Time intervals and indices of left ventricular diastolic filling were studied by M-mode and pulsed Doppler Echocardiography in 18 dilated cardiomyopathy patients. After one two hours captopril(capril(R)) 25mg medication. 1)Systolic blood pressure, Diastolic blood pressure, Heart rate were significantly decreased. 2) Dimensions of LVSD, LVDD, LA, Aorta and EF were not changed measured by M-mode echocardiography. 3) IRT measured by M-mode and Pulsed Doppler echocardiography were significantly increased(45+/-33msec VS 74+/-35msec. 84+/-32msec VS 100+/-22msec P<0.05). 4) A2-E measured by M-mode and Pulsed Doppler echocardiography were significantly increased(114+/-45msec VS 134+/-46msec, 156+/-46msec VS 194+/-48msec, P<0.05). 5) Deceleration time was significantly increased(137+/-36msec VS 205+/-40msec P<0.05). 6) Transmitral peak flow velocities were not changed significantly. In summary captopril influences early diastolic time intervals with dilated cardiomyopathy patients and we interpreted these effects be beneficial on diastolic filling pattern.
Aorta ; Blood Pressure ; Captopril ; Cardiomyopathy, Dilated* ; Deceleration ; Echocardiography ; Echocardiography, Doppler, Pulsed ; Heart Rate ; Humans

Primary central nervous system (CNS) sarcomas are exceedingly rare, and, to the best of our knowledge, there has not yet been a report of intramedullary sarcoma. Here, we report a primary intradural intramedullary sarcoma of the spinal cord in a four-year-old boy who presented with low back pain and a radiculopathy involving both lower extremities. The tumor showed significant enhancement on magnetic resonance (MR) images due to its extreme vascularity. Gross total tumor removal was performed with microelectrical pulse recording, and the patient also received adjuvant radiotherapy and chemotherapy. After the operation, the patient's sensory deficits were improved. Because CNS dissemination is common, entire neuraxis evaluation is essential, although there was no evidence of dissemination in this case. The prognosis of primary CNS sarcoma is poor due to infiltrative nature and early CNS dissemination is common, and the treatment of choice is radical surgical resection. Adjuvant therapy is also beneficial with radiotherapy and chemotherapy.
Central Nervous System ; Humans ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Spectroscopy ; Prognosis ; Radiculopathy ; Radiotherapy, Adjuvant ; Sarcoma ; Spinal Cord

The authors report a case of fusiform aneurysm in the proximal anterior cerebral artery(ACA). A 44-year-old woman presented with severe headache after subarachnoid hemorrhage. The right carotid angiography demonstrated a fusiform aneurysm in the A1 segment of right ACA with vasospasm. Clipping of a fusiform right A1 aneurysm was performed via the right pterional approach. The postoperative cerebral angiography demonstrated complete occlusion of the fusiform aneurysm and moderate degree of vasospasm with preservation of A1 segment. The postoperative course was uneventful. We report a case of fusiform aneurysm of A1 segment that was successfully clipped with the fenestrated aneurysmal clip.
Adult ; Aneurysm* ; Angiography ; Anterior Cerebral Artery* ; Cerebral Angiography ; Female ; Headache ; Humans ; Subarachnoid Hemorrhage

Actinomycosis is difficult to diagnose preoperatively because of non-specific clinical feature. We usually have excessively invasive treatment for actinomycosis. So, we must rule out actinomycosis in the case of patients with a complaint of lower abdominal pain with a long time IUD inserted state and laboratory findings suggestive of inflammation. We experienced two cases of pelvic actinomycosis associated with IUD and report these cases with a brief review of literatures.
Abdominal Pain ; Actinomycosis* ; Humans ; Inflammation ; Intrauterine Devices*

In order to determine the effect of early surgery on poor grade subarachnoid hemorrhage(SAH) patients. 88 such patients were evaluated between January, 1990 and January, 1996. Clinical grade on admission was Hunt-Hess grade IV(n=58) and V(n=30). The protocol involved the use of computed tomography(CT) scanning to diagnose SAH and to obtain evidence of the destruction of vital brain function, involving massive cerebral infarction with midline shift, dominant basal ganglia or brain stem hematoma. Patients were assigned to either the early surgery group(n=54: surgery performed within 3 days of the first hemorrhage) or the non-surgical group(n=33). In seventeen of 58 in Hunt-Hess grade IV patients, the outcome was good(GOS 4 and 5); 15 of these were in the early surgery group. In only one of 30 Hunt Hess grade V patients was there a good outcome, however. Among Hunt-Hess grade IV patients, mortality was 36.8% in the early surgery group and 60% in the non-surgical group; in the Hunt-Hess grade V group, the corresponding figures were 75% and 100%. In conclusion, it is recommended that to prevent rebleeding and other complications, Hunt-Hess grade IV patients, especially those that showing destruction of vital brain function, should undergo early surgery. With regard to early surgery, non-operation and the existence of evidence of destruction of vital brain function, grade V patients showed no difference in terms of their mortality and morbidity rate.
Aneurysm* ; Basal Ganglia ; Brain ; Brain Stem ; Cerebral Infarction ; Hematoma ; Humans ; Mortality ; Subarachnoid Hemorrhage*

The goal of operation in spondylolisthesis is improving radiculopathy and relieving lower back pain preventing further progression of the slip, through decompression of neural elements and fusion of spinal pseudoarthrosis, respectively. The author performed the posterior lumbar interbody fusion technique using a Threaded Fusion Cage(T.F.C.) for 41 patients as the surgical treatment for mild spondylolisthesis. All patients enrolled in the study were implanted with a T.F.C. at a single unstable level. We have investigated the outcome results for at least one year(mean 25.8 months). Of these patients 95% have shown solid fusions. Using the Prolo scale for economic and functional rating, the combined results of excellent, good score is 51%, but clinically symptomatic improvement is 66%. Therefore, posterior lumbar interbody fusion using T.F.C. was useful in treatment of mild degree spondylolisthesis.
Decompression ; Follow-Up Studies* ; Humans ; Low Back Pain ; Pseudarthrosis ; Radiculopathy ; Spondylolisthesis*

OBJECTIVE: The authors report the various factors which correlated with the intraoperative rupture during aneurysm surgery. METHODS: Retrospective study was done in patients who had been perfomed aneurysmal neck clipping by same surgeon from January 1998 to May 2000. A total of 121 patients were operated by using the microsurgical technique of aneurysmal neck clipping and intraoperative ruptures occurred during dissection in 19 cases and aneurysmal neck clipping in 12 cases. In this study, the incidence of intraoperative rupture was 25.6%. We analyzed the followings: preoperative neurologic status(Hunt-Hess grade), preoperative hemorrhage volume on computed tomography(Fisher grade), timing of operation, aneurysm location, aneurysm size, aneurysm direction, shape of the aneurysmal neck, prescence of atherosclerotic plaque around aneurysmal neck and parent vessel and Glasgow outcome scale score. RESULTS: Hunt-Hess grade, Fisher grade, timing of operation, aneurysm location, aneurysm size and direction of the aneurysm had not associated with intraoperative rupture. However, the incidence of intraoperative aneurysmal rupture during surgery was higher in patients whose anterior communicating artery aneurysm was directed inferiorly and aneurysmal neck was broad. The GOS score and the prescence of atherosclerotic plaque around the aneurysmal neck and parent vessel also correlated with the intraopertive rupture but more closely influenced by neck clipping than dissection. CONCLUSION: Surgeons should keep in mind the use of careful microsurgical sharp dissection especially in cases of inferiorly directed anterior communicating artery, broad-neck aneurysm and presence of atherosclerotic plaque around aneurysmal neck and parent vessels.
Aneurysm* ; Arteries ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Neck ; Parents ; Plaque, Atherosclerotic ; Retrospective Studies ; Rupture* ; Subarachnoid Hemorrhage*

A 7-year-old Thoroughbred horse was admitted to the Equine Hospital, Korea Racing Association with signs of colic. Based on the size of impactions, the clinical signs, the results of abdominal paracentesis and medical treatment, the prognosis was poor. The horse died 3 hours later following hopeless discharge. At necropsy, the caecum and large colon were fully filled with fecal contents and there was a rupture (10 cm in dia) in the latero- ventral caecum. The mucosa of the ileo-caecal and caeco- colic valves appeared to the hyperemic, edematous and ulcerous. There were many tapeworms in the affected mucosa. Histopathologically, lesions included hyperaemia, a deep necrotic inflammatory lesion and ulcers in the mucosa and submucosa of ileo-caecal and caeco-colic valves. One hundred thirty four faecal samples were obtained from 16 stables and submitted to parasitic examination. A total of 4 genera of eggs were recovered: Stongylus spp (82.1%), Anoplocephala perfoliata (10.5%), Bovicola equi (0.7%) and Parascaris equorum (1.5%). The major findings in this study are the presence of A perfoliata and its suspected association with the colic which led into an eventual caecal rupture. This study indicates the needs for an epidemiological survey of colic that is associated with Anoplocephala.
Animals ; Cecal Diseases/etiology/pathology/*veterinary ; Cestoda ; Cestode Infections/complications/pathology/*veterinary ; Colic/etiology/*veterinary ; Fatal Outcome ; Fecal Impaction/complications/parasitology/veterinary ; Feces/parasitology ; Horse Diseases/etiology/*parasitology/pathology ; Horses ; Ileocecal Valve/parasitology/pathology ; Intestinal Diseases, Parasitic/parasitology/pathology/*veterinary ; Intestinal Mucosa/parasitology/pathology ; Korea ; Parasite Egg Count/veterinary ; Prognosis ; Rupture, Spontaneous/pathology/veterinary

Approximately one-third of patients with Crohn's disease do not respond to conventional treatments, and some experience significant adverse effects, such as serious infections and lymphoma, and many patients require surgery due to complications. Increasing evidence suggests that specific changes in the composition of gut microbiota, termed as dysbiosis, are a common feature in patients with inflammatory bowel disease (IBD). Dysbiosis can lead to activation of the mucosal immune system, resulting in chronic inflammation and the development of mucosal lesions. Recently, fecal microbiota transplantation, aimed at modifying the composition of gut microbiota to overcome dysbiosis, has become a potential alternative therapeutic option for IBD. Herein, we present a patient with Crohn's colitis in whom biologic therapy failed previously, but clinical remission and endoscopic improvement was achieved after a single fecal microbiota transplantation infusion.
Biological Therapy ; Colitis ; Crohn Disease* ; Dysbiosis ; Fecal Microbiota Transplantation* ; Gastrointestinal Microbiome ; Humans ; Immune System ; Inflammation ; Inflammatory Bowel Diseases ; Lymphoma

Since its introduction, laparoscopic surgery has been often preferred over open surgery in obstetrics and gynecology due to its advantages, such as less bleeding, lower incidence of adhesions, reduced postoperative pain, short hospital stay, and quick return to daily life. However, in the case of complex surgeries, laparoscopy presented some limitations. Nonetheless, since the 1980s, medical robots have been introduced to overcome the technical limitations of laparoscopy and start a new age for minimally invasive surgery. In this review, we explore the indications and advantages and disadvantages of robotic surgery in the field of gynecology, and try to assess the recent trend of robotic surgery.