A case of metastatic cholangiocarcinoma in a ferret / 동물의과학연구지

Cholangiocarcinoma is a relatively rare neoplasm in animals and humans. A four-year-old, neutered male ferret presented with depression, anorexia, cachexia, diarrhea, and icterus. Necropsy findings included ascites, multiple white nodules on the surface of the liver, stomach, and duodenum, gross enlargement of the bile duct and right atrium, hemorrhage of the gastric and duodenal mucosa, and icterus of the mesenteric fat. Infiltrative well-differentiated neoplastic biliary epithelial cells forming ducts and acini with a prominent collagenous stroma were observed on microscopic examination of neoplastic lesions within the liver, mesentery, and the serosa of the stomach and duodenum. This is a report on a rare case of obstructive jaundice due to cholangiocarcinoma in a ferret.

Prevalence and Risk Factors of Asthma and Allergic Rhinitis in Elementary School Children in Jinan-Gun / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to evaluate the prevalence and risk factors associated with asthma and allergic rhinitis in rural elementary school children. METHODS: Children in 12 elementary schools in Jinan-gun, Jeollabuk-do, a typical rural area in Korea, were enrolled. We conducted cross-sectional survey using a Korean version of International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. RESULTS: A total of 947 questionnaires out of 1,062 were completed and the response rate was 89.1%. The symptom prevalence of asthma and allergic rhinitis (AR) in the last 12 months was 7.4% and 28.1%. The prevalence of physician-diagnosed asthma and AR was 7.2% and 22.2%. Male, passive smoking, visible mold at home, and use of antibiotics during infancy more than 3 times were associated with higher prevalence of asthma diagnosis (adjusted odds ratio [aOR] 2.35, 95% confidence interval [CI] 1.30 to 4.26; aOR 2.49, 95% CI 1.38 to 4.48; aOR 2.19, 95% CI 1.23 to 3.89; and aOR 8.45, 95% CI 4.23 to 16.59). Parental history of allergic diseases, children without siblings, use of antibiotics during infancy more than 3 times were associated with higher prevalence of AR (aOR 4.89, 95% CI 3.37 to 7.10; aOR 5.20, 95% CI 2.38 to 11.35; and aOR 2.39, 95% CI 1.36 to 4.19). CONCLUSION: In Jinan-gun, the symptom prevalence of asthma and AR in the last 12 months was 7.4% and 28.1%. The environmental factors such as passive smoking, visible mold at home, use of antibiotics during infancy and number of siblings are associated with asthma and allergic rhinitis.

Is Laparoscopic Multivisceral Resection Applicable to Colorectal Cancer Adherent to Adjacent Organs? / 대한내시경복강경외과학회지

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic multivisceral resection of colorectal cancer adherent to adjacent organs. METHODS: We reviewed retrospectively 32 patients undergoing elective laparoscopic multivisceral resection for colorectal cancer adherent to adjacent organs between June 2003 and May 2009. Survival curves were generated by Kaplan-Meier method. RESULTS: The median age of 32 patients was 73 years. In 10 of 17 rectal cancer patients (59%), neoadjuvant chemoradiation was performed. All the surgeries were completed laparoscopically. The postoperative complications occurred in 21.9% and there was no operative mortality. The median length of hospital stay was 15.5 days. In 23 of 32 patients (72%), the resection was considered curative. Median follow-up period of all patients and curatively resected patients was 22 (range, 2~65) months, 34 (range, 4~65) months respectively. Local recurrence rate, the 3-year overall survival rate and the 3-year disease free survival rate of 23 curatively resected patients was 4.3%, 92.9% and 84.4%, respectively. CONCLUSION: Laparoscopic multivisceral resection is feasible and safe in highly selected patients with colorectal cancer adherent to adjacent organs. Further validation is needed.

Laparoscopic Colorectal Resection for Aged Patients

PURPOSE: The purpose of this study is to assess the periopertive morbidity and mortality rates in relation to the principal variables in aged patients who undergo laparoscopic colorectal resection. METHODS: From March 2001 to March 2006, the prospective laparoscopic colorectal resection database was used to identify 233 patients. Among them, 132 were 70 years of age or older and they were classified as the aged group. 101 were younger than 70 years of age and they were classified as the younger group. RESULTS: Comorbidity was more common in the aged group than in the younger group (67.4% and 53.5%, respectively) (P=0.030). There were higher ASA scores in the aged group (I: 2.3% II: 68.2% III: 29.5%) than in the younger group (I: 27.7% II: 56.4% III: 15.8%) (P<0.0001). There was a higher postoperative complication rate for the aged group than for the younger group (25.0% and 8.9%, respectively) (P=0.002). Only one case of mortality (0.8%) was found in the aged group. The period of the postoperative hospital stay was longer for the aged group than that for the younger group (21.9+/-3/416.3 days and 16.3+/-3/48.1days, respectively) (P= 0.002). For the aged group, univariate analysis revealed that the operative procedure, disease, the T stage and the operation time were significant variables for the postoperative complications, and multivariate analysis identified the operation time as an independent variable faor the postoperative complications. CONCLUSION: More prudent care is needed to prevent postoperative complications for the aged patients who undergo laparoscopic colorectal resection, and particularly for those who can be expected to have a longer operation time.

Risk Factors for Anastomotic Leakage after Laparoscopic Rectal Resection in Rectal Cancer: Does Laparoscopic Rectal Resection Increase Anastomotic Leakage Rate?

PURPOSE: The purpose of this study is to evaluate the risk factors for clinical anastomotic leakage after laparoscopic resection for rectal cancer. METHODS: From March 2001 and February 2006 in Seoul Veterans' Hospital, the prospective laparoscopic colorectal resection database identified 101 patients who a had laparoscopic rectal resection with colorectal or coloanal anastomosis. The associations between clinical anastomotic leakage and patient-, tumor-, surgery- and laparoscopic-related variables were studied. RESULTS: The rate of clinical anastomotic leakage was 4 percent (4 of 101). The patient-related variable significantly associated with clinical anastomotic leakage was preoperative radiotherapy. The surgery-related factor that turned out to be significant was anastomosis situated less than 5 cm from the anal verge. No tumor- or laparoscopic-related variables were significantly associated with clinical anastomotic leakage. CONSLUSIONS: A protective ileostomy should be considered after a laparoscopic rectal resection for an rectal cancer for anastomosis situated less than 5 cm from the anal verge, particularly when preoperative radiotherapy is being used.

Complicatons and Residual Defects After Correction of Noncomplicated Ventricular Septal Defect / 대한흉부외과학회지

BACKGROUND: The purpose of this study is to review the clinical course after the correction of noncomplicated ventricular septal defect and to analyze the morbidity and risk factors of postoperative complications and evaluate residual defect during the follow-up period. MATERIAL AND METHOD: From September 1994 to June 1998 24 patients(median age 10 months) underwent surgery under the diagnosis of ventricular septal defect. We made a retrospective review of the clinical records including the operation notes critical care unit records echocardiography results and the follow-up records. RESULT: There was no early mortality nd late mortality. There was no postoperative complete conduction block. Respiratory complication was the most common complication. The body weight age type of ventricular septal defect associated anomalies and operative procedure were not related to the incidence of complications. residual ventricular septal defects aortic valve regurgitation and tricuspid valve regurgitation were insignificant in postoperative hemodynamics, CONCLUSIONS: Correction of the noncomplicated ventricular septal defect was done without mortality and complete heart block. Aggressive preoperative medical treatment and early surgical treatment may decrease postoperative complications. Postoperative residual shunt and tricuspid regurgitation were not problematic during the follow-up.

Clinical Characteristics of the Geriatric Surgical Patients

BACKGROUND: Due to rapid economic growth and the development of medical science, the human life span is increasing nowadays. Due to this, old-aged people are increasing in number. However, the physiologic reserve power of old-aged people is lower than that of younger people. Therefore, it is necessary to be very careful about peri-operative care when doing surgery on old-aged people under general or spinal anesthesia. METHODS: We analyzed the medical records of 460 patients over 65 years of age who had undergone operations from August 1990 to July 1996 at the Department of General Surgery, Inchon Medical Center. RESULTS: (1) The ratio of geriatric surgical patients to all surgical patients during the same period was 14.7% (460/3122). Especially, the proportion of geriatric surgical patients increased to 17.0% during the last 2 years of this study compared to 16.2% for the previous 2 years, and 10.6% for the first 2 years. (2) The age distribution was 148 patients from 65 to 69 years (32.2%), 158 patients from 70 to 74 years (34.3%), 90 patients from 75 to 79 years (19.6%), and 64 patients over 80 years (13.9%). There was no significant difference between the number of men and women, there being 232 men and 228 women. (3) Among the 464 cases, 99 cases (21.3%) were malignant diseases compared to 365 cases (78.7%) of benign disease. Stomach cancer was the most common, 36 cases, colon cancer accounted for 31 cases and hepatobiliary cancer for 12 cases. Of the benign diseases, 103 cases (28.2%) were acute appendicitis, 85 (23.4%) were hepatobiliary diseases, 73 (20.1%) were hernias, and 35 (9.6%) were anal diseases. (4) Two hundred twenty-two (222) preoperative-associated diseases were found in 460 patients (48.3%). Cardiovascular disease was the most common (17.4%), and pulmonary disease was the 2nd most common (15.9%). (5) Of the total 133 cases of postoperative complication occurrence, wound infection was the most common, 43 cases, followed by pneumonia, 30 cases, respiratory failure, 11 cases, and renal failure, 7 cases. (6) The postoperative mortality rate was 5.0% and the most common cause was respiratory failure, 8 cases, followed by sepsis, 8 cases. CONCLUSION: The field of geriatric surgery must be pioneered and developed more by surgeons because the number of geriatric surgical patients is increasing more rapidly at present than in the past.

A Prospective Randomized Trial of Open and Closed Hemorrhoidectomies

BACKGROUND: Open and closed hemorrhoidectomies are the most common surgical treatment methods for hemorrhoids. However, the advantages and the disadvantages of each procedure have not yet delineated. PURPOSE: To compare open and close hemorrhoidectomies. METHODS: A prospective randomized trial of open and closed hemorrhoidectomies was performed between January 1997 and July 1997. All patients who underwent consecutive, surgery by a single surgeon (JSJ) for grade III or IV homorrhoids were classified into two groups : Open (GI) and closed (GII) hemorrhoidectomies. For the comparison of each procedure, the duration of the hospital stay, the patients' complaints, the pain score (Grade 1-10), and the complications after surgery were assessed.. Followup data were also obtained by telephone interviews. For the physiologic comparison, the preoperative and the postoperative anorectal manometry results were evaluated. RESULTS: Fortyone (41) patients were underwent hemorrhoidectomies : GI (n=18) and GII (n=23). There were no differences between the two groups in terms of duration of symptoms, degree of hemorrhoid, age, and gender. There were no differences respect to parameters related with postoperative complaints during the hospital stay, such as pain on defecation, skin edema, and anal itching. However, bleeding on defecation (83% in GI vs. 43.5% in GII, p<0.05), and anal soiling (61% in GI vs. 13% in GII, p<0.05) were significantly higher in GI patients. The pain score on postoperative day 1 was significantly higher in GI (6.6 vs. 4.9, p<0.05). Other parameters of complications (stricture, 5.7% in GI. vs. 4.3% in GII; defecation difficulty; 5.7% in GI vs. 4.3% in GII; and fecal incontinence; 0% in GI vs. 4.3% in GII) showed no significant differance during the mean followup period of 4.7 months. Neither the mean hospital stay (7 days in GI, 6.2 days in GII) nor the period of complete wound healing (32.7 vs 28.3 days in GI, GII, respectively) was different between the two groups. The preoperative and the postoperative anorectal manometric findings were not different in the two groups. CONCLUSIONS: The closed hemorrhoidectomy was superior to the open procedures in terms of some parameters such as the pain score on postoperative day 1, bleeding on defecation, and postoperative soiling during the hospital stay. However, the intermediate postoperative outcomes were not different for the two procedures.

Risk Factors of Recurrent Hemorrhoid after Primary Management

Before surgery for hemorrhoid, patients always have a worry of postoperative recurrence. The exact incidence and risk factors of recurrent hemorrhoid have not yet been delineated up to now. Therefore, the aim of this study was to assess the etiology of the recurrence after surgery. MATERIAL AND METHODS: Between March, 1997 and Feburary 1998, all patients who visited the Dept. of Surgery, Korea Veteran Hosipital, due to the recurrent hemorroid after surgical managememt including sclerotherapy(Group II: GII, n=60) were compared to the age and sex mathed(1:2) with primary hemorroid patients(group I: GI, n=120). The risk factors which might be related with the recurrence such as 1) hemorroidal factor(duration of symtom, symtom, associated perinial disease) 2) patient factor (constipation, incontience, cardiovascular disease, pulmonary and hepatic disease) 3) anorectal physiologic factors 4) surgical factors were evaluated. Stastical analysis were performed by a chi-square-test or Mann-Whitney U test and set the significance at p<0.05. RESULTS: There were no differences between the two groups in terms of age(GI 58.1+/-8.5, GII 60.9+/-3.3 years), gender(M:F, GI; 97:23, GII; 56:4 ). The ratio of having a contipation before surgery was 41% in GI, 55% in GII. It was not statistically significant. However, the other factors related with constipation such as duration of constipation(GI; 9.85+/-7.73 years, GII; 14.62+/-7.38 years: p<0.05), duration of straining during defecation(GI; 5.82+/-2.34, GII; 7.32+/-5.6 minutes, p<0.05) number of laxative use(GI; 29, GII; 28) were significantly different between the two groups. The fecal incontince are 5% in group Iand 13% in group II. There were no differences in patient's subject symtoms related with hemorrhoid, and comorbid perianal disease between the two groups. In anorectal manometric findings, rectal complince was significantly lower in GII than that of GI(25.1+/-50.04 cc/cmH20 vs 16.0+/-25.2 cc/cmH20 p<0.05). GII has a significant number of preopertive hypertension than GI(6.7% vs. 21.6%, p<0.05). CONCLUSION: When a patient with hemorrhoid has a constipation or hypertension, and lower compliance in manometric findings, it would be related with the postoperative recurrence after treatment. Therefore, we surgeons should correct these comorbid conditions before surgery, otherwise give an information to the patient of high chance of postoperative recurrence after management.

Mode of Death in Patients with Terminal Stomach Cancer

The mode of death was investigated according to 14 easily accessible clinical symptoms in terminal patients with stomach cancer. The purpose of this study was to understand the mode of death during the terminal period in patients with stomach cancer and to identify possible ways in which to improve patient care. Data were collected on all 65 patients with terminal stomach cancer admitted Department of Surgery, Korean Veterans' Hospital between April 1984 and April 1996. Pain was the most common main symptom on admission, occurring in 34 (52.3%) of the 65 patients. Fourteen patients (21.5%) had weakness, 12 patients (18.5%) had anorexia, 10 patients (15.4%) had edema or ascites, and 5 patients (7.7%) had dyspnea. Statistically significant clinical symptoms were as follows: anorexia, pain, weakness, dyspnea, and ascites or edema. Although the ranges of symptoms were similar on admission and at 1 week before death, there was a shift in prevalence of different types (dyspnea 7.7%-->98.5% and weakness 21.5%-->100%). In the last week of care (the week of death), weakness and dyspnea were the most common symptoms. Anorexia together with weakness and dyspnea was also a common problem. Near death, 65 patients (100%) had weakness, and 64 patients (98.5%) developed dyspnea as their main symptoms. Dyspnea became the most severe symptoms at death and appeared to be the most common uncontrollable problem, especially as death approached.

Factors Influencing the Mortality in Patients with Hepatic Cirrhosis Undergoing Major Abdominal Oberations

Recent reports have shown that the mortality is high in cirrhotic patients undergoing major abdominal operations. However, little information is available on the mechanism of the these high operative risks. The aims of this study were to determine the factors that may influence the mortality following major abdominal operations. We reviewed sixty-two patients with cirrhosis who had undergone major abdominal operations at Korea Veterans Hospital during the period from January 1984 to June 1995. There were 49 men and 13 women, with a mean age of 58.0 years (range=37 to 77 years). The postoperative mortality rate was 19.4%. Various clinical and laboratory factors were examined to find their relationships to the postoperative outcome. By univariate analysis, significant prognostic factors affecting the mortality rate were as follows: a serum albumin level less than 3 g/dl, a prothrombin time (PT) and a partial thromboplastin time (PTT) prolongation of more than 2 second over that of the controls, a platelet count of less than 80,000/mm3, an emergency operation, Hb at arrival of less than 10 g/dl, ascites, an intraoperative blood loss greater than 1000 ml, and an operative time longer than 2 hours(P<0.05). However, only two factors, a serum albumin level less than 3 g/dl and a platelet count less than 80,000/mm3 were significant by dpmultivariate analysis. In conclusion, when operative treatment is undertaken in patients with cirrhosis, preoperative correction of coagulopathy and ascites, the simplest and most expeditious operative procedure, and meticulous hemostasis and perioperative hemodynamic monitoring are essential to reduce the postoperative mortality.

Do We Have a Good Patient's Position for Sigmoidoscopy?

Sigmoidscopy is thought to be one of the basest and most essential tools for evaluation of colorectal patient because it could be performed in an out patient clinic with only minimal bowel preparation. AIM: The aim of this study was to assess the patient's best position for sigmoidoscopy. MATERIALS AND METHODS: Between March 4, 1997 and April 18, 1997, all patients who visited the colorectal clinic at the Dept. of Surgery, Korea Veterans Hospital were alternately underwent sigmoidoscopy in these four different positions: supine(S), left lateral(L), right lateral(R), and jack-knife(J). Sigmoidocopy was routinely performed for all patients who had lower gastrointestinal problems and was done by two well traind surgeons who had performed more than 100 sigmoidoscopies previously to this study, The patients who could not be tolerate insertion of the total length (60 cm) of the sigmoidoscope due to poor bowel preparation and/or complete obstruction by a mass were excluded. We evaluated the patient's complaints according to minimal, moderate, and severe discomfort and time between start and complete insertion of the 60 cm length of the sigmoidoscope. Statistical analysis was performed by an appropriate Anova test and Fisher's exact test. RESULTS: There were no differences among these four groups relative to age(5; 58.0+/-12.7, L; 64.3+/-10.0, R; 62.0+/-10.1, J; 56.0+/-12.9), gender(5; 76%, L; 70%, R; 72%, J, 83%,male ratio), degree of discomfort (mild: 42.9% (5), 50% (L), 33.3%(R), 66.7%(J), moderate: 42.9%(5), 34.6%(L),25%(R), 13.3%(J), severe: 14.3%(5), 15.4%(L), 41.7%(R), 20%(J)) and duration of insertion of the sigmoidoscope(5; 264.4 +/-192.9, L; 226.5 +/-267, R; 301.6+/-361.3, J; 202.5 +/-117.8 seconds). Also, there were no statistical significances between the two groups according to the surgeon who performed the procedure. CONCLUSION: The best position for sigmoidoscopy does not depend on the patient's position. Therefore, allowing the patient to change his position during the procedure would be the best way for an easy and comfortable sigmoidscopy.

Management of Small Bowel Obstruction after Previous Abdominal Operation

There is a continuing debate among surgeons about whether postoperative adhesive small bowel obstruction is best managed operatively or nonoperatively. This retrospective study was designed to determine the factors influencing the treatment modality of postoperative small bowel obstruction. A clinical analysis was conducted on 112 cases of small bowel obstruction after previous abdominal operation, who were admitted to the department of general surgery of Korea Veterans Hospital from January, 1984 to December, 1994. The patients were divided into two groups according to the modality of treatment: operatively(N=35) and nonoperatively(N=77) treated groups. Clinical parameters such as age, sex, symptoms and signs, type of previous operation, interval between previous operation and admission due to obstructive symptoms, time period from onset of symptoms to admission, and interval from admission to operation, were compared between two groups. Among 112 cases, the conservative treatment was performed in 77 cases and operative management was performed in 35 cases. There was no significant difference in the distribution of age and sex between two groups. The previous operations leading to adhesive intestinal obstruction were appendectomy(18.8%), gastroduodenal operation(17.0%), operation for multiple organ injury(16.1%), and Obsetric & Gynecologic surgery(9.8%) in that orders. The interval between previous abdominal operation and admission was under 1 month in 20 cases, 1 to 6 months in 10 cases, 7 to 12 months in 16 cases, and 1 to 2 years in 16 cases. The major symptoms and signs were abdominal pain, abdominal tenderness, vomiting, abdominal distension, hyperperistalsis, and leukocytosis. Among the above signs and symptoms, continuous abdominal pain, leukocytosis, and tachycardia were significantly higher in the operative group compared to those of the nonoperative group. The most common procedures of operative management were adhesiolysis, small bowel resection, bypass surgery, and colon resection in that orders. The incidence of postoperative complications was 31.4% and the most common complication was wound infection. In conclusion, at admission, the presence of strangulating signs such as continuous abdominal pain, leukocytosis, and tachycardia in patients with small bowel obstruction after previous abdominal operation mandates early operative intervention rather than conservative treatment.

A Clinical Study on Infantile Spasms with Prednisolone Therapy

PURPOSE: Infantile spasms are considered malignant epilepsy of infancy. Primary objectives of treatment are complete control of seizure attack and prevention of further brain damage. The aim of this study is to assess prednisolone(PDL) efficacy in infantile spasms. METHODS: From June 1985 to July 1994, 20 children with infantile spasms who were diagnosed at Kyung Hee University Hospital and were medicated 2mg/kg PDL analyzed retrospectively. RESULTS: 1) The ratio of male to female was 1.9:1. 2) Mean age at onset of infantile spasms is 7.8 month old and mean age at treatment of infantile spasms is 10.3 month old. Mean duration from onset of the disease to the beginning of the treatment is 1.3 months. 3) The most common type of infantile spasms is flexor type which is 10 cases (50.0%) 4) Among the associated conditions, brain atropy is the most common condition (45.0%). 5) Of forteen cases with developemental delay, six cases were controlled and four of the six cases without developmental delay were controlled. 6) EEG findings were improved in sixteen patients (80.0%) 7) The most common combined anticonvulsant is valproic acid. CONCLUSIONS: The effectiveness of PDL in infantile spasm is 42.9% in group with developmental delay. On the other hand, that is 66.7% in group without developmental delay. Also, because PDL have a merit of cheap and easy for oral medication, it will be necessary that PDL can be selected for hormonal anticonvulsant in infantile spasm. But,it must keep in mind that high dose or longterm PDL can elicit serious side effects.

Acute Tubular Necrosis Associated with Typhoid Fever

Acute tubular necrosis has been rarely reported as a complication of typhoid fever in the literature. We experienced four cases of acute tubular necrosis associated with typhoid fever in children. Patients showed significant titer of widal reaction associated with acute renal failure and one of them rised in 2 months after onset of clinical symptoms. Renal biopsy findings were compatible with acute tubular necrosis and immune complexes were not deposited in the glomeruli. Clinical and urinary findings were normalized by hemodialysis and antibiotic therapies. In conclusion, close longterm follow up of widal titer is mandatory in acute tubular necrosis, especially when associated with high fever.

Splenic Lymphangioma: A case report

Lymphangioma of the spleen is a rare neoplasm and approximately 100 cases have been reported in the world literature. This lesion may involve the spleen alone or may be a part of a syndrome of multivisceral involvement. The pathogenesis is unclear whether this is a true neoplasm of a developmental defect. We report a case of a 87-year-old woman with solitary splenic lymphangioma. The cut surface mass is not encapsulated and located at the subcapsular area in the mid portion of spleen. It is composed of variable sized cystic spaces containing myxoid tissue. Microscopic finding reveals dilated lymphatic spaces lined by endothelial cells and the content is proteinaceous eosinophilic fluid.

A case of infectious mononucleosis associated with facial nerve palsy

Infectious mononucleosis is a common systemic illness primarily invloving children and young adults and due apparently to the Epstein-Barr virus (EBV). Although the typical case is easily recogniged, unusual manifestations or serious complications occur frequently enough to pose problems in diagnosis and management. Neurologic complications are rare(1%). These nerologic complications may actually precede the full clinical picture or present as the sole manifestation of the illness, thereby causing a confusing clinical picture and delay in diagnosis. We have experienced a case of infectious mononucleosis associated with facial nerve palsy in a 22-months old female. She was admitted to the hospital with the fever, right facial nerve palsy and hepatosplenomegaly. The diagnosis was made on the clinical findings, immunologic findings and the typical findings of peripheral blood smear. On peripheral blood smear, atypical lympocytes with relative lympocytosis were seen. On Immunologic study EBV anti-VCA IgM titer was 1:20 and the IgG titer was 1:40. To our knowledge, this is the first report in Korea. So, we report this case and the brief literatures of infectious mononucleosis associated with neurologic complications and other viral diseases which caused facial nerve palsy.

Smooth muscle tumors of the stomach: a clinical analysis- / 대한암학회지

No abstract available.

Computed tomography of lethal midline granuloma

No abstract available.

Percutaneous gastrostomy: a report of twenty-seven cases

No abstract available.