Endoscopic injection sclerotherapy(EIS) has been widely used in treating and eradicating acutely bleeding esophageal varies, but may be associated with some undesirable local and systemic complications. Endoscopic variceal ligation(EVL), which consists of mechanicai ligation and thrombosis of varices using elastic o-band, has been recently developed as a non operative alternative to EIS. We performed EVL in 65 patients who had bled from esophageal varices between November 1991 and September 1993. Total 274 sessions were performed and 774 o-bands were used. Six patients were actively bleeding and all of them were successfully controlled by emergency EVL. During the follow-up period, five patients who had combined hepatoma died. Varices were eradicated or reduced grade I in 43(71.6%) of the 60 survivals by 8-36 ligations(mean 15.6 ligation) in 2-13 EVL sessions(mean 5.6 sessions). During follow up period, five patients had recurred from grade 0 to grade 2 or 3 in 106-260 days(mean 182.6 days), and then eradicated by repeated EVL. During or after EVL, there were no complications, except mild substernal distress and mild dysphagia in 17 and 7 patients respectively. These results showed that EVL is a safe and effective method for eradication of bleeding esophageal varices.
Carcinoma, Hepatocellular ; Deglutition Disorders ; Emergencies ; Esophageal and Gastric Varices* ; Follow-Up Studies ; Hemorrhage ; Humans ; Ligation* ; Thrombosis ; Varicose Veins

Villous tumor of the duodenum are rare, only 89 cases having been reported and reviewed in several recent publication. Malignancy is discovered in approximately 30-45% leading to the recommandation that all such tumors be excised regardless of the endoscopic findings. Two cases of villous tumor of the duodenum were reported and locally excised. The pathologic specimens showed carcinoma in situ, no evidence of hematogenous and lymphatic metastasis.
Carcinoma in Situ ; Duodenum* ; Lymphatic Metastasis ; Publications

Advances in fiberoptic endoscopy have improved diagnostic capabilities and management in piatients with gastrointestinal polyps. The gastrointestinal polyp is a premalignant lesion in varying degrees, according to size, pathology, and location. Endoscopic polypectomy has long been considered as a safe and effective method for removal of polyps. Sixty endoscopic gastrointestinal polypectomies were done in 53 patients who visited Hanyang University Hospital from 1984 to l990, and the clinical characteristics including histopathalogy were evaluated. (continue...)
Endoscopy ; Humans ; Pathology ; Polyps

About a third of the patients with decompensated liver cirrhosis have reduced arterial oxygen saturation and are sometimes cyanosed in the absence of any apparent lung or heart disease; There is a reduction of diffusing capacity without a restrictive ventilatory defect. The aim of this study was to determine diffusing capacities in patients with chronic liver- diseases. The diffusing capacities and arterial oxygen saturations were measured in 25 patients with chronic active hepatitis(CAH), 9 early cirrhotics (early LC), 36 cirrhotics(Child's class A) and 11 cirrhotics(Child's class B). The anterior tibial area was observed for pitting edema, and Thallium-201 test per rectum(shunt index) was done. Hypoxemia was not observed in all subjects. The number of cases with decreased pulmonary diffusing capacity (DLco) is 3/25(12.0%) for CAH, 3/9(33.3%) for CAH with early liver cirrhosis(LC), 17/36(47.2%) for LC(Child's class A) and 6/11(54.5%) for LC(Child's class B). The mean+/-standard deviation of Dlco(% predicred) are 93.1+/-12.1 for CAH, 85.7+/-12.3 for CAH with early LC, 82.2+/-14.7 for LC(Child's class A) and 80.4+/-6.9 for LC(Child's class B), There is a significant difference between DLco in CAH and that in LC(Child's class A)(p<0.01). Patients with higher shunt index(>0.3) had significantly lower DLco than these with lower shunt index(<0.3)(76.4+/-9.7% vs. 89.3+/-13.3%)(p<0.01). The DLco was also lower in patients with pitting edema(77.3+/-10.2%) than in those without pitting edema(85.5+/-13.8%) (p<0.01). These results summarized that the DLco was low in patients with cirrhosis and with higher shunt index(>0.3) or pitting edema. This may be due to an increased systemic blood flow shunt and an increased generalized interstitial edema. Pulmonary function tests including diffusing capacity may be useful as prognostic parameters in patients with chronic liver disease, especially in those with CAH or early LC.
Anoxia ; Edema ; Fibrosis ; Heart Diseases ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Lung ; Oxygen ; Pulmonary Diffusing Capacity* ; Respiratory Function Tests

A 54-year old woman was received subtotal gastrectomy. Gastroscbpy showed Bormann type III tumor located in the antrum, incisura angularis and body. Preoperative serum AFP was 1910ng/mL. Endoscopic biopsy revealed adenocarcinoma, but after subtotal gastrectomy, the tumor contained histologic features resembling hepatocellular carcinoma with lymphatic invasion and venous invasion. So we reported it as a hepatoid adenocarcinoma.
Adenocarcinoma* ; alpha-Fetoproteins ; Biopsy ; Carcinoma, Hepatocellular ; Female ; Gastrectomy ; Humans ; Middle Aged ; Stomach*

Extragonadal choriocarcinoma arising in the stomach of a 53-year-old male is presented. The tumor was diagnosed as choriocarcinorna of the stomach by histologic examination and immunohistologic method of biopsy specimens. The tumor showed the multiple metastases to the lung and liver. The level of human chorionic gonadotropin was significantly increased in the serum. The patient died of hepatic failure at the 26th hospital day.
Biopsy ; Choriocarcinoma* ; Chorionic Gonadotropin ; Female ; Humans ; Liver ; Liver Failure ; Lung ; Male ; Middle Aged ; Neoplasm Metastasis ; Pregnancy ; Stomach

The congenital anomalous origin of the left coronary artery arising from the pulmonary artery, or the Bland-White-Garland syndrome, is uncommon but frequently lethal lesion of both children and adults. In several series, it has a frequency of 0.26-0.46% of all congenital cardiac defects. The mortality rate among infants and children without operation has been eighty to ninety percent. Survival to teen-age and adult has been infrequent ; review of the literature regarding this anomaly in Korean disclosed only 3 cases in infants and children and 2 cases in adults. In a 45-year-old male with palpitation and effort angina, the anomalous origin of the left coronary artery from the pulmonary artery was diagnosed by echocardiogram and coronary arteriography.
Adult ; Angiography ; Bland White Garland Syndrome ; Child ; Coronary Vessels ; Humans ; Infant ; Male ; Middle Aged ; Mortality ; Pulmonary Artery

Tetrodotoxin is a neurotoxin produced by about 90 species of puffer fish and causes paralysis of central nervous system and peripheral nerves by blocking the movement of all monovalent cations. Ingestion of tetrodotoxin produces clinical manifestations such as paresthesias(within 10-45 min), vomiting, lightheadedness, salivation, muscle twitching, dysphagia, difficulty in speaking, convulsion and death that expressed by cardiopulmonary arrest with loss of brain stem reflex sometimes. Tetrodotoxin prevents or delays ischemia induced neuronal death by way of following 3 mechanisms. Firstly, it reduces the energy demand of the brain tissues. Secondly, it delays or even prevents anoxic depolarization. Finally, it diminishes ischemia induced cell swelling and cerebral edema. We report a case of puffer fish poisoning which presented with cardiopulmonary arrest and loss of brain stem reflex, but completely recovered by aggressive cardiopulmonary resuscitation.
Brain ; Brain Edema ; Brain Stem ; Cardiopulmonary Resuscitation ; Cations, Monovalent ; Central Nervous System ; Deglutition Disorders ; Dizziness ; Eating ; Heart Arrest ; Ischemia ; Neurons ; Paralysis ; Peripheral Nerves ; Poisoning* ; Reflex ; Salivation ; Seizures ; Tetraodontiformes* ; Tetrodotoxin ; Vomiting

BACKGROUND/AIMS: The success of Helicobacter pylori eradication is limited by antibiotic resistances, and the primary resistance to metranidazole seems to be high. In this study, the frequency af metronidazole resistance and the eradication rate in metronidazole-resistant H. pylori strain was evaluated. METHODS: Sixty-eight patients were tested for metronidazole resistance using microdilution broth, the E test and disk diffusion method. Twenty-two patients were treated for 14 days with amoxicilline 2000 mg, metronidazole 750 mg, and tripotassium dicitrate bismuth 1200 mg. RESULTS: Metronida-zole resistance was 46% (31/68). The eradication rates for H. pylori was 91.7% in patients with metronidazole-sensistive strains and 70% in patients with metronidazole-resistant strains. CONCLUSIONS: Metronidazole resistance was high (46%) in Korea, however, triple therapy was an efficient method of eradicating H. pylori in both metronidazole sensitive and resistant strains.
Amoxicillin ; Bismuth ; Diffusion ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Metronidazole* ; Peptic Ulcer

BACKGROUND/AIMS: Hemorrlmge from esophageal varices is a catastrophic complication of portal hypertension. Sclentherapy and/or pharmacological reatment have been used in the primary and secondary pevention of hemorrhages in high-risk cirrhotic patients. We compared the efficacy of propranolol with the efficacy of propranolol plus isosorbide mononitrate plus metoclopramide for the prevention of variceal rebleeding METHODS: Forty-six hospitalized patients with cirrhosis and bleeding from esaphageal varices were treated with mhscopic sclerotherapy and randomly assigned to treatment with propranolol (25 patients: group 1) or propranolol plus isosorbide-5-mononitrate plus metoclopramide (21 patients: group 2). The primary outcomes were rebleeding and death. RESULTS: Base-line data were similar in the two groups, and the median follow-up was 15.4 months. Seventeen (68%) of 25 patients in group 1 and 11 (52%) of 21 patients in group 2 had repeated bleeding from varices during the follow-up period, but thae were no significant statistical differences between two groups. 1 he 2-year survival rate of both poups were 56% (14/25) in poup 1 and 62% (13/21) in group 2 during follow-up period. The causes of death in both groups wererebleeding (6/11: group 1 vs 3/8: group 2), hepatic failure (3/11: group 1 vs 3/8: group 2), and hepatoma (1/11: group 1 vs 1/8: group 2). CONCLUSIONS: Propranolol plus isosorbide mononitrate plus metoclopramide triple therapy did not differ from propranolol monotherapy in the aspects of rebleeding and survival in patients with esophageal variceal bleeding after endoscopic sclerotherapy, although the former revealed the tendency of the decrease in rebleeding and mortality rate.
Carcinoma, Hepatocellular ; Cause of Death ; Esophageal and Gastric Varices* ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal ; Isosorbide ; Liver Failure ; Metoclopramide* ; Mortality ; Propranolol* ; Sclerotherapy* ; Survival Rate ; Varicose Veins