No abstract available.
Biopsy, Needle* ; Needles*

Cast formation of biliary sludge leading to obstruction and cholangitis have been reported in patients who received orthotopic liver transplantation. The pathogenesis of biliary cast after orthotopic liver transplantation appeared to be multifactorial. Cold ischemic damage, immunologic attack to the bile duct and bile stasis may have played a role. On the other hand, only three cases of biliary cast have been reported in non-transplanted patients. We described the successful endoscopic removal of this complication in a 70-year-old man whose biliary sludge aggregated into firm casts occupying the extrahepatic ducts which has been developed after cholecystectomy and segmentectomy for intrahepatic cholangiocarcinoma. We speculated on the hemolysis and prolonged fasing as the initiating events but the exact pathogenesis of biliary cast remains to be clarified.
Aged ; Bile ; Bile Ducts ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Cholecystectomy ; Hand ; Hemolysis ; Humans ; Liver Transplantation ; Mastectomy, Segmental ; Cholangiocarcinoma

Cast formation of biliary sludge leading to obstruction and cholangitis have been reported in patients who received orthotopic liver transplantation. The pathogenesis of biliary cast after orthotopic liver transplantation appeared to be multifactorial. Cold ischemic damage, immunologic attack to the bile duct and bile stasis may have played a role. On the other hand, only three cases of biliary cast have been reported in non-transplanted patients. We described the successful endoscopic removal of this complication in a 70-year-old man whose biliary sludge aggregated into firm casts occupying the extrahepatic ducts which has been developed after cholecystectomy and segmentectomy for intrahepatic cholangiocarcinoma. We speculated on the hemolysis and prolonged fasing as the initiating events but the exact pathogenesis of biliary cast remains to be clarified.
Aged ; Bile ; Bile Ducts ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Cholecystectomy ; Hand ; Hemolysis ; Humans ; Liver Transplantation ; Mastectomy, Segmental ; Cholangiocarcinoma

OBJECTIVE: To identify the accuracy and efficiency of the computed tomographic (CT)-based navigation system on upper cervical instrumentation, particularly C1 lateral mass and C2 pedicle screw fixation compared to previous reports. METHODS: Between May 2005 and March 2014, 25 patients underwent upper cervical instrumentation via a CT-based navigation system. Seven patients were excluded, while 18 patients were involved. There were 13 males and five females; resulting in four degenerative cervical diseases and 14 trauma cases. A CT-based navigation system and lateral fluoroscopy were used during the screw instrumentation procedure. Among the 58 screws inserted as C1-2 screws fixation, their precise positions were evaluated by postoperative CT scans and classified into three categories : in-pedicle, non-critical breach, and critical breach. RESULTS: Postoperatively, the precise positions of the C1-2 screws fixation were 81.1% (47/58), and 8.6% (5/58) were of non-critical breach, while 10.3% (6/58) were of critical breach. Most (5/6, 83.3%) of the critical breaches and all of non-critical breaches were observed in the C2 pedicle screws and there was only one case of a critical breach among the C1 lateral mass screws. There were three complications (two vertebral artery occlusions and a deep wound infection), but no postoperative instrument-related neurological deteriorations were seen, even in the critical breach cases. CONCLUSION: Although CT-based navigation systems can result in a more precise procedure, there are still some problems at the upper cervical spine levels, where the anatomy is highly variable. Even though there were no catastrophic complications, more experience are needed for safer procedure.
Cervical Vertebrae ; Female ; Fluoroscopy ; Humans ; Male ; Spine* ; Tomography, X-Ray Computed ; Vertebral Artery ; Wounds and Injuries

OBJECTIVE: Stenotrophomonas maltophilia has been emerging as an important nosocomial pathogen in recent years in patients with impaired host- defense mechanism or who has been exposed to large amount of inocula. This organism is usually resistant to multiple (commonly used) antimicrobial agents, particularly to those of the beta-lactam class. To evaluate the clinical feature of Stenotrophomonas maltophilia infection and in vitro anti- microbial susceptibility, we performed a retrospective study. METHODS: We analyzed the result of in vitro antimicrobial susceptibility test for 200 isolates of S. maltophilia and the annual isolation rate during the period between January 1990 and December 1994 in our institution, and performed a retrospective study for the available records of 165 cases among them. The data were obtained with only the first isolation of the organism for each patients. RESULTS: Total of 165 initial isolates, the isolates were from wounds in 50(30.3%), urine in 47(28.5%), the respiratory tract in 37(22.4%), blood in 9(5.5%), bile in 6(3.6%), and miscellaneous sources in 16(9.7%). The 84.2% of isolates were hospital-acquired isolate and 58.3% of these patients had received antecedent antibiotic therapy: polymicrobial growth was demonstrated in 61.9% of the cases. In vitro antimicrobial susceptibiiity test, ofloxacin was active against the isolates in 89.2%, moxalactam in 85.9%, ciprofloxacin in 83.9%, TMP-SMX(trimethoprim-sulfamethoxazole) in 64.2%, As expected, S. maltophilia isolates were, in general, not susceptible to cephalosporins, penicillins. The annual isolation rate at Kyung Hee University hospital was not increased significantly from 1990 to 1994, 19.53 per 10,000 patients dismissals in 1990, 13.56 in 1994. The major underlying diseases of patients were malignancy(17.6%), cerebrovascular disorder(17%), diabetic mellitus(13.3%). Mortality rate is 10.3%. CONCLUSION: S. maltophilia has been emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad-spectrum antimicrobial therapy. And this organism is resistant to multiple antimicrobial agents, particularly to those of the beta-lactam class. When antimicrobial treatment is necessary, the clinician should be guided by results of in vitro susceptibility testing because of the notable in vitro resistance of S. maltophilia to commonly used antibiotics. And when S. maltophilia has been recovered from a patient, wound and contact isolation is warranted.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bile ; Cephalosporins ; Ciprofloxacin ; Humans ; Immunocompromised Host ; Mortality ; Moxalactam ; Ofloxacin ; Penicillins ; Respiratory System ; Retrospective Studies ; Stenotrophomonas maltophilia ; Stenotrophomonas* ; Wounds and Injuries

PURPOSE: To report drug-resistant fungal keratitis that was treated with voriconazole. CASE SUMMARY: A 31-year-old man was admitted to hospital because of ocular pain, conjunctival injection, and visual weakness 7 days after LASIK surgery. At that time, his vision was counting finger at 30 cm and he presented with corneal epithelial defects, stromal infiltration, and inflammation in the anterior chamber of his eye. He was transferred to our hospital because his infection was resistant to gatifloxacin, tobramycin, amphotericin B, and natamycin eyedrops. At the time of transfer, his vision was counting finger at 30 cm and he presented with corneal epithelial defects, stromal infiltration, and hypopyon. He was treated with topical 2% voriconazole every 2 hours and the lesion improved. However, the hypopyon recurred after 12 days. He was then treated with intracameral voriconazole injection (50 microgram/0.1 cc) and topical 5% voriconazole every hour causing the hypopyon to disappear. His vision improved from counting finger to 20/40 six months after this treatment.
Adult ; Amphotericin B ; Anterior Chamber ; Eye ; Fingers ; Fluoroquinolones ; Humans ; Inflammation ; Keratectomy, Subepithelial, Laser-Assisted ; Keratitis ; Keratomileusis, Laser In Situ ; Natamycin ; Ophthalmic Solutions ; Pyrimidines ; Tobramycin ; Triazoles ; Vision, Ocular

The Mentor inflatable penile prosthesis was designed to decrease the incidence of mechanical failures associated with the Scott inflatable penile prosthesis. The penile cylinders of the Mentor prosthesis are manufactured from Bioflex polyurethane, which is more resistant to abrasion and relatively in elastic than silicone. the material of the Scott prosthesis. The Mentor prosthesis also has a connector system which employs plastic snap-lock ring clamps rather than suture ties to fix tubings to connector. We experienced a case of Mentor inflatable penile prosthesis for vasculogenic erectile impotence in a42 year old male.
Erectile Dysfunction* ; Humans ; Incidence ; Male ; Mentors* ; Penile Prosthesis* ; Plastics ; Polyurethanes ; Prostheses and Implants ; Silicones ; Sutures

OBJECTIVE: We report an analysis of the clinical outcome of surgical treatment of lumbar facet cyst. METHODS: From March, 1996 to June, 2001, we analyzed the symptom and sign, cyst level, combined disease, treatment method, pathology and surgical result(Prolo's scale) of 11 patients. RESULTS: Mean age of 11 patients was 55.6 years and mean follow up duration was 27 months. Of 11 patients, six cases had low back pain and five cases had radiating leg pain as chief complaint. Five had only facet cyst that compressed the nerve root without other combined diseases. Of six patients who had facet cyst with combined disease, three had intraspinal stenosis and the remaining three had spondylolytic spondylolisthesis. There was one case of bilateral facet cyst. We had totally excised facet cyst and treated combined degenerative disease such as lumbar stenosis, lumbar instability or spondylolytic spondylolithesis. The pathologic result were synovial cyst for eight cases and ganglion for three cases. In all cases, symptoms improved without complication or recurrence. CONCLUSION: Surgical outcome of lumbar facet cyst is good and surgical intervention is recommended in facet cyst with back pain, radiculopathy and combined degenerative diseases.
Back Pain ; Constriction, Pathologic ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Leg ; Low Back Pain ; Pathology ; Radiculopathy ; Recurrence ; Spondylolisthesis ; Synovial Cyst

Nesidioblastosis is a rare disease characterized clinically by persistent hypoglycemia with inappropriately elevated circulating insulin concentration. Adequate early diagnosis should be established and subtotal pancreatectomy performed before itreversible cerebral damage caused by glucose deficit. The authors got a chance to anesthetize 56-day-old male patient for subtotal pancreatectomy because of nesidioblastosis, Following an induction of anesthesia with intravenous thiapental sodium 5 mg/kg and succinylchohne 1 mg/kg, endotracheal intubation was performed and anesthesia was maintained with pancuronium bromide and O2-N2O-enflurane. Intravenous fluid was maintained with 1-2-3 solution 30 ml and 15% D/W 40 ml mixed with 20 ml of 20 mEq/L NaCI.
Anesthesia* ; Early Diagnosis ; Glucose ; Humans ; Hypoglycemia ; Insulin ; Intubation, Intratracheal ; Male ; Nesidioblastosis* ; Pancreatectomy* ; Pancuronium ; Rare Diseases ; Sodium

Urinary incontinence is one of the most distressing problems in urologic practice. However, recent advances in implantable devices have significantly improved the outlook for patients with incontinence due to sphincter weakness. Herein we report a case of urinary incontinence treated by artificial sphincter (model AMS 800) implantation. A 25-year-old man presented with continuous and total incontinence, which developed after pelvic bone fracture and urethral injury. cystometry was normal, uroflowmetry and urethrography showed no significant bladder outlet obstruction, and urethral closing pressure was significantly decreased. After artificial sphincter implantation to the bladder neck. the patient showed good results both clinically and urodynamically.
Adult ; Humans ; Neck ; Pelvic Bones ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Incontinence*