PURPOSE: The purpose was to evaluate the procedure-related complications of the TIPS and its clinical significance. MATERIALS AND METHODS: The materials consisted of 52 patients who had 57 TIPS procedures for the management of variceal bleeding due to portal hypertension. To detect the occurrence of complications during transhepatic needle puncture(from hepatic vein to the portal vein), contrast material was injected with the withdrawl of the puncture needle. RESULTS: Procedure-related complications occurred in 28 patients (54%) among 52 patients. The corn lications were biliary tree puncture(15 cases), transperitoneal puncture(14 cases), stent malposition(3 cases) stent migration(1 case), hepatic arteries puncture(1 case), splenic vein perforation(1 case), and paroxysmal tricular tachycardia(1 case). Three patients had acute stent thrombosis with rebleeding immediately after procedure. The procedure was repeated in two patients. One patient was expired due to rebleeding. CONCLUSION: The procedure related complications were clinically insignificant in most instances, when stent thrombosis or proxysmal ventricular tachycardia was developed.
Biliary Tract ; Esophageal and Gastric Varices ; Hepatic Artery ; Hepatic Veins ; Humans ; Hypertension, Portal ; Needles ; Portasystemic Shunt, Surgical* ; Punctures ; Splenic Vein ; Stents ; Tachycardia, Ventricular ; Thrombosis ; Zea mays

No abstract available.
Brain* ; Neoplasm Metastasis*

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*

PURPOSE: A diverting stoma is known to reduce the consequences of distal anastomotic failure following colorectal surgery. The aim of this study was to evaluate the efficacy of a diverting stoma after an ultra-low anterior resection (uLAR) for rectal cancer. METHODS: Between 2000 and 2007, 836 patients who underwent an uLAR were divided into two groups, depending on the fecal diversion: 246 received fecal diversion, and 590 had no diversion. Patient- and disease-related variables were compared between the two groups. RESULTS: Thirty-two of the 836 patients (3.8%) had immediate anastomosis-related complications and required reoperation. Anastomosis leakage comprised 72% of the complications (23/32). The overall immediate complication rate was significantly lower in patients with a diverting stoma (0.8%, 2/246) compared to those without a diverting stoma (5.1%, 30/590; P = 0.005). The fecal diversion group had lower tumor location, lower anastomosis level, and more preoperative chemo-radiation therapy (P < 0.001). In total, 12% of patients in the diverting stoma group had complications either in making or reversing the stoma (30/246). CONCLUSION: The diverting stoma decreased the rate of immediate anastomosis-related complications. However, the rate of complications associated with the diverting stoma was non-negligible, so strict criteria should be applied when deciding whether to use a diverting stoma.
Colorectal Surgery ; Humans ; Ileostomy ; Rectal Neoplasms ; Reoperation

PURPOSE: We compared the reproducibility of 201Tl and 99mTc-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm. MATERIALS AND METHODS: Gated SPECT acquisition was repeated in the same position in 30 patients who received 201Tl and in 26 who received 99mTc-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on 201Tl and 99mTc-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on 201Tl gated SPECT was compared with that of 99mTc-MIBI gated SPECT. RESULTS: Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of 201Tl (r=0.928 to 0.986; p<0.05) and 99mTc-MIBI (r=0.979 to 0.997; p<0.05). However, Bland Altman analysis revealed the 95% limits of agreement (2 SD) for volumes and EF were tighter by repeated 99mTc-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5%) than by repeated 201Tl gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI gated SPECT (EDV: 2.1 ml, ESV: 2.7 ml and EF: 2.3%) than by repeated 201Tl gated SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). CONCLUSION: 99mTc-MIBI provides more reproducible volumes and EF than 201Tl on repeated acquisition gated SPECT. 99mTc-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function.
Humans ; Perfusion* ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon*

Leiomyoma is a neoplasm of smooth muscle relatively common in the stomach, but very rare in the duodenal location. Recurrent bouts of severe melana remain the most frequent presenting symptom for leiomyoma. A 69-year-old man presented to us with a 4-day history of melena. Endoscopy revealed norinal mucosa covered ovoid elevated lesion with central linear depression and ulcer at the second portion of duodenum. Endoscopic biopsy showed chronic inflammation only. Duodenal mass was excised through a duodenotomy. Pathological diagnosis was leiomycena.
Aged ; Biopsy ; Depression ; Diagnosis ; Duodenum ; Endoscopy ; Esophagus* ; Hemorrhage* ; Humans ; Inflammation ; Intestines* ; Leiomyoma* ; MART-1 Antigen ; Melena ; Mucous Membrane ; Muscle, Smooth ; Stomach* ; Ulcer

We studied 73 patients with ischemic stroke (56 patients) and transient ischemic attacks (17 patients) to evaluate the clinical efficacy of the two techniques, tansthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). For detecting potential intracardiac sources of cerebral emboli. Group I (40 cases) patients had no clinical cardiac abnorrnality. And group II (33 cases) patients had cardiac abnormality upon clinical examination. In group I. Intracardiac abnormalities were detected in 5%(2 to 40) with TTE and 37.5%(15 to 40) with TEE, and 34.2%(13 to 38) with TEE among the patients with normal finding with TTE which was statistically significant difference. In group II. Intracardiac abnormalities were detected in 21.1%(7 to 33) with TTE and 75.8%(25 to 33) with TEE, and 69.2% (18 to 26) with TEE arnong the patients with normal finding with TTE In comparison of 40 patients uith intracardiac source of embolism by echocardiogram (group A) and 33 patients without cardiac source of embolism(group B), atrial fibrillation was observed in 12 patients in group A versus 2 in group B (p<0.01), mean atrial size was 41.5mm in group A versus 35.3mm in group B. and left ventricular hypertrophy was in lQ in group A versus 6 in group B. Territories of cerebral arteries in cerebral infarction or TlAs of 40 patients with intracardiac source of embolism showed middle cerebral artery in 32.5%, posterior cerebral artery in 25% and bilateral or multiple in l2.5%. We concluded that TEE is superior to TTE for detecting potential cardiac sources of embolism.
Atrial Fibrillation ; Cerebral Arteries ; Cerebral Infarction ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Humans ; Hypertrophy, Left Ventricular ; Intracranial Embolism* ; Ischemic Attack, Transient ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Stroke

PURPOSE: To determine diagnostic effects of fine needle aspiration cytology (FNA) and frozen section of thyroid follicular neoplasm and its role in the therapeutic approach. METHOD: We performed a retrospective analysis of the data of patients who underwent thyroid surgery at the Gwangju Christian Hospital, between March 2000 and December 2004, and had a report of preoperative fine needle aspiration (FNA) biopsy of thyroid follicular lesions, which comprises cellular lesion, suspicious for follicular neoplasm or follicular carcinoma. RESULTS: Out of 45 patients with preoperative FNA biopsy diagnosis of follicular neoplasm, reveals true follicular carcinoma in 20 (44.4%), a follicular adenoma in 11 (24.5%), a papillary carcinoma in 7 (15.5%), a papillary carcinoma with follicular variant in 4 (8.9%), an adenomatous goiter in 3 (6.7%). Among the 45 patients having an intraoperative frozen sections, only 7 patients (15.5%) were true follicular carcinoma, suspicious for malignant follicular neoplasm in 14 patients (31.1%) and suspicious for benign follicular neoplasm in 8 patients (17.8%). final diagnosis were changed from suspicious for benign follicular neoplasm at intraoperative frozen section to malignant in 3 patients, from suspicious for malignant follicular neoplasm to benign in 1 patient. Three patients underwent a lobectomy and 1 patients a subtotal thyroidectomy followed by a completion thyroidectomy. CONCLUSION: Fine needle aspiration cytology and frozen section results are not good indicators in making the decision of operative extent. the best way to establish a diagnosis and to predict prognosis is to surgically remove the tumor for a proper histopathologic examination.
Adenoma ; Biopsy ; Biopsy, Fine-Needle* ; Carcinoma, Papillary ; Diagnosis ; Frozen Sections* ; Goiter ; Gwangju ; Humans ; Prognosis ; Retrospective Studies ; Thyroid Gland* ; Thyroidectomy

PURPOSE: The aim of this study was to determine the prognostic factors and the significance of metastatectomy for Krukenberg's tumors of gastric origin. MATERIALS AND METHODS: Among the patient who underwent gastric surgery from 1992 through 2005, 90 female patients with Krukenberg's tumors of gastric origin were identified. We retrospectively reviewed the clinicopathologic characteristics, prognostic factors, and treatments for primary gastric cancer. We also investigated the prognostic risk factors for the onset of metachronous Krukenberg's tumors and the survival time of patients who underwent an operation for metachronous Krukenberg's tumors. RESULTS: The presence of a synchronous Krukenberg's tumor (mean survival time=17.6 months, P<0.01), peritoneal seeding (14.5 months, P<0.01), and non-curative resection (15.1 months, P<0.01), were statistically significant prognostic factors for survival time in female patients with gastric cancer. The stage of primary gastric cancer (P=0.049) and lymph node metastasis (P=0.011) were statistically significant risk factors for recurrence time of a metachronous Krukenberg's tumor. In the metachronous Krukenberg's tumor group (n=53), the mean survival time of the metastatectomy group (n=46, 43.2 months, P=0.012) was longer than that in the chemotherapy or conservative treatment groups (n=7 and 24 months, respectively). Metastatectomy, presense or abscence of residual tumor and extent of residual tumor were significant prognostic factors for survival time in female patients with metachronous Krukenberg's tumor of gastric origin. CONCLUSIONS: A close observation and evaluation with ultrasound or computed tomography is necessary in female patients with advanced gastric cancer to detect a metachronous Krukenberg's tumor as soon as possible. The surgeon must operate more aggressively in patients with metachronous Krukenberg's tumors.
Female ; Humans ; Krukenberg Tumor ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Recurrence ; Retrospective Studies ; Risk Factors ; Seeds ; Stomach Neoplasms ; Survival Rate

Angiography is a useful diagnostic tool in cases with massive gastrointestinal bleeding such as angiodysplasia and varicosis when endoscopy is not available. Angiodysplasia and varicosis have distinguishable characteristic features on angiography, such as the presence of a nidus, visible late-draining veins, and the typical vascular tuft. We recently treated a rare case of congenital angiodysplasia without the characteristic angiodysplasia features on angiography. Instead, the patient presented with a very rare case of idiopathic jejunal varicosis. A 42-year-old woman visited the emergency room with the chief complaint of melena for three days and a hemoglobin level of 5.9 g/dL. An abdominal CT angiogram showed varicosis at the jejunal mesentery. Angiography of the superior and inferior mesenteric arteries showed tortuous and dilated jejunal and ileal branches during the venous phase, suggesting a vascular malformation such as varicosis of the jejunum. Surgical exploration with intraoperative endoscopy revealed diffuse engorged veins and a 1.0-cm-diameter superficial ulcer covered with a blood clot that was 70 cm from the ligament of Treitz. A 100-cm segment of jejunum was resected. Histological examination revealed that the lesion was angiodysplasia, not varicosis. The final diagnosis was congenital angiodysplasia.
Adult ; Angiodysplasia ; Angiography ; Emergencies ; Endoscopy ; Female ; Hemoglobins ; Hemorrhage ; Humans ; Jejunum ; Ligaments ; Melena ; Mesenteric Artery, Inferior ; Mesentery ; Ulcer ; Vascular Malformations ; Veins