Although symptoms related to airflow obstruction are the most prominent symptoms in patients with chronic obstructive pulmonary disease (COPD), there are many local and systemic complications contributing to the morbidity and mortality of the patients. This review article briefly discusses the following complications of COPD and their clinical implications: change of pulmonary circulation, peripheral edema, systemic inflammation, cardiovascular complication, weight loss, skeletal muscle dysfunction, osteoporosis, and anxiety. A better understanding and management of these complications as well as treatment of the airflow obstruction can improve the quality of life, and even the survival of the patients.
Anxiety ; Edema ; Humans ; Inflammation ; Mortality ; Muscle, Skeletal ; Osteoporosis ; Pulmonary Circulation ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Weight Loss

The villous adenoma of the duodenum is a rare disease and a considerable portion of the cases are known to be associated with malignancy. Although the diagnosis can be made with duodenoscopy, some cases showed false negative rate for malignancy detection with endoscopic biopsy only. So Whipple's operation is preferred than local excision. We experienced a case of tubulovillous adenoma involving ampulla of Vater, which recurred after local excision. So we report a case of tubulovillous adenoma involving ampulla of Vater with relevant literature.
Adenoma* ; Adenoma, Villous ; Ampulla of Vater* ; Biopsy ; Diagnosis ; Duodenoscopy ; Duodenum ; Rare Diseases

No abstract available.
Smoking* ; Tobacco Products*

Bochdalek hernia through Bochdalek foramen, defect at the posterolateral side of the diaphragm is one of the congenital diaphragmatic hernias. It usually occurs in infants, but very rare in old age and also on the right side. We experienced the right-side Bochdalek hernia including kidney herniation in 68 years old man man ifested by hemoptysis. CT scan revealed diaphragmatic defect and herniated liver, colon and kidney. Thoracotomy was performed and the 10 cm-sized large defect was closed with patch. After then, the patient has been well without symptom.
Aged ; Colon ; Diaphragm ; Hemoptysis ; Hernia* ; Hernia, Diaphragmatic ; Humans ; Infant ; Kidney* ; Liver ; Thoracotomy ; Tomography, X-Ray Computed

Central venous catheterization is a common diagnostic and therapeutic procedure in modern clinical practice. Pseudoaneurysms of the subclavian artery are rare and usually occur immediately after the causative event, whether the cause was trauma or a medical procedure. Here we report the rare case of a 71-year-old woman with delayed presentation of catheter-related subclavian pseudoaneurysm. The patient was treated for aspiration pneumonia with respiratory failure in another hospital. The patient's chest wall swelling began two weeks after the initial catheterization in the other hospital, probably because of slow leakage of blood from the injured subclavian artery caused by incomplete compression of the puncture site and uremic coagulopathy. She was successfully treated with ultrasound-guided thrombin and angiography-guided histoacryl injection without stent insertion or surgery. Her condition improved, and she was discharged to her home.
Aged ; Aneurysm, False* ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Enbucrilate ; Female ; Humans ; Pneumonia, Aspiration ; Punctures ; Respiratory Insufficiency ; Stents ; Subclavian Artery* ; Thoracic Wall ; Thrombin

BACKGROUND: Paroxysmal atrial fibrillation (PAF) causes not only severe symptoms and hemodynamic changes, but may progress to chronic atrial fibrillation. Autonomic nervous system or atrial premature beat (APB) has been suggested to contribute to the spontaneous initiation of PAF, but the exact mechanism has been largely unknown. METHODS: One hundred and twenty nine episodes of PAF lasting longer than 5 sec were analyzed in 18 patients (M:F=11:?). Two minutes of normal sinus rhythm before the onset of PAF, and the initial one minute of PAF were printed and analyzed. RESULTS: Most of PAFs were initiated by APBs (38%) or rapid atrial tachycardias (AT, 59%). The frequency of APBs tended to increase immediately before PAF onset (p=0.08). The coupling intervals and coupling indices were not significantly different between PAF-producing APBs and benign APBs. More than half of PAF episodes were initiated by rapid ATs (rate, 357+/-50 bpm). After the onset, they accelerated over several seconds and then degenerated into AF. In some cases, transition from AF to atrial flutter and vice versa were observed. Heart rate, measured at 60-second intervals during 2 minutes before PAF onset, did not change significantly (p=0.44). CONCLUSION: Most of PAFs were initiated by APBs or rapid ATs. Heart rate did not change significantly but the frequency of APBs tended to increase immediately before PAF onset. Rapid ATs frequently accelerated and degenerated into AF. In this regard, Holter monitoring could be useful in identifying patients with PAF triggered by rapid ATs.
Atrial Fibrillation* ; Atrial Flutter ; Autonomic Nervous System ; Cardiac Complexes, Premature ; Electrocardiography, Ambulatory* ; Heart Rate ; Hemodynamics ; Humans ; Tachycardia

BACKGROUND: Since endotracheal tube is the most important factor involved in the imposed work of breathing during mechanical ventilation, extubation of endotracheal tube is supposed to reduce respiratory work of patient. However, some patients show labored breathing after extubation despite acceptable blood gases. We investigated the changes of work of breathing before and after extubation and the factors involved in the change of WOB after extubation. METHODS: The subjects were 34 patients(M : F = 20 : 14, mean age = 61 l7yre) who recovered from respiratory failure after ventilatory support and were considered to be ready for extubation. The patients with clinical or radiologic evidences of upper airway obstruction before endotracheal intubation for mechanical ventilation were excluded. Vital sign, physical examination, chest X-ray, work of breathing and other respiratory mechanic indices were measured prior to, immediately, 6, 24 and 48 hours after extubation serially. Definition of weaning failure after extubation was resumption of ventilatory support or reintubation of endotracheal tube within 48 hour after extubation because of respiratory failure. The patients were classified into group I (decreased work of breathing), group 2(unchanged work of breathing) and group 3(increased work of breathing) depending on the statistical difference in the change of work of breathing before and after extubation. RESULTS: Work of breathing decreased in 33%(11/34, group 1), unchanged in 41%(14/34, group 2) and increased in 26% (9/34, group 3) of patients after extubation compared with before extubation. Weaning failure occurred 9%(1/11) of group, 1, 28.67(4/14) of group 2 and 44.4%(4/9) of group 3 after extubation(p = 0.07). The change of work of breathing after extubation was positively correlated with change of mean airway resistance(mRaw). (r = 0.794, p> 0.01) In three cases of group 3 whose respiratory indices could be measured until 48 hr ater extubation, the change in work of breathing paralleled with the sequential change of mRaw. The work of breathing was peaked at 6 hr after extubation, which showed a tendency to decrease thereafter. CONCLUSIONS: Reversible increase of work of breathing after extubation may occur in the patients who underwent extubation, and the increase in mRaw could be responsible for the increase in work of breathing. In addition, the risk of weaning failure after extubatuion may increase in the patients who have increased WOB immediately after extubation.
Airway Obstruction ; Gases ; Humans ; Intubation, Intratracheal ; Physical Examination ; Respiration ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Mechanics ; Thorax ; Vital Signs ; Weaning ; Work of Breathing*

Echocardiography and catheterization angiography suffer certain limitations in the evaluation of congenital heart diseases in adults, though these are overcome by MRI, in which a wide field-of view, unlimited multiplanar imaging capability and three-dimensional contrast-enhanced MR angiography techniques are used. In adults, recently introduced fast imaging techniques provide cardiac MR images of sufficient quality and with less artifacts. Ventricular volume, ejection fraction, and vascular flow measurements, including pressure gradients and pulmonary-to-systemic flow ratio, can be calculated or obtained using fast cine MRI, phase-contrast MR flow-velocity mapping, and semiautomatic analysis software. MRI is superior to echocardiography in diagnosing partial anomalous pulmonary venous connection, unroofed coronary sinus, anomalies of the pulmonary arteries, aorta and systemic veins, complex heart diseases, and postsurgical sequelae. Biventricular function is reliably evaluated with cine MRI after repair of tetralogy of Fallot, and Senning's and Mustard's operations. MRI has an important and growing role in the morphologic and functional assessment of congenital heart diseases in adolescents and adults.
Adolescent ; Adult ; Heart Defects, Congenital/*diagnosis ; Human ; *Magnetic Resonance Imaging ; *Magnetic Resonance Imaging, Cine ; Support, Non-U.S. Gov't

BACKGROUND: The radiographic characteristics of tuberculous pneumonia in adults are similar to primary tuberculosis that occurs in childhood, and upper lobe cavitary tuberculosis is the hallmark of postprimary tuberculosis. The purpose of this study was to investigate the factors associated with tuberculous pneumonia by making comparison with cavitary tuberculosis. METHODS: The medical records and radiographic findings of patients with cavitary tuberculosis and tuberculous pneumonia, and who were diagnosed between March 2003 and February 2006, were analyzed retrospectively. RESULTS: Forty patients had cavitary tuberculosis and sixteen patients had tuberculous pneumonia. Fever was more frequent for tuberculous pneumonia, whereas hemoptysis was more frequent for cavitary tuberculosis. The duration of symptoms before visiting the hospital was shorter, but the diagnosis after admission was more delayed for tuberculous pneumonia patients than for cavitary tuberculosis patients. The prevalence of underlying comorbidities such cancer, diabetes, alcoholism and long-term steroid use was not different between the two groups. The patients with tuberculous pneumonia were older and they had lower levels of serum albumin and hemoglobin than those with cavitary tuberculosis. The patients with tuberculous pneumonia showed a tendency to have more frequent endobronchial lesion. Tuberculous pneumonia occurred in any lobe, whereas the majority of cavitary tuberculosis patients had upper lung lesion, but the prevalence of lymphadenopathy, pleural effusion and previous tuberculosis scar was not different between the two groups. CONCLUSIONS: Older age, a lower level of serum albumin and hemoglobin and a random distribution of lesion were associated with tuberculosis pneumonia as compared with cavitary tuberculosis. These findings suggest that the pathogenesis of tuberculous pneumonia might be different from that of cavitary tuberculosis.
Tuberculosis, Pulmonary/blood/*diagnosis/microbiology ; Tomography, X-Ray Computed ; Sputum/microbiology ; Severity of Illness Index ; Serum Albumin/metabolism ; Retrospective Studies ; Radiography, Thoracic ; Pneumonia, Bacterial/blood/*diagnosis/microbiology ; Mycobacterium tuberculosis/isolation & purification ; Middle Aged ; Male ; Lung/microbiology/pathology/radiography ; Humans ; Hemoglobins/metabolism ; Female ; Diagnosis, Differential ; Bronchoscopy ; Biopsy ; Adult