No abstract available.
Thyroid Gland* ; Thyroiditis*

In our comparative study of L1 consensus primers with E6 type-specific primers for detection of human papillomavirus (HPVs) by polymerase chain reaction (PCR) in 35 cases of cervical neoplasia, the detection rate by E6 primers (54%; 19/35) was significantly higher than that by L1 primers (25%; 9/35) (p < 0.01). And all specimens HPV-positive with L1 primers were also positive by E6 primers. HPV DNA could be amplified in 36% (9 of 25) of tissue by L1 consensus primers from which beta-globin gene was amplified as compared with 64% (16 of 25) of tissue by E6 type-specific primers. With the L1 consensus primers, 8 cases were positive for HPV-16 and 1 case was positive for HPV-33. These results show that the L1 consensus primers have inferior sensitivity to the E6 type-specific primers for the detection of HPV by PCR. But the L1 consensus primers have great value in making simultaneous detection of various HPV types in a single tube reaction, thus they permit reduction of time and the economic burden of the experiment.
Base Sequence ; DNA, Viral/analysis ; Female ; Humans ; Molecular Sequence Data ; Oligodeoxyribonucleotides ; Papillomaviridae/genetics/*isolation & purification ; *Polymerase Chain Reaction ; Uterine Cervical Neoplasms/*microbiology

PURPOSE: Infection with Nocardia species is an uncommon yet important cause of morbidity and mortality in renal transplant recipients. METHODS: We experienced 6 cases of nocardiosis among 239 renal transplant recipients maintained on tacrolimus- or cyclosporine-based immunosuppression from May 1999 to February 2001. RESULTS: All the six patients had pulmonary nocardiosis from 36 to 220 (mean 82) days after renal transplantation. Due to a multiplicity of infection sites, cerebral abscess was detected in 2 patients, soft tissue abscess in 2, allograft abscess in 1 and subretinal abscess in 1. Comparing the routine trimethoprim/ sulfamethoxazole (TMP/SMX) prophylaxis after transplantation, 5 out of 6 patients took TMP/SMX for a mean of 1.8 months due to an increased AST/ALT. All the cases required invasive diagnostic procedures such as percutaneous needle aspiration (PC NA) or stereotactic aspiration. In the antimicrobial susceptibility test, isolates were sensitive to TMP/SMX, amikacin and imipenem. In the early stage of infection, we used triple chemotherapy (TMP/SMX, amikacin, imipenem) for cerebral nocardiosis and dual therapy (TMP/SMX, amikacin) for localized pulmonary infection. There were no mortality and all the graft maintained stable function. CONCLUSION: After organ transplantation, pneumonia accompanied with satellite soft tissue infection should be considered as a nocardiosis. Pro- phylactic use of TMP/SMX is crucial for effective prevention of nocardiosis.
Abscess ; Allografts ; Amikacin ; Brain ; Brain Abscess ; Drug Therapy ; Humans ; Imipenem ; Immunosuppression ; Kidney Transplantation* ; Mortality ; Needles ; Nocardia ; Nocardia Infections* ; Organ Transplantation ; Pneumonia ; Soft Tissue Infections ; Sulfamethoxazole ; Transplantation ; Transplants

BACKGROUND/AIMS: Pseudoaneurysm is a life-threatening complication of chronic or acute pancreatitis. This study was undertaken to evaluate the clinical features of pseudoaneurysm complicating pancreatitis. METHODS: We reviewed the medical records of 7 patients diagnosed as pseudoaneurysms with chronic pancreatitis in Korea University Guro and Anam Hospital from January 1995 to March 2006 and analyzed their demographics, clinical courses and outcomes. RESULTS: All patients were men and mean age was 54.6 years (range, 43-67 years). All the cases occurred in the setting of chronic alcoholic pancreatitis complicated by pseudocyst. Abdominal pain was the unique initial clinical symptom in 5 cases, hematemesis in 1 case, and simultaneous abdominal pain with hematemesis in 1 case. Bleeding into pseudocyst developed in 5 cases, flowing into duodenum through pancreatic duct in 1 case and rupture into the descending colon in 1 case. Mean duration between onset of symptom and diagnosis of pseudoaneurysm was 7.8 days (range, 1-23 days). Six cases were diagnosed by abdominal computed tomography disclosing characteristic finding of focal high density area in the pseudocyst. Pulsed doppler abdominal sonography was performed before computed tomography in 3 cases and results were negative in 2 cases. Transcatheter arterial embolizations were initially performed in 6 cases, and there was no recurrent bleeding except one case of splenic infarction. Distal pancreatectomy was initially performed in 1 case. CONCLUSIONS: Pseudoaneurysms complicating chronic pancreatitis shows various clinical features. Transcatheter arterial embolization can be recommended as a primary therapeutic modality.
Adult ; Aged ; Aneurysm, False/*diagnosis/etiology/ultrasonography ; Arteries/injuries ; Demography ; Embolization, Therapeutic ; Hemorrhage/etiology/surgery ; Humans ; Korea ; Male ; Middle Aged ; Pancreatic Pseudocyst/etiology/surgery ; Pancreatitis, Alcoholic/*complications/pathology ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND/AIMS: CBD stones (CBDS) are generally thought to originate from the gallbladder. Recently, EUS appears to be the best imaging method for making the diagnosis of CBDS. We conducted this study to evaluate the role of EUS for detecting CBDS in patients with gallbladder stones (GBS) and to determine the parameters for predicting CBDS. METHODS: From April 2003 to March 2005, 117 GBS patients were enrolled. The patients' clinical and laboratory findings and the radiologic findings of US, EUS, CT and ERCP were reviewed. The sensitivity, specificity, PPV and NPV of EUS for detecting CBDS were evaluated by using ERCP and intraoperative CBD exploration as the gold standard for diagnosing CB. RESULTS: A total 117 patients received EUS and no complications were encountered. After performing ERCP and/or intraoperative exploration, 62 of the patients were examined for determining the presence or absence of CBDS. EUS shows 95% sensitivity and 95% specificity for identifying CBDS. The overall agreement between EUS and ERCP was 94.8%. The patients with CBDS were older than those without CBDS. Fever, jaundice and cholangitis were more prevalent in the patients with CBDS. The results of liver function tests were elevated more frequently in the patients with CBDS (p<0.05). CONCLUSIONS: EUS is an accurate and minimally invasive method for diagnosing CBDS. Evaluating CBD in patients with gallstones is selectively recommended according to clinical and laboratory findings.
Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledocholithiasis* ; Diagnosis ; Endosonography* ; Fever ; Gallbladder* ; Gallstones ; Humans ; Jaundice ; Liver Function Tests ; Sensitivity and Specificity

BACKGROUND/AIMS: There is increasing interest in the use of propofol as a sedative agent for colonoscopy. We evaluated the safety and efficacy of the synergistic sedation with midazolam combined with low-dose propofol versus that of midazolam alone. METHODS: A total of 56 patients from among those who underwent total colonoscopy between August 2004 and October 2004 were randomly assigned to one of three medication treatment groups. Group A (n=18) received low-dose midazolam (0.03 mg/kg IV) plus propofol, group B (n=19) received high-dose midazolam (0.07 mg/kg IV) plus propofol, and group C (n=19) received high-dose midazolam alone. The patients' vital signs were monitored throughout the course of the study. The recovery time and quality as well as the patients' comfort level were also assessed. RESULTS: There were no significant differences in baseline characteristics among the treatment groups. There were also no differences in the duration and insertion time of the colonoscopy among the three groups. The patients' comfort level and cardiorespiratory parameters during colonoscopy were similar among the three groups. The sedation efficacy and recovery times were also similar among the three groups. CONCLUSIONS: Midazolam combined with low-dose propofol as a sedative for colonoscopy exhibits similar effects on safety, patient' comfort level and recovery time to those of midazolam alone.
Colonoscopy* ; Conscious Sedation* ; Humans ; Midazolam* ; Propofol* ; Vital Signs

Hepatorenal syndrome is a severe complication of cirrhosis, leading to death in more than 90% of cases in the absence of liver transplantation. Several treatments have been attempted as a bridge to liver transplantation. Among such treatments, terlipressin is a nonselective V1 vasopressin agonist. When comparing with ornipressin, it is known to have a similar vasoconstricting potency, but much less ischemic complication. We report a case of gangrene on toes and necrosis on the infusion site of left hand which developed after the use of terlipressin due to hepatorenal syndrome in a 41-year-old-man with liver cirrhosis. Ischemic complication of terlipressin is rare and there has been no case report in Korea. Although it is rare, we must pay attention to the peripheral ischemic complication of terlipressin.
Adult ; Hand/*blood supply ; Hepatorenal Syndrome/drug therapy ; Humans ; Ischemia/*chemically induced ; Lysine Vasopressin/adverse effects/*analogs & derivatives/therapeutic use ; Male ; Toes/*blood supply ; Vasoconstrictor Agents/*adverse effects/therapeutic use

BACKGROUND/AIMS: Despite of increasing numbers of reports on intraductal papillary mucinous tumor (IPMT), there is still difficulty in its' diagnosis, treatment and prediction of prognosis. The purpose of this multicenter study was to evaluate the clinico-pathological features of IPMT in Korea and suggest the prediction criteria of malignancy in IPMT. METHODS: We retrospectively reviewed the clinico-pathological data of 208 patients who underwent operations with IPMT between 1993 and 2002 at 28 institutes in Korea. RESULTS: Of the 208 patients with a mean age of 60.5+/-9.7 years, 147 were men and 61 were women. 124 patients underwent pancreatoduodenectomy, 42 distal pancreatectomy, 17 total pancreatectomy, 25 limited pancreas resection. Benign cases were 128 (adenoma (n=62), borderline (n=66)) and malignant cases were 80 (non-invasive (n=29), invasive (n=51)). A significant difference in 5-year survival was observed between benign and malignant group (92.6% vs. 65.3%; p=0.006). Of the 6 factors (age, location, duct dilatation, tumor appearance, main duct type, and tumor size) that showed the statistical difference in univariate analysis between benign and malignant group, we found three significant factors (tumor appearance (p=0.009), tumor size (p=0.023), and dilated duct size (p=0.010)) by multivariate analysis. CONCLUSION: Although overall prognosis of IPMT is superior to ordinary pancreatic cancer, more curative surgery is recommended in malignant IPMT. Tumor appearance (papillary), tumor size (> or =30 mm) and dilated duct size (> or = 12 mm) can be used as preoperative indicators of malig-nancy in IPMT.
Academies and Institutes ; Diagnosis ; Dilatation ; Female ; Humans ; Korea* ; Male ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Prognosis ; Retrospective Studies