BACKGROUND: In the most of emergency department, the diagnosis of appendicitis has been carried by clinical history, physical examination and plain X-ray. But the diagnostic accuracy by these methods was so low that unnecessary operation was common performed, and sometimes the operation was delayed till the physicians could confirm the acute appendicitis clinically. Although many kinds of diagnostic tools such as CT scan, laparoscope, and etc, we believe that ultrasonography(US) would be a quick and sensitive diagnostic method for the evaluation of acute appendicitis in the Emergency Department. METHODS: Forty-seven patients who were clinically suspected as acute appendicitis were evaluated with the grayscaled US by emergency physician. The probe of US was placed on maximal tender point of abdomen, and the appendix image was evaluated while probe was pressed deeply and gentry. When the blind loop was fecund at maximal tender point of abdomen, we evaluated the diameter of appendix, the presence of compressibility, peri-aspen-diceal fluid collection and other mass effect. As soon as the ultrasonographic evidences of the appendicitis were noticed, the operations were done and pathologic report were reviewed later. RESULTS: Among the forty-seven patients, forty patients were diagnosed as a appendicitis by US, and most common ultrasonic findings were as follows; 1) non-compressible blind loop larger than 5 mm in diameter, 2) wall thickening more than 3 mm, 3) peri-appendiceal fluid collection, 4) periappendiceal mass. Among remaining 7 patients in whom we could not get any positive findings of appendicitis, abdominal CT scan was carried in 2 cases who had direct and rebound tenderness on right lower abdomen, and CT scan showed the evidences of the appendicitis. The other 5 cases without rebound tenderness were observed far 2 hours, and abdominal pain was disappeared lately. Finally forty-two patients were operated and confirmed as acute appendicitis by pathologic reports; 24 were reported as suppurative appendicitis, and 12 cases of gangrenous appendicitis, 3 cases of perforated appendicitis, and 3 cases were peri-appendiceal abscess. The specificity of US in the diagnosis of acute appendicitis was 71.4%, and the sensitivity was 95.2%. CONCLUSIONS : In some patients suspected appendicitis, emergency physicians could diagnosis acute appendicitis accurately and rapidly by use of ultrasonography. Although the US was an actuate imaging modality to diagnosis acute appendicitis and evaluate its complications, we recommend a laparotomy or abdominal Cf scan in the patients with negative US findings in spite of presence of peritoneal irritation signs such as rebound tenderness and/or muscle guarding on right lower abdomen.
Abdomen ; Abdominal Pain ; Abscess ; Appendicitis* ; Appendix ; Diagnosis ; Early Diagnosis* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Laparoscopes ; Laparotomy ; Physical Examination ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Ultrasonics ; Ultrasonography*

No abstract available.
Adult* ; Humans ; Life Style*

PURPOSE: To evaluate the clinical significance of the screening mammography in the detection of the breast diseases, especially breast carcinoma. MATERIALS AND METHODS: We analyzed 1,800 cases of mammography retrospectively. The mammography was done as a part of routine check in Health Counselling Center, Korea University Medical Center, during 9 months from November 1993 to July 1994. The age range was from 23 years to 76 years, mean 49.8 years, and the largest age group was 6th decade(31.4%). According to the mammographic findings, we divided the subjects into three groups; normal group, abnormal group in need of follow up study, abnormal group requiring biopsy. RESULT: On mammography, the normal group consisted of 1,534 cases(85%), and the abnormal group consisted of 266 cases(15%). The abnormal findings were benign-looking calcification(n=140), fibroadeno ma (n=29), fibrocystic changes (n=27), cyst(n=23), malignant lesion(n=15), lipoma(n=7), and others. In four of 15 cases, which were suspected to be malignant on mammograms, breast carcinoma was confirmed pathologically. In four cases of breast carcinoma, one was under 40 and the other 3 were over 50 years of age. All of the breast cancers were under 3cm in size, and the mammographic findings of breast cancer included spiculated margin(n=3), parenchymal disortion(n=3), malignant calcification(n=2) and enlarged axillary node (n=l). CONCLUSION: Screening mammogram is helpful for early detection of non-palpable breast cancer, especially for women over 50 years of age.
Academic Medical Centers ; Biopsy ; Breast Diseases* ; Breast Neoplasms ; Breast* ; Female ; Follow-Up Studies ; Humans ; Korea ; Mammography* ; Mass Screening* ; Retrospective Studies

In spite of vigorous efforts to enhance appropriateness of blood usage in surgery, it is recognized that there are still not a few overuse and misuse of blood products in Korean hospitals. To assure appropriate use of blood, continuous monitoring and controlfling blood orders, particularly for surgical operations, should be implemented. The indicator of 'ratio of crossmatching to transfusion' (C/T ratio) has been focalized on in this regard. The authors investigated C/T ratio for eight hospitals, evenly distributed in their geographical location as well as size. Only elective surgeries operated from March 1 to May 31, 1995 were included for analysis. Standardized survey format was distributed, and retrospective reviews of medical records were performed by volunteer surveyors from each hospital after two sessions of pre- survey education. The results were as follows. Average C/T ratio, for all hospitals and all surgeries, was 1.76. Differences in C/T ratio by sex, months, clinical departments, blood components were not significant. However, the ratio showed increasing tendency with ages. The C/T ratio on the average was not higher, compared with the recommended guideline. However, due to study' s limitations ini standardization of survey method and verification of data, we could not conclude that current status of appropriateness of blood use is satisfactory. In addition, to pervasively use the C/T ratio as a quality indicator for blood use management, supplementary measures, such as standardization of data, should be adopted.
Surveys and Questionnaires ; Education ; Medical Records ; Quality Indicators, Health Care* ; Retrospective Studies ; Volunteers

Paranasal sinus CT is known as the most effective imaging modality in the evaluation of inflammatory sinonasal diseases and can depict the distribution, causative lesions obstructing main drainge route, and associated findings. Recently, functional endoscopic sinus surgery has been widely used for the evaluation and treatment. Before operation, PNS CT has been routinely used to evaluate the paranasal sinuses and mucociliary drainage route. The authors analyzed the PNS CT findings of 3156 cases in 1578 patients with chronic sinusitis symptoms. Sinonasal inflammatory diseases were categorized into 5 patterns according to the obstruction sites. They were 1) infundibular (10%, 316/3156), 2) ostimeatal unit (41%, 1294/3156), 3) sphenoethmoidal recess (12%, 379/3156), 4) sinonasal polyposis (30%, 946/3156) , and 5) unclassifiable (6%, 190/3156) patterns. The main causes for infundibular obstruction in order of frequency were inflammatory mucosa, enlarged ethmoidal bulla and Haller's cell. With respect to the middle meatus obstruction, is main causes in the order of frequency were polypoid lesion, inflammatory mucosa and medially deviated uncinate process. In particular, sinonasal polyposis showed one or more of the characteristic associated findings of infundibular enlargement, air-fluid level, ethmoidal sinus was bulging and bony deossification or sclerosis as well as sinonasal polypoid change. In conclusion, the inflammatory sinonasal diseases were classified into five patterns, and the causative lesions or anatomic variations were efficiently detected by the PNS CT. Furthermore, it could provide a guidance for proper management of the sinusitis including functional endoscopic sinus surgery.
Drainage ; Humans ; Mucous Membrane ; Paranasal Sinuses ; Sclerosis ; Sinusitis

No abstract available.
Densitometry* ; Osteoporosis*

Radiation therapy is used for the palliative treatment of malignant tumors and the radiation induced osteonecrosis is one of the well documented complications. Especially, in pelvic region, there are a few reports for osteonecrosis of the femoral head and acetabulum after the radiation therapy for the the malignant tumors such as cervical carcinoma or prostatic cancer. Roentgenographic changes that are caused by radiation include the rarefaction of bone and coarsening of the trabeculae. The radiolucencies tend to coalesce and patchy sclerosis appears. In acetabular region, this Pagetoid appearance mimics the findings of other malignant bone tumors, the recurrence of preexisting malignant peivic tumors and other infectious condition. After the diagnosis is confirmed, the treatment for the femoral head and acetabulum is also difficult. The authors report one case of osteonecrosis of the femoral head and acetabulum following radiation therapy which had many difficulties in its diagnosis and treatment.
Acetabulum* ; Diagnosis* ; Head* ; Osteonecrosis* ; Palliative Care ; Pelvis ; Prostatic Neoplasms ; Recurrence ; Sclerosis

We analyzed the factors of importance for nonunion in series of 91 open fractures of tibial diaphysis which were treated with external fixation. Factors analyzed included, age and sex of the patients, the mechanism of injury, the amount of soft tissue damage, the grade of comminution, the level at which the tibia was fractured, the presence of an intact fibula, the presence of the multiple injuries, the type of the external fixation used(AO external fixator, EXTOR; monotube external fixator, Ilizarov), and the need to supplement the stability of the reduction. We found that the amount of soft tissue damage and comminution of the fracture played a role in the development of the nonunion.
Diaphyses ; External Fixators ; Fibula ; Fractures, Open ; Humans ; Multiple Trauma ; Tibia ; Tibial Fractures*

Injuries of the posterior cruciate ligament have almost universally been treated nonoperatively in the past due to indignity of this complex structure. Recent studies have shown new informations on the anantomical, histological, biomechanical characteristics of the Posterior cruciate ligament PCL), and thereby interest of reconstruction surgery is increasing. But intraarticular PCL reconstruction still remains one of the most challenging problems in knee surgery. Although, various types of graft and surgical techniques have been used for reconstruction, results of surgery has been variable. In this study, three different methods of graft fixation for PCL reconstruction are evaluated biomechanically to determine the effect on mechanical property of reconstructed PCL using 30 porcine knees. Grafts used in this study were bone-patellar tendon-bone fixed with interference screw and Achilles tendon tied with suture. Additionally, five original PCLs were also tested by Instron universal testing instrument to determine its mechanical proprety. Tensile test was performed at extended knee position. It was demonstrated that mechanical strength of bone-patellar tendon-bone graft is superior to that of Achilles tendon graft. All of the failures of bone-patellar tendon-bone graft and Achilles tendon graft occurred at tibial fixation site whereas original PCLs which failed at proximal midsubstance of ligament. In conclusion, tensile strength of Bone-patellar tendon-bone graft used for PCL reconstruction is higher than that of Achilles tendon but latter can be used in terms of as clinical meanings.
Achilles Tendon ; Bone-Patellar Tendon-Bone Grafts ; Knee ; Ligaments ; Posterior Cruciate Ligament* ; Sutures ; Tensile Strength ; Transplants*

Cutaneous leiomyoma is a benign tnmor originating from smooth muscle fibers which are derived from arrector pili muscle, media of blood vessels and dartoic muscle of scrotum, vulvar, or nipple. It is classified into 3 types according to the site of origin, namely pilar leiomyoma, angioleiomyoma and genital leiomyoma. Leiomyoma of the nipple is the less kquent type of cutaneous leiomyoma. We report a case of cutaneous leiomyoma on the nipple in a 53-year-old man.
Angiomyoma ; Blood Vessels ; Humans ; Leiomyoma* ; Male* ; Middle Aged ; Muscle, Smooth ; Nipples* ; Scrotum