Between 1984 and 1996, 8 patients who were suffered from stage g Kienbock's disease underwent interpositional arthroplasty using pronator quadratus pedicled bone. Patients comprised 2 males and 6 females, with an average age of 33 years(range 19-47). Range of motion of the wrist, residual pain, grip strength, and carpal height ratio of the patients were analyzed. The follow-up period was between 1.5 years and 12.5 years(average 5.5 years). The arc of flexion-extension of the wrist was increased from average 74 degrees preoperatively to 96 degrees postoperatively. Among eight patients, five were free of pain and three had intermittent pain during heavy work. None of eight patients had any discomfort in daily work and changed his or her occupation. The grip strength was average 83% of the normal side. Carpal height ratio was average 0.48 preoperatively and was not changed postoperatively. Clinical results, assessed by Lichtman-Evans criteria, showed 4 good and 4 fair. The interpositional arthroplasty using pronator quadratus pedicled bone was considered as a very effective method for the treatment of stage III Kienbock's disease.
Arthroplasty* ; Female ; Follow-Up Studies ; Hand Strength ; Humans ; Male ; Occupations ; Osteonecrosis* ; Range of Motion, Articular ; Wrist

ERCP was performed in 34 cases of obstructive janndice at Busan National University Hospital between June 1981 and October 1982, and those findings were compared with the final surgical operative diagnoses. The results were as follows: 1) The ratio of male to female was about l. 6: 1 and most of them were in the 5th decade to 7th decade, 2) Upper abdominal pain and tenderness were the cardinal symptom and sign, 3) Successful ERCP was obtained in 32 cases among the total of 34 cases(94.1%)Selective success rates by indications were 77.8%(21/27) in suspected biliary lesions and 85.7%(6/7) in suspected panceatic lesions. 4) ERCP diagnoses were biliary stone(11 cases), eholangiocarcinoma(6 cases), pancreatic head ca. (4 cases), Ampulla of Vater ca. (2 cases), normal cholangiogram(2 cases), and normal parcreatogram(2 cases). 5) Eighteen cases out of 24 surgical operative cases were diagnosed by ERCP alone, The diagnostic rates of ERCP by surgical operation in obstructive jaundce was 75%. Complications of ERCP were not clinically significant. It suggests that ERCP is a very useful diagnostic method in the differential diagnosis of obstructive jaundice.
Abdominal Pain ; Ampulla of Vater ; Busan ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diagnosis, Differential ; Female ; Head ; Humans ; Jaundice, Obstructive* ; Male

It is generally considered that enteral feeding is superior to parenteral nutritional support. Thus enteral meal should be given whenever patients have proper gastrointestinal function to take enteral feeding. Because the morbidity and mortality for surgical jejunostomy have been reported as high as 50% and 10% respectively, direct percutaneous endoscopic jejunostomy has been developed to reduce the morbidity and mortality. A 55-year-old male patient, who was suffering from dysphagia and oropharyngeal aspiration, was transferred to the division of gastroenterology to be done permanent enteral feeding. His stomach was resected (subtotal gastrectomy with billroth II anastomosis) due to peptic ulcer hemorrhage 10 years before. We performed direct percutaneous endoscopic jejunostomy without any complication. Herein, we report a successful case.
Deglutition Disorders ; Enteral Nutrition ; Gastrectomy* ; Gastroenterology ; Gastroenterostomy ; Humans ; Jejunostomy* ; Male ; Meals ; Middle Aged ; Mortality ; Nutritional Support ; Peptic Ulcer Hemorrhage ; Stomach

BACKGROUND/AIMS: The transmission routes of HCV infection were not determined in the half of the HCV infected patients. So intrafamilial personal contact, sexual contact, vertical transmission and some vectors are supposed as a route of HCV infection. We investigated the prevalence of anti-HCV positivity in healthy Korean children and compared with the data from the healthy adults whether the vertical transmission is feasible. METHODS: Serum samples from 2,080 children in 8 elementary schools were tested for serum aminotransferases, hepatitis B viral markers by radioimmu- noassay, and anti-HCV by the third generation EIA. Sera from anti-HCV positive children were tested for HCV-RNA by RT-PCR. Six months later, same tests were repeated. RESULTS: Anti-HCV was positive in 17 children among 2,080(0.82%). Among 17 anti-HCV positive children, HCV-RNA was detected only in one case and the HCV genotype was type II by Okamotos classification. Anti-HCV was tested again in 7 of 17 anti-HCV positive children after 6 months later and all of these children were anti-HCV positive and additional 3 of 19 family members were anti-HCV positive. But HCV-RAN was not detected in alL CONCLUSION: Anti-HCV positive rate in children was 0.81%.
Adult ; Biomarkers ; Child* ; Classification ; Genotype ; Hepatitis B ; Humans ; Prevalence* ; Transaminases

BACKGROUND: The major transmission route of hepatitis C virus (HCV) is transfusion of blood or blood products. But transfusion history is found only in half of HCV infected patients. In half of the patients the transmission routes of HCV were not determined. We estimate the prevalence of anti HCV in family members of the patients with HCV. METHODS: We tested anti-HCV by using the second generation enzyme immunoassay and measured HCV-RNA by PCR (polymerase chain reaction). Serum samples from 135 adults who are family members of patients with anti-HCV positive liver disease were tested for serum aminotrasferase activities, hepatitis B viral markers by radioimmunoassay, and anti-HCV by EIA. RESULTS: anti-HCV positive rate in family members of the patients with HCV was 1.48% (2/135). This positive rate was not different from the studies of anti-HCV in general population in Korea (1.44%). CONCLUSION: Interfamilial transmission of HCV may probably occur, but it is uncommon being compare with other diseases such as HBV or HIV.
Adult ; Biomarkers ; Hepacivirus ; Hepatitis B ; HIV ; Humans ; Immunoenzyme Techniques ; Korea ; Liver Diseases ; Polymerase Chain Reaction ; Prevalence ; Radioimmunoassay

PURPOSE: To compare the clinical results of BRTO in the gastric varices with those of TIPS. MATERIALS AND METHODS: From January 2004 to March 2006, eight patients who had been followed up for more than 1 month after BRTO were enrolled in this study. This study compared the clinical efficacy of BRTO with that of TIPS in 13 patients who had undergone TIPS from January 2000 to March 2006. The change in laboratory parameters before and after each procedure and the incidence of rebleeding, encephalopathy, asictes and varices were analyzed after each procedure. Results:In the BRTO group, the level of albumin increased, and the levels of ammonia and the Child-Pugh score decreased. The TIPS group showed no improvement in the liver function. In the BRTO group, the gastric varices were eradicated in 7 patients. Gastric variceal rebleeding and encephalopathy did not occur. However, the esophageal varices worsened in 6 patients. In the TIPS group, rebleeding (n=4), encephalopathy (n=7) and a worsening of the gastric (n=5) or esophageal varices (n=2) occurred. CONCLUSION: BRTO improves the metabolic activity of the liver and has a lower incidence of encephalopathy. Hence, BRTO is a good alternative to TIPS in the gastric varices accompanied by a gastrorenal shunt although a treatment for a worsening of the esophageal varices may be needed after BRTO.
Ammonia ; Esophageal and Gastric Varices* ; Humans ; Incidence ; Liver ; Portasystemic Shunt, Surgical* ; Varicose Veins

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that occurs once in 3,000 live births. Patients with NF1 are prone to develop malignancies, particularly neural tumors, that is, malignant schwannoma and glioma in adults. For non-neural tumors, the NF1 incidence is increased in rhabdomyosarcomas, leukemia, malignant melanomas, breast cancer, lung cancer, thyroid cancer, and other organ cancers. The NF1 gene seems to increase the risk for carcinogenesis. A case of NF1 associated with metachronous cancers, such as breast cancer (1991) and small-bowel leiomyosarcoma (1997), in the same patient is reported. Investigation of the patient's family revealed four further cases (offsprings) of multiple neurofibromatosis. The relevant literature on the subject is reviewed.
Adult ; Breast Neoplasms ; Carcinogenesis ; Genes, Neurofibromatosis 1 ; Glioma ; Humans ; Incidence ; Leiomyosarcoma ; Leukemia ; Live Birth ; Lung Neoplasms ; Melanoma ; Neurilemmoma ; Neurofibromatoses ; Neurofibromatosis 1* ; Rhabdomyosarcoma ; Thyroid Neoplasms

Recurrent annular erythema associated with anti-Ro/La antibody is a diagnostic term for annular erythemas that usually occurs in the face and the upper extremities of patients with positive anti-Ro/La antibodies. They have been reported in patients with Sjogren's syndrome, lupus erythematosus, or Sjogren's syndrome/systemic lupus erythematosus syndrome. Recently, there have been cases without any underlying autoimmune diseases. We, hereby, report an annular erythema, associated with anti-Ro/La antibody occurring in both soles, which is an unusual location for this disease.
Antibodies ; Autoimmune Diseases ; Erythema ; Humans ; Sjogren's Syndrome ; Skin Diseases, Genetic ; Upper Extremity

BACKGROUND: Currently the most common treatment modality of refractory ascites in patients with liver cirrhosis was large volume paracentesis, but this procedure usually needed albumin infusion and occasionally developed unwanted complications. By reason of albumin shortage in Korea and occasional unfavorable complications, we studied the usefulness of dialytic ultrafiltration as an another treatment modality of refractory ascites. METHODS: Dialytic ultrafiltration was done in 10 patients (total 48 times) with liver cirrhosis or hepatocellular carcinoma. Two drainage conduit (via 16 gauge angio-catheter) of input and output were made by puncture of patient's right and left lower quadrant abdomen. The initial ultrafiltration rate of dialyser was 250mL/min. Ascitic fluid was removed continuously until the filtration rate down at 50mL/min. After ultrafiltration, ascitic fluid contained concentrated albumin and large molecules was reinfused via input conduit. Pre-treatment and post-treatment level of blood chemistry, plasma renin concentration, aldosterone, and electrolytes in serum; total protein and albumin in ascites were measured. During the ultrafiltration, we closely observed the change of blood pressure, heart rates and mental status. RESULTS: The mean ultrafiltration time was 231+/-28min, ultrafiltrated volume was 5.15+/-1.41 L. During dialytic ultrafiltration, patient's blood pressure and heart rate were stable and there was no change of mental status. After dialytic ultrafiltration, blood urea nitrogen level significantly decreased from 30.5+/-23.7mg/dL to 25.7+/-20.2mg/dL; serum aldosterone level decreased from 807.3+/-301.1pg/ml to 431.1+/-187.2pg/ml in serum (P<0.01). The albumin level in the ascitic fluid significantly increased from 0.67+/-0.28g/dL to 1.90+/-1.16g/dL (P<0.01). Plasma renin concentration level tend to decreased (P=0.06). The patient's serum total protein, albumin, electrolytes, and creatinine were not changed. Complications of dialytic ultrafiltration were peritonitis (one case) and hypotension (one case). But these unwanted complications were readily managed by adequate antibiotics and intravenous fluid therapy. CONCLUSION: The dialytic ultrafiltration can be used effectively without albumin infusion in the treatment of refrartory ascites in patients with advanced liver cirrhosis.
Abdomen ; Aldosterone ; Anti-Bacterial Agents ; Ascites* ; Ascitic Fluid ; Blood Pressure ; Blood Urea Nitrogen ; Carcinoma, Hepatocellular ; Chemistry ; Creatinine ; Drainage ; Electrolytes ; Filtration ; Fluid Therapy ; Heart Rate ; Humans ; Hypotension ; Korea ; Liver Cirrhosis* ; Liver* ; Paracentesis ; Patient Rights ; Peritonitis ; Plasma ; Punctures ; Renin ; Ultrafiltration*

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is a well-recognized cause of vomiting in infancy and is easily cured by a Ramstedt pyloromyotomy. However there have been no reports on the postoperative appearance of a pyloric mass in Korea. METHODS: Twenty infants with IHPS and 20 control infants were studied ultrasonographically during the first year of life at a regular interval. According to examination intervals, the IHPS infants (n=20) were divided into three groups: Group A (3 months, n=6), B (6 months, n=7), and C (12 months, n=7). At each examination, measurements were obtained concerning the length of the pyloric canal and the muscular thickness. RESULTS: The mean preoperative length of the pylorus of the IHPS group was 19.4+/-3.64 mm, ranging from 17 to 30 mm (control: 7.73+/-2.67 mm) (p<0.0001). The mean pyloric muscle thickness of the IHPS group was 5.08+/-0.67 mm, ranging from 3.5 to 6 mm (control: 2.37+/-0.58 mm) (p<0.0001). The preoperative and postoperative measurements were subsequently compared. Postoperatively, the length of the pylorus averaged 22.0+/-2.66 mm, and the muscular thickness was 6.53+/-1.68 mm (p<0.0001). The reduction rates in pyloric length were 23.5%, 46.3%, and 53.4% for the respective groups. Also, the muscle-thickness reduction rates were 31.8%, 48.9%, and 57.8% respectively. At 6 months after the operation, the pyloric muscular thickness was in the normal control range, and the pyloric length was reduced to the normal range after 12 months. CONCLUSIONS: This prospective study suggests that the pyloric mass undergoes a rapid reduction in size in the first 6 months, followed by a more gradual reduction to a normal value by 12 months after a pyloromyotomy.
Humans ; Infant ; Korea ; Prospective Studies ; Pyloric Stenosis, Hypertrophic* ; Pylorus ; Reference Values ; Ultrasonography ; Vomiting