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*

PURPOSE: This study was performed in an attempt to determine if there was any clnical benefit of microdiscectomy(MD) over standard discectomy(SD). They were all followed up by an impartial observer at 1 year and 5 years. MATERIALS AND METHODS: All patients were operated on by the same surgeon by either method. We evaluate retrospectively 30 cases of microdiscectomy and 30 cases of standard discectomy using data derived from a questionnaire and chart review from January 1. 1988 to December 31. 1993. The operative results were analysed with Kim's criteria and that clinical results were statistically used to Paired two-tailed T test. RESULTS: 1) Mean operating time was about 117minutes in the standard discectomy, while 98 minutes in the microdiscectomy. 2) Mean time to return to work was about 9.6 weeks in the standard discectomy, while 5.9 weeks in the microdiscectomy, 3) In initial and 1 year follow up, microdiscectomy was superior to the standard discectomy but in 5 years follow up, the two procedures have a similar outcome. CONCLUSION: The advantage of microdiscectomy was more safe than standard discectomy, because it was magnified vision and brilliant illumination, precise identification of structures in deep fields(including nerve root and its related structures), a marked advantage to dissect the adhere nerve root to its surroundings structures, its capacity to preserve the integrity of normal tissue, and meticulous hemostasis. From this analysis, we conclude that microdiscetomy represents a small but significant refinement of standard discectomy
Diskectomy* ; Follow-Up Studies* ; Hemostasis ; Humans ; Lighting ; Surveys and Questionnaires ; Retrospective Studies ; Return to Work

Today, lumbar disc surgery has been considerable refined from that performed by Mixter and Barr less than 50 years ago, but there is still room for improvement. The addition of the microsurgical technique may be the most recent means to refine the process of lumbar discectomy. Magnetified vision and brillant illumination have allowed neurosurgeons to refine many standard operations and to devise new ones for hitherto inaccessible areas. Small incisions, meticulous hemostasis, and precise removal of diseased tissue are the contributions of microsurgery to an ideal operation. 37 cases of microsurgical discectomy weer compared to the same number of standard operations. The total patient profiles were the same with other studies. The results demonstrated a 72.9% marked improvement in the standard discectomy category and a 83.9% marked improvement in the microsurgical discectomy group. Also, the mean time until their return to work was 7.3 wks in the microsurgical discectomy group, while 10.8 wks in the standard operation group.
Diskectomy ; Hemostasis ; Humans ; Lighting ; Microsurgery ; Return to Work

A case of T3-4 disc herniation is reported as follows. A 23 year-old patient was presented with paraparesis and anterior chest pain. With the anterolateral approach(transthoracic transpleural approach), decompression and removal of a disc fragment was refered; which resulted is an almost complete recovery of the patient. MRI of the thoracic spine suggested a soft disc herniation. In addition, literatures were reviewed in conjunction with this case report.
Chest Pain ; Decompression ; Humans ; Magnetic Resonance Imaging ; Paraparesis ; Spine ; Young Adult

PURPOSE: To determine the efficacy of an abdominal aortic aneurysm model for stent-graft placement. MATERIALS AND METHODS: The model consists of two parts, the heart and the vascular system. A peristaltic pump and a solenoid valve were used to simulate a pulsatile flow from the heart. A ball-shaped piece of clay was placed inside a square box and liquid silicone was poured. After the silicone was formed, the clay was removed and a silicone tube was used to connect the heart model and the aneurysm model. The silicone tube was also used to simulate the iliac arteries and one end of the artery was clamped and the other one was extended to a water bath. Water at 37 degrees was circulated through the model, and the pressure at the thoracic aorta, aneurysm and iliac artery was measured with the outlet valve opening at 25, 50, and 100% before and after stent-graft placement. RESULTS: The liquid pressure measurements were 253/252, 271/162 and 264/166 mmHg at the thoracic aorta, aneurysm and iliac artery, respectively, when the outlet was 100% open. They were 173/121, 145/99, 145/106 mmHg when the outlet was 50% open, and 35/28, 61/44, 24/22 mmHg when it was 25% open. After placement f the stent-graft, the pressure measurements were 170/132, 174/128, and 167/128 mmHg, respectively. CONCLUSION: Since it was easy to produce, the model was useful for in-vitro stent-graft testing, and a wide range of pressure could be applied.
Aneurysm ; Aorta, Thoracic ; Aortic Aneurysm, Abdominal* ; Arteries ; Baths ; Heart ; Iliac Artery ; Models, Anatomic ; Pulsatile Flow ; Silicones ; Water

PURPOSE: The aim of this study was to examine characteristics of health-related victims identified through the Surveillance System of Heat-related Illness (SSHI) based on emergency department (ED) visits. METHODS: Between July 1 and September 3 of 2011, 443 heat-related patients were reported by 396 of the 461 EDs participating in the SSHI. Heat-related illness included heat (sun) stroke, heat cramp, heat syncope, and heat exhaustion. A hot day was defined as a day above 30degrees C of daily maximum temperature in locations of provincial and metropolitan government offices. We used chi square test for identification of risk factors associated with Heat-related illness in the workplace and heat-related illness heat (sun) stroke. RESULTS: Heatwave, defined as lasting three or more hot days, occurred three times during this period. The daily average number of heat-related patients reported during the heatwave period was 15.7 per day, more than four times the usual rate. The daily maximum temperature showed positive correlation with occurrence of heat-related illness. Heat exhaustion was the most frequent cause (46.0%), with approximately 70% of all cases occurring between noon and 6 p.m. The number of people suffering from heat-related illness while outdoors was three times greater than that of those who experienced it indoors. Work-related occurrence comprised 56.7% of all cases. All six deaths occurred during the heatwave period and were work-related. CONCLUSION: Working conditions, outdoor activities, and old age may be associated with health-related illnesses. A surveillance system that monitors emergency room visits may be useful in assessment of adverse health effects of summer heatwaves.
Climate Change ; Emergencies ; Heat Exhaustion ; Heat Stress Disorders ; Heat Stroke ; Hot Temperature ; Humans ; Infrared Rays ; Korea ; Local Government ; Risk Factors ; Stress, Psychological ; Syncope

BACKGROUND/AIMS: The anatomy of the distal ends of the common bile duct and the main pancreatic duct has received attention becauwe of its importance in pancreaticobiliary disense. The two ducts open into the duodenum either separately or via a common channel. But basie data about the pancreaticabiliary ductal union system has not existed in Korea until now. METHODS: In this study all cases performed with an ERCP were reviewed over the past 5 years (1992.1.1 1996.12.31). Among 3,234 cases, 307 were selected and analyzed because of their clear identification by the pancreaticobiliary ductal union system.
Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Duodenum ; Korea ; Pancreatic Ducts

BACKGROUND/AIMS: The advent of endoscopic retrograde cholangiopancreaticography (ERCP) has made it possible to identify the pancreatic ductal (PD) system. There is no established relationship between the PD system and various pancreaticobiliary diseases. The purpose of this study was to identify the morphological diversities and anatomical variations of PD and to define the relationship between PD types and pancreaticobiliary diseases. METHODS: Five hundred and eighty-two consecutive patients, in whom both PD and common bile duct (CBD) were clearly visualized by ERCP, were included. PD types were categorized according to the relationship between CBD and PD. The anatomical variations were classified into migration, fusion, and duplication anomalies. RESULTS: The PD types were classified into type A 84.4%, type B 9.6%, type C 3.4%, and type D 2.6%. The PD anomalies were noted in 51 patients, which were comprised of 19 (3.3%) fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum) and 32 (5.5%) duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. Hyperamylasemia was more frequently complicated in type C (41.7%) and D (50%) than in type A and B after ERCP. CONCLUSIONS: Though a close relationship was not found between various PD types and pancreaticobiliary diseases, being familiar with the morphology and anatomical variation is worth it, for more accurate interpretation and for prediction of a complication such as pancreatitis.
Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct ; Humans ; Hyperamylasemia ; Pancreas ; Pancreatic Ducts* ; Pancreatitis

BACKGROUND AND AIMS: Long term results of an endoscopic sphincterotomy (EST) have still been poorly estimated. The aim of this study was to assess late complications of EST. METHODS: The rate of late complications were retrospectively evaluated in with 91 patients (mean age, 59.1 years; range, 28~86 years; M:F, 44:47), who underwent EST for choledocholithiasis. RESULTS: Forty six patients (50.5%) had their gallbladder in situ, and 45 patients (49.5%) underwent cholecystectomy. Early complications (<30 days) such as hemorrhage, pancreatitis, and perforation occurred in 7 patients (7.7%). During a mean period of 53.4 months (range, 24~134 months), 26 patients (28.0%) developed late complications, including a recurrence of CBD stones in 20 patients (22.0%) (8-gallbladder in situ, 12-cholecystectomized). An univariate analysis of risk factors for stone recurrence revealed dilated ducts, stone sizes, and stone numbers which were not related with stone recurrence. The history of choledocholithotomy with cholecystectomy was significantly related to stone recurrence. CONCLUSIONS: After EST for bile duct stones, late complications occurred in a significant proportion of patients and it was determined that a history of choledocholithotomy with cholecystectomy was significantly correlated with stone recurrence.
Bile Ducts ; Cholecystectomy ; Choledocholithiasis ; Gallbladder ; Hemorrhage ; Humans ; Pancreatitis ; Recurrence* ; Retrospective Studies ; Risk Factors ; Sphincterotomy, Endoscopic

BACKGROUND/OBJECTIVES: Folic acid supplementation before pregnancy is known to reduce the risk of neural tube defects. The purposes of this study were to investigate the awareness, knowledge, and use of folic acid supplements along with their associated factors among non-pregnant Korean women of childbearing age. SUBJECTS/METHODS: From August 2012 to March 2013, 704 women aged 19–45 years completed a self-administered questionnaire regarding their awareness, knowledge, and use of folic acid as well as questions to identify risk of inadequate folate intake. RESULTS: Approximately 67% of women reported that they had heard of folic acid, and 23.7% had knowledge of both the role of folic acid in preventing birth defects and appropriate time for taking folic acid supplements to prevent birth defects. However, only 9.4% of women took folic acid supplements at the time of the survey. Women aged 19–24 years, unmarried women, and women who had never been pregnant were less likely to be aware and knowledgeable of folic acid or take folic acid supplements. In addition, women at high risk of inadequate folate intake were less likely to take folic acid supplements. In a multivariate analysis, women aged 19–24 years, women with a high school diploma or lower education level, and unmarried women were less likely to be aware and have knowledge of folic acid. The percentage of women taking folic acid supplements was significantly higher among knowledgeable women than among unknowledgeable women. CONCLUSIONS: These results support our hypothesis that women with knowledge of folic acid are more likely to take folic acid supplements. Therefore, educational programs or campaigns to improve knowledge regarding the importance of folic acid and to promote consumption of folic acid supplements as well as folate-rich foods are needed to target young, less educated, and unmarried women.
Congenital Abnormalities ; Dietary Supplements ; Education ; Female ; Folic Acid ; Humans ; Multivariate Analysis ; Neural Tube Defects ; Pregnancy ; Single Person