PURPOSE: Inidence of recurrent common duct stones reported approximately 20% for a second operation, and with even higher rate following subsequent reoperation. However, the factors contributing to recurrent stones have not well defined. Some authors have reported on association of juxtapapillary diverticula with recurrent biliary stones. We have studied to assess the clinical significance of coexisting PAD on recurrent common bile duct stones and to establish the rational operative procedure in primary or recurrent common duct stones with coexisting PAD. METHODS: Medical records of 456 consecutive patients (Feb. 1993~Aug. 2002) who performed ERCP for biliary symptoms were reviewed. We comparative study retrospectively have done between patients with and without PAD on recurrence of common duct stones and outcome of treatment. RESULTS: Incidence of PAD was 15.1% on ERCP, and increased in the old aged patients. Incidence of biliary stone in PAD group was higher than that of non-PAD group (73.9% vs. 50.6%), and gall stone involving common duct was more prevalent in PAD group than non-PAD group. PAD group showed higher stone recurrence rate (23.5% vs. 6.1%) and earlier recurrence following conventional treatment, and needs more multiple treatments, compared with non-PAD group. Intradiverticular papillae (IDP) type showed higher stone recurrence, compared with juxtapapillary diverticula (JPD) type (36.8% vs. 15.6%). CONCLUSION: PAD would be one of important contributing factors for development and recurrence of common bile ductstones. So rational operative procedure for primary or recurrent common duct stones with coexisting PAD should include extirpation of PAD, particulary in IDP type.
Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Diverticulum* ; Gallstones ; Humans ; Incidence ; Medical Records ; Recurrence ; Reoperation ; Retrospective Studies ; Surgical Procedures, Operative

BACKGROUND: Adaptive remodeling of the wall of diseased arterial segments occurs to compensate for the accumulation of atherosclerotic plaque. Histopathologic studies and intraoperative high-frequency epicardial coronary ultrasound imaging as well as intracoronary ultrasound imaging have shown that human coronary arteries enlarge in parallel with the formation of atherosclerotic plaque. Therefore, the lumen area is preserved until the progressive accumulation of plaque exceeds the compensatory mechanisms of the vessel. In 1995, however, Pastercamp et al. reported that arterial wall constriction (shrinkage) or inadequate enlargement may be a different mechanism associated with the development of severe arterial lumen narrowing in addition to plaque proliferation. The aim of this study is to examine what extent of de novo native coronary arterial stenosis is accompanied by compensatory enlargement and to find the predictors of inadequate remodeling with intravascualr ultrasound. METHODS: Fifty eight patients were enrolled from February 1997 through October 1997. Patients who had the lesion of more than 50% stenosis of minimal luminal diameter in coronary angiography were indicated. The lesion which was located in the ostium or was very tortuous or angulated was excluded. The lesion which had the history of balloon angioplasty or stent insertion was also excluded. We used 20 MHz endosonic intravascular ultrasound catheter. We measured EEM area (External Elastic Membrane area), lumen area and plaque plus media area and analysed plaque characteristics. RESULTS: 1) Fifty-eight consecutive patients (43 men, 15 women; mean age 55.4 years, range 33 to 78) who had not undergone previous catheter intervention were studied with a single intravascular ultrasound system. 2) Among 58 patients, 20 patients (35%) had acute myocardial infarction, 30 patients (52%) unstable angina, 6 patients (10%) stable angina and 2 patients (3%) old myocardial infarction. Lesions were located at the left anterior descending arteries in 29 patients (50%), right coronary arteries in 21 patients (36%) and left circumflex coronary artery in 8 patients (14%). 3) Compensatory enlargement was observed in 19 (32%) of 58 lesions and inadequate compensatory enlargement in 39 (68%). 4) EEM and plaque areas at lesion site of compensatory enlargement group were significantly larger than those of inadequate enlargement group (p<0.05). 5) Risk factors for coronary arterial disease including diabetes mellitus, hypertension, hypercholesterolemia (serum cholesterol<0A65B>240 mg/dl), smokings and plaque characteristics were not statistically related with inadequate enlargement. Although there was no statistical significance, there was a tendency of inadequate enlargement in patients with diabetes mellitus and calcified plaque. 6) The only predictor of inadequate remodeling was the postmenopausal female (p<0.05). CONCLUSION: Adaptive compensatory coronary arterial remodeling was occured less frequently in patients with acute coronary syndromes than in patients with stable angina. The only statistically significant predictor of adaptive compensatory coronary arterial remodeling was postmenopausal women. Inadequate compensatory coronary arterial remodeling was occured more frequently in patients with diabetes mellitus or calcified plaque but without statistical significance.
Acute Coronary Syndrome ; Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Catheters ; Constriction ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Diabetes Mellitus ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Membranes ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Risk Factors ; Smoke ; Stents ; Ultrasonics* ; Ultrasonography

OBJECTIVES: To evaluate the clinical significance of heel pain, a frequently associated enthesopathy in Behcet's disease and to evaluate the association with seronegative spondyloarthropathy. METHODS: 15 Behcet's disease patients diagnosed by International Study Group for Behcet's disease criteria with arthritis were studied prospectively in the period of 1994. 3. 1-1995. 3. 31. Modified New York criteria was adopted for the diagnosis of ankylosing spondylitis. The patients were grouped into two by the presence of heel pain which was documented as tenderness on heel. RESULTS: There were 6 patients in the heel pain group and 9 patients in the non-heel pain group. Clinical characteristics were not significantly different between the two groups. Ankylosing sponaylitis was not associated in either group. ESR was higher with the value of 41.2mm/hr in heel pain group than 25.7mm/hr in non-heel pain group but it was not significant. In heel pam group, one patient showed HLA-B27 positivity, one patient showed erosive bone cha. nge, and one patient showed sacroiliitis but non-heel pain group showed no HLA positivity or bony changes. CONCLUSIONS: We find that subset of Behcet's disease patients with heel pain showed tendency to have higher inflammatory activity, erosive bone change, sacroilitis and HLA B-27 association, thus should be classified as seronegative spondyloarthropathy but seems to be different category from ankylosing spondylitis. These observations should be conducted in a large number of patients to establish the clinical value.
Arthritis ; Diagnosis ; Heel* ; HLA-B27 Antigen ; Humans ; Prospective Studies ; Rheumatic Diseases ; Sacroiliitis ; Spondylarthropathies ; Spondylitis, Ankylosing

Hypertensive pontine hemorrhage usually causes profound, irreversible neurological deficits, with ominous prognosis, and is often fatal. There is controversy as to the appropriate treatment modality, but in general, surgical intervention is considered unethical. The authors report the outcome of hypertensive pontine hemorrhage in 13 patients whose Glasgow Coma Scale was 4-9, who on brain CT scan were seen to have over 10cc of hematoma and who underwent suboccipital craniectomy for hematoma removal. These patients could be divided in two groups: 'early'(9 patients), who underwent surgery within 24 hours of ictus, and 'late'(4 patients), who underwent surgery 6 to 20 days after ictus: all had shown neurological deterioration in spite of optimal medical treatment. Surgical outcome did not vary according to the extent of hematoma removal. For patients in the 'early' group, surgery was not useful, but three in the 'late' group, the GCS score improved to between 7 and 11. This study suggests that in hypertensive pontine hemorrhage, an early direct approach may not improve outcome, but for selected patients, who deteriorate during conservative treatment, surgery may be beneficial.
Brain ; Glasgow Coma Scale ; Hematoma ; Hemorrhage* ; Humans ; Prognosis ; Tomography, X-Ray Computed

BACKGROUND: The clinical use of intracoronary stents is impeded by the risk of subacute stent thrombosis and complications associated with the anticoagulant regimen. The use of high pressure balloon dilatations and confirmation of adequate stent expansion by intravascular ultrasound provide assurance that anticoagulation therapy can be safely omitted. Therefore, we evaluated the effect of anticoagulation of subacute thrombosis sfter stenting retrospectively on a consecutive series of patients who received palmaz-Schatz coronary stents with high pressure balloon dilatation. METHOD: From March 1995 to August 1995, 62 patients underwent Palmaz-Schatz coronary stent implantation. After deploying stents successfully, high pressure overdilatation of the stents was performed in all patients. According to post-stent anticoagulation, 32 patients received aspirin 200 mg/day, ticlopidine 500 mg/day and warfarin for two months, 30 patients received aspirin and ticlopidine. RESULTS: The clinical or angiographic variables were not significantly different between the two groups. There was no acute or subacute thrombosis in the two groups. The hospital stay after stenting was significantly shorter in the patients without antcoagulation than in patients with anticoagulation. CONCLUSION: The Palmaz-Schatz stent can be safely implanted without anticoagulation provided that stent expansion is daequate by the use high pressure balloon dilatation This technique significantly reduces hospital time and vascular complications and has a low stent thrombosis rate.
Aspirin ; Dilatation* ; Humans ; Length of Stay ; Retrospective Studies ; Stents* ; Thrombosis ; Ticlopidine ; Ultrasonography ; Warfarin

PURPOSE: To evaluate the usefulness and effectiveness of endoscopic management for recurrent hematospermia, we performed transurethral endoscopy of the seminal vesicles in patients with recurrent hematospermia, despite the administration of oral medication. MATERIALS AND METHODS: Sixteen patients were enrolled this study. Initially, all patients were treated with oral antibiotics for 6-8 weeks. Transrectal ultrasound (TRUS) and/or MRI were performed to find the anatomic abnormality and its relation with pelvic organs. The mean patient age and duration of symptoms were 43.9 years (range 24-64 years) and 21.3 months (range 1-108), respectively. We used a 6.5Fr. rigid ureteroscope and/or 14Fr. endoureterotomy instruments for the seminal vesiculoscopic examination. Patients were followed for more than 12 months after the procedures. RESULTS: An endoscopic seminal vesicle examination was able to be successfully performed in all patients. A midline cyst was found at 10 cases, which were fulgurated. Endoscopic incisions or dilation of the ejaculatory duct were performed in all patients. An ejaculatory duct stone was found at 5 cases, and removed endoscopically. All patients reported improvement of hematospermia after the procedure, and 3 with perineal discomfort became symptom free. Postoperative complications, such as epididymitis, orchitis and ejaculatory abnormalities, were not observed in any patient. CONCLUSIONS: Transurethral endoscopic interventions of the seminal vesicles can be performed easily with a conventional 6.5Fr. rigid ureteroscope and/or 14Fr. endoureterotomy instruments. Transurethral endoscopic managements were effective and safe treatment options in recurrent hematospermia patients.
Anti-Bacterial Agents ; Ejaculatory Ducts ; Endoscopy ; Epididymitis ; Hemorrhage ; Hemospermia* ; Humans ; Magnetic Resonance Imaging ; Male ; Orchitis ; Postoperative Complications ; Semen ; Seminal Vesicles ; Ultrasonography ; Ureteroscopes

PURPOSE: To evaluate the efficacy and stability of the wrap-clipping methods as a reconstructive strategy in the treatment of unclippable cerebral aneurysms. MATERIALS AND METHODS: Twenty four patients who had undergone wrap-clipping microsurgery were retrospectively reviewed. Type and morphology of the treated aneurysm, utilized technique for wrap-clip procedure, and clinical outcome with angiographic results at their last follow-up were evaluated. RESULTS: Of 24 patients, eleven patients had internal carotid artery (ICA) blister-like aneurysms, three had dissecting type aneurysms, and ten had fusiform aneurysms. The follow-up period for the late clinical and angiographic results ranged from 10 to 75 months (mean 35 months). Wrap-clipping was performed in eleven, wrap-holding clipping was in ten, and combination of wrap-clip and wrap-holding clip was in three cases. At the last angiographic follow-up study, twelve aneurysms (50%) were found to have completely healed, and nine aneurysms (38%) were at least stable. However, wrap-holding clip for the elongated blister type of ICA aneurysm was found failed, leading to fatal rebleeding in one case, and two cases of combination of wrap-clip-wrap-holding clip revealed delayed branch occlusion and marked regrowing, respectively. CONCLUSION: Wrap-clipping strategy could be an easy and safe alternative for unclippable aneurysms. The wrapped aneurysm mostly disappeared, or at least remained stationary, after a long-term period. However, surgeons should be aware of that the wrapped aneurysm might become worse. Therefore, follow-up surveillance for an extended period should be mandatory.
Aneurysm ; Blister ; Carotid Artery, Internal ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Methods ; Microsurgery ; Retrospective Studies

No abstract available.
Arteries* ; Atherectomy*

BACKGROUND AND OBJECTIVES: QT dispersion (QTd) represents the inhomogeneity of ventricular repolarization and has been suggested to predict ventricular arrhythmia in patients with coronary artery disease (CAD). This study investigates the short-term effect of percutaneous transluminal coronary angioplasty (PTCA) on QTd in patients with CAD and no history of previous myocardial infarct. MATERIALS AND METHODS: In 84 angina patients (65 men and 19 women, mean age of 58.3+/-9.0 yeras) who underwent successful PTCA of single coronary artery, ECG was checked in baseline, immediate, 1day and 1 month after PTCA. QTd and corrected QTd (c-QTd) were measured in these ECGs by digitizer. RESULTS: PTCA was performed at left anterior descending artery (LAD) in 56, left circumflex artery (LCx) in 12 and right coronary artery (RCA) in 16 patients. Mean and standard error of QTd (c-QTd) at baseline, immediate, 1day and 1month after PTCA was 51.3+/-4.2 (50.7+/-4.1), 54.2+/-4.5 (52.8+/-4.5), 47.7+/-4.3 (48.5+/-4.8) and 36.3+/-4.5 (37.5+/-4.6)msec, respectively. QTd and c-QTd significantly decreased at 1 month following PTCA. The difference was more prominent in pateints with LAD lesion than LCx or RCA lesion and independent of gender, severity of stenosis and use of beta-blockers. CONCLUSION: QTd decreases in CAD patients with no history of myocardial infarct at 1 month following successful PTCA. This may facilitate a favorable recovery from inhomogenous repolarization. These findings call for long-term follow-up of QTd and the incidence of ventricular tachyarrhythmias and sudden death following successful PTCA.
Angioplasty, Balloon, Coronary ; Arrhythmias, Cardiac ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Death, Sudden ; Electrocardiography ; Female ; Humans ; Incidence ; Male ; Myocardial Infarction ; Tachycardia

Metastasis from primary malignancies anywhere in the body can spread to the retroperitoneum and lead to ureteral obstruction. Seventeen patients who had ureteral obstructions caused by advanced gastrointestinal malignancies have been retrospectively analyzed. The results are as follows: 1) Of the 17 patients, 9 were male and 8 were female, and the mean age was 56.9: with a range from 33 to 75. 2) In the 16 patients whose pathologic diagnose were confirmed by primary surgery, the pathologic stages of stomach cancer were stage III in 1 patient and IV in 6 patients, and those of colorectal cancer were stage B in 2 patients, C in 6 patients and D in 1 patient. 3) Urologic symptoms and signs were micro- or macroscopic hematuria (58.8%), elevated BUN (52.9%), and flank pain (29.4%). Sixteen out of 17 patients had one of these findings. 4) The time interval between the original diagnosis of a gastrointestinal malignancy and the subsequent ureteral obstruction in 11 patients (64.7%) was within 2 years. The time interval for a11 17 patients was 33.9 months with a range from 2 months to 10 years. 5) Ureteral involvement was bilateral in 10 patients (58.8%) and unilateral in 7 (41.2%). The levels of ureteral obstruction in stomach cancer were upper (5) and midureter (3), and those in colorectal cancer were upper (1), mid (1) and lower ureter (7). 6) Twenty out of 27 kidneys were managed by a double-J stent (5 kidneys) or a percutaneous nephrostomy (15 kidneys). In conclusion, we believe that the possibility of ureteral obstruction by direct invasion or lymph node metastasis should be taken into account in patients who have advanced gastrointestinal malignancies. If such patients show hematuria, elevated BUN, or flank pain, a secondary ureteral obstruction should be suspected. Also malignant ureteral obstructions should be detected and managed early to preserve the renal function.
Colorectal Neoplasms ; Diagnosis ; Female ; Flank Pain ; Gastrointestinal Neoplasms ; Hematuria ; Humans ; Kidney ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Nephrostomy, Percutaneous ; Retrospective Studies ; Stents ; Stomach Neoplasms ; Ureter* ; Ureteral Obstruction*