The majority of cystic lesions of the pancreas are psudocysts and a small fraction neoplastic. Failure to recognize the true nature of neoplastic cyst will lead to an incorrct treatment strategy. Ultrasonography, computerized tomography and angiography were used to distingish these lesions, but diagnostic value of ERCP is in controversy. To evaluate the diagnostic value of ERCP in cystic lesions of the pancreas, we analysed 33 cases of pancreatic cystic lesions (pseudocyst 18 cases, retention cyst 3 cases and cystic, neoplasm l2 cases) between Apr. 1985 and June 1993. In 18 cases of pseudocysts, ERP findings were communication with cyst in 8 cases (44.4%), chronic pancreatitis in 8 cases (44.4%), obstruction in 4 cases (22.2%) and displscement of pancreatic duct in 2 cases (11.1%), and ERC findings, which were perfomed in 8 cases, showed cholangitis in 3 cases (37.5%), CBD stone in 2 cases (25%), mass effect in 1 case (12.5%) and normal in 2 cases (25%). There was no communication with the cyst and pancreatic duct, except two mucinous ductal ectasia, in 12 cases of cystic neoplasms, and the other findings were displacement of pancreatic duct in 4 cases (33.3%), obstruction in 2 cases (16.7%) and normal in 4 cases (33.3%). ERC findings of cystic neoplasm were almost normal (85.7%) except 1 case of cholangitis. In conclusion, ERCP findings of pseudocysts were communication with pancreatic duct, chronic pancreatitis and biliary tract abnormality. In contrast, ERCP findings of cystic neoplasms were displacement or obstruction of pancreatic duct without communication and chronic pancreatitis, and biliary tract abnormality were rare.
Angiography ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Dilatation, Pathologic ; Mucins ; Pancreas ; Pancreatic Cyst* ; Pancreatic Ducts ; Pancreatitis, Chronic ; Ultrasonography

No abstract available.
Gingival Crevicular Fluid* ; Periodontal Diseases*

Although variation is the rule with pancreatic duct morphology, certain variants occur as a result of altered embroological development. These ductal configurations, most striking deviations from the normal configuration, may be classfied according to alterations of embryological development. These congenital variants of pancreatic duct may be important for several reasons. First, the pseudomass effect of ductal anomalies can be mistaken for carcinoma by the inexperienced radiologists. Second, whether or not the anomaly is important, it is present in many patients with recurrent pacreatitis. Original descriptions were based on small sampling of postmortem studies and surgical specimen, but more recently the advent of endoscopic retrograde cholangiopancreatography(ERCP) has confirmed of the work of early anastomists and increased awareness of these variants. To evalute of frequency, characteristics of associated disease and clinical significance of pancreatic anomalies, we have reviewed of 5330 case of ERCP filmes which were undertaken between July, 1973 and August, 1993. Having reviewed of ERCP filmes, we found out 9 case of pancreatic duct variants. Among them, 7 cases were classified as ductal duplication anomalies, 4 cases of number variation, most, bifuricaiton and 3 cases of form variation, which were composed of loop, spiral and terminal N. Three cases of fusion anomalies were also noted, which were 2 cases of panceratic divisum and 1 case of incomplete pancreatic divisum. The associated diseases were 6 cases of bile duct and galbladder stones and 3 cases of pancreatic cancer. We could not find out the case of congenital anomalies as cause of obstructive pain and pseudomass effect.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Humans ; Pancreatic Ducts* ; Pancreatic Neoplasms ; Pancrelipase ; Strikes, Employee

To evaluate the clinical significance of anomalous pancreaticobiliary ductal union(PBDU), we analysed 11 cases(0.19%) of anomalous PBDU among 5675 cases performed ERCP from Jan. 1973 to Aug. 1992. According to the classification of Kimura et al., 4 cases were type 1(P-C union) and 7 cases type 2(C-P union). The length of common channel ranged from 1.5 cm to 3.1 cm(mean 1.9 cm). The common associated disease were choledochal cyst(7 cases), carcinoma of the gallbladder(5 cases) and biliary stone(3 cases). Four cases of carcinoma of the gallbladder were type 1. The incidence of anomalous PBDU was significantly higher in cases with carcinoma of the gallbladder(5 cases among 49 cases) than in case without carcinoma of the gallbladder(6 cases among 5626 cases). And the incidence of gallbladder carcinoma(45%) among the 11 cases of anomalous PBDU was significantly higher than that(0.78%) among those who did not have anomalous PBDU. In conclusion, the common associated diseases with the anomalous PBDU were choledochal cyst, carcinoma of the gallbladder and stone, and the anomalous PBDU may be risk factor in the development of carcinoma of the gllbladder.
Cholangiopancreatography, Endoscopic Retrograde* ; Choledochal Cyst ; Classification ; Gallbladder ; Incidence ; Risk Factors

BACKGROUND: Dandruff is a common complaint, and is suffered by up to 50% of the population at some time. Malassezia yeasts, which comprise part of the normal skin flora, might be a critical factor in this disease, as they have been found in higher proportions in patients with seborrheic dermatitis or dandruff, its milder form. OBJECTIVE: The aim of this study was to evaluate the clinical efficacy of 4 weeks of treatment with 1% zinc pyrithione (ZP) shampoo. METHODS: A randomized, double-blind, 4-week treatment period was preceded by a 1-week run-in period. A total of 30 patients were enrolled in this study. Assessments included the patient's subjective score (PSS) and the investigator's assessment score (IAS), images of the affected scalp area, the severity of sebum production, and the erythema and moisturizing effect of the shampoo. RESULTS: 1% ZP shampoo significantly reduced the extent and severity of scaling, as measured by folliscope imaging on visit 2 (p=0.0391) and visit 3 (p=0.0381), as well as pruritus related to the disease as measured by the grading systems, PSS (p=0.0352) and IAS (p=0.0142). Additionally, the results of this study show that a treatment regimen with 1% ZP shampoo significantly reduced scalp sebum production as measured by a sebumeter. Erythema measured by the chromameter was not as meaningful. The corneometric values were slightly increased in the group treated with 1% ZP shampoo but not in the group treated with ZP-free shampoo. Side effects of the ZP shampoo were quite mild and tolerable, and were observed only in a small group of patients. CONCLUSION: 1% ZP shampoo appears to be both effective and well-tolerated when used for the treatment of dandruff.
Dermatitis, Seborrheic ; Erythema ; Humans ; Malassezia ; Organometallic Compounds ; Pruritus ; Pyridines ; Scalp ; Sebum ; Skin ; Yeasts ; Zinc

Malignant melanoma is one of the most common malignancies associated with metastatic disease to the gastrointestinal tract. Malignant melanotic melanomas metastasized to the stomach and duodenum, stomach, small bowel, and rectum have been reported in Korea. However, amelanotic malignant melanoma metastasized to the gastrointestinal tract, to our knowledge, has not been reported in Korea. Recently, we experienced a case of amelanotic malignant melanoma metastasized to the duodenum in a 48 year-old man. The primary site was presumed to be the soft tissue near the right knee. Pulmonary and pancreatic metastasis were also noted at presentation. Despite systemic chemotherapy, the patient died of progressive disease at about 13 months after presentation.
Drug Therapy ; Duodenum* ; Gastrointestinal Tract ; Humans ; Knee ; Korea ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Rectum ; Stomach

PURPOSE: We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (alpha-blocker) monotherapy failure. MATERIALS AND METHODS: This retrospective study enrolled 129 patients with BPH who were prescribed an alpha-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an alpha-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR). RESULTS: Of the 129 patients, 54 were in the TURP group and 75 were in the alpha-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in alpha-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively. CONCLUSIONS: At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of alpha-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.
Adrenergic alpha-Antagonists ; Diagnosis ; Factor Analysis, Statistical* ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Transurethral Resection of Prostate

PURPOSE: We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (alpha-blocker) monotherapy failure. MATERIALS AND METHODS: This retrospective study enrolled 129 patients with BPH who were prescribed an alpha-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an alpha-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR). RESULTS: Of the 129 patients, 54 were in the TURP group and 75 were in the alpha-blocker group. Statistically significant differences (p<0.05) between the two groups were found in the prostate volume (50.8 ml vs. 34.4 ml), PSA (6.8 ng/ml vs. 3.6 ng/ml), Qmax (6.84 ml/sec vs. 9.99 ml/sec), and IPSS (27.3 vs. 16.8). According to the multiple regression analysis, the significant factors in alpha-blocker monotherapy failure were the IPSS (p<0.001) and prostate volume (p=0.015). According to the receiver operating characteristic (ROC) curve-based prediction regarding surgical treatment, the best cutoff value for the prostate volume and IPSS were 35.65 ml (sensitivity 0.722, specificity 0.667) and 23.5 (sensitivity 0.852, specificity 0.840), respectively. CONCLUSIONS: At the initial diagnosis of BPH, patients with a larger prostate volume and severe IPSS have a higher risk of alpha-blocker monotherapy failure. In this case, combined therapy with 5-alpha-reductase inhibitor (5-ARI) or surgical treatment may be useful.
Adrenergic alpha-Antagonists ; Diagnosis ; Factor Analysis, Statistical* ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Transurethral Resection of Prostate

OBJECTIVES: Although bronchoscopy is an important diagnostic tool for lung disease, patients compliance is low due to discomfort. Recently, midazolam which has a favorable anterograde amnesia effect and short action duration, has been used to relieve patients discomfort during bronchoscopy. Midazolam was investigated in order to see the beneficial effect and safety during bronchoscopy. METHODS: The study design was single blind, randomized, prospective. 102 patients were included, in whom bronchoscopy was performed between June, 19% and October, 1995 at Samsung Medical Center. They were categorized into midazolam group and control group. Patients were asked about the amnesic effect, discomfort of procedure and the willingness to repeat procedure. The consciousness level of patients during procedure, patient cooperation during procedure and ease of procedure were also reported by bronchoscopists. RESULTS: 1) The difference of oxygen saturation between two groups: There was no significant difference in oxygen saturation between midazolam group and control group before and after bronchoscopy. During procedure, however, mean oxygen saturations in midazolam group (90+/-6.4%) was significantly lower than in control group (93+/-4.7%)(p<0.05). 2) Evaluations by patients (1) Effect of amnesia: 41 patients (82%) in midazolam group could not recall the procedure but 52 patients (100%) recalled the entire procedure in control group. A favorable amnesic effects could be found in midazolam group(p<0.05). {2) The discomfort during the procedure: 43 patents(86%) did not experience discomfort from procedure in midazolam group but 25 patients(48%) complained of discomfort in control group (p<0.05). (3) Most patients except two(96%) were willing to repeat fiberoptic bronchoscopy in midazolam group but 13 patients (25%) answered that they would never repeat bronchoscapy. There was a statistically significant difference between two groups in the willingness to repeat bronchocopy (p<0.05). 3) The evaluations by bronchoscopists Cooperations of the patients and ease of procedure were not different between two groups. The patients in midazolam group except eight could not respond to verbal stimuli but most patients were awakened during procedure in control group(p<0.05). CONCLUSION: Midazolam is a good sedative agent for a patient to give a favorable amnesia, reduction of discomfort during bronchoscopy. We concluded that midazolam is a safe and useful sedative agent and midazolam may be used routinely during bronchoscopy. Monitoring of oxygen saturation, however, is essential to prevent severe hypoxia during procedure.
Amnesia ; Amnesia, Anterograde ; Anoxia ; Bronchoscopy* ; Compliance ; Consciousness ; Humans ; Lung Diseases ; Midazolam* ; Oxygen ; Patient Compliance ; Prospective Studies*

One hundred and twenty seven patients with uterine cervical carcinoma underwent computed tomography(CT) and magnetic resonance(MR) imaging, followed by surgical exploration. MR imaging was superior to CT in visualization of the tumor, for parametrial evaluation, and for tumor staging. MR imaging had an accuracy of 74% in the assessment of thickness of cervical stromal invasion. The accuracy rates for parametrial evaluation were 78% for CT and 88% for MR imaging. The overall accuracy rates for tumor staging were 68% for CT and 80% for MR imaging. The accuracy rates for pelvic lymph node evaluation were 82% for CT and 85% for MR imaging. Our findings suggest that MR imaging is supperior to CT in preoperative staging of uterine cervical carcinoma.
Humans ; Lymph Nodes ; Magnetic Resonance Imaging* ; Neoplasm Staging