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

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.
Menisci, Tibial ; Surgeons ; Suture Anchors* ; Sutures* ; Tears

Serrated adenoma (SA) is a distinct form of colorectal neoplasia and it is defined as a neoplastic lesion composed of a monotonous cell population with atypical nuclei proliferating in serrated glandular architectures. Hyperplastic polyp is considered a benign lesion with no malignant potential. However, SA progressed into frank carcinoma has been demonstrated in an individual case, and 'serrated neoplasia pathway' is suggested by some authors as an alternative to classical adenoma-carcinoma sequence. Distinguishing between hyperplastic polyp and SA is important because of the different management implications and the increased potential for neoplastic progression in the latter, but sometimes it is very difficult. SA is usually small and sessile polypoid lesion. We report a case of SA presenting as large fungating mass similar to colon cancer, diagnosed as hyperplastic polyp initially by colonoscopic biopsy and confirmed as after SA the surgery.
Adenoma* ; Biopsy ; Colon* ; Colonic Neoplasms* ; Polyps

PURPOSE: The incidence of colonic diverticular disease is increasing, and several grading systems based on CT findings have been developed. The objective of this study was to define the impact of various CT findings of colonic diverticulitis and to demonstrate which factors affect the need for operative treatment. METHODS: Three hundred fifty-seven patients diagnosed with colonic diverticulitis from January 2010 to July 2016 were retrospectively evaluated. Patients were excluded if pure diverticulosis, diverticular bleeding, colon cancer, or relevant data deficiencies, and the remaining patients (n = 178) were reviewed. Patients were categorized into a successful nonoperation group and an operation group. The operation group was then matched 1:2 with the nonoperative group based on age, gender, American Society of Anesthesiologists physical status classification, and body mass index. RESULTS: After propensity score matching, there were no significant differences regarding patients' demographic characteristics between the 2 groups. Left location was more associated with need for operation than the right side (79.2% vs. 31.3%, P < 0.001). CT findings such as distant intraperitoneal air, pericolic air, and free fluid were significantly more apparent in the operation group. When these factors were evaluated in a multivariate analysis, distant intraperitoneal air showed statistical significance (P = 0.046) and pericolic air and left location a significant trend (P = 0.071 and P = 0.067, respectively). CONCLUSION: This study suggests that distant intraperitoneal air is the most important factor in the need for surgery in patients with colonic diverticulitis. Further study will be able to identify more detailed CT findings and verify their significance, and will be helpful in designing practical scoring and classification systems.
Body Mass Index ; Classification ; Colon ; Colonic Neoplasms ; Diverticulitis* ; Diverticulitis, Colonic ; Diverticulum ; Hemorrhage ; Humans ; Incidence ; Intraabdominal Infections ; Multivariate Analysis ; Propensity Score ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function. MATERIALS AND METHODS: Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared. RESULTS: Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group. CONCLUSION: There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed.
Femoral Neck Fractures ; Femur ; Fracture Fixation, Intramedullary ; Hip Fractures ; Humans ; Kidney ; Necrosis ; Odds Ratio ; Operative Time ; Partial Thromboplastin Time ; Rehabilitation ; Renal Dialysis*

We report a case of anal squamous cell carcinoma extended to the rectal mucosa that was clinically mistaken for rectal adenocarcinoma and literature reviwed. Sigmoidoscopic finding showed spherical shaped elevated lesion with central ulceration, interpreted as rectal adenocarcinoma in the distal portion of rectum. Anal squamous cell carcinoma is very rare among gastrointestinal cancer. Pathological study of the biopsy specimen demonstrated squamous cell carcinoma and normal rectal glands. Sigmoidoscopic finding of the presented case showed the ulcerarive lesion contineuosly extended from anal verge upward to the rectum. We postulate that the presented case is primarilly originated from the anal squamous cell carcinoma extended proximally to the rectum. Immunohistochemical stain(p-63) of the biopsy specimens showed squamous cell carcinoma. This patient has been completely recovered after treartment of chemoradiation and trans-anal excision. We present a case of anal squamous cell carcinoma invading rectal mucosa clinically mistaken for rectal adenocarcinoma and literature reviewed.
Adenocarcinoma* ; Anus Neoplasms ; Biopsy ; Carcinoma, Squamous Cell* ; Gastrointestinal Neoplasms ; Humans ; Mucous Membrane ; Rectum ; Salt Gland ; Ulcer

Colonoscopy is a safe and standard procedure for diagnosis and therapy of colonic disorders. Iatrogenic colonic perforation during diagnostic colonoscopy, a rare abdominal emergency, has an 0.3~0.8% incidence rate. The choice of treatment for this complication remains controversial. Prompt operative intervention is preferred to minimize morbidity and mortality. However, operative intervention is invasive and needs a long-term recovery period. Conservative treatment is less invasive but can lead to more extensive surgery in case of treatment failure. Very important point on the treatment of iatrogenic perforation of the colon during diagnostic colonoscopy is to avoid the leaking of intestinal contents into the intraperitoneal cavity. We report here a case in which an iatrogenic perforation of the colon during diagnostic colonoscopy was successfully treated by endoscopic clip therapy.
Colon* ; Colonoscopy* ; Diagnosis ; Emergencies ; Gastrointestinal Contents ; Incidence ; Mortality ; Treatment Failure

Gastric volvulus is characterized by an abnormal rotation of the stomach typically 180degrees left to right around a line joining the relatively fixed pylorus and the esophagus. Gastric volvulus can be classified anatomically as organoaxial, mesenteroaxial or combined, and symptomatically as acute or chronic. Acute gastric volvulus is an extremely rare emergency surgical condition. The classical triad of gastric volvulus are severe nausea with a paradoxical inability to vomit, localized epigastric pain and an inability to pass a nasogastric tube. Gastric volvulus may be suspected on a plain radiological examination of the abdomen as well as by its symptoms. It is confirmed by the specific findings on the esophagogastroduodenoscopy. We report a case of acute mesenteroaxial gastric volvulus, that was treated using laparoscopic reduction and anterior gastropexy.
Abdomen ; Emergencies ; Endoscopy, Digestive System ; Esophagus ; Gastropexy ; Gastroscopy ; Nausea ; Pylorus ; Stomach ; Stomach Volvulus*

BACKGROUND/AIMS: H. pylori has been implicated in the pathogenesis of chronic gastritis, gastric ulcer, duodenal ulcer, and gastric cancer. The mode of H. pylori spread among individuals still largely unknown, but three possibilities such as fecal-oral, oral-oral, and gastro-oral transmission were reported. We were not exclusive possibility of H. pylori infection via endoscopic equipmemt, because endoscope was inserted directly into the gastrointestinal tract. METHODS: Fifty eight patients with upper gastrointestinal symptoms, who had visited Pusan National University Hospital from February 1999 to May 1999 were examined endoscopically and two biopsies were taken in each antrum and fundus for rapid urease test. After endoscopy, we collected the washing fluid from the surface and channel of the endoscope before and after cleaning and disinfection. Then we examined H. pylori contamination by H. pylori DNA PCR. RESULTS: The numbers of chronic gastritis, gastric ulcer, duodenal ulcer, gastric ulcer with duodenal ulcer, and gastric cancer were 15, 20, 18, 3, and 2, respectively. The positive rates were 84.5% (49/58) with CLO test, 58.6% (34/58) with H. pylori DNA PCR of the washing fluid of the endoscope surface and channel. In patients with CLO test positive, the positive rates of H. pylori DNA PCR is 44.9% (22/49) in endoscope channel, 24.5% (12/49) in surface before disinfection, but H. pylori DNA was not detected in any cases after washing and disinfection recommended by The Korean Society of Gastrointestinal Endoscopy. CONCLUSIONS: This study demonstrates that endoscopes were frequently contaminated by H. pylori during procedures performed on H. pylori-positive patients and were a potential source of nosocomial spread of the infection. However, this study also shows that the risk of endoscopic transmission of H. pylori infection could be minimized when appropriate cleaning and disinfection techniques were used.
Biopsy ; Busan ; Disinfection ; DNA ; Duodenal Ulcer ; Endoscopes* ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastritis ; Gastrointestinal Tract ; Helicobacter pylori* ; Helicobacter* ; Humans ; Polymerase Chain Reaction ; Stomach Neoplasms ; Stomach Ulcer ; Urease

A gastrointestinal lipoma, though rare, is a mesencymal tumor of the large bowel, and the second most common benign colonic tumor detected after an adenomatous polyp. The lesion may be asymoptomatic when small and may be detected incidentally, usually during a colonoscopic examination for another purpose. Lipomas of the large bowel that are not causing symptoms probably need no treatment, as malignant transformation has not been documented. If the mass is large, it can cause pain, anal bleeding due to intussusception, bowel obstruction and diarrhea, and thus resection should be considered. Due to the risk of perforation, endoscopic resection of large colonic lipomas has been discouraged. However, large colonic lipomas can be removed safely by endoscopic resection with the use of an endoscopic ultrasonogram and submucosal injection to elevate the lesion.
Adenomatous Polyps ; Colon* ; Diarrhea ; Hemorrhage ; Intussusception ; Lipoma* ; Ultrasonography