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

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

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*

BACKGROUND: We tried to assess whether the presence of warning symptoms and age could be useful indicators for performing endoscopy in patients who suffer from various organic gastrointestinal diseases. METHODS: Between May 2005 to August 2005, 827 subjects who visited the health care center were studied via questionnaires and performing upper endoscopy. The questionnaires evaluated the presence and pattern of dyspepsia and the warning symptoms. RESULTS: A total of 808 patients were enrolled. The mean age of patients was 44.6+/-8.9 years (mean+/-SD) with a male to female ratio of 1.2:1. 153 patients (18.9%) were diagnosed with confirmed organic diseases and 52 patients (6.4%) were diagnosed with definite organic diseases. The total number of organic diseases and definite organic diseases (gastroduodenal ulcer, reflux esophagitis and advanced gastric cancer) was statistically higher in the male population (p=0.001 in both). The relative risk of dyspepsia, the presence of warning symptoms and each warning symptom for the organic disease and definite organic diseases were not consistently higher for the males or females. The males over fifty years and the males over sixty years age had a relative risk of 2.046 (95% CI: 1.27~3.30) and 3.105 (95% CI: 1.39~6.95) for organic disease and 1.913 (95% CI: 0.97~3.77) and 5.333 (95% CI: 2.15~13.22) for definite organic disease, respectively. For the male patients over fifty or sixty years old with dyspepsia or warning symptoms, there were tendencies to increase the relative risk of definite organic disease rather than organic disease. CONCLUSIONS: The relative risk of organic diseases in the presence of warning symptoms in males of over fifty years or sixty years age was not sufficiently significant for differentiating organic diseases. Thus, warning symptoms, old age and presence of dyspepsia alone can not be used as a predictor to guide endoscopic examination.
Delivery of Health Care ; Dyspepsia* ; Endoscopy ; Esophagitis, Peptic ; Female ; Gastrointestinal Diseases ; Humans ; Male ; Ulcer ; Surveys and Questionnaires

BACKGROUND/AIMS: The discrepancy of the histopathological diagnosis between endoscopic forcep biopsy, surgery and endoscopic mucosal resection (EMR), has been reported on in a previous study. We compared the results of endoscopic forcep biopsy and the histopathologic diagnosis after performing endoscopic submucosal dissection (ESD). METHODS: We retrospectively reviewed 434 lesions for which we were able to compare the post-ESD histopathologic results with the endoscopic biopsy. RESULTS: 1) Of the 14 lesions that showed chronic gastritis or atypia by endoscopic biopsy, 9 were diagnosed with carcinoma in situ or adenocarcinoma after ESD. 2) fifty one of 141 lesions that showed low grade dysplasia on the endoscopic biopsy were diagnosed with carcinoma in situ or adenocarcinoma after ESD. 3) Of the 60 lesions that showed high grade dysplasia on the endoscopic biopsy, 46 were diagnosis with carcinoma in situ or adenocarcinoma after ESD. CONCLUSIONS: The discrepancy of the histopathological diagnosis was found between ESD and forcep biopsy. In light of these results, if a lesion that is suspected to be EGC, although it is not diagnosed by endoscopic biopsy, then it should be confirmed by ESD.
Adenocarcinoma ; Biopsy ; Carcinoma in Situ ; Gastritis ; Light ; Retrospective Studies ; Surgical Instruments

BACKGROUND: Double balloon enteroscopy was developed to improve access to the small intestine. The aim of this study was to evaluate the efficacy of double balloon enteroscopy in patients with obscure gastrointestinal bleeding. METHODS: From November 2004 through August 2005, 24 consecutuve patients (14 males, 10 females; mean age 48+/-15.1 years, range 2181 years) with gastrointestinal bleeding of an obscure origin were enrolled in this study. The patients underwent enteroscopy using the double balloon technique for the following indications: (1) clinical evidence of gastrointestinal bleeding such as melena and hematochezia (the Hb levels ranged from 5.9 g/dL to 11.9 g/dL, mean 9.0+/-2.3 g/dL) (2) no site and cause of blood loss detected by upper endoscopy and colonoscopy. RESULTS: Of 24 patients that underwent a double balloon enteroscopy, bleeding points were identified in 22 patients. The causes of bleeding were nine small bowel ulcera, six angiodysplasiaa, three cases of Crohn's disease, two gastrointestinal stromal tumors, one Meckel's diverticulum and one cecal diverticular ulcer. However, two cases showed negative findings. No patient suffered from procedure related complication. CONCLUSIONS: Double balloon enteroscopy is a safe and useful diagnostic tool for obscure gastrointestinal bleeding.
Colonoscopy ; Crohn Disease ; Double-Balloon Enteroscopy* ; Endoscopy ; Female ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors ; Hemorrhage* ; Humans ; Intestine, Small ; Male ; Meckel Diverticulum ; Melena ; Ulcer

BACKGROUND/AIMS: We investigated the clinical significance of the criteria of the absolute and relative depth of invasion for submucosal invasive colorectal carcinomas. METHODS: We analyzed retrospectively the clinicopathological features of 29 submucosal invasive colorectal cancers. The relative depth of submucosal invasion was evaluated by a relative (sm1, 2, 3) classification and the absolute depth of submucosal invasion was measured in micrometers from the lower border of the muscularis mucosa to the deepest cancer gland. RESULTS: All sm1 cancers showed a submucosal layer invasion of less than 1,000micronm; invasion was seen between 500micronm and 1,000micronm. The rate of lymphovascular invasion was higher for sm1c, sm2 and sm3 than for sm1a and sm1b, and the rate of invasion was higher for a level of 500micronm or more than for a level of 500micronm or less for the depth of submucosal invasion. One of sixteen patients that underwent surgery showed lymph node involvement. For this patient, the relative depth of invasion was sm1c and the absolute depth was 900micronm. CONCLUSIONS: Endoscopically treated submucosal colorectal cancer needs to be evaluated by the absolute depth in addition to the relative depth. It seems that a submucosal invasive cancer less than 500micronm in submucosal depth probably can be treated by endoscopic resection.
Classification* ; Colon* ; Colonic Neoplasms ; Colorectal Neoplasms ; Humans ; Lymph Nodes ; Mucous Membrane ; Retrospective Studies

BACKGROUND/AIMS: We investigated the clinical significance of the criteria of the absolute and relative depth of invasion for submucosal invasive colorectal carcinomas. METHODS: We analyzed retrospectively the clinicopathological features of 29 submucosal invasive colorectal cancers. The relative depth of submucosal invasion was evaluated by a relative (sm1, 2, 3) classification and the absolute depth of submucosal invasion was measured in micrometers from the lower border of the muscularis mucosa to the deepest cancer gland. RESULTS: All sm1 cancers showed a submucosal layer invasion of less than 1,000micronm; invasion was seen between 500micronm and 1,000micronm. The rate of lymphovascular invasion was higher for sm1c, sm2 and sm3 than for sm1a and sm1b, and the rate of invasion was higher for a level of 500micronm or more than for a level of 500micronm or less for the depth of submucosal invasion. One of sixteen patients that underwent surgery showed lymph node involvement. For this patient, the relative depth of invasion was sm1c and the absolute depth was 900micronm. CONCLUSIONS: Endoscopically treated submucosal colorectal cancer needs to be evaluated by the absolute depth in addition to the relative depth. It seems that a submucosal invasive cancer less than 500micronm in submucosal depth probably can be treated by endoscopic resection.
Classification* ; Colon* ; Colonic Neoplasms ; Colorectal Neoplasms ; Humans ; Lymph Nodes ; Mucous Membrane ; Retrospective Studies

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