To evaluate the significance of chironomid as a respiratory allergen, we performed skin prick tests with Chironomus plumosus (CP) and Tokunagayusurika akamusi (TA) extracts on 475 respiratory allergy patients, and their specific IgE antibodies were detected by enzyme-linked immunosorbent assay (ELISA) in 106 positive reactors to skin prick test and 30 negative controls. Ninety-seven (20.4%) showed more than 2+ of allergen to histamine ratio to CP and 98 (20.6%) to TA on skin prick test. Seventy-one (73.2%) of 97 positive reactors had increased specific IgE to CP, and 34 (34.7%) of 98 positive reactors, to TA. CP-specific IgE was detected in 14 (14.4%) non-atopic asthmatics and 6 (6.2%) non-allergic rhinitis patients. TA-specific IgE was detected in 17 (17.4%) non-atopic asthmatics and 6 (6.1%) non-allergic rhinitis patients. No association was noted between skin reactivity to Dermatophagoides farinae and the prevalence of specific IgE to CP or TA (p > 0.05). The correlation between total IgE level and specific IgE level to CP and TA was poor (r = 0.07, 0.04). ELISA inhibition test suggested specificity of IgE binding and cross-allergenicity between CP and TA. It is suggested that CP and TA can induce IgE-mediated reaction in exposed patients and should be considered as important causative allergens in respiratory allergy patients in Korea.
Allergens/*immunology ; Animals ; Chironomidae/*immunology ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin E/*biosynthesis ; Korea ; Prevalence ; Respiratory Hypersensitivity/*immunology ; Skin/*immunology ; Skin Tests

No abstract available.
Humans ; Venous Thrombosis*

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

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 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

After a lobectomy the apearance of the chest roentgenogram may return so nearly to normal that it isfrequently very difficult to tell which lobe has been moved without refering to the thoracic surgeon's record. Thereriew of literature failed to disclose previous articles concerning the differential diagnosis between upper andlower lobectomy. Clues of a lobectomy may be found in the rib cage, hilar shadows, pleura and disphragms, but they do not specifically incidate which lobe has been removed. In the present study we anlaysed anatomico-spatialchanges of the pulmonary basal arteries, hilar point, vascular redistribution, diaphragm and rib cage on the plainchest films taken before and after a lobectomy in 33 cases seen at the Dept. of Radiology, St. Mary's Hospoital, Catholic Medical College. Firstly we observed the pulmonary basal artery after a lobectomy on plain chest film. In 12 cases of upper lobectomy the pulmonary basal artery was easily identified in every case. However in all of 21cases of lower lobectomy, the pulmonary basal artery was not identified. Next, a shift of the hilar point waschecked after a lobectomy. Regarding to vascular redistribution, the blood vessels was counted at upper and lowerlung fields by simon's method before and after a lobectomy, respectively. Finally, the level of the diaphragm wascompared in the pre. and post-opeative films and resected rib was scrutinized. The present study revealed that themost reliable sign to indicate specifically which lobe has been resected is persistence or disappearance of thepulmonary basal artery. Then i.e. in upper lobectomy the pulmonary basal artery was easily identified, but inlower lobectomy the pulmoanry basal artery was not dectable. Other findings such as vascular redistribution,elevated diaphragm and resected rib were not specific.
Arteries ; Blood Vessels ; Diagnosis, Differential ; Diaphragm ; Methods ; Pleura ; Ribs ; Thorax

Disparity among cholangiograms is rarely observed. The causes of disparity include spontaneous disappearance of gall stone, incomplete filling of smaller branch, technical problems, interpretative errors, and overriding of evidence. 5pontaneous disappearance of gall stone is rare but has been well documented in both radioligic and clinical literatures. Recently we have experienced spontaneous disappearance of a large stone in the common bile duct and this formsthe basis of the present case report. The patient, 53-year-old female, was admitted on January 18, 1982 to 5t. Mary's Hospital, Catholic Medical College because of repeated episodes of pain in the epigastrium and the right upper quadrant for the past 2 months. On admission, physical examination revealed tenderness in the epigastrium and the right μpper quadrant. Laboratory tests revealed bilirubin 2.2 mgfdl and alkaline phosphatase 76 .5 KA/dl. A percutaneous transhepatic cholagiogram(PTC} performed 2 days later revealed a large stone measuring 16 × 26mm in size in the distal CBD. The CBD and CHD proximal to the stone were moderately dilated. Most of the intrahepatic ducts were well delineated without fi lJ ing defect or evidence of stone. However, the in ferior segment of the posterior branch of the right intrahepatic duct (IPRH) was not delineated. The ending of the nonvisualized segment was rather abrupt. The patient suffered severe abdominal pain 2 days after PTC, and was treated with Buscopanø compositum. The attack ceased 20 hours after the onset of colicky abdominal pain. An operation was performed 4 days after PTC. To our surprise there was no stone in the distal CBD. The gallbladder was resected and a T-tube has been placed. A table cholangiogram confirmed disappearance of the stone, but IPRH was agin not opacified except for a short ditance just after bifurcation from the main branch. Eight days after surgery a follow-up T-tube cholangiogram was performed. No residual stone was found in the extrahepatic bile duct. However, IPRH which was not opacifled until then became distinctly visualized demonstrating multiple intra-ductal radiolucent stones, There was a diaphragm-like structure obstructing the lumen and confining the stones located proximally to the site obstructed in the precedent cholangiograms, The radiologic and clinical importances of our observation in this case are four fold: 1. Gall stone up to the diameter of 14 × 23mm can pass through the papilla spontaneously, 2. Repeat diagnostic imaging is imperative when patient became asymptomatic after severe colicky abdominal pain before the intended operation, 3. Without optimal delineation of intrahepatic biliaη radicles, residual stone or stones cannot be exciuded in the cholangiograms, 4. And finally, to avoid misdiagnosis a comprehensive knowledge of normal anatomy of cholangiogram is required.
Abdominal Pain ; Alkaline Phosphatase ; Bile Ducts, Extrahepatic ; Bilirubin ; Common Bile Duct ; Diagnostic Errors ; Diagnostic Imaging ; Diaphragm ; Female ; Follow-Up Studies ; Gallbladder ; Gallstones ; Humans ; Middle Aged ; Physical Examination

No abstract available.
Aneurysm* ; Carotid Artery, External* ; Neurofibromatoses*

We analyzed 20 cases of traumatic carotid cavernous fistula(CCF) during the recent 10 years The results are summarized as follows: 1) In 18 cases(90%), the clinical symptoms & signs of CCF occurred within 2 months after trauma. 2) The sites of fistulae were common in horizontal segment(40%) and at the junction(30%) between horizontal segment and posterior ascending segment of cavernous portion of internal carotid artery. 3) The main draining veins of CCF were the superior ophthalmic vein(90%) and the inferior petrosal sinus(70%). 4) The methods of treatment were occlusion of fistula with balloon(9 cases), occlusion of cavernous ICA with balloon(2 cases), ligation of cervical ICA with Poppen's clamp(4 cases) and trapping(2 cases). Two patients were not treated and another patient was healed spontaneously. 5) The frequency and severity of complication was significantly decreased in cases treated by detachable balloon occlusion than by direct cervical ICA ligation or trapping procedures. 6) The procedure using the self-sealed goldvalve balloon was simple, but had a risk of premature separation and premature deflation.
Balloon Occlusion ; Carotid Artery, Internal ; Fistula* ; Humans ; Ligation ; Veins

BACKGROUND/AIMS: Pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancers. Marked improvements in morbidity and mortality rates following pancreaticoduodenectomy have been reported in recent years. However, pancreatic leakage still occurs in 5% to 25% of patients and is a major cause of morbidity and mortality. METHODS: Between January 1990 to June 1999, eighty-two patients underwent pancreaticoduodenectomy. We compared preoperative, intraoperative characteristics as well as postoperative sandostatin usage in those patients who experienced (n=21) versus those who did not experience pancreatic leakage (n=61). Information was retrospectively collected from hospital record. RESULTS: The clinical leakage rate in this series was 25.6% (n=21). There were no significant differences in preoperative characteristics comparing those with versus those without pancreatic leakage. Among intraoperative characteristics, duct stenting and transfusions were significantly associated with the pancreatic leakage. Finally, postopeative sandostatin usage was able to reduce significantly the incidence of pancreatic leakage. CONCLUSION: Although consensus among surgeons does not exist as to opeative tenchnique and postoperative management, stenting and less bleeding as well as sandostatin usage had better results in this study.
Consensus ; Hemorrhage ; Hospital Records ; Humans ; Incidence ; Mortality ; Octreotide ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Retrospective Studies ; Stents