Endovascular aneurysm repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA) is a widely used method, and its decreased invasiveness compared to traditional surgical repair has brought about reduced rates of morbidity and mortality. Several vascular complications related to the procedure have been reported, but non-vascular complications have rarely occurred. We report herein the case of a 78-year-old man who underwent EVAR for AAA and presented with active duodenal ulcer bleeding and acute acalculous cholecystitis as complications after the procedure. We must consider that a wide spectrum of complications may occur following EVAR, and therefore it is important to evaluate the risks of complication and to take the necessary measures to minimize them.
Acalculous Cholecystitis ; Aged ; Aneurysm ; Aortic Aneurysm, Abdominal ; Duodenal Ulcer ; Hemorrhage ; Humans

PURPOSE: VEGF, a potent angiogenic factor, increases vascular permeability and induces the fluid accumulation in the peritoneal and pleural cavities. This study is designed to know whether the VEGF concentration are associated with the formation of cystic fluid of thyroid nodules and the results of treatment. METHODS: To know whether thyroid follicular cells produce VEGF, we measured the VEGF concentration in the conditioned medium after primary culture of the normal thyroid follicular cells (NT 1.0). Thirty seven patients, who had visited Ajou University Medical Center, were divided into two groups; group A (n=19) is patients whose cystic nodules disappeared completely with 1 or 2 times fine needle aspirations. In Group B (n=18), the cystic nodules recurred rapidly and required aspiration more than 3 times. Clinical records of patients were analyzed and compared with TSH and VEGF levels in cystic fluids. RESULTS: The VEGF concentration in basal conditioned medium were 8.2±1.2 ng/ml in NT 1.0 and 8.2±0.6 ng/ml in thyroid cancer cell line (FTC-133). NT 1.0 was not affected by TSH stimulation. Mean concentration of TSH of all cystic fluids was 4.36µIU/ml (0.13~21.7) and there was no difference between 2 groups. Mean concentration of VEGF of all cystic fluids was 140.7 ng/ml (11.1~688.8). The VEGF concentration (287.9±289.6 ng/ml) in group B was significantly higher than that (104.2±97.1 ng/ml) in group A (P<0.05). CONCLUSION: This study suggests that thyroid follicular cells produce and secrete VEGF, and VEGF is related with the accumulation of cystic fluid in degenerative cysts of thyroid. Cysts with high VEGF concentration promote rapid reaccumulation of the cystic fluid and possibly necessitate operation in selected patients.

The authors diagnosed a 54-year-old male as central mucoepidermoid carcinoma after undegoing clinical, radiologica l and histopathological examinations. The charateristics were as followed : 1. Clinically, the patient complained of the painless unilateral swelling of the left mandibular molar region and had a pus discharge through the fistula. Painful nodule was palpated on the scalp of the left frontal area and it was regarde d as a metastatic lesion. 2. Plain radiographs showed the ill-defined permeative radiolucent lesion. The osteolytic lesions were also detected in the cranial bone, number 9 and 11 ribs, scapula, and vertebral bodies. 3. The mandibular CT and PNS MRI showed the swelling of the left mandible and the enlargement of the several lymph node s of 1.5 cm in size. 4. Histopathologically, many solid epidermoid type cells were mixed with mucus-secreting cells and they were arranged i n duct-like structure. Most of them were epidermoid type, which indicates a high grade tumor. Mucins could be found in mucicarmine staining.
Carcinoma, Mucoepidermoid* ; Fistula ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Male ; Mandible* ; Middle Aged ; Molar ; Mucins ; Neoplasm Metastasis* ; Ribs ; Scalp ; Scapula ; Suppuration

The authors diagnosed a 54-year-old male as central mucoepidermoid carcinoma after undegoing clinical, radiologica l and histopathological examinations. The charateristics were as followed : 1. Clinically, the patient complained of the painless unilateral swelling of the left mandibular molar region and had a pus discharge through the fistula. Painful nodule was palpated on the scalp of the left frontal area and it was regarde d as a metastatic lesion. 2. Plain radiographs showed the ill-defined permeative radiolucent lesion. The osteolytic lesions were also detected in the cranial bone, number 9 and 11 ribs, scapula, and vertebral bodies. 3. The mandibular CT and PNS MRI showed the swelling of the left mandible and the enlargement of the several lymph node s of 1.5 cm in size. 4. Histopathologically, many solid epidermoid type cells were mixed with mucus-secreting cells and they were arranged i n duct-like structure. Most of them were epidermoid type, which indicates a high grade tumor. Mucins could be found in mucicarmine staining.
Carcinoma, Mucoepidermoid* ; Fistula ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Male ; Mandible* ; Middle Aged ; Molar ; Mucins ; Neoplasm Metastasis* ; Ribs ; Scalp ; Scapula ; Suppuration

Epididymis ; Male

BACKGROUND: Patients who are considered for major pulmonary resection are generally evaluated by spirometry and clinical assessment to predict morbidity and mortality. Despite this, none has yet proved to be a convenient and reliable estimate of risk. MATERIAL AND METHOD: A retrospective analysis was performed in 167 patients who were diagnosed for lung cancer, bronchiectasis, pulmonary tuberculosis, and other benign pulmonary disease, and who underwent major lung resections. The relationship of 25 preoperative or postoperative variables to 19 postoperative events were classified into categories as operative mortality, pulmonary or cardiovascular morbidity, and other morbidity was assessed. Logistic regression analysis and x2 analysis were used to identify the relationship of the operative risk factors to the grouped postoperative complications. RESULT: The best single predictor of complications was the percent predicted postoperative diffusing capacity (pulmonary morbidity, p<0.009; cardiovascular morbidity, p<0.003: overall morbidity, p<0.004). CONCLUSION: The diffusing capacity of the lung for carbon monoxide was an important predictor of postoperative complications than the spirometry, and it usually should be a part of the evaluation of patients being considered for pulmonary resection.
Bronchiectasis ; Carbon Monoxide ; Humans ; Logistic Models ; Lung ; Lung Diseases ; Lung Neoplasms ; Mortality* ; Postoperative Complications ; Retrospective Studies ; Risk Factors* ; Spirometry ; Tuberculosis, Pulmonary

Background: Many studies have reported that minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) provides satisfactory treatment comparable to other fusion methods. However, in the case of MI-TLIF, there are concerns about the long-term outcome compared to conventional bilateral PLIF due to the small amount of disc removal and the lack of autogenous bone graft. Long-term follow-up studies are still lacking as most of the previous reports have follow-up periods of up to 5 years. Methods: Thirty patients who underwent MI-TLIF were followed up for > 10 years (mean, 11.1 years). Interbody fusion rates were determined using a modified Bridwell grading system.Adjacent segment disease (ASD) was defined as radiological adjacent segment degeneration (R-ASDeg) as seen on plain X-rays; reoperated adjacent segment disease referred to the subsequent need for revision surgery. Clinical outcomes after surgery were assessed based on back and leg pain as well as the Oswestry disability index (ODI). Results: The overall radiological fusion rate, at the 1-, 5-, and 10-year follow-up was 77.1%, 91.4%, and 94.3%, respectively. The incidence of R-ASDeg 1, 5, and 10 years after surgery was 6.7%, 16.7%, and 43.3% at the proximal adjacent segment and 4.8%, 14.3%, and 28.6% at the distal adjacent segment, respectively. R-ASDeg at either the proximal or distal segment was determined in 50.0% of the patients 10 years postoperatively. All clinical parameters improved significantly during follow-up, although the ODI and the visual analog scale (VAS) for leg pain at the 10-year follow-up were significantly worse in the R-ASDeg group than in the other patients (P = 0.009, P = 0.040). Conclusion MI-TLIF improved both clinical and radiological outcomes, and the improvements were maintained for up to 10 years after surgery. However, R-ASDeg developed in up to 50% of the patients within 10 years, and both leg pain on the VAS and the ODI were worse in patients with R-ASDeg.

OBJECTIVES: The purpose of this study is to analyze sleep habit and investigate the association between insomnia and demographic, health and psycho-behavioral symptomatology in Korean urban elderly. METHOD: A total of 723 community residents aged 65 years or older were surveyed by two stage, random cluster sampling method. The response rate was 76.2%. Interviewers performed door to door visits and administered a questionnaire about sleep, past medical history, and several scales as the Psychogeriatric Assessment Scale (PAS), the short form Quality of Life Scale (SF-36) and etc. RESULTS: The mean scores are as follows: retiring time was ten-sixteen p.m., wake-up time was five twenty two a.m., duration of sleep was seven hours and six minutes. Among the elderly, 11.6% and 14.8% of the subjects reported chronic and intermittent difficulty in sleeping, respectively. The patients with back pain and history of stroke complained of more insomnia symptoms in univariate analysis. In ANCOVA analysis, insomnia symptoms were associated with an old age, depressive symptoms in male. Bodily pain and history of dermatologic disease were additional risk factors in female. CONCLUSIONS: The data suggest insomnia is one of most common health problems among elderly Koreans living in the community. Strong positive relationship between depressive symptoms and insomnia were found. Further research is needed to explore the causal relationship between insomnia and risk factors.
Aged* ; Back Pain ; Depression ; Epidemiology ; Female ; Humans ; Male ; Quality of Life ; Surveys and Questionnaires ; Risk Factors ; Sleep Initiation and Maintenance Disorders ; Stroke ; Weights and Measures

Computerized tomography (CT) is an effective technique in the initial evaluation of the abdomen and head following blunt trauma. To evaluate the efficacy of CT of the thorax, a retrospective study comparing early thoracic CT scanning with initial chest roentgenogram (CXR) was carried out on 134 patients with blunt trauma on the chest. Among 134 patients, 45 patients had normal initial chest roentgenogram and 24 patients showed normal CT findings. Sensitivities of diagnosing pneumothorax and pleural effusion by CXR were low (46.2 and 62.9% respectively), whereas 71.4% (45/63) of patients had thoracostomy only by CXR. Although sometimes abused, CT of the thorax is effective in the initial diagnosis.
Abdomen ; Diagnosis ; Head ; Humans ; Pleural Effusion ; Pneumothorax ; Retrospective Studies ; Thoracostomy ; Thorax* ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: The odor identification tests use natural and synthetic odorants as stimuli. Synthetic odorants span a smaller qualitative range than natural ones, however, they eliminate the need for preparation, preservation and have improved familiarity owing to the improved development techniques. The aim of this study is whether we can use synthetic odorants in odor identification tests by comparing the results of tests using natural odorants and synthetic ones. MATERIALS AND METHODS: Forty-two natural and 21 synthetic odorants familiar to Koreans were applied to 40 normals and 20 patients with decreased sense of smell without sinonasal diseases. Percent-correctness shown by the controls and patients smelling natural and synthetic odorants were compared with those patients showing over 95% identifiability and in 11 corresponding natural and synthetic odorants. RESULTS: Percent-correctness of odor identification test using synthetic odorants was highly correlated with that using natural ones and there was no problem in discriminating patients from the control. CONCLUSION: Synthetic odorants can be used in odor identification tests for Koreans in a clinical context.
Humans ; Odors* ; Olfaction Disorders ; Recognition (Psychology) ; Smell