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

Tumorlet is a rare lesion of disputed origin that was first described by whitwell in 1955, and about one-third of the reported cases have been associated with underlying lung disease. Patient was a 60-year-old female who was admitted with a histroy of chest discomfort and dyspnea. Right lower lobe was partially resected under the clinical diagnosis of the bronchogenic cyst. Grossly, lung tissue around round cystic lesion appeared brown firm and somewhat fibrotic, and showed several scattered ill-defined whitish gray nodules. Microscopically, lung tissue around bronchogenic cyst was partially obliterated by dense fibrous scar tissue. Within this areas of fibrosis, and in the wall of alveolar ducts and respiratory bronchioles, innumerable microscopic tumorlets were found and argyrophilic granules were also demonstrated in scattered tumorlets with Grimelius stain.
Female ; Humans ; Cysts

OBJECTIVES: This study was performed to investigate the effectiveness of the questionnaire. METHODS: Workers'health examination records, work environment record, and questionnaires of selected industries as samples were analysed using logistic regression analysis and discrimination analysis Results'Cases of bearing impairment (Dl+C) as dependent variables, and age, work duration and level of environmental noise as independent variables were selected for multiple unconditional logistic regression analysis. Odds ratio was 4.04 in hearing difficulty, 2.78 in tlnnitus and 1.08 in age. In the second analysis Noise induced hearing loss is selected as dependent variable. The OR in hearing difficulty was 3.67(95 % C.1. : 1.61 8.61), and was 1.09(95 % C.1. : 1.05-1.14) in age. Conditionnal multlple logistic regression analysis was performed. In hearing impairment as dependent variable, the OR of age was 1.02(95 % C.1. : 1.00-1.04) and other variables were not significant. However, NIHL as dependent, the OR of hearing difficulty was 4.57(95 % C.1. : 1.43-14.67). According to multiple logistic regression adopting each items of questionnaire as dependent variable, the only item of hearing difficulty showed significant difference with hearing ability. The discrimination analysis was performed with the class variable of hearing impairment, and discrimination variables of age, work duration, and environment noise level. The sensitivity of 59 %, and specificity of 88 %, and average error count of 23 % were obtained. When the numbers of items answered in questionnaire were assumed as the parameter of judgement for noise induced hearing loss (NIHL), the highest sensitivity and specificity were 33.5% and 49.0% in cases of more than two items answered. CONCLUSIONS: The development of items that is simple and discriminative mainly consisted of chronic and specific diseases related items is needed. Computerization for newly developed items might be needed to establish effective surveillance system for NIHL in the future.
Discrimination (Psychology) ; Hearing Loss* ; Hearing* ; Logistic Models ; Mass Screening* ; Noise* ; Odds Ratio ; Questionnaires* ; Sensitivity and Specificity

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

Proliferating trichilemmal tumor is relatively rare, and is generally considered to be a benign tumor that can be histologically mistaken for well-differentiated squamous cell carcinoma. The proliferating trichilemmal tumor is thought to be a tumor with differentiation toward the hair structure because the characteristic trichilemmal keratinization in this tumor is analogous to that of the outer root sheath of anagen hair or the trichilemmal sac surrounding catagen hair. We report four cases of proliferating trichilemmal tumor removed by surgical excision.

No abstract available.
Malignant Atrophic Papulosis*

No abstract available.
Renal Artery* ; Ureter* ; Veins*

The classic type of Kaposi's sarcoma, or multifocal hemorrhagic sarcoma histologically characterized by proliferating fibroblastic and microvascular elements was described by Kaposi as a relatively rare neoplasm. During the past nine years, we experienced three cases of sporadic, classic Kaposi's sarcomas. They were presented as multiple papules, macules and nodules on the skin of the hands, lower logs and feet without systemic involvement. Histologically, Kaposi's sarcoma is divided into three stages, early patch, plaque and nodular stages. The nodular lesions(case 1, 2 and 3) showed extensive proliferatiion of spindle shaped, somewhat pleomorphic cells having dark prominent nuclei, proliferation of small vessels with solid aggregates of endothelial cells, and extravasation of erythrocytes. In early patch stage(case 3), widely dilated, anastomosing, thin-walled vascular spaces are noted in the upper half of the dermis. In plaque stage(case I and 3), there are proliferation of spindle shaped cells with extravasated erythrocytes and aggregates of blood vessels lined by prominent endothelial cells.

PURPOSE: To compare, through enalysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrone between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. MATERIALS AND METHODS: The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD group (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex, and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. RESULTS: The mean CAC score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.006). The mean CAC score at the sixth decade was also significantly different between group I (81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC+1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly higher than in groups I and II. Multiple regression analysis showed that the CAC score was related to age, diabetes mellitus and hypertension in group I, diabetes mellitus only in group II, but no particular factor in group III. CONCLUSION: The CAC score of the acute coronary syndrome group tended to be lower than that of the chronic CAOD group. It appears to be difficult to predict acute coronary syndrome on the basis of CAC alone. Compared with the asymptomatic high-risk group of atherosclerosis patients, the acute coronary syndrome group, whose members are younger and have a higher incidence of smoking, has a relatively high CAC score.
Acute Coronary Syndrome ; Atherosclerosis* ; Calcium* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Hypercholesterolemia ; Hypertension ; Incidence ; Obesity ; Risk Factors ; Smoke ; Smoking ; Tomography, X-Ray Computed*