The incidence of duodenal diverticulum found incidentally during upper gastrointestinal roentgenographicexamination varies between 2% and 5%. The majority of cases occur along the medial aspect of the second portion of the duodenum, within 2.5cm of the ampulla of Vater. The majority of duodenal diverticula are asymptomatic, but insome cases, complications such as diverticulitis, hemorrhage, perforation, and fistula formation occur in thethird and fourth portions of the duodenum. We describe a case of giant diverticulum of the transverse duodenum,revealed by UGI and angiography, massive gastrointestinal bleeding in a 80-year-old patient.
Aged, 80 and over ; Ampulla of Vater ; Angiography ; Diverticulitis ; Diverticulum* ; Duodenum* ; Fistula ; Hemorrhage* ; Humans ; Incidence

PURPOSE: To assess the diagnostic accuracy and clinical efficacy of noncontrast spiral CT in patients withsuspected acute appendicitis. MATERIALS AND METHODS: Over a six-month period, 100 patients with suspected acuteappendicitis were prospectively evaluated with noncontrast spiral CT. All scans were obtained from the lower bodyof L3 to the symphysis pubis, with 5mm or 10mm collimation and pitich of 1 or 1.5, and without intravenous or oralcontrast material. Diagnosis was established by means of surgical or clinical follow-up. Prospective diagnosisbased on CT findings was compared with surgical results and clinical follow-up. RESULTS: Acute appendicitis wasconfirmed in 47 of 100 patients. On the basis of the basis of the CT findings, SI patients were prospectivelyinterpreted as positive for appendicitis, but in six the diagnosis was false-positive. Two of the 47 with acuteappendicitis were prospectively interpreted as normal. The preoperative diagnosis of acute appendicitis was, thus,45 true-positive, 47 true-negative, six falsepositive and two false-negative, yielding a sensitivity of 96%, aspecificity of 89%, an accurace of 92%, a positive predictive value of 88%, and a negative predictive value of96%. Using CT, an alternative diagnosis was established in 14 patients. CONCLUSION: Noncontrast spiral CT is auseful technique for diagnosing acute appendicitis.
Appendicitis* ; Diagnosis ; Follow-Up Studies ; Humans ; Prospective Studies ; Tomography, Spiral Computed*

Nine adult patients with non-traumatic primary intraventricular hemorrhage (PIVH) were reviewed. Lack of lateralizing sign could be one of the differential points between PIVH and secondary intraventricular hemorrhage (SIVH). In three cases, vascular malformations were identified. Bleeding diathesis was present in one. The pathogenesis of hemorrhage in the remaining five cases was speculated. According to the mainly involved ventricle, prognosis was presumed to be variable. From this study, we conclude that for PIVH investigation including angiography and/or magnetic resonance imaging should be done to identify the etiology and to conduct appropriate management. Survival was more common than SIVH.
Adult ; Angiography ; Disease Susceptibility ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Vascular Malformations

BACKGROUND: Paronychia is a common infectious disease affecting fingernails and toenails. Although bacterial and fungal infections as well as mechanical trauma may play roles in the pathogenesis of this disease, there are few bacteriological studies about paronychia in military personnel. OBJECTIVE: To identify the causative bacteria of paronychia in military personnel. METHODS: We retrospectively analyzed the microbiological results of 145 patients who visited a tertiary referral hospital for Korean soldiers from August 2004 to October 2006. RESULTS: Twenty-eight different types of aerobic bacteria were identified, with the most common being Staphylococcus aureus (38.0%), Streptococcus pyogenes (7.2%), and Pseudomonas aeruginosa (5.4%). Staphylococcus aureus was identified mostly in finger and toe paronychial lesions and Pseudomonas aeruginosa was recovered commonly from toe paronychial lesions. All cases of paronychia were controlled by the combination of antiseptic dressing, topical antibacterial ointment, oral antibiotics, and antimycotic agents. CONCLUSION: The types of bacteria that most commonly caused paronychia in military personnel were Staphylococcus aureus, Staphylococcus pyogenes, and Pseudomonas aeruginosa. Thus, the commonly used oral antibiotics for paronychia, such as amoxicillin-clavulanate, clindamycin, and trimethoprim-sulfamethoxazole, are good choices in the treatment of paronychia in military personnel.
Anti-Bacterial Agents ; Bacteria ; Bacteria, Aerobic ; Bandages ; Clindamycin ; Communicable Diseases ; Fingers ; Humans ; Military Personnel ; Nails ; Paronychia ; Pseudomonas aeruginosa ; Retrospective Studies ; Staphylococcus ; Staphylococcus aureus ; Streptococcus pyogenes ; Tertiary Care Centers ; Toes ; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND: Cardiac transplantation has been established as a treatment of choice for patients with end- stage heart failure. However, the experiences of cardiac transplantation are still limited in Korea. METHODS: Seventeen adult cardiac transplantations (13 males and 4 females) were performed in Seoul National University Hospital since March 1994. Clinical outcome & course, acute rejection, and complications among transplanted patients were reviewed. RESULTS: Underlying cardiac conditions leading to cardiac transplantation were dilated cardiomyopathy in 9, valvular heart disease with severe LV dysfunction after prosthetic valve replacement in 3, restrictive cardiomyopathy in 2, ischemic cardiomyopathy in 1, intractable ventricular tachyarrhythmia in 1 and hypertrophic cardiomyopathy with severe LV dysfunction in 1 patient. Ages of recipients were between 22 and 54 (median:38). Mean follow up duration was 27 months (1-45 months). The frequencies of rejection decreased with time and were similar to those of previous reports: 1.23 episodes of rejections per patients during first 3months after transplantation, 0.25 during second 3months, 0.17 and 0.08 during third and fourth 3 months. Infectious complications developed in 21.4% of patients during the first year after transplantation and infectious agents were Cytomegalovirus (CMV), gram negative bacteria, and Candida. One-year survival rate of recipients was 81.9%. Systemic CMV infection in 1, aortic rupture in 1, and sudden death in 1 patient were the causes of mortality, all of which developed during early post-transplantation period. CONCLUSION: Cardiac transplantation seems to be a reasonable therapeutic regimen for patient with end stage heart failure even in this country with limited experience; however, close attention and management against acute rejection and infectious complications, especially during the early post-transplantation period, are critical for long term survival.
Adult* ; Aortic Rupture ; Candida ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Cardiomyopathy, Restrictive ; Cytomegalovirus ; Death, Sudden ; Follow-Up Studies ; Gram-Negative Bacteria ; Heart Failure ; Heart Transplantation* ; Heart Valve Diseases ; Humans ; Korea ; Male ; Mortality ; Seoul ; Survival Rate ; Tachycardia

BACKGROUND: At present, lamivudine-interferon combination therapy is being tried on chronic hepatitis B patients who had no significant response to interferon-alpha mono-therapy. The therapeutic effect of lamivudine-interferon combination therapy is showing various outcomes depending on the period of therapy and the status of the patient. Thus we conducted this study to compare the therapeutic effect of lamivudine-interferon combination therapy versus interferon-alpha monotherapy in korean patients with chronic hepatitis B. METHOD: Among the chronic hepatitis B patients, 138 patients who showed positive to HBeAg, and serum HBV DNA levels are over 5 pg/mL and serum ALT levels are over 40 IU/L were allocated to IFN-alpha monotherapy group (70 patients) and lamivudine-interferon combination therapy group (66 patients). We compared two groups on ALT normalization rate, HBeAg seroconversion rate, HBV DNA loss rate and HBeAg loss rate in both group. IFN-alpha was percutaneously injected three times a week. Mean administered dose was 27125 (+/-11841) MU and mean administered duration was 6.4 (+/-1.6) months. Lamivudine was concomitantly and continuously administered with IFN-alpha for over 6 months (mean 13.2 +/- 16.5). The lamivudine therapy was terminated at the point when HBeAg turned positive into negative. RESULTS: Mean follow-up period was 28 months. HBeAg loss rate was 40.9% in lamivudine- interferon combination therapy group and 28.6% in IFN-alpha monotherapy group on the 12th month of the therapy, showing there was no significant difference between the two groups (p=0.13). HBeAg seroconversion rate was 40.9% in lamivudine-interferon combination therapy group and 21.4% in IFN-alpha monotherapy group on the 12th month of the therapy (p=0.014). HBV DNA loss rate was 90.9% in lamivudine-interferon combination therapy group and 88.6% in IFN-alpha monotherapy group within 12months of the therapy, showing there was no significant difference between the two groups (p=0.35). Serum ALT normalization rate was 92.4% in lamivudine-interferon combination therapy group and 85.7% in IFN-alpha monotherapy group within 12months of the therapy, showing there was no significant difference between the two groups (p=0.11). CONCLUSION: The lamivudine-interferon combination therapy compared to the Interferon-alpha monotherapy showed a statistically significant higher HBeAg seroconversion rate.
DNA ; Follow-Up Studies ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-alpha* ; Interferons* ; Lamivudine