An occasional patient has both a pressing need for visualization of the biliary system in spite of a past history of reaction to iodinated contrast media. We report a patient, who had reacted adversely to contrast media, underwent ERCP using barium sulfate in order to opacify the biliary and pancreatic duct without side effect successfully. In conclusion, ERCP using barium sulfate as a contrast material is of value in patients who are intolerant of the iodinated contrast media.
Barium Sulfate* ; Barium* ; Biliary Tract ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde* ; Contrast Media ; Humans ; Pancreatic Ducts

No abstract available.
Humans ; Liver Cirrhosis* ; Liver* ; Sepsis* ; Vibrio cholerae* ; Vibrio*

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

The hypertensive lower esophageal sphincter(LES)(mean LES pressure>45mmHg; LES relaxation>75%;normal peristalsis) is an uncommon primary esophageal motor disorder associated with chest pain, dysphagia and globus sensation. We carried out this study to evaluate clinical features, esophageal pressure profiles, endoscopic ultrasonographic findings, and assess the effect of oral nifedipine(30 mg/day for 8 weeks) in patients with hypertensive LES(mean age 53.8 years, M: F:=2:7) and l3 controls(mean age 47.5 years, M:F=4:9), Chief complaints were chest pain(77.8%), dysphagia(33.3%) and globus sensation(22.2%). Esophageal manometry showed a significant(p<0.01) increase in LES pressure and higher trend of residual pressure and body contraction amplitude in patients compared with controls. Two cases of nutcracker esophagus and one case of nonspecific esophageal motor disorder were associated with hypertensive LES patients by eeophageal manometry. Five patients were examined by endoscopic ultrasonography(EUS). Three of them showed a normal ultrasonic structure of the wall of the gastro-esophageal junction. Focal and/ or diffuse thickening of muscularis propria were observed in remaining 2 patients. Oral nifedipine significantly decreased the LES pressure and alleviated most of dysphagia and chest pain in patients with normal EUS finding. In conclusion, hypertensive LES was a heterogenous esophageal motor disorder characterized by high LES pressure, residual pressure and body contraction amplitude. The clinical relevance of endoscopic ultrasonographic finding is yet to be determined, but it may be speculated that nifedipines lack of effect on esophageal pressure profiles in some patients is responsible for thickening of muscularis propria in the area of lower esophageal sphincter. Collecting further data regarding treatment response according to EUS finding is required to validate our speculation.
Chest Pain ; Deglutition Disorders ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower* ; Humans ; Manometry ; Nifedipine ; Sensation ; Thorax ; Ultrasonics

The hypertensive lower esophageal sphincter(LES)(mean LES pressure>45mmHg; LES relaxation>75%;normal peristalsis) is an uncommon primary esophageal motor disorder associated with chest pain, dysphagia and globus sensation. We carried out this study to evaluate clinical features, esophageal pressure profiles, endoscopic ultrasonographic findings, and assess the effect of oral nifedipine(30 mg/day for 8 weeks) in patients with hypertensive LES(mean age 53.8 years, M: F:=2:7) and l3 controls(mean age 47.5 years, M:F=4:9), Chief complaints were chest pain(77.8%), dysphagia(33.3%) and globus sensation(22.2%). Esophageal manometry showed a significant(p<0.01) increase in LES pressure and higher trend of residual pressure and body contraction amplitude in patients compared with controls. Two cases of nutcracker esophagus and one case of nonspecific esophageal motor disorder were associated with hypertensive LES patients by eeophageal manometry. Five patients were examined by endoscopic ultrasonography(EUS). Three of them showed a normal ultrasonic structure of the wall of the gastro-esophageal junction. Focal and/ or diffuse thickening of muscularis propria were observed in remaining 2 patients. Oral nifedipine significantly decreased the LES pressure and alleviated most of dysphagia and chest pain in patients with normal EUS finding. In conclusion, hypertensive LES was a heterogenous esophageal motor disorder characterized by high LES pressure, residual pressure and body contraction amplitude. The clinical relevance of endoscopic ultrasonographic finding is yet to be determined, but it may be speculated that nifedipines lack of effect on esophageal pressure profiles in some patients is responsible for thickening of muscularis propria in the area of lower esophageal sphincter. Collecting further data regarding treatment response according to EUS finding is required to validate our speculation.
Chest Pain ; Deglutition Disorders ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower* ; Humans ; Manometry ; Nifedipine ; Sensation ; Thorax ; Ultrasonics

From May, 1978 through Oct., 1979 the effect of Coenzyme Q10 was evaluated on 10 patients with chronic heart failure. The subjects selected for this study consisted of 7 patients with cardiomyopathy and 3 patients with valvular heart disease admitted to Severance Hospital, Yonsei University College of Medicine, All these patients had symptoms and signs of congestive heart failure which was stable for at least one month before starting Coenzyme Q10. Coenzyme Q10 was administered 30mg daily for eight weeks, one hour before meal and in combination with digitalis and/or diuretics. The drug effects were determined by measuring the cardio-thoracic ratio by chest X-ray, the sum of 'S' wave in V1 and 'R' wave in V5 in electrocardiogram, and PEP/LVET (pre-ejection period/left ventricular ejection time) by simultaneous tracings of carotid pulse and phonocardiogram every two weeks during medication. The cardio-thoracic ratio was improved in 4 of 10 cases, the sum of RV+SV5 was decreased in all 5 cases who showed voltages above 40mm before medication, and PEP/LVET ratio was decresed in 4 of 10 cases. The difference of average values before and after medication were not statistically significant(p<0.05) in all 3 parameters when examined by t-test. During treatment, there was improvement, if any, from two weeks after medication and no significant side effects were noted throughout the study period.
Cardiomyopathies ; Digitalis ; Diuretics ; Electrocardiography ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Heart Valve Diseases ; Humans ; Meals ; Thorax

From May, 1978 through Oct., 1979 the effect of Coenzyme Q10 was evaluated on 10 patients with chronic heart failure. The subjects selected for this study consisted of 7 patients with cardiomyopathy and 3 patients with valvular heart disease admitted to Severance Hospital, Yonsei University College of Medicine, All these patients had symptoms and signs of congestive heart failure which was stable for at least one month before starting Coenzyme Q10. Coenzyme Q10 was administered 30mg daily for eight weeks, one hour before meal and in combination with digitalis and/or diuretics. The drug effects were determined by measuring the cardio-thoracic ratio by chest X-ray, the sum of 'S' wave in V1 and 'R' wave in V5 in electrocardiogram, and PEP/LVET (pre-ejection period/left ventricular ejection time) by simultaneous tracings of carotid pulse and phonocardiogram every two weeks during medication. The cardio-thoracic ratio was improved in 4 of 10 cases, the sum of RV+SV5 was decreased in all 5 cases who showed voltages above 40mm before medication, and PEP/LVET ratio was decresed in 4 of 10 cases. The difference of average values before and after medication were not statistically significant(p<0.05) in all 3 parameters when examined by t-test. During treatment, there was improvement, if any, from two weeks after medication and no significant side effects were noted throughout the study period.
Cardiomyopathies ; Digitalis ; Diuretics ; Electrocardiography ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Heart Valve Diseases ; Humans ; Meals ; Thorax

BACKGROUND: The infection rate of syphilis in married couples has been reported by a few investigators during the 1940s. However, studies on recent trends of that particular aspect of syphilis in married couples have not yet been done. OBJECTIVE: We therefore studied the infectivity of T. pallidum and recent trends of conjugal syphilis by observing the spouses of patients with untreated syphilis. METHODS: Couples married for more than 1 year who visited Yonsei Medical Center from 1983 to 1990 for syphilis were entered into this study. We observed the infection rate among spouses of 224 index patients (defined as, between husband and wife, the one who was the first to be diagnosed to have syphilis) who were not treated for syphilis. Syphilis was diagnosed on the basis of physical examination, history of extramarital sexual contacts, and the results of VDRL, TPHA, FTA-ABS, and 19S(IgM)-FTA tests. RESULTS: Fifty-six wives(48%) of 117 male index patients and 50 husbands (47%) of 107 female index patients had been infected at the time of examination. Among the 224 couples, 106(47%) were both infected and in 118(53%), only either husbands(27%) or wives(26%) were infected. Two spouses(50%) of the 4 first incident patients with primary syphilis, 9(53%) of 17 with secondary syphilis and 23(72%) of 32 with early latent syphilis were infected at the time of examination. CONCLUSION: From our results showing the low infection rates among married couples, even in early syphilis when the infectivity is high, it can be deduced that T. pallidum has only a low infectivity.
Family Characteristics ; Female ; Globus Pallidus ; Humans ; Male ; Physical Examination ; Research Personnel ; Spouses ; Syphilis* ; Syphilis, Latent

Trminal ileum and cecum are the most frequently involved portions of the gastrointestinal tract in Behqet's disease. Esophageal involvement in Behqet's disease is very uncommon and only a few cases have previously been reported. We have observed a case with this disease. A 25-year-old female patient who was diagnosed as having Behqet's disease 7 years before had dysphagia and weight loss of about 10 kg for 4 months. Esophagogastroduodenoscopic examination revealed diffuse ulceration and mucosal nodularities in esophagus which suspected esophageal cancer. But repeated biopsies showed lymphocytic infiltration around vessels in ulcerative lesions. She was treated with conservative managements.
Adult ; Biopsy ; Cecum ; Deglutition Disorders ; Esophageal Neoplasms ; Esophagus ; Female ; Gastrointestinal Tract ; Humans ; Ileum ; Ulcer* ; Weight Loss

After portal vein occlusion, portal to portal collaterals (hepatopetal) develop from preexisting periportal vessels or recanalization of the thrombosed portal vein, undergo compensatory enlargement, bypass the obstructed extrahepatic occlusion and reconstitute the intrahepatic portal branches. Angiographically, collateral veins are seen as multiple tortous winding veins in the porta hepatis and are described as a cavemous transformation of the portal vein. When the common bile duct or gall bladder is compressed by collateral veins, a cholangiogram demonstrates multiple smooth intramural defects and jaundice can develop due to the partial obstruction of the bile duct. Demonstration of the cavernous transformation of the portal vein can be done by ultrasonography, abdominal computed tomography and nuclear magnetic resonance, but Doppler ultrasonography and direct or indirect portography are needed to evaluate its hemodynamic change. We present a 35-year-old female patient complaining repeated jaundice, in whom common bile duct and gall bladder varices accompanied by cavernous transformation of the portal vein and intrahepatic stones were diagnosed by ultrasonography, abdominal computed tomography, ERCP, and Doppler ultrasonograpy and confirmed by surgery. ERCP demonstrated the irregular contour of the common bile duct and gall bladder due to multiple smooth intramural defects. Doppler utrasongraphy revealed the unique flow signal of portal vasculature from the tortous vessls in the porta hepatis and from the vascular structures on the wall of the gall bladder.
Adult ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct* ; Female ; Hemodynamics ; Humans ; Jaundice ; Magnetic Resonance Spectroscopy ; Portal Vein ; Portography ; Ultrasonography ; Ultrasonography, Doppler* ; Urinary Bladder* ; Varicose Veins* ; Veins ; Wind