BACKGROUND: Recently, many institutions have acquired multi-detector computed tomography (MDCT) systems. This made it easier and more convenient to use MDCT as a initial diagnostic modality for hemoptysis. The purpose of this study was to evaluate the usefulness of MDCT before bronchoscopy and/or bronchial arterial embolization (BAE) for hemoptysis. METHODS: We studied a total of 125 patients with hemoptysis who underwent, between 2006 and 2008, MDCT in a routine protocol before bronchoscopy and/or BAE. One hundred two patients underwent bronchoscopy and 29 patients underwent BAE. We compared the usefulness of MDCT and bronchoscopy for detecting the bleeding site and identifying the cause. We also evaluated our ability, using MDCT, to detect instances where the bronchial artery caused hemoptysis. RESULTS: The rate of detection of a bleeding site was 75.5% on MDCT and 50.9% on bronchoscopy. MDCT and bronchoscopy detected the bleeding site in agreement in 62.7% of patients. MDCT alone found the bleeding site in 27.5% of cases. MDCT identified the cause of hemoptysis in 77.5% and bronchoscopy in 11.8%. In 29 patients who underwent BAE, we detected a total of 37 hypertrophied bronchial arteries that were causing hemoptysis. Of 37 bronchial arteries, 23 (62.2%) were depicted on MDCT. CONCLUSION: MDCT is superior to bronchoscopy for detecting the bleeding site and identifying the cause of hemoptysis. MDCT can also predict the side of affected bronchial artery with depiction of hypertrophied bronchial artery and localizing the bleeding site. Doing MDCT before bronchoscopy and BAE can provide a guideline for the next step.
Bronchial Arteries ; Bronchoscopy ; Hemoptysis ; Hemorrhage ; Humans ; Tomography, X-Ray Computed

OBJECTIVE: Vertebral distraction is routinely performed during anterior cervical discectomy and fusion (ACDF). Overdistraction can injure the facet joints and may cause postoperative neck pain consequently. The purpose of this study was to investigate the clinical relevance of distraction force during ACDF. METHODS: This study included 24 consecutive patients with single level cervical disc disease undergoing single level ACDF. We measure the maximum torque just before the the arm of the Caspar retractor was suspended by the rachet mechanism by turning the lever on the movable arm using a torque meter. In order to turn the lever using the torque driver, we made a linear groove on the top of the lever. We compared the neck disability index (NDI) and visual analogue scale (VAS) scores between the high torque group (distraction force>6 kgf.cm) and the low torque group (distraction force< or =6 kgf.cm) at routine postoperative intervals of 1, 3, 5 days and 1, 3, 6 months. RESULTS: The VAS scores for posterior neck pain had a linear correlation with torque at postoperative 1st and 3rd days (y=0.99x-1.1, r2=0.82; y=0.77x-0.63, r2=0.73, respectively). VAS scores for posterior neck pain were lower in the low torque group than in the high torque group on both 1 and 3 days postoperatively (3.1+/-1.3, 2.6+/-1.0 compared with 6.0+/-0.6, 4.9+/-0.8, p<0.01). However, the difference in NDI scores was not statistically significant in all postoperative periods. CONCLUSION: Vertebral distraction may cause posterior neck pain in the immediate postoperative days. We recommend not to distract the intervertebral disc space excessively with a force of more than 6.0 kgf.cm.
Arm ; Diskectomy ; Humans ; Intervertebral Disc ; Neck ; Neck Pain ; Pain, Postoperative ; Spinal Fusion ; Torque ; Zygapophyseal Joint

Deep vein thrombosis (DVT) is a serious illness sometimes causing death due to acute pulmonary thromboembolism (PTE). Blood stasis of the pelvic vein is a major etiologic factor for DVT. Occasionally a huge uterine myoma can cause compression of the pelvic venous system leading to DVT. We experienced a very rare case of pulmonary thromboembolism in a 45-year-old woman with a huge uterine myoma and no other recognized risk factors for PTE and DVT. The patient was successfully treated with thrombolytic and anticoagulation therapy associated with total hysterectomy.
Female ; Humans ; Hysterectomy ; Leiomyoma* ; Middle Aged ; Pulmonary Embolism* ; Risk Factors ; Veins ; Venous Thrombosis

PURPOSE: Fractional exhaled nitric oxide (FeNO) is a maker of airway inflammation, and impedance of low frequency in the impulse oscillometry system (IOS) reflects small-airway obstruction. We investigated the association of the FeNO level with IOS parameters and spirometry results in asthma patients. METHODS: Fifty-eight children with asthma (60.3%, male), mean age 8.3 years (range, 4.5-16.0 years), were enrolled in the study. Reactance and resistance at 5 Hz with IOS, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and forced expiratory flow 25%-75% of the vital capacity (FEF25%-75%) with spirometry and FeNO were measured in all patients. The Z-score of spirometry and IOS parameters and the mean level of FeNO were used for correlation and regression analysis. RESULTS: FeNO was not significantly associated with height, age, or other demographic parameters. There was a statistically significant correlation between spirometry results and IOS measurements. The FeNO level was not significantly correlated with IOS variables. After adjusting for height, sex, atopic status, and the use of inhaled corticosteroid, the FeNO level showed significant correlations with Z-score of FEV1/FVC (P=0.037, adjusted R 2=0.234). CONCLUSION: FeNO was significantly correlated with Z-scores of FEV1/FVC, but not with IOS variables. Therefore, FeNO may be used to detect whole airway obstruction, but not small-airway obstruction.
Airway Obstruction ; Asthma* ; Child* ; Electric Impedance ; Forced Expiratory Volume ; Humans ; Inflammation ; Nitric Oxide* ; Oscillometry* ; Regression Analysis ; Respiratory Function Tests ; Spirometry* ; Vital Capacity

PURPOSE: Bronchopulmonary dysplasia (BPD) is characterized by inflammation with proteolytic damage to the lung extracellular matrix. The results from previous studies are inconsistent regarding the role of proteinases and antiproteinases in the development of BPD. The aim of the present study was to investigate whether matrix metalloproteinase (MMP)-8, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-2, and TIMP-1 levels in the serum of preterm infants at birth are related to the development of BPD. METHODS: Serum was collected from 62 preterm infants at birth and analyzed for MMP-8, MMP-9, TIMP-2, and TIMP-1 by using enzyme-linked immunosorbent assay. MMPs and TIMPs were compared in BPD (n=24) and no BPD groups (n=38). Clinical predictors of BPD (sex, birth weight, gestational age, etc.) were assessed for both groups. The association between predictors and outcome, BPD, was assessed by using multivariate logistic regression. RESULTS: Sex, birth weight, and mean gestational age were similar between the groups. BPD preterm infants had significantly lower TIMP-2 levels at birth compared with no BPD preterm infants (138.1+/-23.0 ng/mL vs. 171.8+/-44.1 ng/mL, P=0.027). No significant difference was observed in MMP-8, MMP-9, and TIMP-1 levels between the two groups. Multivariate logistic regression analysis indicated that the TIMP-2 levels were predictive of BPD after adjusting for sex, birth weight, gestational age, proteinuric preeclampsia, and intraventricular hemorrhage (beta=-0.063, P=0.041). CONCLUSION: Low TIMP-2 serum levels at birth may be associated with the subsequent development of BPD in preterm infants.
Birth Weight ; Bronchopulmonary Dysplasia* ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Gestational Age ; Hemorrhage ; Humans ; Infant, Newborn ; Infant, Premature* ; Inflammation ; Logistic Models ; Lung ; Matrix Metalloproteinases ; Parturition* ; Peptide Hydrolases ; Pre-Eclampsia ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2*

PURPOSE: Although chronic and recurrent rhinosinusitis is prevalent in children, little is known about its causes. Here, we investigated the humoral immunity in children with chronic or recurrent rhinosinusitis. METHODS: We examined 16 children attending the outpatient clinic at the CHA Bundang Medical Center including 11 boys and 5 girls, aged 3.11 years (mean age, 5.6 years), who had rhinosinusitis for >3 months or >3 times per year. The complete blood count with differential and total serum concentrations of Immunoglobulin (Ig) E, IgA, IgD, IgM, IgG, and IgG subclasses (IgG1, IgG2, IgG3, and IgG4) of all children were measured. All subjects received 23-polysaccharide pneumococcal vaccination (PPV), and the levels of antibodies to 5 serologic types (4, 6B, 14, 18C, and 23F) of pneumococcal capsular polysaccharide antigens were measured before and after vaccination. Post-PPV antibody titers > or =0.35 microg/mL or with a > or =4-fold increase were considered as positive responses. RESULTS: The titers of IgG, IgA, IgD, and IgM were within normal range in all 16 children, whereas the total IgE concentration was higher than normal in 2 children. IgG1 deficiency was observed in 1 patient and IgG3 deficiency in 3. After PPV, 1 patient failed to respond to all 5 serologic types, 2 failed to respond to 4 serologic types, and 2 failed to respond to 3 serologic types. CONCLUSION: Clinicians should consider the evaluation of humoral immune functions in children with chronic or recurrent rhinosinusitis who do not respond to prolonged antibiotic treatment.
Aged ; Ambulatory Care Facilities ; Antibodies ; Antibody Formation ; Blood Cell Count ; Child ; Humans ; Immunity, Humoral ; Immunoglobulin A ; Immunoglobulin D ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Reference Values ; Vaccination

Pseudoaneurysm of the femoral artery is a rare complication following the fixation of the fracture of proximal femur or protruded bony fragment and reports injuring on superficial femoral artery is very rare compared to deep femoral artery complicated by the insertion of distal interlocking screw. The chance of injuring superficial femoral artery may increase by deep insertion of drill bit or the repetitive arterial pulsation on prominent distal interlocking screw tip during the perioperative period. Authors experienced one case of injury on the superficial femoral artery postoperative 42 hours followed by the use of proximal femoral nail advocated by the AO group recently and would like to call attention upon the possibilities of vessel injury complicated with the use of the distal interlocking screw.
Aneurysm, False* ; Femoral Artery* ; Femur ; Perioperative Period

OBJECTIVE: Actinomycosis is a rare entity, especially in the female genital tract, which presents some difficulties in establishing a correct preoperative diagnosis. Pelvic actinomycosis can mimick pelvic or intra- abdominal malignancy leading to mutilating surgical exercise. The authors surveyed 12 cases of pelvic actinomycosis for advice to detection and treatment of the pelvic actinomycosis. METHODS: The authors studied retrospectively 12 cases which have admitted to Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center for pelvic actinomycosis from January. 1, 1991 to December. 31, 2000. RESULTS: 41.7% of the cases occurred in 31-40 years age group, 91.7% of cases associated with intrauterine devices for 5-21 years. Most common complaints were abdominal pain and palpable mass, and other complaints were vaginal discharge, bowel habit change, nausea, vomiting and fever. The actinomycosis lesions involved one or both ovaries in all 12 cases. In 11 cases, the lesions extended to other areas, such as the uterus, parametrium, pelvic walls, cul-de-sac, colon and bladder. All patients underwent surgery that included removal of the lesions with ipsilateral or bilateral adnexa and, in specific cases, with extension of the lesions, hysterectomy, colostomy and primary repair of bladder or rectum. After surgery, 9 patients were treated with penicillin and the duration of treatment was 12 months in 2 patients, 6 months in 3, < or = 3 months in 3 and one patient was being treated for 2 months. Other 3 patients were treated with metronidazole, cephalosporin and aminoglycoside during 1-3 weeks. All patients were alive and well. CONCLUSION: It is needed to make an earlier and more correct diagnosis of actinomycosis, and high-dose intravenous antibiotic therapy can reduce the risk of nearby pelvic structure injuries. In cases of pelvic actinomycosis where the abscess can be completely resectable, a shorter period of antibiotic therapy can be required.
Abdominal Pain ; Abscess ; Actinomycosis* ; Chungcheongnam-do ; Colon ; Colostomy ; Diagnosis ; Female ; Fever ; Gynecology ; Humans ; Hysterectomy ; Intrauterine Devices ; Metronidazole ; Nausea ; Obstetrics ; Ovary ; Penicillins ; Rectum ; Retrospective Studies ; Ulsan ; Urinary Bladder ; Uterus ; Vaginal Discharge ; Vomiting

We present a case of in-utero treatment of posterior urethral valve syndrome(PUVS) by vesicoamniotic shunting. The shunt was established by basket-shaped catheter at the 22 weeks' gestation. Enlarged bladder and hydronephrosis were improved after the shunt procedure. The baby was delivered at the 39 weeks' gestation and had normal serum range of BUN and creatinine. Because the outer opening of catheter was burried under abdominal skin on the day before delivery, posterior urethral valve excision and basket removal through urethra were operated by endoscopy on the 2nd day of birth. The baby has been followed up for 5 months and in good health. We report this case with a brief review of literature. Shunt operation in-utero is considered as a safe and effective therapy for lower urinary tract obstruction caused by PUVS.
Catheters* ; Creatinine ; Endoscopy ; Fetal Therapies* ; Hydronephrosis ; Parturition ; Pregnancy ; Skin ; Urethra ; Urinary Bladder ; Urinary Tract

PURPOSE: Immunotherapy is accepted as the only treatment of allergic disease that can modify the natural course of the disease and ameliorate symptoms. This study aimed to evaluate the safety and efficacy of ultra-rush therapy using Dermatophagoides extracts in children. METHODS: Of children older than four years who had visited Bundang CHA Pediatric Allergy Clinic, those showing positive reactions only to Dermatophagoides in the skin prick test and to the nasal provocation test were included. In all, 11 and 12 patients respectively preferred conventional and ultra-rush immunotherapy. We elevated allergen concentrations diluted to 1,000:1 of the end strength by 2-3 times with 30-minute intervals and checked oxygen saturation, pulse rate, blood pressure, and systemic reactions every 15 minutes. Immunotherapy effectiveness was valued by changes in nasal provocation test scores before and after immunotherapy. RESULTS: The average ages of patients in the conventional and ultra-rush immunotherapy groups were 8.3+/-2.3 and 9.2+/-2.8 years, respectively. Systemic reactions were observed in six in the ultra-rush group (50%) without anaphylaxis and one (9%) in the conventional group. The average scores in the nasal provocation test before and after treatment in the conventional group were 8.2+/-1.5 and 4.6+/-2.1, respectively (P=0.043). In the ultra-rush immunotherapy group, the scores changed from 6.2+/-2.2 to 3.7+/2.5 (P=0.017). CONCLUSION: Ultra-rush immunotherapy using Dermatophagoides in children is effective for treating allergic disease but can induce systemic effects rather than conventional immunotherapy.
Anaphylaxis ; Blood Pressure ; Child ; Dermatophagoides pteronyssinus ; Heart Rate ; Humans ; Hypersensitivity ; Immunotherapy ; Nasal Provocation Tests ; Oxygen ; Pyroglyphidae ; Skin