OBJECTIVES: Hemodynamic measurements of chronic portal hypertension were done to study the mechanisms that maintain high portal pressure despite well developed collateral circulations. METHODS: A prehepatic portal hypertensive rat model was produced by partial portal vein ligation. Cardiac output, organ blood flow and porto-systemic shunt were measured by radioisotope labeled microsphere methods, and vascular resistance was calculated by standard equation. RESULTS: There was a significant reduction in the weight of the liver and increase in the weight of the spleen in the portal stenotic rats. Porto-systemic shunting, representing development of the collateral circulations, was 96.7+/-0.6% in the portal stenosis group compared with 0.9+/-0.2% in the control group (p<0.01). Portal pressure was significantly increased in the portal stenosis group compared with the control group(12.8+/-1.4 vs. 6.5+/-0.6mmHg; p<0.01). Mean arterial pressure was significantly decreased in portal stenosis group compared with control group(101.4+/-2.5 vs, 129.9+/-3.9mmHg; p<0.01). In the portal stenosis group, cardiac output(135.7+/-8.0 vs. 111.0+/-4.2ml/min; p<0.01) and splanchnic organ blood flow (28.97+/-2.03 vs. 17.90+/-1.27ml/min, p<0.01) were significantly increased, with concomitant decrease in total peripheral vascular resistance(58.0+/-3.3 vs. 88.2+/-4.8 dyne sec/cm5 X 105; p<0.01) and splanchnic vascular resistance(2.54+/-0.20 vs. 5.47+/-0.33 dyne sec/cm5 X 105; p<0.01), However, the portal venous resistance was not significantly different in both groups of rats (3.57+/-0.31 vs. 3.03+/-0.38 dyne sec/cm5 X 105; p>0.05). CONCLUSION: The hemodynamic results of this study indicate that hyperdynamic status of systemic and splanchnic circulation was present in chronic portal hypertension and that the primary factor contributing to the persistently elevated portal venous pressure was the markedly increased portal venous inflow.
Animals ; Arterial Pressure ; Cardiac Output ; Collateral Circulation ; Constriction, Pathologic ; Hemodynamics* ; Hypertension, Portal ; Ligation ; Liver ; Microspheres ; Models, Animal* ; Portal Pressure ; Portal Vein* ; Rats* ; Splanchnic Circulation ; Spleen ; Vascular Resistance

From January 1988 to December 1994, endoscopic sphincterotomy with stone extraction was attempted in 395 patients with common duct stones at Yeungnam University Hospital. Endoscopic sphincterotomy was successful in 389 patients(98.5 %), and clearance of the duct was achieved in 364 patients with an overall success rate of 92.2%. After sphincterotomy, stone extraction by basket or balloon was undertaken in 298 patients without lithotripsy, and stones could be extracted after fragmentation of stones in 19 patients. In 47 patients, stones were passed into duo denum spontaneously. There were 6 cases of sphincterotomy failure due to large periampullary diverticulum or previous gastrojejunostomy. In patients with success ful sphincterotomy, endoscopic stone extraction was failed in 25 cases due to 14 large stones, 5 bile duct strictures, 4 impacted stones, and 2 cases of technical fail ure. Complications were developed in 13 patients(3.3%); 8 pancreatitis and 5 bleedings. All of them were improved with medical therapy only. Despite relatively high success rate and low complications of the endoscopic management of choledocholithiasis, there were significant difficulties in removing large stones. Developement of more effective and inexpensive methods of lithotripsy, and the search for rapidly effective solvent dissolving stones were needed.
Bile Ducts* ; Bile* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Constriction, Pathologic ; Diverticulum ; Gastric Bypass ; Humans ; Lithotripsy ; Pancreatitis ; Sphincterotomy, Endoscopic

Clonorchiasis is known to be closely related with the development of recurrent pyogenic cholangitis and carcinoma of the bile ducts. In order to ascertain the cholangiographic signs for recurrent pyogenic cholangitis or carcinoma of the bile ducts arising in patients with clonorchiasis. we reviewed cholangiograms in 42 patients with proven clonorchiasis. The population consisted of 29 patients with clonorchiasis alone, six patients with clonorchiasis and recurrent pyogenic cholangitis, and seven patients with clonorchiasis and carcinoma of the bile ducts. Cholangiographic abnormalities in 29 patients with clonorchiasis alone, six patients with clonorchiasis and recurrent pyogenic cholangitis, and seven patients with clonorchiasis and carcinoma of the bile ducts. Cholangiographic abnormalities in 29 patients with clonorchiasis alone were intrahepatic multiple, oval, or elliptic filling defects measuring 2-10 mm in size, representing adult flukes (n=24). The peripheral bile duct were obstructed (n=18), and the margins were ragged (n=20) and hazy (n=12) the intrahepatic bile ducts were dilated diffusely (n=27), and the dilated peripheral small tributaries gave the impression of "too many ducts appearance" (n=7) and dilatation was mid (n=17) In six patients with clonorchiasis and recurrent pyogenic cholangitis, there were filling defects of stones, and the extrahepatic ducts and larger intrahepatic ducts were predominantly dilated. In seven patients with clonorchiasis and cholangiocarcinoma all the biliary tree proximal to the tumor was markedly and diffusely dilated In the latter two groups, filling defects of flukes and associated findings were less prominent, but there was disproportionately severe dilatation of too many intrahepatic ducts. In patients with recurrent pyogenic cholangitis or cholangiocarcinoma, clonorchiasis should be considered as a underlying cause when cholangiogram shows "disproportionately" severe dilatation of too many intrahepatic ducts. intrahepatic ducts.
Adult ; Bile Ducts ; Bile Ducts, Intrahepatic ; Biliary Tract ; Cholangiocarcinoma ; Cholangitis ; Clonorchiasis* ; Dilatation ; Humans ; Trematoda

No abstract available.
Hematoma*

The incidence of Giant Condyloma Acuminata of the penis is unknown but considered rare. They are similar to condyloma acuminata, histologically and grossly similar to squamous cell ca. Most authorists consider that they get the real possibility of malignant change and they had been first described by Buschke in the German literatures in l896 as a variant of condyloma acuminata. A case of malignancy of the penis which has apparently transformed from Giant Condyloma Acuminata of the penis is herein presented with review of related literatures.
Incidence ; Male ; Penile Neoplasms* ; Penis

No abstract available.
Autopsy*

Gastric bezoars are collection of indigestible material in the stomach, and these can be classified into five broad categories: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar and miscellaneous materials such as sand, stone and concrete (gypsum). The treatment of gastric bezoars has recently changed from surgical management to such nonsurgical interventions as enzymatic dissolution, nasogastric suctioning and endoscopic removal by polypectomy snare and basket. Up to the present, electrohydraulic lithotripsy has been a well established method for the treatment of urinary and hepatobiliary stones. We report here on a patient who had a huge gastric bezoar that was formed by the ingestion of gypsum, and this was treated with endoscopic electrohydraulic lithotripsy.
Bezoars* ; Calcium Sulfate* ; Eating* ; Endoscopy ; Humans ; Lithotripsy* ; Silicon Dioxide ; SNARE Proteins ; Stomach ; Suction

PURPOSE: To evaluate regional differences in relative metabolite ratios in the normal human brain by 1H MRspectroscopy (MRS), and compare the spectral quality obtained by the automated prescan method (PROBE) and themanual method. MATERIALS AND METHODS: Localized 1H MRS was performed on a GE 1.5T SIGNA MRI/MRS system (version5.5) with active shielded gradients. For 20 normal volunteers aged 8-47 years, spectral parameters were adjustedby the auto-prescan routine provided by a PROBE package(N=34)and manually (N=33). Five regions of the human brainwere examined (N=PROBE,manual): frontal white matter(N=6,10), parietal white matter(N=8,9), basal ganglia(N=6,5),thalamus(N=4,5), and cerebellum(N=4,4). For all spectra, a STEAM localization sequence with three-pulse CHESS H2Osuppression was used, with the following acquisition parameters: TR=3.0 sec, TE=30 msec, TM=13,7 msec, SW=2500Hz,SI=2048 pts, AVG=48, and NEX=2. RESULTS: A total of 61 reliable spectra were obtained by PROBE (28/34=82%success) and by the manual method (33/33=100% success). Regional differences in the spectral patterns of the fiveregions were clearly demonstrated by both PROBE and the manual methods. For prescanning, the manual method tookslightly longer than PROBE (3-5 mins and 2 mins,respectively). There were no significant differences in spectralpatterns and relative metabolic ratios between the two methods. However, auto-prescan by PROBE seemed to be veryvulnerable to slight movement by patients, and in three cases, an acceptable spectrum was thus not obtained. CONCLUSION: PROBE is a highly practical and reliable method for single voxel 1H MRS of the human brain; the twomethods of prescanning do not result in significantly different spectral patterns and the relative metaboliteratios. PROBE, however, is vulnerable to slight movement by patients, and if the success rate for obtainingquality spectra is to be increased, regardless of the patient's condition and the region of the brain, it must beused in conjunction with the manual method.
Brain* ; Healthy Volunteers ; Humans* ; Magnetic Resonance Spectroscopy* ; Rabeprazole ; Steam

The authors report two cases of high cervical spinal chordomas that were removed via the median labiomandibular glossotomy(MLG) approach. One patient was a 62-year-old female in whom an extradural chordoma was found at the level of C3 vertebra with huge prevertebral extension, and causing dyspnea and dysphagia; the other was a 47-year-old female, found to be suffering from a chordoma of C2 vertebral body, which was found incidentally. After removal of the tumors, ventral instrumented fusions were performed in both patients, who showed good recoveries with only minor complications. The MLG approach is radical, and rarely performed by neurosurgeons, but for treatment of an expanded high cervical lesion that needs ventral surgery and seems to be inaccessible via the conventional transoropharyngeal or anterolateral retropharyngeal route, it should be considered. The authors discuss the clinicopathological characteristics of spinal chordomas and general considerations of the MLG approach to high cervical lesions, and briefly describe the surgical techniques involved in this approach.
Chordoma* ; Deglutition Disorders ; Dyspnea ; Female ; Humans ; Middle Aged ; Spine

No abstract available.
Hematoma, Epidural, Spinal* ; Meningioma*