PURPOSE: The liver and lung are the most common site of metastases after curative resection of colorectal carcinoma, and only 10 months of median survival is achieved once metastases has occurred in the lung. About 10% of patients have a solitary pulmonary metastasis and surgical resection leads to a 5 year survival rate of 21~43%. We have tried to define ideal candidates for pulmonary resection in a patient with pulmonary metastases from colorectal carcinoma. METHODS: Between March 1990 to Feb. 2001, 25 patients underwent pulmonary resection for metastatic colorectal carcinoma. 15 patients were male, and 10 were female with mean age of 60.0 (range, 36~73) years. The primary sites were colon in 7 patients and rectum in 18 patients. RESULTS: The mean disease free interval was 30.04 19.79 (range, 1~84) months and 19 patients had single metastasis and 6 patients had multiple metastatic lesions. Twenty- one patients had unilateral lesion. Wedge resection was done in 10 patients, lobectomy in 7, pneumonectomy in 2, wedge resection with bilobectomy in 2, segmentectomy and wedge resection in 1, and segmentectomy and lobectomy in 1 patient. Six patients recurred mean 13.7 months after the first operation (range, 1~33 months) and they underwent wedge resection in 4 and one case each of lobectomy and segmentectomy. Seven patients died during follow up with 3 year survival rate of 70.8% and 5 year survival rate of 43.4%. CONCLUSIONS: The disease free interval, number of metastases, type and location of pulmonary resection, level of carcinoembryonic antigen had no correlation with the survival rate. We conclude that surgical resection of colorectal lung metastases is safe and effective, and every patients should be evaluated as a surgical candidate.
Carcinoembryonic Antigen ; Colon ; Colorectal Neoplasms* ; Female ; Follow-Up Studies ; Humans ; Liver ; Lung* ; Male ; Mastectomy, Segmental ; Neoplasm Metastasis* ; Pneumonectomy ; Rectum ; Survival Rate

OBJECTIVES: Dry eye disease (DED) is an increasingly important public health problem in Korea. Previous studies conducted in Korea have reported inconsistent results regarding the protective effects of vitamin D on DED, and these discrepancies may be related to the relatively simple questionnaire that has been used. Thus, we evaluated the association of serum vitamin D levels with DED using the ocular surface disease index (OSDI). METHODS: The present study evaluated data from participants in the Study Group for Environmental Eye Disease (2014-2015). This group included data from 752 participants, and data from 740 participants (253 men and 487 women) were analyzed in the present study. DED severity was evaluated using the OSDI. RESULTS: Higher serum vitamin D levels were associated with a non-significantly reduced risk of DED in the crude analysis (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.971 to 1.011) and in the adjusted analysis (OR, 0.988; 95% CI, 0.966 to 1.010). In the crude analysis of no/mild DED vs. moderate/severe DED, men exhibited a decreased risk with increasing serum vitamin D levels (OR, 0.999; 95% CI, 0.950 to 1.051), while women exhibited an increased risk (OR, 1.003; 95% CI, 0.979 to 1.027). In these analyses, we found no significant associations. CONCLUSIONS: The findings of the present study support previous reports that serum vitamin D levels are not associated with DED.
25-Hydroxyvitamin D 2 ; Dry Eye Syndromes ; Eye Diseases* ; Female ; Humans ; Keratoconjunctivitis Sicca ; Korea ; Male ; Public Health ; Vitamin D* ; Vitamins*

Churg-Strauss syndrome(CSS) or the syndrome of allergic granulomatosis and angiitis is a kind of rare systemic vasculitis characterized by bronchilal asthma, peripheral eosinophilia, paranasal sinus abnormality, mono or polyneuropathy, pulmonary infiltrates nonfixed and pathological findings such as prominent eosinophilic infiltration, necrotizing angiitis and extravascular granuloma formation. Clinical features of CSS includes asthma, pulmonary infiltrates, cutaneous lesions, neuropathy, cardiac involvement, gastrointeastinal involvement, renal involvement and musculoskeletal involvement. The diagnosis of CSS is made on the basis of both clinical and pathologic features. We experienced a 30-year-old man who presented peripheral eos'lnophilia, asthma of two year's duration, lower extremity weakness and lung infiltrations. His lung and skin biopsy showed eosinophilic infiltrates and eosinophilic vasculitis. He was diagnosed as Churg-Strauss syndrome based on the clinical manifestations and pathologic finding of lung and skin. He was managed with 3 times of plasmapheresis and methylprednisolone 1.0 g/day of 3 days followed by oral prednisolone 50rag/day and cyclophosphamide 2mg/kg. Clinical symptoms, laboratory and X-ray findings of the patient were improved at 7 days after treatment. After discharge, he has been treated with cyclophosphamide and low dose prednisolone. We report a case CSS with review of the literatures.
Adult ; Asthma ; Biopsy ; Churg-Strauss Syndrome* ; Cyclophosphamide ; Diagnosis ; Eosinophilia ; Eosinophils ; Granuloma ; Humans ; Lower Extremity ; Lung ; Methylprednisolone ; Plasmapheresis ; Polyneuropathies ; Prednisolone ; Skin ; Systemic Vasculitis ; Vasculitis

There are many pancreatic ductal anomalies in which there are clinically significant anomalies associated with acute and chronic pancreatitis or pancreatic carcinoma. Many anomalies of pancreatic duct are diagnosed at clinical evaluation of causes of recurrent acute pancreatitis. ERCP is the gold standard method of diagnosis. Noninvasive method such as MRCP or EUS may also establish the diagnosis. There are many reports for the clinical significance and management of pancreas divisum and anomalous union of the pancreaticobiliary duct. There have been rare cases with the coexistence of a pancreas divisum and anomalous union of the pancreaticobiliary duct in the world and only one case in Korea. The case of a 33 year old man with epigastic pain and fever was recently experienced. It was diagnosed to be the coexistence of a pancreas divisum and anomalous union of the pancreaticobiliary duct by ERCP, PTC and MRCP. We report this case with review of the anomalies.
Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Fever ; Humans ; Korea ; Pancreas* ; Pancreatic Ducts ; Pancreatitis ; Pancreatitis, Chronic

BACKGROUND/AIM: Gastric outlet obstruction due to malignancy causes various symptoms and malnutrition and so decreases the quality of life and shortens the survival. The aim of this study was to assess the feasibility, effectiveness, safety, and outcome of a self-expandable metal stent as a palliative methods. METHODS: From January, 2000 to August, 2002, 29 consecutive patients (36 cases of stent insertion) with inoperable gastric outlet obstruction were treated palliatively with through-the scope stents (Nitis Taewoong, Korea, 29 uncovered, 7 covered). All patients had malignancy. We reviewed the success rate, complications and clinical outcome. RESULTS: There were 21 cases with advanced gastric cancer, 5 with pancreatic head cancer and 2 with cholangiocarcinoma. The other one had primary duodenal carcinoma. Technical success was achieved in thirty four cases (94.4%). After successful placement, 26 patients could eat soft or solid foods with careful education about foods impaction. During the follow-up (mean: 2.6 months, range: 1~9 months), there were no procedure related early complication. Seven stent occlusion occurred due to tumor in-growth (6 case) and over-growth (1 case). CONCLUSIONS: Endoscopic self-expandable metal stent placement in patients with inoperable gastric outlet obstruction is a highly successful, safe and effective palliative method.
Cholangiocarcinoma ; Education ; Follow-Up Studies ; Gastric Outlet Obstruction* ; Head and Neck Neoplasms ; Humans ; Korea ; Malnutrition ; Quality of Life ; Stents* ; Stomach Neoplasms

BACKGROUND AND PURPOSE: Rapid recanalization might improve clinical outcomes after intraarterial thrombolysis (IAT) for acute ischemic stroke patients with collateral circulation. We determined whether rapid recanalization and collateral circulation affect clinical outcomes after IAT. METHODS: We retrospectively evaluated the clinical and radiological data of 134 consecutive patients who underwent IAT for intracranial artery occlusion. The interval from symptom onset to recanalization after IAT (onset-to-recanalization time) as an estimate of the probability of good clinical outcome (modified Rankin scale 0-2) was calculated in patients with collateral circulation in the ischemic hemisphere, which was rated poor (0/1 American Society of Interventional and Therapeutic Neuroradiology criteria) or good (2-4). Changes in National Institute of Health Stroke Scale (NHISS) score before and after IAT and modified Rankins scale scores 3 months after discharge were compared with respect to onset-to-recanalization time. RESULTS: In patients with good collateral circulation, the estimated onset-to-recanalization time for a 0.5 probability of a good clinical outcome was 347 minutes; with poor collateral circulation, it was 172 minutes for a 0.2 probability of good clinical outcome. Outcome analyses according to onset-to-recanalization time showed patients recanalized <6 hours had lower NHISS scores (<4.5, 4.5-6, >6 hours of onset-to-recanalization time, and non-recanalization: 5.1, 6.9, 11.9, and 19.8, respectively) at discharge and higher percentages of good clinical outcome (69%, 66.7%, 21.9%, and 0%, respectively) 3 months after IAT. CONCLUSIONS: The time window to expect a high probability of a good clinical outcome after IAT is highly dependent on the collateral circulation.
Arteries ; Collateral Circulation* ; Humans ; Retrospective Studies ; Stroke

Pulmonary alveolar hemorrhage (PAH) is a rare and often fetal presenting feature of systemic lupus erythematosus (SLE) and enters the differential diagnosis of diffuse lung disease in patients with SLE. Reported mortality rats are extremely high, between 70 and 90 percents. Because death frequently occurs within the first several days of the hemorrhage, the diagnosis needs to be established promptly and treatment should be initiated immediately. Treatment of alveolar hemorrhage has included various combinations of corticosteroids, cytotoxic agents, and plasmapheresis, but survival rates have been extremely low despite aggressive therapy. We experienced a case of diffuse alveolar hemorrhage in a 29 year-old SLE male patient. PAH was diagnosed by hemoptysis, anemia, infiltration on chest X-ray and hemosiderin-laden macrophages in bronchoalveolar lavage. After high dose intravenous steroid, cyclophosphamide intravenous therapy and plasmapheresis, the condition of patient was markedly improved. He was discharged and received monthly intravenous pulse cyclophosphamide. He has done well since, showing no further pulmonary hemorrhage with steroid tapering.
Adrenal Cortex Hormones ; Adult ; Anemia ; Animals ; Bronchoalveolar Lavage ; Cyclophosphamide ; Cytotoxins ; Diagnosis ; Diagnosis, Differential ; Hemoptysis ; Hemorrhage* ; Humans ; Lung Diseases ; Lupus Erythematosus, Systemic* ; Macrophages ; Male ; Mortality ; Plasmapheresis* ; Rats ; Survival Rate ; Thorax

BACKGROUND AND PURPOSE: We evaluated whether stent-assisted thrombectomy (SAT) is safer or more clinically beneficial than aggressive mechanical clot disruption (AMCD) for patients with acute intracranial artery occlusion. METHODS: We retrospectively analyzed the clinical data of 72 patients (33 with SAT and 39 with AMCD) who underwent intra-arterial thrombolysis for acute intracranial artery occlusions. Procedure parameters, clinical outcomes, and incidence of complications were compared between the SAT and AMCD groups. RESULTS: The time interval to recanalization was shorter in SAT patients (69.2+/-39.6 minutes, mean+/-standard deviation) than in AMCD patients (94.4+/-48.0 minutes, p<0.05). Recanalization was achieved in more SAT patients (91%) than AMCD patients (80%), but with no statistically significance. Urokinase was used less frequently in SAT patients (21%) than in AMCD patients (92%, p<0.05), and the incidence of symptomatic hemorrhages was lower in SAT patients (3%) than in AMCD patients (18%, p<0.05). Device-related complications in SAT patients comprised two cases of stent fracture and one case of distal migration of a captured thrombus. The proportion of patients with good outcomes, defined as scores from 0 to 3 on the modified Rankin Scale, was similar in the two groups at discharge (SAT, 46%; AMCD, 39%), but significantly higher in the SAT group than in the AMCD group at 3 months (64% vs. 40%, p<0.05) and 6 months (67% vs. 42%, p<0.05) after discharge. CONCLUSIONS: The outcomes and clinical parameters were better for SAT during thrombolytic procedures for acute intracranial artery occlusions than for AMCD for up to 6 months. However, some device-related complications occurred during stent interventions.
Arteries ; Cerebral Infarction ; Hemorrhage ; Humans ; Incidence ; Mechanical Thrombolysis ; Retrospective Studies ; Stents ; Stroke ; Thrombectomy ; Thrombosis ; Urokinase-Type Plasminogen Activator

BACKGROUND/AIMS: Although an Insulin-like growth factor-1(IGF-1) and an Insulin-like growth factor binding protein-3(IGFBP-3) have been reported to be valuable indices of nutritional state in cirrhotic patients, there is still a dispute. The controversy may be caused by the fact that most studies included heterogeneous groups of patients such as alcoholic and posthepatitic cirrhosis. The aim of this study was two fold: to evaluate whether the Growth hormone(GH), IGF-1, and the IGFBP-3 are significant or not as valuable indices of hepatic function as well as the nutritional state in hepatitis B or C associated cirrhotic patients. METHODS: This study consisted of 36 patients with liver cirrhosis associated with hepatitis B or C. Patients with alcoholic cirrhosis were excluded. The serum GH, IGF-1, and IGFBP-3 were measured while patients were fasting. The variables of liver function and nutritional state included Child-Pugh score, serum bilirubin, albumin, prothrombin time, triceps skinfold thickness(TSF), and midarm muscle circumference (MAMC). The correlation between the variables of liver function or nutritional state and the serum GH, IGF-1, or IGFBP-3 was evaluated. RESULTS: The IGF-1 correlated very well with IGFBP-3 (p<0.001). Both the IGF-1 and IGFBP-3 correlated inversely with Child-Pugh score (p<0.01, P<0.001 respectively). IGFBP-3 correlated very well with the serum bilirubin level as well as the albumin level (p<0.001). Neither the IGF-1 nor IGFBP-3 showed any correlation with TSF or MAMC. CONCLUSIONS: Both IGF-1 and IGFBP-3 were clinically significant as indices of hepatic function in the patients with hepatitic B or C associated cirrhosis but neither of them were significant as indices of nutritional state.
Alcoholics ; Bilirubin ; Dissent and Disputes ; Fasting ; Fibrosis ; Growth Hormone* ; Hepatitis B ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Liver Cirrhosis* ; Liver Cirrhosis, Alcoholic ; Liver* ; Prothrombin Time

Takayasu's arteritis(TA) is a chronic inflammatory and obliterative disease of medium- and large-sized arteries characterized by a strong predilection for the aortic arch and its branches. Renal involvement is usually manifested by renovascular hypertension. Glomerular involvement is rare and largely exists as a mild mesangial proliferative glomerulonephritis, commonly manifesting microscopic hematuria and proteinuria. The association of glomerular disease with TA is of interest since common immunologic mechanisms are proposed for the pathogenesis of both entities. We report a case of TA associated with focal segmental glomerulosclerosis. The patient presented with hypertension(Upper limb; Rt. 200/80mmHg, Lt. 95/60mmHg, Lower limb; Rt. 140/90mmHg, Lt. 110/70mmHg) and nephrotic syndrome(Serum albumin : 2.3g/dL, cholesterol : 454mg/dL, BUN : 18.0mg/dL, creatinine 1.3mg/dL, 24-hour urine protein : 5.17g). Digital substraction angiography showed multiple narrowing and occlusive changes of aortic arch and its branches. Renal biopsy was interpreted as focal segmental glomerulosclerosis. Therapy was instituted with prednisolone.
Angiography ; Aorta, Thoracic ; Arteries ; Biopsy ; Cholesterol ; Creatinine ; Extremities ; Glomerulonephritis ; Glomerulosclerosis, Focal Segmental* ; Hematuria ; Humans ; Hypertension, Renovascular ; Lower Extremity ; Prednisolone ; Proteinuria ; Takayasu Arteritis*