PURPOSE: We reviewed 13 cases of pancreatic pseudocysts treated by percutaneous catheter drainage to determine the value and effectiveness of the procedure. MATERIALS AND METHODS: Sixteen pancreatic pseudocysts(nine infected, seven noninfected) were drained in 13 patients. Access routes were determined by images on CT scan and procedures were performed under fiuoroscopic guidance. Ultrasonogram was used as a guide for drainage when there were bowel loops near the access routes. Various access routes were used for catheter drainage:transperitoneal (10), retroperitoneal (3), transsplenic (2) transhepatic (1). RESULTS: Percutaneous catheter drainage cured 15 of 16 pancreatic pseudocysts(93.8%). No recurrance was encountered in the clinical follow-up of 7 to 69 months(mean 35 months). The mean duration of drainage was 29 days(infected, 24 days; noninfected, 39 days). Five pseudocysts(31%) were communicated with pancreatic duct The mean duration of drainage in these cases was 38 days. Spontaneous of the pancreatic pseudocysts to the gastrointestinal tract was occurred in 3 pseudocysts. Mean duration of drainage in pseudocysts with fistulas was 19 days. CONCLUSION: Percutaneous cather drainage is a safe and effective front-line treatment method in most pancreatic pseudocysts if drainage is done with a adequate follow-up and catheter care.
Catheters ; Drainage* ; Fistula ; Follow-Up Studies ; Gastrointestinal Tract ; Humans ; Pancreatic Ducts ; Pancreatic Pseudocyst* ; Tomography, X-Ray Computed ; Ultrasonography

The experiment was designed to investigate type-selectivity of the involved muscle fibers and changes in the component ratios of the fiber types following the progression of disuse atrophy in the skeletal muscle. After inducing disuse atrophy of the skeletal muscle by applying cast on the hind limb, we used histological and histochemical stains in the sections of the rat Tibialia anterior muscles. The results were as follows. 1. Even 8 weeks after immobilization of the hind limb, differentiation of muscle fiber types by histolo gical and histochemical staining methods in the Tibialis anterior muscle could be possible. 2. Atrophy of muscle fibers was more pronounced in type IIB and type I fibers than in type IIA fibers. 3. Central migration of sarcolemmal nuclei and ring fiber appeared after 6th and 8th weeks of immobilization respectively, in the H&E and trichrome preparations. Ac-pase or Alk-pase positive fibem were not noted throughout the experimental periods.
Animals ; Atrophy ; Coloring Agents ; Extremities ; Immobilization ; Muscle, Skeletal ; Muscles ; Muscular Disorders, Atrophic ; Rats

The central venous catheter(Quinton) was replaced in the right atrium for chemotherapy and blood sampling to a eight-year old girl with acute lymphoblastic leukemia. The catheter was flushed with heparin two times daily and the chemotherapeutic drug regimens by CCSG-105 protocol were vincristine, prednisone, L-asparaginase, daunomycin, methotrexate, cyclophosphamide, cytosine arabinoside, 6-mercaptopurine and adriamycin. On day 31 of catheterization, the lumen for blood sampling was blocked. From day 60 of catheterization, anorexia, nausea, vomiting, abdominal distension and tachypnea were developed. Echocardiogram, lung scan, pulmonary function test(PFT), arterial blood gas analysis (ABGA) were done. Two cemtimeters in diameter of thrombosis was found in the right atrium on echocardiogram. The lung scan showed slight decrease in uptake of Tc-99m on the whole lung fields. Restrictive ventratory impairment on PFT and decreased PaO2(48 mmHg) on ABGA were found. To lysis of thromboembolism, urokinase(4,400 IU/kg for initial 10 minutes and the 4,400 IU/kg for 12 hours) was injected intravenously and aspirin(30 mg/kg/d, po) was given. The thrombosis was disappeared from the atrium on echocardiogram and PaO2 was increased up to 97 mmHg temporary. The catheter was removed but total haziness on the right middle and lower lobes were developed after 5 days. The same dose of urokinase was injected just infront of the embolism through Pitfall catheter for 8 days intermittently as results of pulmonary angiography. Symptoms and PaO2 were alleviated and the lung was expanded with mild atelectasis on day 55 of the first fibrinolytic enzyme therapy. Although the frequent complications of central venous catheter are catheter occlusion and infection, we have to check the development of thromboembolism with echocardiogram periodically or in case of unexplained respiratory symptoms.
6-Mercaptopurine ; Angiography ; Anorexia ; Blood Gas Analysis ; Catheterization ; Catheters ; Central Venous Catheters* ; Cyclophosphamide ; Cytarabine ; Daunorubicin ; Doxorubicin ; Drug Therapy ; Embolism ; Enzyme Therapy ; Female ; Heart Atria ; Heparin ; Humans ; Lung ; Methotrexate ; Nausea ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prednisone ; Pulmonary Atelectasis ; Tachypnea ; Thromboembolism* ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Vincristine ; Vomiting

PURPOSE: To evaluate the effectiveness of transcatheter embolization for the treatment of massive gastrointestinal arterial bleeding. MATERIALS AND METHODS: The study was based on retrospective analysis of twelve cases(8 men, 4 women) including two patients with hemobilia in which transcatheter embolization was attempted for the control of massive gastrointestinal bleeding from March 1987 to October 1993. Clinical diagnoses of these patients were peptic ulcer(5), pseudoaneurysm formation(3) following percutaneous transhepatic biliary drainage or traffic accident, stomach cancer(I), typhoid fever(I), duodenal leiomyoma(1) and Osler-Weber-Rendu disease (1). RESULTS: Embolized vessels are as follows: gastroduodenal artery(6), left gastric artery(2), ileocolic artery(2), and hepatic artery(2). Embolization was effective in immediate control of bleeding in all patients. Although five of the six patients who had undergone embolization of the gastroduodenal artery developed rebleeding within 24 hour, only 2 reguired surgery and none showed serious complication. CONCLUSION: Embolization therapy is safe and effective initial treatment of choice for life-threatening massive gastrointestinal bleeding.
Accidents, Traffic ; Aneurysm, False ; Arteries ; Diagnosis ; Drainage ; Gastrointestinal Hemorrhage* ; Hemobilia ; Hemorrhage ; Humans ; Male ; Retrospective Studies ; Stomach ; Typhoid Fever

PURPOSE: To evaluate the feasibility and efficacy of revision of the transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: Sixteen malfunctioning TIPS (10 occlusions, 6 stenoses) in 14 patients of 103 patients (117 procedures) were revised. Fifteen patients underwent revision to control recurrent variceal bleeding after TIPS and one to restore severely stenotic TIPS found on portal venogram obtained during transarterial chemoembolization of a hepatocellular carcinoma. One patient underwent three revisions. The time intervals between initial TIPS placement and revisional procedures varied between four and 43 months (mean, 17.6 months). Nine occlusions and four stenoses were treated with an additional stent placed in a parallel or overlapping fashion with transjugular approaches. Two stenoses and one acute occlusion were treated with balloon dilatation involving transfemoral approaches. RESULTS: In patients with complete occlusion of TIPS, the sites of occlusion were all within the stent, with or without associated stenosis of the hepatic vein. In five of six patients, with TIPS stenosis, however, the stenoses were located at the hepatic vein just distal to the stents, rather than within the stents. The procedures for revision were in all cases technically feasible and hemodynamically successful. No significant procedure-related complications were encountered. CONCLUSION: The revision of TIPS is a safe and effective method in cases of its partial or complete occlusion.
Carcinoma, Hepatocellular ; Constriction, Pathologic ; Dilatation ; Esophageal and Gastric Varices ; Hepatic Veins ; Humans ; Hypertension, Portal ; Portasystemic Shunt, Surgical* ; Stents

PURPOSE: To evaluate the cilinical results of transjugular intrahepatic portosystemicshunt(TIPS) for the control of variceal bleeding. MATERIALS AND METHODS: TIPS creation was attempted in 23 patients with endoscopically confirmed variceal bleeding. Most patients had multiple episodes of bleeding in the past and have been treated with multiple endoscopic sclerotherapies. Pre- and post-procedural hepatic and portal vein pressures were measured. After creation of TIPS patients were followed up at regular intervals. RESULTS: TIPS has been successfully accomplished in 22 of 23 patients using Wallstent(n=21 ) and Strecker stent(n=1 ). Immediate bleeding control was achieved in all patients with shunt creation. No procedure-related complication was noted. Portal vein pressure was reduced from 30.7+/-5.8 mmHg to 20.8+/-4.7 mmHg. The mean pressure gradient of portosystemic shunt dropped from 22.8+/-6.0 prior to TIPS to 12.2+/-4.1 immediately after. During the follow-up period (6-556 days, mean; 10months), seven patients died; progressive hepatic failure (n=4), variceal rebleeding(n=2), and respiratory failure(n=1). Hepatic encepha-Iopathy after TIPS was noted in 7 patients(31.8%). Variceal rebleeding occurred in 3 patients(13.6%). The remaining 15 patients have survived an average of 11 months. CONCLUSION: This results suggest that TIPS is a safe and effective method for lowering portal pressure and controlling variceal bleeding. Furthermore if these initial results are encourged by further long-term observation, TIPS could replace endoscopic and risky surgical intervention.
Esophageal and Gastric Varices ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver Failure ; Portal Pressure ; Portal Vein ; Portasystemic Shunt, Surgical* ; Sclerotherapy

PURPOSE: To prevent intraperitoneal bleeding, it is critical that the extrahepatic portal vein should not bepunctured during transjugular intrahepatic portosystemic shunt (TIPS). There has, however, been no procedure fordefining the anatomic relationship between the hepatic capsule and the portal vein segment before shunt formation.To avoid a possibly catastrophic outcome of extrahepatic portal puncture before shunt creation, we thereforedevised a new method; the purpose of this study is to report its efficacy and feasibility. MATERIALS AND METHODS:Whenever a portal vein was punctured, we advanced a 9F sheath over a guidewire into the portal vein before balloondilatation of the tract. Contrast material was then injected through the sheath as this was slowly withdrawn fromthe portal vein towards the hepatic vein. When contrast material extravasated or spilled into the peritonealspace, thus suggesting extrahepatic portal vein puncture, a more peripheral segment of the portal vein waspunctured, and a shunt was created using this new tract. We applied this method to 130 consecutive patients whounderwent TIPS to control variceal bleeding due to liver cirrhosis. In all cases, portography and ultrasonographywere used for immediate confirmation of the procedure. RESULTS: Puncture of the extrahepatic portal vein segmentoccurred in three out 130 (2.3%) patients. In these three, TIPS was successfully created using the methoddescribed above. Clinical and ultrasonographic follow-up showed that no patients suffered intraperitonealbleeding. CONCLUSION: For preventing intraperitoneal hemorrhage during TIPS creation, our method is effective andfeasible.
Esophageal and Gastric Varices ; Follow-Up Studies ; Hemorrhage* ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Portal Vein ; Portasystemic Shunt, Surgical ; Portography ; Punctures

A propecive analysis of 50 patients with acute interhemisphric subdural hemorrhage and tentorial hemorrhage, an unusual pattern of acute subdural hematoma, who were managed in a uniform way was analyzed to related outcome to hemorrhagic site, initial Glasgow Coma Scale(GCS) and combined injuries. The incidence of acute interhemisphric subdural hemorrhage(ISH) and tentoria hemorrhage(TH) after head trauma was 3.83%, 50 cases among 1303 head injured cases. And 80% of the above hemorrhage disapperaed within two weeks after trauma. There was no significant relationship between feature of hemorrhage and intial GCS(P>0.05), but there was highly significant relationship between initial GCS and Glasgow Outcome Scale(GOS) (p<0.001). There noted significant relationship between initial combined injury and GOS(p<0.01), and also brainstem injury and GOS(p<0.001).
Brain Stem ; Coma ; Craniocerebral Trauma ; Head ; Hematoma, Subdural* ; Hematoma, Subdural, Acute ; Hemorrhage* ; Humans ; Incidence

Percutaenous transhepatic biliary drainage (PTBD) is widely used to control cholangitis, sepsis, or jaundice caused by biliary tree obstruction. The PTBD tract can be used in percutaneous biliary stone extraction in pre-or post-operative state when ERCP is failed or operation is contraindicated. We performed 16 cases of percutaneous transhepatic biliary stone removal. Locations of biliay stones are combined intrahepatic and extrahepatic in 8 cases (50%), only extrahepati in 7 cases (44%), and only intrahepatic in 1 case (6%). The number of stones was single in 6 cases and multiple in 10 cases. Over all success rate was 81% (13/16), 93% (14/15) in extrahepatic stones and 78% (7/9) in intrahepatic stones. In 5 of 6 cases, complete stone removal was impossible due to marked tortuosity of T-tube tract or peripherally located stones, complete removal of biliary stones was achieved via a new PTBD tract. No significant pre-or post-procedure complication was occured. Percutaneous removal of biliary stones via PTBD tract is an effective and safe alternative method in difficult cases in the menagement of biliary tract stones.
Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Drainage ; Jaundice ; Methods ; Sepsis

An intraosseous epidermal cyst is a rare benign cystic lesion. It is thought to result from congenital factors or trauma and can lead to bone destruction because the cyst develops at the soft tissue around the bone. Radiological findings of intraosseous epidermal cysts are a well-defined radiolucent lesion, with cortical expansion. It is important to differentiate an intraosseous epidermal cyst with other disease developed at distal phalanx because its clinical and radiological findings are similar. We report two rare cases of intraosseous epidermal cysts that developed at the distal phalanx.
Epidermal Cyst*