The appendiceal mucocele is very rare disease of 0.2% incidence. About 24% of patients are asymptomatic and symptomatic patients present with pain in the right lower quadrant of abdomen in 64%, plapable maas in the right lower quadrant of abdomen in 50%, and rarely, melena, hematochezia, anemia, diarrhea, malaise, and abdominal distension. The gastrointestinal bleeding may be presented in the patient with intussusception, but the massive bleeding is generally absent. We report a case of appendiceal mucocele accompanying with gastrointestinal bleeding and review of literature.
Abdomen ; Anemia ; Diarrhea ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Incidence ; Intussusception ; Melena ; Mucocele* ; Rare Diseases

Malignant esophago-bronchial fistula is an incurable and distressing condition. The passage of swallowed saliva and solid or liquid food into the bronchial tree causes coqghing and frequent pulmonary infection and collapse. Most patients are unfit for major surgery, but intubation offers a quick, simple and effective treatment with improved length and quality of life. However, intubation with simple esophageal tubes are liable to result in failure to occlude the fistela, migration of the tube, erosion, and in the case of latex tubes, disintegration. To overcome these problems, the fistula is intubated perorally with a prosthesis surrounded by a foam rubber cuff contained ia silicone sheath, in which vacuum can be created. This cuffed prosthesis is the most satisfactory design for the treatment of malignant esophago-bronchial fistula with effiective and gentle occlusion of the fistula without risk of pressure necrosis. We experienced a case of the endoscopic treatment with a cuffed prosthesis for malignant esophago-bronchial fistula. So we report this case with brief review of the previous literatures.
Bronchial Fistula* ; Esophageal Neoplasms ; Fistula ; Humans ; Intubation ; Latex ; Necrosis ; Prostheses and Implants* ; Quality of Life ; Rubber ; Saliva ; Silicones ; Vacuum

PURPOSE: To evaluate the effectiveness of pelvic arterial embolization (PAE) for intractable postpartum hemorrhage (PPH) after hysterectomy. MATERIALS AND METHODS: From March 2011 to December 2017, 14 patients who received PAE for PPH that persisted after total abdominal hysterectomy were included (mean age, 33.6 years; range, 26–37 years). The delivery type, cause of PPH, and angiographic findings were investigated. The technical and clinical success rates and clinical outcomes were evaluated. RESULTS: Of 14 patients, 8 patients (57%) had positive angiographic findings for bleeding; contrast extravasation (n = 6), and pseudoaneurysm (n = 2). Remnant uterine artery (UA) was the most common bleeding focus (n = 4), followed by vaginal artery (n = 2), left lateral sacral artery (n = 1), and left internal pudendal artery (n = 1). Technical and clinical success rates were 100% and 93% (13/14), respectively. In 1 patient, bleeding was not controlled after initial selective embolization and the entire anterior divisions of both internal iliac arteries were embolized with gelfoam. CONCLUSION PAE for persistent PPH after hysterectomy is a safe and effective treatment. Remnant UA was the most common bleeding site and all patients recovered without any significant sequelae after embolization.

BACKGROUND: It has been suggested that the sympathetic nervous system might play an important role in the development of coronary artery spasm. Recently, advances have made possible the imaging of the cardiac adrenergic nervous system with metaiodobenzylguanidine (MIBG) labeled with iodine-123. The purpose of this study was to assess the presence and location of abnormal sympathetic innervation by iodine-123-metaiodobenzylguanidine single-photon emission computed tomography (SPECT) and to evaluate the clinical efficacy of iodine-123-MIBG SPECT as a noninvasive screening test in patients with coronary artery spasm. METHOD: Coronary arteriography and provocative test with intravenous administration of ergonovine maleate were performed in 26 patients (21 men, 5 women, mean age 49.1+/-9.3, range: 26-59) who were suspected of having a coronary artery spasm. The subjects were divided into 2 groups ; Group 1 comparised of 18 patients subjects to the positive provocative test, Group 2 comparised of 8 patients subjects to the negative provocative test. Four healthy subjects served as control. All patients also underwent iodine-123-MIBG SPECT for the evaluation of cardiac sympathetic integrity. The SPECT findings were qualitatively evaluated by two experienced physicians who were blind to the clinical data. RESULTS: Abnormal sympathetic nervous innervation using iodine-123-MIBG SPECT was observed either as a reduced uptake or defect pattern in the perfused areas in 13 of the 18 vessels of ergonovine induced vasospasm. Normal sympathetic innervation as evidenced by normal iodine-123-MIBG uptake was noted in all of the 60 segments of normal vessel territories. Reduced uptake of iodine-123-MIBG was not detected in the perfused areas of five vasospasm-induced vessels (perfusion territory of LAD in 2 and the RCA in 3 patients). The sensitivity and specificity of iodine-123-MIBG for detection coronary artery spasm were 72.2% (95% confidence interval [CI] 55% to 89%) and 100%, respectively. The positive predictive value and negative predictive value were 100% and 92.3% (95% CI 91% to 93%), respectively. CONCLUSION: Iodine-123-MIBG SPECT is a feasible method to noninvasively evaluate and localize the territories of coronary arteries with spasms. Invasive diagnostic coronary arteriography with ergonovine provocation test may be unnecessary for the diagnosis of coronary artery spasm in patients with typical resting pain, negative exercise test or normal thallium perfusion scan, but abnormal iodine-123-MIBG SPECT.
Administration, Intravenous ; Angiography ; Coronary Vessels* ; Diagnosis* ; Ergonovine ; Exercise Test ; Female ; Humans ; Male ; Mass Screening* ; Myocardial Perfusion Imaging* ; Nervous System ; Neurons* ; Perfusion ; Sensitivity and Specificity ; Spasm* ; Sympathetic Nervous System ; Thallium ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

Advances in fiberoptic endoscopy have improved diagnostic capabilities and management in piatients with gastrointestinal polyps. The gastrointestinal polyp is a premalignant lesion in varying degrees, according to size, pathology, and location. Endoscopic polypectomy has long been considered as a safe and effective method for removal of polyps. Sixty endoscopic gastrointestinal polypectomies were done in 53 patients who visited Hanyang University Hospital from 1984 to l990, and the clinical characteristics including histopathalogy were evaluated. (continue...)
Endoscopy ; Humans ; Pathology ; Polyps

Double pylorus is a rare condition consisting of a double communication between gastric antrum and duodenal bulb; in most cases it is a complication of penetrating ulcer, and sometimes it is a congenital abnormality. The prevalence of this rare anomaly ranges from 0.02% to 0.13%; the male: female ratio is about 2: 1. A case of double pylorus, in 41 year-old male, was diagnosed by gastrofiberscopy and UGIS. Two ovoid and crescent pits of the pyloric canal divided by smooth thickened septum were observed endoscopically. The upper GI series showed gastroduodenal fistula connecting the leeser curve of distal antrum with the duodenal bulb. The relevant literatures on the subject were reviewed.
Adult ; Congenital Abnormalities ; Female ; Fistula ; Humans ; Male ; Prevalence ; Pyloric Antrum ; Pylorus* ; Ulcer

No abstract available.
Down Syndrome

Congenital agammaglobulinemia was described first among all human immunodeficiencies, and characterized by defect of B lymphocyte maturation and severe panhypogammaglobulinemia. These patients frequently acquire infections with high-grade extracellular pyogenic pyogenic organisms since infancy. We experienced a case of congenital agammaglobulinemia in a 10 years old male. He had history of recurrent pneumonia and purulent otitis media since late infancy. Also he had recieved operations for pyogenic arthritis of hip joint & osteomyelitis at 4 years of age. He had been suffered from productive cough, intermittent fever and skin infections for 3 months before admission. His immune status revealed panhypogammaglobulinemia and deficiency in mature B lymphocyte, but cell-mediated immunity was intact. He was treated with antibiotics and intravenous immunoglobulin with good results.
Agammaglobulinemia* ; Anti-Bacterial Agents ; Arthritis ; Child ; Cough ; Fever ; Hip Joint ; Humans ; Immunity, Cellular ; Immunoglobulins ; Lymphocytes ; Male ; Osteomyelitis ; Otitis Media, Suppurative ; Pneumonia ; Skin

BACKGROUND: Anaphylaxis is a systematic allergic reaction, which may be fatal. However, despite its seriousness, its low level of incidence has prevented in depth studies. Thus, we analyzed the causes of anaphylactic shock in patients admitted in a tertiary hospital, observed its clinical symptoms, and formed a basis for adequate emergency treatment, as well preventive methods. METHODS: The patients who visited Ajou university hospitals from June 1994 to May 2000(7 years) and who met the 1974 JAMA definition were selected for this retrospective study. The analysis of causative agents was made on the basis of clinical symptoms and the patients' chief complaints at the time of admission. Patients diagnosed with anaphylactic shock included those showing at least two types of IgEmediated symptoms; and those with a simple rash or breathing difficulties were excluded from the study. RESULTS: Of 36 patients, 22 were male and 14 female, Those below the age of 20 comprised 16.7% of the patients(6 patients), between 20 and 29 comprised 16.7%(6 patients), 30 and 39 comprised 25%(9 patients), 40 and 49 comprised 27.8%(10 patients), over 50 comprised 14%(5 patients). The overall percentage show 70% of the patients in active adult age group. Rash was the most common clinical symptoms(89%, 32 patients) and hypotension the second(75%, 27 patients), followed by respiratory distress, fainting, and arrhythmia. Causative agents were insect bites, including bee stings(15 patients), medication(12 patients), food(8 patients), and unknown(1 patients). Nine(9) of the 36 case, were diagnosed as having an atopic origin. CONCLUSION: Bee sting was the single most common cause in the insect criteria while penicillin and NSAIDs accounted for most of medication-induced cases. Food showed a varied distribution. An atopic origin was not a basis for anaphylactic shock, but did show a two-fold increase of prevalence. This study is the first of its kind in addressing anaphylactic shock, a potentially severe illness, over a period of 7 years.
Adult ; Anaphylaxis* ; Anti-Inflammatory Agents, Non-Steroidal ; Arrhythmias, Cardiac ; Bees ; Bites and Stings ; Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment ; Exanthema ; Female ; Hospitals, University ; Humans ; Hypersensitivity ; Hypotension ; Incidence ; Insect Bites and Stings ; Insects ; Male ; Penicillins ; Prevalence ; Respiration ; Retrospective Studies ; Syncope ; Tertiary Care Centers*

Endoscopic biliary drainage has been established as the palliative treatment of choice for malignant obstructive jaundice. But the clogging of biliary endoprosthesis has been a persistent problem faced by endoscopists over many years. Different materials, sizes, and designs have been used in efforts to overcome this problem. Recently, there are some reports that incorporating sideholes increases the risk of stent clogging, and prostheses without sideholes had significantly lower clogging compared to those with sideholes. And then Soehendra and his colleagues introduced a new design Teflon straight stent without sideholes, designated "Tan-nenbaum" (TB) stents, and reported that TB stent had significantly longer patency than Teflon pigtail stent with sideholes. When placing the TB stent, we used OASIS (One Action Stent Introduction System). This introducer enables the stent to be pre-loaded onto the distal tip of the guiding catheter and placed endoscopically in one step. By using OASIS, we reduced the duration of placing the stent in narrowed bile duct and the patients were more tolerable. Now, we report our experience of endoscopic retrograde biliary drainage by use of TB stent and OASIS" in 12 patients with obstructive jaundice due to malignancy.
Bile Ducts ; Catheters ; Drainage ; Humans ; Jaundice, Obstructive ; Palliative Care ; Polytetrafluoroethylene ; Prostheses and Implants ; Stents*