Relationship between Ischemia–Modified Albumin and the Healing Period of Amputation Wounds in Patients with Diabetes Mellitus Following Non-traumatic Below-Knee Amputation / 대한족부족관절학회지

Purpose@#The present study examined the effectiveness of the preoperative ischemia-modified albumin (IMA) levels in predicting the healing period of amputation wounds in patients with diabetes mellitus following a non-traumatic below-knee amputation (BKA). @*Materials and Methods@#This study enrolled 41 diabetic foot ulcer patients who underwent BKA at the authors’ hospital diabetic foot center from April 2016 to April 2022. Among the 41 patients, 29 (70.7%) were male and 12 (29.3%) were female. Their mean age was 64.54±11.38 years (41~81 years). The mean follow-up period was 19.48±5.56 weeks (14~48 weeks) after BKA. The patients were divided into two groups (high IMA group and normal IMA group), which evaluated the healing period, wound dehiscence, and revision operation rate using a Fisher's exact test and Mann–Whitney U test. Three orthopedic surgeons performed stump wound evaluation, and they were evaluated as healing when all sutures were fused without oozing. @*Results@#Thirty patients (73.2%) (group A) showed a high level of IMA (median: 91.2 U/mL), and 11 (26.8%) patients (group B) showed a normal range of IMA (median: 82.7 U/mL). In group A, the median period for wound healing took 1.4 weeks longer, which was significant (p=0.001). No statistical relationship was observed between wound dehiscence, revision operation rate, and IMA value. There was no correlation between the other risk factors (estimated glomerular filtration rate, HbA1c) and the wound healing period. @*Conclusion@#Although there was a limitation in using IMA as the sole factor to predict the healing period of amputation wounds in patients after BKA, this study revealed a significant positive correlation between IMA and the period of stump healing after BKA. Therefore, the preoperative IMA levels may help predict the period of stump healing after BKA.

Minimal Invasive Surgery for Acute Achilles Tendon Rupture / 대한족부족관절학회지

Recently, the incidence of Achilles tendon rupture has been increasing with an increase in the elderly and the sports population. Various kinds of surgical options have been introduced up to now. Among them, the traditional open repair is most commonly used despite the risk of re-rupture or post-operative infections, which in turn can impair the blood flow to the Achilles tendon. Therefore, minimally invasive methods to overcome these complications have been studied with excellent outcomes.

The Current Status of Bacterial Identification by Wound Culture for Diabetic Foot Lesions in a Single Tertiary Hospital in South Korea / 대한족부족관절학회지

Purpose@#The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investigating bacterial isolates. @*Materials and Methods@#This study included 223 DFU patients that visited a single tertiary hospital and underwent bacterial culture between January 2016 and February 2020. The study was conducted in two parts: 1) to compare bacterial isolates and wound healing according to comorbidities such as chronic kidney disease (CKD) and peripheral artery disease (PAD), and 2) to compare bacterial isolates according to wound depth using the Wagner classification. @*Results@#Of the 223 patients, 43 had CKD (group A), 56 had PAD (group B), 30 had CKD and PAD (group C), and 94 had none of these comorbidities (group D). The isolation rate for multidrug-resistant gram-negative bacteria (MRGNB) and gram-negative to grampositive bacteria ratio were highest in group C (p=0.018, p=0.038), and the proportion that achieved wound healing was lowest in group C (p<0.001). In the second part of the study, subjects were classified into 5 grades by wound depth using the Wagner classification; 13 grade I, 62 grade II, 60 grade III, 70 grade IV, and 17 grade V. No significant difference was observed between these grades in terms of isolation rates or gram-negative to gram-positive bacteria ratios. @*Conclusion@#This study suggests antibiotics that cover gram-negative bacteria including MRGNB produces better results in the presence of CKD and PAD and that initial antibiotic choice should be based on the presence of CKD and PAD rather than wound depth.

Minimal Invasive Surgery for Acute Achilles Tendon Rupture / 대한족부족관절학회지

Recently, the incidence of Achilles tendon rupture has been increasing with an increase in the elderly and the sports population. Various kinds of surgical options have been introduced up to now. Among them, the traditional open repair is most commonly used despite the risk of re-rupture or post-operative infections, which in turn can impair the blood flow to the Achilles tendon. Therefore, minimally invasive methods to overcome these complications have been studied with excellent outcomes.

The Current Status of Bacterial Identification by Wound Culture for Diabetic Foot Lesions in a Single Tertiary Hospital in South Korea / 대한족부족관절학회지

Purpose@#The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investigating bacterial isolates. @*Materials and Methods@#This study included 223 DFU patients that visited a single tertiary hospital and underwent bacterial culture between January 2016 and February 2020. The study was conducted in two parts: 1) to compare bacterial isolates and wound healing according to comorbidities such as chronic kidney disease (CKD) and peripheral artery disease (PAD), and 2) to compare bacterial isolates according to wound depth using the Wagner classification. @*Results@#Of the 223 patients, 43 had CKD (group A), 56 had PAD (group B), 30 had CKD and PAD (group C), and 94 had none of these comorbidities (group D). The isolation rate for multidrug-resistant gram-negative bacteria (MRGNB) and gram-negative to grampositive bacteria ratio were highest in group C (p=0.018, p=0.038), and the proportion that achieved wound healing was lowest in group C (p<0.001). In the second part of the study, subjects were classified into 5 grades by wound depth using the Wagner classification; 13 grade I, 62 grade II, 60 grade III, 70 grade IV, and 17 grade V. No significant difference was observed between these grades in terms of isolation rates or gram-negative to gram-positive bacteria ratios. @*Conclusion@#This study suggests antibiotics that cover gram-negative bacteria including MRGNB produces better results in the presence of CKD and PAD and that initial antibiotic choice should be based on the presence of CKD and PAD rather than wound depth.

Surgical Treatment of Calcaneal Fractures of Sanders Type II and III by A Minimally Invasive Technique with 6.5 mm Cancellous Screw / 대한족부족관절학회지

PURPOSE: This study evaluated the clinical and radiological results of 6.5 mm full threaded cancellous bone screw fixation of calcaneal fractures. MATERIALS AND METHODS: Thirty seven patients diagnosed with Sanders type II or III calcaneal fractures, who underwent open reduction and internal fixation with a 6.5 mm full threaded cancellous bone screw between August 2014 and August 2017, were analyzed. Both the preoperative and postoperative Böhler angle and Gissane angle were measured radiographically. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale on the final follow-up were also assessed. RESULTS: The mean age of the patients was 52.7 years and the mean follow-up period was 29.5 months. In the Sanders classification, type II and III were 16 and 24 cases, respectively. The Böhler and Gissane angles improved from 21.2° and 122.6° preoperatively to 21.6° and 120.3°, respectively, in the postoperative radiographs. All cases achieved bony union, and the AOFAS ankle-hindfoot scale was 90.7 and 91.3 in Sanders type II and III, respectively, at the final follow-up. CONCLUSION: The treatment of calcaneal fractures using a 6.5 mm full threaded cancellous bone screw can reduce the complications with minimally invasive surgery and achieve firm fixation.

Comparative Study of Clinical Outcome of Three Surgical Techniques in the Achilles Tendon Rupture: Open Repair, Percutaneous Repair, and Minimal Incision Repair by Achillon / 대한족부족관절학회지

PURPOSE: This study compared the clinical outcomes of open repair, percutaneous repair, and minimal incision repair by Achillon in ruptured Achilles tendon. MATERIALS AND METHODS: The outcomes of 12 patients with open repair (group 1), 8 patients with percutaneous repair (group 2), and 10 patients with minimal incision repair by Achillon (group 3) from February 2013 to March 2016 were analyzed retrospectively. The postoperative clinical evaluations were done by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Arner-Linholm scale, mid-calf circumference difference, one-leg heel raise difference, visual analogue scale (VAS) for postoperative scarring, time to return to work, and complications. RESULTS: No significant difference in the AOFAS ankle-hindfoot score, Arner-Linholm scale, and time to return to work was observed among three groups (p=0.968, 0.509, and 0.585). The mean differences in the mid-calf circumference in groups 1, 2, and 3 were 1.09, 0.73, and 0.58, respectively; groups 2 and 3 were significantly higher than group 1 (p=0.002). In addition, the mean VAS scores for postoperative scarring in groups 1, 2, and 3 were 7.0, 9.1, and 9.1, respectively; groups 2 and 3 were significantly higher than group 1 (p=0.001). The mean differences in one-leg heel raising in groups 1, 2, and 3 were 2.03, 1.91, and 1.33, respectively; group 3 was significantly higher than groups 1 and 2 (p=0.010). The complications encountered were one case of deep infection in group 1 and one case of sural nerve hypoesthesia in group 2. CONCLUSION: Minimal incision repair by Achillon is recommended as an effective surgical treatment for Achilles tendon rupture because it minimizes the risk of complications, leads to an improved tendon strength and healing, and achieves cosmetic satisfaction.

Usefulness of Percutaneous Transluminal Angioplasty before Operative Treatment in Diabetic Foot Gangrene / 대한족부족관절학회지

PURPOSE: Diabetic foot gangrene has a high morbidity rate and a great influence on the quality of life. Amputation is an appropriate treatment if conservative treatment is impossible according to the severity of gangrene and infection. The purpose of this study was to evaluate the usefulness of preoperative percutaneous transluminal angioplasty for the postoperative outcome. MATERIALS AND METHODS: From February 2013 to April 2016, among 55 patients with diabetic foot gangrene, who require surgical treatment, percutaneous transluminal angioplasty was performed on patients with an ankle brachial index (0.9 and stenosis) 50% on angiographic computed tomography. The study subjects were 49 patients, comprised of 37 males (75.5%) and 12 females (24.5%). The mean age of the patients was 70.0±9.6 years. The treatment results were followed up according to the position and length of the lesion and the changes during the follow-up period. RESULTS: As a result of angiography, there were 13 cases of atherosclerotic lesions in the proximal part, 11 cases in the distal part and 25 cases in both the proximal and distal parts. As a result of the follow-up after angiography, in 13 patients, the operation was not performed and only follow-up and dressing were performed around the wound. Sixteen patients underwent debridement for severe gangrene lesions and 20 patients, in whom the gangrene could not be treated, underwent amputation (ray amputation or metatarsal amputation, below knee amputation). CONCLUSION: Preoperative percutaneous angioplasty in diabetic foot gangrene patients with peripheral vascular occlusive disease is simple, and 59.2% of the patients with diabetic foot gangrene could be treated by conservative treatment or debridement.

Supramalleolar Osteotomy for Moderate Degenerative Ankle Osteoarthritis / 대한족부족관절학회지

This paper reviews the indications and surgical technique of supramalleolar osteotomy as one of the treatments for moderate degenerative ankle osteoarthritis. Although it is technically demanding and requires extensive preoperative planning, supramalleolar osteotomy will be a good treatment option for moderate degenerative ankle osteoarthritis. The osteotomy is designed to shift the weightbearing axis to the lateral side of the ankle joint and unload the medial side of the joint. In our experience, a supramalleolar osteotomy is effective to the treatment of moderate ankle osteoarthritis with a small amount of preoperative talar tilt and varus or normal heel alignment.

Two-Year Follow-up Results of Anteroposterior Cannulated Screw Fixation of Posterior Malleolar Fragment in the Trimalleolar Fracture / 대한족부족관절학회지

PURPOSE: The purpose of this study was to assess the 2-year follow-up results of patients with a trimalleolar fracture, who had undergone an anterior incision cannulated screw fixation of the posterior malleolar fragment, which had more than 25% of articular involvement or had no cortical continuity with the distal tibia. MATERIALS AND METHODS: Among 28 patients with a trimalleolar fracture who had undergone fixation of the posterior malleolar fragment between February 2005 and February 2010, 14 patients, who underwent an anterior incision cannulated screw fixation of posterior malleolar fragment and were followed-up for more than 2 years, were selected. The postoperative clinical and radiological findings immediately and at the 1- and 2-year follow-up were compared. The clinical findings were evaluated as American Orthopaedic Foot and Ankle Society (AOFAS) score. The radiological assessment was evaluated as the maintenance of reduction, period to bone union, and the presence of nonunion, malunion, and complications. RESULTS: The clinical outcome by mean AOFAS score revealed 83.0 points in the group with preoperative displacement below 2 mm and 80.7 points in the group with preoperative displacement above 2 mm postoperatively. The mean AOFAS score was 91.7 and 93.1 points in the group with preoperative displacement below 2 mm on 1- and 2-year follow-up, respectively, and 89.8 and 91.7 points in group with the preoperative displacement above 2 mm on 1- and 2-year follow-up, respectively. After a 2-year follow-up among 14 cases selected for this study, 13 cases showed an excellent reduction state and only 1 case (7.1%) showed a displacement of more than 2 mm. No complication were encountered in the group with preoperative displacement below 2 mm. On the other hand, among 8 patients in the group with preoperative displacement above 2 mm, there were 3 with limitations of the range of motion of the ankle joint (37.5%) and 1 post-traumatic arthritis (12.5%) at the 2-year follow-up. CONCLUSION: Anterior incision cannulated screw fixation of the posterior malleolar fragment could be a valuable method for the treatment of trimalleolar fractures that provides satisfactory results.

Prediction of Cochlear Implant Outcomes in Patients With Prelingual Deafness

OBJECTIVES: To evaluate the factors that limit post-cochlear implantation (CI) speech perception in prelingually deaf children. METHODS: Patients with CI were divided into two groups according to Category of Auditory Performance (CAP) scores 3 years post-CI: the poor performance group (poor performance group, CAP scores≤4, n=41) and the good performance group (good performance group, CAP scores≥5, n=85). The distribution and contribution of the potential limiting factors related to post-CI speech perception was compared. RESULTS: Perinatal problems, inner ear anomalies, narrow bony cochlear nerve canal (BCNC), and intraoperative problems was significantly higher in the poor performance group than the good performance group (P=0.010, P=0.003, P=0.001, and P=0.045, respectively). The mean number of limiting factors was significantly higher in the poor performance group (1.98±1.04) than the good performance group (1.25±1.11, P=0.001). The odds ratios for perinatal problems and narrow bony cochlear nerve canal in the poor performance group in comparison with the good performance group were 4.878 (95% confidence interval, 0.067 to 0.625; P=0.005) and 4.785 (95% confidence interval, 0.045 to 0.972; P=0.046). CONCLUSION: This study highlights the comprehensive prediction of speech perception after CI and provides otologic surgeons with useful information for individualized preoperative counseling of CI candidates.

Lisfranc Joint Injury / 대한족부족관절학회지

The Lisfranc joint complex is an anatomical association of many bones and articulation, restrained by an even more complex network of ligaments, capsules, and fascia, which must work in concert to provide normal and painless motion. Careful diagnostic workup with high-quality radiographs and computed tomography of the foot are used to diagnose injuries and fractures of this complex. We have to understand the normal anatomy and injury mechanism in order to appropriately treat Lisfranc injuries. Good results have been associated with anatomic reductions of all bones, which was achieved with restoration of proper alignment.

Recurred Macrodystrophia Lipomatosa of the Foot: A Case Report / 대한족부족관절학회지

We reported on a rare case of recurred macrodystrophia lipomatosa of the foot, and reviewed the literature. A 62-year-old male patient presented with right foot second toe pain; preoperative magnetic resonance imaging and radiograph examination was performed. After surgery the biopsy confirmed the diagnosis. American Orthopaedic Foot and Ankle Society score was checked before and after surgery. Wide excision of the affected area including ray amputation is an effective way to prevent recurrence and relieve the pain after surgery. The 2nd toe ray amputation was performed in the treatment of recurred macrodystrophia lipomatosa of the foot, and is thought to be an effective way to relieve pain and prevent recurrence. After minimally invasive surgery with complete excision surgery, additional data on recurrence and pain relief rate are needed.

The Surgical Outcome of Tibiotalocalcaneal Arthrodesis Using a Retrograde Intramedullary Nail / 대한족부족관절학회지

PURPOSE: Tibiotalocalcaneal arthrodesis has been used as a treatment option for severe deformity including Charcot arthropathy, avascular necrosis of the talus, and severe osteoarthritis of the ankle and subtalar joint. The purpose of this study was to evaluate the result of the surgical outcome of tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail. MATERIALS AND METHODS: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail was performed by one surgeon in 36 cases. Clinical and radiological finding was evaluated using assessment of fusion time, 5th metatarsal-tibial angle, possibility of postoperative complication, visual analogue scale for pain and American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: Union was achieved in 33 cases at an average of 23 weeks (11~29 weeks). There were 3 cases of nonunion and 1 case of reoperation. Nail-tibial angle tended to be larger in nonunion cases. AOFAS score showed significantly poor outcome at malalignment (> or =5degrees), negative value of 5th metatarsal-tibial angle. CONCLUSION: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail is considered a useful treatment option for severe destruction and deformity involving ankle and subtalar joint.

Benign Lymphoepithelial Cyst of the Parotid Gland as an Initial Manifestation of Human Immunodeficiency Virus Infection / 대한내과학회지

Benign lymphoepithelial cysts are rare, and are associated with swelling of the salivary glands (usually the parotid gland). The cytopathological features include lymphoid hyperplasia with an epithelial component, exhibiting cystic and proliferative changes. Development of a benign lymphoepithelial cyst commonly precedes acquisition of acquired immunodeficiency syndrome, but may also be the initial clinical manifestation of human immunodeficiency virus (HIV) infection. A 43 year-old male presented with a slowly growing multilocular cystic mass in his right cheek. Computed tomography of the neck revealed a well-circumscribed cystic lesion in the bilateral parotid glands. A provisional diagnosis of a benign lymphoepithelial cyst associated with HIV infection was made, and Western blotting confirmed the HIV infection. Three months after initiation of antiretroviral therapy, the parotid swelling was completely resolved. We report this case to suggest that clinicians should consider the possibility of HIV infection when patients present with benign lymphoepithelial cysts of the parotid gland.

Corelation between the Treatment Result and Causative Bacteria in Amputation of Diabetic Foot / 대한족부족관절학회지

PURPOSE: To evaluate correlation between the clinical results and causative bacteria in diabetic foot patients with lower extremity amputation. MATERIALS AND METHODS: One hundred twenty nine patients(131 feet) of diabetic foot amputations were followed for more than one year. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Retrospective analysis was performed using chart review and interview with the patients. Depending on the culture result, level of amputation, reinfection, duration of treatment, death rate, patient satisfaction and admission dates were evaluated. RESULTS: Microorganisms were confirmed in 114 cases. In the other 17 cases, there were no cultured microorganisms. In bacterial growth group, Methicillin-sensitive Staphylococcus aureus was the most common pathogen and accounted for 34 cases. As other common pathogens, there were Methicillin-resistant Staphylococcus aureus(24 cases) and mixed infection(14 cases). Mortality is no difference in each infected group. Mixed bacterial infected patients have higher reinfection, longer hospital day and duration of treatment, but there is no difference in patients satisfaction and pain at last follow up. CONCLUSION: The most common pathogen in diabetic foot patients with lower extremity amputation was Methicillin-sensitive Staphylococcus aureus, and mixed bacterial infected patients have higher reinfection rate, longer admission date and duration of treatment than other bacterial infected patients.

Comprehension of Patient-Physician Interaction through Analysis of Relationships between Domains in Clinical Performance Examination / 한국의학교육

PURPOSE: This research investigated the psychometric properties of the patient-physician interaction (PPI) domain in the clinical performance examination (CPX). This research aimed to understand the PPI domain in the CPX through a psychometric and relationship analysis between the domains. METHODS: Data were drawn from 1,302 examinees on a set of 6 common CPX cases and 1,066 on a 'bad news delivery' case. All cases included 7 PPI items, among which we calculated internal consistency reliability. Correlations were made between PPI and the other domains. Analyses using the structural equation model (SEM) were conducted to assess the relationships between latent factors and controlled measurement errors. To calculate the disparity between colleges, we performed a multi-level analysis. Also, we conducted t-tests to investigate the consistency of the PPI and information sharing (IS) scores in the 'bad news delivery' case. RESULTS: Correlation between the mean PPI score and the total CPX score was high (0.707). The correlations between PPI and other domains were; 0.904 for the patient's overall satisfaction, 0.41 for history taking, and 0.327 for patient education. In SEM, these correlations between latent variables increased. The proportion of level-2 (between-school component) variance in PPI was 4.1%. For 'bad news delivery', the group that checked 'yes' on the IS items had higher PPI scores (mostly p<0.01). CONCLUSION: PPI is an influential domain of the CPX and is highly related with the patient's overall satisfaction, clinical courtesy, and history taking. Disparities between schools in PPI are relatively small, such that the PPI could be due to individual factors rather than the school.

Smoking Status and Augmentation Index in Korean Male Subjects

BACKGROUND: Smoking is a major risk factor of cardiovascular morbidity and mortality. Arterial stiffness has been identified as an important determinant of cardiovascular risk. Augmentation index is an indicator of arterial stiffness, which can be quantified noninvasively. The goal of this study was to assess the effect of current smoking status on augmentation index (AIx) in Korean male subjects. METHODS: A total of 70 males without clinical cardiovascular diseases were studied in this cross sectional study. AIx was measured in 35 current smokers and 35 nonsmokers by recording pressure waveforms using radial applanation tonometry in a SphygmoCor device. RESULTS: Augmentation index was significantly higher in the current smokers (19.4+/-12.9% vs. 9.7+/-12.8%; P<0.05). A multiple regression model confirmed that smoking status was independently associated with arterial stiffness (beta=0.350, P<0.001). CONCLUSION: Current smoking is associated with increased augmentation index, which is a marker of cardiovascular disease. Further studies are required to investigate clinical applications of arterial stiffness.

Analysis of HPV-16 E6-related gene expression using cDNA microarray / 대한산부인과학회잡지

OBJECTIVE: To examine the effect of HPV-16 E6 expression on the transcription of cellular genes, we used cDNA microarray in HPV-16 E6 transfected stable cancer cell lines. METHODS: Using cDNA microarray consisting of 1,024 genes, we have performed a systematic characterization of gene expression in A549E6 human lung adenocarcinoma and RC10.1 human colon adenocarcinoma cell lines stably expressing HPV-16 E6 gene. The up-regulated and down-regulated genes were classified into the different functional categories; oncogenes, apoptosis, cell cycle, signal transduction, gene regulation, immune response, cell adhesion, protein transport, metabolism, redox control and angiogenesis. RESULTS: Among 1,024 known genes and ESTs (expressed sequence tags) tested, we found 27 up- regulated and 43 down-regulated genes in A549E6 (HPV-16 E6) compared to A549. The major up-regulated genes were as follows. GTPase-activating protein Rho 4, transcription factor D2, IKAROS, integrin-alpha 6, cadherin 11, ephrin-beta 2, RAN binding protein 2, branched-chain amino transferase 2. The major down-regulated genes were as follows. K-ras 2, CDC (cell division cycle) 37, CDC16, CDC7L1, IRF3, interferon-gamma-inducible protein 30, cadherin 6, desmoglein 1, desmocollin 2, endothelin 2. Also, we found 48 up-regulated and 34 down-regulated genes in RC10.1 (HPV-16 E6) compared to RKO. The major up-regulated genes were as follows. Colon cancer familial nonpolyposis type 1 (COCA 1), Bcl 2, jagged 1, MAP2K6, E2F1, ephrin receptor-beta 2, ephrin-beta 2, desmoglein 1, transforming growth factor-beta 3. The major down-regulated genes were as follows. KIT, Rad51C, Bcl 2 antagonist killer 1, STAT 4, epidermal growth factor receptor, high mobility group protein 2, cadherin 11, cadherin 12, cadherin 3, integrin-alpha 1, intergrin-alpha 8, chromosome segregation 1-like. CONCLUSION: Various expression patterns of cellular genes by HPV-16 E6 could be wholy grasped and classified into different functional groups using both cell line system stably expressed HPV-16 E6 and cDNA microarray analysis. These analysis methods must be helpful to understand multiple effects of a specific gene on cellular genes in a short period.

Ultrasonography in obstructive jaundice : a comparison with percutaneous transhepatic cholangiography

The value of ultrasonography and percutaneous transhepatic cholangiography in determining the site and etiology of biliary obstruction with surgical jaundice was studied in 30 patients. All diagnoses were subsequently made by surgery and pathology. The results were as follows; 1. In ultrasonography, the site of obstruction was delineated in 46%, while the etiology of the lesion was established in 40%, In comparison, percutaneous transhepatic cholangiography delineated the site in 100% and the etilogy in 93%. 2. Although the percutaneous transhepatic cholangiography is invasive to the human body, it is considered to be the single procedure of choicein the managment of the patient with biliary obstructive jaundice because of its diagnostic accuracy, technical simplicity and relative safety.