Background: s/Aims: Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding. Methods: Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed. Results: Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002). Conclusions Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding.

BACKGROUND/AIMS: In patients with liver cirrhosis, drugs acting on the central nervous system can lead to hepatic encephalopathy and the effects may be prolonged. Recently, misuse of propofol has been reported and the associated risk of death have become an issue. Propofol is commonly used during sedative endoscopy; therefore, its safety in high-risk groups must be further investigated. We performed a pilot study of the safety and efficacy of propofol during endoscopy in Korean patients with cirrhosis. METHODS: Upper gastrointestinal endoscopy was performed under sedation with propofol along with careful monitoring in 20 patients with liver cirrhosis and 20 control subjects. The presence or development of hepatic encephalopathy was assessed using the number connection test and neurologic examination. RESULTS: Neither respiratory depression nor clinically significant hypotension were observed. Immediate postanesthetic recovery at 5 and 10 minutes after the procedure was delayed in the cirrhotic patients compared with the control group; however, at 30 minutes, the postanesthetic recovery was similar in both groups. Baseline psychomotor performance was more impaired in cirrhotic patients, but propofol was not associated with deteriorated psychomotor function even in cirrhotic patients with a minimal hepatic encephalopathy. CONCLUSIONS: Sedation with propofol was well tolerated in cirrhotic patients. No newly developed hepatic encephalopathy was observed.
Adult ; *Endoscopy, Gastrointestinal ; Female ; Hepatic Encephalopathy/chemically induced ; Humans ; Hypnotics and Sedatives/*adverse effects ; *Liver Cirrhosis ; Male ; Middle Aged ; Propofol/*adverse effects ; Republic of Korea

BACKGROUND: The skin shows many physiological changes during pregnancy. Although these physiological skin changes do not usually impair the health of the mother or the fetus, some can be cosmetically significant and of importance to the dermatologist. OBJECTIVE: The aim of our study was to determine the incidence and clinical findings of these skin changes during pregnancy. METHODS: We made a prospective study of 157 women in the third trimester of pregnancy who visited the prenatal care clinic at Seoul National University Hospital from January 1996 to June 1996. Women with pathological pregnaneies were excluded. RESULTS: The results of the study are summarized as follows. 1. Various skin changes occurred such as pigmentary alteration, vascular changes, striae, abnormalities in hair growth, and nail changes. In all subjects, one or more of these changes were found. 2. The incidence of hyperpigmentation was highest among the skin changes. The incidence of hyperpigmentation of areola and nipple was 100%. Linea nigra were observed in 81.5%. 3. Palmar erythema, suprapubic hirsutism, and abdominal striae were observed in 36.3%, 14.0%, and 40.1 %, respectively. CONCLUSION: Physiological skin changes during pregnancy were various and observed with high frequency. The incidences of vascular changes, hair and nail changes in Korean pregnant women were reported for the first time.
Erythema ; Female ; Fetus ; Hair ; Hirsutism ; Humans ; Hyperpigmentation ; Incidence ; Mothers ; Nipples ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnancy* ; Pregnant Women ; Prenatal Care ; Prospective Studies ; Seoul ; Skin*

BACKGROUND: Pruritus, which is a frequent accompanying symptom of dermatological diseases, is also common during pregnancy, either localized or generalized. It may be related to specific dermatoses of pregnancy. OBJECTIVE: A clinical study was performed to know the exact nature of pruritus in pregnancy. METHODS: Subjects with systemic diseases, or laboratory abnormalities were excluded. People who have had pruritic dermatologic diseases before pregnancy were also excluded. One hundred and fifty five pregnant women were interviewed with physical examinations and followed up to the date of delivery. Pruritus was graded. RESULTS: Pruritus was present in 31.6%. Most affected subjects had mild or moderate severity. The abdomen was the most common site. There was a tendency for the duration of itching to increase with the duration of pregnancy. CONCLUSION: Conclusion: These findings may provide basic and useful data on pruritus during pregnancy.
Abdomen ; Clinical Study* ; Female ; Humans ; Physical Examination ; Pregnancy* ; Pregnant Women ; Pruritus* ; Skin Diseases

Percutaneous removal of renal and upper ureteral stone is becoming an established procedure, especially for stones lying free in the pelvis. The kidneys, which are frequently malformed. often lay within the kyphosis and it is hard to do open surgery. We report 4 cases of renal or upper ureteral stones managed with percutaneous nephrolithotomy(PNL) in kyphosis patients.
Deception ; Humans ; Kidney ; Kyphosis* ; Nephrostomy, Percutaneous* ; Pelvis ; Ureter

The patient was a 51 year-old woman suffering fraen dysphagia due to upper esoyhageal lye stricutue whieh had developed as a result of a suicide attempt 21 years ago. Shortly after that, she underwent feeding gastrostomy and has lived in the gastrostomy state for 2l years. After admission, she underwent a barium esophagoram which revealed a near total obstruction at the cricoid cartilage level. Bougie dilatation with American Dilation System was tried on day 3. But the spring tip marked guide wire which was to be used with the American Dilation System could not be passed through the stricuture. Therefore, we performed a bougie dilatation using angiographic guide wire M(H-AG-35in-150 cm) with success. On day 14, she underwent a barium esophagogram which revealed her improved condition, and she was discharged on day 16.
Barium ; Constriction, Pathologic* ; Cricoid Cartilage ; Deglutition Disorders ; Dilatation* ; Female ; Gastrostomy* ; Humans ; Lye* ; Middle Aged ; Suicide

To investigate the variations of the renal segments in Korean adults. the findings of selective renal arteriograms from l3O kidneys were analyzed. The boundary on the lateral surface of the kidney between the areas supplied by anterior and posterior branches of the renal artery was investigated by analysis of the findings of 100 renal arteriograms. In 75% of the cases the boundary was observed to be posterior to the lateral borderline of the kidney and the configuration of it was variable. Under the definition of the segmental artery as the eecorrd branch of the renal artery that could be tied outside the hilum, the distribution of the renal segments was observed. The number of the renal segments in a kidney ranged from 3 to 7 and the frequency was 1.6%. 24.2%. 50.8%. 22.6% and 0.8% in the order of increment. The 5-segment-kidney, the most common form described in many textbooks, was observed in 50.8% of the cases and also was the most common form in this study. In most of the cases(90%) superior and inferior segments were observed. The level of each boundary of the superior and inferior segments was observed on the ventral and dorsal surface of the kidney and compared. The level was identical on both surfaces in 56.1% and 31.8 5t of the superior and inferior segments respectively. The variations in the origin and the number of arteries supplying the superior and inferior segments was compared and the result revealed more complex variations in the former. From the viewpoint of clinical application these results may provide useful information and important suggestions for renal conservative surgery. Considering that the distribution of the renal segments is variable and the number and origin of the arteries supplying the superior and inferior segments, which are frequently indicated for partial nephrectomy. are variable. it may contribute to better surgical results if surgeons observe and decide the resection margin preoperatively by taking the selective renal arteriography from several directions.
Adult* ; Angiography ; Arteries ; Humans ; Kidney ; Nephrectomy ; Renal Artery

No abstract available.
Renal Artery* ; Ureter* ; Veins*

No abstract available.
Autopsy*

For many years ERCP has been contraindicated in acute pancreatitis. The injection of contrast medium. which may cause hyperamylasemia and occasionally an attack of acute pancreatitis even in normal indivisuals, was allowed only two to three weeks after subsidence of symptoms. Gallstone disease is one of the most common etilogical factors in pancreatitis and migration or impaction of gallstone in the ampulla of Vater causes pancreatitis. (continue...)
Ampulla of Vater ; Cholangiopancreatography, Endoscopic Retrograde* ; Gallstones ; Hyperamylasemia ; Pancreatitis*