Viral myocarditis is a inflammatory process of the heart caused by virus. Its manifestation ranges from asymptom to acute fulminent congestive heart failure and often mimics acute myocardial infarction. A 22 year old man was admitted to the hospital because of prolonged anterior chest pain. 15 days before entry, anterior chest pain with cough and fever brought him to the another hospital. At that time, the LDH level was 1160U/L, the CPK level was 659.7U/L and MB band was 16.1%. The ECG revealed acute inferior wall infarction. And 3 days later, extensive anterior wall infarction findings appeared. 2D-Echo findings showed proximal septal hypokinesia. On admission time to this hospital, physical examination was negative. The ECG showed no interval change. 2D-Echo findings showed increased echogenicity of anterior and inferior wall. Treadmill test did not evoked chest pain or change of ECG. The LDH, CPK levels returned to normal range. The antibody titers of Coxsackievirus type A-16 was positive. Coronary angiography showed normal findings. 3 months later, antibody's titer of Coxsackievirus A-16 was increased. A diagnosis of acute viral myocarditis was made.
Chest Pain ; Coronary Angiography ; Cough ; Diagnosis ; Electrocardiography ; Exercise Test ; Fever ; Heart ; Heart Failure ; Humans ; Hypokinesia ; Infarction ; Myocardial Infarction* ; Myocarditis* ; Physical Examination ; Reference Values ; Young Adult

Hamartoma is the most common benign neoplasm occurring in the lung. By contrast, endobronchial hamartomas are rare and cause irreversible lung damage due to bronchial obstruction if not diagnosed early and treated properly. Of the various treatments for this rare disease, surgical resection and removal using rigid bronchoscopy remains the most popular; this requires general anesthesia and relatively more time to recover from the procedure. Here, we report the cases of a 50-year-old woman and 65-year-old man who presented with endobronchial hamartomas that were removed successfully using cryotherapy and electrocoagulation via a flexible bronchoscope.
Aged ; Anesthesia, General ; Bronchoscopes ; Bronchoscopy ; Cryotherapy ; Electrocoagulation ; Female ; Hamartoma ; Humans ; Lung ; Middle Aged ; Rare Diseases

PURPOSE: We wanted to assess the cerebral activation of the motor function after deep cortical (lentiform nucleus and thalamus) infarction. MATERIALS AND METHODS: We studied the motor function of eight right-handed deep cortical infarcted patients (mean age, 61 years; 7 men and 1 woman) who suffered a single unilateral deep cortical (lentiform nucleus or thalamus) infarction. The grade of muscle power by the grading system of the Medical Research Council was II in two patients, III in three patients and IV in three patients. All the MRI experiments were performed with a 1.5T scanner. The fMRI protocol consisted of eight alternating periods of task performance and rest. The activation tasks consisted of finger movements. Data analysis of activated area and calculation of the activated volumes in sensorimotor cortex were done. RESULTS: For the six lentiform nucleus acute infarction patients, one right hemiparetic patient (MRC Grade: II), and only the right sensorimotor cortex (the unilateral non-lesion side) were activated. In five (MRC Grade: III-IV) of the six lentiform nucleus infarcted patients, bilateral activations of the primary sensorimotor cortex were recorded. In four of the five bilaterally activated patients, extended activations in the lesion side sensorimotor cortex were observed. In the two right thalamic infarction patients, bilateral activations of the primary sensorimotor cortex were recorded. One patient (MRC Grade: II) was observed to have an extended activation in the non-lesion side sensorimotor cortex. On the follow up fMRI done on this patient after 40 days (MRC Grade: III at that time), the activated volumes of both sensorimotor cortexes were increased. The activated volume in the lesion side sensorimotor cortex was more than that in the non-lesion side sensorimotor cortex. The other patient (MRC Grade: IV) was observed to have extended activation in the lesion side sensorimotor cortex. CONCLUSION: fMRI allows for the study of the motor function in deep cortical infarction. We were able to investigate the differences in motor activation according to the individual MRC Grades. fMRI may be a useful tool to monitor and study deep cortical infarction, and it may be important to help us understand the function of the deep cortical areas.
Basal Ganglia* ; Brain ; Corpus Striatum ; Fingers ; Follow-Up Studies ; Humans ; Infarction* ; Magnetic Resonance Imaging* ; Male ; Statistics as Topic ; Task Performance and Analysis ; Thalamus*

PURPOSE: The aims of this study were to immunohistochemically identify lymph node micormetastases in Dukes' B colorectal cancer patients, and determine the relationship between lymph node micrometastases and other prognostic factors and recurrence rates. METHODS: A retrospective analysis was conducted of 990 lymph nodes from Dukes' B 42 patients who had undergone radical colorectal resection. These lymph nodes were immunohistochemically examined with monoclonal antibodies against cytokeratin-19. The prognostic factors and recurrent rates were compared between patients with and without lymph node micrometastases. RESULTS: Micrometastases were confirmed in 19 nodes (1.9%) from 9 patients (21.4%). No correlations were observed between micrometastases and the prognostic factors, with the exception of the preoperative CEA level. 8 of the 9 (88.9%) patients with micrometastases had preoperative CEA levels significantly elevated above 5 ng/ml (P<0.0001). There were no significant differences in the recurrent rates (P=0.0572) between patients with and without micrometastases during the short term follow up period (14.8 months) at the 95% confidence interval, but there were significant differences at the 90% confidence interval. CONCLUSION: High preoperative CEA levels increase the risk for micrometastases, and the presence of micrometastases might increase the possibility of recurrence. Thus, a routine immunohistochemical technique for identifying micrometastases is recommended in the patients with a high preoperative CEA level. However, a more definite clinical significance of lymph node micrometastases awaits further extensive prospective studies.
Antibodies, Monoclonal* ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Keratin-19* ; Lymph Nodes* ; Neoplasm Micrometastasis* ; Recurrence ; Retrospective Studies

PURPOSE: The aims of this study were to immunohistochemically identify lymph node micormetastases in Dukes' B colorectal cancer patients, and determine the relationship between lymph node micrometastases and other prognostic factors and recurrence rates. METHODS: A retrospective analysis was conducted of 990 lymph nodes from Dukes' B 42 patients who had undergone radical colorectal resection. These lymph nodes were immunohistochemically examined with monoclonal antibodies against cytokeratin-19. The prognostic factors and recurrent rates were compared between patients with and without lymph node micrometastases. RESULTS: Micrometastases were confirmed in 19 nodes (1.9%) from 9 patients (21.4%). No correlations were observed between micrometastases and the prognostic factors, with the exception of the preoperative CEA level. 8 of the 9 (88.9%) patients with micrometastases had preoperative CEA levels significantly elevated above 5 ng/ml (P<0.0001). There were no significant differences in the recurrent rates (P=0.0572) between patients with and without micrometastases during the short term follow up period (14.8 months) at the 95% confidence interval, but there were significant differences at the 90% confidence interval. CONCLUSION: High preoperative CEA levels increase the risk for micrometastases, and the presence of micrometastases might increase the possibility of recurrence. Thus, a routine immunohistochemical technique for identifying micrometastases is recommended in the patients with a high preoperative CEA level. However, a more definite clinical significance of lymph node micrometastases awaits further extensive prospective studies.
Antibodies, Monoclonal* ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Keratin-19* ; Lymph Nodes* ; Neoplasm Micrometastasis* ; Recurrence ; Retrospective Studies

BACKGROUND/AIMS: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. METHODS: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. RESULTS: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. CONCLUSIONS: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.
Abdominal Pain ; Bile Ducts ; Bile* ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis ; Common Bile Duct ; Congenital Abnormalities ; Constriction, Pathologic ; Cystic Duct ; Diagnosis ; Drainage ; Hepatic Duct, Common ; Humans ; Liver ; Medical Records ; Patient Care ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Stents