PURPOSE: To evaluate the effectiveness, patency and safty of a self-expandable nitinol stent for palliative treatment of malignant stricture of gastroesophageal junction. MATERIALS AND METHODS: An esophageal stent was inserted in five consecutive patients with malignant stricture of esophagogastric junction. Histologicaily, four cases were adenocarcinoma, and one was squamous cell carcinoma. The location and severity of stricture were evaluated with gastrografin just before stent insertion. In one patient with past subtotal gastrectomy, esophagography revealed fistulous tract at stricture site. RESULTS: No technical failure or procedural complications occurred, and improvement of dysphagia was noted in all patients soon after stent insertion. On follow up esophagograms performed 3 to 7 days after stent insertion, all stents were completely expanded and unchanged in positions. In one patient with fistulous connection at stricture site, esophagogram immediately after the procedure revealed complete occlusion of the fistula. Three patients died within 4, 7 and 8 consecutive months after stent insertion. Two patients are alive maintaining adequate body weight and passing most diet. CONCLUSIONS: Self-expandable nitinol stent with it's good longitudinal flexibility and efficient radial force was effective in the palliative treatment of dysphagia in patient with malignant stricture at esophagogastric junction.
Adenocarcinoma ; Body Weight ; Carcinoma, Squamous Cell ; Constriction, Pathologic* ; Deglutition Disorders* ; Diatrizoate Meglumine ; Diet ; Esophagogastric Junction ; Fistula ; Follow-Up Studies ; Gastrectomy ; Humans ; Palliative Care ; Pliability ; Stents*

PURPOSE: To evaluate the difference in each procedure time and complication rates related to percutaneous transhepatic biliary drainage(PTBD) via the right and the left hepatic lobe. MATERIALS AND METHODS: We performed PTBD in 120 patients with biliary obstruction below both main hepatic ducts. Of the 120 catheters, 54 were introduced via a left lobe approach and 66 through the right lobe. All procedures were performed under fluoroscopic guidance by the same operator. For each patient, procedure time was recorded prospectively. PTBD related complications were classified as either early(up to 30 days after procedure) or late(after 30 days), and each complication graded as major, or minor according to its intensity. RESULTS: The difference in the mean procedure time(28.8min versus 36.2rain, left versus right approach group) and that in complication rates (37% versus 58%) were statistically significant(p<0.05). Concerning major complications(bile peritonitis, sepsis, massive hemobilia, liver abscess, pyothorax), the percentages related to left and right lobe approach were 1.8% and 10.6%, and concerning minor complications(catheter obstruction or dislodgement, transient hemobilia, persistent fever or pain), the percentages were 36%and 51%respectively. CONCLUSIONS: PTBD via the left lobe approach was superior with short procedure time and low complication rates than the right approach.
Catheters ; Fever ; Hemobilia ; Hepatic Duct, Common ; Humans ; Liver Abscess ; Peritonitis ; Prospective Studies ; Sepsis

In several pathologic conditions of the joints, it is rather frequent to find a swollen joint. The authors performed an analysis of the joint fluid proteins from 20 cases of rheumatoid arthrit is and 20 normal Kore an adults with the object of evaluating the significance of it s clinical application. The study was done with Beckman Model R System, Durrum type cell, and scanned with Model RB Analytrol. Scheicher and Schuell 2043-A paper was used with diethyl barbituric acid-sodium diethyl barbituratebuffer, pH 8.6, ionic strenght 0.075 and stianed with 0.1% bromphenol blue. The results obtained were as follows: 1) The amount of total protein was significantly increased with average of 4.80 + 1.249gm% in comparison with 2.34 + 0.553gm% in normal group. 2) Albumin fraction showed the average of 41.86 + 6.219% in comparison with 64.85 + 5.288% in normal group. 3) Alpha 2 globulin fraction disclosed the average of 10.19 + 3.379% in comparison with 4.24 + 1.158% in normal group, which was significantly increased one. 4) Gammaglobulin fraction was also significantly elevated with the average of 21.51 + 8.942% in comparison with 11.70 + 1.923% in normal group. 5) There was noted a decreased A/G ratio, the average of 0.74 + 0.196, in comparison with 1.911 + 0.430 in normal group.
Adult ; Arthritis, Rheumatoid ; Bromphenol Blue ; Humans ; Hydrogen-Ion Concentration ; Joints

Corneal ulcerations are divided into two morphologic types: central and marginal. Marginal corneal ulcerations are characterized by focal, muItifocal, multifocal or diffuse ulcerative, infiltrative, or vascular involvement of the peripheral cornea, and the exact pathogenesis of these ulcerations is not clearly understood but infectious, toxic or autoimmune factors may be involved. The authors treated one peripheral corneal ulcer patient, no respond to steroid and antibiotic therapy, with lamellar keratoplasty and had a good result.
Cornea ; Corneal Transplantation* ; Corneal Ulcer* ; Humans ; Ulcer

Primary carcinoma of the uterine tube is one of the least common gynecologic malignancies with a reported incidence of approximately 0.3%. As a result of it, the experience of any one physian is limited. Almost all cases are adenocarcinoma and the cilinical presentation is generally nonspecific, of which the most common symptom is postmenopausal vaginal bleeding. Primary fallopian tube carcinima is infrequently diagnosed before explolatory laparotomy and the majority of patients have extensive disease at diagnosis. We have experienced a case of fallopian tube cancer and report with brief review of literature
Adenocarcinoma ; Diagnosis ; Fallopian Tube Neoplasms ; Fallopian Tubes* ; Female ; Humans ; Incidence ; Laparotomy ; Uterine Hemorrhage

It has been Known that silicone intubation may be an effective procedure for total or partial obstruction in infants of age one year or less, and the older the patient, the lower the success rate. We had performed silicone intubation on 40 eyes of 39 patients from january 1995 to May 1996, and they were divided into 3 groups according to age: group 1, 6 months to 6 years: group 2,6 to 16.: group 3, one 16 years. The success rate was 92.4% in groups 1 and 2, respectively: 83.3% ingroup 3. The success rate in patients with partial obstruction in group 3 was 100% In view of the results of the present study, silicone intubation may be in primary procedure for partial obstruction of lacrimal drainage system.
Drainage ; Humans ; Infant ; Intubation* ; Silicones*

Aspiration and resultant chemical pneumonitis remain a serious hazard associated with the administration of anesthesia. Anticholinergic drugs are commonly used to reduce the volume and acidity of gastric secretion. We studied the effectiveness of atropine, glycopyrrolate and cimetidine in increasing gastric pH, free acidity and total acidity in the pre-and the 1hr post-anesthesia. Fifty patients scheduled for elective surgery in Dept. of Ansthesiology in EWUH, were randomly allocated into five groups with ten patients in each group. Patients in the control group were given neither anticholinergics nor cimetidine; patients in group I received 0.5 mg of atropine intramuscularly 1 hr. before induction of anesthesia, patients in group II received 0.2 mg of glycopyrrolate intramuscularly 1 hr. before induction of anesthesia, patients in group III received 200 mg of cimetidine intravenously and atropine as in group I, patients in group IV received 200 mg of cimentidine intravenously and glycopyrrolate as in group II. The results were as follows; 1) There were not any significant changes in the gastric pH, free acidity or total acidity in any of the patient groups in pre-and post-anesthesia. 2) In the control group, the mean gastric pH was 1.86+/-0.07, free acidity was 33.48+/-8.73 and total acidity was 49.31+/-9.10. 3) In the group I, the mean gastric pH was 2.62+/-0.24, free acidity was 5.65+/-1.89 and total acidity was 19. 76+/-3.27. Compared with the control group, the gastric pH in group I increased but free acidity and total acidity both decreased significantly(p<0.05). 4) In the group II, the mean gastric pH was 3.46+/-0.52, free acidity was 4.18+/-l.75 and total acidity was 19.76+/-3.27. 5) In the group III, the mean gastric pH was 6.17+/-0.66, free acidity was 10.96+/-4.42. Compared with the control group, the mean gastric pH in group III increased but free acidity and total acidity both decreased significantly(p<0.001).6) In the group IV, the mean gastric pH was 2.70+/-0.39, free acidity 11.01+/-4.73 and total acidity was 33.41+/-5.81. Compared with the control group, the gastric pH in group IV increased but free acidity and total acidity both decreased significantly(p<0.05). So, compared with the control group, the mean gastric pH above 2.5 increased significantly in the all groups. In conclusion, it would seem that the incidence of severe aspiration pneumonitis can be decreased by anticholinergic drugs and cimetidine pretreatment in surgical patients.
Anesthesia ; Atropine ; Cholinergic Antagonists* ; Cimetidine ; Glycopyrrolate ; Humans ; Hydrogen-Ion Concentration* ; Incidence ; Pneumonia

We have experience with a case of eclampsia under general anesthesia for primary Cesarean section. The patient had fits 6 times for 9 hours at home and hospital. The Apgar score of the neonatal infant was five and seven points at one and five minutes after delivery, respective1y. After the end of the operation, the patient had attacks, of fits 2 times and a semicomatous mental state in the recovery room. Then l2 hours later the patient recoveried completely without any special complications. A review of the literature is reported with the incidence etiology and treatment of the eclampsia during pregnancy.
Anesthesia, General* ; Apgar Score ; Cesarean Section* ; Eclampsia* ; Female ; Humans ; Incidence ; Infant ; Pregnancy ; Recovery Room

Spinal anesthesia is a type of regional anesthesia obtained by blocking the spinal nerves with the introduction of local anesthetic solutions into the subarachnoid space. Historically, in 1885 Corning accidentally introduced spinal anesthesia and in 1898 August Bier produced true spinal anesthesia in animal and man for the first time. Even though spinal anesthesia is widely used because of many advantages, headache, the most common untoward complication, has been said to be the greatest single deterrent to the patient who is considering this anesthetic technique. The obstetric patient is more likely to suffer from headache than the surgical patient after spinal anesthesia. Authors observed the incidence of post-spinal headache in 288 patients who received spinal anesthesia for cesarean section at department of anesthesiology in Ewha Womans University Hospital from March 1979 to February 1980. The patients were divided into 2 groups according to the needle size, used to perform spinal tap i.e. 22 and 25 gauge (G). The results obtained were as follows; 1) Among 288 cases, 63 cases underwent spinal anesthesia with 22 G and 225 cases with 25 G. 2) The indications for cesarean section were previous cesarean section(36. 8%), cephalopelvic disproportion(20.5%), malpresentation(10. 7%) and placenta previa(4. 2%) in order of frequency. 3) In the age distribution, the majority(72.6%) was in 20~29 years age group. 4) The incidence of headache was higher in the group of 22 G(17.8%) than in 25 G group (9. 8%), but there was no statistical significance. 5) The onset of headache was within 2 or 3 days after spinal anesthesia in both groups. 6) In the severity of headache, the group of larger size needle showed headache worse than that of small size needle. 7) In the location of headache, generalized headache developed in 54. 5% of cases in the group of 22 G needle and frontal headache developed in 40. 9% in the group of 25 G needle. 8) Ocular complication associated with headache noted in 2 cases of the group of 25 G needle. There was no auditory complication.
Age Distribution ; Anesthesia, Conduction ; Anesthesia, Spinal ; Anesthesiology ; Animals ; Cesarean Section* ; Clinical Study* ; Female ; Headache* ; Humans ; Incidence ; Needles ; Placenta ; Pregnancy ; Spinal Nerves ; Spinal Puncture ; Subarachnoid Space ; Zea mays

It is well known that the medullary carcinoma of the breast is one of the special types of breast carcinoma with a good prognosis. At present, the medullary carcinoma of the breast is subclassified into 3 types: typical medullary, atypical medullary and nonmedullary carcinoma. Among them, the former has the best prognosis. We reviewed the film mammographic and ultrasonomammographic findings of 13 patients according to the reevaluated histopathologic diagnosis. Typical medullary carcinoma shows a well circumscribed mass with surrounding halo on film mammogram, and well defined mass with central intermediate echogenicity and peripheral low echogenicity and posterior acoustic enhancement on ultrasonomammogram. Atypical medullary carcinoma shows relatively well circumscribed mass with partial marginal obliteration on film mammogram, and irregular bordered mass with inhomogeneous echogenicity due to focal necrosis in the mass and associated findings of thick boundary, asymetrical lateral shadowing on ultrasonomammogram. Nonmedullary carcinoma shows lobulated mass with surrounding parenchymal distortion and skin thickening on film mammogram, and relatively well defined lobulating mass with surrounding parenchymal distortion and marked heterogeneous internal echogenicity on ultrasonomammogram. Therefore, differentiation between typical medullary carcinoma with good prognosis and atypical medulary or nonmedullary carcinoma with poor prognosis, may be possible by various diagnostic imaging modalities preoperatively. But further collective study shall be needed in near future.
Acoustics ; Breast Neoplasms ; Breast* ; Carcinoma, Medullary* ; Classification* ; Diagnosis ; Diagnostic Imaging ; Humans ; Necrosis ; Prognosis ; Shadowing (Histology) ; Skin