Bochdalek hernia through Bochdalek foramen, defect at the posterolateral side of the diaphragm is one of the congenital diaphragmatic hernias. It usually occurs in infants, but very rare in old age and also on the right side. We experienced the right-side Bochdalek hernia including kidney herniation in 68 years old man man ifested by hemoptysis. CT scan revealed diaphragmatic defect and herniated liver, colon and kidney. Thoracotomy was performed and the 10 cm-sized large defect was closed with patch. After then, the patient has been well without symptom.
Aged ; Colon ; Diaphragm ; Hemoptysis ; Hernia* ; Hernia, Diaphragmatic ; Humans ; Infant ; Kidney* ; Liver ; Thoracotomy ; Tomography, X-Ray Computed

Chronic exposure to cadmium (Cd) results in an inhibition of protein endocytosis in the renal proximal tubule, leading to proteinuria. In order to gain insight into the mechanism by which Cd impairs the protein endocytosis, we investigated the effect of Cd on the acidification of renal cortical endocytotic vesicles (endosomes). The endosomal acidification was assessed by measuring the pH gradient-dependent fluorescence change, using acridine orange or FITC-dextran as a probe. In renal endosomes isolated from Cd-intoxicated rats, the Vmax of ATP-driven fluorescence quenching (H -ATPase dependent intravesicular acidification) was significantly attenuated with no substantial changes in the apparent Km, indicating that the capacity of acidification was reduced. When endosomes from normal animals were directly exposed to free Cd in vitro, the Vmax was slightly reduced, whereas the Km was markedly increased, implying that the biochemical property of the H -ATPase was altered by Cd. In endosomes exposed to free Cd in vitro, the rate of dissipation of the transmembrane pH gradient after H -ATPase inhibition appeared to be significantly faster compared to that in normal endosomes, indicating that the H -conductance of the membrane was increased by Cd. These results suggest that in long-term Cd-exposed animals, free Cd ions liberated in the proximal tubular cytoplasm by lysosomal degradation of cadmium-metallothionein complex (CdMT) may impair endosomal acidification 1) by reducing the H -ATPase density in the endosomal membrane, 2) by suppressing the intrinsic H -ATPase activity, and 3) possibly by increasing the membrane conductance to H+ ion. Such effects of Cd could be responsible for the alterations of proximal tubular endocytotic activities, protein reabsorption and various transporter distributions observed in Cd-exposed cells and animals.
Acridine Orange ; Animals ; Cadmium* ; Cytoplasm ; Endocytosis ; Endosomes ; Fluorescence ; Hydrogen-Ion Concentration ; Ions ; Kidney ; Membranes ; Proteinuria ; Proton-Motive Force ; Rats

AIMTo investigate the value of Tc-99m ciprofloxacin imaging in the differential diagnosis of chronic bacterial prostatitis.

METHODSThe study included 4 normal subjects as the negative controls, 2 patients with acute prostatitis or cystourethritis as the positive controls and 59 patients diagnosed as chronic bacterial prostatitis or chronic pelvic pain syndrome by traditional laboratory tests. In every subject, the single photon emission computerized tomography images were obtained 3 h after intravenous injection of Tc-99m Ciprofloxacin. The results of the imaging were compared with those of laboratory tests.

RESULTSOn the images, negative uptake was observed in all normal subjects, while strong hot uptake, in the whole prostate of acute prostatitis patients and in the whole urethra of acute cystourethritis patients. In 13 (68%) of 19 patients categorized as chronic bacterial prostatitis by standard laboratory tests, hot uptake with less intensity than that of acute prostatitis was observed in the prostate area around the prostatic urethra. Negative uptake in the prostate was observed in 6 of 19 patients (32%) categorized as chronic bacterial prostatitis. Interestingly, hot uptake in the prostate was exhibited in 28 (70%) of the 40 patients categorized as chronic pelvic pain syndrome.

CONCLUSIONTc-99m ciprofloxacin imaging is helpful in the differential diagnosis of prostatitis syndrome.

Adult ; Aged ; Bacterial Infections ; diagnostic imaging ; microbiology ; Chronic Disease ; Ciprofloxacin ; analogs & derivatives ; pharmacokinetics ; Humans ; Male ; Middle Aged ; Organotechnetium Compounds ; pharmacokinetics ; Pelvic Pain ; diagnostic imaging ; Prostatitis ; diagnostic imaging ; microbiology ; Radionuclide Imaging ; Radiopharmaceuticals ; pharmacokinetics ; Urethritis ; diagnostic imaging

BACKGROUND: Although recent studies have demonstrated that infusion of L-arginine reduces myocardial necrotic area during prolonged ischemia, its effects on transient postischemic myocardial dysfunction(myocardial stunning) and microvascular dyfunction(vascular stunning) are not well known. To investigate whether intravenous administration of L-arginine, physiological nitric oxide(NO) precursor, during reperfusion would attenuate postischemic myocardial dysfunction and microvascular dysfunction, 15 open-chest dogs were studied. METHODS: In 15 pentobarbital anesthesized open-chest dogs, left circumflex coronary artery was occluded for 20 minutes and was followed by a reperfusion for 60 minutes. L-Arginine(30mg/kg)(L-arginine group, n=8) or saline(control group, n=7) was given intravenously by a bolus 1 minute before reperfusion and was followed by a continuous infusion(10mg/kg/min) for 30 minutes during reperfusion. Before coronary occlusion and 60 minutes after reperfusion, coronary blood flow(CBF) and coronary vascular resistance(CVR) wre measured after intracoronary injection of each of acetylcholine(0.01/kg) and adenosine(1.5/kg), and reactive hyperemia with coronary occlusion(RH20) for 20 seconds was measured. Myocardial segment thickening in the area of ischemia-reperfusion was measured using 2D-echocardiography. The echocardiographic images were digitized and analyzed by cardiac image analyzer. RESULTS: The results obtained 60 minutes after reperfusion were as follows. 1) CBF was decreased by 41% in L-arginine group vs 30.1% in control group(p < 0.05) and CVR was increased by 83.9% in L-arginine group vs 19.3% in control group after 60 minutes of reperfusion, compared with pre-occlusion baseline values. 2) Percent change of CBF was decreased in control group(acetylcholine by 25.8%, adenosine by 29.2%, RH20 by 39.8%), while it was increased in L-arginine group(acetylcholine by 60%, adenosine by 22%, RH20 by 26.7%). Percent change of CVR was increased in control group(acetylcholine by 10.5%, adenosine by 6.9%, RH20 by 21%), but it was decreased in L-arginine group(acetylcholine by 10%, adenosine by 6.6%, RH20 by 1.6%). Increase of CBF and decrease of CVR were significant on acetylcholine and RH20 between control group and L-arginine group. 3) Fraction of myocardial segment thickening was significantly decreased in L-arginine group(by 80%) compared with control group(by 61.7%, p < 0.05). CONCLUSIONS: The finding that L-arginine depressed post-ischemic myocardial contractil function suggests that systemic infusion of L-arginine has unfavorable effect on myocardial stunning. In contrast, the finding that L-arginine improved CBF and CVR with acetylcholine and adenosine and reactive hyperemia indicates that L-arginine may exert a beneficial effect on vascular stunning. These results suggest that L-arginine may have independent effects on myocardial stunning and vascular stunning.
Acetylcholine ; Adenosine ; Administration, Intravenous ; Animals ; Arginine* ; Coronary Occlusion ; Coronary Vessels ; Dogs* ; Echocardiography ; Hyperemia ; Ischemia ; Myocardial Reperfusion ; Myocardial Stunning ; Nitric Oxide ; Pentobarbital ; Reperfusion

We report a case of an anomalous origin of left coronary artery from the pulmonary artery with severe mitral regurgitation. A 20-year-old female was admitted to hospital for recurrent syncope and dyspnea on exertion. Cardiac ausculatation revealed systolic murmur radiating to left axilla and blood pressure of 90/70 mmHg. Electrocardiography showed a nonspecific ST-T wave change on V1, V2, V6, I, & aVL leads. Holter monitering showed no significant abnormality except occasional premature ventricular complexes. Chest radiography showed mild cardiomegaly with mitral valvular heart configuration and no pulmonary abnormality. Echocardiography showed normal left ventricular dimension and systolic function with marked dilated left atrium, severe mitral regurgitation, & severe resting pulmonary hypertension. Aortogram didn't show left coronary artery ostium. Right coronary angiogram showed normal right coronary artery which supplied major left epicardial coronary arteries via good collaterals (Rentrop grade III). Pulmonary angiogram showed anomalous origin of left coronary artery from main pulmonary trunk. She underwent mitral valvuloplasty and coronary artery bypass graft.
Axilla ; Blood Pressure ; Cardiomegaly ; Coronary Artery Bypass ; Coronary Vessels* ; Dyspnea ; Echocardiography ; Electrocardiography ; Female ; Heart ; Heart Atria ; Humans ; Hypertension, Pulmonary ; Mitral Valve Insufficiency* ; Pulmonary Artery* ; Radiography ; Syncope ; Systolic Murmurs ; Thorax ; Transplants ; Ventricular Premature Complexes ; Young Adult

No abstract available.
Cerebellopontine Angle* ; Intraoperative Neurophysiological Monitoring* ; Neuroma, Acoustic*

BACKGROUND AND PURPOSE: Non-motor symptoms are common in Parkinson's disease (PD), and are the primary cause of disability in many PD patients. Our aim in this study was to translate the origin non-motor symptoms scale for PD (NMSS), which was written in English, into Korean (K-NMSS), and to evaluate its reliability and validity for use with Korean-speaking patients with PD. METHODS: In total, 102 patients with PD from 9 movement disorders sections of university teaching hospitals in Korea were enrolled in this study. They were assessed using the K-NMSS, the Unified Parkinson's Disease Rating Scale (UPDRS), the Korean version of the Mini-Mental Status Examination (K-MMSE), the Korean version of the Montgomery-Asberg Depression Rating Scale (K-MADS), the Epworth Sleepiness Scale (ESS), and Parkinson's Disease Questionnaire 39 (PDQ39). Test-retest reliability was assessed over a time interval of 10-14 days in all but one patient. RESULTS: The K-NMSS was administered to 102 patients with PD. The internal consistency and reliability of this tool was 0.742 (mean Cronbach's alpha-coefficient). The test-retest correlation reliability was 0.941 (Guttman split-half coefficient). There was a moderate correlation between the total K-NMSS score and the scores for UPDRS part I [Spearman's rank correlation coefficient, (rS)=0.521, p<0.001] and UPDRS part II (rS=0.464, p=0.001), but there was only a weak correlation between the total K-NMSS score and the UPDRS part III score (rS=0.288, p=0.003). The total K-NMSS score was significantly correlated with the K-MADS (rS=0.594, p<0.001), K-MMSE (rS=-0.291, p=0.003), and ESS (rS=0.348, p<0.001). The total K-NMSS score was also significantly and positively correlated with the PDQ39 score (rS=0.814, p<0.001). CONCLUSIONS: The K-NMSS exhibited good reliability and validity for the assessment of non-motor symptoms in Korean PD patients.
Depression ; Hospitals, Teaching ; Humans ; Korea ; Movement Disorders ; Parkinson Disease ; Reproducibility of Results ; Surveys and Questionnaires

Background and Objectives: We compared pain levels, cardiovascular parameters, and complications according to whether patients underwent nasal packing with non-absorbable or biodegradable materials. Methods: Patients who underwent septoplasty from May 2015 to April 2020 were retrospectively reviewed. Numeric rating scale (NRS) scores for pain, blood pressure, and heart rate were measured three times (immediately after surgery, 6 hours later, and on postoperative day [POD] 1). We collected data on complications, including postoperative bleeding, septal hematoma, adhesions, septal perforation, and the recurrence of septal deviation. Results: In total, 200 patients underwent septoplasty, of whom 100 underwent nasal packing with Merocel and 100 underwent packing with Nasopore. The summed NRS scores over the three time points did not differ significantly between the groups. The NRS scores at 6 hours after surgery were highest in both groups. The systolic and diastolic blood pressure and the heart rate immediately after surgery were significantly higher than before surgery in both groups. The blood pressure and heart rate at 6 hours after surgery and on POD 1 did not differ significantly from those before surgery in either group. The incidence of sleep disturbance, postoperative bleeding, septal hematoma, adhesions, septal perforation, and recurrence of septal deviation did not differ significantly between the two groups. Conclusion Although the level of postoperative pain and the cardiovascular parameters changed over time, we found no significant differences in pain, blood pressure, heart rate, or the complication rate according to whether patients underwent nasal packing with Nasopore or Merocel.

Background: To propose a deep learning architecture for automatically detecting the complex structure of the aortic annulus plane using cardiac computed tomography (CT) for transcatheter aortic valve replacement (TAVR). Methods: This study retrospectively reviewed consecutive patients who underwent TAVR between January 2017 and July 2020 at a tertiary medical center. Annulus Detection Permuted AdaIN network (ADPANet) based on a three-dimensional (3D) U-net architecture was developed to detect and localize the aortic annulus plane using cardiac CT. Patients (N = 72) who underwent TAVR between January 2017 and July 2020 at a tertiary medical center were enrolled. Ground truth using a limited dataset was delineated manually by three cardiac radiologists. Training, tuning, and testing sets (70:10:20) were used to build the deep learning model. The performance of ADPANet for detecting the aortic annulus plane was analyzed using the root mean square error (RMSE) and dice similarity coefficient (DSC). Results: In this study, the total dataset consisted of 72 selected scans from patients who underwent TAVR. The RMSE and DSC values for the aortic annulus plane using ADPANet were 55.078 ± 35.794 and 0.496 ± 0.217, respectively. Conclusion Our deep learning framework was feasible to detect the 3D complex structure of the aortic annulus plane using cardiac CT for TAVR. The performance of our algorithms was higher than other convolutional neural networks.

BACKGROUND/AIMS: Compared with metallic drug-eluting stents (DES), bioresorbable vascular scaffolds (BVS) may further improve long-term outcomes of percutaneous coronary intervention (PCI) in patients with coronary artery disease. We report our early experience with BVS in Korea. METHODS: We evaluated 105 consecutive patients with BVS implanted at Asan Medical Center, Korea between October 21, 2015 and June 3, 2016. Angiographic results, and in-hospital and 6-month clinical outcomes were assessed. RESULTS: A total of 134 BVS were implanted to treat 115 lesions. The mean age was 62 ± 10.5 years; 85 patients (81%) were males, 26 patients (25%) were presented with acute coronary syndrome. Among 115 lesions treated with BVS, 76 (66.1%) were B2/C type, 27 (23.5%) were bifurcation lesions, and four (3.5%) were chronic total occlusion. Pre-dilation and post-dilation using high-pressure non-compliant balloon was performed in 104 lesions (90.4%) and 113 lesions (98.2%), respectively. During the procedure, intravascular imaging was used for all patients (100%; intravascular ultrasound 89 and optical coherence tomography 40 patients). Device success rate was 100%. In-segment and in-scaffold acute again were 1.1 ± 0.6 and 1.3 ± 0.5 mm, respectively. Periprocedural myocardial infraction occurred in four patients (3.8%). No deaths, stent thrombosis, or urgent revascularizations occurred either during hospitalization or the follow-up period. CONCLUSIONS: In this single-center experience, implantation of BVS with intravascular imaging support was feasible and early clinical outcomes were excellent. Evaluation of long-term efficacy and safety of BVS and its feasibility in clinical use for a broader range of lesions is warranted.
Absorbable Implants ; Acute Coronary Syndrome ; Chungcheongnam-do ; Coronary Artery Disease* ; Coronary Vessels* ; Drug-Eluting Stents ; Endovascular Procedures ; Follow-Up Studies ; Hospitalization ; Humans ; Korea* ; Male ; Percutaneous Coronary Intervention ; Stents ; Thrombosis ; Tomography, Optical Coherence ; Ultrasonography