Femur neck fracture is well known as one of the major death cause after trauma in elderly patients, and unsolved fracture due to its frequent association with complications such as avascular necrosis and nonunion. Through meticulous evaluation of the patient, hip and surgeon's experiences, reduction of mortality and morbidity as well as rapid recovery of the patient to the preinjury social and ambulatory status without local complications and revision after treatment is urgently needed. Many factors about this fracture in itself were noted, but we have analyzed 18 femur neck fracture of the patients older than 50 years preliminarily according to age, fracture pattern, osteoporosis, etiology and method of treatment with its delay in association with major complications especially avascular necrosis and nonunion. The results are as follows; 1. Of these 18 fractures, 11 were in females, 8 were caused by minor trauma such as slipdown accident and 4 were associated with definite osteoporosis according to the Sing's classification. 2. Fracture pattern of these 18 are undisplaced in 4, displaced subcapital in 11, displaced transcervical in 3. 11 fractures in the patients older than 60 year are composed of 3 undisplaced or impacted fractures and 8 displaced subcapital fractures. 3. These 18 fractures were treated by closed reduction and internal fixation with multiple pins in 13, and hemiarthroplasty in 4, but one was not treated to die after discharge from hospital. 4. Undisplaced or impacted fractures and 3 displaced transcervical fractures were not associated with any complications such as avascular necrosis or nonunion. But 4 of 6 displaced subcapital fractures were complicated by avascular necrosis, 3 of which were reduced in the varus position within 1 week, and the other was reduced in the good position on 1 week after trauma. There was no complication in 2 displaced subcapital fractures reduced in valgus position within 3 days after trauma. According to the above results, the prognosis of the femur neck fracture is dependent upon the fracture pattern and delay in its treatment. So it is inevitable to reduce the fracture in anatomical or valgus position as early as possible. But the arthroplasty may be needed in displaced subcapital fractures delayed for several days, with its reluction in extreme varus position or impossible and with preexisting disease in the same hip joint (total hip replacement).
Keloids are abnormally healed skin wounds that develop in the subpapillary layer of the dermis. They are a lesion with wide, raised and deep scars. They exceed the original dimensions of the wound and grow mounds upon mounds of collagen in a pseudotumor fashion. Their treatment may take several forms such as surgery, intralesional injection of steroid, compression, superficial irradiation, and combination therapy. However, absolute method is nothing until now. Recently, the cryosurgery shows relatively good effect in treatment, so we tried the clinical experience with cryosurgery in the treatment of keloids. Material and methods: During the past 2 years, we treated 20 individuals of the keloids with severe itching and pain. The age ranged from 5 to 45 years old. Only 6 cases were biopsied before and after cryotherapy. The cryosurgery set we used was Toitu model CR 201 N₂O gas (tip temperature in 80℃) and was applied directly on the lesion about 4 to 5 minutes with slight compression. After cryosurgery in keloids, the following results were obtained: 1. It is both quick and easy method. 2. It is causes little or no pain and no loss of blood. 3. Integumentary normalization is rapid. The new scar tissue is smaller, and more elastic and soft. 4. The pain, itching and paresthesia commonly associated with keloid is usually disappeared. 5. Other treatment can be used after cryosurgery. 6. Histologic picture after cryosurgery is similar with the result of steroid injection. 7. The mechanism of the cryosurgery in keloids is the result of the direct tissue destroying action and cryoimmunologic reaction.
To assess the effect of postoperative pain control of upper abdominal surgery through lumbar epidural narcotic injection, the 3rd or 4th lumbar epidural puncture was done, and were injected 1 mg of morphine (Group I) or 10 mg of demerol (Group II) mixed with 10 ml of normal saline into the epidural space, after operation of the cholecystectomy in 10 patients and antrectomy and vagotomy, subtotal or total gastrectomy in 10 patients. Time interval of the postoperative analgesic effect between morphine and demerol groups were compared. The results of this study were as follows: 1. In the group I, average analgesic duration was 29.4 hours. 2. In the group II, average analgesic duration was 4.0 hours. It is concluded that postoperative pain control of upper abdominal surgery through the lumbar epidural narcotic injection was effective, and morphine injection was more effective than demerol.
It is well known that intracranial pressure (ICP) and mean arterial pressure (MAP) are increased by laryngoscopy and endotracheal intubation during induction of general anesthesia, and it may be very dangerous in neurosurgical patients who had increased ICP. Therefore, this study was performed to know the range of ICP increase during induction of the conventional general anesthesia with intubation following thiopental and succinylchohne injections. Intracranial pressure and MAP were measured in 13 patients who underwent craniotomy. All the patients were monitored cerebral epidural ICP and intraarterial pressure preoperatively. The results were as follow: 1. Intracranial pressure was increased of 7.1±7.23 mmHg. 2. Arterial pressure was increased of 43.5±25.46 mmHg. 3. Cerebral perfusion pressure was increased of 33.3±27.53 mmHg. It is stressed that certain procedures are necessary to prevent from further increase of ICP due to induction of general anesthesia in patients with increased ICP.
Many pictures must be taken for the presumption of the stereorelation of the cerebral artery, which obtained with ordinary cerebral angiography. And it is very difficult to understand the stereoimage and required many experiences. But it is able to presume the stereorelationship in only brief eye's training without the aid of the stereoscope using the prism. For the stereoview, we need the paired angiograms obtained only straight and tilting the X-ray tube. In practice, with this stereoview in cerebral angiogram, we could know the directions of the aneurysmal neck and fundus with the stereorelationship of the cerebral artery and indeed helps us greatly in operation field. In addition, we might guess the location and stereorelationships of the feeding artery and draining vein in arteriovenous malformation and other vascular tumors and it was great aid in diagnosis and operation. Now we present the methods of the pictures for the stereoview in cerebral angiogram and the methods for eye's training.
Treatment of the olecranon fractures by prolonged immobilization often results in limited elbow motion. With the use of tension band wiring, anatomical reduction was obtainable, and only a short period of immobilization was needed. We reviewed the cases of 17 patients who underwent surgical treatment of the olecranon fracture. All patients were treated by tension band wiring. In the overall series, we were able to obtain 53 percent excellent, 30 percent good, and 18 percent fair results.
For evaluation on the histopathologic studies, and age and sex distribution of the gatric carcinomas in the Taegu Area, the gastrectomized and gastroscopic biopsy materials were collected at the Department of Pathology, College of Medicine, Yeungnam University, and the analyzed results were as follows: 1. In total of 350 cases of gastroscopic biopsy materials adenocarcinomas are 344 cases (98.3%), squamous cell carcinomas and undifferentiated carcinomas are only 6 cases (1.7%). In adenocarcinomas the most of all are tubular type, 215 cases (61.4%). In age distribution the highest is the 50th age group, and 120 cases (34.3%), the next 60th, 81 cases (23.1%), 40th, 76 cases (21.7%), respectively. 2. In total of 130 cases of gastrectomized materials adenocarcinomas are 127 cases (97.7%), and are the highest incidence, the next, carcinomas originated from chronic peptic ulcer of the stomach, and are 3 cases (2.3%). In adenocarcinomas the highest are tubular type, 86 cases (66.2%), the next, signet ring cell type, 20 cases (15.4%). The highest age incidence of the age group is 50th, and the next, 60th, 40th, 30th, 70th and 10th age group, respectively.
The clinical state with EEG pattern similar to interval discharge of epileptics is named as latent epilepsy, which does not necessarily mean that the patient will develop epilepsy later. However, since there is possibility of developing epilepsy on later date, antiepileptic mainly dilantin was tried to control the abnormal EEG. Since January to October 1985, total 580 headache cases with more than moderately abnormal EEG visited the Neurology Clinic. Among them 162 cases with interval seizure pattern (ISP) of epilepsy were selected for the study. The main ISP was 1. diffuse theta and/or delta bursts and 2. spikes. Since the study in only analysis of clinical treatment of 162 cases without previous planning based on financial aid, about 30% of the patients did not return after the 1st EEG examination, in 42% failed to follow the EEG after the treatment and only remaining 28% of the cases were studied. Among 29 patients who were treated with Dilantin 100mg tid po, 16 improved and 13 not. Of the 13, 4 showed partial improvement and partial progression. Case1. In 4 weeks of antiepileptic therapy (AR), spikes disappeared but in 2 months developed bursts. Case2. In 17days of AR, spikes and bursts disappeared but in 3 months bursts reccured. Case3. In 1 week of AR, bursts disappeared but spikes developed. Case4. In 3 months of AR, no change of spikes and bursts and she discontinued the AR. In 6 months she developed grandma seizure. Eighteen cases, treated with other drugs except antiepileptics, all showed improvement. The other drugs were vincaprol, polygammalon, aronamin, ATP and hydergine. The improved cases had spikes more often than theta bursts. In view of the small number of the cases due to dropping most patients out of present study, it is considered meaningless to perform statistical analysis. Further well planned study with more patients is to be expected.
The R-R interval analyzer was developed to measure the autonomic nervous system function using microcomputer. The system based on 8 bit microcomputer including bandpass filter, R-wave detector and clock generator in order to obtain the mean value, standard deviation, total time, CV value, maximum value and minimum value in the specific view point of R-R interval variation. The pattern of R-R interval change after resting, voluntary standing and deep breathing can be analyzed in normal subjects and diabetics with autonomic nervous dysfunction. The amplitude of the R-R interval variation showed sensitive pattern for normal subjects at resting, standing and deep breathing. On the contrary, the periodicities of amplitude for abnormal subjects with autonomic nervous dysfunction showed dull pattern. It was suggested that R-R interval analyzer is a good detection method for dysfunction of autonomic nervous system.
Management of the small lower ureteral stone has been attempted by either transurethral manipulation or expectant therapy. To date, however, the choice of proper method has depended mostly on clinician's preference, and the effectiveness of the transurethral stone manipulation has remained controversial. Herein we evaluated the effectiveness of the transurethral stone manipulation, using with the Dormia dislodger, in 37 patients with lower ureteral stone less than 10mm in greatest diameter. The results are summarized as follows. 1. The overall success rate was 68% (25 of 37 patients); Immediate delivery of the stone was observed in 16 of 37 patients. In another 5 patients the stone was removed at the time when the indwelled ureteral catheter was taken out. In the remaining 4 patients the stone passed spontaneously within a week following the procedure. 2. Higher success rate was observed in smaller stone; 79% in less than 4 mm, 58% in 46 mm, and 33% in 610 mm in it's greatest diameter, respectively. 3. The morbidity rate was 8.1% (3 of 37 patients); In one patient a broken basket was retained in the ureter, which was removed at the time of ureterolithotomy. In another patient a ureteral stricture requiring periodic dilation was complicated. And in the other patient persistent hematuria was observed, which was relieved by conservative management. These results suggest that transurethral manipulation might have to be initially applied to unremittingly painful patients with small lower ureteral stone.
Intraabdominal abscess usually causes distress with fever, leukocytosis, pain and toxicity. Diagnosis of intraabdominal abscess is occasionally difficult and it has high morbidity. However radiologic method, such as ultrasonography, CT scan, or RI scan are helpful to early detection of intraabdominal abscess. Among these methods, ultrasonography is a noninvasive technique and performed without discomfort to patient. And also differential diagnosis between cystic and solid lesion is very easy and sequential ultrasonography in same patient is valuable for the evaluation of treatment effect. We analyzed the ultrasonic features of 48 cases with intraabdominal abscesses and the results are as follows; 1. In total 48 cases, the intraabdominal abscesses were 30 cases, the retroperitoneal abscesses, 5 cases, and the visceral abscesses, 13 cases. 2. The causes of the intraabdominal abscesses were perforating appendicitis (25 cases), postoperative complications (5 cases), pyogenic and amebic hepatic abscesses (13 cases), and the other (5 cases). 3. Round or oval shaped lesions were 26 cases (54%), irregular shape, 18 cases (38%), and multiple abscess formation in 4 cases (8%). 4. The size of the lesions were between 5 and 10cm in diameter in 54% of total 48 cases, and the most frequent feature of the echo pattern of the lesions was cystic with or without internal echogenicity (69%).
This report offers descriptive data about the drugs utilized in outpatient department (OPD) of Yeungnam University Hospital (YUH) in the period of March to August in 1985. The data in this report were produced by the computerized totalization of the number of mentions of individual drugs included in the prescriptions. The 100 drug entries that were most frequently recorded are listed in rank order. The listing is arbiturarily restricted to the drugs that were prescribed as single preparations, the drugs of basis of compound preparations and the drugs of adjuvant or corrective of compound preparations that have significant therapeutic effects either by generic names. And in addition, the listing also involves the compound preparations used in relatively large frequency, and the individual components of which have the unique pharmacological actions each other by proprietary names. And all routes of administrations were allowed. The 10 drugs most frequently named are diazepam, aluminum compounds, acetaminophen, isoniazid, metoclopramide, polaramine®, carboxymethylcystein, ephedrine, codeine and caroverine in order. The 521, 855 drug mentions listed as above are described by the chief therapeutic usage that each is intended to apply generally. The drugs which account the largest proportion of total mentions were those acting on the central nervous system (20.57%), including tranquillizers and sedative hypnotics (11.71%), analgesic antipyretics (5.55%), antidepressants (2.15%) etc. Gastrointestinal drugs and smooth muscle preparations (18.64%) included antacids and antiulcer drugs (9.24%), antiemetics (3.57%), spasmolytics (3.14%) and others. Respiratory drugs (16.11%) included expectorants and cough preparations (10.99%) and bronchodilators (5.12%). Chemotherapeutic agents (15.12%) included the antiTbc drugs (7.09%) most frequently, and the penicillins (3.33%) accounted the largest proportion among the antibiotics. Cardiovascular drugs (5.64%) included cardiac drugs and coronary vasodilator (4.12%) and antihypertensives and vasodilators (1.06%). And antiinflammatory drugs (4.33%), vitamins of single preparations (3.76%), hormones and their antagonists (3.29%), common cold preparations (3.12%), diuretics (2.81%), drugs supporting liver function (2.02%), drugs affecting autonomic nervous system (1.89%) including antiglaucomas, atropine and cerebral vasodilators, antihistamine drug (1.02%) and disinfectants (0.74%) were following in order. The data in the report were compared to those reported by H. Koch, et al. in United States (US), 1981 as “Drugs Most Frequently Used in Office Practice : National Ambulatory Medical Case Survey, 1981.” Cardiovascular drugs prescribed in YUH were much less in proportion than in US (10.56%), but gastrointestinal drugs accounted the larger proportion than in US (3.72%). Expectorants and preparations in YUH also accounted the larger proportion than in US (2.74%). In conclusion, in the period of March to August, 1985, OPD of YUH prescribed the CNS drugs including diazepam most frequently, and gastrointestinal, respiratory and chemotherapeutic drugs in next orders. It is supposed that the eating habits of Koreans and a unique atmospheric condition in Taegu as a basin were some important factors that affected the proportions of drugs acting on gastrointestinal and respiratory tracts.
Childhood epilepsy which has high prevalence rate and inception rate is one of the commonest problem encountered in pediatrician. In contrast with epilepsy of adult, in childhood epilepsy, more variable and varying manifestations are found because the factors of age, growth and development exert their influences in the manifestations and the courses of childhood epilepsy. Moreover epilepsy children have associated problems such as physical and mental handicaps, psychological disorders and learning disability. For these reasons pediatrician who deals with epileptic children experiences difficulties in making diagnosis and managing them. In order to improve understanding and management of childhood epilepsy, authors reviewed 103 cases of epileptic patients seen at pediatric department of Yeungnam University Hospital retrospectively. The patients were classified according to the type of epileptic seizure. Suspected causes of epilepsy, associated conditions of epileptic patients, age incidence and the findings of brain CT were reviewed. Large numbers of epileptic patients (61.2%) developed their first seizures under the age of 5. The most frequent type of epileptic seizure was generalized tonic-clonic, tonic, clonic seizure (49.5%), followed by simple partial seizure with secondary generalization (17.5%), simple partial seizure (7.8%), atypical absence (5.8%) and unclassified seizure (5.8%). In 83.5% of patients, we could not find specific cause of it, but in 16.5% of cases, history of neonatal hypoxia (4.9%), meningitis (3.9%), prematurity (1.9%), small for gestational age (1.0%), CO poisoning (1.0%), encephalopathy (1.0%) were found. 30 cases of patients had associated diseases such as mental retardation, hyperactivity, delayed motor milestones or their combinations. The major abnormal findings of brain CT performed in 42 cases were cortical atrophy, cerebral infarction, hydrocephalus and brain swelling. This review stressed better designed classification of epilepsy is needed and with promotion of medical care, prevention of epilepsy is possible in some cases. Also it is stressed that childhood epilepsy requires multidisciplinary therapy and brain CT is helpful in the evaluation of epilepsy with limitation in therapeutic aspects.
The authors studied anxiety, using Zung's SelfRating Anxiety Scale (SAS), in the subjects of 3,893 male and 1,976 female college students of Yeungnam University. The authors collected the reports of SAS during the periods from October to November, 1984, and applied ANOVA and ttest on the anxiety scores in order to compare them between various psychosocial factors, and sexes. The results could be summarized as follows: There was significant difference in the mean averages of total anxiety scores between male and female students; male students scored 36.92±7.07, female students scored 39.63±7.51, p<0.001. The anxiety scores relating to the items of sweating, apprehension, restlessness, insomnia, dyspnea were relatively higher in both groups. The anxiety scores in the items of paresthesias, mental disintegration, tremors, faintness, dizziness were lower in both groups. Two hundred and one male students (5.2%) showed seriously high anxiety scores of 50 or higher, while 201 female students (10.2%) showed the same scores. So the authors inferred that the features of anxiety symptoms were much the same in our country, but females showed more various symptoms and higher level of anxiety than males. In a comparison between male students in different school grades, freshmen showed the highest level of anxiety scores and as the grades of the students became higher, the levels of anxiety scores were lower. The female students who resided in dormitory or other residences, and whose educational fees were paid by brothers or sisters, showed higher level of anxiety scores. There was s strong tendency toward higher anxiety scores in the students who were dissatisfied with their colleges or departments, and who had pessimistic views of self-image in the past, present, or future, in both groups.
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Influence of Anxiety, Depression and Stress on Adjustment to College in Freshmen of a University Sin-Hyeong Lee, Hwee-Soo Jeong, Dong-Wook Lee, Ki-Heum Park, Zu-Young Yun, Jung-Jae Park Korean Journal of Family Medicine.2009; 30(10): 796. CrossRef
The authors studied depression in 5,869 college students (male: 3,893, female: 1,976) using Zung's Self-Rating Depression Scale (SDS). The results are as follows: 1) Female college students showed significantly higher total depression scores than male college students (p<0.001). 2) The items of confusion, indecisiveness, and psychomotor retardation were scored higher in both groups and the items of suicidal rumination, psychomotor agitation, constipation and tachycardia were scored lower in both groups. 3) 18.2% of male college students showed rather serious depression level of score 50 or higher, while 33.1% of female college students showed the same scores. 4) The psychosocial factors relating to pessimistic views to past, present & future self-images showed significantly high depression scores. 5) The depression items of fatigue, anxiousness, tachycardia, apprehension, fear, and body aches & pain were correlated significantly over 0.40 of correlation coefficient.
The authors studied neuroticism, using Eysenck's Maudsley Personality Inventory (MPI), in 3,893 male college students and 1,976 female college students of Yeungnam University. There was significant difference in the mean averages of total neuroticism scores between male and female students, male students scored 13.45±.44, female students scored 16.89±7.19. The items relating to (16) Do you sometimes feel happy, sometimes depressed, without any apparent reason? (38) Do you daydream a lot? (1) Do you have dizzy turns? (2) Do you get palpitations or thumping in your heart? And (35) Do you worry about your health? were scored highly in male, and the items relating to (16) Do you sometimes feel happy, sometimes depressed, without any apparent reason? (1) Do you have dizzy turns? (38) Do you daydream a lot? (8) Do you worry too long over humiliating experiences? (9) Do you consider yourself rather a nervous person? Were scored highly in female. Three hundreds and ninety eight male students (10.3%) showed seriously high neuroticism scores of 24 or higher, while 256 female student (13.0%) showed high neuroticism scores of 26 or higher. In a comparison between male students in different school grades, freshman showed the highest level of neuroticism scores. Among the psychosocial factors, there were strong tendencies toward higher neuroticism scores in the students who were dissatisfied with their colleges or departments, and who had pessimistic views of self-image in the past, present, or future in both groups. The male students whose educational fees were paid by their parents, and whose spending money per month was under 10,000 won, showed higher neuroticism scores. The female students whose educational fees were paid by their brothers or sisters, and whose maturation locations were U-P, and who resided in dormitory or other residencies, shoed higher neuroticism scores.
The authors studied Psychoticism, using SCL-90, in the subjects of 3,893 male college students and 1,976 female college students of Yeung Nam University, collecting data during the periods from October to November, 1984. The results could be summarized as follows: 1. There was significant difference in the mean averages of total psychoticism scores between male and female students; male students scored 6.81±5.13 female students scored 8.14±5.05. 2. Eighty eight male students (2.4%) showed seriously high psychoticism scores of 20 or higher, while 63 female students (3.2%) showed the same scores. 3. In a comparison between male students in different school grades, freshmen showed the highest level of psychoticism scores, and as the grades of students became higher, the levels of psychoticism scores were lower. 4. Among the psychoticism factors, there were strong tendencies toward higher psychoticism scores in the students who were dissatisfied with their college, and had pessimistic views of self-image in the past, present or future, in both groups. 5. The male students whose educational fees were paid by their parents, and whose spending money per month was under 10,000 won, showed higher level of psychoticism scores. 6. The female students whose maturation locations were city, who were dissatisfied with their departments, who resided in dormitory of other residencies, and whose educational fees were paid by their brothers or sisters, showed higher level of psychoticism scores. 7. The items relating to 5 (Feeling lonely with people) 9 (Never feeling close to another) 10 (Idea something writh mind) in psychoticism and the item of depressed affect in SDS were significantly correlated over 0.40 of correlation coefficient.
Endobronchial tuberculosis is frequently associated with lymphadenopathy, bronchial stenosis, atelectasis which needs to be differentiated with other pulmonary disease. Authors are presenting 25 cases of endobronchial tuberculosis which were confirmed boy bronchoscopic biopsy and AFB smear and/or culture. The study was done on patients who visited Yeungnam University Hospital from May 1983 to July 1985. The following results were obtained: 1. Of the 25 cases, 8 cases were male and 17 cased were female (male:female=1:2). 32 percent of the cases was older than 60 years of age. 2. Abnormal findings on chest x-ray were seen on 22 cases of 25 cases (88%) and its most predilective site was right upper lobe (24%). 3. Symptoms were coughing (56%), hemoptysis, hoarseness, chest pain, dyspnea and fever in orders. 4. The positive results were obtained in 73 percent of sputum AFB smear (11 cases of 15 cases). 60 percent of AFB culture (3 cases of 5 cases) and 58 percent of bronchoscopic biopsy (14 cases of 24 cases). 5. Complete pulmonary function test was done on 19 cases and showed normal result in 6 cases, restrictive pattern in 8 cases and small airway dysfunction in 5 cases. No case of obstructive airway disease was detected. 6. Associated disease were hypertension (2 cases), tuberculous meningitis (1 case), diabetes mellitus (1 case), and cataract (1 case). 7. The site of bronchoscopic lesion on bronchoscopic examination were as follow; 8. All 25 patients were treated with anti-tuberculosis therapy and 6 patients were treated with additional steroid therapy because of severe respiratory symptom and showed dramatic improvement of symptom as well as lung function.
It has been well recognized that the various cutaneous manifestations associated with liver diseases. A clinical study was made of 255 patients (AVH84, LC70, HC41, CAH26, CPH23, AH11) with the liver diseases at Yeungnam University Hospital during the periods from May to November, 1985. The authors classified the cutaneous manifestations into 7 groups according to pathogenesis, and compared them with other reports. The results were as follows: 1. In 255 patients with various liver diseases, 161 patients (63%) showed the various cutaneous manifestations. 2. The various cataneous manifestations were jaundice and/or pruritus (43.1%), vascular changes (39.6%), allergic manifestations (10.6%), nail changes (5.1%), hormone-induced changes (4.3%), pigmentary changes (3.5%) and others (2.4%) in that order. 3. Cutaneous manifestations were associated most frequently with liver cirrhosis (1.6 groups) and the least with chronic active hepatitis (0.7 group). 4. Allergic manifestations were seen mainly in patients with acute viral hepatitis. Three patients showed the serum sickness-like prodrome. 5. The other cutaneous manifestations were seen mainly in patients with chronic liver diseases.
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Agrobacterium tumefaciens induces cancerous growths called crown galls at wound sites on dicotyledonous plants. A large plasmid called T1 plasmid is responsible for virulence. Upon tumor induction, part of the plasmid, termed T-DNA, becomes integrated into plant genome and its genetic sequences are expressed. These properties allow T1 plasmids to be used as gene vectors in plants. Several in vitro methods for the transfer of T1 plasmid into plant cell have been developed. One of them is the treatment of bacterial spheroplasts and plant protoplasts mixture with polyethylene glycol that is generally used as fusogen in cell-to-cell fusion. Several workers investigated the interaction of bacterial spheroplasts with plant protoplasts in the presence of polyethylene glycol and suggested that the interaction is not fusion but endocytosis. In this report we observed the interaction of Agrobacterium tumefaciens spheroplasts with Nicotiana tabacum protoplasts by electron microscope. Agrobacterium tumefaciens spheroplasts with Nicotiana tabacum protoplasts were prepared and mixed in the presence of polyethylene glycol and high pH-high Ca²⁺ buffer. Then the interaction of the spheroplasts with the protoplasts was examined by transmission electron microscope. After the treatment of polyethylene glycol the spheroplasts adhered to the surface of the protoplasts and then they were engulfed by the protoplasts. After the high pH-high Ca²⁺ buffer treatment the engulfed spheroplasts lost their cell integrity. No fusion process was observed. Thus all these observation suggest that the introduction process of Agrobacterium tumefaciens spheroplasts into Nicotiana tabacum protoplasts with the aid of polyethylene glycol is endocytosis.
The glucose nonfermenting gram-negative bacilli encountered about 10% of all gram-negative bacilli isolated from clinical material. Therefore, a rapid and correct identification of glucose nonfermenting gram-negative bacilli is impotent for a better management of infectious disease. There are many conventional systems for the identification of glucose nonfermenting gram-negative bacilli but most of them have problems and difficulties. Commercial Kit Systems exist and they are too expensive for daily use in Korea because of high cost. Based on 12 selected tests we propose a new code system, MCRCODE-N for rapid and inexpensive identification of glucose nonfermenting gram-negative bacilli. The selective 12 tests are oxidase, glucose oxidation motihty, urease, DNase arginine dehydrolase, nitrate reduction, gelatin Liquefaction, esculin hydrolysis, mannitol oxidation, maltose oxidation, Lactose oxidation. The 12 tests are divided 4 group and then each group has 3 tests. The result of each group is expressed by the number as below. The positive test is given by specific number (1st test=1, 2nd test=2, 3rd test=4), while any negative result is 0. Each 3 numbers of one group are added and make number of 1 digit. Four digit number is referred to the code book of MCRCODE-N system or MCRCODE system using computer (Apple-II model) created by authors. This MCRCODE-N system is suitable ones for out use in Korea. We propose the MCRCODE-N system for clinical use.
As the result of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 20 years, the life expectancy of Korea people has lengthened considerably and as a result the number of old aged people has markedly increased. Such an increase of the number of aged people brought about many problems. Authors would like to take a medical look at the “Problem of old aged people” presently facing us in Korea. Currently the number of people over 65 has increased rapidly and is 1,620,000, 4% of total population. But it is still much lower than 8.9% in Japan, 10.7% in U.S.A., and 14.9% in the United Kingdom. Over 25% of these aged people were found to have at least more than one disease which requires medical care. Diseases occur in the circulatory system, 30.9%, respiratory system, 17.1%, digestive system 8.6%, metal disorders, 8.4%, malignant neoplasms, 7.0%. About 51% of the aged over 65 are under medical security benefit, mostly with partial coverage plan. Their clinic visit rate was very low (2.0% in 1981), which might be due to financial reasons. Since diseases affecting the aged progress chronically, early detection and long term care are utter most important. However there is almost no special facility, long term care center or geriatric specialist. For proper management of medical problems in the growing population of the Korea elderly expansion of medical security coverage, greater number of specialized facilities, education of geriatric special manpower and efficient operating system should be established.
Febrile morbidity after cesarean section is one of the major problems in obstetric practice. This morbidity is most often due to endometritis. Although parenteral prophylactic antibiotics or antibiotic irrigation has been reported to reduce the incidence of endometritis after cesarean section, its incidence remains high. Among the patients who were undergoing cesarean section at Yeungnam University Hospital from the beginning of March, 1985, three group were evaluated in the orders. 1) 30 cases as intrauterine irrigation group with cephradine solution, 2) 35 cases as intravenous injection group with cephradine, 3) 35 cases as control group are neither irrigated nor injected. Febrile morbidity was also evaluated by means of a fever index. The incidence of clinically diagnosed endometritis in the three group were 6.7%, 2.9%, and 22.9%. As these results, two study groups were markedly reduced the incidence of endometritis than control group. There was no significant difference between the intrauterine irrigation with cephradine and control, but significant difference between the intravenous cephradine injection and control (P<0.05). With the results of fever index analysis, both prophylactic intrauterine irrigation and intravenous injection markedly reduce the incidence of endometritis after cesarean section with statistical significance (P<0.05), and also markedly reduce the febrile degree.
Serum HBsAg, AntiHBs, HBeAg, AntiHBe, and AntiHBc were detected by radioimmunoassay in 39 patients with acute viral hepatitis, 79 patients with chronic hepatitis, 30 patients with liver cirrhosis, 16 patients with primary hepatocellular carcinoma, 14 patients of HBsAg carriers and 129 cases of controls: 78 cases of normal level of SGOT, SGPT, and 51 cases of elevated level of SGOT, SGPT. Following results were obtained: 1. HBsAg was detected in 66.7% of acute viral hepatitis, 63.3% of chronic hepatitis, 36.7% of liver cirrhosis, 81.3% of primary hepatocellular carcinoma and 27.1% of controls. 2. AntiHBs was positive in 0% of acute viral hepatitis, 21.5% of chronic hepatitis, 36.7% of liver cirrhosis, 31.3% of primary hepatocellular carcinoma, 0% of carrier and 44.2% of controls. 3. HBeAg was detected in 45.6% of chronic hepatitis, 23.3% of liver cirrhosis and 31.3% of primary hepatocellular carcinoma. 4. Among chronic liver diseases, antiHBe was positive in 56.3% of primary hepatocellular carcinoma, 23.3% of liver cirrhosis and 20.3% of chronic hepatitis. 5. AntiHBc was detected in most of all examinees and the significance of presence of AntiHBc does not seem to represent liver disease itself but the evidence of infection of HBV. 6. Among 14 HBV carriers, 6 cases presented with abnormal SGOT, SGPT. 7. All HBV markers were negative in 5.1% of acute viral hepatitis, 5.1% of chronic hepatitis and 14.7% of controls: 17.6% of subjects with abnormal SGOT, SGPT and 12.8% of subjects with normal SGOT, SGPT. 8. Beside of HBV, other causes, such as non A, non B virus, Delta-agent, other viruses or related factors should be excluded among the patients with evidence of HBV infection associated with elevation of SGOT & SGPT.
Thirty-four patients with suspected ectopic pregnancy whose serum hCG levels had been measured by beta-hCG EIA before surgery were evaluated retrospectively. The results were as follows: 1. Final diagnosis of thirty- four patients with suspected ectopic pregnancy comprised twenty-eight tubal pregnancy, five ruptures of hemorrhagic corpus luteum and one tubo-ovarian abscess. One of the five patients with rupture of hemorrhagic corpus luteum was accompanied by missed abortion. 2. Range of serum hCG levels in twenty-eight patients with tubal pregnancy was 59-21, 980 mIU/ml and that of four patients with rupture of hemorrhagic corpus luteum and one patient with tubo-ovarian abscess was 0.6-6.6 mIU/ml. Serum hCG level of a patient with rupture of hemorrhagic corpus luteum who was accompanied by missed abostion was 200 mIU/ml. 3. Serum hCG levels in twenty-two of twenty-eight patients with tubal pregnancy were lower than 3,000 mIU/ml. Low serum hCG level below 100 mIU/ml and high serum hCG levl above 6,500 mIU/ml were noticed in four and six patients with tubal pregnancy recpectively. 4. Mean serum hCG levels (±SD) of twelve patients with tubal pregnancy who had intraabdominal free blood of less than 500ml and sixteen patients with tubal pregnancy who had intraabdominal free blood of more than 500ml were 4,131 (±7,801) mIU/ml and 3,208 (±5,081) mIU/ml, respectively. There was no statistical difference in the mean level of serum hCG between both group (P>0.05). 5. Mean serum hCG levels (±SD) of thirteen patients with unruptured tubal pregnancy and fifteen patients with ruptured tubal pregnancy were 2,628 (±5,448) mIU/ml and 4,449 (±6,938) mIU/ml, respectively. Mean level of serum hCG was statistically higher in ruptured tubal pregnancy (P<0.01). 6. Positive rate of urine pregnancy test in the diagnosis of ectopic pregnancy was 64% (16/25) and mean range of serum hCG level of nine patients with false negative result were 353 mIU/ml and 59933 mIU/ml.
This study was undertaken for the clinical evaluation and statistical analysis on the 88 women with histopathologically confirmed ectopic pregnancies who were admitted and treated from grand opening on May-28, 1983 to Sept.-30, 1985. Incidence of ectopic pregnancy was 1 in 22.2 deliveries and the most common age group was in 30~34 years of age. There was tendency of decreasing incidences as the gravidity, parity or artificial abortion were over 3. The most common etiologic factor was pelvic inflammatory disease and procedures for family planning were the next common. Common symptoms were lower abdominal pain (85.2%) and vaginal spotting (56.8%). At the admission, hemoglobin level under 10gm% were 44.3%. 69.5% of urine HCG tests were positive. Culdocentesis was positive only in 75.9%. Termination was frequent at 6~7 weeks of gestation mostly with rupture or abortion. Free blood in the abdominal cavity was averaged 1,224ml. 4 cases of clinicobiochemically suspected ectopic pregnancies with spontaneous regression were excluded, and there was no fatal case treated in hospital.
Abdominal pregnancy is one of the rare but extremely harzardous complications of childbearing. The diagnosis of the abdominal pregnancy is rarely made before surgery and the management of it also has many difficult problems. I experienced a case of abdominal pregnancy developed after the previous unilateral adnexectomy and it was a suspicious primary abdominal pregnancy as though did not fulfilled the Studdiford's the following criteria for primary abdominal pregnancy. 1) Normal tubes and ovaries with no evidence of recent or remote injury, 2) absence of any evidence of uteroplacental fistula, and 3) presence of a pregnancy related exclusively to the peritoneal surface and young enough to eliminate the possibility of secondary implantation following primary nidation in the tube. And now I present a case with brief review of literatures.
Bacterial endocarditis has been well recognized as an important complication of congenital heart disease, such as ventricular septal defect, patent ductus arteriosus or pulmonary stenosis. The incidence of right sided bacterial endocarditis is lesser than left sided bacterial endocarditis. Also, pulmonic valve vegetation has been thought to be relatively uncommon. So in a patient with fever and evidence of recurrent pulmonary infarction, changing heart murmurs and scattered pneumonic infiltrates, one should direct attention to the heart as a possible source of the infection. Echocardiography with M-mode, 2-D and Doppler mode represents the only noninvasive technic available for detecting vegetations in bacterial endocarditis. In fact, the technic is more sensitive in identifying these lesions than angiography. We experienced a case of ventricular septal defect with bacterial endocarditis, pulmonic valve vegetation and multiple pulmonary embolism diagnosed with Echocardiogram and lung scan, and confirmed by operation. Patch repair of ventricular septal defect, resection of pulmonic valve and vegetation and artificial valve formation with pericardium were done.
Polyps of the male urethra are relatively uncommon lesions, They usually arise from the prostatic urethra mostly verumontanum or just lateral to the verumontanum. Posterior urethral polyp often presents with hematuria, hemospermia and sometimes lower urinary tract obstruction. We recently experienced a pedunculated prostatic urethral polyp in a 63-year-old man who complained of gross total hematuria and difficult micturition for several years. On rectal examination the prostate was slightly enlarged with normal consistency. Excretory urogram showed a round filling defect in the right side of the bladder neck measuring about 2×2 cm in size. Cystourethroscopy revealed trabeculation of the vesical wall, mild bilateral prostatic hypertrophy and a round cystic mass with a long stalk arising from the prostatic floor 1cm. Proximal to the verumontanum which caused ball-valve obstruction in the bladder neck. This pedunculated polypoid mass was then resected at its base with resectoscope and was removed transurethrally using Lowsley's grasping forceps. The specimen was proved as fibrous polyp histologically.
The congenital tracheoesophageal fistula without atresia of the esophagus is considered a rare variant, and the literature concerned to the tracheoesophageal fistula fistula without atresia is little in adult especially. The 22-year-old male was admitted to Yeungnam University Hospital with his chief complaints of weight loss (6 kg/6 months), abdominal discomfort, and intermittent coughing. The diagnosis was made by the endoscopy and esophagography. The fistula was 1.5 cm in diameter, 0.5 cm in length. The level was around second thoracic vertebra. The operation was performed transpleurally through the right third intercostals space and the fistula was secured with interrupted silk suture after division. The fibrotic adhesion was seen around the tracheoesophageal fistula. The postoperative course was uneventful, and postoperative esophagogram revealed no extraluminal leakage. Herewith we report this unusual case of isolated tracheo-esophageal fistula with review of literatures.
Neuroblastoma is the most common extracranial solid tumor of childhood which presents various clinical symptoms depending on the primary and metastatic sites. However, it has been rarely reported that sudden onset of blindness was the chief complaint of neuroblastoma. A four years old boy was admitted to the Yeungnam University Hospital with the chief complaint of a sudden onset of blindness due to a distant metastasis of abdominal neuroblastoma to the sphenoid sinus. On admission, both side pupils were dilated without light reflex, fundoscopy showed pale optic disk, electroretinogram was subnormal and visual evoked potential showed no response. The liver was palpable in 3 ½ finger breadth from the right costal margin and adult fist sized mass was palpable in the right flank. Skull X-ray showed destructed sphenoid bone and clinoid process and brain CT scan showed tumor mass in the sphenoid sinus and left orbit. Ultrasonogram and CT scan of the abdomen showed large tumor masses around the right kidney and para-aortic and retropancreatic lymph node. IVP showed displaced right calyceal system with preserved contour. Left supraclavicular lymph node which appeared after admission was biopsied and it showed poorly differentiated neuroblasts. He was treated according to the multiagent chemotherapy schedule for stage IV neuroblastoma patient of children's cancer study group. Abdominal tumor masses and sphenoid sinus mass were markedly reduced after 2 courses of the combination chemotherapy of cyclophosphamide, vincristine, DTIC, adriamycin and VM-26. Eventhough the blindness was not improved, the patient has been in good clinical codition.
Small bowel malignancy consists 1~2% of overall gastrointestinal tract cancer and leiomyosarcomas of small intestine are 10~20% of small bowel malignancy. Small bowel leiomyosarcomas are rare in incidence and have no specific symptoms, signs or definite radiologic findings, so it is not easy to diagnose at early stage of disease. They are found occasionally by unknown origined gastrointestinal bleeding, abdominal pain, intestinal obstruction, perforation and palpable mass, and diagnosed mostly by operation. Recently annual case reports are increasing trend in Korea. We experienced two cases of small bowel leiomyosarcomas which was diagnosed finally by pathologic findings, so we report them with literatural review.
Myasthenia gravis is usually defined as a state of abnormal fatigability. The cause of myasthenia gravis is not known. Several disorders tend to occur more frequently in patients with myasthenia gravis, such as hyperthyroidism or other thyroidal disorder. Anesthetic experiences with thymectomies for two patients with myasthenia gravis has been reported. Both of them tolerated the surgical procedures under endoteracheal Nitrous oxide-Oxygen-Halothane anesthesia well. Diagnosis and clinical features including choice of preanesthetic medication, anesthetic agents, techniques and of neuromuscular blocking agents for myasthenic patients have been discussed. Paramount importance of rigid attention to ventilation, the maintenance of a patent airway and the removal of secretions whenever necessary for the patient safety throughout operative and postoperative period has been stressed.
Primary germ cell tumor of the testis is rare, which occupies 1 to 2% of all reported malignant male neoplasms. Combined primary germ cell tumor of the testis composed of embryonal carcinoma and seminoma is more rare tumor. The authors experienced a case of 50-year old male who presented with painless enlargement of right testicle. He has had radical orchiectomy and diagnosed by pathologically as combined germ cell tumor of testis. The testicle is measuring 180 gm in weight and 9×6×5 cm in dimension, and almostly replaced by tumor mass. Grossly the tumor is rubbery solid smooth tumor mass, with variegated cut surface with geographically outlined diffuse necrotic area. Histologically the tumor is composed of two components of tumor, which are solid growth pattern of large round to polyhedral cells with clear or granular cytoplasm and distinct cell border, and anastomosing glandular and papillary arrangement of anaplastic epithelial cells. The former corresponds to seminoma, and the latter to embryonal carcinoma. Each tumor lobule is separated by abundant fibrous stroma.
Congenital dilatation of the common bile duct is relatively rare anomaly. Its pathogenesis has not been completely understood. Complications of the choledochal cyst are mainly suppurative cholangitis, liver cirrhosis, stone formation, malignant change, bile peritonitis due to spontaneous and traumatic rupture. We experienced one case of choledochal cyst associated with hemorrhagic tendency and a cerebral hematoma, which is extremely rare complication. The 3 months old male patient reported here was treated with complete excision of cyst and Roux-en-Y choledochojejunostomy after correction of bleeding tendency and removal of cerebral hematoma. Postoperative course was relatively uneventful. 11 days after operation, the patient was discharged with full improvement.