This study examined the efficacy and safety of a new β-lactam/β-lactamase inhibitor of Amoxicillin/Sulbactam(Sultamox®) compared with Amoxicillin/Clavulanic acid(Augmentin®) in Bronchial asthma with mixed infection.

A randomized, controlled study was conducted in 56 patients who are diagnosed as Bronchial asthma with mixed infection. The patients were randomly assigned to receive Sultamox® 1500mg or Augmentin® 1200mg intravenously 3 times daily during admission period. Sputum culture, CBC and blood chemistry were taken before, during and after treatment. Symptom scores for cough, sputum amount, sputum color and dyspnea were graded from 1(no symptom) to 4(severe symptom). All patients were evaluated for clinical efficacy on clinical, microbiological responses and side effects or toxicities.

In Sultamox® treatment group, reduction of total symptom score was 2.54 and it was 2.40 in the Augmentin® treatment group which revealed a statistically significant difference(p<0.01). The clinical success rate were 86.7%(n=30) for the 30 clinically evaluable patients who received Sultamox? and 73.1%(n=26) for the 26 clinically evaluable patients who received Augmetin?. Drug-related serious adverse events were not occurred in all patients.

Sultamox® and Augmentin® are as effective and safe as the comparative therapies for community acquired lower respiratory tract of asthma patients.

The aims of this study were to assess the clinical observation of outpatient who showed hematochezia, and to determine whether specific clinical symptoms associated with hematochezia were predictive of important gastrointestinal pathology.

Prospective study was carried out from July 1998 to July 1999 with sixty-five outpatients(35 males and 30 females with mean age, 43±11 years) who had no evidence of recent bleeding. Patients were interviewed by questionnaires about the amount and frequency of bleeding, change in bowel habits, weight loss, usage of aspirin/NSAIDs, and family history, prior gastrointestinal pathologic illness before colonoscopy. Based on this information, endoscopist were asked to predict whether the bleeding was from a benign perianal or other lesion. Important gastrointestinal pathology was defined as carcinoma, adenomas more than 1cm, active ulcerative colitis, and active tuberculosis by colonoscopy.

Colonoscopic findings were as follows : 27 cases of benign anorectal lesion ; 16 cases of polyps, 10 cases of normal ; 8 cases of acute colitis and nonspecific colitis ; 7 cases of coloerctal cancer, 7 cases of ulcerative colitis and intestinal tuberculosis ; and other cases. Important gastrointestinal pathology was 17 cases. Variables including duration, type and frequency of bleeding, weight loss and change in bowel habit did not predict the colonoscopic diagnosis. Of the 35 patients diagnosed clinically by endoscopist to begin anorectal lesion alone, 18 patients were found to have benign anorectal lesion, 2 patients had cancer, 2 patient had polyp(bigger than 1cm), and 1 patient had ulcerative colitis.

In outpatients with hematochezia, the incidence of colon cancer was 10.8%. Clinicians were unable to distinguish significant colonic lesions by history. Therefore accurate diagnostic workup is needed for this group of patients.

Magnetic resonance cholangiography(MRC) has emerged as an accurate and noninvasive modality for the evaluation of the biliary diseases. We performed this study to access the accuracy and efficacy of MRC for the diagnosis of obstructive biliary diseases.

From March 1999 to September 2000, 87 patients with obstructive biliary diseases(24 malignant cancers, 55 cholelithiasis, 8 other obstructive biliary diseases) underwent MRC.

MRC correctly revealed the obstructing biliary lesions and the cause of obstructions in 100% and 92% of the cases of malignancy respectively. The sensitivity and specificity of MRC were 94%, and 82% for extrahepatic bile duct stones, 94%, 100% for intrahepatic bile duct stones, and 84%, 100% for gallbladder stones retrospectively. In the other cause of biliary obstructions(3 benign biliary stricture, 2 acalculous cholecystitis, 2 xanthogranulomatous cho-lecystitis, and 1 extrinsic compression due to lymphadenopathy), MRC correctly showed the level of obstructions in all patients. But, MRC could not diagnose accurate causes of the obstruction except 3 patients(1 acalculous cholecystitis, 1 xanthogranulomatous cholecystitis, and 1 extrinsic compression due to lymphadenopathy).

This study demonstrated that MRC was able to accurately identify the level and the cause of biliary obstructions in both malignancy and cholelithiasis. MRC was easily performed for a short duration and was a noninvasive diagnostic modality for assessing the biliary tree. Therefore, MRC was very efficacious clinically for the diagnosis of obstructive biliary diseases.

It is important to improve treatment efficacy in the management of urolithiasis in respect of time saving cost effectiveness. An experimental study reported that optimal fluid act as an interface between stone and urothelium improves fragmentation. We investigated the effect of diuretic usage in the SWL treatment of urolithiasis.

Sixty renal stone patients were selected for the prospective randomized double blind study. Patient in group A were given a placebo injection and patient in group B were given 20mg IV furosemide at the time of SWL treatment. Both groups received standard SWL monotherapy using Modulith SLX2000 lithoclast(Storz®, Germany). The energy setting, number of shock waves per session were identical in both groups. Treatment results were compared three weeks later after the first SWL treatment.

Mean age of the patients was 44.5±11.3 years old in group A, and 43.1±11.5 years old in group B. Mean size of the calculus before treatment were 9.2±4.8, and 8.9±5.1mm, which did not shown any statistical difference(p>0.05). Three weeks after the treatment, stone fragmentation and stone free rate was significantly higher in group B(p<0.05).

This study suggest that administration of furosemide intravenously during SWL improve stone fragmentation and stone free rate.

To evaluate pathologic findings of fibrocystic disease correlated with sonographic findings in the patients with solid lesion on ultrasonography.

Total 63 pathologically proven fibrocystic disease in 57 patients are retrospectively evaluated. On ultrasonography, the lesions were divided into solid and non-solid mass-like lesions. We analyzed the margin and echogenicity of solid mass-like lesions that were correlated with pathologic findings and also statistically analyzed Chi-square and Fisher's exact test.

Ultrasonogram of fibrocystic disease showed solid mass-like lesion in 73% and non solid mass-like lesion in 27%. Among the solid lesions, well-defined margin revealed in 72%, ill-defined margin in 28% and hypoechoic in 59%, isoechoic 41%. On the pathologic analysis, the solid and the non-solid mass-like lesion showed respectively : fibrous stroma in 56.5% and 53%, fibroadenomatous change in 50% and 12%, mixed stroma in 41% and 35.3%, cystic change in 37% and 70.6%, ductectasia in 28% and 58.8%, lobular hyperplasia in 26% and 12%, ductal hyperplasia 13% and 5.9%, and adenosis in 8.7% and 0%. The solid lesions showed more fibroadenomatous change and the difference between there was statistically significant(p=0.008).

The solid mass-like lesion, which represented as a well-defined isoechoic benign mass on ultrasonogram was more common than as expected, and this was due to the fibroadenomaous change on histopathology.

To determine the computed tomographic findings of cervical lymphadenopathy which distinguish tuberculous lymphadenitis from metastatic lymphadenopathy.

We retrospectively analyzed the CT findings of 21 patients with tuberculous lymphadenitis and 19 with metastatic lymphadenopathy in terms of location, size, shape, presence and shape of necrosis, and presence of extranodal extension.

The tuberculous lymphadenopathy was predominantly located in spinal accessory chain(level V)(42%), but metastatic lymphadinopathy was predominantly located in internal jugular chain(level II)(37%). Of the 21 patients with tuberculous lymphadenitis, the shape was conglomerated lesion with irregular margin in 13 cases. Of the 19 patients with metastatic lymphadenopathy, conglomerated lesion in 4 cases, which were statistically significant(p<0.05). The presence of central necrosis was more frequent in tuberculous lymphadenitis(n=20) than metastatic lymphadenopathy(n=11)(p<0.05). The presence of extranodal extension was significantly different between tuberculous(n=19) and metastatic lymphadenopathy(n=1)(p<0.05).

Cervical tuberculous lymphadenitis frequently involves the spinal accessory chain in young woman. The irregular conglomerated lesion with irregular central necrosis and extranodal extension on CT scan is suggestive of cervical tuberculous lymphadenitis, which is useful in differentiating from metastatic lymphadenopathy.