No abstract available.
Pancreaticoduodenectomy* ; Pancreaticojejunostomy*

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

PURPOSE: To evaluate the size of normal pons and cerebellum in vivo and the change in size according to age, and to compare those with measurement of the diseased pons and cerebellum. MATERIALS AND METHODS: 121 normal adults(M:F=54:67), 5 patients with OPCD and 19 patients with WallerJan degeneration were studied. The normal group was divided into 5 subgroups according to the age (ranged from 20 to 72 years). 1.5T GE Signa MR unit was used. On axial plane, the AP(A) and transverse(B) diameters of the pons, the size of the middle cerebellar peduncle(C), and transverse diameter of the posterior fossa(D) and the cerebellum(E) were measured. On midsagittal plane, the longitudinal(F) and AP(G) diameters of the basis pontis were measured. The ratios of E/D and F/G were calculated. The student t test was used for statistical analysis. RESULTS: C, E and F/G were 15.5mm+/-1.3, 99.8mm+/-4.3 and 1.63+/-.10, respectively. F/G, H/I, and H/J were larger in male(p<.01). All data of the pons showed no statistically significant differences among age groups. E of the seventh decades was shorter than that of the third decades(p<.05). C(12.7 mm+/-1.4) in OPCD and F/G(1. 81+/-.10) in Wallerian degeneration(p<.01) showed the most significant differences when they were compared to the normal. CONCLUSION: Although the cerebellum decreased in size with age, the pons maintained its size up to eighth' decades. The measurement of middle cerebellar peduncle on axial plane (C) and the ratio of basis pontis on midsagittal plane (F/G) were important in the evaluation of OPCD and WallerJan degeneration, respectively.
Cerebellum* ; Humans ; Magnetic Resonance Imaging* ; Pons*

Twenty cases of polypoid lesions of the gallbladder were reviewed. Seven were benign lesions. Among them, there were 4 (20%) adenomas and 3 (15%) adenomatous hyperplasias. All of the benign lesions were less than 1 cm in diameter. Thirteen cases involved a carcinoma of the gallbladder, of which 92% were more than 1 cm in diameter, 76.9% were over 60 years of age, and 38.5% were associated with gallstones. The accuracy of the preoperative ultrasonographic diagnosis of the polypoid lesions of the gallbladder was 80%. The spread and the size of the tumor showed a close correlation. Therefore, the size of the tumor is a vital indicator for the treatment of polypoid lesions of the gallbladder; lesions between 0.6~1 cm in diameter should be followed up by ultrasonography. An operation may be considered if stones are present. Lesions bigger than 1 cm should be resected since malignancy can not be excluded.
Adenoma ; Diagnosis ; Gallbladder Neoplasms ; Gallbladder* ; Gallstones ; Hyperplasia ; Polyps ; Ultrasonography

Intestinal tuberculosis has been known since antiquity. After about 1950's, effective antituberculous chemotherapy and an improved standard of living resulted in a steady decline in all forms of tuberculosis. However, intestinal tuberculosis has been reported with impressive frequency in developing countries including Korea. Disease affecting the duodenum is reported to be rare and isolated duodenal tuberculosis sparing the rest of the intestine is uncommon. We experienced a case of tuberculosis of duodenal bulb associated pulmonary tuberculosis. The diagnosis was made on the basis of the histological study of the endoscopic biopsy specimen. We have confirmed the healing of the duodenal lesion by the follow-up endoscopy after 9 months treatment of antituberculous medication.
Biopsy ; Developing Countries ; Diagnosis ; Drug Therapy ; Duodenum* ; Endoscopy ; Follow-Up Studies ; Intestines ; Korea ; Socioeconomic Factors ; Tuberculosis* ; Tuberculosis, Pulmonary*

Double primary cancer means that more than two cancers with different origin exist independently in an individual. The diagnosis of double primary cancer was determined by following criteria. Each of the tumors must present a definite picture of malignancy, and each must be distinct, and the probability of one being a metastasis of the other must be excluded. Small cell carcinoma has a distinct biological behavior such as, early invasion and metastasis, a rapid clinical course, and significant sensitivity to chemotherapy. Small cell carcinoma in the esophagus is relatively rare, and rarer when it is combined with other malignant disease. We have experienced a case of double primary cancer, a 70-year-old man with esophageal small cell carcinoma and gastric adenocarcinoma, which were diagnosed by gastrointestinal endoscopic biopsy. A review of the Korean medical literature failed to reveal any previously described case of esophageal small cell carcinoma with gastric adenocareinoma. We report this case with review of literatures.
Adenocarcinoma* ; Aged ; Biopsy ; Carcinoma, Small Cell* ; Diagnosis ; Drug Therapy ; Esophagus ; Humans ; Neoplasm Metastasis

Heterotopic mesenteric ossification is a very uncommon disorder that is characterized by new bone formation in the mesentery, which does not normally undergo ossification. A 52-year-old female experienced a small bowel obstruction 12 days after a segmental resection of the small bowel following a trauma. A laparotomy was performed 16 days after the initial operation, and a 2 cm hard mass was detected in the small bowel mesentery, with severe fibrous adhesions around the mass, involving the jejunum, which required resection. Postoperatively, the patient developed an intraabdominal abscess, followed by intestinal fistulation. The patient gradually recovered by conservative management, and left hospital 70 days after the first operation. Microscopic examination of the mass showed well oriented trabeculae of the osseous tissue, osteoid formation, with fine calcification and osteoblastic activity, but there was no formation of mature lamellar bone or clear evidence of the "zone phenomenon" that is classically described in heterotopic ossification. These findings appeared consistent with an early stage of heterotopic ossification. The etiology and pathogenesis are unknown; the heterotopic mesenteric ossification was thought to be associated with the trauma (intraabdominal surgery). The previous literature on heterotopic mesenteric ossification is reviewed, and a new case reported.
Abscess ; Female ; Humans ; Intestinal Obstruction ; Jejunum ; Laparotomy ; Mesentery ; Middle Aged ; Ossification, Heterotopic ; Osteoblasts ; Osteogenesis

Heterotopic mesenteric ossification is a very uncommon disorder that is characterized by new bone formation in the mesentery, which does not normally undergo ossification. A 52-year-old female experienced a small bowel obstruction 12 days after a segmental resection of the small bowel following a trauma. A laparotomy was performed 16 days after the initial operation, and a 2 cm hard mass was detected in the small bowel mesentery, with severe fibrous adhesions around the mass, involving the jejunum, which required resection. Postoperatively, the patient developed an intraabdominal abscess, followed by intestinal fistulation. The patient gradually recovered by conservative management, and left hospital 70 days after the first operation. Microscopic examination of the mass showed well oriented trabeculae of the osseous tissue, osteoid formation, with fine calcification and osteoblastic activity, but there was no formation of mature lamellar bone or clear evidence of the "zone phenomenon" that is classically described in heterotopic ossification. These findings appeared consistent with an early stage of heterotopic ossification. The etiology and pathogenesis are unknown; the heterotopic mesenteric ossification was thought to be associated with the trauma (intraabdominal surgery). The previous literature on heterotopic mesenteric ossification is reviewed, and a new case reported.
Abscess ; Female ; Humans ; Intestinal Obstruction ; Jejunum ; Laparotomy ; Mesentery ; Middle Aged ; Ossification, Heterotopic ; Osteoblasts ; Osteogenesis

Hantavirus pulmonary syndrome(HPS) is a systemic disease that is caused by a newly discorved and characterized virus of the Hantavirus genus, which is most frequently referred to as the sin nombre virus. The clinical syndrome resembles other hantavirus syndromes worldwide, except that it is characterized by a brief prodromal illness followed by rapidly progressive, noncardiogenic edema, and that it is more deadly than any previously recognized hantavirus infection. The clinical manifestations of HPS are characterized by four clinical phases prodrome, pulmonary edema and shock, diuresis, and convalescence. Mortality is greatest in the first 24 hours of the pulmonary edema and shock phase of the illness. These phases are strikingly similar to the clinical phases of Hemorrhagic fever with renal syndrome(HFRS) induced by Hantaan virus, except that HPS has not been associated with renal failure and Disseminated intravascular coagulation(DIC). We here report a case of hantavirus pulmonary syndrome developed in a 58 year-old man. He had a flu-like illness followed by the rapid onset of respiratory failure due to noncardiogenic pulmonary edema. HPS was diagnosed by clinical manifestations, identification of high titer antibody to Hantaan virus antigen and histologic finding of transbronchial lung biopsy (TBLB) specimen. The patient was treated with mechanical ventilation and initial corticosteroid pulse therapy resulting in successful outcome.
Biopsy ; Convalescence ; Diuresis ; Edema ; Fever ; Hantaan virus ; Hantavirus Infections ; Hantavirus Pulmonary Syndrome* ; Hantavirus* ; Humans ; Lung ; Middle Aged ; Mortality ; Pulmonary Edema ; Renal Insufficiency ; Respiration, Artificial ; Respiratory Insufficiency ; Shock ; Sin Nombre virus

BACKGROUND: The goal of this study is to identify the factors that predict mortality in elderly trauma patients. METHOD: We reviewed retrospectively the medical record of 144 cases of geriatric trauma admitted to Kyungpook National University Hospital firm January 1998 to December 1998. We evaluated the general characteristics, mechanisms of injury, Revised Trauma Score(RTS), Injury Severity Score(ISS), Probability of survival(Ps) by TRISS(Trauma and Injury Severity Score) method, amount of blood transfused, preexisting disease, complications, length of stay, and mortality. RESULTS: 1. The mean age was 75.39+/-7.89 years old, and male to female ratio was 0.89 : 1. 2. The mechanisms of injury were primarily frills(56.3%) followed by bicycle or motorcycle(13.9%), and pedestrian injuries(13.2%) and motor vehicle accidents(6.9%). 3. The mean Glasgow Coma Scale(GCS), RTS and ISS ate 13.3+/-3.5, 7.2+/-1.4 and 14.2 +/-11.6 respectively. 4. The actual mortality rate was 18.1% (26/144). But by TRISS method, predicted mortality rate was 9.3%(12.5/144), excess mortality rate was 108% and Z score was 3.99 indicating that actual number of death exceed predicted number of death. 5. Between the survivors and nonsurvivors, the insults were significantly different as follows ; systolic blood pressure(141.9+/-28.3 vs. 116.8+/-48.7 mmHg), GCS(14.3+/-2.0 vs. 9.0 +/-5.1), RTS(7.8+/-0.7 vs 5.4+/-2.3), ISS(11.3+/-5.6 vs 27.2+/-20.2), Ps by TRISS(0.97+/-0.06 vs 0.65+/-0.37), preexisting diseases(50.8 vs 69.8%). CONCLUSION: Geriatric patients are more likely to die after trauma than other age groups. The cause of higher actual mortality rate compared to predicted mortality rate was considered as the higher incidence of delayed death due to sepsis or multiple organ failure. In order to reduce the mortality, even with relatively stable initial vile sign, invasive hemodynamic monitoring and intensive treatment are recommended and also, prevention and treatment of nosocomial infection are very important.
Aged ; Coma ; Cross Infection ; Female ; Gyeongsangbuk-do ; Hemodynamics ; Humans ; Incidence ; Length of Stay ; Male ; Medical Records ; Mortality* ; Motor Vehicles ; Multiple Organ Failure ; Preexisting Condition Coverage ; Retrospective Studies ; Sepsis ; Survivors