Self - Expanding UltraflexTM Esophageal Prosthesis of Malignant Esophageal Stenosis / 대한소화기내시경학회지

Endoscopic intubation is well established as a cheap, fast and durable procedure for palliation of malignant dysphagia. However, the placement of conventional esophageal endopros-thesis is difficult in some cases and this procedure is associated with significant complications such as perforation, hemorrhage and dysfunetion of the prosthesis in the long term. The self-expanding metallic stents offer an attractive alternative to conventional esophageal stents. These can be compressed into and inserted through a small lumen catheter, making placement easier, safer and less painful to patients. But, open mesh of self-expanding metallic stent such as Wallstent allows tumor ingrowth, unfinished wire ends can lead to perforation and bleeding, and immense stent shortening makes precise positioning difficult. Inflammatory response at site of the metal strut, difficulty in retrieving prostheses that place and very expensiveness in cost-benefit analysis are also problems. Recently developed Ultraflex" esophageal prosthesis is knitted from single strand of Elastalloy' wire, undulates to conform with normal esophageal peristalsis, maintaining patency and promoting patient comfort. Unlike other metallic stent that have sharp, bare-wire ends, the Ultraflex' Stent has smooth looped ends, with Teco-flex coating, which provide an atraumatic transition from the stent to the esophageal wall. We experienced a case of a 60-year old male with malignant stenosis of esophageal cancer in whom Ultraflex esophageal prosthesis was implanted with successful oral nutrition.

A Case of Mirizzi Syndrome with Cholecystocholedochal Fistula / 대한소화기내시경학회지

Mirizzi syndrome is a so-called functional hepatic syndrome with obstruction of the common hepatic duct secondary to pressure from an impacted stone, either in the cystic duct or the neck of the gallbladder. Mirizzi syndrome is classified into two types based on endoscopic retrograde cholangio-pancreatographic findings. Type I involves external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch. In type II, a chole-cystocholedochal fistul is present, caused by a calculus which has eroded partly or completely into the common bile duct. Gallstone obstruction of the cystic duct with resulting repeated attacks of inflammation and pressure necrosis leads to the formation of cholecystocholedochal fistulas. We experienced a 70-year-old female patient with Mirizzi syndrome type II, who complained of abdominal discomfort. ERCP revealed multiple filling defects in contracted gallbladder, which compressed lateral wall of common hepatic duct. Peroral cholangioscopy revealed an impacted stone at the neck of the gallbladder with neighboring mucosal erosions. She was treated under the diagnosis of Mirzzi syndrome type II by endoscopic biliary drainage and surgical operation.

A Case of Mirizzi Syndrome with Cholecystocholedochal Fistula / 대한소화기내시경학회지

Mirizzi syndrome is a so-called functional hepatic syndrome with obstruction of the common hepatic duct secondary to pressure from an impacted stone, either in the cystic duct or the neck of the gallbladder. Mirizzi syndrome is classified into two types based on endoscopic retrograde cholangio-pancreatographic findings. Type I involves external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch. In type II, a chole-cystocholedochal fistul is present, caused by a calculus which has eroded partly or completely into the common bile duct. Gallstone obstruction of the cystic duct with resulting repeated attacks of inflammation and pressure necrosis leads to the formation of cholecystocholedochal fistulas. We experienced a 70-year-old female patient with Mirizzi syndrome type II, who complained of abdominal discomfort. ERCP revealed multiple filling defects in contracted gallbladder, which compressed lateral wall of common hepatic duct. Peroral cholangioscopy revealed an impacted stone at the neck of the gallbladder with neighboring mucosal erosions. She was treated under the diagnosis of Mirzzi syndrome type II by endoscopic biliary drainage and surgical operation.

Endoscopic Variceal Ligation for Treatment of Bleeding Esophageal Varices / 대한소화기내시경학회지

Endoscopic injection sclerotherapy(EIS) is currently the most widely practiced method for treating and eradicating acutely bleeding esophageal varices in repeated sessions, but may be associated with some uadesirable local and systemic complications. Endoscopic variceal ligation(EVL), which consists of mechanical ligation and thrombosis of varices using elastic "0"- rings, has been recently developed as a non-operative alternative to EIS. We performed EVL in 16 patients who had recently bled from esophageal varices. Total 249 variceal ligations were performed during 71 separate EVL sessions. Three patients were actively bleeding at initial EVL; all of them were successfully controlled by emergency EVL. During the study period two patients died after initial EVL; one who refused te return for repeated EVL died from rebleeding, the other died from hepatic failure without any rebleeding. Rebleeding, following initiation of EVL, occured in 3 patients(l8.8%); two patients had bled from varices except previousiy ligated site and were successfully controlled by emergency EVL, remained one who refused any repeat endoscopy could not be confirmed the bleeding site. Varices were eradicated or reduced to grade I in 10(71.4%) of the 14 survivors by 14-28 ligations(mean, 19.5 ligations) in 3 -7 EVL sessions(mean, 5.4 sessions), During or after EVL, there were no complications, except transient mild dysphagia in 3 patients of 16 patients. These results indicated that EVL is a safe and effective method for treatmet of bleeding esophageal varices.

A Case of the Poorly Differentiated Metastatic Adenocarcinoma with Unknown Origin in Stomach / 대한소화기내시경학회지

Metastatic cancer with unknown origin(MUO) is not a rare disease in general hospitals and cancer therapeutic centers with a overall incidence of 4-10%. Although there is no universally accepted definition of MUO, an adequate definition includes any case with histologically confirmed metaetatie Carcinoma in which no primary site has been identified inspite of a thorough history; careful physical examinations, and screening tests. Tha diagnostic procedures are important because of therapeutic plans and the prognosis are more dependent upon the cancer tissue type rather than any other factors. Metastasis to the stomach is much more rare occasion in clinical situations of cancer metastasis. We experienced a case of poorly differentiated metastatic adenocarcinoma in stomach which showed: multiple doughnut-like submucosal tumors with central ulceration by gastrofiberscopy and could not identified the primary site in spite of a thorough diagnostic studies including immunochemical histology.

Nonsurgical Treatment of Gallbladder Stones with Percutaneous Transhepatic Cholecystoscopy / 대한소화기내시경학회지

With the technical development of ultrasonically guided punture of the gallbladder, percutaneous transhepatic cholecystoscopy(PTCCS) was first performed in 1981 by Inui et al. and Ichikawa et al. This procedure useful for preoperative, accurate diagnosis of carcinoma and nonsurgical treatment of high-risk patients with gallbladder stones. PTCCS-lithotripsy(PTCCS-L) is one of the non-surgical treatment modalities for gallbladder stones, and is a safe, reliable and technically easy therapeutic procedure through improvement in PTCCS-L manipulation and the development of new devices for this technique. PTCCS-L is performed when the patients with gallbladder stones cannot be operated on because of the risk of complications, such as renal failure, congestive heart failure etc. In this report, we present the proeedures of PTCCS-L for the the nonoperative treatment of gallbladder stones in the patient with cholangitis and cholecystitis because of common bile duct stone and gallbladder stones. Since a sinus tract of about 5 mm in diameter was needed to pass an endoscope, the sinus tract of percutaneous cholecystostomy was dilated immediately upto 18 French in diameter in a single step following percutaneous cholecystostomy itself, using a dilator set containing 10, 14, 16 and 18 French dilators and 18 French sheath. And then PTCCS-L with electrohydraulic lithotripter was successfully performed with a complete removal of gallbladder stones. There- after endoscopic sphincterotomy and mechanical lithotripsy was successfully done for the removal of common bile duct stone. There has been no recurrence of gall stones for up to 1 year.

A study of referral patterns in Dept. of family medicine

No abstract available.

Depressive trends in patients with upper gastrointestinal complaints

No abstract available.

Diagnostic Values of pH of Vaginal Discharge, Amine Test, and Microscopic Examination of Infectious Vaginitis / 영남의대학술지

Vaginitis is one of the most common disease in gynecologic field in recent days. About 90% of these patients suffer from the infection of the vagina caused by Gardnerella vaginalis, Candida, or Trichomonas, either alone or in combination. For the effective diagnosis and management, it is essential to get an accurate identification of the causative agent. Applying simple and easy diagnostic methods such as pH of vaginal discharge, amine test and microscopic examination of wet mount preparation of normal saline and 10% KOH to 549 cases of randomly selected patients visiting Out-patient Department of Obstetrics and Gynecology of Yeungnam University Hospital through May 1st to Sept. 31st, 1987, the following results were obtained. 1. In the Gardnerella vaginitis vaginal pH was more than 5.0 in 81.0% of total cases, positive amine test in 62.8%, decreased lactobacilli in 77.4% & decreased WBC counts in 70.1%, In the Trichomonas vaginitis vaginal pH more than 5.0 was noted in 93.3% of the cases, negative amine test in 90%, decreased showed vaginal pH of 3.0~4.0 in 83.2%, negative amine test in 90%, decreased lactobacilli in 90% & increased WBC counts in 93.3%, whereas Candida vaginitis and normal groups showed vaginal pH of 3.0~4.0 in 83.2%, negative amine test in 100%, normal distribution of lactobacilli in 89.7%, normal WBC counts in 72.4%. 2. The accuracy rates of physical diagnosis by wet mount preparation of normal saline and 10% KOH revealed 26.3%, 47.5%, 70.0% in Gardnerella vaginitis, Candida vaginitis, and Trichomonas vaginitis, respectively. The vaginal pH and amine test showed 83.2% of accuracy rate in Candida vaginitis group, 60.6% in Gardnerella vaginitis group and 83.3% in Trichomonas vaginitis group. 3. In 23 cases of Gardnerella vaginitis showing vaginal pH of 3.0 or 4.0 and positive amine test, the clue cells were observed in 10% or less in 12 cases, 30% in 5 cases, 50% in 4 cases and 50% or more in 2 cases. In summary vaginal pH and amine test could be useful in screening and differentiating the different types of infectious vaginitis. Furthermore by adding microscopic examination of normal saline and 10% KOH wet mount preparation to them, they not only could obtain higher diagnostic accuracy rate but would be more valuable in selecting the patients requiring cultures to confirm the diagnoses.