BACKGROUND: The criteria established by Light et al in 1972 have been used widely for the differential diagnosis of the pleural effusions in transudates and exsudates. However, in recent years, several reports have agreed that these criteria misclassified an important number of effusions. For this reason, different parameters have been proposed for differentiation the transudates from exudates. Nevertheless, all these alternative parameters have not been better than the past criteria of Light et al. In response the usefulness of two parameters for differentiation pleural transudate from exudates were evaluated : pleural fluid cholinesterase level and pleural fluid to serum cholinesterase ratio. METHODS: A total of forty-three patient with know causes of the pleura effusion by diagnostic thoracentesis were studied. The following criteria for differentiating the pleural effusions in transudates and exsudates were analyzed : Light's criteria, the pleural fluid cholesterol level, the pleural fluid to serum cholesterol ratio. the pleural fluid cholinesterase level, and the pleural fluid to serum cholinesterase ratio. RESULTS: The conditions of forty-three patients were diagnosed. Ten were classified as having transudates and thirty-three as exudates. The percentage of effusions misclassified by each parameter was as follows : Light's criteria, 9.3% ; pleural fluid cholesterol, 2.3% ; pleural fluid to serum cholesterol ratio, 2.3% ; pleural fluid cholinesterase, 4.7% ; and pleural fluid to serum cholinesterase ratio, 2.3%. CONCLUSIONS: The pleural fluid to serum cholinesterase ratio is one of the accurate criteria for differentiating pleural transudates from exudates. If further studies confirm these results, the cholinesterase ratio could be used as the first step in the evaluation of pleural effusion and if evaluated together with the other criteria, the differentiation of pleural transudate from exsudates will become more accurate.
Cholesterol ; Cholinesterases* ; Diagnosis, Differential* ; Exudates and Transudates* ; Humans ; Pleura ; Pleural Effusion

Dieulafoy's lesions are often unrecognized cause of obscure, massive gastrointestinal bleeding, reported to be 0.3~1.5% of cases of major gastrointestinal bleeding. It is characterized by severe bleeding from rupture of an exposed submucosal artery. Dieulafoy's lesion is usually occured in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been described in the esophagus, duodenum, small intestine, colon, and rectum. The diagnosis is made by endoscopy, angiography, laparoscopy, or laparotomy. Endoscopy showed protruding and eroded artery with pulsatile bleeding or adherent thrombus. Currently, various therapeutic options are available to the endoscopist for the treatment of Dieulafoy's lesions. Therapeutic endoscopy should now become first-line therapy for Dieulafoy's lesions. We experienced a rare case of bleeding from the duodenal Dieulafoy's lesion. Endoscopic hemoclipping was performed successfully. We report this case with a review of the literature.
Angiography ; Arteries ; Colon ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Duodenum ; Endoscopy ; Esophagogastric Junction ; Esophagus ; Hemorrhage* ; Intestine, Small ; Laparoscopy ; Laparotomy ; Rectum ; Rupture ; Stomach ; Thrombosis

Dieulafoy's lesion is an uncommon source of massive gastrointestinal hemorrhage. The lesion predominantly occurs in the proximal stomach, but may occur in all parts of the gastrointestinal tract including small bowel, colon and rectum. We herein report a case of a patient who presented with hematochezia from Dieulafoy's lesion of the terminal ileum with adherent blood clots. Bleeding was successfully controlled with endoscopic treatment by utilizing hemoclipping.
Colon ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileum ; Rectum ; Stomach

Left ventricular pseudoaneurysm, in which a ventricular free wall rupture is locally contained by adherent pericardium, is a rare complication of myocardial infarction. Compared w'th a true left ventricular aneunsm, a pseudoaneurysm has a greater propensity to sudden rupture, with catastrophic sequelae. Pseudoaneurysm may be surgically curable, a prompt and accurate diagnosis is thus essential. Transthoracic echocardiography has been the procedure of choice in the diagnosis of pseu- doaneurysm. Transesophageal echocardiography can provide more accurate information than transthoracic echocardiography for the evaluation of ventricular pseudoaneurysm located in posterior and inferior wall. We experienced a case of pseudoaneurysm of left ventricle in a 75-year-old female who presented with dyspnea. A large pseudoaneurysm of left ventricle vith narrow neck was de- tected by transesophageal echocardiography.
Aged ; Aneurysm, False* ; Diagnosis ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart Rupture ; Heart Ventricles ; Humans ; Myocardial Infarction ; Neck ; Pericardium ; Rupture

BACKGROUND: The most widely utilized indexes of sinus node dysfunction are the sinus node recovery time (SNRT) and the corrected sinus node recovery time (CSNRT), which generally require catheterization. Adenosine has negative chronotropic effect on the sinoatrial node. Non-invasive and reliable sinus node function test with intravenous adenosine was investigated. METHODS AND RESULT: The clinical value of rapid intravenous injection of adenosine for assessing sinus node dysfunction was examined in 14 patients with sick sinus syndrome (SSS) and 31 controls. After prophylactic insertion of a temporary pacemaker in the right ventricle, overdrive suppression test was conducted using the standard technique and CSNRT was measured to evaluate the sinus node function. Then, the CSNRT after administration of an intravenous bolus of adenosine (6 mg and 12 mg) was measured. Post-adenosine corrected sinus node recovery time (ADO: SNRT) was calculated by subtracting the basal sinus cycle length from the longest sinus cycle length. When ADO: SNRT over 550 msec was assumed as an indicator of sinus node dysfunction, intravenous injection of 6 mg of adenosine had a sensitivity of 85% and specificity of 100%, and 12 mg of adenosine had a sensitivity of 100% and specificity of 90% for detection of sick sinus syndrome. There were significant differences in ADO: SNRT between patient and control group (6 mg 1501+/-1081 msec vs 64+/-109 msec; 12 mg 4005+/-2055 msec vs 216+/-315 msec, respectively). CONCLUSION: he ADO: SNRT was a highly sensitive and specific index for diagnosing sick sinus syndrome, and should be considered as an alternative to invasive testing in patients with suspected sick sinus syndrome.
Adenosine* ; Catheterization ; Catheters ; Diagnosis* ; Heart Ventricles ; Humans ; Injections, Intravenous ; Sensitivity and Specificity ; Sick Sinus Syndrome* ; Sinoatrial Node

Primary venous thrombosis caused by deficiency or qualitative abnormality of antithrombin III, protein C and protein S is usually inherited as an autosomal dominant trait. Usually, deep vein thrombosis or pulmonary thromboembolism is developed by such abnormalities, however, mesenteric vein thrombosis is rarely reported. A 27-year-old man with previous history of deep vein thrombosis underwent segmental resection of jejunum due to mesenteric vein thrombosis complicated by necrosis of jejunum. Postoperative investigation disclosed combined deficiency of antithrombin III and protein C. His son also showed deficiency of antithrombin III. Postoperatively, he is on life-long warfarin therapy without experiencing recurrence of venous thrombosis.
Adult ; Antithrombin III* ; Humans ; Jejunum ; Mesenteric Veins ; Necrosis ; Protein C* ; Protein S ; Pulmonary Embolism ; Recurrence ; Thrombosis ; Venous Thrombosis* ; Warfarin

BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.
Administration, Oral ; Adult ; Aged ; Colonic Diseases/diagnosis ; Colonoscopy/*methods ; Humans ; Male ; Middle Aged ; Patient Compliance ; Phosphates/*administration & dosage ; Polyethylene Glycols/*administration & dosage ; Questionnaires ; Solutions ; Therapeutic Irrigation