No abstract available.
Hepatitis, Chronic*

Nonoperative dilatation techniques such as bougination, balloon dilatation, endoscopic laser therapy, and endoscopic electro-coagulation, have been applied to relieve dysphagia due to esophageal strictures, but the most widly used ia peroral dilatation once a guide wire has been passed under direct vision using a fiberoptic endoscope. Some cases of severe and curved esophageal strictures coutd'nt be introduced the conventional steel guide wire. We desecibe a method of cannulation of these difficult strictures guided by torque control angiographic catheter with radiogrphic control. A case of 18 year old man with severe corrosive esophageal stricture ingested HCl was successfully treated with esophageal dilatation with Savary-Gilliard dilator guided by Judkin's right coronary artery catheter.
Adolescent ; Catheterization ; Catheters* ; Constriction, Pathologic ; Coronary Vessels* ; Deglutition Disorders ; Dilatation* ; Endoscopes ; Esophageal Stenosis* ; Humans ; Laser Therapy ; Steel ; Torque

Choledochal cyst of the common bile duct is usually considered to be large cystic dilatation that extends from the wall of the common bile duct. Choledochal cyst is a very rare cond.ition in adult, These cysts are commonly distinctive in childran under the age of ten. Even in this age group they are considered rare. The classicajl triad of a choledochal cyst inclule pain, jaundice and a palpable right upper quadrant mass. This triad was found in only 21~63% and the most common finding is jaundice. Diagnoais of choledochal cyst usually is made during laparotomy, In nonjaundiced patients, oral cholangiogram and/or intravenous cholangiogram may yield the diagnosis. In jaundiced patiente where the diagnosis may be more difficult to make, one may consider doing ERCP and/or percutaneous transhepatic cholangiogram. The percutaneous transhepatic cholangiogram seems to be very helpful in diagnosing jaundiced patients. It is being used more and more in recent years but this method is not without complication. With advent of ERCP, visualization of the biliary tree has become a simple procedure when performed by expert endoscopists. To our knowlege, no previous case of choledochal cyst diagnosed by ERCP has been reported. yet in our country This paper reports 4 cases of choledochal cyst diagnosed by ERCP.
Adult ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde* ; Choledochal Cyst ; Common Bile Duct ; Diagnosis ; Dilatation ; Humans ; Jaundice ; Laparotomy

Peri-vater divertieula may interfere with the normal flow of biliary and pancreatic secretion, thus leading to pancreatobiliary diseasa and the very presence of juxtapapillary diverticulum makes cannulation technically difficult and contributes to the low success rate. In this present series, the relationship between duodenal diverticula and age, sex, and biliary-pancreatic pathology was stud.ied in 1400 patients examined with ERCP. The results are as follows. 1) Duodenal diverticula was demonstrated in 73 of 1400 patients(5, 2%). 2) The incidence of duodenal divertieular increased with age and they were more frequent in men. 3) The cannulation of one or both duct system was suecessful in 69 of the 73 patients, the success rate was 94. 5%. 4) The biliary pathology was found in 41 of the 73 patients and the pancreatic pathology in 6 of the 73 patients. The rnost common finding was biliary calculi which were demonstrated in 35 patients(47. 9%).
Catheterization ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis* ; Diverticulum* ; Gallstones ; Humans ; Incidence ; Male ; Pathology

Postcholecystectomy syndrome is the persistence or recurrence of symytom complex following cholecystectomy, The majority of the patients have mild symptoms. However, the cause of recurrent symptoms is often obscure and as a consequence, a plan of management is difficult to formulate. Recently ERCP has proved to be increasingly helpful in the investigation of postcholecystectomy patients. The purpose of this study was to test the effectiveness of the ERCP in the evaluation of patients with postcbiolecystectomy syndrorae. The results are as follows 1) 102 postcholecystectomy patients were studied by endoscopic retrograde cholangiopancreatography and successful cannulation with demonstration of at least one duct was achieved in 49 of 50 jaundiced patients and in 49 of 52 non-jaundiced patients. The overall success rate was 96. 1%. 2) The results of ERCP were normal in 26 patients(26.5%) and abnormal in 72 patients (73.5%), Only 3 of 50 jaundiced patients were normal, but 23 of 52 non-jaundiced patients showed no abnormal findings. 3) The most common abnormality was biliary stone in common bile duct and intrahepatic duct which were present in 51 patients(50%). Cholangitis without stone was next common finding which was in 13 patients(13%). Of the remaining patients have air biligram, 2 CBD stricture, 1 CBD aseariasis & 1 chronic pancreatitis. 4) Time lapse between onset of symptoms and cholecystectomy was variable. 31 patients were studied less than 2 years after cholecystectomy. 18 of these patients had jaundice and 13 had no jaundice. Within 2 years afte chklecystectomy, the biliary stone was most common finding which were present in 14 out of 31 patients.
Catheterization ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Cholecystectomy ; Common Bile Duct ; Constriction, Pathologic ; Humans ; Jaundice ; Pancreatitis, Chronic ; Postcholecystectomy Syndrome ; Recurrence

Candida Albicans is a saprophytic organism under normal circumstances and a limited pathogen when presents in large numbers. The common site of infection are the mouth, skin, vagina and respiratory tract. It is a common inhabitant of the G-I tract, where it does not usually cause symptoms. With impared defense mechanism or long-term antibiotic therapy, however it can became a significant pathogen. The clinical symptoms and endoscopic findings present a spectrum of changes depending on the degree of esophageal involvement. Painful awallowing and substernal chest pain are most common symptoms. Esophgeal infection is an unusual but impartant form of the diseases and can easily be confirmed by esophagoscopy. Recently we have experienced 4 cases of esophageal moniliasis confirmed by esophagoscopy and tissue biopay.
Candida albicans ; Candidiasis* ; Chest Pain ; Esophagoscopy* ; Mouth ; Respiratory System ; Skin ; Vagina

To delineate the coronary anatomy and the left ventricular function during early myocardial infarction, coronary arteriography and left ventriculography were performed prospectively in 28(34%) of 83 patients who were admitted to the coronary care unit at Severance Hospital from November 1983 to August 1984 within 30 days(median : 14 days;range : 4 hours to 30 days) after the onset of symptoms. The frequency of total occlusion of the infarct related artery was evaluated in the time course of infarction. To prove spontaneous recanalization, 3 patients who had total coronary occlusion underwent serial study within 11-20 days after the first study. We categorized the patients into two comparable groups according to the infarction site, coronary angiographic findings, and age. Comparison of clinical and angiographic findings between each group was made. The following results were obained. 1) There were 23 patients with transmural myocardial infarction(82.1%) and 5 with nontransmural infarction(17.9%). Among 23 patients with transmural infarction, 14 had anterior infarction(60.9%) and 9(39.1%) inferior infarction. 2) The mean age was 51.3 years(range : 31-79 years). The ratio of male to female was 3.7:1. 3) Fifteen patients(53.6%) had one-vessel disease, 10(35.7%) two-vessel disease and 2(7.1%) three-vessel disease, One patient(3.6%) had insignificant disease(less than 50% reduction in luminal diameter). Nontransmural infarction had a tendency to be associated with higher prevalence of multivessel disease than transmural infarction(80% vs 34.8%). 4) In 23 patients with transmural infarction, 12(52.2%) had complete occlusion and 11(47.8%) incomplete occlusion of the infarct related artery. Three patients(13.0%) had subtotal occlusion(90-99%) and 4(17.4%) had lesions of 70-89% luminal diameter narrowing. Three patients(13.0%) had 50-69% lesions and the remaining 1(4.4%) had insignificant obstructive lesions. 5) Of the 23 patients with transmural infarction, 12 were studied within 14 days and 11 in 15-30 days after the onset of symptoms. The frequency of total coronary occlusion was significantly higher in the patients studied within 14 days of symptom onset vs those studied in the 15-30 days period(83.3% vs 18.2%;p<0.001). Serial studies of 3 patients with total coronary occlusion at the initial study demonstrated occurrance of spontaneous recanalization in 2 patients. 6) The left ventricular-ejection fraction was higher in the patients with nontransmural infarction, inferior infarction, and incomplete coronary occlusion(65+/-14%, 58+/-16% and 57+/-17%) than that of the patients with transmural infarction, anterior infarction, and complete coronary occlusion(51+/-15%, 47+/-14% and 46+/-13, p<0.05). But there was no significant difference in left ventricular ejection fraction between the young(<45 year) and the old(> or =45 year) age groups. And also 0-1 vessel disease and 2-3 vessel disease groups did not show significant difference in ejection fraction. The degree of congestive heart failure was more severe in the patients with anterior infarction than in those with inferior infaction. multi-vessel disease group was significantly older than 0-1 vessel disease group(55+/-8 yrs vs 46+/-12 yrs, p<0.05), and the young age group had a tendency to be associated with higher prevalence of single vessel disease. 7) As for the complications of angiocardiography in this study, there was ventricular finbrillation in 2 patients(7.1%) without mortality. It is concluded that coronary arteriography can be safely performed within one month after acute myocardial infarction;high prevalence of one-vessel disease in acute myocardial infarction in the Korean adult patients admitted to a general hospital;lower incidence of total coronary occlusion in the late time course of infarction due to spontaneous recanalization;better left ventricular function in the patient groups with nontransmural infarction, inferior infarction and incomplete coronary occlusion.
Adult* ; Angiocardiography ; Angiography ; Arteries ; Coronary Care Units ; Coronary Occlusion ; Female ; Heart Failure ; Humans ; Incidence ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Phenobarbital ; Prevalence ; Prospective Studies ; Stroke Volume ; Ventricular Function, Left

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most useful diagnostic tool in biliary and pancreatic disease. However, ERCP cannot be performed successfully in all patients. Cannulation failure is the most common cause of failure of ERCP. Mechanical pathologies, such as peri-Vater diverticulum, cancer of the papilla of Vater, and impacted stone were the common causes of cannulation failure. We experienced two cases of carcinoma of the papilla of Vater in whom cholangiography and insertion of the nasobiliary tube were performed througth an artificial choledoehoduodenal fistula made by a needle type diathermy knife, beacuse cannulation to the duct was failed due to the tumor.
Catheterization ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Diathermy ; Diverticulum ; Fistula* ; Humans ; Needles ; Pancreatic Diseases ; Pathology

Isolated pulmonary stenosis, a relatively common congenital anomaly that accounts for about 10 percent of all congenital heart disease, is characterized by stenosis of pulmonary valve itself, infundibulum or both of them. Since cardiac catherterization was applied to man by Cournand and Ranges, pulmonary stenosis had been easily diagnosed and many clinical studies had been investigated. It has a wide clinical spectrum depending on the degree of stenosis. The electrocardiogram, phonocardiogram and chest X-ray have proved useful in estimating the severity of hemodynamic facotrs in individual cases. This series comprises 47 cases in whom the clinical diagnosis of isolated pulmonary stenosis was confirmed by right heart catheterization with cardiac cineangiography at Severance Hospital, Yonsei University. An attempt was made to correlate the electrocardiographic, phonocardiographic, chest X-ray findings, and types of stenosis with the hemodynamic data in these cases. 1. Of 47 patients, 33 were male and 14 female. Their ages ranged from 2 to 42 years: the mean age was 19.1 years. 2. The incidence was 5.9 percent of all 797 catheterized congenital heart disease cases. The pulmonary valvular stenosis was 30 (68.3%), infundibular 7 (14.6%) and combined 10 (21.6%) cases. 3. The correlation between electrocardiogram and hemodynamic data were as follows. i) The regression equation between right ventricular sysytolic pressure (RVSP) and height of R wave in V1 lead (RV1) was RVSP=3.32 RV1+48.2: its correlation coefficient was 0.818 and it was very significant (p=0.000). ii) The higher the RVSP, the more the frontal axis of QRS complex shifted to the right side (r=0.55. p=0.001). iii) The RVSP of the groups with positive ECG findings such as p-pulmonale, right ventricular hypertrophy or right ventricular strain were much higher than the RVSP of the groups without such findings (p=0.032.0.000, 0.000). iv) The group with RV1 higher than 20 mm showed much more elevated mean of RVSP than the group with lower RV1 (p=0.000). v) The groups with the above mentioned positive ECG findings showed good correlation with the severity of RVSP which was arbitrarily classified as 49 or less, 50~100, and 100 mmHg or more (chi-square=8.96, 26.69, 19.06; p=0.011, 0.000, 0.000). 4. The group with late occurrence of the maximum intensity of the ejection systolic murmur showed higher mean of RVSP than the group with early peak of the murmur (p=0.014). 5. The means of RVSP of the groups with chest X-ray findings such as decreased pulmonary vascularity, were much higher than the means of RVSP of the groups without such findings (p=0.000, 0.005, 0.015). The groups with above mentioned positive chest X-ray findings showed good corelations with the severity of RVSP which was classified as above limits (chi-square=7.55, 10.94, 13.36; p=0.022, 0.004, 0.001). 6. Combined pulmonary valvular and infundibular stenosis showed more severe systolic pressure gradient and higher mean of RVSP than the isolated types (p=0.000).
Axis, Cervical Vertebra ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Catheters ; Cineangiography ; Constriction, Pathologic ; Diagnosis ; Electrocardiography ; Female ; Heart Defects, Congenital ; Hemodynamics* ; Humans ; Hypertrophy, Right Ventricular ; Incidence ; Male ; Pulmonary Valve ; Pulmonary Valve Stenosis* ; Systolic Murmurs ; Thorax

Primary cancer af the duodenum is rare. An extensive experience with fiberoptic eaophag-ogastro-duodenoscopy in our institution has indicated that duodenal cancer may be more frequent thsn suspeeted and readily diagnesed by this modality, With this in mied, clinical, pathological, diagnostic and therapeetie aspects of the 26 patients with primary duodenal cancer which had been endoscopically diugnosed were reviewed. The results obtained were as follows: 1) Ages ranged from 16 to 75, with the mean of 55.2 years. Seventeen patients were men and nine patients women being l. 9:1 of male-female ratio. 2) Hndoscoyic findings were 46. 1 percent ulcerative anld 34. 8 per cent ulcerative-infiltrative, 3) The diatribution within the duodenum was 50 per cent suprapapillary, 42. 4 per cent peri- papillary aecl 7. 6 per cent infrapapillary. 4) The twenty-three patients had adenocarcinoma, two patients leiomyosarcoma and 1 patient lymphoma. 5) Twenty patients were confirmed by duodenoseopic biipsies and six patients by operations. 6) The mast common presenting mmyliiints were abdominal pain, chronic blood lais leading anemia, jaundice, anorexia, indigestion, weight lass and palpable abdominal mass. 7) Of the 26 patients, eight patients underwent attempted curative resection, six patients underwent palliative bypasa procedures or exploratory laparotomy.
Abdominal Pain ; Adenocarcinoma ; Anemia ; Anorexia ; Diagnosis* ; Duodenal Neoplasms ; Duodenum ; Dyspepsia ; Female ; Humans ; Jaundice ; Laparotomy ; Leiomyosarcoma ; Lymphoma ; Male ; Ulcer