PURPOSE: The purpose of this study was to evaluate the safety, feasibility and effectiveness of an endoluminally-placed bifurcated stent-graft (Vanguard) for the treatment of infrarenal abdominal aortic aneurysm (AAA). METHODS: Transluminal endovascular stent-graft placements were attempted in 29 patients (28 male, mean age 69+/-7 years) with AAAs involving the common iliac arteries from Aug. 1997 to Jan. 1999. Endovascular therapy was performed in the cardiac catheterization laboratory with epidural anesthesia. One side of the femoral artery was opened by surgical cutdown for the bifurcated stent-graft entry and the other side was punctured percutaneously for the straight stent-graft. Computed tomography and/or intraarterial angiography were performed during an average follow-up of 10 months (2-18 months). RESULTS: Primary success rate was 75.9% (22 of 29 patients) and the overall success rate was 79.3% with successful correction of one perigraft leak. Twenty patients (69.0%) had significant coronary artery disease. There were two technical failure cases, the one was tortuous iliac vessel with spasm, the other was disconnection of the stent-graft connecting portion. Complications related to procedure occurred in 13.8% of patients (4 of 29 patients) and two of these four patients had procedure-related mortality because of acute renal failure following contrast overdose and sepsis after operation. CONCLUSIONS: Endovascular treatment of infrarenal AAA with bifurcated stent-graft (Vanguard<0A397>) is effective, feasible and relatively safe. However, further investigation for the outcome, complication and long-term follow-up are needed.
Acute Kidney Injury ; Anesthesia, Epidural ; Angiography ; Aortic Aneurysm, Abdominal* ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Artery Disease ; Endoleak ; Femoral Artery ; Follow-Up Studies ; Humans ; Iliac Artery ; Male ; Mortality ; Sepsis ; Spasm

No Abstract Available.
Pterygium*

PURPOSE: Paradoxical embolism due to the presence of patent foramen ovale(PFO) is a well-established possible mechanism of ischemic stroke of unknown origin, and the closure of PFO seems to be a kind of most effective method of the prevention of stroke recurrence. We report the initial and intermediate-term result of transcatheter closure of PFO associated with paradoxical embolism leading to cryptogenic transient ischemic attack or cerebrovascular accident using the Amplatzer(R) PFO Occluder. METHODS: From January 2003 through May 2005, 10 patients with PFO(4 male, 6 female) with history of at least 1 cryptogenic transient ischemic attack or cerebrovascular accident underwent percutaneous transcatheter closure of PFO using Amplatzer(R) occluder assisted by transesophageal echocardiography(TEE). All procedure were performed under general anesthesia and assisted by TEE. RESULTS: In all patients, the implantation procedure was successful and no significant complication was observed(in one case, peri-interventional ST-segment elevation observed). During the follow-up period of mean 13.1 months(range, 1-28 months), no recurrence of neurologic episode were observed and there was no residual shunt through PFO. CONCLUSION: We were able to implant the device without significant complication in all our patients and close PFO effectively. No recurrence of neurologic episode were observed. We conclude that in this initial and intermediate-term follow up, the transcatheter closure of PFO associated with paradoxical embolism using the Amplatzer(R) PFO Occluder is a safe and effective method in prevention of stroke recurrence and there is no significant adverse effect until now. And this procedure may be the treatment choice in patients with the high risk of recurrence ischemic attack. However, in this study, the number of patients included[5 patients(50%) had multiple thromboembolic events] is small and follow-up period is not long. So, we need more clinical cases and long-term clinical follow-up.
Anesthesia, General ; Embolism, Paradoxical* ; Follow-Up Studies ; Foramen Ovale, Patent* ; Humans ; Ischemic Attack, Transient ; Male ; Recurrence ; Stroke

OBJECTIVE: To investigate an appropriate depth of needle insertion during trigger point injection into the rhomboid major muscle. METHODS: Sixty-two patients who visited our department with shoulder or upper back pain participated in this study. The distance between the skin and the rhomboid major muscle (SM) and the distance between the skin and rib (SB) were measured using ultrasonography. The subjects were divided into 3 groups according to BMI: BMI less than 23 kg/m2 (underweight or normal group); 23 kg/m2 or more to less than 25 kg/m2 (overweight group); and 25 kg/m2 or more (obese group). The mean+/-standard deviation (SD) of SM and SB of each group were calculated. A range between mean+1 SD of SM and the mean-1 SD of SB was defined as a safe margin. RESULTS: The underweight or normal group's SM, SB, and the safe margin were 1.2+/-0.2, 2.1+/-0.4, and 1.4 to 1.7 cm, respectively. The overweight group's SM and SB were 1.4+/-0.2 and 2.4+/-0.9 cm, respectively. The safe margin could not be calculated for this group. The obese group's SM, SB, and the safe margin were 1.8+/-0.3, 2.7+/-0.5, and 2.1 to 2.2 cm, respectively. CONCLUSION: This study will help us to set the standard depth of safe needle insertion into the rhomboid major muscle in an effective manner without causing any complications.
Back Pain ; Humans ; Muscles ; Needles* ; Overweight ; Pneumothorax ; Ribs ; Shoulder ; Skin ; Superficial Back Muscles* ; Thinness ; Trigger Points* ; Ultrasonography

Endometriosis is defined as the presence of endometrial tissue(gland and stroma) outside the uterus. The incidence of scar endometriosis is quite rare, and must differentiate with cellulitis and abscess. We have experienced one case of perineal endometriosis and one case of abdominal wall endometriosis at the site of postoperative wound scar. The possible pathogenesis of endometriosis and treatment were discussed.
Abdominal Wall ; Abscess ; Cellulitis ; Cicatrix* ; Endometriosis* ; Female ; Incidence ; Uterus ; Wounds and Injuries

Cerebrotendinous xanthomatosis is a rare autosomal recessive disease that involves multiple organs, including the peripheral nervous system. The present study is the first to report the ultrasonographic findings of peripheral nerves in a patient with cerebrotendinous xanthomatosis. The patient presented with bilateral Achilles tendon enlargement and foot hypesthesia. Sonographic examination revealed hypoechoic, swollen peripheral nerves with enlarged bilateral Achilles tendons. Since the ultrasonographic findings revealed peripheral involvement, the diagnosis of cerebrotendinous xanthomatosis was established after laboratory and genetic studies along with clinical findings.
Achilles Tendon ; Diagnosis ; Foot ; Humans ; Hypesthesia ; Peripheral Nerves ; Peripheral Nervous System ; Polyneuropathies* ; Ultrasonography* ; Xanthomatosis, Cerebrotendinous*

We report a case of a large peritoneal loose body diagnosed on computed tomography. The most common causes of a peritoneal loose body are thought to be torsion and separation of the appendices epiploicae. Peritoneal loose bodies are usually small, 0.5 to 2.5 cm in diameter. However, "giant" peritoneal loose bodies, larger than 4 cm in diameter, are an uncommon disease and present with various symptoms, and are difficult to diagnose preoperatively. Especially, abdominal large peritoneal loose bodies are frequently misdiagnosed as tumorous disease preoperatively. In our case, the loose body appeared as a round pelvic mass with central calcifications and a distinct fat plane separating it from adjacent organs. Preoperatively, we suspected a tumorous lesion from the wall of the upper rectum; however, at laparoscopy, a large peritoneal loose body was detected. An extraction of the giant peritoneal loose body was performed laparoscopically.
Laparoscopy

An applied technique of contrast enhancement for X-ray image is proposed which is based on combined enhancement of scaling and wavelet coefficients in discrete wavelet transform space. Conventional contrast enhancement methods such as contrast limited adaptive histogram equalization (CLAHE), multi-scale image contrast amplification (MUSICA) and gamma correction were applied on scaling coefficients to enhance the contrast of an original. In order to enhance the detail as well as reduce the blurring caused by up scaling of contrast modified scale coefficients from lower resolution, the sigmoid manipulation function was used to manipulate wavelet coefficients. The contrast detail mammography (CDMAM) phantom was imaged and processed to measure the image line profile of results and contrast to noise ratio (CNR) comparatively. The proposed technique produced better results than direct application of various contrast enhancement methods on image itself. The proposed method can enhance contrast, and also suppress the amplification of noise components in a single process. It could be useful for various applications in medical, industrial and graphical images where contrast and detail are of importance.
Colon, Sigmoid ; Mammography ; Noise ; Wavelet Analysis

OBJECTIVE: Mind-body training (MBT) may control reactions to stress and regulate the nervous and immune systems. The present study was designed to assess the effects of MBT on plasma cytokines and their interactions with catecholamines. METHODS: The study group consisted of 80 subjects who practice MBT and a control group of 62 healthy subjects. Plasma catecholamine (norepinephrine, NE; epinephrine, E; and dopamine, DA) and cytokine (TNF-alpha, IL-6, IFN-gamma, and IL-10) levels were measured, and the differences between the MBT and control groups and the interactions of cytokines with catecholamines were investigated. RESULTS: A significant increase in IL-10+IFN-gamma was found in females of the MBT group compared with controls. Also, a significant increase of IL-10 (anti-inflammatory cytokine) in the MBT group was shown in a specific condition in which TNF-alpha and IL-6 (pro-inflammatory cytokines) are almost absent (≤1 ng/L) compared with controls. In the MBT group, significant positive correlations were found between IL-10 and the NE/E ratio and between IL-10 and the DA/E ratio, whereas the control group did not show any such correlations. CONCLUSION: MBT may increase IL-10, under specific conditions such as a decrease of pro-inflammatory cytokines or E, which may regulate the stress response and possibly contribute to effective and beneficial interactions between the nervous and immune systems.
Catecholamines* ; Cytokines* ; Dopamine ; Epinephrine ; Female ; Healthy Volunteers ; Humans ; Immune System ; Interleukin-10 ; Interleukin-6 ; Plasma ; Tumor Necrosis Factor-alpha

Castleman's disease is a relatively rate disorder of lymphoid tissue and poorly understood etiology. The disease may occur anywhere along the lymphatic chain, but is most commonly found as a solitary mass in the mediastinum. The hyaline vascular type represents 91% of Castlemen's disease, and these are most often discovered in the asymptomatic patient on routine chest film. Patients with the plasma cell type often exhibit systemic symptoms, including fever, night sweats, anemia, and hypergammaglobulinemia. Surgical excision effects cure, although resection of the hyaline vascular type may be associated with significant hemprrage owing to extreme vascularity. We recently experienced a case of hyaline vascular type Castleman's disease which was treated by surgical resection through the anterior mini-thoracotomy, and report with its review.
Anemia ; Fever ; Giant Lymph Node Hyperplasia ; Humans ; Hyalin ; Hypergammaglobulinemia ; Lymphoid Tissue ; Mediastinal Neoplasms ; Mediastinum* ; Plasma Cells ; Sweat ; Thorax