Infarction in the territory of the posterior choroidal artery(PChA) is rare. The main clinical manifestations of the PCHA infarction are known to be visual field defect, sensory-motor dysfunction, neuropsychological disturbances. Neuropsychological disturbances include of transcortical aphasia and amnesia. The latter disturbance is very rare and reported to be transient. We report a 77 year old man who presented with severe selective amnesia due to PChA infarction. Neurologic examination revealed right homonymous hemianopsia. Brain MRI showed infarction of PChA territory and multiple lacunes in the preventricular deep white matter.
Aged ; Amnesia* ; Aphasia ; Arteries* ; Brain ; Choroid* ; Hemianopsia ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Neurologic Examination ; Visual Fields

Infarction in the territory of the posterior choroidal artery(PChA) is rare. The main clinical manifestations of the PCHA infarction are known to be visual field defect, sensory-motor dysfunction, neuropsychological disturbances. Neuropsychological disturbances include of transcortical aphasia and amnesia. The latter disturbance is very rare and reported to be transient. We report a 77 year old man who presented with severe selective amnesia due to PChA infarction. Neurologic examination revealed right homonymous hemianopsia. Brain MRI showed infarction of PChA territory and multiple lacunes in the preventricular deep white matter.
Aged ; Amnesia* ; Aphasia ; Arteries* ; Brain ; Choroid* ; Hemianopsia ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Neurologic Examination ; Visual Fields

PURPOSE: To evaluate the usefulness of transperineal sonography of the prostate in patients with previousabdominoperineal resection. MATERIALS AND METHODS: Transperineal prostatic sonograms were obtained from ninepatients with abdominoperineal resection. The shortest distance between the probe and the prostate gland, itsvolume, and its internal and external structures were evaluated for image quality, shape, border, and the degreeof distortion in internal echo. Because the number of patients was small, statistical analysis was not performed. RESULTS: Transperineal sonography of the prostate in eight patient was obtained at ease, except that one of ninepatients was not able to continue the procedure because of severe tenderness of the perineum and poor cooperation.Acceptable images of the prostate gland and their adjacent structures were obtained in one patient with less than1cm between the probe and prastate gland, three of four with between 1cm and 1.5cm, and one of three with morethan 1.5cm. CONCLUSION: In patients with previous abdominoperineal resection, transperineal sonography of theprostate may be a good imaging modality.
Humans ; Perineum ; Prostate*

PURPOSE: The purpose of this study is to evaluate the changes of conditional survival (CS) probabilities and to identify the prognostic parameters that significantly affect CS over time post-surgery in upper tract urothelial carcinoma (UTUC) patients. MATERIALS AND METHODS: A total of 330 patients were examined in the final analysis. Primary end point was conditional cancer-specific survival (CSS), overall survival (OS), and intravesical recurrence-free survival (IVRFS) after surgery. The Kaplan-Meier method was used for calculation of CS. Cox regression hazard ratio model was used to determine the predictors of CS. RESULTS: UTUC patients who had already survived 5 years after radical nephroureterectomy had a more favorable CS probability in all given survivorships compared to those with shorter survival times. Patients with unfavorable pathologic features showed a higher increment of 5-year conditional CSS and OS compared to their counterparts. For 5-year conditional CSS, several factors, including high-grade tumor, lymphovascular invasion, and tumor location showed significant association with risk elevation over time. Only age remained as a predictor of 5-year conditional OS with increased risk in all given survivorships. For 5-year IVRFS, no variables remained as significant predictive factors over time after surgery. CONCLUSION: Our study provides valuable information for practical survival estimation and relevant prognostic factors for patients with UTUC after surgery.
Carcinoma, Transitional Cell ; Effect Modifier, Epidemiologic ; Humans ; Retrospective Studies* ; Survival Rate ; Urinary Tract ; Urologic Surgical Procedures

BACKGROUND/AIMS: Gabexate, a protease inhibitor, has been known to prevent pancreatic damage following ERCP. We conducted a prospective and randomized study to assess the preventive effect of gabexate. Methods: Of the 96 patients enrolled, 46 were treated with gabexate and 50 with placebo. The groups were similar with regard to sex, age, body-mass index, and the final diagnosis of ERCP. RESULTS: 24 patients (25.0%) had elevated pancreatic-enzyme levels; the frequency was similar in the two groups (P=0.48). Mean serum amylase value at 4 hours after ERCP was similar in patients with elevated basal level (220.5+/-43.2 U/L) and those with normal basal level (170.4+/-31.2 U/L). After the procedures, serum amylase values were lower in the gabexate group (137.1+/-19.8 U/L) than in the placebo group (212.0+/-50.4 U/L). The differences were not significant in the mean levels of amylase between the groups for any of imaging of the pancreatic ducts (pancreatic-duct imaging, 201.5+/-49.4 U/L, bile-duct imaging, 153.7+/-30.0 U/L). But in the patients with pancreatic duct imaging, serum amylase values were significantly higher in the placebo group (295.0+/-97.6 U/L) than in the gabexate group (112.0+/-10.6 U/L)(p<0.05). CONCLUSIONS: Prophylactic treatment with gabexate does not reduce pancreatic damage related to ERCP, but only in the patients with pancreatic duct imaging there were the significant differences between in the gabexate group and in the placebo group.
Amylases ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis ; Gabexate* ; Humans ; Pancreatic Ducts ; Pancreatitis ; Prospective Studies ; Protease Inhibitors

No abstract available.
Humans ; Hypertension* ; Perindopril*

Occlusive disease of the iliac segment, proximal to the transplant artery (prox-TRAS), in kidney transplant recipients is a rare complication. Prox-TRAS, located in the common iliac artery, is extremely rare in these patients. Herein, we present an interesting case of a common iliac artery stenosis that manifested as decreased allograft function and uncontrolled blood pressure without other typical clinical symptoms. The patient was successfully treated with percutaneous luminal angioplasty and stent insertion.
Allografts* ; Angioplasty ; Arteries ; Blood Pressure ; Constriction, Pathologic* ; Humans ; Hypertension* ; Iliac Artery* ; Kidney ; Kidney Transplantation ; Phenobarbital ; Stents ; Transplant Recipients

Hemiparkinson-hemiatrophy (HP-HA) syndrome is a rare form of secondary parkinsonism. We present a case of a 19-year-old, left-handed man with subcortical heterotopia. He had hemiatrophy and hemiparkinsonian symptoms on his right side. We described the clinical, neuroradiological and neurophysiologic findings including transcranial magnetic stimulation study. These findings were compatible with HP-HA syndrome and his symptoms were markedly improved with levodopa treatment.
Humans ; Levodopa ; Parkinson Disease, Secondary ; Transcranial Magnetic Stimulation ; Young Adult

Choledochocele is a kind of choledochal cyst and represents a prolapse or herniation of the intramural segment of the distal common bile duct into the duodenal lumen. It is rare congenital anomaly and, easlily overlooked due to non-specific clinical symptoms, signs, and non-characteristic radiologic features. The cause of choledochocele remains uncertain and it was suggested that thete are two distinct types in the pathogenesis of it, i.e., congenital and acquired. Recently, many cases of choledochocele were reported, which diagnosed by ERCP and safely treated with endoscopic unroofing and EST followed by continued observation as well as interval ERCP and/or endoscopic ultrasonography. We present here four cases of symptomaatic choledochoceles that had been managcd by end- oscopic therapy and continucd observation.
Biliary Tract* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst* ; Common Bile Duct ; Endosonography ; Pancreas* ; Prolapse

BACKGROUND: Piriformis syndrome (PS) is an uncommon disease characterized by symptoms resulting from compression/irritation of the sciatic nerve by the piriformis muscle. Uncertainty and controversy remain regarding the proper diagnosis and most effective form of treatment for PS. This study analyzes the diagnostic methods and efficacy of conservative and surgical treatments for PS. METHODS: From March 2006 to February 2013, we retrospectively reviewed 239 patients who were diagnosed with PS and screened them for eligibility according to our inclusion/exclusion criteria. All patients underwent various conservative treatments initially including activity modification, medications, physical therapy, local steroid injections into the piriformis muscle, and extracorporeal shock wave therapy for at least 3 months. We resected the piriformis muscle with/without neurolysis of the sciatic nerve in 12 patients who had intractable sciatica despite conservative treatment at least for 3 months. The average age of the patients (4 males and 8 females) was 61 years (range, 45 to 71 years). The average duration of symptoms before surgery was 22.1 months (range, 4 to 72 months), and the mean follow-up period was 22.7 months (range, 12 to 43 months). We evaluated the degree of pain and recorded the responses using a visual analog scale (VAS) preoperatively and 3 days and 12 months postoperatively. RESULTS: Buttock pain was more improved than sciatica with various conservative treatments. Compared with preoperatively, the VAS score was significantly decreased after the operation. Overall, satisfactory results were obtained in 10 patients (83%) after surgery. CONCLUSIONS: PS is thought to be an exclusively clinical diagnosis, and if the diagnosis is performed correctly, surgery can be a good treatment option in patients with refractory sciatica despite appropriate conservative treatments.
Buttocks ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Piriformis Muscle Syndrome* ; Retrospective Studies ; Sciatic Nerve ; Sciatica ; Shock ; Uncertainty ; Visual Analog Scale