No abstract available.
Humans* ; Kidney*

No abstract available.
Humans* ; Kidney*

Pulmonary embolism can occur in various situations and it can result in severe hemodynamic instability, including cardiac arrest. Because of its fatality, diagnosis and treatment should be immediate and proper. We report a case of pulmonary embolism just after combined spinal epidural anesthesia. We diagnosed pulmonary embolism by echocardiogram, spiral CT and pulmonary angiography. Besides immediate use of heparin, tissue plasminogen activator therapy was started with 10 mg bolus and 90 mg intravenous infusion during 2 hours. Despite the therapy, pulmonary embolism was not resolved and the patient was expired.
Anesthesia, Epidural ; Angiography ; Heart Arrest ; Hemodynamics ; Heparin ; Humans ; Infusions, Intravenous ; Plasminogen ; Pulmonary Embolism ; Tissue Plasminogen Activator ; Tomography, Spiral Computed

PURPOSE: This study was aimed to review findings of gray-scale ultrasonography and to assess the diagnostic value of the resistive index (RI) in patients with acute epididymitis by comparing with that in normal volunteers. MATERIALS & METHODS: Gray-scale ultrasonogram was reviewed in nine patients with acute epididymitis for echogenicity, size and reactive hydrocele. Normal values of resistive index (RI) were obtained in 20 epididymides from 10 volunteers (aged 20-28, mean 23.7). Nine patients of epididymitis (aged 18-67, mean 37.2) were examinated with color Doppler sonography and RI was measured at 11 sites on epididymal arteries. For the prediction of acute epididymitis, accuracy, sensitivity and specificity were calculated at the cut-off value of RI in 0.65 and 0.70. RESULTS: Gray-scale ultrasonography showed echogenicity that was variable among the 9 cases (hype- rechoic 2 cases, isoechoic 2, hypoechoic 5), enlargement of epididymis in 8, and reactive hydrocele in 8 cases. Normal volunteers displayed color Doppler signals in 14 out of 20. The range of RI in normal volunteers were between 0.64 and 1.00 (mean, 0.79 +/- SD 0.10). In patients with acute epididymitis, color Doppler signals were detected in all patients. The range of RI in epididymitis were 0.40-0.68 (mean, 0.56 +/- SD 0.10). At cut-off RI value of 0.65, accuracy was 88%, sensitivity 81.8%, and specificity 92.7%. At cut-off value of 0.70, accuracy was 92%, sensitivity 100%, and specificity 85.7%. CONCLUSION: In addition to the findings of gray-scale ultrasonography, resistive index and color flow changes are valuable in diagnosing acute epididymitis.
Arteries ; Epididymis ; Epididymitis* ; Healthy Volunteers ; Humans ; Male ; Reference Values ; Sensitivity and Specificity ; Ultrasonography ; Volunteers

Since laparoscopic cholecystectomy(LC) was first introduced in early 1990 in Korea, LC is now widely used with an acknowledgement of the benefits of LC.The author retrospectively analyzed 120 patients who were treated by LC and 40 patients who were treated by open cholecystectomy(OC), at the Department of Surgery, Kwang Hye Hospital from Jan. 1992 to July 1995. For the statistical analysis of the variables, student's t-test and ANOVA F-test were used to assess the differences between two groups(p value = 0.05). The obtained results were as follows. 1. The mean age and sex ratio(M:F) between LC and OC group were 48.3-years-old and 1:1.45, 57.6-years-old and 1:3.4, respectively. 2. Associated diseases were observed in 62 patients (51.7%) of the LC group and 23 patients (57.5%) of the OC group. Peptic ulcer and DM were most frequent, respectively. 3. 20 patients (16.7%) had a previous abdominal operation, with appendectomy, the most frequent among them. 4. The operation times(p=0.05), hospitalization stay(p=0.0001), and postoperative hospitalization stay(p=0.0001) were significantly shorter in the LC group than in the OC group. 5. In the preoperative, intraoperative, and postoperative ABGA of the LC group, especially, intraoperative PCO2 was increased due to CO2 retension and metabolic acidosis was developed, intraoperatively. PaO2 was excessively increased due to hyperventilation to correct the metabolic acidosis, intraoperatively. Satistically, intraoperative pH (p=0.0001), PaO2 (p=0.0001), PCO2 (p=0.0001) except bicarbonate (p=0.1987) were significantly changed, compared with preoperative pH or postoperative pH. 6. Operative cholangiography(OPC) was proceeded in 17 patients(14.2%) and concurrent laparoscopic appendectomy was done in 7 patients (5.8%) of the LC group. 7. Postoperative complications were occurred in 19 patients (15.8%) of the LC group. 3 patients (2.5%) were explorated, the remainders were recovered by conservative treatment. 8. On pathologic findings, cholelithiasis and chronic cholecystitis with 105 patients (87.5%) were most frequent in the LC group. In the OC group, cholelithiasis and chronic cholelithiasis with 25 patients (62.5%) were also most frequent, GB empyema with 8 patients (20%), acute cholecystitis with 7 patients (17.5%). Conclusively, laparoscopic cholecystectomy can be safely applied with lower morbidity, shorter operation times, and shorter hospital stay in selected patients.
Acidosis ; Appendectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute ; Cholelithiasis ; Empyema ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation ; Korea ; Length of Stay ; Peptic Ulcer ; Postoperative Complications ; Retrospective Studies

PURPOSE: Combined chemoradiotherapy is standard management for locally advanced non-small cell lung cancer (LA-NSCLC), but standard treatment for elderly patients with LA-NSCLC has not been confirmed yet. We evaluated the feasibility and efficacy of concurrent chemoradiotherapy (CCRT) for elderly patients with LA-NSCLC. MATERIALS AND METHODS: Among patients older than 65 years with LA-NSCLC, 36 patients, who underwent CCRT were retrospectively analyzed. Chemotherapy was administered 3-5 times with 4 weeks interval during radiotherapy. Thoracic radiotherapy was delivered to the primary mass and regional lymph nodes. Total dose of 54-59.4 Gy (median, 59.4 Gy) in daily 1.8 Gy fractions and 5 fractions per week. RESULTS: Regarding the response to treatment, complete response, partial response, and no response were shown in 16.7%, 66.7%, and 13.9%, respectively. The 1- and 2-year overall survival (OS) rates were 58.2% and 31.2%, respectively, and the median survival was 15 months. The 1- and 2-year progression-free survivals (PFS) were 41.2% and 19.5%, respectively, and the median PFS was 10 months. Regarding to the toxicity developed after CCRT, pneumonitis and esophagitis with grade 3 or higher were observed in 13.9% (5 patients) and 11.1% (4 patients), respectively. Treatment-related death was not observed. CONCLUSION: The treatment-related toxicity as esophagitis and pneumonitis were noticeably lower when was compared with the previously reported results, and the survival rate was higher than radiotherapy alone. The results indicate that CCRT is an effective in terms of survival and treatment related toxicity for elderly patients over 65 years old with LA-NSCLC.
Aged ; Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy ; Disease-Free Survival ; Esophagitis ; Humans ; Lymph Nodes ; Pneumonia ; Retrospective Studies ; Survival Rate

The transjugular intrahepatic portosystemic shunt (TIPS) is an effective and relatively safe and widely accepted treatment for complications arising from portal hypertension. Shunt or hepatic vein stenosis and shunt occlusion are common short- and medium-term complications arising from the procedure, though if detected early, these conditions may be treated before the recurrence of gastrointestinal bleeding or ascites. Doppler US is a relatively inexpensive, accurate, and noninvasive method for the evaluation of shunt status.
Ascites ; Constriction, Pathologic ; Hemorrhage ; Hepatic Veins ; Hypertension, Portal ; Portasystemic Shunt, Surgical* ; Recurrence

Vascular complications after liver transplantation may involve the hepatic artery, and hepatic and portal veins. Arterial complications are common and significant vascular complications include thrombosis or stenosis, as well as pseudoaneurysms. Venous complications include thrombisis or stenosis of the inferior vena cana, or hepatic or portal vein. Since recent evidence has shown that emergent revascularization leads to improved graft salvage and patient survival with a relatively low rate of late biliary complications, accurate and pronpt di-agnosis of hepatic arterial complications is important. Doppler US is a relatively inexpensive, accurate, and non-invasive method of diagnosing the vascular complications which may arise from liver transplantation.
Aneurysm, False ; Constriction, Pathologic ; Hepatic Artery ; Humans ; Liver Transplantation* ; Liver* ; Portal Vein ; Thrombosis ; Transplants

Actinomycosis is a rare acute-to-chronic bacterial infection caused by Actinomyces. A 7-year-old healthy girl presented with left-sided nasal obstruction and purulent discharge. She had no special medical or trauma history, and the symptoms developed gradually after severe vomiting one month prior to the visit. Nasal endoscopy revealed white-black-colored cheesy material that appeared as a foreign body or fungal material in the left nasal cavity. The lesion was completely removed endoscopically under local anesthesia. The patient was prescribed only a topical antibiotic ointment without any additional systemic antibiotics. She was diagnosed with actinomycosis based on histopathological examination after a few days. There was no recurrence at six months post-procedure. The common treatment for actinomycosis is surgical removal and a systemic antibiotic therapy. However, this case was successful with complete surgical removal and only a short-term topical antibiotic ointment therapy. Therefore, the treatment for actinomycosis should differ based on clinical characteristics and the patient’s condition.

BACKGROUND:Hydromorphone is a semi-synthetic opioid that has recently been used for the control of acute and chronic pain.It has been reported that epidural infusion of hydromorphone provides rapid onset of analgesia and a lower incidence of side effects than morphine.However, comparative studies of hydromorphone and lipophilic opioids such as fentanyl are rare.Therefore, we compared the analgesic effects and side effects of hydromorphone infused epidurally with fentanyl in patients who underwent total knee arthroplasty. METHODS:In a randomized, double-blind manner, 79 patients (ASA I-III, aged 60?75) underwent total knee arthroplasty and were provided with patient-controlled epidural analgesia (PCEA) using a lumbar spinal/epidural-combined technique. Group HR (n = 39) received epidurally administered hydromorphone (4microg/ml) with 0.1% ropivacaine, while group FR (n = 40) received epidural fentanyl (2microg/ml) with 0.1% ropivacaine for 24 h after surgery at a rate of 5 ml/h. The visual analogue scale (VAS) was used to evaluate pain and the incidence of side effects such as nausea/vomiting, pruritis, dizziness, and respiratory depression were recorded at 4, 8, 12, 24 h after surgery. RESULTS:Group HR showed a lower VAS than group FR at 4, 12 and 24 h after surgery, but a higher incidence of nausea and vomiting at 8 h after surgery, and a higher incidence of pruritis at 8 and 12 h after surgery. None of the patients showed respiratory depression. CONCLUSIONS:Lumbar epidural infusion of hydromorphone more effectively controlled acute pain after total knee arthroplasty when compared with fentanyl, but some adverse effects such as nausea and vomiting appeared to occur more frequently.
Acute Pain ; Aged ; Amides ; Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Arthroplasty ; Dizziness ; Fentanyl ; Humans ; Hydromorphone ; Incidence ; Knee ; Nausea ; Pruritus ; Respiratory Insufficiency ; Vomiting