This study was designed retrospectively to evaluate Ranson's criteria and APACHE II scores as a predictor of mortality in patients with acute pancreatitis. Acute pancreatitis is a common disorder. From mild disease to multiorgan failure, it is a disorder that has numerous causes, an obscure pathogenesis. An accurate history and through physical examination will often raise clinical suspicion of acute pancreatitis in the differential diagnosis of a patient with acute abdominal pain. The retrospective analysis by chart review of 86 cases of acute pancreatitis who visited emergency department of Dongsan hospital from Jan to Dec 1996. The results were as follows. The majority of the patients with acute pancreatitis presented with chief complaints of abdominal pain. The male patient outnumbered female by the ratio of 2.9:1. The highest incidence of age group was between 40 and 50. The majority of our patients had past histories of either chronic alcoholic or gallbladder problems e.g.. the number being 53 cases(61.6%) and 31 cases(36%) respectively. Among 7 patients who had changes in consciousness, 5 were expired. Of those expired, 3 patients had less than 90 mmHg of systolic blood pressure. The overall mortality rate was 10.5%(9 cases). It has been known that acute pancreatitis would be the results of traumatic and non-traumatic causes. The exact mechanism of its pathophysiolgy has not been known yet, but it has been well known that the majority of patients who in forties and fifties had history of alcoholic abuse, the rest being mainly gallbladder problem and, some other diseases implicated too. The relationship of acute pancreatitis with familiar Ranson's criteria was such that 3 patients of the Ranson's out of 9 death were noted to have more than 3 of the criteria, but another 3 had less than 3. Among the 60 patients in whom the required physiologic variables were available out of total 86 patients studied, 9 were expired and 51 survived, average APACHE II scores for the survival and the expired being 6.92+/-3.99 & 18.11+/-5.68 respectively (P<0.05). We concluded that the APACHE II score could be used to better than Ranson's criteria to predict hospital mortality in patients with acute pancreatitis.
Abdominal Pain ; Alcoholics ; APACHE ; Blood Pressure ; Consciousness ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Gallbladder ; Hospital Mortality ; Humans ; Incidence ; Male ; Mortality ; Pancreatitis* ; Physical Examination ; Retrospective Studies

No abstract available.
Stevens-Johnson Syndrome*

PURPOSE: The aim of this study is to correlate the non-characteristic dual-phase CT imaging findings of hepato-cellular carcinoma with the observed characteristics of surgical specimens. MATERIALS AND METHODS: We studied four cases in which homogeneous low attenuation was observed during the arterial and delayed phases of dynamic CT scanning and in which hepatocellular carcinoma with coagulation necrosis above 95% was pathologically confirmed. We compared the findings of dual phase CT scanning, ultrasonography, angiography and Lipiodol CT scanning with the observed features of surgical specimens. RESULTS: Nodules were 30-50 (mean, 41) mm in size, and were round in three cases and oval in one. In all four cases, a low density lesion was observed during the arterial and delayed phases of dual-phase CT scanning. Ultrasonography demonstrated internal echo and the presence of a hypoechoic halo, implying that in all cases a capsule was present. At angiography and LiCT, minimal peripheral and central tumor staining or lipiodol up-take was observed. In all surgical specimens a complete capsule was visible, and histologic structures were mainly of the trabecular type, Edmondson grade II or III was recorded, and the mass had undergone extensive coagulation necrosis (above 95%). CONCLUSION: In cirrhotic liver which is hepatitis B-antigen positive, clear sonographic findings of internal echo and a capsule, rather than a simple cyst, indicate the possibility of hepatocellular carcinoma with extensive coagulation necrosis. This is so even if the arterial and delayed phases of dual-phase CT scanning indicate the presence of a low-density lesion, and in such cases additional work-up is therefore required.
Angiography ; Carcinoma, Hepatocellular* ; Diagnosis* ; Ethiodized Oil ; Hepatitis ; Liver ; Liver Neoplasms ; Necrosis* ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: Signet-ring cell carcinoma is rather invasive and infiltrative than other histologic types of gastric cancer. We evaluated the characteristic CT findings of signet-ring cell carcinoma especially in the intensity and pattern of contrast enhancement. MATERIALS AND METHODS: We analyzed the CT findings of 22 cases with histologically proven signet-ring cell carcinoma, and compared them with those of 35 cases with histologically proven tubular adenocarcinoma. RESULTS: The double ring enhancement of the gastric mass was seen in 12 cases of signet-ring cell carcinoma and only one case of tubular adenocarcinoma. The masses of signet-ring cell carcinoma were enhanced more by the CT number of 10.2 than those of tubular adenocarcinoma. Of the masses of signet-ring cell carcinoma, those showed double ring enhancement were more intensely enhanced than those showed diffuse enhancement by the CT number of 22.9. CONCLUSION: We thought that neovascularity and different infiltration of the tumor cells in the gastric wall were responsible for the intense enhancement and double ring sign of signet-ring cell carcinoma. The possiblity of signet-ring cell carcinoma is high if a gastric mass show double ring sign and strong contrast enhancement.
Adenocarcinoma ; Carcinoma, Signet Ring Cell* ; Stomach Neoplasms ; Stomach*

PURPOSE: To investigate the problems of the Hanaro stent (Solco Intermed, Seoul, Korea) when used in the palliative treatment of patients with inoperable malignant biliary obstruction. MATERIALS AND METHODS: Between January 2000 and May 2001, the treatment of 46 patients with malignant biliary obstruction involved percutaneous placement of the Hanaro stent. Five patients encountered problems during removal of the stent's introduction system. The causes of obstruction were pancreatic carcinoma (n=2), cholangiocarcinoma (n=2), and gastric carcinoma with biliary invasion (n=1). In one patient, percutaneous transhepatic cholangiography and stent insertion were performed as a one-step procedure, while the others underwent conventional percutaneous transhepatic biliary drainage for at least two days prior to stent insertion. A self-expandable Hanaro stent, 8-10 mm in deameter and 50-100 mm in lengh, and made from a strand of nitinol wire, was used in all cases. RESULTS: Among the five patients who encountered problems, breakage of the olive tip occourred in three, upward displacement of the stent in two, and improper expansion of the distal portion of the stent, unrelated with the obstruction site, in one. The broken olive tip was pushed to the duodenum in two cases and to the peripheral intrahepatic duct in one. Where the stent migrated during withdrawal of its introduction system, an additional stent was inserted. In one case, the migrated stent was positioned near the liver capsule and the drainage catheter could not be removed. CONCLUSION: Although the number of patients in this study was limited, some difficulties were encountered in withdrawing the stent's introduction system. To prevent the occurrence of this unusual complication, the stent should be appropriately expansile, and shape in the olive tip shoud be considered.
Catheters ; Cholangiocarcinoma ; Cholangiography ; Drainage ; Duodenum ; Humans ; Liver ; Olea ; Palliative Care ; Seoul ; Stents*

PURPOSE: Right middle lobe symdrome is characterized by a spectrum of disease from recurrent atelectasis and pneunomitis to brobchiectasis of the Right middle lobe symdrom. It was first reported gy Grahm describing 12 patients with middle loge atelectasis and bronchiectasis due to enlarged lymph nodes. The incidence of Right middle lobe syndome seems tobe increasing in children, byt there have been only a few studies of right middlelobe syndrome in Korea. METHODS: Twenty-five children with RMLS who had been admitted during the last 10 years were evaluated with particular attention to clinical features, laboratory results, bronchographic findings, and treatment RESULTS: All patients were symptomatic and complained of chronic cough(25), sputum(20), fever(16), dyspnea(3), vomiting(2), and foreign body in the bronchus(2). Most of the patients had recurrent pneumonia: 6 patients had Mycoplasma pneumonia, and 6 patients had ashma and allergic disorders. Only 5 out of the 25 patients showed sufficient obstruction on bronchography and 6 patients took computed tomography scans. Chest radiography, bronchography and computed tomography scans were evaluated for review in 25 patients showing consolidation(17), patchy infiltration(14), atelectasis(12), hyperinflation(5), bronchiectasis(2), and air bronchogram(2). Most patients were improved by conservative medical management and only 2 patients had closed thoracostomy. CONCLUSION: These 25 patients who had been diagnosed as Right middle lobe syndrome were improved after 2 week treatment of antibiotics and conservative management and their prognosis were good during the follow-up period.
Anti-Bacterial Agents ; Bronchiectasis ; Bronchography ; Child ; Follow-Up Studies ; Foreign Bodies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Middle Lobe Syndrome* ; Pneumonia ; Pneumonia, Mycoplasma ; Prognosis ; Pulmonary Atelectasis ; Radiography ; Thoracostomy ; Thorax

No abstract available.
Craniocerebral Trauma* ; Head* ; Humans ; Tomography, Emission-Computed, Single-Photon*

Peritonitis is a frequent and serious complication in continuous ambulatory peritoneal dialysis (CAPD) patients. Recently, due to educational promotion in general hygiene and development of laboratory technique for bacterial cultures and sensitivity test, proper use of antibiotics, the incidence of CAPD peritonitis has gradually decreased. However, CAPD peritonitis is still one of the most common causes of peritoneal dialysis failure and of removal peritoneal catheter. It has been suggested that the formation of biofilm on the inner surface of peritoneal catheter leads to relapsing peritonitis and removal of the peritoneal catheter in CAPD patients. The biofilm is a kind of protecting coat which consists of fibrin inhibiting the penetration of antibiotics. It surrounds and covers the bacteria, making them to survive from the attack of antibiotics. Therefore thrombolytic therapy, urokinase modifies the structure of biofilm, and helps the antibiotics penetrating the fibrin coat, eventually amplify the bacteriocidal effect. We experienced two cases of successful treatment with urokinase and antibiotics in CAPD peritonitis patients. The combination of thrombolytic agents and antibiotics might be one of the strategies for the treatment of CAPD patients who experienced it frequently.
Anti-Bacterial Agents ; Bacteria ; Biofilms ; Catheters ; Fibrin ; Fibrinolytic Agents ; Humans ; Hygiene ; Incidence ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator*

Stones in the common duct occur in 10% to 15% of patients with cholelithiasis. In our case, coexistent cholelithiasis and choledocholithiasis were diagnosed by endoscopic retrograde cholangiopancreatography. The stone basket was easily introduced into the gallbladder and common bile duct, then fortunately removed stones. However, endoscopic retrograde cholelithiasis removal is known to be difficult because of the anatomical approach. We herein present a rare case of cholelithiasis successfully treated by retrograde endoscopic removal.
Cholangiopancreatography, Endoscopic Retrograde* ; Choledocholithiasis ; Cholelithiasis* ; Common Bile Duct ; Gallbladder ; Humans

Autoimmune neutropenia is characterized by severe neutropenia with cell-bound neutrophil antibodies or circulating antibodies for neutrophils. Diagnosis of disease is made of the basis of the presence of antibodies for neutrophil. Corticosteroid or rhG-CSF have been reported to be effective in some patients. Recently we experienced one case of autoimmune neutropenia patient who was admitted to our hospital in 1997 because of stomach cancer and degenerative joint disease. She had severe neutropenia without underlying autoimmune disease. And cell-bound neutrophil antibodies were detected by indirect immunofluorescence test. Treatments with rhG-CSF and steroid result in transient improvement of neutropenia and subtotal gastrectomy was done successfully. We herein report one case of autoimmune neutro- penia patient, to our best knowledge, the first report in Korea, with a brief review of literature.
Antibodies ; Autoimmune Diseases ; Diagnosis ; Fluorescent Antibody Technique, Indirect ; Gastrectomy ; Humans ; Joint Diseases ; Korea ; Neutropenia* ; Neutrophils ; Stomach Neoplasms