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

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*

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

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

OBJECTIVE: This study is to investigate the efficacy and toxicity of paclitaxel plus carboplatin used as a salvage therapy. METHODS: Between June 2000 and November 2003, 10 patients aged 43-74 (median 55.0) with recurrent ovarian carcinoma were given combination chemotherapy including paclitaxel and carboplatin. The subjects received initial chemotherapy with paclitaxel plus cisplatin/carboplatin. On recurrence, paclitaxel was administered intravenously at a dose of 175 mg/m2 with carboplatin by AUC 5 every 3 weeks. The median treatment cycle was 10 cycles (range, 1 to 15 cycles). Recurrence of ovarian carcinoma was determined by elevation of serum CA-125, or radiologic imaging. Responses and toxicities were evaluated according to Gynecologic Oncology Group criteria and Common Terminology Criteria for Adverse Events from NCI (National Cancer Institute). RESULTS: The overall clinical response rate was 60.0% (6/10). Better response was observed in patients who were sensitive with initial chemotherapy. Anemia was the most frequent complication. CONCLUSION: Paclitaxel and carboplatin has been shown to be a feasible agent in patients with recurrent ovarian cancer.
Anemia ; Area Under Curve ; Carboplatin* ; Drug Therapy* ; Drug Therapy, Combination ; Humans ; Ovarian Neoplasms ; Paclitaxel* ; Recurrence ; Salvage Therapy

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

OBJECTIVE: We performed this study to understand correlation between clinical aspects and pathological findings of abnormal uterine bleeding (AUB) and to evaluate the prognostic variables of endometrial hyperplasia. METHODS: We reviewed 500 premenopausal women with abnormal uterine bleeding who underwent endometrial biopsy from January 1996 to February 2003, retrospectively. Pregnant women, or women who had hematologic disease, or who used iatrogenic hormones were excluded. The age of women with AUB was mostly in the 5th decade (41.3 +/- 6.8). Body mass index (BMI) in most of women (69.6%) was between 18.6 and 24.9 (22.7 +/- 3.5). RESULTS: Among AUB menorrhagea (51.0%) was the most common bleeding pattern, and the next one was intermenstrual bleeding (38.0%). Histologic findings of endometrium were proliferative phase (34.0%), hyperplasia (26.4%), and seceretory phase (22.6%), in order of frequency. 79.0% (104 cases) of endometrial hyperplasia were simple hyperplasia, 16.0% (21 case) were complex hyperplasia, and 5.0% (7 case) were atypical hyperplasia. The associated diseases were myoma uteri, hypertension, and diabetes mellitus, in order of frequency. The endometrial hyperplasia was diagnosed in 46.4% of patients whose BMI was between 27.0-29.9, in 40% of patients between 30.0-34.9 and in 100% of patients whose BMI was 35.0 or more. The endometrial hyperplasia was diagnosed in 40.6% of patients with an endometrial thickness measured 15.1 mm to 20.0 mm, in 57.1% of patients with 20.1 mm to 25.0 mm, and in 100% of patients with 25.1 mm or higher. CONCLUSION: In premenopausal woman with AUB, the endometrial hyperplasia was highly associated with women whose BMI was 27.0 or higher, or with endometrial thickness measured more than 15.0 mm. Therefore endometrial biopsy should be taken in women with AUB whose BMI is high, or endometrial thickness is thick to exclude the endometrial hyperplasia.
Biopsy ; Body Mass Index ; Diabetes Mellitus ; Endometrial Hyperplasia* ; Endometrium ; Female ; Hematologic Diseases ; Hemorrhage ; Humans ; Hyperplasia ; Hypertension ; Metrorrhagia ; Myoma ; Pregnant Women ; Retrospective Studies ; Uterine Hemorrhage* ; Uterus

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