BACKGROUNDS: Reflux esophagitis has been known to be a frequent complication after a total gastrectomy. Reflux esophagitis is very annoying to the patients, so various types of reconstructions has been introduced to eliminate this complication. METHODS: This study is a retrospective clinical analysis of 34 patients with gastric cancer who were treated with a total gastrectomy from January 1989 to December 1997 at the Department of Surgery, Seoul Adventist Hospital. RESULTS: During 9 years, the operation was performed on 194 patients with gastric cancer, amomg which 34 (17.3%) were total gastrectomies. The peak age was in the 5th and the 6th decades (58.8%), and the sex ratio of males to females was 1.6:1. The sites of the stomach cancer were the cardia (C) in 10 cases (29.4%), the body (M) in 19 cases (55.9%), and the cardia and body in 5 cases (14.7%). The TNM classification was stage I in 15.6% of the cases, stage II in 15.6% of the cases, stage III in 62.5% of the cases, and stage IV in 6.3% of the cases. Three methods of alimentary tract reconstruction were used:a loop esophagojejunostomy with a Braun anastomosis (27), a Roux-en-Y esophagojejunostomy (6), and an uncut Roux procedure (1). The reflux esophagitis rates for patients treated with a loop esophagojejunostomy with a Braun anastomosis and for patients treated with a Roux-en-Y esophagojejunostomy were 25.9% and 16.7%, respectively. The perioperative mortality was 5.8%, and the causes of death were pneumonia and anastomotic leakage. The most common recurrent site was the anastomotic site. CONCLUSIONS: Reflux esophagitis developed more often after a loop esophagojejunostomy with a Braun anastomosis than after a Roux-en-Y anastomosis. This finding was not significant statistically. Thus, further study of more cases is needed.
Anastomosis, Roux-en-Y ; Anastomotic Leak ; Cardia ; Cause of Death ; Classification ; Esophagitis, Peptic* ; Female ; Gastrectomy* ; Humans ; Male ; Mortality ; Pneumonia ; Retrospective Studies ; Seoul ; Sex Ratio ; Stomach Neoplasms*

To estimate the child and infant mortality rates among Korean children, a mortality survey was carried out in the province of Kyongsangnam,buk-do. The study population are the beneficiaries of Korea Medical Insurance Coorporation (KMIC), Kyongsangnam,buk-do area, among which the 3,867 and 1767 deaths occurred from January, 1989 to December, 1990 in Kyongsangnam-do area and from January, 1991 to December, 1991 in Kyongsangbuk-do area respectively. We reviewed the data to confirm the causes of death. These were based on the death certificates and medical utilization records before dying which were available through the computerized databases on medical care utility of KMIC. The survey conducted along three steps. At first, the death certificates were examined, as a second step, medical utilization records were reviewed, and finally direct contacts to the family members of the deceased were done. As a result, 115 deaths were found under 20 years of age. Using them, age specific mortalities and causes of death were estimated. Mortality rate in this area was estimated 129 per 100,000 person-years during 1 month to 11 months of age, 67 during 1 year to 4 years of age, 23 during 5 years to 9 years of age, 10 during 10 years to 14 years of age, and 29 during 15 years to 19 years of age, respectively. And the frequent causes of death were congenital anomalies, central nervous system (CNS) diseases, certain condition originating from perinatal period during 1 months of age; accidents, congenital anomalies, malignancies, CNS diseases, and pneumonia or bronchiolitis during 1 to 4 years of age; accidents, malignancies, CNS diseases, and congenital anomalies during 5 to 14 years of age; and accidents, suicide, malignancies, and CNS diseases during 15 to 19 years of age.
Bronchiolitis ; Cause of Death ; Central Nervous System ; Central Nervous System Diseases ; Child ; Child Mortality* ; Child* ; Death Certificates ; Gyeongsangbuk-do ; Gyeongsangnam-do ; Humans ; Infant ; Infant Mortality ; Insurance ; Korea ; Mortality ; Pneumonia ; Suicide

The calcar femorale is a specific anatomic entity which is often confused with the medial trabecular system or posteromedial cortex of the neck of the femur. The clinical significance of its architecture is evident when one considers the great number of operative procerdures performed in the upper end of the femur. This study deals with 45 cases of the Korean Dry femur(male: 27, female: 12, useless: 6) and two pairs of the femur from the cadavers. The authors observed the three dimensional structure of the calcar femorale and studied the relation between anteversion and calcar femorale. The results obtained were as follows: 1. The calcar femorale was a vertical plate of the thickened bone that lay deep to the lesser trochanter. The length in the vertical axis of the calcar femorale was 44.82±3.59mm. The calcar femorale was thickest medially where it joins the medial trabecular system of the femoral neck (maximal thickness: 2.65±0.65, width: 8.90±1.82mm). 2. The calcar femorale lay in one plane, which inclined 30.02±7.80 degree to the discondylar axis of the femur. By using this inclination of the calcar plane, it could be best visualized with about 60° external rotation of femur in a simple X-ray. 3. The angle between the calcar plane and the diacondylar axis was proportionate to the anteversion of the femoral neck. Correlation coefficient(r=0.80) was calculated. The regression line of y (anteversion) on x(calcar angle) was y=0.75X−8.53(slope). With this proportion, the angle of the femoral anteversion could be determined. 4. Microscopic features of the calcar femorale was revealed in the scanning electron microscopic studies. The medial side of the calcar was a cortical extension and it became thinner posterolaterally and than it was composed of fused or thickened trabeculae.
Cadaver ; Female ; Femur Neck ; Femur ; Humans ; Neck

BACKGROUND: Tumor necrosis factor-alpha(TNF-alpha) has been thought to play a major role in neurological injury during global brain ischemia and subsequent reperfusion following resuscitation in cardiac arrest. So, we hypothesized that the elevation in TNF-alpha was dependent upon the duration of the global brain ischemia, and related to delayed neuronal damage. METHODS: Fourteen rats were divided two groups ; 1 minute-cardiac arrest group(n=7) and 3 minute-cardiac arrest group(n=7). we induced cardiac arrest by chest compression and damping of tracheal tube for 1 minute and 3 minutes respectively. And then, resuscitation was initiated. To measure the plasma activity of TNF-alpha, blood samples were drawn before and at the end of cardiac arrest, and 30, 60, 90, and 120 minutes after initiation reperfusion. At 72 hours after resuscitation, the ND(neurologic deficit) score was determined and the histopathologic outcome of hippocampal CA1 neuron was observed by the percent dead hippocampal CA1 neurons. RESULTS: 1. TNF-alpha level during the early reperfusion period(<2h) was significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(p=0.0001). 2. There was a no significant difference of neurologic deficit score between 1 min- and 3 min-cardiac arrest. 3. Percent dead hippocampal neurons were significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(9.1+/-1.2% vs 1.2+/-0.9%, p<0.05). CONCLUSION: The results suggest that longer duration of global brain ischemia causes a more profound increase in plasma TNF-alpha level during the early reperfusion period(<2h) and more delayed neuronal damage than lessor duration of global brain ischemia, and that increase in TNF-alpha level during the early reperfusion period(<2h) is related to delayed neuronal damage.
Animals ; Brain Ischemia ; Brain* ; Heart Arrest* ; Heart Arrest, Induced ; Necrosis ; Neurologic Manifestations ; Neurons ; Plasma ; Rats* ; Reperfusion ; Reperfusion Injury* ; Resuscitation ; Thorax ; Tumor Necrosis Factor-alpha*

BACKGROUND: The increase of smoking prevalence in adolescents Is serious problem because of physical and psychological influences furthermore, fixation of smoking habit. This study is aimed at providing applicable basic information to setting up the education programs and strategies to prevent smoking among high school students by analysing smoking behavior and its related factors. METHODS: 835 students from one senior high school in Taegu completed a self administerd questionnaire during school hours in May, 1996. 813 questionnaires with adequate responses were analyzed using SPSS/PC program. All students were asked class years, school satisfaction, school performance score, number of their three best friends who smoke, smoking status of their fathers, religion, allowance, alcoholic drinks, addicting drug use, Zung's self-rating depression scale(SDS) and Zung's self-rating anxiety scale(SAS), Smokers were asked amount of smoking, motives for smoking, when they started smoking, Fagerstrom score. RESULTS: Of the 813 students in the sample 135(16.6%) were current smokers. About the amount of smoking, 59.3% smoked less than 5 cigarettes/day. About the motives of smoking, 34.8% started smoking through the solicitation by friends or for making friends. About when they started smoking, 52.6% started smoking before entrance into senior high school. The related factor with smoking Included class years, school satisfaction, school performance score, numbers of three best friends who smoke, allowance, alcoholic drinking, addicting drug use, SDS. Predictor of smoking were number of three best friends who smoke, number of alcoholic drinking, and allowance. The related factors of nicotine dependency were amount of smoking, allowance, when they started smoking. Predictor of nicotine dependency were amount of smoking, number of three best friends who smoke. CONCLUSIONS: The related factors with smoking included class years, school satisfaction, school performance score, number of three best friends who smoke, allowance, alcoholic drinking, addicting drug use, and SDS. Predictors of smoking were number of three best friends who smoke, number of alcoholic drinking, and allowance.
Adolescent ; Alcoholics ; Anxiety ; Daegu* ; Depression ; Drinking ; Education ; Fathers ; Friends ; Humans ; Male* ; Nicotine ; Prevalence ; Smoke* ; Smoking* ; Surveys and Questionnaires

BACKGROUND : There is so different between Doctors at managing the patient with intestinal obstruction. Some prefer conservative management and prefer to delay the operation. But others prefer the early operation. So, we have studied in order to compare the clinical difference between early operation and delayed operation for intestinal obstruction. METHODS : This clinical report is based on a review of the records of 226 patients with intestinal obstruction that have been managed at the Department of General Surgery, Seventh Adventist Hospital in Seoul, during about 4 years from January, 1994 to October, 1997. RESULTS : 1) Male to female ratio was 2.32 : 1. The most frequent age group was within 1 year. 2) The common causes of intestinal obstruction were postoperative adhesion (35.8%), intussusception (19.1%), hernia (16.6%) and neoplasm (8.6%). 3) The chief complaints on admission were abdominal pain in 142 cases (62.8%), nausea and vomiting in 110 cases (48.7%), bloody stool in 43 cases (19.0%) and fever in 27 cases (11.9%). The physical findings were abdominal tenderness in 117 cases (51.8%), increased peristalsis in 98 cases (43.4%) and abdominal distension in 64 cases (28.3%). 4) The previous abdominal operation leading to intestinal obstruction were appendectomy in 16 cases (27.6%), small bowel operation in 13 cases (23.4%), gastro-duodenal operation in 9 cases (15.5%) and gynecologic operation in 7 cases (12.1%). 5) In patients who admit because of intestinal obstruction due to previous operation, most of them entered in hospital within 6months after previous operation. 6) Among 226 cases, 46 cases (20.4%) had emergency operation, 64 cases (28.3%) had only conservative treatment and 116 cases (51.3%) had elective delayed operation 7) In patients who was cured with only conservative management, 12 cases (18.8%) of them stayed for 1day on hospital and 32 cases (50%) of them stayed for 1 or 2 days. 8) Exploratory laparotomy was performed in 162 cases. The types of obstruction were composed of 36 cases (22.2%) of strangulated obstruction and 126 cases (77.8%) of simple obstruction. The frequency of strangulated obstruction was 14 cases (38.9%) when the early operation were done, and that ofstrangulated obstruction was 22 cases (61.1%) when the delayed operation were done. There was significant difference between early operation group and delayed operation. 9) As for operative procedure, adhesiolysis was done in 38 cases (23.5%), bandlysis was done in 30 cases (26.1%), manual reduction and incidental appendectomy was done in 28 cases (17.3%). 10) The incidence of postoperative complication was 46 cases (28.4%) and the most cause of death was septic shock. CONCLUSIONS : The early operation for the patient who suffered from intestinal obstruction due to previous operation is better than delayed operation.
Abdominal Pain ; Appendectomy ; Cause of Death ; Emergencies ; Female ; Fever ; Hernia ; Humans ; Incidence ; Intestinal Obstruction* ; Intussusception ; Laparotomy ; Male ; Nausea ; Peristalsis ; Postoperative Complications ; Seoul ; Shock, Septic ; Surgical Procedures, Operative ; Vomiting

BACKGROUND: As the mean life span is prolonged, the concern about health care in postmenopuasal women is now promoted. Expecially, osteoporosis is the serious health problem in postmenopausal women. Bone mineral density in postmenopause is controlled by that in premenopause. Therefore, we searched for the factors which contribute to bone mineral density in premenopause. METHODS: The study subjects who visited the Health Screening and Diagnosis Center in Yeungnam University Hospital from March 1998 to July 1999 was measured BMD at the lumbar spine using Dual Energy X ray Absorptiometry. Subjects were checked past medical history, life style(smoking, drinking, physical activity, exercise etc.), birth history, breast feeding, oral pill intake. The subjects who had disorders known to interfere with bone metabolism and premature menopausal and surgical menopausal women were excluded from the study. And we reviewed the results of the laboratory and radiologic findings which had done in Health Screening and Diagnosis Center. RESULTS: 352 women were included in this study. The number of normal BMD was 228 and the number of osteopenia was 124. Weight, height, BMI, exercise was significant positively correlated with bone mineral density(p<0.05). Previous operation history was significant negatively correlation with bone mineral density(p<0.05). Multiple logistic regression result showed that weight was the most significant factor affecting to BMD and the history of operation and exercise were significant factor affecting BMD(p<0.05). CONCLUSION: In postmenopausal women, who has low weight, past operation history and lack of exercise were need to evaluation of BMD and education for prevention of osteoporosis is needed.
Absorptiometry, Photon ; Bone Density ; Bone Diseases, Metabolic ; Breast Feeding ; Delivery of Health Care ; Diagnosis ; Drinking ; Education ; Female ; Humans ; Logistic Models ; Mass Screening ; Metabolism ; Motor Activity ; Osteoporosis ; Postmenopause ; Premenopause ; Reproductive History ; Spine

BACKGROUND: Osteoporosis is an important and common medical problem in postmenopausal women. Depression is another major public health concern. Due to the high prevalence of both depression and osteoporosis, even a weak association between them might result in a greater health problem. We have investigated whether depression is associated with bone mineral density (BMD) in peri- and postmenopausal women. METHODS: The study subjects who visited the office of family medicine department and the health screening and diagnosis center in one general hospital from January to May, 2000 were selected. BMD was measured at the lumbar spine using Dual Energy X-ray Absorptiometry. We evaluated the depression scale using the Beck Depression Inventory. The subjects who had disorders known to interfere with bone metabolism or those who had taken medication related to depression were excluded from the study. RESULTS: Significant positive correlation were noted between BMD and height and weight (P<0.05) but no correlation was found with depression in perimenopausal women. In postmenopausal women, significant negative correlation was noted between BMD and age, and postmenopausal duration and depression. Significant positive correlation was found between BMD and height and weight (P<0.05). CONCLUSION: Our results showed that depression was associated with BMD in postmenopausal women which was independent of other factors strongly associated with osteoporosis.
Absorptiometry, Photon ; Bone Density* ; Depression* ; Diagnosis ; Female ; Hospitals, General ; Humans ; Mass Screening ; Menopause ; Metabolism ; Osteoporosis ; Prevalence ; Public Health ; Spine

Erythema elevatum diutinum(EED) is a rare chronic skin disease characterized by red, purple, and yellowish papules, plaques, and nodules that are usually distributed acrally and symmetrically over extensor surface. It is characterized histologically by a leukocytoclastic vasculitis. Although no treatment has shown a complete response, dapsone is reported to be effective to EED. We report a rare severe case of EED with good response to dapsone treatment.
Dapsone ; Erythema* ; Skin Diseases ; Vasculitis

Overcrowding of emergency department is a serious and growing problem at St. Mary's Hospital. This has motivated the development of short-stay unit(SSU) as an alternative ward to routine hospital admission and ED discharge. In our hospital a SSU begun to admit patients in January 6, 1997. the SSU received 247 patients from the ED during the eight month interval(January 6, 1997 to August 31, 1997). To examine the utilization of the SSU in ED, we retrospectively analyzed 247 patients admired in SSU from the ED, and compared the average hours per patient with acute gastroenteritis spent in the ED doing the 2-month intervals before(July-August 1996) and after(July-August 1997) the establishment of the SSU. The following results were obtained; 1. The total patients consist of EM 92(37.2%), GS 48(19.4%), IM 24(9.7%), PS 21(8.5%), OS 20(8.1%), OBGY 14(5.7%) and others 28(11.3%). 2. The results of EM patients admitted in SSU from ED 1) Sex ratio of male to female was 1:1.1 and the mean age was 37.3+/-16 years. 2) In diagnosis, acute gastroenteritis was 29 cases(31.5%), multiple contusion 14 cases(15.2%), drug intoxication 12 cases(13%), limb laceration 6 cases(6.5%), tendon rupture offhand 6 cases(6.5%), and others 19 cases(20.6%). 3) Mean length of stay in ED was 9.18 hours. 4) Among 92 patients to the SSU, 79 patients(85.9%) were discharged, 11 patients(11.9%) formally admired to hospital and 2 patients(2.2%) transferred to otherhospital. The mean hospital stay time of the patients admitted to SSU was 2.6 days. 3. There was a significant reduction in the average stay time spent in the ED by treat-and-releasing patients with acute gastroenteritis after the establishment of the SSU(from 14.65+/-9.6 to 7.52+/-5.4 hr/patient, p<0.001). Conclusively, the establishment of the SSU can shorten the average stay time that treat-and-releasing patients spend in the ED, and reduce the number of admixed patients waiting in the ED.
Contusions ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Extremities ; Female ; Gastroenteritis ; Humans ; Lacerations ; Length of Stay ; Male ; Retrospective Studies ; Rupture ; Sex Ratio ; Tendons