No abstract available.
Hemorrhage* ; Humans ; Warfarin*

Percutaneous endoscopic gastrostomy (PEG) is a relative safe but invasive procedure associated with both minor and major complications. Gastric perforation is one of the major complications, usually requiring surgical intervention. As most patients undergoing PEG have severe, chronic underlying diseases and are in a poor general condition, surgical intervention may substantially increase the risk of subsequent complications. A 75-year-old female suffering from an advanced glioblastoma underwent PEG to allow enteral nutrition in a local hospital. Four days later, she presented with fever and confusion. Three days after that, she presented with a generalized tonic-clonic seizure and was referred to the Asan Medical Center emergency room. Diagnostic work-up revealed PEG tube dislocation and a gastric wall defect. Therefore, the PEG tube was removed and endoscopic primary closure was performed using a detachable snare, hemoclips, and fibrin glue. Three weeks after closure, fluoroscopy revealed no leakage and the patient resumed enteral feeding without any complication.
Aged ; Chungcheongnam-do ; Dislocations ; Emergency Service, Hospital ; Endoscopy ; Enteral Nutrition ; Female ; Fever ; Fibrin Tissue Adhesive ; Fluoroscopy ; Gastrostomy* ; Glioblastoma ; Humans ; Seizures ; SNARE Proteins ; Stomach

Obesity, along with its comorbidities, has become a significant public health concern worldwide. Bariatric surgery is considered the most effective treatment modality; however, only 2% of patients with obesity undergo bariatric surgery. Endoscopic bariatric and metabolic therapies (EBMTs) are emerging alternatives to traditional bariatric surgery for patients who are not eligible for or do not prefer surgical treatment. EBMTs are generally categorized as space-occupying, gastric restrictive, aspiration, and small bowel therapies. We aimed to review various non-balloon and non-gastroplasty devices with available clinical data and discuss the possible mechanisms of action, efficacy, and safety profile of these EMBTs.

The long-term clinical issues in Kawasaki disease are concerned with the coronary artery lesions that result in aneurysmal formation, thrombotic occlusion, progression to ischemic heart disease, and premature atherosclerosis. We here report a 3 month old infant with Kawasaki disease complicated by giant coronary aneurysm with thrombosis. After urokinase(10,000 IU/kg) and heparin(400 IU/kg) were injected for two days as thrombolytic agents, thrombi were successfully dissolved. Even though long-term oral anticoagulation with low-dose aspirin, dipyridamole and coumadin were administered, thrombosis of the left main coronary artery was slowly increased. five years later, coronary angiography showed nearly total occlusion of the left anterior descending artery and collaterals from the right posterior branch and radionuclide scan demonstrated complete reversible perfusion defect of several portions of the left ventricle.
Aneurysm ; Arteries ; Aspirin ; Atherosclerosis ; Child* ; Coronary Aneurysm* ; Coronary Angiography ; Coronary Vessels ; Dipyridamole ; Fibrinolytic Agents ; Follow-Up Studies* ; Heart Ventricles ; Humans ; Infant ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Ischemia ; Perfusion ; Thrombolytic Therapy* ; Thrombosis* ; Warfarin

PURPOSE: To examine the effect of simvastatin on vascular endothelial growth factor (VEGF) expression in cultured human retinal pigment epithelial (RPE) cells under oxidative stress. METHODS: RPE cell viability was measured using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay after 24 hours of incubation with various concentrations of simvastatin or H2O2. Cultured human RPE cells were pretreated with various concentrations of simvastatin and then incubated with 100 microm H2O2. After 24 hours of incubation, an enzyme-linked immunosorbent assay (ELISA) was performed to evaluate the expression of VEGF. RESULTS: Simvastatin showed no toxicity up to 10 microm, but cell viability gradually decreased with increased concentration of simvastatin. Human RPE cells showed increased VEGF expression when exposed only to H2O2. When RPE cells were preincubated with simvastatin and later exposed to H2O2, VEGF expression was relatively lower. CONCLUSIONS: Simvastatin downregulated the expression of VEGF in human RPE cells under oxidative stress. Simvastatin may have some clinical benefits in preventing retinal diseases associated with VEGF.
Cell Survival ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; Humans ; Macular Degeneration ; Oxidative Stress ; Retinal Diseases ; Retinaldehyde ; Simvastatin ; Tetrazolium Salts ; Thiazoles ; Vascular Endothelial Growth Factor A

No abstract available.
Hip ; Hip Joint ; Osteoma, Osteoid

Recently, the increasing use of antenatal high resolutional ultrasonographic studies, and the increasing expertise of sonographers have contributed to the more frequent prenatal detecton of fetal hepatic calcification. Fetal hepatic calcification can arise from peritoneal, ischemic, infectious, neoplastic, and idiopathic causes. There are many reports that the prognosis is good in isolated fetal hepatic calcification without chromosomal aberrations, associated congenital malfomations or other organ abnormalities. We report one case of fetal hepatic calcification diagnosed by prenatal ultrasonography at gestational age of 27 weeks, without chromosomal abnormalities or other associated organ abnormalities, showing good prognosis.
Chromosome Aberrations ; Fetus ; Gestational Age ; Prognosis* ; Ultrasonography, Prenatal

Percutaneous endoscopic gastrostomy (PEG) has substituted surgical gastrostomy for long-term enteral nutrition. Percutaneous endoscopic transgastric jejunostomy (PEG-J) entails placing a feeding tube into the jejunum through PEG. Unlike PEG, PEG-J is associated with complications caused by the jejunal extension tube. Herein, we report a rare complication of PEG-J. A 71-year-old woman who underwent PEG-J for the administration of carbidopa-levodopa, complained of epigastric pain, dyspepsia, and weight loss of more than 10% in 2 months. Esophagogastroduodenoscopy revealed a duodenal decubitus ulcer caused by the pressure from the jejunal extension tube. After removal of the PEG-J and a 4-week treatment with a proton pump inhibitor, the ulcer healed and the symptoms resolved.

Percutaneous endoscopic gastrostomy (PEG) has substituted surgical gastrostomy for long-term enteral nutrition. Percutaneous endoscopic transgastric jejunostomy (PEG-J) entails placing a feeding tube into the jejunum through PEG. Unlike PEG, PEG-J is associated with complications caused by the jejunal extension tube. Herein, we report a rare complication of PEG-J. A 71-year-old woman who underwent PEG-J for the administration of carbidopa-levodopa, complained of epigastric pain, dyspepsia, and weight loss of more than 10% in 2 months. Esophagogastroduodenoscopy revealed a duodenal decubitus ulcer caused by the pressure from the jejunal extension tube. After removal of the PEG-J and a 4-week treatment with a proton pump inhibitor, the ulcer healed and the symptoms resolved.

Background: There has been controversy regarding the association between primary aldosteronism (PA) and dyslipidemia and few studies considered the effects of diabetes and renal function on lipid metabolism. We analyzed lipid profiles of PA patients and compared them to propensity-score (PS)-matched essential hypertension (EH) patients adjusting for glycemic status and renal function. Methods: Patients who were diagnosed with PA using a saline-infusion test at Seoul National University Hospital from 2000 to 2018 were retrospectively analyzed. EH patients who had aldosterone-renin ratio (ARR) results were selected as controls. Covariates, including diabetes, were PS-matched for patients with PA, lateralized PA, non-lateralized PA, and high ARR to EH patients, respectively. Results: Among a total of 80 PA and 80 EH patients, total cholesterol (TC) and triglyceride (TG) levels were significantly lower in the PA patients than in the EH patients (least-squares mean±standard error: 185.5±4.4 mg/dL vs. 196.2±4.4 mg/dL, P=0.047, for TC; and 132.3±11.5 mg/dL vs. 157.4±11.4 mg/dL, P=0.035, for TG) in fully adjusted model (adjusting for multiple covariates, including diabetes status, glycosylated hemoglobin level, and estimated glomerular filtration rate). There were no significant differences in high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol levels between the two groups. According to increments in aldosterone levels, an increasing tendency of HDL-C and decreasing tendencies of TG and non-HDL-C were observed. Conclusion PA patients had lower TC and TG levels than EH patients, independent of glycemic status and renal function.