PURPOSE: We reviewed 13 cases of pancreatic pseudocysts treated by percutaneous catheter drainage to determine the value and effectiveness of the procedure. MATERIALS AND METHODS: Sixteen pancreatic pseudocysts(nine infected, seven noninfected) were drained in 13 patients. Access routes were determined by images on CT scan and procedures were performed under fiuoroscopic guidance. Ultrasonogram was used as a guide for drainage when there were bowel loops near the access routes. Various access routes were used for catheter drainage:transperitoneal (10), retroperitoneal (3), transsplenic (2) transhepatic (1). RESULTS: Percutaneous catheter drainage cured 15 of 16 pancreatic pseudocysts(93.8%). No recurrance was encountered in the clinical follow-up of 7 to 69 months(mean 35 months). The mean duration of drainage was 29 days(infected, 24 days; noninfected, 39 days). Five pseudocysts(31%) were communicated with pancreatic duct The mean duration of drainage in these cases was 38 days. Spontaneous of the pancreatic pseudocysts to the gastrointestinal tract was occurred in 3 pseudocysts. Mean duration of drainage in pseudocysts with fistulas was 19 days. CONCLUSION: Percutaneous cather drainage is a safe and effective front-line treatment method in most pancreatic pseudocysts if drainage is done with a adequate follow-up and catheter care.
Catheters ; Drainage* ; Fistula ; Follow-Up Studies ; Gastrointestinal Tract ; Humans ; Pancreatic Ducts ; Pancreatic Pseudocyst* ; Tomography, X-Ray Computed ; Ultrasonography

No abstract available.
Adenocarcinoma*

PURPOSE: To evaluate the effectiveness of transcatheter embolization for the treatment of massive gastrointestinal arterial bleeding. MATERIALS AND METHODS: The study was based on retrospective analysis of twelve cases(8 men, 4 women) including two patients with hemobilia in which transcatheter embolization was attempted for the control of massive gastrointestinal bleeding from March 1987 to October 1993. Clinical diagnoses of these patients were peptic ulcer(5), pseudoaneurysm formation(3) following percutaneous transhepatic biliary drainage or traffic accident, stomach cancer(I), typhoid fever(I), duodenal leiomyoma(1) and Osler-Weber-Rendu disease (1). RESULTS: Embolized vessels are as follows: gastroduodenal artery(6), left gastric artery(2), ileocolic artery(2), and hepatic artery(2). Embolization was effective in immediate control of bleeding in all patients. Although five of the six patients who had undergone embolization of the gastroduodenal artery developed rebleeding within 24 hour, only 2 reguired surgery and none showed serious complication. CONCLUSION: Embolization therapy is safe and effective initial treatment of choice for life-threatening massive gastrointestinal bleeding.
Accidents, Traffic ; Aneurysm, False ; Arteries ; Diagnosis ; Drainage ; Gastrointestinal Hemorrhage* ; Hemobilia ; Hemorrhage ; Humans ; Male ; Retrospective Studies ; Stomach ; Typhoid Fever

PURPOSE: To evaluate the feasibility and efficacy of revision of the transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: Sixteen malfunctioning TIPS (10 occlusions, 6 stenoses) in 14 patients of 103 patients (117 procedures) were revised. Fifteen patients underwent revision to control recurrent variceal bleeding after TIPS and one to restore severely stenotic TIPS found on portal venogram obtained during transarterial chemoembolization of a hepatocellular carcinoma. One patient underwent three revisions. The time intervals between initial TIPS placement and revisional procedures varied between four and 43 months (mean, 17.6 months). Nine occlusions and four stenoses were treated with an additional stent placed in a parallel or overlapping fashion with transjugular approaches. Two stenoses and one acute occlusion were treated with balloon dilatation involving transfemoral approaches. RESULTS: In patients with complete occlusion of TIPS, the sites of occlusion were all within the stent, with or without associated stenosis of the hepatic vein. In five of six patients, with TIPS stenosis, however, the stenoses were located at the hepatic vein just distal to the stents, rather than within the stents. The procedures for revision were in all cases technically feasible and hemodynamically successful. No significant procedure-related complications were encountered. CONCLUSION: The revision of TIPS is a safe and effective method in cases of its partial or complete occlusion.
Carcinoma, Hepatocellular ; Constriction, Pathologic ; Dilatation ; Esophageal and Gastric Varices ; Hepatic Veins ; Humans ; Hypertension, Portal ; Portasystemic Shunt, Surgical* ; Stents

PURPOSE: To evaluate the feasibility of MR arthrography and ultrasonography in evaluating shoulder pain. MATERIALS AND METHODS: The subject group consisted of all patients who visited our institute complaining of shoulder pain or instability from June 2002 to December 2004. There were a total of 92 patients with a mean age of 48. On the basis of arthroscopic results, the sensitivity, specificity, and accuracy of ultrasonography and MR arthrography were evaluated by comparing them with each other. RESULTS: In the diagnosis of supraspinatus tendon tears, ultrasonography had sensitivity and specificity of 100% and 64%, respectively, whereas MR arthrography had sensitivity and specificity of 80% and 94%, respectively. Ultrasonography also had high sensitivity and specificity in the diagnosis of subscapularis tendon tears (100% and 90%). MR arthrography was appropriate for identifying glenoid labral abnormalities (sensitivity, 95% and specificity, 61%). Similar results from ultrasonography and MR arthrography were obtained in the diagnosis of subscapular tendon tears or full-thickness tears of the rotator cuff tendons (kappa value, 0.644 and 0.911). CONCLUSION: While evaluating rotator cuff abnormalities, ultrasonography was appropriate for screening, whereas MR arthrography was useful to confirm the results of the ultrasonography.
Arthrography* ; Diagnosis ; Humans ; Mass Screening ; Rotator Cuff* ; Sensitivity and Specificity ; Shoulder Pain ; Tendons ; Ultrasonography*

PURPOSE: To evaluate the cilinical results of transjugular intrahepatic portosystemicshunt(TIPS) for the control of variceal bleeding. MATERIALS AND METHODS: TIPS creation was attempted in 23 patients with endoscopically confirmed variceal bleeding. Most patients had multiple episodes of bleeding in the past and have been treated with multiple endoscopic sclerotherapies. Pre- and post-procedural hepatic and portal vein pressures were measured. After creation of TIPS patients were followed up at regular intervals. RESULTS: TIPS has been successfully accomplished in 22 of 23 patients using Wallstent(n=21 ) and Strecker stent(n=1 ). Immediate bleeding control was achieved in all patients with shunt creation. No procedure-related complication was noted. Portal vein pressure was reduced from 30.7+/-5.8 mmHg to 20.8+/-4.7 mmHg. The mean pressure gradient of portosystemic shunt dropped from 22.8+/-6.0 prior to TIPS to 12.2+/-4.1 immediately after. During the follow-up period (6-556 days, mean; 10months), seven patients died; progressive hepatic failure (n=4), variceal rebleeding(n=2), and respiratory failure(n=1). Hepatic encepha-Iopathy after TIPS was noted in 7 patients(31.8%). Variceal rebleeding occurred in 3 patients(13.6%). The remaining 15 patients have survived an average of 11 months. CONCLUSION: This results suggest that TIPS is a safe and effective method for lowering portal pressure and controlling variceal bleeding. Furthermore if these initial results are encourged by further long-term observation, TIPS could replace endoscopic and risky surgical intervention.
Esophageal and Gastric Varices ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver Failure ; Portal Pressure ; Portal Vein ; Portasystemic Shunt, Surgical* ; Sclerotherapy

PURPOSE: To prevent intraperitoneal bleeding, it is critical that the extrahepatic portal vein should not bepunctured during transjugular intrahepatic portosystemic shunt (TIPS). There has, however, been no procedure fordefining the anatomic relationship between the hepatic capsule and the portal vein segment before shunt formation.To avoid a possibly catastrophic outcome of extrahepatic portal puncture before shunt creation, we thereforedevised a new method; the purpose of this study is to report its efficacy and feasibility. MATERIALS AND METHODS:Whenever a portal vein was punctured, we advanced a 9F sheath over a guidewire into the portal vein before balloondilatation of the tract. Contrast material was then injected through the sheath as this was slowly withdrawn fromthe portal vein towards the hepatic vein. When contrast material extravasated or spilled into the peritonealspace, thus suggesting extrahepatic portal vein puncture, a more peripheral segment of the portal vein waspunctured, and a shunt was created using this new tract. We applied this method to 130 consecutive patients whounderwent TIPS to control variceal bleeding due to liver cirrhosis. In all cases, portography and ultrasonographywere used for immediate confirmation of the procedure. RESULTS: Puncture of the extrahepatic portal vein segmentoccurred in three out 130 (2.3%) patients. In these three, TIPS was successfully created using the methoddescribed above. Clinical and ultrasonographic follow-up showed that no patients suffered intraperitonealbleeding. CONCLUSION: For preventing intraperitoneal hemorrhage during TIPS creation, our method is effective andfeasible.
Esophageal and Gastric Varices ; Follow-Up Studies ; Hemorrhage* ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Portal Vein ; Portasystemic Shunt, Surgical ; Portography ; Punctures

Percutaenous transhepatic biliary drainage (PTBD) is widely used to control cholangitis, sepsis, or jaundice caused by biliary tree obstruction. The PTBD tract can be used in percutaneous biliary stone extraction in pre-or post-operative state when ERCP is failed or operation is contraindicated. We performed 16 cases of percutaneous transhepatic biliary stone removal. Locations of biliay stones are combined intrahepatic and extrahepatic in 8 cases (50%), only extrahepati in 7 cases (44%), and only intrahepatic in 1 case (6%). The number of stones was single in 6 cases and multiple in 10 cases. Over all success rate was 81% (13/16), 93% (14/15) in extrahepatic stones and 78% (7/9) in intrahepatic stones. In 5 of 6 cases, complete stone removal was impossible due to marked tortuosity of T-tube tract or peripherally located stones, complete removal of biliary stones was achieved via a new PTBD tract. No significant pre-or post-procedure complication was occured. Percutaneous removal of biliary stones via PTBD tract is an effective and safe alternative method in difficult cases in the menagement of biliary tract stones.
Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Drainage ; Jaundice ; Methods ; Sepsis

PURPOSE: To compare the accuracy of computed tomography (CT) and ultrasound (US) in the diagnosis of bezoars in small bowel obstruction. MATERIALS AND METHODS: During a recent eight-year period, 23 patients underwent surgery due to small bowel obstruction caused by bezoars, and 14 who underwent both CT and US were included in this study. The scans obtained were retrospectively reviewed by two radiologists working independently, and the usefulness of each modality in terms of diagnostic capacity, determination of the level of obstruction and detection of additional bezoars was assessed. RESULTS: At surgery, a total of 22 bezoars were removed: 19 from the small intestine and three from the stomach; multiple bezoars were found in five of the 14 patients. The presence of bezoars was demonstrated by CT in all patients, and by US in ten (71%) (p=0.125). The level of obstruction was correctly predicted in 57% of cases at US and in 100% at CT (p=0.03). Overall sensitivity was 55% for US (12/22) and 96% for CT (21/22) (p<0.01). In three patients with associated gastric bezoars, US revealed only one, whereas all were demonstrated by CT. In five with multiple lesions, only five (39%) of 13 were apparent at US, but 12 (92%) were revealed by CT. CONCLUSION: Both US and CT were useful for the diagnosis of small bowel obstruction caused by bezoars. CT however, was more accurate in determining the level of obstruction and in revealing additional bezoars in the small bowel and stomach.
Bezoars* ; Diagnosis ; Humans ; Intestine, Small ; Retrospective Studies ; Stomach ; Ultrasonography

Torsion of the gallbladder is a rare and acute abdominal condition. Even with the recent advances in radiologic imaging modalities, it is difficult to make a correct preoperative diagnosis of gallbladder torsion. We recently experienced a case of gallbladder torsion at the body portion in which an accurate preoperative diagnosis could be made on the gray scale and by using color Doppler ultrasonography. We report the imaging and operative findings with particular emphasis on the ultrasonographic "whirlpool sign".
Diagnosis ; Gallbladder* ; Ultrasonography, Doppler, Color