Aneurysm of the splanchnic arteries are an uncommon form of vascular disease that have a significant potential for rupture or erosion into an adjacent viscera, resulting in life-threatening hemorrhage. Nearly 22% of these aneurysms present as surgical emergencies, including 8.5% that result in death. The major splanchnic vessels affected, in descending order of frequency, include the splenic(60%), hepatic(20%), superior mesenteric, celiac, gastric and gastroepiploic, jejunal-ileal-colic, pancreaticoduodenal and pancreatic, gastroduodenal arteries. Although in most instances these aneurysms are asymptomatic, their propensity for catastrophic exsanguinating rupture has long been recognized. Surgical and nonsurgical intervention has paralleled advances in angiography and vascular surgical technique. Currently, the increased use of percutaneous catheter-based therapy in the management of that disease. We report our experiences with surgical intervention and transcatheter arterial embolization(TAE) in 7 patients with splanchnic artery aneurysms. These consisted of 2 splenic, 3 hepatic, and 2 gastroduodenal artery aneurysms. Two splenic artery aneurysm patients were treated surgically with ligation of the proximal and distal aneurysm and splenectomy; one died of a ruptured splenic artery aneurysm before surgery was initiated and another was no further treatment. Other 5 patients were treated by TAE; no complications and no further treatments during follow-up. TAE is a safe and highly successful technique for the effective identification and treatment of splanchnic artery aneurysm.
Aneurysm ; Angiography ; Arteries ; Emergencies ; Follow-Up Studies ; Hemorrhage ; Humans ; Ligation ; Rupture ; Splenectomy ; Splenic Artery ; Vascular Diseases ; Viscera

BACKGROUND: It is common practice for surgeons to place a T-tube after common bile duct exploration. T-tubes are regarded as safe and they allow postoperative cholangiography. But the unexpected cases of bile peritonitis after T-tube removal raised questions of common factors in etiology. The aim of this study is to investigate risk factors of biliary leakage after removal of T-tube from common bile duct. Materials and METHODS: Seven cases of biliary leakage after removal of T-tube have been experienced in Department of Surgery of Chonnam National University Hospital from January 1988 to March 2000. Seven cases were investigated with respect to the following parameters : presenting disease, underlying disease, laboratory findings, nutritional status, findings associate with T-tube, clinical findings and the results of treatments. RESULTS: The mean age of the patients was 62.9years(range, 45-77years). The presenting diseases were CBD stone with GB stone in three cases, CBD stone in two cases, IHBD stone in two cases. Previous medical history was unremarkable with the exceptions of one hypertensive patient and one patients with early gastric cancer concurrently undergoing treatment for hypertrophic cardiomyopathy. The mean body mass index(BMI) of the patients was 20.5. Arterial blood gas analyses and pulmonary function tests were normal. Preoperative laboratory findings were unremarkable except one patient of hypoalbuminemia. Liver function tests were normal, except in one patient with toxic hepatitis. In all cases, silastic T-tube was inserted following cholecystectomy and choledocholithotomy. The mean CBD diameter was 16.4mm (range, 12-21mm). CBD repair was done with absorbable sutures. Postoperative T-tube cholangiography revealed a remnant stone in the patients with the left intrahepatic stone and were unremarkable in all other cases. The T-tube was removed after a mean duration of 24.6days(range, 15-53). The abdomial pain and tenderness in all patients, most frequently in the right upper qudrant, was the significant sign and symptom associated with bile leakage. The symptoms resolved in four of five patients by drainage using a nelaton tube. The remaining patients(n=3) underwent reinsetion of T-tube. CONCLUSIONS: It is very difficult to predict the occurrence of bile leakage after T-tube removal. And early diagnosis and immediate percutaneous drainage make a good result in patient with localized peritonitis.
Bile* ; Blood Gas Analysis ; Cardiomyopathy, Hypertrophic ; Cholangiography ; Cholecystectomy ; Common Bile Duct* ; Drainage ; Drug-Induced Liver Injury ; Early Diagnosis ; Humans ; Hypoalbuminemia ; Jeollanam-do ; Liver Function Tests ; Nutritional Status ; Peritonitis* ; Respiratory Function Tests ; Risk Factors ; Stomach Neoplasms ; Sutures

OBJECTIVE: The purposes of this study were 1) to determine whether preeclampsia itself affects failure of labor induction with prostaglandin E2 and oxytocin and 2) to investigate risk factors for failed induction in women with preeclampsia. METHOD: Fifty preeclamptic women and 175 nonpreeclamptic women requiring labor induction were studied prospectively. Intravaginal prostaglandin (PG) E2 tablet (Dinoprostone, The Upjohn company, 3 mg) followed by a second dose if the cervix assessed 6 hours later was 5 or less of Bishop score, and oxytocin were used for labor induction. Women with rupture of membrane, spontaneous contraction resulting in cervical change or an initial cervical examination showing more than 2 cm dilatation and 50% effacement were excluded. Statistics were analyzed with 2 test, Student t test, and multiple logistic regression. RESULTS: 1) The women with preeclampsia had a significantly higher rate of failed induction than did those without preeclampsia [24% (2/50) versus 9% (16/175); p <0.05]. However, the women with preeclampsia had a higher rate of the use of magnesium sulfate, and were more likely to decrease gestational age at induction and increase maternal weight than those without preeclamp sia (p <0.0001, respectively). There were no significant differences in prevalence of nulliparity and low initial Bishop score (< or =3) between the women with and without preeclampsia. 2) Multiple logistic regression showed that preeclampsia itself was not associated with failed induction after correction of known confounding variables (odds ratio 0.22, 95% confidence interval 0.03-2). 3) In women with preeclampsia, the use of magnesium sulfate only was associated with increased risk of failed induction analyzed by multiple logistic regression(odds ratio 38.5, 95% confidence interval 1.6-897). Maternal weight with 70 kg or more was associated with increased risk of failed induction, but it is not statistically significant (p=0.055). CONCLUSIONS: 1) The risk of failed induction is increased in women with preeclampsia, but not by preeclampsia itself but by the use of magnesium sulfate, prematurity, and increased maternal weight secondary to preeclampsia. 2) The use of magnesium sulfate is independent risk factor for failed induction in women with preeclampsia.
Cervix Uteri ; Confounding Factors (Epidemiology) ; Dilatation ; Dinoprostone* ; Female ; Gestational Age ; Humans ; Logistic Models ; Magnesium Sulfate ; Membranes ; Oxytocin* ; Parity ; Pre-Eclampsia* ; Prevalence ; Prospective Studies ; Risk Factors ; Rupture

Mature cystic teratoma comprises approximately 10-20% of all ovarian neoplasms and malignant transformation from mature cystic teratoma is reported to be less than 2%. Squamous cell carcinoma is the most frequent malignancy (80%) arising in mature cystic teratoma followed by sarcoma (7-8%), adenocarcinoma (6-7%), carcinoid tumor, melanoma, choriocarcinoma (1-2%). Prognosis of squamous cell carcinoma in mature cystic teratoma is reported much poorer than that of epithelial ovarian cancer with the same stage. We experienced one case of squamous cell carcinoma arising in mature cystic teratoma.
Adenocarcinoma ; Carcinoid Tumor ; Carcinoma, Squamous Cell* ; Choriocarcinoma ; Female ; Melanoma ; Ovarian Neoplasms ; Ovary* ; Pregnancy ; Prognosis ; Sarcoma ; Teratoma*

BACKGROUND: It is difficult to treat patients with hepatolithiasis because of recurrent or residual stones and serious postoperative complications. This study was done to compare the operation method and postoperative progression related to location of the hepatolithiasis. METHODS: Retrospective analysis was done in 234 patients who underwent operation due to hepatolithiasis from Jan. 1989 to Dec. 1998 in Chonnam University Hospital. RESULTS: The patients with left intrahepatic duct stones were 135, with right intrahepatic duct stones were 30 and with both intrahepatic duct stones were 69. In cases of resection of the liver, left lobectomy, left lateral segmentectomy, right posterior segmentectomy or right lobectomy was done. In a patient with stone in caudate lobe, caudate lobectomy was done. In non-resected group choledocholithotomy was done. Of 135 patients with left intrahepatic stones, 117 patients(86.7%) underwent hepatic resection and 18 patients(13.3%) underwent choledocholithotomy. Of 30 patients with right intrahepatic stones, 6 patients(20.0%) underwent hepatic resection and 24 patients(80.0%) underwent choledocholithotomy. Of 69 patients with both intrahepatic stones, 36 patients(52.2%) underwent resection and 33 patients(47.8%) underwent choledcholithotomy. Overall incidence of remnant stone was 28.2%. In resected group of left intrahepatic stones, the incidence of remnant stones was 8.5% and in non-resected group 33.3%. In resected group of right intrahepatic stones, the incidence of remnant stones was 0% and in non-resected group 37.5%. In resected group of both intrahepatic stones, the incidence of remnant stones was 55.6% and in non-resected group 63.6%. Incidence of postopertive complications was 22.6% and wound complication was most common. There was no postoperative mortality. CONCLUSIONS: Hepatic resection for hepatolithiasis confined to one lobe has an advantage of low incidence of remnant stone without increasing the morbidity and mortality rate. In both intrahepatic stones, the treatment is difficult, but if operation is performed with proper selection of extent of hepatic resection, favorable result would be expected.
Humans ; Incidence ; Jeollanam-do ; Liver ; Mastectomy, Segmental ; Mortality ; Postoperative Complications ; Retrospective Studies ; Wounds and Injuries

Typically, patients afflicted with syndrome X complained of stress induced angina pectoris, and their electrocardiograms show corresponding ST-segment depressions during exercise. However, angiography is unable to demonstrate significant coronary artery luminal narrowing and significant coronary artery spasm to provocation test. And left ventricular performance at rest remains remarkably unimpaired. Syndrome X is characterized by reduction of coronary vascular reserve but without depression of left ventricular performance or negative effect on survival. The reduction of coronary vascular response is supposed to be resulted from reduced coronary vasodilator reponse due to abnormal contraction of coronary prearteriolar vessels. This case is a 43-year-old female who has had exertional chest pain since 5 months ago. The chest pain was relieved by rest and subligual nitroglycerin administration. The exercise electrocardiography showed significant ST segment depressions on lead II, III aVF and V4-V6 at stage 1, when she experienced chest pain. On 24 hour ambulatory electrocardiogram, significant ST segment depression was recorded at the time when the patient had chest pain. But coronary arteriography demonstrated normal coronary artery and no significant coronary artery spasm to provocation test with ergonovine maleate. On exercise thallium-201 scintigraphy, perfusion decrease was suspected on anterolateral wall of left ventricle. The patient was diagnosed as a syndrome X and was managed with isosorbide and nifedipine and her exercise tolerance increased significantly on follow up exercise test performed 1 month later. But she has complained of a few of attack of chest pain until now.
Adult ; Angina Pectoris ; Angiography ; Chest Pain ; Coronary Vessels ; Depression ; Electrocardiography ; Ergonovine ; Exercise Test ; Exercise Tolerance ; Female ; Follow-Up Studies ; Heart Ventricles ; Humans ; Isosorbide ; Nifedipine ; Nitroglycerin ; Perfusion Imaging ; Phenobarbital ; Spasm

Tetrodotoxin is a neurotoxin produced by about 90 species of puffer fish and causes paralysis of central nervous system and peripheral nerves by blocking the movement of all monovalent cations. Ingestion of tetrodotoxin produces clinical manifestations such as paresthesias(within 10-45 min), vomiting, lightheadedness, salivation, muscle twitching, dysphagia, difficulty in speaking, convulsion and death that expressed by cardiopulmonary arrest with loss of brain stem reflex sometimes. Tetrodotoxin prevents or delays ischemia induced neuronal death by way of following 3 mechanisms. Firstly, it reduces the energy demand of the brain tissues. Secondly, it delays or even prevents anoxic depolarization. Finally, it diminishes ischemia induced cell swelling and cerebral edema. We report a case of puffer fish poisoning which presented with cardiopulmonary arrest and loss of brain stem reflex, but completely recovered by aggressive cardiopulmonary resuscitation.
Brain ; Brain Edema ; Brain Stem ; Cardiopulmonary Resuscitation ; Cations, Monovalent ; Central Nervous System ; Deglutition Disorders ; Dizziness ; Eating ; Heart Arrest ; Ischemia ; Neurons ; Paralysis ; Peripheral Nerves ; Poisoning* ; Reflex ; Salivation ; Seizures ; Tetraodontiformes* ; Tetrodotoxin ; Vomiting

OBJECTIVE: Leptin, the protein encoded by the Ob gene in the adipose cell, is produced by the placenta during pregnancy and materanal serum leptin is increased in preeclampsia. The objective of this study was to compare umbilical cord plasma leptin level between infants of mothers who experienced preeclampsia and infants of control subjects and to understand the physiology of leptin. METHODS: Leptin concentrations were measured in cord blood at birth using a specific radioimmunoassay employing human recombinant leptin (Human leptin RIA kit; Linco Research, Inc. U.S.A.). We compared cord plasma leptin between preeclamptic (n=17 women) and normal pregnancies (n=21 women). RESULTS: Gestational age is the only one significant variable among the demographic variables (P=0.011). There was no statistically significant difference in cord plasma leptin level between infants of mothers who experienced preeclampsia and infants of control subjects, but preeclampsia group had slightly lower leptin levels than control subjects (Control subjects: 4.8 [3.7-7.9] ng/ml, Preeclamptic women: 2.7 [2.3-6.8] ng/ml, P=0.142). There was also no difference in the leptin value adjusted for different gestational age, or ratio between cord plasma leptin level and gestational age (Control subjects: 0.017 [0.013-0.018], Preeclamptic women: 0.010 [0.008-0.025], P=0.131). CONCLUSION: We found no difference between umbilical cord plasma leptin in infants of mothers who had preeclampsia and umbilical cord plasma leptin in infants of control subjects, but insignificantly lower levels of umbilical cord plasma leptin in infants of mothers who had preeclampsia. It suggest that maternal serum concentration do not correlate with cord leptin concentration and dysregulation of leptin metabolism and/or function in the placenta may be implicated in the pathogenesis of preeclampsia.
Female ; Fetal Blood ; Gestational Age ; Humans ; Infant ; Leptin* ; Metabolism ; Mothers ; Parturition ; Physiology ; Placenta ; Plasma* ; Pre-Eclampsia ; Pregnancy ; Pregnant Women* ; Radioimmunoassay ; Umbilical Cord*

OBJECTIVE: To compare the usefulness of prenatal screening tests for chromosomal abnormalities by analyzing the cytogenetic results of midtrimester amniocentesis METHODS: We reviewed a total of 1264 cases of midtrimester prenatal genetic amniocentesis performed from February 1997 to September 2003, of which accorded to indications of cytogenetic studies. Cytogenetic results were analyzed with the distribution of maternal age, indications of amniocentesis. RESULTS: The most common age of total subjects was in between 35-39 years (37.1%). The indications of amniocentesis were abnormal maternal serum marker (60.0%), advanced maternal age (34.8%), abnormal ultrasonographic findings (3.2%), in order. The overall incidence of chromosomal aberration was 3.9% (49/1264). No significant difference was found between the mean maternal age with and without abnormal fetal karyotype. According to indications, there was 12.5% (5/49) of chromosomal abnormalities in abnormal sonographic finding group, 5.2% (36/688) in abnormal maternal serum screening group and 2.4% (12/498) in advanced maternal age group. There was statistical significance (P=0.004) only in abnormal ultrasonographic finding group. CONCLUSION: Ultrasonography was become to be more important due to development of high resolution ultrasonography, skillful technique and awareness of sonographic markers. Ultrasonographic abnormality could be the most predictive marker for abnormal fetal karyotypes.
Amniocentesis* ; Biomarkers ; Chromosome Aberrations ; Cytogenetics ; Female ; Humans ; Incidence ; Karyotype ; Mass Screening ; Maternal Age ; Pregnancy ; Pregnancy Trimester, Second* ; Prenatal Diagnosis ; Ultrasonography

OBJECTIVE: The purposes of this study was to evaluate the frequency of Leiden mutation (missense mutation in the factor V gene at exon 10, 1691 CGA to CAA) in Korean women with well characterized pregnancy-induced hypertension (PIH) compared with normotensive gravid women. METHODS: Genomic DNA from 121 PIH cases and 98 normotensive pregnant control cases were used for polymerase chain reaction (PCR). To genotype Leiden mutation (missense mutation in the factor V gene, exon 10 (1691 G to A)), primers (5'-TGC CCA GTG CTT AAC AAG ACC A-3', 5'-TGT TAT CAC ACT GGT GCT AA-3') were employed to make 267 base pair (bp) PCR product. There was an initial denaturation at 94 degrees C 5 min, followed by 30 cycles of one minute at 94 degrees C, one minute at 55 degrees C, and one minute at 72 degrees C. A 267 bp PCR product was further digested with Mnl I for 2 hour at 37 degrees C and analysed through 12% polyacrylamide gel electrophoresis to determine genotype. Allele 1691G yielded 37 bp, 67 bp, 163 bp fragment and allele 1691A yielded 67 bp, 200 bp fragment. RESULTS: We examined the genotypes of factor V of 121 Korean women with pregnant induced hypertension and 98 normal pregnant women. None of the 219 Korean women carried the factor V Leiden mutation. CONCLUSION: The factor V Leiden mutation is absent and not a common cause of PIH in Korean women.
Alleles ; Base Pairing ; DNA ; Electrophoresis, Polyacrylamide Gel ; Exons ; Factor V* ; Female ; Genotype ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced* ; Polymerase Chain Reaction ; Pregnancy ; Pregnant Women