No abstract available.
Smoking* ; Tobacco Products*

PURPOSE: Intrahepatic duct stone (IHD) disease, especially bilateral lesion, is difficult to management for complete cure. The purpose of this study is to analyze the clinical manifestations and treatment outcomes and is to consider adequate strategy of treatment between unilateral and bilateral IHD stones. METHODS: From October 1993 to July 2004, 218 patients with IHD stone were performed by surgical management at Ewha Womans University Mokdong Hospital. The medical records of these patients were reviewed retrospectively. We classified into two groups, such as unilateral group (U group) and bilateral group (B group), and compared two groups for clinical manifestations and outcomes. RESULTS: Of the 218 IHD stone patients, 188 cases underwent conventional open surgery, 20 cases underwent laparoscopic surgery, and 10 cases underwent laparoscopic assisted surgery. U group and B group was composed 162 and 56 cases, respectively. IHD stones were more common in left lobe of liver than right lobe in U group (P<0.001). IHD stricture were more common in U group (P=0.048). On the other hand, remnant stones were more common in B group (P<0.001). There was no statistical significance for postoperative complication and method of operation include liver resection between two groups. CONCLUSION: We presume that the pathogenesis may be different between unilateral and bilateral IHD stone. To cure or reduce the remnant stone rate, more aggressive treatment such as liver resection should be also considered in the patients with bilateral as well as unilateral IHD stone because of no difference of complication rate of two groups.
Constriction, Pathologic ; Female ; Hand ; Humans ; Laparoscopy ; Liver ; Medical Records ; Postoperative Complications ; Retrospective Studies

OBJECTIVES: To investigate the pattern of subclinical hypothyroidism (SCH) in patients with bipolar disorders managed by lithium or valproic acid. METHODS: The study participants were 106 patients with DSM-IV bipolar disorders receiving planned maintenance treatment at the Mood Disorders Clinic of Seoul National University Bundang Hospital (aged between 17 and 64, mean duration of follow-up = 875.65 days). Using the bipolar disorder registry, thyroid function data were analyzed to assess the frequency of and the risk factors for SCH in patients managed by lithium (n = 64) or valproic acid (n = 42) for more than 5 months. RESULTS: Overall frequencies of SCH were 20.3% (13/64) in the lithium group, 14.3% (6/42) in the valproic acid group, and between the two groups there is no difference (p = 0.43). No differences were observed in the potential risk factors for SCH between the two groups including age, sex, subtype of bipolar disorder, baseline TSH, and concomitant antipsychotic use. In cases with SCH, thyroid-stimulating hormone (TSH) showed a tendency to increase at 3 month after the initiation of lithium or valproic acid. A gradual increase in the number of patients showing SCH was found within the first 3 years of medication. CONCLUSIONS: With regular monitoring and careful assessment, there was no difference in the risk of SCH between lithium and valproic acid maintenance. The risk of mood stabilizer-associated SCH may gradually increase within 3 years following the commencement of medication, thereby mandating close monitoring for the first 3 years of treatment. Further studies with large sample size would be needed to confirm these findings.
Bipolar Disorder* ; Diagnostic and Statistical Manual of Mental Disorders ; Follow-Up Studies ; Humans ; Hypothyroidism* ; Lithium* ; Mood Disorders ; Risk Factors ; Sample Size ; Seoul ; Thyroid Gland ; Thyrotropin ; Valproic Acid*

Exogenous lipoid pneumonia occurs rarely in healthy people. In most cases, exogenous lipoid pneumonia is usually caused by aspiration of mineral, vegetable, or animal oil. We report the case of 42-year-old woman, who have experienced lipoid pneumonia after silicon injection into her breast for cosmetic purposes. The patient experienced fever, dyspnea, sputum, and hemoptysis after silicon injection into her breast. Chest computed tomography demonstrated non-segmental distribution of bilateral consolidation in both lung fields. A transbronchial lung biopsy specimen shows foamy microphages in alveolar spaces. Papanicolaous staining of bronchoalveolar lavage fluid showed abundant foamy marcrophages and many neutrophils. With these results, we confirmed lipoid pneumonia was associated with silicon oil injection into breast.
Adult ; Animals ; Biopsy ; Breast ; Bronchoalveolar Lavage Fluid ; Cosmetics ; Dyspnea ; Female ; Fever ; Hemoptysis ; Humans ; Lung ; Mammaplasty ; Neutrophils ; Pneumonia ; Pneumonia, Lipid ; Silicone Oils ; Sputum ; Thorax ; Vegetables

PURPOSE: To evaluate the usefulness of supine lateral bone mineral density (BMD) measurement using DXA bycomparing AP and lateral spine BMD in patients with degenerative change. MATERIALS AND METHODS: Six hundred andseventy-two women underwent AP and lateral BMD measurement of L-spine, using DXA. Spur changes and end-platesclerosis were considered as degenerative change, and osteoporosis was defined according to WHO criteria. Theratio of mid-lateral BMD to AP BMD was calculated and the differences in ratio were analyzed in the degenerativegroup and controls, according to aging and osteoporosis, using the t test and ANOVA. The correlation coefficiencybetween aging and AP BMD and lateral BMD, respectively, was calculated. RESULT: The mLat/AP ratio in the controland degenerative group was 0.710(0.005 / 0.622(0.028 (p=0.003) in the 40-49-year-old group, 0.663(0.006 /0.612(0.016 (p=0.002) in the 50-59-year-old group, 0.626(0.015 / 0.552(0.023 (p=0.007) in the 60-69 year-oldgroup, and 0.717(0.028 / 0.600(0.045 (p=0.076) in those aged over 70. The ratio was 0.656(0.015 / 0.598(0.038(p=0.099) in osteoporosis, 0.684(0.008 / 0.596(0.016 (p=0.000) in osteopenia, and 0.688(0.005 / 0.583(0.019(p=0.000) in normal subjects, showing that lateral BMD is more sensitive than AP BMD, especially in thedegenerative group. There was negative correlation between aging and AP BMD(r= -0.545), lateral BMD(r= -0.571),and mid-lateral BMD(r=-0.583). CONCLUSION: In a selective group of patients with degenerative change, supinelateral BMD measurement of L-spine is useful.
Aging ; Bone Density* ; Bone Diseases, Metabolic ; Female ; Humans ; Osteoporosis ; Spine*

A 31-year-old woman admitted because of fever, chilling and sore throat for 4 days. The symptom was developed after receiving methimazole 20mg per day and carteolol 10mg per day due to Graves disease during last 4 weeks. Physical examination revealed hyperemic enlarged tonsils with whitish plaque. The peripheral blood total neutrophil count was 1,400/mm3 (absolute neutrophil count, ANC 36) and a peripheral blood smear revealed rare neutrophil with lymphocytosis. On the first day of hospitalization, the patient was severely ill with ANC 0, it was decided to administer G-CSF 2ug/kg daily. On the fifth day of hospitalization, ANC in peripheral blood count was persistently zero and bone marrow aspiration and biopsy were performed, which revealed hypocellularity and myeloid hypoplasia. G-CSF given daily for 7days, it was discontinued when the ANC reached 1,539/mm3. The availability of G-CSF may help to shorten the course of agranulocytosis and to reduce its mortality rate.
Adult ; Agranulocytosis* ; Biopsy ; Bone Marrow ; Carteolol ; Colony-Stimulating Factors* ; Female ; Fever ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Graves Disease ; Hospitalization ; Humans ; Lymphocytosis ; Methimazole* ; Mortality ; Neutrophils ; Palatine Tonsil ; Pharyngitis ; Physical Examination

We herein describe a 70-year-old woman who presented with respiratory failure due to extensive lung adenocarcinoma. Despite advanced disease, care in the intensive care unit with ventilator support was performed because she was a newly diagnosed patient and was considered to have the potential to recover after cancer treatment. Because prompt control of the cancer was needed to treat the respiratory failure, empirical treatment with an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor was initiated before confirmation of EGFR-mutant adenocarcinoma, and the patient was successfully treated. Later, EGFR-mutant adenocarcinoma was confirmed.
Adenocarcinoma* ; Aged ; Female ; Humans ; Intensive Care Units ; Lung* ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Respiration, Artificial ; Respiratory Insufficiency* ; Ventilators, Mechanical ; Erlotinib Hydrochloride

BACKGROUND: Right ventricular apical (RVA) pacing induces left ventricular (LV) dyssynchrony, increases the risk of persistent atrial fibrillation in the long term. The aim was to investigate the effects of RVA pacing on left atrial (LA) function, which are unknown. METHODS: Echocardiographic evaluation including LV dyssynchrony based on conventional Doppler, tissue Doppler imaging and speckle tracking strain echocardiography was done before and after (12 months) single-chamber ventricular pacemaker implantation in 40 patients with sick sinus syndrome. Patients were divided to 2 groups, according to the RVA pacing frequency (group I had higher pacing rate of more than 50% and group II, less than 50%). RESULTS: There was no significant difference in LV ejection fraction, however, mean global LV strain, myocardial performance index, and parameters of LV dyssynchrony had shown significant changes after 12 months of RVA pacing. There were also significant increase in the LA volume index and the reduction of peak systolic LA strain and strain rate (SR), peak early and late diastolic SR after RVA pacing. Moreover, there was significant deterioration of LV dyssynchrony and both LA and LV longitudinal function in even group II. LA functional deterioration and LA volume was significantly correlated with the frequency of RVA pacing. CONCLUSION: LV dyssynchrony, induced by RVA pacing, significantly impaired active LA contraction and passive stretching, and these findings were shown in the patients with even less than 50% of RVA pacing. Impairment of LA strain/SR was significantly correlated with the frequency of RVA pacing.
Atrial Fibrillation ; Atrial Function ; Atrial Function, Left ; Contracts ; Echocardiography ; Humans ; Muscle Stretching Exercises ; Sick Sinus Syndrome ; Sprains and Strains ; Track and Field

BACKGROUND: Right ventricular apical (RVA) pacing induces left ventricular (LV) dyssynchrony, increases the risk of persistent atrial fibrillation in the long term. The aim was to investigate the effects of RVA pacing on left atrial (LA) function, which are unknown. METHODS: Echocardiographic evaluation including LV dyssynchrony based on conventional Doppler, tissue Doppler imaging and speckle tracking strain echocardiography was done before and after (12 months) single-chamber ventricular pacemaker implantation in 40 patients with sick sinus syndrome. Patients were divided to 2 groups, according to the RVA pacing frequency (group I had higher pacing rate of more than 50% and group II, less than 50%). RESULTS: There was no significant difference in LV ejection fraction, however, mean global LV strain, myocardial performance index, and parameters of LV dyssynchrony had shown significant changes after 12 months of RVA pacing. There were also significant increase in the LA volume index and the reduction of peak systolic LA strain and strain rate (SR), peak early and late diastolic SR after RVA pacing. Moreover, there was significant deterioration of LV dyssynchrony and both LA and LV longitudinal function in even group II. LA functional deterioration and LA volume was significantly correlated with the frequency of RVA pacing. CONCLUSION: LV dyssynchrony, induced by RVA pacing, significantly impaired active LA contraction and passive stretching, and these findings were shown in the patients with even less than 50% of RVA pacing. Impairment of LA strain/SR was significantly correlated with the frequency of RVA pacing.
Atrial Fibrillation ; Atrial Function ; Atrial Function, Left ; Contracts ; Echocardiography ; Humans ; Muscle Stretching Exercises ; Sick Sinus Syndrome ; Sprains and Strains ; Track and Field

Effective treatment for community-acquired pneumonia (CAP) requires administration of appropriate empirical therapy based on etiologic, clinical, and radiological features. However, in Korea, CAP is poorly characterized, and data on viral CAP are particularly sparse. Therefore, improper use of antibiotics is common, and is detrimental the potential for development of bacterial. Thus, we investigated clinical and radiological findings for discrimination of viral CAP from bacterial CAP. Etiologic, clinical, and radiological data from 467 patients with CAP at Chungbuk National University Hospital from October 2010 to September 2011 were analyzed retrospectively. Viruses were identified in 23 cases (11.4%); the influenza virus A was the most common virus detected (N=18, 25.4%), followed by the respiratory syncytial virus A (N=14, 17.9%). Bacteria were identified in 48 cases (23.8%); Streptococcus-pneumonia was the most common (N=24, 25.5%), followed by Staphylococcus aureus (N=20, 21.3%). Depending on hospitalization time, the following significant differences were observed between viral and bacterial CAP: on admission, (1) high fever (> or = 38.5degrees C), (2) purulent sputum, (3) white blood cell count, (4) C-reactive protein levels, (5) and bilateral lung involvement on chest X-ray were higher in bacterial CAP; and at discharge, (1) duration of high fever and (2) radiologic improvement within three days were higher in viral CAP. Regarding seasonal patterns, both viruses and bacteria have been identified with relative frequency in the winter season. This study described the etiological, clinical, and radiological findings of viral and bacterial CAP. Conduct of additional large-scale, prospective investigations will be required in order to improve the appropriate treatment of CAP.
Anti-Bacterial Agents ; Bacteria ; Bacterial Infections* ; C-Reactive Protein ; Discrimination (Psychology) ; Fever ; Hospitalization ; Humans ; Korea ; Leukocyte Count ; Lung ; Orthomyxoviridae ; Pneumonia* ; Respiratory Syncytial Viruses ; Retrospective Studies ; Seasons ; Sputum ; Staphylococcus aureus ; Thorax ; Viruses