Heart failure is a recognized, although uncommon, cause of massive liver cell necrosis, the clinical consequence of which are intermingled with those of cardiac insufficiency in most case. But, hepatic coma is rerely caused by hepatic congestion only. We report the three cases with heart failure resulted in massive liver cell necrosis and fulminant hepatic failure. The manifestations of fulminant hepatic failure were hepatic encephalopathy, jaundice, marked increase of prothrombin time and serum transaminase and there were no evidences of viral hepatitis and toxic hepatitis as a cause of liver failure.
Drug-Induced Liver Injury ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Hepatic Encephalopathy ; Hepatitis ; Jaundice ; Liver ; Liver Failure ; Liver Failure, Acute* ; Necrosis ; Prothrombin Time

Mitomycin C may change the time course for effective releasable scleral-flap suture removal. The authors evaluated the safety and efficacy of releasable scleral-flap sutures in 83 eyes of 61 patients undergoing mitomycin C(MMC) filtering operation. Of these eyes, 38 underwent scleral-flap suture removal and these eyes were divided into three groups according to the timing of suture removal(Group 1: within 3 days after trabeculectomy, Group 2: from 4 to 14 days, Group 3: from 15 to 30 days). The pre-release IOP was 26.0 +/- 7.6, 23.8 +/- 8.5 and 18.4 +/- 4.6 mmHg, respectively. Immediately after releasable suture removal, the percent IOP reduction was 46 +/- 18, 46 +/- 17 and 30 +/- 20%, respectively. The percent IOP reduction after releasable suture removal was greater in the group 1 and group 2 compared with group 3(p<0.05). Mean follow-up period was 9.0 +/- 5.3, 14.4 +/- 7.2 and 12.6 +/- 7.6 months, respectively. Twelve eyes(80%), 12 eyes(100%), 10 eyes(91%) achieved successful control of final IOP of 21 mmHg or less with or without topical antiglaucoma medications, respectively. After releasable suture removal, the shallow anterior chamber was noted in 1 eye, 2 eyes and 1 eye, respectively. One eye developed a hypotony in the group 3. Adjunctive MMC therapy extended the period that releasable scleral-flap suture removal is effective beyond first 2 postoperative weeks. Also these results indicate that this method is efficient for IOP reduction and relatively safe.
Anterior Chamber ; Follow-Up Studies ; Humans ; Mitomycin* ; Sutures* ; Trabeculectomy*

During a 9-year period 43 children and adolescents 2 to 18 years old underwent 140 extracorporeal shock wave lithotripsy (ESWL) treatments for 48 calculi. The second generation piezoelectric lithotriptor (LT01) was used in 28 cases (65%) while the remaining cases were treated with the third generation piezoelectric lithotriptor (LT02). LT02 lithotriptor differs from an earlier model LT01 in 2 important respects; a stone localization system consisting of ultrasound and fluoroscopy, and more energy per shock wave. The LT01 necessitated caudal anesthesia in 14 cases (50%) while the LT02 necessitated caudal anesthesia in 2 cases (13%) and intravenous anesthesia in 2 cases (13%). Two upper ureteral stones without ureteral dilatation and 1 mid ureteral stone, which were difficult to detect with ultrasound, could be localized by combined ultrasound and fluoroscopy on LT02. The success rate by LT01 and LT02 ESWL was 92.9% and 100%, respectively. The mean session of LT01 and LT02 ESWL was 3.6+/-.4.09 and 2.6+/-2.47, respectively, and the total storage of LT02 ESWL (93+/-97.8) was much less(p<0.05) than that of LT01 ESWL (363+/-380.3). There were no statistical differences in regard to success and the use of stents, stone size or location between the 2 lithotriptors. Six patients required adjuvant procedures, and ESWL complications were not required admission or surgical management. Therefore, LT02 piezoelectric lithotripsy, in comparison with LT01, is more efficient to localize stones and can lessen total storage by reducing treatment sessions in children and adolescents.
Adolescent* ; Anesthesia, Caudal ; Anesthesia, Intravenous ; Calculi ; Child* ; Dilatation ; Fluoroscopy ; Humans ; Lithotripsy* ; Shock ; Stents ; Ultrasonography ; Ureter ; Urinary Calculi

The purpose of this study is to evaluate the influence of clinical factors on the development of postoperative hypotony, and also to determine whether the occurrence of hypotony has any effect on the outcome of trabeculectomy with intraoperative mitomycin C. The authors retrospectively reviewed the outcome in 160 eyes of 112 patients who underwent tight scleral flap trabeculectomy with releasable sutures. Mitomycin C with 0.25 or 0.5mg/ml was applied for 3 or 5 minutes between the Tenon's capsule and the sclera. The mean follow-up period was 16.5 +/- 11.5 months. Success of the trabeculectomy was defined as intraocular pressure (IOP) 6-21 mmHg with or without medications. Hypotony(IOP Anterior Chamber ; Cataract ; Choroid ; Follow-Up Studies ; Glaucoma ; Humans ; Incidence ; Intraocular Pressure ; Mitomycin* ; Postoperative Complications ; Retrospective Studies ; Sclera ; Sutures ; Tenon Capsule ; Trabeculectomy* ; Wounds and Injuries

Leg swelling in patients with paraplegia due to spinal cord injury (SCI) occurs for various reasons, including heterotopic ossification (HO), deep vein thrombosis (DVT), fracture, or cellulitis. The clinical presentations of these conditions may overlap in part or in whole and it may occasionally be difficult to distinguish. Of these conditions, DVT and subsequent pulmonary embolism remain significant causes of morbidity and mortality in patients with SCI. Therefore, a prompt diagnostic work-up, particularly for DVT, is essential in patients with SCI, who present with leg swelling. Here, we report a case of leg swelling in a paraplegic patient, resulting from HO mimicking DVT and discuss the differential diagnosis.
Cellulitis ; Diagnosis, Differential ; Humans ; Leg* ; Mortality ; Ossification, Heterotopic* ; Paraplegia ; Pulmonary Embolism ; Spinal Cord Injuries ; Venous Thrombosis*

Lethal catatonia is a life-threatening febrile neuropsychiatric syndrome, mainly consist of bizzare behavior, mounting fever, extreme hyperactivity, stuporous exhaustion and evenlual death. Although the entity has been reported in the literaure for over 160 years, the rarity of the illness makes prompt recognition being very difficult tasks, particularly in young children. We experienced a typical case of lethal catatonia in 7-year-old boy who previously had no organic illness. Electroconvulsive therapy (ECT) was the most successful mode of treatment among many therapies attempted. We feel that this could be the youngest case in the literature of lethal catatonia.
Catatonia* ; Child* ; Electroconvulsive Therapy ; Fever ; Humans ; Male ; Stupor

Although spontaneous bacterial peritonitis is a frequent complication in the childhood nephrotic syndrome, it is very rare in adults with nephrotic syndrome. It frequently develops when the patients are either in relapse or receiving steroid therapy at the time peritonitis is diagnosed. We report an unusual case of a spontaneous bacterial peritonitis as the presenting feature in a 15-year-old male patient with nephrotic syndrome. He presented with diffuse abdominal pain and distension for 15 days. Abdominal paracentesis revealed the diagnostic laboratory findings of peritonitis, and the bacterial culture of the ascites showed a mixed growth of Escherichia coli and Pseudomonas aeruzinosa. His serum albu- min level was 1.6gldL and the amount of 24 hours proteinuria was 21.0g/day. Although he was treated with adequate antibiotics for 3 weeks, the peritonitis was more aggravated. We decided to insert a catheter into the peritoneal cavity for continuous drainage of the intractable ascites. Two weeks after drainage, the peritonitis improved as the peritonitis subsided, the proteinuria disappeared completely without a steroid therapy. Six months after spontaneous remission, the proteinuria have recurred, and the kidney biopsy then showed focal segmental glomerulorsclerosis.
Abdominal Pain ; Adolescent ; Adult ; Anti-Bacterial Agents ; Ascites ; Biopsy ; Catheters ; Drainage ; Escherichia coli ; Humans ; Kidney ; Male ; Nephrotic Syndrome* ; Paracentesis ; Peritoneal Cavity ; Peritonitis* ; Proteinuria ; Pseudomonas ; Recurrence ; Remission, Spontaneous

OBJECTIVE: It has been reported that untreated sleep-disordered breathing (SDB) deteriorates over time, however this remains contentious. The aim of the present study is to evaluate the clinical course of SDB in middle-aged and older SDB patients, and to identify how relevant factors contribute to the change in SDB severity. METHODS: Baseline and follow-up polysomnographic data of 56 untreated SDB patients (mean age, 61.2±5.71) were obtained retrospectively and the mean interval was 62.4±22.0 months. Subgroup analysis was performed based on the baseline severity, and the factors associated with the course of SDB were analyzed. RESULTS: At the baseline, 13 subjects were simple snorers, 15 had mild to moderate SDB, and 28 were severe SDB patients. While there was no significant change in apnea-hypopnea index (AHI) as a whole, subgroup analysis showed decrease of AHI in severe SDB patients (43.9±10.6 to 35.6±20.0, p=0.009). The change in supine time percent and baseline AHI were associated with the change in AHI (β=0.387, p=0.003; β=-0.272, p=0.037). CONCLUSION: Untreated SDB did not deteriorate over time with modest improvement in severe SDB. A proportion of severe SDB patients might expect decrease in SDB severity irrespective of changes in sleep position or body weight.
Aged* ; Body Weight ; Follow-Up Studies ; Humans ; Retrospective Studies ; Sleep Apnea Syndromes*

BACKGROUND AND OBJECTIVES: There have been many studies about elevated bone conduction (BC) thresholds in patients with chronic otitis media (COM) with or without cholesteatoma and the relationships between operative techniques and postoperative changes of BC thresholds. The purposes of this study are evaluation of the effect of chronic otitis media on BC thresholds, the relationships between various operative techniques and postoperative BC threshold changes. MATERIALS AND METHODS: Preoperative BC thresholds in 237 patients with ipsilateral COM were evaluated and pre- and postoperative differences of BC thresholds were compared by each frequency in all patients. The patients were divided into three groups according to the severity of diseases: (1) Simple: relatively healthy middle ear mucosa and thus only simple mastoidectomy (SM) was done (N=92), (2) Severe: mastoidectomy with posterior tympanotomy (ICWM) or open cavity mastoidectomy (OCM) were done because of severe edematous middle ear mucosa, granulation tissues, or poor ventilation (N=89), (3) cholesteatomas (Chole, N=56). RESULTS: Preoperative audiograms revealed a significant relationship between the elevation of BC threshold and the severity of diseases. Postoperative BC thresholds were improved in 49% of SM (13.8 +/- 8.5), 51% of ICWM (13.8 +/- 6.1), and 35% of OCM (14.4 +/- 8.4), maintained in 45% of SM, 37% of ICWM, and 43% of OCM, but worsened in 6% of SM (-8.7 +/- 1.4), 12% of ICWM (-10.9 +/- 5.2), and 22% of OCM (-13.8 +/- 6.0). CONCLUSION: The preoperative BC threshold were maintained or improved in the majority of patients postoperatively. In OCM, more patients were worsened in BC hearing postoperatively than the others.
Bone Conduction* ; Cholesteatoma ; Ear, Middle ; Granulation Tissue ; Hearing ; Humans ; Mucous Membrane ; Otitis Media ; Ventilation

OBJECTIVE: To measure the lumbar segmental range of motion (ROM) with 3-dimensional motion analysis system and compare the results with radiologic ROM measurements. METHOD: Ten healthy adult volunteers were included. We attached surface markers at the corresponding skin surface of each lumbar vertebral bodies and measured lumbar segmental ROM in flexion-extension, right bending, left bending, axial rotation with 3-D motion analysis. We compared some of the results with radiologic segmental ROM measurements. RESULTS: In 3-D motion analysis, segmental ROM of flexion and extension, right bending, left bending, right rotation, left rotation were, respectively: 10.1degrees, 45degrees, 3.5degrees, 1.7degrees and 1.9degrees(L1-L2); 17.9degrees, 6.2degrees, 5.1degrees, 1.4degrees and 1.1degrees (L2-L3); 15.0degrees, 7.2degrees, 4.9degrees, 2.1degrees and 1.1degrees (L3-L4); 14.9degrees, 5.8degrees, 4.6degrees, 1.7degree and 1.6degree (L4-L5); 10.6degrees, 4.9degrees, 3.8degree, 2.6degree and 0.8degree (L5-S1). There was no statistically significant difference in segmental ROM between 3-D motion analysis measurements and radiologic measurements except L5-S1 right bending, L2-L3 and L5-S1 left bending. No statistical significant difference in lumbar flexion and bending ROM was found between two methods. CONCLUSION: 3-D motion analysis is a useful method when measuring the lumbar segmental range of motion and it has an advantage to analyze segmental lumbar motion with three directions simultaneously.
Adult* ; Humans ; Range of Motion, Articular* ; Skin ; Volunteers