A Case of an Accessory Cystic Duct Draining into the Right Intrahepatic Duct / 대한췌담도학회지

Anatomic variations in the biliary tree may not be detected until adulthood and they can cause unexplained jaundice and biliary pain. Recognition of these anatomic variations is important to avoid an incorrect diagnosis and significant ductal injury during biliary surgery. Although there are numerous anatomic bile duct variations, an accessory cystic duct draining into the right hepatic duct is rare. We report a case of an accessory cystic duct draining into the right hepatic duct with cholelithiasis, in which the abnormality was identified by endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography and confirmed by laparoscopic cholecystectomy.

Pseudomembranous Colitis: A Complicated Case with Transient Increase of Carcinoembryonic Antigen / 이화의대지

Pseudomembranous colitis (PMC) is a frequent cause of morbidity and mortality among hospitalized patients. Although diarrhea is the most common manifestation, PMC may be associated with intraperitoneal fluid accumulation in the severe cases. And a few cases showing both ascites and pleural effusion have been reported in patients with PMC. We report a case of PMC who showed elevated serum and ascites levels of carcinoembryonic antigen (CEA) with a normal CEA level in pleural effusion and who successfully recovered after oral administration of metronidazole. After treatment, the serum CEA level returned to the reference range.

A Case of Near Total Occlusion of the Renal Artery after Endovascular Abdominal Aortic Aneurysm Repair

Endovascular abdominal aortic aneurysm repair is a safe, durable, and effective procedure. However, complications could occur with stent graft devices. When the renal ostia become obstructed by this device, renovascular hypertension may result. In general, renal artery occlusion secondary to stent graft impingement remains uncommon. We herein describe a patient with renal atrophy, new-onset hypertension, and elevated serum renin and aldosterone levels following endovascular aneurysm repair. Blood pressure and the levels of renin and aldosterone were normalized by renal artery stenting.

Postimplantation Syndrome After Endovascular Aortic Aneurysm Repair in an Elderly Patient

Endovascular procedures have been proposed as minimally invasive alternative treatments, allowing safe and effective aortic aneurysm repair. Despite the potential benefits, endovascular stent grafting may elicit an unexpected systemic inflammatory response, called postimplantation syndrome (PIS). The main features of PIS include fever, elevated C-reactive protein levels, leukocytosis and/or coagulation disturbances, perigraft air on abdominal computed tomography, and no evidence of infection. The main management of PIS is supportive care. Antibiotics have no clinical benefit. We report a case of PIS after endovascular aortic aneurysm repair in an elderly patient.

Obesity Increases Blood Pressure Variability during the Night

BACKGROUND: Previous studies have reported that obesity increases heart rate variability. Body mass index (BMI) has been reported to affect blood pressure variability (BPV) over 24 hours. However, the diurnal variation in the effect of BMI on BPV has not been evaluated. This study aimed to clarify the diurnal variation in the effect of BMI on BPV. METHODS: A total of 2,044 patients were consecutively enrolled in this study, and the data were analyzed retrospectively. All patients underwent 24-hour ambulatory blood pressure monitoring. We divided patients into two groups according to BMI (non-obese group: n = 1,145, BMI or = 25). We compared BPV during daytime and nighttime between the non-obese and obese groups. We also evaluated the impact of BMI on BPV by multivariate regression analysis. RESULTS: On univariate regression analysis, there was no significant difference in BPV during daytime (systolic BP [SBP] variability: 20.7 vs. 21.7, p = 0.511; diastolic BP [DBP] variability: 16.8 vs. 17.5, p = 0.539). However, both SBP variability (13.8 vs. 17.6, p = 0.009) and DBP variability (11.7 vs. 14.3, p = 0.042) during nighttime were affected significantly by BMI. After adjusting other compounding variables (age > 60 years, current smoking habit, hypertension, diabetes mellitus, and use of calcium channel blockers and renin-angiotensin-aldosterone system blockers), multivariate analysis showed that BMI was an independent factor associated with increase in BPV during the night (SBP variability: p = 0.039; DBP variability: p = 0.034). CONCLUSIONS: Obesity increased BPV during nighttime.

The Inflammation Markers According to the Presence of Coronary Artery Disease in Patients with Peripheral Artery Disease

OBJECTIVE: Prevalence of coronary artery disease (CAD) has been reported to be high in patients with atherosclerotic peripheral artery disease (PAD) in lower extremities. Various inflammatory markers have been known to be associated with CAD. The aim of study was to explore the role of inflammatory makers for CAD in patients with PAD. METHODS: A total of 346 PAD patients (71.51+/-9.41 years, 337 males) who underwent percutaneous transluminal angioplasty from June 2006 to April 2012 were included in this study. Patients were divided into the Group I (PAD with CAD: n=151, 149 males) and the Group II (PAD without CAD: n=195, 188 males). RESULTS: Among 346 patients, 149 patients had CAD (43.6%). The prevalence of diabetes mellitus (DM) (p=0.023) and smoking (p=0.010) were significantly higher in the group I when compared withthe group II. The level of high sensitivity C-reactive protein (hs-CRP) increased (p or =3.0 mg/dL) (OR=2.595, 95% CI: 1.548-4.350, p<0.001), and age (OR=0.645; 95% CI, 0.454-0.915; p=0.014) were independent predictors for the development of CAD in PAD patients. CONCLUSION: 43.6% of patients with PAD also had CAD, and the predictors of CAD were smoking, DM, and high level of hs-CRP.

Transradial Coronary Intervention: Comparison of the Left and Right Radial Artery Approach

BACKGROUND AND OBJECTIVES: We evaluated the efficacy and safety of the left transradial approach as compared to the right radial approach when performing transradial coronary intervention. SUBJECTS AND METHODS: We performed the transradial coronary intervention in 711 cases via the left approach (Lt. group) and in 614 cases via the right approach (Rt. group) for patients with a normal Allen's test of both arms. We evaluated the procedural success rate, the crossover rate, the puncture time, the total procedural duration, the fluoroscopy time, the amount of contrast agent used and the local vascular complications of both groups. RESULTS: The baseline clinical and angiographic profiles were comparable between both groups. The puncture time, the amount of contrast agent used, choice of the guide catheter and local vascular complications were similar for the two groups. There was no difference in the procedural success rate (Rt. group; 96.4% vs. Lt. group; 96.2%, p=NS). However, there was tendency for a higher success rate via radial access for the Lt. group than for the Rt. group (Rt. group; 91.9% vs. Lt. group; 93.5%, p=0.056). The crossover rate was lower for the Lt. group than for the Rt. group (2.7 % vs. 4.6%, respectively; p=0.04). The total procedural time (32.3+/-15.4. vs. 30.7+/-17.6 min, respectively; p=0.03) and fluoroscopy time (16.9+/-12.6 vs. 13.9+/-7.9 min, respectively; p<0.01) were shorter in the Lt. group. The number of guide catheters used was higher in the Rt. group compared to the Lt. group (1.21+/-0.48 vs. 1.08+/-0.33, respectively; p=0.04). CONCLUSION: The left radial approach may provide increased procedural efficacy for transradial PCI compared to the right radial approach along with similar complications.

A Diagnostic Value of Ischemia Modified Albumin in Patients with Suspected Acute Coronary Syndrome with Normal EKG and Cardiac Markers

BACKGROUND AND OBJECTIVES: In the early phase of acute chest pain, the diagnosis of acute coronary syndrome (ACS) is often difficult to achieve in an emergency department (ED) due to the non-diagnostic ECG and cardiac markers. Ischemia modified albumin (IMA) has recently been shown to be a sensitive early biochemical marker of ischemia. The aim of this study was to evaluate the diagnostic value of IMA for the patients with suspected ACS and who have normal ECG/cardiac markers. SUBJECTS AND METHODS: We enrolled 142 consecutive patients who presented to the ED due to suspected ACS, and they had a normal EKG and troponin-I/CK-MB within 5 hours after the onset of their chest pain. The diagnosis of ACS was based upon the clinical findings, the results of serial ECG/troponin and the coronary angiography. The ideal cutoff value of IMA for ACS was calculated by the receiver operator characteristic (ROC) curve analysis. RESULTS: The ACS was diagnosed in 80/142 (56%). The ROC curve area for the IMA test was 0.77 (CI; 0.70-0.85, p<0.01). At a cutoff value of 98.5 U/mL, the sensitivity, specificity and negative predictive values for ACS were 73%, 75% and 75%, respectively. At a cutoff value of 85 U/mL, the sensitivity and specificity and negative predictive values for ACS were 92%, 35% and 95%, respectively. CONCLUSION: IMA might be a useful diagnostic marker of ACS for those patients with normal ECG/cardiac markers and who present within 5 hours after the onset of chest pain.

Primary Carcinoid Tumor of the Testis / 대한남성과학회지

Primary testicular carcinoid is a rare disease, accounting for less than 1% of all testicular neoplasms, with the potential for distant metastasis. We report a case of primary testicular carcinoid in a 44-year-old-man who presented with a painless, palpable mass in the left testis. Preoperative testicular ultrasound examination revealed a solid mass. Radical orchiectomy was performed, and pathologic examination showed a carcinoid tumor confined to the testis. There was no evidence of carcinoid syndrome, and a 24-hour urinary 5-HIAA assay was normal. Abdominopelvic CT scan and gastrointestinal contrast study showed no evidence of carcinoid in other organ. At 12 months postoperatively, the patient was without evidence of tumor recurrence.

In-situ Extracorporeal Shock Wave Lithotripsy (ESWL) Using an Ultrasonographic Localization System for Mid-Ureteral Stones / 대한비뇨기과학회지

PURPOSE: In situ ESWL is the most attractive treatment for mid-ureteral stones as it is non-invasive and effective. X-ray fluoroscopy is usually used to localize the mid-ureteral stones for in-situ ESWL, since it is easy to manipulate, although a radiation hazard and high maintenance costs are involved. We report our experience of in-situ ESWL, using an ultrasonographic localization system, for the treatment of mid-ureteral stones. MATERIALS AND METHODS: Between June 1992 and June 2001, the mid-ureteral stones overlying the pelvic bone were treated with a Siemens Lithostar Ultra lithotriptor using a Sonoline SL-1 (Siemens, Germany) ultrasonographic localization system, with no anesthesia nor pain control. The mid-ureteral stones, located at the upper half of the pelvic bone, were treated in the prone position, with the shock waves delivered through the back wall using the kidney, renal pelvis and ureter, as landmarks for targeting. The mid-ureteral stones, located at the lower half of the pelvic bone, were treated in supine position, with the shock waves delivered through the abdominal wall using a filled bladder as the landmark for targeting. The localization success, stone free, ESWL success rates, and complications, were evaluated. RESULTS: Of the 96 patients, with mid-ureteral stones, we failed to localize the stone in only 2 patients. Therefore, the success rate for the stone localization was 97.9% (94/96). The stone free rate at 3 months after completion of the in-situ ESWL was 97.9% (92/94). Therefore, in-situ ESWL success rate was 95.8% (92/96). The mean ESWL sessions needed to be free of stones were 1.3+/-0.8 (126 sessions/92 patients). Some patients had hematuria and colicky pain, but serious complications, such as febrile UTI or severe hematuria requiring a transfusion were not encountered. CONCLUSIONS: In-situ ESWL, using an ultrasonographic localization system, is a non- invasive and effective treatment for mid-ureteral stones.

The Nocturia in BPH

PURPOSE: Nocturia is one of the most bothersome of all benign prostatic hyperplasia(BPH) symptoms. Nocturia with BPH is generally thought to be closely associated with change of detrusor receptor and infection secondary to bladder outlet obstruction. However, age-associated physiological changes in bladder function and concurrent disease, for example, congestive heart failure, cause nocturia in elderly. Therefore, in BPH with nocturia, evaluation for etiology of nocturia is important for proper control of nocturia permanently and this study was performed to investigate the underlying etiology of nocturia. MATERIALS AND METHODS: The twenty-seven BPH patients who complained more than three times of nocturia were included in this study. Evaluation included voiding diary for 24 hour, and urodynamic study. Based on diary and urodynamic study, functional bladder capacity was determined and etiology of nocturia was classified into one of three groups : noctural polyuria, hyperactivity nocturia and functional nocturia. Noctural polyuria was defined as overnight urine volume is over than 33% of 24 hour urine volume, hyperactive nocturia as the number of nocturia is more than (overnight urine volume/functional bladder capacity)-1 and functional nocturia as the number of nocturia is equal to (overnight urine volume/functional bladder capacity)-1. RESULTS: Overall 7(26%) had noctural polyruia. 4(15%) hyperactive nocturia and 13(48%) were mixed with noctual polyuria and hyperactive nocturia. The other 3(11%) were classified into functional nocturia. CONCLUSIONS: The cause of nocturia in the patient with BPH was multifactorial and unrelated to bladder outlet obstruction in significant proportion of BPH patients. Therefore in BPH patients with nocturia, we think that sufficient evaluation to find cause of nocturia is needed preoperatively and treatment should be directed to each condition with BPH management.

A Case of Interstitial Pneumonitis Following BCG Bladder Instillation in A Patient with Superficial Bladder Tumor / 결핵

Bacillus Calmette-Guerin(BCG) has been widely used for the prophylaxis of superficial bladder tumor recurrence and for the treatment of bladder carcinoma in situ. More than 95% of patients who receive BCG instillation tolerate the treatment well and side reactions have been reported in less than 5% of patients. Most side effects are minor and self-limiting. However, a rear occurrence of severe systemic reactions have been reported. Among the severe systemic reactions, hypersensitivity pneumonitis should be considered in patients with pneumonic complications after BCG instillation in cases where the culture for mycobacteria is negative in the sputum, brochoalveolar lavage and blood specimen. In addition, a fiberoptic bronchoscopy with transbronchial lung biopsy demonstrates a fibrosis of the alveolar septums, where there is and an increased lymphocyte count without tuberculous inflammatory changes, the and CD4:CD8 ratio is increased and no symptomatic response to antituberculosis chemotherapy is observed. Here we report a 68 years old man with interstitial pneumonitis following intravesical BCG instillation.

Non-Urodynamic Diagnostic Model in Geriatric Incontinence / 대한비뇨기과학회지

No abstract available.