Necrotizing pneumonia causes necrosis of pulmonary parenchyma and may lead to pulmonary gangrene. Prior to theantibiotic era, extensive pulmonary involvement was potentially fatal, but the incidence of necrotizing pneumoniais now less common. On contrast-enhanced CT scans, consolidation with contrast enhancement containing necroticfoci with low attenuation and cavities is characteristic. Radiologic findings do not differ according to thecausative organism and in most of cases, specific diagnosis may be impossible. Clinical findings and certaincharacteristic radiologic findings may be helpful for narrowing the differential diagnosis. We illustrate theclinical and radiologic characteristics of necrotizing pneumonia according to causative bacterial organisms.
Diagnosis ; Diagnosis, Differential ; Gangrene ; Incidence ; Necrosis ; Pneumonia* ; Tomography, X-Ray Computed

No abstract available.
Colorectal Neoplasms*

BACKGROUND: The cases of Methicillin-Resistant Staphylococcus aureus(MRSA) infection after middle ear surgery, most of which are thought to be hospital acquired infection, are increasing recently in our hospital. MRSA infection is apt to be long lasting and to bring many complications because MRSA is resistant to aminoglycosides and cephalosporin as well as methicillin. There are many reports that medical personnel have a role to transmit that organisms to other patients. OBJECTIVES: To find and eradicate infection source and transmission route are both essential because medical personnel who contact MRSA infected patients can be a continuing transmission route. MATERIALS AND METHODS: Bacterial cultures from the noses and hands of medical personnel working in the department of Otolaryngology of Korea University Hospital were done and ribotyping through Southern blot technique was used to compare and prove an identical strain of MRSA organism between medical personnel and patients. RESULTS: As a result of ribotyping with EcoRI and HindIII, one distinct subtype(type I) was identified to be shared between medical personnel and patients. Among 30 medical personnel, 10 were carriers of MRSA. Seven MRSA isolates from these 10 medical carriers and 18 from 30 isolates of otorrhea shared the same type I ribotype. CONCLUSION: This finding reveals that MRSA transmission could occur between medical personnel and patients. Medical personnel should be aware of their possible role as a relay-stay of transmission of pathogenic organisms and should give efforts to prevent it.
Aminoglycosides ; Blotting, Southern ; Ear, Middle* ; Hand ; Humans ; Korea ; Methicillin ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Nose ; Otolaryngology ; Ribotyping ; Staphylococcus

PURPOSE: To evaluate the correlation between MRI findings and hip joint lesions evaluated by arthroscopy in patients affected by paralabral cyst. MATERIALS AND METHODS: Of patients treated by hip arthroscopy from Jan 1996 to Mar 2010, 17 cases symptomatic of paralabral cyst as observed by preoperative MRI were analyzed. The presence of an acetabular labrum tear, and the location and size of the cyst were evaluated using both preoperative MRI and intraoperative arthroscopy. Visual analogue scale (VAS), modified Harris hip scale, and Hip outcome score results were compared as determined by the two assessment methods. RESULTS: According to the MRI findings, the locations of the cysts included 5 cases in the anterosuperior, 2 anterior, 4 anteroinferior, 2 posterosuperior and 4 posteroinferior. The mean size of all cysts was 25.1x12.5x13.8 mm3. Postoperatively, the mean VAS score for all patients improved from 7.7 to 1.5, their modified Harris hip score improved from 58.8 to 90.7, and their Hip outcome score improved from 54 to 93.5. CONCLUSION: Painful paralabral cyst was mainly associated with an acetabular labral tear and we concluded that observation of paralabral cyst upon preoperative MRI provided indirect evidence of proximal acetabular labral pathology.
Arthroscopy ; Hip ; Hip Joint ; Humans

PURPOSE: To analyze the characteristics and causes of periprosthetic huge mass which occur after treatment by total hip arthroplasty. MATERIALS AND METHODS: Of the patients who had undergone total hip arthroplasty from January 2000 to October 2007, we retrospectively evaluated the 10 patients who suffered huge soft tissue mass. Five of these patients had received metal-on-metal bearing (group 1) prostheses, and the other 5 had received metal-on-polyethylene bearings (group 2). We evaluated the size and location of the mass, the extent of osteolysis, and the hematologic and pathologic examination results. RESULTS: Roentgenographically, the location of the masses varied from the acetabular area to the distal femoral stem. The mean mass diameter of all 10 patients was 14.6 cm(7-21 cm)x6.2 cm(3-9 cm)x7.2 cm(4-12 cm). Osteolytic lesions were found in 3 group 1 patients and 3 patients in group 2. High counts of lymphocytes and eosinophils were present in group 1. High counts of macrophages were present in group 2. CONCLUSION: The occurrence of osteolysis and huge soft mass after total hip arthroplasty is thought to be related to foreign body reaction by polyethylene wear particles and metal hypersensitivity. Outside-in patterned cortical thinning was considered to be indicative of a long standing periprosthetic soft tissue mass effect.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Eosinophils ; Foreign-Body Reaction ; Hip ; Humans ; Hypersensitivity ; Lymphocytes ; Macrophages ; Osteolysis ; Polyethylene ; Prostheses and Implants ; Retrospective Studies ; Ursidae

BACKGROUND AND OBJECTIVES: The measurement of the coronary flow velocity reserve (CFR) using transthoracic Doppler echocardiography (TTDE) has been reported to be useful for assessing the physiological significance of left anterior descending coronary artery (LAD) stenosis. This study was performed to evaluate the usefulness of CFR by TTDE for diagnosis of restenosis following revascularization procedures. SUBJECTS AND METHODS:Patients who were scheduled for follow-up coronary angiography following percutaneous intervention, or coronary bypass, surgery for a LAD lesion were enrolled. Prior to the follow-up coronary angiography, flow velocities in the distal LAD were measured by TTDE, both at rest and during the intravenous infusion of adenosine. CFR was defined as the ratio of the hyperemic to the basal peak diastolic velocities. Angiographic restenosis was defined as a diameter stenosis of more than 50% of the normal value by a quantitative coronary angiography. Of 142 consecutive patients, measurement of the CFR was possible in 95% (n=135), with 39 patients having a myocardial infarction in the LAD territory. The remaining 96 patients were used as the subjects ofin this study. RESULTS: The diameter stenosis was 41+/-26%, with angiographic restenosis found in 33 patients (34%). The mean CFR by TTDE was 2.5+/-1.1. CFR <2.0 was used to diagnose restenosis, with a sensitivity and specificity of 79% (26/33) and 89% (56/63), respectively. CONCLUSION: The noninvasive measurement of the CFR with TTDE is highly feasible, and can be a useful diagnostic modality for restenosis of a LAD following a revascularization procedure.
Adenosine ; Blood Flow Velocity ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Echocardiography, Doppler* ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Myocardial Infarction ; Reference Values ; Sensitivity and Specificity

PURPOSE: The purpose of this article is to analyze the results of combined agioplasity and femorofemoral bypass in patients with unilateral iliac arterial occlusive disease. METHOD: During the 11-year period from 1990 to 2000, 44 patients with iliac artery occlusion and a hemodynamically significant contralateral iliac artery stenosis were treated by using a combination of percutaneous transluminal angioplasity (PTA) and femorofemoral bypass (n=18) as well as aortobifemoral bypass (n=12) and iliofemoral bypass (n=14) at Korea university medical center. PTA was performed if the lesions in the donor iliac artery were less than 3 cm in length with no more than one well-localized lesion in either the common or external iliac artery, or both. Stent was deployed for suboptimal PTAs. The femorofemoral bypass was done within 3 to 5 days after PTA or stenting. RESULT: The mean age was 61.2 years. The Indications of femorofemoral bypass were hypertension, ischemic heart disease, chronic obstructive lung disease, old age (>75), cancer, and previous abdominal operation. The complication rate of the combination treatment was lower than that of the others. Primary patency rate at 1 and 3 years were 89%, 78% for aortobifemoral bypass, 83%, 66% for iliofemoral bypass, and 77%, 65% for femorofemoral bypass, respectively. CONCLUSION: The combination of PTA with or without stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis in patients with severe comorbid illness, advanced age, and intra-abdominal pathology. Angioplasity can allow more widespread use of femorofemoral bypass in these patients.
Academic Medical Centers ; Angioplasty* ; Arterial Occlusive Diseases* ; Constriction, Pathologic ; Humans ; Hypertension ; Iliac Artery ; Korea ; Myocardial Ischemia ; Pathology ; Pulmonary Disease, Chronic Obstructive ; Stents ; Tissue Donors

Intraductal papillary mucinous tumor (IPMT) of the pancreas, a lesion consisting of mucin-producing cells with neoplastic potential, is characterized by duct ectasia, mucin hypersecretion, often extensive papillary intraductal growth, varying degrees of cytologic atypia, and relatively indolent growth. The clinical presentation of IPMT of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. Less commonly these lesions may be detected as asymptomatic radiographic abnormalities. Interestingly, a case of a minute IPMT (2 mm in height and 7 mm in length, adenoma) in the main pancreatic duct presenting with acute pancreatitis in a 55 year-old man has been reported in the Japanese literature. Recently, we also experienced a case of a minute IPMT in a branch pancreatic duct causing repeated bouts of acute pancreatitis in a 75 year-old man. A filling defect at the neck of the main pancreatic duct seen on an endoscopic retrograde pancreatogram performed after recovery of the second attack of acute pancreatitis led the patient to undergo an exploratory laparotomy. After a near-total pancreatectomy was carried out, a minute (3 x 7 mm) IPMT of borderline malignancy was discovered in a branch duct at the head portion near the pancreatic neck without any lesions in the main pancreatic duct. Surprisingly, despite the resective surgery the patient died of carcinomatosis 8.5 months after the operation. We herein report a case of a minute but aggressive IPMT of the pancreas with a review of the literature.
Acute Disease ; Aged ; Case Report ; Cholangiopancreatography, Endoscopic Retrograde ; Human ; Male ; Mucins/secretion* ; Pancreatic Ducts/pathology ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/complications* ; Pancreatitis/etiology* ; Recurrence ; Tomography, X-Ray Computed

The clinical presentation of intraductal papillary mucinous tumor (IPMT) of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. The episodes of pancreatitis due to IPMT of the pancreas are usually mild in severity. Recently, however, we experienced a case of IPMT of the pancreas causing severe acute pancreatitis with a protracted course in a 65 year-old woman. Initially, she presented with pancreatic ascites and hyperenzynemia without duct ectasia and mucus extrusion through the papillary orifice. Refeeding caused aggravation of hyperenzynemia and abdominal pain. The 4th follow-up abdominal computed tomography taken about 2 months after admission only revealed marked dilatation of the main pancreatic duct. Distal pancreatectomy disclosed IPMT, combined type and carcinoma in situ histologically. The patient has been followed for 2 years after operation with an uneventful clinical course. We herein report a case of IPMT of the pancreas with an unusual presentation.
Abdominal Pain ; Aged ; Ascites ; Carcinoma in Situ ; Dilatation ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Humans ; Mucins* ; Mucus ; Pancreas* ; Pancreatectomy ; Pancreatic Ducts ; Pancreatitis*

PURPOSE: By virtue of advances in scientific methods and technical systems, there has been a rapid growth in the number of end stage renal disease (ESRD) patients treated using continuous ambulatory peritoneal dialysis (CAPD) as their primary renal replacement therapy. However, there are various catheter related complications that are limiting factors in patient and catheter maintenance. This study was aimed at introducing of the techniques of CAPD catheter implantation designed for reducing the complication rate, as well as conducting an investigation of the incidence of CAPD catheter related complications and patient survival and catheter survival rates. METHODS: We performed 234 cases of CAPD catheter implantation using a conventional surgical method (n=162, between January 1993 and December 1997) or a modified surgical method (n=72, between January 1998 and December 1999), and retrospectively reviewed the patient's medical records to elucidate the incidence of early catheter related complications and the catheter removal rate in relation to the surgical methods. RESULTS: There were 21 cases (23.8%) of peritonitis in the modified group, which was less than that in the conventional group (79 cases, 48.8%) (P=0.036). There were 9 cases (12.5%) of exit site and tunnel infection in the modified group, which was less than that in the conventional group (36 cases, 22.2%) (P=0.019). We were able to reduce the peritonitis as well as exit site and tunnel infection by a long segment of tunneling and immobilization of the catheter to the skin. Nine cases of leakage (5.5%) have occurred in the conventional group and one case (1.3%) in the modified group; the difference was statistically significant (P=0.046). CONCLUSION: These results indicate that our modified surgical methods can reduce the rate of early catheter related complications.
Catheters* ; Humans ; Immobilization ; Incidence ; Kidney Failure, Chronic ; Medical Records ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Replacement Therapy ; Retrospective Studies ; Skin ; Survival Rate ; Virtues