A 55 yr -old female patient visited to the OPD of OS department complaining of the lumbago, the radiating pain to right thigh and the swelling of right knee and calf regions. On routine chest and abdominal X -ray and ECG, the dextrocardia was revealed. For further detail examination, Doppler US, lung perfusion scan, MRI images were obtained. As a result, the situs inversus with dextrocardia was confirmed. Other congenital anomalies or diseases were not combined. The patient was cared with conservative treatment of lowback pain via OPD. And she was recovered successfully.
Dextrocardia ; Electrocardiography ; Female ; Humans ; Knee ; Low Back Pain ; Lung ; Magnetic Resonance Imaging ; Perfusion ; Situs Inversus* ; Thigh ; Thorax

The pathophysiological mechanism of cardiovascular disease in patients with chronic kidney disease (CKD) is complicated. Mediation analysis is an important statistical tool for gaining insight into the complex mechanisms of exposure-outcome effects. We investigated the potential mediating role of the left ventricular mass index (LVMI) on the association between fluid balance (overhydration/extracellular water, OH/ECW) and left ventricular diastolic function (E/e´ ratio) in patients with CKD not yet on dialysis. Methods: Bioimpedance spectroscopy, echocardiography, and laboratory evaluations were performed on 425 consecutive patients on the same day. The patients were classified into two groups according to the estimated glomerular filtration rate corresponding to CKD stages 3 and 5. Mediation analysis was performed using the PROCESS macro and bootstrapping methods. Results: OH/ECW and LVMI were positively correlated with the E/e´ ratio in both the CKD stages 3 and five groups. In CKD stage 5, there was a statistically significant association between OH/ECW and LVMI, whereas no correlation was observed in CKD stage 3. In the mediation analysis, LVMI positively mediated the relationship between OH/ECW and E/e´ ratio when controlling for confounders in patients with CKD stage 5 (B = 2.602; Boot 95% confidence interval, 1.313–4.076). Conclusion: In our analysis, the indirect effect of mediators was significant in patients with advanced CKD. Therefore, our study suggests that further research on several other risk factors may be needed to determine the underlying mechanisms of association between the associated factors in all CKD stages.

BACKGROUND AND OBJECTIVES: The conventional transseptal transsphenoidal approach can inhibit visualization of the surgical field and may change the shape of external nose. We used the transseptal transsphenoidal technique to remove septal cartilage except the L strut via a modified Killian's incision and preserved the ‘key-stone area.’ The aim of this study was to verify the usefulness of this technique. SUBJECTS AND METHOD: Retrospective analysis was carried out on 42 pituitary tumor patients who received this technique by a single otolaryngologist from March 2005 to March 2012 at Kangbuk Samsung Hospital. RESULTS: The mean patient age at time of surgery was 52 years, and 41 cases were pituitary adenoma and 1 was Rathke's cleft cyst. Three patients had undergone prior surgery; of which 2 used a pterional approach and 1 a transsphenoidal approach. With regard to complication, there were 2 cases of CSF leakage and 5 cases of septal laceration. There were no cases of meningitis, deformity of external nose, septal perforation, anosmia, or sinusitis. In post operation follow up, 25 cases (59.5%) had no residual tumor, while 17 cases (40.5%) had residual tumor. CONCLUSION: This study reveals that transseptal transsphenoidal surgery with septal cartilage removal and a replacement technique for a pituitary tumor are effective, allow easy exposure, and result in a low complication rate.
Cartilage ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Lacerations ; Meningitis ; Methods ; Neoplasm, Residual ; Nose ; Olfaction Disorders ; Pituitary Neoplasms ; Retrospective Studies ; Sinusitis

PURPOSE: We investigate biases in the assessments of left ventricular function (LVF), by compressed sensing (CS)-cine magnetic resonance imaging (MRI). MATERIALS AND METHODS: Cardiovascular cine images with short axis view, were obtained for 8 volunteers without CS. LVFs were assessed with subsampled data, with compression factors (CF) of 2, 3, 4, and 8. A semi-automatic segmentation program was used, for the assessment. The assessments by 3 CS methods (ITSC, FOCUSS, and view sharing (VS)), were compared to those without CS. Bland-Altman analysis and paired t-test were used, for comparison. In addition, real-time CS-cine imaging was also performed, with CF of 2, 3, 4, and 8 for the same volunteers. Assessments of LVF were similarly made, for CS data. A fixed compensation technique is suggested, to reduce the bias. RESULTS: The assessment of LVF by CS-cine, includes bias and random noise. Bias appeared much larger than random noise. Median of end-diastolic volume (EDV) with CS-cine (ITSC or FOCUSS) appeared −1.4% to −7.1% smaller, compared to that of standard cine, depending on CF from (2 to 8). End-systolic volume (ESV) appeared +1.6% to +14.3% larger, stroke volume (SV), −2.4% to −16.4% smaller, and ejection fraction (EF), −1.1% to −9.2% smaller, with P < 0.05. Bias was reduced from −5.6% to −1.8% for EF, by compensation applied to real-time CS-cine (CF = 8). CONCLUSION: Loss of temporal resolution by adopting missing data from nearby cardiac frames, causes an underestimation for EDV, and an overestimation for ESV, resulting in underestimations for SV and EF. The bias is not random. Thus it should be removed or reduced for better diagnosis. A fixed compensation is suggested, to reduce bias in the assessment of LVF.
Bias (Epidemiology) ; Compensation and Redress ; Diagnosis ; Magnetic Resonance Imaging ; Magnetic Resonance Imaging, Cine ; Noise ; Stroke Volume ; Ventricular Function, Left ; Volunteers

Because sublingual region is well-vascularized and sublingual artery is passed throughout this region, it should be careful not to perforate lingual cortex when placing dental implant on mandible. A 83-years-old male complained severe sublingual hematoma, hemorrhage and dyspnea came our outpatient department. He had received dental implant placement in the same day. He needed hemostasis and airway control. If soft tissue of sublingual region and the artery are injured, it may result in life-threatening excessive hemorrhage. In dental implant surgery, especially mandible, we should recognize the accurate shape of mandible and anatomy of sublingual region. It is important to stop anticoagulant agent before surgery. When a patient has airway obstruction, the operator should manage airway quickly.
Airway Management ; Airway Obstruction ; Arteries ; Dental Implants ; Dyspnea ; Hematoma ; Hemorrhage ; Hemostasis ; Humans ; Male ; Mandible ; Mouth Floor ; Outpatients ; Porphyrins ; Tracheotomy

BACKGROUND: The presence of airway wall thickening and its relationship with pulmonary functions or airway hyperresponsiveness (AHR) have not yet been sufficiently clarified in bronchial asthma. OBJECTIVE: We investigated the relation of airway wall thickness to the pulmonary functions and AHR in patients with asthma. METHODS: After baseline measurement of pulmonary functions and PC20 in 24 patients, we measured airway wall thickness (T), internal diameter (d) using HRCT and calculated external diameter (D)[(D)=(d)+ 2x(T)]. We used the T/D ratio as a parameter for comparisons with pulmonary functions and PC20. RESULTS: We measured total 185 airways (upper;92, lower;93). The mean T/D ratio of small airways (diameter< 2mm;n=111) showed higher value than that of large airways (diameter>or=2mm;n=74) (0.324 +/- 0.028 vs 0.274 +/- 0.033, p<0.001). The mean T/D ratio of each subjects showed significant negative correlation with FEV1(% of predicted) in total (r=-0.407, p=0.048) and small airways (r=-0.468, p=0.024). PC20 showed a tendency of weak negative correlation with mean T/D ratio in small airways (r=-0.290, p=0.179). CONCLUSION: The thicker the airway wall is, the lower the FEV1 (% of predicted) in patients with bronchial asthma. Airway wall thickening occurred predominantly in the small airways.
Asthma* ; Humans

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder of the hematopoietic stem cells characterized by chronic intravascular hemolysis, venous thrombosis, deficient hematopoiesis. Kidney involvement is usually benign and secondary to chronic deposition of hemosiderin. However, acute kidney injury may rarely occur in association with a hemolytic crisis or thrombotic complication. Hemolytic crisis is precipitated by nonspecific factors, such as infection, surgery and transfusion. A 35-year-old woman, who developed hemolytic crisis and acute kidney injury was admitted to our hospital presenting with acute gastroenteritis. After being treated by hemodialysis and oral low dose steroid, she was discharged with recovered renal function. Renal biopsy demonstrated acute tubular necrosis with considerable hemosiderin deposition without evidence of vascular thrombosis. A review of Korean cases showed that most of the cases featured severe renal dysfunction to such an extent to require a hemodialysis although there were no definite etiologies other than the deposition of blood iron due to massive hemolysis unlike the foreign cases. It also showed that the disease duration was longer. It can therefore be inferred that the early diagnosis and active treatment will be mandatory for the treatment of Korean patients with PNH. We reported a case of PNH with acute kidney injury and hemolytic crisis and documented by renal biopsy with review of Korean literature.
Acute Kidney Injury ; Adult ; Biopsy ; Early Diagnosis ; Female ; Gastroenteritis ; Hematopoiesis ; Hematopoietic Stem Cells ; Hemoglobinuria, Paroxysmal ; Hemolysis ; Hemosiderin ; Humans ; Iron ; Kidney ; Korea ; Necrosis ; Renal Dialysis ; Thrombosis ; Venous Thrombosis

PURPOSE: Nephrotoxicity of cyclosporin A (CsA) remains a major obstacle for the clinical use of this potent immunosuppressant. It is likely that the transforming growth factor-beta(TGF-beta) and endothelin-1 (ET-1) play a central role in initiation and/or progression of CsA induced nephropathy in renal ischemia-reperfusion injury. It is proposed that the new immunosuppressive drug mycophenolate mofetil (MMF) reduces the incidence of acute rejection in comparison with azathioprine. Thus, the aim of the present study was to analyze the expression of TGF-beta and ET-1 in renal ischemia-reperfusion injured rats and to see the effect of CsA or MMF on the expression of these mediators. Effects of coadministration of CsA and MMF were also evaluated. METHODS: Sprague-Dawley rats (N=60) performed right nephrectomy were classified into five groups according to experimental methods. Control group underwent right nephrectomy. After the right nephrectomy, to induce renal ischemia, the left renal vascular pedicle was occluded for 30 minutes with vascular clamps in all experimental groups. After 30 minutes, the clamps were removed to undergo reperfusion. In control group, ischemic injury wasn't done. CsA group was administered CsA (10 mg/kg/ day, S.C) after the operation. CsA and MMF group was coadministered CsA (10 mg/kg/day, S.C) and MMF (10 mg/kg/day, P.O). MMF group was administered MMF (10 mg/kg/day, P.O). After 7 days, the left kidney was removed and processed for histological, immunohistochemical, immunofluorescent and molecular analyses for TGF-beta 1 and histological, immunohistochemical, immunofluorescent analyses for ET-1. RESULTS: The immunohistochemical and immunofluorescent expression density for TGF-beta1 in CsA group was higher than control and other experimental groups. The immunohistochemical and immunofluorescent expression density and mRNA production for ET-1 in CsA group was higher than control and other experimental groups. The expression density for TGF-beta1 and ET-1 in CsA and MMF group was less than in CsA group. The expression density for TGF-beta 1 and ET-1 in MMF group was less than in CsA group and CsA and MMF group, was similar to ischemia-reperfusion group. CONCLUSION: These results suggest that MMF does not seem to have nephrotoxic effects, and seems to have a reno-protective effect from CsA induced nephrotoxicity in the ischemia-reperfusion model. The present study might partially explain that MMF is going to contribute to the improvement of the survival rate of the transplanted kidney associated with acute and/or chronic rejection and to the reduction of CsA dosage and its complications.
Animals ; Azathioprine ; Cyclosporine* ; Endothelin-1* ; Incidence ; Ischemia ; Kidney ; Nephrectomy ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; RNA, Messenger ; Survival Rate ; Transforming Growth Factor beta ; Transforming Growth Factor beta1

Increased or decreased pulmonary blood flow (PBF) and an increased pulmonary vascular resistance (PVR), represent common and important change in pulmonary hemodynamics. In this study, we constructed 3 hemodynamic models in 5 dogs, that is, an increased and a decreased PBF model, and an increased PVR model. A CT perfusion scan was performed in each hemodynamic model. Perfusion parameters including blood flow (BF), blood volume (BV), mean transit time (MTT), and maximal slope (MS) were calculated automatically by specialized software and analyzed for changes according to hemodynamic status. In terms of the normal state, blood flow was affected by gravity and dependent area showed higher BF and BV and lower MS and MTT than the non-dependent area. The decreased PBF model showed a significant increase in BF and MS (p=0.046, 0.005) but no significant change in BV (p > 0.05), and a slight elongation of MTT (p > 0.05) versus the normal state. The increased PBF model showed a slightly increased BV and a slightly decreased MTT (p > 0.05). The increased PVR model showed significant reduction in BF, BV, and MS (p < 0.000, 0.007, 0.000) and a slight increase in MTT, but without statistical significance (p > 0.05). However, it was noticeable that the distribution of MTT with respect to gravity in the normal lung was completely reversed in the increased PVR model. In conclusion, based on our understanding of perfusion characteristic in normal state, abnormal regional hemodynamic changes in the lung can be detected and evaluated. Predicting changes in pulmonary vascular resistance should be possible by a thorough analysis of CT perfusion parameters.
Animals ; Dogs ; *Hemodynamic Phenomena ; *Pulmonary Circulation ; *Radiography, Thoracic ; *Tomography, X-Ray Computed

BACKGROUND/AIMS: The aims of this study were to validate the prognostic value of the JIS score for HCC and to compare discriminatory ability and predictive power with other staging systems such as Okuda, TNM and CLIP. METHODS: We analyzed the clinical records of 210 patients who were diagnosed as HCC from 2000 to 2002. Univariate and multivariate survival analyses were done to find out factors to affect survival. To validate prognostic value of those staging systems, survival curve was obtained and analyzed by the Kaplan-Meier's method, and to compare discriminatory ability and predictive power, Homogeneity LR chi-square test and AIC score were used. RESULTS: The median survival was 19.5 months (19.1+/-14.9). The number of patients and 3-year survival rate for those staging systems were Okuda 1(126, 57.7%), 2(63, 9.0%) and 3(21, 0.0%) (p<0.001); TNM I (34, 63.1%), II (71, 59.4%), III (50, 22.4%), IV-A (6, 14.3%) and IV-B (1, 6.5%) (p<0.001); CLIP 0 (79, 68.5%), 1 (39, 34.2%), 2 (36, 16.7%), 3 (25, 20.0%), 4 (18, 5.1%), 5 (9, 11.1%) and 6 (4, 0.0%) (p<0.001) and JIS 0 (26, 78.9%), 1 (65, 65.3%), 2 (43, 21.9%), 3 (40, 25, 8.0%) and 5 (11, 2.0%)(p<0.001) in univariate analysis using Kaplan-Meier analysis. Homogeneity LR chi-square test showed more stratification power in JIS (Okuda, 102.8; TNM, 128.2; CLIP, 148.4 and JIS, 185.6) and AIC score showed superior predictive power in JIS system (Okuda, 1228.5; TNM, 1130.3; CLIP, 1117.1 and JIS, 1093.6). CONCLUSIONS: The proposed JIS system is useful system to predict survival of HCC patients. The discriminate ability of the JIS score is much better than other staging systems and has better prognostic predictive power compared to other staging systems.
Aged ; Carcinoma, Hepatocellular/*mortality/pathology ; Female ; Humans ; Liver Neoplasms/*mortality/pathology ; Male ; Middle Aged ; Multivariate Analysis ; *Neoplasm Staging ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Survival Analysis