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

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

No abstract availalbe.
Gallstones*

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

Although the endoscopic retrograde biliary drainage(ERBD) is the preferred palliative treatment for unresectable mlignant obstructive jaundice, the failure of endaprosthesis insertion occurs in 15% of the cases. Espeeially in hilar malignancy, the failure results from the inability to pass ei~ther a guide wire or a stent due to biliary stenosis or obstruction by tumorous extension. In such caae, percutaneous transhepatic biliery drainage(PTBD) can be achieved. When the tumor extends into the hilum, isolating the right and left hepatic ducts, drainage of unilateral hepatic duct will usually provide adequate palliation. However, when patients have contralateral cholangitis or jaundice fails to resolve with unilateral biliary drainage, bilateral drainage may be necessary. Compared to ERBD, the method of prolonged external biliary drainage has unwanted disadvantages. In order to achieve internal biliary drainage in case with complete obstruction of hepatic ducts due to tumor extension, percutaneous transhepatic transtumoral biliary drainage(PTTBD) could be considered. We report a case with obstructive jaundice and cholangitis due to complete obstruction of right hepatic duct and stenosis of common hepatic duct from Klatskin tumor, which was sucessfully managed by internal biliary drainage with transtumoral biliary stenting under the guidance of computed tomography.
Cholangitis ; Constriction, Pathologic ; Drainage* ; Hepatic Duct, Common ; Humans ; Jaundice ; Jaundice, Obstructive* ; Klatskin's Tumor* ; Palliative Care ; Stents

The gastric adenomas could be premalignant lesions and they should be removed as possible, especially in eases with its size aver 2cm. The gastric adenomas can be removed by the various endoscopic methods. Endoscopic polypectomy has been widely used for the treatment of benign and malignant polyps with the advent of technical improvement. Polypectomy with snare and electrocautery is mainly used for pedunculated polyps, but sessile polyps pose some technical difficulties and occasionally cause serious gastrointestinal hemorrhage or perforation. We resected two cases of gastric flat adenoma using Stiegman-Goff ligator used in endoscopic variceal ligation to make flat adenoma as semipedunculated form, and also to decrease the risk of bleeding. After ligation, we successfully removed it with conventional snare polypectomy. We recognized that endoscopic mucosal resection with band ligation can be used for the removal of sessile polyps or flat adenioma with ease, safety and no bleeding.
Adenoma* ; Electrocoagulation ; Gastrointestinal Hemorrhage ; Hemorrhage ; Ligation* ; Polyps ; SNARE Proteins

BACKGROUND/AIMS: Endoscopic variceal ligation(EVL) is a method to manage esophageal varices bleeding and induces mechanical ligation and strangulation of varices by using elastic O-rings. The lower complication rate seen with EVL compared to sclerotherapy can be explained by the more limited degree of local tissue injury induced by EVL. Only the mucosal and submucosal layers are aspirated into cylinder attachment of the ligating devices, thus limiting injury to these layers. But, sometimes band induced ulcer shows massive bleeding. In these cases, endoscopic therapy is very difficult. This study was performed in order to find out the effectiveness of Histoacryl ingection for band-induced esophageal ulcer bleeding, METHODS: We tried to control band-induced bleeding by injecting Histoacryl in 8 cases of band-induced ulcer bleeding. RESULTS: This therapeutic trials show exellent control of bleeding in all cases without rebleeding. CONCLUSIONS: The cyanoacrylate tissue adhesive Histoacryl(N-butyl-2-cyanoacrylate) is a remarkable substance that transforms from its original liquid state into a solid state when mixed with a physiologic medium such as blood. Histoacryl undergoes an instantaneous polymerization reaction and hardens, thereby plugging the varix or bleeding vessel lumen. Rapid hemostasis of an active bleeding occurs and rebleeding of the treated lesion is prevented. We found out that Histoacryl injection is a safe and effective treatment for band-induced ulcer bleeding.
Cyanoacrylates ; Enbucrilate* ; Esophageal and Gastric Varices ; Esophagus* ; Hemorrhage* ; Hemostasis ; Intestines* ; Ligation ; Polymerization ; Polymers ; Sclerotherapy ; Stomach* ; Tissue Adhesives ; Ulcer* ; Varicose Veins

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

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