The Effect of Residential Migration on the Utilization and Accessibility of Medical Care / 보건행정학회지

Background@#In Korea, the health gap widens due to the number of medical resources and access to medical services between metropolitan and rural. The purpose of this study is to identify the impact of residential migration on medical utilization and accessibility. @*Methods@#This study extracted 528,516 claimed cases in the National Health Insurance Service-Cohort Sample Database from 2006 to 2015. Subjects were classified into two groups by the magnitude of the region, the metropolitan and the rural. The inversed probability weights were calculated for each group. And coefficients of the two-part model were estimated by generalized estimation equation. @*Results@#Those who moved region from metropolitan to rural tend to increase the length of stay and inpatients with ambulatory care sensitive conditions (ACSC) disease. Contrariwise, those who moved areas from rural to metropolitan tend to decrease the total medical cost, the adjusted patient days, the number of outpatients and the number of outpatients and inpatients with ACSC disease. @*Conclusion@#This study identified that between the residents who continued to reside in the region and the migrants, there were significant differences in the medical accessibility, quality of primary care, and unmet medical need.

The Effect of Residential Migration on the Utilization and Accessibility of Medical Care / 보건행정학회지

Background@#In Korea, the health gap widens due to the number of medical resources and access to medical services between metropolitan and rural. The purpose of this study is to identify the impact of residential migration on medical utilization and accessibility. @*Methods@#This study extracted 528,516 claimed cases in the National Health Insurance Service-Cohort Sample Database from 2006 to 2015. Subjects were classified into two groups by the magnitude of the region, the metropolitan and the rural. The inversed probability weights were calculated for each group. And coefficients of the two-part model were estimated by generalized estimation equation. @*Results@#Those who moved region from metropolitan to rural tend to increase the length of stay and inpatients with ambulatory care sensitive conditions (ACSC) disease. Contrariwise, those who moved areas from rural to metropolitan tend to decrease the total medical cost, the adjusted patient days, the number of outpatients and the number of outpatients and inpatients with ACSC disease. @*Conclusion@#This study identified that between the residents who continued to reside in the region and the migrants, there were significant differences in the medical accessibility, quality of primary care, and unmet medical need.

Quantitative assessment of steroid amount in the tissue after epidural steroid injection: a new rabbit model

BACKGROUND: To develop a rabbit epidural steroid injection (ESI) model for analyzing steroid retention in the tissue, and to assess the difference in steroid retention in the model according to the location and time elapsed after ESI. METHODS: Fluoroscopy-guided ESI was performed using the interlaminar approach between the lowest two lumbar segments in 13 female New Zealand white rabbits. Four rabbits were allocated to each of three different groups according to the time of sacrifice: 3, 7, and 15 days post-ESI; the remaining rabbit was sacrificed immediately post-ESI to obtain baseline data. After sacrifice, two segments were harvested: the lowest two lumbar vertebrae and another two lumbar vertebrae immediately above these. The residual steroid amount (RSA) and residual steroid concentration (RSC) in the collected spinal columns were analyzed. A linear mixed model was used to compare RSAs and RSCs between the injected and adjacent segments, and among the number of days until sacrifice; P < 0.05 was considered statistically significant. RESULTS: Both RSA and RSC of the injected segment were significantly higher than those of the adjacent segment (P < 0.001, both). The RSA and RSC significantly decreased over time (P = 0.009 and P = 0.016, respectively). CONCLUSIONS: The developed rabbit ESI model verified that significantly more steroid was retained at the injected segment than at the adjacent segment and the residual steroid decreased over time. This model could be useful not only for comparing current steroid medications, but also for developing new, better steroid formulations.

Qualitative correlation between postoperatively increased vertical dimension and mandibular position in skeletal class III using partial-least-square path modeling / 대한악안면성형재건외과학회지

BACKGROUND: This study constructed a partial-least-square path-modeling (PLS-PM) model and found the pathway by which the postsurgical vertical dimension (VD) affects the extent of the final mandibular setback on the B point at the posttreatment stage for the skeletal class III surgery-first approach (SFA). METHODS: This study re-analyzed the data from the retrospective study by Lee et al. on 40 patients with skeletal class III bimaxillary SFA. Variables were obtained from cone beam computed tomography (CBCT)-generated cephalograms. Authors investigated all variables at each time point to build a PLS-PM model to verify the effect of the VD on the final setback of the mandible. RESULTS: From PLS-PM, an increase in VD10 was found to decrease the absolute value of the final setback amount of the mandible, which reflects the postsurgical physiological responses to both surgery and orthodontic treatment, which, in turn, can be interpreted as an increase in postoperative mandibular changes. CONCLUSIONS: To resolve the issue of collinear cephalometric data, the present study adopted PLS-PM to assess the orthodontic treatment. From PLS-PM, it was able to summarize the effect of increased postsurgery occlusal vertical dimension on the increased changeability of the B point position at the posttreatment stage.

SOCS1 suppresses IL-1β-induced C/EBPβ expression via transcriptional regulation in human chondrocytes

CAAT/enhancer-binding protein-beta (C/EBPβ) is a transcription factor that regulates interleukin-1β (IL-1β)-induced catabolic pathways, including the expression of matrix metalloproteinases (MMPs), in chondrocytes. We previously reported that suppressor of cytokine signaling 1 (SOCS1) inhibits IL-1β signaling in chondrocytes. However, the effect of SOCS1 on C/EBPβ has not been explored. To investigate the interaction between SOCS1 and C/EBPβ, we established human SW1353 cells with overexpression or knockdown of SOCS1 or C/EBPβ. Both SOCS1 and C/EBPβ were involved in transcription of MMP-3 and MMP-13. When stimulated with IL-1β, C/EBPβ levels were significantly increased by SOCS1 knockdown and decreased by SOCS1 overexpression. A similar change in IL-1β-induced C/EBPβ expression was observed in SOCS1-transfected human articular chondrocytes. However, C/EBPβ overexpression or knockdown did not change the levels of IL-1β-induced SOCS1. SOCS1 regulated the levels of C/EBPβ mRNA by ubiquitination of C/EBPβ as well as transcriptional regulation. Furthermore, it suppressed the phosphorylation of cAMP response element-binding protein (CREB), an active transcription factor of C/EBPβ. In addition, p38 mitogen-activated protein kinases, a target of SOCS1, was involved in CREB phosphorylation. The chromatin immunoprecipitation assay confirmed that SOCS1 overexpression led to reduced binding of C/EBPβ to the MMP-13 promoter. Taken together, our results demonstrate that SOCS1 downregulates the p38-CREB-C/EBPβ pathway resulting in increased expression of MMPs in chondrocytes.

Development and Validation of a Liquid Chromatography-Tandem Mass Spectrometry Method for the Determination of epsilon-Acetamidocaproic Acid in Rat Plasma

A simple and rapid liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated for the quantification of epsilon-acetamidocaproic acid (AACA), the primary metabolite of zinc acexamate (ZAC), in rat plasma by using normetanephrine as an internal standard. Sample preparation involved protein precipitation using methanol. Separation was achieved on a Gemini-NX C18 column (150 mm x 2.0 mm, i.d., 3 microm particle size) using a mixture of 0.1% formic acid-water : acetonitrile (80 : 20, v/v) as the mobile phase at a flow rate of 200 microl/min. Quantification was performed on a triple quadrupole mass spectrometer employing electrospray ionization and operating in multiple reaction monitoring (MRM) and positive ion mode. The total chromatographic run time was 4.0 min, and the calibration curves of AACA were linear over the concentration range of 20~5000 ng/ml in rat plasma. The coefficient of variation and relative error at four QC levels were ranged from 1.0% to 5.8% and from -8.4% to 6.6%, respectively. The present method was successfully applied for estimating the pharmacokinetic parameters of AACA following intravenous or oral administration of ZAC to rats.

Measurements and Comparative Considerations of Velocities of Primary Bloodstain Spatters using a High Speed Camera / 대한법의학회지

Bloodstain pattern analysis is a forensic discipline that reconstruct events of a crime scene by analyzing sizes, shapes, distributions, positions of bloodstains. Bloodstain pattern can be classified into the low velocity, medium velocity, and high velocity system. Velocities in this system represent the velocity of the wounding agent (the force applied) and not to the velocity of the blood in flight. Thus there is no reference system about the velocity of the blood in flight in the existing bloodstain classification system. Applying bloodstain pattern analysis to the real crime case, we needed to have the reference system of velocities of impact spatter, cast-off spatter, and expectorate spatter. Therefore we measured the velocities of these spatters using high speed camera and we analyzed the results. In this experiments the average velocity of impact spatter that generated by swinging a hammer with all experimenter's strength at the pool of blood is about 4.7 times faster than that of swing cast-off spatter that generated by swinging a red-wat hammer with all experimenter's strength, and about 3.9 times faster than that of expectorate spatter that generated by emitting blood from the mouth with all experimenter's strength. The velocities of cast-off spatter and expectorate spatter, however, showed similar distributions. Our experiments that measure the velocities of droplets of blood spatters in flight under the specific conditions that generated at fastest speed can give some reference to the classification system of velocities of bloodstains which is not distinct up to now, as well as some real bloodshed crime cases.

A Study of Similarities Between Bloodstain Pattern Analysis and Fire Investigation In Point View of Event Analysis / 대한법의학회지

Crime scene reconstruction is the use of scientific methods, physical evidence, deductive and inductive reasoning and their interrelationships to gain explicit knowledge of the series of events that surround the commission of a crime. Event analysis is the method of crime scene reconstruction. As disciplines of crime scene reconstruction, bloodstain pattern analysis and fire investigation have many common points. Comparing bloodstain pattern analysis with fire investigation in point view of event analysis helps us to further understand crime scene reconstruction as well as bloodstain pattern analysis and fire investigation themselves. We study event analysis and apply it to cases and we seek similarities and differences between bloodstain pattern analysis and fire investigation by analyzing the methodology of both of them. In a fire scene, the point with the greatest damage is the point where the fire burned longest, which is likely to be the origin. In bloodstained scenes this approach is reversed. The greatest bloodshed point is most likely the ending point of the incident and is likely at or near the point where the bloodshed started. Above this, there are other similarities between them. Mastering the crime scene reconstruction requires long time hard training. Thus if the fire investigation experts or arson experts among crime scene investigators join the field of bloodstain pattern analysis(or reverse), then there will be many synergy effects to both of them.

A Study on Usefulness of Specific Agents with Liver Disease at MRI Imaging: Comparison with Ferucarbotran and Gd-EOB-DTPA Contrast Agents / 의학물리

The purpose of this experiment is to know the relation of the detection and characterization of liver's diseases as comparison of finding at MR imaging using a Ferucarbotran (SPIO) and Gd-EOB-DTPA (Primovist) agents in diffuse liver disease. A total of 50 patients (25 men and 25 women, mean age: 50 years) with liver diseases were investigated at 3.0T machine (GE, General Electric Medical System, Excite HD) "with 8 Ch body coil for comparison of diseases and contrast's uptake relation, which used the LAVA, MGRE." All images were performed on the same location with before and after Ferucarbotran and Gd-EOB-DTPA administrations (p<0.05). Contrast to noise ratio of Ferucarbotran and Gd-EOB-DTPA in the HCC were 3.08+/-0.12 and 7.00+/-0.27 with MGRE and LAVA pulse sequence, 3.62+/-0.13 and 2.60+/-0.23 in the hyper-plastic nodule, 1.70+/-0.09 and 2.60+/-0.23 in the meta, 2.12+/-0.28 and 5.86+/-0.28 in the FNH, 4.45+/-0.28 and 1.73+/-0.02 in the abscess and ANOVA test was used to evaluate the diagnostic performance of each disease (p<0.05). In conclusions, two techniques were well demonstrated with the relation of the detection and characterization of liver's diseases.

Anesthetic Management in a Patient with Severe Primary Pulmonary Hypertension with Right Ventricular Dysfunction: A case report / 대한마취과학회지

Primary pulmonary hypertension is characterized by progressive increase in pulmonary vascular resistance leading to right ventricular (RV) failure and death.The desirable goal of primary pulmonary hypertension is preserving coronary perfusion of RV while decreasing pulmonary arterial pressure with selective pulmonary vasodilators.We report a case in which anesthetic management was successfully performed in a 67 years old man, who had experienced ventricular tachycardia at the previous anesthesia induction, with severe pulmonary hypertension and right ventricular dysfunction.

The Use of Radiofrequency Lesion Generation on the Ganglion Impar for the Treatment of Chronic Coccygodynia: A case report / 대한마취과학회지

Coccygodynia is a common problem that is characterized by pain in the tailbone that radiates to the lower sacral and perineal areas. Coccygodynia may occur after a fall in the sitting position or damage to the sacrococcygeal ligament during a difficult vaginal delivery.Currently, the therapeutic options for coccygodynia are unclear, however, a number of treatment approaches have been proposed.In this case a favorable outcome was obtained by using a radiofrequency lesion generator to create a lesion on the ganglion impar in a patient with chronic coccygodynia.

Effect of Slow Walking Speed on Gait

OBJECTIVE: To investigate the effect of slow walking speed on the gait. METHOD: Twenty healthy young male subjects were recruited. The temporospatial data, kinematic and kinetic data in sagittal plane at two different walking speed (2 km/hr, 4 km/hr) were obtained through three dimensional analyzer with the force plate, and compared these parameters at slow gait speed to those at normal gait speed. RESULTS: The cadence and step length decreased significantly and double support time increased significantly (p<0.05) at slow speed compared to at normal speed. The most peak angle of hip, knee and ankle joint decreased, maximal ankle dorsiflexion angle in stance phase increased significantly at slow speed compared to at normal speed (p<0.05). The most maximal extension and flexion moment and power in sagittal plane decreased compared to at normal speed (p<0.05). CONCLUSION: The results of this study demonstrate that only slow walking speed without any pathology may change the temporospatial, kinematic and kinetic parameters of gait, and these results may be useful to interpret the data of gait analysis in the disabled persons with slow walking speed.

Synthesis and evaluation of PDLs22 recombinant protein / 대한치주과학회지

Periodontal ligament (PDL) is the connective tissue located between the tooth root and alveolar bone. In a previous study, PDLs22 was isolated as a PDL-specific gene by using subtractive hybridization between cultured PDL fibroblasts and gingival fibroblasts. It was also suggested that PDLs22 plays important roles in the development, differentiation and maintenance of periodontal tissues. However, little is known about functional study of PDLs22 using recombinant protein in PDL fibroblast differentiation and periodontium formation. In this study, in order to produce the PDLs22 recombinat protein, PDLs22-expression vector were constructed and expressed its protein in various host cell and temperature conditions. The results were as follows: 1. PDLs22 protein was not strongly expressed in the induction system using pRSET-PDLs22 construct. 2. When the BL21(DE3) pLysS was used as a expression host, PDLS22 protein was strongly expressed in the induction system using pHCEIIBNd-PDLs22 construct. 3. The PDLs22 protein was recognized at a molecular weight of 28 kDa in western blots. 4. Almost of the expressed PDLs22 protein was not soluble and observed like as inclusion body. 5. The protein solubility was not improved after modification of induction time and temperature during PDLs22 protein production. In this study, the system for the PDLs22 protein production was connstructed. However, the results suggest that further studies will be needed to produce the considerable amount of PDLs22 recombinat protein, which can use for the periodontal regeneration.

Expression and function of OD314, Apin protein during ameloblast differentiation and amelogenesis / 대한치과보존학회지

This study was aimed to elucidate the biological function of OD314 (Apin protein), which is related toameloblast differentiation and amelogenesis. Apin protein, calcifying epithelial odontogenic (pindborg) tumors (CEOTs)-associated amyloid, were isolated from CEOTs, and has similar nucleotide sequences to OD314. We examined expression of the OD314 mRNA using in-situ hybridization during tooth development in mice. Expression of OD314 and several enamel matrix proteins were examined in the cultured ameloblast cell line up to 28 days by reverse transcription-polymerase chain reaction (RT-PCR) amplification. After inactivation and over-expression of the OD314 gene in ameloblast cell lines using U6 vector-driven RNA interference and CMV-OD314 construct, RT-PCR were performed to evaluate the effect of the OD314 during amelogenesis. The results were as follows: 1. In in-situ hybridization, OD314 mRNAs were more strongly expressed in ameloblast than odontoblast. 2. When ameloblast cells were cultured in the differentiation and mineralization medium for 28 days, the tuftelin mRNA expression was maintained from the beginning to day 14, and then gradually decreased to day 28. The expressions of amelogenin and enamelin were gradually decreased according to the ameloblast differentiation. 3. Inactivation of OD314 by U6-OD314 siRNA construct down-regulated the expression of OD314, MMP-20, and tuftelin, whereas over-expression of OD314 by CMV-OD314 construct up-regulated the expression of OD314 and MMP-20 without change in tuftelin. These results suggest that OD314 is considered as an ameloblast-enriched gene and may play the important roles in ameloblast differentiation and mineralization.

A Case of Brain Stem Neuro-Behcet's Disease Presenting as Paroxysmal Headache With Autonomic Features

Migraine without aura was significantly frequent in Beh et's disease patients. While, the relationship of TAC(trigeminal autonomic cephalalgia) and Beh et's disease was not known. And, it is thought that pathogenesis of proxysmal headache with autonomic features in neuroBehcet's disease as our case may be different from those of clust headache and TAC. A 45-year-old male admitted with left sided periobital poxysmal headache accompained by ipsilateral conjunctival injection and lacrimination with autonomic features. T2WMR image showed about 1.5x2.6x2.6 cm sized mass with high signal intensity surrounded by a rim of low signal intensity in pons. Enhanced MR image showed enhancing mass-like lesion inside the T2 high signal intensity. CSF study revealed neutrophilic pleocytosis with normal pressure, protein and glucose concentration. No malignant cell were seen. Antiphospholipid antibody and cryoglobuline was significantly increased. 3 days after hospitalvisit, oral ulcerations appeared in the patient. He was treated with high-dose steroid for a week and his headache and abnormal findings of CSF study became fully recovered. Two weeks later, the mass was nearly reduced in the pons on follow-up MR image. We suggest to include a careful interviewfor 2ndary TAC as the first neurologic symptom in the diagnostic work-up of Behet's disease.

Interictal Motor Cortex Excitability in Migraine and Chronic Tension Type Headache using Transcranial Magnetic Stimulation

BACKGROUND: The pathophysiology of migraine is only partly understood. Transcranial magnetic stimulation has been developed to study cortical physiology noninvasively. Chronic tension-type headache has not been studied with transcranial magnetic stimulation. Among other hypotheses, it has been proposed that interictal hypoexcitability could be partly responsible for the migraine. METHODS: Patients were divided into three groups: normal subjects(n=30), migraine with(n=11) or without aura(n=19) and chronic tension-type headache(n=30) according to the International Headache Society criteria. We studied cortical excitability between normal subjects and patients with migraine with or without aura and between normal and patients with chronic tension-type headache. RESULTS: The mean amplitude of cortex and spinal cord for normal subjects was 3.76 +/-1.74 mV, 2.03 +/-1.54 mV(abductor digiti minimi muscles, respec-tively) and 2.99 +/-2.04 mV, 3.88 +/-3.89 mV(abductor hallucis muscles, respectively). The mean amplitude of cortex and spinal cord for migraine with aura or without aura was 2.16 +/-1.21 mV, 0.90+0.80 mV(abductor digiti minimi muscles, respectively) and 1.88 +/-1.23 mV, 2.31 +/-2.25 mV(abductor hallucis muscles, respectively). The mean amplitude of cor-tex and spinal cord for chronic tension-type headache was 1.61 +/-0.50 mV, 0.72 +/-0.32 mV(abductor digiti minimi mus-cles, respectively) and 1.54 +/-0.55 mV, 1.51 +/-0.59 mV(abductor hallucis muscles, respectively). The amplitude of motor evoked potentials of cortex and spinal cord in migraine and chronic tension-type headache showed significant decreases compared to normal subjects( p < 0.001). CONCLUSIONS: These results are explained by cortical and spinal hypoexcitability in migraine and chronic tension-type headache. We suggest that enhanced serotonergic activity could be some rule for cortical hypoexcitability.

A Case of Wernicke's Encephalopathy associated with Hyperemesis Gravidarum / 대한산부인과학회잡지

Hyperemesis gravidarum is characterized by severe nausea, vomiting followed by weight loss, dehydration, electrolyte imbalance and acid-base derangements. Its treatment was composed of adequate fluid therapy, electrolyte replacement and nutrient supply. In severe case, it also leads to a variety of neurological symptoms including confusion, gait disturbance and nystagmus, possibly due to thiamine deficiency and may result in so called Wernicke's disease. We have experienced a case of Wernicke's encephalopathy associated with severe hyperemesis gravidarum and this case is presented with a brief review of literature.

Two cases of conservative management of 10 and 8 week cervical pregnancies / 대한산부인과학회잡지

Cervical pregnancy is a rare and dangerous form of ectopic pregnancy in which the blastocyst implants within the cervical canal below the internal os of the uterine cervix. The characteristic clinical sign is a severe asymptomatic uterine bleeding in early pregnancy or during curettage. Most cervical pregnancies result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervical tissue. Because of uncontrolled profuse vaginal bleeding, total hysterectomy has been the mostly necessitated to control life-threatening bleeding. Transvaginal sonography allows early diagnosis, and conservative treatment (two-time treatment : first treatement with systemic or intraamnionic methotrexate, secondly with curettage or ligature of the uterine arteries) improves the patient's fertility. Successful treatment is defined as elimination of the cervical pregnancy with preservation of the uterus. We report two cases of cervical pregnancy managed, successfully with methotrexate, leucovorin and curettage.

Studies on Heart Rate Variability in Patients with Acute Myocardial Infarction

BACKGROUND: Heart rate variability(HRV) represents one of the methods of examining the function of autonomic nervous system. Many patients with acute myocardial infarction show evidence of autonomic disturbance during the acute phase of the attack and reduced heart rate variability is a significant predictor of mortality in patients after acute myocardial infarction. METHOD: The study groups included 25 patients admitted to our hospital with acute myocardial infarction and 23 age matched control group. Heart rate variability(time domain measures : mean NN, SDNN, SDANN, SD, rMSSD, pNN50 and frequency domain measures : TF, LF, HF) was measured from 24 hour Holter recording and wall motion score index(WMSI)was calculated from echocardiography in both groups. Jeopardy score(JS) and ejection fraction(EF) were calculated from coronary angiogram and left ventricular cineangiogram. In patients, HRV, echocardiography and coronary angiography were taken at a mean of 9+/-4, 4.3+/-2.9, and 13+/-6 days after admission. Results: 1) HRV(time domain measures : SDNN, SDANN, SD, rMSSD, pNN50 and frequency domain measures : TF, LF, HF) except mean heart rate was significantly decreased in patients with acute myocardial infarction(AMI)(p<0.001). 2) The angiographic EF and echocardiographic WMSI showed significant negative correlation in patients with AMI(r=-0.49, p<0.05). 3) The EF was significantly related with mean heart rate(r=0.52, p<0.05), SD(r=0.45, p<0.05), TF(r=0.46, p<0.05) and LF(r=0.50, p<0.05) in patients with AMI. 4) There was no correlation among the JS, WMSI, and HRV in patients with AMI. CONCLUSIONS: These findings support that the autonomic control of the heart was pathologically changed in patients with AMI and among the HRV measurements, mean NN, SD, TF and LF were closely related with left ventricular function.

Clinical Analysis of Choledochal Cyst / 대한소화기내시경학회지

We studied and analyzed 66 cases of choledochal cyst in a 9 year period from March, 1985 to December, l993 at Hangang, Kangnam and Chuncheon Sacred Heart Hospital. The results were as follows; 1) Age ranged from 1 year to 82 years and ll of 66 cases were below 10 years. The ratio of men to women was 1: 1.9. 2) The frequency of the triad of symptoms and signs were in order of abdominal pain 53 cases(80.3%), jaundice 12 cases(18.2%) and abdominal mass 9 cases(13.6%). The classical triad of pain, mass and jaundice was present in only 2 cases(3.0%). 3) Alkaline phosphatase was elevated in 42 cases(63.6%), hyperbilirubinemia in 29 cases(43.9%) and hyperamylasemia in 9 cases(13.6%). 4) Performed diagnostic procedures were ultrasonogram in 57 cases(86.4%), endo- scopic retrograde cholangiopancreatogram in 32 cases(48.5%), DISIDA scan in 18 cases(27.3%), computed tomogram in 14 cases(21.2%) and percutaneous transhepatic cholangiagram in 6 cases(9.1%). 5) Among 38 cases which ERCP or PTC were performed, according to the Todani's classification, Type I was seen in 28 cases(73.7%), Type IVA in 7 cases(18. 4%), Type II in 2 cases(5.3%) and Type V in I case(2.6%). 6) The associated diseases were cholangitis in 15 cases(22.7%), choledocholithiasis in 12 cases(18.2%) and cholangiocarcinoma in 2 cases(3.0%). 7) Operative procedures were performed in 22 of 66 cases, excision of cyst with Roux-en-Y c~holedochojejunostomy in 17 cases, choledochocystojejunostomy in 2 cases and external drainage in 3 cases.