Development of Korean Adult ADHD Rating Scale

OBJECTIVES: Symptoms of attention-deficit hyperactivity disorder (ADHD) during childhood may persist into adulthood. This study included the development and validation process of the Korean Adult ADHD Rating Scale (K-AARS), which was developed for screening and monitoring treatment of adults with ADHD. METHODS: Preliminary questionnaires of the K-AARS were based on the reviews of previous adult ADHD scales and clinical experiences of the board certified child and adolescent psychiatrists in Korea. For this study, 136 adults (18-50 years old) with inattention, hyperactivity and/or impulsivity symptoms were enrolled as ADHD subjects, and compared with 406 control subjects (18-50 years old) without ADHD symptoms. Construct validity was examined using explorative factor analysis and Cronbach's alpha to obtain internal reliability coefficients. Concurrent validity was evaluated by comparison with the Conners' Adult ADHD Rating Scale (CAARS). RESULTS: An explorative factor analysis showed that the K-AARS had 8 factors (inattention, hyperactivity, impulsivity, antisocial personality disorder/conduct disorder/oppositional defiant disorder, impairment, driving, emotional dysregulation, disorganization). K-AARS was highly reliable in terms of internal consistency (Cronbach's alpha 0.77-0.95) and correlation between factors (0.57-0.86). Concurrent validity with the CAARS and discriminant validity were statistically significant. CONCLUSION: The K-AARS is a valid and reliable measure for assessment of Korean adults with ADHD.

Clinical Characteristics of Children with Autism Spectrum Disorder According to the Presence of Motor Stereotypes

OBJECTIVES: Repetitive and stereotyped behaviors are core symptoms in children with autism spectrum disorders (ASD). The purpose of our study was to investigate the frequency of motor stereotypes in ASD children and their clinical features. METHODS: Among 171 ASD children (age range, 3-15), the ASD group with motor stereotypes was defined according to two items in the Korean version of Autism Diagnostic Interview-Revised (K-ADI-R). We compared the clinical features, behavior problems and severity of other domains in the K-ADI-R and executive functions between the ASD group with motor stereotypes and the ASD group without motor stereotypes. RESULTS: Ninety (52.6%) of 171 ASD children had motor stereotypes. The ASD group with motor stereotypes had a lower intelligence quotient score (62.23 vs. 84.94, p<.001) compared to the ASD group without motor stereotypes. The ASD group with motor stereotypes had more impairments in the social interaction domain [adjusted odds ratio (AOR) 1.11, p=.001] and communication domain (AOR 1.15, p=.008). Thought problems and lethargy were more frequent in the ASD group with motor stereotypes than the ASD group without motor stereotypes (AOR 2.059, p=.034 ; adjusted OR 1.045, p=.046). However, no significant differences in executive function were observed between the ASD group with motor stereotypes and the ASD group without motor stereotypes. CONCLUSION: The ASD group with motor stereotypes showed more impairment in social interaction and communication domains, which are core symptoms of autism. Motor stereotypes may indicate greater severity of ASD.

Psychopathology Associated with Cyberbullying among Middle School Students / 신경정신의학

OBJECTIVES: Cyberbullying has recently become a major concern in Korea and especially poses a serious threat to adolescents. The object of this study is to examine the psychopathology of perpetrators and victims of cyberbullying. METHODS: In a cross-sectional study, 490 middle school students completed questionnaires on bullying and victimization experiences in cyberspace. Korean-Youth Self Report (K-YSR) was included to evaluate the psychopathology of the students. RESULTS: The prevalence rates of victims and perpetrators of cyberbullying were 6.92% and 3.33%, respectively. Among 9 sub-scales of K-YSR, the scores of depressed/anxious (p=0.049), thought problems (p=0.002), and attention problems (p=0.039) were significantly different between victim, perpetrator, victim/perpetrator, and control group. Multinomial logistic regression indicated that the victim group was associated with depressed/anxious [odds ratio (OR)=1.10], social immaturity (OR=1.24), thought problems (OR=1.32), and self-destructive identity problems (OR=1.16). The perpetrator group was associated with thought problems (OR=1.37) and attention problems (OR=1.21). The victim/perpetrator group was associated with delinquent behavior (OR=2.04). CONCLUSION: Middle school students involved in cyberbullying were associated with psychopathologies including depression, anxiety, thought problems, attention problems, and delinquent behaviors. The risk of cyberbullying is escalating with the rapid advancement in technology. Therefore, a comprehensive approach should be employed for prediction and prevention of cyberbullying in adolescents.

The Relationship between Geriatric Depression Scale Structure and Cognitive-Behavioral Aspects in Patients with Alzheimer's Disease

BACKGROUND AND PURPOSE: Although the 15-item Geriatric Depression Scale (GDS15) is a widely used depression screening questionnaire, the implications of the GDS15 in patients with Alzheimer's disease (AD) are questionable. We designed this study to explore the GDS15 factor structure and the relationships between these factors and cognitive-behavioral aspects. METHODS: The GDS15, cognitive function tests, and the Korean-Neuropsychiatry Inventory were administered to 310 patients with probable AD, who were not medicated before visiting the hospital. Three factors were identified by principal components analysis. A bivariate correlation analysis was conducted to determine the relationships between factors and neurocognitive and behavior symptoms. RESULTS: Factor 2 was correlated with the Korean Boston Naming Test, calculating ability, the go-no-go test, the Controlled Oral Word Association Test (COWAT), the Color Word Stroop Test (CWST; words and color), aggression, depression, and apathy. Factor 3 was correlated with calculating ability, the Seoul Verbal Learning Test, immediate recall, copy, and delayed recall on the Rey-Osterieth Complex Figure Test, contrasting on the COWAT, and words and delusion on the CWST. We identified three factors and revealed that the GDS15 may be comprised of a heterogeneous scale. CONCLUSIONS: These results suggest that the GDS15 may be comprised of a heterogeneous scale and suggest multi-dimensional properties of the GDS15 in patients with AD.

Clinical Characteristics of Developmental Regression in Autism Spectrum Disorders

OBJECTIVE: A significant proportion of children with autism spectrum disorders (ASD) have regression characterized by loss of previously acquired skills. The purpose of this study was to compare demographic, clinical characteristics and autism-related symptomatology of the children who have regression with children who don't have regression. METHODS: The subjects with ASD and their unaffected siblings (SIB) were recruited from the Korean Autism Genetic Study Consortium. Typically developing children (TC) were volunteered from community. The subjects were administered the Korean version of Autism Diagnostic Interview-Revised (K-ADI-R) and the Korean version of Autism Diagnostic Observation Schedule (K-ADOS) to diagnose or exclude ASD. Regression was defined on the basis of K-ADI-R data. The Korean version of Vineland Adaptive Behavior Scale (K-VABS), Aberrant Behavior Checklist (K-ABC) and Social Responsiveness Scale (K-SRS) were obtained from their parents. RESULTS: Regression occurred in 8.33% (n=14) of children with ASD (n=168). Any SIB (n=166) and TC (n=53) did not experience regression. Regression was associated with lower IQ and lower score of K-VABS. There was no difference in autism symptom severity and K-ABC, K-SRS scores, between children with ASD who experienced regression and who did not. CONCLUSION: Regression seems to be a distinctive feature of ASD. Regression is associated with cognitive and more general functions, rather than symptoms specific to autism.

A Case of Isolated Ileal Ganglioneuroma

Ganglioneuromas of the gastrointestinal tract are rare, but have an established association with genetic disorders, such as the multiple endocrine neoplasia (MEN) syndrome (type 2b) and neurofibromatosis (type 1). However, solitary ganglioneuromas are not associated with an increased risk for MEN 2b, neurofibromatosis type 1, or any other systemic conditions. Ganglioneuromas of the gastrointestinal tract have been reported to predominantly involve the colon and rectum, and are thereby occasionally detected during colonoscopy or surgery. Although there are no characteristic symptoms of solitary ganglioneuromas, symptoms can be induced by solitary ganglioneuromas, such as abdominal pain, bleeding, or obstruction, depending on the location and size. Herein we report a case of a solitary ganglioneuroma of the ileum. A 34-year-old man sought evaluation at our hospital for anemia. The medical and family histories were benign and there was no history of genetic disorders. The evaluation for anemia revealed iron-deficiency anemia and CT enterography revealed a single mass in the ileum. Laparoscopic resection of the lesion was performed and the pathologic examination confirmed an ileal ganglioneuroma.

A Case of Isolated Ileal Ganglioneuroma

Ganglioneuromas of the gastrointestinal tract are rare, but have an established association with genetic disorders, such as the multiple endocrine neoplasia (MEN) syndrome (type 2b) and neurofibromatosis (type 1). However, solitary ganglioneuromas are not associated with an increased risk for MEN 2b, neurofibromatosis type 1, or any other systemic conditions. Ganglioneuromas of the gastrointestinal tract have been reported to predominantly involve the colon and rectum, and are thereby occasionally detected during colonoscopy or surgery. Although there are no characteristic symptoms of solitary ganglioneuromas, symptoms can be induced by solitary ganglioneuromas, such as abdominal pain, bleeding, or obstruction, depending on the location and size. Herein we report a case of a solitary ganglioneuroma of the ileum. A 34-year-old man sought evaluation at our hospital for anemia. The medical and family histories were benign and there was no history of genetic disorders. The evaluation for anemia revealed iron-deficiency anemia and CT enterography revealed a single mass in the ileum. Laparoscopic resection of the lesion was performed and the pathologic examination confirmed an ileal ganglioneuroma.

Does blastomere biopsy in preimplantation genetic diagnosis affect early serum beta-hCG levels? / 대한생식의학회지

OBJECTIVE: To determine whether the serum beta-human chorionic gonadotropin (hCG) profile following preimplantation genetic diagnosis (PGD) is lower than that of intracytoplasmic sperm injection (ICSI) cycles. METHODS: A total of 129 PGD cycles and 1,161 age-matched ICSI cycles, which resulted in pregnancy (serum beta-hCG> or =5 mIU/mL) on post-ovulation day (POD) 12 were included. We compared the mean serum beta-hCG levels on POD 12, 14, 21, and 28, doubling time of serum hCG, and created a cut-off value for predicting a singleton pregnancy in each group. RESULTS: The mean serum beta-hCG concentration of the PGD group was significantly lower than that of the control group on POD 12, 14, and 21. The doubling time of serum beta-hCG at each time interval showed no significant difference. The cut-off-value of serum beta-hCG for predicting a single viable pregnancy was 32.5 mIU/mL on POD 12 and 113.5 mIU/mL on POD 14 for the PGD group, which was lower than that for the control group. CONCLUSION: Blastomere biopsy may decrease the beta-hCG-producing activity of the trophoblasts, especially in early pregnancy. Setting a lower cut-off value of serum beta-hCG for predicting pregnancy outcomes in PGD may be needed.

Does blastomere biopsy in preimplantation genetic diagnosis affect early serum beta-hCG levels? / 대한생식의학회지

OBJECTIVE: To determine whether the serum beta-human chorionic gonadotropin (hCG) profile following preimplantation genetic diagnosis (PGD) is lower than that of intracytoplasmic sperm injection (ICSI) cycles. METHODS: A total of 129 PGD cycles and 1,161 age-matched ICSI cycles, which resulted in pregnancy (serum beta-hCG> or =5 mIU/mL) on post-ovulation day (POD) 12 were included. We compared the mean serum beta-hCG levels on POD 12, 14, 21, and 28, doubling time of serum hCG, and created a cut-off value for predicting a singleton pregnancy in each group. RESULTS: The mean serum beta-hCG concentration of the PGD group was significantly lower than that of the control group on POD 12, 14, and 21. The doubling time of serum beta-hCG at each time interval showed no significant difference. The cut-off-value of serum beta-hCG for predicting a single viable pregnancy was 32.5 mIU/mL on POD 12 and 113.5 mIU/mL on POD 14 for the PGD group, which was lower than that for the control group. CONCLUSION: Blastomere biopsy may decrease the beta-hCG-producing activity of the trophoblasts, especially in early pregnancy. Setting a lower cut-off value of serum beta-hCG for predicting pregnancy outcomes in PGD may be needed.

Prenatal, Perinatal and Infancy History of Autism Spectrum Disorder

OBJECTIVES: The purpose of this study was to evaluate the prenatal, perinatal, and infancy history of children with autism spectrum disorder (ASD) as compared to unaffected siblings (SIB) and typically developing children (TC). METHODS: Subjects with ASD, their SIB, and TC were recruited. All subjects were assessed using both the Korean version of Autism Diagnostic Interview-Revised (K-ADI-R) and the Korean version of Autism Diagnostic Observation Schedule (K-ADOS) and were subsequently identified as affected or unaffected. Prenatal, perinatal, and infancy history was obtained from the primary caregivers and each facet was compared in those with ASD, the SIB, and the TC groups using SPSS ver. 17.0 (p<.05). RESULTS: 70 individuals with ASD (63 males, 87.94+/-37.8months), 53 SIB (27 males, 85.40+/-48.06 months), and 32 TC (19 males, 104.19+/-23.409 months) were analyzed. The ASD group showed significantly higher rates of insufficient vaccination as they aged age (chi2=15.54, p=.000). Among the scheduled vaccinations, the DPT vaccination (chi2=10.08, p=.006) was insufficient in ASD groups. The ASD group also showed higher rates of sleep disturbances from infancy. Differences in maternal/paternal age at conception, gestational age, and growth parameters at birth were not significantly difference among the three groups. CONCLUSION: These results do not support the previous controversies regarding the relationship between prenatal/perinatal complications and ASD. However, these results indicate that perinatal and prenatal factors may contribute to the development of ASD.

A Study of Sexual Assaults on Children and Adolescents: Based on Data from a One-Stop Service Center

OBJECTIVES: The aim of this study was to identify characteristics of children and adolescents who were victims of sexual assault in Korea. METHODS: The subjects were 60 children and adolescents who visited the one-stop center as victims of sexual assault. The medical records of victims of sexual trauma were retrospectively reviewed. We studied the demographic data of the victims, their relationship to their perpetrator, the characteristics of the assault (frequency, duration, place, type), and the process from sexual assault to treatment. We also paid special attention to how the characteristics of the victims or perpetrators affected the characteristics of the assault or follow-up treatment. RESULTS: There were several differences between sexual assaults committed by strangers and those committed by acquaintances. Sexual assaults committed by acquaintances lasted for a longer period of time than those committed by strangers. In addition, it took more time for victims of sexual assaults committed by acquaintances to seek treatment than those who were victims of sexual assaults committed by strangers. The majority (55.0%) of victims were between 10 and 15 years of age. Forty percent of the perpetrators were teenagers, and two of them were under the age of 10. Voluntary discontinuation of treatment was more frequent in adolescents than in children. CONCLUSION: All teenage victims of sexual assault need some sort of urgent intervention. In addition, approachable methods are needed in order to prevent sexual abuse by strangers or acquaintances.

A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient / 감염과화학요법

Sedosporium apiospermum is a saprophytic fungus commonly found in soil and polluted water. This organism is known as a cause of mycetoma, which may occur in immunocompetent hosts following trauma. However, in immunocompromised patients, S. apiospermum can also cause life-threatening invasive disease, including central nervous system infection or disseminated infection. We report a fatal case of disseminated S. apiospermum infection in a 46-year-old woman after liver transplantation. Eight days postoperatively, she developed pneumonia, followed by altered mentality in the 15 days. A head CT demonstrated multiple brain abscesses. Sputum and stereotactic-aspirated brain abscess culture yielded S. apiospermum. Despite treatment with voriconazole, the patient died of intracranial hemorrhage.

A Case of Disseminated Scedosporium apiospermum Infection in a Liver Transplant Patient / 감염과화학요법

Sedosporium apiospermum is a saprophytic fungus commonly found in soil and polluted water. This organism is known as a cause of mycetoma, which may occur in immunocompetent hosts following trauma. However, in immunocompromised patients, S. apiospermum can also cause life-threatening invasive disease, including central nervous system infection or disseminated infection. We report a fatal case of disseminated S. apiospermum infection in a 46-year-old woman after liver transplantation. Eight days postoperatively, she developed pneumonia, followed by altered mentality in the 15 days. A head CT demonstrated multiple brain abscesses. Sputum and stereotactic-aspirated brain abscess culture yielded S. apiospermum. Despite treatment with voriconazole, the patient died of intracranial hemorrhage.

A Case of Diffuse Large B-cell Lymphoma in a Kidney Transplant Recipient / 대한신장학회잡지

Posttransplant lymphoproliferative disorders (PTLD) is an infrequent but serious complication of transplantation. Previous studies have suggested the terms of reference, "early PTLD" (referring to PTLD that occurs within 1 year of transplantation) and "late PTLD" (PTLD that occurs after 1 year). Early PTLD generally involves a single organ or nodal region and often responds favorably to a decrease in immunosuppression. Late PTLD tends to be disseminated, responds less frequently to a decrease in immunosuppression, and has a dismal prognosis. We encountered a diffuse large B-cell lymphoma in a 44-year-old man who underwent kidney transplantation over 10 years ago, in 1995. In situ hybridization for Epstein-Barr virus showed positive results in tumor cell. With decreased immunosuppressants and chemotheraphy, he is currently in complete remission.

Comparison of Clinical Findings between Autoimmune Pancreatitis with Bile Duct Involvement and Primary Sclerosing Cholangitis / 대한소화기학회지

BACKGOUND/AIMS: The involvement of bile ducts is frequently reported in autoimmune pancreatitis (AIP), which seem to have similar features to primary sclerosing cholangitis (PSC). Recent systematic comparative studies about these diseases are rare in Korea. METHODS: We retrospectively analyzed 26 patients with AIP with bile duct involvement and 30 patients with classic PSC who were diagnosed during the last decade. RESULTS: The mean age of patients was significantly higher in AIP than PSC at the time of diagnosis. There was a preponderance of men in both group, which was more prominent in AIP. The most common symptom in patients with AIP was jaundice, but PSC patients usually visited hospitals due to incidentally detected abnormal liver function tests. Most (26/31) of AIP had bile duct involvement. All of these patients showed narrowing of intrapancreatic common bile ducts and one patient exhibited hilar involvement as well. About 80% of PSC had both intra- and extrahepatic ducts involvement, and the characteristic features involve multifocal strictures. AIP patients showed improvement with steroid treatment, however, most PSC patients showed clinical deterioration. CONCLUSIONS: The clinical and cholangiographic findings of patients with AIP and PSC have many different characteristics. Therefore, further study of two diseases is required for the proper diagnosis and management.

Thirteen Cases of Intrahepatic Biliary Cystadenoma and Cystadenocarcinoma: A Single Center Experience / 대한소화기학회지

BACKGROUND/AIMS: Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCACa) are rare cystic neoplasms that usually arise from the liver. We reviewed the clinicopathologic and radiologic findings of 13 cases of intrahepatic biliary cystic neoplasms. METHODS: Seven patients with BCA and 6 patients with BCACa which were pathologically proven within past 10 years were included in this retrospective study. RESULTS: BCA (7 of 7) was more common in female compared to BCACa (4 of 6). Mean age at diagnosis was 53.4 years (BCA) and 58.5 years (BCACa). Abdominal pain (54%) was the most common presenting symptom. Eleven patients (61.5%) exhibited normal liver function profiles and 5 patients (38%) showed elevated levels of serum CA19-9 levels (mean 894.2 U/mL, range: 78.7-2,080). Mean size of tumor was 11.7 cm (range: 5-15). Most frequent radiologic finding was a single cystic mass with septation. BCACa tended to have intracystic solid portion. The cut surface revealed a unilocular or multilocular cystic mass with mucinous contents. Complete surgical excision was done in 12 patients. After the complete resection, recurrence was observed in 1 case of BCACa. CONCLUSIONS: The possibility of biliary cystic neoplasm should be suspected when an intrahepatic cystic lesion with multiseptation or solid portion is noted on imaging study. In addition, complete excision for definite diagnosis and treatment need to be performed.

Outcome of Intensive Medical Treatments in Patients with Infected Severe Necrotizing Pancreatitis / 대한소화기학회지

BACKGROUND/AIMS: Infection of pancreatic necrosis is one of the leading cause of death in patients with severe necrotizing pancreatits. Because of high mortality rate up to 50%, immediate surgical debridement including pancreatectomy is recommended. However, early surgical treatment still showed high mortality rate and better treatment strategy is required. This study was conducted to evaluate the outcomes of early intensive non-surgical treatments in patients with infected necrotizing pancreatitis. METHODS: This study was based on retrospective analysis of 71 patients with acute severe necrotizing pancreatitis (APACHE II score>or=8, or Ranson's score>or=3, and pancreatic necrosis on CT scan), who were admitted to medical center during past 16 years. Infection of pancreatic necrosis was confirmed by fine needle aspiration, and early intensive medical treatments comprised of prophylactic antibiotics coverage, fluid resuscitation, organ preserving supportive measures, and percutaneous catheter drainage were carried out. RESULTS: Among the enrolled patients, infections were suspected in 46 patients, but fine needle aspirations were done only in 32 patients. In 21 patients, infections of necrotic tissue were confirmed by bacteriology, while other 11 patients showed no evidence of bacterial growth. Of 21 patients with infected necrosis, initial surgical interventions were performed in 2 patients, while initial medical treatments were performed in 19 patients. The success rate of medical treatment group in infected necrotizing pancreatitis was 79% (15/19). The mortality rate of medical treatment group and surgical treatment group was 5% (1/19) and 50% (1/2). CONCLUSIONS: Early intensive medical treatment seems to be a good therapeutic strategy, even if the infection has developed in pancreatic necrosis. Further prospective randomized studies are required to confirm this finding.

Initial Experience of Robotic Cardiac Surgery / 대한흉부외과학회지

BACKGROUND: In general, cardiac surgery has been performed via median sternotomy. During the past decade, improvements in endoscopic equipment and operative techniques have resulted in development of minimally invasive cardiac operation using small incisions. With the advent of a voice controlled camera-holding robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning), cardiac surgery entered the robotic age. MATERIALS AND METHOD: Between April 2004 and December 2004, a total of seventy eight patients underwent robotic cardiac surgery, of whom sixty four patients underwent robot-assisted minimally invasive cardiac surgery via 5cm right lateral minithoracotomy using voice controlled robotic arm, femoral vessels cannulation, percutaneous internal jugular cannulation, transthoracic aortic cross clamp. Other fourteen patients underwent MIDCAB via internal mammary artery harvesting using AESOP. RESULT: Robotic cardiac surgery were mitral valve repair in 37 cases, mitral valve replacement in 10 cases, aortic valve replacement in 1 case, MIDCAB in 14 cases, ASD operation in 9 cases, and isolated Maze procedure in 1 case. In mitral operation, mean CPB time was 165.3+/-43.1 minutes and mean ACC time was 110.4+/-48.2 minutes. Median length of hospital stay was 6 days (range 3 to 30) in mitral operation, 4 days (range 2 to 7) in MIDCAB, and 4 days (range 2 to 6) in ASD operation. For complications, 3 patients were required by reoperation for bleeding. There was no hospital mortality. CONCLUSION: Our experience of robot cardiac surgery suggests that many cardiovascular surgeons will be able to perform minimally invasive cardiac operations through small incisions with robot-assisted video-direction. Well-designed studies and close long- term follow-up will be required to analyze the benefits of robot-assisted operation.

Expression of Voltage-dependent Na+ Channels in the Albino Guinea Pig Cochlea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The endolymph produced from cochlear lateral wall regulates fluid and maintains positive endocochlear potential. Although many immunohistochemical studies of ion transport enzymes in the cochlear lateral wall have been reported, their mechanisms are still not completely understood. And there are no reports on the studies of anti-Na+ channels in the cochlea of the guinea pig. The voltage-dependent ion channels are fundamental components of neuronal activity. The Na+ channel has a single alpha subunit with 4 pseudosubunits of 6 transmembrane segments each. Expression of the pore-forming and voltage-sensing alpha or alpha1 subunit typically leads to the appearance of channels with voltage- and time-dependent gating and ion conductance. The purpose of this study is to evaluate the expression of the Na+ channel type I and II in the cochlea lateral wall. MATERIALS AND METHODS: We investigated the protein identification by western blot after homogenization and immunohistochemical localization by FITC to the anti-Na+ channel type I and II in the cochlea of the Preyer's positive, white guinea pigs. RESULTS: The results showed that the anti-Na+ channel type I and II were expressed strongly in the intermediate cells of the stria vascularis, and weakly in the stria vascularis. CONCLUSION: We suggest that there are voltage-dependent Na+ channels in the stria vascularis of cochlea and those functions are further evaulated physiologically by the patch clamp technique.

Primary common bile duct closure and antegrade stent insertion in choledocholithiasis patients / 한국간담췌외과학회지

BACKGROUND/AIMS: After common bile duct exploration, placement of drainage tube was accepted as the standard treatment for choledocholithiasis patients. But placement of the drainage tube may create several complications including bile leakage. We undertake primary common bile duct closure with temorary antegrade stent after common duct exploration in cholodocholithiasis patients to prevent the complications due to drainage tube. METHODS: Between Febuary 1999 and January 2001, 38 patients underwent primary common bile duct closure with antegrade stent after common bile duct exploration without the placement of drainage tube. The study population included 19 men and 19 women with a median age of 61 years (range 26 to 84 years). Laparoscopic choledochotomy was perfromed in 10 patients . Open choledochotomy was performed in 28 patients. Antegrade stent was inserted using choledochoscope. RESULTS: Postoperative hospital stay of the laparoscopic choledochotomy patients were 6 +/- 1.8 days and of the open choledochotomy patients were 10 +/- 4.3 days. Antegrade stent was spontneously passed through the papailla and disappeared in the abdomen in 22 +/- 12.4 days postoperatively. Treatment-related morbidity was seen in 2 cases ( 5.3 %). CONCLUSION: Primary common bile duct closure with temporary antegrade stent after common bile duct exploration is a safe, effective alternative to the routine T-tube drainage in the choledocholithiasis patients.