No abstract available.

The location of the sigmoid colon varies within the abdominal cavity, but its mesocolon is fixed to the left side. Right side fixation of the sigmoid colon is a very rare congenital positional anomaly. In addition, it has been reported that hepatocolic fistula is also a very rare disease that may present lower gastrointestinal bleeding. Here, the authors describe a case of a 71-year-old man who underwent surgery for hepato-sigmoidocolic fistula complicated by hepatocellular carcinoma and the right side fixation of the sigmoid colon.
Abdominal Cavity ; Carcinoma, Hepatocellular ; Colon, Sigmoid ; Fistula ; Hemorrhage ; Humans ; Mesocolon ; Rare Diseases

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Constriction, Pathologic ; Coronary Vessels* ; Eating ; Female ; Humans ; Hypertension ; Incidence ; Myocardial Infarction* ; Oxygen ; Periodicity ; Plasma ; Smoking ; Thorax ; Thrombosis ; Ulcer

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Constriction, Pathologic ; Coronary Vessels* ; Eating ; Female ; Humans ; Hypertension ; Incidence ; Myocardial Infarction* ; Oxygen ; Periodicity ; Plasma ; Smoking ; Thorax ; Thrombosis ; Ulcer

PURPOSE: To report the expression of decorin and TGF-beta in partial myotomy of the extraocular muscle in rats. METHODS: Partial myotomy of the superior rectus muscle was performed on the right eye of 10 Sprague-Dawley rats followed by exposure of the left superior rectus muscle and a simple suture of the conjunctiva. The bilateral superior rectus muscle was obtained from all rats at 2 weeks postoperatively. The tissues were observed under light microscopy with hematoxylin-eosin, Masson's trichrome staining and immunohistochemistry. RESULTS: Histological examinations of the surgical area at 2 weeks after postoperatively showed irregularly concentrated fibrosis on light microscopy with hematoxylin-eosin and Masson's trichrome staining of the experimental eyes. Immnohistochemistry showed that expression of decorin was in the same location as TGF-beta in the experimental group. CONCLUSIONS: The expression of decorin was found in the healing process after partial myotomy of the extraocular muscle in rats. Immunohistochemistry showed that expression of decorin was in the same location as with TGF-beta.
Animals ; Conjunctiva ; Decorin* ; Fibrosis ; Immunohistochemistry ; Microscopy ; Rats* ; Rats, Sprague-Dawley ; Sutures ; Transforming Growth Factor beta*

PURPOSE: For the exposure of the labyrinthine segment of the facial nerve, transmastoid approach is not usually considered due to being situated behind the superior semicircular canal. To obtain a better view and bigger field for manipulation in the peri-geniculate area during facial nerve decompression, retraction of temporal lobe after bony removal of tegmen mastoideum was designed via transmastoid approach. MATERIALS AND METHODS: Fifteen patients with traumatic facial paralysis [House-Brackmann (HB) grade IV–VI], 3 patients with Bell's palsy (HB grade V–VI), and 2 patients with herpes zoster oticus (HB grade V–VI) underwent facial nerve decompression surgery between January 2008 and July 2014. In all patients, we performed temporal lobe retraction for facial nerve decompression via the transmastoid approach. Patients were examined using pre operative tests including high-resolution computed tomography, temporal magnetic resonance imaging, audiometry, and electroneurography (degenerative ratio >90%). Facial function was evaluated by HB grading scale before and 6 months after the surgery. RESULTS: After the surgery, facial function recovered to HB grade I in 9 patients and to grade II in 11 patients. No problems due to surgical retraction of the temporal lobe were noted. Compared to the standard transmastoid approach, our method helped achieve a wider surgical view for improved manipulation in the peri-geniculate ganglion in all cases. CONCLUSION: Facial nerve decompression via the transmastoid approach with temporal lobe retraction provides better exposure to the key areas around the geniculate ganglion without complications.
Audiometry ; Bell Palsy ; Decompression* ; Facial Nerve* ; Facial Paralysis ; Ganglion Cysts* ; Geniculate Ganglion ; Herpes Zoster Oticus ; Humans ; Magnetic Resonance Imaging ; Methods ; Semicircular Canals ; Temporal Lobe*

PURPOSE: For the exposure of the labyrinthine segment of the facial nerve, transmastoid approach is not usually considered due to being situated behind the superior semicircular canal. To obtain a better view and bigger field for manipulation in the peri-geniculate area during facial nerve decompression, retraction of temporal lobe after bony removal of tegmen mastoideum was designed via transmastoid approach. MATERIALS AND METHODS: Fifteen patients with traumatic facial paralysis [House-Brackmann (HB) grade IV–VI], 3 patients with Bell's palsy (HB grade V–VI), and 2 patients with herpes zoster oticus (HB grade V–VI) underwent facial nerve decompression surgery between January 2008 and July 2014. In all patients, we performed temporal lobe retraction for facial nerve decompression via the transmastoid approach. Patients were examined using pre operative tests including high-resolution computed tomography, temporal magnetic resonance imaging, audiometry, and electroneurography (degenerative ratio >90%). Facial function was evaluated by HB grading scale before and 6 months after the surgery. RESULTS: After the surgery, facial function recovered to HB grade I in 9 patients and to grade II in 11 patients. No problems due to surgical retraction of the temporal lobe were noted. Compared to the standard transmastoid approach, our method helped achieve a wider surgical view for improved manipulation in the peri-geniculate ganglion in all cases. CONCLUSION: Facial nerve decompression via the transmastoid approach with temporal lobe retraction provides better exposure to the key areas around the geniculate ganglion without complications.
Audiometry ; Bell Palsy ; Decompression* ; Facial Nerve* ; Facial Paralysis ; Ganglion Cysts* ; Geniculate Ganglion ; Herpes Zoster Oticus ; Humans ; Magnetic Resonance Imaging ; Methods ; Semicircular Canals ; Temporal Lobe*

BACKGROUND: QT dispersion(QTD : QTmax-QTmin) or JT dispersion(JTD:JTmax-JT-min)in 12 leads ECG has been known to reflect regional variations in ventricular repolarization and has been reported to bel one of the marker of regional myocardial ischemia. To evaluate the significance of QTD or JTD of exercise ECG in diagnosis of coronary artery disease, we studied 106 patients(mean age, 56.9 years old, male 63) who were referred for the evaluation of chest pain on exertion. METHOD: Treadmill exercise stress test with modified Bruce protocol and coronary angiography were performed in 106 patients with chest pain on exertion. ST-segment depression by >1.0 mm 0.08 second after J-point during or after exercise in exercise test and >50% stanosis of epicardial artery in coronary angiogram were defined as positive. Of 106 patients, 41 had positive exercise ECG and positive coronary angiogram(true positive, TP), 20 had positive exercise ECG and negative coronary angiogram(false positive, FT), 20 had negative exercise ECG and positive coronary angiogram(faalse negative, FN), and 23 had negative exercise ECG and negative coronary angiogram(true negative, Tn). QT and JT interval in 12 leads were measured at baseline and peakexercise and were corrected for heart rate using Bazett's formula. QTD and JTD were measured by calculation the difference between the maximum QT and mininum QT and that between maximum JT and minumum JT. RESULTS: QTD at baseline for TP(72.8ms)was prolonged compared to Tn(52.2ms,P<0.01), but was not different from that for FT(70.2 ms). At peak exercise, QTD for TP(81.3 msec) was significantly prolonged(p<0.01), while QTD for FP(71.2 msec) was not different from that for TN(56.8 msec). JTD at baseline(78.4 msec) and at peak exercise(88.2 msec) for TP were significantly prolonged compared to those for TN(55.2msec and 55.1msec p<0.01,p<0.01, respectively), but those for FP were not porlonged(77.0msec and 79.0msec, respectively). QTD and JTD at peak exercise were more markedly prolonged in patients with sever stenosis of coronary artery(p=0.053 and p<0.05, repectively) and multivessels diseases(p<0.01, 0<0.05) than those with less severe disease and single vessel disease. Patients with left anterior descending artery lesion had greater QTD and JTD at peak exercise than those with other vessels lesion(p<0.01). In addition to standard criteria with ST segment displacement in exercise EGC, inclusion of exercise induced QTD of more than 60msec increased the sensitivity of exercise ECG from 66.7% to 83.3%, and JTD of more than 70msec increased the specificity from 52% to 76.0%. CONCLUSION: Measurement of QT dispersion and JT dispersion of exercise ECG may be useful method to identify the severity of coronary artery disease and to improve diagnostic accuracy of exercise ECG in coronary artery disease.
Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Depression ; Diagnosis ; Electrocardiography* ; Exercise Test ; Heart Rate ; Humans ; Male ; Myocardial Ischemia ; Sensitivity and Specificity

The continuous epidural anesthesia is an effective method for postoperative pain control and improvement of pulmonary function. A 39-year-old man was scheduled for postoperative intestinal obstruction. After adhesiolysis under the general anesthesia, epidural anesthesia was done for postoperative pain control. Because an accidental dural puncture was noticed, the adjacent interspace of epidural anesthesia was tried and catheter was inserted. Respiratory depression, hypotension, loss of consciousness and cardiac arrest were developed about 20 minutes after the first injection of 1% lidocain 10ml. Endotracheal intubation was performed and the respiration was controlled using 100% oxygen. Self respiration and alert mentality returned after 180 minutes. No CSF leakage, delayed onset time, severe hypotension, complete recovery may be the result of subdural anesthesia and postoperative hypoxia. But radiological examination was not performed.
Adult ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anoxia ; Catheters ; Heart Arrest* ; Humans ; Hypotension ; Intestinal Obstruction ; Intubation, Intratracheal ; Oxygen ; Pain, Postoperative* ; Punctures ; Respiration ; Respiratory Insufficiency ; Unconsciousness

BACKGROUND/AIMS: As a result of the rapid development of medical diagnostic tools, physicians require concrete evidence to evaluate the effectiveness of the tools. We aimed to investigate the effectiveness and additional diagnostic benefits of capsule endoscopy (CE) in patients with small bowel Crohn’s disease (CD). METHODS: We performed a systematic search of databases, including MEDLINE, EMBASE, and the Cochrane Library, as well as eight domestic databases. Two reviewers independently screened all references. Diagnostic data from the studies were collected, and a meta-analysis was performed. RESULTS: Twenty-four studies were included. In cases of suspected CD, CE demonstrated a superior diagnostic yield compared with small bowel follow-through (SBFT) and enteroclysis (EC); however, there was no difference compared with computed tomography enterography or magnetic resonance enterography. In cases with established CD, CE demonstrated a higher diagnostic yield only compared with EC. In the detection of terminal ileum lesions, CE exhibited a significantly increased detection rate compared with ileoscopy. CONCLUSIONS: The findings of our meta-analysis indicate that CE is superior to SBFT and EC in the evaluation of suspected CD cases. CE is also a more effective diagnostic modality in patients with established CD compared with EC.
Capsule Endoscopy* ; Crohn Disease ; Humans ; Ileum ; Intestines