No abstract available.
Fosinopril* ; Humans ; Hypertension*

Thoracoscopic esophagectomy can be performed in esophageal diseases to reduce the postoperative complications. Recently, We encountered a case of esophageal cancer and successfully treated it by thoracoscopic esophagectomy with gastric pull-up. A 59-year-old male was presented with swallowing difficulty and an esophagogram, esophagoscopy, and chest CT showed an ulcerating tumor on the lower esophagus. The operation was performed in three stages: mobilization of the esophagus by thoracoscopic surgery, construction of a gastric tube through a laparotomy, and cervical anastomosis between the esophagus and the gastric pull-through. Hoarseness developed postoperatively, and the postoperative esophagogram showed leakage at the esophagogastric anastomotic site. The anastomotic leakage was healed following surgical drainage and the patient was discharged in good health. Hoarseness subsided spontaneously two months after surgery.
Anastomotic Leak ; Deglutition ; Drainage ; Esophageal Diseases ; Esophageal Neoplasms* ; Esophagectomy* ; Esophagoscopy ; Esophagus ; Hoarseness ; Humans ; Laparotomy ; Male ; Middle Aged ; Postoperative Complications ; Thoracoscopy ; Tomography, X-Ray Computed ; Ulcer

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Only a few patients reach adulthood without surgical correction. Unrepaired TOF patients with mild to moderate right ventricular outflow tract (RVOT) obstruction may be clinically silent until adulthood. TOF with hypoxic spells present as periods of profound cyanosis that occur because of almost total RVOT obstruction. So, hypoxic spell typically occurs in a crying infant but is rare in an adult. In this report, we presented a case of a 75-year-old patient with uncorrected TOF presenting with hypoxic spell, consequent pulmonary hypertension and chronic heart failure. This is the oldest case of natural survivor with uncorrected TOF in Korea and the oldest patient presenting hypoxic spell worldwide.
Adult ; Aged* ; Anoxia ; Crying ; Cyanosis ; Heart Defects, Congenital ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Infant ; Korea ; Survivors* ; Tetralogy of Fallot*

OBJECTIVES: Pneumocystis carinii pneumonia(PCP) is one of the most common life-threatening opportunistic infections in patients with acquired immunodeficiency syndrome(AIDS). This study reports the clinical charac teristics of PCP in the patients with AIDS and prognostic factors for short-term survival of them. METHODS: We investigated 43 patients of AIDS to evaluate the frequency of PCP in patients in AIDS by retrospective analysis, and classified the 17 patients with PCP into survivors and non-survivors to compare epide miology, clinical characteristics and laboratory findings. We also analyzed whether the these findings influenced the short-term survival in patients with PCP that was combined with AIDS. RESULTS: In this retrospective study of 43 patients of AIDS, the frequency of PCP in AIDS patients was relatively high as 17 patients(39%), of whom eight pa tients(47%) died of PCP. The epidemiologic findings such as age, route of human immunodeficiency virus(HIV) infection and co-existing disease were not significantly different between survivors and non-survivors. Coughing was the most common symptom and bilateral infiltrates of lung was the most common form in the chest X-ray examination. But these clinical features were similar in the both groups. Total lymphocyte count, CD4 cell count, serum albumin level and arterial oxygen tension were decreased and serum LDH was increased in patients with PCP that was the first episode in patients with AIDS. Lymphocyte and CD4 cell count were significantly lower in the non-survivor group (p=.002 and p=.03, respec tively). Survivors had higher serum albumin level and arterial oxygen tension than non-survivors (p=.02 and p=.04, respectively). And non-survivors were found to have higher serum LDH level than survivors (p=.02). CONCLUSION: Lymphocyte and CD4 cell counts, serum albumin and LDH, and arterial oxygen tension may be considered as the prognostic factors for short-term sur vival of patients with PCP that is combined with AIDS.
CD4 Lymphocyte Count ; Cough ; Humans ; Lung ; Lymphocyte Count ; Lymphocytes ; Opportunistic Infections ; Oxygen ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia, Pneumocystis* ; Retrospective Studies ; Serum Albumin ; Survivors ; Thorax

Typhoid fever is a bacteremic disease and many organs, including intestine, liver, bone, lung, thyroid, kidney, spleen, heart and pancreas may be invaded by the organism. Acute pancreatitis associated with typhoid fever sometimes needs prolonged total parenteral hyperalimentation and antibiotic treatment. Systemic Candida infections are usually encountered as opportunistic infections in a setting of immunologic depression. The authors report a case of Candida parapsilosis fungemia associated parenteral nutrition in acute pancreatitis associated with typhoid fever. A 17 year-old man was transfered to Pusan national university hospital on May 4th, 1998 under diagnosis of salmonella sepsis. High fever, nausea, vomiting and diarrhea developed 10 days before entery. On admission, serum amylase, lipase and transaminase showed elevation. The patient was treated with antibiotics(ceftriaxon) and total parenteral hyperalimentation was done under diagnosis of acute pancreatitis and hepatitis associated with typhoid fever. On 3rd hospital day, body temperature returned to normal but abdominal pain, nausea and vomiting continued. On 18th hospital day, high fever recurred and ceftriaxon was re-administered. Three days later, body temperature returned to normal. On 25th hospital days, culture of blood and catheter tip was positive for C. parapsilosis. On 27th hospital days, sudden onset high fever, pnumonic infiltration, confusion, hypotension, oliguria and azotemia developed. On 34th hospital day, sudden onset ventricular fibillation developed. On 35th hospital day, the patients died. We report a case of candida fungemia in acute pancreatitis and hepatitis associated with typhoid fever.
Abdominal Pain ; Adolescent ; Amylases ; Azotemia ; Body Temperature ; Busan ; Candida* ; Catheters ; Ceftriaxone ; Depression ; Diagnosis ; Diarrhea ; Fever ; Fungemia* ; Heart ; Hepatitis* ; Humans ; Hypotension ; Intestines ; Kidney ; Lipase ; Liver ; Lung ; Nausea ; Oliguria ; Opportunistic Infections ; Pancreas ; Pancreatitis* ; Parenteral Nutrition ; Parenteral Nutrition, Total ; Salmonella ; Sepsis ; Spleen ; Thyroid Gland ; Typhoid Fever* ; Vomiting

Neurofibromatosis type 1 is the most common neurocutaneous disorders and affects between 1/2,000 and 1/4,500 people. This occurs at any age and is hereditary disease with autosomal dominant fashion. Renovascular hypertension is major form of renal manifestation of the disease. There are few reported cases in Japan and Hungary of Recklinghausen's neurofibromatosis with several glomerular lesions but their relationship is not apparent. A 21-year-old man was admitted to the hospital because of general edema. On admission, the blood pressure was 130/ 80 mmHg and general edema was noted. He had a plexiform neuroma on right flank and multiple cafe- au-lait spots on chest and extremites. Laboratory findings were as follows : Hemoglobin 14.2 g/dL, AST 28 IU/L, ALT 12 IU/L, albumin 1.2 gm/dL, total cholesterol 533 mg/dL, urinary protein 4.0 gm/ day, C3 86.6 mg/dL, C4 19.9 mg/dL, HBs Ag/Ab (+/-), HBe Ag/Ab (+/-), HCV Ab (-), HBV DNA probe 6,000 pg/mL. Renal biopsy was performed and the histological findings were compatible with minimal change disease. The immunohistochemical method revealed that HBsAg was negative. We experienced a case of minimal change disease concurrent with Neurofibromatosis type 1, but their relationship is not clear. We report this case with a brief review.
Biopsy ; Blood Pressure ; Cholesterol ; DNA ; Edema ; Genetic Diseases, Inborn ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic ; Humans ; Hungary ; Hypertension, Renovascular ; Japan ; Nephrosis, Lipoid* ; Neurocutaneous Syndromes ; Neurofibroma, Plexiform ; Neurofibromatoses* ; Neurofibromatosis 1* ; Thorax ; Young Adult

BACKGROUND: Serum potassium level assessment is one of the commonly requested laboratory tests. Hypokalemia is defined as a serum potassium level of less than 3.5 mEq/L. It can be potentially life-threatening when severe, due to its association with cardiac arrhythmia and sudden deaths. The aim of our study is to determine the prevalence and to define clinical characteristics of severe hypokalemia in internal medicine hospitalized patients. METHODS: From December 1999 to June 2000, the group with at least one recorded plasma potassium concentration of less than 3.0 mEq/L was selected in department of internal medicine, Pusan national university hospital. Routine records of age, sex and prevalence was collected. Severe hypokalemia is defined as a serum potassium concentration less than 2.6 mEq/L. This patients were retrospectively studied for discharge diagnosis, medications prescribed before and during hospital stay, hospital course and laboratory findings. RESULTS: There were 7.52% (235/3124) with at least one recorded potassium level of less than 3.0 mEq/L. Severe hypokalemia were 75 patients (2.4%). It were more likely to be female, but statically insignificant. Of the 75 patients, 59 patients (77.3%) had hypokalemia during hospitalization. Gastrointestinal loss of potassium was only 13.8% of the patients. The main causes were combination of iatrogenic factors, including the adminstration of intravenous fluids with insufficient or no potassium, malnutrition, and several drugs. The discharge diagnosis included infection 20 patients (26.6%), malignancy 19 patients (25.3%), gastointestinal disorders 8 patients (10.6%). And each of cardiovascular, respiratory and renal disorders have 7 patients (9.3%). In-hospital mortality was 34.6% (26/75) in severe hypokalemia. Compared to the alive group, death group showed statically significant decrease in serum albumin concentration (p<0.05). CONCLUSION: Severe hypokalemia is fatal electrolyte disorder. The most frequent cause of this lethal condition is drug therapy and intravenous fluids with insufficient or no potassium replacement. It can be prevented by regular potassium monitoring and appropriate potassium supplementation in risky hospitalized patients.
Arrhythmias, Cardiac ; Busan ; Death, Sudden ; Diagnosis ; Drug Therapy ; Female ; Hospital Mortality ; Hospitalization ; Humans ; Hypokalemia* ; Internal Medicine* ; Length of Stay ; Malnutrition ; Plasma ; Potassium ; Prevalence ; Retrospective Studies ; Serum Albumin

OBJECTIVES: Gallium 67(Ga-67) scintigraphy has been used to diagnose inflammatory and neoplastic diseases. We undertook a study to determine the clinical value of Ga- 67 renal scan in patients with various glomerular diseases. METHODS: Ga-67 scintigraphy was performed in 48 patients with various biopsy proven forms of renal diseases. Renal uptake in 48 patients images was graded as follow: Grade 0 = not visualization at 48 hours: 1 = faintly visualize: 2 = equal to uptake in spine: 3 = greater than over the spine: 4 = greater than activity over the liver. RESULTS: 1) Of the 48 patients, 31 were male, and mean age was 32 years. 11 patients had hypertension and 29 patients had hematuria. 2) Positive scintigram were seen in 40 of 48(83%) cases. In results of renal biopsy, IgA nephropathy(IgAN) was 15 patients, minimal change disease(MCD) was 14, focal segmental glomerulosclerosis (FSGS) was 8, membranoproliferative glomerulonephritis (MPGN) was 3, lupus nephritis(LN) was 3, poststreptococcal glomerulonephritis(PSGN) was 3 and membranous glomerulonephritis(MGN) was 2. 3) In 26 patients (54%) with nephrotic-range proteinuria, Grade 2 or higher renal uptake was observed in 9 (75%) of MCD, 5(100%) of FSGS, 2(100%) of LN and 3(75%) of IgAN. 4) In comparision nephrotics with non-nephrotics at biopsy, renal Ga-67 uptake in who patients had nephrotic-range proteinuria was correlated with clinical severity determined by serum albumin, serum total cholesterol and 24 hours urine protein excretion. CONCLUSIONS: Renal Ga-67 scintigraphy may be able to be a predictor in the assessment for severity of nephrotic syndrome.
Biopsy ; Cholesterol ; Gallium ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Humans ; Hypertension ; Immunoglobulin A ; Liver ; Male ; Nephrotic Syndrome ; Proteinuria ; Radionuclide Imaging* ; Serum Albumin ; Spine

PURPOSE: Combination chemotherapy has shown promising activity in small cell lung cancer (SCLC). This study was perfonned to determine the efficacy of the combination chemotherapy with etoposide, ifosfamide and cisplatin (VIP) in previously untreated patients with SCLC. MATERIALS AND METHODS: Patients with SCLC were treated with etoposide (75 mg/m iv. D1-4), ifosfamide (1200 mg/m iv. Dl-4 with mesna) and cisplatin (20 mg/m iv. D1-4). The treatment was repeated every 3 weeks for 6 cycles in principle. Thoracic radiotherapy was administered to patients with limited disease (LD) of SCLC after initial 2 or 3 cycles of chemotherapy subsequently. Praphylactic cranial irradiation (PCI) was given to complete responders of SCLC. RESULTS: From April 1996 through June 1998, 42 patients were included, but 32 were eligible for the study (4 refused of treatment, 2 lost in follow-up, and 4 combined with other disease). The median age was 62 years (range, 42-74). Twelve patients had LD and 20 patients were with extended disease (ED). Complete response (CR) rate was 34% (LD 58%, ED 20%) and overall response rate was 72% (LD 83%, ED 65%). The median duration of response was 28 weeks (38 weeks in LD, 24 weeks in ED, P=0.016) With the median follow-up period of 65 weeks (6-134 weeks), overall median survival was 43 weeks (56 weeks in LD, 34 weeks in ED, P 0.001), and the median disease free survival (DFS) of eleven CR patients was 16 weeks. Stage, performance, and LDH level were significant prognostic factom (P 0.011, 0.002, 0.043, respectively), but sex and age did not affect the outcome significantly. The hematologic side effects (WHO grade 2) of evaluable 152 cycles of chemotherapy were leukopenia (53%), thrombocytopenia (31%) and anemia (16%); and nonhematologic side effects (WHO grade >2) were alopecia (84%), nausea/vomiting (45%) and stomatitis (19%). CONCLUSION: It appears that VIP combination chemotherapy is a safe, effective and well tolerated regimen for the patients with SCLC.
Alopecia ; Anemia ; Cisplatin* ; Cranial Irradiation ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide* ; Follow-Up Studies ; Humans ; Ifosfamide* ; Leukopenia ; Radiotherapy ; Small Cell Lung Carcinoma* ; Stomatitis ; Thrombocytopenia

BACKGROUND AND OBJECTIVE: IgG subclass deficiency has been reported in patients with bronchial asthma and is associated with recurrent respiratory tract infections. This study was done to identify prevalence of IgG subclass deficiency and to evaluate the possible difference between atopic and non-atopic asthmatics. Subjects and METHODS: We measured serum levels of IgG and IgG subclass in 35 asthmatic patients and 50 healthy controls using nephelometry. Reference values of each IgG subclass was defined as cumulative percentile between 2.5% to 97.5% of controls. RESULTS: Total IgG, IgG1 and IgG2 of asthmatics were significantly lower than for those of controls(p<0.05, respectively). In atopic asthmatics, compared with non-atopic asthmatics, IgG4 level was significantly higher (p<0.05). The frequency of IgG subclass levels below the reference value was eight (22.9%) of 35 asthmatics. CONCLUSION: IgG, IgG1 and IgG2 were significantly lower in asthmatic patients. Some patients had IgG subclass levels below reference value. Further studies will be needed to evaluate their clinical significance.
Asthma* ; Humans ; Immunoglobulin G* ; Nephelometry and Turbidimetry ; Prevalence ; Reference Values ; Respiratory Tract Infections