Impaction of a gallstone in the cystic duct or neck of the gallbladder can cause partial hepatic duct obstruction. Mirizzi originally described the syndrome of obstructive jaundice presented in the patient with gallstone in 1948. Cholecystobiliary fistula is a complicated form of Mirizzi syndrome in longstanding cholecystitis. A 70 year-old female was admitted due to jaundice. On laparotomy, the right heaptic duct was compressed by distended gallbladder. The other 60 year-old male patient was referred with jaundice. The patient underwent laparoscopic cholecystectomy two years ago. A large stone was migrated from remnant cystic duct through a cholecystocholedochal fistula. We report two cases of Mirizzi syndrome with a review of literature.
Aged ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cystic Duct ; Female ; Fistula ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Jaundice ; Jaundice, Obstructive ; Laparotomy ; Male ; Middle Aged ; Mirizzi Syndrome* ; Neck

BACKGROUND: Airway hyperresponsiveness (AHR) to direct stimuli, such as methacholine (MCh), is observed not only in asthma but other diseases. AHR to indirect stimuli is suggested to be more specific for asthma. The purpose of this study was to determine whether asthmatic airway inflammation is more closely related to AHR to hypertonic saline (HS), an indirect stimulus, than to MCh. METHODS: Sixty-four consecutive adult patients with suspected asthma (45 asthma and 19 non-asthma) performed a combined bronchial challenge and sputum induction with 4.5% saline, and MCh challenge on the next day. RESULTS: Both HS-PD15 and MCh-PC20 were significantly lower in asthma patients than in non-asthma patients. However, the sensitivity/ specificity for asthma was 48.9%/100%, respectively, in the HS test and 82.2%/ 84.2%, respectively, in the MCh test. There was a significant relationship between HS-PD15 and MCh-PC20 and only 52.9% of patients with MCh-PC20 < or= 4 mg/mL showed HS-AHR, but 4 patients with HS-AHR showed MCh-PC20 > 4 mg/mL. There were significant correlations between both HS-PD15 and MCh-PC20 and FEV1, or sputum eosinophils, but FEV1 was more closely related to MCh-PC20 (r=0.478, p < 0.01) than to HS-PD15 (r=0.278, p < 0.05), and sputum eosinophils were more closely related to HS-PD15 (r=-0.324, p < 0.01) than to MCh-PC20 (r=-0.317, p < 0.05). Moreover, the IL-5 level (r=-0.285, p < 0.05) and IFN-gamma/IL-5 ratio (r=0.293, p < 0.05) in sputum were significantly related to HS-PD15, but not to MCh-PC20. CONCLUSION: HS-AHR may reflect allergic asthmatic airway inflammation more closely than MCh-AHR.
Asthma/*physiopathology ; Bronchial Hyperreactivity/*physiopathology ; Bronchial Provocation Tests ; Bronchoconstrictor Agents/*diagnostic use ; Comparative Study ; Female ; Human ; Male ; Methacholine Chloride/*diagnostic use ; Saline Solution, Hypertonic/*diagnostic use ; Support, Non-U.S. Gov't

Objective To investigate the clinical outcomes of an invasive strategy for elderly (aged≥75 years) patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Methods Data on 366 of 409 elderly CS patients from a total of 6,132 acute STEMI cases enrolled in the Korea Acute Myocardial Infarction Registry between January 2008 and June 2011, were collected and analyzed. In-hospital deaths and the 1-month and 1-year survival rates free from major adverse cardiac events (MACE;defined as all cause death, myocardial infarction, and target vessel revascularization) were reported for the patients who had undergone invasive (n=310) and conservative (n=56) treatment strategies. Results The baseline clinical characteristics were not significantly different between the two groups. There were fewer in-hospital deaths in the invasive treatment strategy group (23.5%vs. 46.4%, P＜0.001). In addition, the 1-year MACE-free survival rate after invasive treatment was significantly lower compared with the conservative treatment (51%vs. 66%, P=0.001). Conclusions In elderly patients with acute STEMI complicated by CS, the outcomes of invasive strategy are similar to those in younger patients at the 1-year follow-up.

Severe acute lung injury (ALI), leading to respiratory failure caused by H1N1 infection, developed in a 34-year-old man during a work-up for non-small cell lung cancer. Although he fully recovered through instant treatment with oseltamivir, mechanical ventilation was required again, 7 days later, due to subsequent diffuse alveolar hemorrhage (DAH). Finally, his condition improved and he was able to move out of the intensive care unit. However, multiple pulmonary metastatic nodules appeared over a period of one month, suggesting the aggressive nature of lung cancer. Although he was discharged after chemotherapy, his prognosis seemed poor, considering the rapidity of growth of the lung cancer. It is important to recognize that DAH can occur after acute lung injury caused by influenza virus.
Acute Lung Injury ; Adult ; Carcinoma, Non-Small-Cell Lung ; Hemorrhage ; Humans ; Influenza, Human ; Intensive Care Units ; Lung Neoplasms ; Orthomyxoviridae ; Oseltamivir ; Prognosis ; Respiration, Artificial ; Respiratory Insufficiency

BACKGROUND: Complementary and alternative medicine (CAM) is now being increasingly used among cancer patients. The objectives of our study were to assess the prevalence, types, cost, subjective effects, and side effects of CAM use, reasons for CAM use, characteristics of CAM users compared to those of nonusers, and patients' expectations of doctors regarding their CAM use among Korean cancer patients at a single cancer center. METHODS: From April to August, 2003, we interviewed 186 cancer patients hospitalized in the Korea Cancer Center Hospital using a structured questionnaire, and analyzed the data. RESULTS: 78.5% of experimental subjects (146 patients) had been treated with at least one type of CAM, in addition to conventional Western treatment, with a mean monthly cost of 1, 380, 000 Won/person (approximately, 1, 100 U.S. dollars on July, 2004). The most prevalent types of CAM used by these patients included medicinal mushrooms (67.1%), herbs (54.1%), vegetable diets (50.6%), and ginseng (46.5%). The main reported reasons for the use of CAM in addition to conventional medicine were nutritional support (19.1%) and physical strengthening (17.8%). 5% of CAM users experienced side effects. The younger and more educated the patients were, the more likely they were to employ CAM. 66% of CAM users wanted to discuss CAM techniques with their doctors. CONCLUSION: More than two-thirds of cancer patients used various kinds of CAM, incurring considerable costs. Therefore, in order to help patients make informed decisions, medical society should be open to communication with patients. Not only the scientific aspects, but also the economic aspects of CAM usage should be examined more thoroughly, in order to ensure proper distribution of medical resources.
Complementary Therapies/economics/*utilization ; Female ; Humans ; Korea ; Male ; Middle Aged ; Neoplasms/*therapy ; Questionnaires

PURPOSE: The purpose of this study was to evaluate the effects of age at onset of the first major depressive episode on the clinical features of individuals with major depressive disorder (MDD) in a large cohort of Korean depressed patients. MATERIALS AND METHODS: We recruited 419 MDD patients of age over 18 years from the Clinical Research Center for Depression study in South Korea. At the start of the study, the onset age of the first major depressive episode was self-reported by the subjects. The subjects were divided into four age-at-onset subgroups: childhood and adolescent onset (ages <18), early adult onset (ages 18-44), middle adult onset (ages 45-59), and late onset (ages 60+). Using analysis of covariance (ANCOVA) and ordinal logistic regression analysis with adjusting the effect of age, the relationships between clinical features and age at onset of MDD were evaluated. RESULTS: There was an apparent, but inconsistent correlation between clinical features and age at onset. Earlier onset MDD was significantly associated with higher proportion of female gender [adjusted odds ratio (AOR)=0.570, p=0.022], more previous suicide attempts (AOR=0.635, p=0.038), greater number of previous depressive episodes (F=3.475, p=0.016) and higher scores on the brief psychiatric rating scale (F=3.254, p=0.022), its negative symptom subscale (F=6.082, p<0.0001), and the alcohol use disorder identification test (F=7.061, p<0.0001). CONCLUSION: Early age at onset may increase the likelihood of distinguishable MDD subtype, and age at onset of the first major depressive episode is a promising clinical indicator for the clinical presentation, course, and outcome of MDD.
Adolescent ; Adult ; Age Distribution ; Age of Onset ; Aged ; Depression/epidemiology ; Depressive Disorder, Major/*classification/*diagnosis/psychology ; Female ; Humans ; Life Change Events ; Male ; Middle Aged ; Odds Ratio ; Psychiatric Status Rating Scales ; Regression Analysis ; Republic of Korea ; Suicide, Attempted/psychology ; Young Adult

OBJECTIVES: The aim of this study was to compare the cleaning efficacy of different final irrigation regimens in canal and isthmus of mandibular molars, and to evaluate the influence of related variables on cleaning efficacy of the irrigation systems. MATERIALS AND METHODS: Mesial root canals from 60 mandibular molars were prepared and divided into 4 experimental groups according to the final irrigation technique: Group C, syringe irrigation; Group U, ultrasonics activation; Group SC, VPro StreamClean irrigation; Group EV, EndoVac irrigation. Cross-sections at 1, 3 and 5 mm levels from the apex were examined to calculate remaining debris area in the canal and isthmus spaces. Statistical analysis was completed by using Kruskal-Wallis test and Mann-Whitney U test for comparison among groups, and multivariate linear analysis to identify the significant variables (regular replenishment of irrigant, vapor lock management, and ultrasonic activation of irrigant) affecting the cleaning efficacy of the experimental groups. RESULTS: Group SC and EV showed significantly higher canal cleanliness values than group C and U at 1 mm level (p < 0.05), and higher isthmus cleanliness values than group U at 3 mm and all levels of group C (p < 0.05). Multivariate linear regression analysis demonstrated that all variables had independent positive correlation at 1 mm level of canal and at all levels of isthmus with statistical significances. CONCLUSIONS: Both VPro StreamClean and EndoVac system showed favorable result as final irrigation regimens for cleaning debris in the complicated root canal system having curved canal and/or isthmus. The debridement of the isthmi significantly depends on the variables rather than the canals.
Debridement ; Dental Pulp Cavity ; Linear Models ; Molar ; Multivariate Analysis ; Syringes ; Tooth ; Ultrasonics

Budd-Chiari syndrome (BCS) represents a spectrum of disease states resulting in hepatic venous outflow occlusion. Prothrombotic disorders, such as protein S deficiency may cause thrombosis of the portal and hepatic veins. We report the management of a 30-year-old BCS primigravida with protein S deficiency and destroyed lung by the pulmonary tuberculosis scheduled for Cesarean section. Moreover, patient's lungs were destroyed by the pulmonary tuberculosis. Spinal anesthesia was selected for the anesthetic management. The patient recovered without any complication and discharged from hospital on the fifth postoperative day.
Adult ; Anesthesia, Spinal ; Budd-Chiari Syndrome ; Cesarean Section ; Female ; Hepatic Veins ; Humans ; Lung ; Pregnancy ; Protein S Deficiency ; Thrombosis ; Tuberculosis, Pulmonary

OBJECTIVES: The purpose of this study was to compare the cutting efficiency of a newly developed microprojection tip and a diamond-coated tip under two different engine powers. MATERIALS AND METHODS: The apical 3-mm of each root was resected, and root-end preparation was performed with upward and downward pressure using one of the ultrasonic tips, KIS-1D (Obtura Spartan) or JT-5B (B&L Biotech Ltd.). The ultrasonic engine was set to power-1 or -4. Forty teeth were randomly divided into four groups: K1 (KIS-1D / Power-1), J1 (JT-5B / Power-1), K4 (KIS-1D / Power-4), and J4 (JT-5B / Power-4). The total time required for root-end preparation was recorded. All teeth were resected and the apical parts were evaluated for the number and length of cracks using a confocal scanning micrscope. The size of the root-end cavity and the width of the remaining dentin were recorded. The data were statistically analyzed using two-way analysis of variance and a Mann-Whitney test. RESULTS: There was no significant difference in the time required between the instrument groups, but the power-4 groups showed reduced preparation time for both instrument groups (p < 0.05). The K4 and J4 groups with a power-4 showed a significantly higher crack formation and a longer crack irrespective of the instruments. There was no significant difference in the remaining dentin thickness or any of the parameters after preparation. CONCLUSIONS: Ultrasonic tips with microprojections would be an option to substitute for the conventional ultrasonic tips with a diamond coating with the same clinical efficiency.
Dentin ; Diamond ; Microscopy, Confocal* ; Tooth ; Ultrasonics*

BACKGROUND: 1,1-dichloro-1-fluoroethane (HCFC-141b) has been known to be relatively safe except irritation of the skin and upper airway, and pulmonary disease directly associated with HCFC-141b exposure has not been reported yet. OBJECTIVE: We report a highly suspicious case of HCFC-141b-related occupational asthma, which was assessed by workplace challenge, but not confirmed by specific inhalation test. We also performed animal experiment to evaluate whether long-term exposure to HCFC-141b could cause inflammation of the airway and parenchymal lung tissue. METHOD: Forty Sprague-Dawley rats were divided into 4 groups. HCFC-141b exposure for each group was carried out under the condition of 6 hours a day, 5 days a week for 13 weeks by inhalation with different concentration of HCFC-141b; Group A-control: Group B-low concentration, 1500 ppm: Group C-moderate concentration, 3000 ppm: and Group D-high concentration, 6000 ppm. Bronchoalveolar lavage (BAL) and histopathological examination of lung tissue was undertaken after HCFC-141b exposure. RESULTS: HCFC-141b did not induce any abnormal change in the clinical and behavioral signs during and at the termination of the inhalation exposure. Compared with control rat, significantly abnormal findings in the microscopic examination of BAL and tissue preparations was not noted in HCFC-141b exposed rats. CONCLUSION: We report a suspicious case of occupational asthma due to HCFC-141b exposure. Animal experiment, however, revealed that HCFC-141b has no toxic or side effect on the respiratory system regardless of its concentration.
Animal Experimentation ; Animals ; Asthma, Occupational ; Bronchoalveolar Lavage ; Inflammation ; Inhalation Exposure ; Inhalation* ; Lung ; Lung Diseases ; Rats ; Rats, Sprague-Dawley ; Respiratory System* ; Skin