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 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

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

BACKGROUND: The C-arm fluoroscope is known as the most important equipment in pain interventions. This study was conducted to investigate the completion rate of education on radiation safety, the knowledge of radiation exposure, the use of radiation protection, and so on. METHODS: Unsigned questionnaires were collected from the 27 pain physicians who applied for the final test to become an expert in pain medicine in 2011. The survey was composed of 12 questions about the position of the hospital, the kind of hospital, the use of C-arm fluoroscopy, radiation safety education, knowledge of annual permissible radiation dose, use of radiation protection, and efforts to reduce radiation exposure. RESULTS: In this study, although most respondents (93%) had used C-arm fluoroscopy, only 33% of the physicians completed radiation safety education. Even though nine (33%) had received education on radiation safety, none of the physicians knew the annual permissible radiation dose. In comparing the radiation safety education group and the no-education group, the rate of wearing radiation-protective glasses or goggles and the use of radiation badges or dosimeters were significantly higher in the education group. However, in the use of other protective equipment, knowledge of radiation safety, and efforts to reduce radiation exposure, there were no statistical differences between the two groups. CONCLUSIONS: The respondents knew very little about radiation safety and had low interest in their radiation exposure. To make the use of fluoroscopy safer, additional education, as well as attention to and knowledge of practices of radiation safety are required for pain physicians.
Surveys and Questionnaires ; Eye Protective Devices ; Eyeglasses ; Fluoroscopy ; Glass ; Surveys and Questionnaires ; Radiation Monitoring ; Radiation Protection

OBJECTIVES: The prevalence of hepatitis A decreases with improved hygiene and changing lifestyle. However, hepatitis A remains a global problem causing sporadic food-borne infections. Over the past 5 years, hepatitis A incidence has increased, and 15 deaths were reported in 2009 in Korea. Concerns about hepatitis A infection have increased. We checked hepatitis A virus antibody (HAV anti-IgG) in a large manufacturing company, so that the results could be a guideline for workplace preventive plan and health policy for hepatitis A. METHODS: We investigated the seroprevalence of HAV anti-IgG and the demographic characteristics of employee volunteer, in a company in Ulsan. In addition, we estimated those factors that affected seroprevalence of HAV anti-IgG. RESULTS: A total of 2,719 employee volunteers were enrolled into the study. The seropositive rate of HAV anti-IgG was 69.8% (n=1,899) and, the seronegative rate was 30.2% (n=820). There were no enrolled employees under age 24 years who tested positive for HAV anti-IgG; in this group, the seropositive rate was 0.0% (n=0); in 25~29 years the rate was 3.9% (n=12) and 26.5% (n=118) in 30~34 years olds. In the 35-39 ears, 61.1% (n=203) tested HAV anti-IgG positive and 86.8% (n=256) of 40~44 years tested positive. Other group tested as follows: 96.5% (n=335) in 45~49 year olds, 98.7% (n=593) in 50~54 year olds, and 100% (n=382) in over 55 years. There was a significantly increasing tendency to test HAV anti-IgG positive according to age group. In the 34-35 year olds, the seropositive rate exceeded the seronegative rate. CONCLUSIONS: HAV anti-IgG seropositive rate increased according to age. The result can used for guideline recommendationsand establishing hepatitis A policies.
Antibodies, Anti-Idiotypic ; Ear ; Health Policy ; Hepatitis ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A virus ; Humans ; Hygiene ; Incidence ; Korea ; Life Style ; Prevalence ; Seroepidemiologic Studies

Endometriosis represents extrauterine nonneoplastic endometrial tissue. It is most commonly diagnosed in women of childbearing age, with a peak age of 40 to 44 years. The incidence of genitourinary involvement ranges from 1% to 2%. Ureteral endometriosis is a rare entity, and its diagnosis requires a high index of suspicion. We report a case of ureteral endometriosis in a 44-year-old multiparous woman with a brief review of literature.
Adult ; Diagnosis ; Endometriosis* ; Female ; Humans ; Hydronephrosis ; Incidence ; Ureter*

Angioedema is a well-demarcated localized edema involving the deeper layers of the skin, including the subcutaneous tissue. Angioedema occurs with Cl esterase inhibitor (Cl INH) deficiency that may be inborn as an autosomal dominant characteristic or may be acquired. Acquired angioedema (AAE) is a rare disorder characterized by adult onset and lack of evidence of inheritance of the disease. Two types of AAE are known today: type I in which there are lowering of functional Cl INH, an underlying disease such as a B-cell disease, and no detectable autoantibodies to Cl INH, type II with anti Cl INH autoantibodies in the circulation without detectable underlying disease and with depressed functional Cl INH levels. We experienced a case of angioedema in a 29-year old man. He had no family history of angioedema and laboratory data showed depressed Cl-INH levels. We diagnosed the case as acquired type of angioedema. Even though we could not measure anti-Cl INH auto-antibodies, we identified the case as type II because there was no evidence of underlying disease.
Adult ; Angioedema* ; Angioedemas, Hereditary* ; Autoantibodies ; B-Lymphocytes ; Complement C1 Inhibitor Protein* ; Complement C1s* ; Edema ; Humans ; Skin ; Subcutaneous Tissue ; Wills

Acinar Cells ; Adult ; Carcinoma, Acinar Cell ; Classification ; Female ; Hemangioma ; Humans ; Palate, Hard ; Prognosis ; Vascular Malformations

BACKGROUND: Postlaminectomy peridural fibrosis is inevitable. Some studies have compared and identified the effects of high molecular weight hyaluronic acids (HMWHA) and low molecular weight hyaluronic acids (LMWHA) on peridural fibrosis in postlaminectomy animal models. However, no studies have been found that compare pain behaviors between hyaluronic acids or among hyaluronic acids and other solid materials. The purpose of this study was to examine the correlation between pain-related behaviors and histopathologic changes in laminectomized rats using various peridurally administered materials. METHODS: Forty male Sprague-Dawley rats, laminectomized at the L5 and L6 levels, were divided into four groups: group C, laminectomy only; group L, laminectomy and LMWHA application; group H, laminectomy and HMWHA application; group F, laminectomy and fat interposition. Pain behaviors were checked before, 3 days, 1 week, and 3 weeks after surgery. Histopathological changes were checked at the L5 level 3 weeks after the surgery. RESULTS: The 50% withdrawal thresholds in groups L and H were higher than that in groups C and F three days after laminectomy (P < 0.05). The paw withdrawal time did not change among the groups and in each group during the study period. Peridural fibrosis in group F was significantly lower than in the other groups (P < 0.05). CONCLUSIONS: Hyaluronic acids significantly reduced mechanical allodynia but not thermal hyperalgesia. Peridural fibrosis did not show any correlation with pain behaviors. There have been limited studies on the correlation between peridural fibrosis and pain behavioral change, which should be verified by further studies.
Animals ; Failed Back Surgery Syndrome ; Fibrosis ; Humans ; Hyaluronic Acid ; Hyperalgesia ; Inflammation ; Laminectomy ; Male ; Models, Animal ; Molecular Weight ; Rats ; Rats, Sprague-Dawley

Cystic lymphangioma is a relatively rare congenital malformation of the lymphatic system. It is very rare that retroperitoneal cystic lymphangioma was detected by prenatal ultrasonography. There has been no case reported that scrotal cystic lymphangioma was detected by prenatal ultrasonography. We detected a cystic structure with multiseptation in the scrotum at 30 weeks gestation. In addition, we detected the same structure in the retroperitoneum at 35 weeks gestation by routine ultrasonography. Because of increasing size of the cyst, we performed induction delivery at 38 weeks gestation. Operation of the neonate was performed on the 13th day after birth by a pediatric surgeon and the mass was excised and confirmed as cystic lymphangioma. We experienced a case of huge cystic lymphangioma of the retroperitoneum and scrotum by prenatal sonography and report our case with a brief review of literature.
Fetus* ; Humans ; Infant, Newborn ; Lymphangioma, Cystic* ; Lymphatic System ; Parturition ; Pregnancy ; Scrotum* ; Ultrasonography ; Ultrasonography, Prenatal