Bleeding from esophageal or gastric varix is the most critical and life-threatening complication of portal hypertension and the most common cause of deaths in the patients with cirrhosis. In the management of variceal bleeding, the various therapeutic interventions including operation and nonoperative procedure were tried, but neither of management was successfully achieved. Between February 1992 and November 1994, we performed endoscopic injection sclerotherapy(EIS) in 35 cirrhotic patients who had recently bled from esophageal varices and had a past history of esophageal variceal bleeding in Chonbuk National Univesity Hospital. Among 35 patients, 32 were male and 3 were female. The underlying severity of liver disease was graded A, B or C according to modification of Child-Pugh classification. EIS was repeated every 1 week until the esophageal varices had been complete obliterated and removed. To investigate the effects of esophageal varix eradication by EIS on combined peri- cardial varix, endoscopic examinations were performed both before procedure and after complete EIS sessions and this study was performed to examine a changes of combined pericardial varices after EIS procedure for the treatment of esophageal varices bleeding secondary to portal hypertesion. We reviewed medical records and compared changes or sizes of pericardial varices before and after EIS procedure. Mean follow up peiod was 61 days. Total number of 162 EIS for variceal eradication were performed. Mean session for eradication of esophageal varices was 4.6 per person, mean amount of injected sclerosant was 8.3cc(1-18cc), mean duration of EIS was 39 days, and mean follow up was 62 days after complete EIS procedure. In total 162 EIS procedure, complications associated with EIS including substernal discomfort 53.7%(n=87), substernal chest pain 45.7%(n=74), fever 4.9%(n=8), dysphagia 14.2%(n=23) and pleural effusion 3.1%(n=5), were transient and not required specific management. During the follow-up period, complete disapperance of pericardial varix or reduction of size was appeared in l8 cases(51.4%) among total 35 patients. No significant changes of variceal size before and after procedure were l6 cases(45.7%) and only 1 case(2.9%) was more aggravated. So, these results suggest that EIS procedure of esophageal varix on pericardial varix seems either to improve or to maintain the severity of the pericardial gastric varix without aggravation.
Cause of Death ; Chest Pain ; Classification ; Deglutition Disorders ; Esophageal and Gastric Varices* ; Ethanolamine* ; Female ; Fever ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal ; Jeollabuk-do ; Liver Diseases ; Male ; Medical Records ; Oleic Acid* ; Pleural Effusion ; Sclerotherapy* ; Varicose Veins

Bleeding from esophageal or gastric varix is the most critical and life-threatening complication of portal hypertension and the most common cause of deaths in the patients with cirrhosis. In the management of variceal bleeding, the various therapeutic interventions including operation and nonoperative procedure were tried, but neither of management was successfully achieved. Between February 1992 and November 1994, we performed endoscopic injection sclerotherapy(EIS) in 35 cirrhotic patients who had recently bled from esophageal varices and had a past history of esophageal variceal bleeding in Chonbuk National Univesity Hospital. Among 35 patients, 32 were male and 3 were female. The underlying severity of liver disease was graded A, B or C according to modification of Child-Pugh classification. EIS was repeated every 1 week until the esophageal varices had been complete obliterated and removed. To investigate the effects of esophageal varix eradication by EIS on combined peri- cardial varix, endoscopic examinations were performed both before procedure and after complete EIS sessions and this study was performed to examine a changes of combined pericardial varices after EIS procedure for the treatment of esophageal varices bleeding secondary to portal hypertesion. We reviewed medical records and compared changes or sizes of pericardial varices before and after EIS procedure. Mean follow up peiod was 61 days. Total number of 162 EIS for variceal eradication were performed. Mean session for eradication of esophageal varices was 4.6 per person, mean amount of injected sclerosant was 8.3cc(1-18cc), mean duration of EIS was 39 days, and mean follow up was 62 days after complete EIS procedure. In total 162 EIS procedure, complications associated with EIS including substernal discomfort 53.7%(n=87), substernal chest pain 45.7%(n=74), fever 4.9%(n=8), dysphagia 14.2%(n=23) and pleural effusion 3.1%(n=5), were transient and not required specific management. During the follow-up period, complete disapperance of pericardial varix or reduction of size was appeared in l8 cases(51.4%) among total 35 patients. No significant changes of variceal size before and after procedure were l6 cases(45.7%) and only 1 case(2.9%) was more aggravated. So, these results suggest that EIS procedure of esophageal varix on pericardial varix seems either to improve or to maintain the severity of the pericardial gastric varix without aggravation.
Cause of Death ; Chest Pain ; Classification ; Deglutition Disorders ; Esophageal and Gastric Varices* ; Ethanolamine* ; Female ; Fever ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal ; Jeollabuk-do ; Liver Diseases ; Male ; Medical Records ; Oleic Acid* ; Pleural Effusion ; Sclerotherapy* ; Varicose Veins

Embolization of a carotid cavernous fistula(CCF) by means of a detachable balloon is a well-established method for treating CCFs while preserving a patent parent internal carotid artery(ICA). However, failure to embolize the CCF may occur on a few occasions. Herein we describe a stent-assisted Guglielmi detachable coil embolization that completely occludes the fistulous opening rather than fills the cavernous sinus. By applying this technique, we successfully treated a CCF, without compromise of the parent ICA in patients who has failed with balloon technique previously.
Cavernous Sinus ; Embolization, Therapeutic ; Fistula* ; Humans ; Parents ; Stents*

Diastasis of the ankle joint was associated with extensive ligamentous rupture and resulted from external rotation or abduction injuries at the ankle. It might occur without associated fracture but was more frequently seen in cases of bimalleolar fracture in which there was fracture of the medial malleolus or rupture of the deltoid ligament with fracture of the lower third of the fibula. Thirty patients of diastasis of the ankle joint were admitted and treated by internal fixation with screw and bolt from January 1978 to December 1981. The following results were obtained: 1. The main cause of the injuries was falling from a height and the other causes were slipping down and sports injury in order. 2. The most common type by Lauge-Hansen classification was supination-external rotation type (20 cases, 67%). 3. Partial diastasis of the ankle joint or anterior type was 14 cases (47%) and complete diastasis or total type was 16 cases (53%). 4. In all cases, mixed oblique fibular fracture and medial instability were seen. 5. The good results were achieved in 24 patients (80%).
Accidental Falls ; Ankle Fractures ; Ankle Joint ; Ankle ; Athletic Injuries ; Classification ; Clinical Study ; Fibula ; Humans ; Ligaments ; Rupture

Hyponatremia is frequently seen in intracranial hemorrhagic patients and has been often attributed to inappropriate secretion of antidiuretic hormone. But in recent years, a number of studies have shown that hyponatremia in many patients with intracranial disease may actually be caused by cerebral salt wasting (CSW) syndrome and circulating Atrial natriuretic peptide (ANP) and Brain natriuretic peptide (BNP) are probably involved. This report describes a patient who developed bacterial meningites caused by pseudomonas aeruginosa and CSW syndrome after removal of pituitary adenoma. CSW syndrome resolved by fluid and salt replacement after 4 months.
Humans ; Hyponatremia ; Meningitis* ; Meningitis, Bacterial ; Natriuretic Peptide, Brain ; Pituitary Neoplasms* ; Pseudomonas aeruginosa ; Pseudomonas* ; Wasting Syndrome*

Preoperative embolization of hypervascualr brain tumors is known to be an effective method to reduce intraoperative bleeding and to reduce the operative difficulty. The most commonly tumor vessels are branches of the external carotid artery, which are frequently embolized as a preoperative procedure. However, branches from the internal carotid artery, such as the ophthalmic artery, tentorial artery, or cortical branches sometimes feed tumors, but there are some limitations of embolization of branches from the internal carotid artery. In addition, hypervascular tumors are rarely associated with neoplastic aneurysms. Their possible role in producing massive intraoperative hemorrhage has been well recognized. We describe the successful embolization of the tumor vessels from branches of the internal carotid artery and their neovascularization.
Aneurysm ; Arteries ; Brain Neoplasms* ; Brain* ; Carotid Artery, External ; Carotid Artery, Internal* ; Hemorrhage ; Ophthalmic Artery ; Preoperative Care

Pulmonary embolism of lipiodol or ethanol may occur inadvertently during the procedure of diagnostic or therapeutic embolization. We studied the nature of pulmonary damage, and its relation to the amount of lipiodol and ethanol embolized into the lung. Various doses of embolic agents(lipiodol 0.4cc/kg, 0.08cc/kg, absolute ethanol 0.4cc/kg, 0.03cc/kg and normal saline 0.4cc/kg)were injected intravenously through femoral vein in 50 rats(10 rats in each group). Pulmonary pathologic changes were analyzed on the 3rd and 28th days subsequent to injection. On the 3rd day, three of 10 lipiodol cases and all(10) ethanol cases showed multifocal pulmonary hemorrhages. Accompanying inflammatory cell infiltration was found only in lipiodol cases. On the 28th day, one of 10 lipiodol cases and four of 10 ethanol cases showed non-specific pneumopathy suggesting mild focal pulmonary fibrosis. The degree of pulmonary damage appeared to depend on the amount of injected embolic agents although their safety doses could not be clarified exactly. Therefore, we suggest careful injection of embolic agents, especially ethanol, during the embolization procedure to prevent possible pulmonary damage by inadvertent pulmonary embolism.
Animals ; Embolization, Therapeutic ; Ethanol* ; Ethiodized Oil* ; Femoral Vein ; Hemorrhage ; Lung ; Pulmonary Embolism* ; Pulmonary Fibrosis ; Rats

Recent advances in stent technology have allowed the introduction of more flexible stents that may be tracked more easily in the intracranial vessels. We present a patient with improved cerebral perfusion as assessed by single-photon emission computed tomographic(SPECT) scan after stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. A 72-year-old man presented with multiple episodes of transient verbral disturbance and right-sided motor weakness for 5 months despite treatment with aspirin and clopedigrel. Angiography revealed a 50% to 60% stenosis of the left middle cerebral artery. 99m Tc-exametazime-SPECT scan demonstrated decreased cerebral blood flow in the left cerebral hemisphere, particularly in the left middle cerebral artery territory. The patient was recommended a stent-assisted angioplasty for middle cerebral artery stenosis. The patient underwent uncomplicated stenting with S-660 2.5- by 9-mm stent(Arterial Vascular Engineering, Santa Rosa, CA) of the left middle cerebral artery, with excellent angiographic results. Follow-up brain SPECT scan showed markedly improved perfusion. Stent-assisted percutaneous transluminal angioplasty can provide a favorable clinical course as well as improved cerebral perfusion for a patient with middle cerebral artery stenosis. Long-term follow-up data and additional clinical experience are required to assess the durability of this procedure.
Aged ; Angiography ; Angioplasty* ; Aspirin ; Brain ; Cerebrum ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Middle Cerebral Artery* ; Perfusion* ; Rosa ; Stents ; Tomography, Emission-Computed, Single-Photon

Recent advances in stent technology have allowed the introduction of more flexible stents that may be tracked more easily in the intracranial vessels. We present a patient with improved cerebral perfusion as assessed by single-photon emission computed tomographic(SPECT) scan after stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. A 72-year-old man presented with multiple episodes of transient verbral disturbance and right-sided motor weakness for 5 months despite treatment with aspirin and clopedigrel. Angiography revealed a 50% to 60% stenosis of the left middle cerebral artery. 99m Tc-exametazime-SPECT scan demonstrated decreased cerebral blood flow in the left cerebral hemisphere, particularly in the left middle cerebral artery territory. The patient was recommended a stent-assisted angioplasty for middle cerebral artery stenosis. The patient underwent uncomplicated stenting with S-660 2.5- by 9-mm stent(Arterial Vascular Engineering, Santa Rosa, CA) of the left middle cerebral artery, with excellent angiographic results. Follow-up brain SPECT scan showed markedly improved perfusion. Stent-assisted percutaneous transluminal angioplasty can provide a favorable clinical course as well as improved cerebral perfusion for a patient with middle cerebral artery stenosis. Long-term follow-up data and additional clinical experience are required to assess the durability of this procedure.
Aged ; Angiography ; Angioplasty* ; Aspirin ; Brain ; Cerebrum ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Middle Cerebral Artery* ; Perfusion* ; Rosa ; Stents ; Tomography, Emission-Computed, Single-Photon

Before and after conducting the health promotion program by group occupational health service during 5 years, we surveyed knowledge, attitude and practice about general health(30 items) and occupational health (30 items) among 25 small and medium scale industry workers (before : 355 workers, after : 279 workers) for evaluation of effectiveness. The scores of knowledge for smoking, drinking, cholesterol, mental stress, management of hypertension, and risks in younger or women workers were significantly increased after conducting group occupational health service. The scorers of attitude for controlling of fatty food consumption and cleaning workplace and bathing for health and that of practice for taking the periodic health examination and choking blood pressure were significantly increased but most of items in attitude and practice didn't be changed after services. According to sex, the scorers of men were significantly increased in knowledge of general health, but there were not significant differences in age, job status and work duration group. In conclusion, through the group occupational health service during 5 years, only the scores of knowledge in general health were increased. It suggested that the effective program which can change workers' attitude and practice for health promotion, should be developed and conducted in small and medium scale industry workers.
Airway Obstruction ; Baths ; Blood Pressure ; Cholesterol ; Drinking ; Female ; Health Promotion* ; Humans ; Hypertension ; Male ; Occupational Health Services* ; Occupational Health* ; Smoke ; Smoking