Pseudoaneurysm due to chronic pancreatitis is uncommon, but it can cause recurrent and massive hemorrhage. Because of high morbidity and mortality associated with the pseudoaneurysm, early detection and treatment is essential. Surgical ligation or resection of the aneurysm has a high mortality and therefore, transcatheter embolization is preferably carried out. We report a case in which gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis was successfully treated by transcatheter embolization using Gelfoam and Gianturco spring coils.
Aneurysm ; Aneurysm, False* ; Arteries* ; Gelatin Sponge, Absorbable ; Hemorrhage ; Ligation ; Mortality ; Pancreatitis, Chronic*

We evaluated the role of retroperitoneal laparoscopic ureterolithotomy (RPLU) for upper ureter stones. Between February 1998 and July 2004, 12 patients (10 men and 2 women) underwent RPLU for upper ureter stones (mean size 18.1 mm, range 10-25). RPLU was carried out in 5 patients as a salvage treatment after failed shock wave lithotripsy (SWL) (3) and both of failed SWL and ureteroscopy (URS) (2), and in 7 patients as primary treatment for large impacted stones. Total 6 of 12 cases were converted to open surgery. The reason of open conversion was failure of locating ureter due to severe adhesion in 5 cases and vascular injury in 1 case. In 6 successful cases, mean operation time, mean estimated blood loss, and mean postoperative hospital stay were respectively 109 min (90-120 min), 50 mL (10-100 mL), 4.6 days (2-7 days). There was no serious postoperative complication except for one patient who showed delayed urinary leakage but was cured with conservative management. Our experience suggested that RPLU was not easy to perform simply because it was indicated mainly in ureter stones with severe adhesion or after failed SWL and/or URS. Nevertheless, it can be considered as a primary procedure before open ureterolithotomy.
Urologic Surgical Procedures/*methods ; Ureteral Calculi/*therapy ; Ureter/pathology ; Treatment Outcome ; Time Factors ; Sex Factors ; Retroperitoneal Space/pathology ; Peritoneum ; Middle Aged ; Male ; Lithotripsy/*methods ; Laparoscopy/*methods ; Humans ; Female ; Adult

We report a case of histopathologically confirmed hepatic angiosarcoma. A 29-year old patient was admitted with fever and palpable tender mass in the right upper abdomen. On ultrasonography, a large, well circumscribed mixed echoic mass was seen in the right lobe of the liver. On CT scan, irregular enhancement was seen mainly in the peripheral portion of the mass ; the central portion was not enhanced. The mass showed low signal intensity on T1W1, and high signal intensity on T2WI. Peripheral nodular enhancement was noted on Gd-enhanced MR images; In the peripheral portion of the mass,
Abdomen ; Adult ; Angiography ; Fever ; Hemangiosarcoma* ; Hepatic Artery ; Humans ; Liver* ; Radionuclide Imaging ; Sarcoma ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: The purposes of this study were to evaluate the plain radiologic findings of the childhood intussusception and to evaluate the role of plain abdominal films in predicting the success of air or barium reduction. SUBJECTS AND METHODS: We retrospectively reviewed 140 cases with the diagnosis of intussusception in children. The radiological signs that included soft tissue mass, dilatation of small bowel suggesting obstruction, crescent sign, and target sign were evaluated in terms of frequency. The relationship between radiological findings and outcome of reduction was analyzed. The site of soft tissue mass or crescent sign seen on plain radiographs was correlated with the position of the apex of the intussusceptum seen at the beginning of barium enema. The degree of dilated small bowel was evaluated by calculating the proportion of air-filled small bowel occupying peritoneal cavity and measuring the maximal diameter of dilated bowel lumen. The radiological finding for small bowel obstruction is determined by observation of the degree of small bowel dilatation and/or air-fulid levels. RESULTS: Ninety-two cases out of 140 showed one or more radiographic signs. Two most common signs were soft tissue mass and small bowel obstruction. The success rate of air or barium reduction was significantly lower in patients with most severe degree of dilatation of small bowel and/or more than 7 air-fulid levels on erect view. The suspected location of intussusception on plain radiographs correlated well with the true location of intussusception seen in the first few seconds of barium reduction. CONCLUSION: Plain abdominal radiography is useful in the diagnosis of intussusception and provides helpful informations for the reduction procedure as well as for the exclusion of the contraindications such as bowel perforation.
Barium ; Child ; Diagnosis ; Dilatation ; Enema ; Humans ; Intussusception* ; Peritoneal Cavity ; Radiography, Abdominal ; Retrospective Studies

PURPOSE: Status epilepticus(SE) is a pediatric and neurologic emergency associated with significant morbidity and mortality. Prompt recognition and management are needed for successful outcomes. We evaluated, clinical manifestations, treatment and prognosis of the patients whose first seizure attacks were presented as SE. METHODS: According to the department of pediatrics and the emergency room in Inha University Medical Center, there were a total of 25 children between 1 month and 5 years old who were diagnosed as status epilepticus from July 1996 to June 2002. Also, their medical records were reviewed and analyzed interms of age distribution, accompaning diseases, the types and duration of convulsion, medications, EEG and MRI findings and prognosis. RESULTS: Twenty-five cases were studied. The mean age at the time of the diagnosis was 20+/-1.6 months and 80% of the patients were less than 3 years old. The most common type of the status epilepticus was generalized tonic clonic seizure comprising 15 cases(60%). 64% of the patients were symptomatic:fever(40%), CNS infection(20%), ischemic injury(4%) while 36% were idiopathic. Seizure attacks were terminated within an hour in seventeen patients(68%) and they controlled by one antiepileptic drug in thirteen patients(52%). Of the 20 EEGs, abnormal findings were shown in 13 cases(65%); namely, electrical seizure(30%), abnormal background(30%), and focal epileptiform discharge(5%). Of the 19 brain MRIs, abnormal findings were shown in 9 cases(47%). CONCLUSION: The children whose first seizure attack were presented as SE were less than 3 years old. The prognosis is good in that most of the seizure attacks were terminated within an hour and controlled by one epileptic drug. However those seizure attacks with longer duration, multiple antiepileptic druge and underlying causeare had poor prognosis.
Academic Medical Centers ; Age Distribution ; Brain ; Child* ; Child, Preschool ; Diagnosis ; Electroencephalography ; Emergencies ; Emergency Service, Hospital ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Mortality ; Pediatrics ; Prognosis ; Seizures* ; Status Epilepticus*

Dieulafoy's lesion is an unusual cause of massive gastrointestinal bleeding resulting from the erosion of an abnormally large submucosal artery. Recently, improvement of endoscopic techniques has made effective hemostasis possible in most cases of Dieulafoy's lesion. Aspirin, which is an anti-inflammatory agent, increases the incidence of major upper gastrointestinal complications. Gastroduodenal mucosal injury associated with aspirin therapy in patients in the acute phase of Kawasaki disease is a rare complication that may require urgent medical intervention. We experienced a rare case of active bleeding from Dieulafoy's lesion in the stomach who was treated with oral aspirin in the acute phase of Kawasaki disease. If there is massive hematemesis during the treatment of Kawasaki disease, Dieulafoy's lesion should be considered even though it is rare.
Arteries ; Aspirin ; Child* ; Hematemesis ; Hemorrhage* ; Hemostasis ; Humans ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Stomach

The causes of the chylothorax can be classified to the congenital cases, such as the atresia of thoracic duct and thoracic duct-pleura fistula, and the acquired ones, such as thoracic surgery, trauma, malignant disease, venous thrombosis, infection and so on. We experienced a case of left chylothorax in a 10-year-old girl with a lymphangiomatosis of left thorax extending from axillar to buttock. She first received the two weeks of conservative management, which was unsuccessful to subside the chylothorax. Then she was taken the partial pleurectomy and chemical pleurodesis under the thoracoscopy as a surgical intervention, but this is also insufficient to reduce the chylous effusion. Finally she received 10 times of radiotherapy on left thorax, then the chylothorax is controlled completely.
Buttocks ; Child ; Chylothorax* ; Female ; Fistula ; Humans ; Pleurodesis ; Radiotherapy* ; Thoracic Duct ; Thoracic Surgery ; Thoracoscopy ; Thorax* ; Venous Thrombosis

This study was conducted to evaluate the accuracy of the official death registry in rural area. The base data used for the study was 379 deaths registered during the period of 1993 and 1994 in 4 rural townships of Chonnam Province. The interview survey for cause-of-death was performed on the next of kin and/or neighbor. Additional medical informations were collected from hospitals and medical insurance associations for the purpose of verification. The underlying cause-of-death of 278 cases presumed by the survey was compared to the cause on official death registry. There was a prominent disagreement of cause-of-death between the survey data and the registry data(agreement rate: 38.9~44.6%%, according to disease classification method). These results may be caused by extremely low rates of physicians' certification, which were mostly confined to the poisoning and injury. Symptoms, signs, and ill defined conditions on death registry could be classified into circulatory disease(32.3%), neoplasm(21.2%), digestive disease(7.l%), injury and poisoning(7.l%) and so on. These results suggest that careful attention and verification be required on utilization of death registry data in rural area.
Cause of Death ; Certification ; Classification ; Insurance ; Jeollanam-do ; Poisoning

PURPOSE: To evaluate useful findings and diagnostic value of TI-201 thyroid scan in differentiating benign from malignant nodules. MATERIAL AND METHOD: We studied 77 cold thyroid nodules proven histologically(27 malignat and 50 benign). Early (5--15rain) and delayed images(3--5hours) were obtained after intravenous injection of thallium 201. In these nodules, we retrospectively analyzed the degree of TI-201 uptake in early and delayed images, histopathologic type, size, and presence or absence of cystic change in the sonograms of 22 malignant nodules. RESULTS: Useful finding for diagnosis of malignant nodules was strong uptake of TI-201 in early and delayed images(specificity:98%, sensitivity:63%, positive predictive value:94.4%). Useful finding for benign nodules was no uptake of TI-201 in delayed image(specificity :88.9%, sensitivity :68%, positive predictive value :91.9%). The accuracy of TI-201 thyroid scan in differentiating benign from malignant nodules was 66.2%. The nodules with strong TI-201 uptake in early image and low TI-201 uptake in delayed image were malignant in 29.4%. Cystic changes were found in 40% of malignant nodules with atypical TI-201 uptake. TI-201 thyroid scan showed high specificity in follicutar neoplasm and adenomatous goiter in which differentiation of benignancy and malignancy is difficult with only cytologic examination. CONCLUSION: We consider that TI-201 thyroid scan is valuable in differentiating benign from malignant nodules and when combined with fine needle aspiration and ultrasound examination, it will enable more accurate differential diagnosis between benign and malignant thyroid nodules.
Biopsy, Fine-Needle ; Diagnosis ; Diagnosis, Differential* ; Goiter ; Injections, Intravenous ; Retrospective Studies ; Sensitivity and Specificity ; Thallium* ; Thyroid Gland* ; Thyroid Nodule ; Ultrasonography

PURPOSE: To measure the normal size of the styloid process using 3D (three-dimensional) reconstruction CT. MATERIALS AND METHODS: We retrospectively analyzed 3D reconstruction images obtained after coronal and axial CT scanning of the temporal bone or neck of 115 patients. The length and shape of both sides of the styloid process, the location of its tip, and calcification of the stylohyoid ligament were retrospectively analysed. RESULTS: The mean length of the styloid process was 26.6 (+/-7.9)mm on the right side, and 26.4(+/-8.3)mm on the left, a statistically insignificant difference (p=0.694). Its mean length was 26.2 (+/-8.5)mm in men and 26.7 (+/-7.2)mm in women, a statically in significant difference (p=0.733). As for variation with age, mean length tended to increase until the third decade, but not beyond. Segmental type (104/230, 45.2%) and fragmental type (73/230, 31.7%) were more commonly seen in shape of styloid process, and tapering tip of styloid process (156/230, 67.9%) is more commonly seen than clubbing tip of it (74/230, 32.1%). The process was angulated in six cases (2.6%); its tip was more frequently located between the internal and external carotid artery (211 cases, 91.7%) than more medially (19 cases, 8.3%). In the former location, the length of the process was 26.2(+/- 7.2)mm, and in the latter, 37.0(+/-6.0)mm. The difference was statistically significant (p=0.000). Calcification had occurred in 33 cases (14.3%). CONCLUSION: The length of a normal styloid process was 18-32 mm. There were no statistically significant differences between its two sides, or between the sexes. Length tended to increase until the third decade, but not beyond. Predominantly the tip was located between the internal and external carotid artery, though the process was longer when its tip was located medially.
Carotid Artery, External ; Female ; Humans ; Ligaments ; Male ; Neck ; Retrospective Studies ; Temporal Bone ; Tomography, X-Ray Computed