Bronchoscopy has evolved over the past few decades and has been used by respiratory physicians to diagnose various airway and lung diseases. With the popularization of medical check-ups and growing interest in health, early diagnosis of lung diseases is essential. With the development of endobronchial ultrasound, ultrathin bronchoscopy, and electromagnetic navigational bronchoscopy, bronchoscopy has been able to widen its scope in diagnosing pulmonary diseases. In this review, we have described the brief history, role, and complications of bronchoscopy used in diagnosing pulmonary lesions, from simple flexible bronchoscopy to bronchoscopy combined with several up-to-date technologies.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis that commonly affects the peripheral nervous system. EGPA rarely presents with acute polyneuropathy resembling Guillain-Barré syndrome (GBS). A 51-year-old female patient with a history of asthma suddenly developed bilateral lower extremityparesthesia that progressed to asymmetric ascending paralysis within 10 days of onset. Nerve conduction study results were compatible with acute motor sensory axonal neuropathy, consistent with a GBS subtype. A clinical and neurophysiological diagnosis of GBS was made, and high-dose intravenous immunoglobulins were administered. However, the patient's painful motor weakness persisted. Furthermore, she had newly developed skin lesions on her back, face, and arms. Her blood test revealed marked eosinophilia (>60%). In addition, antineutrophil cytoplasmic antibodies were reported positive. A Water's view radiographic image showed bilateral maxillary sinusitis. Considering the history of asthma, we suspected EGPA-associated polyneuropathy and started steroid treatment. The patient's strength and eosinophilia improved rapidly and dramatically. EGPA can mimic GBS and should be differentiated because of different treatment strategies. Early diagnosis and prompt treatment help achieve a good outcome.
Antibodies, Antineutrophil Cytoplasmic ; Arm ; Asthma ; Axons ; Diagnosis ; Early Diagnosis ; Eosinophilia ; Eosinophils ; Female ; Granulomatosis with Polyangiitis ; Guillain-Barre Syndrome ; Hematologic Tests ; Humans ; Immunoglobulins, Intravenous ; Maxillary Sinus ; Maxillary Sinusitis ; Middle Aged ; Neural Conduction ; Paralysis ; Peripheral Nervous System ; Polyneuropathies ; Skin ; Systemic Vasculitis

No abstract available.
Surgery, Plastic*

STUDY DESIGN: This was a retrospective study to evaluate anterior cervical interbody fusion with plates. OBJECTIVE: To examine the degree of angulation and translation after an anterior interbody fusion, using anterior plate fixation, upon the fusion rate and clinical outcome. SUMMARY OF LITERATURE REVIEW: Anterior cervical interbody fusion with plate allows immediate rigid internal fixation after decompression and bone grafting. MATERIALS AND METHODS: 65 cases had an anterior interbody fusion on the cervical spine, using an anterior approach and Smith-Robinson's method, between January 1998 and August 2003. Of these, 41 cases, which could be followed up for at least one year, were selected. There were 26 and 15 males and females, respectively, with an average age of 43.5 and mean follow up period of 2.1 years. 15 cases underwent an operation due to dislocation or fracture of the cervical spine due to trauma, and 26 due to cervical diseases. The angulation and translation of the plate was measured by postoperative X-rays. The fusion rate was also determined by the follow up X-rays. The Chi-squared test was used to analyze the data. RESULTS: Bony fusion was obtained in all cases. Two patients developed hoarseness and one showed torticollis, but all had recovered by the follow up. The average angulation of the plate and translation were 6.2 degrees and 3.21mm, respectively, but there was no significant difference of the interbody fusion period due to angulation and translation of the plate or in the improvement of the clinical outcomes. CONCLUSION: In the cases of anterior interbody fusion of the cervical spine, the angulation and translation of the plate had no influence on the fusion time and clinical outcomes. Long term studies and research will be needed to bring about clinically more valuable data.
Bone Transplantation ; Decompression ; Dislocations ; Female ; Follow-Up Studies ; Hoarseness ; Humans ; Male ; Retrospective Studies ; Spine ; Torticollis

STUDY DESIGN: The changes of the disc height in patients diagnosed with lumbar disc herniation who underwent a discectomy were subjected to a retrospective study. OBJECTIVES: The goal of this study was to find the relationship between the disc height and degenerative disc changes in patients diagnosed with lumbar disc herniation who underwent a discectomy. SUMMARY OF LITERATURE REVIEW: Disc height changes according to age, degenerative change and the amount of removed disc. MATERIALS AND METHODS: The patients in this study were those diagnosed with HNP who undergone a discectomy in our hospital. The fifty seven observed patients had a discectomy in our hospital between March, 2001 and March, 2003. Patients who had posterior fusion during surgery were excluded. There were 35 males and 22 females, with an average age of 35.9 yrs old (17-55) and a mean follow-up period of 2.7 yrs. The degrees of HNP and degenerative disc were examined with MRI and measured through the T2 MRI, respectively, before the operation. The disc heights were measured before and after surgery, and the anterior, posterior and middle disc heights were measured with a simple lumbar lateral X-ray. There were 6, 20, 25 and 6 cases of degeneration grades II, III, IV and V, respectively. There were also 27, 25 and 5 cases of protruded, extruded and sequestrated discs, respectively. RESULTS: When patients with a lumbar disc herniation underwent a discectomy, the changes of disc height in people of those with a postoperative degenerative disc change were notable, but there was no difference in disc height change with regard to the degree of HNP. CONCLUSION: In lumbar disc herniation patients after a discectomy, the changes of disc height decrease significantly in severe degenerative discs in the short term; therefore, further long term periods of study will be required.
Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging ; Male ; Retrospective Studies

PURPOSE: To evaluate the effectiveness of a blocking screw in intramedullary nailing at the tibia proximal shaft fracture. MATERIALS AND METHODS: 63 tibia proximal shaft fractures from January 2000 to December 2002 treated with only intramedullary nailing were referred to as group I, and 8 fractures from January 2003 to December 2003 treated with both intramedullary nailing and the blocking screw were referred to as group II. Retrospective studies were done for group I and II. The incidence of nonunion and the postoperative angular alignments were compared. Malalignment was defined as an angle of 5 degrees anteroposteriorly or mediolaterally. RESULTS: There were 7 nonunion (11%) in group I in compare with none in group II. There were 21 angular malalignments (33%) in group I and 1 in group II (12%) and most of them had valgus deformity or anterior anglulation. No complications were directly due to the use of the Blocking screw. CONCLUSION: The technique of the blocking screw used to be one of the option for proximal tibial nailing at tibial proximal shaft fracture helps to overcome angular malalignments of bones.
Congenital Abnormalities ; Fracture Fixation, Intramedullary ; Incidence ; Retrospective Studies ; Tibia ; Tibial Fractures*

We carried out an immunohistochemical study and DNA analysis of 14 surgical specimens of primary bladder carcinoma and paired sample of normal bladder mucosa to evaluate p53 over expression, point mutation by polymerase chain reaction single-strand conformation polymorphism analysis(PCR-SSCP). The immunohistochemical study demonstrated immunoreactivity for p53 protein in ten cases out of 14(71%) with monoclonal antibody (NCL-p53-DO-7, Novocastra Lab. UK). Mobility shifts were detected by PCR-SSCP in p53 gene exons 4-8 in six cases out of 14(42.9%). p53 gene mutations were observed in invasive cases(85.7%) and superficial cases (50%) by immunohistochemistry. Correlation was not observed between the presence of p53 gene mutations and the histological differentiation and invasiveness of the cancer. Considering frequent p53 alterations in invasive cases, it will be necessary to reevaluate p53 alterations in bladder cancer and the correlation to the prognosis in bladder cancer.
DNA ; Exons ; Genes, p53* ; Immunohistochemistry* ; Mucous Membrane ; Point Mutation ; Polymerase Chain Reaction ; Prognosis ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. METHODS: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. RESULTS: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. CONCLUSION: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.
Abbreviated Injury Scale ; Abdominal Injuries ; Accidents, Traffic ; Blood Pressure ; Demography ; Emergencies ; Erythrocytes ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Injury Severity Score ; Intensive Care Units ; Liver ; Male ; Medical Records ; Pelvic Bones ; Retrospective Studies ; Shock

STUDY DESIGN: A prospective study. PURPOSE: To assess the effectiveness of the straight leg raising test during an arthroscopic microdiscectomy. MATERIALS AND METHODS: 52 patients, 38 men and 14 women, took part in this experiment. The mean followed up and age were 21, ranging from 13 to 41 months, and 26.4, ranging from 13 to 42 years old. There were 19, 28 and 9 cases between the 3rd- 4th lumbar vertebrae, between the 4-5th lumbar vertebrae between the 5th lumbar vertebra and the 1st sacral vertebra, respectively. 41 patients were able to perform the SLRT (straight leg raising test) procedure, and were called group I, and 11 patients could not perform the test, and were classed as group II. In order to perform the intraoperative SLRT, a lateral decubitus position was adopted. After the disc removal, the SLRT was carried out. When the test result gave an angle of 70 degrees or greater, the surgery was carried out on a pertinent domain. The success of the surgery was graded by the JOA score. RESULTS: In group I, after removal of the disc, the first 31 patients were checked over a 4 week period to assess their recoveries. A year after the surgery, their follow up results were better than Good. In 9 patients, there were little improvements from the first SLRT, so they were re-tested after a 2nd discectomy, which resulted in improvements., with better than good results. 1 patient, whose test result was fair after four weeks and one year, was diagnosed with spinal stenosis, so underwent an operation. In group II, the SLRT during surgery was untestable, due to overweight and uncooperative patients. The results in 3 patients were fair, and in another 8 they better than good. Overall, 97.6% of the patients in group I showed a rapid recovery, but in the group II, only 72.2% showed a rapid recovery. CONCLUSION: From the short term follow up, the use of a SLRT during surgery is very effective. Further research is required to give more precise results.
Adult ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Leg* ; Lumbar Vertebrae ; Male ; Overweight ; Prospective Studies ; Spinal Stenosis ; Spine

Emery-Dreifuss muscular dystrophy (EDMD) is a degenerative myopathy characterized by mild, slowly progressing weakness, muscle atrophy, and early contracture of the neck, ankle and elbow. Heart involvement becomes apparent during the teenage years and is characterized by cardiac conduction defects and the infiltration of the myocardium by fibrous and adipose tissues. Heart block can eventually lead to sudden death, and therefore, early treatment with a cardiac pacemaker may improve symptoms and be lifesaving in patients with heart block. We describe our experience of pacemaker implantation in a 14-year old boy with X-linked recessive EDMD and emerin gene mutation. His electrocardiogram findings showed junctional escape beats, and his clinical features, i.e., ECG, nerve conduction test, electromyography and muscle biopsy findings were compatible with EDMD. He was implanted with a VVI type permanent pacemaker following an electrophysiologic study.
Adolescent ; Ankle ; Atrophy ; Biopsy ; Contracture ; Death, Sudden ; Elbow ; Electrocardiography ; Electromyography ; Heart ; Heart Block ; Humans ; Male ; Muscle Weakness ; Muscular Diseases ; Muscular Dystrophy, Emery-Dreifuss* ; Myocardium ; Neck ; Neural Conduction ; Pacemaker, Artificial ; United Nations