Endoscopic retrograde cholangiopancreatography(ERCP) procedures are more difficult in patients who have undergone partial gastrectomy with Billroth II anastomosis. Because its altered anatomical relationship. the endoscopist is presented with additional problems: (i) Dfficulties in entering the afferent loop, depending on the surgical techiques used. (ii) The endoscope may be too sort to reach the papillary region unless the loops are suecessfully straightened out. (iii) Difficulties in passing the ligament of Treitz, especially in patients with Braun's anastomosis, (iv) Problems in cannulating the papilla and especially the common bile duct from a reversed position. (v) Problems in carrying out a papillotomy in a correct position. We attempted endoscopic sphincterotomy in 3 opatients previously subjected to gastrectomy with needle knife, and succeeded in 2 of them. In the two patients, successful billary drainage was achieved. And one patients with Billroth II gastrectomy, presented with CBD stone and cholangit, was successfully treated with endoscopic stone retriveial. The patient with a Billroth-II operation may unergo endscopic diagnostic as well as therapeutic procedures with a high rate of success, and can be suitable candidates for ERCP and endoscopic sphincterotomy
Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Drainage ; Endoscopes ; Gastrectomy* ; Gastroenterostomy* ; Humans ; Ligaments ; Needles ; Sphincterotomy, Endoscopic

Forty patients(9 male and 31 female) with tsutsugamushi disease were evaluated clinically. The diagnosis of tsutsugamushi disease was confirmed by indirect immunofluoresent test or isolation of causative agent. More than 77% of patients were over 40 years of age. After the incubation period(5 to 13 days, average 8 days) symptoms developed suddenly. The frequent symtoms were fever(100%), chill(100%), headache(100%), rnalaise(97%), and myalgia(95%). On physical exammination the rash, eschar, and lymphadenopathy were found in 97%, 82%, and 67% respectively. Eschar was observed in the trunk, especially axillary, abdominal and inguinal area. Serum transarninase(SGOT snd SGPT) was elevated(89 and 87%). Urinalysis revealed proteinuria in 35%(12/34) and hematuria in 19%(7/36). Chest roentgram and ECG demonstrated abnormalities in 39%(14/36) and 73%(26/36) respectively, The treatment with doxycycline was very effective in all cases.
Diagnosis ; Doxycycline ; Electrocardiography ; Exanthema ; Hematuria ; Humans ; Lymphatic Diseases ; Male ; Proteinuria ; Scrub Typhus* ; Thorax ; Urinalysis

Respiratory syncytial virus is the most common cause of lower respiratory infection (bronchiolitis and pneumonia) of infancy and early childhood. We analyzed clinical and radiological features of 76 patients with lower respiratory infections by respiratory syncytial virus, which were diagnosed by indirect immunofluorescent test or culture of nasal aspirate in Hep-2 cell monolayer, during the period of January-December, 1991. There were peaks of incidences in March-May and November-December, accounting for 87% of eases. Sixty-two cases (82%) were under 1 year of age. Fifty cases(66%) had underlying diseases. Major radiographical findings were overaeration (83%), parahilar peribronchial infiltrates(67%), segmental or subsegmental atelectasis(32%), and segmental or lobar consolidation(16%). In 15 cases(20%), overaeration was the only radiological findings. There was no evidence of pleural effusion or hilar lymph node enlargement in all cases. By considerig clinical features(symptoms, age. Underlying diseases, epidemic seasons) in addition to the radiological findings, radiologists would be familiar with lower respiratory infection by respiratory syncytial virus. Air space consolidation, which is generally though to represent bacterial pneumonia, is also observed not infrequently in respiratory syncytial virus infections.
Child* ; Humans ; Incidence ; Infant* ; Lymph Nodes ; Pleural Effusion ; Pneumonia, Bacterial ; Respiratory Syncytial Virus Infections ; Respiratory Syncytial Viruses* ; Respiratory Tract Infections

Acute mobile thrombus of the abdominal aorta after chemotherapy is a very unusual finding, which can be a potential source of arterial embolism. We report here on a case of an acute mobile aortic thrombus with renal infarction. We successfully treated the patient with hybrid operation-open surgical and endovascular approach. Our case shows that hybrid treatment using wire-directed balloon catheter thrombectomy is a feasible, minimally-invasive treatment for a mobile aortic thrombus.
Angioplasty ; Aorta ; Aorta, Abdominal ; Catheters ; Chimera ; Embolism ; Humans ; Infarction ; Thrombectomy ; Thrombosis

The authors conducted a clinical observation of 55 cases of solitary pulmonary nodules at Yeungnam University Hospital from June 1986 to October 1990, and the following results were obtained: 1. The age distribution was ranged from 18 to 77 years, and the male-to female ratio was 1.8:1. 2. Among 55 cases of nodules, 28 cases were benign and 27 cases were malignant nodules, and of malignant nodules, the primary lung cancer was 23 cases and of benign nodules, 18 cases were tuberculoma. 3. 23 cases (41.8%) was asymptomatic and the other 32 cases were symptomatic; chest pain 12 cases, hemoptysis; 8 cases, cough; 8 cases and dyspnea; 4 cases. 4. The non-smoker-to-smoker ratio was 1:1.04, but among 23 smoker over 20 pack years, 14 cases were malignant nodules. 5. According to nodular size, there is no striking differences between benign and malignant nodules except 3-4 cm sized nodules. 6. The lobar distribution of nodules, 35 cases were in the right lung (upper lobe; 14 cases, middle lobe; 11 cases, and lower lobe; 10 cases) and 23 cases were in the left lung (upper lobe; 9 cases, lower lobe; 11 cases), and the malignant nodules were most commonly observed in the right upper lung.
Age Distribution ; Chest Pain ; Cough ; Dyspnea ; Female ; Hemoptysis ; Humans ; Lung ; Lung Neoplasms ; Solitary Pulmonary Nodule* ; Strikes, Employee ; Tuberculoma

PURPOSE: To describe the clinical manifestations, radiologic findings, and treatment outcomes of pediatric pseudotumors. METHODS: A retrospective chart review of patients diagnosed with pediatric pseudotumor (age under 20 years old) from August 2008 to February 2012 was performed. RESULTS: Thirteen patients (16 eyes) were included in this study. The mean age of the subjects was 14.2 years (5-20 years). Swollen eyelid (56.3%), ptosis (43.8%), conjunctival injection (18.8%), localized mass (18.8%), limitation of ocular movement (12.5%), proptosis (6.3%), and decreased visual acuity (6.3%) were found initially. Dacryoadenitis (62.5%), myositis (18.8%), anterior orbital inflammation (18.8%), and diffuse type (6.3%) were observed on orbital computed tomography (CT). Among the 13 patients (16 eyes), 8 patients (10 eyes) were administered oral systemic corticosteroids, 2 patients (2 eyes) received IV systemic corticosteroid, 1 patient (1 eye) received systemic corticosteroids combined with NSAID, and 2 patients (3 eyes) were prescribed NSAIDs only. Symptoms improved 4.1 days after initiation of treatment. CT scans revealed that one patient experienced diffuse-type disease recurrence twice. CONCLUSIONS: Orbital pseudotumors, which are rare in younger people, are likely to respond very well to corticosteroid treatment, and the recurrence of orbital inflammation is rare.
Adrenal Cortex Hormones ; Anti-Inflammatory Agents, Non-Steroidal ; Dacryocystitis ; Exophthalmos ; Eyelids ; Humans ; Inflammation ; Korea ; Myositis ; Orbit ; Orbital Pseudotumor ; Recurrence ; Retrospective Studies ; Visual Acuity

PURPOSE: To investigate the different types of anatomical connection between the lacrimal sac and the canaliculi using digital subtraction dacryocystography (DCG) in Koreans. METHODS: The authors of the present study performed digital subtraction DCG in Korean patients who presented with epiphora from January 2010 until December 2010. The 248 patients (496 eyes) who achieved a satisfactory DCG image were classified as follows: 1) type I: visible common canaliculus (CC), 2) type II: no visible CC and the canaliculi entering the sac at the point where they meet on the sac wall (common opening), 3) type III: no visible CC and common opening, and each canaliculus entering the sac from different points. RESULTS: Out of a total of 496 eyes, CC was observed in 449 eyes (type I: 90.5%). In 41 eyes (8.3%), the CC was absent (type II), but the upper and lower canaliculi joined at the wall of the lacrimal sac. In 6 eyes (1.2%), the upper and lower canaliculi entered the sac separately (type III). Eighteen patients (7.3%) showed different types of lacrimal drainage system between the 2 eyes. CONCLUSIONS: The CC may not exist in all patients, and the type of anatomical connection between the lacrimal sac and the canaliculi may be different between the eyes in the same individuals. Although such patients comprise a minority, anatomical knowledge of the lacrimal drainage system could be helpful to assess and manage patients with lacrimal drainage disorder.
Drainage ; Eye ; Humans ; Lacrimal Apparatus Diseases

OBJECTIVE: To investigate the effect of mirror therapy on recovery of upper limb function and strength in subacute hemiplegia after stroke. METHOD: Fourty subacute hemiplegic stroke patients (onset <6 months) were enrolled and randomly assigned to either the mirror therapy (MT, n=19), or control group (n=21). MT group received mirror therapy for 30 minutes after each treatment, additionally with the traditional rehabilitation programs, 5 days per week for 4 weeks; 2 hours or more per day, 3 days or more per week. To measure the outcome, we performed the manual muscle test (MMT), manual function test (MFT) and Jarmar grip strength test. RESULTS: MT group showed significant improvements in MMT, grasp and lateral pinch force of grip strength test (p<0.05), compared to control group. Improvement in MFT was more evident in MT group (p<0.05). CONCLUSION: Mirror therapy can be used as an adjuvant therapeutic technique for improving upper limb function and strength for subacute hemiplegia.
Hand Strength ; Hemiplegia ; Humans ; Muscle Strength ; Muscles ; Organometallic Compounds ; Stroke ; Upper Extremity

Objective: To demonstrate the effects of chin-down maneuver on swallowing by using high-resolution manometry (HRM). Methods: HRM data of 20 healthy subjects and 64 dysphagic patients were analyzed. Participants swallowed 5 mL of thin and honey-like liquids in neutral and chin-down positions. HRM was used to evaluate maximal velopharyngeal pressure/area, maximal tongue base pressure/area, maximal pharyngeal constrictor pressure, pre-/post-swallow upper esophageal sphincter (UES) peak pressure, minimal UES pressure, UES activity time, and nadir duration. Results: Compared to the neutral position, the chin-down maneuver significantly increased tongue base pressure in both normal and dysphagic groups as well as for both honey-like and thin viscosities, although the honey-like liquid did not reach statistical significance in the dysphagic group. Regarding pharyngeal constrictors and pre-swallow peak UES pressure, the healthy group showed a significant decrease in thin liquid swallowing and decreasing tendency in honeylike liquid swallowing. UES nadir duration was significantly decreased for honey-like liquid swallowing in the dysphagic group and for both thin and honey-like liquids in the healthy group. UES nadir duration of honey-like and thin flow swallowing in the dysphagia group was 0.26 seconds after the chin-down maneuver, which was severely limited. Conclusion This study showed a different kinetic effect of the chin-down maneuver between the healthy and dysphagic groups, as well as between thin and honey-like viscosities. The chin-down maneuver increased tongue base pressure and decreased UES nadir duration, which the latter was severely limited in dysphagic patients. Therefore, appropriate application of the chin-down maneuver in clinical practice is required.

Crossed renal ectopia is an unusual congenital anomaly, probably produced by abnormal development of the ureteral bud. The deformity itself produces no symptoms and the clinical presentation generally is for obstruction and infection. The pediatric patients present most often with multiple congenital anomalies, especially of the skeletal system. We report the two cases of crossed renal ectopia with fusion with review of literatures.
Congenital Abnormalities ; Humans ; Ureter