Multiple biliary papillomatosis involves an epithelial field change of the intrahepatic and extrahepatic portions of the biliary tree. Pathologically it is benign, occasionally with dysplasia, but the clinical behavior is regarded as having a low-grade malignant potential. Such malignancy is rare but the prognosis is poor if it is impossible to remove the tumor completely. Here, we report one case of multiple biliary papillomatosis in the biliary tree.
Biliary Tract ; Papilloma* ; Prognosis

PURPOSE: Having been disappointed with standard anticoagulation therapy for acute deep vein thrombosis (DVT) in lower extremity, we started catheter-directed thrombolytic therapy. And the aim of this study was to evaluate the effects on venous function of catheter-directed thrombolytic therapy by noninvasive venous tests such as Air plethysmography (APG) and duplex ultrasonography. METHOD: 36 patients with DVT of less than 3 weeks after development into two groups according to treatment modality:Group 1; catheter-directed thrombolysis with Urokinase followed by low-molecular weight heparin (LMWH) and coumadin therapy (n=19, men; 11, women; 8, mean age 47.6 years), Group 2; conventional anticoagulation with LMWH followed by coumadin therapy (n=17; men; 12, women; 5, mean age 47.1 years). The results of lytic therapy were examined by complete phlebography on time of removal of catheter. The location and extent of thrombotic changes were followed-up with duplex scan and venous function was examined with APG. RESULT: Complete clot resolution by lytic therapy was obtained in 12 cases out of 19 cases (63.2%) in Group 1. The residual thrombi at follow-up around 1 year were detected in 4 cases in Group 1, in 11 cases in Group 2. APG parameters that were significantly different (P<0.05) between the two groups were the venous filling index:(Group 1; 1.63+/-1.36 ml/sec, Group 2; 2.66+/-1.58 ml/sec), residual volume fraction (Group 1; 27.54+/-17.40%, Group 2; 49.19+/-20.45%) and outflow fraction (Group 1; 37.79+/-7.05%, Group 2; 32.36+/-6.31 %). The parameters of APG and ultrasonography in Group 1 revealed lesser degree of reflux and smaller amount of residual thrombi. CONCLUSION: Catheter-directed thrombolytic therapy shows better results in complete resolution rate of the acute DVT, reducing remnant thrombi, and preserving venous function such as venous filling index, residual volume fraction and outflow fraction. APG and duplex scanning seem to be useful methods for a complete follow-up evaluation of limbs with DVT.
Catheters ; Extremities ; Female ; Follow-Up Studies ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Lower Extremity* ; Male ; Phlebography ; Plethysmography ; Residual Volume ; Thrombolytic Therapy ; Ultrasonography ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis* ; Warfarin

We report a case of myiasis on the left submandibular area after radiation therapy for squamous cell carcinoma. A 77-year-old man visited our hospital, 7 weeks after complicating a course of radiation therapy, had a 7cm diameter necrotic ulcer on the left submandible. The margin of the lesion were undermined by numerous interlinking passages containing 20 maggots. The maggots were removed by simple extraction and were identified as Calliphoridae Lucilia. The probable origin of the myiasis in this case was attributed to poor environmental condition and general weakness of the patient. Oppotunistic cutaneous myiasis can be prevented by protecting open wounds from flies, wound should not be left without a covering capable of excluding flies, especially in the summer month.
Aged ; Carcinoma, Squamous Cell* ; Diptera ; Humans ; Larva ; Myiasis* ; Ulcer ; Wounds and Injuries

Continuous glucose monitoring (CGM) has revolutionized diabetes management, significantly enhancing glycemic control across diverse patient populations. Recent evidence supports its effectiveness in both type 1 and type 2 diabetes management, with benefits extending beyond traditional glucose monitoring approaches. CGM has demonstrated substantial improvements in glycemic control across multiple metrics. Studies report consistent glycosylated hemoglobin reductions of 0.25%–3.0% and notable time in range improvements of 15%–34%. CGM effectively reduces hypoglycemic events, with studies reporting significant reductions in time spent in hypoglycemia. CGM also serves as an educational tool for lifestyle modification, providing real-time feedback that helps patients understand how diet and physical activity affect glucose levels. While skin-related complications remain a concern, technological advancements have addressed many initial concerns. High satisfaction rates and long-term use suggest that device-related issues are manageable with proper education and support. Despite high initial costs, CGM’s prevention of complications and hospitalizations ultimately reduces healthcare expenditures. With appropriate training and support, CGM represents a transformative technology for comprehensive diabetes care.

Continuous glucose monitoring (CGM) has revolutionized diabetes management, significantly enhancing glycemic control across diverse patient populations. Recent evidence supports its effectiveness in both type 1 and type 2 diabetes management, with benefits extending beyond traditional glucose monitoring approaches. CGM has demonstrated substantial improvements in glycemic control across multiple metrics. Studies report consistent glycosylated hemoglobin reductions of 0.25%–3.0% and notable time in range improvements of 15%–34%. CGM effectively reduces hypoglycemic events, with studies reporting significant reductions in time spent in hypoglycemia. CGM also serves as an educational tool for lifestyle modification, providing real-time feedback that helps patients understand how diet and physical activity affect glucose levels. While skin-related complications remain a concern, technological advancements have addressed many initial concerns. High satisfaction rates and long-term use suggest that device-related issues are manageable with proper education and support. Despite high initial costs, CGM’s prevention of complications and hospitalizations ultimately reduces healthcare expenditures. With appropriate training and support, CGM represents a transformative technology for comprehensive diabetes care.

Continuous glucose monitoring (CGM) has revolutionized diabetes management, significantly enhancing glycemic control across diverse patient populations. Recent evidence supports its effectiveness in both type 1 and type 2 diabetes management, with benefits extending beyond traditional glucose monitoring approaches. CGM has demonstrated substantial improvements in glycemic control across multiple metrics. Studies report consistent glycosylated hemoglobin reductions of 0.25%–3.0% and notable time in range improvements of 15%–34%. CGM effectively reduces hypoglycemic events, with studies reporting significant reductions in time spent in hypoglycemia. CGM also serves as an educational tool for lifestyle modification, providing real-time feedback that helps patients understand how diet and physical activity affect glucose levels. While skin-related complications remain a concern, technological advancements have addressed many initial concerns. High satisfaction rates and long-term use suggest that device-related issues are manageable with proper education and support. Despite high initial costs, CGM’s prevention of complications and hospitalizations ultimately reduces healthcare expenditures. With appropriate training and support, CGM represents a transformative technology for comprehensive diabetes care.

Continuous glucose monitoring (CGM) has revolutionized diabetes management, significantly enhancing glycemic control across diverse patient populations. Recent evidence supports its effectiveness in both type 1 and type 2 diabetes management, with benefits extending beyond traditional glucose monitoring approaches. CGM has demonstrated substantial improvements in glycemic control across multiple metrics. Studies report consistent glycosylated hemoglobin reductions of 0.25%–3.0% and notable time in range improvements of 15%–34%. CGM effectively reduces hypoglycemic events, with studies reporting significant reductions in time spent in hypoglycemia. CGM also serves as an educational tool for lifestyle modification, providing real-time feedback that helps patients understand how diet and physical activity affect glucose levels. While skin-related complications remain a concern, technological advancements have addressed many initial concerns. High satisfaction rates and long-term use suggest that device-related issues are manageable with proper education and support. Despite high initial costs, CGM’s prevention of complications and hospitalizations ultimately reduces healthcare expenditures. With appropriate training and support, CGM represents a transformative technology for comprehensive diabetes care.

PURPOSE: To learn the long-term prognosis of patients with deep vein thrombosis (DVT), we evaluated the location and extent of thrombotic changes, hemodynamic status and clinical symptoms of patients of more than 12 months after development of acute thrombosis. METHODS: 31 patients (man; 24, female; 7, mean age; 44.7 13.2 years) with phlebograpically documented DVT were followed-up for 13~90 months (mean: 32.6 20.4 months) with Duplex scanning, and photo-plethysmography (PPG), and clinical symptoms. To evaluate the effects of treatment modality, the patients were devided into 3 groups; Group 1 (heparine warfarin, n=17), Group 2 (heparine warfarin catheter directed urokinase, n=10), Group 3 (heparine warfarin systemic urokinase, n=4). But, the size of Group 3 was inappropriate to compare with other groups, we performed analysis of the results of Group 1 and 2. RESULTS: Remained thrombi were detected in 22 patients (70.2%) of 31 patients by Duplex scanning, even 1 year later. Of the 29 patients studied with PPG, 24 patients (83%) revealed valvular incompetence in deep (11 cases, 38%) and superficial venous systems (13 cases, 45%). Thrombolytic rate in Group 2 was much higher than Group 1; complete resolution (40% vs 23%), complete obstruction (0% vs 41%). The statistically significant correlation between resolution degree and symptomatic improvement was shown (p=0.008). CONCLUSION: Residual thrombi and valvular damages after DVT were common. But, thrombolysis by catheter-directed urokinase may be associated with a higher rate of thrombolysis and clinical improvement. Anticoagulation alone may not be a sufficient method for treatment of DVT.
Catheters ; Female ; Follow-Up Studies* ; Hemodynamics ; Humans ; Lower Extremity* ; Prognosis ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis* ; Warfarin

BACKGROUND: In aerometabolic process, the human heart mainly utilizes free acid as fuel. During anaerobic process, lactate production by the myocardium is increased and accumulates in the myocardium. Thus it decreases the contractility of myocadium. Therefore in patients with ischemic heart disease, lactate prodution must be increased by the myocardium during myocardial ischemia. During paroxysmal supraventricular tachycardia, patients frequently experience chest pain and ST segment depression suggesting acute myocardial ischemia. However it occurs on a physiologic basis independent of ischemia. The purpose of this study was to assess whether tachycardia induced by artial pacing produces myocardial ischemia in patients without evidence of ischemic heart disease. METHODS: Between May 28, 1996 and August 13, 1996, at the University of Keimyung, Dong-San Medical center, 15 patients(male 9, female 6, mean age of 38 years) with palpititation underwent electrophysiologic testing and had radiofrequency cather ablation. There were no evidence of ischemic heart disease. Right artrial pacing was done with lengths of 500msec, 400msec and 350msec in each 5 patients. A 12 lead electrdcardiogram, left ventricular enddiastolic pressure, blood from femoral artery and coronary sinus for lactate determinations and blood gas analysis were dbtained simultaneously. They were obtained at baseline, at 1, 5, 10 and 15 minute of atrial pacing and at 1, 5, 10 minute after cessation of pacing. RESULT: Significant changes were not observed in , , concentration of , pH and saturation. In all patients, mean percent lactate extraction was above 10% and not significantly changed during atrial pacing. However ST segment depression was significantly progressive during atrial pacing and according to decrease the cycle length(p<0.05), also left ventricular end-diastolic pressure was significantly decreased during atrial pacing(p<0.05). Conclusion: Therefore tachycardia induced by atrial pacing for 15 minutes did not produce myocardial ischemia in patients without evidence of ischemic heart disease. Depression of STsegment during supraventricular tachycardia or atrial pacing, in patient without underlying heart disease is necessary to inveestigate what makes this phenomenon.
Blood Gas Analysis ; Blood Pressure ; Chest Pain ; Coronary Sinus ; Depression ; Female ; Femoral Artery ; Heart ; Heart Diseases ; Humans ; Hydrogen-Ion Concentration ; Ischemia ; Lactic Acid ; Metabolism* ; Myocardial Ischemia ; Myocardium ; Tachycardia ; Tachycardia, Supraventricular

Peliosis hepatis is an uncommon liver condition involving abnormal dilation of hepatic sinusoids, eventually leading to blood-filled cavities within the hepatic parenchyma. Although the pathogenesis is not understood fully, peliosis hepatis has usually been associated with the use of anabolic steroid therapy, oral contraceptives, various malignancies or tuberculosis. We report a case of 59-year-old patient with cholangiocarcinoma with peliosis hepatis. The patient was admitted for evaluation of abdominal pain and fever. Abdomen CT showed a round cytic and solid mass with peripheral duct dilatation in liver. Grossly, the spongy-like solid mass and cyst was noted. Microscopically, the solid mass was composed of tubular and solid adenocarcinoma in fibrotic stroma and a blood-filled cavity with dilated sinusoids was noted.
Abdomen ; Abdominal Pain ; Adenocarcinoma ; Cholangiocarcinoma* ; Contraceptives, Oral ; Dilatation ; Fever ; Humans ; Liver ; Middle Aged ; Peliosis Hepatis* ; Tuberculosis