Acute Pancreatitis after Extracorporeal Shock Wave Lithotripsy for a Urolithiasis / 대한췌담도학회지

48-year-old woman was admitted to emergency room due to left flank pain. It was diagnosed with left ureteral stone and underwent extracorporeal shock wave lithotripsy (ESWL). However, 12 hours later, the patient complained acute upper abdominal pain with pulmonary edema and low blood pressure. A diagnosis of moderate acute pancreatitis with local complication was considered and we decided conservative therapy including fluid resuscitation, inotropics and antibiotics. It was suggested that ESWL was responsible for the acute pancreatitis. The patient gradually recovered and was discharged on 13th day of admission. ESWL is considered the standard treatment for urolithiasis. Although, it has proved to be safe and effective, serious complications have been reported in 1% of patients, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, and cardiac arrhythmia. Although the possibility of post-ESWL acute pancreatitis is extremely low, physicians should take care of this complication.

Prevalence and clinical features of hypersensitivity reaction to contrast media after prescreening skin test

PURPOSE: Hypersensitivity reactions to contrast media (CM) are one of the most common causes of drug adverse reactions. The overall prevalence of immediate hypersensitivity reaction (IHR) was 0.16%–7.7% to nonionic CM. Although IHR to CM has been traditionally considered nonallergic, there is growing evidence that the mechanism of IHR to CM is mediated by IgE. It can be severe, even fatal, and a legal problem. To reduce IHR, the prescreening skin test is on the rise. METHODS: We reviewed cases of IHR to CM during enhanced computed tomography (CT) from 2008 to 2015 at a secondary hospital in South Korea. Patients who underwent enhanced CT were performed the 2-step prescreening skin test before nonionic CM-enhanced CT. If patients had adverse reactions to CM, the reactions were reported. IHR to CM was defined as an immediate reaction within 1 hour after CM administration. The Ring and Messmer system was used to classify the severity of reactions by grades I to IV, and we defined grades III and IV as severe reactions. RESULTS: A total of 30,105 CM-enhanced CT cases were recruited from 2008 to 2015. A total 46 patients with CM adverse reactions were reported. The IHR were noted in 30 of the total patients (0.1%), of which 6 had severe reaction. CONCLUSION: The prevalences of IHR and severe IHR to CM were 0.1% and 0.02%, respectively. Further studies are needed to evaluate the usefulness of prescreening skin tests to prevent IHR to CM.

Development of a Complete Atrioventricular Block Associated with Intake of Evening Primrose Oil / 대한내과학회지

A complete atrioventricular block is seen in patients due to a variety of causes, including drugs. The resolution of a drug-induced atrioventricular block is often accomplished by drug discontinuation. We report a case of a complete atrioventricular block in a 31-year-old woman following a month of treatment with evening primrose oils. After excluding all other likely causes of conduction disorders, an adverse effect of the evening primrose oils seemed to be the most likely diagnosis. After discontinuation of the oils, no associated symptoms or conduction disturbances were observed for 4 months after discharge. We stress the reconsideration of taking medicines and functional foods continuously as most patients are not aware of the hazards they pose.

Infective Endocarditis in a Patient after Percutaneous Mitral Balloon Valvuloplasty / 대한내과학회지

Percutaneous mitral balloon valvuloplasty (PMBV) is the treatment of choice for mitral stenosis. Only a few reported cases have been reported in PMBV patients worldwide. In this study, a case of a 34 year-old female with infective endocarditis a year after PMBV is presented. The patient presented with fever, and peripheral vascular symptoms. Transthoracic echocardiography showed vegetation on the anterior mitral leaflets and Staphylococcus Viridans was isolated from blood cultures. The patient was successfully treated with Amoxicillin + Clavulate and Gentamicin. Further studies on the correlation between PMBV and infective endocarditis are needed.

Adequate Change Interval of Transfusion Kits during Rapid Transfusion / 대한수혈학회지

BACKGROUND: For a rapid transfusion, pressure is sometimes applied to packed red blood cells during the operation. However, there are neither standard guidelines nor reported data regarding adequate change interval of transfusion kits. The aim of this study is to present relevant data by simulating a surgical situation. METHODS: Each unit of packed red blood cells was mixed with 50 mL of normal saline. Pressure (250 mmHg) was applied to the mixed red blood cells. Each filtration time was measured without change of the transfusion kit. The weight of the mixed red blood cells was measured before and after administration. The passed blood was examined microscopically for detection of possible microaggregation. Eight transfusion sets were tested with 70 packed red blood cells. RESULTS: International guidelines have recommended replacement of the transfusion set if flow rate decreased to less than 100 mL/min. The flow rate of five transfusion sets was recorded as less than 100 mL/min. The flow rate of the third packed red blood cells decreased to less than 100 mL/min. No microaggregate was detected. CONCLUSION: Therefore, we recommended replacement of the blood filter after filtering two units of packed red blood cells with pressure under operation room circumstances.

The effect of oral care interventions on intensive care unit (ICU) patients with stroke / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to evaluate the effects of oral care interventions on stroke patients in the intensive care unit (ICU). Oral hygiene levels, periodontal health, and presence of Candida were evaluated in patients who received an oral care intervention and control patients who did not receive the intervention. METHODS: In this study, 22 stroke patients who were admitted to the ICU between June 2011 and August 2012 underwent oral examinations and were provided with an oral care intervention that included tooth brushing with an interdental brush and the use of a chlorhexidine mouthwash (oral care group), while 21 patients who were admitted to the ICU during the same period did not receive the oral care intervention but underwent oral examination and served as controls (non-oral care group). In the oral care group, oral care was performed once a day for 1-5 weeks according to the general health of the patient. The patients in the oral care group underwent oral examination before and after the oral care intervention. Plaque index, gingival index, clinical attachment loss (CAL), and presence of Candida were evaluated in both the groups. RESULTS: The plaque index and gingival index of the oral care group were significantly lower than those of the non-oral care group; however, no significant difference in CAL was observed. The levels of Candida in the oral care group were lower than those in the non-oral care group. However, no significant intergroup difference was observed in the levels of Candida. CONCLUSIONS: Oral care interventions improved oral health, including oral hygiene and periodontal health, of stroke patients in the ICU. Therefore, this study showed that oral care interventions can be effectively used to improve the oral health of stroke patients in the ICU.

The characteristics of high caries risk group for 12-years children in Korea / 대한구강보건학회지

OBJECTIVES: The aim of this study was to examine the characteristics of the high caries risk group among 12-year-old children in Korea. METHODS: Information on oral health status and interview data were collected from 6,253 children (3,309 male and 2,944 female children) aged 12 years who participated in the Korea National Oral Health Survey in 2010. The subjects were sorted according to the decayed missing filled tooth (DMFT) data. The highest one-third was selected as the significant caries (SiC) group (N=2,184), and the others were classified as the middle group (N=4,466) and the caries-free group (N=7,067). This study also used demographic variables such as gender and area of residence. The variables for the oral health behavior were the number of dental sealants on the first molar, self-perceived oral health, average frequency of tooth brushing per day, and the mean frequency of daily snack consumption. The variables for the oral health status were the mean number of DMFTs and the SiC index. The associations between the high caries risk group and the demographic and social variables, oral health status, and oral health-related consciousness and behavior were evaluated by logistic regression analysis. RESULTS: A significant proportion of the high caries risk group participants had no dental sealant on the first molar (46.4%) and lived in rural areas (38.1%, P<0.05). The determinants of the high-risk group were whether the first molar was sealed ('0', OR=52.67) and the self-perceived oral health ('fair', OR=1.43, 'poor', OR=2.09). CONCLUSIONS: The characteristics of the high caries risk group among 12-year-old Korean children were the absence of dental sealant on the first molar, poor self-perceived oral health, gender, and region.

Improved periodontal health aspects according to the tooth position through the non-surgical professional oral hygiene care in the diabetic youth / 대한구강보건학회지

OBJECTIVES: The aim of this study was to compare short-term and medium-term effects of gingival index (GI) and dental plaque index (PI), according to the tooth position through the oral hygiene education in the diabetic youth. METHODS: The total number of participants were 31 diabetics and 87 controls in the city of Daegu. Oral examination and professional oral hygiene care were performed among the 31 diabetic youth who consented to the study at the first visit. The professional oral hygiene care consisted of the tooth brushing method, oral prophylaxis, scaling, fluoride application, sealant and dental auxiliary education. We collected the data from all participants for the identification of oral condition at 2 weeks and 3 months. The #11, #14, #16, #31, #34, #36 teeth were selected for the measurement of the oral hygiene conditions. GI and PI were used for oral hygiene scores. The data was analyzed with SPSS 18.0 program. RESULTS: Both GI and PI were significantly decreased in the treatment group of the 31 diabetic youth in comparison to the controls, by tooth position compared to the baseline (P<0.001). In particular, GI measurements constantly decreased upto 3 months and the PI measurements decreased upto 2 weeks and increased slightly from 2 weeks to 3 months. In the GI measurements, the decrement of #14 was the highest (48.4%) and #36 was the lowest (25.2%) among all teeth. In the PI measurements, the decrement of #14 was the highest (45.5%) and #16 was the lowest (19.8%) among all teeth. In the control group, PI increased on all tooth positions, and GI increased on some tooth positions. CONCLUSIONS: The program of professional oral hygiene care in the diabetic youth has improved the oral health care when compared to the controls. We suggest that the sites where oral hygiene is more difficult to control have more oral hygiene education than the other sites.

A Case of Fungal Folliculitis Clinically Mimicking Lupus Miliaris Disseminatus Faciei / 대한피부과학회지

Dermatophytes generally cause infection of the stratum corneum and superficial layers of skin. They are, therefore, found less frequently in the rete layer and do not ordinarily penetrate deeper than the basal cell layer. Nevertheless, under special circumstances such as the pressure generated during trauma or long term topical steroid application, the fungus elements of some dermatophytes will be forced into the dermis where they instigate a chronic granulomatous reaction. We report a 43-year-old male who presented with multiple erythematous brown colored dome-shaped papules on both periorbital areas, which were clinically similar to lupus miliaris disseminatus faciei (LMDF). Histologic examination revealed follicular and perifollicular infiltration by inflammatory cells, and perifollicular granuloma. Trichophyton species were isolated from the fungus culture of the lesional tissue. The patient was treated with an antifungal agent, resulting in clearance of the skin lesions, and there was no recurrence of skin lesions during a 13-month follow-up period. We suggest that it is important to perform biopsies and cultures on periorbital papules which mimick LMDF, refractory to conventional therapy.

Validity of Diagnostic Categories Based on Computed Tomography Findings for Acute Lobar Cerebral Hematoma in Patients with a Ruptured Cerebral Aneurysm Compared with That of Patients with Hypertensive Lobar Cerebral Hematoma

PURPOSE: The rupture of a cerebral aneurysm generally presents as a subarachnoid hemorrhage (SAH) and less often involves a lobar cerebral hematoma (LCH). Also, compared with a hypertensive LCH, an aneurysmal LCH is an unfavorable factor for a favorable outcome. Thus, the earlier we detect an aneurysmal LCH, the more favorable the outcome we can expect. We designed this study to use diagnostic categories to compare aneurysmal LCHs with hypertensive LCHs based on computed tomography (CT) findings. METHODS: From Mar. 2003 to Feb. 2004, patients with LCH who visited the emergency department of Kyung Hee University Hospital were divided into two groups. One was the aneurysmal LCH group (29 patients), and the other was the hypertensive LCH group (155 patients). Based on CT findings, we retrospectively compared the two groups by using the following six diagnostic categories: 1) location of hematoma, 2) presence of an aneurysm on enhanced CT findings, 3) disruption of the cerebral cortex, 4) connection of the hematoma to the main cerebral artery, 5) a hematoma involved with a SAH or an intraventricular hemorrhage (IVH), and 6) heterogeneity of a hematoma in Hounsfield unit. RESULTS: The patterns of aneurysmal LCHs and hypertensive LCHs were specific. Statistically, frontal, corpus callosal, and temporal hematomas may result from ruptured aneurysms, but systemic hypertension may cause thalamic, pontine, cerebellar, and subcortical hematomas. The other diagnostic categories, except for heterogeneity of the hematoma, were statistically more specific for the aneurysmal LCH group than they were for the hypertensive LCH group. CONCLUSION: Based on CT findings, we can make a diagnosis of whether the hematoma in a cerebral parenchyma is due to a ruptured aneurysm or not. Moreover, enhanced CT gives more valuable information for a differential diagnosis. Thus, we propose that enhanced CT be carried out for all non-traumatic LCH patients.

Acute Spontaneous Thoracic Spinal Epidural Hematoma: A Case Report

Spontaneous spinal epidural hematoma (SSEH) is a rare entity that has been reported to occur in different age groups, from pediatric to elderly patients. The etiology and the pathogenesis remain unclear. By definition, SSEH excludes that due to obvious trauma, anticoagulant therapy, coagulopathy, vascular malformation, and tumors. The pre-senting symptoms vary, but the usual earliest presentation is a sudden stabbing pain associated with a nerve-root type of irradiation. A variable degree of sensorimotor deficit then rapidly develops. An urgent computed tomography (CT) myelography and magnetic resonance imaging (MRI) can be performed to diagnose the hematoma. For patients with incomplete sensorimotor deficit, favorable outcomes are thought to correlate highly with surgery (decompressive laminectomy) within 48 hours. This critical time is sharply reduced to 12 hours for patients with complete sensorimotor deficit.

Spontaneous Hemobilia Complicating Warfarin Therapy: A Case Report

Hemobilia is defined as hemorrhage into the biliary tract as a result of a communication between the biliary tract and arteriovenous circulation. A classical triad of symptoms and signs are upper abdominal pain, gastrointestinal bleeding, and jaundice. Hemobilia is a rare condition that may be difficult to recognize; it is, nevertheless, important to include it in the differential diagnosis of gastrointestinal bleeding. The causes include accidental and iatrogenic trauma, gallstones, inflammation, vascular malformation, and tumors. Due to the frequent use of diagnostic and therapeutic procedures involving hepatobiliary and portal systems, there has been an increase in the incidence of iatrogenic hemobilia during the last two decades. Like hematuria and epistaxis, hemobilia may also occur in coagulopathy, but acquired coagulopathy with anticoagulation therapy is very rarely associated with this condition. We present a case of acquired coagulopathy following warfarin therapy that resulted in spontaneous hemobilia complicating acalculous cholecystitis and cholangitis.

Symptomatic Eosinophilic Peritonitis in CAPD Treated with Low Dose of Oral Prednisolone / 대한신장학회잡지

Eosinophilic peritonitis is not uncommonly observed in patients on peritoneal dialysis. It typically occurs within the first 3 months after the initiation of peritoneal dialysis. Eosinophilic peritonitis is usually a benign and self-limiting process with the exception of fungal eosinophilic peritonitis. The use of oral or intraperitoneal steroids has been suggested only for patients with abdominal pain or with markedly turbid peritoneal effluent. We report a case of eosinophilic peritonitis with severe abdominal pain, which successfully resolved on treatment with single dose of oral prednisolone.

Contractile and relaxing responses of the contralateral renal artery in renovascular hypertensive rats / 대한내과학회지

Although only a small portion of patients with hypertension have renal hypertension, studies regarding renal hypertension may provide insight into the pathophysiology of essential hypertension. An increased vascular reactivity to vasoconstrictor substances has been observed both in clinical hypertension and in animal models of hypertension. This study was designed to evaluate the contractile and relaxing responses of the contralateral renal artery in renovascular hypertension and to provide an explanation of one of the mechanisms of renovascular hypertension. METHODS: In the first experiment, an experimental renovascular hypertension model was established by clipping the left renal artery of Sprague-Dawley rats. These rats were then divided into two groups of which one was given enalapril during one week post-operation before being terminated. Ring preparations of the contralateral side of the renal artery were obtained one week after the operation. The contraction of renal artery strips were induced by high potassium or norepinephrine, and the relaxation of them were produced by acetylcholine or sodium nitroprusside. The contractile and relaxing responses were recorded and compared with the data obtained from control group. In the second experiment, the rats received angiotensin converting enzyme inhibitor, 5mg percent enalapril in the drinking water for 7 days after induction of renal artery stenosis operation. Then, the contractile and relaxing responses were evaluated by the same method as control group. RESULTS: 1) The contralateral renal artery of renovascular hypertensive rats showed significantly increased contractile responses to the high potassium or norepinephrine as compared with that of control group (p<0.05). 2) Increased contractile reponses of the renal artery to the high potassium or norepinephrine were normalized to the control group level when enalapril was given. 3) The relaxing responses by acetylcholine were reduced on the contralateral renal artery in renovascular hypertensive rats as compared with that of the control group. However, no remarkable differences were noted between them with the sodium nitroprusside. 4) There were no significant differences in the acetylcholine or nitroprusside induced vasodilation response between enalapril-given renovascular hypertensive rats and control rats. CONCLUSION: These results suggest that endothelial dysfunctions may lead to renal hypertension and that enalapril(ACE inhibitor) may prevent the development of renal hypertension by maintaining endothelial function.

Contractile and relaxing responses of the contralateral renal artery in renovascular hypertensive rats / 대한내과학회지

Although only a small portion of patients with hypertension have renal hypertension, studies regarding renal hypertension may provide insight into the pathophysiology of essential hypertension. An increased vascular reactivity to vasoconstrictor substances has been observed both in clinical hypertension and in animal models of hypertension. This study was designed to evaluate the contractile and relaxing responses of the contralateral renal artery in renovascular hypertension and to provide an explanation of one of the mechanisms of renovascular hypertension. METHODS: In the first experiment, an experimental renovascular hypertension model was established by clipping the left renal artery of Sprague-Dawley rats. These rats were then divided into two groups of which one was given enalapril during one week post-operation before being terminated. Ring preparations of the contralateral side of the renal artery were obtained one week after the operation. The contraction of renal artery strips were induced by high potassium or norepinephrine, and the relaxation of them were produced by acetylcholine or sodium nitroprusside. The contractile and relaxing responses were recorded and compared with the data obtained from control group. In the second experiment, the rats received angiotensin converting enzyme inhibitor, 5mg percent enalapril in the drinking water for 7 days after induction of renal artery stenosis operation. Then, the contractile and relaxing responses were evaluated by the same method as control group. RESULTS: 1) The contralateral renal artery of renovascular hypertensive rats showed significantly increased contractile responses to the high potassium or norepinephrine as compared with that of control group (p<0.05). 2) Increased contractile reponses of the renal artery to the high potassium or norepinephrine were normalized to the control group level when enalapril was given. 3) The relaxing responses by acetylcholine were reduced on the contralateral renal artery in renovascular hypertensive rats as compared with that of the control group. However, no remarkable differences were noted between them with the sodium nitroprusside. 4) There were no significant differences in the acetylcholine or nitroprusside induced vasodilation response between enalapril-given renovascular hypertensive rats and control rats. CONCLUSION: These results suggest that endothelial dysfunctions may lead to renal hypertension and that enalapril(ACE inhibitor) may prevent the development of renal hypertension by maintaining endothelial function.

Lymphocyte Subpopulations in Patients with Minimal Change Disease and IgA Nephropathy / 대한신장학회잡지

The pathogenetic mechanisms of minimal change disease and immunoglobulin A nephropathy remain uncertain, but recently various reports have reported the important role of the immunological aspect in the pathogenesis of glomerular injury. To assess the abnormalities of immunoregulatory system in these glomerular disease, the percentages of lymphocyte subpopulations in peripheral blood were studied in 24 cases of minimal change disease and 28 of immunoglobulin A nephropathy diagnosed by renal biopsy. The results were as follows: 1) CD4/CD8 ratio of the minimal change disease was significantly increased, compared with normal controls and immunoglobulin A nephropathy(P<0.05). 2) No significant difference in T helper cell and T suppressor cell was found between steroid response group and steroid non-response group in minimal change disease. 3) No significant difference in lymphocyte subpopulation was found between group with nephrotic range of proteinuria and group without nephrotic range of proteinuria in minimal change disease. 4) The discrepancies in lymphocyte subpopulations was not observed between group with infection and group without infection in immunoglobulin A nephropathy. 5) The pathologic grade (criteria of WHO) did not demonstrate a significant difference in lymphocyte subpopulation in immunoglobulin A nephropathy. In conclusion, these results suggest that the dysregulation of cell-mediated immunologic system is involved in the pathogenesis of minimal change disease and immunoglobulin A nephropathy, and some differences of immunoregulatory abnormalities between minimal change disease and immunoglobulin A nephropathy exist. But in this study the change in lymphocyte subpopulation does not anticipate the clinical course and prognosis of minimal change disease and immunoglobulin A nephropathy.

Aneurysm of the Right Coronary Artery with Acute Myocardial Infarction after Blunt Chest Trauma : A Case Report

Despite a large number of automobile accidents, the aneurysm of a coronary artery from blunt chest trauma in a very rare entity. Especially aneurysm of the right coronary artery has been few previously described. A 24-yeal old man sustained blunt chest trauma from steering wheel contact during automobile accident 6 hours after admission, an electrocardiogram revealed complete heart block with ST elevation in lead II, III, and aVF. He needed temporary transvenous cardiac pacing and large amount fluid infusion for treatment of cardiogenic shock from bradycardia and right ventricluar infarction in emergency center. 2-dimensional echocardiogram showed akinetic inferior wall of the left ventricle and dilatation of the right ventricle. Coronary arteriography revealed a saccular aneurysm in the proximal right coronary artery without atherosclerotic change. Size of aneurysm in right coronary artery remained unchanged on repeat coronary arteriogrpahy. His hospital course was uneventful and discharged without any sign of residual ischemia.

Utility of fine needle aspiration in patients with thyroid nodules classified by surgical pathology / 대한내분비학회지

No abstract available.