Posttraumatic pseudoaneurysms of the sphenopalatine artery are rare. Only a few cases have been reported. We report two cases of hemorrhage due to pseudoaneurysm of the sphenopalatine artery. The hemorrhage was uncontrollable. It required embolization. Two patients visited our hospital for treatment of zygomaticomaxillary complex fracture. At the emergency room, patients presented with massive nasal bleeding which ceased shortly. After reduction of the fracture, patients presented persistent nasopharyngeal bleeding. Under suspicion of intracranial vessel injury, we performed angiography. Angiograms revealed pseudoaneurysms of the sphenopalatine artery. Endovascular embolization was performed, leading to successful hemostasis in both patients. Due to close proximity to pterygoid plates, zygomaticomaxillary complex fracture involving pterygoid plates may cause injury of the sphenopalatine artery. The only presentation of sphenopalatine artery injury is nasopharyngeal bleeding which is common. Based on our clinical experience, although pseudoaneurysm of maxillary artery branch after maxillofacial trauma has a low incidence, suspicion of injury involving deeply located arteries and early imaging via angiogram are recommended to manage recurrent bleeding after facial trauma or surgery.
Aneurysm, False ; Angiography ; Arteries ; Embolization, Therapeutic ; Emergency Service, Hospital ; Epistaxis ; Hemorrhage ; Hemostasis ; Humans ; Incidence ; Maxillary Artery

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.
Aneurysm ; Arteries ; Axis, Cervical Vertebra ; Coronary Angiography ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Infarction ; Ioxaglic Acid ; Ischemia ; Myocardial Infarction* ; Myocardium* ; Perfusion* ; Ventricular Dysfunction, Left

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.
Aneurysm ; Arteries ; Axis, Cervical Vertebra ; Coronary Angiography ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Infarction ; Ioxaglic Acid ; Ischemia ; Myocardial Infarction* ; Myocardium* ; Perfusion* ; Ventricular Dysfunction, Left

BACKGROUND: In acute myocardial infarction, left ventricular remodeling, which was influenced by infarct size, location, and patency of infarct related artery(IRA), is a important prognostic factor for chronic heart failure and survival. Recently, several reports suggested that patent IRA does not always mean true myocardial reperfusion, and myocardial contrast echocardiography(MCE) may be a useful tool for assessing infarct size and viability of infarcted myocardium. So, we investigated the association between the degree of myocardial reperfusion assessed by MCE and long term change of left ventricular volume in acute anterior wall myocardial infarction patients who had patent IRA. METHODS: The study population was consisted of 17 patients with first acute anterior wall myocardial infarction patients who had patent left anterior descending artery by thrombolytic therapy or rescue PTCA. MCE was done immediately after coronary angiography within two weeks of myocardial infarction onset and analyzed by semiquantitative method to get opacification index. For analysis of left ventricular ejection fraction, wall motion abnormality and left ventricular volume, echocardiogram was taken within 2 weeks of myocardial infarction oneset and 9 months later in each case. Wall motion abnormality was quantified as wall motion index. According to serial changes of left ventricular volume, patients were divided into two groups ; group 1(less than 10% increase of LV volume at follow-up compared to intial echocardiographic exam) and group 2(more than 10% increase of left ventricular volume). We compared the opacification index of infarcted myocardium, wall motion abnormality, and ejection fraction between the two groups. RESULTS: Initial left ventricular volume and ejection fraction were not different between group 1 and group 2, but the opacification index was lower and initial wall motion index higher in group 2 than group 1. Opacification index, wall motion index, ejection fraction and left ventricular volume were closely correlated in the whole cases. By multivariate ananlysis, opacification index was the only significant factor predicting left ventricular volume increment. CONCLUSION: Myocardial reperfusion, which is closely correlated with ejection fraction and wall motion abnormality, acts as a independent predictor of left ventricular dilatation after acute anterior wall myocardial infarction. This result suggests that assessment of microvascular integrity with myocardial contrast echocardiography may be a valuable indicator to predict long-term change of left ventricular volume, although this is suggestive result in a limited number of patients.
Anterior Wall Myocardial Infarction* ; Arteries ; Coronary Angiography ; Dilatation ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Myocardial Reperfusion* ; Myocardium ; Stroke Volume ; Thrombolytic Therapy ; Ventricular Remodeling

BACKGROUND: Recently, there has been an increase of emerging concerns between dietary fiber and diabetics. Increasing intake of dietary fiber leads to delaying absorption of glucose, and lowering of serum insulin levels. In the past studies, there were inconsistent glycemic control effect of beta-glucan. Our purpose was to assess the glycemic control effect of beta-glucan in adults. METHODS: Electronic searches (Cochrane, PubMed, EMBase), hand-searching and review of reference were done. The search term for beta-glucans [mh], "Avena sativa" [mh], "Hordeum" [mh], beta glucan* [tw], oat [tw], barley [tw], with no language restriction were used. All RCT that included available data of beta-glucan or that could impute dose of beta-glucan, at least one relevant outcome of glycemic control, run-in period more than 2 weeks, and intervention period of more than 2 weeks or greater were selected. A fixed-effect model was used to assess the summary effect of studies. RESULTS: A total of 43 articles were identified, 4 studies met our inclusion criteria and then analyzed. In pooled analysis, the effect size of fasting glucose level was 0.13 (95%CI: -1.25 to 1.51), and serum insulin level was -0.95 (95%CI, -2.37 to 0.47). It was impossible to adjust for sex and age owing to the lack of raw data. CONCLUSION: In this review, the results suggested that there were negative impacts of beta-glucan on fasting glucose and serum insulin level in adults, but we concluded that there was insufficient evidence to confirm about glycemic control effect. More powerful and well-designed RCT were required to confirm about glycemic control effect of beta-glucan.
Absorption ; Adult ; Avena ; beta-Glucans ; Diabetes Mellitus ; Dietary Fiber ; Electronics ; Electrons ; Fasting ; Glucose ; Hordeum ; Humans ; Insulin

OBJECTIVE: To know the clinical and histopathologic profiles of ovarian tumors. METHODS: 822 women undergone operations for their ovarian tumors were enrolled in this study from July of 1996 to June of 2004 at Inha University Hospital in S. Korea. Incidence, age, laterality and size were analyzed according to their histopathologic results. RESULTS: Among 822 women, there were 2.1% of non-neoplastic ovarian cysts, 81.0% of benign tumors, 4.4% of borderline tumors, and 12.5% of malignant tumors. Among benign tumors, 48.2 were cystic teratomas, 22.5% were mucinous, and 19.4% were serous tumors. Among borderline tumors, 52.8% were mucinous and 42.2% were serous. Among malignant tumors, 25.2% were serous and metastatic, respectively, and 18.4% were mucinous. The average and median age of non-neoplastic cysts were 39.1 +/- 12.7, 41 years old, those of benign tumors were 38.2 +/- 18.4, those of borderline tumors were 33.4 +/- 16.7, 28, and those of malignant tumors were 47.8 +/- 15.4, 49. The bilaterality of benign tumors was 10.7%, that of borderline were 16.7%, and that of malignant were 24.2%. The average and median diameter of non-neoplastic cysts were 3.2 +/- 1.4 cm, 3 cm, those of benign tumors were 8.1 +/- 4.3 cm, 7 cm, those of borderline tumors were 13.5 +/- 7.8 cm, 12 cm, and those of malignant tumors were 10.2 +/- 6.1 cm, 9.3 cm. CONCLUSION: We analyzed clinical and histopathologic data of 822 ovarian tumors.
Adult ; Female ; Humans ; Incidence ; Korea ; Mucins ; Ovarian Cysts ; Ovarian Neoplasms ; Teratoma

To evaluate the feasibility and usefulness of transthoracic Doppler echocardiography (TTDE) as a non-invasive method in recording distal anterior descending (LAD) coronary flow velocity, we compared coronary flow reserve (CFR) measured by TTDE with measurements by intracoronary Doppler wire (ICDW). Twenty-one patients without LAD stenosis were studied. ICDW performed at baseline and after intracoronary injection of 18 microg adenosine. TTDE was performed at baseline and after intravenous adenosine (140 microg/kgmin for 2 min). Adequate Doppler recordings of coronary flow velocities during systole were obtained in 14 of 21 study patients (67%) and during diastole in 17 (81%) patients. Baseline and hyperemic peak diastolic flow velocities measured by TTDE were significantly smaller than those obtained by ICDW (p<0.05). However, diminishing trends of diastolic and systolic velocity ratio after hyperemia were similarly observed in both methods. CFR obtained by TTDE (3.0+/-0.5), was higher than the value calculated by ICDW (2.5+/-0.4). There were significant correlations between the values obtained by the two methods (r=0.72, p<0.01). It is concluded that TTDE is a feasible method in measuring coronary flow velocity and appears to be a promising non-invasive method in evaluating CFR.
Adult ; Aged ; Blood Flow Velocity ; Comparative Study ; Coronary Angiography ; Coronary Circulation* ; Coronary Disease/ultrasonography* ; Echocardiography, Doppler/standards ; Echocardiography, Doppler/methods* ; Female ; Heart Rate ; Human ; Hyperemia/ultrasonography ; Linear Models ; Male ; Middle Age ; Prospective Studies ; Reproducibility of Results

Acetic Acid ; Chloroform ; Cryotherapy ; Epithelium ; Ethanol ; Mandible ; Odontogenic Cysts ; Recurrence

PURPOSE: In Korea, the number of laparoscopy-assisted distal gastrectomies for early gastric cancer patients has been increasing lately. Although minimally invasive surgery is more beneficial, no reported case of a totally laparoscopic distal gastrectomy has been reported because of difficulty with intracorporeal anastomosis. This study attempts, through our experiences, to determine the feasibility of a totally laparoscopic distal gastrectomy using an intracorporeal gastroduodenostomy in treating early gastric carcinoma. MATERIALS AND METHODS: We investigated surgical results and clinicopatholgic characteristics of eight(8) patients with an early gastric carcinoma who underwent a totally laparoscopic distal gastrectomy at the Department of Surgery, Our Lady of Mercy Hospital, The Catholic University of Korea, between June 2004 and September 2004. The intracorporeal gastroduodenostomy was performed with a delta-shaped ananstomosis by using only laparoscopic linear staplers (Endocutter 45 mm; Ethicon Endosurgery, OH, USA). RESULTS: The operative time was 369.4+/-62.5 minutes (range 275~65 minutes), and the anastomotic time was 45.1+/-14.4 minutes (range 32~0 minutes). The anastomotic time was shortened as surgical experience was gained. The number of laparoscopic linear staplers for an operation was 7.1+/-0.6. The number of lymph nodes harvested was 31.9+/-13.1. There was 1 case of transfusion and no case of conversion to an open procedure. The time to the first flatus was 2.8+/-0.5 days, and the time to the first food intake was 4.1+/-0.8 days. There were no early postoperative complications, and the postoperative hospital stay was 10.0+/-3.9 days. CONCLUSION: A totally laparoscopic distal gastrectomy using an intracorporeal gastroduodenostomy with a delta-shaped anastomosis is technically feasible and can maximize the benefit of laparoscopic surgery for early gastric cancer.
Conversion to Open Surgery ; Eating ; Flatulence ; Gastrectomy* ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Postoperative Complications ; Stomach Neoplasms ; Surgical Procedures, Minimally Invasive

Atopic dermatitis (AD) is a chronic eczematous skin disease attended by pruritus, erythema, edema, excoriation, and dryness. This study was to evaluate the effects of Korean red ginseng (RG) on AD in NC/Nga mice treated with 1-chloro-2,4,6-trinitrobenzene (picryl chloride; PC). Experimental groups were divided into 4 groups; normal control (NC), PC control, and PC-RG (50 and 100 mg/kg). RG was orally administered every day repeatedly during 6 weeks. The skin lesions in severity score, scratching behavior, serum immunoglobulin E (IgE), interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) levels, and histological appearance were examined. AD-like lesions were developed on the NC/Nga mice by topical PC applications. Oral administration of RG (50 and 100 mg/kg) significantly suppressed the development of AD, as analyzed by a modified SCORAD score. The scratching behavior decreased after RG administration. The levels of serum IgE, IL-4 and IFN-gamma were increased by PC stimulation, but treatment with RG (100 mg/kg) suppressed the increment of the serum IgE, IL-4 and IFN-gamma levels. Histologically, RG inhibited dermatitis lesions such as hypertrophy, hyperkeratosis, and infiltration of inflammatory cells into epidermis and dermis. These results suggest that the administration of RG may be effective in alleviating the AD induced by PC.
Administration, Oral ; Animals ; Dermatitis ; Dermatitis, Atopic ; Dermis ; Edema ; Epidermis ; Erythema ; Hypertrophy ; Immunoglobulin E ; Immunoglobulins ; Interferon-gamma ; Interleukin-4 ; Mice ; Panax ; Picryl Chloride ; Pruritus ; Skin ; Skin Diseases, Eczematous