We experienced one case of an unusual acute osteomyelitis of orbital margin, of which frontal, zygomatic and maxillary bone was involved in 10-month old infant. His clinical symptomes were similar to the acute osteomyelitis of superior maxilla but the primary site seemed to be in the frontal bone by history. We treated him with massive antibiotics and surgery (anterior approach). The causative organism was staphylococcus sureus, being very sensitive to penicillin. Also we reviewed the literatures of the orbital osteomyelitis comparing with thia case.
Anti-Bacterial Agents ; Frontal Bone* ; Humans ; Infant ; Maxilla* ; Orbit* ; Osteomyelitis* ; Penicillins ; Staphylococcus

Aniridia is a congenital lack of iris and rudimentary iris tissue, almost always bilateral, occuring as a dominant characteristic by an autosomal gene with high penetrance and variable expression. The syndrome of congenital aniridia may be composed of four phenotypes. The authors have experienced one an iridic family: mother, one daughter and four sons. The most family members have ectopia lentis. cataract. corneal pannus and glaucoma as well as aniridia, so they were expected the first phenotype of aniridia due to a failure in development of retinal ectoderm. Two sons of them were operated in Chungnam National University Hospital for control of glaucoma and visual impairment due to cataractous ectopic lens. In one case the intraocular pressure was not controlled after trabeculectomy and in another case lens extraction resulted in visual improvement. The review was made of relating literatures for the case of aniridia family, breifly.
Aniridia* ; Cataract ; Chungcheongnam-do ; Ectoderm ; Ectopia Lentis ; Glaucoma ; Humans ; Intraocular Pressure ; Iris ; Mothers ; Nuclear Family ; Penetrance ; Phenotype ; Retinaldehyde ; Trabeculectomy ; Vision Disorders

A 40-year-old man who underwent 2 times of operation for the graft interposition with aortic valve replacement because of aortic dissection was admitted due to high fever and multiple petechiae on extremities for several days. We performed Transthoracic echocardiogram and MRI, revealed vegetation in the aortic arch and descending aorta. Re-do operation of aortic segment replacement and vegetation removal was carried out. Histological evaluation of vegetatation found fungal mass of aspergillus fumigatus.
Adult ; Aorta, Thoracic ; Aortic Valve ; Aspergillus fumigatus ; Extremities ; Fever ; Humans ; Magnetic Resonance Imaging ; Purpura ; Transplants*

PURPOSE: N-13 ammonia uptake and retention in the myocardium is related to perfusion and metabolism. There are several potential advantages of N-13 ammonia positron emission tomography (PET) to detect myocardial ischemia, such as higher spatial resolution, greater counting efficiencies, and robust attenuation correction. But there are few reports comparing Tc-99m myocardial perfusion single photon emission tomography (MPS) and N-13 ammonia PET. We thus compared adenosine stress N-13 ammonia PET/CT and Tc-99m sestamibi MPS in patients with suspected coronary artery stenosis. MATERIALS AND METHODS: Seventeen patients (male 13 : 63+/-11 years old) underwent adenosine stress N-13 ammonia PET/CT (Discovery ST, GE), Tc-99m sestamibi MPS (dual head gamma camera, Hawkeye, GE) and coronary angiography within 1 week. N-13 ammonia PET/CT and Tc-99m sestamibi MPS images were assessed with a 20-segment model by visual interpretation and quantitative analysis using automatic quantitative software (Myovation, GE). RESULTS: Both sensitivities and specificities of detecting an individual coronary artery stenosis were higher for N-13 ammonia PET/CT than Tc-99m sestamibi MPS (PET/CT: 91%/ 89% vs MPS: 65%/ 82%). N-13 ammonia PET/CT showed reversibility in 52% of segments that were considered non-reversibile by Tc-99m sestamibi MPS. In the 110 myocardial segments supplied by the stenotic coronary artery, N-13 ammonia PET/CT showed higher count densities than Tc-99m MPS on rest study (p<0.01), and the difference of count density between the stress and the rest studies was also larger on N-13 ammonia PET/CT. CONCLUSION: Adenosine stress N-13 ammonia PET/CT had higher diagnostic sensitivity and specificity, more reversibility of perfusion defects and greater stress/rest uptake differences than Tc-99m sestamibi MPS. Accordingly, N-13 ammonia PET/CT might offer better assessment of myocardial ischemia and viability.
Adenosine ; Ammonia ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Gamma Cameras ; Head ; Humans ; Myocardial Ischemia ; Myocardium ; Perfusion ; Positron-Emission Tomography ; Retention (Psychology) ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

BACKGROUND/AIMS: Various magnifying endoscopic classifications have been introduced in esophageal and gastric lesions. However, studies on an agreement between observers according to the form classification of magnifiying endoscopic findings have not been performed yet. The aim of this study was to determine the interobserver agreement for magnifying endoscopic classifications. METHODS: The patients were divided into 3 groups. The first group of patients had post-EMR ulcer scar (50 cases), the second group, elevated gastric lesion (38 cases), and the third group, gastritis (43 cases). Two mucosal patterns were used in the post-EMR ulcer scar group, 6 mucosal patterns in the elevated gastric lesion group, and 3 patterns of the collecting venule in the gastritis group. Three experienced observers (A, B, C) blinded to the patients' data participated in this study. The agreement between observers was evaluated by calculated kappa. The kappa value of 0.75 or greater was rated excellent, 0.4~0.74, fair to good, and 0.4 or less, poor. RESULTS: Regarding 2 mucosal pattern in post-EMR ulcer scar, agreements between A and B, A and C, and B and C were 0.896, 0.793, and 0.901, respectively (p<0.01). Regarding 6 mucosal patterns in elevated gastric lesion, agreements between A and B, A and C, and B and C were 0.607, 0.458, and 0.557, respectively (p<0.01). Regarding 3 collecting venule pattern in gastritis, agreements between A and B, A and C, and B and C were 0.822, 0.823, and 0.751, respectively (p<0.01). CONCLUSIONS: Interobserver agreement is good to excellent in mucosal pattern and collecting venule by magnifying endoscopy. However magnifying endoscopic classification needs to be refinded in order to improve an agreement between observers.
Cicatrix ; Classification ; Endoscopy* ; Gastritis ; Humans ; Ulcer ; Venules

BACKGROUND/AIMS: The relationship between the symptoms and severity of GERD may be difficult to prove. The intensity and frequency of reflux induced symptoms are poor predictors of the presence or severity of an endoscopic mucosal break. The aim of this study was to determine which factors can be predicted by the presence of GERD symptoms among esophageal sensitivity to acid, abnormal acid reflux, and severity of esophagitis in pateints with reflux esophagitis. METHODS: Fourty-four patients who were diagnosed with reflux esophagitis by an endoscopy at a tertiary medical facility, were given a validated questionnaire, and underwent an acid perfusion test, 24 hr ambulatory esophageal pH monitoring, and esophageal manometry. These patients were divided into a symptomatic group and asymptomatic group according to the questionaire. Comparisons between the two groups for each factor were analyzed by Chi-square. RESULT: Of 44 patients, 26 had symptoms and 18 did not. The positive and equivocal rates of the acid perfusion test were not different between the symptomatic and asymptomatic groups (47% vs. 39%). The abnormal reflux rate (DeMeester score > 14.72) from pH monitoring was significantly higher in the symptomatic group than in the asymptomatic group (65% vs. 28%, p < 0.05). The severity of esophagitis, presence of a hiatal hernia, and abnormal esophageal manometric findings were not different between the two groups. CONCLUSION: It would be impossible to predict esophageal sensitivity to acid, severity of the esophagitis grade, and the presence of hiatal hernia with GERD symptoms, but it could be possible to predict abnormal gastroesophageal reflux.
Endoscopy ; Esophageal pH Monitoring ; Esophagitis ; Esophagitis, Peptic* ; Gastroesophageal Reflux* ; Hernia, Hiatal ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Perfusion ; Surveys and Questionnaires

BACKGROUND/AIMS: A gastrointestinal mesenchymal tumor contains a leiomyoma and gastrointestinal stromal tumor (GIST). The natural course can vary according to the histology and other characteristics. This study evaluated the natural course of a benign mesenchymal tumor in the upper gastrointestinal tract using endoscopic ultrasonography (EUS). METHODS: Submucosal mesenchymal tumors are considered benign according to the following criteria of EUS: 1) the tumor originates from the muscularis mucosa or muscularis propria; 2) is well demarcated, homogenous and hypoechoic; and 3) has a regular surface. In this study, the changes of size, internal echo pattern and marginal regularity were evaluated retrospectively in 26 lesions that all were < 3 cm and were followed up for more than 2 years. RESULTS: The average size of the tumors on EUS was 11.5 mm. The mean follow-up period was 47.4 months. The follow-up EUS revealed no change in echo features in any patient. In only one patient, the size of the tumor increased from 26 to 34 mm without a change in the internal echo or marginal regularity after 24 months. This patient underwent a laparoscopic gastric wedge resection. The pathologic diagnosis was a leiomyoma. CONCLUSIONS: Most small submucosal tumors that are compatible with the EUS criteria of a benign GIST/ leiomyoma do not change over a period of 24 months, and the EUS criteria are effective in diagnosing benign GISTs/leiomyomas. A benign GIST/leiomyoma at EUS might be followed up by EUS at an interval of 2 years.
Diagnosis ; Endosonography ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Humans ; Leiomyoma ; Mucous Membrane ; Retrospective Studies ; Upper Gastrointestinal Tract*

Gastrointestinal fistula is a disease of varying etiologies. It may occur spontaneously or as a result of an iatrogenic cause. Spontaneous fistula occurs as a result of an inflammatory process, malignancy or radiotherapy. The majority of fistula are caused by iatrogenic causes, most frequently as a complication of surgical intervention. Treatment of gastrointestinal fistulae usually consists of surgery and conservative management such as nutritional support and control of inflammation. Recently, it has been reported that gastrointestinal fistulae can be treated endoscopically using tissue adhesive agents such as Histoacryl and fibrin glue. We report two cases of gastrointestinal fistulae that were successfully treated by endoscopic local injection therapy with a review of literature.
Enbucrilate ; Fibrin Tissue Adhesive ; Fistula* ; Inflammation ; Nutritional Support ; Radiotherapy ; Tissue Adhesives

BACKGROUND/AIMS: p53 is known to play a central role in sensing and signaling for the growth arrest and apoptosis in cells with DNA damage. Mutation of p53 is a frequent event in esophageal squamous cell carcinoma (ESCC). p16 protein binds to cyclin dependent kinase 4 (CDK4) inhibiting the ability of CDK4 to interact with cyclin D1, and stimulates the passage through the G1 phase of cell cycle. We observed the expression patterns and frequencies of p53, p16, and cyclin D1 in esophageal dysplasia and in esophageal squamous cell carcinomas. METHODS: In 15 patients of ESCC, 5 patients of esophageal dysplasia and 5 volunteers with normal esophagus, tissue specimens were taken from esophageal lesions during the operation or endoscopic examination. We used specific monoclonal antibodies for p53 protein, p16INK4 protein and cyclin D1. Immunoreactivity was scored. RESULTS: Mean age of all groups was 66 years old (range 47-93) and men to women ratio was 19:1. p53 mutation was observed in 87% (13/15) of ESCC, in 80% (4/5) of esophageal dysplasia, in 0% (0/5) of normal mucosa (p=0.001). p16 expression was seen in 40% (2/5) of esophageal dysplasia, 27% (4/15) of ESCC and 100% (5/5) of normal mucosa (p=0.016). Cyclin D1 expression was not significantly different among 20% (1/5) of esophageal dysplasia, 53% (8/15) of ESCC and 20% (1/5) of normal mucosa. Either the expression of p53 mutation or the loss of p16 occurred in 80% (4/5) of esophageal dysplasia and in 93% (14/15) of ESCC. CONCLUSIONS: The expression of p53 mutation and the loss of p16 might play a central role in the pathogenesis of esophageal squamous cell carcinoma (ESCC), and contribute to the development of precancerous lesion such as dysplasia. In addition, there is a possibility that the mutations of p53 and p16 silencing would be the early events in ESCC development.
Aged ; Carcinoma, Neuroendocrine/*diagnosis/pathology ; Chromogranin A/analysis/immunology ; Drainage ; Female ; Humans ; Immunohistochemistry ; Liver Abscess/*radiography/surgery ; Liver Neoplasms/*diagnosis/pathology ; Radiography, Abdominal ; Synaptophysin/analysis/immunology ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Although various solutions are being tested for submucosal injection during endoscopic resection, ideal solution has not been established yet. We performed an animal study to evaluate the possibility of sodium alginate as an ideal submucosal injection solution for endoscopic mucosal resection (EMR). METHODS: To compare the lesion-lifting properties of different solutions, injection was done to the submucosal layer of porcine stomach. Then the height of mucosal elevation was measured. In addition, EMR was performed after submucosal injection of sodium alginate solution in six dogs. Two were euthanized after 30 minutes of endoscopic observation while the others were euthanized after 1-4 weeks. Retrieved stomachs were examined microscopically. RESULTS: Sodium alginate and sodium hyaluronate solutions maintained longer elevation of the submucosal layer than other solutions. There was no significant difference in the height between two solutions. A clear separation of the mucosal layer from the proper muscle layer was achieved by injecting sodium alginate solution. Histological examination of EMR-induced artificial ulcers revealed no apparent tissue damage and showed normal healing process. CONCLUSIONS: Sodium alginate solution creates a sufficient submucosal fluid cushion without apparent tissue damage. It can be considered as an effective submucosal injection material.
Animals* ; Dogs ; Hyaluronic Acid ; Sodium* ; Stomach ; Ulcer