Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Female ; Gallstones ; therapy ; Humans ; Male ; Middle Aged ; Moxibustion

Lysimachiae Herba and Desmodii Styracifolii Herba are common traditional Chinese medicines for treating lithiasis. Both of them have efficacies of clearing heat, diuresis and eliminating calculi. However, there are some differences in their clinic applications. The former is mainly used to treat hepatolithiasis, gallstones, jaundice, stranguria and gout; Whereas the latter is mainly used to treat urinary calculus. In this paper, the pharmacological effects of Lysimachiae Herba and Desmodii Styracifolii Herba on removing calculus, choleresis, anti-inflammation and oxidation resistance were compared and analyzed based on document retrieval. In conclusion, both of them show the preventive and therapeutic effects on kidney stones and gallstones. Particularly, Desmodii Styracifolii Herba has a better effect in treating the kidney stones, while Lysimachiae Herba has a better effect in treating cholesterol gallstones.
Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Fabaceae ; Gallstones ; drug therapy ; Humans ; Kidney Calculi ; drug therapy ; Medicine, Chinese Traditional ; Phytotherapy ; Primulaceae

Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Fibrosis ; drug therapy ; pathology ; surgery ; therapy ; Gallstones ; complications ; Humans ; Middle Aged ; Somatostatin ; therapeutic use ; Varicose Veins ; drug therapy ; pathology ; surgery ; therapy

The management of intrahepatic stones is very difficult and troublesome because of the high incidence of residual stones and complications. A retrospective study was undertaken to evaluate the results of multimodal treatment for 50 patients with intrahepatic stones who had been treated at the Department of Surgery, Pusan National University Hospital from March 1992 to February 1996. The results obtained are as follows: 1) The incidence of the intrahepatic-stones in the 413 gallstone patients was 12.1% (50 cases). The mean age of intrahepatic stone patients was 50.8 years old, and the ratio of males to females was 1.17:1. Of these 50 cases of intrahepatic stones, 23 cases involved the left hepatic duct, 7 cases the right hepatic duct, and 20 cases both ducts. 2) The most frequent drainage procedure was an end to side hepaticocutaneous jejunostomy (28 cases, 56.0%). This include 8 cases involving a combination of surgeries with hepatic resections. The other major treatment modality was a hepatic resection (16 cases, 32.0%). After the initial operations, the overall incidence of residual stones was 28.0%. The treatment by hepatic resection had the lowest incidence of residual stones, 2 cases (12.5%) of 16 patients. In the 20 cases involving a hepaticocutaneous jejunostomy, 5 (25.0%) had residual stones. Among the 5 choledocoduodenostomies, 2 patients (40.0%) had residual stones. Among the 5 transduodenal sphincteroplasties 2 patients (40.0%) had residual stones. For the 4 cases of other operations, 3 had residual stones (75.0%). 3) Of the 14 cases with residual stones, 11 cases underwent an additional lithotomy: 7 cases of a percutaneoustranshepatic cholangiographic lithotomy (PTC-L), and 4 cases of a choledochoscopic lithotomy through an anchored subcutaneous jejunal limb (Endo-L). All the PTC-Ls were successful. However, two Endo-Ls failed, and these patients were later successfully treated with a PTC-L. In conclusion, the data showed a high incidence of intrahepatic stones in gallstone patients. For the treatment of intrahepatic stones, hepatic resections seemed to be the best choice, showing the lowest incidence of residual stones. For the drainage procedure, the hepaticocutaneous jejunostomy seemed to be the best choice for the following reasons: the ease of performing the frequently required lithotomy using a choledochoscope after the initial operation, and the ease of intervening in case of complications during a PTC-L.
Busan ; Combined Modality Therapy* ; Drainage ; Extremities ; Female ; Gallstones ; Hepatic Duct, Common ; Humans ; Incidence ; Jejunostomy ; Male ; Retrospective Studies ; Sphincterotomy, Transhepatic

Inflammatory pancreatic fluid collection, such as pseudocysts, pancreatic abscesses and infected walled-off pancreatic necrosis, arise as a complication of acute pancreatitis. Recently endoscopic ultrasound (EUS)-guided drainage has emerged as the leading treatment modality for symptomatic pancreatic fluid collection. EUS-guided endoscopic drainage is less invasive than surgery and avoids local complications related to percutaneous drainage. In addition, this endoscopic treatment can drain non-bulging fluid collection and may reduce the risk of procedure related bleeding and perforation. Excellent treatment success rates exceeding 90% have been reported for pancreatic pseudocysts and abscesses. Intervention such as endoscopic drainage with necrosectomy may be indicated for infected pancreatic necrosis, and ideally be delayed as long as possible, 4 weeks or longer after the onset of disease, for better demarcation and liquefaction of the necrosis. Multimodal treatments by specialists with specific expertise in management of peripancreatic fluid collection is essential to achieve the best outcomes. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Early ERCP should be performed in patients with gallstone pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected.
Abscess ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Combined Modality Therapy ; Drainage ; Gallstones ; Hemorrhage ; Humans ; Necrosis ; Pancreatic Pseudocyst ; Pancreatitis ; Specialization

Approximately 3-15% of patients who have undergone removal of bile duct stones with endoscopic sphincterotomy have recurrence of stones which often presents as acute cholangitis. Despite better understanding on the factors and mechanisms underlying the recurrence of bile duct stones achieved during the past few decades, endoscopic removal still remains the mainstay of management for recurrent bile duct stones. Recently investigated and suggested management of recurrent bile duct stones are highlighted in this review.
Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis/pathology ; Gallstones/surgery/*therapy ; Humans ; Recurrence ; Risk Factors ; Sphincterotomy, Endoscopic ; Ursodeoxycholic Acid/administration & dosage

A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.
Abdominal Pain/radiography ; Colonoscopy ; Female ; Gallstones/*diagnosis/therapy ; Humans ; Ileus/*diagnosis/therapy ; Intestinal Obstruction/diagnosis/therapy ; Lithotripsy/*methods ; Middle Aged ; Tomography, X-Ray Computed

Treatment for chronic pancreatitis (CP) should be started early to prevent further pancreatic fibrosis and managed with a multidisciplinary approach to prevent complications and to maintain a good quality of life. The management strategies of CP can be divided into medical, endoscopic, and surgical treatment. The role of pancreatic enzymes and antioxidants for pain relief is not clearly defined, but their role in maintaining nutritional support by correcting exocrine insufficiency is well established. Endoscopic treatment is applied for resolution of pancreatic or bile duct strictures, clearance of pancreatic duct stones, and pseudocyst drainage. Endosonography-guided celiac plexus or celiac ganglia block for pain relief are known to be safe procedures but evidence for their effectiveness is still lacking. Surgery is commonly recommended when endoscopic therapy fails or there is suspicion of malignancy. New evidence-based guidelines for the management of CP are needed.
Antioxidants/therapeutic use ; Cholangiopancreatography, Endoscopic Retrograde ; Endosonography ; Enzyme Replacement Therapy ; Fibrosis ; Gallstones/therapy ; Humans ; Lithotripsy ; Pancreas/pathology ; Pancreatitis, Chronic/*drug therapy/pathology

Acute pancreatitis is common but remains a condition with significant morbidity and mortality. Despite a better understanding of the pathophysiology of acute pancreatitis achieved during the past few decades, there is no specific pharmacologic entity available. Therefore, supportive care is still the mainstay of treatment. Recently, novel interventions for increasing survival and minimizing morbidity have been investigated, which are highlighted in this review.
Acute Disease ; Antioxidants/therapeutic use ; Bacteremia/complications ; Cholangiopancreatography, Endoscopic Retrograde ; Fluid Therapy ; Gallstones/complications ; Humans ; Necrosis ; Pancreatitis/mortality/*pathology/therapy ; Protease Inhibitors/therapeutic use ; Renal Dialysis

Primary gallbladder carcinoma is relatively uncommon, but not a very rare disease. It accounts for 3- 4% of all gastrointestinal tract tumors, and is the most common malignant disease of the biliary tract. It occurs more frequently in women than in men at a ratio of 3:1. The etiology of gallbladder carcinoma is unknown, but the association of gallstones with it is well known. The diagnosis often is not made before laparotomy because its symptoms and signs are very nonspecific and are similar to those of cholecystitis. Commonly, it is encountered in the later stages and has very unfavorable courses. Recently, the operative treatments of gallbladder carcinoma have advanced significantly, and many studies revealed that more aggressive surgery gives rise to better prognosis in comparison with previous surgical treatment modalities. We reviewed 60 cases of this disease experienced in our hospital from October, 1988 to February, 1998. We evaluated whether the aggressive surgical treatment and the adjuvant therpy of gallbladder cancer had influence on prognosis. And additionally, we examined the clinical situations of primary gallbladder carcinoma. Only 33 patients of 60 were followed up until a recent date, and so all survival data were calculated within 33 cases. The results are as follows : 1) The incidence of gallbladder carcinoma in females outnumbered in males at a ratio of 1.2:1, and sixty per cent of all patients were 7th and 8th decades of age. 2) Almost all patients had varying degrees of upper abdominal pain, and the duration of symptoms was less than 4 weeks in half of the patients. 3) Forty-five per cent of all patients had gallstones. 4) Preoperative diagnoses were made in 28 cases(46.7%). 5) At the time of diagnosis, many patients(about 70%) were on the TNM stage III and IV. 6) The curative resectability rate of the cancer was merely 53.3%(32/60), and in the remainder of patients(n=28), palliative surgery and only laparotomy were carried out. The operative methods performed on purpose of a curative resection of the cancer were simple cholecystectomy in 14 patients(23.3%), cholecystectomy plus liver wedge resection plus LN dissection(radical cholecystectomy) in 15 patients(25%), radical cholecystectomy plus Roux-en-Y hepaticojejunostomy in 1(1.7%), and radical cholecystectomy plus right hepatic lobectomy in 2(3.3%). 7) The cumulative 5-year-survival rates of gallbladder carcinoma were 80% in stage I, 75% in stage II, 33% in stage III, and 0% in stage IV(p=0.002). In advanced cases(that is, in stage III and IV), the survival data was analized according to the operation methods. The mean survival times were 25.9 months in curative operation group and 3.3 months in palliative operation or explo-laparotomy group(p=0.003). 8) In a small number of patients of stage III and IV, chemotherapy and radiation therapy were carried out. But we could not find the statistical significances on the differences of survival rates.
Abdominal Pain ; Biliary Tract ; Cholecystectomy ; Cholecystitis ; Diagnosis ; Drug Therapy ; Female ; Gallbladder Neoplasms* ; Gallbladder* ; Gallstones ; Gastrointestinal Tract ; Humans ; Incidence ; Laparotomy ; Liver ; Male ; Palliative Care ; Prognosis ; Rare Diseases ; Survival Rate