No abstract available.
Fibrin Tissue Adhesive* ; Fistula*

No abstract available.
Lung* ; Lymph Nodes* ; Neoplasm Metastasis*

We treated 654 patients with simultaneous bilateral sympathectomy for essential hyperhidrosis from March 1989 to September 1997 (354 males and 300 females). The exposure afforded by thoracoscopy is actually superior to that seen at the time of either thoracotomy or axillary thoracotomy. The use of single-lumen intubation with alternating partially collapsed lung by CO2 inflation resulted in shorter anesthesia, shorter operative time, and shorter hospitalization. 2-mm extended thoracoscopic T2-sympathectomy is not only a time-saving method but also a very simple and effective one in the treatment of hyperhidrosis by experienced surgeons. The modification on our technique of thoracoscopic sympathectomy as described allowed us to significantly improve our previous results. A majority of the patients were relieved, and over 95% were satisfied initially.
Anesthesia ; Hospitalization ; Humans ; Hyperhidrosis* ; Inflation, Economic ; Intubation ; Lung ; Male ; Operative Time ; Sympathectomy* ; Thoracoscopy ; Thoracotomy

BACKGROUND: Postprimary pulmonary tuberculosis is located mainly in upper lobes. The tuberculous lesion involving the lower lobes usually arises from the upper lobe cavity through endobronchial spread. When tuberculosis is confined to the lower lung field, it often masquerades as pneumonia, lung cancer, bronchiectasis, or lung ahscess. Thus the correct diagnosis may be sometimes delayed for a long time. METHODS: We carried out, retrospectively, a clinical study on 50 patients confirmed with lower lung field tuberculosis who visited the Department of Pulmonary Medicine at Hanyang University Hospital from January 1992 to December 1994. The following results were obtained. RESULTS: Lower lung field tuberculosis without concomitant upper lobe disease occurred in fifty patients representing 6.9% of the total admission with active pulmonary tuberculosis over a period of 3 years. It occurred most frequently in the third decade but age distribution was relatively even. The mean age was 43 years old. Female was more frequently affected than male (male to female ratio 1:1.9). The most common symptom was cough(68%), followed by sputum(52%), fever(38%), and chest discomfort(30%). On chest X-ray of the S0patients, consolidation was the most common finding in 52%, followed by solitary nodule(22%), collapse(16%), cavitary lesion(l0%), in decreasing order. The disease confined to the right side in 25 cases, left side 20 cases, and both sides 5 cases. Endobronchial tuberculosis (1) Endobronchial involvement was proved by bronchoscopic examination in 20 of S0patients. (2) Mean age was 44years old and female was more affected than man (male to female ratio 1 : 3). Sputum AFB stain and Mycobacterium tuberculosis culture were positive only in 50% of cases unlikely upper lobe tuberculosis, additional diagnostic methods were needed. In our study, bronchoscopic examination and percutaneous fine needle aspiration biopsy increased diagnostic yield by 18% and 32%, respectively. The most common associated condition was diabetes mellitus(18%) and others were anemia, anorexia nervosa, stomach cancer, and systemic steroid usage. CONCLUSION: When we find a lower lung field lesion, we should suspect tuberculosis if the patient has diabetes mellitus, anemia, systemic steroid usage, malignancy or other immune suppressed states. Because diagnostic yield of sputum AFB smear & Mycobacterium tuberculosis culture was low, additional diagnostic methods such as bronchoscopy and fine needle aspiration biopsy were needed.
Adult ; Age Distribution ; Anemia ; Anorexia Nervosa ; Biopsy ; Biopsy, Fine-Needle ; Bronchiectasis ; Bronchoscopy ; Diabetes Mellitus ; Diagnosis ; Female ; Humans ; Lung Neoplasms ; Lung* ; Male ; Mycobacterium tuberculosis ; Pneumonia ; Pulmonary Medicine ; Retrospective Studies ; Sputum ; Stomach Neoplasms ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary

Many organic and nonorganic agents can cause chemical pneumonitis. Chemical pneumonitis induced by inhalation of acetic acid is a rare clinical condition. As acetic acid is a water soluble agent, it causes chemical irritation to respiratory tract and causes variable symptoms. We experienced a case of acute lung injury due to inhalation of acetic acid fume. A 56-year-old male patient was admitted due to dyspnea with vomiting for one day. After he inhaled acetic acid fume in occupational situation, he had chest tightness, chilling sense, and productive cough. Our case was good response to oxygen inhalation, antibiotics, and systemic steroids.
Acetic Acid* ; Acute Lung Injury ; Anti-Bacterial Agents ; Cough ; Dyspnea ; Humans ; Inhalation* ; Male ; Middle Aged ; Oxygen ; Pneumonia* ; Respiratory System ; Steroids ; Thorax ; Vomiting ; Water

BACKGROUND: The incidence of mycoplasmal pneumonia is predominantly at childhood and early adulthood, but in adults, its incidence is low and its symptoms and physical findings are nonspecific. The definite diagnosis of M. pneumoniae pneumonia can be made by sputum culture, but requires several weeks for positive results, and the early diagnosis must initially be based on the serologic tests and appropriate clinical findings. Thus, we evaluated the clinical aspects of M. pneumoniae pneumonia in the adults patients. METHOD: Among the admitted patients due to pneumonia, the definite diagnosis is anti-M. pneumoniae antibody titer of > 1:40 and a single cold agglutinin titer of > 1:64. The presumptive diagnosis is anti-M. pneumoniae antibody titer of > 1:40 or a single cold agglutinin titer of > 1:64 and the clinical characteristics or chest X-ray findings are compatible with M. pneumoniae pneumonia. We studied the age and sex distribution, seasonal distribution, clinical symptoms, physical findings, serologic test, chest X-ray findings, treatment and its progression. RESULTS: 1) The age distribution was even and the ratio of male to female was 1:1. 2) The monthly distribution was most common in January(16.7%) and the seasonal distribution in autumn and winter(autumn: 30%, winter: 33.3%). 3) The cold agglutinin titers were higher than 1:64 in 12 cases(40%), and reached the peak level around 2 weeks from onset and antimycoplasma antibody titers were higher than 1:160 in 5 cases(16.7%). 4) On the chest X-ray, pulmonary infiltration was noted in 28 cases(93.3%) among 30 cases and right lower lobe involvement was the most common(33.3%) and both lower lobe involvement was noted in 7 cases(23.3%). 5) The mean treatment duration was most common(33.3%) in 1 week to 2 weeks after admission and 26 cases(86.7%) were improved within 4 weeks. 6) On admission, there was fever(> or =38.9degreesC) in 17 cases(56.7%), and the fever subsided in 12 cases(70%) within 3 days after treatment using erythromycin. CONCLUSION: The mycoplasmal pneumonia in adults shows milder clinical patterns than that in childhood and can be completely recovered without complication by early diagnosis and treatment.
Adult* ; Age Distribution ; Diagnosis ; Early Diagnosis ; Erythromycin ; Female ; Fever ; Hospital Distribution Systems ; Humans ; Incidence ; Male ; Pneumonia* ; Seasons ; Serologic Tests ; Sex Distribution ; Sputum ; Thorax

As internet technology rapidly improves, clinical services are increasingly computerized in most hosptials. In order to effectively support patient care and clinical researches, information technologies are widely utilized to integrate clinical databases and disseminate information. However, most hospital information systems in Korea are still independently implemented and not fully integrated due to lack of standardization and security measure. In order to meet increasing demand for better patient care and upgrading clinical research, there is a need for a development and sharing of integrated clinical information system with a common database including clinical data collected from various hospitals. The purpose of this study was to develop a web-based clinical information system for management of Behcet's disease by constructing an integrated database with treatment data, test results, and patient demographic data in collaboration with several hospitals. Specifically, current treatment procedure for Behcet's disease was analyzed first and enhanced treatment procedure as well as a web-based clinical information system for management of Behcet's disease was proposed using a structured systems analysis and literature review on the shared clinical information systems. Expected benefits of the system include an improvement of consistency in patient management and reduction of duplicate prescriptions and test orders. In addition, this system can help improve communication among clinics and tertiary hospitals by sharing common clinical database. In a long run, the share system can also help reducing hospital expenditures by reducing duplicate investment on high cost equipments by sharing them among hospitals.
Cooperative Behavior ; Health Expenditures ; Hospital Information Systems ; Humans ; Information Systems* ; Internet ; Investments ; Korea ; Patient Care ; Prescriptions ; Security Measures ; Systems Analysis ; Tertiary Care Centers

OBJECTIVES: To investigate the incidence of antiphospholipid antibodies in patients with proven endometriosis and apparently normal controls, and to evaluate the changes in profiles of humoral immune factors in endometriosis after treatment with gonadotropin releasing hormone agonist (GnRHa). METHODS: Sera of 92 patients with endometriosis, 40 patients without endometriosis and 128 normal male blood doners (normal controls) were tested for the presence of autoantibodies to six phospholipids (cardiolipin, phosphatidylserine, phosphatidyglycerol, phosphatidylethanolamine, phosphatidylinositol, phosphatidic acid) and beta 2-glycoprotein I(GPI)- dependent anticardiolipin antibodies. Also, antiendometrial antibodies (AEA), antiphospholipid antibodies (APA), Immunoglobulin (Ig)G, IgA, IgM, complement C3, C4 and CA-125 were measured in 26 endometriosis patients before and after 3 months of GnRHa treatment. RESULTS: Eighteen (19.6%) patients with endometriosis had at least one of the APA compared with normal controls (8.3%). The prevalence of beta 2-GPI-dependent anticardiolipin antibodies was higher in patients with endometriosis than in normal controls. There were no significant changes in the positivity and levels of AEA and APA after GnRHa Treatment and the levels of immunoglobulins and complement showed similiar pattern. However, the numbers of patients with the level of CA-125 > 35 IU/ml, which is defined as the upper limit of normal level and the levels of CA-125 decreased. CONCLUSIONS: Around 20% of patients with endometriosis had APA and CA-125 measurement may be better than humoral factor tests in monitoring patients with endometriosis after GnRHa treatment.
Antibodies ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Autoantibodies ; Complement C3 ; Complement System Proteins ; Endometriosis* ; Female ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Humans ; Immunoglobulin A ; Immunoglobulin M ; Immunoglobulins ; Immunologic Factors ; Incidence ; Male ; Phosphatidylinositols ; Phospholipids ; Prevalence

No abstract available.
Lung*

Excessive sweating of the palms, axillae, and face has a strong negative impact on the quality of life for many people. The existing non-operative therapeutic options seldom give sufficient relief and have a transient effect. But a definitive cure can be obtained by upper thoracic sympathectomy. From June 1997 to October 1997, 117 cases of the needle (2 mm) thoracoscopic thoracic sympathectomies were performed in the Department of Thoracic and Cardiovascular Surgery in the Respiratory Center Yong-dong Severance Hospital in Seoul, Korea. We have followed up on 94 cases which include palmar hyperhidrosis (n=85), facial hyperhidrosis (n=5) and axillary hyperhidrosis (n=4). There were 42 males and 52 females whose ages ranged from 14 to 63 years (median:23 years). The T2 ganglia and T3-4 ganglia were excised by electrocuting with a hook and endoscissors and were removed for histologic examination. There have been no mortalities or life-threatening complications. The surgical results were classified as excellent (much improvement,very dry) in 93.6%, good (some improvement, minimally wet) in 2.1%, and fair (slight improvement, still wet) in 4.2%. Five patients (5.3%) required closed thoracostomy drainage because of pneumothorax in the immediate postoperative day. Horner's syndrome occurred in one case. The compensatory sweating occurred in 67 cases (71.2%) and was embarrassing in 21 cases (22.3%) and disabling in 9 cases (9.6%) of these cases. Primary failure occurred in one case. The patient with primary failure underwent successful operation. Fifty-one patients had concomitant hyperhidrosis. Our experiences indicate needle thoracoscopic sympathectomy is a very effective, safe, and time-saving procedure for essential hyperhidrosis.
Axilla ; Drainage ; Female ; Ganglia ; Horner Syndrome ; Humans ; Hyperhidrosis* ; Korea ; Male ; Mortality ; Needles* ; Pneumothorax ; Quality of Life ; Respiratory Center ; Seoul ; Sweat ; Sweating ; Sympathectomy* ; Thoracoscopy ; Thoracostomy