Pulmonary embolism is the impaction of material into branches of the pulmonary arterial bed. It usually occurs in patients with primary hypercoagulable states or secondary hypercoagulable states like cancer, preganancy, and estrogen replacement therapy. We report a case of a pulmonary embolism in a patient with positive lupus anticoagulant who received estrogen replacement therapy. The patient was referred due to suddenly developed shortness of breath and echogenic mass densities in the right atrium on 2 dimensional echocardiography. The patient was markedly improved with intravenous urokinase and subsequent oral anticoagulant therapy. Related articles are also reviewed.
Dyspnea ; Echocardiography ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Heart Atria ; Humans ; Lupus Coagulation Inhibitor* ; Pulmonary Embolism* ; Urokinase-Type Plasminogen Activator

No abstract available.
Aspergillus* ; Sinusitis*

Laser surgery of allergic rhinitis has been reported to be successful by several authors, but there has been little study on factors that may help the physician select patients who are likely to respond to surgery. The aim of this study was to assess the factors that influence the surgical outcome of laser surgery for allergic rhinitis patients. We analyzed the data from questionnaire in 211 patients who were diagnosed as perennial allergic rhinitis and underwent CO2 laser surgery in our department from October 1993 to October 1995. All nasal symptoms including nasal obstruction, watery rhinorrhea and sneezing were significantly improved. Improvement rates do not differ according to the number of surgery, follow-up period, number of positive allergens and residency type. The results of this study suggest that laser surgery might improve nasal symptoms in patients with perennial allergic rhinitis. There was no significant difference in improvement rate in terms of both number of surgery and follow-up period.
Allergens ; Follow-Up Studies ; Humans ; Internship and Residency ; Laser Therapy ; Lasers, Gas ; Nasal Obstruction ; Surveys and Questionnaires ; Rhinitis* ; Sneezing ; Turbinates*

No abstract available.
Pancreatitis*

PEG is a simple, safe and rapid method for the placement of feeding gastrostomy tube because of its low morbidity and mortality. Also, exchange of gastrostomy tube can be easily performed because several types of exchange tube, suich as replacement balloon gastrostomy tube are available. But, less has been known about complications of exchange tube. The authors experienced a case of severe gastric ulcer bleeding in seventy one years old male patient who had been suffered from melena after exchange of old PEG tube for replacement balloon gastrostomy tube. Gastroscopy showed bleeding from acute, large and deep ulcer on the body of stomach, and replacement tube tip directed to the center of ulcer. Bleeding was thought to be caused by gastric ulcer due to replacement balloon gastrostomy tube, After removal of tube and conservative management with H2 receptor antagonist, bleeding ceased
Gastroscopy ; Gastrostomy* ; Hemorrhage* ; Humans ; Male ; Melena ; Mortality ; Stomach ; Stomach Ulcer* ; Ulcer

Although inverted papillomas of urinary tract have been reported, the lesion of the ureter is rare and peculiar tumor characterized by unique microscopic finding. The prognosis of ureteral inverted papilloma is very favorable, only small number progress to higher grade tumor. We report 2 cases of ureteral inverted papilloma which were treated by segmental resection with end-to-end anastomosis of ureter.
Papilloma, Inverted* ; Prognosis ; Ureter* ; Urinary Tract

PURPOSE: There are some disagreements about the optimal dosages of intravenous gammaglobulin(IVGG) and oral aspirin(ASA) in the treatment of Kawasaki disease. So authors performed a prospective clinical study to evaluate the efficacy of IVGG 1g/kg plus ASA 50mg/kg/day. METHODS: We treated 29 patients who were admitted to Inha University Hospital from June 1993 through May 1994 with IVGG 1g/kg plus ASA 50mg/kg/d. We compared the outcomes of above patients with those of two other groups of patients, group A and B in authors' previous study. Group A(20 patients) had been treated with IVGG 2g/kg plus ASA 50mg/kg/d and group B(19 patients) with IVGG 2g/kg plus ASA 100mg/kg/d. The outcomes had been similar in group A and B, which was published on this journal in 1995 (vol. 38:378-385). RESULTS: 1) Twenty five patients(86.2%; group C) were given only one dose of IVGG 1g/kg, and remaining 4 patients(13.8%; group D) were given two doses of IVGG 1g/kg because of persistent high fever. 2) The age and sex distributions, durations of fever before treatment, and durations of ASA therapy in group C were not significantly different from those in group A and B (p>0.05). 3) Laboratory findings on admission in group C were not significantly different from those in group A and B, except that the mean ESR was lower in group C than in group A and B (35.1+/-19.8 vs 55.5+/-5.95 & 50.2+/-11.4mm/hr; p<0.01, respectively). 4) The durations of fever after treatment in group C were not significantly different from those in group A and B (1.32+/-1.07 vs 2.65+/-3.28 & 1.74+/-1.52 days; p>0.05, respectively). 5) In group C, the mean hemoglobin concentration at the 3rd week of illness was higher than in group A (11.1+/-0.98 vs 10.1+/-1.24g/dl; p<0.05), the mean platelet count at the 2nd week of illness was lower than in group A (59.4+/-18.0x10(4) vs 73.6+/-19.0x10(4)/ l; p<0.05), and the mean ESRs at the 2nd and 3rd week of illness were lower than in group A (43.3+/-14.7 vs 54.0+/-9.16, 31.9+/-19.0 vs 47.7+/-13.0mm/hr; p<0.05, respectively). Other follow-up laboratory findings in group C were not significantly different from those in group A and B. 6) Echocardiography was done 2 and 4 weeks after onset of illness. Coronary arterial dilation was observed in four(4/25; 16%) and two(2/23; 8.7%) patients respectively in group C, and the proportions were not significantly different from those in group A(40% & 25%) and B(31.6% & 10.5%) (p>0.05, respectively). In follow-up examinations, coronary aneurysm was observed in only one(1/23; 4.3%) in group C, which was similar to group A(1/18; 5.5%) and B(1/19; 5.2%) (p>0.05, respectively). Giant aneurysm was not observed in any patients. 7) Four patients(group D) were given one more dose of IVGG 1g/kg because high fever persisted 48 hours after injection of the first dose of IVGG. Afterthen fever subsided within 1 to 7 days. Echocardiography revealed mild coronary arterial dilation in two patients initially, but follow-up examinations revealed no coronary aneurysm. CONCLUSIONS: The medium-dose combined regimen with IVGG 1g/kg plus ASA 50mg/kg/d seems to be more cost-effective than the high-dose regimen with IVGG 2g/kg plus ASA 50-100mg/kg/d. If high fever persists 48 hours or more after the first dose of IVGG 1g/kg, it is desirable to give one more dose of IVGG 1g/kg.
Aneurysm ; Aspirin* ; Coronary Aneurysm ; Echocardiography ; Fever ; Follow-Up Studies ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Platelet Count ; Prospective Studies ; Sex Distribution

The purpose of this study provides measurements of radiation dose from MDCT of head, chest, abdomen and pelvic examinations. A series of dose quantities that are measured of patient weight to compare the dose received during MDCT examinations. Data collected included: weight together with CT dose descriptors, volume CT dose index (CTDIvol) and dose length product (DLP). The effective dose was also estimated and served as collective dose estimation data. Data from 1,774 adult patients attending for a CT examination of the head (n=520) or chest (n=531) or abdomen (n=724) was obtained from spiral CT units using a same CT protocol. Mean values of CTDIvol was a range of 48.6 mGy for head and 6.9, 10.5 mGy for chest, abdomen examinations, respectively. And mean values of DLP was range of 1,604 mGy.cm for head, 250 mGy.cm for chest, 575 mGy.cm for abdomen examinations, respectively. Mean effective dose values for head, chest, abdominal CT were 3.6, 4.2, and 8.6 mSv, respectively. The degree of CTDIvol and DLP was a positive correlation with weight. And there was a positive correlation for weight versus CTDIvol (r2=0.62), DLP (r2=0.694) in chest. And head was also positive correlation with weight versus CTDIvol (r2=0.691), DLP (r2=0.741). We conclude that CTDIvol and DLP is an important determinant of weight within the CT examinations. The results for this study suggest that CT protocol should be tailored according to patient weight.
Abdomen ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; Cone-Beam Computed Tomography ; Cytarabine ; Gynecological Examination ; Head ; Humans ; Subject Headings ; Thioguanine ; Thorax ; Tomography, Spiral Computed

PURPOSE: To get the normal predicted value of airway resistance in Korean primary school-aged children by using flow interrupter technique which is simple and easy enough to be applicable even to young children. METHODS: Among all the children of one primary school, we selected 964 (Male 469, Female 495). Excluded children were out of normal range in growth with Korean standard and/or history and/or symptom and sign of airway diseases. One medical doctor, well trained to the Microlab 4000 (Micromedical Co. England) educated the children before check and carried out all the procedure. Rint (Airway resistnace by interrupter technique) was checked 5 times. After exclusion of both highest and lowest values, we got the average of remaining 3 values as Rint (in both inspiratory and expiratory phases). We got mean, standard deviation, regression equation, correlation coefficient in every age, height group, weight group, and chest circumference group in both sex. RESULTS: 1) Age ranged from 6 to 11 years. 6-year-old boys' Rint were 0.56+/-0.15 kPa.l-1.s and 0.56+/-0.15 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.55+/-0.16 kPa.l-1.s and 0.55+/-0.18 kPa.l-1.s in girls. The Rint decreased as the children getting older. 2) Height ranged from 105 to 160 cm. Rint of boys from 111 to 115 cm in height were 0.54+/-0.11 kPa.l-1.s and 0.55+/-0.15 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.56+/-0.18 kPa.l-1.s and 0.56+/-0.19 kPa.l-1.s in girls. The Rint decreased as the children getting taller. 3) Weight ranged from 16 to 57 kg. Rint of boys from 16 to 18 kg in weight were 0.52+/-0.07 kPa.l-1.s and 0.59+/-0.07 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.47+/-0.15 kPa.l-1.s and 0.43+/-0.14 kPa.l-1.s in girls. The Rint decreased as the children getting heavier. 4) Chest circumference ranged from 50 to 85 cm. Rint of boys from 50 to 55 cm in chest circumference were 0.49+/-0.12 kPa.l-1.s and 0.46+/-0.13 kPa.l-1.s in inspiratory and expiratory phase, respectively. They were 0.53+/-0.16 kPa.l-1.s and 0.52+/-0.17 kPa.l-1.s in girls. The Rint decreased as the children's chest circumference increase. 5) We got regression equations and correlation coefficient by age, height, weight, and chest circumference in both boys and girls and in both inspiratory and expiratory phases. Correlation was best with height but correlation coefficient was less than 0.45. CONCLUSION: We got the normal predicted value of airway resistance by flow interrupter technique. It can be used in evaluating lung condition, progression of lung disease, and effectiveness of drugs in lung disease.
Airway Resistance* ; Child* ; Female ; Humans ; Lung ; Lung Diseases ; Reference Values ; Respiratory Function Tests ; Thorax

Generally, absolute alcohol embolization has been commonly used for treatment of arteriovenous malformation (AVM) because complete surgical extirpation of AVM can be an extremely hazardous and difficult. Even if absolute alcohol is safe embolic agent, it can result in pain, pulmonary hypertension, pulmonary embolism and post-embolization syndrome such as nausea, vomiting, hemolysis and myoglobinuria. So, general anesthesia is needed for alcohol embolization. In this case, anesthesia was induced with intravenous (IV) propofol 110 mg and succinylcholine 60 mg and maintained with propofol and vecuronium. The pulmonary artery pressure was monitored with a Swan-Ganz catheter. After alcohol injectons, systolic pulmonary artery pressure was increased, ranging 35-40 mmHg. And cola-colored urine was noticed. For treatment of pulmonary hypertension, nitroglycerine was given IV. The IV fluid rate was increased and furocemide was given IV to increase the urine output. After general anesthesia, the patient was awake but appeared to be alcohol-intoxicated. Blood alcohol level was 42 mg/dl. Urinalysis showed large amounts of myoglobin, hemoglobin and albumin. So, anesthesiologists have to keep in mind of such complications when absolute alcohol embolization is done.
Anesthesia ; Anesthesia, General ; Arteriovenous Malformations* ; Catheters ; Ethanol* ; Hemolysis ; Humans ; Hypertension, Pulmonary ; Myoglobin ; Myoglobinuria ; Nausea ; Nitroglycerin ; Propofol ; Pulmonary Artery ; Pulmonary Embolism ; Succinylcholine ; Urinalysis ; Vecuronium Bromide ; Vomiting