Idiopathic Myointimal Hyperplasia of Mesenteric Veins / 대한소화기학회지

No abstract available.

Unexpectedly Discovered Duodenal Perforation / 대한췌담도학회지

Duodenal perforation can occur due to complications caused by ulcers, other inflammation or by the instrument used during the procedure such as endoscopy, endoscopic retrograde cholangiopancreatography (ERCP); however, its incidence is not high. Most cases of perforation of the lateral wall of the duodenum are acute and require immediate surgical or endoscopic treatment. Cases of chronic duodenal perforation are rarely reported. This report presents the case of a previous perforation that was discovered unexpectedly during ERCP in a patient with cholangitis due to common bile duct stones. The time of occurrence of the perforation was unknown. After medical treatment, the patient was able to return to daily life. We have reported this case along with a literature review.

A Case of Metastatic Low-Grade Endometrial Stromal Sarcoma Treated with Letrozole after Ovarian Ablation by Radiotherapy / Journal of the Korean Cancer Association, 대한암학회지

A 50-year-old woman was admitted to our hospital due to multiple lung nodules detected incidentally on a chest X-ray. A video-assisted thoracoscopic lung biopsy revealed low-grade endometrial stromal sarcoma (LG-ESS). She had undergone a simple hysterectomy 1 year earlier owing to a diagnosis of adenomyosis. A review of her previous hysterectomy specimen showed not endometriosis but LG-ESS. According to the patient's levels of serum follicle stimulating hormone and estradiol, she was in the premenopausal state with retained and normally functioning ovaries. She then underwent ovarian ablation by radiotherapy, after which she was administered 2.5 mg of letrozole once per day. Three months later, the size of the metastatic nodules in both lungs had decreased. The patient was followed up for 24 months while continuing on letrozole, and maintained a partial remission. We report herein on a case of metastatic LG-ESS treated with letrozole after ovarian ablation by radiotherapy.

Intramedullary Spinal Cord Metastasis From Rectal Cancer

Intramedullary spinal cord metastasis (ISCM) is an uncommon condition of the central nervous system (CNS) cause by systemic malignant tumors. Most ISCM cases are known to occur in patients with lung cancer and breast cancer; however, ISCM also very rarely occurs in patients with colorectal cancer. For the first time in Korea, we experienced a case of ISCM arising from rectal cancer, where a 75-year-old man presented with an abruptly-developed left-foot drop and numbness in both legs. The patient had lung metastases from rectal cancer that had been treated with chemotherapy. Magnetic resonance imaging revealed an intramedullary nodular lesion at the T12 level. ISCM was diagnosed and treated with steroids and radiotherapy. The patient's neurological symptoms were relieved for a while after treatment, but his condition deteriorated progressively. He died 4 months after ISCM had been diagnosed.

The Ratio Between the Percentage of Lymphocytes and Glucose Levels in Pericardial Fluid as a Method to Diagnose Tuberculous Pericarditis / 대한내과학회지

BACKGROUND/AIMS: Adenosine deaminase (ADA) is a valuable biochemical marker for pericardial effusion (PE) and may be useful for diagnosing tuberculous pericarditis (TPE) in patients with PE. However, no definite cut-off or borderline values for ADA currently exist to distinguish TPE from other PE etiologies. In this study, we identified other useful parameters and characterized their relationship with ADA as a method for diagnosing TPE. METHODS: From June 2004 to November 2011, 42 patients underwent pericardiocentesis due to moderate or severe PE, as confirmed by echocardiography or chest computed tomography (CT). Patients were subdivided into TPE and non-TPE (NTPE) groups. We analyzed ADA (p) (the pericardial ADA) and %Lymph (p)/Glucose (p) (the ratio between the percentage of lymphocytes and glucose levels in PE). RESULTS: We defined the cut-off value of ADA (p) as 48.5 IU/L, and that of %Lymph (p)/Glucose (p) as 0.678%.dL/mg. In a multivariate logistic regression analysis, an odds ratio (OR) of 44.24 and a 95% confidence interval (CI) of 2.85-686.97 were observed in patients with an ADA (p) > or = 48.5 IU/L (p = 0.023). An OR of 20.39 and a 95% CI of 1.06-392.93 were observed in patients with a %Lymph (p)/Glucose (p) > or = 0.678%.dL/mg (p = 0.046). The combination of ADA (p) and %Lymph (p)/Glucose (p) had a higher positive predictive value (PPV, 80.0%) and specificity (Sp, 93.8%) than either ADA (p) (PPV, 47.4%; Sp, 68.8%) or %Lymph (p)/Glucose (p) (PPV, 69.2%; Sp, 87.5%) alone. CONCLUSIONS: %Lymph (p)/Glucose (p) is a useful parameter for distinguishing TPE from other pericardial diseases if combined with an ADA (p) > or = 48.5 IU/L.

Effects of Combined Antiplatelets on Bleeding in Off-Pump Coronary-Artery Bypass Surgery / 영남의대학술지

BACKGROUND: Antiplatelet agent administration is critical in managing coronary-artery disease, but there is a concern regarding operation-related bleeding and an increase in blood transfusion in such, especially when delivering combined antiplatelet agents. This study was conducted to evaluate the effect of the administration of antiplatelet agents on off-pump coronary-artery bypass surgery (OPCAB). METHODS: From March 2003 to December 2009, 49 patients who had undergone OPCAB were collected retrospectively. The patients were divided into three groups according to the administration of antiplatelet agents before the OPCAB operation: 21 patients were given an aspirin agent (group 1), 19 patients were given combined agents (aspirin+clopidogrel) (group 2), and nine patients were not given any antiplatelet agent (group 3). The three groups' perioperative hematologic and coagulation profiles, including their platelet counts, hemoglobin levels, hematocrit, prothrombin times, and aPTTs (activated partial thromboplastin times), and their postoperative bleeding, related complications, transfusion requirements, and operation times, were compared. RESULTS: The operation time in group 2 was 4.3 hours, longer than those in the two other groups, and urgent operation was significantly most frequent in group 2 (63%). The amount of blood loss and the number of patients who received blood transfusion were not different in the three groups. The perioperative hemoglobin level, hematocrit, platelet count, prothrombin time, and aPTT were also not significantly different among the three groups. CONCLUSION: The continuous administration of antiplatelet agents to the patients in this study did not increase their postoperative bleeding or operation-related complications. Therefore, OPCAB may well be considered even if combined antiplatelet agents are being administered.

A Case of Poncet's Disease in a Patient with Pulmonary Tuberculosis Accompanying Erythema Nodosum / 결핵및호흡기질환

Poncet's disease is an aseptic polyarthritis developing in the presence of active Tuberculosis occurring elsewhere, and is not due to direct involvement of joints but to an immunological reaction to tuberculoprotein. We experienced a case of Poncet's disease accompanying erythema nodosum in a 55-year-old female patient with pulmonary tuberculosis. She had multiple tender erythematous nodules on both lower limbs for 3 months and a cough and sputum from one month ago. She felt severe pain in both knees and ankles with swelling one week before admission. Her chest X-ray, computed tomography (CT) scan and positive sputum AFB stain results revealed that she had active pulmonary tuberculosis accompanying erythema nodosum and aseptic polyarthritis. Her arthritis and erythema nodosum were dramatically improved within four weeks after anti-tuberculosis therapy. We report a case of Poncet's disease in pulmonary tuberculosis accompanying erythema nodosum.

Intracardiac Tumor Presenting as Complete Atrioventricular Block

No abstract available.

Neuroprotection for Acute Spinal Cord Injury: Comparison of Simvastatin and Atorvastatin / 대한정형외과학회잡지

PURPOSE: To evaluate the neuroprotective effect of statins after a spinal cord injury. MATERIALS AND METHODS: Twenty four Sprague Dawley rats had a spinal cord injury at T9/10 using an Ohio State University (OSU) impactor. The animals were randomized to receive either simvastatin, atorvastatin, or saline with oral gavage everyday for 7 days. A behavioral outcome assessment was performed on days 2, 4 and 7, and then every week using the Basso, Bresnahan, and Beattie (BBB) score and subscore. The animals also underwent sensory threshold testing using a von Frey monofilament device. The animals were sacrificed at the end of 6 weeks and a spinal cord specimen was harvested. Histology and immunohistochemistry were performed to measure the areas of white and gray matter, and the sparing of oligodenrocytes. RESULTS: For the animals treated with simvastatin, atorvastatin and saline, the mean BBB scores at 6 weeks post-injury was 13.2+/-0.1, 11.8+/-0.5, and 11.3+/-0.2 and the BBB subscores were 9.2+/-1.1, 4.8+/-1.8 and 4.4+/-1.4 respectively (p<0.05). The areas of white matter at the lesion epicenter were 0.78+/-0.05, 0.5+/-0.18 and 0.41+/-0.03 mm2 in the simvastatin, atorvastatin and saline groups respectively, and the number of spared oligodendrocytes was significantly higher in the simvastatin treated animals (p<0.05). CONCLUSION: The simvastatin treatment improved the behavior and histological sparing of the spinal cord after an acute spinal cord injury in rats.

Comparison of the Results of the Decompression Methods for Degenerative Lumbar Spinal Stenosis: Comparison of Posterior Element Saving Procedures / 대한척추외과학회지

STUDY DESIGN: This is a prospective study. OBJECTIVES: We wanted to analyze the radiographic and clinical results of the three posterior element saving decompression techniques for treating lumbar degenerative spinal stenosis. SUMMARY OF THE LITERATURE REVIEW: Minimal invasive decompression reduces patient morbidity and the hospital stay. MATERIALS AND METHODS: We evaluated 30 patients, who were treated with posterior element saving microscopic decompression for their lumbar spinal stenosis (without instability), during the period from March, 2002 and February, 2004. The procedures were bilateral laminotomy (10 cases), spinous process osteotomy (8 cases) and laminoplasty (12 cases). We evaluated the estimated blood loss, the amount of transfusion, the complications and the radiographic instability at the last follow-up. The clinical results were evaluated with using the Oswestry disability index (ODI) and the visual analogue scale (VAS) for buttock and leg pain both preoperatively and at postoperative 1, 3, 6 and 12 months, respectively. RESULTS: There was no radiographic instability noted for any of the patients at the last follow up. The mean ODI and VAS scores were substantially improved at postoperative 1 month and then they were marginally improved afterwards. However, there were no statistically significant differences among three procedures (p>0.05). The mean blood loss and the amount of transfusion for each spinal level were 290 ml and 0.5 U for bilateral laminotomy, 370 ml and 0.9 U for spinous process osteotomy and 180 ml and 0.1 U for laminoplasty, respectively. CONCLUSION: There were no significant differences in the radiograhic and clinical results among bilateral laminotomy, spinous process osteotomy and laminoplasty. Yet in terms of blood loss and transfusion, laminoplasty was better than the other techniques. We believe that laminoplasty is a useful and safe technique for treating degenerative lumbar spinal stenosis.

Revision of Total Hip Arthroplasty Using Wagner Femoral Revision Stem / 대한정형외과학회잡지

PURPOSE: The aim of this study was to see the results of total hip arthroplasty revision using Wagner femoral revision stem. MATERIALS AND METHODS: From January 1994 and December 1998, we implanted to twenty-three Wagner revision stems in 22 patient (23 cases). The patients'average age was 54 years and the average follow-up time was 48 months. The causes of the revision were as follows: aseptic loosening (18 cases), periprosthetic fractures with loosening (4 cases), and septic loosening (1 case). RESULTS: The preoperative Harris hip score was 47 points, and this improved to 90.5 points postoperatively. There were 3 cases of inguinal pain, 2 cases of thigh pain, 3 cases of leg length discrepancy, and one case of subsidence of stem exceeding more than 5 mm. Postoperative complications included 2 cases of hip posterior dislocation, and 2 cases of heterotopic ossification. CONCLUSION: No patient required re-revision surgery to treat stem loosening or other problems. The results of the operations were excellent. However, we had difficulty selecting the optimal stem size with respect to preventing subsidence problems.