Enteroenteric anastomotic strictures of UGI tract are common and require treatment if significant obstruction occurs. We performed fluoroscopic guided balloon dilatation in 6 patients who had symptomatic stricture of gastrojejunostomy. The stricture was successfully resolved in 4 patients with benign stricture. But 2 patients with malignant stricture had recurrence of obstructive symptom 2 weeks later, and they required a stent. Asymptomatic balloon rupture was seen in one patient, but other procedural complications did not occur. We found that fluoroscopic guided balloon dilatation is an effective and safe method in the treatment of anastomotic stricture of gastrojejunostomy. We also found transient effect in malignant gastrojejunal anastomotic strictures, which required an interventional procedure, such as placement of a stent.
Constriction, Pathologic* ; Dilatation* ; Gastric Bypass* ; Humans ; Methods ; Recurrence ; Rupture ; Stents

Enteroenteric anastomotic strictures of UGI tract are common and require treatment if significant obstruction occurs. We performed fluoroscopic guided balloon dilatation in 6 patients who had symptomatic stricture of gastrojejunostomy. The stricture was successfully resolved in 4 patients with benign stricture. But 2 patients with malignant stricture had recurrence of obstructive symptom 2 weeks later, and they required a stent. Asymptomatic balloon rupture was seen in one patient, but other procedural complications did not occur. We found that fluoroscopic guided balloon dilatation is an effective and safe method in the treatment of anastomotic stricture of gastrojejunostomy. We also found transient effect in malignant gastrojejunal anastomotic strictures, which required an interventional procedure, such as placement of a stent.
Constriction, Pathologic* ; Dilatation* ; Gastric Bypass* ; Humans ; Methods ; Recurrence ; Rupture ; Stents

The purpose of this study is to report our 5-year experience with fluoroscopic removal of blunt esophageal foreign body or impacted food in 15 consecutive patients who were referred by endoscopists because they couldn's remove it endoscopically. The foreign body or impacted food was a pieced of meat, a bean, a badug stone or a beef bone. Thirteen patients had underlying disease(11 of corrosive stricture, 2 of postoperative stricture) but 2 patients did not. We removed the object using one of the following 4 techniques: Basket extraction technique, Foley catheter technique, single balloon technique (dilatation of stenosis for passing the food into the stomach and for the treatment of the stricture as well), double balloon technique(removal of the foreign body by trapping it with two valvuloplasty balloons). Removal was successful in all patients. Esophageal perforation occurred in one patient using the single balloon technique, who treated nonoperatively by means of fasting, antibiotics and parenteral alimentation. No procedure related death occurred in these series. In conclusion, fluoroscopic removal of blunt esophageal foreign bodies of impacted food with various techniques is promising alternative to esophagoscopic removal.
Anti-Bacterial Agents ; Catheters ; Constriction, Pathologic ; Esophageal Perforation ; Fasting ; Foreign Bodies* ; Humans ; Meat ; Red Meat ; Stomach

Objective: To assess the efficacy and safety of posterior facetectomy with fusion using pedicle screw (PF using FPS) for severe cervical foraminal stenosis of parallel shape. Methods: Patients (n=8) with 1- or 2-level parallel-shaped cervical foraminal stenosis who underwent posterior facetectomy with fusion using cervical pedicle screw between March 2012 and August 2016 were enrolled. Patients were followed up immediately postoperatively and at 1, 3, 6, and 12 months postoperatively. We assessed arm and neck pains and clinical outcomes using a numeric rating scale (NRS) and neck disability index (NDI). We determined cervical Cobb's and segmental angles by radiological evaluations. We identified screw breech as a neurovascular complication. Results: Neck and arm pains were significantly reduced postoperatively (neck visual analog scale [VAS]: 4.9±3.7 [preoperative] to 0.4±1.1 [final follow-up]; arm VAS: 9.0±0.8 to 0.4±1.1). Cobb's angle for cervical sagittal alignment improved from 11.1±8.4 to 17.0±5.9. Segmental angle of index surgery was maintained (3.4±7.0–4.9±5.6). NDI was also remained from 36.1±26.3 to 13.8±8.4. There are no injuries to the vertebral arteries and neural tissues because of screw insertion. Conclusion PF using FPS is a practical treatment option for parallel-shaped cervical foraminal stenosis.

Background: Postoperative pulmonary complications are important problems that prolong the length of the hospital stay and increase patient mortality. However, our knowledge of the postoperative factors that increase the risk of these complications is less than complete. Methods: We conducted a prospective study to determine the risk factors for postoperative pulmonary complications. A total of 199 patients were referred to the Pulmonology Department for preoperative pulmonary evaluation. We reviewed the perioperative variables according to the National Surgical Quality Improvement Program (NSQIP). Postoperatively, we collected data on the occurrence of postoperative pulmonary complications and we evaluated the relationship between the perioperative variables and outcomes. Results: Twenty two patients (11%) had pulmonary complications; 6 had respiratory failure, 4 had pneumonia, 13 had pleural effusion and, 2 had atelectasis. Five variables were statistically significantly associated with pulmonary complications on the bivariate analyses. Multiple logistic regression analyses revealed that three of these variables were independently associated with an increased risk of pulmonary complications; a high cardiac risk index (OR 16.5, p=0.002), emergency surgery (OR 10.3, p=0.017), and thoracic/abdominal surgery (OR 3.8, p=0.047). Conclusion: The risk factors for postoperative pulmonary complications are a high cardiac risk index, emergency surgery and thoracic/abdominal surgery.
Emergencies ; Humans ; Length of Stay ; Logistic Models ; Mortality ; Pleural Effusion ; Pneumonia ; Prospective Studies* ; Pulmonary Atelectasis ; Pulmonary Medicine ; Quality Improvement ; Respiratory Insufficiency ; Risk Factors*

On 7 December 2007, the Hebei Spirit ran aground near Taean and released approximately 10,900 tons of oil into the sea. Crude oil on the coastal areas and fumes in the air increased the number of health problems among the local population. We report a case of respiratory failure after the oil spill clean-up work. A 66-year-old female was admitted to hospital with cough, sputum, and dyspnea of 1-month duration after the oil spill clean-up. She was diagnosed with community-acquired pneumonia and treated with empirical antibiotics. However, she had progressive respiratory failure without identification of the pathogen. Respiratory failure due to chronic inhalation of hydrocarbons from the crude oil spill clean-up was suspected. After mechanical ventilation care, she recovered from respiratory failure and was discharged. We report a case of severe respiratory toxic effects after an oil spill clean-up. We concluded that long-term hydrocarbon inhalation during the oil spill clean-up may have induced respiratory failure in this case.
Aged ; Anti-Bacterial Agents ; Cough ; Dyspnea ; Female ; Humans ; Hydrocarbons ; Inhalation ; Petroleum ; Petroleum Pollution ; Pneumonia ; Respiration, Artificial ; Respiratory Insufficiency ; Sputum

Acute eosinophilic pneumonia (AEP) is characterized by idiopathic acute febrile illness, diffuse pulmonary infiltration, severe hypoxemia, and pulmonary eosinophilia. We report a case of AEP associated with intramuscular administration of progesterone as luteal phase support after in vitro fertilization. A 33-year-old woman presented to our emergency room with tachypnea and hypoxemia, complaining of fever and cough for 4 days, and dyspnea for 2 days. The symptoms began 9 days after the first injection of progesterone. Chest radiograph showed bilateral infiltrates, located predominantly in the periphery of the lungs, with blunting of the costophrenic angle. Symptoms and chest radiograph dramatically improved after corticosteroid therapy and shifting the progesterone from an intramuscular form of administration to a vaginal form of administration.
Adult ; Anoxia ; Cough ; Dyspnea ; Emergencies ; Eosinophilia ; Eosinophils ; Female ; Fertilization in Vitro ; Fever ; Humans ; Lung ; Luteal Phase ; Progesterone ; Pulmonary Eosinophilia ; Tachypnea ; Thorax

BACKGROUND AND OBJECTIVES: The objective of this study was to assess the short- and long-term clinical outcomes and valvular changes after percutaneous mitral valvuloplasty (PMV) in Sejong Hospital. SUBJECTS AND METHOD: Four hundred sixty-seven patients received PMV (Ed-already defined above) using the Inoue Balloon at Sejong hospital from 1990 to 2002. Short and long-term results, restenosis-free survival rate and prognostic factors for each result were analyzed by Chi-square, Cox regression analysis, Life table method and Cox proportional hazard model. RESULTS: After PMV, mitral valve area increased from 0.94+/-0.21 cm2 to 1.76+/-0.37 cm2 and the success rate (MVA>1.5 cm2 or increased by at least 50% without the development of moderate to severe mitral regurgitation) was 78.9%. Age (< or =50 years, p=0.018), echo score (< or =9, p=0.05) and pre-procedural mitral valve area (MVA, > or =1.1 cm2, p=0.001) were independent favorable prognostic factors for short-term result. As for the development of moderate to severe mitral regurgitation, pre-procedural MVA (< or =1.0 cm2, p=0.031) and echo score (>9, p=0.043) were independent predictive factors. Median restenosis-free survival was 82.98 months and the restenosis-free survival rate was 70.9% at 3 years post-PMV, 48.1% at 6 years and 29.6% at 10 years. The independent prognostic factor for restenosis-free survival rate was left atrial dimension (LAD< or =60 mm, p=0.015). In addition, echo score (< or =8, p=0.412), pre-procedural MVA (> or =1.0 cm2, p=0.24) and ejection fraction (EF> or =55%, p=0.146) had an effect on the good long-term results of PMV from multivariate analysis. CONCLUSION: PMV was a very successful treatment method for mitral stenosis. Pre-procedural MVA was a representative predictive factor for short and long-term outcomes and the development of mitral regurgitation.
Balloon Valvuloplasty ; Echocardiography ; Humans ; Life Tables ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Multivariate Analysis ; Proportional Hazards Models ; Survival Rate

BACKGROUND: There is little data on the 3 year prognosis and quality of life of patients on long-term (>72 hour) mechanical ventilation in a medical intensive care unit (MICU). METHODS: Patients with long-term mechanical ventilation from May 2003 through July 2003 in MICU of Asan Medical Center, Seoul were enrolled in this studay. The survival rates were observed prospectively at 1, 3, 6, 12, 24, 36 months, and the quality of life of survivor was measured at 12 months by using Short Form 36 (SF-36). RESULTS: The survival rate at 1, 3, 6, 12, 24 and 36 months was 54.8% (40/73), 39.7% (29/73), 30.1% (22/73), 20.5% (15/73), 18.3% (13/71) and 16.9% (12/71), respectively. There was a similar survival rate regardless of the diseases that required mechanical ventilation. A neoplasm or chronic liver disease had a worse survival rate than chronic lung or kidney disease (p>0.05). Each SF-36 domain except for the Role-emotional was inferior to the general population. CONCLUSIONS: The survival rate of patients with mechanical ventilation more than 72 hours is decreases continuously until 12 months but is relatively constant from 12 to 36 months. In these patients quality of life is also decrased.
Chungcheongnam-do ; Humans ; Intensive Care Units* ; Critical Care* ; Kidney Diseases ; Liver Diseases ; Lung ; Prognosis* ; Prospective Studies ; Quality of Life ; Respiration, Artificial* ; Seoul ; Survival Rate ; Survivors