No abstract available.
Insurance*

PURPOSE: The purpose of this paper was to evaluate the treatment results according to bone union, union time, and complications, including infection of unreamed nailing of tibial fractures between closed and open fractures. MATERIALS AND METHODS: We reviewed 64 tibial shaft fractures that were treated with unreamed tibial nail. These included 42 closed fractures and 22 open fractures. RESULTS: Average union time of closed fractures was 19.8 weeks and that of open fractures was 20.2 weeks, nonunion rate were 4/42 and 3/22 in closed and open fractures. Average union time were 19.2, 20.4, 21.3 weeks in open grade I, II, llla fractures. According to the type of fractures, average union time were 18.5, 20.2, 24.6 weeks and nonunion rate were 2/29, 3/26, 2/9 in type A, B, C fractures. According to the level of fractures, average union time were 20.0, 20.3, 19.4 weeks and nonunion rate were 1/5, 4/37, 2/22 in proximal, middle, and distal fractures. There was no significant differences in average period of radiologic union, infection rate and nonunion rate between closed and open fracture group, but longer union time and higher nonunion rate in complex and comminuted fractures (P<0.05). CONCLUSIONS: We consider unreamed intramedullary nailing in the tibial shaft fractures as a good treatment modality for closed and open grade I, II, IIIa fractures
Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Tibial Fractures*

PURPOSE: The purpose of this study is to assist the optimal placement of sacroiliac screw by evaluating the anatomic and radiologic features of upper sacrum. MATERIALS AND METHODS: Fourteen fresh-frozen cadaveric pelvises and 13 normal adults were studied for the evaluation of morphology of first sacrum and dysplastic patterns. Measurement of anatomic parameters and CT imaging of pelvis were performed. Thirty-two patients with complicated pelvic fracture were evaluated for detection of variations in the sacral alar anatomy and slope found in upper sacral segmentation. RESULTS: The mean distance between midpoint of sacrum and sacroiliac joint was 52.75 mm. The height of first sacral body was 21.71 mm. The longest antero-posterior distance in sacral alar was 52.36 mm. The mean angle between the coronal plane of S1 vertebra and anterior aspect of the alar was 29.3 degree. The mean angle between the superior aspect of S1 vertebral body and superior edge of the alar was 34.8 degree. The mean angle between the superior aspect of S1 vertebral body and supero-posterior edge of the alar was 12.5 degree. The studies revealed about 28 to 33% of cases as dysplastic sacrum. CONCLUSIONS: We studied anatomic and radiologic features of upper sacrum in cadaveric and clinical cases to gain information on the optimal placement of sacroiliac screw.
Achilles Tendon* ; Adult ; Cadaver ; Humans ; Pelvis ; Rupture* ; Sacroiliac Joint ; Sacrum ; Spine

A lymphangionma is a rare benign tumor occuring in the gastrointestinal tract, which is composed of lymphatic vessels of various size. A sharply demarcated smooth, soft, cystic submucosal tumor which is easily compressible and covered with normal mucosa is a characteristic ally an endoscopic feature. This lesion is considered to be a benign lesion, which does not need to be treated, but in cases that involve risk of any complications or symptoms, the lesion needs to be removed. Servral endoscopic treatment methods for a symptomatic lymphangioma have been introduced, but accompanying risk of complications, such as bleeding or perforation were reported. As complete removal of a lymphangioma is impossible due to its broad base, a newly developed unroofing method is presented to be effective and safe for resection of a large lymphan-gioma. Recently, 2 cases were experienced involving a lymphangioma in the large intestine, which was removed successfully by colonscopic unroofing therapy.
Colon* ; Colonoscopy ; Gastrointestinal Tract ; Hemorrhage ; Intestine, Large ; Lymphangioma* ; Lymphatic Vessels ; Mucous Membrane

BACKGROUND/AIMS: Cannulation failure to biliary tract has been reported in 10% of patients who are performed diagnostic and therapeutic ERCP. Infundibulotomy by use of needle knife is cutting a bulbar part of protruding papilla, which has merit to avoid complete destruction of sphincter of Oddi and serious side effects than general precutting method. We want to know effectiveness and safety of infundibulotomy. METHODS: From January 1997 to December 1998, 36 patients who failed cannulation over three times trial by conventional method are included to this study. We compared the success rate of cannulation and procedure related complication according to bile duct dilatation, periampullary diverticulum and shape of ampulla of Vater. RESULTS: 1) Success rate of cannulation to bile duct is 81% (29/36). 2) All patients in group of bile duct dilatation (14) are succeed to cannulation, which is significantly high compare to other group (p=0.0288). 3) There was no statistical difference in success rate according to presence of periampullary diverticulum. 4) In groups of bulging prominent papilla are succeed in 23 among 26 patients, which is tendency of high in patients than other group (p=0.0760). 5) Total occurrence of procedure related complication was 33% (12/36). 6) The complication rate was not different in two groups according to cannulation success 7) The complication rate was tendency of high in patients without bile duct dilatation (p=0.0756). CONCLUSIONS: Infundibulotomy by use of needle knife is effeetive and safe cannulation method to patient who failed cannulation to bile duct. Success of cannulation is low and occurrence of complication is tendency of high in patient without bile duct dilation, which propose endoscopists attention in selection of indications.
Ampulla of Vater ; Bile Ducts ; Biliary Tract ; Catheterization* ; Cholangiopancreatography, Endoscopic Retrograde* ; Dilatation ; Diverticulum ; Humans ; Needles ; Sphincter of Oddi

Pseudomelanosis duodeni is a rare benign condition that manifests endoscopically as diffuse, small brownish-black spots in the duodenal mucosa, and the histochemical findings show an accumulation of hemosiderin pigment in the duodenal villi's lamina propria. This condition produces no specific symptoms, and it may be reversible. The cause and natural history of the pigmentation have not been clarified, although it is associated with a variety of systemic illnesses and medications. We describe two cases of pseudomelanosis duodeni and the patients had histories of diabetes mellitus, hypertension, chronic renal insufficiency and specific medications. We also review the relevant medical literature on this rare condition.
Diabetes Mellitus ; Duodenum ; Hemosiderin ; Humans ; Hypertension ; Iron ; Melanosis ; Mucous Membrane ; Natural History ; Pigmentation ; Renal Insufficiency, Chronic

Intussusception is defined as the telescoping of one segment of the gastrointestinal tract into an adjacent one. The incidence of the adult intussusception is low. It constitutes approximately 5% of all intussusception and accounts for 5% of all cases of intestinal obstruction in adult. The clinical feature in adults is not typical. General symptoms and signs of intestinal obstruction dominate the clinical feature of intussusception in adult. The classic appearance of intussusception on barium studies is the coil spring appearance as contrast is trapped between the intussusceptum and intussuscipiens. Ultrasound and CT scan shows a target-like lesion. Colonofiberscopy shows a round invaginated mass with congested mucosa and by air inflation, round mass is decreased in size and is changed in shape. Differential diagnosis can be made by colonofiberscopy because the most common cause of colonic intussusception in adult is a primary colon cancer. A case of diverticulitis associated with intussusception diagnosed by colonofiberscopy in a 72 years old man was presented with brief review of the literature.
Adult ; Aged ; Barium ; Colon ; Colonic Neoplasms ; Diagnosis, Differential ; Diverticulitis* ; Estrogens, Conjugated (USP) ; Gastrointestinal Tract ; Humans ; Incidence ; Inflation, Economic ; Intestinal Obstruction ; Intussusception ; Mucous Membrane ; Tomography, X-Ray Computed ; Ultrasonography

Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmentation of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amylase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by computed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial.
Abdominal Pain ; Afferent Loop Syndrome* ; Amylases ; Constriction, Pathologic ; Endoscopes ; Gastrectomy ; Gastric Bypass ; Humans ; Lithotripsy* ; Middle Aged ; Pancreatic Ducts ; Pancreatitis

Schwannoma is a peripheral nerve sheath tumor first reported by Verocay in 1910. Most schwannomas are found in the spinal cord and large nerves of the neck and limbs. They rarely occur in the digestive tract. Gastric schwannomas comprise approximately 0.2% of all gastric tumors and 4% of benign gastric tumors. Usually, diagnosis is difficult without histopathologic evaluation because their clinical symptoms and endoscopic findings are not specific. Immunocytochemical studies are required to distinguish schwannomas from gastrointestinal stromal tumors (GISTs) and leiomyomas. This is a report of one case of gastric schwannoma presenting with iron deficiency anemia, a gastric submucosal tumor on endoscopy, and is diagnosed by immunohistochemical evaluation after subtotal gastrectomy.
Anemia, Iron-Deficiency* ; Diagnosis ; Endoscopy ; Extremities ; Gastrectomy ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Iron* ; Leiomyoma ; Neck ; Neurilemmoma* ; Peripheral Nerves ; Spinal Cord ; Stomach

BACKGROUND/AIMS: ERCP is being used increasingly as a diagnostic and therapeutic tool for children with pancreaticobiliary disorders. Differences between thirteen pediatric ERCPs and adult ERCPs were reviewed with respect to their indications, method of anesthesia, choice of endoscope and complications. METHODS: The medical records of 13 ERCPs for 10 children (age: 23 months to 14 years) done between 2005 and 2008 were reviewed retrospectively. RESULTS: ERCP was indicated for gallstone pancreatitis (6), choledocholithiasis (3), and unexplained pain (1). The method of anesthesia was intravenous sedation with a single agent or a combination of midazolam, propofol or ketamine. The quality of sedation was satisfactory in 10 cases and unsatisfactory in three cases. These 3 cases were less than 8 years old and sedated with a combination of midazolam and propofol. Selective biliary cannulation was successful in 92.3% (12/13) of attempts. Therapeutic ERCP included sphincterotomy (4), endoscopic papillary balloon dilatation (3), and both (5). Complications occurred in 7.7% of attempts (1/13; 1 duodenal perforation) which was successfully managed by surgery. CONCLUSIONS: Pediatric ERCP is a feasible and useful technique. Special caution is needed, however, because of differences with adult ERCP in terms of the effectiveness of intravenous sedation, complications, and size of the gastrointestinal tract.
Adult ; Anesthesia ; Catheterization ; Child ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Dilatation ; Endoscopes ; Gallstones ; Gastrointestinal Tract ; Humans ; Ketamine ; Medical Records ; Midazolam ; Pancreatitis ; Propofol ; Retrospective Studies