PURPOSE: To investigate the effect of a nasal cavity abnormality on the success rate of endonasal dacryocystorhinostomy (DCR). METHODS: Two hundred seventy eyes of 230 patients who had undergone endonasal DCR from February 2003 to July 2004 were retrospectively analyzed. The patients were classified into three groups after all were preoperatively examined by an otolaryngologist. Group A consisted of patients who had no nasal cavity abnormality; Group B, patients who had a nasal cavity abnormality and who received treatment; and Group C, patients with a nasal cavity abnormality but who received no treatment. RESULTS: The success rate of endonasal DCR were 83.9% in Group A, 87.5% in Group B, and 79.2% in Group C, with no statistical significance among the three groups (p>0.05). CONCLUSIONS: The presence of a nasal cavity abnormality did not affect the success rate of endonasal DCR.
Dacryocystorhinostomy* ; Humans ; Nasal Cavity* ; Retrospective Studies

BACKGROUND: Bronchoconstriction is known to be induced by hypocarbia or hypercarbia. But the above effect has not been studied during general anesthesia. This study was proposed to investigate the effects of hypocarbia and hypercarbia on the respiratory system mechanics in 0.5 MAC enflurane anesthetized cats. METHODS: Six cats, weighing 3.0~3.6 kg were used. Pentobarbital sodium was intraperitonially injected to induce anesthesia and endotracheal intubation was followed. The anesthesia was maintained by 0.5 MAC enflurane, oxygen, and air (FiO2; 0.5). Intermittent mandatory ventilation was applied with Siemens Servo 900C ventilator. The inspiratory flow rate and tidal volume were fixed througout the experiment. Only the respiratory rate was adjusted to achieve normocarbia(PaCO2; 31~38 mmHg), hypercarbia(PaCO2; 38~45 mmHg) and hypocarbia(PaCO2; 24~31 mmHg), which were done not in the order. We used the flow-interruption technique to measure respiratory mechanics. The course of changes in the pressure along with the prefixed flow rate and volume were monitored and recorded with Bicore CP100 pulmonary monitor. The data were transfered to a PC and analyzed by Anadat processing software. Total respiratory system, airway and tissue viscoelastic resistances, and dynamic and static compliances were calculated for normocarbia, hypercarbia and hypocarbia. RESULTS: There are no significant differences of resistances and compliances of respiratory system among hypocarbia, normocarbia and hypercarbia. CONCLUSIONS: The changes in PaCO2 do not influence significantly the resistances and compliances measured by the flow interruption technique used in the study.
Airway Resistance ; Anesthesia ; Anesthesia, General ; Anesthetics ; Animals ; Bronchoconstriction ; Carbon Dioxide* ; Carbon* ; Cats* ; Compliance ; Enflurane* ; Intubation, Intratracheal ; Lung ; Mechanics* ; Oxygen ; Pentobarbital ; Respiratory Mechanics ; Respiratory Rate ; Respiratory System* ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

Endoscopic retrograde cholangiopancreatography (ERCP) of the intradiverticular papilla with its invisible orifice remains challenging. Several techniques have been introduced to evert the papillary opening to facilitate cannulation. A 79-year-old woman with bile duct stones underwent ERCP, which revealed that the papilla was located inside a large diverticulum and tended to rotate inward with a trial of papillary cannulation. Submucosal papillary injection of 3 cc of normal saline was performed at 3 and 9 o’clock. Eversion and fixation of a papilla in the diverticulum with this technique allowed selective cannulation of the biliary tree. Stones were retrieved after endoscopic papillary balloon dilation without complications. She had an uneventful post-procedural course. Our findings suggest that submucosal saline injection technique is safe and effective for selective cannulation and can be recommended when cannulation is very difficult because of an intradiverticular papilla.
Aged ; Ampulla of Vater ; Bile Ducts ; Biliary Tract ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Diverticulum ; Female ; Gallstones ; Humans

The fate of a grafted radial artery remains unknown. The purpose of this study was to determine whether the preoperative severity of stenosis of the target vessel influence short-term patency of radial artery (RA) grafts used as coronary artery bypass conduits. In 54 patients who had coronary artery bypass grafting (CABG) with RA grafts, RA patency was determined with multi-slice computed tomography (MSCT) 1 year after CABG. These patients were divided into three groups on the basis of the percentage of the target vessel stenosis: mild (< 60%, n=17), moderate (60% to 79%, n=19), and severe (> or = 80%, n=18). MSCT was also performed 1 week later to exclude early occlusion of RA grafts. In 3 patients, the MSCT failed to adequately discriminate the status of the RA graft due to poor image resolution. The overall incidence of RA occlusion was 23.5% (12 of 51) at 1 year in the entire population. The mild stenosis, moderate stenosis and severe stenosis group showed an occlusion rate of 50% (8 of 16), 23.5% (4 of 17) and 0% (0 of 18), respectively. The severe stenosis group had significantly lower rate of RA graft occlusion compared to the mild stenosis group (p< 0.001) and moderate stenosis group (p< 0.05). No difference in occlusion between grafts used for the different coronary artery branches could be demonstrated. Preoperative severity of the target coronary artery significantly affected the short-term RA grafts patency. Correct indication is the key factor for short-term RA patency.
Aged ; Coronary Arteriosclerosis/pathology/*radiography/*surgery ; Coronary Artery Bypass/*methods ; Coronary Vessels/pathology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Radial Artery/*transplantation ; Severity of Illness Index ; Tomography, X-Ray Computed ; Vascular Patency

IgA nephropathy is usually localized to the kidney, however, it can accompany systemic disease, including gastrointestinal disease, skin disease, connective tissue disease, and malignant tumor. In some patients with IgA nephropathy which manifested as an extraintestinal symptom of Crohn's disease, recovery of renal function was achieved following treatment of Crohn's disease. The pathophysiology of each disease remains unclear. According to some studies, however, immunological, genetic, and environmental factors may be involved in a complex manner. In patients receiving renal replacement therapy for treatment of renal dysfunction due to IgA nephropathy, occurrence of Crohn's disease as an extrarenal symptom has not been reported. We experienced a case of Crohn's disease which developed in a patient receiving hemodialysis for treatment of end-stage renal disease due to IgA nephropathy.
Connective Tissue Diseases ; Crohn Disease ; Gastrointestinal Diseases ; Glomerulonephritis, IGA ; Humans ; Immunoglobulin A ; Kidney ; Kidney Failure, Chronic ; Renal Dialysis ; Renal Replacement Therapy ; Skin Diseases

We report a case of aspergillosis of the central nervous system in patient with rheumatoid arthritis (RA). A 46-year-old woman with 20-year history of RA and on treatment with corticosteroid, hydroxychloroquine and methotrexate, was admitted because of drowsiness, dizziness and dysarthria. On admission, physical examination and laboratory data showed, among other findings, disappearance of pupil reflex, positive Babinski and Chaddock reflex. Magnetic resonance imaging (MRI) of brain showed multiple high signal intensity lesion on medulla, pons, midbrain, basal ganglia, internal capsule, thalamus and hypothalmus. Stereotactic brain biopsy was performed and biopsy specimen revealed an invasive Aspergillus.
Arthritis, Rheumatoid* ; Aspergillosis* ; Aspergillus ; Basal Ganglia ; Biopsy ; Brain ; Central Nervous System ; Dizziness ; Dysarthria ; Female ; Humans ; Hydroxychloroquine ; Internal Capsule ; Magnetic Resonance Imaging ; Mesencephalon ; Methotrexate ; Middle Aged ; Physical Examination ; Pons ; Pupil ; Reflex ; Sleep Stages ; Thalamus

PURPOSE: Our aim was to evaluate the usefulness of fluid-attenuated inversion recovery (FLAIR) MR imaging for detection of acute subarachnoid hemorrhage (SAH) compared with unenhanced CT. MATERIALS AND METHODS: We compared FLAIR MR images with unenhanced CT scans in 28 patients with acute SAH. Findings of SAH on CT and MR images were graded as 0 (absence), 1 (suspicious), 2 (definite) in the cerebral sulci, sylvian fissure, basal cistern, and cisterns of the posterior fossa. We also compared FLAIR MR images of 28 patients with those of 35 normal subjects, and then the sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of acute SAH were calculated. RESULTS: FLAIR MR image was superior to CT in detecting SAH in the posterior fossa (1.41+/-.74 vs 0.78+/-.80; p<0.05) and cortical sulci(1.11+/-.80 vs 0.70+/-.83; p<0.05). There was no significant difference between FLAIR MR image and CT in detecting SAH in the basal cistern and sylvian fissure. The sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of SAH were 100% in all. CONCLUSION: FLAIR MR image is useful in detecting acute SAH, especially in patients with small amount of SAH or SAH in the posterior fossa.
Humans ; Magnetic Resonance Imaging* ; Sensitivity and Specificity ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

Bordetella bronchiseptica is a common cause of respiratory disease in animals but is a rare cause of human infection. Furthermore, most patients with Bordetella bronchiseptica infections are immunocompromised. The Bordetella bronchiseptica organism can cause pneumonia, septicemia, and peritonitis in humans with impaired immune systems. Additionally, it can lead to a life-threatening infection patients who have an underlying debilitation or impaired immunity. The respiratory tract is the most common site of infection. Sixty-two human cases of Bordetella bronchiseptica have been published in the English literature, and 84 % hadof the cases were associated with pneumonia or bronchitis. However, only one case of Bordetella bronchiseptica has been reported in South Korea, and it was associated with peritonitis. In the current study, we report a case of Bordetella bronchiseptica pneumonia diagnosed in an immunocompromised patient.
Animals ; Bordetella bronchiseptica* ; Bordetella* ; Bronchitis ; Humans ; Immune System ; Immunocompromised Host ; Korea ; Lung Neoplasms ; Peritonitis ; Pneumonia ; Respiratory System ; Sepsis

BACKGROUND/AIMS: Endoscopic papillary balloon dilation (EPBD) has been advocated as an alternative therapy to endoscopic sphincterotomy for the treatment of common bile duct (CBD) stones. However, there is no established consensus on the optimal balloon dilation duration (BDD). We prospectively evaluated the efficacy and post-endoscopic retrograde cholangiopancreatography (ERCP) complications between the 20- and 60-second EPBD groups. METHODS: A total of 228 patients with small CBD stones (< or =12 mm) were randomly assigned to undergo EPBD with a 20- or 60-second duration at six institutions. We evaluated baseline patient characteristics, endoscopic data, clinical outcomes, and procedure-related complications. In addition, we analyzed risk factors for postprocedural pancreatitis. RESULTS: CBD stones were removed successfully in 107 of 109 patients (98.1%) in the 20-second group and in 112 of 119 patients (94.1%) in the 60-second group (p=0.146). Post-ERCP pancreatitis developed in seven patients (6.4%) in the 20-second group and nine patients (7.5%) in the 60-second group (p=0.408). In multivariate analysis, contrast dye injection into the pancreatic duct is a significant risk factor for post-EPBD pancreatitis. CONCLUSIONS: Based on the data showing that there were no significant differences in safety and efficacy between the two BDD groups, 20 seconds of BDD may be adequate for treatment of small CBD stones with EPBD.
Choledocholithiasis ; Common Bile Duct* ; Consensus ; Humans ; Multivariate Analysis ; Pancreatic Ducts ; Pancreatitis ; Prospective Studies* ; Risk Factors ; Sphincterotomy, Endoscopic

Combination therapy with pegylated interferon (IFN) and ribavirin is the mainstay of treatment for chronic hepatitis C. An important side effect of IFN is the induction of an autoimmune disease such as autoimmune thyroid disease or, rarely, rheumatoid arthritis. However, the introduction of pegylated formulations of IFN can minimize the risk of autoimmune induction by reducing immunogenicity. Detection of anti-cyclic citrullinated peptide (anti-CCP) antibodies can help distinguish rheumatoid arthritis from hepatitis C-related arthritis. Here, we report the first Korean case of a 48-year-old female who developed anti-CCP antibody-positive rheumatoid arthritis following peginterferon alpha-2a therapy for hepatitis C.
Antibodies ; Arthritis ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Female ; Hepatitis ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Middle Aged ; Ribavirin ; Thyroid Diseases