BACKGROUND: Improved intranasal visualization with endoscope allowed easy identification and opening of the lacrimal sac, without need for skin incision. OBJECTIVES: We studied and described the endoscopic dacryocystorhinostomy which has success rates comparable to those obtained by external approach. MATERIALS AND METHODS: Endoscopic dacrycystorhinostomy has been used for the treatment of nasolacrimal duct obstruction in 17 patients. The nasolacrimal apparatus related to the lateral nasal wall was approached using endoscopic technique. And bicanalicular nasal silicone tubes were placed during surgery in all cases. RESULTS: In our cases, it appears that lacrimal obstruction is related with congenital, idiopathic, facial trauma and other nasal or paranasal sinus diseases. Epiphora was relieved in 15 patients (88.2%), with a followup of 6 to 9 months. The causes of failure were granulation formation and obstruction of opening of lacrimal sac in 2 patients. CONCLUSION: Endoscopic dacryocystorhinostomy appear to be a safe and effective procedure which should be considered as an alternative to external dacryocystorhinostomy for the surgical treatment of nasolacrimal duct obstruction.
Dacryocystorhinostomy* ; Endoscopes ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Nasolacrimal Duct* ; Paranasal Sinus Diseases ; Silicones ; Skin

BACKGROUND: An earlier index of reperfusion is desirable to determine whether additional therapy is necessary for myocardial salvage. Using the washout phenomenon of biochemical markers, many investigator have reported noninvasive methods for detection coronary reperfusion in patients with acute myocardial infarction. Recently cardiac Troponin-T has been developed as a new myocardial specific marker, especially myocardial damage. The object of this study is to investigate the utility of cardiac Troponin-T for early assessment of reperfusion therapy. METHODS: The study group comprised 10 patients with acute myocardial infarction and reperfusion therapy that was initiated within 6 hours after the onset of symptoms. Blood samples were taken before treatment, every 30 min interval for 3 hours and then 6, 24, 72 hours after the onset of reperfusion therapy to measuring Troponin-T, Creatin Kinase(CK), and CK-MB level. Serum concentration of cardiac Troponin-T level was measured with immunoassed using ES-300, Boehringer Mannheim. We compared the real reperfusion that was assessed by coronary angiogram, chest pain disappearence and resolusion of St-segment elevation with an index of coronary reperfusion, the increase in Troponin-T(big up tri, open Troponin-T) 60, 90 min after repefusion therapy(Successful Reperfusion Index : Tn-T 60(90)-0>0.3 ng/ml) and the sensitivity, specificity, Positive, and negative predictive value were calculated using this threshold(Successful Reperfusion Index). RESULTS: 1) The studied patients(M/F : 7/3, mean age 54+/-12 year) were treated within 3 hour with thrombolytic therapy(7 patients, t-PA) or emergency angioplasty(3 patients). 2) The cardiac Troponin-T levels in eight patients with successful reperfusion showed early peak within 24 hours after reperfusion therapy were initiated but in 2 patients without successful reperfusion showed sustained increase without early peak within 24 hours. The CK-MB levels in patients with successful reperfusion also showed early peak within 24 hours but 5 of 8 patients showed no significant increase until 2 hours after reperfusion therapy. 3) The sensivity, specificity, positive and negative predictive value for detecting reperfusion using a threshold value of 0.3 ng/ml of big up tri, open Troponin-T 90 min(60 min) after reperfusion therapy was 100%(56%), 50(100%), 89%(100%), and 100%(20%), respectively. CONCLUSION: Serial measurements of cardiac Troponin-T, especially reperfusion index(0.3 ng/ml of big up tri, open Troponin-T 90 min after reperfusion therapy) are useful for early assessment of reperfusion therapy in acute myocardial infarction.
Biomarkers ; Chest Pain ; Emergencies ; Humans ; Myocardial Infarction* ; Myocardial Reperfusion ; Reperfusion* ; Research Personnel ; Sensitivity and Specificity ; Troponin T*

BACKGROUND/AIMS: The aim of this study was to evaluate the clinical features, radiologic findings, treatment modalities, and outcomes based on the origin of infection in patients with pyogenic liver abscesses. METHODS: We retrospectively analysed the medical records of 118 patients who were treated for pyogenic liver abscesses between January 2004 and December 2006. Of the 118 patients, 56 patients had biliary risk factors. RESULTS: The clinical characteristics were similar between the two groups, but the biliary risk group was characterized by an older age and the presence of jaundice. The size of the abscess was smaller in the group with biliary risk factors than in the cryptogenic group (p=0.02). Klebsiella pneumonia was the most common organism overall; however, Escherichia coli was more prevalent in the biliary risk group than in the cryptogenic group (p=0.03). Comparing the treatment modalities between the two groups, antibiotic therapy alone was more frequently used in the biliary group (p<0.01). The death rate was higher in the biliary group than in the non-biliary group (7.1 vs. 0.0%, p=0.04). The higher death rate in the biliary group was associated with multi-organ failure, absence of biliary drainage, and underlying diseases. CONCLUSIONS: There were differences between the two groups with respect to the size of the abscess, patient age, cultured organisms, and treatment modalities. The death rate was higher in the biliary group than the cryptogenic group.
Abscess ; Biliary Tract Diseases ; Drainage ; Escherichia coli ; Humans ; Jaundice ; Klebsiella ; Liver ; Liver Abscess, Pyogenic ; Medical Records ; Pneumonia ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: Active bleeding and non-bleeding visible vessels in patients with bleeding peptic ulcer are associated with a high risk of rebleeding. The aim of our study was to define the risk factors associated with failure of endoscopic hemostasis and rebleeding in patients with active peptic ulcer bleeding. METHODS: We retrospectively reviewed 119 patients (90 men and 29 women; mean age, 60.14+/-14.67 years) with active peptic ulcer bleeding (spurting, oozing and/or non-bleeding visible vessel) and who were treated in Wonkwang Medical Center from January 2002 to January 2007. They were classified to endoscopic hemoclipping alone group (n=75) or endoscopic hemoclipping combined with epinephrine injection group (n=44), according to the therapeutic modality. RESULTS: Initial hemostasis was achieved in the two groups (100%), and permanent hemostasis was achieved 71.4% in all the patients. Operation was done in eight patients (6.7%), and six patients (5%) in the two groups, respectively, died within 1 month after initial hemostasis because of bleeding related complications. Recurrent bleeding, the duration of the hospital stay, blood transfusion requirements, complications and the operation and mortality rates were not statistically different between the hemoclip alone and combination groups. Univariate analysis showed that rebleeding was related to the presence of shock on admission (p=0.01), complication (p=0.00), the pulse rate (<100/min) on admission (p=0.04), single ulcer (p=0.032), the level of hemoglobin (<8 g/dL) (p=0.02) and the volume of transfusion (<3 units) after the procedure (p=0.005) in all the patients. On the multivariate analysis that was adjusted for age and gender, the hemoglobin level (<8 g/dL) (odds ratio = 10.5) was the only significant predictor for early rebleeding. CONCLUSIONS: This result may suggest that the combination method does not provide a substantial advantage over hemoclipping alone for the hemostatic management of active peptic ulcers bleeding. A low hemoglobin level on admission may be useful to predict rebleeding after initial endoscopic hemostasis in patients with active peptic ulcer. However, this study was designed retrospectively, so the comparison between these two groups should be re-evaluated prospectively in a large, multicenter trial.
Blood Transfusion ; Epinephrine ; Heart Rate ; Hemoglobins ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Imidazoles ; Length of Stay ; Male ; Multivariate Analysis ; Nitro Compounds ; Peptic Ulcer ; Retrospective Studies ; Risk Factors ; Shock ; Ulcer

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) has recently been found to be a novel component of metabolic syndrome (MS), which is one of the leading causes of chronic liver disease. The serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) levels are suggested to affect liver fat accumulation and insulin resistance. We assessed the associations of serum ALT and GGT concentrations within the reference ranges with MS and NAFLD. METHODS: In total, 1,069 subjects enrolled at the health promotion center of Wonkwang University Hospital were divided into 4 groups according to serum ALT and GGT concentrations levels within the reference ranges. We performed biochemical tests, including liver function tests and lipid profiles, and diagnosed fatty liver by ultrasonography. Associations of ALT and GGT concentrationgrading within the reference range with fatty liver and/or MS were investigated. RESULTS: The presence of MS, its components, and the number of metabolic abnormalities [except for high-density lipoprotein-cholesterol (HDL-C) and fasting blood glucose] increased with the ALT level, while the presence of MS, its components, and the number of metabolic abnormalities (except for HDL-C) increased with the GGT level. The odds ratios for fatty liver and MS increased with the ALT level (P<0.001 and P=0.049, respectively) and the GGT level (P=0.044 and P=0.039, respectively). CONCLUSIONS: Serum ALT and GGT concentrations within the reference ranges correlated with the incidence of NAFLD and MS in a dose-dependent manner. There associations need to be confirmed in large, prospective studies.
Adult ; Alanine Transaminase/*blood ; Cholesterol, HDL/blood ; Fatty Liver/*diagnosis/enzymology/ultrasonography ; Female ; Humans ; Liver Function Tests ; Male ; Metabolic Syndrome X/*diagnosis/enzymology ; Middle Aged ; Odds Ratio ; Reference Values ; Retrospective Studies ; gamma-Glutamyltransferase/*blood