Spontaneous perforation of bile duct in adults is very rare, with less than 30 cases described in the literature to date. We repoit a case of a 65-year-old man who presented with severe colicky abdominal pain and fever, just like symptoms of peritonitis. ERCP provided a preoperative noninvasive confirmation of the diagnosis of the rupture of right intrahepatic duct. The patient was performed T-tube choledochotomy and drainage of retroperitoneal bile collection. The etiolgy, diagnosis, and treatment of spontaneous perforation of bile duct is discussed.
Abdominal Pain ; Adult ; Aged ; Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis* ; Drainage ; Fever ; Humans ; Peritonitis ; Rupture

BACKGROUND: Some research viewed that effective dietary therapy was enough to control proper blood glucose level, but in the most patient, dietary therapy was not practiced and the most difficult part of managing their diabetes. The purpose of this research study was to investigate dietary practice adherence and perceived barriers among the elderly diabetes. METHODS: The survey was mailed to 852 persons with diabetes member via diabetic educator of 156 hospitals or clinics and 24 health centers. Questionnaire had background information of patients, meal regularity, food intake as a dietary practice adherence, barriers of 36 items which have 3 areas such as motive/attitude, knowledge, authority/resource. We asked the person with diabetes to rate barrier to dietary practice adherence. 432 questionnaire were returned the response. we selected 69 persons who were over 65 year old. RESULTS: 1) meal regularity was more satisfactory than food intake. 2) deficit of meal regularity were evening snack and resonable spacing between evening meal and evening snack. 3) deficit of food intake was serving of milk. 4) main barrier to dietary practice adherence was that of knowledge. CONCLUSION: For practice effectively dietary therapy to elderly diabetes, individual consultation or small group education must be pursued and more easily educational skills should be required.
Aged* ; Blood Glucose ; Eating ; Education ; Humans ; Meals ; Milk ; Postal Service ; Surveys and Questionnaires ; Snacks

Patients with chronic renal failure(CRF) suffer from muscular dysfunction of varying degrees. 31P-nuclear magnetic resonance(NMR) spectroscopic studies of skeletal muscle have shown that these patients have less energy reservoir. Chronic metabolic acidosis has been known to decrease intracellular pH in rat muscle. We investigated the effect of correction of metabolic acidosis with sodium bicarbonate on muscle energy metabolism. Eight patients(6M, 2F) with CRF(creatinine clearance <20ml/min/1.73m2) who were clinically stable and had serum bicarbonate level less than 18mEq/L were included. The median age was 48 years (range; 29-56 years). The patients were treated with daily doses of 3 gram sodium bicarbonate for 3 months. Phosphocreatine to inorganic phosphate ratio(PCr/Pi) and intracellular pH were measured with 31P-NMR spectroscopy, at resting, nadir and maximum recovery state after all-out exercise, before and after correction of acidosis. Plasma bicarbonate level increased from 16.2+/-0.9 to 21.9+/-1.1mmol/L(p<0.05). Creatinine clearance, hematocrit and serum albumin did not change during the study period. The exercise capacity, as measured by the time holding the weight, did not improve with sodium bicarbonate treatment. PCr/Pi ratio at resting state was 7.0+/-1.9 before treatment, which did not change after treatment, 6.2+/-0.8, although plasma bicarbonate level increased significantly. The ratio reached bottom immediately after the all-out exercise(the nadir state) and then recovered toward preexercise value. The PCr/Pi ratio at nadir and maximum recovery state were not different between before and after treatment. The intracellular pH became more acidotic immediately after exercise, but no difference was found between before and after sodium bicarbonate treatment in resting state, nadir or maximum recovery state. With our results, we conclude that the partial correction of acidosis does not improve energy reserve and serum albumin in CRF patients.
Acidosis* ; Animals ; Creatinine ; Energy Metabolism* ; Hematocrit ; Humans ; Hydrogen-Ion Concentration ; Kidney Failure, Chronic* ; Muscle, Skeletal ; Phosphocreatine ; Plasma ; Rats ; Serum Albumin ; Sodium Bicarbonate ; Spectrum Analysis

No abstract available.
Dust* ; Mastoid*

Transfusion-related acute lung injury (TRALI) is a serious clinical syndrome associated with transfusion and has come to be recognized as the leading cause of transfusion-related death recently. TRALI occurs more often in critically ill patients (sepsis, surgery, massive transfusion, cytokine administration) than in a general hospital population, possibly due to the presence of underlying inflammatory conditions that may prime pulmonary neutrophils. We report a case of TRALI developed in a female aplastic anemia patient who presented with a persisting fever for several days. Serologic tests of the patient were consistent with acute EBV infection. As hemophagocytic lymphohistiocytosis developed under septic condition, bicytopenia persisted and the patient needed repeated transfusions. Following transfusion of the blood components, the patient experienced hypotension and a significant change in respiratory status within 6 hours. A chest computed tomography showed newly developed diffuse ground-glass opacities on both lungs. The finding was a non-cardiogenic effect and there was no volume overloading. Anti-neutrophil antibody was detected in serum, and the patient was diagnosed as TRALI. Recurrent lung injury with prolonged pancytopenia caused pulmonary hemorrhage. The patient was managed with mechanical ventilation prior to death.
Acute Lung Injury ; Anemia, Aplastic ; Critical Illness ; Epstein-Barr Virus Infections ; Female ; Fever ; Hemorrhage ; Hospitals, General ; Humans ; Hypotension ; Lung ; Lung Injury ; Lymphohistiocytosis, Hemophagocytic ; Neutrophils ; Pancytopenia ; Respiration, Artificial ; Serologic Tests ; Thorax

PURPOSE: Polyethylene glycol(PEG) with electrolytes has been used for intestinal clearance for colonoscopy and operations in children. But its efficacy and safety for disimpaction in children with chronic functional constipation has been studied little. METHODS: This study enrolled 26 patients with chronic functional constipation(11 children had failed to disimpaction by conventional management at OPD) who were admitted to the Eul-Ji Hospital between May 2000 and July 2003. PEG with electrolytes was administered per oral and/or rectal enema. We observed the effects for disimpaction by measuring the frequency and consistency of stools, and by simple abdominal X-ray. We evaluated the safety by measuring serum electrolytes and osmolarity in three hours after PEG with electrolytes administration, and by observation of the clinical status of the patients. The protocol of PEG with electrolytes was a dose of 60-80 mL/kg within three hours per oral and/or of 15-25 mL/kg by rectal enema. RESULTS: In all patients, simple abdominal X-ray films showed improvements of fecal impaction. Consistency and frequency of stool were improved in all patients except one. As for side effects, diarrhea developed in three patients(11.5% of all patients). Headaches developed in one patient(3.8% of all patients) but it improved without treatment. Serum electrolytes was checked in 16 patients after PEG with electrolytes management and mild hypernatremia(146 mmol/L) was checked in one patient. Serum osmolarity was checked in 11 patients after PEG with electrolytes management and was normal in all patients. CONCLUSION: PEG with electrolytes was effective and safe for disimpaction in children with chronic functional constipation, including patients who had failed in disimpaction by conventional management.
Child* ; Colonoscopy ; Constipation* ; Diarrhea ; Electrolytes* ; Enema ; Fecal Impaction ; Headache ; Humans ; Osmolar Concentration ; Polyethylene Glycols ; Polyethylene* ; X-Ray Film

OBJECTIVE: To assess the safety of anti-tumor necrosis factor (TNF)-alpha therapy in patients with rheumatic disease and chronic Hepatitis B virus (HBV) infection. METHODS: We used infliximab or etanercept therapy in patients with rheumatic disease and chronic HBV infection. Records concerning these patients were retrospectively reviewed for the duration of disease, treatment, serological status and biological data. RESULTS: Six relevant cases with chronic HBV infection were identified: three of RA; three of AS. Four patients had received etanercept; two had been given etanercept after infliximab. One of the cases treated with lamivudine before anti-TNF-alpha therapy for chronic hepatitis B treatment. His hepatitis status was maintained stable after he initiated anti-TNF-alpha therapy. Five of the cases started anti-TNF-alpha therapy without lamivudine. Two of these five cases were received lamivudine during anti-TNF-alpha therapy due to elevation of HBV DNA titer without liver function test abnormality and then HBV DNA was normalized. Three cases without lamivudine continued to show the stable level of liver enzyme but, one of the three cases showed persistently elevated HBV DNA titer. CONCLUSION: Prophylactic or early intervention strategies with anti-viral agent and regular monitoring of aminotransferases and viral load are needed for patient with evidence of chronic HBV infection.
DNA ; Early Intervention (Education) ; Hepatitis ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine ; Liver ; Liver Function Tests ; Necrosis ; Retrospective Studies ; Rheumatic Diseases* ; Transaminases ; Viral Load ; Infliximab ; Etanercept

PURPOSE: The angiographic demonstration of absent cerebral blood flow is presently considered to be the most reliable method of confirming brain death. The purpose of this study is to determine whether CT angiography (CTA) with spiral CT can rapidly and specifically establish a diagnosis of brain death. MATERIALS AND METHODS: A total of fifteen CT angiograms (brain death, n=9;severe coma, n=6 within 24 hours of the study) were obtained prospectively in 12 patients with an established clinical diagnosis; Two patients underwent repeated CTA. Twenty seconds after beginning the injection of contrast media (100 mL at a rate of 3 mL/sec), CT scanning (30 -second continuous exposure and 60 -mm length) was performed with a table speed of 2 mm/sec and a section thickness of 2 mm. For each case, the presence or absence of opacification of inter-nal carotid arteries (ICA), vertebral and basilar arteries (VBA), anterior cerebral arteries (ACA), middle cerebral arteries (MCA), posterior cerebral arteries (PCA), distal branches of cerebral arteries, and superficial temporal arteries (STA) was ascertained. RESULTS: Except in one clinically brain-dead patient, whose EEG was difficult to interpret due to excessive arti-facts, the distal branches of cerebral arteries did not opacify. STA, on the other hand, was always visible on both sides. In all brain-dead patients but three, the ICA and proximal ACA, MCA, or PCA escaped visualiza-tion. In the remaining three cases with large skull defect or skull fracture, however, CT angiography showed faint opacification of the ICA and proximal segments of cerebral arteries. Cerebral arterial flow was preserved in all six patients in whom there was no clinical evidence of brain death. CONCLUSION: CTA may be used as a confirmatory test for the determination of brain death.
Angiography* ; Anterior Cerebral Artery ; Basilar Artery ; Brain Death* ; Brain* ; Carotid Arteries ; Cerebral Arteries ; Coma ; Contrast Media ; Diagnosis ; Electroencephalography ; Hand ; Humans ; Middle Cerebral Artery ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery ; Prospective Studies ; Skull ; Skull Fractures ; Temporal Arteries ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; United Nations

An ankylosis of temporomandibular joint (TMJ) can cause severe trismus, thus it may bring on many difficulties in airway management such as orotracheal intubation or laryngeal mask airway insertion. Such difficulties may cause serious complications related to airway management because the trismus due to ankylosis of TMJ can not be improved by administration of muscle relaxants or deep anesthesia in most cases. We report a case of nasotracheal intubation guided by a fiberoptic bronchoscope in a male patient with severe trismus due to TMJ ankylosis, who was scheduled for undergoing ophthalmic surgery.
Airway Management* ; Anesthesia ; Anesthesia, General* ; Ankylosis* ; Bronchoscopes ; Humans ; Intubation ; Joints ; Laryngeal Masks ; Male ; Temporomandibular Joint* ; Trismus*

BACKGROUND: Reduced bone mineral density (BMD) is a significant sequelae in children receiving chemotherapy for acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). Reduced BMD is associated with an increased risk for fractures. Pamidronate, a second-generation bisphosphonate, has been used to treat osteoporosis in children. This study evaluated the safety and efficacy of pamidronate in children with low BMD during and after chemotherapy for ALL and NHL. METHODS: Between April 2007 and October 2011, 24 children with ALL and NHL were treated with pamidronate. The indication was a decreased BMD Z-score less than -2.0 or bone pain with a BMD Z-score less than 0. Pamidronate was infused at 1 mg/kg/day for 3 days at 1-4 month intervals (pamidronate group, cases). The BMD Z-scores of the cases were compared with those of 10 untreated patients (control group). Lumbar spine BMDs were measured every 6 cycles using dual energy X-ray absorptiometry and Z-scores were calculated. Bone turnover parameters (25-hydroxyvitamin D, alkaline phosphatase, parathyroid hormone, osteocalcin, and type I collagen c-terminal telopeptide) were analyzed. RESULTS: The median cycle of pamidronate treatment was 12. Increases in BMD Z-scores were significantly higher in the pamidronate group than in the control group (P<0.001). BMD (mg/cm2) increased in all pamidronate-treated cases. Twenty patients who complained of bone pain reported pain relief after therapy. The treatment was well tolerated. CONCLUSION: Pamidronate appears to be safe and effective for the treatment of children with low BMD during and after chemotherapy for ALL and NHL.
Absorptiometry, Photon ; Adrenal Cortex Hormones ; Alkaline Phosphatase ; Bone Density ; Child ; Collagen Type I ; Diphosphonates ; Humans ; Lymphoma, Non-Hodgkin ; Osteocalcin ; Osteoporosis ; Parathyroid Hormone ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Spine