Open frsctures with extensive soft tissue injuries resulting from motor vehicles and sccidents present serious problems in the management. Authors present the cases who had open, severely com-minuted fractures of femurs with inoperable conditions and we present their follow up analysis.
Femur ; Follow-Up Studies ; Fractures, Comminuted ; Motor Vehicles ; Soft Tissue Injuries

The purpose of this study is to evaluate the applicability of intravenous atropine sulfate therapy in infantile hypertrophic pyloric stenosis (IHPS). From 1998 to 2000 among 35 cases of IHPS, pyloromytomy was performed in 13 (Group A), and intravenous atropine was given as a primary therapy in 22 cases (Group B). In group A, all cases were cured completely. In group B, 13 (59 %) out of 22 cases were successfully treated with atropine, but 9 were failed therapy, and required operation. The recovery period to normal feeding and the hospital stay of the successful atropine group were longer than those of pyloromyotomy, 8.6 days vs. 2.9 days and 13.2 days vs. 4.1 days, respectively. In conclusion, intravenous atropine therapy did not replace pyloromyotomy, but it might be an alternative for the selected patients with contraindications for operation.
Atropine* ; Humans ; Length of Stay ; Pyloric Stenosis, Hypertrophic*

A heterotopic or ectopic pancreas is defined as the presence of pancreatic tissue that lacks anatomic and vascular continuity with the main body of the pancreas. Pancreatic heterotopia is characterized by the presence of pancreatic acinar, islet, and ductular elements. Most examples are incidentally encountered during surgery, and, on rare occasions, epigastric pain, weight loss, hemorrhage, gastric outlet obstruction, and intussusception have been directly attributable to the presence of the heterotopic pancreas. A malignant transformation in an ectopic pancreas is exceptional and intestinal obstruction of the small bowel by an adenocarcinoma arising in an ectopic pancreas has not been reported yet. We present the case of a ductal adenocarcinoma originating in the heterotopic pancreas in the jejunum of a 73-year-old man. The tumor was found to obstruct the jejunum at a distance of about 25 cm distal to the ligament of Treitz. The resected jejunum histologically showed a ductal adenocarcinoma that originated from the ectopic pancreas. To our knowledge, this would be the first case in Korea, which the patient presented with a small bowel obstruction due to a malignant transformation of an ectopic pancreas.
Adenocarcinoma* ; Aged ; Gastric Outlet Obstruction ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intussusception ; Jejunum* ; Korea ; Ligaments ; Pancreas* ; Weight Loss

PURPOSE: To characterize the magnetic resonance (MR) imaging features of cervical tuberculous lymphadenitis. MATERIALS AND METHODS: The cervical MR images of 14 patients with pathologically or clinically proven cervical tuberculous lymphadenitis were retrospectively analyzed. T1- and T2-weighted or proton density images and contrast enhanced MR images were obtained in all patients. RESULTS: Most patient had multiple (n=12), unilateral lesions (n=l0), 8 mm to 45 mm in size, round (n=46) or ovoid (n=46) in shape and all with smooth and well-defined margins mostly at internal jugular chain(N2: 41, N3: 2, N4: 21 ). The signal intensities of the most lymph nodes were isointense or slightly hyperintense on T1 -weighted images, and hyperintense (all) with variable homogeneity on T2-weighted and/or proton density images. After contrast enhancement most showed characteristic thin peripheral rim enhancement (n=71). CONCLUSION: The characteristic MR features of cervical tuberculous lymphadenitis would be multiple, unilateral enlarged lymph nodes which show iso or slightly increased signal intensity on T1 -weighted image, high signal intensity on T2-weighted and/or proton density image and peripheral rim enhancement.
Humans ; Lymph Nodes ; Protons ; Retrospective Studies ; Tuberculosis, Lymph Node*

Radiation dose escalation and acceleration improves local control but also increases toxicity. Proton radiation is an emerging therapy for localized cancers that is being sought with increasing frequency by patients. Compared with photon therapy, proton therapy spares more critical structures due to its unique physics. The physical properties of a proton beam make it ideal for clinical applications. By modulating the Bragg peak of protons in energy and time, a conformal radiation dose with or without intensity modulation can be delivered to the target while sparing the surrounding normal tissues. Thus, proton therapy is ideal when organ preservation is a priority. However, protons are more sensitive to organ motion and anatomy changes compared with photons. In this article, we review practical issues of proton therapy, describe its image-guided treatment planning and delivery, discuss clinical outcome for cancer patients, and suggest challenges and the future development of proton therapy.
Carcinoma, Hepatocellular ; radiotherapy ; Female ; Four-Dimensional Computed Tomography ; Head and Neck Neoplasms ; radiotherapy ; Humans ; Liver Neoplasms ; radiotherapy ; Lung Neoplasms ; radiotherapy ; Male ; Neoplasms ; radiotherapy ; Photons ; therapeutic use ; Prostatic Neoplasms ; radiotherapy ; Protons ; therapeutic use ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Intensity-Modulated ; methods ; Uterine Cervical Neoplasms ; radiotherapy

BACKGROUND/AIMS: A laparoscopic cholecystectomy (LC) has many clinical advantages and is now recognize as the choice of treatment for gallstones. However a laparoscopic cholecystectomy is often not feasible or is converted to the conventional open method in patients with acute cholecystitis because of inflammation around the gallbladder, adhesion, unclear anatomy, or intraoperative complications. Recent studies recommended that acute cholecystitis patients or gallbladder empyema patients undergo a percutaneous transhepatic GB drainage (PTGBD) first and a laparoscopic cholecystectomy later because PTGBD can be very helpful for improving the patient's state. METHODS: This study was carried out on 99 patients with acute cholecystitis or GB empyema who underwent a laparoscopic cholecystectomy after PTGBD at Eulji University School of Medicine from January 1996. These cases were compared with a control group of 41 patients who showed similar symptoms, ultrasonographic finding, operative finding, and pathologic results. RESULTS: There were no differences in the age and the sex distributions, the symptom duration, laboratory finding except alkaline phosphatase and leucocytosis. Among PTGBD group, a successful laparoscopic cholecystectomy was possible in 63 patients (63.6%), the other 36 patients were converted to open cholecystectomy. In control group, only 15 patients (36.6%) out of 41 underwent a successful laparoscopic cholecystectomy. This difference was statistically significant (P= 0.003). We analyze two groups about factors that can affect open conversion during laparoscopic cholecystectomy. In multivariate analysis, preoperative PTGBD and degree of wall thickening are the independent risk factors that can convert LC into open cholecystectomy. CONCLUSION: We think that a laparoscopic cholecystectomy performed some time after PTGBD to improve the patient's condition by eliminating acute inflammation or decompressing the gallbladder may be recommended for management of acute cholecystitis patients with severe clinical symptoms and ultrasonographic findings of marked gallbladder dilatation or pericholecystic fluid collection.
Alkaline Phosphatase ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Dilatation ; Drainage ; Empyema ; Gallbladder ; Gallstones ; Humans ; Inflammation ; Intraoperative Complications ; Multivariate Analysis ; Risk Factors ; Sex Distribution

PURPOSE: To evaluate the efficacy and safety of intravitreal bevacizumab for polypoidal choroidal vasculopathy (PCV). METHODS: In this retrospective interventional pilot study, 12 eyes of 11 patients with active PCV were treated with intravitreal bevacizumab (1.25 mg) alone or in combination with photodynamic therapy (PDT) depending on the informed patient's choice. Intravitreal bevacizumab was repeated at 6-week intervals until the regression of active lesion was detected on fluorescein angiography (FA) which was done on a regular basis, Indocyanine green angiography (ICGA) and optical coherence tomography (OCT) analyses. RESULTS: Intravitreal bevacizumab was given alone in 8 eyes (Group 1) and in combination with PDT in 4 eyes (Group 2). Mean follow-up duration was 17 weeks in group 1 and 15 weeks in group 2 after bevacizumab treatment. The mean number of bevacizumab injections was 2.2 in group 1 and 2.5 in group 2. Mean BCVA improved from 20/63 to 20/40 in group 1 and 20/63 to 20/32 in group 2. Of all eyes, the BCVA improved by > or =2 lines in seven (58%) eyes and resolution of fluid and hemorrhages in clinical examination, an absence of leakage on repeat FAs, or resolved pigment epithelial detachment (PED) and/or subretinal fluid (SRF) on OCT exam was confirmed in 10 (83%) eyes. Partial or complete regression of the polypoidal vessels and interconnecting vessels was reported for most cases at the last follow-up. No significant ocular or systemic side effects were observed in both groups. CONCLUSIONS: Short-term results indicate that intravitreal bevacizumab (1.25 mg) alone or in combination with PDT is well tolerated and associated with improvement in BCVA and reduced angiographic leakage in most patients. Further evaluation of intravitreal bevacizumab therapy for the treatment of PCV is warranted.
Aged ; Aged, 80 and over ; Angiogenesis Inhibitors/adverse effects/*therapeutic use ; Antibodies, Monoclonal/adverse effects/*therapeutic use ; Choroid/*blood supply/pathology ; Coloring Agents/diagnostic use ; Combined Modality Therapy ; Female ; Fluorescein Angiography ; Humans ; Indocyanine Green/diagnostic use ; Injections ; Male ; Middle Aged ; Peripheral Vascular Diseases/diagnosis/*drug therapy/physiopathology ; *Photochemotherapy ; Pilot Projects ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity/physiology ; Vitreous Body

BACKGROUND: As the average lifespan of human increases, osteoporosis and osteoporosis-related fractures have become major health care problems. Despite recent advances in medical treatment, few studies have assessed the recognition of osteoporosis in general adults. This study examined the recognition of osteoporosis and analysed the relating factors. METHODS: We made a survey in a rural area called Chunjunlee in Chunchon city. The questionnaire contained general characteristics of people, sociocultural factors, questions constructed to know the recognition of osteoporosis and factors that were presumed to influence people's recognition of osteoporosis. DEXA was performed on those who visited our medical office free of charge. RESULTS: The total number of people who responded to the questionnaire was 204. They were composed of 81 men and 123 women. Among the total, 83% of women and 72.8% of men said that they had heard about osteoporosis. There was no significant recognition score difference between men and women. In the items of recognition, wrong answer rate concerning the association between osteoporosis and musculoskeletal disorders such as osteoarthritis and low back pain was above 90%. The significant factors that influenced its recognition were age, education level, menopause state and newspaper/ magazine subscription. All men who were diagnosed with osteoporosis on DEXA initially said that they did not have osteoporosis. CONCLUSION: Many people had a conceptual confusion between osteoporosis and other muscular skeletal disorders such as osteoarthritis and low back pain. Physicians played no significant role in improvement of people's recognition of osteoporosis. Generally, men thought that osteoporosis was a problem in women only.
Adult ; Delivery of Health Care ; Education ; Female ; Gangwon-do ; Humans ; Low Back Pain ; Male ; Menopause ; Osteoarthritis ; Osteoporosis* ; Periodicals as Topic ; Periodicals

PURPOSE: The hepatolithiasis and associated cholangitis result in liver atropy, biliary stricture, liver abscess and intrahepatic malignancy, and a hepatic resection should be performed in such cases. The technical difficulty and accompanied inflammation with a hepatic resection frequently cause postoperative complications. Therefore, the factors affecting the postoperative complications were evaluated. METHODS: Twenty one patients, with hepatolithiasis that had received a hepatectomy at the Department of Surgery, Eulji University Hospital between March 2001 and January 2003, were reviewed. RESULTS: The postoperative complications were intraabdominal abscess (7 cases), pleural effusion (3 cases), wound complication (3 cases), T-tube site leakage (1 case), cardiac arrest (1 case), acute pancreatitis (1 case), hepatitis A (1 case) and delayed gastric emptying (1 case). The overall complication rate was 57% (12/21 patients) and the most common complication was an intraabdominal abscess (7 cases). The factors that may affect these complications were analyzed. Preoperative percutaneous transhepatic biliary drainage (PTBD) increased the postoperative complications, which was statistically significant (p=0.027). Especially, preoperative PTBD and hepaticojejunostomy increased the rate of an intraabdominal abscess, which was statistically significant (p=0.026, p=0.008). CONCLUSION: With hepatolithiasis requiring hepatic resection there is a need to avoid unnecessary preoperative PTBD and bypass surgery for the reduction of postoperative complications, including an intraabdominal abscess. Conversely, it is considered important to remove every stone and avoid needless bypass surgery under an operation and for a hepatic resection to be performed after removing PTBD, where possible.
Abscess ; Cholangitis ; Constriction, Pathologic ; Drainage ; Gastric Emptying ; Heart Arrest ; Hepatectomy ; Hepatitis A ; Humans ; Inflammation ; Liver ; Liver Abscess ; Pancreatitis ; Pleural Effusion ; Postoperative Complications* ; Wounds and Injuries

PURPOSE: Hemodialysis remains the most important support for patients with end stage renal disease, and vascular access is an essential component for their life. Since 1966, internal arteriovenous fistula (AVF) has been used widely today. If vessels were not available for AVF, the alternative would be used such as prosthetic graft. But in 1997, the National Kidney Foundation-Dialysis Outcome and Quality Initiative (DOQI) recommended increased use of native arteriovenous fistula to improve overall patency and curtail angioaccess costs. This retrospective study is to review our experience and to evaluate the overall patency rate and the influencing factors on the patency of the AVF. METHOD: From March 1995 through October 2000, 111 fistulas were created of 111 patients in Eulji university hospital. Among them, 106 cases were able to follow up survey. The statistical analysis used by SPSS package. RESULT: The male versus female ratio was 1.22:1 and the age distribution was occurred on from 3rd decade to 9th decade. the common causes of renal failure was hypertension, glomerulonephritis and diabetes (62.1%). the autogenous graft fistulas were performed in 101 cases (wrist/antecubital fossa. 101/3), Goretex graft fistula were 7 cases. The early graft failures were 12 cases (11.4%) and the causes was thrombosis or stricture, and immaturation, psudoaneurysm, venous hypertension in order of frequency. At 12, 24, 36 months, the assisted patency rates of AVF were 80.4, 76.5, 71.3%, respectively. CONCLUSION: We could get higher patency rate of AVF due to liberal use of native veins and aggressive intervention of the failing AVF as recommendation of DOQI.
Age Distribution ; Arteriovenous Fistula* ; Constriction, Pathologic ; Female ; Fistula ; Follow-Up Studies ; Glomerulonephritis ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Male ; Polytetrafluoroethylene ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Thrombosis ; Transplants ; Veins