ABSTRACT
This report describes the case of a 26-year-old male diagnosed with angina on exertion. A diagnostic coronary angiography revealed significant luminal narrowing at the middle third of the left anterior descending artery and proximal circumflex artery. The patient underwent implantation of sirolimus-eluting stents. Eight months after implantation of the stents, a follow-up coronary angiography showed intrastent coronary artery aneurysms. We suggest that the implantation of the sirolimus-eluting stent caused late formation of a coronary artery aneurysm.
Subject(s)
Adult , Humans , Male , Aneurysm , Arteries , Coronary Aneurysm , Coronary Angiography , Coronary Vessels , Follow-Up Studies , Phenobarbital , Sirolimus , StentsABSTRACT
PURPOSE: To report one case of recurrent Valsalva retinopathy presented as subretinal hemorrhage associated with exercising a barbell in a healthy man. METHODS: A 47-year-old healthy man visited our hospital complaining of a pericentral blind-spot in the right visual field. At first visit, visual acuity was 20/20 without correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a subretinal hemorrhage in the inferior area of the macula. We followed up the visual acuity, anterior segment exam, fundus examination, and fluorescein angiography for several weeks. RESULTS: Three weeks after the first visit, the size of subretinal hemorrhage decreased, but recurrent subretinal hemorrhage presented after exercising a barbell at the existing hemorrhagic part and its inferior area. Six weeks after the recurrent hemorrhage, the hemorrhage was resolved completely and the pericentral blind-spot was recovered. CONCLUSIONS: Valsalva hemorrhagic retinopathy is characterised by retinal hemorrhage occurring in healthy individuals due to a rapid rise in intrathoracic or intra-abdominal pressure. In this case, there was recurrent subretinal hemorrhage after repeatedly exercising a barbell. So, it is very important to educate patients about the restriction of excessive Valsalva maneuver to prevent recurrent Valsalva retinopathy.
Subject(s)
Humans , Middle Aged , Fluorescein Angiography , Hemorrhage , Retinal Hemorrhage , Valsalva Maneuver , Visual Acuity , Visual FieldsABSTRACT
PURPOSE: To determine clinical outcomes of mini Monoka silicone monocanalicular lacrimal stent (from now, mini Monoka stent) in canalicular injury. METHODS: From June 1996 to December 2001, mini Monoka stent was used in 70 eyes(77 canaliculi) of superior, inferior and bicanalicular injury. Mini Monoka stent was shortened about 20 mm with round tip and intubated. Punctal fixation suture was not done. RESULTS: The mean follow-up period was 7.9+/-1.0 months (4-12 months). The outcome of our repair was judged by the existence of epiphora, dye disappearance test, probing and irrigation. In 57 eyes (81.4%), there was no epiphora. In 11 eyes (15.7%), epiphora was developed only after certain stimuli. In 2 eyes (2.9%), there was epiphora at all times. Postoperative complications were premature stent loss 6 eyes (8.6%), conjunctival injection 3 eyes (3.9%). CONCLUSIONS: The intubation of mini Monoka stent for the lacerated canaliculus is the simply operative procedure in the outpatient department. The shortening of mini Monoka stent made this procedure easier. Despite no punctal fixation suture, the occurrence rate of the premature stent loss was not higher than that for published reports of mini Monoka stent.
Subject(s)
Humans , Follow-Up Studies , Intubation , Lacerations , Lacrimal Apparatus Diseases , Outpatients , Postoperative Complications , Silicones , Stents , Surgical Procedures, Operative , SuturesABSTRACT
PURPOSE: To evaluate the incidence of persistent diplopia and enophthalmos and possible risk factors leading to their occurrence in patients who had orbital blowout fracture repair. METHODS: We retrospectively evaluated clinical features in 76 eyes of 76 patients with orbital blowout fracture, who were repaired surgically after its diagnosis from March 1995 to November 2001. We analysed the relationship between persistent diplopia and enophthalmos after reconstruction and timing of surgery, patient age, fracture location, fracture size and alloplast material. RESULTS: Postoperatively, 11 patients (22.9%) expirienced diplopia and enophthalmos persisted in 11 (28.2%) patients. Timing of surgery, patient age, fracture location, fracture size was found to be significant for the development of postoperative diplopia but alloplast material was not significant for the development of postoperative diplopia (p>0.05). Timing of surgery and fracture size was found to be significant for the development of postoperative enophthalmos but patient age, fracture location and alloplast material was not significant for the development of postoperative enophthalmos (p>0.05). CONCLUSIONS: We believe that timing of surgery is important prognostic factor that decreases the incidence of persistent diplopia and enophthalmos after surgical repair of blowout fracture. In addition, this study will provide important prognostic informations that can be of benefit to both patients and surgeon in performing surgical repair of blowout fracture.
Subject(s)
Humans , Diagnosis , Diplopia , Enophthalmos , Incidence , Orbit , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: The serum B-type natriuretic peptide (BNP) is released from the ventricles as a response to volume or pressure overload of the ventricles. A few studies have reported that the BNP measurements are useful in differentiating between heart failure and pulmonary causes in patients who visited the emergency department with dyspnea as the chief complaint. It is difficult to differentiate a right heart failure from a left heart failure in the emergency room. However, there is no report on the application of a BNP assay to differentiate in right heart failure from left heart failure. In this study, the BNP levels were measured from dyspneic patients in the emergency department to determine whether or not the BNP level would be useful in differentiating the cause of the dyspnea from right ventricular failure and left ventricular failure. METHOD: 89 patients who visited emergency department of the Bundang Cha Hospital with dyspnea from June 2002 to March 2003 were selected. The 29 patients from the outpatient clinics and inpatients were randomly selected as the control. RESULTS: The BNP levels of patients in the left heart failure group were significantly different from that of the patients in the right heart failure group (682+/-314 pg/mL vs. 149+/-94 pg/mL, p=0.000). When the BNP cut-off level was designated as 219 pg/mL using the receiver operating characteristic curve, the sensitivity was 94.3%, and specificity was 92.9%. In addition, the positive predictive value was 97% and the negative predictive value was 86.7% in differentiating right heart failure from left heart failure. CONCLUSION: Measurements of the serum BNP levels is an accurate and rapid method that can aid in distinguishing between right heart failure and left heart failure.
Subject(s)
Humans , Ambulatory Care Facilities , Dyspnea , Emergency Service, Hospital , Heart Failure , Inpatients , Natriuretic Peptide, Brain , Pulmonary Heart Disease , ROC Curve , Ventricular Dysfunction, LeftABSTRACT
BACKGROUND AND OBJECTIVE: A myocardial bridge(MB) is an anatomical arrangement in which an epicardial coronary artery becomes engulfed for a limited segment by myocardial fibers. Although it has generally been felt that most instance of bridge are benign. Recent reports have suggested that MB can be associated with evidence of myocardial ischemia, myocardial infarction, arrhythmia and sudden death. This study investigated clinical characteristics of myocardial bridge and significance of treadmill test(TMT). METHOD: Among 4317 consecutive coronary angiograms performed from November 1995 to June 1999, 52 patients had a myocardial bridge. For the patients with MB, the clinical data, coronary angiography and the results of treadmill tests were reviewed. RESULT: The overall prevalence of myocardial bridge was 1.22%. Stable angina, atypical chest pain, variant angina, AMI were 33(63%), 15(29%), 2(4%), 2(%) cases, respectively. Electrocardiographic finding were normal in 31 cases(59%), ST-T change in 20 cases(38%), OMI in 1 case(3%). Mean systolic stenosis of MB was 54%, Mean length of segment of MB was 11.96 4.96mm and all patients had MBs of left anterior descending(LAD) coronary artery. Among 23 cases which had been performed TMT, 17 were positive(77%). There was no significant statistical difference between TMT(+) and TMT(-) in clinical characteristic and coronary angiographic data. We divided the patients with MB into two groups [group I(34 cases): systolic compression < 50%(mean 35.1 10.7%), group II(18 cases): systolic compression 50%(mean 63.6 14.7%)] and there were no statistical difference in clinical characteristics, TMT and angiographic data. CONCLUSION: The patients with MB present variable clinical characteristics of stable angina, atypical chest pain, variant angina, acute myocardial infarction. There is no relationship between the degree of systolic compression and TMT positive in MB. We think that symptoms of MB are not developed only by mechanical compression but concerned with other variable mechanism.
Subject(s)
Humans , Angina, Stable , Arrhythmias, Cardiac , Chest Pain , Constriction, Pathologic , Coronary Angiography , Coronary Vessels , Death, Sudden , Electrocardiography , Exercise Test , Myocardial Infarction , Myocardial Ischemia , PrevalenceABSTRACT
Since the Inoue balloon was first introduced for percutaneous mitral valvuloplasty (PMV) in 1984, this procedure has come into widespread use because of its effectiveness, simplicity, and reduced exposure to X-ray radiation. It's the procedure's complications include cardiac tamponade, atrial septal defect, thromboembolism, ventricular perforation, mitral regurgitation, and rarely balloon rupture. We report a case of Inoue balloon deformity during PMV in 62-year old woman with rheumatic mitral stenosis. Echocardiography revealed severe rheumatic mitral stenosis with a valvular area of 0.95 cm2 (by pressure half-time method), and an Echo score of 10 points. The PMV with Inoue balloon 28 mm was performed. We inflated the balloon to 28 mm in diameter first, and to 29 mm second. A bulging deformity with asymmetrical overinflation of one side of both proximal and distal balloon was recognized. A bulging deformity at the proximal part of Inoue balloon after second inflation. Balloon was not ruptured. Following completion of the procedure, the mitral valve area increased to 1.8 cm2. Moderate mitral regurgitation (grade II) was newly developed. This may be the first case of asymmetrical one side inflation and focal bulging deformity reported in Korea.
Subject(s)
Female , Humans , Middle Aged , Cardiac Tamponade , Congenital Abnormalities , Echocardiography , Heart Septal Defects, Atrial , Inflation, Economic , Korea , Mitral Valve , Mitral Valve Insufficiency , Mitral Valve Stenosis , Rupture , ThromboembolismABSTRACT
BACKGROUND: Spontaneous echo contrast (SEC) of the left atrium (LA) is associated with increased risk of thromboembolism in patients with mitral stenosis(MS). The determination of the presence and severity of LA spontaneous echo contrast(SEC) is of prognostic importance in these patients. Harmonic imaging(HI), a novel echocardiographic technique that differs from conventional fundamental imaging(FI) by transmitting ultrasound at one frequency and receiving at twice the transmitted frequency, produces better endocardial border definition and myocardial opacification. However, there are no data about its value on the detection of LA SEC. The purpose of this study was to investigate the utility of transthoracic noncontrast HI in the detection of LA SEC in patients with. METHODS: Seventy-four consecutive patients with MS (49 female, mean age 51) underwent standard transthoracic echocardiograms (TTE) in both HI and FI and transesophageal echocardiography (TEE) to determine the presence and severity of LA SEC. LA SEC was graded by TEE; mild if only seen at high gain, severe if visible in the entire LA at normal gain control of the equipment. Control subjects comprised of 30 patients randomly selected from patients who did not have LA SEC at TEE examination. RESULTS: Atrial fibrillation was found in 46 patients (62.2%). The mean mitral valve area and mean mitral gradient were 1.0+/-0.3cm2 and 8.2+/-4.1mmHg, respectively. Nine patients (12.2%) had episodes of systemic embolism; stroke in 8 and peripheral embolism in 1. LA thrombus was found in 11 patients (14.9%) by TEE. LA SEC was present in all but one patient by TEE (mild in 35, severe in 38 patients). FI of TTE, however, revealed LA SEC in only 5 (6.8%) of the 73 patients. In contrast, in HI, LA SEC could be detected in 63 (86.3%) of the 73 patients. In the detection of severe LA SEC, the sensitivity of FI and HI were 13.2% (5/38) and 100% (38/38), respectively. LA SEC was not observed in control subjects either by FI or HI. CONCLUSION: Transthoracic HI significantly enhances the detection of LA SEC in patients with MS.
Subject(s)
Female , Humans , Atrial Fibrillation , Echocardiography , Echocardiography, Transesophageal , Embolism , Heart Atria , Mitral Valve , Mitral Valve Stenosis , Stroke , Thromboembolism , Thrombosis , UltrasonographyABSTRACT
Unilateral developmental deficiency of lung is rare. As the most of those, unilateral agenesis or Scimitar syndrome(hypogenetic lung syndrome) had been reported. We experienced that two cases of unilateral developmental deficiency of lung, which is different form each other, are found in identical twin. To our knowledge, this condition has not been reported before. We evaluated lung parenchyma and bronchus(; simple chest PA, chest CT(HRCT, 3DCT)), vasculatures(; pulmonary angiography and cardiac catheterization) and combined anomalies (;abdominal ultrasound, echocardiography, routine blood chemistry, and chromosomal study). This 31 yrs old twin female patient was confirmed as an unilateral agenesis of left upper lobe and hypoplasia of left lower lobe without combined anomalies. She's twin younger sister was confirmed as unilateral agenesis of right lung with atrial septal defect(ASD).
Subject(s)
Female , Humans , Angiography , Chemistry , Echocardiography , Lung , Siblings , Thorax , Twins, Monozygotic , UltrasonographyABSTRACT
Left ventricular pseudoaneurysm, in which a ventricular free wall rupture is locally contained by adherent pericardium, is a rare complication of myocardial infarction. Compared w'th a true left ventricular aneunsm, a pseudoaneurysm has a greater propensity to sudden rupture, with catastrophic sequelae. Pseudoaneurysm may be surgically curable, a prompt and accurate diagnosis is thus essential. Transthoracic echocardiography has been the procedure of choice in the diagnosis of pseu- doaneurysm. Transesophageal echocardiography can provide more accurate information than transthoracic echocardiography for the evaluation of ventricular pseudoaneurysm located in posterior and inferior wall. We experienced a case of pseudoaneurysm of left ventricle in a 75-year-old female who presented with dyspnea. A large pseudoaneurysm of left ventricle vith narrow neck was de- tected by transesophageal echocardiography.
Subject(s)
Aged , Female , Humans , Aneurysm, False , Diagnosis , Dyspnea , Echocardiography , Echocardiography, Transesophageal , Heart Rupture , Heart Ventricles , Myocardial Infarction , Neck , Pericardium , RuptureABSTRACT
PURPOSE: To investigate the causes of gastric wall shortening in early gastric cancer, upper gastrointestinal study was correlated with pathologic findings. MATERIALS AND METHODS: We evaluated 41 cases(M :F=1.7:1, average age=49) of early gastric cancer, retrospectively. The gastric wall shortening were classified as Grade I; none, Grade II ;intermediate, and Grade III; prominent. Pathologic findings such as size of lesions, depth of tumor invasion, degree of the submucosal fibrosis, degree of thickness of the submucosa and muscularis propria, and morphologic patterns of lesions including conversing mucosal folds were correlated with the degree of gastric wall shortening on upper gastrointestinal series. RESULTS: Submucosal fibrosis was present in 4 cases in Grade I (n=21), 4 cases in Grade II (n=6) and 8 cases in Grade III (n=10). Positive conversing mucosal folds were seen in 5 cases in Grade I (n=17), 0 case in Grade II (n=2) and 9 cases in Grade III (n=9). Gastric wall shortening was significantly associated with submucosal fibrosis and conversing mucosal folds of early gastric cancer. (p=.0001 and p=.002, respectively) CONCLUSION: Upper gastrointestinal finding of gastric wall protrusion in patients with early gastric cancer should not misinterprete as advanced gastric cancer since the finding could be a result of submucosal fibrosis.
Subject(s)
Humans , Fibrosis , Retrospective Studies , Stomach NeoplasmsABSTRACT
PURPOSE: To investigate the causes of gastric wall shortening in early gastric cancer, upper gastrointestinal study was correlated with pathologic findings. MATERIALS AND METHODS: We evaluated 41 cases(M :F=1.7:1, average age=49) of early gastric cancer, retrospectively. The gastric wall shortening were classified as Grade I; none, Grade II ;intermediate, and Grade III; prominent. Pathologic findings such as size of lesions, depth of tumor invasion, degree of the submucosal fibrosis, degree of thickness of the submucosa and muscularis propria, and morphologic patterns of lesions including conversing mucosal folds were correlated with the degree of gastric wall shortening on upper gastrointestinal series. RESULTS: Submucosal fibrosis was present in 4 cases in Grade I (n=21), 4 cases in Grade II (n=6) and 8 cases in Grade III (n=10). Positive conversing mucosal folds were seen in 5 cases in Grade I (n=17), 0 case in Grade II (n=2) and 9 cases in Grade III (n=9). Gastric wall shortening was significantly associated with submucosal fibrosis and conversing mucosal folds of early gastric cancer. (p=.0001 and p=.002, respectively) CONCLUSION: Upper gastrointestinal finding of gastric wall protrusion in patients with early gastric cancer should not misinterprete as advanced gastric cancer since the finding could be a result of submucosal fibrosis.
Subject(s)
Humans , Fibrosis , Retrospective Studies , Stomach NeoplasmsABSTRACT
Mediastinal tuberculous lymphadenitis is rare in adults, and it is even rarer for dysphagia to be the presenting symptom of mediastinal tuberculous lymphadenitis. Mediastinal tuberculous lymphadenitis with esophageal symptoms has been presented as esophageal ulceration, mucosal or submucosal mass with ulceration, fistula or sinus formation, extrinsic compression, or displacement of the esophagus. An exaggerated form of extrinsic compression may be presented as a submucosal tumor, radiologically or endoscopically. A barium esophagography of a 34 year-old woman with painful dysphagia revealed a large submucosal tumor-like mass on the mid-esophagus. The symptom was spontaneously improved over a 3-week period together with reduction of the mass size. A computed tomography of the chest disclosed an enlarged subcarinal lymph node and histologic examination of the specimen obtained by thoracoscopic biopsy brought about a diagnosis of tuberculosis. We herein report a case of mediastinal tuberculosis with unusual manifestations.
Subject(s)
Adult , Female , Humans , Deglutition Disorders/etiology , Diagnosis, Differential , Esophageal Neoplasms/diagnosis , Esophagoscopy , Esophagus/pathology , Mediastinal Diseases/complications , Radiography, Thoracic , Tomography, X-Ray Computed , Tuberculosis, Lymph Node/complicationsABSTRACT
PURPOSE: Recently, indirect lymphangiography has been developed as a relatively good and noninvasive imaging modality of the lymphatic system at extremities. But the disadvantage of the indirect lymphangiography is a low contrast ratio between the surrounding tissues and the contrast media in lymphatic vessels, because dimeric nonionic contrast media is water soluble and diluted in the proximal leg lymphatic vessels. We could have relatively better image than previously published images for the leg lymphatic system, when we injected contrast media with adequate high pressure in intradermal space of the interdigital areas at the foot dotsum. So, we would like to report the results. MATERIALS AND METHODS: We could study all 9 lymphedemas(primary :6, secondary: 3) from April 1990 to May 1993 on outpatient base. They were diagnosed as lymphedema clinically and radiologically. Ten ml of dimeric nonionic aget, iotrolan(Isovist 300 ) was injected into intradermal space with five 30-gauge needles The injection speed was more than 0.2mi/min. We have done one side pedal lymphangiogram in 30 minutes. The evaluation of the anterior superficial lymphatics was accordig to the criteria of the Weissleder(2). RESULTS: The results were as follows:1. All lymphatic vessels from foot to inguinal area could be visualized. 2. Two or three inferior inguinal lymph nodes could be visualized about 42%. 3. The most common abnormal finding of the lymphedma was the neovascularization of the lymphatics on indirect pedal lymphangiogram. CONCLUSION: If we use adequate technique relatively high pressure injection, correct intradermal needle insertion, adequate soft tissue exposure technique indirect lymphangiography is considered to be a safe and noninvasive imaging modality for the evaluation of the lymphedema of lower extremity lymphatics including inferior inguinal lymph nodes.
Subject(s)
Humans , Contrast Media , Extremities , Foot , Leg , Lower Extremity , Lymph Nodes , Lymphatic System , Lymphatic Vessels , Lymphedema , Lymphography , Needles , OutpatientsABSTRACT
PURPOSE: We performed this study to evaluate the usefulness and the limitation of magnetic resonance angiography in imaging portal vein and hepatic vein. MATERIALS AND METHODS: Magnetic resonance portography was performed in five normal subjects and seven patients with hepatomas, two patients with Budd-Chiari syndromes, one patient with liver cirrhosis and one patient with hepatic metastasis from stomach cancer. Magnetic resonance angiography was done with a 1.5-T Scanner. Breath-hold two-dimensional time-of flight images with spoiled gradient echo technique were acquired. Scan parameters were 34/8/40degrees(TR ms/TE ms/flip angle). The portal vein and the hepatic vein were selectively imaged by applying two presaturation bands. These images were then postprocessed by a maximum intensity projection algorithm. MRA findings were compared with ultrasonography in all cases of the hepatic disease, and conventional angiography (SMA portography) in four cases. RESULTS: In normal subjects, the splenic vein, intrahepatic and extrahepatic portions of the portal vein, and the hepatic veins were well visualized. In the patients with hepatic diseases, the varices (4 cases), the splenorenal shunts (2 cases), and the recanalized umbilical vein (1 case) were demonstrated. There were portal vein thrombosis in the cases of hepatomas and hepatic metastasis. In the cases of Budd-Chiari syndrome, the hepatic veins were not visualized and there were inferior vena cava obstructions with multiple collateral vessels. CONCLUSION: Compared with ultrasonography, MRP may be useful in evaluation of varices, splenorenal shunts, and other collaterals, though less accurate than conventional angiography. MRP can be useful as a noninvasive screening alternative in the evaluation of portal vein and hepatic veins.