BACKGROUND : Anomalous pancreaticobiliary ductal union (APBDU) is a congenital defect defined as a union of the pancreatic and the biliary ducts located outside the duodenal wall. Accordingly, this anomalous connection between the choledochus and the pancreatic duct is considered to be a factor in the development of biliary tract diseases such as choledochal cysts, pancreatitis, cholangitis, gallbladder cancer, and bile duct cancer. Our purpose is to analyze combined disease, especially biliary neoplasm, and to evaluate biliary tract microscopic changes in the biliary tract. METHODS : To study the clinical characteristics of APBDU, we reviewed 21 APBDU cases which were treated from June 1994 to January 1998. We studied the associated diseases, the surgical treatment, histological findings and the PCNA expression. We also analyzed the gallbladder epithelium in 10 control patients without APBDU. RESULTS : Among the 21 cases, 12 cases were accompanied by a choledochal cyst. A gallbladder carci noma occurred in 5 cases. Of the 13 operations, 4 involved a cholecystectomy only, and 9 involved a cholecystectomy, bile duct resection and hepaticojejunostomy. The histologic findings were reviewed in 13 cases. Bile duct metaplasia was found in 8 of the 9 cases with a bile duct resection, and gallbladder metaplasia was found in 8 of the 12 cases whereas metaplasia was detected in 1 of the 10 control patients. The PCNA expression was significantly high in APBDU group. CONCLUSIONS : The patients with APBDU showed a high incidence of gallbladder carcinoma and meta plasia in the epithelium of the gallbladder and the bile duct. This metaplasia in the gallbladder and the bile duct was thought to be related to the cancerous change.
Bile Duct Neoplasms ; Bile Ducts* ; Bile* ; Biliary Tract ; Biliary Tract Diseases ; Cholangitis ; Cholecystectomy ; Choledochal Cyst ; Common Bile Duct ; Congenital Abnormalities ; Epithelium ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Incidence ; Metaplasia ; Noma ; Pancreatic Ducts ; Pancreatitis ; Proliferating Cell Nuclear Antigen

Tinnitus-the perception of sound in the absence of an actual external sound-represents a symptom of an underlying condition rather than a single disease. Several theories have been proposed to explain the mechanisms underlying tinnitus. Tinnitus generators are theoretically located in the auditory pathway, and such generators and various mechanisms occurring in the peripheral auditory system have been explained in terms of spontaneous otoacoustic emissions, edge theory, and discordant theory. Those present in the central auditory system have been explained in terms of the dorsal cochlear nucleus, the auditory plasticity theory, the crosstalk theory, the somatosensory system, and the limbic and autonomic nervous systems. Treatments for tinnitus include pharmacotherapy, cognitive and behavioral therapy, sound therapy, music therapy, tinnitus retraining therapy, massage and stretching, and electrical suppression. This paper reviews the characteristics, causes, mechanisms, and treatments of tinnitus.
Auditory Pathways ; Autonomic Nervous System ; Cochlear Nucleus ; Massage ; Music Therapy ; Otoacoustic Emissions, Spontaneous ; Tinnitus

Adult ; Humans ; Malocclusion ; Orthognathic Surgery ; Surveys and Questionnaires

Patients undergoing maintenance dialysis show an increased susceptibility to tuberculosis because host immunity is decreased secondary to malnutrition, impaired cellular immunity, acidosis and etc. Extrapulmonary tuberculosis is more prevalent in patients with end stage renal disease than in normal subjects. Among the extrapulmonary tuberculosis in patients receiving hemodialysis, the diagnosis of tuberculous spondylitis is difficult because the symptoms are non specific and attributable to uremia, and the appearance of plain radiographs is often normal during the early phase of the disease. We experienced a case of tuberculous spondylitis in a hemodialysis patient. A 55 years old female admitted with fever, weight loss and back pain. Conventional radiograph of T-spine showed no definite abnormal finding. However, chest CT revealed heterogeneously enhancing soft tissue around the T8 vertebral body and T-spine MRI showed compatible finding to tuberculous spondylitis. She received radical excision of involved vertebra and confirmed tuberculous spondylitis with histologic finding from a surgical specimen. Following the administration of anti-tuberculosis medication(isoniazid, rifampin, pyraziamide, ethambutol) and radical excision, patient's symptom and sign were improved. The patient is maintaining dialysis with anti-tuberculosis medication for 5 months.
Acidosis ; Back Pain ; Diagnosis ; Dialysis ; Female ; Fever ; Humans ; Immunity, Cellular ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Malnutrition ; Middle Aged ; Renal Dialysis* ; Rifampin ; Spine ; Spondylitis* ; Tomography, X-Ray Computed ; Tuberculosis ; Uremia ; Weight Loss

BACKGROUND: Autologous or implant-based breast reconstruction after nipple-sparing mastectomy is increasingly preferred worldwide as a breast cancer treatment option. However, postoperative nipple-areola complex (NAC) necrosis is the most significant complication of nipple-sparing mastectomy. The purpose of our study was to identify the risk factors for NAC necrosis, and to describe the use of our skin-banking technique as a solution. METHODS: We reviewed cases of immediate autologous breast reconstruction after nipple-sparing mastectomy at our institution between June 2005 and January 2014. The patients' data were reviewed and the risk of NAC necrosis was analyzed based on correlations between patient variables and NAC necrosis. Moreover, data pertaining to five high-risk patients who underwent the donor skin-banking procedure were included in the analysis. RESULTS: Eighty-five patients underwent immediate autologous breast reconstruction after nipple-sparing mastectomy during the study period. Partial or total NAC necrosis occurred in 36 patients (43.4%). Univariate analysis and binary regression modeling found that body mass index, smoking history, radiation therapy, and mastectomy volume were significantly associated with NAC necrosis. Of the 36 cases of NAC necrosis, 31 were resolved with dressing changes, debridement, or skin grafting. The other five high-risk patients underwent our prophylactic skin-banking technique during breast reconstruction surgery. CONCLUSIONS: NAC necrosis is common in patients with multiple risk factors. The use of the skin-banking technique in immediate autologous breast reconstruction is an attractive option for high-risk patients. Banked skin can be used in such cases without requiring additional donor tissue, with good results in terms of aesthetic and reconstructive outcomes.
Bandages ; Body Mass Index ; Breast Neoplasms ; Breast* ; Debridement ; Female ; Humans ; Mammaplasty* ; Mastectomy* ; Necrosis* ; Nipples ; Risk Factors ; Skin ; Skin Transplantation ; Smoke ; Smoking ; Surgical Flaps ; Tissue Donors

OBJECTIVE: Recently, carotid artery stenting (CAS) has become as the first choice of treatment for carotid artery stenosis. Although there are many differences in the outcomes of patients receiving stents among many different study groups, some reports suggest that stenting can be performed with periprocedural complication rates similar to those of a carotid endarterectomy (CEA). In this study, we investigated 39 cases of CAS. METHODS: From May 2003 to March 2007, 39 patients undergoing CAS were reviewed. We analyzed the 30-day morbidity/mortality rate. A minor stroke was defined as a new neurological deficit that either resolved completely within 30 days or increased the NIH Stroke Scale by< or =3. A major stroke was defined as a new neurological deficit that persisted for 30 days and increased the NIH Stroke Scale by> or =4. RESULTS: Among 39 patients, a minor stroke was noted in three patients (7.7%), and there were no major strokes and deaths. The overall 30-day stroke and death rate was 7.7% (n = 3). CONCLUSION: With the evolution and maturation of equipment and technique, carotid angioplasty and stenting (CAS) is increasingly being used for the treatment of carotid artery disease.
Angioplasty ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Stenosis* ; Endarterectomy, Carotid ; Humans ; Mortality ; Stents* ; Stroke

OBJECTIVES: Peptic ulcer is the major condition that affect numerous individuals every year. In 1983, Warren and Marshall presented the evidence that H. pylori was associated with gastritis and peptic ulcer. Thereafter, K. pylori infection is thought to be a important factor in the pathogenesis of gastric and duodenal ulcer. In western studies, about 58% to 100% of patients with peptic ulcer disease were infected with H. pylori. But in Korea, there is no study about the prevalence of H. pylori infection in peptic ulcer disease despite of its high prevalence and importance. The aim of this study was to investigate the prevalence of H. pylori infection in case of gastric and duodenal ulcer disease in Korea. METHODS: We surveyed the prevalence of H. pylori infection of 1031 patients, who were diagnosed as gastric or duodenal ulcer by gastrofiberoscopy. H. pylori infection was evaluated with Rapid Urease Test(CLO test) and/or histology by Wright-Giemsa staining. RESULTS: 1) Peptic ulcer was more frequently developed in males than females, as the frequency of peptic ulcer was 77% in males, and 23% in females. But in view of the prevalence of H. pylori infection, there was no significant difference between males and females, 73% in males and 71% in females. 2) Gastric ulcer was most common in sixth decade(29.8%), but the prevalence of H. pylori infection was peak in fourth(76%), and fifth decade (73%). 3) Duodenal ulcer was most common in fourth decade(26.3%), but the prevalence of H. pylori infection was peak in teenagers(93%) and third decade(87%). 4) The patients who had both gastric ulcer and duodenal ulcer concurrently were most common in sixth decade(27.9%), but the prevalence of H, pylori infection was peak in third decade(100%). CONCLUSION: We concluded that the majority of peptic ulcer patients in Korea had H. pylori infection. Particularly, young aged patients had higher H. pylori infection rate than old aged.
Duodenal Ulcer* ; Female ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Male ; Peptic Ulcer ; Prevalence* ; Prospective Studies* ; Stomach Ulcer* ; Urease

Propofol (2,6-diisopropylphenol) is an ultrashort-acting sedative agent with sedative and amnestic effects that is used not only for anesthesia but also for sedation during minor outpatient procedures and endoscopic examinations. Rare cases of anaphylaxis following propofol administration have been reported in the medical literature. Documentation of anaphylaxis is often lacking because the cause and effect relationship is often hard to prove. Only a minority of patients get referred for allergy testing to confirm the offending drug. Here we report a 74-year-old woman who had an anaphylactic reaction with severe oropharyngeal edema and bronchospasm for a few minutes after receiving propofol during endoscopic examination. An allergy skin test was positive for both propofol and soybean. Soybean in the intralipid is one component of propofol, and we concluded that this anaphylaxis was caused by soybean.
Aged ; Anaphylaxis ; Anesthesia ; Angioedema ; Bronchial Spasm ; Edema ; Emulsions ; Female ; Humans ; Hypersensitivity ; Outpatients ; Phospholipids ; Propofol ; Skin Tests ; Soybean Oil ; Soybeans

A pre-transplant screening work-up of donors for allogeneic hematopoietic stem cell transplantation (HSCT) is essential. Inadvertent transmission of malignancy from donors with subclinical diseases to recipients has been reported recently in several cases. A 49-year-old male was diagnosed with acute myeloid leukemia. He underwent a course of induction chemotherapy and achieved cytogenetic complete remission (CR). He was treated with an additional cycle of consolidation chemotherapy followed by full matched sibling allogeneic HSCT due to an additional deletion in 9q known as an adverse prognostic factor. Post transplantation bone marrow biopsy revealed molecular CR, but conventional cytogenetics identified the presence of 46,XY,t(1:2)(p32:q35). A cytogenetic analysis of the donor graft specimen revealed t(1:2). We confirmed the donor origin of t(1:2). We report the first case of a person with constitutional t(1;2) serving as a stem cell donor.
Biopsy ; Bone Marrow ; Chromosome Aberrations* ; Consolidation Chemotherapy ; Cytogenetic Analysis ; Cytogenetics ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Induction Chemotherapy ; Leukemia ; Leukemia, Myeloid, Acute ; Male ; Mass Screening ; Middle Aged ; Siblings ; Stem Cells ; Tissue Donors ; Transplants

Most pancreatic pseudocysts are located in or around the pancreas, but they can be found in all the potential spaces around viscera in and outside of the abdominal cavity. The complications of pancreatic pseudocysts are infection, rupture, fistula, obstruction and hemorrhage. However, an upper gastrointestinal bleeding caused by pancreatic pseudocyst is rare. Pseudocysts with complication like hemorrhage require percutaneous, endoscopic or surgical treatment. We report a case of the pancreatic pseudocyst involving duodenal wall with upper gastrointestinal hemorrhage, which was improved by conservative treatment.
Abdominal Cavity ; Duodenum* ; Fistula ; Gastrointestinal Hemorrhage* ; Hemorrhage ; Pancreas ; Pancreatic Pseudocyst* ; Rupture ; Viscera