Hepatobiliary interventional procedures are most important and commonly practiced procedures in Korea. These procedures comprise about 60~80% of procedures in interventional radiology. We can do percutaneous transhepatic biliary drainage(PTBD), percutaneous cholecystostomy in patients with bile duct and cystic duct obstruction. These procedures prevent high-risk operation and are performed on an emergency basis in some patients with bile infection. A residual biliary stone after operation can be removed with basket and shock wave without reoperation and multiple intrahepatic stones also can be removed through the PTBD tract without operation. Transarterial chemoembolization is a very effective method and has the widest range of indications in treatment of hepatocellular carcinoma(HCC). Also we can treat HCC percutaneously with local injection of absolute ethanol and radiofrequency ablation. Transjugular intrahepatic portosystemic shunt(TIPS) has replaced surgical shunt operation in variceal bleeding in liver cirrhosis. Resection of a large volume of liver is a very safe method after portal vein embolization of a lobe to be resected due to hypertrophy of the remaining lobes of the liver. Metallic stenting of kinking vessels always shows excellent results and we can employ this technique for hepatic vein and portal vein kinking after living-donor liver transplantation.
Bile ; Bile Ducts ; Catheter Ablation ; Cholecystostomy ; Cystic Duct ; Emergencies ; Esophageal and Gastric Varices ; Ethanol ; Hepatic Veins ; Humans ; Hypertrophy ; Korea ; Liver ; Liver Cirrhosis ; Liver Transplantation ; Methods ; Portal Vein ; Radiology, Interventional ; Reoperation ; Shock ; Stents

Surgery for a mid-esophageal lesion requires an open thoracotomy, But authors resected out a stenotic thoracic esphageal lesion with laparoscopic instrument without open thoracotomy. The patient was 50 years old woman with a long history of progressive dyaphagia. A small (3 cm in diameter) smooth ovoid submucosal mass lesion was found at 26 cm distal from incisor on both esophagoscopy and esophagogram. Two 5 mm and two 10 mm trocars were inserted into the right pleural cavity under general anesthesia with double lumen endotracheal tube, An induced pneumothorax by insuffulation of CO2 gas made lung collapse and a good exposure of esophagus. Transorally introduced esophagoscope helped to demonstrate the exact location of lesion and also to give a guide at safe excision of mass with prevention of mucosal perforation. The lesion was found to be a congromeration of an inflammed hilar lympnode and hypertorphic esophageal muscle. The entire lesion was carefully dissected from esphageal mucosa and resected out en bloc. A chest tube was introduced through a trocar site. The lung was reinflated immediately. Post-operatively patient was very comfortable. Laparoscopic surgery is very effective and safe, and it could be applied for the resection of lung bullae, benign pulmonary neoplasm and for an excision of benign esophageal tumor.
Anesthesia, General ; Chest Tubes ; Esophagoscopes ; Esophagoscopy ; Esophagus ; Female ; Humans ; Incisor ; Laparoscopy ; Lung ; Lung Neoplasms ; Middle Aged ; Mucous Membrane ; Pleural Cavity ; Pneumothorax ; Pulmonary Atelectasis ; Surgical Instruments ; Thoracotomy*

Takayasu's arteritis(arteritis syndrome) is an inflammatory disease process affecting primarily the aorta and its main branches. It's etiology and pathogenesis are unknown. Controversy exists in treatment. Segmental stenoses, occlusions, and aneurysmal degeneration of the aorta and the proximal arterial tree are frequent findings. Clinical presentations may include cerebrovascular ischemia, limb ischemia, aortic valvular insufficiency, heart failure, renovascular hypertension, or renal failure. Recently, we experienced a case of Takayasu's arteritis in a 24 years old female with severe dizziness, claudication in right upper extremity. Patient was treated by angioplasty of left vertebral artery and concomitant left subclavian-to-right axillary artery bypass surgery followed by percutaneous transluminal angioplasty with stent therapy of right vertebral artery to prevent cerebrovascular ischemia during the operation. Postoperative result was excellent and dizziness and claudication of right arm were completely relieved.
Aneurysm ; Angioplasty ; Aorta ; Arm ; Axillary Artery ; Constriction, Pathologic ; Dizziness ; Extremities ; Female ; Heart Failure ; Humans ; Hypertension, Renovascular ; Ischemia ; Renal Insufficiency ; Stents ; Takayasu Arteritis* ; Upper Extremity ; Vertebral Artery* ; Young Adult

Since calcification or ossification of the posterior longitudinal ligament of the spine was first described inJapan in 1960 by Tsukimoto, Terayama used the term of OPLL(Ossification of Posterior Longitudinal Ligament) in1964 and mainly reported in Japanese. But recently, the incidence of the OPLL has been reported increasing amongthe non-Japanese. Because of the OPLL may be associated wtih severe neurologic symptoms, which need to havesurgical decompression, exact diagnosis and analysis are necessary. The OPLL can be diagnosed by simple spine,conventional tomography, myelography and CT. Authors analysed radiologic findings of the OPLL in 8 patients, whowere diagnosed by simple spine. Conventional tomography, myelography and CT, and then performed spinal operation,at Hanyang University Hospital from March 1980 to June 1983. The results were as followings; 1. The age range wasbetween 45 and 63 years and most prevalent age was 6th decades(63%). 2. All of the patients were male. 3. All ofthe OPLL occurred in the cervical spine and predominant at the level of C3,4 (48%). 4. The most common length ofthe OPLL was 2 vertebral level. 5. Except one, which was discontinuous at the level of disc space, all of the OPLLwere continuous in length. 6. 7 of 8 OPLL were located in the midline, but one was in right. 7. The OPLL seemed tocorrelate with spondylotic changes. 8. Of all diagnostic procedure, CT provided better and exact visualization ofthe lesion with axial scan and sagittal reconstruction.
Asian Continental Ancestry Group ; Decompression ; Diagnosis ; Humans ; Incidence ; Longitudinal Ligaments ; Male ; Myelography ; Neurologic Manifestations ; Spine

To evaluate the efficacy of the retroperitoneal approach when compared with the transperitoneal approach in elective infrarenal aortoiliac reconstruction, retrospective review of consecutive cases was made with multiple intra-and postoperative parameters. Twenty consecutive cases of infrarenal aortoiliac diseases were performed reconstructive surgery from June 1994 to July 1996 at Department of Surgery, Yeungnam University Hospital. Among these patients, 12 cases underwent aortoiliac reconstruction through the transperitoneal approach(8 cases for infrarenal abdominal aortic occlusion and 4 cases for infrarenal abdominal aneurysm) and 8 cases underwent aortoiliac reconstruction through the retroperitoneal approach (5 cases for infrarenal abdominal aortic occlusion and 3 cases for infrarenal abdominal aortic aneurysm). Both groups had similar associated diseases, such as hypertension, myocardial ischemia and COPD. Intraoperative blood loss was minimal and similar in both groups. The intraoperative crystalloid requirements were not significantly higher for the retroperitoneal approach(4800 ml) than the transperitoneal approach(4400 ml)(p>0.05) and perioperative blood requirements were also similar in both groups. The operation time was not taken significantly longer for the retroperitoneal approach(4.4hr) than the trasperitoneal approach(3.9hr)(p>0.05). Nasogastric intubation and initiation of oral feeding was not significantly prolonged in the transperitoneal group(5 days) when compared with the petroperitoneal group(2.5 days)(p>0.05). Postoperative hospitalization was not considerably prolonged in the transperitoneal approach(19 days) when compared with the retroperitoneal approach(16 days)(p>0.05). There noted significant pulmonary complication in the transperitoneal approach group, whereas wound pain was major complication in the retroperitoneal approach group. These experiences demonstrate that the retroperitoneal approach is a preferable alternative to the transperitoneal route in elective aortoiliac reconstruction.
Aorta, Abdominal ; Hospitalization ; Humans ; Hypertension ; Intubation, Gastrointestinal ; Myocardial Ischemia ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Wounds and Injuries

While the microbiology of cellulitis in the pediatric population and systemic diseases(DM, Cirrhosis, etc) is well known,the causative bacteria and clinical aspect of cellulitis in young adults are less descrihed. this study was undertaken to identify the causative organisms and clinical aspect of adult cellulits. We analysed 121 medical records of 115 young adult patients with cellulitis who had been admitted at the department of orthopaedic surgery, National Police hospital from Jan. 1994. to Dec. 1996. The results were as follows. 1. The age of patient was between 21 yrs and 25 yrs, and the sex of all patients was male. 2. The lower leg and foot were the most frequently involved site of cellulitis as 92 cases(74.2%). 3. The potals were suspected in 65 cases(56.5%),of them, traumas were detected in 43 cases(66.1%), non-traumatic skin lesions in 23 cases(33.9%). 4. In most cases, initial systemic symptoms (fever, chill, headache, etc.) and local symptoms (local heating, tenderness, etc.) were found. 5. The laboratory findings revealed leukocytosis in 19%, elevated ESR in 94%, positive CRP in 80%. 6. Microorganism were detected in 16 of 38 pus cultures. Gram positive microorganisms were detected in 15 of 16 cases culture positive. 7. 6.7% of patients with cellulitis experienced recurrence in same lesions. In conclusion, the retrospective analysis of 115 young adult patients with cellulitis showed that primary cause of young adult cellulit was circulatory disturbance and lymphatic obstruction of the lower extremities most often involved by trauma. therefore, supportive treatments such as rest,elevation,ice packs are considered prior to antibiotic treatment.antibiotic treatment aimed at gram-positive cocci appears to be sufficient.
Adult ; Bacteria ; Cellulitis* ; Fibrosis ; Foot ; Gram-Positive Cocci ; Headache ; Heating ; Hot Temperature ; Humans ; Leg ; Leukocytosis ; Lower Extremity ; Male ; Medical Records ; Police ; Recurrence ; Retrospective Studies ; Skin ; Suppuration ; Young Adult*

PURPOSE: To compare the results of posterior cruciate ligament reconstruction by open and arthroscopic method. MATERIALS AND METHODS: From 1995 to 1997, 18 reconstructions of posterior cruciate ligament were performed. Group 1 (open method) was composed of 9 cases and group 2 (arthroscopic method) was consisted of 9 cases. After 21-month follow-up, The two groups were compared by clinical and radiologic methods. RESULTS: Clinically, Lysholm knee score was 80 points in group 1 and 83 points in group 2 after operation. Post operative results by Hughston's criteria were good in 5, fair in 2 and poor in 2 cases (group 1) and good in 6, fair in 2 and poor in 1 cases (group 2). Radiologically, post operative average of posterior drawer stress view was 5.2 mm (group 1) and 5.0 mm (group 2). Almost double the operation time was taken to reconstruct posterior cruciate ligament by arthroscopic method than open method. There were technical errors in 2 cases performed by arthroscopic method. CONCLUSIONS: The results of both methods had no significant difference. We think that the reconstruction of PCL using patellar tendon by open method is a recommendable treatment method together with arthroscopic method, if the merits or demerits of both methods are considered carefully. But more long-term follow-up is necessary to compare the results of PCL reconstruction by open and arthroscopic methods.
Follow-Up Studies ; Knee ; Patellar Ligament ; Posterior Cruciate Ligament

Entrapment neuropathy of the suprascapular nerve is rare and frequently overlooked in the differential diagnosis of shoulder pain. There have been few published reports on a ganglion compressing the suprascapular nerve. We experienced a case of entrapment neuropathy of the suprascapular nerve by a ganglion that compressed the inferior branch of suprascapular nerve at the spinoglenoid notch.
Diagnosis, Differential ; Ganglion Cysts ; Shoulder Pain

Expandable metallic stents(EMS) were implanted in 7 patients with malignant (4 cholangio- carcinnoma, 1 pancreatic cancer, 1 ampullary carcinoma and 1 lymph node metastasis) biliary stricutres and 17 patients with benign(13 intrahepatic strictures of primary intrahepatic stone patients, 2 postoperative stricutres, 1 ampullary stenosis followed by endoscopic sphineterotomy and 1 bilioenteric anastomosis) biliary stricutures. In the fifteen patients out of 17 patients with benign biliary stricture, relief of cholangitis, improvement of liver function or loss of pruritus was observed. But in the 2 patients with.biliary cirrhosis, no clinical improvement was noted. In the malignant strictures with cholangio-carcinoma, the occlusion of EMS occurred in 3 patients and the duration of stent patency was average 2 months in those patients.
Cholangitis ; Constriction, Pathologic ; Fibrosis ; Humans ; Liver ; Lymph Nodes ; Pancreatic Neoplasms ; Pruritus ; Stents*

With the radioactivity clearance curve of 99mTc-DTPA which was injected into the flusing device, the authors measured cerebrospinal fluid(CSF) flow rate through the shunt tube. The CSF flow rates in resting state in control group and malfunction group were considerably variable and there was no difference of CSF flow rates between the two groups. The significance, advantages, and problems of CSF flow rate measurement were discussed. The changes of CSF flow rate according to physiologic and pathologic fluctuation of intracranial pressure(ICP) should be taken into consideration for a valuable clinical application of this study.
Radioactivity