OBJECTIVE: We wanted to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and large profile catheter maintenance method for the management of patients with anastomotic biliary strictures following liver transplant. MATERIALS AND METHODS: From May 1999 to June 2003, 12 patients with symptomatic benign biliary stricture complicated by liver transplantation were treated with the percutaneous balloon dilatation and large profile catheter maintenance method (1-6 months). The patients were eight males and four females, and their ages ranged from 20 to 62 years (mean age: 44 years). Ten patients underwent living donor liver transplantation and two underwent cadaveric liver transplantation. Postoperative biliary strictures occurred from two to 21 months (mean age: 18 months) after liver transplantation. RESULTS: The initial technical success rate was 92%. Patency of the bile duct was preserved for eight to 40 months (mean period: 19 months) in 10 of 12 (84%) patients. When reviewing two patients (17%), secondary balloon dilatations were needed for treating the delayed recurrence of biliary stricture. In one patient, no recurrent stenosis was seen during the further 10 months follow-up after secondary balloon dilatation. Another patient did not response to secondary balloon dilatation, and he was treated by surgery. Eleven of 12 patients (92%) showed good biliary patency for 8-40 months (mean period: 19 months) of follow-up. CONCLUSION: The percutaneous balloon dilatation and large profile catheter maintenance method is an effective therapeutic alternative for the treatment of most biliary strictures that complicate liver transplantation. It has a high success rate and it should be considered before surgery.
Treatment Outcome ; Middle Aged ; Male ; Liver Transplantation/*adverse effects ; Humans ; Hepatic Artery/ultrasonography ; Female ; Constriction, Pathologic/etiology/therapy ; Cholangiography ; Bile Duct Diseases/etiology/*therapy ; Balloon Dilatation/*methods ; Adult

OBJECTIVE: To determine the value of selective intra-arterial calcium stimulation with hepatic venous sampling using serum insulin and C-peptide gradients for the preoperative localization of insulinomas. MATERIALS AND METHODS: Seven consecutive patients [three men and four women aged 15-77 (mean, 42.7) years] with hypoglycemia underwent selective intra-arterial calcium stimulation in conjunction with hepatic venous sampling. Insulin gradients were calculated by an individual blinded to all other preoperative imaging studies and operative findings. In all patients except one, C-peptide gradients were also analyzed. The results were compared with the preoperative findings of ultrasonography, computed tomography, arteriography and endoscopic ultrasonography, as well as with the intraoperative findings of ultrasonography and palpation at surgery. RESULTS: Eight insulinomas (mean diameter, 12.5 mm) were diagnosed after surgery. In six patients, the calcium stimulation test with insulin gradients allowed accurate localization of the pathologic source of insulin secretion. Both C-peptide and insulin gradients substantially increased diagnostic accuracy. In one patient, C-peptide gradients were more helpful than insulin gradients for tumor localization. CONCLUSION: Selective intra-arterial calcium stimulation with hepatic venous sampling is a highly accurate and safe method for the preoperative localization of insulinomas. Additional C-peptide gradients seem to be helpful in assessing tumor location, but further study is needed.

Acute eosinophilic pneumonia is reported as a specific disease entity. But, it is different from chronic eosinophilic pneumonia in its onset, clinical course and recurrence. Badesh et al reported the following diagnostic criteria os acute eosinophilic pneumonia a less than one-month history of symptoms prior to diagnosis, no evidence of asthma, the absence of other organic disease, no obvious etiology and an evidence of recurrent disease. We experienced a case of acute eosinophilic pneumonia in 37 old male. Pathologically eosinophilic pneumonia is confirmed and other features meet Badesh's criteria.
Asthma ; Diagnosis ; Eosinophils* ; Humans ; Male ; Pulmonary Eosinophilia* ; Recurrence

OBJECTIVE: To assess the efficacy and safety of a "mini-perc" technique of percutaneous nephrolithotomy using a 14-Fr peel-away sheath for the removal of pyelocaliceal stones, and to determine appropriate inclusion criteria. MATERIALS AND METHODS: From July 1999 to June 2002, the medical records and radiographic images of 72 patients who underwent the "mini-perc" technique of percutaneous nephrolithotomy with a 14-Fr peel-away sheath, were reviewed to determine clinical history, stone characteristics, immediate stone free rate, final stone free rate after additional procedures, complications, and hospital stay. We also analyzed the effect of the longest stone diameter, the cumulative longest diameter of stones, the cumulative stone burden, and the stone density on the immediate stone free rate using a Fisher exact test. RESULTS: The only major complication, arterial bleeding, occurred in a patient with Child A liver cirrhosis and was successfully treated by embolization with coils and a gelatin sponge. The immediate stone free rate was 80.6 %, which was significantly influenced by stone diameter but not stone density. The mean hospital stay after the procedure was 3.97 days. CONCLUSION: The "mini-perc" technique of percutaneous nephrolithotomy, which uses the 14-Fr peel-away sheath, is a safe and effective modality for treating renal calculi.
Nephrostomy, Percutaneous/adverse effects/*instrumentation ; Middle Aged ; Male ; Length of Stay ; Kidney Calculi/*therapy ; Infant ; Humans ; Follow-Up Studies ; Female ; Child, Preschool ; Child ; Aged ; Adult ; Adolescent

OBJECTIVE: To investigate whether the uterine artery pulsatility index (UtA PI) of hypertensive pregnancies is higher than that of normal pregnancies in the puerperium, as well as in the antepartum period. METHODS: The UtA PI was measured in hypertensive (group 1) and normal pregnancies (group 2) during antepartum, immediate postpartum or late postpartum periods. Using the transvaginal approach, the bilateral uterine artery indices were measured. RESULTS: One hundred twenty-two women were enrolled: group 1, hypertensive disease in pregnancy (11 cases in antepartum, 13 cases in immediate postpartum and 10 cases in late postpartum period); group 2, normal pregnancies (32 cases in antepartum, 29 cases in immediate postpartum and 27 cases in late postpartum). In antepartum and immediate postpartum periods, the mean UtA PI and the proportion of cases with an early diastolic notch were higher in group 1 than in group 2 (antepartum mean UtA PI, 1.14 in group 1 vs. 0.68 in group 2, P<0.001; early diastolic notch, 46% vs. 9%, P<0.05; immediate postpartum mean UtA PI, 1.30 vs. 1.08, P<0.05; early diastolic notch, 85% vs. 48%, P<0.05). In late postpartum period, the mean value of UtA PI of group 1 was still higher than that of group 2, although the proportion of cases with an early diastolic notch was not different (mean UtA PI, 1.43 vs. 1.20, P<0.05; early diastolic notch, 60% vs. 52%, P=0.73). CONCLUSION: The UtA PI in hypertensive pregnancies was still higher than normal pregnancies in puerperal periods, suggesting that more than several weeks are required to resolve increased uterine artery vascular impedance.
Electric Impedance ; Female ; Humans ; Hypertension ; Postpartum Period* ; Pre-Eclampsia ; Pregnancy* ; Uterine Artery*

PURPOSE: This study aimed to evaluate the ultrasonographic findings for various types of vascular closure devices (VCDs) immediately after the angiographic procedure and at 6-month follow-up. METHODS: We included 18 VCDs including Angio-Seal (n=4), FemoSeal (n=8), ExoSeal (n=3), Perclose (n=2), and StarClose (n=1) in this study. Four patients were implanted with 2 VCDs at the each side of bilateral femoral arteries, while the remaining 8 patients were inserted 1 VCD at the right femoral artery. Ultrasonography was performed within 10 days and at approximately 6 months after the angiographic procedure. Ultrasonographic morphology of the attached VCD and its relationship with the arterial wall were analyzed. RESULTS: Initial ultrasonography revealed the attached VCD as the relevant unique structure with successful deployment and hemostasis. Follow-up ultrasonography demonstrated partial absorption of hemostatic materials in cases of Angio-Seal (n=3), FemoSeal (n=5), and ExoSeal (n=3), changes in the soft tissue surrounding the femoral artery in case of Angio-Seal (n=1), arterial intimal hyperplasia in cases of FemoSeal (n=3), and no gross changes as compared with the initial ultrasonographic findings in cases of Perclose (n=2) and StarClose (n=1). CONCLUSION: Initial ultrasonographic evaluation reflected the unique structure of each VCD, with most of them being easily distinguishable. Follow-up ultrasonography revealed various changes in the affected vessels.
Absorption ; Femoral Artery ; Follow-Up Studies* ; Hemostasis ; Humans ; Hyperplasia ; Ultrasonography ; Vascular Access Devices

Takayasu's arteritis is one of the most important causes of the renovascular hypertension in orientals. Among the multiple treatment modalities, percutaneous transluminal renal angioplasty(PTRA) has become the treatment of the choice for major renal artery stenosis and is a safe, repeatable, effective procedure for the treatment of renovascular hypertension due to Takayasu's arteritis. We experienced a case of percutaneous transluminal balloon angioplasty of Takayasu's arteritis involving the proximal left renal artery. After PTRA, clinical and angiographical improvements were achieved.
Angioplasty* ; Angioplasty, Balloon ; Hypertension, Renovascular ; Renal Artery Obstruction* ; Renal Artery* ; Takayasu Arteritis*

BACKGROUND: We reviewed the long-term outcomes of aortic root replacement at Asan Medical Center and investigated the predictors affecting mortality. MATERIALS AND METHODS: A retrospective analysis was performed on 225 consecutive adult patients undergoing aortic root replacement with mechanical conduits (n=169), porcine aortic root prosthesis (n=23), or aortic homografts (n=33) from January 1992 to September 2009. The median follow-up duration was 6.1 years (range, 0 to 18.0 years). RESULTS: The porcine root group was older than the other groups (freestyle 55.9+/-14.3 years vs. mechanical 46.3+/-14.6 years, homograft 48.1+/-14.7 years; p=0.02). The mechanical group had the highest incidence of the Marfan syndrome (mechanical 22%, freestyle 4%, homograft 3%; p=0.01). Surgery performed for infective endocarditis was more frequent in the homograft group (mechanical 10%, freestyle 10%, homograft 40%; p<0.001). The overall 30-day mortality was 5.3% (12/225). Actuarial survival rates in the mechanical, porcine root, and homograft groups were 79.4%, 81.5%, and 83.5% at 5 years and 67%, 61.9%, and 61.1% at 10 years, respectively (p=0.73). By multivariate analysis, preoperative diabetes mellitus, older age, and longer cardiopulmonary bypass time were independent predictors of mortality. Incidence of postoperative complications, including infective endocarditis and thromboembolism were comparable in all of the groups. CONCLUSION: Aortic root replacement can be safely performed with different types of prostheses as the outcome was not affected by the choice of prosthesis. Further studies are required to assess the long-term durability of biological prostheses.
Adult ; Cardiopulmonary Bypass ; Diabetes Mellitus ; Endocarditis ; Follow-Up Studies ; Heart Valve Prosthesis ; Humans ; Incidence ; Marfan Syndrome ; Multivariate Analysis ; Postoperative Complications ; Prostheses and Implants ; Retrospective Studies ; Survival Rate ; Thromboembolism ; Transplantation, Homologous

Churg-Strauss Syndrome is a disorder of hypereosinophilia and systemic vasculitis in subjects with asthma and allergic rhinitis. Clinically, a multiple organ system can be involved with various manifestations of disease of lung, heart, skin, musculoskeletal system, nervous system, gastrointestinal and hepatobiliary tract. We experienced a case of Churg- Strauss syndrome presenting as the appendicitis and the lower gastrointestinal bleeding in a 37-year-old male patient with acute lower abdominal pain. He also showed peripheral eosinophilia, bronchial asthma, and mononeuritis multiplex. He initially received a high dose corticosteroid and was maintained with low doses of corticosteroid, cyclophosphomide and exchange plasmapheresis.
Abdominal Pain ; Adult ; Appendicitis* ; Asthma ; Churg-Strauss Syndrome* ; Eosinophilia ; Heart ; Hemorrhage* ; Humans ; Lung ; Male ; Mononeuropathies ; Musculoskeletal System ; Nervous System ; Plasmapheresis ; Rhinitis ; Skin ; Systemic Vasculitis

The Alstrom syndrome is inherited autosomal recessive disorder, characterized by obesity, diabetes mellitus, pigmentary retinal degeneration, normal intelligence, sensorineural hearing loss, baldness, acanthosis nigricans, male hypogonadism, hyperuricemia and hypertriglyceridemia. There is no reported case of Alstrom syndrome in Korea yet. We experienced a 29-year-old female patient with clinical characteristics similar to Alstrom syndrome who was admitted due to poorly controlled diabetes mellitus and diabetic retinopathy with hemorrhage. We report this case with the review of literatures.
Acanthosis Nigricans ; Adult ; Alopecia ; Alstrom Syndrome* ; Diabetes Mellitus ; Diabetic Retinopathy ; Female ; Hearing Loss, Sensorineural ; Hemorrhage ; Humans ; Hypertriglyceridemia ; Hyperuricemia ; Hypogonadism ; Intelligence ; Korea ; Male ; Obesity ; Retinal Degeneration