Injectable Collagen Implan, is composed of purified bovine dermal collagen emulsified in saline and lidocaine(0.3%) base, and has been promoted for correction of soft tissue contour defects. Although collagen is a relatively nontoxic, nonimmunologic and biolegically nonreactive biomaterial, some side reactions have been reported. We report herein a case of cutaneous side reaction to collagen implantation in a 38-year-old female. The patient presented with puritic, irritating, multiple, erythematous nodules on both the temporal and interorbital area, which had been observed since 1 day after collagen(KOKEN ATELOCOLLA-GEN IMPLANT-Japan) implantation. Histopathologic findings showed dense infiltration of acute and chronic inflammatory cells in the dermis, especially the perivascular and periadnexal area.
Adult ; Collagen* ; Dermis ; Female ; Humans

Sensation is the key element that allows the fingertip to participate effectively in virtually all hand functions. Therefore, it is very important to restore sensation as well as well padded, durable skin coverage following severe fingertip injuries. Many ingenious operations have been described to provide the fingertip with sensate coverage. Among them, the innervated cross-finger flap, reported by Cohen et al. in 1983, is very effective and successful in reconstruction of severe fingertip injuries, We report five cases of severe fingertip injuries treated with innervated cross-finger flap. The results are as follows : 1. The level of sensory return and the functional result is excellent in those fingertips reconstructed with the innervated cross-finger flap. 2. Mean time for flap detachment is 16 days post operative and local anesthesis at outpatient department is sufficient. 3. Four of five treated patients achieved excellent sensibility with measurable two-point discrimination(mean 5.0 mm) and ability to recongnize textures and objects.
Fingers ; Hand ; Humans ; Outpatients ; Sensation ; Skin

The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.
Administration, Intravenous ; Amnesia ; Anesthesia ; Blood Pressure ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Premedication*

To determine the most effective and tolerable method of preparation with Golytely for colonoscopy, 141 consecutive cases were randomly allocated to drink either 2,000cc(74 cases, Group I) or 4,000cc(67 cases, Group 2), with infusion rate of 1,000cc/h. The reaults were as follows. 1) The rates of effective colonic clearance in group 1 and group 2 was 94.6% and 94.0%, respectively. There is no significance difference between two groups. 2) There was no significant difference in the ingested volume until the first bowel movement and the time required for rectal efflunt to be clear between two groups. 3) Patient acceptance was higher in group 1 than in group 2. 4) Side effects were less noticed in group 1 than group 2, and incraased in body weight (average 0.8 kg) after ingestion of Golytely was observed only in group 2.
Body Weight ; Colon ; Colonoscopy* ; Eating ; Humans ; Therapeutic Irrigation*

Non-operative palliative treatment for malignant colonic obstruction can sometimes be accomplished by the insertion of anorectal tube, endoscopic balloon dilation or endoscopic laser therapy. But these methods have some disadvantages, such as limitaation of activity, need of repetitive treatment and high-risk of perforation. Endoscopic prosthesis is generally accepted as a safe, effective palliative treatment for malignant esophageal stricture, because this method has no above disadvantages. Neverthless, there is only a few experence with endoecopic prosthesis in malignant colorectal stricture over the world. We report two cases which were safely, effectively performed endoscopic prosthesis in palliative treatment for their malignant rectal strictures.
Colon ; Constriction, Pathologic* ; Esophageal Stenosis ; Laser Therapy ; Palliative Care ; Prostheses and Implants*

Gastric lipomas are rare benign submucosal tumors which can present the diagnostic and therapeutic problems. The preferred treattment is observation or local excision. Since preoperative diagnosis and differentation from malignant tumors can be difficult by use of the conventional diagnostic modalities such as X-ray or endoscopic examination, patients are sometimes subjected to more extensive surgical procedures than warranted. As to the diagnosis of submucosal tumors of the upper digestive tract, a newly developed diagnostic modality of endoscopic ultrasonography(EUS) allows us to visuialize the structures underlying the gastrointestinal wall in a noninvasive maneuver, and can contribute to make differential diagnosis and decision of management. Strip biopsy is an endascopic tissue resection technique which permits resection of both mucosal and submucosal tissue regardless of the morphological type of the lesion, because the submucosal saline injections during the procedures make the flat or depressed lesions to be elevated. Now, we report a 56-yr-old female which had a Yamada type I polypoid gastric submucosal lipoma in the antrum, which could be performed the different diagnosis and successful endoscopic removal by endoscopic ultrasonography and strip biopsy.
Biopsy* ; Diagnosis ; Diagnosis, Differential ; Endosonography ; Female ; Gastrointestinal Tract ; Humans ; Lipoma*

A new method for combining ultrasonography snd endoscopy, endoscopic ultrasonography (EUS), was developed to improve the diagnostic accuracy of ultrasound by direct image of the target lesion via the gastrointestinal lumen. EUS has the unique ability to provide clear sonographic images of the wall structure of the stomach. This capability can be ultilized in assessing the depth of cancer invasion of the stomach by identifying which layer the ultrasonographic change extends to. However, the depressed types of early gastric cancer(EGC) are often accompanied by ulcerative change in the tumor foci. And the ultrasonographic picture is also influenced by the ulcerative change. (continue...)
Endoscopy ; Endosonography* ; Stomach ; Stomach Neoplasms* ; Ulcer ; Ultrasonography

OBJECTIVE: Our purpose was to investigate the relation between types of early diastolic notch and placental location and to evaluate the differences in perinatal outcomes. METHODS: We evaluated the Doppler waveform of the uterine artery in 149 pregnant women having an early diastolic notch after 26 weeks gestation, however we were unable to follow the obstetric outcomes in 20 women. Placental location was determined by transverse view of ultrasonography and classified as central and lateral placenta. The unilateral diastolic notches were divided into 3 groups depending on the placental location (ipsilateral: same side of the placenta, contralateral: opposite side of the placenta, and median: central placenta) RESULTS: In the bilateral notch group, the S/D ratio of the contralateral uterine artery was higher than the ipsilateral one(n=60, mean=3.22 Vs 2.80, p=0.0067). Of the 89 unilateral notches observed, the S/D ratio of the uterine artery in patients having early diastolic notch was higher compared to those without early diastolic notch.(t-test, mean=2.74,1.92, p=0.0001) Patients with bilateral notches were associated with poor perinatal outcomes significantly more than the patients with unilateral notches(p=0.003). Among the unilateral groups (ipsilateral: n=10, median: n=21, contralateral: n=58), there was no significant difference in perinatal outcomes. CONCLUSION: The early diastolic notch can be observed on both or either sides of the uterine artery independent on placental location. More bilateral notches were associated with poor pregnancy outcomes than unilateral notches. The pregnancy outcomes tended to be similar in unilateral notch irrespective of placental location, but showed worse outcomes than the control group. Careful analysis of the uterine artery in nonplacental side is necessary because of the frequent appearance of early diastolic notch and higher vascular resistance.
Female ; Humans ; Placenta ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Rheology* ; Ultrasonography ; Uterine Artery* ; Vascular Resistance

PURPOSE: This study is to assess the occurence rate, severity, and duration of the back pain after lumbar puncture. METHODS: The occurence rate, severity and duration of the back pain that developed after lumbar puncture were recorded prospectively in patients with aseptic meningitis who had been admitted to the department of Pediatrics, St. Benedict Hospital in Pusan, from May 1993 to July 1993. The cases with traumatic taps, repeated taps, undelying diseases and age group below 2 year were excluded. The overall number of cases included in this study was 136. RESULTS: 1) In the 136 patients, back pain was developed in 53 cases (39.0%) after lumbar puncture and mean age of 53 cases was 5.4+/-2.8 years and male to female ratio was 1.4:1. 23 cases (16.9%) were mild, 17 cases (12.5%) were moderate and 13 cases (9.6%) were severe. 2) On each age group, the incidence of back pain was as followed : These were 21 patients (38.9%) out of 54 cases in group 1 (2-4 yrs), 22 patients (37.3%) out of 59 cases in group 2 (5-8 yrs) and 10 patients (43.5%) out of 23 cases in group 3 (9-12yrs). After lumbar puncture, there were no significant correlations between occurence rate of back pain and age groups. 3) The mean intervals between onset of back pain and lumbar puncture were 0.5 day in 8 patients, 0.5-1.0 day in 25 patients (47.2%), 1.0-1.5 days in 12 patients (22.6%), and 1.5-2.0 days in 4 patients. 4) The mean duration of the back pain was 2.4+/-1.3 days, and 1.4+/-0.8 days in mild pain group, 2.9+/-1.2 days in moderate pain group and 3.3+/-1.2 days in severe pain group. The mean duration of the back pain was significantly longer in moderate and severe pain groups than mild pain group (p<0.01). CONCLUSIONS: In the patient with aseptic meningitis, occurence rate of the back pain after lumbar puncture was 39.0%. All back pain were subsided within six days after onset of pain.
Back Pain* ; Busan ; Female ; Humans ; Incidence ; Male ; Meningitis, Aseptic* ; Pediatrics ; Prospective Studies ; Spinal Puncture*

Cutaneous and subcutaneous metastases from the neoplasm of visceral organs are uncommon and have been estimated to occur in only 0.7%∼9% of patients. Among these cases, breast cancer is the most frequently observed malignancy. The incidence of cutaneous metastasis of breast cancer is 23.9%. The most common clinical manifestation of cutaneous metastasis of breast cancer is non-fixed painless erythematous nodules on the anterior chest. However, cutaneous metastasis of breast cancer shows a wide range of clinical manifestations and can mimic benign dermatologic lesions such as erythema annulare centrifugum, contact dermatitis, cellulitis, and erysipelas. We report a 52-year-old woman who presented with diffuse purpuric macules and patches on the right trunk. Finally, based on the clinical and pathologic findings, a diagnosis of cutaneous metastasis of breast cancer was made, and the patient expired 1 year later.