Aorta Remodeling after Endovascular Treatment of a Chronic DeBakey IIIb Aneurysm and Simultaneous Palliation of a Renal Cell Carcinoma

We report the case of a patient with a chronic DeBakey type IIIb aneurysm who underwent thoracic endovascular aortic repair to seal the primary entry tear and stent-graft insertion to cover the re-entry tear at the renal artery. The procedure was performed in order to achieve complete thrombosis in the entire thoracoabdominal false lumen, leading to favorable aortic remodeling. Simultaneously, ethanol ablation and renal artery embolization were performed to treat a renal tumor suspicious of renal cell carcinoma. Radical nephrectomy then confirmed clear cell carcinoma. To the best of our knowledge, no other cases of this type have been reported in the Korean literature.

A Case of Invasive Aspergillosis Involving the Orbital Apex and Occipital Lobe:Successful Treatment with Voriconazole

PURPOSE: To report an immunocompetent patient with more than 1-year survival after treatment with voriconazole, despite invasive paranasal sinus aspergillosis involving the orbital apex. CASE SUMMARY: A 74-year-old woman with only preexisting hypertension visited our clinic complaining of pain and immovable left eye that occurred approximately 4 days prior. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a sphenoid sinusitis with suspicious lesion involving the orbital apex of the left eye. A biopsy by functional endoscopic sphenoid surgery (FESS) was performed through the sphenoid sinus, which enabled us to diagnose aspergillosis. The patient had esotropia, ophthalmoplegia, positive RAPD, and ptosis in the left eye. On follow-up, a new MRI showed acute to subacute stage infarction at the left occipital lobe. After the patient was treated with intravenous voriconazole, ptosis, and ophthalmoplegia improved. At the 13-month follow-up, she was alive with no disease recurrence. CONCLUSIONS: Invasive aspergillosis of orbit and cerebrum in healthy patients is a rare clinical entity. In case of central nervous system involvement, the survival outcome is poor with high mortality; however, good results can be obtained by treatment with voriconazole.

Diagnostic Criteria of Pattern VEP in Adult Monocular Amblyopic Patients

PURPOSE: To suggest a diagnostic criteria of pattern visual evoked potential (VEP) in adult monocular amblyopic patients in comparison to normal subjects. METHODS: The medical records of patients' military service certificates from January 2000 to December 2011 were reviewed. The parameters of pattern VEP were analyzed by comparing monocular amblyopic patients with normal controls. RESULTS: This study included 47 monocular amblyopia and 39 normal control patients. All parameters of pattern VEP were statistically significantly different between monocular amblyopic eyes and normal eyes. The cut-off values for diagnosis of adult amblyopia using receiver operating characteristic (ROC) curve were 113.50 msec (P100 latency), 1.05 (ratio of P100 latency), 8.50 msec (interocular difference of P100 latency), and 5.25 microV (interocular difference of P100 amplitude). Cut-off value sensitivities were generally low: (51.1%, 70.2%, 53.2%, and 31.9%, respectively). CONCLUSIONS: The value of pattern VEP parameters had limitations due to low sensitivity and could be considered as ancillary diagnostic criteria when diagnosing amblyopia.

Total Arch Replacement with Stented Elephant Trunk in DeBakey Type I Acute Aortic Dissection

A 67-year-old female patient was treated with conventional total arch replacement and insertion of a stented elephant trunk (SET) graft into the descending thoracic aorta for acute DeBakey type I aortic dissection at one time. She had been treated with right coronary artery stent insertion for acute myocardial infarct 4 days earlier, and at that time, she was diagnosed with acute DeBakey type I aortic dissection from the ascending aorta to the suprarenal artery based on trans-esophageal echocardiography and aorta computed tomography. Through a median sternotomy, we inserted the SET graft through the opened aorta to the descending aorta. We also performed anastomosis between the proximal stented graft and the distal aortic arch, and then performed total arch replacement. For acute DeBakey type I aortic dissection, we report total arch replacement with insertion of a SET graft as a combination of conventional surgery and the interventional technique.

Difference in the distribution pattern of Helicobacter pylori and grade of gastritis in the antrum and in the body between duodenal ulcer and benign gastric ulcer patients

OBJECTIVES: To investigate the relationship between the Helicobacter pylori (H. pylori) colonization and the grade of gastritis in the antrum and in the body of patients with duodenal ulcer (DU) or benign gastric ulcer (BGU). METHODS: This study was performed in H. pylori-positive 220 DU patients and 180 BGU patients. H. pylori density was evaluated by modified Giemsa staining and CLO test, and gastritis grade was graded by H+ACY-E staining in the antrum and in the body. RESULTS: H. pylori grade by Giemsa staining was 1.24 in the antrum and 0.82 in the body for DU group (p +ADw- 0.01), and those of BGU group were slightly reversed, 0.83 and 0.87, respectively, but without statistical significance. Similarly H. pylori grade by CLO test was 3.1 in the antrum and 2.8 in the body for DU group (p +ADw- 0.01), and those of BGU group 2.3 and 2.6 (p +ADw- 0.05), respectively. In contrast, gastritis grade was 1.7 in the antrum and 1.2 in the body for DU group (p +ADw- 0.01), and those of BGU group 1.6 and 1.3 (p +ADw- 0.01), respectively, similar to those of DU. However, there was a correlation between H. pylori grade and gastritis grade in the antrum and in the body, not only in DU but also in BGU group (p +ADw- 0.01). CONCLUSION: In spite of different distribution patterns of H. pylori between DU group and BGU group, gastritis grade of the antrum was significantly higher than that of the body in both DU and BGU. However, gastritis is correlated with H. pylori density not only in DU but also in BGU patients. It looks like the inflammatory reaction to H. pylori is stronger in the antrum than in the body.

Establishment of an Helicobacter pylori-Eradication Regimen in Consideration of Drug Resistance , Recrudescence and Reinfection Rate of H . pylori / 대한내과학회지

OBJECTIVE: This study was conducted to establish an ideal treatment regimen for H. pylori eradication in three aspects: clinical, microbiological, and reinfection. METHODS: Four hundred thirty two patients with H. pylori positive peptic ulcer were randomized to receive two types of triple therapy: one includes colloidal bismuth subcitrate, metronidazole and tetracycline (BMT), and the other includes omeprazole, amoxicillin and clarithromycin (OAC). RESULTS: More than 50% of symptom reduction within 1 week was 94.4% both in OAC and in BMT group. The percentages of side effects were 21.6% and 27.1% in OAC and BMT regimen, respectively. Good compliance with at least 85% intake was 99.0% and 95.2% in OAC and BMT regimen. The eradication rates of H. pylori were 85.9% and 89.1% in OAC and BMT regimen. Resistance rates to metronidazole and clarithromycin were 40.6% and 10.2% by E test, 74.3% and 27.0% by broth microdilution, and 45.3% and 10.9% by disk diffusion method. The eradication rates for H. pylori was 100% and 77.8% by BMT in patients with metronidazole-sensitive and -resistant strains, and 100% and 80.0% by OAC with clarithromycin- sensitive and -resistant strains, without significance by their resistances. The recrudescence rate within 1 year after eradication was 21.2% and 14.2% for OAC and BMT regimen without significant difference. The reinfection rate after 1 year was 4.0% and 5.0% for OAC and BMT regimen. CONCLUSION: Because the eradication rate of BMT regimen is 89.1% in spite of high metronidazole resistance rate, and there was no statistical difference in the aspects of symptom reduction, side effect, compliance, recrudescence and reinfection rate, BMT regimen is as favorable as OAC to eradicate H. pylori.

The Detection Rate of H. pylori and Intestinal Metaplasia in the Antrum and in the Body / 대한소화기내시경학회지

AIMS: In this paper we have investigated the detection rate of each H. pylori test in the antrum and in the body for patients with nonulcer dyspepsia (NUD), duodenal ulcer (DU), benign gastric ulcer (BGU), and stomach cancer. In addition, we examined whether or not there is any relationship between the decrease of H. pylori detection rate and intestinal metaplasia in the antrum. METHODS: Three different test methods for identifying H. pylori infection-CLOtest, Gram stain, H&E stain-were taken in the antrum and in the body. RESULTS: 1) The detection rates of CLOtest, Gram stain, and H&E stain for NUD group were 88%, 75%, and 64% (mean: 76%) in the antrum, and 89%, 78%, and 67% (mean: 78%) in the body, respectively, and those of DU group were 95%, 95% and 81% (mean: 90%) in the antrum, and 97%, 87% and 64% (mean: 83%) in the body, respectively. Those of BGU group were 86%, 74%, 53% (mean: 71%) and 98%, 82%, 58% (mean: 79%), respectively, and those of stomach cancer group were 80%, 88%, 58% (mean: 75%) in the antrum, and 100%, 96%, 83% (mean: 93%) in the body, respectively. The B/A detection ratio which means the ratio of mean H. pylori detection rate of body to that of antrum was 1.03 in NUD, 0.93 in DU, 1.11 in BGU, and 1.24 in stomach cancer group. 2) The rate of intestinal metaplasia in the antrum was 12% for NUD, and 15% for DU group. Those of BGU and stomach cancer group were 47% and 72%, respectively. 3) The correlation etween B/A detection ratio and intestinal metaplasia in the antrum was good (correlation coefficient(r)=0.93). CONCLUSIONS: The result that body is more adequate for H. pylori detection in BGU and stomach cancer patients rather than antrum can be explained by the high rate of intestinal metaplasia in the antrum which is hostile surrounding for H. pylori.

A Case of Mediastinal Abscess following Esophageal Perforation / 대한소화기내시경학회지

We recently experienced a case of an elderly patient with mediastinal abscess, which is a rare complication of esophageal perforation, in whom dyspnea, chest pain and odynophagia were main clinical symptoms after eating cooked fish. During evaluation, upper mediastinal widening, with air-fluid level, and eaophageal perforation plugged with pus were detected by chest X-ray films and endoscopic examinatien. After draining of pus(about 300 cc) through the perforation site by careful manipulation of endoscope, inner wall of abacess cavity communicating with esophagus could be observed through esophago-mediastinal fistula. For further management, drainage procedure of mediastinal abscess, esophageal diversion and feeding gastrostomy were done.