The bleeding duodenal varices are a rare complication in patients with portal hypertension, but present a difficult diagnostic problem. If there is no bleeding esophageal, gastric fundal varices or ulcer in a patient with upper gastrointestinal bleeding and portal hypertension, the possibility of bleeding duodenal varices should be kept in mind. Thorough endoscopic examination of the entire duodenal mucosa is essential to document bleeding from duodenal varices. As an initial treatment, endoscopic sclerotherapy has had limited success in controlling active duodenal variceal bleeding. However, rebleeding rate is high, surgical treatment including shunt operation may be required for permanent control of bleeding and portal decompression. We report three cases of duodenal varices causing massive hemorrhage. All the patients had portal hypertension caused by liver cirrhosis of various etiologies and had varices in their esophagus. The second portion of the duodenum was the site of duodenal varices in all cases. The management was tailored to the condition of each patient, but only one patient among three survived.
Decompression ; Duodenum ; Esophageal and Gastric Varices ; Esophagus ; Gastrointestinal Hemorrhage* ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Mucous Membrane ; Sclerotherapy ; Ulcer ; Varicose Veins*

The safety of endoscopic retrograde cholangiopancreatography(ERCP) in patients with acute pancreatitis(AP) was confirmed in the past decade. Especially in ease of acute gallstone panereatitis, early ERCP/EST(endoscopic sphincterotomy) may reduce the incidence of complications by removing gallstone which causes acute attack of pancreatitis. To assess clinical usefulness of ERCP/EST in the setting of AP, we reviewed clinical records of 58 patients with AP who had undergone ERCP /EST during the same period of admission.(continue...)
Cholangiopancreatography, Endoscopic Retrograde* ; Gallstones ; Humans ; Incidence ; Pancreatitis*

Laparoscopic procedures for urological diseases in children have been proven to be safe and effective. However, the availability of laparoscopic procedures is still partly limited to experienced, high-volume centers because the procedures are technically demanding. The da Vinci robot system is being used for an increasing variety of reconstructive procedures because of the advantages of this approach, such as motion scaling, greater optical magnification, stereoscopic vision, increased instrument tip dexterity, and tremor filtration. Particularly in pediatric urologic surgery, where the operational field is limited owing to the small abdominal cavity of children, robotic surgical technology has its own strengths. Currently, robots are used to perform most surgeries in children that can be performed laparoscopically. In this review, we aimed to provide a comprehensive overview of the current role of robot-assisted laparoscopic surgery in Pediatric Urology by analyzing the published data in this field. A growing body of evidence supports the view that robotic technology is technically feasible and safe in pediatric urological surgery. Robotic technology provides additional benefits for performing reconstructive urologic surgery, such as in pyeloplasty, ureteral reimplantation, and enterocystoplasty procedures. The main limitations to robotic surgery are its high purchase and maintenance costs and that the cost-effectiveness of this technology remains to be validated.
Child ; Humans ; Laparoscopy/*methods ; Robotic Surgical Procedures/*methods ; Urologic Diseases/*surgery ; Urologic Surgical Procedures/*methods

No abstract available.
Female ; Humans

PURPOSE: Testicular microlithiasis (TM) is a relatively rare clinical entity of controversial significance characterized by the existence of hydroxyapatite microliths located in the seminiferous tubules. The aim of this study was to observe the natural course of changes in the calcific density of pediatric TM. MATERIALS AND METHODS: We included a total of 23 TM patients undergoing scrotal ultrasound (US) on at least two occasions from July 1997 to August 2014. We retrospectively analyzed the patient characteristics, clinical manifestations, specific pathological features, and clinical outcomes. We measured the calcified area and compared the calcific density between the initial and final USs. RESULTS: The mean age at diagnosis was 11.3+/-4.6 years, and the follow-up period was 79.1+/-38.8 months (range, 25.4-152.9 months). During the follow-up period, no patients developed testicular cancer. Calcific density on US was increased in the last versus the initial US, but not to a statistically significant degree (3.74%+/-6.0% vs. 3.06%+/-4.38%, respectively, p=0.147). When we defined groups with increased and decreased calcification, we found that diffuse TM was categorized into the increased group to a greater degree than focal TM (10/20 vs. 4/23, respectively, p=0.049). In addition, five of eight cases of cryptorchidism (including two cases of bilateral cryptorchidism) were categorized in the increased calcification group. CONCLUSIONS: Diffuse TM and cryptorchidism tend to increase calcific density. Close observation is therefore recommended for cases of TM combined with cryptorchidism and cases of diffuse TM.
Adolescent ; Calcification, Physiologic ; *Calculi/complications/epidemiology/pathology/physiopathology ; Child ; Cryptorchidism/diagnosis/etiology ; Densitometry/methods ; Follow-Up Studies ; Gonadoblastoma/diagnosis/etiology ; Humans ; Male ; Republic of Korea ; Scrotum/*ultrasonography ; Seminiferous Tubules/*pathology ; *Testicular Diseases/complications/epidemiology/pathology/physiopathology ; *Testicular Neoplasms/diagnosis/epidemiology/etiology

This experiment involved 12 rabbits of both sexes, weighing 2.1 kg. After anesthesia, the kidneys were exposed, isolated and cannulated in the renal artery, ureter and sometimes in the vein as well. The kidney were perfused through the renal artery with Krebs-Henseleit solution, which were then filtered to be free of particles, gased with 95% O2-5% CO2, and kept at 37 degrees C. We measured RBCs concentrations by means of Coulter Counter in the venous outflow collected, and plotted them against the volume perfused. Using 2 different flow rates, 9 ml/min (group I) and 19 ml/min (group II), we found that the RBCs decreased in a multiexponential decay fashion and a biophysical model for each flow rate was constructed. These models indicated that there were more cell stores (2.20 x 10(10)) in the fast compartment of group II than in group I (1.72 x 10(10)). This difference is not statistically significant, but certainly coincides with urine flow collected from ureter cannula during perfusion. Our present data clearly suggest that in order to clear 99% blood cells out of 10-12 gm rabbit kidneys, at least 3-6 ml of cell free perfusate is required while clearing the whole blood cells out of human kidneys (200-240 gm) may need 600 ml or more. Thus, we recommend that at least 600 ml of perfusate should be used to clear most of the blood cells in the renal vasculature before renal transplantation is performed.
Animal ; Erythrocyte Count ; Erythrocytes/*physiology ; Female ; In Vitro ; Kinetics ; Male ; Models, Biological ; Perfusion ; Rabbits ; *Renal Circulation ; Support, Non-U.S. Gov't

BACKGROUND/AIMS: The study proposed to evaluate the efficacy of anticancer drugs of intraarterial chemoinfusion and investigate prognostic factors influencing survival. METHODS: A total of 127 patients diagnosed as having advanced hepatocellular carcinoma(HCC) of same stage (TNM stage IVa) from 1996 to 1998 were examined. Two intraarterial infusion chemotherapeutic regimens were employed: Adriamycin(Group I) and Cisplatin(Group II). RESULTS: Overall survival was significantly diffrent(10.0 vs 5.7months) and favored Group I. By the univariate analysis, significant prognostic factors included: age, portal vein thrombosis(PVT), size(>5cm) and type of tumor, response rate (size & -fetoprotein) at 3 months after therapy, level of albumin, alkaline phosphatase, and total bilirubin. After repeated therapy, Group I showed better survival (14.0 vs 7.9 months), but there was no statistical difference in survival rate between two groups in the case of large size, PVT, and diffuse type. CONCLUSION: Group I showed better survival than Group II in advanced HCC of TNM stage IVa. But, considering prognostic factors, there was no significant difference in survival rate between two groups except small size or nodular type of HCC. TNM classification of stage IVa should be reconsidered to include prognostic factors influencing survival rate such as PVT, size and type of HCC.
Alkaline Phosphatase ; Bilirubin ; Carcinoma, Hepatocellular* ; Classification ; Humans ; Infusions, Intra-Arterial ; Neoplasm Staging ; Portal Vein ; Psychotherapy, Group ; Survival Rate ; Treatment Outcome*

OBJECTIVES: Patients with chronic renal failure have increased hemorrhagic tendency due to an uremic platelet dysfunction and complications from anticoagulants used in hemodialysis. They are also prone to have thrombotic complications in the cerebral vessels, coronary arteries and A-V fistula, due to hypercoagulability from changes in various factors. Recently, deficiencies in plasma protein C and S, which are physiological anticoagulants, have been reported to cause thrombosis. In chronic renal failure, plasma protein C and S activities are known to be decreased. METHODS: In the present study, activities and antigen concentrations of plasma protein C and S, as well as AT-III activities were investigated in three groups; the normal control group, the predialysis group of chronic renal failure patients treated conservatively, and the hemodialysis group. The findings were analyzed for their relationship to hypercoagulability. RESULTS: 1) The activities of plasma protein C, S and antithrombin-III were significantly lower in the predialysis chronic renal failure group as compared to the control. Antithrombin-III concentrations in the hemodialysis group assayed immediately prior to dialysis were significantly lower than those of the control group. But, protein C antigen concentrations in the hemodialysis group assayed immediately prior to dialysis were significantly higher than those of the control group. There was no significant difference between these groups in plasma protein C activities, and plasma protein S activities and antigen concentrations. 2) In the hemodialysis group, antithrombin-III activities, antigen concentration and activities of plasma protein C were significantly higher than after dialysis as compared to those before the dialysis. 3) There were no significant difference in plasma protein C, S and antithrombin-III activities and plasma protein C and S antigen concentrations in hemodialysis patients between with and without thrombosis at arterio-venous fistula site. However, plasma protein C and antithrombin-III activities were significantly lower in those with thrombosis as compared to those of the normal control group. There were no significant difference in plasma protein C and S activities and antigen concentrations in those without thrombosis as compared to those of the normal control group. 4) There were no significant diffrences in plasma protein C, protein S and antithrombin-III activities and antigen concentrations in dialysis patients with and without recombinant erythropoietin treatment. 5) There were no significant correlations between serum creatinine and creatinine clearance, and plasma antithrombin-III, protein C and protein S activities and antigen concentrations in predialysis group. CONCLUSION: These results suggest that the decrease in plasma antithrombin-III, protein C and S could be the factors causing hypercoagulability in chronic renal failure patients, and the decreased activities of these factors may return to normal by dialysis. In the hemodialysis group, there were no significant diffrences in plasma protein C and S and antithrombin-III activities and antigen concentrations between the group which showed clinical thrombosis and the group which did not. However, in those who had thrombosis, plasma protein C and antithrombin-III activities are significantly lower than the control group. Administration of recombinant human erythropoietin does not appear to affect the activities of plasma protein C and S and antithrombin-III. In predialysis chronic renal failure patients, there was no significant relationship between renal function and plasma protein C and S and antithrombin-III.
Anticoagulants ; Arteries ; Blood Platelets ; Coronary Vessels ; Creatinine ; Dialysis ; Erythropoietin ; Fistula ; Humans ; Kidney Failure, Chronic* ; Plasma ; Protein C* ; Protein S ; Renal Dialysis ; Thrombophilia ; Thrombosis

According to the general principle that a surgical procedure should be as atraumatic as possible several authors proposed stereotaxic urokinase treatment in spontaneous intracerebral hematomas. Authors presented 29 cases of spontaneous intracerebral hematomas which were managed with stereotaxic urokinase treatment including 10 cases of preliminary report on Journal of Korean Neurosurgical Society June 1986. 19 cases were basal ganglia hematomas with or without ventricular rupture, 4 cases were thalamic hematomas with ventricular rupture, 3 cases were subcortical hematomas and 3 cases were intraventricular hematomas. The outcome of the treatment was analysed by the location and amount of hematomas, and the degree of disability of patient on admission and discharge. The outcome was worst in thalamic hematomas than putaminal or subcortical hematomas, and poorer as the amount of hematoma increased. The outcome was bad also in the patient who showed poor neurologic condition on admission. Time requiring hematoma dissapperance with urokinase treatment was estimated by the short term follow up CT scanning. All of the patient except moribund cases showed complete disappearance of hematomas within 10 days after treatment, and mean period was 6.7 days. Rebleeding after the urokinase treatment was noted in 4 cases, which was 2 putaminal, one thalamic and one ventricular hematoma. The cause of rebleeding might be mechanical injury of catheter insertion or too strong negative pressure on aspiration. But in 1 case of intraventricular hematoma, the possible causative factor should be anticoagulant effect of urokinase on the injured vessel. With above result, we concluded that this procedure may be better and safer than conventional craniotomy especially in cases of high risky or elderly patient with deep seated intracerebral hematomas. But the efficacy and safety must be studied further with the exact experimental model of spontaneous intracerebral hematomas.
Aged ; Basal Ganglia ; Catheters ; Craniotomy ; Follow-Up Studies ; Hematoma* ; Humans ; Models, Theoretical ; Rupture ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator*

Lymphangioma occuring in the gastrointestinal tract is a rare benign tumor, which is composed of lymphatic vessels of various size. A sharply demarcated smooth, soft, cystic submucosal tumor which is easily compressible and covered with normal mucosa is a characteristic eadoscapic feature. Recently, we experienced a case of lymphangioma in ascendmg colon and removed it successfully by colonoscopic snare polypectomy.
Colon ; Colonoscopy ; Gastrointestinal Tract ; Intestine, Large* ; Lymphangioma* ; Lymphatic Vessels ; Mucous Membrane ; SNARE Proteins