No abstract available.
Bile* ; Carcinoembryonic Antigen* ; Gallbladder* ; Mesenteric Veins*

Poor control of bowel movement in some bed-ridden patients with various causes such as stroke or spinal cord injury which causes fecal leakage and diarrhea, increases the risk of perianal excoriation, bed sores and is a burden on caregivers. PURPOSE: To evaluate the efficacy of fecal evacuation, prevention and treatment of skin complications in intractable diarrhea patients employing a new device. METHODS: A continent anal plug (CAP: US Patent No. 5,569,216: Join Ent. Seoul, Korea) comprises an inner balloon surrounded by an external balloon both of which are mounted on a silicone tube containing a pair of air passages and an enema fluid inlet. The tube is secured in place in the rectum by the inflatable external balloon and is designed to drain fecal matter through a thin collapsible hose situated in the anal canal. Thirty two patients (21 male, median age 61 years, range; 28~76) were evaluated after fully informed consent. Median duration (range) was 12 (3~37) days. RESULTS: CAP evacuated efficiently in those with loose or watery stools who only required once daily irrigation or not. Skin excoriations improved in 3~7 days. Minimal leakage was seen around the anus. There was no anorectal mucosal injury noted over 37 days. Conclusions: The CAP was an efficient method of treating patients with loss of bowel control and incontinence because it enabled controlled fecal evacuation and helped reduction of skin complications without causing anorectal mucosal injury.
Anal Canal ; Bays ; Caregivers ; Diarrhea* ; Enema ; Humans ; Informed Consent ; Male ; Pressure Ulcer ; Rectum ; Seoul ; Silicones ; Skin ; Spinal Cord Injuries ; Stroke

BACKGROUND: Panel reactive antibody (PRA) test is important in that it could minimize the errorneous report of HLA crossmatch in emergent situation and be used as a information on nationwide organ sharing. However, only a few laboratories manage to do this test by home-ade tray. This study was intended to resolve the cause of discrepancy between EIA and AHG-DC which would be encountered when supplement AHG-DC was tested for EIA positive samples. METHODS: Reactivity of Lambda Antigen Tray class I and class II mixed (LAT-, One Lambda, CA, USA) was evaluated to 23 specimens which had been positive in AHG phase of HLA crossmatch. All the samples for PRA were tested by EIA screening kit primarily and then AHG-DC was applied only in EIA positive samples. Samples showing discrepant results between two tests were further evaluated by EIA identification panel, platelet absorption test, dithiothreitol (DTT) treatment, and HLA crossmatch (AHG-DC and flowcytometry) with lymphocytes having antigen specificity reactive to antibodies identified by EIA kit. RESULTS: Of 23 samples, 21 (91.3%) showed strong reactivity to EIA and remaining 2 were confirmed to have IgM type alloantibodies. Of 92 samples for PRA, 22 (23.9%) were positive in anti-LA class I. 10 of 22 samples with positive EIA showed negative results by AHG-DC. While three of them were identified of their antibody specificity, of which 2 samples confirmed to have CYNAP (cytotoxicity negative, adsorption positive) antibodies and one sample to be nonspecific reaction to class I antigens, remaining 7 samples were negative to all the wells of EIA identification (id.) kit. Signal/cut-ff (S/C) of all three samples reactive to EIA id. kit were more than 1.75. CONCLUSIONS: HLA antibody screening by EIA from transplant candidate is considered to be appropriate in that EIA could detect IgG anti-LA of all tested sera and CYNAP antibodies as well. It needs further study with larger number of samples whether S/C of EIA would be informative in cases showing EIA positive/ AHG-DC negative.
Absorption ; Adsorption ; Antibodies ; Antibody Specificity ; Blood Platelets ; Dithiothreitol ; Histocompatibility Antigens Class I ; Immunoenzyme Techniques* ; Immunoglobulin G ; Immunoglobulin M ; Isoantibodies ; Lymphocytes ; Mass Screening ; Sensitivity and Specificity

BACKGROUND: Panel reactive antibody (PRA) test is important in that it could minimize the errorneous report of HLA crossmatch in emergent situation and be used as a information on nationwide organ sharing. However, only a few laboratories manage to do this test by home-ade tray. This study was intended to resolve the cause of discrepancy between EIA and AHG-DC which would be encountered when supplement AHG-DC was tested for EIA positive samples. METHODS: Reactivity of Lambda Antigen Tray class I and class II mixed (LAT-, One Lambda, CA, USA) was evaluated to 23 specimens which had been positive in AHG phase of HLA crossmatch. All the samples for PRA were tested by EIA screening kit primarily and then AHG-DC was applied only in EIA positive samples. Samples showing discrepant results between two tests were further evaluated by EIA identification panel, platelet absorption test, dithiothreitol (DTT) treatment, and HLA crossmatch (AHG-DC and flowcytometry) with lymphocytes having antigen specificity reactive to antibodies identified by EIA kit. RESULTS: Of 23 samples, 21 (91.3%) showed strong reactivity to EIA and remaining 2 were confirmed to have IgM type alloantibodies. Of 92 samples for PRA, 22 (23.9%) were positive in anti-LA class I. 10 of 22 samples with positive EIA showed negative results by AHG-DC. While three of them were identified of their antibody specificity, of which 2 samples confirmed to have CYNAP (cytotoxicity negative, adsorption positive) antibodies and one sample to be nonspecific reaction to class I antigens, remaining 7 samples were negative to all the wells of EIA identification (id.) kit. Signal/cut-ff (S/C) of all three samples reactive to EIA id. kit were more than 1.75. CONCLUSIONS: HLA antibody screening by EIA from transplant candidate is considered to be appropriate in that EIA could detect IgG anti-LA of all tested sera and CYNAP antibodies as well. It needs further study with larger number of samples whether S/C of EIA would be informative in cases showing EIA positive/ AHG-DC negative.
Absorption ; Adsorption ; Antibodies ; Antibody Specificity ; Blood Platelets ; Dithiothreitol ; Histocompatibility Antigens Class I ; Immunoenzyme Techniques* ; Immunoglobulin G ; Immunoglobulin M ; Isoantibodies ; Lymphocytes ; Mass Screening ; Sensitivity and Specificity

Coxiella burnetii is the etiological agent of Q fever, that may occur either acutely or the chronically. To understand the seroepidemiological patterns of C. burnetii infection in Korea, we examined a total of 3,178 sera from patients with acute febrile episodes by using indirect immunofluorescence assay (IFA) for detectable antibodies to C. burnetii and other eight rickettsial antigens. The IFA seropositivity>or=1:20 for C. burnetii phase II was 11.5% (368 out of 3,178 sera). The co-existence of antibodies to other rickettsial antigens was found in 216 out of the 368 positive sera. Thirty-seven point five percent (n=138) had antibodies to R. tsutsugamushi (cutoff>or=1:20), 16% (n=59) to Ehrlichia sennetsu, 14.9% (n=55) to Rickettsia typhi, 13.5% (n=50) to R. akari, 11.4% (n=42) to R. japonica, 8.9% (n=33) to R. prowazekii, 7.6% (n=28) to R. sibirica, and 6.7% (n=25) to R. conorii by IFA, respectively. These results are consistent with previous reports documenting diverse serum cross-reactivity in chronic Q fever. Therefore we excluded the samples that reacted to other rickettsial antigens at same or higher titers than to C. burnetii, resulting in the seropositive rate of 4.1%. The serological prevalence was 2% (n=64) when the conventional cut-off titer of 1:80 was used. Our results suggest that infections with C. burnetii are more prevalent than expected previously and should be differentially diagnosised for febrile illness occurring after exposure to ticks or other vectors.
Antibodies ; Coxiella burnetii* ; Coxiella* ; Diagnosis ; Fluorescent Antibody Technique, Indirect ; Humans ; Korea ; Neorickettsia sennetsu ; Prevalence ; Q Fever ; Rickettsia ; Rickettsia typhi ; Seroepidemiologic Studies* ; Ticks

BACKGROUND: The purpose of this study was to evaluate the usefulness of the pleural fluid carcinoembryonic antigen (CEA) and cytokeratin fragment 19 (CYFRA 21-1) tumor markers as complementary tools for the diagnosis of malignant pleural effusions. PATIENTS AND METHODS: The levels of pleural and serum CEA and CYFRA 21-1 were prospectively assayed in 222 patients with pleural effusions (150 benign effusions, 57 bronchogenic carcinomas and 15 metastatic carcinomas). RESULTS: The levels of pleural fluid CEA and CYFRA 21-1 in the malignant effusions were significantly higher than those in the benign effusions. With a specificity of 95%, the cut off values for the CEA and CYFRA 21-1 in pleural effusions were 5 and 89 ng/ml, respectively. The diagnostic sensitivities of the pleural fluid CEA and CYFRA 21-1 in malignant effusions were 72 and 54%, respectively, whereas using a combination of the two, the sensitivity increased to 87% (p<0.05). CONCLUSIONS : These findings suggest that a combination of the pleural fluid CEA and CYFRA 21-1 in pleural effusions can be useful in the diagnosis of malignant pleural effusions.
Carcinoembryonic Antigen ; Carcinoma, Bronchogenic ; Diagnosis ; Humans ; Keratins ; Pleural Effusion ; Pleural Effusion, Malignant* ; Prospective Studies ; Biomarkers, Tumor

Variceal bleeding from enterostomy site is an unusual complication of portal hypertension. The bleeding, however, is often recurrent and may be fatal. The hemorrhage can be managed with local measures in most patients, but when these fail, surgical interventions or portosystemic shunt may be required. Herein, we report a case in which recurrent bleeding from stomal varices, developed after a colectomy for rectal cancer, was successfully treated by placement of transjugular intrahepatic portosystemic shunt (TIPS) with coil embolization. Although several treatment options are available for this entity, we consider that TIPS with coil embolization offers minimally invasive and definitive treatment.
Colectomy/adverse effects ; Contrast Media/pharmacology ; Embolization, Therapeutic/*methods ; Esophageal and Gastric Varices/surgery ; Gastrointestinal Hemorrhage/*therapy ; Humans ; Male ; Middle Aged ; *Portasystemic Shunt, Transjugular Intrahepatic ; Rectal Neoplasms/surgery ; Tomography, X-Ray Computed/methods ; Treatment Outcome

Purpose: Development of malignancy is one of the key issues in the renal transplant recipients after long term follow up. Methods: We reviewed our renal transplant registry for the incidence of de novo malignancy after renal transplantation. Results: Among the 1006 renal transplant recipients from July 1969 until January 2006, 47 cases of de novo malignancy developed in 43 patients: stomach cancer (7 cases), Kaposi's sarcoma (6), post-transplantation lymphoproliferative disorder (PTLD, 7), primary liver cancer (4), thyroid cancer (3), skin cancer (4), colon cancer (3),), renal cell carcinoma (2), bladder cancer (2), anal cancer (2), sarcoma (3) and one malignancy case from conjunctiva, pancreas, uterine cervix, and tongue, respectively. Mean age at the time of diagnosis of cancer was 45.8+/-12.0 years (mean+/-standard deviation). The cancer diagnosis was made at 97.1+/-73.6 months after the renal transplantation. We have high prevalence of cancers with suspected viral etiology - i.e., Kaposi's sarcoma, PTLD, primary liver cancer and uterine cervix cancer. Conclusion: Careful surveillance of malignancy in renal allograft recipients is highly recommended.
Allografts ; Anus Neoplasms ; Carcinoma, Renal Cell ; Cervix Uteri ; Colonic Neoplasms ; Conjunctiva ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Kidney Transplantation* ; Kidney* ; Liver Neoplasms ; Lymphoproliferative Disorders ; Pancreas ; Prevalence ; Sarcoma ; Sarcoma, Kaposi ; Skin Neoplasms ; Stomach Neoplasms ; Thyroid Neoplasms ; Tongue ; Transplantation ; Urinary Bladder Neoplasms

The common bile duct normally enters the posteromedial aspect of the second part of the duodenum. However, anomalous drainage of the common bile duct into the stomach, pyloric channel, duodenal bulb and fourth portion of the duodenum has been reported in the literature. An anomalous pancreatic duct, with ectopic drainage of the common bile duct, is particularly rare. Herein, we report the case of a 69-year-old woman who showed pancreatic ductal variation and anomalous drainage of the common bile duct into the duodenal bulb. The patient required a cholecystectomy and choledochoenteric anastomosis to relieve the obstructive jaundice and abdominal pain.
Abdominal Pain ; Aged ; Cholecystectomy ; Common Bile Duct* ; Drainage* ; Duodenum ; Female ; Humans ; Jaundice, Obstructive ; Pancreatic Ducts* ; Stomach

BACKGROUND/AIMS: A few studies showed that hood-cap assisted colonoscopy (CAC) had improved cecal intubation rate and cecal intubation time but did not help in finding colon polyps in comparison with conventional colonoscopy (CC). However, other studies have shown different results. Therefore, we investigated the efficacy of CAC for the cecal intubation time and polyp detection rate. METHODS: Patients for colonoscopy in Busan St. Mary's Medical Center were enrolled to this randomized controlled trial between July 2010 and September 2010. The evaluated outcomes were polyp detection rate, adenoma detection rate, and cecal intubation time in all patients, in difficult cases (history of previous abdominal or pelvic surgery, obesity, old age), and in the expert and non-expert groups. RESULTS: A total of 260 patients enrolled in this study were randomly allocated to the CAC group (n=130), or CC group (n=130). The overall cecal intubation time was shorter in the CAC group (5.7+/-3.4 min vs. 7.8+/-5.7 min, P<0.001). The polyp detection rate was higher in the CAC group (58.4% vs. 43%, P=0.008). The cecal intubation time in the expert and non-expert groups were shorter in the CAC group (expert: 4.1+/-2.2 min vs. 5.5+/-2.0 min, P=0.001; non-expert: 6.7+/-3.7 min vs. 9.4+/-5.9 min, P=0.001). CONCLUSIONS: The use of CAC improved the detection rate of colon polyps and shortened the cecal intubation time for both the expert and non-expert groups.
Adenoma ; Colon ; Colonoscopy ; Humans ; Intubation ; Obesity ; Polyps