PURPOSE: To evaluate the effectiveness, patency and safty of a self-expandable nitinol stent for palliative treatment of malignant stricture of gastroesophageal junction. MATERIALS AND METHODS: An esophageal stent was inserted in five consecutive patients with malignant stricture of esophagogastric junction. Histologicaily, four cases were adenocarcinoma, and one was squamous cell carcinoma. The location and severity of stricture were evaluated with gastrografin just before stent insertion. In one patient with past subtotal gastrectomy, esophagography revealed fistulous tract at stricture site. RESULTS: No technical failure or procedural complications occurred, and improvement of dysphagia was noted in all patients soon after stent insertion. On follow up esophagograms performed 3 to 7 days after stent insertion, all stents were completely expanded and unchanged in positions. In one patient with fistulous connection at stricture site, esophagogram immediately after the procedure revealed complete occlusion of the fistula. Three patients died within 4, 7 and 8 consecutive months after stent insertion. Two patients are alive maintaining adequate body weight and passing most diet. CONCLUSIONS: Self-expandable nitinol stent with it's good longitudinal flexibility and efficient radial force was effective in the palliative treatment of dysphagia in patient with malignant stricture at esophagogastric junction.
Adenocarcinoma ; Body Weight ; Carcinoma, Squamous Cell ; Constriction, Pathologic* ; Deglutition Disorders* ; Diatrizoate Meglumine ; Diet ; Esophagogastric Junction ; Fistula ; Follow-Up Studies ; Gastrectomy ; Humans ; Palliative Care ; Pliability ; Stents*

PURPOSE: To evaluate the difference in each procedure time and complication rates related to percutaneous transhepatic biliary drainage(PTBD) via the right and the left hepatic lobe. MATERIALS AND METHODS: We performed PTBD in 120 patients with biliary obstruction below both main hepatic ducts. Of the 120 catheters, 54 were introduced via a left lobe approach and 66 through the right lobe. All procedures were performed under fluoroscopic guidance by the same operator. For each patient, procedure time was recorded prospectively. PTBD related complications were classified as either early(up to 30 days after procedure) or late(after 30 days), and each complication graded as major, or minor according to its intensity. RESULTS: The difference in the mean procedure time(28.8min versus 36.2rain, left versus right approach group) and that in complication rates (37% versus 58%) were statistically significant(p<0.05). Concerning major complications(bile peritonitis, sepsis, massive hemobilia, liver abscess, pyothorax), the percentages related to left and right lobe approach were 1.8% and 10.6%, and concerning minor complications(catheter obstruction or dislodgement, transient hemobilia, persistent fever or pain), the percentages were 36%and 51%respectively. CONCLUSIONS: PTBD via the left lobe approach was superior with short procedure time and low complication rates than the right approach.
Catheters ; Fever ; Hemobilia ; Hepatic Duct, Common ; Humans ; Liver Abscess ; Peritonitis ; Prospective Studies ; Sepsis

Purpose: To evaluate the risk factors for the development of osteonecrosis in civilian professional divers by an epidemiologic study and to determine the correlation between osteonecrosis in divers and coagulopathy by analysis of serologic markers that are related to thrombophilia and hypofibrinolysis. Materials and Methods: Forty-two divers, who collected pen shells (Atrina pinnata), and among whom 10 had osteonecrosis (group 1), were compared with 32 divers without osteonecrosis (group 2). Both groups were evaluated based on the number of years of diving experience, number of dives per year, mean number of dives per day, mean diving time and depth, and diving methods. We determined any statistically significant differences among these variables. We measured the levels of serologic markers that were related to hyperlipidemia, thrombophilia, and hypofibrinolysis from the divers and a control group of 20 physicians (group 3). The levels of the serologic markers were compared between groups 1 and 2 and between the divers and the control group, in order to determine the relationship between the serologic markers and the development of dysbaric osteonecrosis. Results: None of the variables demonstrated any statistically significant differences, except for the mean diving time, in which group 1 had a mean diving time of 124 minutes and group 2 had a mean diving time of 62.1 minutes (P<0.05). In the analysis of the serologic markers, there were no statistically significant differences between groups 1 and 2; however, in comparison with the group 3, the divers demonstrated significantly decreased activity levels of proteins C and S (Protein C: P<0.05; Protein S: P<0.05), and an increase in the levels of plasminogen activator inhibitor-1 (PAI-1) (P<0.05). Conclusion: The divers with osteonecrosis had a longer mean diving time than did those divers without osteonecrosis. In the serologic marker analysis, the divers with osteonecrosis demonstrated significantly decreased activity levels of Proteins C, S and a significant increase in the levels of PAI-1, compared with the control group.
Biomarkers* ; Diving ; Epidemiologic Studies* ; Epidemiology ; Hyperlipidemias ; Osteonecrosis* ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Protein S ; Risk Factors ; Thrombophilia

PURPOSE: To determine the significance of anomalous position of the gallbladder. MATERIALS AND METHODS: Sixteen patients with anomalous position of the gallbladder were evaluated for analysis. The diagnosis was confirmed by ultrasonography(15 patients) and oral cholecystography(1patient). Among those, six patients underwent CT scan and a patient had 99mTc-DISIDA scan. The images were analysed with respect to the location of the GB and configuration and associated abnormality of the liver and hepatobiliary systems. Medical records of each patient were also reviewed. RESULTS: Among 16 patients having an anomalous position of the gallbladder, nine had retrodisplaced gallbladder, four had left-sided gallbaldder, two had suprahepatic gallbladder, and one had floating gallbladder. Except for one patient, fifteen had abnormality in the liver such as focal atrophic or hypoplastic change and liver cirrhosis. Intrahepatic stones were demonstrated in 6 patients. CONCLUSION: Our results showed that anomalous position of the gallbladder was commonly associated with atrophy or hypoplasia of the liver rather than congenital in origin. The possiblity of an anomalous location of gallbladder should be kept in mind when GB is not in its normal location.
Atrophy ; Diagnosis ; Gallbladder* ; Humans ; Liver ; Liver Cirrhosis ; Medical Records ; Technetium Tc 99m Disofenin ; Tomography, X-Ray Computed

Membranous obstruction of the hepatic inferior vena cava(MOVC)is one of the common causes of Budd-Chiari syndrome. The aim of this study is to ascertain and compare the characteristic sonographic and CT findings of Budd-Chiari syndrome caused by MOVC. We studied 10 patients of Budd-Chiari syndrome caused by MOVC through sonography and CT. MOVC was confirmed by operation and/or inferior vena cavography. The cases included 9 men and one woman. With sonography. IVC obstruction was diagnosed in 9 cases. The cause of IVC obstruction was web in 5 cases and fibrous cord in 3 cases. The cause was unspecified in on case. Obliteration of the hepatic veins and intrahepatic collateral vessels were delineated in 9 cases. With color doppler sonography, the directions of blood flow of the hepatic veins through the intervenous communication were fairly well demonstrated in all 5 cases. With CT, IVC obstruction was diagnosed in 7 cases. The obliteration of the hepatic segment of the IVC were segmental in 6 cases and diffuse in one case. Ct demonstrated communicating vessels between the hepatic veins in 3 cases. Furthermore. Systemic collateral vessls(azygos and hemiazygos veins. Veins along the abdominal wall, and internal mammary veins)were demonstrated in all cases. Liver cirrhosis was combined in all cases and hepatoma developed in 4 cases. Sonography is useful to detect the MOVC and to demonstrate hepatic venous obstruction and intrahepatic collateral vessels. Color doppler sonography is easily performed to show the direction of the blood flow through interconnecting vessels. CT shows the obliterated segment of the IVC clearly and multiple prominent systemic coliaterals. In conclusion, and Budd-Chiai syndrome caused by MOVC is accurately diagnosed by combined color doppler sonography and CT.
Abdominal Wall ; Budd-Chiari Syndrome* ; Carcinoma, Hepatocellular ; Female ; Hepatic Veins ; Humans ; Liver Cirrhosis ; Male ; Ultrasonography ; Veins ; Vena Cava, Inferior*

No abstract available.
Vulva

No abstract available.
Hypertension, Pulmonary*

PURPOSE: To analyse unusual radiologic manifestations of colonic adenocarcinoma, and to correlate these with pathologic findings. MATERIALS AND METHODS: Radiologic findings of ten patients with atypical adenocarcinoma ofthe colon were retrospectively evaluated. The unusual radiologic findings were difined as terminal ileal involvement of the cecal mass, long segmental involvement of over 9cm, and exophytic tumor growth. radiologic and sonographic findings were compared with pathologic specimens obtained from surgical resection. RESULTS: Involvement of the terminal ileum was noted in three cases, long segmental involvement of over 11cm in five cases, and exophytic mass in two. Of three cases with thickening of the terminal ileum, two revealed the infiltration of cancer into the terminal ileum through the ileocecal valve, and the other revealed vascular congestion and edemaon microscopic examination. Five cases with long segmental involvement of over 11cm comprised one of cancer totally infiltrated through the submucosal and proper muscle layer, one of inflammatory thickening distal to thecancer, two of inflammatory change of pericolic fat and serosal adhesion and one of a large intraluminal fungatingmass. In the cases of exophytic mass, one with a larger extraluminal and a smaller intraluminal component revealed necrosis and abscess on pathologic examination, accounting for low attenuation on CT, whereas the other, with exophytic growth, disclosed abundant pools of mucin, resulting in low attenuation on CT. These two cases could notbe differentiated from submucosal tumors. CONCLUSION: Atypical colon cancer may have various manifestations, suchas thickening of the terminal ileum, involvement of a long segment, and an exophytically growing mass. An appreciation of the radiologic findings of this cancer may therefore help in differential diagnosis in cases simulating colitis or submucosal tumors of the colon, such as lymphoma or leiomyoma.
Abscess ; Adenocarcinoma* ; Colitis ; Colon* ; Colonic Neoplasms ; Diagnosis, Differential ; Estrogens, Conjugated (USP) ; Humans ; Ileocecal Valve ; Ileum ; Leiomyoma ; Lymphoma ; Mucins ; Retrospective Studies

Cubital tunnel syndrome is the second most common nerve entrapment syndrome affecting the upper extremity. Surgical treatment is indicated for those who have motor weakness or when conservative measures have failed. Several different surgical techniques have been introduced, however, the optimal treatment for cubital tunnel syndrome is still under debate. In the recent years, well-performed prospective randomized studies show that there is no difference in outcome among various surgical techniques regardless of the severity and presence of subluxation. It is advised that in situ decompression is the preferred technique because it is simpler and less time consuming procedure. Although in situ decompression is effective in uncomplicated ulnar nerve subluxation, anterior transposition should be considered when the subluxation is painful or when the ulnar nerve actually snaps back and forth over the medial epicondyle. Anterior transposition of the ulnar nerve is still indicated for revision surgery, previous trauma around the elbow, distal humerus fractures, severe osteoarthritis needing medial spur excision, and severe valgus deformity of the elbow.
Congenital Abnormalities ; Cubital Tunnel Syndrome ; Decompression ; Elbow ; Humerus ; Nerve Compression Syndromes ; Osteoarthritis ; Ulnar Nerve ; Upper Extremity

PURPOSE: Authors retrospectively evaluated the efficacy of superselective renal arterial emboliation in 5 patients with symptomatic renal angiomyolipoma. MATERIALS AND METHODS: Five Patients with renal angiomyolipoma who had been treated with superselective renal arterial embolization were analysed retrospectively. Two patients who had multiple bilateral lesions were associated with tuberous sclerosis. The mbolic materials used were absolute alcohol in 6 sessions, absolute alcohol mixed with lipiodol in one session, and polyvinyl alcohol in one session. RESULTS: We could observe devascularization of the tumor on the post-embolization arteriograms. The symptoms such as flank pain were improved in all patients during the follow-up period of 3 months to 3years. CONCLUSION: Superselective renal arterial embolization is an effective and safe procedure in the management of renal angiomyolipomas.
Angiomyolipoma* ; Ethanol ; Ethiodized Oil ; Flank Pain ; Follow-Up Studies ; Humans ; Polyvinyl Alcohol ; Retrospective Studies ; Tuberous Sclerosis