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

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

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

In order to investigate the prevalence and the factors related to the depression and burnout among private practice physicians, a SDS(self-rating depression scale) and MBl(Maslach burnout inventory) -based questionnaire study was performed on 344 private practice physicians in Kwangju and chonnam area. The results were summarized as follows. 1. Mean SDS score was 38.3 in total subjects and the prevalence rate of depression was 48.8%. As for the frequency order of the items of the SDS, decreased libido, diurnal variation and hopelessness were relatively high, and suicidal rumination, constipation and agitation were noted low. 2. Noticeable factors related with depression were smoking, coffee use, sleeping time and satisfaction with income. 3. As a result a factor analysis with the MBl data, five factors named as emotional exhaustion, depersonalization, personal accomplishment, involvement and self-interest were extracted. Statistical analysis of the data demonstrated that 48.8% of the physician sample reported high scores on emotional exhaustion, and 45.3% scored high on depersonalization. Personal accomplishment scores remained high with 45.3% reporting high personal accomplishment. 4. Variables related to the burnout were age, sleeping time, family size religion, medical speciality. duration of practice setting, visiting patient number, closing day per month and job satisfaction. 5. In the relationship with depression, burnout was closely related to depression. Above results showed that the high percentage of private practice physicians experiencing depression and burnout suggests the need for further research to establish trends, to identify causal factors, and to develop avenues to reduce stress.
Coffee ; Constipation ; Depersonalization ; Depression* ; Dihydroergotamine ; Family Characteristics ; Gwangju ; Humans ; Jeollanam-do ; Job Satisfaction ; Libido ; Prevalence ; Private Practice* ; Surveys and Questionnaires ; Smoke ; Smoking

PURPOSE: The purpose of this study was to evaluate the CT features of second branchial cleft cysts. MATERIALS AND METHODS: We retrospectively analyzed the computed tomographic images in nine cases of second branchial cleft cyst which was confirmed pathologically. Emphasis was on localization of the masses to fascial spaces as defined by the deep cervical fasica. RESULTS: In all nine cases, the lerions were located in the submandibular and carotid spaces. Among these cases, six(67%) had simultaneous involvement of the other contiguous spaces, such as anterior and posterior cervical spaces. All cases had round or oval, unilocular, cystic masses with partial or complete rim enhancement. In eight cases(89%), smooth and thin walls were observed. In one case, thick wall and septations were noted. No definite calcifications were noted in all cases. The internal contents of cystic masses showed relatively homogeneous appearance, and CT number ranged from 20 to 35.2 Hounsfield unit(HU)(mean, 28.4HU). CONCLUSION: CT diagnosis of second branchial cleft cyst would be easily obtained from recognition of frequent simultaneous involvement of the other contiguous spaces, along with a typical location and characteristic morphology.
Branchial Region* ; Branchioma* ; Diagnosis ; 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

PURPOSE: The purpose of this study was to determine the efficacy of sonography in the evaluation of normal pseudocapsular morphology and the detection of complications after total hip arthroplasty. MATERIALS AND METHODS: Between Janvary 1997 and June 2000, 47 patients [35 men and 12 women aged 24 to 84 (mean, 61) years] using real-time linear-array, convex US units with 3.5-MHz and 10-MHz transducers. Normal capsular morphology in 30 with total hip replacements, who had been asymptomatic for at least one year, was studied, and the prosthetic joint infection demonstrated in six of 17 who had experienced was confirmed at surgery or by US-guided aspiration. RESULTS: Sonograms indicated that a normal pseudocapsule lay straight over the neck of the prosthesis or was slightly convex toward the neck, and that the mean bone-to-pseudocapsule distance was 2.9 mm. However, in the 11 symptomatic patients in whom no evidence of infection was revealed by cultures, th mean distance was 4.7 mm; in the remaining six patients, whose joints were infected (a condition strongly suggested by the presence of extracapsular fluid), the mean distance was 5.5 mm, with no significant difference between the two groups. CONCLUSION: Sonography can be used to evaluate normal caspular morphology after total hip replacement and to diagnose infection around hip prostheses. In all patients in whom sonography revealed the presence of extra-articular fiuid, infection had occurred.
Arthroplasty, Replacement, Hip* ; Female ; Hip Prosthesis ; Humans ; Joints ; Male ; Neck ; Prostheses and Implants ; Transducers ; Ultrasonography*

BACKGROUND/AIMS: Along with the expansion of the field of laparoscopic surgery, many laparoscopic instruments have been developed and these all together made laparoscopic surgery possible in many operative procedures which used to be considered impossible to be done using a laparoscope. Suturing is a technique quite often required during laparoscopic surgery and so far we have used imported suture material. In this article, we have compared the safety and harmfulness of suture material developed domestically in Korea with those imported using house rabbits. METHODS: A total of 40 white house rabbits from New Zealand weighing 3.0-3.4 Kg were used from July 1, 2000 until April 30, 2001. Under general anesthesia, we created a pneumoperitoneum using a veress needle with a pressure of 10 mmHg followed by insertion of a 5mm laparoscope right above the umbilicus and two 5mm trocars were inserted in the right and left midclavicular lines 5cm below the costal margin. After perforating the pylorus of the stomach using laparoscopic scissors, we sutured two sites using Laploop and then perforated the body of the stomach and again sutured two sites but this time using Vicryl #3-0 for comparison with Laploop. 10 house rabbits were sacrificed each on post operation days 10, 20, 30 and 40 and tissues obtained from those house rabbits were compared using the Sewell method. RESULTS: Suturing and ties were done without any problems and there were no postoperative complications or deaths. On postoperation days 10 and 20, Laploop showed a moderate degree of tissue reaction proved by a Sewell score of 57 and 48 respectively and on postoperation days 30 and 40, a mild to moderate degree of tissue reaction occurred with a S score of 36 and 33 respectively. In models using Vicryl, the S scores were 67 an 62 on postoperation days 10 and 20 respectively showing a moderate degree of tissue reaction and on postoperation days 30 and 40, it showed a mild to moderate degree of tissue reaction with a S score of 52 and 44 respectively which is similar to the results obtained by Laploop. CONCLUSION: Imported Vicryl and Laploop were both applicable in terms of biologic compatibility but Laploop was easier to apply, more cost effective compared to Vicryl but most of all, there were no complications such as a loosening of a knot or a knot being undone. Therefore it could be concluded that Laploop shows a promising future as a suture material in laparoscopic surgery.
Anesthesia, General ; Korea ; Laparoscopes ; Laparoscopy ; Needles ; New Zealand ; Pneumoperitoneum ; Polyglactin 910 ; Postoperative Complications ; Pylorus ; Rabbits* ; Stomach ; Surgical Instruments ; Surgical Procedures, Operative ; Sutures ; Umbilicus