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A Case of Cholethorax following Percutaneous Transhepatic Cholangioscopy (경피경간 담도내시경술 이후에 발병한 담즙흉 1예)

  • Park, Chan Sung;Lee, Soon Jung;Do, Gi Won;Oh, Ssang Yong;Cho, Hyun;Kim, Min Su;Hong, Il Ki;Bang, Sung Jo;Jegal, Yang Jin;Ahn, Jong-Joon;Seo, Kwang Won
    • Tuberculosis and Respiratory Diseases
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    • v.65 no.2
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    • pp.131-136
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    • 2008
  • Cholethorax (bilious pleural effusion) is an extravasation of bile into the thoracic cavity via a pleurobiliary fistula (and also a bronchobiliary fistula). It is an extremely rare complication of thoraco-abdominal injuries. It can be caused by congenital anomaly and also by hepatobiliary trauma, severe infection or iatrogenic procedures. The definitive diagnosis is made with aspiration of bilious fluid from the pleural space during thoracentesis, by finding a fistulous tract during endoscopic retrograde cholangiopancreatography (ERCP) or cholagioscopy, or with finding an abnormal pleural accumulation of radioisotope during hepatobiliary nuclear imaging. Its symptoms include coughing, fever, dyspnea and pleuritc chest pain. Herein we report on a case of cholethorax following performance of percutaneous transhepatic cholangioscopy (PTCS) to remove incidentally discovered common bile duct (CBD) stones.

Review of Sarcoidosis in a Province of South Korea from 1996 to 2014

  • Kim, Min-Seok;Park, Cheol-Kyu;Shin, Hong-Joon;Seo, Hyeong-Won;Chang, Jinsun;Ahn, Seong;Kim, Tae-Ok;Lim, Jung-Hwan;Oh, In-Jae;Kwon, Yong-Soo;Kim, Yu-Il;Lim, Sung-Chul;Kim, Young-Chul
    • Tuberculosis and Respiratory Diseases
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    • v.80 no.3
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    • pp.291-295
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    • 2017
  • Background: Since the introduction of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) of mediastinal lymph nodes, the incidence of histopathologically-confirmed sarcoidosis has increased. Methods: The electronic medical records of Chonnam National University (CNU) Hospital and CNU Hwasun Hospital (CNUHH) were searched for confirmed cases of sarcoidosis diagnosed between 1996 and 2014. Cases were selected using a combination of clinical, radiological, and pathological evidence. Of 115 cases with the relevant disease codes, 16 cases were excluded, as they had not been confirmed pathologically or had no definitive clinical features of sarcoidosis. Results: Among 99 cases of confirmed sarcoidosis, only nine patients were diagnosed with sarcoidosis before 2008; the rest were diagnosed from 2008 onward, after the introduction of EBUS-TBNA. EBUS-TBNA was used in 75.8% of patients, open surgical biopsy in 13.2%, and mediastinoscopic biopsy in 5.1%. At the time of diagnosis, 42.4% of sarcoidosis cases were at stage I, 55.6% at stage II, and 2% at stage III. Spontaneous remission of sarcoidosis was observed in 33.3% of cases, and stable disease in 37.4%; systemic steroid treatment was initiated in 23.2% of cases. Of the patients treated with systemic steroids, 69.6% showed improvement. The median duration of steroid treatment was 5 months. Conclusion: Following the introduction of EBUS-TBNA, the number of newly diagnosed sarcoidosis patients has increased. Clinical features of sarcoidosis were similar to those previously reported. Spontaneous remission occurred in about one-third of patients, while one-fourth of patients required systemic steroid treatment.

Unplanned Excision of Soft Tissue Sarcoma: Patient Profile and Treatment Outcomes (연부 조직 육종에 대한 무계획적 절제술: 환자의 임상적 특징 및 치료 결과)

  • Lee, Jae Hoo;Cho, Yong Jin;Kim, Seung Hyun;Shin, Kyoo Ho
    • The Journal of the Korean bone and joint tumor society
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    • v.18 no.2
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    • pp.72-77
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    • 2012
  • Purpose: Unplanned excision of a soft tissue sarcoma is defined as the operation performed for gross removal of a soft tissue sarcoma without regard for preoperative imaging or the necessity to removal a margin of normal tissue covering the cancer. We report our experience of treating primary soft tissue sarcoma after an unplanned excision. Materials and Methods: We retrospectively reviewed 31 patients referred to our hospital after unplanned excision at other hospitals for treatment of a STS. The clinical information was reviewed with a focus on the patient's age, gender, tumor location, tumor size, tumor depth, presumptive diagnoses at the previous surgery, refer hospital, definitive diagnosis, interval between the initial and additional surgery and local recurrence. Results: There were 19 males and 12 females with a median age of 48 years (range, 17-75 years) at the time of referral. Seventeen patients (54.8%) had tumors in their lower limb, 6 (19.4%) had tumors in their upper limb, and 8 (25.8%) had tumors in their trunk. Tumor depth could be determined for 8 patients (25.8%), with superficial and 22 deep tumors (71%). The medial interval between unplanned excision to re-excision ranged from 2 weeks to 1 year (median, 5 weeks). Local recurrence was detected in 2 patients. All patients were alive without metastasis at last follow up. Conclusion: Even in upper class general hospital, many unplanned excision had been performed, which is considered to be avoided. When the relatively huge mass located in deeper layer it requires enough preoperative imaging studies and biopsy.

Development of Learning Place for Geologic Field Survey around the Duta Mountain, Chungbuk, Korea (충북 괴산군 두타산 일대의 야외지질조사 학습장 개발)

  • Lee, Chang-Xin;Cheong, Sang-Won
    • Journal of the Korean earth science society
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    • v.26 no.1
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    • pp.41-57
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    • 2005
  • The purpose of the study is to develop a educational data in order for students to perform geologic field survey effectively by themselves. A area around the Duta Mountain is selected. which is located at the southeastern part of Eumsung sedimentary basin because various rock types and geologic structures are well shown in this area and also it is convenient to reach there. Thirteen stops for observation are chosen m a route f3r exercising field geologic investigation. Data for field research are given and described in detail from each stop for observation. To do this, students make their own route map using general or digital geographic map and aerial photo is added to know relationship between large-scale structure and different rock types regionally. Moreover, it is designed to minimize conflict factors that may be experienced from the real field survey by showing outcrop photographs and polarizing photomicrographs of rut samples related to each stop and geologic structures. The attitude of students is investigated with the data of field geologic survey for students of an Earth Science class in the College of Education in Chungbuk National University. The results indicate that the educational data for geologic field survey brought positive changes that greatly help students perform field survey in definitive side, especially formation of absolute concepts on earth science.

Full mouth rehabilitation of the patient with worn dentition using full-contour monolithic zirconia prostheses at an increased vertical dimension of occlusion: a case report (치아 마모 환자에서 수직고경 증가를 동반하여 단일구조 지르코니아 보철물로 완전구강회복을 시행한 증례)

  • Oh, Kyung-Chul;Chung, Moon-Kyu;Kim, Jee-Hwan;Shim, June-Sung
    • The Journal of Korean Academy of Prosthodontics
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    • v.50 no.3
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    • pp.198-203
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    • 2012
  • Excessive occlusal wear results in unacceptable damage to the occluding surfaces, and can cause pulpal injury, occlusal disharmony, impaired function, and aesthetic deformity. Patients with severely worn dentition need to be classified as several categories relative to the vertical dimension of occlusion (VDO) and the interocclusal distance for the prosthetic space. When treating patients classified as those who have excessive wear without loss of occlusal vertical dimension but with limited space, we could consider treating them at an increased vertical dimension of occlusion. Treatments at an increased vertical dimension of occlusion may provide stability, given that the amount of its increase was minimal, and a perfected occlusion was achieved after enough stabilization period. A 50-year-old male visited the department of Prosthodontics in Yonsei University Dental Hospital with the chief complaint of worn teeth on lower anterior area. Reconstruction at an increased vertical dimension of occlusion was planned. After the compatibility of the new vertical dimension of occlusion had been confirmed under interim fixed restorations, definitive fixed restorations composed of full-contour monolithic zirconia prostheses were placed. This case presents that a satisfactory clinical result was achieved by restoring the worn dentition at an increased vertical dimension of occlusion with an improvement in esthetics and function.

Immediate implant placement into extraction sites with periapical lesions in the esthetic zone: a case report (치근단 병소를 가진 치아의 발치 후 즉시 임플란트 식립 및 보철을 통한 심미성 회복)

  • Yi, Jae-Young;Kim, Jee-Hwan;Han, Dong-Hoo
    • The Journal of Korean Academy of Prosthodontics
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    • v.50 no.3
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    • pp.191-197
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    • 2012
  • Esthetics is important in restoring maxillary anterior area. Alveolar bone resorption and loss of interdental papilla may be minimized by immediate implantation. Previous studies showed successful results with the immediate implantation in healthy extraction socket, while many of these studies objected the immediate implantation into extraction sites with periapical lesions. Recent studies, however, reported successful results of the immediate implantation into extraction sites with periapical lesions with careful debridement of extraction sockets and general medication of antibiotics prior to implantation. A 73-year-old female visited the department of Prosthodontics in ${\bigcirc}{\bigcirc}$ University Dental Hospital with the chief complaint of fallen post-core and crown on left maxillary incisor. Although the incisor was with vertical root fracture and periapical lesion, the immediate implantation following the extraction of tooth was planned. Thorough socket debridement, irrigation with chlorhexidine, and tetracycline soaking were followed by immediate implantation. The general medication of antibiotics (Moxicle Tab.$^{(R)}$, 375 mg) was prescribed before and after the surgery. Immediate provisional restoration was delivered two days after the surgery, and the definitive metal-ceramic restoration was placed about six months later after reproducing the emergence profile from the provisional restoration. This case presents satisfying result esthetically and functionally upto two years after the placement of prosthesis with the harmonious gingival line and no loss of marginal bone.

Twenty Four Cases of Idiopathic Bronchiolitis Obliterans Organizing Pneumonia, Reported in Korea and a Review of Literatures (국내 보고된 특발성 폐쇄성세기관지염 기질화폐렴 24예와 문헌 고찰)

  • Chang, Jung-Hyun;Park, Sa-Yong
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.5
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    • pp.709-717
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    • 1999
  • Background & Method : Bronchiolitis obliterans organizing pneumonia(BOOP) is a specific clinicopathologic condition characterized by chronic inflammatory interstitial infiltrates. Cryptogenic form of BOOP presents subacute clinical course of flu-like illness, such as cough, fever, dyspnea with exertion and other constitutional symptoms. Pathologically it shows the presence of granulation tissue filling the lumen of terminal and respiratory bronchioles, extending into distal airspaces. Recently, we reviewed 24 cases of idiopathic type of BOOP, 5 cases of our hospital and another 19 cases on Korean literatures, and compared with reviewed data from foreign literatures. Results : Mean age was 54 years old and there was female preponderance in domestic reports. Their common presenting symptoms were dyspnea and cough, and mean duration of illness was 41 days. On chest examination, inspiratory crackle was a common finding. The laboratory findings were nonspecific except hypoxemia. Lung function studies revealed restrictive defect or combined obstructive and restrictive pattern in most patients. Bilateral patchy and nonsegmental alveolar opacities constituted characterized radiographic finding, highlighted on high resolution computed tomogram. It showed a favorable prognosis with an excellent responsiveness to corticosteroid therapy. The clinical features and laboratory findings were similar between domestic and foreign cases except female preponderance in Korean cases. Conclusion : If the clinical course is atypical or pregressive under proper treatment, clinicians should reevaluate clinical features and radiographic findings under the consideration of BOOP. Tissue confirmation would be recommended for the definitive diagnosis of BOOP.

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The Importance of the Simple Chest X-ray Tend to Make Careless Interpretation: with a Case of Mediastinal Tumor (흉부 질환 진단에서 소홀하기 쉬운 단순 흉부 X-선 사진의 중요성: 종격동 종양을 중심으로)

  • Kim, Eun Young;Lim, Ju Eun;Park, Byung Hoon;Yoon, Jin Young;Jung, Ji Ye;Son, Ji Young;Lee, Kyung Jong;Yoon, Yoe Wun;Kang, Young Ae;Moon, Jin Wook;Park, Moo Suk;Kim, Young Sam;Chang, Joon;Shin, Sung Kwan;Kim, Se Kyu
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.6
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    • pp.482-485
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    • 2009
  • The middle mediastinum contains several important organs and pluripotent cells. It is difficult to make a definitive diagnosis in patients with middle mediastinal tumors due to a wide range of diseases. The likelihood of malignancy is influenced primarily by the following factors: patient age, size, tumor location, and the presence or absence of symptoms. We describe a case of a middle mediastinal tumor, which was suspected on chest x-ray; chest computed tomography revealed the eccentric mass of distal esophagus. This case emphasizes the diagnostic importance of the chest x-ray to the physicians. The possible differential diagnoses are reviewed.

Pulmonary Sarcoidosis Diagnosed by Endobronchial Ultrasound Fine Needle Aspiration (초음파 기관지 내시경 세침흡인을 이용하여 진단한 폐 사르코이드증)

  • Kim, Won-Young;Chang, You-Jin;Lyu, Ji-Won;Park, Young-Soo;Jang, Se-Jin;Song, Jin-Woo;Oh, Yeon-Mok;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Choi, Chang-Min
    • Tuberculosis and Respiratory Diseases
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    • v.68 no.5
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    • pp.267-272
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    • 2010
  • Background: Pulmonary sarcoidosis often involves mediastinal or hilar lymph nodes in the lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis. Methods: Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial lung biopsy, and bronchoalveolar lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performed to confirm a final diagnosis. Results: A total 25 EBUS procedures were done and 50 lymph nodes were aspirated. Thirty-three (37) out of 50 lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure. Conclusion: EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.

Experimental life history of Spirometra erinacei (우리 나라에 분포하는 스파르가눔의 실험실 내 생활사)

  • 이순형;위재수
    • Parasites, Hosts and Diseases
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    • v.28 no.3
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    • pp.161-174
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    • 1990
  • The complete life cycle of Spirometra erinacei has been experimentally maintained in the laboratory. The cyclops were reared as the first intermediate host, and the tadpoles of Rana nigromaculata as the second intermediate host. ICR mice were used as another second host. The experimental definitive hosts were dogs and cats. Maturation and hatching of the eggs took 8 to 14 days by incubation at 29℃. The coracidium measured 43.8×36.9㎛. Mesocyclops leuckarti and Eucyclops serrulatus were susceptible to the coracidial infection. The procercoids older than 5 days in the cyclops had minute spines at the anterior end, calcium corpuscles in the body parenchyme and the cercomer at the posterior end. Procercoids 10 to 20 days old were infective to tadpoles, and 15 or 21 day old worms could infect the mice. The plerocercoids from the tadpoles at 15 days after experimental infection were pear-shaped and shorter than 1 mm in the length and were infective to mice. Fifteen to 18 days after experiMental inoculation of plerocercoids to dogs or cats, the adult worms began to produce eggs. One life cycle from egg to egg needed 48 to 67 days in the laboratory. The morphology of larval or adult worms was compatible with the description of Spirometra erinacei.

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