PURPOSE: Urea-splitting organisms have known to participate in the formation of infected calculi, but sometimes, causative organisms were not detected in urine culture. We compared results of polymerase chain reaction which detect urease gene in infected calculi to urine culture, to follow pathogens which involved in the formation of infected calculi and establish preventive antimicrobial therapy. MATERIALS AND METHODS: Urine culture were performed in 25 patients who were diagnosed as infected calculi. The DNA was extracted from the PBS solution that was used for washing stones and lysis solution which inserted after calculi crushing. And then, PCR were performed with universal primers for beta-globin gene, 16S ribosomal RNA gene, and primers for urease gene of Proteus mirabilis and Ureaplasma urealyticum which synthesized by order. Stone analysis was performed using infrared spectroscopy. RESULTS: Proteus mirabilis and Ureaplasma urealyticum were not detected in urine culture. All results of PCR to beta-globin gene and 16S ribosomal RNA gene were negative in calculi washing solution. In 18 of 25 cases(72.0%), the result of PCR to 16S ribosomal RNA gene were positive in calculi lysis solution. Each 2 and 3 of 18 cases(total; 27.7%) which were positive in PCR to 16S ribosomal RNA gene, Proteus mirabilis and Ureaplasma urealyticum were cultured respectively. From 16 cases which were available to perform infrared spectroscopic stone analysis, 7 cases were shown to have specfic absorbance band of infected calculi and were positive in PCR to 16S ribosomal RNA gene. CONCLUSIONS: We detected urea-splitting organisms in crushed calculi specimen using PCR. It suggests that PCR for urea-splitting organisms will be helpful to identify process of infected calculi and causative organisms.
beta-Globins ; Calculi* ; DNA ; Humans ; Polymerase Chain Reaction* ; Proteus mirabilis ; RNA, Ribosomal, 16S ; Spectrum Analysis ; Ureaplasma urealyticum ; Urease*

Primary duodenal tuberculosis, duodenal Crohn's disease, duodenal lymphoma, duodenal cancer is extremely rare event. Vague upper abdominal pain, weight loss(10 Kg) had been present for several months in a 52-yeer-old woman. Endoscopy revealed an irregular ulcer in the second part of the duodenum. CT of the abdomen revealed pooly defined hypodense and centrally low density masses along the hepatoduodenal ligament, with poor separation from the head of pancreas. Hypotonic duodenogram showed spiculation and smooth indentation of mucosal fold at medical aspect of sup. portion m descending duodenum. ERCP showed medially displaced distal CBD and main pancreaticduct. At first, lymphoma, cancer, Crohn's disease, duodenal tuberculosis were considered in the differential diagnosis. Endoscopic biopsy sepecimen of duodenal lesion showed atypical lymphocytes. We excluded the diagnosis of the duodenal cancer. We started anti-tubercular drugs because in our country tuberculosis is endemic. After 4 weeks anti-tuberculosis therapy, follow up endoscopy and biopsy specimens showed healing stage of duodenal ulcer and chronic granulomatous inflammation with multinucleated giant cell. Thus we concluded that when duodenal lesion which could not confirmed histopathologically it was wise to start antitubercular therapy than to perform exploraparotomic dianostic procedures.
Abdomen ; Abdominal Pain ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Crohn Disease ; Diagnosis ; Diagnosis, Differential ; Duodenal Neoplasms ; Duodenal Ulcer ; Duodenum ; Endoscopy ; Female ; Follow-Up Studies ; Giant Cells ; Head ; Humans ; Inflammation ; Ligaments ; Lymphocytes ; Lymphoma* ; Pancreas ; Tuberculosis* ; Ulcer

The patency of graft vessels and their effects on the native coronary circulation were studied by evaluation of 78 graft sites in 35 patients who underwent selective bypass graft angiography among 152 CABG cases at a mean follow-up 12.6 month. The result were as follows ; 1) The overall graft patency rate was 70.5% : 73.8% for left anterior descending artery, 68.4% for left circumflex arterty, 64.7% for right coronary artery. 2) The patency rate of internal mammary artery was 77.8%. 3) In twenty eight patients who underwent native coronary angiography, twelve pateints showed progression of coronary artery disease in grafted vessel and two patients showed progression of coronary artery disease in non-grafted vessel. 4) The treadmill test was performed before and after coronary artery bypass graft in thirteen patients. Among 13 patients, nine patinets showed improved exercise tolerance. 5) The percutaneous transluminal coronary angioplasty were successfully performed for dilating three cases of stenotic vein graft and two cases of left main lesions after CABG and one case of stenotic left internal mammary artery graft.
Angiography ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Circulation ; Coronary Vessels* ; Exercise Test ; Exercise Tolerance ; Follow-Up Studies ; Humans ; Mammary Arteries ; Transplants ; Veins

PURPOSE: This study evaluated the effectiveness of a selective nerve root block (SNRB) for a lumbar spinal stenosis (LSS) that indicated surgery. MATERIALS AND METHODS: Twenty-one LSS patients, who were indicated for surgery but could not be operated on due to a high anesthetic risk, were evaluated retrospectively an evaluated on average of 19.5 months (range, 12 to 60 months) following the SNRB from April 1998 to October 2002. There were 9 males and 12 females with a mean age of 66.4 years (range, 59 to 78 years). The medical records and radiologic studies were reviewed, and a telephone interview was carried out where needed. The anesthetic risk was evaluated by the American Society of Anesthesiologists (ASA) physical status classification. The Kirkaldy-Willis criteria (at 9 months after SNRB and last FU) and the recurrence of symptoms (at 2 weeks, 1 month, 3 months, 5 months, 9 months after the SNRB, and the last FU) were analyzed. RESULTS: Among the 21 patients, 8 patients were in the ASA class 3, 13 in class 4. The major physical conditions that indicated a high anesthetic risk was cardiac problems in 17 patients, renal problems in 2, and endocrine problem in 2. The interval between the onset of symptom and the SNRB ranged from one month to 30 years (average, 41.6 months). All but 3 patients had a recurrence of their symptoms at an average 1.9 months (range, 1 day to 9 months) after the SNRB. According to the Kirkardy-Wills criteria, 9 months after SNRB, the results were good in 1 patient, fair in 2, and poor in 18. At the last follow-up, all but 4 patients did not show a chang in their status according to the Kirkardy-Wills criteria, and 4 patients improved (poor to good in 2, poor to fair in 2) without treatment. CONCLUSION: The symptoms of LSS improved for a very short period (average, 1.9 month) by SNRB. These results suggest that SNRB suitable for the LSS patients who require need surgery.
Classification ; Female ; Follow-Up Studies ; Humans ; Interviews as Topic ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Spinal Nerves* ; Spinal Stenosis*

Liddle's syndrome was described in 1963 by Liddle, et al., as the disease featuring a hypertension and hypokalemia but with negligible secretion of aldosterone. This syndrome, which morphologically belongs to an abnormal intrinsic tubular disorder with normal renal function, is characterized by hypokalemia, metabolic alkalosis, and hypertension due to the abnormal increase in excretion of potassium in distal tubules or collecting duct and the increase in reabsorption of sodium in distal tubules. This syndrome, which is rare disease, is observed with the low level of plasma and urinary aldosterone and suppressed plasma renin level and is known as dominant mode of inheritance with a family background. The authors paid attention to a 79-year-old man who showed a high blood pressure of 210/130mmHg as well as musle weakness, especially lower extremities due to metabolic alkalosis featuring a hypokalemia level of 2.0mEq/L when he was admitted to our hospital, Because his serum potassium were not improved with the medication of intravenous potassium supply, and his blood pressure continued to be high without the improvement of muscle weakness, we prescribed 300mg of spironolactone for two weeks. His symptom, however, was not cured. Then, instead of spironolactone, we prescribed 150mg of triamterene and a low salt diet which finally improved his symptoms. Because there has been no reported case in the Korean medical literature, we report a case of successfully treated Liddle's syndrome due to triamterene administration.
Aged ; Aldosterone ; Alkalosis ; Blood Pressure ; Diet ; Humans ; Hypertension ; Hypokalemia ; Lower Extremity ; Muscle Weakness* ; Plasma ; Potassium ; Rare Diseases ; Renin ; Sodium ; Spironolactone ; Triamterene ; Wills