgeons

A granular cell tumor (GCT) is a relatively rare benign tumor that has been seldom reported since Abrikossoff first described it as a granular cell myoblastoma in 1926. While GCTs can occur anywhere in the human body, they are very rarely observed in the gastrointestinal tract and are especially rare in the large intestine. Most GCTs are small and asymptomatic and are often found by endoscopy, upper gastrointestinal series, and autopsy. We report two cases in which a submucosal tumor in the cecum was accidentally discovered by colonoscopy and was subsequently removed by colon polypectomy and endoscopic mucosal resection. Immunohistochemical analysis of the samples confirmed both cases as GCT. The literature review and reports of other growths in the gastrointestinal tracts support the necessity for proper identification of GCTs within the body to differentiate them from more malignant tumors.

BACKGROUND: Diverticulosis of the cecum and ascending colon is a rare disease in Western countries, it is more common in the Orient. Making the diagnosis preoperatively could be difficult, and the intraoperative assessment and decision of optimal treatments are difficult. METHODS: Therefore, we reviewed the patient's charts of diverticulosis of the cecum and ascending colon at our hospital from 1992 to 1997. RESULTS: During the past 5 years, a total of 53 cases of diverticulosis of the cecum and ascending colon had been treated at this hospital. Mean age was 41.8 years (range 20-70). The male to female ratio was 1.8 : 1. Frequent complaints were abdominal pain (46 cases, 86.8%), followed by diarrhea (5 cases, 9.3%), indigestion (4 cases, 7.5%), and bowel habits change (2 cases, 3.8%). Mean duration of illness was 3.5 days(range 24 hours~15 days). In non-surgical cases, diagnoses were established with barium enema, CT scan, or ultrasonography. The accuracy of these methods was 91%, 75%, and 25%. In surgical cases, the preoperative diagnoses were appendicitis(13 cases, 50.1%), diverticulitis (7 cases, 31.8%), and abscess (2 cases, 9.1%). Treatments of the cecum and ascending colon diverticulitis were conservative management (3 teases,58.5%) and surgical treatment (22 cases,41.5%). The operative procedures were right hemicolectomies (2 cases), ileocecal resections (2 cases), diverticulectomies (6 cases) and appendectomies only (11 cases). CONCLUSION: These results suggest that correct diagnosis of the diverticulitis of the cecum and ascending colon made before treatment is very important because correct assessment of diverticulitis intraoperatively is difacut. Liberal use of diagnostic modalities could facilitate to make correct diagnosis to set a proper plan for treatment.
Abdominal Pain ; Abscess ; Appendectomy ; Barium ; Cecum* ; Colon, Ascending* ; Diagnosis ; Diarrhea ; Diverticulitis ; Diverticulum* ; Dyspepsia ; Enema ; Female ; Humans ; Male ; Rare Diseases ; Surgical Procedures, Operative ; Tomography, X-Ray Computed ; Ultrasonography

Neonatal diabetes mellitus (NDM) is defined as hyperglycemia that presents clinical symptoms within the first month of life and requires insulin therapy to maintain euglycemia. The diabetic condition may be transient, permanent, or transient with recurrence later in life. NDM is a rare clinical disorder. Three cases of NDM have been reported in Korea so far. We experienced two cases of NDM in twin brothers who were born with small for gestational ages. Their HLA typings were DR9 and DR14, and insulin autoantibody, islet cell antibody, GAD-reactive autoantibody, and insulin receptor antibody were not found. The genetic analysis with polymorphic DNA markers for chromosome 6 indicated paternal uniparental isodisomy.
Chromosomes, Human, Pair 6 ; Diabetes Mellitus* ; Genetic Markers ; Gestational Age ; Histocompatibility Testing ; Humans ; Hyperglycemia ; Insulin ; Islets of Langerhans ; Korea ; Receptor, Insulin ; Recurrence ; Siblings* ; Twins* ; Uniparental Disomy

Myopathy due to hypothyroidism can be detected in its early stage, but as the symptom is mild, complications such as rhabdomyolysis are rare. Thrombotic thrombocytopenic purpura in hypothyroidism is not yet clearly defined, and rare cases of it are reported. Reported herein is a case of thrombotic thrombocytopenic purpura and rhabdomyolysis associated with acute renal failure in hypothyroidism. A 70-year-old male was admitted to the hospital due to general weakness and muscle pain. Later, based on the laboratory findings, he was diagnosed with rhabdomyolysis associated with acute renal failure and thrombotic thrombocytopenic purpura combined with hypothyroidism. Initially, he was treated with fluid resuscitation due to rhabdomyolysis combined with acute renal failure but eventually, the levothyroxine supplement lowered the thyrotropin-stimulating hormone level. As a result, the patient recovered from rhabdomyolysis and thrombotic thrombocytopenic purpura without receiving plasmapheresis treatment.
Acute Kidney Injury* ; Aged ; Humans ; Hypothyroidism* ; Male ; Muscular Diseases ; Myalgia ; Plasmapheresis ; Purpura, Thrombotic Thrombocytopenic* ; Resuscitation ; Rhabdomyolysis* ; Thyroxine