PURPOSE: To determine the effect of intraluminal brachytherapy on stent patency and survival after metallic stent placement in patients with primary bile duct carcinoma. MATERIALS AND METHODS: Twenty-seven patients with primary bile duct carcinoma underwent metallic stent placement; in 16 of the 27 intraluminal brachytherapy with an iridium-192 source (dose, 25 Gy) was the performed. Obstruction was due to either hilar (n=14) or non-hilar involvement (n=13). For statistical comparison of patients who underwent/did not undergo intraluminal brachytherapy, stent patency and survival were calculated using the Kaplan-Meier method and an independent t test. RESULTS: The mean durations of stent patency and survival were 9.1 and 10.0 months respectively in patients who underwent intraluminal brachytherapy, and 4.2 and 5.0 months in those who did not undergo this procedure (p<0.05). The mean durations of stent patency and survival among the 22 patients who died were 7.6 (range, 0.8 -16.1) and 8.3 (range, 0.8-17.3) months, respectively, in the eleven patients who underwent intraluminal brachytherapy, and 4.2 (range, 0.9-8.0) and 5.0 (range, 0.9-8.4) months in those whom the procedure was not performed (p<0.05). CONCLUSION: Intraluminal brachytherapy after stent placement extended both stent patency and survival in patients with primary bile duct carcinoma.
Bile Ducts* ; Bile* ; Brachytherapy* ; Humans ; Stents*

Afferent loop obstruction caused by enterolith formation is rare and cannot be easily treated with endoscopy because of the difficulty associated with the nonsurgical removal of enteroliths. A 74-year-old woman was admitted with fever and acute abdominal pain. Clinical features and imaging studies suggested afferent loop obstruction caused by an enterolith after Roux-en-Y hepaticojejunostomy. Percutaneous transhepatic biliary drainage was initially performed because of severe cholangitis with septic shock. The enterolith was located in the jejunal limb adjacent to the hepaticojejunostomy site. Cholangioscopic lithotripsy was performed through the percutaneous transhepatic route to the enterolith, and the fragments were moved into the efferent loop using scope push and saline flush methods. Here, we describe a case of afferent loop syndrome caused by an enterolith that developed after Roux-en-Y hepaticojejunostomy and was treated with percutaneous transhepatic cholangio-enteroscopic lithotripsy.
Abdominal Pain ; Afferent Loop Syndrome* ; Aged ; Anastomosis, Roux-en-Y ; Cholangitis ; Drainage ; Endoscopy ; Extremities ; Female ; Fever ; Humans ; Lithotripsy* ; Methods ; Shock, Septic

To clarify the effect of bradykinin(Bk)on cultured bovine corneal endothelial cells(BCEC), cytosolic free calcium([Ca2+])mobilization and cell proliferation were investigated. The [Ca2+] was determined using a Ca2+ sensitive indicator, Fura-2/AM, and cell proliferation was evaluated by counting the cell number. Bk induced the transient increase of [Ca2+] in a concentration-dependent manner(10(-11)M~10(-7)M)and its 50% effective concentration was about 5x10(-11)M. The basal [Ca2+] with 1mM CaCl2 in the bathing solution was 87+/-9nM. Transient Bk(10(-8)M)-induced [Ca2+] increase was inhibited slightly but significantly by the pretreatment with EGTA. The pretreatment with U-73122(5x10(-6)M), an inhibitor of phospholipase C, also attenuated Bkinduced [Ca2+] mobilization. To identify and characterize the Bk receptor subtype in BCEC, Bk1 and Bk2 antagonists were investigated. Transient Bk(10(-8)M)-induced [Ca2+] increase was almost absolutely attenuated by the pretreatment with Bk2 antagonist for 10 minutes. To investigate the physiological effect of Bk, Bk-induced mitogenic effect was studied. 10(-8)M of Bk produced significant increase of intracellular ATP levels from the day 2 to the day six of culture period. This Bk-induced mitogenic effect was inhibited by the treatment with Bk2 antagonist. Bk-induced ion transport was determined by measuring intracellular ATP contents. Intracellular ATP content([ATP]i)was decreased by the treatment with 10(-8)M Bk for 10 minutes. Bk-induced [ATP]i decrement was significantly restored by the pretreatment with ouabain for 30 minutes. In summary, stimulation of intracellular signal transduction by Bk in BCEC is coupled with Bk2 type receptor. And also, Bk produces mitogenic effect and enhancesion and fluid transport in BCEC.
Adenosine Triphosphate* ; Baths ; Bradykinin ; Calcium* ; Cell Count ; Cell Proliferation ; Cytosol ; Egtazic Acid ; Endothelial Cells* ; Ion Transport ; Ouabain ; Signal Transduction ; Type C Phospholipases

PURPOSE: The goal of this study was to determine the role of postoperative radiation therapy in extrahepatic bile duct cancers. MATERIALS AND METHODS: Between 1997 and 2001, 41 patients with extrahepatic bile duct cancer having undergone surgical resection were retrospectively analyzed. Of the 41 patients, 22 were treated by surgery alone (Group I) with remaining 19 treated by surgery and postoperative radiation therapy (Group II). A gross total surgical resection with pathologically negative margins was performed in 11 of the patients (50%) in Group I, and in 7 of the patients (36.8%) in Group II. There were no significant differences in the disease stage, surgical procedure or pathological characteristics of the two groups. The patients in group II received 45~54 Gy (median: 50.4 Gy) of external beam radiation therapy to the tumor bed and draining nodal area. RESULTS: The local failure rate was significantly higher in group I (54.5%) than in group II (15.8%)(p=0.010). Of the 12 failed patients in Group I and the 3 failed patients in group II, 7 and 3 had a positive resection margin. The overall 3-year survival rates were 38.3 and 38.9% and the 3-year disease free survival rates were 18.8 and 26.3% in groups I and II, respectively. However, the patients with positive resection margins who received adjuvant radiation therapy had higher 3-year overall survival rates than those with surgery alone (36.4% vs. 24.2%, p=0.06), and 3-year disease free survival rate was significantly higher in the group II patients who had positive margins compared with those in group I (25.0% vs. 18.2%, p=0.04). CONCLUSION: Postoperative adjuvant radiation therapy appeared to reduce the incidence of local failure in patients with extrahepatic bile duct cancer, and might improve the survival rate in the patients with positive resection margins.
Bile Duct Neoplasms ; Bile Ducts, Extrahepatic* ; Disease-Free Survival ; Humans ; Incidence ; Retrospective Studies ; Survival Rate

A localized extramedullary tumor mass composed of immature cells has been reported in association with acute myeloid leukemia, myeloproliferative disorders, myelodysplasia in blast transformation or chronic myeloid leukemia with trilineage hematopoiesis, as well as in patients with no known hematological disorder. Although this tumor may involve anywhere in the body and give rise to a variety of signs and symptoms, there are several case reports of extramedullary tumor in Korea which described the involvement of the gastrointestinal tract. We report the occurrence of gastric extramedullary tumor and lymphoid blast crisis in a patient with complete remission after lymphoblastic transformation of chronic myelogenous leukemia. Endoscopic biopsy for gastric elevated lesion showed diffuse lymphoblast infiltration with TdT (terminal deoxynucleotidal transferase) and CD20 positive immature cells.
Biopsy ; Blast Crisis ; Gastrointestinal Tract ; Hematopoiesis ; Humans ; Korea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukemia, Myeloid, Acute ; Lymphocyte Activation ; Myeloproliferative Disorders ; Sarcoma, Myeloid

Ciliated hepatic foregut cysts are uncommon lesions of the liver. They arise from remnants of the embryonic foregut, and are usually asymptomatic and benign. They are lined with a layer of ciliated columnar cells and contain mucoid material and debris. Ciliated hepatic foregut cysts are not malignant neoplasms and must be differentiated from cystic neoplasms and hypovascular solid tumors. We experienced a case of ciliated hepatic foregut cyst, which was successfully removed by laparoscopic excision, so we report the case with review of the literature.
Laparoscopy ; Liver

A littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen. A 60-year-old man, with multiple nodules in imaging study and liver cirrhosis graded as Child-Pugh classification class A, was transferred for splenomegaly. A thrombocytopenia was found on hematological evaluation. Because there was no evidence of hematological and visceral malignancy, a splenectomy was performed for a definitive diagnosis. The histological and immunohistochemical features of the splenic specimens were consistent with a LCA. After the splenectomy, the thrombocytopenia recovered to the normal platelet count. There has been no previous report of a LCA combined with liver cirrhosis. Herein, the first case of a LCA in Korea, diagnosed and treated by a splenectomy, is reported.
Hemangioma/*complications/pathology/surgery ; Humans ; Liver Cirrhosis/*complications/pathology ; Male ; Middle Aged ; Splenectomy ; Splenic Neoplasms/*complications/pathology/surgery

PURPOSE: To introduce and demonstrate the advantages of the new hybrid two-dimensional (2D) proton spectroscopic imaging (Sl) over the single voxel spectroscopy (SVS) and conventional 2D Sl in the clinical application of spectroscopy for pediatric cerebral disease. MATERIALS AND METHODS: Eighty-one hybrid 2D proton spectroscopic imaging was performed in 79 children (36 normal infants and children, 10 with hypoxic-ischemic injury, 20 with toxic metabolic encephalopathy, seven with brain tumor, three with meningoencephalitis, one with neurofibromatosis, one with Sturge-Weber syndrome and one with lissencephaly) ranging in age from the third day of life to 15 years. In adult volunteers (n = 5), all three techniques including hybrid 2D proton Sl, SVS using PRESS sequence, and conventional 2D proton Sl were performed. Both hybrid 2D proton Sl and SVS using PRESS sequence were performed in clinical cases(n= 12). All measurements were peformed with a 1.5-T scanner using standard head quadrature coil. The 16 x 16 phase encoding steps were set on variable field of view (FOV) depending on the size of the brain. The hybrid volume of interest inside FOV was set as 75 x 75 x 15 mm3 or smaller to get rid of unwanted fat signal. Point-resolved spectroscopy (TR/TE = 1,500 msec/135 or 270 msec) was employed with standard chemical shift selective saturation (CHESS) pulses for water suppression. The acquisition time and spectral quality of hybrid 2D proton Sl were compared with those of SVS and conventional 2D proton Sl. RESULTS: The hybrid 2D proton Sl was successfully conducted upon all patients. The 2D spectral data acquisition time was less than 6 minutes, while the data acquisition time of SVS was 4.3 minutes. This was short enough for pediatric application. The spectra acquired with hybrid 2D proton Sl showed nearly the same sensitivity and spectral resolution with SVS. The spectral quality of hybrid 2D proton Sl was, on the other hand, far better than that of conventional 2D proton Sl. The other advantage of hybrid 2D proton Sl was that the extent of metabolic abnormalities could be evaluated through the characteristics of the relative levels of the three metabolites, i.e., N-acetylaspartate, choline, and creatine. CONCLUSION: The hybrid 2D proton Sl can be successfully employed for the evaluation of the metabolic abnormalities in the various pathologic conditions of pediatric brain without penalty in acquisition time and spectral quality when compared to SVS. The extent of metabolic abnormalities, which cannot be obtained with SVS technique, also can be evaluated with hybrid 2D proton Sl.
Adult ; Brain Diseases, Metabolic ; Brain Neoplasms ; Brain* ; Child ; Choline ; Creatine ; Hand ; Head ; Humans ; Infant ; Magnetic Resonance Spectroscopy ; Meningoencephalitis ; Neurofibromatoses ; Protons* ; Spectrum Analysis ; Sturge-Weber Syndrome ; Volunteers ; Water

BACKGROUND/AIMS: Surgery has been the mainstay of treatment for duodenal perforations after the introduction of endoscopic retrograde cholangiopancreatography (ERCP). Yet there have recently been arguments that conservative management with or without endoscopic intervention may be possible and safe. METHODS: For the patients who received ERCP at Inha University Hospital from Jan. 2001 to Dec. 2007, we retrospectively analyzed the clinical manifestations, the treatment and the clinical outcomes of the cases with duodenal perforation. RESULTS: Among the 1708 ERCP cases, duodenal perforation occurred in eleven (0.6%) patients. There were two cases of duodenal perforations (type I), four cases of peri-Vaterian injury (type II), two cases of bile duct perforations (type III) and three cases of retroperitoneal perforations (type IV). Six patients (55%) were treated surgically while the others were managed conservatively. Except for one death (9.1%), ten patients fully recovered. Either residual diseases or fluid collections, as seen on CT, were present in the surgically managed patients. The median time interval between ERCP and surgery was 19 hours (range: 8~30 hours). CONCLUSIONS: To decide on the management of duodenal perforation after ERCP, the presence of residual disease or the leakage of intraluminal contents should be considered along with the type of the perforation.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Duodenum ; Humans ; Retrospective Studies