Tomography has played an important role in diagnosis of facial bone fracture. Nowadays, it still acts as ainevitable process in decision of adequate treatment in patient with facial bone fracture. At the Department ofRadiology, Hanyang University Hospital, 74 patients who have facial bone fracture, were observed and analyzed withsimple skull films, mainly skull A-P, lateral and Water's view, after comparison with tomographic findings. Theresults were as follows; 1. Male was in 90.5% incidence. Most frequent age distribution was 21 to 40 years andmarked 62.2%. 2. Most frequent cause of trauma was traffic accident as 41 cases and the next one was fall down as13 cases. Other cause were blunt trauma such as first, stone, heavy metal etc. and explosion. 3. Clinical symptomsand physical signs were painful swelling, abrasion, ecchymosis and subconjuctival hemorrhage in almost allpatient. 4. Fracture distribution was 22 cases in simple fracure and 52 cases in complex fractures which were 26cases in Tripod fractures, 14 cases in Le Fort fractures and 12 cases in combined complex fractures. 5. Theradiologic findings on tomography were opacity of orbit of P.N.S. 87.8%, regional soft tissue swelling 85.1%,displacement of bony fragment 56.8%, abnormal linear density in orbit or P.N.S. 48.6%, bony fragment in orbit orP.N.S. 47.3% change of size of orbit of P.N.S. 40.5%, foreign body in orbit or P.N.S. 16.2%, and others 27.0%.These radiologic findings of simple fracture were less than those of complex fracture. 6. Radiologic findings offacial bone fracture on simple films were analyzed after comparison with tomograhs. Detectable possibility ofobvious fracture lines such as cortical disruption or separation was 67.6% on simple filsm. Detectable possibilityof other radiologic findings on simple films were displacement of bony fragment 86.7%, abnormal linear density inorbit or P.N.S. 88.6%, bony fragment in orbit or P.N.S. 71.4%, opacity of orbit or P.N.S. 90.8%, change of size ororbit or P.N.S. 96.4%, regional soft tissue swelling 96.2%, foreign boy in orbit or P.N.S.41.7%. Others such asabsence or deformity of infraorbital foramen, subcutaneous emphysema or intraorbital air 40.0%. Thereforetomography is inevitably taken to correct diagnosis of facial bone fracture.
Accidents, Traffic ; Age Distribution ; Congenital Abnormalities ; Diagnosis ; Ecchymosis ; Explosions ; Facial Bones ; Foreign Bodies ; Fractures, Bone ; Hemorrhage ; Humans ; Incidence ; Male ; Orbit ; Skull ; Subcutaneous Emphysema

Dieulafoy ulcer is an unusual cause of massive, recurrent and frequently fatal gastrointestinal hemorrhage that results from erosion of abnormally large submucosal artery. Although the lesion has been found throughout the gastrointestinal tract, it most commonly occurs in the proximal stomach. Diagnosis depends on the observation of protruding and eroded artery with pulsatile bleeding or adherent thrombus by endoscopy. Even during active bleeding, the endoseopic examination can be negative if intraluminal blood or clots obscure the source of bleeding. If the bleeding has stopped, the small mucosal lesion can be easily overlooked. Unlike peptic ulceration, there is no excavation of the mucosa. A 76-year-old man presented with massive hematemesis and melena. The patient had no previous history of peptic ulcer disease. He did not drink alcohol and use aspirin or NSAIDs. Physical examination revealed a pale, severely diaphoretic male with hypotension and melenic stools. He was found to have hemoglobin 4.0 g/dL and hematocrit 12.7%. We performed emergency endoscopy which showed a pulsatile and bleeding exposed artery without evidence of surrounding ulcerative lesion on the posterior wall of upper body of stomach. Endoscopic ligation using O ring of Stiegman-Goff endoscopic ligator kit was done successfully and the bleeding stopped immediately after ligation. Ten days after treatment, endoscopy showed artificial ulcerative lesion on previous ligated site and no evidence of bleeding. Another endoscopy four days later revealed healing ulcerative lesion. After improvement, the patient was discharged and rebleeding has not occurred to date.
Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Arteries ; Aspirin ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hematemesis ; Hematocrit ; Hemorrhage ; Humans ; Hypotension ; Ligation* ; Male ; Melena ; Mucous Membrane ; Peptic Ulcer ; Physical Examination ; Stomach ; Thrombosis ; Ulcer*

Heterotopia (of Ectopia) is defined as the occurrence of normal tissue in an abnormal location. Heterotopic gastric mucosa has been found throughout the length of the gastrointestinal tract from oral cavity to the rectum. Curiously, it is extremely rare in the gailbladder, but when it occurs, it tends to cause symptoms of acute cholecystitis in patients under 20 years of age, and chronic cholecystitis and gallstones in older patients. The heterotopic mucosa results in an intramural mass, a polyp or multiloculated gallbladder. A firm diagnosis of gastric heterotopia is based on the presence of fundic or pyrolic mucosa replete with parietal and chief cells. A clear distinction from intestinal rnetaplasia should be made, but at times may be difficult. Potential complications include mucosal ulceration, obstruction, and hemorrhage. Treatment is cholecystectomy. We report a case of gastric heterotopia in the gallbladder of a 35-year-old-man. Ultrasonography showed fatty change of liver with a 1.5 cm-sized polypoid lesion in the gallbladder. Endoscopic retrograde cholangiography showed a small filling defect, revealed by pooling of the dye in the center, in the body of gallbladder. Laparoscopic cholecystectomy was performed. A sessile polypoid leision with central umbilication was seen in the upper body of gallbladder, without gallstones. The microscopic finding of polypoid lesion consisted of gastric pyloric glands with parietal and chief cells. The surrounding mucosa revealed ordinary gallbladder epithelium without any metaplastic change. We report a case of this condition in which there was a separate loculus lined by gastric epithelium.
Cholangiography ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Diagnosis ; Epithelium ; Gallbladder* ; Gallstones ; Gastric Mucosa ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Liver ; Mouth ; Mucous Membrane ; Polyps ; Rabeprazole ; Rectum ; Ulcer ; Ultrasonography

BACKGROUND: Ethical issues in medical practice focuses mainly on critically ill hospitalized pateints or sophiscated technologic developments. However, in the outpatient setting physicians enco unter many problems that require ethical decision making. This study is an assessment of awareness and understanding of ethical issues commonly encountered in ambulatory setting in order to develop education curriculum. METHODS: A questionnaire was designed to evaluate general knowledge of medical ethics using 12 clinical vignettes. The questionnaire was distributed to medical students and residents who were asked to answer whether an ethical issue was present, its significance, and what the specific issues was involved. RESULTS: The response rate was 53%, with 106 of 200 students or residents completing the questionnaire-63 medical students, 14 interns and 25 residents. Respondents' ability to identify that an ethical issue was involved in each vignette ranged from 42.9% to 78.3%. The significance rating ranged from 2.9 to 4.1 on the Likert scale of 1 to 5. A majority of respondents did not identify the correct ethical issue invloved in each vignette. CONCLUSION: This survey showed that the medical students and residents seem to have insufficient knowledge to recognize ethical dilemmas in ambulatory setting. Appropriate medical ethics education should be developed in medical education with particular emphasis on commonly encountered situation.
Critical Illness ; Curriculum ; Decision Making ; Education ; Education, Medical ; Ethics ; Ethics, Medical* ; Humans ; Outpatients ; Students, Medical* ; Surveys and Questionnaires

Endoscopic incision therapy was applied to two patients with postoperative anast-omotic stenosis. Radial diathermy incision was performed by needle knife papillot-ome using cutting current. Tne anastomotic stenosis was characteristic of short fibrotic segment and frequent restenosis after dilatation. An sufficient caliber and smooth, supple wall at the site of the stenosis was produced by incisional therapy by needle knife papillotome using cutting current. Clinical symptoms and endoscopic findings were improved after endoscopic incision. It is concluded that endoscopic incisional therapy seems to be safe and effective method for the treatment of anastomotic stenosis after gastrointestinal operation.
Constriction, Pathologic* ; Diathermy ; Dilatation ; Humans ; Needles*

Endoscopic incision therapy was applied to two patients with postoperative anast-omotic stenosis. Radial diathermy incision was performed by needle knife papillot-ome using cutting current. Tne anastomotic stenosis was characteristic of short fibrotic segment and frequent restenosis after dilatation. An sufficient caliber and smooth, supple wall at the site of the stenosis was produced by incisional therapy by needle knife papillotome using cutting current. Clinical symptoms and endoscopic findings were improved after endoscopic incision. It is concluded that endoscopic incisional therapy seems to be safe and effective method for the treatment of anastomotic stenosis after gastrointestinal operation.
Constriction, Pathologic* ; Diathermy ; Dilatation ; Humans ; Needles*

BACKGROUND: In patient-controlled analgesia (PCA), ketorolac tromethamine has been mixed with nalbuphine HCL in the same PCA balloon or syringe. The compatibility of mixed drugs is an important factor in determining the effects of the administered drugs, so we examined the compatibility of the mixed solution of the both drugs in various dilutions. METHODS: Ketorolac tromethamine (K1, 3, 7, 19 group; n = 10/group) or nalbuphine HCl (N1, 3, 7, 19 group; n = 10/group) was diluted 1: 1, 3, 7, or 19 with normal saline and then the other drug was added. The presence of precipitates, turbidity by visual and spectrophotometric methods, and the pH of the mixed solutions were evaluated 0, 1, 6, 12 and 24 hours later. RESULTS: Precipitates were observed in all studied solutions except in solutions of nalbuphine HCl diluted 1 : 19 with normal saline plus ketorolac tromethamine at the observed intervals. Turbid changes were observed in N1, 3, K1, 3, and 7, but significantly decreased from 6 hours after mixing. The pH of the K groups were significantly lower than those of the N groups. CONCLUSIONS: The mixed solutions of ketorolac tromethamine with nalbuphine HCl were visually incompatible in almost all studied cases, so careful considerations are needed in mixing ketorolac tromethamine with nalbuphine HCl.
Analgesia, Patient-Controlled ; Hydrogen-Ion Concentration ; Ketorolac Tromethamine* ; Ketorolac* ; Nalbuphine* ; Passive Cutaneous Anaphylaxis ; Syringes

Although the endoscopic retrograde biliary drainage(ERBD) is the preferred palliative treatment for unresectable mlignant obstructive jaundice, the failure of endaprosthesis insertion occurs in 15% of the cases. Espeeially in hilar malignancy, the failure results from the inability to pass ei~ther a guide wire or a stent due to biliary stenosis or obstruction by tumorous extension. In such caae, percutaneous transhepatic biliery drainage(PTBD) can be achieved. When the tumor extends into the hilum, isolating the right and left hepatic ducts, drainage of unilateral hepatic duct will usually provide adequate palliation. However, when patients have contralateral cholangitis or jaundice fails to resolve with unilateral biliary drainage, bilateral drainage may be necessary. Compared to ERBD, the method of prolonged external biliary drainage has unwanted disadvantages. In order to achieve internal biliary drainage in case with complete obstruction of hepatic ducts due to tumor extension, percutaneous transhepatic transtumoral biliary drainage(PTTBD) could be considered. We report a case with obstructive jaundice and cholangitis due to complete obstruction of right hepatic duct and stenosis of common hepatic duct from Klatskin tumor, which was sucessfully managed by internal biliary drainage with transtumoral biliary stenting under the guidance of computed tomography.
Cholangitis ; Constriction, Pathologic ; Drainage* ; Hepatic Duct, Common ; Humans ; Jaundice ; Jaundice, Obstructive* ; Klatskin's Tumor* ; Palliative Care ; Stents

The gastric adenomas could be premalignant lesions and they should be removed as possible, especially in eases with its size aver 2cm. The gastric adenomas can be removed by the various endoscopic methods. Endoscopic polypectomy has been widely used for the treatment of benign and malignant polyps with the advent of technical improvement. Polypectomy with snare and electrocautery is mainly used for pedunculated polyps, but sessile polyps pose some technical difficulties and occasionally cause serious gastrointestinal hemorrhage or perforation. We resected two cases of gastric flat adenoma using Stiegman-Goff ligator used in endoscopic variceal ligation to make flat adenoma as semipedunculated form, and also to decrease the risk of bleeding. After ligation, we successfully removed it with conventional snare polypectomy. We recognized that endoscopic mucosal resection with band ligation can be used for the removal of sessile polyps or flat adenioma with ease, safety and no bleeding.
Adenoma* ; Electrocoagulation ; Gastrointestinal Hemorrhage ; Hemorrhage ; Ligation* ; Polyps ; SNARE Proteins

The main objective of palliative treatment of malignant esophageal stenosis is rapid restoration of passage of fluid and solids. Endoscopic intubation with plastic endoprosthesis may lead to prompt relief of dysphagia and is a effective procedure for the palliative treatment of malignant esophageal stenosis. However, the insertion procedure, which necessitates prior dilatation, is traumatic and associated with considerable risk for perforation and bleeding. Tumor overgrowth, stent migration and stent blockage are frequent complications. Recently, self expanding metal stents woven in the form of tubular mesh made from surgical grade stainless steel alloy filaments(Wallstent), have been developed to offer possible advatage over conventional plastic tubes. The small diameter of introducer system carrying the compressed stent(18Fr) allows a relatively easy insertion procedure that dose not require prior dilatation. This stent is pliable. self-expanding and flexible in the longitudinal axis. We experienced a case of a 74-year-old male with malignant esophageal stenosis in whom self-expanding Wallstent was implanted with successful oral nutrition and much improvement of dysphagia.
Aged ; Alloys ; Axis, Cervical Vertebra ; Deglutition Disorders ; Dilatation ; Esophageal Stenosis* ; Hemorrhage ; Humans ; Intubation ; Male ; Palliative Care* ; Plastics ; Stainless Steel ; Stents