The presense of the esophageal varices might have a partial machanical obstruction and cushion effect on esophageal lumen due to blood within the varices. It may affect on the motility and acid clearance in the esophagus. The aim of this study was to evaluate the acid clearance and the esophageal motility according to the degree of the varices in patients with esophageal varices. We have performed esophageal manometry and acid clearance test in 41 patients with esophageal varices. Esophageal motility disorder was abserved in 29.4% of patients with esophageal varices. The number of swallowing for acid clearance was significantly increased in patients with esophageal varices than control group(23.5 +/- 14.1 Vs 6.1 +/- 1.6, p=0.004). However, there was no significant corelation with form, location, and redcolor sign of the varices. In conclusion, patients with esophageal varices accompanied esophageal motility disorders and delayed acid clearance. This results might be a useful referance data for changes in esophageal motility before and after treatment of esophageal varices.
Deglutition ; Esophageal and Gastric Varices* ; Esophageal Motility Disorders ; Esophagus ; Humans ; Manometry ; Varicose Veins

No abstract available.
Humans ; Infant, Newborn ; Infant, Premature* ; Nephroma, Mesoblastic* ; Ultrasonography, Prenatal*

BACKGROUND: Diabetic ketoacidosis(DKA) is serious acute metabolic complication and the most important cause of high morbidity and mortality of diabetes. The object of this study is to examine the clinical characteristics of patients with DKA who had a prior history of diabetes or not. METHOD: Authors reviewed retrospectively the medical records of 49 cases adimitted to Kyungpook National University Hospital from January 1991 to June 1997 with a diagnosis of DKA and classified cases as type I, type II and newly diagnosed diabetics according to prior history of diabetes. RESULTS: 1. Of 49 cases of DKA, 24(49%) were classified as type I, 17(35%) as type II from data available in the medical records, and 8(16%) had DKA as the initial manifestation of the disease. 2. The male to female ratio was 0.5 : 1 in type I, 1.1 : 1 in type II and 1.7 : 1 in newly diagnosed diabetics, and the mean age was 24.4 in type I, 57.9 in type II and 23.9 years old in newly diagnosed diabetics. 3. The mean duration between initial diagnosis of diabetes and the occurrence of DKA was 2.6 in type I and 6.9 years in type II diabetes. The occurrence of DKA within 2 years of initial diagnosis of diabetes was 54% in type I and 18% in type II diabetes, but the occurrence of DKA after 5 years of initial diagnosis of diabetes was 17% in type I and 47% in type II diabetes. 4. The precipitating factors of DKA were identified in 88% in type I, 76% in type II and 38% in newly diagnosed diabetics, and the most common precipitating factor was omission of treatment in both type I and type II(type I: 56%, type II: 35%). 5. The altered mental status was correlated with increased osmolality (p<0.05), but not with other laboratory values such as pH, bicabonate, glucose, anion gap and dehydration status(p>0.05). CONCLUSION: It is necessary to conduct early aggressive evaluation for early diagnosis and proper treatment of DKA, because DKA occurs in patients with prior history of type II diabetes and without prior diabetic history as well as patients with prior history of type I diabetes.
Acid-Base Equilibrium ; Dehydration ; Diagnosis ; Early Diagnosis ; Female ; Glucose ; Gyeongsangbuk-do ; Humans ; Hydrogen-Ion Concentration ; Male ; Medical Records ; Mortality ; Osmolar Concentration ; Precipitating Factors ; Retrospective Studies

Conventional hemorrhoidectomy is still the main stairway to the treatment of the third or the fourth degree hemorrhoids. Among the various methods of hemorrhoidectomy, open hemonhoidectomy is claimed to decrease postoperative pain and wound infection, but to have disadvantage of long period of wound healing. Semi-closed hemorrhoidectomy has the advantage of rapid wound healing without increased risk of wound infection, but more painful postoperative course than open hemorrhoidectomy is suggested. To assess this conventional concept, two hundreds of patients were randomly allocated to either an open hemorrhoidectomy(Group 4, Operated by modified Goligher method, n=100) or a semi-closed hemorrhoidectomy(Group B, Operated by modified Nesselrod method, n=100), and postoperative results were analyzed. In group 4, the average time for disappearance of wound edema was 4.9days, average time for disappearance of wound pain was 9.0days, average time for painless defecation was 14.1 days, average time for complete wound healing was 28.4days. The main complications were overgranulation, skin tag, anal discharge and pruritus. The overgranulation requires curettage, the skin tags were resected under local anesthesia. Anal discharge and pruritus were spontaneously disappeared after the healing of the wound. In group B, the average time for disappearance of wound edema was 6.1 days, average time for disappearance of wound pain was 6.3days, average time for painless defecation was 9.2days, average time for complete wound healing was 20.7days. The main complications were skin tags, more prevalent than group 4, requiring resection under local anesthesia. No infectious complications were noted in both groups. Consequently, the old concept that open hemorrhoidectomy has advantage of less painful postoperative course than semiclosed hemorrhoidectomy cannot be accepted. Semi-closed hemorrhoidectomy offers more rapid loss of pain and more rapid healing of the wound than open hemorrhoidectomy, without increased risk of infectious complications. In conclusion, semi-closed hemorrhoidectomy is superior method to open hemorrhoidectomy in third or fourth degree hemorrhoids.
Anesthesia, Local ; Curettage ; Defecation ; Edema ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Pain, Postoperative ; Pruritus ; Skin ; Wound Healing ; Wound Infection ; Wounds and Injuries

No abstract available.
Cervix Uteri* ; Female

No abstract available.
Adenocarcinoma* ; Appendix*

Dieulafoy's lesion is a rare distinetive arterial malformation that can cause massive gastrointestinal henorrhage. Although in most cases the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction, similar lesions have been described in the antrum, duodenum, jejunum, colon, and rectum. We report 3 unusually located Dieulafoy-like lesion, two gastric antrum and one jejunum in patient who had gastrojejunostomy for pancreatic caneer. After a year follow up there was no bleeding episode in patient after endoscopic treatment.
Colon ; Duodenum ; Esophagogastric Junction ; Follow-Up Studies ; Gastric Bypass ; Hemorrhage ; Humans ; Jejunum* ; Pyloric Antrum* ; Rectum ; Stomach

To elucidate the mechanism involved in the cerebral vascular spasm following subarachnoid hemorrhage (SAH), the effects of the cerebrospinal fluid (CSF) obtained from the SAH patients on the resting tension and its influence on the contractile responses to various vasoactive agents and to hypoxia were investigated in isolated porcine cerebral arteries. All the CSFs containing hemoglobin (Hb) produced contraction and some Hb-free CSFs also elicited contraction. When the Hb-free CSF was separated by microfilter, the filtrate of < 30,000 MW did not produce contraction, while the fraction above 30,000 MW elicited more marked contractile responses than the unfractionated CSF. The CSF contraction was significantly attenuated in the presence of indomethacin or nimodipine, whereas the contractions induced by KCl, prostaglandin F2alpha (PGF2alpha), or endothelin-1 (ET-1) were not affected by the CSF pretreatment. However, the contractile responses induced by 5-hydroxytryptamine (5-HT) and phenylephrine (PE) were markedly potentiated by the pretreatment. Hypoxia-induced vasoconstriction was significantly potentiated by the pretreatment with either unfractionated CSF or the CSF fraction of above 30,000 MW. These results suggest that unknown vasocontractile substance(s) exists in the Hb-free CSF and that the substance, with its MW above 30,000, is activated by hypoxia and acts synergistically with 5-HT and PE, and that extracellular calcium influx and cyclooxygenase are also involved in the cerebral vasoconstrictory effect of Hb-free CSF.
Anoxia ; Calcium ; Cerebral Arteries* ; Cerebrospinal Fluid* ; Dinoprost ; Endothelin-1 ; Humans* ; Indomethacin ; Nimodipine ; Phenylephrine ; Prostaglandin-Endoperoxide Synthases ; Serotonin ; Spasm ; Subarachnoid Hemorrhage ; Vasoconstriction

BACKGROUND: To examine whether nonemergency patients can be identified and be safely triaged out of the emergency department. METHODS: Adult patients(16 years or older) who visited to the emergency department were prospectively studied from July 1 to August 31, 1997. Authors developed a new triage composed of vital signs, mental status, chief complaints, etiology, and a mode of transfer. Chi-square test and a discriminant analysis were applied for statistical analysis. RESULTS: In a discriminant analysis, mode of transfer, chief complaint, age, heart rate, mental status, etiology, and body temperature were significant variables in order. In a canonical discriminant value at group mean, a nonemergent value is 0.450 and a emergent value -0.219. CONCLUSIONS: In simply applicable triage method, mode of transfer and chief complaints are more important than vital sign and mental status. This method is useful in disaster situation and non-medical personnel may use this triage method easily. But some patients are not triaged by this triage method, thus more studies and discussions are necessary.
Adult ; Body Temperature ; Disasters ; Emergencies* ; Emergency Service, Hospital* ; Heart Rate ; Humans ; Prospective Studies ; Triage* ; Vital Signs

Two cases of Castleman's disease (Giant lymph node hyperplasia) are reported. The first case was a multicentric cervical giant lymph node hyperplasia. Excisional biopsy confirmed the diagnosis of Castleman's disease of the plasma-cell type. Despite repeated dissection of the cervical lymph nodes, complete removal of the lymph nodes was impossible, and the type was changed into mixed type, and regrowth of the tumor was noted. Prednisolone was of no benefit. The patient is now living with cervical masses in situ without general symptoms, 4 years after the initial diagnopsis. The second case was a solitary retroperitoneal giant lymph node hyperplasia, incidentally found. Complete excision was performed and biopsy confirmed the diagnosis of Castleman's disease of hyaline-vascular type. No recurrence was found at 2 years after the excision.
Biopsy ; Diagnosis ; Giant Lymph Node Hyperplasia* ; Humans ; Lymph Nodes* ; Neck ; Prednisolone ; Recurrence