No abstract available.
Humans ; Mortality* ; Risk Factors*

No abstract available.
Snake Bites* ; Snakes*

No abstract available.
Abdomen, Acute* ; Aged* ; Geriatrics* ; Humans

PURPOSE: We observed the actual half life of the alpha-fetoprotein (AFP) had clinical meaning in that it reflected the long term prognosis more individually at a certain level of preoperative alpha-fetoprotein. METHODS: From preoperative and postoperative measurements of alpha-fetoprotein in 96 hepatocellular carcinomas the actual half lives were calculated with the formula: AHL T1/2 (days) = -0.3x(T/log(C1/C0)), where T was the time interval between C1 and C0, in which C1 meant the level of AFP at postoperative 7 day, C0 the original AFP level. We investigated overall survival and disease free survival rate between delayed AHL group and non-delayed AHL group under various definitions of delay. RESULTS: The average actual half life of all cases was 5.1+/-13.6 days. One, three and five year overall survival rates of the group with actual half life less than 4 days were 82.1%, 66.7%, 61.1% respectively, whereas those of the group with actual half life more than 4 days showed 83.0%, 36.5%, 18.2% respectively. The significance of different survival rates was much higher, when only the patients with preoperative alpha-fetoprotein above 100 ng/ml were taken into account (n=53, P=0.0019). The disease free five year survival rates were also significantly different. CONCLUSION: We can predict the elevated postoperative survival rate in the patients with actual half life of alpha-fetoprotein less than 4 days. And this has also relevant clinical meaning in the prognostication of disease free survival, if the preoperative alpha-fetoprotein of patients has elevated up to over 100 ng/ml. The measurement of actual half life of postoperative hepatocellular carcinoma patientscan be a clinical useful parameter for the prognosis of long term survival.
alpha-Fetoproteins* ; Carcinoma, Hepatocellular* ; Disease-Free Survival ; Half-Life* ; Humans ; Prognosis ; Survival Rate

No abstract available.

BACKGROUND: Due to its high diagnostic accuracy, preoperative sonographic evaluation of gallbladder disease is accepted as the most reliable and effective procedure. However we have encountered, though not so often, cases in which the sonographic tumor revealed only sludge material in reality. METHODS: A retrospective review of 11 cases that had been preoperatively diagnosed as a gallbladder mass or stone focused on the features of the patients and the characteristics of the sonographic findings. RESULTS: Of the cholecystectomized 2486 cases in which gallstones or gallbladder polyps had been preoperatively diagnosed, 0.4% had only sludge in reality. Symptomatic patients were 7 (64%). Pseudo- tumorous lesions of the gallbladder resembled the shapes of the stones, as well as the shapes of polyps, in their echogenic characteristics. CONCLUSIONS: Gallbladder sludge alone can make the sonographic image of a stone or a polyp. The application of more advanced sonography, such as contrast-enhanced Doppler sonography, may contribute to the differential diagnosis of pseudo-tumorous lesions of the gallbladder; however, an indefinite lesion on sonography always deserves operative intervention.
Diagnosis, Differential ; Gallbladder Diseases ; Gallbladder* ; Gallstones ; Humans ; Polyps ; Retrospective Studies ; Sewage* ; Ultrasonography*

Although the "Duodenogastric reflux" was often developed in normal persons, it was more frequently developed in the majority of patients who had a gallstone disease or malfunctioned gallbladder. The "duodenogastric reflux" induced chronic gastritis, peptic ulcer, and esophagitis causing upper abdominal symptoms. After the cholecystectomy was performed, most patients have no further symptoms but a significant minority of patients still have persistent symptoms. Such symptoms was often explained with the "duodenogastric reflux". We examined the degree of duodenogastric reflux in the patients with gallstones and the changes of the degree of the duodenogastric reflux after the laparoscopic cholecystectomy in these patients. The study population consisted of 9 patients with gallstone disease. The clinical symptoms (upper abdominal pain, bloating, early satiety, nausea, vomiting, heartburn, dysphagia, indigestion, fat intolerance) were graded and all subjects had standard esophageal manometry to identify the location of the lower esophgeal sphincter and the 24 hour gastric pH monitoring to ascertain the duodenogastric reflux at before and 3 months after laparoscopic cholecystectomy. On the results of our study, the severity of clinical symptoms was decreased after operation and the time percentage above pH 7, longest time above pH 7, frequency above pH 7 and frequency persistent 5 min above pH 7 in supine and upright position were not significantly different after operation at statistical analysis. It is revealed that the degree of duodenogastric reflux was not changed on 24 hour gastric pH monitoring. We concluded that laparoscopic cholecystectomy did not affect on the duodenogastric reflux in the patients of gall bladder stone.
Abdominal Pain ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Deglutition Disorders ; Duodenogastric Reflux* ; Dyspepsia ; Esophagitis ; Gallbladder ; Gallstones* ; Gastritis ; Heartburn ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Nausea ; Peptic Ulcer ; Urinary Bladder Calculi ; Vomiting

Cavernous transformation of the portal vein that is resulted as a collateral vessel formation from a portal hypoplasia is very rarely to be observed in human being. Such an abnormal transformation can be caused by congenital defect of vein formation in the early embryonal development or congenital hematologic hypercoagulability which gives rise to the cavernous development of cavernous collateral branches. Acute thrombosis of portal vein can also be the cause of acquired cavernous transformation. In most cases it extends into the parenchyme of liver, and often has porto-systemic shunt (with left gastropiploic vein and varices around spleen) or porto-portal shunt (with varices around gallbladder). A 48 years old male patient underwent splenectomy at the age of 24 owing to splenomegaly. He had liver cirrhosis without hepatitis and alcohol history. Intrahepatic stone in left lateral lobe of liver was diagnosed in the course of medical treatment. The cavernous transformation of portal vein with right lobe hypoplasia was confrimed during the operation.
Congenital Abnormalities ; Hepatitis ; Humans ; Liver Cirrhosis ; Liver* ; Male ; Middle Aged ; Portal Vein* ; Splenectomy ; Splenomegaly ; Thrombophilia ; Thrombosis ; Varicose Veins ; Veins

BACKGROUND: In spite of the development of diagnostic tools, gallbladder carcinoma is often diagnosed at a late stage because of the lack of symptomatic awareness of patients in early stage. Early diagnosis and proper resectional treatment is, therefore, the most important factor for the prognosis. This study aims at the analysis of clinical characteristics and the effect of various modes of surgical treatment on long-term survival. METHODS: From January 1989 to December 1997 we operated on 132 patients with gallbladder carcinoma. Age, sex, stage distribution, clinical manifestations and mode of operations were analyzed. The cumulative survival rates were also analyzed for 107 patients who had been finally followed up, and the significance of survival difference was tested (p<0.05). RESULTS: The average age of 132 patients was 64 years old, and female patients suffered more frequent incidence than male patients by a ratio of 1.7:1. The distribution of patients according to the pathologic TNM staging showed early stage (stage 0 & I) accounted for only 9.8% whereas the advanced stages (stage II, III, IVa, IVb) accounted for the majority of the patients (90.2%). The chief complaints were abdominal pain (84.8%), indigestion, weight loss, palpable mass and so forth in a decreasing frequency order. Among the patients, 30 cases (22.7%) were irresectable, 50 cases (38%) were curative resected, and 52 cases (39%) were palliative resected. The overall cumulative survival rates of 107 patients were 53.7%, 41.7% and 30.1% for 1-year, 2-year and 5-year survival respectively. Although the 5-year survival rate of curative resected patients showed a significantly better survival rate (p<0.005) than that of non-curative resected patients, the different modes of combined radical surgery did not affect the survival rates. CONCLUSION: Combined curative resection ameliorated long-term survival of patients with gallbladder carcinoma. For the further evaluation of the efficacy of combined radical surgery on survival, more extensive data needs to be accumulated.
Abdominal Pain ; Dyspepsia ; Early Diagnosis ; Female ; Gallbladder* ; Hospital Distribution Systems ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Survival Rate ; Weight Loss

It has been reported that dyspeptic symptoms in a minority of the patients who undergo cholecystectomy are persistent. Cholecystectomy may have a direct effect on the development of dyspeptic symptoms, predisposing the patient to increased duodenogastric reflux. Excessive reflux of noxious duodenal content into the stomach has been associated with chronic gastritis, gastric ulceration, and esophagitis. We examined 9 patients with gallstone disease who underwent laparoscopic cholecystectomy to determine the changes in the gastroesophageal reflux and the esophageal function. All the patients underwent looth standard esophageal manometry to study esophageal function and 24-hr esophageal pH monitoring to ascertain the gastroesophageal reflux the prior to at the time of, and 3 months after the laparoscopic cholecystectomy. The mean lower esophageal sphincter(LES) length, the abdominal esophageal sphincter length, and the resting pressure of LES were increased from 3.1 cm, 2.3 cm 19.9 mmHg to 3.2 cm, 2.6 cm, 22.9 mmHg, with no statistical significance. The mean sphincter function index increased from 1484 to 1888 after the operation with no statistical significance. The mean ampulitude of contraction in the upper, the middle, and the lower portions of the esophageal body, but again increased from 44.4 mmHg, 59.8 mmHg, and 87.5 mmHg to 56.7 mmHg, 84.44 mmHg, and 117.8 mmHg, respectively, after the operation. The mean DeMeester acid reflux score decreased from 13.5 to 7.0 after the operation(p=0.343). In this study, the laparoscopic cholecystectomy did not affect the lower esophageal sphincter function. However there was an increase in the amplitude and the duration of contractions in the esophageal body. Therefore, the heartburn that persists after a cholecystectomy may be an esophageal origin. We suggest that all patients with biliary symptoms, but without documented acute cholecystitis should undergo full upper gastrointestinal investigations with esophagogastroduodenoscopy and pH monitoring (especially dual channel gastric and esophageal pH moniotring) to differentiate the esophageal pathology from other origins.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Duodenogastric Reflux ; Endoscopy, Digestive System ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophagitis ; Gallstones* ; Gastritis ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Pathology ; Stomach ; Stomach Ulcer