Malignant biliary or pancreatic duct stricture is dilatated using dilatating catheter or balloon catheter but a high grade stricture is difficult to dilate by general dilatating methods. Using Soehendra stent retriever is an effective method for exchanging an impacted stent. Recently, high grade malignant biliary strictures have been dilatated by Soehendra stent retriever. We report 3 cases of successful biliary drainage in high grade malignant biliary strictures using 7 Fr Soehendra stent retriever.
Catheters ; Constriction, Pathologic* ; Drainage* ; Pancreatic Ducts ; Stents*

PURPOSE OF STUDY: Lingual nerve damage can be caused by surgery or trauma such as physical irriatation, radiation, chemotherapy, infection and viral infection. Once nerve damage occurred, patients sometimes complain taste change and loss of taste along with serious disturbance of tongue. The purpose of this study was to evaluate the effects of unilateral lingual nerve transection on taste as well as on the maintenance of taste buds. MATERIALS AND METHODS: Male Sprague-Dawley rats weighing 220-250g received unilateral transection of lingual nerve, subjected to the preference test for various taste solutions (0.1M NaCl, 0.1M sucrose, 0.01M QHCl, or 0.01M HCl) with two bottle test paradigm at 2, 4, 6, or 8 weeks after the operation. Tongue was fixed with 8% paraformaldehyde. After fixation, they were observed with scanning electron microscope(JSM-840A(R), JEOL, JAPAN) and counted the number of the dorsal surface of the fungiform papilla for changes of fungiform papilla. And, Fungiform papilla were obtained from coronal sections of the anterior tongue(cryosection). After cryosection, immunostaining with Galpha gust(I-20)(Santa Cruz Biotechnology, USA), PLCbeta2(Q-15)(Santa Cruz Biotechnology, USA), and T1R1(Alpha Diagnostic International, USA) were done. Immunofluorescence of labeled taste bud cells was examined by confocal microscopy(F92-300., Olympus, JAPAN). RESULTS: The preference score for salty and sweet tended to be higher in the operated rats with statistical significance, compared to the sham rats. Fungiform papilla counting were decreased after lingual nerve transaction. In 2 weeks, maximum differences occurred. Gustducin and T1R1 expressions of taste receptor in 2 and 4 weeks were decreased. PLCbeta2 were not expressed in both experimental and control group. CONCLUSION: This study demonstrated that the taste recognition for sweet and salty taste changed by week 2 and 4 after unilateral lingual nerve transection. However, regeneration related taste was occurred in the presence of preserving mesoneurial tissue and the time was 6 weeks. Our results demonstrated that unilateral lingual nerve damage caused morphological and numerical change of fungiform papilla. It should be noted in our study that lingual nerve transection resulted in not only morphological and numerical change but also functional change of fungiform papillae.
Animals ; Biotechnology ; Drug Therapy ; Fluorescent Antibody Technique ; Humans ; Lingual Nerve Injuries* ; Lingual Nerve* ; Male ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Sucrose ; Taste Buds* ; Tongue

BACKGROUND/AIMS: Improvements in dialysis therapies and patient care are leading to more patients receiving dialysis for longer periods of time. Survival rates with peritoneal dialysis (PD) are superior to those with hemodialysis (HD) during the initial 2-3 years; however, data comparing the outcomes of these two methods are lacking. Thus, we performed a retrospective study of patients treated with dialysis for longer than 3 years to investigate patient condition according to mode of dialysis. METHODS: A total of 80 patients currently being treated by dialysis for at least 36 months at the Eulji Medical Center were included in this study. Patients' laboratory data and admissions histories over the prior 3 years were reviewed. Dialysis adequacy, body composition, and cytokine levels were quantified. RESULTS: A total of 39 PD and 41 HD patients, with no difference in mean age or gender, were compared. Regarding dialysis adequacy, 97.5% of HD patients met the criterion of 1.2 Kt/V or higher, whereas only 58% of PD patients satisfied the required weekly Kt/V of 1.7. Inflammatory cytokines were significantly elevated in PD patients; however, PD patients with adequate dialysis expressed the same inflammatory cytokines as HD patients. CONCLUSIONS: The delivery of adequate dialysis to PD patients over extended periods of time is difficult. Thus, more rigorous management of PD patients is required to avoid insufficient dialysis and inflammation.
Body Composition ; Cytokines ; Dialysis ; Humans ; Inflammation ; Patient Care ; Peritoneal Dialysis* ; Renal Dialysis* ; Retrospective Studies ; Survival Rate

Streptococcus constellatus (S. constellatus) is a commensal microorganism belonging to the "Streptococcus milleri" group, but may cause infections in different locations in immunocompromised patients. The infection of S. constellatus has high mortality and morbidity due to its tendency to cause abscesses in infected patients, which require immediate surgical drainage for effective treatment. We report on a 72-year-old woman with end stage renal disease, who suffered from dyspnea and general weakness that had developed over 7 days. Chest CT showed loculated pleural effusion. S. constellatus was cultured from exudative pleural effusions and confirmed by an analysis of 16S rRNA sequence. The patient was treated with drainage of pleural effusion and piperacillin/tazobactam for 5 weeks.
Abscess ; Aged ; Drainage ; Dyspnea ; Empyema ; Female ; Humans ; Immunocompromised Host ; Kidney Failure, Chronic ; Pleural Effusion ; Streptococcus ; Streptococcus constellatus ; Streptococcus milleri Group ; Thorax

A pseudochylothorax, a chyliform pleural effusion, is a rare disease of pleural effusion that contains cholesterol crystals or high lipid content that is not the result of a disrupted thoracic duct. Most of the cases were found in patients with long-standing pleural effusion due to chronic inflammatory disease, such as old tuberculous pleurisy or chronic rheumatoid pleurisy. We experienced a case of pseudochylothorax in a 74-year-old man, who was being treated for pulmonary tuberculosis and pleurisy 10 years ago. The diagnosis was confirmed on pathological study of the pleural effusion, which contained cholesterol crystals having a diagnostic rhomboid appearance.
Aged ; Cholesterol ; Humans ; Pleural Effusion ; Pleurisy ; Rare Diseases ; Thoracic Duct ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary

Doxylamine succinate is an over-the-counter drug widely used for treating insomnia. We experienced a case of severe rhabdomyolysis complicating acute renal failure after doxylamine overdose in a 24-year- old male. The maximum values of creatine kinase and creatinine level during hospitalization were 264,141 IU/L and 8.4 mg/dL, respectively. Oliguria and severe dyspnea occurred on the sixth hospital day and were treated with hemodialysis. Then, he recovered without any sequelae. To the best of our knowledge, the maximum creatine kinase level of 264,141 IU/L in the present case is the highest value among the case reports on doxylamine-induced rhabdomyolysis and this is the first case report in Korea of doxylamine-induced severe rhabdomyolysis accompanying oliguric acute renal failure and requiring treatment with hemodialysis.
Acute Kidney Injury* ; Creatine Kinase ; Creatinine ; Doxylamine* ; Dyspnea ; Hospitalization ; Humans ; Korea ; Male ; Oliguria ; Renal Dialysis ; Rhabdomyolysis* ; Sleep Initiation and Maintenance Disorders ; Succinic Acid

PURPOSE OF STUDY: The temporomandibular joint (TMJ) occupies a key functional role in mastication and contributes to normal deglutition, speech as well as cosmesis. When a large amount of mandible including the condyle head is resected, it is very difficult to reconstruct it as a functional unit. In this retrospective study, we present the functional, radiographic and cosmetic results of reconstructed temporomandibular joint using free fibular flap. PATIENTS AND METHODS: Total 12 patients (M:F = 6:6) who underwent condylar reconstruction with the fibular flap were interviewed and examined by radiographs and Bio-PAK(R). Mean follow up periods was 47.7+/-20.0 months and the average age was 38.7+/-15.3 years. Remodeling of condyle and function of TMJ were evaluated and facial contour was judged subjectively. RESULTS: All flaps were viable and no immediate postoperative complication had happened. One patient showed decreased mouth opening, so interpositional gap arthroplasty was performed. The resorption rates of reconstructed fibular were minimal and the condyle heads were changed into domeshaped neocondyle after 2 years. All patients had normal diet and no speech difficulty was reported. Nine patients were satisfied with their facial contour but three patients complained about the depression of cheek. CONCLUSION: The reconstruction of TMJ with free fibular flap was reliable methods and very effective means of restoring mandibular function. The functional and morphologic results were excellent and showed little complications.
Arthroplasty ; Cheek ; Deglutition ; Depression ; Diet ; Follow-Up Studies ; Head ; Humans ; Mandible* ; Mastication ; Mouth ; Postoperative Complications ; Retrospective Studies ; Temporomandibular Joint*

PURPOSE: This study analyzed the tumor response, overall survival, progression free survival and related prognostic factors in patients with muscle invasive bladder cancer subjected to bladder preserving treatment. MATERIALS AND METHODS: Between August 1995 and June 2004, 37 patients with muscle invasive (transitional cell carcinoma, clinically stage T2-4) bladder cancer were enrolled for the treatment protocol of bladder preservation. There were 33 males and 4 females, and the median age was 67 years (range 38~86 years). Transurethral resection of the bladder (TURB) was performed in 17 patients who underwent complete resection. The median radiation dose administered was 64.8 Gy (range 55.8~67 Gy). The survival rate was calculated by the Kaplan-Meier method. RESULTS: An evaluation of the response rate was determined by abdomen-pelvic CT and cystoscopy at three months after radiotherapy. A complete response was seen in 17 patients (46%). The survival rate at three years was 54.7%, with 54 months of median survival (range 3~91 months). During the study, 17 patients died and 13 patients had died from bladder cancer. The progression free survival rate at three years was 37.2%. There were 24 patients (64.9%) who had disease recurrence: 16 patients (43.2%) had local recurrence, 6 patients (16.2%) had a distant recurrence, and 2 patients (5.4%) had both a local and distant recurrence. The survival rate (p=0.0009) and progression free survival rates (p=0.001) were statistically significant when compared to the response rate after radiotherapy. CONCLUSION: The availability of complete TURB and appropriate chemoradiotherapy were important predictors for bladder preservation and survival.
Chemoradiotherapy ; Clinical Protocols ; Cystoscopy ; Disease-Free Survival ; Female ; Humans ; Male ; Radiotherapy ; Recurrence ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Lipomas are common soft tissue tumors that are located in the body tissues containing adipose tissues. However, lipomas arising from the walls of a vein are very rare. Intravascular lipomas have been described most commonly in association with the inferior vena cava. Intravascualar lipomas involving the subclavian vein are rare. We are reporting a case of an asymptomatic lipoma of the right subclavian vein, growing into the right brachiocephalic vein.
Brachiocephalic Veins ; Lipoma ; Subclavian Vein ; Veins ; Vena Cava, Inferior