Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease.
Chyle ; Chylous Ascites ; Humans ; Pancreatic Neoplasms ; Pancreatitis ; Parenteral Nutrition, Total ; Peritoneum ; Portal Vein ; Rare Diseases ; Rupture ; Thrombosis

PURPOSE: This study was conducted to identify correlations in hospital nurses' work environment, emotional labor and happiness index to provide basic resources for nurses' happiness at work. METHODS: Resources were gathered from 291 nurses who agreed to participate. Random sampling of nurses in nine hospitals in G-do was done between July 15 and August 14, 2014. Data were analyzed using chi2 tests, independent t-test, One-way ANOVA, Pearson correlation coefficients and multiple hierarchical regression with SPSS/WIN 18.0. RESULTS: Mean scores (scale of 5) were nurses' work environment, 2.81, emotional labor, 3.24, and happiness index, 2.94. There were significant differences on the happiness index for: age, marriage, children, clinical experience, position, payment, and future work plans and a negative correlation between work environment and emotional labor, emotional labor and happiness index but a positive correlation between happiness index and work environment. Happiness index was influenced by work environment, emotional labor, future work plans. Explanatory power of these variables was 26%. CONCLUSION: Based on the findings of this study, so it is necessary to improve the work environment and reduce the frequency of emotional labor in order to increase the happiness index of hospital nurses.
Child ; Happiness* ; Humans ; Marriage ; Personal Satisfaction

PURPOSE: Early traditional methods of surveillance to detect failing graft relied on recurrence of symptoms, change of pedal pulses, or a decrease in the Ankle-Brachial Index (ABI). More recently, graft surveillance with Duplex scan which has become an appropriate first-line alternative has been shown to be effective in identifying the patency of threatened femorodistal graft. The purpose of this study was to determine the relationship and significance among ABI change, run-off resistance score, and Duplex scan parameters in femorodistal graft bypass. METHOD: Among 52 patients who received femorodistal bypass, thirty-one femorodistal grafts (19: above knee, 12: below knee) which had followed up for more than 2 years were followed up by ABI at regular interval and Duplex scan at 2 year. Those were grouped according to the grade of ABI decrease as follows; Group I: <0.1 ABI decrease, Group II: 0.1or= 0.2 ABI decrease. Peak systolic flow velocity (PSFV) ratio, luminal diameter at near proximal and distal anastomosis, mean body graft velocity (cm/sec) were evaluated. Runoff resistance score was calculated by the finding of the pre-operative angiogram. RESULT: In proportion to the severity of ABI decrease, proximal and distal peak systolic flow velocity (PSFV) ratio and stenosis (%) increased, mean body graft velocity decreased. Significant statistical difference between groups were shown as follows; Group II and IV: distal PSFV ratio (2.17 vs 2.95, P=0.02), proximal stenosis (32.8% vs 47.4%, P=0.026), distal stenosis (21.7% vs 62.0%, P=0.007), mean body graft velocity (81 cm/sec vs 46 cm/sec, P=0.02) Group III and IV: distal PSFV ratio (2.29 vs 2.95, P=0.02), distal stenosis (40.5% vs 62.0%; P=0.003), body flow velocity (70 cm/sec vs 46 cm/sec, P=0.02). The higher runoff resistance score was, the more distal PSFV ratio, distal stenosis increased, but proximal stenosis, PSFV ratio, and mean body graft velocity did not change significantly. CONCLUSION: This study shows that higher decrease in ABI (>0.2) is well correlated with critical Duplex parameters. Longer graft patency and economic benefit may be obtained by active evaluation of failing graft using by Duplex scan when the ABI decrease is more than 0.2 in femorodistal graft bypass at regular examination.
Ankle Brachial Index ; Constriction, Pathologic ; Humans ; Knee ; Phenobarbital ; Recurrence ; Transplants*

PURPOSE: Having been disappointed with standard anticoagulation therapy for acute deep vein thrombosis (DVT) in lower extremity, we started catheter-directed thrombolytic therapy. And the aim of this study was to evaluate the effects on venous function of catheter-directed thrombolytic therapy by noninvasive venous tests such as Air plethysmography (APG) and duplex ultrasonography. METHOD: 36 patients with DVT of less than 3 weeks after development into two groups according to treatment modality:Group 1; catheter-directed thrombolysis with Urokinase followed by low-molecular weight heparin (LMWH) and coumadin therapy (n=19, men; 11, women; 8, mean age 47.6 years), Group 2; conventional anticoagulation with LMWH followed by coumadin therapy (n=17; men; 12, women; 5, mean age 47.1 years). The results of lytic therapy were examined by complete phlebography on time of removal of catheter. The location and extent of thrombotic changes were followed-up with duplex scan and venous function was examined with APG. RESULT: Complete clot resolution by lytic therapy was obtained in 12 cases out of 19 cases (63.2%) in Group 1. The residual thrombi at follow-up around 1 year were detected in 4 cases in Group 1, in 11 cases in Group 2. APG parameters that were significantly different (P<0.05) between the two groups were the venous filling index:(Group 1; 1.63+/-1.36 ml/sec, Group 2; 2.66+/-1.58 ml/sec), residual volume fraction (Group 1; 27.54+/-17.40%, Group 2; 49.19+/-20.45%) and outflow fraction (Group 1; 37.79+/-7.05%, Group 2; 32.36+/-6.31 %). The parameters of APG and ultrasonography in Group 1 revealed lesser degree of reflux and smaller amount of residual thrombi. CONCLUSION: Catheter-directed thrombolytic therapy shows better results in complete resolution rate of the acute DVT, reducing remnant thrombi, and preserving venous function such as venous filling index, residual volume fraction and outflow fraction. APG and duplex scanning seem to be useful methods for a complete follow-up evaluation of limbs with DVT.
Catheters ; Extremities ; Female ; Follow-Up Studies ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Lower Extremity* ; Male ; Phlebography ; Plethysmography ; Residual Volume ; Thrombolytic Therapy ; Ultrasonography ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis* ; Warfarin

Neuroendocrine pancreatic tumors (NPTs) arise from the pancreatic islet cells and belong to the amine and precursor uptake and decarboxylation (APUD) system. These tumors are rare and account for only 1% to 5% of pancreatic tumor. The pancreas is an extremely uncommon site of neoplasia in children and adolescents. For this reason, our understanding of these tumors is still quite limited. Although the complete surgical resection is the key to successful management of all malignant adolescence pancreatic tumors, the information on the possible role of chemotherapy and radiation in recurrent, unresectable, or metastatic cases is purely anecdotal. The 17-year-old man transferred to our hospital with abnormal ultrasonographic findings. Result of abdominal ultrasonographic examination showed a mass in the upper abdomen. He presented with 6months history of intermittent abdominal pain and vomiting and diarrhea. A computed tomography (CT) scan and magnetic resonance showed a 4.5 x 6 cm mass in the head of the pancreas. An ultrasound-guided core biopsy confirmed an pancreatoblastoma or pancreas islet cell tumor. On operative findings, there was locally advanced, unresectable tumor within the pancreatic head. We report a 17-years-old man patient with non-functional panceratic islet cell carcinoma.
Abdomen ; Abdominal Pain ; Adenoma, Islet Cell ; Adolescent* ; Biopsy ; Carcinoma, Islet Cell ; Child ; Decarboxylation ; Diarrhea ; Drug Therapy ; Head ; Humans ; Islets of Langerhans* ; Pancreas ; Vomiting

PURPOSE: Although duodenal perforation following ERCP is very rare compared to other complications, it can result in a fatal outcome. To find the most effective treatment strategy, the cases experienced at our hospital were reviewed and analyzed. METHODS: A retrospective chart review, conducted at our hospital between December 1994 and April 2006, identified 15 periduodenal perforation cases related to ERCP; a rate of 0.53%. The following parameters were reviewed: clinical presentation of perforation, diagnostic methods, time to diagnosis and operation, method of management, length of stay and outcome. RESULTS: Fourteen patients were managed by surgery and one conservatively. Eleven patients were cured without complications, but four suffered from severe complications, and required several re-operations. Two patients (50%) of the re-operated group died. The mean time to surgery was longer in the re-operated than non-re-operated group (34.3+/-12.4 hours vs. 17.2+/-21.7 hours). The causes for the reoperation were an anastomosis blowout in the duodenotomy for transduodenal sphincteroplasty in 3 and duodenal perforation at the site of transduodenal sphincteroplasty in the remaining patient. All re-operated cases had large retroperitoneal fluid collection, as seen on CT scanning, and had been operated on by inexperienced surgeons. CONCLUSION: The early detection is important for the treatment of a duodenal perforation following ERCP. If surgical treatment is needed, it must be performed within 24 hours. Although the type of surgical procedure will depend on the surgeon's preference, a less invasive procedure, such as simple closure & drainage, will be adequate in cases with a delayed diagnosis, a septic condition or an inexperienced surgeon.
Cholangiopancreatography, Endoscopic Retrograde* ; Delayed Diagnosis ; Diagnosis ; Drainage ; Fatal Outcome ; Humans ; Length of Stay ; Reoperation ; Retrospective Studies ; Sphincterotomy, Transhepatic ; Tomography, X-Ray Computed

The laparoscopic cholecystectomy has been clearly established as the gold standard for the surgical treatment of calculous biliary diseases. The currently used most popular technique is the four-trocar technique. This prospective study was designed to examine whether or not three-trocar technique could be chosen as an alternative to the standard four-trocar technique. Prospective data were collected on 98 patients undergoing a laparoscopic cholecystectomy at Wonkwang University Hospital from December 1995 to July 1996. We excluded 40 cases of acute cholecystitis which under went an operative cholangiogram with conversion to the four-trocar method as unfit for this study. We evaluated all associated clinical factors for the three-trocar technique (28 cases); and the four-trocar technique (30 cases), and we analysed the operating time, the intraoperative gallbladder perforation, postoperative complications, the postoperative hospital stay, and the duration for compliants of pain. Between the two techniques, there were no significant differences in the operating times, the postoperative complications, the postopeative hospital stays, and the durations for complaint of pain. However, intraoperative gallbladder perforation more frequently developed in the three-trocar technique than in the four-trocar technique (4 cases versus 1 case, P=0.02). However, gallbladder perforation didn't cause a prolonged operating time; or any other postoperative complication. In our series, the three-trocar technique had results similar to those of the four trocar technique. Morever, the three trocar technique was more economical and had cosmetic advantages. We conclud that a qualified laparoscopic surgeon can choose the three-trocar technique as an alternative to the four-trocar technique.
Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Gallbladder ; Humans ; Length of Stay ; Postoperative Complications ; Prospective Studies ; Surgical Instruments

PURPOSE: There were many studies for adverse effects of carbon dioxide insufflation for laparoscopic cholecystectectomy, mainly focused on cardiovascular and respiratory system. The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects. However, its effect on tissue trauma & postoperative pain remains controversial. The aim of this study was to compare postoperative pain intensity between different insufflation pressures in laparoscopic cholecystecetomy. METHODS: We randomly allocated fifty four patients to 7 mmHg (LC7), 9 mmHg (LC9) and 12 mmHg (LC12) pneumoperitoneum group and examined operation time, postoperative pain intensity using visual analogue scale, amount of administered analgesics and complications prospectively. RESULTS: The characteristics of the patients were similar among groups. The procedure was successfully completed in all patients in the LC12 gruop, but in five patients of LC7 group and one patient of LC9 group the insufflation pressure was increased to 12 mmHg to complete the operation. There were no significant difference in postoperative pain scores, analgesic comsumptions among groups. There were difficulties to get a safe hemostasis and to create a adequate working space at acute cholecystitis in LC7 group. CONCLUSION: In our study, there was no superior advantage for postoperative pain when low pressure pneumoperitoneum was applied.
Analgesics ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Hemodynamics ; Hemostasis ; Humans ; Insufflation* ; Pain, Postoperative* ; Pneumoperitoneum ; Prospective Studies ; Respiratory System

Myotonic dystrophy is a multisystemic disorder inherited as an autosomal dominant trait. The characteristic clinical features include the presence of myotonia, atrophy of the muscles of the face and the sternocleidomastoids and numerous nonmusclar manifestations such as cataracts, frontal baldness, gonadal dysfunctions and cardiac abnormalities. We experienced one case of myotonic dystrophy with prolonged atrial flutter in 30-year-old male who was admitted because of palpitation. We present this case with reviewing literatures.
Adult ; Alopecia ; Atrial Flutter* ; Atrophy ; Cataract ; Gonads ; Humans ; Male ; Muscles ; Myotonia ; Myotonic Dystrophy*

Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. The tumor was characterized by high serum alpha-fetoprotein (AFP) levels. A 73-year-old male patient was admitted to the hospital with abdominal pain. Gastrofiberscopy revealed a gastric tumor occupying the antrum and pylorus. Radical subtotal gastrectomy was done and the result of biopsy was poorly differentiated adenocarcima of stomach and stage 3B. At postoperation 8 month, AFP was elevated and liver mass was detected on CT. Right extended hepatectomy was done under the impression of primary liver tumor. But, the biopsy revealed metastatic hepatoid adenocarcinoma of the stomach. Re-examination of the resected stomach was done and the result was hepatoid adenocarcinoma of the stomach. Two months later, after the hepatic resection, multiple metastases developed. This type of tumor has frequent early liver metastasis and poor prognosis. Therefore, early diagnosis and more careful investigation for liver metastasis are recommended.
Abdominal Pain ; Adenocarcinoma ; Aged ; alpha-Fetoproteins ; Biopsy ; Early Diagnosis ; Gastrectomy ; Hepatectomy ; Humans ; Liver ; Male ; Neoplasm Metastasis ; Prognosis ; Pylorus ; Stomach