BACKGROUND: The occurrence of atrial fibrillation after ablation of atrial flutter is clinically important. We investigated variables predicting this evolution in ablated patients without a previous atrial fibrillation history. MATERIALS AND METHODS: Thirty-six patients (Male=28) who were diagnosed as atrial flutter without previous atrial fibrillation history were enrolled in this study. Group 1 (n=11) was defined as those who developed atrial fibrillation after atrial flutter ablation during 1 year follow-up. Group 2 (n=25) was defined as those who has not occurred atrial fibrillation during same follow-up term. Echocardiogram was performed to all patients. We measured left atrial size, left ventricle end diastolic and systolic dimension, ejection fraction and left atrial volume index before and after ablation of atrial flutter. The differences of each variables were compared and analyzed between two groups. RESULTS: The preablation left ventricular ejection fraction (preLVEF) and postablation left ventricular ejection fraction (postLVEF) are 54+/-14%, 56+/-13% in group 1 and 47+/-16%, 52+/-13% in group 2. The differences between each two groups are statistically insignificant (2.2+/-1.5 in group 1 vs 5.4+/-9.8 in group 2, p=0.53). The preablation left atrial size (preLA) and postablation left atrial size (postLA) are 40+/-4 mm, 41+/-4 mm in group1 and 44+/-8 mm, 41+/-4 mm in group 2. The atrial sizes of both groups were increased but, the differences of left atrial size between two groups before and after flutter ablation were statistically insignificant (0.6+/-0.9mm in group 1 vs -3.8+/-7.4 mm in group 2, p=0.149). The left atrial volume index before flutter ablation was significantly reduced in group 1 than group 2 (32+/-10 mm3/m2, 35+/-10 mm3/m2 in group 1 and 32+/-10 mm3/m2, 29+/-8 mm3/m2 in group 2, p<0.05). CONCLUSION: The difference between left atrial volume index before and after atrial flutter ablation is the robust predictor of occurrence of atrial fibrillation after atrial flutter ablation without previous atrial fibrillation.
Atrial Fibrillation* ; Atrial Flutter* ; Catheter Ablation* ; Follow-Up Studies ; Heart Atria ; Heart Ventricles ; Humans ; Stroke Volume

Kaposi's sarcoma, a rare tumor, usually presents itself with skin lesions. There is, however, an increased incidence in patients using immunosupressive drugs and with the acquired immunodeficiency syndrome (AIDS). Gastrointestinal Kaposi's sarcoma is usually asymptomatic, but may cause massive intestinal hemorrhage, perforation, intestinal obstruction, intussusception, protein-losing enteropathy, or sepsis. The gastroscopic appearances of Kaposi's sarcoma range from reddish purple maculopapules to polypoid, umbilicated nodule. In Korea, 3 case's of gastrointestinal kaposi's sarcoma have been reported so far. We experienced a 45-year-old man, who was positive for human immunodeficiency virus (HIV) antibodiy and developed Kaposi's sarcoma. A case of gastrointestinal Kaposi's sarcoma treated with paclitaxel is herein reported with the endoscopic findings before and after chemotherapy.
Acquired Immunodeficiency Syndrome ; Drug Therapy ; Duodenum* ; Hemorrhage ; HIV ; Humans ; Incidence ; Intestinal Perforation ; Intussusception ; Korea ; Middle Aged ; Paclitaxel ; Protein-Losing Enteropathies ; Sarcoma, Kaposi* ; Sepsis ; Skin ; Stomach*

Primary duodenal adenocarcinoma is rare disease with a poorly defined natural history. It represents less than 0.35% of all gastrointestinal tract malignant neoplasms and accounts for up to 33 to 45% of small bowel cancers. Diagnosis is always late because of the non-specific symptoms, consequently leading to poor prognosis. Surgical resection is the only potentially curative treatment, but not all patients whose tumor is removed necessarily survive long term. Recent widespread use of endoscopy has increased early detection of duodenal adenocarcinoma. Thanks to early detection, duodenal adenocarcinoma can now be treated endoscopically, which allows the patient's quality of life to be maintained. We have experienced one case of the primary early duodenal adenocarcinoma of the first portion, which was diagnosed by biopsy with endoscopic examination as part of a routine medical evaluation and was resected by endoscopic mucosal resection technique. We report the first primary early duodenal adenocarcinoma successfully treated by EMR method in Korea.
Adenocarcinoma ; Biopsy ; Diagnosis ; Endoscopy ; Gastrointestinal Tract ; Humans ; Korea ; Natural History ; Prognosis ; Quality of Life ; Rare Diseases

No abstract available.
Cor Triatriatum ; Echocardiography ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets

Abiotrophia defectiva, a nutritionally variant streptococci can cause bacteremia, brain abscess, septic arthritis and in rare cases, infective endocarditis, which accounts for 5-6% of all cases. A. defectiva is characteristically difficult to diagnose and the mortality, morbidity and complication rates are high. Here, we discuss a case of infective endocarditis caused by A. defectiva. A 62-year-old female had previously undergone prosthetic valve replacement 6 years prior to admission. She developed infective endocarditis after tooth extraction. Her endocarditis was successfully treated with antimicrobial therapy and mitral valve replacement surgery. This is the first case of infective endocarditis caused by A. defectiva reported in Korea. This case shows that A. defectiva could be considered as a causative organism of infective endocarditis in Korea.
Abiotrophia* ; Arthritis, Infectious ; Bacteremia ; Brain Abscess ; Endocarditis* ; Female ; Humans ; Korea* ; Middle Aged ; Mitral Valve ; Mortality ; Tooth Extraction

Pedunculated thrombus in the aortic arch that is associated with cerebral infarction is very rare requires prompt diagnosis and treatment to prevent occurrence of another devastating complication. Transesophageal echocardiography is useful for detecting source of embolism including aortic thrombi. The treatment options of aortic thrombi involves anticoagulation, thrombolysis, thromboaspiration, and thrombectomy. Here we report a case of huge thrombus in the aortic arch, resulting in acute multifocal cerebellar embolic infarct in patient without any risk factors for vascular thrombosis. Thrombi in the aortic arch were diagnosed by transesophageal echocardiography and treated with anticoagulants successfully.
Anticoagulants ; Aorta, Thoracic ; Cerebral Infarction ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Humans ; Risk Factors ; Thrombectomy ; Thrombosis

BACKGROUND: Accurate assessment of mitral regurgitation (MR) severity is crucial for clinical decision-making and optimizing patient outcomes. Recent advances in real-time three dimensional (3D) echocardiography provide the option of real-time full volume color Doppler echocardiography (FVCD) measurements. This makes it practical to quantify MR by subtracting aortic stroke volume from the volume of mitral inflow in an automated manner. METHODS: Thirty-two patients with more than a moderate degree of MR assessed by transthoracic echocardiography (TTE) were consecutively enrolled during this study. MR volume was measured by 1) two dimensional (2D) Doppler TTE, using the proximal isovelocity surface area (PISA) and the volumetric quantification methods (VM). Then, 2) real time 3D-FVCD was subsequently obtained, and dedicated software was used to quantify the MR volume. MR volume was also measured using 3) phase contrast cardiac magnetic resonance imaging (PC-CMR). In each patient, all these measurements were obtained within the same day. Automated MR quantification was feasible in 30 of 32 patients. RESULTS: The mean regurgitant volume quantified by 2D-PISA, 2D-VM, 3D-FVCD, and PC-CMR was 72.1 +/- 27.7, 79.9 +/- 36.9, 69.9 +/- 31.5, and 64.2 +/- 30.7 mL, respectively (p = 0.304). There was an excellent correlation between the MR volume measured by PC-CMR and 3D-FVCD (r = 0.85, 95% CI 0.70-0.93, p < 0.001). Compared with PC-CMR, Bland-Altman analysis for 3D-FVCD showed a good agreement (2 standard deviations: 34.3 mL) than did 2D-PISA or 2D-VM (60.0 and 62.8 mL, respectively). CONCLUSION: Automated quantification of MR with 3D-FVCD is feasible and accurate. It is a promising tool for the real-time 3D echocardiographic assessment of patients with MR.
Echocardiography ; Echocardiography, Doppler, Color ; Echocardiography, Three-Dimensional ; Evaluation Studies as Topic ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Mitral Valve Insufficiency ; Stroke Volume

Cytomegalovirus (CMV) infection is one of important opportunistic infections and cause significant morbidity and mortality in immunocompromised patients. The colon, stomach, and esophagus are the organs frequently involved with CMV infection. CMV enteritis makes up less than 10% of the CMV gastroenteritis cases, usually presents with diarrhea, bleeding and perforation. Several reports have described patients with acquired immune deficiency syndrome (AIDS) in whom CMV enterocolitis were complicated by ileal perforation, but have been rarely reported in Korea. We report a case of multiple ileal perforation associated with CMV enteritis in 67 years old man who was diagnosed as AIDS later. He complained of hematochezia and abdominal pain. During emergency operation, multiple perforated lesions were seen at the distal ileum above ileocecal valve. Colonoscopic examination revealed multiple shallow aphthoid ulcers at descending colon. CMV enteritis and colitis were diagnosed by microscopic findings of both surgical and endoscopic specimens. He was recovered by antiviral therapy with ganciclovir.
Abdominal Pain ; Acquired Immunodeficiency Syndrome* ; Aged ; Colitis ; Colon ; Colon, Descending ; Cytomegalovirus* ; Diarrhea ; Emergencies ; Enteritis* ; Enterocolitis ; Esophagus ; Ganciclovir ; Gastroenteritis ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Ileocecal Valve ; Ileum ; Immunocompromised Host ; Intestinal Perforation ; Korea ; Mortality ; Opportunistic Infections ; Stomach ; Ulcer