PURPOSE: Acute gangrenous cholecystitis (AGC) is a severe advanced form of cholecystitis, and it has a higher morbidity and mortality rate than that that of acute nongangrenous cholecystitis (ANGC). Identifying the CT findings of gangrenous cholecystitis will enable physicians to make an early diagnosis and administer aggressive treatment. METHODS: From January 2005 to October 2007, the CT scans in 277 patients (80 with AGC, 149 with ANGC and 45 with normal gallbladder (NGB)) were retrospectively reviewed by 2 radiologists. We evaluated the findings that included wall thickening (>3mm), distension (transverse diameter > 5cm), gallstones, pericholecystic fluid, pericholecystic inflammation, mural striation, adjacent hepatic enhancement, pericholecystic abscess, an intraluminal membrane, an irregular or absent wall, gas in the wall or lumen, and intraperitoneal fluid. The sensitivity and specificity of the each CT finding for diagnosing AGC were calculated. The dimension and wall thickness of the gallbladder were also measured. RESULTS: The sensitivity, specificity and accuracy of CT for diagnosing AGC were 27%, 94% and 74%, respectively. The findings with the highest specificity for AGC were gas in the wall or lumen (100%), intraluminal membranes (99.5%), pericholecystic abscess (99.5%), an irregular or absent wall (98.5%), adjacent hepatic enhancement (97.9%), intraperitoneal fluid (96.9%), pericholecystitic fluid (95.6%), and mural striation (93.8%). The difference of the mean gallbladder wall thickness between the groups was statistically significant. CONCLUSION: These specific CT findings, including the GB wall thickness, will assist clinicians in making an earlier and more exact diagnosis of gangrenous cholecystitis
Abscess ; Cholecystitis ; Early Diagnosis ; Gallbladder ; Gallstones ; Humans ; Inflammation ; Membranes ; Retrospective Studies ; Sensitivity and Specificity

A 9-year-old boy showed orofacial dyskinesia and psychic symptoms shortly after open heart surgery with deep hypothemia and cardiopulmonary bypass for congenital cyanotic heart disease. The choreothetosis progressed to be generalized and accompanied by mental deterioration. This involuntary movement partially responded only to repetitive administration of sedatives. After 3 month the patient expired with sudden development of ventricular tachycardia and cardiogenic shock.
Cardiopulmonary Bypass* ; Child ; Dyskinesias ; Heart Diseases ; Humans ; Hypnotics and Sedatives ; Hypothermia* ; Male ; Movement Disorders ; Shock, Cardiogenic ; Tachycardia, Ventricular ; Thoracic Surgery

PURPOSE: Single port laparoscopic inguinal hernia repair has been performed to further reduce port related morbidities and to improve the cosmetic outcome. However, the cosmetic result of single port laparoscopic totally extraperitoneal inguinal hernia repair (TEP) has not been superior to that of transabdominal preperitoneal hernia repair (TAPP). The aim of this study is to introduce and assess the Single Umbilical Tangential Incision (SUTI) for Lap-TEP repair. METHODS: Forty one hernia repairs of 34 patients were performed using SUTI-TEP method. SUTI was made all along the inferolateral skin of the umbilical pit and a vertical incision of less than one centimeter was made in the supra- or infraumbilical skin if needed; the total length of the incision was 2~2.5 cm. SILS(TM) port and conventional instruments were used for the procedure. RESULTS: All procedures were completed without conversion to the conventional TEP procedure. Mean operation time was 73 minutes for unilateral primary hernia, 119 minutes for bilateral primary hernia, 88.5 minutes for unilateral recurrent hernia, and 120 minutes for bilateral recurrent hernia. There were two cases of wound seroma and four cases of urinary retention postoperatively. Other significant complications were not noted. There was no recurrence of hernia during the follow-up period of one to 24 months. At routine follow-up visit at three months postoperative, the scar was barely visible and overall level of patient satisfaction was very high. CONCLUSION: The SUTI-TEP inguinal hernia repair is safe and shows superior cosmetic results. Further studies are required in order to assess the long-term outcome.
Cicatrix ; Follow-Up Studies ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Patient Satisfaction ; Recurrence ; Seroma ; Skin ; Urinary Retention ; Wounds and Injuries

We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.
Aged ; Arm ; Chemoradiotherapy ; Colon ; Compliance ; Humans ; Manometry* ; Peritonitis ; Prostatic Neoplasms ; Radiotherapy ; Rectal Neoplasms

Traumatic splenic vein aneurysm (SVA) is an extremely rare entity. Traditionally, treatment varied from noninvasive followup to aneurysm excision with splenectomy. However, there has been no prior report of traumatic SVA treated with endovascular stent graft for SVA via percutaneous transsplenic access. Therefore, we report the case of a 56-year-old man successfully treated with endovascular stent graft for traumatic SVA via percutaneous transsplenic access.
Aneurysm* ; Blood Vessel Prosthesis* ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Middle Aged ; Splenectomy ; Splenic Vein* ; Stents*

Traumatic splenic vein aneurysm (SVA) is an extremely rare entity. Traditionally, treatment varied from noninvasive followup to aneurysm excision with splenectomy. However, there has been no prior report of traumatic SVA treated with endovascular stent graft for SVA via percutaneous transsplenic access. Therefore, we report the case of a 56-year-old man successfully treated with endovascular stent graft for traumatic SVA via percutaneous transsplenic access.
Aneurysm* ; Blood Vessel Prosthesis* ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Middle Aged ; Splenectomy ; Splenic Vein* ; Stents*

PURPOSE: The purpose of this study is to help determine the optimal time and method for operation of pulmonary atresia(PA) with ventricular septal defect(VSD). METHODS: Seventy patients who were diagnosed as PA with VSD in the Pediatric Department of Cardiology, Severance Hospital between May, 1991 and April, 1995, were included in our study. Subjects were divided into two groups depending on the presence of major aorto-pulmonary collateral arteries(MAPCAs). In patients with MAPCAs, the distribution of MAPCAs concerning its relationship with central PA were analyzed, while in patients without them, morphologic changes of PA after performing conventional modified Blalock-Taussig(B-T) shunt were studied. RESULTS: After performing modified B-T shunts, the number of cases of PA stenosis and interruption increased from 26 to 37. Fifteen cases of advanced stenosis and six cases of interrupted PA were also observed. After performing modified B-T shunt, CSAI of both PA was increased from 197+/-101 to 311+/-138, more remarkably in cases without progression of PA stenosis. Among the patients with MAPCAs, 12 cases showed PDA, while 16 cases showed confluent PA. On average, MAPCAs were present in 2.5 cases. Concerning the types of MAPCAs, 14 cases were unifocal, while 36 cases were multifocal and most of them originated from descending aorta. CONCLUSION: In cases where pulmonary flow is maintained by PDA, stenosis of central PA is common, and can result in retarded pulmonary arterial development or increased stricture after modified B-T shunt, so careful attention is needed during follow-up. In cases with dominant MAPCAs, confluent PA is common, and multifocal pulmonary supply renders surgery difficult, so careful analysis of pulmonary supplies to each pulmonary segments, their shapes and relationships, are indicated preoperatively.
Aorta, Thoracic ; Cardiology ; Classification* ; Constriction, Pathologic ; Equipment and Supplies ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular* ; Humans ; Pulmonary Artery* ; Pulmonary Atresia*

OBJECTIVE: At present, epidural steroid injection is one of the most frequently used method in the treatment for low back pain. But this method is nonspecific and results in a widespread of injected agent around the target point. So, we introduce combined nerve block and had good results. METHODS: The authors evaluated the effects of combined nerve block in 153 patients with low back pain, retrospectively. They had spinal stenosis, facet syndrome, herniated lumbar disc and failed back surgery syndrome. We operated combined nerve block to patients respectively, that is caudal block, facet block and iliolumbar & sacroiliac joint block. We used Depomedrol(R) 80mg in 2ml and 2% Emcaine(R) 400mg in 20ml as injection agents, Visual analog scale(VAS) for assessment of the effect was used. RESULTS: Six months after nerve block, the outcome of treatment for back pain was cured(a decrease in VAS score from 4 and over to 3 and under) in 35.3%, improved(a decrease in VAS score but 4 and over) in 32.7% and unchanged(no change in VAS score) in 32.0%. Overall rate of improvement was 68.0%. CONCLUSION: We think that combined nerve block is more specific and effective in patients with low back pain. Therefore, this technique could be alternative method to epidural steroid injection.
Back Pain ; Failed Back Surgery Syndrome ; Humans ; Low Back Pain* ; Nerve Block* ; Retrospective Studies ; Sacroiliac Joint ; Spinal Stenosis

Trauma is frequently not purely penetrating or purely blunt. Such mixed trauma can result from the mechanism of injury. Recently, we encountered a patient who accidentally shot himself with a shotgun. He had a 15 x 8-cm-sized penetrating injury on left flank that did not penetrate into the peritoneal cavity and a blunt splenic injury with hemoperitoneum. Surgical and interventional treatments were performed for each injury. We present this case with a review of the related literature.
Hemoperitoneum ; Humans ; Peritoneal Cavity

The traditional drug for anticoagulation in those with a high risk of thrombosis is a vitamin K antagonist, such as warfarin. On the other hand, this drug has several limitations and hemorrhagic complications. Recently, novel or non-vitamin K-dependent antagonist oral anticoagulants (NOACs) have been developed to solve these problems. This paper presents a case of adaptation of NOAC for a warfarin anticoagulated patient with traumatic ongoing hemorrhages with a discussion of the clinical implications of NOAC.
Anticoagulants* ; Hand ; Hemorrhage* ; Humans ; Thrombosis ; Vitamin K ; Warfarin*