The complications of bile duct stone are cholangitis, pancreatitis, obstructive jaundice, liver abscess, and secondary biliary cirrhosis. Liver abscess may produce pyothorax, peritonitis, subphrenic abscess, and pyogenic pericarditis. The case studies of pyogenic pericarditis secondary to pyogenic liver abscess are rarely reported. Stones greater than 20mm in diameter are difficult or impossible to remove with a standard basket or balloon after sphincterotomy. There are several nonsurgical treatment options for large bile duct stone: mechanical lithotripsy, endoprosthesis, extracorporeal shock-wave lithotripsy (ESWL), electrohydraulic lithotripsy, contact dissolution therapy, and laser lithotripsy. We experienced a case of large bile duct stone which complicated by pyogenic pericarditis, liver abscess, and pyothorax. He treated with antibiotics, closed thoracostomy, partial pericardiectomy, and removal of bile duct stones by extracorporeal shock-wave and mechanical lithotripsy after endoscopic sphincterotomy and nasobiliary drainage.
Anti-Bacterial Agents ; Bile Ducts* ; Bile* ; Cholangitis ; Drainage ; Empyema ; Empyema, Pleural* ; Jaundice, Obstructive ; Lithotripsy ; Lithotripsy, Laser ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver Cirrhosis, Biliary ; Liver* ; Pancreatitis ; Pericardiectomy ; Pericarditis* ; Peritonitis ; Sphincterotomy, Endoscopic ; Subphrenic Abscess ; Thoracostomy

Dieulafoy lesion is very small and easily overlooked as a course of massive, often recurrent hemorrhage that results from the crosion of a submucosal artery, typically in the gastric cardia or fundus. The clinical picture of Dieulafoy lesion is quite uniform: patients commonly present with massive hemorrhage and melena without any relevant history. The diagnostic procedure of choice in patients with severe gastrointestinal bleeding is emergency endoscopy. The lesion is rare but potentially life threatening source of upper gastrointestinal bleeding. Before the endoscopic era, the prognosis for patients with these lesions was quite poor. However, recent reports have described the success of endoscopic therapy in the management of Dieulafoy lesion. We performed emergency endoscopy in 3 patients who had massive or recurrent episode of upper gastrointestinal bleeding, identified to the Dieulafoy lesion. We tried to Endoscopic "0" band ligation, successfully in hemostasis and prevention of recurrence.
Arteries ; Cardia ; Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis ; Humans ; Ligation* ; Melena ; Prognosis ; Recurrence

Endoscopic injection sclerotherapy(EIS) has been shown to be the most effective simple method for control of bleeding and eradication of varices. This method has been aceepted widely as a standard treatment of bleeding esophageal varices. However, EIS may be associated with undesirable local and systemic complications. (continue...)
Esophageal and Gastric Varices* ; Hemorrhage* ; Ligation* ; Varicose Veins

BACKGROUND: High-resolution carotid ultrasonography is considered a fundamental technique for the investigation of the vascular system. However, it is still very unclear whether ultrasonographic studies of carotid arteries are useful for the prediction of cardiovascular events in patients with coronary heart disease. We have tried to assess the usefulness of carotid ultrasonography to predict the severity of coronary artery stenosis in the patients with ischemic heart disease. METHODS: We studied in 80 patients(53 men, 27 women) with acute chest pain, mean ages 63.1 10.8 yr(35 to 84 yrs), who underwent both coronary angiography and carotid ultrasonography with 10 MHz transducer. The patients who had received revascularization procedure were excluded. We classified the patients into two groups, the control group without significant coronary stenosis(23 patients) and the coronary artery disease(CAD) group(57 patients) with significant stenosis(>50%). The intima-media thickness (IMT) was measured in the far wall of CCA at 10 mm proximal to carotid bulb and the abnormal IMT was defined when the measurement was greater than mean IMT+2 SD of control group(>0.99 mm). Serum total cholesterolQlC), low density lipoprotein(LDL), high density lipoprotein(HDL), triglyceride(TG) and lipoprotein (a) (LP(a)) were measured and history of hypertension, diabetes mellitus, and smoking were investigated. RESULTS: A significant difference in IMT of the CCA was found between control and CAD group(0.75+/-0.12mm vs. 1.02+/-0.34 mm; p<0.001). Also a significant difference in the existence of plaque(control; 26.1% vs. CAD; 73.7%, p<0.00l) and the number of plaque(control; 0.39+/-0.94 vs. CAD; 2.20+/-1.87 p<0.001) was found. The existence and number of carotid plaque were more conelated with coronary artery stenosis severity than carotid IMT. The sensitivity of IMT for prediction of significant CAD was 42.1%, the specificity 95.7%, the positive predictive value 96%, and the negative predictive value 40%. The sensitivity of plaque presence on the carotid artery for prediction of CAD was 73.7%, the specificity 73.9%, the positive predictive value 87.5% and the negative predictive value 53.1%. Among the risk factors, age and LP(a) were correlated with IMT of CCA, and diabetes, hypertension, age were correlated with the presence of plaque. Smoking and hypertension were correlated with coronary artery disease. CONCLUSION: Carotid atherosclerosis was significantly correlated with severity of coronary atherosclerosis. We therefore suggest that carotid ultrasonography is useful to predict the severity of coronary artery stenosis and that the best index of coronary artery stenosis severity may be carotid plaque rather than carotid intima-media thickness.
Carotid Arteries ; Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Coronary Stenosis* ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Hypertension ; Lipoprotein(a) ; Male ; Myocardial Ischemia ; Risk Factors ; Sensitivity and Specificity ; Smoke ; Smoking ; Transducers ; Ultrasonography*

No abstract available.
Cytokines* ; Mast Cells*

A 38-year-old Korean man was diagnosed with hereditary sensory and autonomic neuropathy (HSAN) type 2 because of his chronic sensory neuropathy and progressive acro-mutilation. Genetic analysis revealed that he was a compound heterozygous for two novel mutations in the HSN2 gene including a nonsense mutation (Gln73X) and a 1-bp insertion mutation (Asp379fsX1). To our knowledge, this is the first report of a genetically confirmed case of HSAN type 2 in the Asian population and supports the genetic homogeneity of this rare disease.
Adult ; Asian Continental Ancestry Group ; Codon, Nonsense ; Hereditary Sensory and Autonomic Neuropathies ; Humans ; Mutagenesis, Insertional ; Rare Diseases

Objective: To identify the clinical characteristics of patients with myasthenia gravis (MG) according to age at onset. Methods: We retrospectively recruited 227 non-thymomatous MG patients with adult onset who had been followed up for more than one year. The patients were classified based on the age of symptom onset as “early-onset MG” (EOMG,18–50 years; N=135), “late-onset MG” (LOMG, 50–64 years; N=53), and “very late-onset MG” (VLOMG, 65 years; N=39). Clinical features and serological findings were compared between these groups. Results: LOMG patients showed more frequent ocular MG (55%) and less frequent thymic hyperplasia (9%) compared to EOMG patients (31% and 38%; p=0.006 and p<0.001, respectively), and no female preponderance compared to VLOMG patients (female, 49% vs.77%; p=0.014). However, there were no significant differences between VLOMG and EOMG patients, except for more frequent thymic hyperplasia (p<0.001) in EOMG patients. When analyzing female patients only, less frequent secondary generalization (10%) were additionally found in LOMG patients, compared to EOMG (47%, p= 0.008) and VLOMG (59%, p=0.004) patients. Anti-acetylcholine receptor antibody (HR, 5.48; 95% CI, 1.73–17.37; p=0.004) was independently associated with secondary generalization in female EOMG patients. Conclusion: Our study suggests that LOMG patients, especially female, were characterized by frequent ocular MG and less frequent secondary generalization, distinguished from EOMG and VLOMG patients. Further large epidemiologic studies in Korea are needed to determine the characteristics of MG patients according to the age at onset and gender.

A squamous odontogenic tumor (SOT) is rare disease and it is believed to originate from epithelial rests of Malassez of the periodontal membrane. Neither sex nor site predilection in either jaw has been established. Some lesion can be shown in juxtaposition in tooth roots. Although most lesions remain smaller than 2 cm, our cases involved a half of left mandibular ramus. The exact pathogenesis is still unknown. We report a case of SOT including the results of immunohistochemical study of pancytokeratin and p53.
Jaw ; Mandible* ; Membranes ; Odontogenic Cysts* ; Odontogenic Tumor, Squamous* ; Rare Diseases ; Tooth Root

This study was performed to investigate the anatomical features of vertebral artery between the atlas and the axis. For this, we examined four angles (angle I, angle II, angle III and angle IV) to identify tortuosity of vertebral artery and diameter between the atlas and the axis. Materials used in this study were 93 vertebral arteries obtained from 48 adult Korean cadavers (34 males, 14 females) ranging from 18 to 90 years in age. On the anterior view, the vertebral artery relatively ascended vertically from C6 to the axis and then laterally passed through the foramen transversarium (FT) of the axis. The average of this angle I was 83.3 degree. The average of the right and left sides of this angle I were 84.7 degree and 82.0 degree, respectively. The average of angle I (95.4 degree) in female was larger than that (80.5 degree) of male. The artery passed through the FT of the axis turned to the superior direction. The average of this angle II was 95.9 degree. The right and left sides of the angle II were 97.8 degree and 93.8 degree, respectively. As the angle I, the average of angle II (110.6 degree) in female was larger than that of angle II (93.1 degree) in male. On the lateral view, the vertebral artery relatively ascended vertically from C6 to the axis and then posteriorly passed through the FT of the axis. The average of this angle III was 71.3 degree. The artery passed through the FT of the axis turned to the superior direction. The average of this angle IV was 87.3 degree. In angle III and angle IV, the average of angle in female were larger than that of male. These results show that female has greater tortuosity than male. The average diameter of the vertebral artery was 3.7 mm and the average diameter of right and left are 3.5 mm and 4.0 mm, respectively. In 76% of the total, left vertebral artery diameter was larger than that of the right.
Adult ; Arteries ; Axis, Cervical Vertebra* ; Cadaver ; Female ; Humans ; Male ; Vertebral Artery*

PURPOSE: We investigated the localizing and lateralizing values of auras in patients with lesional partial epilepsy on an outpatient basis. MATERIALS AND METHODS: A total of 276 subjects were retrospectively selected for this study if they had a unilateral single lobar lesion based on magnetic resonance image (MRI) results, and their scalp electroencephalography (EEG) findings were not discordant with the MRI-defined lobar localization and lateralization. According to the lesion locations, subjects were considered as having mesial temporal (MTLE), lateral temporal (LTLE), frontal (FLE), parietal (PLE), or occipital (OLE) lobe epilepsies. Auras were classified into 13 categories. RESULTS: A hundred and seventy-six subjects (63.8%) had experienced at least one aura. FLE subjects had the fewest number of auras. Epigastric and psychic auras were frequent among MTLE subjects, while visual auras were common in those with PLE and OLE. Somatosensory auras and whole body sensations were more frequent in the subjects with PLE than those without. Autonomic auras were more common in MTLE subjects than in LTLE subjects. Dysphasic auras were more frequently found in left-sided epilepsies. Five pairs of aura categories showed concurrent tendencies, which were the epigastric and autonomic auras, autonomic and emotional auras, visual and vestibular auras, auditory and vestibular auras, and whole-body sensation and auditory auras. Autonomic and emotional auras had a concurrent tendency in left-sided epilepsies, but not in right-sided epilepsies. CONCLUSION: Our results support the previously known localizing value of auras, and suggest that dysphasic auras and the association of emotional and autonomic auras may have a lateralizing value.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Epilepsies, Partial/*pathology ; Epilepsy/*pathology ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Young Adult