BACKGROUND: To determine the advantage of laparoscopic splenectomy techniques in immune thrombocytopenic purpura (ITP), we compared it with an open splenectomy. METHODS: The cases of all patients who had undergone (52) a splenectomy for ITP at St. Mary's Hospital from January 1993 to December 1997 were reviewed. From the 52 cases, 21 cases were managed with a laparoscopic technique only and 31 cases were managed with an open technique. RESULTS: Blood and platelet transfusion requirements were reduced in the laparoscopic group. Although the mean operating time was slightly longer in the laparoscopic group (110 versus 184 minutes, p<0.001), the mean hospital stay (9.7 versus 5.9 days, p<0.001) was slightly shorter and the postoperative analgesic requirement (p<0.001) and the incidence of post operative complications (9.5 versus 48.4%) were greatly reduced. The detection rates of accessory spleens was low in the laparoscopic group. CONCLUSIONS: The laparoscopic splenectomy produced better clinical outcomes than an elective splenectomy for ITP. Also, such laparoscopic methods reduced costs.
Humans ; Incidence ; Laparoscopy ; Length of Stay ; Platelet Transfusion ; Purpura, Thrombocytopenic, Idiopathic* ; Spleen ; Splenectomy*

Metastatic cancer of the esophagus is unusual, Toreson discovered 19 in 599 autopsies on carcinoma patients, an incidence of 3.2%, Most of the patients had primary tumors of the lung, stomach, larynx or breast. Contiguous spread of tumor into the esophagus may produce an ulcerative lesioin resembling primary cancer of the esophagus, as examplified by the direct extension of tumor from the gastric cardia. These tumors may produce esophageal symptoms, notable dysphagia, and present no particular problem to the endoscopist because the ulcerative tumor in the lumen of the eaophagus makes diagnosis easy. Unusuually these tumor will extend into the esophagus submucosally producing submucosal nodules or cicatricial stricture of the esophagus without ulceration inito the lumen. This increases the diagnostic problems because of the difficulty of obtaining a endoscopic biopsy. We experienced a case of multiple nodular metastatic esophageal carcinoma, which was submucosally extended from the stomach cancer, confirmed by endoscopic biopsy. So we report this case with brief review of the previous litera- tures.
Autopsy ; Biopsy ; Breast ; Cardia ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis ; Esophageal Neoplasms ; Esophagus ; Humans ; Incidence ; Larynx ; Lung ; Stomach Neoplasms* ; Stomach* ; Ulcer

Fournier described five patients with gangrene of male external genitalia in 1883 and emphasized three characteristics: (1) abrupt onset in young healthy male, (2) rapid progression to gangrene,(3) absence of discernible cause. But more recent reports described genital gangrene as occurring in any age group and 4 patients in our cases, the mean age was 46 years with an age range of 31 to 59 years. Predisposing causes were as follows: case 1. prostatic calculi, Buerger's disease, case 2, perianal abscess, case 3, diabetes mellitus, case 4, tuberculous spondylitis accompanied by paraplegia and bed sores, liver cirrhosis. The duration of symptoms prior to the development of gangrene varied between 4 to 10 days. The cultured organisms were as follows : case 1. Alpha-hemolytic streptococcus, case 2. E. coli, Alpha-hemolytic streptococcus case 3. Alpha-hemolytic streptococcus, case 4, Mycobacterium tuberculosis, proteus species. Reconstructive surgery of defected scrotum was performed postoperative 8 to 41 days (mean 28.7) and total admission period was 25 to 83 days (mean 46 days).
Abscess ; Calculi ; Diabetes Mellitus ; Fournier Gangrene* ; Gangrene ; Genitalia ; Humans ; Liver Cirrhosis ; Male ; Mycobacterium tuberculosis ; Paraplegia ; Pressure Ulcer ; Proteus ; Scrotum ; Spondylitis ; Streptococcus ; Thromboangiitis Obliterans

Over 26 kinds of tablets and capsules, such as Tetracycline, Quinidine and Potassium preparations were reported to cause esopbageal ulcerations, eharacterized in various size, shape and number, ind sually in mid-esophagus, Recently authors experienced 10 cases of drug-induced esophageal ulcerations due to antibiotics and antiinflammatory agents such as Tetracycline, Aspirin, etc. Four cases were men and six were women. Four cases were in third dades, three in fourth cleeades, two in fifth decades and one in sixth decades. Presenting symptoras were odynophagia(4/10), dysphagia(3/10), substernal pain(7/10) and epigastric pain(3/10). Endoscopic examination of the esophgus showed single or multiple, small and shallow ulcers on the mid-esophgeal mucosa at the level of 30cm from the ineisor in eight cases, one Iarge and deep ulcer at the level of 40cm from incisor in one patient and one amall, shallow and one large, deep ulcers at the same time. in one patient The shape of alcers were various from a round to a large horseshoe shaped one. The clinical course was mild without complications. It was suggested that drug-induced esophsgeal ulcers with antibiotics and antiinflammatory agents could be found frequently and they had benign and mild clinicalc ourse,
Anti-Bacterial Agents ; Anti-Inflammatory Agents ; Aspirin ; Capsules ; Female ; Humans ; Incisor ; Male ; Mucous Membrane ; Potassium ; Quinidine ; Tablets ; Tetracycline ; Ulcer*

OBJECT: A hangover is characterized by the constellation of unpleasant physical and mental symptoms that occur 8-16hr after alcohol drinking. We evaluated the effects of experimentally induced alcohol hangover on immune functions by the measurement of cytokine production. METHODS: A total of 13 normal adults males participated in this study. They did not have any previous histories of psychiatric or medical disorder. We defined the experimentally induced hangover condition by 13 hours after drinking high doses of alcohol(1.5g/kg of body weight). Venous blood was taken before the alcohol drinking & during the experimental hangover conditions. Monocyte was separated and stimulated with phytohemagglutinin. Cytokine production was measured by ELISA for IL-1beta, IL-2, IL-4, IL-6, IL-10, IL-12, INF-gamma, TNF-alpha. RESULTS: The production of cytokines IL-10, IL-12 and INF-gamma were increased during hangover conditions. CONCLUSIONS: There is an changes in the production of cytokines IL-10, IL-12 and INF-gamma during hangover conditions. Thus, our results supported the hypothesis that acute alcohol treatment might affect Th1/Th2 immune balance by altering monocyte production of IL-12 and IL-10. These results suggested that elevated monocyte-derived IL-10 can contribute to the cellular immune abnormalities during hangover conditions.
Adult ; Alcohol Drinking* ; Cytokines ; Drinking ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-10 ; Interleukin-12 ; Interleukin-2 ; Interleukin-4 ; Interleukin-6 ; Male ; Monocytes ; Tumor Necrosis Factor-alpha

OBJECTIVES: This study was performed in order to assess the incidence of hypertension based on two-years follow-up of a rural hypertension-free cohort in Korea. METHODS: The study cohort comprised 2,580 subjects aged above 20 (1,107 men and 1,473 women) of Chung-Song County in Kyungpook Province judged to be hypertensive-free at the baseline examination in 1996. For each of two examinations in the two-year follow-up, those subjects free of hypertension were followed for the development of hypertension to the next examination one year (1997) and two years later (1998). The drop-out rate was 24.7% in men and 19.6% in women. Hypertension was defined as follows 1) above mild hypertension as a SBP above 140 mmHg or a DBP above 90 mmHg, 2) above moderate hypertension as a SBP above 160 mmHg or a DBP above 100 mmHg or when the participant reported having used antihypertensive medication after beginning this survey. RESULTS: The age-standardized incidence of above mild hypertension was 6 per 100 person years (PYS) in men and that of above moderate hypertension was 1.2. In women, the age-standardized rate for above mild hypertension was 5.7 and 1.5 for above mild and moderate hypertension, respectively. However, the rates of incidence as calculated by the risk method were 4.8% and 1.0% in men and 4.6%, 1.2% in women, respectively. In both genders, incidence was significantly associated with advancing age(p<0.01), In men, the incidences of above moderate hypertension by age group were 0.5 per 100 PYS aged 20-39, 0.7 aged 40-49, 1.7 aged 50-59, 3.6 aged 60-69, and 5.8 aged above 70(p<0.01). In women, those the incidence measured 0.6 per 100 PYS aged 20-39, 1.8 aged 40-49, 1.3 aged 50-59, 3.3 aged 60-69, and 5.6 aged above 70(p<0.01). After age 60, the incidence of hypertension increased rapidly. CONCLUSIONS: The incidence data of hypertension reported in this study may serve as a reference data for evaluating the impact of future public efforts in the primary prevention of hypertension in Korea.
Adult* ; Cohort Studies* ; Female ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Hypertension* ; Incidence* ; Korea ; Male ; Primary Prevention

BACKGROUND: Inadequate preoperative evaluation leads to delay or cancellation of elective surgery. To minimize this problem, we launched an anesthesia preoperative evaluation clinic. We analyzed major causes of referral, requested departments and distribution of age to make guidelines of management and laboratory tests. METHODS: The data was collected based on 6,902 patients referred to the anesthesia preoperative evaluation clinic from August 1997 to February 2002. The number of patients each year, distribution of sex, age, requested departments and clinical causes of referral were analyzed retrospectively. RESULTS: The sex ratio (M/F) was 42:58. Twenty-three percent of the patients were in their 7th decade. Obstetrics and gynecology (24.3%), general surgery (20.7%), and orthopedic surgery (15.4%) were the main requested departments. Major causes of referral were cardiovascular problems (27.5%) and pulmonary problems (21.0%). Irrespective of age and department, the most common consultations were related to cardiovascular or pulmonary problems. Nineteen percent of patients had more than two problems that included diabetes mellitus and hypertension. CONCLUSIONS: We concluded that increases in the number of referral patients and making guidelines related to cardiovascular and pulmonary problems will contribute to reduce delay or cancellation of elective surgery.
Anesthesia* ; Diabetes Mellitus ; Gynecology ; Humans ; Hypertension ; Obstetrics ; Orthopedics ; Referral and Consultation ; Retrospective Studies ; Sex Ratio

von Hippel-Lindau disease(VHL) is an autosomal dominant disorder, associated with tumors and cysts in multiple organ systems, whose expression and age of onset are highly variable There has been considerable progress in the molecular genetics of VHL disease. The VHL disease gene belongs to the family of tumor suppressor genes. The disease gene has been located in 6 to 8 centimorgan interval between RAF1 and D3S18, an anonymous DNA marker located at 3p26. It should be possible for the probe that flank the disease genes to identify carrier of the disease gene by DNA polymorphism analysis. We tested the feasibility of this approach by prospectively comparing the results of restriction fragment length polymorphism(RFLP) analysis with a comprehensive clinical examination in asymptomatic, at risk members of family with VHL disease. We found that RFLP analysis can distinguish VHL disease gene carriers from their healthy siblings. The result of this study suggests that the inheritance of the VHL gene was linked to RAF1. Deletions of chromosome 3p25-26 region were also detected in other VHL disease patient and a recurrent abortion case through karyotyping and RAF1 southern blotting. DNA polymorphism analysis can identify individuals likely to carry the VHL disease gene among asymptomatic members of disease families.
Abortion, Habitual ; Age of Onset ; Anonyms and Pseudonyms ; Blotting, Southern ; Diagnosis* ; DNA* ; Female ; Genes, Tumor Suppressor ; Genetic Markers ; Humans ; Karyotyping ; Molecular Biology ; Polymorphism, Restriction Fragment Length ; Pregnancy ; Prospective Studies ; Siblings ; von Hippel-Lindau Disease* ; Wills

Endometriosis is the presence of normal endometrial tissue in an ectopic location. Its involvement of urinary tract occurs in up to 10 percent. Especially the incidence of vesical endometriosis is very rare. We report one case of vesical endometriosis that have been treated by partial cystectomy and then discussed with references to its unusual features management.
Cystectomy ; Endometriosis* ; Female ; Incidence ; Urinary Tract

This study was conducted to evaluate the blood lead levels in 141 pregnant women who were not occupationally exposed to lead and their umbilical cord, arid to identify some differences in blood lead levels by living area. ; The subjects-were all delivered at St. Benedict Hospital in Pusan and the blood lead levels were measured by graphite furance atomic absorption spectrophotometer. The summarized results were as follows. 1. The geometric mean lead levels in maternal and cord blood were 8.0+/-1.8microgram/dl, 5.0+/-0.6lmicrogram/dl respectively. 2. Lead levels in maternal (8.7+/-1.7microgram/dl) and cord blood(5.4+/-0.7microgram/dl) of industrial area(n=24) were higher than residential area(n= 124) which were 7.9+/-1.7microgram/dl and 5.0+/-0.6microgram/dl respectively (p<0.05). 3. Maternal blood lead concentration was significantly correlated to cord blood lead concentration (r=0.6090, p<0.001), but other variables (maternal age, paternal smoking, birth weight, etc) were not correlated.
Absorption ; Birth Weight ; Busan ; Female ; Fetal Blood* ; Graphite ; Humans ; Occupations ; Paternal Age ; Pregnant Women ; Smoke ; Smoking ; Umbilical Cord*