PURPOSE: This study was performed to know the clinical profile and effectiveness of colonoscopic polypectomy in patients with solitary juvenile polyp. METHODS: This study included 19 children, aged 1.8 to 11.4 years, who underwent colonoscopic polypectomy and histologically proven solitary juvenile polyps between March 1998 and August 2002. We analyzed their detailed history, clinical manifestations, colonoscopic examination, method of anesthesia and results of colonoscopic polypectomy. RESULTS: The mean age of the 19 cases was 4.7+/-2.8 year. The male to female ratio was 1 : 1.1.Hematochezia, the main indication of colonoscopy, was present in all cases. Combined symptoms were mucoid stool or diarrhea(42%), abdominal pain(26%), constipation(11%) and anal fissure(11%). Anemia(Hb <10 g/dL) in four cases recovered spontaneously after polypectomy. Complications associated with premedication, sedation and colonoscopy itself did not occur. Bleeding developed in two cases(11%) after polypectomy. One of them was controlled with hemoclipping. The main site of polyps was the rectosigmoid colon in 15 cases(79%). The size of the polyps ranged from 0.5 to 3.5 cm. The interval between the onset of symptoms and polypectomy was from 0.1 to 42 months. CONCLUSION: Juvenile polyps are a common cause of benign, chronic and recurrent rectal bleeding. Colonoscopic polypectomy is a simple, safe and effective therapeutic method. So earlier colonoscopy might avoid uneffective treatment and prevent untoward problems such as fear of parents and anemia.
Anemia ; Anesthesia ; Child* ; Colon ; Colonoscopy ; Female ; Hemorrhage ; Humans ; Male ; Parents ; Polyps* ; Premedication

OBJECTIVES: It was revealed that autonomic dysfunction, especially decreased parasympathetic functions, seems to be one of the major etiological factors in functional gastrointestinal disorders(FGID) The physiological characteristics of sympathetic and parasympathetic functions are externally similar to the features of Yin and Yang based on oriental medicine theory. And it was also revealed that gastrointestinal symptoms are prevalent in Lesser Yin constitutional type riginated from four types of constitution shown in Sasang constitutional theory. If we obtain the findings on the similarities or compatibilities between autonomic nervous functions and physical constitutional features in functional gastrointestinal disorders, we could apply various oriental treatment modalities to the patients with functional disorders, especially according to Yin-Yang constitutional concept. METHODS: We investigated the correlations between characteristics of physical constitution(Yin and Yang)and imbalance of the autonomic functions in patients with FGID. Subjects consisted with three groups: 27 patients with FGID (including irritable bowel syndrome, functional dyspepsia, functional abdominal pain syndrome according to the Rome criteria) 28 patients with somatoform disorders who had symptoms other than abdominal symptoms (other somatoform disorders) and 26 normal healthy controls. Characteristics of constitutions were evaluated and divided into two major groups, i.e., Lesser Yin constitution and other constitutions (Greater Yin & Yang and Lesser Yang included)according to the Je-Ma Lee's Classification Questionnaire for Four Constitutional Types (Song et al. 1993) For evaluating the autonomic functions, three parasympathetic functions and two sympathetic functions were measured. Levels of anxiety and depression were also evaluated to be used as a covariant controlling the autonomic functions. RESULTS: 1)FGID group showed significantly lower parasympathetic functions compared to healthy controls, however, there was no differences between FGID and other somatoform disorder groups. 2)Lesser Yin constitutional type was not so prevalent in FGID group. 3)When FGID and other somatoform disorder groups were combined and compared with normal healthy controls, the former group showed significantly lower parasympathetic functions than the latter group. CONCLUSIONS: According to these results, Lesser Yin constitutional type do not seem to be closely related with FGID. However, it was suggested that decreased parasympathetic functions were partly associated with this group. We could not find any correlations or compatibilities between two constitutional characteristics and autonomic dysfunction in FGID. This means that functional symptoms of FGID when those were deducted as Yin and Yang characteristics based on oriental medicine could not be understood as two oppositional and co-operative functions such as autonomic functions. Further research with more restricted symptoms selected in the functional disorders and with other physiological cues applied would be needed.
Abdominal Pain ; Anxiety ; Classification ; Constitution and Bylaws ; Cues ; Depression ; Dyspepsia ; Gastrointestinal Diseases* ; Humans ; Irritable Bowel Syndrome ; Medicine, East Asian Traditional ; Psychophysiologic Disorders ; Surveys and Questionnaires ; Somatoform Disorders ; Yin-Yang*

We have treated a total of 16 cases of advanced Kienbock's disease, stage III and IV by Lichtman's classification, with triscaphe fusion, tendon ball replacement arthroplasty after excision of lunate, proximal row carpectomy as a salvage procedure and limited wrist fusion, since 1985. All cases were followed for minimal 16 months after each operation. Tendon ball replacement arthroplasty after excision of lunate could not prevent further carpal collapse with persistent chronic wrist pain. The triscaphe fusion or radio-lunate fusion induced a marked limited wrist motion later, and the triscaphe fusion alone was not fit for the treatment of advanced one because of progressive proximal migration of capitate and continuous wrist pain due to ligamentous carpal instability in follow-up. So we tried to simultaneously combine tendon ball replacement arthroplasty after excision of lunate with triscaphe fusion in far advanced Kienbock's disease, and their end results was favorable. Proximal row carpectomy could be done in far advanced Kienbock's disease with reasonably painless wrist motions. The overall end results of proximal row carpectomy are much better than any form of carpal arthrodesis. Conclusively the proper way to treat advanced Kienbock's disease seems to depend on the patient's age, their job and sex, and the stage of disease. And the cause of wrist pain in advanced Kienbock's disease seems due to ligamentous carpal instability rather than osteoarthritis on radio-lunate joint.
Adult ; Arthrodesis ; Carpal Bones ; Case Report ; Comparative Study ; Female ; Hand Strength ; Human ; Joint Prosthesis ; Male ; Middle Age ; Osteochondritis/complications/radiography/*surgery ; Osteonecrosis/etiology/surgery ; Osteotomy ; Patient Selection ; Range of Motion, Articular ; Wrist Joint/radiography/*surgery

Primary duodenal tuberculosis, duodenal Crohn's disease, duodenal lymphoma, duodenal cancer is extremely rare event. Vague upper abdominal pain, weight loss(10 Kg) had been present for several months in a 52-yeer-old woman. Endoscopy revealed an irregular ulcer in the second part of the duodenum. CT of the abdomen revealed pooly defined hypodense and centrally low density masses along the hepatoduodenal ligament, with poor separation from the head of pancreas. Hypotonic duodenogram showed spiculation and smooth indentation of mucosal fold at medical aspect of sup. portion m descending duodenum. ERCP showed medially displaced distal CBD and main pancreaticduct. At first, lymphoma, cancer, Crohn's disease, duodenal tuberculosis were considered in the differential diagnosis. Endoscopic biopsy sepecimen of duodenal lesion showed atypical lymphocytes. We excluded the diagnosis of the duodenal cancer. We started anti-tubercular drugs because in our country tuberculosis is endemic. After 4 weeks anti-tuberculosis therapy, follow up endoscopy and biopsy specimens showed healing stage of duodenal ulcer and chronic granulomatous inflammation with multinucleated giant cell. Thus we concluded that when duodenal lesion which could not confirmed histopathologically it was wise to start antitubercular therapy than to perform exploraparotomic dianostic procedures.
Abdomen ; Abdominal Pain ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Crohn Disease ; Diagnosis ; Diagnosis, Differential ; Duodenal Neoplasms ; Duodenal Ulcer ; Duodenum ; Endoscopy ; Female ; Follow-Up Studies ; Giant Cells ; Head ; Humans ; Inflammation ; Ligaments ; Lymphocytes ; Lymphoma* ; Pancreas ; Tuberculosis* ; Ulcer

Liddle's syndrome was described in 1963 by Liddle, et al., as the disease featuring a hypertension and hypokalemia but with negligible secretion of aldosterone. This syndrome, which morphologically belongs to an abnormal intrinsic tubular disorder with normal renal function, is characterized by hypokalemia, metabolic alkalosis, and hypertension due to the abnormal increase in excretion of potassium in distal tubules or collecting duct and the increase in reabsorption of sodium in distal tubules. This syndrome, which is rare disease, is observed with the low level of plasma and urinary aldosterone and suppressed plasma renin level and is known as dominant mode of inheritance with a family background. The authors paid attention to a 79-year-old man who showed a high blood pressure of 210/130mmHg as well as musle weakness, especially lower extremities due to metabolic alkalosis featuring a hypokalemia level of 2.0mEq/L when he was admitted to our hospital, Because his serum potassium were not improved with the medication of intravenous potassium supply, and his blood pressure continued to be high without the improvement of muscle weakness, we prescribed 300mg of spironolactone for two weeks. His symptom, however, was not cured. Then, instead of spironolactone, we prescribed 150mg of triamterene and a low salt diet which finally improved his symptoms. Because there has been no reported case in the Korean medical literature, we report a case of successfully treated Liddle's syndrome due to triamterene administration.
Aged ; Aldosterone ; Alkalosis ; Blood Pressure ; Diet ; Humans ; Hypertension ; Hypokalemia ; Lower Extremity ; Muscle Weakness* ; Plasma ; Potassium ; Rare Diseases ; Renin ; Sodium ; Spironolactone ; Triamterene ; Wills