A case report of the salivary duct cyst and review of literatures

The salivary duct cyst is a rare disease and usually found in the parotid gland. A 55-years-old man presented swelling in the left buccal area and pathological diagnosis was a salivary duct cyst. Though its recurrence has been reported rare, the presented case showed recurrent swelling after enucleation. The recurrent lesion was successfully treated by incision and drain insertion.

Case report: Maxillary sinus aspergillosis

The incidence of aspergillosis infections in the maxillary sinus has increased recently, because of overuse of antibiotics, steroids, anticancer agents, immunosuppressant, antimetabollites, and uncontrolled diabetes mellitus. The clinical features of maxillary sinus aspergillosis include pain, swelling and foul odor nasal excretion. This needs to be differentiated from bacterial maxillary sinusitis, and surgical treatment with antifungal agents are suggested. Recently, we treated two patients with maxillary sinus aspergillosis surgically (Caldwell Luc operation) and with antifungal agents(itraconazole). The results were satisfactory so we report these cases with literature review.

The clinical study of maxillary sinus septa used in panorama, CT

PURPOSE: The aim of this study was to examine the incidence, location and morphology of antral septa using radiographic exam.(Panorama, CT) in the dentate/non-atrophic and edentulous/atrophic maxillary segments. MATERIAL AND METHODS: 232 sinuses were subdivided into two groups(group1 : 175 sinuses were classified as complete & partial dentate maxillary segments, group2 : 57 sinuses were classified as complete edentulous maxillary segments) and were investigated for the incidence, location and morphology of maxillary sinus septa. RESULTS: A total of 80 septa were observed in 232 maxillary sinuses, which corresponded to 30.65% of the sinuses(71 of 232). 67.5% of the total septa was observed in the complete & partial dentate groups, but 32.5% of the total septa was observed in the complete edentulous group. Upon analysis of the anatomical location of the septa, it was seen that 14 septa(17.5%) were located in the P1 area, 15 septa(18.7%) were located in the P2 area, 19 septa(23.8%) were located in the M1 area and 32 septa(40%) were located in the M2 area and dista area of M2. we found 45 septa in the apical lesion of teeth, Group 1. However the remaining 9 septa were found in the edentulous area. CONCLUSION: CT is a better method than panoramic radiography for detecting the presence of the maxillary sinus septa. Maxillary sinus septa are more commonly detected in complete edentulous maxillary segments than in complete and partial dentate maxillary segments. Also maxillary sinus septa are more commonly detected posteriorly than anteriorly.

Current Indications for Open Stone Surgery in the Treatment of Renal and Ureteral Calculi after Introduction of ESWL / 대한비뇨기과학회지

PURPOSE: The developments and advances in extracorporeal shock wave lithotripsy and endourological procedures have greatly diminished the need for open surgery in the treatment of renal and ureteral stones. We reviewed our experience of open stone surgery to determine current indications and efficacy of this treatment modality. MATERIALS AND METHODS: We undertook a review of hospital and office charts, operative records, and pertinent radiographic studies of all patients that had undergone open stone surgery from May 1986 to June 2001 at a single tertiary university hospital. Of 5,533 procedures performed for stone removal, 355 were open surgical procedures (6.4%), these included ureterolithotomy in 215 (60.6%), pyelolithotomy in 50 (14.1%), anatrophic nephrolithotomy in 43 (12.1%), and nephrectomy in 47 (13.2%). RESULTS: The indications for open surgery were complex stone burden (61%), failure of extracorporeal shock wave lithotripsy or endourological treatment (9%), other co- operation (10.4%) and anatomical abnormalities, such as: ureteropelvic junction obstruction, infundibular stenosis and/or renal caliceal diverticulum (6.5%). Stone free rate, following surgery, was 90.7%. All patients had minor postoperative complications that were resolved with appropriate therapy. CONCLUSIONS: Open stone surgery continues to be a reasonable alternative modality for a small proportion of patients with urinary stones. Those patients with large urinary stone, failed less invasive method, anatomical abnormality and serious medical diseases would be recommended for open stone surgical correction.

Proximal Migration of Ureteral Stent after Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

Double-pigtail ureteral stent has been used to prevent the ureteral obstruction from calculi and to pass the urine easily after extracorporeal shock wave lithotripsy (ESWL). One of the complications in stent indwelling is the migration of the stent. Especially the proximal migration of double-pigtail ureteral stents is rare. One of the several theories that have been proposed to account for cephalad migration is a stent movement in conjunction with kidney movement during respiration. The reason is that the respiration makes the kidney move in both upward and downward directions while the stent, held by fragemented ureteral stone, moves only in upward direction. We call this cause of the proximal migration of the stent, 'Jack' phenomenon. Therefore, if the residual calculi remain after ESWL with ureteral stent, we need close observation.

Microbial Features and Antibiotic Prophylaxis of Prosthetic Joint Infection / 감염

BACKGROUND: Success in orthopedic implant surgery relies on reducing infection by preventive methods including antibiotic prophylaxis. The lack of published data on orthopedic implant infections with methicillin-resistance Staphylococcus aureus (MRSA) and methicillin-resistance coagulase-negative staphylococcus (MRCNS) makes it difficult to choose correct prophylactic antibiotics. We therefore reviewed the etiology of prosthetic joint infection and the effectiveness of current antibiotic prophylaxis. METHODS: We reviewed retrospectively the clinical notes and microbial records of patients with prosthetic joint infection who had admitted in Asan Medical Center from June 1989 to July 1999. RESULTS: During a eleven-year period, prosthetic joint infections occurred in 18 (0.9%) of 2,028 patients who received a total hip or total knee arthroplasty at Asan Medical Center (AMC). The cephalosporins were administered to most of patients before surgery for prophylaxis. Twenty two patients were referred to our institution because of prosthetic joint infection. Thirty five patients had positive bacteriological cultures from tissue removed at the time of surgery or joint aspiration. Staphylococci were the most common pathogens and accounted for twenty four (68.8%) of the 35 isolates. Seven (50%) of the fourteen isolates of coagulase-negative staphylococci were MRCNS. Eight (80 %) of the ten ioslates of S. aureus were MRSA. Gram-negative bacilli accounted for five (14.3%) of the isolates and included Escherichia coli, Serratia marcescens, Pseudomonas aeruginosa. CONCLUSION: First-or second-generation cephalosporins were effective prophylatic antibiotics in total hip or total knee arthroplasty because the rate of prosthetic joint infections was low (0.9%). But the prevalence of MRCNS or MRSA prosthetic joint infection was high, we must consider glycopeptides prophylaxis if there is, or has been, infection or carriage with MRCNS or MRSA.

A Case of Systemic Amyloidosis

Systemic amyloidosis is an uncommon disease characterized by deposits of fibrillar aggregates of monoclonal immunoglobuloin light chains in vital organs. This amyloid deposit cause cardiac or renal dysfunction and ultimately, death. Cardiac amyloidosis may be asymptomatic or important causes of progressive heart failure and refractory arrhythmia. Cardiac involvement from AL amyloidosis is rapidly fatal. The amyloidoses are classified according to the biochemical nature of the fibril-forming protein. Cardiac amyloidosis is common in primary (AL) and heterofamilial amyloidosis and very rare in the secondary (AA) form. As we experienced a case of systemic amyloidosis affected heart, liver and kidney, which was confirmed by histology. We present a 57-year-old female case with literature review.

Relation of Carotid Artery Intima-Media Thickness and Atherosclerotic Plaque with the Extent of Coronary Artery Stenosis

BACKGROUND: Noninvasive measurements that relate to the extent and severity of coronary atherosclerosis have long been sought for clinical screening of patients with chest pain syndromes and for use in clinical trials. Intima-media thickeness (IMT) of the carotid artery has been suggested to be associated with coronary artery atherosclerosis. In this study, we tried to assess the relation of carotid artery atherosclerosis by B-mode ultrasonography with presence and severity of coronary artery disease. METHOD: We studied 57 patients (36 men, 21 women) with ischemic heart disease, mean age 65+/-8 yrs (48 to 83 yrs), who underwent both coronary angiography and carotid ultrasonography with 10 MHz transducer. The patients who had received revascularization procedure were excluded. We classified the patients into two groups, the control group without significant coronary stenosis (18 patients) and the coronary artery disease (CAD) group (39 patients) with significant luminal stenosis (> or =50%). The CAD group was divided into single vessel disease group (SVD, 19 patients) and multivessel disease group (MVD, 20 patients). IMT was measured in far wall of common carotid artery (CCA) at 10 mm proximal to carotid bulb and abnormal IMT was defined if the measurement was greater than mean IMT+2SD of control group. Serum total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglyceride (TG), Lipoproteinp (a)(Lp(a)) were measured and history of hypertension, diabetes mellitus, and smoking were investigated. RESULTS: A significant difference in IMT of the CCA was found between control and CAD group (0.76+/-0.09 mm vs. 0.97+/-0.20 mm; p<0.0001). Also a significant difference in the number of atherosclerotic plaque was found between the two groups (control; 0.67+/-1.14 vs. CAD; 1.87+/-1.75; p<0.005). In the CAD group, both mean IMT and numbers of athero-sclerotic plaque tended to increase in MVD group compared with SVD group (1.03 mm vs. 0.91 mm; p=NS, 2.65 vs. 1.05; p<0.05). The sensitivity of IMT for prediction of significant CAD was 66.7%, the specificity 83.3%, the positive predictive value 89.7%, and the negative predictive value 53.6%. The sensitivity of plaque presence on the carotid artery for prediction of CAD was 71.8%, the specificity 61.3%, the positive predictive value 80.3% and the negative predictive value 50.5%. Among risk factor, diabetes mellitus and Lp (a) were correlated well with IMT of CCA, Hypertension was correlated with atherosclerotic plaque. History of smoking was correlated with coronary artery disease. CONCLUSION: Increases in IMT and plaque of the carotid artery, as measured noninvasively by ultrasonography, can be used as a predictor of significant coronary artery stenosis.

A Case of Double-Chamber Right Ventricle Associated with Ventricular Septal Defect

Double-chamber right ventricle (DCRV) is a rare congenital heart disease consisting in right ventricular obstruction due to one or several anomalous muscle bundles that divide the right ventricle into two chambers. The right ventricular outflow tract obstruction is generally progressive in these patients. A ventricular septal defect is one of the commonly associated malformations. A 23-year-old woman with exertional dyspnea was admitted to our hospital and undertaken echocardiography, cardiac catheterization and both ventricular angiograms. The diagnosis was established and report with review of literatures.

A Case of Femoral Artery Pseudoaneurysm , which was Developed after Interventional Cardiology Procedure , Treated with Color Doppler Ultrasound-Guided Direct Compression

Vascular complications such as hematoma, pseudoaneurysm and arteriovenous fistula that occur after intracoronary or intracardiac procedures are responsible for considerable morbidity and some mortality. Iatrogenic aneurysms are usually postcatheterization pseudoaneurysms of the femoral artery. Nowadays, it is not uncommon as a consequence of more complex interventional procedures, larger catheters and prolonged anticoagulation treatment. Surgical repair has been mainstay of treatment for pseudoaneurysm. However, recently has it been shown that color Doppler ultrasound-guided direct, noninvasive compression of the pseudoaneurysm stops the blood flow in the communication and lead to pseudoaneurysm clotting and obliteration. We report a case of pseudoaneurysm in femoral artery, which was developed at the right inguinal puncture site in 74 year old male patient with myocardial infarction who had received continuous intravenous infusion of heparin and had undergone primary percutaneous coronary angioplasty and temporary pacemaker insertion treated successfully with color Doppler ultrasound guided direct compression.

Melena as a Unusual Presentation of Sarcomatoid Renal Cell Carcinoma / 대한비뇨기과학회지

No abstract available.

Hypotensive Effect of Diltiazem Hydrochloride(Herben(R)) in Essential Hypertension: A Clinical Study

The hypotensive effect of diltiazem hydrochloride(Herben(R)) was investigated with 32 cases of essential hypertension. Diltiazem, 90-180mg per day, was administer ed in divided doses to each of the subjects for 6 week and the blood pressure lowering effect was assessed, as remarkably effective when the lowering of blood pressure was, 20mmHg or more of systolic pressure and 10mmHg or more of diastolic pressure; as satisfactorily effective when 20mmH or more of systolic pressure or 10mmHg or more of diastolic pressure was lowered; as fairly effective when 10-19mmHg of systolic pressure and 5-9mmHg of diastolic pressure. 1. With above mentioned criteria, diltiazem was remarkably, satisfactorily and fairly effective in 11(37%), 13(43%) and 1(3%) of 30 patients, respectively, while the drug was ineffective in 5(17%). 2. Diltiazem was effective in lowering of both systolic and diastolic blood pressure, and was effective as a sole agent of as an agent of combination therapy. 3. With diltiazem treatment, the depressed ST segment was conversed to isoelectric line in all of 10 cases which showed ST depression before diltiazem treatment and the elevated ST segment was conversed to isoelectric line in 1 of 2 cases. all of 4 cases with flat T wave and 10 of 12 cases with inverted T wave showed conversion to upright T waves after diltiazem treatment. 4. Undesirable side effects was observed in 2 cases out of 32 cases(6%); 1 case of erythema multiforme-like skin eruption and 1 case of the clinical aggravation of congestive heart failure, in whom the diltiazem administration was discontinued.