External dacryocystorhinostomy(DCR) has been a main surgery for epiphora since its introduction, offering the advantages of the complete formation of the ostium, the formation of flap, and potential application in all cases suffering from chronic epiphora although the disadvantages of postoperative morbidity and a cutaneous scar. In this study, the authors report the extent of patient's content for epiphora and skin scar in 131 cases treated with external DCR perfomed on 112 patients between december 1994 and January 1996. DCR incision followed the periorbital relaxed skin gension lines in order to minimize cutaneous scar. External DCR were combined with silicone intubation of the lacrimal drainage system. The medical records of all patients undergoing external DCR procedures were reviewed retrospectively in detail. the authors asked about postoperative epiphora and skin sacr through the questionnaire or the telephone. Phtients with follow-up periods less than 6 months or conjunctivo-dacryocystorhinostomy were not included in the study. Of 131 cases, 126 were improved for epiphora in comparision with preoperative state after a single attempt, yielding a success rate of 96.2%. Of 131 cases, 129(98.2%) did not express discontent for skin scar. Although endonasal DCR is considered as an increasingly attractive alternative to external DCR, external DCR is still a good procedure to treat epiphora in unexperienced surgeon for endonasal DCR.
Cicatrix* ; Dacryocystorhinostomy* ; Drainage ; Follow-Up Studies ; Humans ; Intubation ; Lacrimal Apparatus Diseases* ; Medical Records ; Surveys and Questionnaires ; Retrospective Studies ; Silicones ; Skin* ; Telephone

Atrophic tracts of the retinal pigment epithelium are angiographic images of the posteior pole, esp, inferior hemispheric retina. It is likely that serous detachment of the neuroepithelium constituting the central serous chorioretinopathy (CSC) of the posterior pole prolongs itself downwards, leaving a localized atrophy as a mark on the pigmented epithelium. In this study, they are presented in 8 cases (10 eyes) afected jointly by the CSC. All of the patients were male. The average age at the time of follow-up examination was 44.5 years. One of 10 eyes was noted to have clinically discernible, dependent peripheral retinal detachment. Retinal pigment epithelial atrophic tracts in this study were classified by 3 patterns in the FAG. One pattern presents as an irregular atrophic tract, which almost is located at the watershed zone near the temporal margin of the optic disc. Another pattern presents as the atrophic tract with a vertical line, which coursed vertically from the posterior pole into the inferior fundus. The other pattern composes of the two previous patterns. The atrophic tract of the RPE in the FAG showed hyperfluorescence. The lesions within the atrophic tracts of the RPE showed several depigmented spots and a pronounced window defect in the FAG. In the ICG angiography, the atrophic tracts of the tetinal pigment epithelium showed hypofluorescence distinctly during late phase of the ICG angiography.
Angiography ; Atrophy ; Central Serous Chorioretinopathy* ; Epithelium ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Male ; Retina ; Retinal Detachment ; Retinal Pigment Epithelium* ; Retinaldehyde*

Aneurysms arising from the ophthalmic artery itself are very rare compared with aneurysms originating from the bifurcation of the ophthalmic artery and carotid artery. There was only one reported case of a ruptured aneurysm of the ophthalmic artery itself. We discuss clinical significance of an aneurysm at this site, as well as the role of three dimentional image of multislice computed tomography angiogram(3D-image of MCTA) in determining the cause of subarachnoid hemorrhage(SAH).
Aneurysm ; Aneurysm, Ruptured* ; Carotid Arteries ; Multidetector Computed Tomography ; Ophthalmic Artery*

The complications of bile duct stone are cholangitis, pancreatitis, obstructive jaundice, liver abscess, and secondary biliary cirrhosis. Liver abscess may produce pyothorax, peritonitis, subphrenic abscess, and pyogenic pericarditis. The case studies of pyogenic pericarditis secondary to pyogenic liver abscess are rarely reported. Stones greater than 20mm in diameter are difficult or impossible to remove with a standard basket or balloon after sphincterotomy. There are several nonsurgical treatment options for large bile duct stone: mechanical lithotripsy, endoprosthesis, extracorporeal shock-wave lithotripsy (ESWL), electrohydraulic lithotripsy, contact dissolution therapy, and laser lithotripsy. We experienced a case of large bile duct stone which complicated by pyogenic pericarditis, liver abscess, and pyothorax. He treated with antibiotics, closed thoracostomy, partial pericardiectomy, and removal of bile duct stones by extracorporeal shock-wave and mechanical lithotripsy after endoscopic sphincterotomy and nasobiliary drainage.
Anti-Bacterial Agents ; Bile Ducts* ; Bile* ; Cholangitis ; Drainage ; Empyema ; Empyema, Pleural* ; Jaundice, Obstructive ; Lithotripsy ; Lithotripsy, Laser ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver Cirrhosis, Biliary ; Liver* ; Pancreatitis ; Pericardiectomy ; Pericarditis* ; Peritonitis ; Sphincterotomy, Endoscopic ; Subphrenic Abscess ; Thoracostomy

Dieulafoy lesion is very small and easily overlooked as a course of massive, often recurrent hemorrhage that results from the crosion of a submucosal artery, typically in the gastric cardia or fundus. The clinical picture of Dieulafoy lesion is quite uniform: patients commonly present with massive hemorrhage and melena without any relevant history. The diagnostic procedure of choice in patients with severe gastrointestinal bleeding is emergency endoscopy. The lesion is rare but potentially life threatening source of upper gastrointestinal bleeding. Before the endoscopic era, the prognosis for patients with these lesions was quite poor. However, recent reports have described the success of endoscopic therapy in the management of Dieulafoy lesion. We performed emergency endoscopy in 3 patients who had massive or recurrent episode of upper gastrointestinal bleeding, identified to the Dieulafoy lesion. We tried to Endoscopic "0" band ligation, successfully in hemostasis and prevention of recurrence.
Arteries ; Cardia ; Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis ; Humans ; Ligation* ; Melena ; Prognosis ; Recurrence

Primary papillary serous carcinoma of the peritoneum(PPSCP) is vere rare. It has been suggested that PPSCP derives from embryonal coelomic epithelium with m llerian ducts potential. PPSCP can develop from a single or multicentric focus. The clinical and histologic disease entities are similar to those of primary papillary serous carcinoma of the ovary, but PPSCP involves the ovarian surface only minimally(microscopic disease) or spares the ovaries entirely. We have experienced a case of primary papillary serous carcinoma of the peritoneum and report this case with brief review of the concerned literature.
Epithelium ; Female ; Ovary ; Peritoneum*

No abstract available.

For a complete colonoscopic examination, a high intubation rate and a short intubation time have been demanded to colonoscopists, if possible. The aim of the present study was to compare these examination parameters, intubation time and rate, according to the length of colonoscope. A total of 507 healthy Korean subjects were randomly assigned into two groups: intermediate length adult-colonoscope (n=254) and long length adult-colonoscope (n=253). There were significant differences in cecal intubation time and in terminal ileal intubation rate according to the length of the colonoscope. Time-to-cecal intubation was shorter for the intermediate-scope group than for the long-scope group (234.2 +/- 115.0 sec vs 280.7 +/- 135.0 sec, P < 0.001). However, the success rate of terminal ileal intubation was higher in the long-scope group than in the intermediate-scope group (95.3% vs 84.3%, P < 0.001). There were no significant differences in other colonoscopic parameters between the two groups. The intermediate length adult-colonoscope decreased the time to reach the cecum, whereas the long-scope showed a success rate of terminal ileal intubation. These findings suggest that it is reasonable to prepare and use these two types of colonoscope appropriate to the needs of the patient and examination, instead of employing only one type of colonoscope.
Adult ; Cecum ; *Colonoscopes ; Colonoscopy/*instrumentation/*methods ; Equipment Design ; Female ; Humans ; Ileum ; Intubation, Gastrointestinal/*instrumentation/*methods ; Male ; Middle Aged ; Prospective Studies ; Questionnaires ; Time Factors

OBJECTIVE: The purpose of this study is to examine the influence of cranioplasty on dynamics of cerebral blood flow(CBF) and cerebrovascular reserve capacity(CVRC), and to investigate the usefulness of single photon emission computed tomography (SPECT) as a prognostic factor for neurological improvement after cranioplasty. METHODS: Between March 2003 and December 2005, a prospective study was performed on 24 patients who had undergone total 25 cranioplasty operations. Cerebral blood flow velocities in the middle cerebral artery(MCA) and internal carotid artery (ICA) were obtained by transcranial Doppler ultrasonography(TCD). The CVRC was assessed by SPECT in the natural state and after stimulation with 1g of acetazolamide. Neurological improvement after cranioplasty was compared between patients who showed hyperactivity to acetazolamide-activated SPECT (Group 1, n=7) and hypoactivity to acetazolamide-activated SPECT (Group 2, n=17). These measurements were obtained two weeks prior to and two weeks after cranioplasty. RESULTS: The blood flow velocities at the opposite site to the cranioplasty as well as at the cranioplasty site were significantly increased (P<0.05). Compared with Group 2, there was significant increase in CBF and neurological imrovement after cranioplasty in Group 1. CONCLUSION: Among patients with surgical bony defects, the patients who had normal reactivity of the CVRC showed a significant increase in CBF and neurological improvement after cranioplasty. The authors suggest that CVRC measurement prior to surgery may be an important prognostic factor for neurological improvement after cranioplasty.
Acetazolamide* ; Blood Flow Velocity ; Carotid Artery, Internal ; Humans ; Prospective Studies ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: To investigate the changes of body fluid status after kidney transplantation (KT) and to find out the associated factors. METHODS: Forty-five patients who had received KT were classified into hemodialysis (n=32), peritoneal dialysis (n=5), and preemptive (n=8) groups by dialysis modality. %TBW, %ECF, %ICF, and edema index which were examined by bioelectrical impedance analysis as well as clinical parameters were prospectively measured before KT and 1st month, 3rd month, 6th month after KT. RESULTS: Before KT, there were no significant differences in all of the parameters listed above among the three groups. Mean %TBW and %ICF were not different compared to those of before KT. In contrast, mean %ECF markedly decreased within 1st month (before KT 21.13+/-3.04 L/kg, 1st month 20.03+/-2.37 L/kg, 3rd month 19.61+/-2.18 L/kg, 6th month 18.32+/-5.02 L/kg: p=0.007, p<0.001, p=0.001, respectively). Edema index also decreased from 1st month (1st month 0.354+/-0.014, 3rd month 0.352+/-0.011, 6th month 0.348+/-0.014: p=0.016, p=0.012, respectively). Only edema index was higher at 1st and 3rd month in hemodialysis group. Serum creatinine and 24 hour urine total protein were positively correlated with %ECF at 1st and 3rd month, and with %TBW at 3rd month. CONCLUSION: The recovery of body water distribution after KT starts with reduction of ECF within the 1st month. Serum creatinine and proteinuria are related to the recovery. No significant difference according to dialysis modality was found. Further study with larger sample size is necessary to confirm these findings.
Body Composition ; Body Fluids ; Body Water ; Creatinine ; Dialysis ; Edema ; Electric Impedance ; Extracellular Fluid ; Humans ; Kidney Transplantation ; Peritoneal Dialysis ; Prospective Studies ; Proteinuria ; Renal Dialysis ; Sample Size ; Transplants