During recent 3 years, 10 patients with epidural cord compression from a lesion in the anterior portion of the thoracic or upper lumbar area have been treated surgically by an anterolateral approach combined with modified posterolateral approach for decompression. Of 10 patient-two cases of OPLL(ossification of posterior longitudinal ligament) with herniated disc, two cases of metastatic tumor, one case of neurilemmoma, one case of pyogenic osteomyelitis of the vertebral body, two cases of herniated disc, one case of traumatic fracture-dislocation, and one case of congenital hemivertebra-5 patients with mild paraparesis improved postoperatively and returned to normal neurologically, 4 patients with moderate gait disturbance were ambulatory without any device, and one completely paraplegic patient was able to walk with device at 1 year after the operation. This approach could be used for removal of disc material, transverse process, lamina, or pedicle through one stage operation. This point is an advantage of this method compared to postero-lateral approach, lateral approach, or anterolateral approach. Anterior decompression by a modified anterolateral approach should be considered for management of spinal cord compressions such as tumor, infective lesion, traumatic lesion, or congenital malformation.
Decompression ; Gait ; Humans ; Intervertebral Disc Displacement ; Lumbosacral Region* ; Neurilemmoma ; Osteomyelitis ; Paraparesis ; Spinal Cord Compression

For the patients suffering from extensive deep vein thrombosis (DVT), the placement of an inferior vena cava (IVC) filter in conjunction with anticoagulant therapy has been used to prevent pulmonary embolisms. However, for the patients who anticoagulant is contraindicated or if this is complicated, the use of an IVC filter without concurrent anticoagulation may become the sole treatment for pulmonary embolisms. In this situation, the thrombi trapped in the IVC filter may cause significant clinical problems. We report here on a case of IVC filter thrombosis that was successfully treated by aspiration thrombectomy after placing another filter proximal to the previous filter.
Humans ; Pulmonary Embolism ; Thrombectomy* ; Thrombosis* ; Vena Cava Filters* ; Vena Cava, Inferior* ; Venous Thrombosis

Right atrial aneurysm is a rare abnormality of unknown origin. Approximately half of patients with right atrial aneurysm show no symptoms. Right atrial aneurysm is usually detected by chance at any time between fetal and adult life and can be associated with atrial arrhythmia and systemic embolism. The diagnosis of right atrial aneurysm can be established with echocardiography, computed tomography (CT) or magnetic resonance imaging (MRI). Because of thromboembolic risk, aneurysmectomy is usually recommended. We review the case report of a 69-year-wold woman with right atrial appendiceal aneurysm, whose diagnosis was established by echocardiography and CT angiography.
Adult ; Aneurysm ; Angiography ; Arrhythmias, Cardiac ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Female ; Humans ; Magnetic Resonance Imaging

Colorectal varix (CRV) is a rare cause of lower gastrointestinal bleeding and usually associated with portal hypertension from liver cirrhosis or portal venous obstruction. Idiopathic CRV have no identifiable underlying cause and can only be diagnosed after the cause of portal or mesenteric vein circulation have been excluded. We report a case of idioipathic CRV presented with rectal bleeding for a week. Colonoscopy revealed markedly dilatated tortuous, and bluish veins in the rectum as well as coexistent adenomatous polyp and internal hemorrhoid. Despite extensive investigation, there was no evidence of portal hypertension or any other cause. Family history was also negative. Although blood transfusions were required, the patient remained asymptomatic without further rectal bleeding.
Adenomatous Polyps ; Blood Transfusion ; Colonoscopy ; Hemorrhage ; Hemorrhoids ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Mesenteric Veins ; Rectum ; Varicose Veins* ; Veins

Aortopulmonary fistula is an uncommon but often fatal condition resulting as a late complication of an aortic aneurysm. The most common cause is erosion of a false aneurysm of the descending thoracic aorta into the pulmonary artery, resulting in the development of a left-to-right shunt and leading to acute pulmonary edema and right heart failure. We report an our experience with aortopulmonary fistula as a rare complication associated with thoracic aortic aneurysm and high output heart failure.
Aneurysm, False ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Arterio-Arterial Fistula ; Fistula ; Heart Failure ; Pulmonary Artery ; Pulmonary Edema

Boerhaave's syndrome is a spontaneous tear through all the layers of the left lateral wall of the esophagus just above the diaphragm, produced by a sudden increase in esophageal pressure. Boerhaave's syndrome is a rare but grave syndrome, with a mortality rate around 40%. Most affected patients are middle-aged men who experience violent vomiting after heavy eating or alcohol intake or both. Vomiting followed by the abrupt onset of pain, dyspnea, and/or shock are the major symptoms. The most important diagnostic tool may be an upright chest X-ray. However, esophagograms and/or a chest CT may be required to locate the lesion. The management of esophagopleural fistula must be individualized, and both the patient's condition and the specific characteristics of the fistula must be considered. Successful management of patients must include adequate nutritional support and effective therapy of the associated empyema. A case of esophagopleural fistula complicated by Boerhaave's syndrome, which was successfully treated by endoscopic injection of Histoacryl , in herein reported.
Diaphragm ; Dyspnea ; Eating ; Empyema ; Enbucrilate* ; Esophagus ; Fistula* ; Humans ; Male ; Mortality ; Nutritional Support ; Shock ; Thorax ; Tomography, X-Ray Computed ; Vomiting

Objectives: . Endoscopic tympanoplasty (ET) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility for the treatment of tympanic membrane (TM) perforations. However, the literature on surgical outcomes for large TM perforations is lacking and limited to small series. This study aimed to evaluate the clinical benefits of ET for large TM perforations. Methods: . This retrospective cohort study was conducted at nine tertiary referral hospitals in South Korea, where 252 patients who underwent ET as primary surgery from September 2019 to August 2021 were included. The outcome measures included the graft success rate and pre- and postoperative audiometric data. Results: . In 239 patients, the graft success rate of ET for large or subtotal perforations was 86.2% (206 patients), while the graft failure rate was 13.8% (33 patients). The graft failure rate was directly correlated with surgical techniques, including overlay and medial or lateral underlay tympanoplasty (P=0.027). Lateral underlay tympanoplasty showed the most favorable results. Sex, laterality, etiology, site and size of perforation, operation time, and graft materials did not vary significantly between the graft success and failure groups (P>0.05). The mean air-bone gap (ABG) improved significantly in both groups (graft success group: 10.0±0.6 dB and graft failure group: 7.7±0.3 dB; P<0.001). However, the ABG improvement did not significantly differ between the groups. Analysis of covariance revealed that the postoperative 500-Hz bone conduction threshold improved after successful ET (adjusted coefficient, –11.351; 95% confidence interval, –21.491 to –1.212; P=0.028). Conclusion . This study involved the largest population to date of large TM perforations treated by ET. The study findings suggest that ET is feasible and effective in treating large TM perforations.

Angioimmunoblastic lymphadenopathy with dysproteinemia(AILD), first described at early seventies, is a clinico-pathologic syndrome which has common features of lymphadenopathy, hepatosplenomegaly, fever, rash and dysproteinemia. It is a lymphoproliferative disease, differs from malignant lymphoma by the high frequency of constitutional symptoms and by the presence of generalized lymph node enlargement, hepatosplenomegaly, cutaneous menifestations and polyclonal hypergammaglobulinemia at the time of clinical onset. Peripheral T cell lymphomas(PTCL) are morphologically and immunologically heterogeneous group of lymphoproliferative disorders that are composed of postthymic lymphocytes. There are group of cases showing features similar to AILD, and these cases are classified as AILD like PTCL. We report a rare case of AILD like PTCL in an 8 year old boy, who visited Seoul National University Hospital with fever, hepatosplenomegaly and cervical lymphadenopathy, and diagnosed as AILD like PTCL by lymph node biopsy. He did not respond to conventional chemotherapy and died 1 year after clinical onset during chemotherapy, showing feature of multiple brain infarction of unknown etiology.
Biopsy ; Brain Infarction ; Child ; Drug Therapy ; Exanthema ; Fever ; Humans ; Hypergammaglobulinemia ; Immunoblastic Lymphadenopathy* ; Lymph Nodes ; Lymphatic Diseases ; Lymphocytes ; Lymphoma ; Lymphoma, T-Cell, Peripheral* ; Lymphoproliferative Disorders ; Male ; Paraproteinemias ; Seoul

A case of a 42-year-old man who had massive and refractoty bleeding from multiple gastric ulcers complicating gastric amyloidosis and a case of a 62- year-old woman who had massive hematochezia from rectal amyloidosis in predialytic chronic renal failure patients are reported. Emergency total gastrectomy and simple ligation were performed in two patients. Two patients were confirmed by showing apple green birefringence under the polarized microscope with Congo-red stain through stomach and rectal specimen. Immunoelectrophoresis and protein electrophoresis of serum and urine showed no significant findings. 2 cases of gastrointestinal amyloidosis presenting massive bleeding in predialytic chronic renal failure patients were discussed with brief literature.
Adult ; Amyloidosis* ; Birefringence ; Electrophoresis ; Emergencies ; Female ; Gastrectomy ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Immunoelectrophoresis ; Kidney Failure, Chronic* ; Ligation ; Stomach ; Stomach Ulcer

The receptor for advanced glycation end products (RAGE) has been reported to have a pivotal role in the pathogenesis of Alzheimer's disease (AD). This study investigated RAGE levels in the hippocampus and cortex of a triple transgenic mouse model of AD (3xTg-AD) using western blotting and immunohistochemical double-labeling to assess cellular localization. Analysis of western blots showed that there were no differences in the hippocampal and cortical RAGE levels in 10-month-old adult 3xTg-AD mice, but significant increases in RAGE expression were found in the 22- to 24-month-old aged 3xTg-AD mice compared with those of age-matched controls. RAGE-positive immunoreactivity was observed primarily in neurons of aged 3xTg-AD mice with very little labeling in non-neuronal cells, with the notable exception of RAGE presence in astrocytes in the hippocampal area CA1. In addition, RAGE signals were co-localized with the intracellular amyloid precursor protein (APP)/amyloid beta (Abeta) but not with the extracellular APP/Abeta. In aged 3xTg-AD mice, expression of human tau was observed in the hippocampal area CA1 and co-localized with RAGE signals. The increased presence of RAGE in the 3xTg-AD animal model showing critical aspects of AD neuropathology indicates that RAGE may contribute to cellular dysfunction in the AD brain.
Advanced Glycosylation End Product-Specific Receptor ; Alzheimer Disease/genetics/*metabolism ; Amyloid beta-Peptides/metabolism ; Animals ; Astrocytes/*metabolism ; CA1 Region, Hippocampal/growth & development/metabolism/pathology ; Humans ; Mice ; Mice, Transgenic ; Neurons/*metabolism ; Receptors, Immunologic/genetics/*metabolism ; tau Proteins/genetics/metabolism