PURPOSE: To evaluate the efficacy of combined treatment of metallic biliary stent placement and radiotherapy in malignant biliary obstruction. MATERIALS AND METHODS: Between January 1992 and February 1994, 22 patients with malignant biliary obstruction were treated with metallic biliary stent placement and radiotherapy. The causes of the obstruction included cholangiocarcinoma(n=14), gallbladder carcinoma(n=4), colon cancer(n=2), pancreatic head cancer (n=1), and stomach cancer(n=1). According to the sites of obstruction level, patient were divided into 2 groups; hilar obstruction(n=18) and common bile duct obstruction(n=4). The patients received dose of 45 Gray/18 fraction by external radiotherapy and 20Gy/8f by high dose rate brachytherapy with iridium--192 source through percutaneous transhepatic biliary drainage(PTBD) catheter. The duration of stent patency after placement, survival period and survival rate by Kaplan Meier method were calculated in dead and alive patients, respectively. RESULTS: In all 22 patients, the duration of stent patency was 5.5(1.3--18.5)months. Survival periods after stent placement and PTBD were 5.3(2.0--8.5 )months and 7.9(4.0--14.7)months respectively in 9 dead patients and 7.7(1.3--21.0)months and 9.5(2.3--23.0)months in 13 alive patients. In all 22 patients, the survival rates in 6, 12 and 18 months were 78.9%, 47.5 % and 35.6 %, respectively. CONCLUSIONS: The results with combined metallic biliary stent placement and radiotherapy for the palliative treatment of malignant biliary obstruction in this study was more favorable, as compared with those of the other authors with only metallic biliary stent placement.
Brachytherapy ; Catheters ; Colon ; Common Bile Duct ; Gallbladder ; Head and Neck Neoplasms ; Humans ; Palliative Care ; Radiotherapy* ; Stents* ; Stomach ; Survival Rate

PURPOSE: To evaluate the usefullness of repeated alcohol sclerotherapy for two days through the percutaneous catheter in the treatment of renal cyst. MATERIALS AND METHODS: Repeated sclerotherapies using absolute ethanol(99.9%) were parformed on 20 renal cysts in 18 patients through the indwelling catheter. The cyst volume ranged from 50 ml to 1000ml(mean, 300ml). Under the ultrasound- or CT-guidance, 6F catheter was inserted into the cyst percutaneously. After aspirating the fluid in the cyst, absolute ethanol was injected. While maintaining the catheter for 16-20 hours, at least 3 times of sclerotherapies performed with total procedure time of 30-60 minutes. Follow-up sonography was performed to evaluate the recurrence or collapse of the cysts at 1 and 3 months after the procedure. RESULTS: Among 20 renal cysts, 2 cases were recurred on 1 month follow-up sonography(10%). However, the volumes of recurred cysts were decreased to 40% and 10%, respectively. There was no immediate or delayed complication after sclerotherapy. DISCUSSION: Repeated sclerotherapy for 2 days using absolute ethanol through the percutaneous catheter insertion is a useful method of treatment for renal cyst.
Catheters* ; Catheters, Indwelling ; Ethanol ; Follow-Up Studies ; Humans ; Recurrence ; Sclerotherapy*

BACKGROUND: Several recent studies have reported that generation of inflammatory cytokines and activation of complements may be associated with febrile nonhemolytic transfusion reactions (FNHTR). However, few data are available for whole blood, which is still commonly utilized for massive transfusion and for autologous transfusion. METHODS: A total of 15 whole blood units from healthy adult donors was collected and stored at 4degrees C for 35 days. During the storage time, samples for analyses of cytokines including interleukin-1alpha (IL-1alpha), IL-2, IL-6, IL-8, and tumor necrosis factor alpha (TNFalpha) and anaphylatoxins such as C3a and C5a were obtained on day 0, 1, 3, 5, 7, 14, 28, and 35. Cytokines were measured by enzyme-linked immunosorbent assay and anaphylatoxins by radioimmunoassay. RESULTS: IL-1alpha (<0.5 pg/mL), IL-2 (<7 pg/mL), and TNFalpha (<4.4 pg/mL) were not detectable. IL-6 was measured in 4 units with low level (1.1-4.0 pg/mL) and IL-8 showed slightly higher level (10.5 pg/mL) on day 35. Anaphylatoxins (C3a and C5a) were detectable at the level of 1350.0 ng/mL on day 21 and of 14.6 ng/mL on day 14, respectively, which were significantly increased levels compared with those on day 0. The levels of C3a and C5a reached 2513.3 ng/mL and 18.4 ng/mL on day 35, respectively. CONCLUSIONS: It is not likely that cytokines generated during storage of whole blood under normal blood banking condition could explain FNHTR. However, anaphylatoxins are elevated in whole blood after 2 weeks of storage, which might be due to complement activation by the plastic surface of blood bag.
Adult ; Anaphylatoxins* ; Blood Banks* ; Blood Group Incompatibility ; Complement Activation ; Complement System Proteins ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-1alpha ; Interleukin-2 ; Interleukin-6 ; Interleukin-8 ; Plastics ; Radioimmunoassay ; Tissue Donors ; Tumor Necrosis Factor-alpha

BACKGROUND: Telemedicine can be useful in dermatology in which there is a physical barrier between the dermatologist and patient or primary care giver. OBJECTIVE: Our purpose of this study is to examine a usefulness of teledermatology system in Korean situation. METHODS: We made store-and forward teledermatology system on world wide web for it's usefulness. We examined the difference of diagnostic accuracy, level of certainty, and quality of images of photographs and still digital images. RESULTS: The merits of our teledermatology system are summarized as follows1. It has more diagnostic accuracy than classic store-and forward system. 2. The real-time additional history taking and request of laboratory examinations are possible by chatting system between dermatologist and primary care giver. 3. Patient follow-up is easier than store-and forward system. The difference of diagnostic accuracy, level of certainty, and quality of images of photographs and still digital images are summarized as follows. 1. There is no difference of diagnostic accuracy between photographic readers and digital image readers. 2. There is no difference of level of certainty between photographic readers and digital image readers. 3. In assesment of quality of photographs, no difference was founded between photographic readers and digital image readers 4. The satisfaction of quality of photographs is very high in all groups. The average is 97.5%. CONCLUSION: This study provides evidence that our teledermatology system is useful in korean situation and still digital image can substitute historic photographs in teledermatology.
Dermatology* ; Equidae ; Follow-Up Studies ; Humans ; Internet ; Primary Health Care ; Telemedicine*

PURPOSE: The purpose of the study was to evaluate the relationship between the location of bone signalabnormality and associated injury, as seen on MR, in patients with acute knee joint injury. MATERIALS AND METHODS: Thirty-six patients with acute knee injury and bone signal abnormalities on MR were included in this study. Thefemur and tibia were each divided into six compartments, namely the anteromedial, medial, posteromedial,anterolateral, lateral, and posterolateral ; these were obtained in each knee joint. We evaluated the location ofbone signal abnormality and the corresponding arthroscopic or operative findings of injury to ligaments andmenisci. Cases with signal abnormalities involving more than three compartments were excluded. RESULT: Bonesignal abnormalities were demonstrated in 51 compartments. Most(84%, 43/51) were noted in the lateral half of theknee joint, the most common location being the tibio- posterolateral compartment(13/51). The femoro-lateral(11/51) and tibio- anterolateral compartment(8/51) were the next most common locations. All cases(13/13)with bone signal abnormality in the tibio- posterolateral compartment had tears at the anterior cruciate ligament,while 9 of 11 cases(81%) with abnormality in the femoro- lateral compartment had tears at the anterior cruciateligament. Six of eight cases(75%) with signal abnormality in the tibio- anterolateral compartment had tears at theposterior cruciate ligament ; 31 of 43 cases (72%) with abnormality in the lateral half of the knee joint hadtears at the medial collateral ligament. Six of eight cases(75%) with signal abnormality in the medial half of theknee joint had tears at the medial meniscus, but no lateral meniscal tear was found. Among patients with signalabnormality in the lateral half of the knee joint, the tear was lateral meniscal in nine of 43 cases(21%) andmedial meniscal in six of 43(14%). CONCLUSION: The location of bone signal abnormality, as seen on knee MR, inpatients with acute knee joint injury could be an important finding suggesting associated injury.
Collateral Ligaments ; Humans ; Inpatients ; Joints ; Knee Injuries ; Knee Joint* ; Knee* ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Tibia

Lymphangiomas are rare congenital benign tumors arising from the lymphatic system, and are mostly encountered in the neck and axillary regions of pediatric patients (95%). Lymphangioma of the pancreas is extremely rare accounting for less than 1% of these tumors. We report here on a case of pancreatic cystic lymphangioma. A 54-year-old woman presented with intermittent postprandial abdominal discomfort and radiating back pain. Abdominal computed tomography scan revealed 8 x 6.5 cm hypodense cystic mass arising from the tail of the pancreas without septa or solid component. The initial impression was a pancreatic pseudocyst. The patient underwent distal pancreatectomy with splenectomy. The histopathologic and immunohistochemical study helped make the diagnosis of a pancreatic cystic lymphangioma. Herein, we report a case of pancreatic cystic lymphangioma mimicking pancreatic pseudocyst and review the relevant medical literature.
Accounting ; Back Pain ; Female ; Humans ; Lymphangioma ; Lymphangioma, Cystic ; Lymphatic System ; Middle Aged ; Neck ; Pancreas ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Pseudocyst ; Splenectomy

BACKGROUNDS/AIMS: The purpose of this study was to evaluate the role of peripheral eosinophilia as a predictable factor associated with Eosinophilic cholecystitis (EC) compared with other forms of cholecystitis in patients who underwent a cholecystectomy. METHODS: Between January 2001 and May 2011, the histopathologic features of 3,539 cholecystectomy specimens were reviewed retrospectively. EC was diagnosed in 30 specimens (0.84%). Data from 30 consecutive patients with EC (eosinophilic cholecystitis group [E-group]) were compared with a retrospective control group of 60 patients (other cholecystitis group [O-group]) during the same period. The two groups were matched for age, gender, and the presence of cholelithiasis. RESULTS: The median absolute eosinophil count 1 day post-operatively was 144 cells/mm3 (range: 9-801 cells/mm3) in the E-group and 93 cells/mm3 (range: 0-490 cells/mm3) in the O-group (p=0.036). Pre-operative peripheral eosinophilia was more common in the E-group than the O-group (20% vs. 3.3%, p=0.015). Multivariate analysis revealed that pre-operative peripheral eosinophilia was an independent significant predictable factor associated with EC (odds ratio=7.250, 1.365 <95% confidence interval<38.494, p=0.020). CONCLUSIONS: In the present study, pre-operative peripheral eosinophilia was shown to be an independent predictable factor associated with EC. Further researches seem to be necessary to confirm this finding.
Cholecystectomy ; Cholecystitis ; Eosinophilia ; Eosinophils ; Humans ; Multivariate Analysis ; Retrospective Studies

Adenoid basal carcinoma of the cervix is very rare tumor. It is slow-growing and locally invasive tumor amenable to simply hystrectomy. It is common to be associated with severe dysplasia and carcinoma in situ(CIS) of cervix Occasionally, concommitant microinvasive squamous cell carcinoma or adenocarcinoma may also be seen. Differential diagnosis includes adenoid cystic carcinoma, which is more aggressive tumor associated with regional lymph node involvement and late pulmonary metastasis. We have recently experienced a case of adenoid basal carcinoma of the cervix in 61 years-old woman, which is presented with a brief review of the literature.
Adenocarcinoma ; Adenoids* ; Carcinoma, Adenoid Cystic ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Diagnosis, Differential ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis

PURPOSE: Even with recent advances of diagnostic tools and therapeutic strategies, the prognosis of gallbladder cancers remains poor. The clinical outcome has not improved much over the past couple of decades. This study analyzed our surgical results to evaluate the prognostic factors associated with survival after surgery in patients with gallbladder malignancies. METHODS: Retrospective review of 69 patients with gallbladder carcinomas operated on at our surgical department over a period of 9 years from May 1995 to April 2004. RESULTS: The overall 5-year survival rate was 45.9%, 3-year survival rate 52.8% and 1-year survival rate 72.4%. The 5-year survival rates according to the AJCC stage were 0 100%, Ia 100%, Ib 71.0%, IIa 41.7%, IIb 23.8%, III 50.0%, and IV 11.0% for each. The 5-year survival rates according to the depth of invasion were Tis 100%, T1a 100%, T1b 66.6%, T2 57.1%, T3 36.8%, and T4 22.7%. A univariate analysis of clinicopathologic factors showed that the T stage, N stage, M stage, radical surgery, tumor location, surgical procedure and histological grade were significant prognostic factors. Multivariate Cox-regression analysis of these eight important factors demonstrated that lymph node metastases and the degree of radical surgery were independent variables associated with prognosis. CONCLUSION: The results of this study showed that lymph node metastases and degree of radical surgery were associated with patient prognosis. Therefore, long-term survival may be achieved by an early diagnosis with curative radical tumor resection.
Early Diagnosis ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate

BACKGROUND: Chronic kidney disease has deleterious influences on pregnancy, both fetus and mother. To determine the pregnancy outcome and associated risk factors, we analyzed 36 pregnancies in 26 women with various chronic kidney diseases. METHODS: Retrospective analysis of 36 pregnancies was performed in women with chronic kidney disease who underwent antenatal care and delivery at Pusan National University Hospital from January 1993 to December 2002. RESULTS: The mean age of patients was 29.7 +/- 3.6 years. Underlying kidney disease was lupus nephritis in 10 patients (11 pregnancies), IgA nephropathy in 7 patients (8 pregnancies), focal segmental glomerulosclerosis in 4 patients (9 pregnancies), membranoproliferative glomerulonephritis in 4 patients (7 pregnancies), membranous glomerulonephritis in 1 patient (1 pregnancy). Of the 36 pregnancies, fetal loss occurred in 14 pregnancies (38.9%), premature delivery 7 pregnancies (19.4%) and normal delivery 15 pregnancies (41.7%). Deterioration of maternal renal function occurred in 10 pregnancies (27.8%), hypertension 18 pregnancies (50.0%) and aggravation of proteinuria 26 pregnancies (72.2%). Fetal loss and deterioration of maternal renal function were more frequent in patients with preconception serum creatinine value (SCr) >or=1.4 mg/dL than in those with SCr <1.4 mg/dL (85.7% vs. 27.6%, p<0.05; 100% vs. 10.3%, p<0.05, respectively). Neither fetal loss nor deterioration of maternal renal function was associated with hypertension and aggravation of proteinuria. In multivariate analysis, preconception SCr was associated with fetal loss (p=0.014, OR 32.7, 95% CI 2.0-526.0) and BP >or=140/90 mmHg during pregnancy was associated with low birth weight (p=0.027, OR 0.034, 95% CI 0.002-0.682). Deterioration of maternal renal function during pregnancy was recovered in 40.0%, hypertension was recovered in 50.0% and proteinuria was recovered in 77.8% within 1 year after delivery. CONCLUSION: Preconceptional impairment of maternal renal function and uncontrolled hypertension during pregnancy seem to be an important factors associated with fetal loss and low birth weight, respectively.
Busan ; Creatinine ; Female ; Fetus ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Humans ; Hypertension ; Infant, Low Birth Weight ; Infant, Newborn ; Kidney Diseases ; Lupus Nephritis ; Mothers ; Multivariate Analysis ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Proteinuria ; Renal Insufficiency, Chronic* ; Retrospective Studies ; Risk Factors