Transurethral resection syndrome (TURS) is one of the complications of endoscopic transurethral operation with irrigation fluid. TURS comprehensively refer to several clinical symptoms and signs caused by intravascular absorbtion of irrigation fluid, hypertension, bradycardia, arrhythmia, respiratory distress, hypotension, confusion, blindness, seizure, coma, hyponatremia, and hypoosmolarity. TURS is mainly known as the complication of the transurethral resection of prostate (TURP), and rarely found in the procedures such as transurethral resection of bladder tumor (TUR-BT), hysteroscopy, cystoscopy, and arthroscopy. Only a few cases of TURS after TUR-BT have been reported. The patients on maintenance hemodialysis were restricted in the amount of water intake for volume control. They were susceptible to the absorption of irrigation fluid during TUR-BT since they had anuria. We hereby report the 2 cases maintenance hemodialysis patients who were led to TURS after TUR-BT.
Absorption ; Anuria ; Arrhythmias, Cardiac ; Arthroscopy ; Blindness ; Bradycardia ; Coma ; Cystoscopy ; Drinking ; Humans ; Hypertension ; Hyponatremia ; Hypotension ; Hysteroscopy ; Kidney Failure, Chronic ; Renal Dialysis ; Seizures ; Transurethral Resection of Prostate ; Urinary Bladder ; Urinary Bladder Neoplasms

A spontaneous pneumoperitoneum is air in the peritoneal space that is detectable radiologically and can be managed successfully by observation alone or a laparotomy. A 73-year-old man was admitted for low back pain. He had a giant bulla in the left upper lung, detected radiologically 7 years earlier. On admission, he had free air in the subphrenic area bilaterally, while the previous giant bulla was not seen. Based on the physical examination, we thought that the new free air did not indicate a surgical abdomen, and performed additional examinations to rule out other disease. There was no abnormal finding linked to the free air. The free air had almost disappeared on a subsequent chest X-ray. We report a rare case of spontaneous pneumoperitoneum caused by a giant bulla, with a literature review
Abdomen ; Aged ; Blister ; Humans ; Laparotomy ; Low Back Pain ; Lung ; Physical Examination ; Pneumoperitoneum ; Thorax

The definition of C1q nephropathy has been categorized since 1985. However, the clinical correlation and pathophysiology has not yet been fully revealed. Therefore, the treatment of C1q nephropathy has not been established. Our subject was a 23 year-old female patient with both leg edema and oliguria, who was presented with weight gain. Renal biopsy confirmed C1q nephropathy. Prednisolone and cyclosporine therapy was selected for treatment. After 2 weeks of treatment, the patient lost 8 kg of body weight and all laboratory examination results were normalized. Both leg edema and oliguria were resolved. After 21 weeks of regular follow-up, she stopped the medicine by herself. Eight weeks later, the patient came to the Emergency room because both leg edema recurred. Same regimen was administered for 3 weeks, and complete remission was achieved again.
Biopsy ; Body Weight ; Cyclosporine ; Edema ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Leg ; Oliguria ; Porphyrins ; Prednisolone ; Weight Gain

BACKGROUND: Robotic radical prostatectomy is performed in elderly patients and requires extreme changes in the patient's position and is often associated with a long surgery time. This study reviewed the pulmonary complications occurring after a robotic radical prostatectomy and analyzed the potential risk factors. METHODS: The medical records of all patients who had undergone robotic radical prostatectomy at our institution were reviewed. Among the 80 total patients, 58 were capable of spontaneous respiration at the end of surgery (Group I), whereas 22 patients required assisted ventilation (Group II). A comparison between the two groups was made in terms of the demographic characteristics, coexisting diseases, anesthesia and operation time, amount of intraoperative blood loss and transfused blood products. RESULTS: The mean age of the patients was 67.2 +/- 7.3 years. The mean operation time was 384.1 +/- 203.4 min (range, 195-1,180 min). The anesthesia and operation time, amount of intraoperative blood loss and number of transfused patients were all significantly higher in Group II. Univariate analysis revealed age, body mass index, intraoperative blood loss and transfusion, anesthesia and operation time to be related to postoperative respiratory insufficiency. Multivariate analysis revealed intraoperative transfusion and operation time to be predictive risk factors. CONCLUSIONS: Prolonged laparoscopic surgery in a steep Trendelenburg position has a high likelihood of postoperative respiratory insufficiency, with the intraoperative transfusion and a longer operation time being possible contributing factors.
Aged ; Anesthesia ; Body Mass Index ; Head-Down Tilt ; Humans ; Laparoscopy ; Medical Records ; Multivariate Analysis ; Prostatectomy ; Respiration ; Respiratory Insufficiency ; Risk Factors ; Ventilation

OBJECTIVE: Cerebral vasospasm still remains a major cause of the morbidity and mortality, despite the developments in treatment of aneurysmal subarachnoid hemorrhage. The authors measured the utility and benefits of external lumbar cerebrospinal fluid (CSF) drainage to prevent the clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage in this randomized study. METHODS: Between January 2004 and March 2006, 280 patients with aneurysmal subarachnoid hemorrhage were treated at our institution. Among them, 107 patients met our study criteria. The treatment group consisted of 47 patients who underwent lumbar CSF drainage during vasospasm risk period (about for 14 days after SAH), whereas the control group consisted of 60 patients who received the management according to conventional protocol without lumbar CSF drainage. We created our new modified Fisher grade on the basis of initial brain computed tomography (CT) scan at admission. The authors established five outcome criteria as follows : 1) clinical vasospasm; 2) GOS score at 1-month to 6-month follow-up; 3) shunt procedures for hydrocephalus; 4) the duration of stay in the ICU and total hospital stay; 5) mortality rate. RESULTS: The incidence of clinical vasospasm in the lumbar drain group showed 23.4% compared with 63.3% of individuals in the control group. Moreover, the risk of death in the lumbar drain group showed 2.1% compared with 15% of individuals in the control group. Within individual modified Fisher grade, there were similar favorable results. Also, lumbar drain group had twice more patients than the control group in good GOS score of 5. However, there were no statistical significances in mean hospital stay and shunt procedures between the two groups. IVH was an important factor for delayed hydrocephalus regardless of lumbar drain. CONCLUSION: Lumbar CSF drainage remains to play a prominent role to prevent clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage. Also, this technique shows favorable effects on numerous neurological outcomes and prognosis. The results of this study warrant clinical trials after endovascular treatment in patients with aneurysmal SAH.
Aneurysm ; Brain ; Drainage ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Length of Stay ; Prognosis ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial

BACKGROUND: Obesity has been generally diagnosed by 'Body Mass Index (BMI)' in primary care. Recently the use of Bioelectrical Impedance Analyzer' has become popular in Korea to evaluate body fat rate (BFR), as cost is inexpensive and the method to use is simple. As a result, the opposed finding of normal BMI and elevated BFR vice versa in same individuals are being encountered frequently. We designed this study to find out the characteristics and cardiovascular risk of people in these groups. METHODS: The medical records of health promotion center were obtained and 22,704 applicants visitor who undeerwent health risk questionnaire, screening tests and physical examination for cardiovascular disease were reviewed. RESULTS: After adjusting for age, sex, exercise and education level, cardiovascular risk such as hypertension, DM, and hypercholesterolemia, LDL tended to increase linearly and HDL tended to decrease linearly with increase of BFR or BMI. In comparison with normal BMI and BFR group, the odds ratios of normal BMI and elevated BFR group or vice versa were increased. CONCLUSION: If either one of BMI or BFR of a person was elevated, even though the other was within normal range, the cardiovascular risk of that person was shown to be high.
Adipose Tissue* ; Body Mass Index* ; Cardiovascular Diseases ; Education ; Electric Impedance ; Health Promotion ; Humans ; Hypercholesterolemia ; Hypertension ; Korea ; Mass Screening ; Medical Records ; Obesity ; Odds Ratio ; Physical Examination ; Primary Health Care ; Reference Values ; Risk Factors* ; Surveys and Questionnaires

OBJECTIVES: The evaluations of the pathogenetic roles of cell mediated immunity and of the preventive effect for disease progression with interferon(IFN) treatment in patients with chronic active hepatitis-B(CAH-B) are the objectives of this study. METHODS: Thirty-two patients with CAH-B were treated with interferon alpha-2b(IFN alpha-2b) with prednisolone withdrawal and 30 control patients were treated with conventional hepatotonics for 6 months. Peripheral total T cell fractions and T cell subsets of the patients with CAH-B, treated with IFN alpha-2b with prednisolone withdrawal, were examined 1 month before administration of prednisolone, and compared with 12 normal controls for assessing the potential role of cellular immunity in the development of CAH-B. To estimate the effectiveness of IFN therapy for the patients with CAH-B, levels of various liver function tests, HBsAg, anti-HBs, HBeAg, anti-HBe, HBV DNA, anti-HCV and others were assessed for the treatment group and compared with control patients at pre- and post-treatment period each. RESULTS: The value of CD4 was significantly lower in patients with CAH-B than normal controls (36.3 +/- 7.7% vs 42.1 +/- 5.7%, p < 0.05) and the value of CD8 was significantly higher in patients with CAH-B than normal controls (30.6 +/- 10.3% vs 24.3 +/- 5.2%, p < 0.05) before prednisolone administration. The patients in responder group (n = 26) had significantly lower CD4 cells compared with normal controls, but non-responders (n = 6) did not have. The levels of liver function test(LFT) in the patients with IFN alpha-2b treatment with prednisolone withdrawal were not different from the control patient group at pretreatment, but significantly lower than control patient group's after treatment, regardless of response to IFN alpha-2b treatment with prednisolone withdrawal. CONCLUSIONS: The cellular immunity of the host may have a potential role in the pathogenesis of chronicity of hepatitis B infection. IFN alpha-2b treatment with prednisolone withdrawal may be regarded as one of the effective treatment modalities for the inhibition of disease progression in patients with CAH-B.
Adult ; DNA, Viral/blood ; Female ; Hepatitis B Antibodies/blood ; Hepatitis B e Antigens/blood ; Hepatitis B, Chronic/therapy* ; Hepatitis B, Chronic/physiopathology ; Hepatitis B, Chronic/immunology* ; Human ; Interferon Alfa-2b/therapeutic use* ; Male ; Middle Age ; Prednisolone/administration & dosage ; T-Lymphocyte Subsets/immunology*

BACKGROUND/AIMS: The purpose of this study was to examine the clinical observations of patients with hematochezia in attempt to determine the appropriate evaluation and treatment of this group of patients. METHODS: Seventy patients with hematochezia were admitted to Intemal medicine (IM) Department of Chungnam National University Hospital from January 1990 to August 1997. The clinical observations of patients with hematochezia were reviewed and the results are as follows. RESULTS: 1) The causes of the hematochezia were ischemic colitis (18.6%), hemorrhoids (15.7%), ulcerative colitis (14.3%), unknown (12.8%), rectal cancer (7.1%), nonspecific ulcers (rectum; 4.3%, colon; 1.4%), diverticulosis (5.7% ), colon cancer (4.3%.), mdiation colitis (2.9%), angiodysplasia (2.9%), polyps (2.9%), Samonella colitis (2.9%), rectal varix (1.4%), ileitis(1.4%) and ileal ulceration (1.4%). 2) The average hemoglobin of the patients with hematochezia was 9.6 g/dl. Forty percent of the patients with hematochezia required a transfusion and the average transfusion amount was 4.4 packs (Pack Red Cell). Patients with nonspecific ulcers (recutum, colon), angiodysplasia, colon cancer, ilieal lesion and rectal varix required more transfusions (average transfusion amount, 5.7 packs). 3) Patients who improved with eonservative treatment only were 85.7%, and 11.4% required surgical intervention. Also 2.9% required endoscopic intervention. 4) Confirmative modalities of hematochezia included colonoscopy (80%), and others (angiography, barium enema, and operation etc.). CONCLUSIONS: In patients with hematochezia admitted to the IM Department, the cause of hematochezia was confirmed by colonoscopy and patients with hematochezia were mainly managed using conservative treatment.
Angiodysplasia ; Barium ; Chungcheongnam-do ; Colitis ; Colitis, Ischemic ; Colitis, Ulcerative ; Colon ; Colonic Neoplasms ; Colonoscopy ; Diverticulum ; Enema ; Gastrointestinal Hemorrhage* ; Hemorrhoids ; Humans ; Polyps ; Rectal Neoplasms ; Ulcer ; Varicose Veins

BACKGROUND/AIMS: The efficacy and adverse effects of two different dosages of recombinant a2b interferon were studied in 45 patients with chronic active hepatitis B from March 1991 to December 1996. METHODS: The 19 patients received in a dose of 3MU thrice weekly for 16 weeks, the 14 patients received in a dose of 5MU thrice weeldy for 16 weeks and the 12 patients received conservative management. We evaluated serologic examination and adverse effects. Results 1) The rate of improvement in aminotransferase was significantly higher in interferon treated group (75.0%) compared to control group (16.7%) and it tended to be higher in 5MU group (85.6%) than 3MU group (68.4%) but, the latter had no statistical signifcance (P=0.27). 2) The disappearance rate of HBV-DNA was significantly higher in interferon treated group (72.7%) compared to control group (0%) and it tend to be higher in 3MU group (78.5%) than 5MU group (62.5%) but, the latter had no stastical significance (P=037). 3) The loss rate of HBeAg was significantly higher in interferon treated group (50.0%) compared to control group (O%) and it tend to be higher in 5MU group (66.7%) than 3MU group (37.5%) but, the latter had no stastical significance(P=0.13). 4) Fever (75.8%), leukopenia (41.2%), headache (30.3%), myalgia (18.2%), thrombocytopenia (17.6%), anorexia (11.8%) were noted and fever was significantly higher in 5MU group compared to 3MU group (P=0.02). Conclusion The effective improvement of liver function test and disappearance rate of HBeAg tended to be higher in 5MU group than 3MU group, but it was not stastistically significant. Fever was significantly higher in 5MU group compared to 3MU group.
Anorexia ; Fever ; Headache ; Hepatitis B e Antigens ; Hepatitis, Chronic* ; Humans ; Interferons* ; Leukopenia ; Liver Function Tests ; Myalgia ; Thrombocytopenia

BACKGROUND/AIMS: Juxtapapillary duodenal diverticuli are often associated with biliary stones. The aim of this study was to investigate the prevalence of juxtapapillary duodenal diverticuli in biliary stones. METHODS: Three hundred and thirteen patients underwent endoscopic retrograde cholangiopancreatography were studied prospectively. RESULTS: Seventy-five patients had juxtapapillary duodennl diverticuli(24%). The occurrence of diverticuli increased with age and more commomly in female patients. The prevalence of diverticulii was higher in patients with commom bile duct stones(35.6% vs 17.6%; P 0.002) and gallbladder stones(33.3% vs 17.6%; P=0,001) than in patients without biliary stones (17.6%). CONCLUSIONS: We conclude that biliary stones are associated with juxtapapillary diverticuli.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Female ; Gallbladder ; Gallstones* ; Humans ; Prevalence ; Prospective Studies