An infant presented with persistent epiphora after successful probing of the lacrimal system. Examination of the nose showed a cystic structure occluding lower portion of the lacrimal drainage system. In cases of recurrent obstruction, nasal examination and endoscopic marsupialization may help guide the clinician towards the most appropriate treatment.
Cysts/*complications/surgery ; Dacryocystitis/*complications/surgery ; Endoscopy ; Female ; Humans ; Infant ; Lacrimal Apparatus Diseases/*complications/surgery ; *Nasolacrimal Duct ; Recurrence

Acute eosinophilic pneumonia is reported as a specific disease entity. But, it is different from chronic eosinophilic pneumonia in its onset, clinical course and recurrence. Badesh et al reported the following diagnostic criteria os acute eosinophilic pneumonia a less than one-month history of symptoms prior to diagnosis, no evidence of asthma, the absence of other organic disease, no obvious etiology and an evidence of recurrent disease. We experienced a case of acute eosinophilic pneumonia in 37 old male. Pathologically eosinophilic pneumonia is confirmed and other features meet Badesh's criteria.
Asthma ; Diagnosis ; Eosinophils* ; Humans ; Male ; Pulmonary Eosinophilia* ; Recurrence

OBJECTIVE: We wanted to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and large profile catheter maintenance method for the management of patients with anastomotic biliary strictures following liver transplant. MATERIALS AND METHODS: From May 1999 to June 2003, 12 patients with symptomatic benign biliary stricture complicated by liver transplantation were treated with the percutaneous balloon dilatation and large profile catheter maintenance method (1-6 months). The patients were eight males and four females, and their ages ranged from 20 to 62 years (mean age: 44 years). Ten patients underwent living donor liver transplantation and two underwent cadaveric liver transplantation. Postoperative biliary strictures occurred from two to 21 months (mean age: 18 months) after liver transplantation. RESULTS: The initial technical success rate was 92%. Patency of the bile duct was preserved for eight to 40 months (mean period: 19 months) in 10 of 12 (84%) patients. When reviewing two patients (17%), secondary balloon dilatations were needed for treating the delayed recurrence of biliary stricture. In one patient, no recurrent stenosis was seen during the further 10 months follow-up after secondary balloon dilatation. Another patient did not response to secondary balloon dilatation, and he was treated by surgery. Eleven of 12 patients (92%) showed good biliary patency for 8-40 months (mean period: 19 months) of follow-up. CONCLUSION: The percutaneous balloon dilatation and large profile catheter maintenance method is an effective therapeutic alternative for the treatment of most biliary strictures that complicate liver transplantation. It has a high success rate and it should be considered before surgery.
Treatment Outcome ; Middle Aged ; Male ; Liver Transplantation/*adverse effects ; Humans ; Hepatic Artery/ultrasonography ; Female ; Constriction, Pathologic/etiology/therapy ; Cholangiography ; Bile Duct Diseases/etiology/*therapy ; Balloon Dilatation/*methods ; Adult

OBJECTIVE: To determine the value of selective intra-arterial calcium stimulation with hepatic venous sampling using serum insulin and C-peptide gradients for the preoperative localization of insulinomas. MATERIALS AND METHODS: Seven consecutive patients [three men and four women aged 15-77 (mean, 42.7) years] with hypoglycemia underwent selective intra-arterial calcium stimulation in conjunction with hepatic venous sampling. Insulin gradients were calculated by an individual blinded to all other preoperative imaging studies and operative findings. In all patients except one, C-peptide gradients were also analyzed. The results were compared with the preoperative findings of ultrasonography, computed tomography, arteriography and endoscopic ultrasonography, as well as with the intraoperative findings of ultrasonography and palpation at surgery. RESULTS: Eight insulinomas (mean diameter, 12.5 mm) were diagnosed after surgery. In six patients, the calcium stimulation test with insulin gradients allowed accurate localization of the pathologic source of insulin secretion. Both C-peptide and insulin gradients substantially increased diagnostic accuracy. In one patient, C-peptide gradients were more helpful than insulin gradients for tumor localization. CONCLUSION: Selective intra-arterial calcium stimulation with hepatic venous sampling is a highly accurate and safe method for the preoperative localization of insulinomas. Additional C-peptide gradients seem to be helpful in assessing tumor location, but further study is needed.

Disseminated mucormycosis is a rare fungal infectious disease with a high mortality rate and is infrequently diagnosed ante mortem. It is most frequently seen in immunocompromised hosts such as diabetes mellitus, hematologic malignancies, or in the long-term use of steroids or chemotherapeutic agents. Tissue invasion by the hyphae of mucormycosis must be seen microscopically to establish the diagnosis. Treatment consists of correction of the predisposing condition, surgical debridement, and amphotericin-B therapy. A 35-year-old man was admitted through the emergency room due to fever and the right flank pain. He had received an allogenic bone marrow transplantation eight months ago and had been medicated with prednisolone and cyclosporine since the procedure. He was diagnosed with disseminated mucormycosis that involved the spleen, right kidney, and right lung. He is being successfully treated with amphotericin B, flucytosine, and liposomal amphotericin B.
Adult ; Amphotericin B ; Ants ; Bone Marrow Transplantation* ; Bone Marrow* ; Communicable Diseases ; Cyclosporine ; Debridement ; Diabetes Mellitus ; Diagnosis ; Emergency Service, Hospital ; Fever ; Flank Pain ; Flucytosine ; Hematologic Neoplasms ; Humans ; Hyphae ; Immunocompromised Host ; Kidney ; Lung ; Mortality ; Mucormycosis* ; Prednisolone ; Spleen ; Steroids

PURPOSE: The purpose of this study was to investigate the effects of emotional labor, emotional intelligence and social support on job stress in clinical nurses. METHODS: Participants were 123 clinical nurses and data were collected from October to December, 2011 and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and multiple regression with SPSS 18.0. RESULTS: A positive correlation was found between job stress and emotional labor. Emotional labor showed a significant negative correlation with emotional intelligence and social support, whereas a positive correlation was found between emotional intelligence and social support. The strongest predictor of job stress was emotional labor. In addition, institution satisfaction (dissatisfaction) and the reason for selecting the job (opportunities for service) accounted for 21% of variance in job stress. CONCLUSION: The results of this study suggest that it is important to manage emotional labor as well as to improve job satisfaction in order to reduce job stress in clinical nurses.
Emotional Intelligence ; Job Satisfaction

Churg-Strauss Syndrome is a disorder of hypereosinophilia and systemic vasculitis in subjects with asthma and allergic rhinitis. Clinically, a multiple organ system can be involved with various manifestations of disease of lung, heart, skin, musculoskeletal system, nervous system, gastrointestinal and hepatobiliary tract. We experienced a case of Churg- Strauss syndrome presenting as the appendicitis and the lower gastrointestinal bleeding in a 37-year-old male patient with acute lower abdominal pain. He also showed peripheral eosinophilia, bronchial asthma, and mononeuritis multiplex. He initially received a high dose corticosteroid and was maintained with low doses of corticosteroid, cyclophosphomide and exchange plasmapheresis.
Abdominal Pain ; Adult ; Appendicitis* ; Asthma ; Churg-Strauss Syndrome* ; Eosinophilia ; Heart ; Hemorrhage* ; Humans ; Lung ; Male ; Mononeuropathies ; Musculoskeletal System ; Nervous System ; Plasmapheresis ; Rhinitis ; Skin ; Systemic Vasculitis

H. pylori produces urease abundantly amounting to 6% of total protein of bacterial mass. Urease genes are composed of a cluster of 9 genes of ureC, ureD, ureA, ureB, ureI, ureE, ureF, ureG, ureH. Production of H. pylori urease in E. coli was studied with genetic cotransformation. Structural genes ureA and ureB produce urease apoprotein in E, coli but the apoprotein has no enzymatic activity. ureC and ureD do not affect urease production nor enzyme activity ureF, ureG, and ureH are essential to produce the catalytically active H. pylori urease of structural genes (ureA and ureB) in E.coli. The kinetics of activation of H. pylori urease apoprotein were examined to understand the production of active H. pylori urease. Activation of H. pylori urease apoprotein, pH dependency, reversibility of CO2 binding, irreversibility of CO2 and Ni2+ incorporation, and CO2 dependency of initial rate of urease activity have been observed in vitro. The intrinsic reactivity (ko) for carbamylation of urease apoprotein coexpressed with accessory genes was 17-fold greater than that of urease apoprotein expressed without accessory genes. It is concluded that accessory genes function in maximizing the carbamylating deprotonated E-amino group of Lys 219 of urease B subunit and metallocenter of urease apoprotein is supposed to be assembled by reaction of a deprotonated protein side chain with an activating CO2 molecule to generate ligands that facilitate productive nickel binding.
Apoproteins* ; Helicobacter pylori* ; Helicobacter* ; Hydrogen-Ion Concentration ; Kinetics ; Ligands ; Nickel ; Urea ; Urease*

Takayasu's arteritis is one of the most important causes of the renovascular hypertension in orientals. Among the multiple treatment modalities, percutaneous transluminal renal angioplasty(PTRA) has become the treatment of the choice for major renal artery stenosis and is a safe, repeatable, effective procedure for the treatment of renovascular hypertension due to Takayasu's arteritis. We experienced a case of percutaneous transluminal balloon angioplasty of Takayasu's arteritis involving the proximal left renal artery. After PTRA, clinical and angiographical improvements were achieved.
Angioplasty* ; Angioplasty, Balloon ; Hypertension, Renovascular ; Renal Artery Obstruction* ; Renal Artery* ; Takayasu Arteritis*

The Alstrom syndrome is inherited autosomal recessive disorder, characterized by obesity, diabetes mellitus, pigmentary retinal degeneration, normal intelligence, sensorineural hearing loss, baldness, acanthosis nigricans, male hypogonadism, hyperuricemia and hypertriglyceridemia. There is no reported case of Alstrom syndrome in Korea yet. We experienced a 29-year-old female patient with clinical characteristics similar to Alstrom syndrome who was admitted due to poorly controlled diabetes mellitus and diabetic retinopathy with hemorrhage. We report this case with the review of literatures.
Acanthosis Nigricans ; Adult ; Alopecia ; Alstrom Syndrome* ; Diabetes Mellitus ; Diabetic Retinopathy ; Female ; Hearing Loss, Sensorineural ; Hemorrhage ; Humans ; Hypertriglyceridemia ; Hyperuricemia ; Hypogonadism ; Intelligence ; Korea ; Male ; Obesity ; Retinal Degeneration