BACKGROUND: In the Far East, it is well known that hepatic resection is a best form of treatment for complicated intrahepatic stones (IHS). However, many investigators have reported that the associated intrahepatic biliary stricture is the main cause of treatment failure, requiring additional management because of recurrent cholangitis. PURPOSE: A retrospective comparative study was undertaken to clarify the long term efficacy of hepatic resection in IHS and to investigate the clinical significance of intrahepatic biliary stricture affected on treatment failure after hepatic resection. Patient and METHOD: The clinical records of 44 among 51 consecutive patients with symptomatic IHS who underwent hepatic segmentectomy or lobectomy between July 1986 and October 1996 were reviewed. We excluded 7 patients from study group because of postoperative death or incomplete follow- up. Patients were divided into two study groups: group A with intrahepatic biliary stricture (n=28) and group B without stricture (n=16). Residual or recurrent stones, recurrence of intrahepatic biliary stricture, late cholangitis, and final outcomes were analyzed and compared statistically between group A and B. Patients were followed up for a median duration of 65 months after hepatectomy. RESULTS: The overall incidence of residual or recurrent stones were 36% and 11%, respectively. The initial treatment failure rate was 50% in group A and 31% in group B. Intrahepatic biliary stricture was recurred in 46% of group A, but in none of group B (P=0.001). More than two thirds of restrictures were identified on the primary site. The incidence of late cholangitis was higher in group A (54%) than in group B (6%)(p=0.002). The late cholangitis was severe, recurrent and related to stones and strictures in 11 of the 15patients in group A. Twelve patients (ten in group A and two in group B) needed additional secondary multiple procedures at a median of 12 months after hepatectomy. These consisted of percutaneous fluoroscopic stone retrieval (n=6), postoperative cholangioscopy (POC) or percutaneous transhepatic cholangioscopy (PTCS) with electrohydraulic lithotripsy (EHL)(n=3), balloon dilatation (n=7)choledochotomy (n=3), S4 segmentectomy (n=1), Sphincteroplasty (n=1), drainage of the delayed subphrenic or liver abscess (n=2), and repair of prolonged biliary fistula (n=1). The final outcomes after hepatectomy with or without secondary management were good in 80%, fair in 16%, and poor in 4% of the cases. CONCLUSION: The majority of the recurrent cholangitis after hepatectomy in IHS were related to recurrent intrahepatic ductal strictures. Therefore, hepatic resection should be included the strictured duct. However, with hepatectomy alone, it is difficult to clean the IHS and relieve the ductal strictures completely, particularly in cases of bilateral IHS, so a perioperative team approaches, including both radiologic and cholangioscopic interventions, should be used for effective management of IHS.
Biliary Fistula ; Cholangitis ; Constriction, Pathologic* ; Dilatation ; Drainage ; Far East ; Hepatectomy ; Humans ; Incidence ; Lithotripsy ; Liver Abscess ; Mastectomy, Segmental ; Recurrence ; Research Personnel ; Retrospective Studies ; Treatment Failure

BACKGROUND: Although surgical angioplasty for isolated coronary ostial stenosis is assumend as an alternative approach to CABG, the clinical features of isolated coronary ostial stenosis, postoperative complications and follow-up angiographic results would have not been well studied. METHODS: We retrospectively studied 24 patients (female : male = 20 : 4, mean age 50.0 +/- 12.3 yr) who underwent surgical angioplasty for isolated coronary ostial stenosis using patch ( 22 fresh autologous pericardium, 2 saphenous vein) during the period of March 1990 through February 1998. Repeat coronary angiography (16 patients) and echocardiography (24 patients) were performed. Aortic regurgitation was evaluated semiquantitatively (Grade I - Grade IV). RESULTS: There were 3 deaths after surgical angioplasty. One death was due to acute coronary dissection perioperatively, the second due to low cardiac output syndrome 2 weeks post-surgery, and the third due to traumatic panperitonitis 10 months post-procedure. Angina recurred in 4 patients and the remaning 18 patients were symptom-free. Repeat angiography (19.3 +/- 20.7 Mo) showed widely patent ostium with excellent run-off except 2 patients (1 distal patch stenosis, 1 ostial restenosis in Takayasu's arteritis). The third symptomatic patient was proven to have coronary spasm by ergonovine test. AR increased in the fourth patient (Grade II -> III) with patent ostium. CONCLUSION: Surgical angioplasty may be feasible and alternative operative method to CABG for isolated coronary ostial stenosis. It should however be noted that postop AR can develop and/or increase. Further investigation is needed to evaluate the clinical significance of the AR.
Angiography ; Angioplasty* ; Aortic Valve Insufficiency ; Cardiac Output, Low ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Echocardiography ; Ergonovine ; Follow-Up Studies ; Humans ; Male ; Pericardium ; Postoperative Complications ; Retrospective Studies ; Spasm

PURPOSE: We applied lateral lithotomy position to the severe ureteral stricture cases supposed to fail with only retrograde approach. MATERIAL AND METHODS: From October 1997 to April 1999, 13 patients with severe ureteral stricture (lenghth>2cm or complete obstruction) supposed to fail with only retrograde approach and one patient with study. The causes of ureteral strictures were pelvic malignancy in 5, tuberculosis in 4, trauma in 2 and others in 2. The patient's ipsilateral shoulder was rotated and fixed like lateral position. And ipsilateral pelvis was elevated with sandbag or pad and rotated about 45 degrees, too. The retrograde approach was tried at first, if fail, antegrade approach was combined. RESULTS: We could insert ureteral stent via retrograde approach only in 3 patients and we needed aid of antegrade approach for passage through ureteral stricture in the other 11 patients (79%). Percutaneous antegrade approaches were combined in those 11 patients and we could pass the guide wire and indwell the stent in 10 of 11 patients (91%) using this position. CONCLUSIONS: The lateral lithotomy position was very helpful to the simultaneous retrograde and antegrade approach in severe fibrotic or malignant ureteral strictures.
Constriction, Pathologic ; Humans ; Pelvis ; Shoulder ; Stents ; Tuberculosis ; Ureter*

Traumatic hemoperitoneum can still induce high mortality and morbidity rates, despite current method of intensive management. This study was performed to identify the independent prognostic factors in patients with traumatic hemoperitoneum. Two hundred thirty-six patients who underwent emergency operations because of traumatic hemoperitoneum at the Department of Surgery, Dong Kang General Hospital, Ulsan, from January 1986 to June 1994, were entered into this retrospective study. One hundred eighty-six patients were male, and fifty were female. The median age of the patients was 34 years (2 to 77 years). The modes of trauma were 131 motor-vehicle accidents, 43 fall down injuries, 30 stab injuries, 23 assaults, and 9 others . The common sites of injury were lthe iver and the spleen, followed by the mesentery, the stomach, the small bowels, the large bowels, the pancreas, the kidney, the diaphragm, and the retroperitoneum in order of frequency. Prognostic variables were identified from the perioperative parameters by using a univariate analysis(student t- test, chi-square test), and independent prognostic factors were determined by a multivariate stepwise logistic regression analysis, using the SPSS Win. Ver.5.0 PC package program. Statistical significance was present for p < 0.05. The overall postoperative morbidity and mortality rates were 34.3% and 19%, respectively. By using univariate analysis, the amount of bleeding, transfusion, and the immediate post-operative blood pressure were identified as significant prognostic factors for morbidity. Also age over 50, accompanying brain injury, time interval (less than 3 hrs), the systolic blood pressure on arrival (less than 100 mmHg), trauma score (less than 10), grade of liver injury (greater than IV), great vascular injury, total amount of resuscitative fluid (more than 4,000cc), the total amount of transfusion (more than 10 units), and the immediate postoperative systolic blood pressure (less than 100 mmHg) were identified as significant factors for mortality. Multivariate analysis demonstrated the following important independent prognostic factors : the total amount of transfusion for morbidity and mortality, and the post-operative blood pressure and trauma score for mortality. Our results suggest that early massive resuscitation, early operation to minimize the total amount of blood loss, and intensive immediate postoperative care to maintain blood pressure, are of utmost importance in multiple trauma patients with hemoperitoneum.
Blood Pressure ; Brain Injuries ; Diaphragm ; Emergencies ; Female ; Hemoperitoneum* ; Hemorrhage ; Hospitals, General ; Humans ; Kidney ; Liver ; Logistic Models ; Male ; Mesentery ; Mortality ; Multiple Trauma ; Multivariate Analysis ; Pancreas ; Postoperative Care ; Resuscitation ; Retrospective Studies ; Spleen ; Stomach ; Ulsan ; Vascular System Injuries

PURPOSE: Minimally invasive donor nephrectomy has become a favored procedure for kidney transplantation. To compare the outcomes of kidneys procured using open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN) and hand-assisted laparoscopic donor nephrectomy (HALDN). MATERIALS AND METHODS: A total of 243 patients were included in the study. 177 HALDN and 24 LDN patients were compared with 42 ODN patients. The operation times, warm ischemic times, transfusions, times to regular diet, post-operation hospital stays, analgesics use, post-operation serum creatinine, complications, graft functions and survivals were evaluated. RESULTS: The mean operation times were 197+/-43, 213+/-32.7 and 189+/-28.2 minutes for HALDN, LDN and ODN, respectively. The warm ischemic times were 175+/-76.7, 174+/-67.5 and 135+/-25.4 seconds for HALDN, LDN and ODN, respectively. The mean post-operation hospital stays were shorter for the HALDN and LDN than for ODN. There were no significant differences between the three groups in terms of the times to regular diet. The graft survivals were 98, 96 and 97.6% in the HALDN, LDN and ODN, respectively. The postoperative serum creatinine levels of the recipients showed no differences between the three groups. CONCLUSIONS: HALDN and LDN are technically feasible, and appear to be safe and effective for live-donor transplantation. Evaluation of the HALDN and LDN showed less pain, a more rapid recovery and minimal cosmetic disfigurement than the ODN. The recipient graft functions were also similar in the laparoscopic and open surgery groups. Therefore, HALDN and LDN may result in increased acceptance of the donor operation and expand the pool of potential kidney donors.
Analgesics ; Creatinine ; Diet ; Graft Survival ; Hand ; Humans ; Kidney ; Kidney Transplantation ; Laparoscopy ; Length of Stay ; Nephrectomy* ; Tissue Donors* ; Transplants ; Warm Ischemia

No abstract available.

No abstract available.
Humans

PURPOSE: We evaluated the advantages of simultaneous procedure in bilateral percutaneous nephrolithotomy for the management of bilateral renal stones. MATERIALS AND METHODS: The charts of patients with bilateral renal stones from January 1990 to April 1998 were retrospectively reviewed. We compared operative time, hospital stay, decrease in hemoglobin, and complications of simultaneous procedure with those of sequential procedure. RESULTS: Among the 13 patients with bilateral renal stones treated percutaneously, 9 patients were underwent simultaneous procedure and 4 patients were underwent sequential procedure. Mean operative time was 190 minutes in simultaneous group and 335 minutes in sequential group (p<0.05), mean hospital stay was 10.1 and 16.8 days (p<0.05) and mean decrease in hemoglobin was 2.6 and 1.6g/dl (p>0.05), respectively. Complications included blood loss requiring transfusion in 1 case and paralytic ileus in 1 of simultaneous group, and blood loss in 2 and fever in 1 of sequential group. CONCLUSIONS: Simultaneous bilateral percutaneous nephrolithotomy is a well-tolerated, safe, expeditious, and cost-effective approach to patients with bilateral renal stones at centers proficient in percutaneous techniques.
Fever ; Humans ; Intestinal Pseudo-Obstruction ; Length of Stay ; Nephrostomy, Percutaneous* ; Operative Time ; Retrospective Studies

PURPOSE: We evaluated the advantages of simultaneous procedure in bilateral percutaneous nephrolithotomy for the management of bilateral renal stones. MATERIALS AND METHODS: The charts of patients with bilateral renal stones from January 1990 to April 1998 were retrospectively reviewed. We compared operative time, hospital stay, decrease in hemoglobin, and complications of simultaneous procedure with those of sequential procedure. RESULTS: Among the 13 patients with bilateral renal stones treated percutaneously, 9 patients were underwent simultaneous procedure and 4 patients were underwent sequential procedure. Mean operative time was 190 minutes in simultaneous group and 335 minutes in sequential group (p<0.05), mean hospital stay was 10.1 and 16.8 days (p<0.05) and mean decrease in hemoglobin was 2.6 and 1.6g/dl (p>0.05), respectively. Complications included blood loss requiring transfusion in 1 case and paralytic ileus in 1 of simultaneous group, and blood loss in 2 and fever in 1 of sequential group. CONCLUSIONS: Simultaneous bilateral percutaneous nephrolithotomy is a well-tolerated, safe, expeditious, and cost-effective approach to patients with bilateral renal stones at centers proficient in percutaneous techniques.
Fever ; Humans ; Intestinal Pseudo-Obstruction ; Length of Stay ; Nephrostomy, Percutaneous* ; Operative Time ; Retrospective Studies

BACKGROUND: It has been reported that bilateral pediatric inguinal hernias (PIH) are around 10% and that a late contralateral herniorrhapy is needed in up to 34% of ipsilateral operations. However, clinical prediction of the contralateral patent processus vaginalis (PPV) is difficult. The aims of this study were to measure the mean diameter of the internal inguinal ring (IIR) of the PIH at rest and during straining and to define the diagnostic criterion for positive contralateral PIH (or PPV) by using ultrasonography (USG). METHODS: The diameters of both ipsilateral and contralateral IIRs at rest and during straining were measured preoperatively by USG in 104 consecutive pediatric patients (75 male, 29 female; mean age of 3 years) who had undergone an ipsilateral herniorrhaphy with contralateral exploration from March 1997 to December 1997. Fifty-seven right inguinal hernias (RIH), 43 left inguinal hernias (LIH), and 4 bilateral inguinal hernias were enrolled. The contralateral PPV was defined as a sac greater than 3 mm in diameter and longer than 2 cm in length measured intraoperatively. Statistical analysis was performed by using the t-test and the chi-square test. RESULTS: Contralateral exploration showed positive PPV in 44% of RIH and 47% of LIH (p>0.05). In RIH, the mean diameter of right IIR (RIIR) was wider than that of left IIR (LIIR) (5.02+/-0.27 mm vs 2.94+/-0.12 mm at rest and 7.50+/-0.52 mm vs. 3.82+/-0.23 mm during straining, p<0.01), and the difference in diameters between straining and rest were also significant (2.38+/-0.37 mm in RIIR and 0.76+/-0.14 mm in LIIR, p<0.01). In LIH, the mean diameter of LIIR was wider than that of RIIR (4.59+/-0.27 mm vs. 3.13+/-0.19 mm at rest, 6.82+/-0.43 mm vs. 3.61+/-0.26 mm during straining, p<0.01). The diameter difference between straining and rest of LIIR and RIIR were also significant (2.17+/-0.28 mm in LIIR, 0.60+/-0.12 mm in RIIR, p<0.01). Cases of positive contralateral PPVs in RIH had significantly wider LIIRs than those of negative PPV (3.5+/-0.16 mm vs. 2.5+/-0.14 mm at rest and 4.70+/-0.32 mm vs. 2.97+/-0.20 mm during straining, p<0.01). The difference of diameter between strainingand rest of positive and negative PPVs were significant (1.16+/-0.25 mm and 0.38+/-0.09 mm, respectively, p<0.01). Cases of positive contralateral PPVs in LIH had wider RIIRs than those of negative PPV significantly (3.83+/-0.27 mm vs. 2.52+/-0.18 mm at rest and 4.58+/-0.38 mm vs. 2.68+/-0.19 mm during straining, p<0.01). The diameter difference between straining and rest of positive and negative PPVs was significant (0.93+/-0.21 mm and 0.3+/- 0.09 mm, respectively, p<0.05). CONCLUSION: In most negative PPVs, the diameter of the IIR did not exceed 3.0 mm. Therefore, contralateral IIR with diameters wider than 3.0 mm and diameters of difference more than 1.0 mm between straining and rest, as determined by using USG need to be explored.
Female ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Inguinal Canal* ; Male ; Ultrasonography