PURPOSE: A flow diverter (FD) is an effective treatment option for intracranial aneurysms. The Flow Re-direction Endoluminal Device (FRED) is a relatively new flow diverter with a unique dual-layer design. We report our experience and short-term results with the FRED. MATERIALS AND METHODS: We did a retrospective review of all consecutive cases in which the FRED was used to treat intracranial aneurysms at a single institution from March 2014 till December 2015. Clinical parameters, aneurysm characteristics, technical results and short-term outcomes were reviewed. RESULTS: Eleven intracranial aneurysms were treated with the FRED in 11 patients. The technical device deployment success rate was 100%. Immediate reduction in intra-aneurysmal flow after deployment was noted in 10 cases. The aneurysm occlusion rate at 6 months was 75%. There was 1 complication of in-stent thrombosis immediately after deployment. There was no side branch occlusion, delayed aneurysm rupture, stroke, or intraparenchymal haemorrhage. There was no neurological deficit, morbidity, or mortality. CONCLUSION: The FRED is a new FD. It has shown to be safe and effective in our series. The unique dual-layer design of the device renders it to have technical advantages over other FDs. The 6-month aneurysm occlusion rate and complication profile of FRED are similar to other FDs.
Aneurysm ; Follow-Up Studies* ; Humans ; Intracranial Aneurysm* ; Mortality ; Retrospective Studies ; Rupture ; Stents ; Stroke ; Thrombosis

BACKGOUND: The present study was undertaken to determine the effect of remifentanil on the bispectral index (BIS) during intubation under TIVA (total intravenous anesthesia) using propofol. METHODS: In this prospective, randomized, double-blind study, 80 healthy patients aged 18~60 years undergoing elective surgery were investigated. Anesthesia was induced using propofol (target effect-site concentration 4microgram/ml). After the loss of consciousness, rocuronium (0.9 mg/kg) and remifentanil was infused. The patients in the R group were infused with remifentanil using a target effect-site concentration of 4 ng/ml, and patients in the P group were infused with saline. The BIS value, mean arterial pressure (MAP) and heart rate (HR) were measured before induction, before remifentanil infusion and before and after tracheal intubation. RESULTS: The BIS value remained constant after intubation in the two groups. The MAP and HR increased significantly after intubation in the two groups, but the degree of increase of MAP and HR was less in group R than in group P significantly. CONCLUSIONS: We suggest that the BIS value is not affected by the administration of remifentanil during intubation under TIVA using propofol.
Anesthesia ; Arterial Pressure ; Double-Blind Method ; Heart Rate ; Humans ; Intubation* ; Propofol* ; Prospective Studies ; Unconsciousness

BACKGROUND/AIMS: Bamboo joint-like (BJL) appearance is an endoscopic finding characterized by swollen longitudinal folds transversed by erosive fissures or linear furrows on the lesser curvature side of gastric body and cardia. It has been reported to be associated with Crohn's disease (CD). This study was aimed to evaluate the incidence of BJL appearance in Korean patients with CD. METHODS: From January to December in 2005, we performed esophagogastroduodenoscopy (EGD) in patients diagnosed as CD and ulcerative colitis (UC) in our hospital. Non-inflammatory bowel disease (IBD) subjects with upper gastrointestinal symptoms who underwent EGD were consecutively enrolled during the same period. One endoscopist performed all the endoscopic examinations to avoid inter-observer variation. A dye-spraying technique with 0.4% indigocarmine was used to allow the detection of subtle changes during the endoscopic examination. RESULTS: A total of 21 patients with CD (mean age+/-SD, 40+/-15 yr; M/F, 13/8), 28 patients with UC (42+/-15 yr; 21/7), and 685 non-IBD subjects (49+/-14 yr; 354/331) were enrolled. EGD findings in CD patients were gastric erosions (11/21), chronic superficial gastritis (5/21), chronic atrophic gastritis (1/21), duodenal erosions or ulcers (2/21), and normal (2/21). Incidence of BJL appearance was significantly higher in patients with CD (47.6%, 10/21) than others (UC, 3.6%, 1/28; non-IBD, 0.1%, 1/685) (p<0.0001). Among patients with CD, incidence of BJL appearance was not significantly different according to the sex, status of H. pylori infection, Vienna classification for phenotype, medications or EGD findings. CONCLUSIONS: BJL appearance on the gastric body and cardia can be a diagnostic clue to CD.
Adult ; Crohn Disease/diagnosis/*pathology ; Endoscopy, Digestive System ; Female ; Humans ; Male ; Middle Aged ; Stomach/*pathology

BACKGROUND/AIMS: Colonoscopy is the golden standard used as a surveillance test and screen for colon cancer, and the current demand for colonoscopy exceeds its availability. This study is an assessment of the colonoscopic surveillance intervals currently practiced. METHODS: A multiple choice survey of the colonoscopic surveillance interval used in six case scenarios [hyperplastic polyp; two 0.5 cm tubular adenomas (TAs); a 1.5 cm TA; 0.8 cm triple TAs; a 1.5 cm TA with high grade dysplasia; current normal exam after polypectomy of a <1 cm sized TA 3 years ago] was sent via e-mail to members of the KASID. RESULTS: A total of 131 colonoscopists (104 men, 27 women) replied, and the mean age of the respondents was 36 years (range 28~58). All respondents were board- certified in their respective specialties (internal medicine 75, general surgery 3, and GI subspecialty 53). When compared with the AGA guidelines, 90.1~99.2% of the respondents performed the first post-polypectomy surveillance colonoscopy prematurely, and 75.6% of respondents performed the second surveillance prematurely. CONCLUSIONS: Most post-polypectomy surveillance colonoscopies were performed prematurely. It is quite possible that unnecessary surveillance may account for a significant portion of the demand for colonoscopy.
Adenoma ; Colonic Neoplasms ; Colonoscopy* ; Surveys and Questionnaires ; Electronic Mail ; Humans ; Male ; Polyps

The purpose of this study was to evaluate cumulative survival rate (CSR, %) of mandibular posterior single tooth implants replaced with ITI SLA (sand-blasted, large-grit, acid-etched) implant system and compare the CSR between first and second molar. The findings from the results were as follows; 1. Total of 158 implants were inserted into 147 patients. 68 patients were males, 79 patients were females and their mean age was 47.8 years. 98 implants were placed in first molar area and 60 implants were placed in second molar area. In terms of diameter, implants with wide diameter over 4.8mm dominated (91.1%). Implants with length over 10mm were used (96.2%). 2. In the two cases, there was a slight transient numbness which recovered within 1-2 months. Nine SynOcta screw type abutments demonstrated screw loosening. There were ten cases of crown fallen-out from decementation. 3. Only one failed out of 158 implants. The CSR was 99.4%. The CSRs for first molar and second molar were 99% and 100%, respectively. From the results, it was concluded that single tooth replacement implant in the mandibular posterior area, might be considered as the effective treatment modality comparable to the conventional crown and bridge.
Crowns ; Dental Implants, Single-Tooth ; Female ; Humans ; Hypesthesia ; Male ; Molar ; Retrospective Studies* ; Survival Rate ; Tooth*

This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.
*APACHE ; Adult ; Aged ; Aged, 80 and over ; Emergency Service, Hospital ; Female ; Hospital Mortality ; Humans ; *Intensive Care Units ; Male ; Middle Aged ; Organophosphate Poisoning/*diagnosis/mortality ; ROC Curve ; Sensitivity and Specificity ; *Severity of Illness Index

Facioscapulohumeral muscular dystrophy (FSHD) presents a muscular weakness in the face, shoulder girdle, and legs. In addition, bilateral, progressive, high-frequency sensorineural hearing loss (SNHL) can be expressed. A 3-year-old boy visited with bilateral facial paralysis and bilateral hearing loss. Audiological evaluations revealed bilateral, progressive, sloping SNHL and bilateral hearing aids was used for more than 3 years. Cochlear implantation was carried out on left side when he was 6 years old and on right side when he was 7 years old. Seven months after cochlear implantation on left side, his shoulder muscle weakness was found and the genetic analysis showed decreased D4Z4 repeat size in 4qA allele confirming a diagnosis of FSHD. After auditory rehabilitation using electroacoustic stimulation, his hearing and speech perception were much improved. This case suggests that cochlear implantation can be beneficial in patients with SNHL associated with FSHD.
Alleles ; Child, Preschool ; Cochlear Implantation* ; Cochlear Implants* ; Diagnosis ; Facial Paralysis ; Hearing ; Hearing Aids ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Sensorineural* ; Humans ; Leg ; Male ; Muscle Weakness ; Muscular Dystrophy, Facioscapulohumeral* ; Rehabilitation ; Shoulder ; Speech Perception

Although rare, hepatic artery aneurysms are associated with a high morbidity and mortality, necessitating a prompt diagnosis. A significant proportion of hepatic artery aneurysms are pseudoaneurysms, and the major risk factors of which have already been identified in previous literatures. Presentation can be variable, but diagnosis almost relies entirely on computed tomography and digital subtraction angiography. The endovascular approach has progressively become the preferred option due to its better performance when compared to the traditional surgical approach. However, formulation of an endovascular treatment plan for these lesions remains difficult as multiple factors should be considered to identify the best endovascular treatment modality. Five cases of pseudoaneurysm due to recent Whipple operation, hepatobiliary infections, and underlying malignancy are presented in this article to illustrate the effectiveness and complexity of endovascular treatment in this disease entity.

BACKGROUND/AIMS: It has been reported that the risk of gastric polyp is increased in various colonic polyposis syndromes or in series of patients with sporadic colonic polyps. However, there are only a few large case controlled studies of colon cancer incidence in gastric cancer patients who underwent colonoscopy. The aims of this study were to determine the incidence of colorectal neoplasm and to evaluate the necessity of colonoscopic surveillance in patients with gastric cancer. METHODS: We performed colonoscopy in 105 patients with gastric cancer who agreed to undergo colonoscopy before or after 6 months from gastric resection between January 2002 and December 2004 in Kangbuk Samsung hospital. As a control group, 269 consecutive, age and sex matched patients without gastric neoplasm on gastroscopy who underwent colonoscopy within 6 months for the evaluation of various gastrointestinal symptoms during the year 2004 were included. Endoscopic reports and pathological results were reviewed retrospectively. RESULTS: In the patient group, adenomatous polyps were diagnosed in 24/105 patients (22.9%) and colorectal adenocarcinoma in 10/105 patients (9.5%). In the control group, adenomatous polyps were diagnosed in 78/269 patients (29.0%) and colorectal adenocarcinoma in 2/269 patients (0.7%). The incidence of colorectal adenocarcinoma between the patient group and control group showed significant differences (odds ratio 11.04, p=0.003). CONCLUSIONS: The risk of colorectal adenocarcinoma increases significantly in patients with gastric cancer. We suggest that the patients with gastric cancer might carry a high risk for colorectal cancer whom require surveillance colonoscopy.
Adenocarcinoma/*diagnosis/*secondary ; Adenomatous Polyps/diagnosis ; Colonic Polyps/diagnosis ; *Colonoscopy ; Colorectal Neoplasms/*diagnosis/*secondary ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary/*diagnosis ; Stomach Neoplasms/*pathology

BACKGROUND/AIMS: Antibiotic resistance and poor compliance are the main causes of Helicobacter pylori (H. pylori) eradication failure. This study evaluated the eradication rate, tolerability, and compliance of levofloxacin- azithromycin combined triple therapy for H. pylori eradication. METHODS: 1) First-line eradication: A total of 78 H. pylori-positive patients were enrolled. Seventeen military men in Armed Forces Capital Hospital were treated with 7 days of levofloxacin-azithromycin combined triple therapy (omeprazole 20 mg bid, levofloxacin 500 mg od, and azithromycin 500 mg od), and 61 patients in Kangbuk Samsung Hospital were treated with standard PPI-based triple therapy (omeprazole 20 mg bid, amoxicillin 1.0 g bid, and clarithromycin 500 mg bid) for 7 days. 2) Second-line eradication: A consecutive series of 59 patients who failed H. pylori eradication with standard PPI-based triple therapy in Kangbuk Samsung Hospital were randomized to two groups. Thirty patients were retreated with 7 days of bismuth-based quadruple therapy (omeprazole 20 mg bid, bismuth 120 mg qid, metronidazole 500 mg tid, and tetracycline 500 mg qid), and remaining 29 patients were retreated with levofloxacin-azithromycin combined triple therapy. Patient's compliance and tolerability were evaluated at the end of treatment. The status of H. pylori infection was assessed 8 weeks later then. The successful eradication of H. pylori was defined as negative results from histology and CLO test, or 13C-urea breath test. RESULTS: First-line eradication rate of levofloxacin-azithromycin triple therapy was lower than that of standard PPI-based triple therapy, but there was no statistically significant difference (70.6% vs. 80.3%, p=0.390). Second-line eradication rate of levofloxacin-azithromycin combined triple therapy was significantly lower than that of bismuth-based quadruple therapy (ITT/PP 65.5%/73.1% vs. 90%/90%, p<0.0001). The compliances of all patients were more than 85%. Two of patients with levofloxacin-azithromycin combined triple therapy complained self-limiting side effects (mild dizziness; mild insomnia with general weakness). CONCLUSIONS: Levofloxacin-azithromycin combined triple therapy should not be recommended as the first-line or second-line H. pylori eradication regimen in Korea.
Adult ; Anti-Bacterial Agents/*administration & dosage ; Azithromycin/*administration & dosage ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy/microbiology ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Ofloxacin/*administration & dosage