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

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*

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

No abstract available.
Arthroscopy* ; Retrospective Studies* ; Temporomandibular Joint*

Direct laryngoscopy and endotracheal intubation cause increased arterial blood pressure and heart rates. These cirulatory effects are due to mechanical stimulation of the laryngopharynx and traches via efferent cervical sympathestic fibers. And various cardiac arrhythmias, even-cardiac arrest may occur by stimulation of the vague nerve during intubation. The present study observed the ECG and circulatory changes following i.v. injection of meperidine, 50 mg, and diazepam, 10mg, as primary i.v. anesthetic agents, for the purpose of the prevention of circulatory stimulation before laryngoscopy and tracheal intubation. This study was undertaken on eight-eight, ASA class l-ll patients of either sex undergoing elective surgical procedures in the Department of Anesthesiology at Ewha Womans University hospital. The results were as follows: 1) The increases of systolic blood pressure following intubation were markedly reduced in the pre-treated groups for both normotensive and hypertensive individuals. 2) Heart rates following intubation were markedly increased in all groups. 3) Transient abnormal findings in the ECG appeared in sixty-nine cases(78.4%) following intubation and the majority showed sinus tachycardia. 4) pH, PaCO2, and PaO2 values were within normal range following intubation in all groups.
Anesthesiology ; Anesthetics ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Pressure ; Diazepam* ; Electrocardiography ; Female ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy* ; Meperidine* ; Reference Values ; Surgical Procedures, Elective ; Tachycardia, Sinus

The authors have experience with a case of cephalo-pelvic disproportion associated with acute hapatitis during fullterm pregnancy under the spinal anesthesia for Cesarean section at the Ewha Womans University Hospital. The past ohstetric history revealed spontaneous abortion 2 times and no special medication and blood transfusion. During operation the patients condition was unstable due to severe hypotension after spinal anesthesia. At 14 hours after the end of the operation, the patient expired because of acute renal shut down accompanied by continuous vaginal, bleeding and oozing from the operation wound. The neonatal infant expired also. A review of the literature is reported with the incidence, eriology, signs, symptoms and treatment of the liver disease during pregnancy.
Abortion, Spontaneous ; Anesthesia, Spinal* ; Blood Transfusion ; Cesarean Section* ; Female ; Hemorrhage ; Hepatitis* ; Humans ; Hypotension ; Incidence ; Infant ; Liver Diseases ; Pregnancy ; Wounds and Injuries

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

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