After failed removal of common bile duct or intrahepatic bile duct (IHD) stones by endoscopic retrograde cholangiopancreatography (ERCP), percutaneous lithotripsy is well-known as an effective procedure. However, it is time-consuming because multiple sessions of transhepatic tract dilatation are required. Endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) has been recently used to approach IHD to remove difficult bile duct stones. We recently experienced EUS-guided CDS performed with metal stent. Common bile duct or IHD stones were removed by retrieval accessories after initial failed or inadequate ERCP in three patients. Serious complications including bleeding, infection, and perforation were not noted. The duration of hospital stay from EUS-guided procedure to discharge ranged from 10 to 14 days. Although this result is interim and ongoing, it suggests that EUS-guided CDS might be an effective and safe procedure after failed ERCP to remove difficult bile duct stones through the tract.

Ulcerative colitis, an inflammatory bowel disease, often exhibits extra-intestinal manifestations including various dermatological problems. Pyoderma gangrenosum (PG) is a painful ulcerative cutaneous disorder characterized by the development of rapidly enlarging nodules. The lesion may become aggravated when ulcerative colitis is active, and it commonly affects the extensor surfaces of the lower extremities but rarely the upper extremities, face, periauricular area, anterior chest, back, or buttocks. We encountered a rare case of PG of the chest wall near the left breast, on the face and pretibial area of a male patient with ulcerative colitis. He had not undergone breast surgery and had no history of trauma. The lesion and symptoms were successfully treated by steroid and mesalazine; there was no need for surgery or more potent drugs.

Small bowel obstructions (SBOs) that develop for various reasons often require prompt medical treatment. Migration of a gastric bezoar (indigestible foreign material that has accumulated in the stomach) is a rare cause of SBO. Treatment of a symptomatic SBO caused by a bezoar requires a multidisciplinary approach that considers the patient’s physical status and comorbidities and the bezoar volume, location, and pathology. Although surgery is the treatment of choice, endoscopic treatments such as fragmentation and retrieval may serve as alternatives. We present the first case of resolution of a large phytobezoar via mechanical compression after covered metal stent insertion, followed by stent retrieval, in a patient with a symptomatic SBO that persisted even after two sessions of push-endoscopic fragmentation.

Ulcerative colitis, an inflammatory bowel disease, often exhibits extra-intestinal manifestations including various dermatological problems. Pyoderma gangrenosum (PG) is a painful ulcerative cutaneous disorder characterized by the development of rapidly enlarging nodules. The lesion may become aggravated when ulcerative colitis is active, and it commonly affects the extensor surfaces of the lower extremities but rarely the upper extremities, face, periauricular area, anterior chest, back, or buttocks. We encountered a rare case of PG of the chest wall near the left breast, on the face and pretibial area of a male patient with ulcerative colitis. He had not undergone breast surgery and had no history of trauma. The lesion and symptoms were successfully treated by steroid and mesalazine; there was no need for surgery or more potent drugs.

Small bowel obstructions (SBOs) that develop for various reasons often require prompt medical treatment. Migration of a gastric bezoar (indigestible foreign material that has accumulated in the stomach) is a rare cause of SBO. Treatment of a symptomatic SBO caused by a bezoar requires a multidisciplinary approach that considers the patient’s physical status and comorbidities and the bezoar volume, location, and pathology. Although surgery is the treatment of choice, endoscopic treatments such as fragmentation and retrieval may serve as alternatives. We present the first case of resolution of a large phytobezoar via mechanical compression after covered metal stent insertion, followed by stent retrieval, in a patient with a symptomatic SBO that persisted even after two sessions of push-endoscopic fragmentation.

Colon cancer arising in a colonic diverticulum is very rare. There are only a few reported cases of colon cancer associated with a diverticulum. Of these reported cases, only a few are those of a mucinous adenocarcinoma. Here, we report a case of an 82-year-old female with a mucinous adenocarcinoma arising in the ascending colonic diverticulum, which clinically and radiologically mimicked perforated diverticulitis with abscess formation. Although such cases are rare, our findings suggest that malignant tumors may be misdiagnosed as diverticular diseases and should be considered during work-up.

OBJECTIVE: The aim of this study was to compare the success rates of the manual and motor-driven mini-screw insertion methods according to age, gender, length of mini-screws, and insertion sites. METHODS: We retrospectively reviewed 429 orthodontic mini-screw placements in 286 patients (102 in men and 327 in women) between 2005 and 2010 at private practice. Age, gender, mini-screw length, and insertion site were cross-tabulated against the insertion methods. The Cochran-Mantel-Haenszel test was performed to compare the success rates of the 2 insertion methods. RESULTS: The motor-driven method was used for 228 mini-screws and the manual method for the remaining 201 mini-screws. The success rates were similar in both men and women irrespective of the insertion method used. With respect to mini-screw length, no difference in success rates was found between motor and hand drivers for the 6-mm-long mini-screws (68.1% and 69.5% with the engine driver and hand driver, respectively). However, the 8-mm-long mini-screws exhibited significantly higher success rates (90.4%, p < 0.01) than did the 6-mm-long mini-screws when placed with the engine driver. The overall success rate was also significantly higher in the maxilla (p < 0.05) when the engine driver was used. Success rates were similar among all age groups regardless of the insertion method used. CONCLUSIONS: Taken together, the motor-driven insertion method can be helpful to get a higher success rate of orthodontic mini-screw placement.
Female ; Hand ; Humans ; Male ; Maxilla ; Private Practice ; Retrospective Studies

BACKGROUND: Elevated serum cholesterol level is a major risk factor for cardiovascular morbidity and mortality. Simvastatin is effective for treating hypercholesterolemia. The aim of the study was to evaluate efficacy and safety of 6-month therapy with simvastatin with relatively low dose, 10 mg and 20 mg/day over 60-year-old patients. METHODS: Seventy-senven patients with hyperlipidemia(triglycerides <400 g/dL and low-density lipoprotein(LDL) cholesterol >130 mg/dL) were randomized to receive either simvastatin 10 mg/day(n=32) or 20 mg/day(n=45). Efficacy was determined by measuring changes from baseline in lipid parameters including LDL cholesterol, total cholesterol, triglycerides and high-density lipoprotein(HDL) cholesterol. RESULTS: Of the senventy-seven patients randomized to treatment, eighteen patients were men and fiftynine patients were women. sixty-five percent of patients had hypertension, eighteen percent coronary artery disease and fourteen percent type 2 diabetes mellitus. Mean baseline lipid concentrations were 254 (total cholesterol), 291(triglycerides), 50(HDL) and 166 mg/dL(LDL). Both 10 mg and 20 mg of simvastatin produced statistically significant improvements in all measured serum lipid parameters(p<0.001). Compared with 10 mg of simvastatin, 20 mg of simvastatin produced significantly greater(p<0.001) reductions from baseline LDL cholesterol(32.9 mg/dL vs 24.2 mg/d). There was no significant difference in both doses at improving total cholesterol and HDL cholesterol level and TG cholesterol level. Percentage of patients at goal LDL as recommended by NCEP guideline(ATP III) were 100% and 89% for patients in low risk but 25% and 38.5% for patients in coronary heart disease and its risk equivalents, taking 10 mg and 20 mg/day respectively. Both doses were well tolerated. Only 3 patients(6.6%) in the 20 mg group and one patient(3. 1%) in the 10 mg group experienced mild adverse events. Most patients contacted by telephone wanted to take 10 mg of simvastatin. CONCLUSION: In patients with hypercholesterolemia over 60 year old in Korea, both doses(10 mg, 20 mg) of simvastatin were effective in improving serum lipid parameters and well-tolerated. We recommend, considering patients preference, that 10 mg of simvastatin be intial dosage and in patients with coronary heart disease, higher doses than 20 mg should be prescribed to allow most patients to reach their NCEP target levels.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Coronary Artery Disease ; Coronary Disease ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Hypercholesterolemia* ; Hypertension ; Korea ; Male ; Middle Aged* ; Mortality ; Risk Factors ; Simvastatin* ; Telephone ; Triglycerides

PURPOSE: In this study, the effect arthroscopic adhesiolysis and the need for additional quadricepsplasty were evaluated by reviewing the patients 'data. MATERIALS AND METHODS: From July 1996 to January 2002, 18 patients received operation for the stiff knee. The patients were classified into 2 groups according to treatment method - Group 1: arthroscopic adhesiolysis and Group 2: arthroscopic adhesiolysis plus Judet quadricepsplasty. The Judet quadricepsplasty was performed when maximal knee flexion was not achieved over 90 degree even after arthroscopic adhesiolysis. We reviewed primary causes and the duration of contracture of stiff knee. Preoperative, postoperative, and final range of motion was evaluated. RESULTS: Preoperative, postoperative, and final range of motion was evaluated. In group 1, the average range of motion was 34 degree preoperatively, 107 degree intraoperatively, and 103 degree at the last follow-up. In group 2, the average range of motion, 26 degree preoperatively, 67 degree (after arthroscopic adhesiolysis)-115 degree(after quadricepsplasty) intraoperatively, and 112 degree at the last follow-up. CONCLUSION: Arthroscopic adhesiolysis has an effect in releasing intrarticular adhesion. Additional quadricepsplasty should be considered when the duration of contracture is over 12 months and primary causes of stiff knee is distal femur fracture which causes damages in the quadriceps muscle.
Contracture ; Femur ; Follow-Up Studies ; Humans ; Knee* ; Quadriceps Muscle ; Range of Motion, Articular

Missed lung cancers on chest radiograph (CXR) may delay the diagnosis and affect the prognosis. CXR is the primary imaging modality to evaluate the lungs and mediastinum in daily practice. The purpose of this article is to review chest radiographs for common blind spots and highlight the importance of various radiologic presentations in primary lung cancer to avoid significant diagnostic errors on CXR.