A functional upper airway obstruction due to a vocal cord dysfunction(VCD) is characterized by a paradoxical adduction of the vocal cords throughout the respiratory cycle with no obvious organic cause for the obstruction. It commonly occurs paroxysmally and imitates acute asthmatic attacks, often in patients with coexisting asthma. They present with episodes of dyspnea associated with inspiratory wheezing that persists despite conventional asthma treatment and a flattening of the inspiratory limb of the flow-volume curve; an adduction of the vocal cord during inspiration. Failure to recognize concurrent vocal cord dysfunction and asthma has led not only to the excessive use of bronchodilators and corticosteroids, but also to intubation and tracheostomy. Here, we report a case of coexistent obstructive pulmonary disease and functional upper airway obstruction due to a vocal cord dysfunction where a bronchoscopy showed a paradoxical vocal cord motion and typical features of a variable extrathoracic obstruction and a lower airway obstruction on the Flow-volume loop during a symptomatic period.
Adrenal Cortex Hormones ; Airway Obstruction* ; Asthma ; Bronchodilator Agents ; Bronchoscopy ; Dyspnea ; Extremities ; Humans ; Intubation ; Lung Diseases, Obstructive* ; Respiratory Sounds ; Tracheostomy ; Vocal Cord Dysfunction* ; Vocal Cords*

Tibial nonunion is often associated with the soft tissue atrophy and the local circulatory disturbance, so it is important to minimize the soft tissue injury and maintain the stability at fracture site for bone union. We reviewed 29 cases of subcortical onlay bone grafts and plate fixations for the nonunion and delayed union of tibial shafts, from Jan. 1988 through Jan. 1994. The results were as follows. 1. Twenty-nine patients who had nonunion of the tibia underwent subcortical cancellous onlay bone graft and plating, and 28 fractures(96.6%) went on to union. 2. Subcortical elevation or shingling of cortical bone fragments of the tibial cortex, is advocated to provide sound biological condition in atrophic soft tissue envelope. 3. Narrow DCP encouraged early motion and reliably promoted obtaining anatomical alignment. So, in treatment of protracted tibial nonunion, especially in an area with deficient soft tissue or unyielding scar tissue, subcortical onlay bone graft and plate fixation is very useful method, result in good union and no skin problem.
Atrophy ; Cicatrix ; Humans ; Inlays ; Methods ; Skin ; Soft Tissue Injuries ; Tibia ; Transplants

BACKGROUND: Helicobacter pylori(H. pylori) infection is known to be strongly associated with varied dermatoses such as rosacea, vasculitic purpura, and Sweet's syndrome. Also, many antibiotics including amoxicillin, clarithromycin, and tetracycline have been used to ameliorate chronic urticaria. This recent knowledge posed the plausibility that H. pylori infection might be an underlying causative factor of chronic urticaria. OBJECTIVE: This study was conducted to investigate the role of H. pylori infection in patients with chronic urticaria. METHODS: Sixty-five subjects with chronic urticaria were examined for H. pylori infection with enzyme-linked immunosorbent assay for IgG/M against H. pylori and rapid urease test(CLO test) for endoscopically biopsied gastric mucosa. Amoxicillin or clarithromycin combined with omeprazole as a therapy was administrated to the 44 patients with positive test results for 4 weeks. RESULTS: H. pylori infection was more frequently diagnosed in 44 of 65(67.7%) patients with chronic urticaria than in the control subjects(8.8%). After the completion of treatment for 4 weeks, specific IgG antibodies and a CLO test against H. pylori were negative in 28 of 38(73.7%) and 43 of 44(97.7%) patients respectively. At the post-treatment evaluation, 37 of 44(84.1%) patients with H. pylori-positive urticaria showed significant clinical remission of urticaria. CONCLUSION: Eradication of H. pylori in patients with chronic urticaria was accompanied by clinical remission of urtication. There is substantial evidence that unexplained causes of chronic urticaria may be associated with H. pylori infection.
Amoxicillin ; Anti-Bacterial Agents ; Antibodies ; Clarithromycin ; Enzyme-Linked Immunosorbent Assay ; Gastric Mucosa ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Korea* ; Omeprazole ; Prevalence* ; Prospective Studies* ; Purpura ; Rosacea ; Skin Diseases ; Sweet Syndrome ; Tetracycline ; Urease ; Urticaria*

No abstract available.
Pulmonary Embolism*

Laryngoscopy and endotracheal intubation are potent stimuli that increase heart rate and blood pressure. These transient stress responses are probably not harmful in healthy individuals. However hypertensive patients are more prone to have significant increase in heart rate and blood pressure whether they have been treated beforehand or not and these responses also can lead to fstal complications. A randomized double-blind study was csrried out on 40 ASA physical status II-III adult elective surgical patients with hypertension to assess the effects of continuous intravenous infusion of esmolol, ultrashortacting cardioselective beta blocker, on hemodynamic responses to laryngoscopy and endotracheal intubation. Patients received a continuous infusion of esmolol(500mcg/kg/min for 1 minute, followed by 200mcg/kg/min for 12minutes) or an equal volume of saline before and throughout the induction periods of anesthesia. Using noninvasive automatic blood pressure monitor, blood pressure( systolic, diastolic and mean arterial pressure) and heart rate were measured at 6 points: 1) as the control value, on arrival to operating room, 2) just after IV loading dose of saline or esmolol, 3) just after IV thiopental, 4) 1 minute after intuhation, 5) 3 minutes after intubation, and 6) 5 minutes after intubation. The rate-pressure product was calculated in each time. During this study, anesthesia was maintained with enflursne-N2O-O2 vecuronium and controlled ventilstion. In patients given esmolol, systolic pressure, diasolic pressure, mean arterial pressure, heart rate, and rate pressure product at 1 minute, 3 minutes, 5 minutes after intubation were less increased than control group. And the heart rste response was more effectively blunted than the blood pressure response. The continuous infusion of esmolol can blunt hemodynamic changes caused by laryngoscopy and endotracheal intubation in hypertensive patients, yet it is needed to find out the optimal dosage of esmolol for complete blocking of the sympathetic response without the adverse effects.
Adult ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Blood Pressure Monitors ; Double-Blind Method ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension* ; Infusions, Intravenous ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Operating Rooms ; Thiopental ; Vecuronium Bromide

Pseudomonas aeruginosa pneumonia is characteristically found as a hospital-acquired infection in patients with underlying medical disorders. Few cases of community acquired P. aeruginosa pneumonia have been reported in individuals without underlying diseases. We report a case of P. aeruginosa pneumonia in a healthy 33-year-old man. He visited our hospital because of fever, non-productive cough, and pleuritic chest pain. On physical examination, the breathing sounds were decreased on the right lower lung field. The chest radiograph showed lobar consolidations with a cavity on the right upper lung field. Blood cultures and a pleural fluid culture yielded P. aeruginosa. Despite aggressive management including antibiotics and mechanical ventilation, he died 26 hours after the onset of symptoms. P. aeruginosa should be included in the differential diagnosis of severe community-acquired pneumonia.
Adult* ; Anti-Bacterial Agents ; Chest Pain ; Cough ; Diagnosis, Differential ; Fever ; Humans ; Lung ; Physical Examination ; Pneumonia* ; Pseudomonas aeruginosa* ; Pseudomonas* ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Sounds ; Sepsis

The main aim of dental implant placement on the anterior region is to recover the function and esthetics. Therefore, this study examined the angulation between the long axis of the anterior teeth and the alveolar process, and thickness of the alveolar bone on the anterior region. Twenty-five cadaver heads (18 maxillae and 23 mandibles) were examined (16 male and 9 female, mean: 56.7 years). The angulation between the long axis of the anterior teeth and the alveolar process was measured, and the alveolar bone thickness was measured in the three levels (crest; C, middle; M, apex; A) on the labial and lingual sides. All data was analyzed statistically using one-way ANOVA. The maxillary anterior teeth showed two to three times more lingual inclination than the mandibular teeth. The difference in maxillary alveolar bone thickness on the labial and lingual sides was significant in all levels, particularly in the apex. The mandibular alveolar bone thickness on the labial and lingual side was significantly different only in the apex. In conclusion, the alveolar bone thickness on the anterior region was too thin, and the long axis of the maxillary anterior teeth showed more lingual inclination than the alveolar process. Therefore, clinicians need to be a detailed assessment of the labial alveolar bone for dental implant placement.
Alveolar Process ; Axis, Cervical Vertebra ; Cadaver ; Dental Implants ; Esthetics ; Female ; Head ; Humans ; Male ; Maxilla ; Tooth

The main aim of dental implant placement on the anterior region is to recover the function and esthetics. Therefore, this study examined the angulation between the long axis of the anterior teeth and the alveolar process, and thickness of the alveolar bone on the anterior region. Twenty-five cadaver heads (18 maxillae and 23 mandibles) were examined (16 male and 9 female, mean: 56.7 years). The angulation between the long axis of the anterior teeth and the alveolar process was measured, and the alveolar bone thickness was measured in the three levels (crest; C, middle; M, apex; A) on the labial and lingual sides. All data was analyzed statistically using one-way ANOVA. The maxillary anterior teeth showed two to three times more lingual inclination than the mandibular teeth. The difference in maxillary alveolar bone thickness on the labial and lingual sides was significant in all levels, particularly in the apex. The mandibular alveolar bone thickness on the labial and lingual side was significantly different only in the apex. In conclusion, the alveolar bone thickness on the anterior region was too thin, and the long axis of the maxillary anterior teeth showed more lingual inclination than the alveolar process. Therefore, clinicians need to be a detailed assessment of the labial alveolar bone for dental implant placement.
Alveolar Process ; Axis, Cervical Vertebra ; Cadaver ; Dental Implants ; Esthetics ; Female ; Head ; Humans ; Male ; Maxilla ; Tooth

BACKGROUND: Cutaneous vasculitis associated with viral hepatitis seems to occur as a hypersensitivity reaction against the circulating viral antigens. Hepatitis B virus(HBV)-encoded X antigen(HBxAg) is known to participate in the carcinogenesis of hepatocellular carcinoma(HCC) by the inactivation of p53. However, HBxAg has been found in chronic infiammatory lesions without the overexpression of p53. Accordingly, not only EBsAg and HBcAg but also HBxAg may be involved in HCC-associated cutaneous vasculitis, regardless of the alteration of p53. OBJECTIVE: This study was conducted to investigate the expression of HBV-encoded antigens in cutaneous vasculitis accompanied by HBV hepatopathy. Additionally, we have compared the expression of 3 HBV antigens and p53 between vasculitic patients with HCC and in others showing HCC-non-associated vasculitis. METHODS: Immunohistochemically, we examined the expression of HBsAg, HBcAg, and HBxAg in the tissue specimens taken from the vasculitic lesions of the 33 HBsAg-positive enrolled patients with cutaneous vasculitis proven by skin biopsy. RESULTS: 1. The immunohistochemical positivity rate to HBsAg in vasculitic patients with HBV hepatopathy was 66.7% overall. It was 90% in HCC-associated vasculitic subjects and 56.5% in the vasculitic subjects without HCC, respectively. 2. We found the expression of HBxAg in 80% of the vasculitic subjects showing HCC. The vasculitic patients without HCC showed 17,3% of the positivity rate to HBxAg. 3. We could not find the overexpression of p53 in the vasculitic tissue specimens of the HCC patients without the cutaneous metastasis from primary HCC. CONCLUSION: HBsAg, HBcAg and HBxAg may participate in the pathogenesis of cutaneous vasculitis with HBV hepatopathy, regardless of tumorigenesis.
Antigens, Viral ; Biopsy ; Carcinogenesis ; Hepatitis B Core Antigens ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Hypersensitivity ; Neoplasm Metastasis ; Skin ; Vasculitis*

Bee pollen is a mixture made by worker bees and consists of pollen, nectar, and salivary secretions. Due to its abundant nutritional and medicinal effects, people are consuming bee pollen increasingly these days. By the way, some of the elements of bee pollen, such as pollen and fungus, can cause allergic reactions. Anaphylaxis is the most common symptom and other symptoms such as bronchospasm, abdominal pain and urticaria can occur. But localized cutaneous bee pollen allergy has never been reported. A 29-year-old man presented with erythematous vesicular patches on the lower abdomen 3 months ago. The skin biopsy specimen showed a subcorneal pustule filled with eosinophilic microabscess, perivascular eosinophilic infiltration, and epidermal spongiosis. He was diagnosed with skin allergy caused by bee pollen. He stopped ingesting bee pollen and was treated with oral antihistamines and a topical steroid. We report this case because of its unique clinical and histological appearance.