Common Bile Duct Stone Removed by Endoscopic Sphincterotomy / 대한소화기내시경학회지

Endoscopic sphincterotomy (E.S.T.) has relatively low complications and is the theraphy of choice in patients with common bile duct stones. It is also an useful technique for decompression of biliary tract obstruction. Thirty two cases of patients were selected according to opedrative risks: old age, severe jaundice and recurrent or retained bile duct stones after cholecystecomy from 1986 to 1988. The results were as follows, 1) In thirty two cases nf E.S.T., male to female ratio was 1:1.46. Most frequent age was older than 40 years. (male, 84.6%, female, 84.2%). 2) Out of thirty two cases, 20 cases (62.5% were under post clholecystectomy state, 12 eases (37.5%) were obstructive jaundice. 3) Spontaneous stone passage after E.S.T. was 81.3% (26 cases), and total stone remoral rate was 87.5% (28 cases), 4) Complications of E.S.T. were noted in three cases. In the two cases of bleeding, it was spontaneously improved and a case of acute pancreatitis was treated by medical care.

Endoscopic Retrograde Chalangiopancreatography (ERCP) in Obstructive Jaundice / 대한소화기내시경학회지

ERCP was performed in 34 cases of obstructive janndice at Busan National University Hospital between June 1981 and October 1982, and those findings were compared with the final surgical operative diagnoses. The results were as follows: 1) The ratio of male to female was about l. 6: 1 and most of them were in the 5th decade to 7th decade, 2) Upper abdominal pain and tenderness were the cardinal symptom and sign, 3) Successful ERCP was obtained in 32 cases among the total of 34 cases(94.1%)Selective success rates by indications were 77.8%(21/27) in suspected biliary lesions and 85.7%(6/7) in suspected panceatic lesions. 4) ERCP diagnoses were biliary stone(11 cases), eholangiocarcinoma(6 cases), pancreatic head ca. (4 cases), Ampulla of Vater ca. (2 cases), normal cholangiogram(2 cases), and normal parcreatogram(2 cases). 5) Eighteen cases out of 24 surgical operative cases were diagnosed by ERCP alone, The diagnostic rates of ERCP by surgical operation in obstructive jaundce was 75%. Complications of ERCP were not clinically significant. It suggests that ERCP is a very useful diagnostic method in the differential diagnosis of obstructive jaundice.

Clinical Studies on 40 Cases of Postpartum Heart Failure

Fourty cases of postpartum heart failure occuring in Korean women in the Dept. of Int. Med., Pusan University Hospital are reported, with and analysis of clinical data including frequency, age, time of onset, clinical features, hemoglobin, liver function, electrocardiographic and chest X-ray findings. The following results were obtained. 1. The cases were mostly found in 20-29 years age group, 50% of the total cases. 2. Eighteen cases of fourty patients experienced the symptoms during the 2nd week after delivery and 12 cases complained the symptoms during 4th week. 3. Only six cases noted onset of heart disease following the 4th pregnancy, whereas sixteen patients experienced this phenomenon after the first gestation, eight patients after the 2nd gestation and ten patients after the 3rd pregnancy. 4. At the admission the patients were suffering from paroxysmal nocturnal dyspnea, orthopnea, exertional dyspnea and generalized edema. Physical findings revealed cardiomegaly, gallop rhythm, edema, pulmonary fine rales and systolic murmur in frequency. 5. Electrocardiograms were available at the time of presentation in thirty patients. Twenty four patients had left ventricular hypertrophy, 18 patients sinus tachycardia, 3 patients lower voltage. 6. The chest X-ray film showed the cardiomegaly in 15 cases, 83.3% of the obtained 18 cases, 12 cases pulmonary edema, 3 cases pericardial effusion. 7. The venous pressure was measured in 15 patients. In 5 cases the venous pressure was normal and in 10 increased above 150mmH2O. 8. With prompt treatment by rest, salt restriction, diuretics and digoxin the clinical symptoms improved in 31 cases but 9 patients died at the admission.