PURPOSE: The diagnosis of hypertrophic pyloric stenosis(HPS) can be made by clinical manifestations and upper gastrointestinal(UGI) series in most cases. Recently, the ultrasonogram(US) is a more accurate and reliable method for the diagnosis of HPS in early stage. METHODS: We retrospectively studied 27 HPS patients confirmed surgically from January 1999 to March 2000. We reviewed clinical histories and physical and laboratory findings. Among these patients, ultrasonograms were carried out in 23 cases preoperatively. Therefore, we analyzed pyloric muscle thickness(PT), pyloric diameters(PD), and pyloric canal lengths(PL), and calculated pyloric volume(PV) by the equation of 'PV=pie(1/2PV)2xPL'. RESULTS: The mean age on admission was 39.0+/-20.4 days and 70.4% of the patients were under 6 weeks of age. The mean age at onset was 26.9+/-20.4 days and the duration of symptoms was 12.7+/-11.6 days. On physical examination, the pyloric tumors were palpated in 14 cases(51.9%) and the gastric peristalses were noted in 8 cases(29.6%). UGI series were carried out in 21 cases, and all of them had the characteristic findings of HPS. The mean PT was 5.23+/-1.05mm, the mean PD wase 13.56+/-2.25mm, the mean PL was 21.42+/-3.85mm, and the calculated PV was 3.23+/-1.35 mL. According to the criteria by Stunden, et al., PT(>=4mm), PD(>=12mm) and PL(>=15mm) were satisfied in 91.3, 73.9 and 91.3% respectively. The PV(>=1.4mL) was satisfied in 95.7% according to the criterion by Westra, et al. CONCLUSION: The US in the diagnosis of HPS is safe and useful. With measurements of PV parameter, the diagnosis by US will be more reliable and more accurate.
Diagnosis ; Humans ; Peristalsis ; Physical Examination ; Pyloric Stenosis, Hypertrophic* ; Retrospective Studies ; Ultrasonography

Gastritis cystica polyposa was diagnosed in three patients with ages of 49, 56 and 66 years. All patients had been operated on for gastric cancer 1 to 5 years earlier, with Billroth II gastroenteric anastomose being made at that time. The lesions were diagnosed by regular follow-up endoscopic examination without any presenting symptoms. Macroscopically, all lesions were located on the gastric side of the anastomosis, with polypoid growth of 1.5x1.0, 2.0x1.5, and 0.5x0.5 cm in size respectively. The surfaces of the lesions were coarsely nodular and brittle, and one of them protruded into the anastomosis lumen. Histologic examination revealed polypoid mucosal changes associated with functionally active, hyperplastic and cystic dilatation of the glands which had infiltrated to into the underlying submucosa. An endoscopic polypectomy was performed in two patients, and all has gone well, without evidence of a recurrent tumor 6 & 18 months after polypectomy. The other patients refused a polypectomy. Gastritis cystica polyposa should be differentiated from a stump carcinoma to avoid a further unnecessary surgical intervention. Awareness of the entity will lead to better diagnosis of gastritis cystica polyposa.
Diagnosis ; Dilatation ; Follow-Up Studies ; Gastritis* ; Gastroenterostomy ; Humans ; Stomach Neoplasms

PURPOSE: Accurate evaluation of side branch (SB) ostium could be critical to the treatment of bifurcation lesions. We compared measured and calculated values of side branch ostial length (SBOL) in coronary bifurcation lesions with intravascular ultrasound (IVUS). MATERIALS AND METHODS: Pre-intervention and post-intervention IVUS was performed in 113 patients who underwent stent implantation of bifurcation lesions. For the IVUS longitudinal reconstruction of the bifurcation lesions, SBOL, SB diameter, and the angle between the distal portion of the main vessel (MV) and SB were directly measured. In addition, SBOL was calculated as: SB diameter/sin (angle between distal MV and SB). The relationship between measured and calculated SBOL was then evaluated. RESULTS: The angled between the distal MV and SB were 57.3+/-12.4degrees at pre-intervention and 59.4+/-12.6degrees at post-intervention. The mean measured and calculated SBOL values were 2.91+/-0.86 mm and 3.06+/-0.77 mm at pre-intervention and 2.79+/-0.82 mm and 2.92+/-0.69 mm at post-intervention, respectively. Differences between measured and calculated SBOL were 0.15+/-0.44 mm at pre-intervention and 0.13+/-0.41 mm at post-intervention. We found that calculated SBOL was correlated with measured SBOL (pre-intervention r=0.863, p<0.001; post-intervention r=0.868, p<0.001). CONCLUSION: There was a good correlation between measured and calculated SBOLs of the bifurcation lesions in IVUS longitudinal reconstruction. SBOL in the bifurcation lesions can therefore be estimated using the SB diameter and the angle between distal MV and SB.
Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Artery Disease/surgery/*ultrasonography ; Coronary Vessels/*ultrasonography ; Female ; Humans ; Male ; Middle Aged ; Ultrasonography, Interventional

BACKGROUND AND OBJECTIVES: Previous studies have shown that uptake of 18Fluoro-2-deoxy-glucose in head and neck cancer, as determined by the standardized uptake value (SUV) on positron emission tomography scan (PET scan), is associated with the biology of tumor. The aims of this study were to confirm the association with the biology of tumor and to establish whether a high SUV had prognostic significance. MATERIALS AND METHOD: Thirty patients with the head and neck cancer diagnosed as squamous cell carcinoma underwent a PET scan before treatment. SUVs were analyzed for possibility correlated with diseasefree survival. RESULTS: In univariate survival analysis, when patients were divided into two groups based on the SUV cut-off value of 8, the group whose SUV was greater than 8 in the pre-treatment PET scan showed significantly worse outcome (p=0.029). Correlation analysis demonstrated that SUV provided prognostic information independent of the tumor size, pathologic differentiation and stage. CONCLUSION: We conclude that high FDG uptake on PET (SUV >8 in pre-treatment PET scan) is an important prognostic indicator for poor outcome. Identified patients are thought to require intensive treatment protocol and more careful follow up.
Biology ; Carcinoma, Squamous Cell ; Head and Neck Neoplasms* ; Head* ; Humans ; Positron-Emission Tomography*

PURPOSE: There have been few studies concerned with the hiccup patients who visit the emergency department. The purpose of this study is to investigate the epidemiology and clinical characteristics of hiccup patients. METHODS: We retrospectively reviewed 60 hiccup patients who visited the emergency departments of Chungbuk National University Hospitals, Chungnam National University Hospital and Chonnam National University Hospital in Korea from January 2005 to December 2007. We categorized the patients into 2 groups of the discharged and the admitted and also into groups of patients who had different types of treatments. We compared clinical outcomes and characteristics of the groups. RESULTS: A total of 60 cases of hiccup patients visited the emergency department from January 2005 to December 2007. There was a significant difference in the recovery rate from hiccups between the discharged group and the admission group (72.4% & 100.0%, p=0.04). The 3 major drugs used for treatment were metoclopramide, chlorpromazine, and benzodiazepine. The patients showed a broad spectrum for the final diagnosis, from the benign hiccups to ischemic stroke in the pons area. CONCLUSION: In this study, the hiccup patients who visited the ED showed simple temporal signs to various severe diseases such as the ischemic stroke in the pons. These findings can be useful reference for the decision making at admission or discharge and for predicting the prognosis of the hiccup patients who visit the emergency department.
Benzodiazepines ; Chlorpromazine ; Decision Making ; Emergencies ; Hiccup ; Hospitals, University ; Humans ; Korea ; Metoclopramide ; Pons ; Prognosis ; Retrospective Studies ; Stroke

Damages on the recurrent laryngeal nerve (RLN) during thyroid surgery is the most common iatrogenic cause of vocal cord paralysis. Identification of the recurrent laryngeal nerve and meticulous surgical techniques can significantly decrease the incidence of this complication. The nonrecurrent inferior laryngeal nerve is an exceedingly rare anomaly of the recurrent laryngeal nerve. The nonrecurrent inferior laryngeal nerve is associated with abnormal development of the aortic arch, where the innominate (brachiorephalic) artery is not found and the right common carotid artery rises directly from the aortic arch. The aberrant right subclavian artery can always be felt against the vertebral column behind the esophagus. Surgeons need to be aware of the positions of these arteries to avoid damaging them. We experienced a case of nonrecurrent inferior laryngeal nerve in the right side with the aberrant right subclavian artery. The patient received a total thyroidectomy with neck dissection for thyroid carcinoma with nodal metastasis. Incidentally, we also found nonrecurrent inferior laryngeal nerve, and also found an aberrant right subclavian artery by the computed tomography scan. The patient presented transient vocal cord paralysis but gained complete recovery of vocal cord mobility after one and a half month later.
Aorta, Thoracic ; Arteries ; Carotid Artery, Common ; Esophagus ; Humans ; Incidence ; Neck Dissection ; Neoplasm Metastasis ; Recurrent Laryngeal Nerve* ; Spine ; Subclavian Artery ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Vocal Cord Paralysis ; Vocal Cords

The effectiveness of below-the-knee (BTK) percutaneous transluminal angioplasty to obtain successful revascularization in patients with critical limb ischemia has been well established, and many of these patients with chronic lower-extremity disease have been treated by endovascular intervention as the firstline treatment. Dorsal-plantaer loop technique is one of the new BTK interventional techiniques, and includes recanalization of both pedal and plantar arteries and their anatomical anastomoses. This method generally needs two approaches simultaneously, including antegrade and retrograde. In this report, however, we describe a case in which dorsal-plantar loop technique with only one antegrade approach, using chronic total occlusion devices via anterior tibial artery, was used to successfully recanalize BTK arteries. We think that this new technique, which may represent a safe and feasible endovascular option to avoid more invasive, time-consuming, and riskier surgical procedures, especially in end-stage renal disease and diabetes, should be considered whenever the foot is at risk, and results of above-the-ankle percutaneous transluminal angioplasty remain unsatisfactory or insufficient to achieve limb salvage.
Angioplasty, Balloon/*methods ; Diabetic Foot/*therapy ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease/*therapy ; *Tibial Arteries

The purpose of this study was to investigate implant-supported restoration as a technique for restoring missing teeth in patients with aplastic anemia. Recurrent bleeding from wound sites leads to persistent release of iron in the tissue. Excessive iron in tissue is related to clinical findings, including fibrosis, poor wound healing, and high level of angiogenesis, which are possible etiological factors of reduced osseointegration. A 44-year-old female patient with aplastic anemia was treated with multiple endosseous implants throughout the mandible and in the posterior region of the maxilla. After 14 implants were placed, radiological and clinical parameters were assessed during the follow-up period. Marginal bone did not change significantly during the follow-up period. The fine trabecular bone in intimate contact and enclosing the implant fixture was sufficient for successful osseointegration. None of the 14 implants were associated with compilations during the seven-year experimental period. This study suggests that dental implant procedures are a safe and reliable treatment option for restoration of missing dentition in patients with aplastic anemia.
Adult ; Anemia, Aplastic* ; Dental Implants* ; Dentition ; Female ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Iron ; Mandible ; Maxilla ; Osseointegration ; Rehabilitation* ; Tooth ; Wound Healing ; Wounds and Injuries

Approximately 10% of pheochromocytomas are malignant and its major criteria are tumor invasion of capsular blood vessel as well as metastatic invasion of other tissues. It is general rule that all resectable masses have to be removed surgically. However, there is no definite treatment modality about unresectable masses or microinvasive lesions. We experienced a case of 45 year-old male patient who was referred to our hospital for treatment of hypertension and headache. The plasma and urine catecholamine were increased above normal values and its metabolites also were increased. 131I-metaiodobenzylguanidine (MIBG) scan showed right adrenal mass and metastatic lesion of left iliac bone. This lesion was consistent with findings of the abdomen computed tomography (CT) and electron beam tomography (EBT) scan. We diagnosed this case as malignant pheochromocytoma. We removed primary tumor mass by wide excision and treated this patient with high dose 131I-MIBG. We report this case who shows good response to the high dose 131I-MIBG after surgery.
3-Iodobenzylguanidine ; Abdomen ; Blood Vessels ; Headache ; Humans ; Hypertension ; Male ; Middle Aged ; Neoplasm Metastasis ; Pheochromocytoma* ; Plasma ; Reference Values ; Tomography, X-Ray Computed

PURPOSE: Data comparing the clinical benefits of medical treatment with those of percutaneous coronary intervention (PCI) in an elderly population with angina pectoris are limited. Therefore, we evaluated the efficacy of elective PCI versus optimal medical treatment (OMT) in elderly patients (between 75 and 84 years old) with angina pectoris. MATERIALS AND METHODS: One hundred seventy-seven patients with significant coronary artery stenosis were randomly assigned to either the PCI group (n=90) or the OMT group (n=87). The primary outcome was a composite of major adverse events in the 1-year follow-up period that included cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and stroke. RESULTS: Major adverse events occurred in 5 patients (5.6%) of the PCI group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no significant differences between the PCI group and the OMT group in cardiac death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval (CI) 0.041-5.019, p=0.520], myocardial infarction (HR 0.399; 95% CI 0.039-4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057-14.709, p=0.952). However, the PCI group showed a significant preventive effect of the composite of major adverse events (HR 0.288; 95% CI 0.106-0.785, p=0.015) and against the need for coronary revascularization (HR 0.157; 95% CI 0.035-0.703, p=0.016). CONCLUSION: Elective PCI reduced major adverse events and was found to be an effective treatment modality in elderly patients with angina pectoris and significant coronary artery stenosis, compared to OMT.
Aged ; Aged, 80 and over ; Angina Pectoris/mortality/*therapy ; Coronary Stenosis/therapy ; Female ; Humans ; Male ; Myocardial Infarction/prevention & control/*therapy ; *Percutaneous Coronary Intervention ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea ; Stroke/epidemiology ; Treatment Outcome