No abstract available.
Drainage* ; Pancreatic Pseudocyst*

Endoscopic injection sclerotherapy(EIS) has been widely used in treating and eradicating acutely bleeding esophageal varies, but may be associated with some undesirable local and systemic complications. Endoscopic variceal ligation(EVL), which consists of mechanicai ligation and thrombosis of varices using elastic o-band, has been recently developed as a non operative alternative to EIS. We performed EVL in 65 patients who had bled from esophageal varices between November 1991 and September 1993. Total 274 sessions were performed and 774 o-bands were used. Six patients were actively bleeding and all of them were successfully controlled by emergency EVL. During the follow-up period, five patients who had combined hepatoma died. Varices were eradicated or reduced grade I in 43(71.6%) of the 60 survivals by 8-36 ligations(mean 15.6 ligation) in 2-13 EVL sessions(mean 5.6 sessions). During follow up period, five patients had recurred from grade 0 to grade 2 or 3 in 106-260 days(mean 182.6 days), and then eradicated by repeated EVL. During or after EVL, there were no complications, except mild substernal distress and mild dysphagia in 17 and 7 patients respectively. These results showed that EVL is a safe and effective method for eradication of bleeding esophageal varices.
Carcinoma, Hepatocellular ; Deglutition Disorders ; Emergencies ; Esophageal and Gastric Varices* ; Follow-Up Studies ; Hemorrhage ; Humans ; Ligation* ; Thrombosis ; Varicose Veins

No abstract availalbe.
Gallstones*

The ulcerative colitis is a relatively common disease in the European and North American countries aince Dr. Wilks has first reported the cases in 1895, But in Korea, this disease is a rare entity and only a few case have been reported. However, rescently the diagnoetic methods for ulcerative colitis are much developed we have experienced 28 cases of ulcerative colitis which were diagnosed by endoscopy, barium enema exam and biopsy. Therefore a total of 28 patient with ulcerative colitis diagnosed and treated at the department of internal medicine of HYUH from June 1979 to June 1986 was reviewed. We obtained the results as follows; 1) The sex distribution assumed a ratio of 1 to 1.33 with 12 males and 16 females. 2) The age dietribution was relatively even but the majority of cases were between 5th and 6th decade (32.1%), 3) The most prominent clinical symptoms were rectal bleeding, abdominal pain, diarrhea, fever, wight loss and vomiting. 4) Significant laboratory findins were anemia, eleveited ESR, leukocytosis, positive stool OB, electrolyte imbalance and decreased serum albumin level. 5) As to the extent of disease determined by the barium enema examination and endoscopic exam., rectum or rectosigmoid colon is involved in majority of the cases (92.8%). 6) The endoscopic examination was performed in all 28 cases and showed significant findings such as ulceration, hyperemia, mucosal friability, bleeding etcs. 7) The barium enema examination was performed in 19 cases and showed positive findings such as ulceration, luminal narrowing, bowel shortening and rigidity in 17 cases. 8) 21 of 28 patients treated by medical therapy showed relatively improved but 4 of 28 patients was exacerbated or relapsed and one has expired.
Abdominal Pain ; Anemia ; Barium ; Biopsy ; Colitis, Ulcerative* ; Colon ; Diarrhea ; Endoscopy ; Enema ; Female ; Fever ; Hemorrhage ; Humans ; Hyperemia ; Internal Medicine ; Korea ; Leukocytosis ; Male ; Phenobarbital ; Rectum ; Serum Albumin ; Sex Distribution ; Ulcer* ; Vomiting

OBJECTIVES: Abnormalities of bone metabolism could be followed in gastrectomized patients as a late complication. Nowadays, many biochemical and radiologic measurements are applied to detect these abnormalities. The aim of our study is to determine the valuable parameter as an appropriate screening test during long-term follow-up periods and define the usefulness of new biochemical markers for bone metabolism by comparing with traditional markers. METHODS: Fifteen patients who had undergone partial gastrectomy were chosen randomly and fifteen healthy controls were compared. Then, several biochemical and radiologic tests were measured. We excluded subjects who proved to have other causes of bone metabolism abnormalities. Ten patients and 10 controls were finally selected. RESULTS: Comparing the data with those of a corresponding control group, the lumbar bone density measured by quantitative computed tomography (QCT) was statistically significantly lower in the patient group (p +ADw- 0.01). The urinary deoxypyridinoline, a biochemical marker for bone resorption, was statistically higher in the patient group (p +ADw- 0.025). Osteocalcin, Procollagen I C-terminal peptide (PICP) and Type I collagen C-terminal telopeptide (ICTP) were slightly but not significantly higher in the patient group. The serum parathyroid hormone (PTH) and 25-hydroxy vitamin D levels were similar in both groups. CONCLUSION: We could suggest that urinary deoxypyridinoline and QCT are appropriate parameters as screening tests for the detection of bone metabolism abnormalities in gastrectomized patients during long-term follow-up. Urinary deoxypyridinoline may be a simple and rapid test which could replace cumbersome 24-hour urinary hydroxyproline.
Absorptiometry, Photon ; Adult ; Biological Markers/analysis ; Bone Density/physiology+ACo- ; Bone Diseases, Metabolic/etiology+ACo- ; Bone Diseases, Metabolic/diagnosis ; Bone Diseases, Metabolic/blood ; Comparative Study ; Gastrectomy/methods ; Gastrectomy/adverse effects+ACo- ; Human ; Male ; Middle Age ; Reference Values ; Sensitivity and Specificity

H2-receptor blockers are widely used for therapy of peptic ulcer disease and gastroesophageal reflux disease. H2-receptor blockers infrequently cause adverse hepatic effects, and when they occur they are usually asymptomatic. There are several previous reports of liver injury related to ranitidine. Until now, only two cases of acute hepatitis associated with the use of famotidine were reported in the world. We report three cases of clinical hepatitis that followed administration of famotidine (2 cases) and ranitidine (1 case). First, a 54-year-old woman received famotidine, 40mg, daily for treatment of erosive gastritis. After 6 weeks of treatment with famotidine, jaundice and itching sense developed. Second, a 45-year-old man was hospitalized for jaundice. He had a long history of duodenal ulcer and had been intermittently treated with famotidine. He had 6 weeks of treatment with famotidine prior to admission. Third, a 19-year-old woman was hospitalized for nausea, vomiting and urticaria. She had a history of acute hepatitis B virus infection and was discharged 4 weeks prior to readmission. She had been received ranitidine, 300 mg, daily for treatment of gastritis. After 17 days of drug ingestion, whenever she had taken her medication, she developed these symptoms of nausea, vomiting and urticaria. Other causes of hepatitis were ruled out and all patients recovered after discontinuation of drug ingestion.
Duodenal Ulcer ; Eating ; Famotidine* ; Female ; Gastritis ; Gastroesophageal Reflux ; Hepatitis B virus ; Hepatitis* ; Humans ; Jaundice ; Liver ; Middle Aged ; Nausea ; Peptic Ulcer ; Pruritus ; Ranitidine* ; Urticaria ; Vomiting ; Young Adult

H2-receptor blockers are widely used for therapy of peptic ulcer disease and gastroesophageal reflux disease. H2-receptor blockers infrequently cause adverse hepatic effects, and when they occur they are usually asymptomatic. There are several previous reports of liver injury related to ranitidine. Until now, only two cases of acute hepatitis associated with the use of famotidine were reported in the world. We report three cases of clinical hepatitis that followed administration of famotidine (2 cases) and ranitidine (1 case). First, a 54-year-old woman received famotidine, 40mg, daily for treatment of erosive gastritis. After 6 weeks of treatment with famotidine, jaundice and itching sense developed. Second, a 45-year-old man was hospitalized for jaundice. He had a long history of duodenal ulcer and had been intermittently treated with famotidine. He had 6 weeks of treatment with famotidine prior to admission. Third, a 19-year-old woman was hospitalized for nausea, vomiting and urticaria. She had a history of acute hepatitis B virus infection and was discharged 4 weeks prior to readmission. She had been received ranitidine, 300 mg, daily for treatment of gastritis. After 17 days of drug ingestion, whenever she had taken her medication, she developed these symptoms of nausea, vomiting and urticaria. Other causes of hepatitis were ruled out and all patients recovered after discontinuation of drug ingestion.
Duodenal Ulcer ; Eating ; Famotidine* ; Female ; Gastritis ; Gastroesophageal Reflux ; Hepatitis B virus ; Hepatitis* ; Humans ; Jaundice ; Liver ; Middle Aged ; Nausea ; Peptic Ulcer ; Pruritus ; Ranitidine* ; Urticaria ; Vomiting ; Young Adult

The main objective of palliative treatment of malignant esophageal stenosis is rapid restoration of passage of fluid and solids. Endoscopic intubation with plastic endoprosthesis may lead to prompt relief of dysphagia and is a effective procedure for the palliative treatment of malignant esophageal stenosis. However, the insertion procedure, which necessitates prior dilatation, is traumatic and associated with considerable risk for perforation and bleeding. Tumor overgrowth, stent migration and stent blockage are frequent complications. Recently, self expanding metal stents woven in the form of tubular mesh made from surgical grade stainless steel alloy filaments(Wallstent), have been developed to offer possible advatage over conventional plastic tubes. The small diameter of introducer system carrying the compressed stent(18Fr) allows a relatively easy insertion procedure that dose not require prior dilatation. This stent is pliable. self-expanding and flexible in the longitudinal axis. We experienced a case of a 74-year-old male with malignant esophageal stenosis in whom self-expanding Wallstent was implanted with successful oral nutrition and much improvement of dysphagia.
Aged ; Alloys ; Axis, Cervical Vertebra ; Deglutition Disorders ; Dilatation ; Esophageal Stenosis* ; Hemorrhage ; Humans ; Intubation ; Male ; Palliative Care* ; Plastics ; Stainless Steel ; Stents

BACKGROUND/AIMS: The aim of this study was to evaluate the usefulness of intraductal endoscopy in pancreaticobiliary tract disease by means of percutaneous cholangioscopy(PCS), peroral cholangioscopy(POCS) and peroral pancteatoscopy(POPS). METHODS: PCS was performed in 33 patients, including 24 patients with biliary tract stones, and 8 patients with malignant biliary tract disease, and one with villous adenoma of common bile duct(CBD), POCS was performed in 5 patients, including two with cholangiocarcinoma, two with icteric hepatoma and one with benign stenosis of bile duct. POPS performed in 6 patients, ineluding 3 patients with chronic pancreatitis, two with pancreatic cancer and one with mucinous ductal ectasia. RESULTS: 1. Complete removal of the stones was achieved in 22 of 24 patie~nts(91.7%). 2. Accuracy rate of forceps biopsy in PCS was achieved 13 fo 14 patients(92.9%). 3. Success rate of therapeutic PCS was 100%. 4. Accuracy rate of forceps biopsy in POCS was achieved 3 of 5 patients(60%). 5. Diagnostic gain of POPS was achieved 5 of 6 patients(83.3%). 6. There was no serious complications with only mild complications in 3 patients, including mild bleeding in 2 patients and cholangitis in only one. CONCLUSIONS: Intraductal endoscopy of biliary tract, including PCS and POCS were useful diagnostic and therapeutic methods with advantages of direct visualization of intraductal disease and POPS using ultrathin pancreatoscope could provide direct assessment of the pancreatic duct.
Adenoma, Villous ; Bile ; Bile Ducts ; Biliary Tract Diseases ; Biliary Tract* ; Biopsy ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Cholangitis ; Constriction, Pathologic ; Dilatation, Pathologic ; Endoscopy* ; Hemorrhage ; Humans ; Mucins ; Pancreas* ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis, Chronic ; Surgical Instruments

Jaundice associated with hepatocellular carcinoma usually occurs in the later stages due to the advanced underlying liver cirrhosis or tumor infiltration of the liver parenchyme. In the rare cases, obstructive jaundice presents as the ininitial manifestation of hepatocellular carcinoma. The possible mechanisms of bile duct obstruction associated with hepatocellular carcinoma include extrinsic compression of bile duct by extensive tumor infiltration of the liver or enlarged lymph node, direct tumor invasion of the biliary duct system, and bile duct obstruction by tumor thrombus, necrotic debris, or blood clots. We experienced three cases with hepatocellular carcinoma in whom obstructive jaundice were caused by intraductal involvement of the tumor, which were confirmed by percutaneous transhepatic cholangioscopy(PTCS) and peroral cholangioscopy(POCS). PTCS and POCS finding showed multiple, irreguarly shaped, yellowish soft tissue(chicken fat) and blood clots and, round protruded mass in the ble duct. Biopsy specimens revealed pathologically hepatocelluar carcinoma.
Bile Ducts ; Biopsy ; Carcinoma, Hepatocellular* ; Cholestasis ; Jaundice ; Jaundice, Obstructive* ; Liver ; Liver Cirrhosis ; Lymph Nodes ; Thrombosis