Two Cases of Ectopic Gallstones Treated by Endoscopic Therapy / 대한소화기내시경학회지

Two cases are herein reported involving patients with ectopic gallstones which were discharged into the stomach and duodenum through a cholecystoduodenal fistula and successfully removed by endoscopic therapy. In the first case, a 75-year-old man was admitted with epigastric pain. Simple abdomen film demonstrated a round laminated calcification and air biliarygram in the RUQ. Endoscopic examination revealed a fistula on the posterior wall of the duodenal bulb and a brown stone (about 5 cm in diameter) was found in the second portion of the duodenum, It was demolished through endoscopic electrohydraulic lithotripsy (EEH1) and discharged with the stool. In the second case, a 55-year-old man was admitted with epigastric pain. A CT scan revealed an ovoid laminated calcification in the dependent portion of the stomach. Endoscopic examination revealed a fistula on the anterior wa11 of' the duodenal bulb and a black pigmented stone (about 2.5 cm in diameter) was found in the stomach. This stone was removed orally by an endoscopic snare. These patients were discharged and remained asymptomatic.

A Case Rhabdomyolysis by Rare Causes: After Consumption of Common Doses of Acetaminophen and Sauna / 대한신장학회잡지

A 21-year-young man had an episode of myalgia and chilling 3 days prior to hospital admission. He had consumed common doses of acetaminophen for one day, and was presented in the sauna room for an hour. On the next morning, he complained of dyspnea and was admitted. He presented in rhabdo-myolysis and acute renal failure with increased up-take in the proximal muscles by (99m)Tc-MPD bone scan. He was treated by hemodialysis and discharged on the twenty-eighth hospital day. Rhabdomyolysis has the variable causes. The causes of this case are two, the first cause is common doses of acetaminophen. But, there is no reports for rhabdomyolysis by common doses of acetaminophen only. However, we should consider that acetaminophen is a contributing factor in this case. The second cause is viral infection. Our patient had myalgia and chilling prior to hospital admission. Heat- stroke is well known cause of rhabdomyolysis. The mechnisms for rhabdomyolysis in this disease are hypovolemia, total body potassium deficit, and increased variable cytokines. Sauna, the last cause of our rhabdomyolysis case may have the same mechanisms with heatstroke. Our case had two causative factors, common doses of acetaminophen and sauna. These factors might be cooperated in our case of rhabdomyolysis and acute renal failure.

Clinical Effect of Transurethral Needle Ablation (TUNA) in Durg Refractory Chronic Nonbacterial Prostatitis : Initial Experinece / 대한비뇨기과학회지

No abstract available.

Model Development of Hospital Process Reengineering by Activity-Based Costing / 대한의료정보학회지

The purpose of this research is to suggest a model for hospital process and verily the model through analyzing the results before and after reengineering grounded on the activity -based costing. The summary of research is as follows: First, two reengineering-applicable processes for a case hospital are chosen based on the issues from the patient requirements analysis and current process analysis as well as the general characteristics of hospital operations: accounting and clinical laboratory e xami nation processes. The integration of payment-related functions principle is applied to an accounting process which includes three sub processes. while the automatic transition of laboratory output principle is applied to a clinical laboratory examination process. Second, the studs shows more than 50% reduction of activities: nine activities from nineteen by the principle of integration of payment-related functions, and nine activities from fourteen by the principle of automatic transition of laboratory output. Finally. activity-based cost analysis before and alter reengineering results in 44% cost reduction: 43.9% in payment-related subprocesses and 41.1% in a clinical laboratory examination process. Therefor this research finds an enormous gap between costs before and after reengineerring. The contributions of this research are two-fold: one is that activity-based costing methodology is practically valid for measuring the cost-performance analysis of hospital process reengineering, and another is that activity -based costing can he utilized not only an initiative of process engineering hut also as a tool for evaluating a variety of activities by a simulation technique.

A case of Peutz - Jeghers syndrome with duodenal adenocarcinoma and obstruction / 대한내과학회지

Peutz-Jeghers syndrome is a rare autosomal dominant disorder defined by harmatomatous polyps of the gastrointestinal tracts and the occurrence of melanin spots on the lips(oral mucosa), hands and feet. This syndrome is associated with a variety of gastrointestinal and extraintestinal neoplasms, both benign and malignant. A 28-year old male was admitted to our hospital with abdominal pain and nausea for two months. He had melanin spots involving his lips, buccal mucosa, hands and feet. A small bowel series showed luminal obstruction at the forth portion of the duodenum. And abdominal CT scan showed target-like mass suggesting intussusception on the small bowel. On laparotomy, there was an annular constricting mass adherent to retroperitoneum with metastasis to preaortic lymph nodes. Palliative duodeno-jejunostomy was performed. The histologic finding disclosed signet-ring cell type adenocarcinoma.

Changes in Vertebral Rotation Following Segmental Pedicle Screw Instrumentation and Rod Derotation in Idiopathic Thoracic Scoliosis : Part I - CT Evaluation / 대한정형외과학회잡지

The employment of segmental pedicle screw instrumentation has greatly enhanced the correction of scoliotic deformity. However there is still much controversy on the ability of the system to correct the rotational deformity. This prospective study with 12 idiopathic throacic scoliosis patients subjected to segmental pedicle screw instrumentation was performed to determine the effect of the system on the rotational deformity of idiopathic throacic scoliosis. In addition to the standing films to measure the magnitude of scoliotic curvatures, preand postoperative CT were utilized for the measurement and comparison of angle of rotation relative to the sagittal plane(RAsag.), relative rotation with reference to the upper and lower end vertebrae(RAend), relative rotation with reference to the sacrum(RAsac.), frontal translation(TF) and sagittal translation(TS) for the apical vertebrae. Despite the high correction rate obtained in the frontal plane(average 71.1%) and normalization of sagittal contour, the rotational corrections were statistically insignificant in all parameters and showed no significant correlation to the correction of the curvatures nor horizontal plane displacement as represented by the frontal and sagittal displacement. In conclusions, the segmental pedicle screw instrumentation with rod derotation does not produce significant derotation by itself.

Clinical Results of Selective Thoracic Fusion by Segmental Pedicle Screws in King type II Adolescent Idiopathic Scoliosis ( AIS ) / 대한정형외과학회잡지

STUDY DESIGN: This study analyzes the results of selective thoracic fusion by segmental pedicle screw fixation in King type II adolescent idiopathic scoliosis(AIS). OBJECTIVES: To verify the efficacy of selective thoracic fusion by segmental pedicle screw fixation in King type II adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Decompensations following selective thoracic fusion in King type II adolescent idipathic scoliosis have been attributed to relative inability of the lumbar curves to accommodate correction of the thoracic curves. However, with segmental pedicle screw fixation, selective thoracic fusions yielded satisfactory results in most of the patients regardless of the lumbar curve characteristics. MATERIALS AND METHODS: Eighty patients subjected to selective thoracic fusion by segmental pedicle screw fixation were analyzed after a minimum follow-up of 2 years for deformity correction and spinal balance. Deformity correction was performed by derotation of rod contoured to the normal sagittal curve without additional compression or distraction. RESULTS: Mean preoperative thoracic curve of 53.3 was corrected to 20.3 showing a correction of 63.2%. The mean preoperative lumbar curve was 34.4 with a flexibility of 97.2% and mean lumboapical distance(LAD)of 18.0mm, L4 tilt of 8.0, and lumbar apical rotation (LAR) of 10.9. It was corrected to 16.5 showing a correction of 55.5%. All the patients were balanced clinically and radiologically. CONCLUSIONS: Selective thoracic fusion with segmental pedicle screw fixation and rod rotation offers a satisfactory correction of the deformity and maintenance of spinal balance in King type g AIS regardless of lumbar curve magnitude, LAD, L4 tilt or LAR.

A Case of Idiopathic Bilateral Chylothorax Treated by Conservative Approach / 결핵

Chylothorax is a debilitating condition to the point of threatening life. Diagnosis and subsequent management present significant problems for the clinician and the adverse effects of chyle loss on nutrition status and immune function result in devastating consequences for the patient. prompt diagnosis is essential to institute an effective therapeutic regimen. we reported a patient of idiopathic bilateral chylothorax treated by conservative approach with review of literatures.

A Case of Malignant Mixed Mullerian Tumor of Uterus / 대한부인종양콜포스코피학회잡지

A Malignant mixed miillerian tumor of uterus is rare and highly malignant containing epithelial and mesenchymal components. A case of mixed germ cell tumor was exprienced and presented with a brief review of concerned literature.