Hemorrhagic radiation proctitis is infrequently seen in patients receiving pelvic irradiation. The treatment of hemorrhagic ralation proctitis is often difficult. Many patients need reyeated hospitalizations and blood transfusions. Occasionally patiets will develop severe or recurrent rectal bleeding. In case of massive bleeding requiring excessive transfusion, colonic diversion by construction of a colostomy or excision of the diseased segment may be inevitable. However, surgical procedures in these patients are associated with a high mortality and morbidity. Moreover, medical therapy is usually ineffective. Recently formalin therapy has been introduced as a simple and effective treatment for hemorrhagic radiation proctitis. We experienced a 69 year-old woman patient who developed severe homorrhagic proctitis 1 year after radiotherapy for carcinoma of the cervix. She had not improved by conservative management and required blood tranafusions and repetitive hospitalizations. After local application of a 4% formalin solution in the diseased rectum under caudal anesthesia, the bleeding immediately stopped and the patient was discharged from the hospital, and no recurrence has been observed until now.
Aged ; Anesthesia, Caudal ; Blood Transfusion ; Cervix Uteri ; Colon ; Colostomy ; Female ; Formaldehyde* ; Hemorrhage ; Hospitalization ; Humans ; Mortality ; Proctitis* ; Radiotherapy ; Rectum ; Recurrence

Proper management of childhood and adolescent varicocele remains still controversial. In general, all methods for varicocele ablation for adults are available and include open surgical ligation, laparoscopic ligation, or percutaneous ablation. We evaluated the usefulness of percutaneous embolization of internal spermatic vein in boys with varicocele. Between February 1988 to May 1996, 48 boys of 53 varicoceles underwent percut aneous embolization. In 49 cases, the embolization were technically possible and in the other 4 cases, we could not access the internal spermatic vein because of vasospasm and venous abnormality. The results were successful in 40 cases (81.6%) and failed in 9 cases (18.4%), including 4 (8.2%) of persistent and 5 (10.2%) of recurred cases. There were no major complications except 3 cases of extravasation of contrast material. Percutaneous embolization may be recommended as a primary treatment for childhood and adolescent varicocele.
Adolescent* ; Adult ; Humans ; Ligation ; Varicocele* ; Veins*

Acute mountain sickness is an illness caused by climbing to a high altitude without prior acclimatization. Neurological consequences, like parkinsonism following acute mountain sickness without lesion of brain MRI have been reported rarely. A healthy 56-year-old man presented with dysarthria and gait disturbance. Neurological examination revealed tremor of hands, limb rigidity, and bradykinesia. The symptoms developed approximately 30 days following a 3,500 m climb of the Annapurna in the Himalayas. Brain MRI did not reveal any abnormalities including globus pallidus. The parkinsonism symptoms persisted for about 3 months before a complete recovered was made. We suggest that parkinsonism can develop after climbing to a high altitude but that the symptoms can be transient if a brain MRI detects no abnormalities.

PURPOSE: To evaluate the radiological and clinical results after open reduction and internal fixation with calcaneal F plate and locking calcaneal plate using lateral extensile approach in the treatment of intra-articular calcaneal fracture. MATERIALS AND METHODS: This study included 34 cases of 33 patients followed up for at least 6 months postoperatively. F plate was applied in 18 cases (Group 1), locking plate was used in 16 cases (Group 2) and compared radiological and clinical results between two groups. RESULTS: Radiollogically, the mean Bohler angle was improved from 5.5degrees preoperatively to 20.1degrees postoperatively and 18.8degrees at the last follow up in group 1 and 8.6degrees preoperatively, 21.4degrees postoperatively and 20.3degrees at last follow up in group 2. Bone union was observed in all cases and 4 cases of screw loosening were noted in Group 1 with extended fracture to anterior process. At the last follow up, both groups showed clinical results in American orthopedic foot and ankle society ankle hindfoot score, 76(77 in Sanders type II and 75 in type III) in group 1 and 72(73 in type II and 70 in type III) in group 2. CONCLUSION: F plate and locking plate showed firm fixation and satisfactory clinical results in the treatment of intra-articular calcaneal fracture. We suggest applying locking plate in cases with extended fracture to anterior process, considering screw loosenings in those who were treated with F plate fixation.
Animals ; Ankle ; Calcaneus ; Follow-Up Studies ; Foot ; Humans ; Intra-Articular Fractures ; Orthopedics

Functional brain imaging is very important in the diagnosis and evaluation of the various neurologic disorders, In addition to electroencephalography (EEG) and positron emission tomography(PET), single photon emission computed tomography (SPECT)have increasingly gained importance in determination of disturbancesin regional brain functions. Both ictal and interictal Tc-99m hexamethy-propyleneamine oxime single photon emission computed tomography (TC-99m HMPAO SPECT)was done in a patient with the neonatal seizure and right cerebral hemiatrophy. The left parieto-occipital area revealed increased redioactivity during ictal stage and decreased radioactivities during interictal stage on Tc-99m HMPAO Brain SPECT. This brain ares was thought to be a epileptogenic focus. Ictal and interictal Tc-99m HMPAO brain SPECT could be a safe and sensitive diagnostic method in localization of epileptogenic foci.
Brain* ; Diagnosis ; Electroencephalography ; Electrons ; Functional Neuroimaging ; Humans ; Nervous System Diseases ; Radioactivity ; Seizures* ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Thalium 201(TI-201) has been a widely applied myocardial perfusion agent for the detection of coronary artery disease. however its low emission energy and long half-life make this agent suboptiomal for the examination of coronary artery disease. To circumvent the physical limitation of TI-201, a group of technetium 99m-labeled isonitril complex has been developed. Our study was done to examine the value of SPECT with 99mTc-HexaMIBI in estimating myocardial perfusion in patients with myocardial infarction. METHODS: We evaluated the sensitivity of SPECT with 99mTc-HexaMIBI in 29 patients with acute myocardial infarction. We also compared the severity and vascular territory of abnormal perfusion on SPECT scanning with severity of coronary artery stenosis, values of serum enzyme and sites in ECG. RESULTS: 1) There were 26 patients(90%) who showed perfusion defect, and 3 patients(10%) who showed normal perfusion in myocardial SPECT. The 3 patients with normal perfusion demonstrated non Q-wave infarction of ECG. 2) Among 23 patients performed coronary argiography, there were 19 patients(82%) who showed positive findings on myocardial SPECT and luminal narrowing above 50% on coronary angiogram, and there were 3 patients(13%) who showed significant coronary artery stenosis in spite of negative myocardial SPECT. 3) The grade of perfusion defect showed no significant difference between groups undergone thrombolytic therapy and groups not undergone thrombolytic therapy. 4) There was good correlation between the site of perfusion defect on SPECT and the site of infarction on ECG. CONCLUSION: We conclude that SPECT with 99mTc-HexaMIBI is a promising non invasive test for simultaneous diagnosis of myocardial infarction and evaluation of perfusion defect.
Coronary Artery Disease ; Coronary Stenosis ; Diagnosis ; Electrocardiography ; Half-Life ; Humans ; Infarction ; Myocardial Infarction* ; Perfusion ; Phenobarbital ; Technetium ; Technetium Tc 99m Sestamibi* ; Thrombolytic Therapy ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.
Analgesia ; Analgesia, Patient-Controlled* ; Arthroplasty, Replacement, Knee ; Humans ; Nalbuphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency ; Visual Analog Scale ; Vomiting

Although technological advances and clinical studies on stem cells have been increasingly reported in stroke, research targeting hemorrhagic stroke is still lacking compared to that targeting ischemic stroke. Studies on hemorrhagic stroke are also being conducted, mainly in the USA and China. However, little research has been conducted in Korea. In reality, stem cell research or treatment is unfamiliar to many domestic neurosurgeons. Nevertheless, given the increased interest in regenerative medicine and the increase of life expectancy, attention should be paid to this topic. In this paper, we summarized pre-clinical rodent studies and clinical trials using stem cells for hemorrhagic stroke. In addition, we discussed results of domestic investigations and future perspectives on stem cell research for a better understanding.

Rice bodies are numerous small fibrinous, cartilaginous-like materials which were first described in tuberculous joints. Rice bodies are common findings in joints afflicted with rheumatoid arthritis or other seronegative arthropathy. But less commonly, those can be seen in periarticular bursae or at the sites of tendon or ligament insertion. Rice bodies, thought to be a nonspecific response to synovial inflammation, probably evolve from ischemia in a proliferative synovium. Some of these bodies contain a core of collagen with a mantle of fibrin, others contain only fibrin. Subacromial bursa are sometimes involved in the patients with rheumatoid arthritis and can reach impressive dimensions before becoming clinically detectable because significant constrain is lacking. Subacromial arthrography or magnetic resonance imaging accurately delineated the existence of cartilaginous loose bodies before surgical exision. We experienced a man with rheumatoid arthritis who had massive subacromial bursitis with rice bodies. His shoulder had been swollen since 5 years ago. He felt no pain and had only mild limitation of motion. Subacromial arthrography or magnetic resonance imaging of right shoulder showed multiple rice bodies in enlarged subacromial bursa. Operation finding showed a large encapsulated mass in the subacromial bursa, and hundreds of fibrinous rice bodies were revealed, which were resected. We report this patient with a review of literatures.
Arthritis, Rheumatoid* ; Arthrography ; Bursitis* ; Collagen ; Fibrin ; Humans ; Inflammation ; Ischemia ; Joints ; Ligaments ; Magnetic Resonance Imaging ; Shoulder ; Synovial Membrane ; Tendons

OBJECTIVE: This study was undertaken to review the disease course, clinical and laboratory manifestations, prognosis and treatment of adult onset Still s disease (AOSD) in Korea. METHODS: Thirty-two patients with AOSD were enrolled from 1986 to 1997 in Hanyang University Hospital. Diagnosis of AOSD was based on the criteria proposed by Yamaguchi. We classified the disease course into self-limited, inter mittent, or chronic disease course. RESULTS: Twenty-four (75%) patients were female. Skin rash occurred in 28 (88%) patients, lymphadenopathy in 8 (25%), hepatomegaly in 4 (13%), and pericarditis in 2 (6%) out of 32 patients. The most commonly affected joints were knee joints (88%). Elevated LDH was seen in 18 (60%) patients and decreased CK in 17 (61%) patients. Rheumatoid factor was detected in 4 (13%) patients and ANA in 12 (38%) patients. Anemia (Hb < 10 g/dL) was seen in 13 (41%) patients and hypoalbuminemia (<3. 5 g/dL) in 14 (52%) patients. Elevated ferritin (300 ng/mL) level was seen in 23 (79%) patients. Twenty-five (78%) patients had elevated serum transaminase. Bone marrow studies were performed in 16 patients. Nine out of 16 patients showed hyperplasia of the myeloid series and 2 patients displayed the features of a hemophagocytic syndrome. The mean duration of follow up of 32 patients was 32 months (range 3- 108). Eight (27%) patients had a self-limited, 9 (30%) an intermittent, and 13 (43%) a chronic disease course. The hypoalbuminemia was significantly associated with an "intermittent or chronic disease group" (p<0. 05). Thirty-two patients received systemic corticosteroids and 21 patients received single or combination of disease modifying antirheumatic drugs. CONCLUSION: We found that hypoalbuminemia at presentation was significantly associated with an unfavorable outcome, intermittent or chronic disease group. The clinical manifestations and disease course of AOSD in Korea were similar to those previously reported in other countries except significantly lower incidence of lymphadenopathy, hepatomegaly, and pericarditis.
Adrenal Cortex Hormones ; Adult* ; Anemia ; Antirheumatic Agents ; Bone Marrow ; Chronic Disease ; Diagnosis ; Exanthema ; Female ; Ferritins ; Follow-Up Studies ; Hepatomegaly ; Humans ; Hyperplasia ; Hypoalbuminemia ; Incidence ; Joints ; Knee Joint ; Korea* ; Lymphatic Diseases ; Lymphohistiocytosis, Hemophagocytic ; Pericarditis ; Prognosis ; Rheumatoid Factor ; Still's Disease, Adult-Onset*