We present two cases of compression of the common hepatic duct by overriding of the right hepatic artery. One case is gall bladder, common hepatic duct stone and one case is right intrahepatic duct stone. We observed the compression of the common hepatic duct caused by overriding of the right hepatic artery in the both cases. The final diagnosis was made at operative fields. These patient were successfully treated by dissection of adhesion, suture, fixation between gall bladder bed and right hepatic artery.
Diagnosis ; Hepatic Artery* ; Hepatic Duct, Common* ; Humans ; Sutures ; Urinary Bladder

PURPOSE: Gemcitabine is the most active agent to treat unresectable pancreatic cancer. The superiority of combining other drugs with cisplatin is still controversial; therefore, we performed a retrospective analysis of gemcitabine versus gemcitabine combined with cisplatin to determine the treatment outcomes for patients with locally advanced or metastatic pancreatic cancer. MATERIALS AND METHODS: From 2001 to 2007, we enrolled 60 patients who were treated with gemcitabine or gemcitabine combined with cisplatin for locally advanced or metastatic pancreatic cancer. Gemcitabine 1, 000 mg/m2 (G) was administrated at day 1 and day 8 every 3 weeks. Cisplatin 60 mg/m2 was added at day 1 every 3 weeks to the gemcitabine schedule (GP). RESULTS: Number of G: GP was 34: 26, locally advanced to metastatic ratio was 35% to 65% in group G and 46% to 54% in group GP. Median follow up duration was 29 months. The median number of chemotherapy cycles was 4 (range: 2~11) for the G group, and 4 (range: 1~11) for the GP group. The response rate of the G and GP groups was 17% and 11%, respectively. The progression free survival (PFS) was 4.5 months and 2.8 months, respectively, for the G and GP groups. The overall survival (OS) was 10.7 and 8.7 months respectively, for the G and GP groups, but there is no statistically significant difference of the PFS (p=0.2396) and OS (p=0.4643) between the 2 groups. The hematological toxicity profile was similar (the grade III neutropenia and thrombocytopenia was 4.4% and 3.1%, respectively, in G group, and 7.5% and 2.8%, respectively, in the GP group). But non-hematological toxicities such as skin rash, abnormal liver function and nausea/vomiting were observed in 3 patients of the GP group. On the prognostic factor analysis, no factors predicted a longer PFS and OS for both the G and GP groups. CONCLUSIONS: Gemcitabine single treatment might be more tolerable and it had the same efficacy compared to cisplatin combination treatment in this retrospective study.
Appointments and Schedules ; Cisplatin ; Deoxycytidine ; Disease-Free Survival ; Exanthema ; Follow-Up Studies ; Humans ; Liver ; Neutropenia ; Pancreatic Neoplasms ; Retrospective Studies ; Thrombocytopenia

BACKGROUND/AIMS: Midazolam is utilized as a premedication for uppoer gastrointestinal endoscopy. Midazolam has a more rapid onset of reaction than that of diazepam and its duration is shorter. But the Consciousness of premedicated patients has not been regained sooner. The Purpose of this study was to examine the effectiveness of flumazenil against midazolam as premedication for upper gastrointesinal endoscopy. METHODS: Sixty patients underwent upper gastrointestinal endoscopy. These patients were divided to three groups: Group I included twenty patients without premedication; Group II Included twenty patients with premedication of midazolam and then were not given an antisedative agent excluign of normal saline; and Group III included the others with midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam injection, compared with presedation value. Modified Steward Coma Scale showed a significant increase after flumazenil injection as an antagonist of midazolam. The assessment of the endoscopist and the comfort of patients were satisfactory. When the 40 patients were asked about their willingness to undergo the same procedure in the future, thirty-four patients responded favorably. CONCLUSION: Midazolam was safe and effective for sedation for upper gastrointestinal endoscopy. There was rapid regaining of consciousness with flumazenil indection after midazolam, so the use of flumazenil against midazolam injection also appeared to be effective.
Coma ; Consciousness ; Diazepam ; Endoscopy ; Endoscopy, Gastrointestinal* ; Flumazenil* ; Humans ; Midazolam* ; Premedication* ; Vital Signs

Cytomegalovirus (CMV) infection is more frequent in immunocompromised patients those with acquired immunodeficiency syndrome (AIDS), malignant disease, steroid therapy. However, CMV can infect a healthy person who has normal immunity. Most cases of CMV infections are due to reactivation of latent virus. We report a case of cytomegalovirus colitis in a 73 years old woman who has congestive heart failure with normal immunity. Sigmidoscopy reveals cobble stone like mucosa and deep ulceration. CMV infection produces a cytomegalic cell containing a intranuclear inclusion, which is surrounded by clear halo in Hematoxylin-Eosin stain. Immunohistochemical stain for CMV reveals focal positive in cytoplasm and in nuclei of large cells. We diagnosed CMV colitis with histopathologic finding and immunohistochemistry through sigmoidoscopic mucosal biopsy.
Acquired Immunodeficiency Syndrome ; Aged ; Biopsy ; Colitis* ; Cytomegalovirus* ; Cytoplasm ; Female ; Heart Failure ; Humans ; Immunocompromised Host ; Immunohistochemistry ; Intranuclear Inclusion Bodies ; Mucous Membrane ; Ulcer

BACKGROUND: Radioiodine treatment is effective for the removal of remnant thyroid tissues after thyroidectomy in patients with differentiated thyroid carcinoma. To induce the elevation of serum TSH level which facilitates the uptake of radioiodine into remnants, a 4 to 6 week interval between thyroidectomy and radioiodine administration has been established. During the period of preparation, most patients have experienced overt symptoms of hypothyroidism which have led to the development of alternative strategies. Some reports have suggested that the interval could be reduced to about 3 weeks with less symptoms. We reevaluated the adequate time needed for the elevation of serum TSH level above 30microU/mL after thyroidectomy. METHODS: Forty five patients who had undergone total thyroidectomy for differentiated thyroid carcinoma were investigated. Serum TSH and free T4 levels were measured one or more times within 3 weeks after operation(total 97 blood samples). Eighty nine blood samples were obtained within 15 days. RESULTS: In 41 patients (91.1%) serum TSH levels increased to 30 microU/mL until 15 days after operation. Until postoperative 21 days, serum TSH levels in all the other patients reached 30microU/mL. In linear equation, the daily increment of serum TSH levels was 2.62microU/mL for the first 8 days after operation and 5.34micorU/mL for the next 7 days. The half-life of serum free T4 levels showed marked individual variations. CONCLUSION: Measurement of serum TSH level at about 15 days after total thyroidectomy for differentiated thyroid carcinoma may be useful in determining the time of radioiodine administration.
Half-Life ; Humans ; Hypothyroidism ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin

Head and neck cancers have never been systematically studied for clinical purposes yet in Korea. This epidemiological survey on head and neck cancer patients was undertaken from January to December 2001 in 79 otorhinolaryngology resident-training hospitals nationwide. The number of head and neck cancer patients was 1,063 cases in the year. The largest proportion of cases arose in the larynx, as many as 488 cases, which accounted for 45.9%. It was followed by, in order of frequency, oral cavity (16.5%), oropharynx (10.0%), and hypopharynx (9.5%). The male:female ratio was 5:1, and the mean age was 60.3 yr. Surgery was the predominant treatment modality in head and neck cancers: 204 (21.5%) cases were treated with only surgery, 198 (20.8%) cases were treated with surgery and radiotherapy, 207 cases (21.8%) were treated with combined therapy of surgery, radiotherapy, and chemotherapy. Larynx and hypopharynx cancers had a stronger relationship with smoking and alcohol drinking than other primary site cancers. Of them, 21 cases were found to be metastasized at the time of diagnosis into the lung, gastrointestinal tract, bone, or brain. Coexisting second primary malignancies were found in 23 cases. At the time of diagnosis, a total of 354 cases had cervical lymph node metastasis accounting for 42.0%.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/epidemiology ; Carcinoma, Squamous Cell/epidemiology* ; Child ; Female ; Head and Neck Neoplasms/epidemiology* ; Health Surveys ; Human ; Korea/epidemiology ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasms, Second Primary/epidemiology ; Occupations ; Registries/statistics & numerical data ; Risk Factors ; Smoking/epidemiology

OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. METHOD: This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points: at baseline, and 1,2,4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. RESULTS: 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action: a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. CONCLUSIONS: This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.
Dyskinesias ; Dystonia ; Electrocardiography ; Hospitalization ; Hospitals, University ; Humans ; Parkinsonian Disorders ; Risperidone* ; Schizophrenia* ; Vital Signs ; Weights and Measures