Emergency endoacopy was performed in 315 patients for recent four years The source of upper GI bleeding in these 315 caaes were as follows: Esophageal varix(93), gastric ca(39), Mallory-weiss syndrome(14), gastric ca(38), Duodenal ulces(21), Erosive gastritis(14), Marginal ulcer(2), Combined case(24) Unknown cases(10), Essentiall Tx was not performed in 4 died case because of poor general conditions, After check up BP, Heart, Pluae rate, that examination was performed during drip infusion to be 'safety of cireulatary system. No compication were encountered. To confirm the source of bleeding at earlier stage, was useful to decid which way, that is conservative of surgical therapy in which better for the Management. The results are as follows: 1) The sex incidence of upper GI bleeding showed Male predominance c a ratio 4. 6: 1 and peak age groups were 4th & 5th decade. 2) Endoscopic diagnosis of npper GI bleeding in the studied case were in the order of Esophageal varix bleeding(29%), Gastric ulcer (23. 5%), Mallory weiss syndrome(12. 4%) Duodenal ulcer(6.7%) Erosive gastritis(4.4%) We could not find the bleedi site in 3.2% of the studied case. 3) The cause of emergeney endoseopy are Melena(19%), Hemstenesis(22.0%) and ccenbined (58. 4%) 4) Among the 315 cases of upper GI bleeding, 70. 1% of the cases revealed moderste degree of bleeding. 5) Among the 315 cases of apper BI bleeding, 28. 1% of the cases were confirmed of inducing factor. 6) Among the 315 cases of upper BI bleeding, 69% of the cases received an endcrscopic examination within 72 hr after initial episode of bleeding. (continue...)
Diagnosis ; Emergencies* ; Endoscopy* ; Esophageal and Gastric Varices ; Heart ; Hemorrhage* ; Humans ; Incidence ; Infusions, Intravenous ; Male ; Stomach Ulcer

PURPOSE: Subungual squamous cell carcinoma is a very rare malignant tumor of the digitus especially in toe making it very difficult to differentiate from tinea unguium, verruca vulgaris, eczema, pyogenic granuloma, and malignant melanoma due to their clinical similarities. Therefore this article reports on subungual squamous cell carcinoma of left 5th toe. METHODS: A patient visited at our hospital due to pain and incurable inflammation on left 5th toe with no improvement for four months. Despite of antibiotics and dressing for a week, treatment was ineffective. After excisional biopsy, he was diagnosed with subungual squamous cell carcinoma. And ray amputation and prophylactic inguinal lymph node dissection was done. RESULTS: The biopsy was showed irregular cells made up of anaplastic and squamous cells in the dermis and epidermis. And the inguinal lymph node showed no metastasis. The patient had been treated without significant complications or recurrence for a year. CONCLUSION: This article emphasizes the need of diagnostic biopsy on the subungual lesions that have resistance to the conventional treatments. And if that is subungual squamous cell carcinoma, complete resection of the lesion and prophylactic inguinal lymph node dissection is essential.
Amputation ; Anti-Bacterial Agents ; Bandages ; Biopsy ; Carcinoma, Squamous Cell ; Dermis ; Eczema ; Epidermis ; Granuloma, Pyogenic ; Humans ; Inflammation ; Lymph Node Excision ; Lymph Nodes ; Melanoma ; Neoplasm Metastasis ; Onychomycosis ; Recurrence ; Toes ; Warts

PURPOSE: We studied 250 men who are over 50 years of age to evaluate the feature of benign prostatic hyperplasia and its impact on quality of life in rural areas of the Korea. MATERIALS AND METHODS: Two hundred fifty men participated in this study. Urinalysis, urine culture, uroflowmetry, digital rectal examination and serum PSA were examined on all the participants. Transrectal ultrasonography(TRUS) were performed in 234 men. RESULTS: Of these 250 men, symptom prevalence was 78.71%. The age distributions of 50-59, 60-69, 70-79 and > or =80 years of age were 91, 111, 43 and 5 men respectively(mean 62.4). The mean prostatic volumes for 50-59, 60-69, 70-79 and > or =80 years of age group were 27.33cm3, 29.95cm3, 28.89cm3 and 33.55cm3. Of these, its volume difference was not statistically significant. Of 250 men, mildly symptomatic group(IPSS< or =7) was 22.5%, moderately symptomatic group(8< or =IPSS< or =19) 43%, and severely symptomatic group(IPSS> or =20) 34.5%. Severely symptomatic group showed higher mean age(p=0.0478), lower maximal flow rate(MFR)(p=0.024) and average flow rate(AFR)(p=0.003). Mildly symptomatic group showed smaller prostatic volume(p=0.013). Mean quality of life score for mildly, moderately, and severely symptomatic group were 2.09, 3.50, and 4.51 points, the score of which showed statistical difference(p<0.001). On comparison between the group of MFR<15ml/sec and the group of MFR> or =15ml/sec, statistical difference for the mean age (p<0.001), voided volume (p<0.001), QOL (p=0.02) and symptom score (p=0.002) was found. But no difference was found in prostatic volume(p=0.261). MFR, AFR and voided volume did not show significant correlation with prostatic volume. But serum PSA level was strongly correlated with prostatic volume. The AFR was a greatest determinant to symptom score in multiple regression analysis. CONCLUSIONS: The symptom prevalence in rural areas of the Korea is not any less than that of western society. This study shows that it too has a great impact on the quality of life in rural Korea. The prostatic volume itself had no significance on symptom score nor uroflowmetric parameters. The uroflowmetric parameter such as MFR is more important in evaluating symptomatic patients than prostatic volume itself.
Age Distribution ; Digital Rectal Examination ; Gangwon-do* ; Humans ; Korea ; Male ; Prevalence ; Prostatic Hyperplasia* ; Quality of Life* ; Ultrasonography ; Urinalysis

PURPOSE: The objectives of this study are to observe the clinical characteristics, outcome of treatment and incidence of diastasis of the symphysis pubis after delivery and to evaluate the risk factors of the lesion. MATERIALS AND METHODS: Seventy-six patients diagnosed with diastasis of the symphysis pubis were reviewed. The diagnostic criteria of diastasis were; 1) positive signs and symptoms of pelvic instability, 2) radiological evidence of widening of the symphysis pubis by more than 6 mm and/or vertical mobility of more than 3 mm, or widening of the sacroiliac joint by more than 4 mm. Several factors that increase the risk of this lesion during delivery were reviewed and analyzed using the chi-square test, t-test, and by logistic regression. RESULTS: Seventy-six diastasis of the symphysis pubis were diagnosed in 24,089 deliveries during the study period. Joint widening ranged from 3 mm to 34 mm. Twenty-three cases had accompanying vertical mobility. Pain in the pelvic joint and walking difficulty were most common clinical characteristics. History of pelvic girdle relaxation during pregnancy was found to increase the risk of the lesion (P=0.0028). CONCLUSION: We found that a history of pelvic girdle relaxation during pregnancy was a risk factor of diastasis of the symphysis pubis after delivery. Early detection and satisfying results by optimal treatment are associated with recognizing the lesion's characteristic clinical findings.
Humans ; Incidence ; Joints ; Logistic Models ; Pregnancy ; Relaxation ; Risk Factors ; Sacroiliac Joint ; Walking

A generalized Shwartzman reaction(gSr) is characterized by vascular injury with microvascular fibrin deposition, leukocyte aggregation and hemorrhagic lesions in various organs and elicited by endotoxin from gram-negative bacteria. Leukocyte adherence to endothelial cells has been regarded as a pivotal event in this type of neutrophil mediated inflammatory response. Recently, it was described that leukocyte adhesion to endothelium is facilitated by the adhesion molecules, such as LFA-1(CDIIa/CD18) or Mac-1 (CDllb/CD18) binding to intercellular adhesion molecule-1(ICAM-1). To investigate the role of cell adhesion molecules in inflammatory vascular injury, the authors examined the expression of cell adhesion molecules, ICAM-1 and CD18, in gSr. Group A(n=5) received two injections of lipopolysaccharide(LPS) from E. coli 055:B5; 200 microgram/kg and 200 microgram/kg 24hours apart. Group B(n=5) received one dose of LPS(200 microgram/kg) after glucocorticoid treatment(methylprednisolone, 25mg/kg/day). Group C(n=5) received single dose of LPS(200 microgram/kg). The control group(n=3) received two injections saline instead of LPS. Animals were sacrificed four hours after the last dose of LPS or saline, The results were as follows: 1) Group A and B showed numerous fibrin micro-thrombi, inflammatory cell infiltration and some he-morrhagic change in kidney and lung, but group C and the control group did not show any lesions. In kidney the degree of fibrin deposition by IF was significantly increased in group A and B when compared to group C(p<0.05). 2) ICAM-1 was expressed by vascular endothelium including glomerular capillaries and some lymphocytes in the control group, This expression was increased in group C. But, group A and B was significantly decreased in ICAM-1 expression, especially in kidney comparing with group C and the control group(p<0.05). 3) Group A and B were significantly increased in CD18 expressing cells in glomerulus when compared with the control group(p<0.05). The number of CD18 expressing cells in glomerulus correlated significantly with a degree of fibrin deposition. In conclusion, these results suggest that the development of gSr requires the adhesion of activated inflammatory cells especially neutrophils to vascular endothelium and these are achieved by the interaction of adhesion molecules like ICAM-1 and CD18. Replacing the LPS with a glucocorticoid also expressing ICAM-1 on endothelium and prepares for leukocyte adhesion to endothelium.
Animals ; Capillaries ; Cell Adhesion Molecules ; Cortisone* ; Endothelial Cells ; Endothelium ; Endothelium, Vascular ; Fibrin ; Gram-Negative Bacteria ; Intercellular Adhesion Molecule-1 ; Kidney ; Leukocytes ; Lung ; Lymphocytes ; Neutrophils ; Shwartzman Phenomenon* ; Vascular System Injuries

Since Winslow and Edwards24) reviewed 20 cases of the arteriovenous fistulas involving temporal artery described in the world wide literatures up to 1934, several authors have added the cases sporadically, but the arteriovenous fistula of the superficial temporal artery is unusual to the head and neck surgeons. Recently we experienced one case of huge traumatic arteriovenous fistula involving the superficial temporal artery and present it here.
Arteriovenous Fistula* ; Head ; Neck ; Temporal Arteries*

PURPOSE: To study the microscopic anatomic relation of capsulopalpebral fascia, orbital septum, and tarsus of the lower eyelid in Korean. METHODS: Foureteen normal Korean lower eyelids from 14 formalin-fixed cadavers (mean age of 66.5 years) were harvested and studied with light microscopy after staining with hematoxylin and eosin. Dimensions of the structures and distances between them was measured by analyzing the digital photographs. RESULTS: There was no fusion of the orbital septum and the capsulopalpebral fascia at the lower border of the tarsal plate in 10 specimens and limited fusion of these tissue in 4 specimens. The average distance from the inferior tarsal border to the first identifiable smooth muscle nuclei of the inferior tarsal muscle was 1.38 mm. The average tarsal plate thickness was 0.98 mm and the average tarsal plate height was 3.96 mm. CONCLUSIONS: The Korean lower lid anatomy differs from that of their non-Asian counter parts. Furthermore, there was a difference in tarsal plate thickness in comparison to Chinese lower lids. There was no consistent fusion between the capsulopalpebral fascia and the orbital septum. No extension of the capsulopalpebral fascia to the skin was observed.
Ankle ; Asian Continental Ancestry Group ; Cadaver ; Eosine Yellowish-(YS) ; Eyelids* ; Fascia ; Hematoxylin ; Humans ; Microscopy ; Muscle, Smooth ; Orbit ; Skin

The development of renal glomerular lesions secondary to severe visceral infection (pulmonary, pleural, retroperitoneal or hepatic abscess) is not generally appreciated. Such patients resemble those with infective endocarditis. The suggested pathogenetic mechanisms by which infection can cause glomerular damage are immunologic interaction, direct toxicity of a bacterial products, and some other triggering factors; However, direct correlation between the infectious and immunologic events has not been demonstrated. The histopathologic findings of infectious glomerulonephritis are variable, and these findings, as well as the clinical abnormalities, may resolve with effective antimicrobial therapy or abscess drainage. We experienced a case of glomerulonephritis and acute renal failure due to staphylococcal retroperitoneal abscess. The patient was a 58-year-old man who presented with abdominal and back pain. We performed an abdominal CT scan which showed a retroperitoneal abscess which was proven to be a staphylococcal infection upon percutaneous abscess drainage. Furthermore, we performed a renal biopsy in order to investigate hematuria, RBC casts, and proteinuria. Pathologic findings revealed postinfectious glomerulonephritis. Abscess drainage and sensitive antibiotics were administered, after which his symptoms and urinary abnormalities disappeared, and the retroperitoneal abscess subsided. Here, we report a case of a staphylococcal retroperitoneal abscess which led to postinfectious glomerulonephritis and acute renal failure along with a brief review of the literatures.
Abscess* ; Acute Kidney Injury ; Anti-Bacterial Agents ; Back Pain ; Biopsy ; Drainage ; Endocarditis ; Glomerulonephritis* ; Hematuria ; Humans ; Middle Aged ; Proteinuria ; Staphylococcal Infections ; Tomography, X-Ray Computed

Although tourniquet application is a widely accepted adjuvant technique in the field of extremity surgery, its complication may be neglected. A 37-year-old healthy male underwent arthroscopic surgery for left posterior cruciate ligament reconstruction under a combination of spinal and epidural anesthesia. During the eleven hour operation, a tourniquet was applied four times in nine hours on the left thigh. The pressure reached 450 millimeters of mercury. Compartment syndrome developed with muscle ischemia and edema postoperatively. On the first day of the operation, a fasciotomy was performed to prevent the development of crush syndrome. However, bleeding due to vascular injury during the fasciotomy continued and crush syndrome including myoglobinemic renal failure, hyperkalemia, hypovolemic shock, and cardiac arrhythmia developed. On the second day, sudden cardiac arrest occurred during artery ligation. The patient was immediately resuscitated; he recovered, but his mental state was stuporous. Thereafter, the patient was cared intensively for eight days with fluid and electrolyte therapy, ventilatory care, hemodialysis, antibiotics for crush syndrome and renal failure, but the result was unsuccessful.
Adult ; Anesthesia, Epidural ; Anti-Bacterial Agents ; Arrhythmias, Cardiac ; Arteries ; Arthroscopy ; Compartment Syndromes ; Crush Syndrome* ; Death, Sudden, Cardiac ; Edema ; Extremities ; Hemorrhage ; Humans ; Hyperkalemia ; Ischemia ; Ligation ; Male ; Posterior Cruciate Ligament ; Renal Dialysis ; Renal Insufficiency ; Shock ; Stupor ; Thigh ; Tourniquets* ; Vascular System Injuries

PURPOSE: The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the a-neurysmal sac, especially the width of the neck. We describe an early experience and technical aspects of treating wide-necked cerebral aneurysm using a Guglielmi detachable coil (GDC) and simultaneous application of a temporary balloon. MATERIALS AND METHODS: Four cases of unruptured wide-necked cerebral aneurysm were treated with GDC, with simultaneous application of a temporary balloon. Patients were aged between 29 and 49 years. On admission, clinical presentation was subarachnoid hemorrhage (SAH) in all cases. Hunt and Hess grade was II in two cases, III in one case, and traumatic SAH in one case. In all patients angiography revealed an asymptomatic a-neurysm after rupture of another aneurysm or traumatic SAH. The aneurysms were occluded with GDC-10, and a Cirrus balloon occlusion system was used simultaneously. All procedures were performed under endo-tracheal general anesthesia and systemic heparinization. RESULTS: All cases were treated successfully, without parent artery compromise. The occlusion rate at the end of the procedure was total in three cases and subtotal in one. In one case a heparin-related hematoma occurred during post-procedural treatment and the patient eventually expired. One patient underwent follow-up angiography after 6 months, and the coil was not changed. CONCLUSION: An aneurysm may not be completely occluded, but with regard to coil compaction and parent artery preservation, the technique is an attractive alternative.
Anesthesia, General ; Aneurysm ; Angiography ; Arteries ; Balloon Occlusion ; Follow-Up Studies ; Hematoma ; Heparin ; Humans ; Intracranial Aneurysm* ; Neck ; Parents ; Rupture ; Subarachnoid Hemorrhage