Acute aortic dissection is the most common catastrophic illness of the aorta. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode, but survival may be significantly improved by the timely institution of diagnostic modalities and appropriate medical and surgical therapy. But, approximately 10-20% of patients with acute aortic dissection present with a clinical picture of acute myocardial infarction. This sometimes can not only delay the diagnosis and adequate treatment of acute aortic dissection but also inappropriately treat with thrombolytic agents and anticoagulants which result in rapid deterioration of clinical condition of patient. We report a case of acute aortic dissection with dynamic ST changes in electrocardiogram which resulted in delay of accurate diagnosis and adequate treatment of acute aortic dissection.
Anticoagulants ; Aorta ; Catastrophic Illness ; Diagnosis ; Electrocardiography* ; Fibrinolytic Agents ; Humans ; Myocardial Infarction

BACKGROUND/AIMS: Screening for hepatocellular carcinoma (HCC) is a common practice in the endemic countries but its exact role has not been fully investigated. The purpose of this study was to determine whether screening can achieve early diagnosis and survival benefits. METHODS: All HCC patients diagnosed at our hospital (September 1994~April 2000) were enrolled; They were divided into two groups; a surveilled group screened with alpha-fetoprotein (AFP) and ultrasound (US) for longer than 6 months before diagnosis and a non-surveilled group. We compared the tumor size, portal vein thrombosis, and stage at initial diagnosis and survival rate between the two groups. RESULTS: A total of 247 patients were enrolled. 64 were in the surveilled group and 183 were in the non-surveilled group. The tumor size at initial diagnosis in the surveilled group was smaller than in the non-surveilled group (2.6+/-2.0 cm vs. 5.7+/-4.1 cm, p<0.05). The percentages of patients with stage I, II, III, and IV were 42.2%, 20.3%, 14.1%, 23.4% in the surveilled group and 8.7%, 19.7%, 36.6%, 35.0% in the non-surveilled group. A significantly higher proportion in the surveilled group had earlier stage compared with the non-surveilled group (p<0.05). Portal vein thrombosis in the surveilled group was noticed as significantly less than in the non-surveilled group (9.4% vs. 26.8%, p<0.05). Among Child-Pugh A patients, the cumulative survival rate in the surveilled group was significantly higher than in the non-surveilled group (1 year; 91.4% vs. 70.7%, 2 year; 71.5% vs. 59.9%, p<0.05). CONCLUSIONS: Screening with AFP and US is a useful tool for early diagnosis of HCC, especially with improved survival in Child-Pugh A patients.
Adult ; Aged ; Carcinoma, Hepatocellular/*diagnosis/mortality/therapy ; Female ; Humans ; Liver Neoplasms/*diagnosis/mortality/therapy ; Male ; Middle Aged ; Survival Rate ; alpha-Fetoproteins/analysis

Colonic lipomas represent the most frequent mesenchymal benign tumors of the large intestine after hyperplastic polyps and adenomatous polyps, but the pathogenesis is unclear. These tumors are composed of mature fatty tissue and usually arise in the submucosa. They are usually solitary and small, and may be sessile or pedunculated. Most patients are asymptomatic and their tumors are often detected incidentally, but tumors larger than 2 cm tend to produce change in bowel habit, abdominal pain, rectorrhagia and complications such a luminal obstruction or intestinal intussusception. Diagnosis may be aided by colonoscopy with biopsy, barium enema and computed tomography. Colonic lipomas occur most often in the right colon, particularly in the ileocecal valve. Some cases of such lipoma of transverse colon have been reported in Europe and the United States, but rare in Korea. We report a case of lipoma of the transverse colon that was originated in subserosa and presented as a intussusception in a 63-year-old woman with brief review of literatures.
Abdominal Pain ; Adenomatous Polyps ; Adipose Tissue ; Barium ; Biopsy ; Colon ; Colon, Transverse* ; Colonoscopy ; Diagnosis ; Enema ; Europe ; Female ; Humans ; Ileocecal Valve ; Intestine, Large ; Intussusception* ; Korea ; Lipoma* ; Middle Aged ; Phenobarbital ; Polyps ; United States

BACKGROUND/AIMS: In western countries, symptomatic diverticulitis develops in about 20% of the population with colonic diverticula, and it is mainly located at the left-sided colon. The clinical characteristics of diverticulitis have rarely been investigated although its incidence is increasing in Asia including Korea. The aim of this study was to compare diverticulitis with asymptomatic diverticulosis and to compare the clinical characteristics of right-sided diverticulitis with those of left-sided diverticulitis. METHODS: We retrospectively investigated the medical records of the patients who had symptoms and signs of diverticulitis. Their diagnosis was confirmed with computed tomography, barium study, colonoscopy and/or operations at Samsung Medical Center from September 1998 to February 2002. The control cases of asymptomatic and incidental diverticulosis were randomly selected during routine health check-up after matching age and sex. RESULTS: Twenty-seven patients with diverticulitis (male : female=14 : 13) were included. The mean age was 53 (27~86). The ratio of right and left diverticulitis was 20:7, which was similar to the ratio of diverticulosis. The complications, especially perforation, were more frequent in the patients with left-sided diverticulitis (p<0.05). CONCLUSIONS: Colonic diverticulitis is more prevalent at the right colon and left colonic diverticulitis has more complications than right colonic diverticulitis in Korea.
Adult ; Aged ; Aged, 80 and over ; Diverticulitis, Colonic/*diagnosis ; Female ; Humans ; Korea ; Male ; Middle Aged