Cirrhotic patients may exhibit circulatory derangement and renal dysfunction during the clinical course. Renal dysfunction on cirrhosis can occur without specific causative factors. This functional renal failure in cirrhosis is considered as a consequence of renal vasoconstriction. These alteratons of renal hemodynamics are already present in the early phase of the disease, even in the condition that the conventional kidney function tests are normal. A new method for noninvasive evaluation of arterial tone is duplex Doppler sonography. Among the various sonographic indices proposed, the renal resistive index(RI) is the most widely used for the estimation of intrarenal arteriolar vascular resistence.

This study was performed to evaluate the role of Doppler sonography in early detection of renal dysfunction and to assess the clinical significance of RI. In 25 cirrhotic patients without overt kidney failure and ten control subjects, the RI of the acurate artery in both kidneys was measured by Doppler sonography. The mean RI of cirrhotic group was significangly higher than that of control subjects(0,68±0.08 vs -0.62±0.05,p<0). Accordiing to Child class, the RI showed increasing tendency from A to C, through witout statistical significance. In this study, the RI was significantly inversely correlated with 24hr urinary sodium amount(r=-0.39, p<0,05)and correlated with serum creatinine(r=6.60,p<0.01). This study indicates that the measurement of RI is a sensitive method to assess intarenal hemodynamics and to detect early changes of the renal dysfunction in cirrhotic patients.

Hepatocellular carcinoma(HCC), a highly malignant tumor with a poor prognosis, is one of the common cancers in Korea like other Asian and African countries. Despite of recent advances in diagnostic and surgical techniques, early diagnosis of HCC is difficult and chance of surgical resection is still very low due to the multiplicity of tumor and associated liver cirrhosis. Transcatheter arterial chemoembolization(TAE) is a proven effective method of treating HCC regardless of operability.

The current study was undertaken on 111 cases to evaluate the survival period of the pat-ients with HCC and to find their prognostic factors.

The results were as follows:

1) The mean age of the patients was 54.8 years, with a range from 33 to 79 years. The highest incidence of age was in the 6th decade and the male to female ratio was 4.6:1.

2) The survival period of the patients was significantly related to serum albumin, SGOT, bilirubin and treatment(TAE).

3) The survival period was not significantly related to size and type of tumor.

4) The revised staging systems by Primack and Okuda were not significantly related to the survival period. But Child's classification was significantly related to the survival period.

5) The median survival period of TAE group was 11 months while non-TAE group was 0.5 month(p=0.0023).

6) Multivariate Cox regression analysis showed that the treatment modality(TAE or non-TAE group) was the factor with the greatest relative risk and an independent prognostic value.

Accordingly, it is suggested that TAE is an effective method for treating unresectable HCC, and the prospective investigations on TAE are needed.

We studied the clinical features of 43 patients of trberculous peritonitis who had been admitted to Ewha Womans University Hospital from January, 1984 to December, 1994. The results are summarized as followings :

1) The male to female ratio was 1:2.3 and the peak incidence was between 21 and 30 years of age.

2) Chief complaints were abdominal distension(65.1%), and abdominal pain(51.2%). Besides these symptoms, indigestion, diarrhea, abdominal mass and general weakness were also noted.

3) Physical findings were abdominal tendemess(53.5%), abdominal mass(32.6%), jaundice(14.0%) and heparomegaly(2.3%)

4) The mean values of hemoglobin, WBC and ESR were 11.9g/dl. 8,300/mm³, and 65mm/hr respectively

5) The ascitic fluid analysis showed that the specific gravity was 1.031, protein concentration 5.0g/dl, mean lymppcyte percentage 98%, and the mean ADA activity was 61u/l.

6) On chest X-ray, the findings related to the pulmonary tuberculosis were noted in 26 patients(60.5%).

Double pylorus is one of the rare anomalies of gastrointestinal tract, which have an accessory canal connecting the distal stomach to the duodenal bulb. The majority of the cases is thought to be acquired lesions from ulcer disease except some congenital cases. We report a case of a 77 year-old male who was visited the hospital because of the melena and diagnosed double pylorus. The relevant literatures on subject were reviewed.

A gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and expresses CD117, a c-kit proto-oncogene, which can be detected immunohistochemically. We reported a GIST of the rectum of a 61-year-old-woman who had visited emergency room complaining of constipation over one week. Upon rectal examination, a round hard mass was palpated. Colonoscopy showed a 7×5 cm sized protruded lesion with surface ulceration on a rectum, adjacent the anus. And abdomen computed tomography revealed the soft tissue mass compressing anterolateral wall of the rectum and these findings suggest possibility of rectal submucosal tumor such as GIST. The patient had been treated with a ultra anorectal anastomosis with loop ileostomy. Immunohistochemical studies on the surgically resected specimen showed c-kit (+) and CD34 (+). The final diagnosis was a GIST of the rectum. She was grouped into high risk and she has been given adjuvant chemotherapy with Imatinib.

Acute appendicitis is the one of the most common operative disease in general surgery following by acute cholecystitis and intestinal obstruction, and most of the acute appendicitis is diagnosed at the emergency room.

Especially, because the number of patient who present atypical symptoms of acute appendicitis increases, it is hard to be diagnosed as acute appendicitis and it is often misdiagnosed as other disease.

We report one case of acute appendicitis diagnosed by colonoscopy performed to evaluate for atypical abdominal pain.