PURPOSE: To evaluate the efficacy of combined treatment of metallic biliary stent placement and radiotherapy in malignant biliary obstruction. MATERIALS AND METHODS: Between January 1992 and February 1994, 22 patients with malignant biliary obstruction were treated with metallic biliary stent placement and radiotherapy. The causes of the obstruction included cholangiocarcinoma(n=14), gallbladder carcinoma(n=4), colon cancer(n=2), pancreatic head cancer (n=1), and stomach cancer(n=1). According to the sites of obstruction level, patient were divided into 2 groups; hilar obstruction(n=18) and common bile duct obstruction(n=4). The patients received dose of 45 Gray/18 fraction by external radiotherapy and 20Gy/8f by high dose rate brachytherapy with iridium--192 source through percutaneous transhepatic biliary drainage(PTBD) catheter. The duration of stent patency after placement, survival period and survival rate by Kaplan Meier method were calculated in dead and alive patients, respectively. RESULTS: In all 22 patients, the duration of stent patency was 5.5(1.3--18.5)months. Survival periods after stent placement and PTBD were 5.3(2.0--8.5 )months and 7.9(4.0--14.7)months respectively in 9 dead patients and 7.7(1.3--21.0)months and 9.5(2.3--23.0)months in 13 alive patients. In all 22 patients, the survival rates in 6, 12 and 18 months were 78.9%, 47.5 % and 35.6 %, respectively. CONCLUSIONS: The results with combined metallic biliary stent placement and radiotherapy for the palliative treatment of malignant biliary obstruction in this study was more favorable, as compared with those of the other authors with only metallic biliary stent placement.
Brachytherapy ; Catheters ; Colon ; Common Bile Duct ; Gallbladder ; Head and Neck Neoplasms ; Humans ; Palliative Care ; Radiotherapy* ; Stents* ; Stomach ; Survival Rate

PURPOSE: To evaluate the usefullness of repeated alcohol sclerotherapy for two days through the percutaneous catheter in the treatment of renal cyst. MATERIALS AND METHODS: Repeated sclerotherapies using absolute ethanol(99.9%) were parformed on 20 renal cysts in 18 patients through the indwelling catheter. The cyst volume ranged from 50 ml to 1000ml(mean, 300ml). Under the ultrasound- or CT-guidance, 6F catheter was inserted into the cyst percutaneously. After aspirating the fluid in the cyst, absolute ethanol was injected. While maintaining the catheter for 16-20 hours, at least 3 times of sclerotherapies performed with total procedure time of 30-60 minutes. Follow-up sonography was performed to evaluate the recurrence or collapse of the cysts at 1 and 3 months after the procedure. RESULTS: Among 20 renal cysts, 2 cases were recurred on 1 month follow-up sonography(10%). However, the volumes of recurred cysts were decreased to 40% and 10%, respectively. There was no immediate or delayed complication after sclerotherapy. DISCUSSION: Repeated sclerotherapy for 2 days using absolute ethanol through the percutaneous catheter insertion is a useful method of treatment for renal cyst.
Catheters* ; Catheters, Indwelling ; Ethanol ; Follow-Up Studies ; Humans ; Recurrence ; Sclerotherapy*

Ten emhalmed cadaveric adult bony hemipelvis specimens were ohtained to evaluate the configuration of the posterior column of acetabulum and to find a safe path for screw placement into it as well as to report on the morphological data of the ischial tuherosity and to determine the most optimaI technique for ischial tuberosity screw placement for open reduction and internal fixation of posterior acetabular fracture. Cadaveric studies were performed analyzing icm cross-sections through the acetabulum for the purpose of studying the anatomical configuration of the danger zone. The plane of the cross-section was perpendicular to the posterior column. Each cross-section had the medial boundary ot the acetabulum projected onto the posterior column. By analysing the projections on the posterior column, the exact configuration of the danger zone was determined. In this study, the average width of the posterior column at the mid-acetabular Ievel was 3.9cm. Computed tomography scan of the acetabulum yielded valuable int'ormation regarding screw placement in the posterior column. The average width, height and depth of the ischial tuberosity were 25.7 mm, 33. 1 mm and 31.7mm, respectively. The average angles hetween the posterior and medial aspects and hetween the posterior and lateral aspects of the ischial tuherosities were 79.5degreesand 111.5degrees, respectively. The entry point of the screw should be Smm or 10mm medial to the lateral margin of the ischial tuherosity and the screws should be directed 35-40degrees, 45-50degrees and 50-55degrees caudally at the level of the inferior acetahular margin and lcm and 2cm below it, respectively. to obtain the most favorable bony purchase.
Acetabulum* ; Adult ; Cadaver ; Humans

The esophageal electrocardiogram is of increasing significance in the study and diagnosis of cardiac arrhythmia and of posterior myocardial disease. We used both bipolar and unipolar esophageal recording leads and standard electrocardiogram equipment, and compared the effectiveness of esophageal electrocardiogram with co nventional electrocardiogram. The effectiveness of esophageal electrocardiogram were as follows: 1) Differentiation of sinus, atrial, junctional, or ventricular rhythm. 2) Differentiation of origin of premature beats. 3) Differentiation of atrial flutter and fibrillation. 4) Detection of retrograde atrial conduction of extraventricular systole. 5) Detection of electrical alternance of QRS amplitude. 6) Diagnosis of posterior myocardial infarction. The results reported here indicate that the esophageal electrocardiogrm seems to be a valid method in the diagnosis of cardiac arrhythmias without invasiveness.
Arrhythmias, Cardiac ; Atrial Flutter ; Cardiac Complexes, Premature ; Cardiomyopathies ; Diagnosis ; Electrocardiography* ; Myocardial Infarction ; Systole

Hyponatremia in patients with central nervous system disorders is suggestive of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and volume restriction is recommended for its correction. However, if volume depletion is present in a situation otherwise compatible with SIADH, cerebral salt wasting syndrome (CSWS) should be considered as the cause of the hyponatremia to avoid hypovolemic shock that may be induced by the standard management of SIADH, i.e. volume restriction. We present a case of a 17-year-old male patient with CSWS associated with tuberculous meningitis. The clinical feature of the patient comprised hyponatremia, excessive natriuresis, polyuria, and hypovolemia. Following the administration of saline and fludrocortisone, natriuresis and polyuria were decreased, and the hyponatremia improved
Adolescent ; Central Nervous System Diseases ; Fludrocortisone ; Humans ; Hyponatremia ; Hypovolemia ; Inappropriate ADH Syndrome ; Male ; Natriuresis ; Polyuria ; Shock ; Tuberculosis, Meningeal* ; Wasting Syndrome*