Although the measurement of tear film break-up time (BUT) is the most frequently used diagnostic test for dry eye syndrome, there have been no reports for the relationship between clinical manifestations of dry eye patients and the degree of their BUTs. To investigate the relationship, we analyzed retrospectively clinical manifestations of 466 dry eye patients and categorized them into two groups in terms of BUT, the group of BUT <5 seconds and BUT >or=5 seconds, in various clinical manifestations. The two groups were compared by X2-test and the results were as follows. The two groups did not show statistically significant difference in sex, age, duration of symptoms, degree of corneal erosion, and time from the beginning of management to symptom improvement. Therefore we thought that there was no statistically significant correlation beteween the above-mentioned clinical manifestations of this study patients and their BUT's. There were more patients whose BUT were below 5 seconds than those having BUT above 5 seconds in group complaining foreign body sensation as a main symptom and in group having associated chronic conjunctivitis. (BUT, dry eye)
Conjunctivitis ; Diagnostic Tests, Routine ; Dry Eye Syndromes ; Foreign Bodies ; Humans ; Retrospective Studies ; Sensation ; Tears

Mucinous cholangiocarcinoma, characterized by large quantities of mucin production, is a rare subtype of peripheral cholangiocarcinoma and usually shows rapid progression and a fatal outcome. We report here a case of mucinous cholangiocarcinoma in a 69 year-old man, who was infected with Clonorchis sinensis. Histologically, the tumor was an adenocarcinoma with extensive intracellular and extracellular mucin production, up to 70% of the tumor mass and there was frequent lymphovascular invasion of the tumor cells. The liver adjacent to the mass contained eggs of Clonorchis sinensis in the bile duct lumen and showed ductal epithelial hyperplasia, mucinous metaplasia and adenomatous proliferation of intramural glands. The patient was treated with a right hepatectomy. Four months after the surgery, the tumor recurred in the soft tissue of the right flank.
Aged ; Bile Duct Neoplasms/*complications/secretion ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*complications/secretion ; Clonorchiasis/*complications ; English Abstract ; Humans ; Male ; Mucins/secretion

In Order to evaluate determinants of successful percutaneous transluminal coronary angioplasty (PTCA), PTCA was performed for 172 coronary arterial lesions in 120 patients(89 male, 31 female) at Yeungnam university hospital from Sep. 1992 to Aug 1993. The corinary artery luminal diameter at the site of the original stenosis was eveluated from end-diastolic frames of identical projections of the preangioplasty and immediate post angioplasty. The coronary luminal and balloon diameters were measured with using of computer measuring system. Overall success rate of 172 attempted lesions was 87.2%. Success rate of female patients was 93.5% and higher than those of male patients. According to the clinical diagnosis, success rate in stable angina was 93.7% and higher than those of post myocardial infarction angina, unstable angina and acute myocardial infarcrion. Success rate of American Heart Association type C lesion was 65.5% and lower those of type A(95.7%), type B (89.%). There was significantly difference in preangioplasty luminal stenosis, elastic recoil and length of lesion between successful PTCA group and failed PTCA group. Success rate of lesion location at a bed >45° and presence of intracoronary thrombus were lower than than those of other angiographic findings. In coclusion, primary angioplasty success was affected by specific angiographic factors, Stenosis severity, thrombus, lesion location at a bend >45°, elastic recoil, and length of lesion were the principle of determinants of coronary angioplasty success rate.
American Heart Association ; Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary* ; Arteries ; Constriction, Pathologic ; Diagnosis ; Female ; Humans ; Male ; Myocardial Infarction ; Phenobarbital ; Thrombosis

The development of back pain following epidural analgesia is one reason for patient refusal of neuraxial analgesia. The primary endpoint of this study was to compare the incidence and severity of back pain following midline and paramedian epidural technique. The secondary endpoint was to identify the risk factors associated with the occurrence of back pain. Methods: This prospective randomized study included 114 patients receiving thoracic epidural catheterization for pain management following upper abdominal or thoracic surgery. Patients were allocated to either the midline or the paramedian group by computer-generated randomization. An investigator who was blinded to the patient group interviewed patients at 24, and 48 h, and 3–5 days after surgery about the existence of back pain and its severity. Results: The total incidence of back pain following epidural anesthesia was 23.8% in the midline group and 7.8% in the paramedian group. The numerical rating scale of back pain was not different between the two groups at 24 h and 4 days after surgery. The paramdian technique was associated with a lower incidence of back pain than the midline technique (95% confidence interval 0.05–0.74, odds ratio 0.2, P < 0.01). However, the number of attempts, surgical position, body mass index, and duration of surgery were not associated with back pain. Conclusions: This study showed that the midline group of thoracic epidural analgesia demonstrated higher incidence of back pain than the paramedian group. However, the pain was mild in intensity and decreased with time in both groups.

BACKGROUND/AIMS: Rapid urease tests are used commonly for the detection of H. pylori. These tests are inexpensive and can be done easily and rapidly in the endoscopy room. A new rapid urease test, Hp Kit test, was developed for the first time in Korea. The test kit has two wells for two biopsies taken from each gastric antrum and corpus. We performed this study to estimate the diagnostic usefulness of Hp Kit test for the detection of H. pylori. METHODS: In one hundred patients undergoing gastroscopy, biopsy specimens were taken for Hp Kit test, polymerase chain reaction, culture, and histologic examination (Warthin-Starry stain). The 13C-urea breath test was also performed. The results of Hp Kit test were read after 2 hours. RESULTS: The sensitivity, specificity, positive and negative predictive value of Hp Kit test to diagnose H. pylori infection were 90.0%, 97.5%, 98.2%, and 86.7%, respectively. The positive reactions in only one well were observed in 12.9% of true positives with Hp Kit test. The reaction times of the Hp Kit test were 35.2+/-21.4, 26.6+/-15.3, and 17.8+/-15.8 minutes (mean+/-S.D.) at grade 1, 2, and 3, respectively (r=-0.3, p<0.05), therefore the results were usually observed within 1 hour. CONCLUSIONS: Hp Kit test has a high sensitivity and specificity, and may be used as an alternative rapid urease test to diagnose H. pylori infection.
Biopsy ; Breath Tests ; Endoscopy ; Gastroscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Polymerase Chain Reaction ; Pyloric Antrum ; Reaction Time ; Sensitivity and Specificity ; Urease

BACKGROUND/AIMS: Pronto Dry test, a new rapid urease test, is consisted of a dry filter paper containing urea and has been reported to have a more rapid reaction time than others. We performed this study to compare the accuracy of Pronto Dry test with the other conventional tests for detection of H. pylori. METHODS: One hundred patients underwent gastroscopy in our hospital for gastrointestinal symptoms. Biopsy specimens were taken for Pronto Dry test, polymerase chain reaction, culture, and histologic examination (Warthin-Starry stain). 13C-urea breath test was also performed. The results of Pronto Dry test were read after 1 hour. RESULTS: The sensitivity, specificity, positive and negative predictive value of Pronto Dry test to diagnose H. pylori infection were 90.0%, 100%, 100%, and 90.9%, respectively. The kappa statistic between H. pylori status and Pronto Dry test was 0.90, demonstrating an acceptable level of reliability. CONCLUSIONS: Pronto Dry test has a high sensitivity and specificity, and can be used as a rapid test to diagnose H. pylori infection.
Biopsy ; Breath Tests ; Diagnosis* ; Gastroscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Polymerase Chain Reaction ; Reaction Time ; Sensitivity and Specificity ; Urea ; Urease

BACKGROUND/AIMS: Pronto Dry test, a new rapid urease test, is consisted of a dry filter paper containing urea and has been reported to have a more rapid reaction time than others. We performed this study to compare the accuracy of Pronto Dry test with the other conventional tests for detection of H. pylori. METHODS: One hundred patients underwent gastroscopy in our hospital for gastrointestinal symptoms. Biopsy specimens were taken for Pronto Dry test, polymerase chain reaction, culture, and histologic examination (Warthin-Starry stain). 13C-urea breath test was also performed. The results of Pronto Dry test were read after 1 hour. RESULTS: The sensitivity, specificity, positive and negative predictive value of Pronto Dry test to diagnose H. pylori infection were 90.0%, 100%, 100%, and 90.9%, respectively. The kappa statistic between H. pylori status and Pronto Dry test was 0.90, demonstrating an acceptable level of reliability. CONCLUSIONS: Pronto Dry test has a high sensitivity and specificity, and can be used as a rapid test to diagnose H. pylori infection.
Biopsy ; Breath Tests ; Diagnosis* ; Gastroscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Polymerase Chain Reaction ; Reaction Time ; Sensitivity and Specificity ; Urea ; Urease

BACKGROUND/AIMS: The prevalence of Barrett's esophagus might also be changing along with changes in the epidemiology of GERD, and the incidence of Barrett's cancer is expected to increase even more. The aim of this study is to evaluate the clinicopathologic features and outcome of the patients with Barrett's cancer and who were seen at a single institution over a period of 13 years. METHODS: The records of 39 patients with the esophageal adenocarcinoma and who were treated at Samsung Medical Center from January 1995 to August 2008 were reviewed. Among them, 11 patients (28%) with histologically-confirmed Barrett's cancer were included in the study. The clinicopathological features, endoscopic manifestations and treatment outcome were evaluated. RESULTS: The male to female ratio was 10:1. The mean age was 64 years. Most of the patients were diagnosed with Barrett's cancer after 2000, and there were three such patients (27.3%) in 2008. The frequent chief complaints were epigastric pain (27.3%) and chronic acid reflux symptom (18.2%). Three patients (27.3%) were detected incidentally during screening endoscopy. The macroscopic types based on the endoscopic findings were as follows: 4 lesions with a type IIa appearance (36.4%) and 2 with a type IIb appearance (18.2%). The mean tumor size was 1.2 cm at the longest dimension and 0.8 cm at the shortest dimension. Tumor was located in the mucosal layer in six cases (54.5%) and the 5 cases (45.5%) showed submucosal invasion. Lymph node metastasis was found in one case (9.1%). All the cases underwent surgery, except one case for which the tumor was removed by endoscopic submucosal dissection. There was no recurrence during the follow up period. CONCLUSIONS: As the incidence of Barrett's cancer is increasing, a standard surveillance program that includes the endoscopic biopsy method, the grading system for the dysplasia and the treatment modality should be established.
Adenocarcinoma ; Barrett Esophagus ; Biopsy ; Endoscopy ; Female ; Follow-Up Studies ; Gastroesophageal Reflux ; Humans ; Incidence ; Korea ; Lymph Nodes ; Male ; Mass Screening ; Neoplasm Metastasis ; Prevalence ; Recurrence ; Treatment Outcome

Serotonin syndrome, an adverse drug reaction, is a consequence of excess serotonergic agonism of central nervous system receptors and peripheral serotonergic receptors. Serotonin syndrome has been associated with large numbers of drugs and drug combinations, and serotonin-norepinephrine reuptake inhibitor-induced serotonin syndrome is rare. It is often described as a sign of excess serotonin ranging from tremor in mild cases to delirium, neuromuscular rigidity, and hyperthermia in life-threatening cases. Diagnosis is based on the symptoms and patient's history, and several diagnostic criteria have been developed. We experienced a rare case of fibromyalgia accompanied by tremor, hyperreflexia, spontaneous clonus, muscle rigidity, and diaphoresis after 10 days of single use of duloxetine 30 mg. Only one case of serotonin syndrome resulting from administration of duloxetine has been reported in Korea, however that case resulted from co-administration of fluoxetine. We report here on this case along with a review of the relevant literature.
Central Nervous System ; Delirium ; Diagnosis ; Drug Combinations ; Drug-Related Side Effects and Adverse Reactions ; Duloxetine Hydrochloride* ; Felodipine ; Fever ; Fibromyalgia* ; Fluoxetine ; Humans ; Korea ; Muscle Rigidity ; Reflex, Abnormal ; Serotonin Syndrome* ; Serotonin* ; Tremor

A 45-year-old male with alleged asymptomatic hepatic hemangioma of 4 years duration had right upper-quadrant pain and was referred to a tertiary hospital. Computed tomography and magnetic resonance imaging scans revealed a hypervascular mass of about 7 cm containing intratumoral multilobulated cysts. A preoperative liver biopsy was performed, but this failed to provide a definitive diagnosis. The patient underwent a partial hepatectomy of segments IV and VIII. The histologic findings revealed multifocal proliferation of flattened or cuboidal epithelioid cells and a highly vascular edematous stroma. Immunohistochemistry findings demonstrated that the epithelioid tumor cells were positive for cytokeratin (AE1/AE3), vimentin, calretinin, and cytokeratin 5/6, and were focally positive for CD10, and negative for WT1 and CD34, all of which support their mesothelial origin. Immunohistochemistry for a mesothelial marker should be performed for determining the presence of an adenomatoid tumor when benign epithelioid cells are seen.
Adenomatoid Tumor/*diagnosis/pathology/surgery ; Calcium-Binding Protein, Vitamin D-Dependent/metabolism ; Hemangioma/*diagnosis/pathology/surgery ; Hepatectomy ; Humans ; Keratins/metabolism ; Liver Neoplasms/*diagnosis/pathology/surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neprilysin/metabolism ; Tomography, X-Ray Computed ; Vimentin/metabolism