A Peculiar Type of Anomalous Pancreaticobiliary Ductal Union / 대한소화기내시경학회지

Anomalous pancreaticobiliary ductal union (APBDU) is an uncommon anomaly, defined as the junction between the common bile duct and the pancreatic duct outside the duodenal wall and beyond the influence of the sphincter of Oddi. This anomaly, which has been recognized frequently since the introduction of ERCP, is believed to be associated with biliary tract lesions such as congenital biliary dilatation, biliary tract carcinoma, and pancreatic lesions such as pancreatitis new paragraph. A 28-year-old male was admitted due to sudden abdominal pain and vomiting. An ERCP revealed a peculiar type of APBDU; the duct of Wirsung and CBD fused and formed a long common channel before entering the major papilla, and the duct of Santorini connected to the duct of Wirsung is patent. So, when contrast dye was inserted into the minor papilla, both the CBD and the duct of Wirsung were made visible. This case of the peculiar type of APBDU which showed characteristic ERCP findings are herein reported.

A case of Thrombotic thrombocytopenic purpura - hemolytic uremic syndrome presenting with cortical blindness confirmed by MRI / 대한내과학회지

Thrombotic thrombocytopenic purpura (TTP) and the related hemolytic uremic syndrome (HUS) are disorders characterized by thrombocytopenia, microangiopathic hemolytic anemia, a variable degree of impairment of renal function and fluctuating neurological symptoms, which are thought to be due to platelet activation and subsequent formation of thrombi in the microcirculation. The fact that there was no clear-cut clinical and laboratory features that differentiate HUS from TTP has lead to view these two syndromes as a clinical continuum. Microvascular thrombosis is the typical lesion and closely related with endothelial injury and platelet activation. Pathologic alterations of the brain parenchyma are mainly manifested by small multiple infarcts. Numerous cases of CNS complications of these syndromes have been evaluated by using CT, but few reports have mentioned the MR findings. We experienced a case of TTP-HUS that had clinical features of cortical blindness and the brain lesion was confirmed by MRI showing cerebral infarct at the occipital area but it was reversible course. So we report this case with a brief review of literature.

A Case of Lipoid Pneumonia after Ingestion of Green Perilla Oil / 결핵

We report a case of lipoid pneumo nia in a 57-year-old man who had a history of ingestion of green perilla oil and residual neurologic deficit of cerebral infarction with right hemiparesis. Lipoid pneumonia was diagnosed by bronchoalveolar lavage.

Exercise Performance Test Using Bicycle Ergometer in Patients with Diabetes Mellitus

The physical activity has an important physiological and psychological benefit for all people, and the exercise program has a key role in the management of diabetes. This article presents exercise recommendations for people with diabetes. Though the patients with diabetes may give many benefits from regular physical exercise, there may be several hazards from exercise as well. We assessed 30 patients with type 2 Diabetes Mellitus and 15 normal control subjects with sedentary life-style for their workload, heart rate on maximal performance and maximal oxygen uptake, change of blood glucose level after exercise using bicycle ergometer and Astrand nomogram. The workload, heart rate on maximal performance and maximal oxygen uptake were lower in diabetic patient than control subjects. Blood glucose decreased in diabetic patient than control subjects, after exercise and the lowered value was maintained until 60 minutes after exercise. The maximal oxygen uptake was lower in diabetic patients than control subjects. The blood glucose decreased in both diabetic patients and normal control after exercise.

The Prediction of Postoperative Pulmonary Complications in the Elderly Patients / 결핵

BACKGROUND: we have evaluated the association of age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases with postoperative pulmonary complications and identified which parameter of preoperative spirometry was a predictor of postoperative pulmonary complications. METHOD: In 270 patients older than 60 years, the postoperative pulmonary complications were evaluated according to age, smoking, type of anesthesia, type of operation, duration of surgery, previous history of chronic pulmonary diseases and the parameters of preoperative spirometry were analyzed. RESULTS: The postoperative pulmonary complications rates were significant higher among patients older than 70 years, and among those with previous chronic pulmonary diseases or their smoking history. The pulmonary complications were increased among patients with general anesthesia or duration of surgery more than 2 hours. The pulmonary complications rates did not differ according to sex, type of operation. The patients with hypercarbia(PaCO2> 45mmHg) have more increased postoperative complications. The preoperative FEVl less than 1 liter, FVC, MMEFR & MVV less than 50% of predicted respectively were predictive of complications. CONCLUSION: Age 70, history of smoking,duration of operation more than 2 hours, general anesthesia, previous chronic pulmonary disease and hypercarbia (> or=45mmHg) on preoperative arterial blood gas analysis were predictivd of pulmonary complications. Among the parameters of spirometry, FEV1, FVC, MMEFR and MVV were indicator of predicting postoperative pulmonary complications.