PURPOSE: To report a patient who developed an unusual combination of central retinal artery occlusion with ophthalmoplegia following spinal surgery in the prone position. METHODS: A 60-year-old man underwent a cervical spinal surgery in the prone position. Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia. Upon examination, we determined that he had a central retinal artery occlusion with total ophthalmoplegia. RESULTS: Despite medical treatment, optic atrophy was still present at the following examination. Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up. CONCLUSIONS: A prolonged prone position during spinal surgery can cause external compression of the eye, causing serious and irreversible injury to the orbital structures. Therefore, if the patient shows postoperative signs of orbital swelling after spinal surgery the condition should be immediately evaluated and treated.
Visual Acuity ; Severity of Illness Index ; Retinal Artery Occlusion/*complications/diagnosis ; Postoperative Complications ; Ophthalmoplegia/*complications/diagnosis ; Neck Injuries/diagnosis/*surgery ; Middle Aged ; Male ; Magnetic Resonance Imaging ; Laminectomy/*adverse effects ; Humans ; Fundus Oculi ; Follow-Up Studies ; Fluorescein Angiography ; Diagnosis, Differential ; Cervical Vertebrae/injuries/*surgery ; Blindness/*etiology

The aim of this paper is to report a salvage treatment for malpositioned stent graft due to mislabeled product during thoracic endovascular aortic repair (TEVAR) in descending thoracic aneurysm (DTA). A 78-year-old male presented with 6.7×4.1 cm sized saccular DTA and 7.1×7.3 cm sized abdominal aortic aneurysm (AAA). DTA was initially treated by TEVAR and 2 months later AAA was treated by open aortic repair. Unfortunately, although the stent graft was correctly labeled for DTA, the actual size of product wrapped in a box was different contrary to our expectations. On completion angiography, proximal sealing zone showed no endoleak, however, celiac trunk and superior mesenteric artery (SMA) was found to be accidentally occluded. Through an emergent thoracotomy, distal part of stent graft was removed by cutting distal segment of stent graft and pulling out maneuver to restore blood flow. The completion angiography presented no endoleak, and celiac trunk and SMA were secured. Cutting distal segment of stent graft and pulling out maneuver is one of feasible rescue technique to maintain blood flow of occluded celiac trunk during TEVAR.
Aged ; Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal ; Blood Vessel Prosthesis ; Endoleak ; Humans ; Male ; Mesenteric Artery, Superior ; Salvage Therapy ; Stents ; Thoracotomy

Primary diffuse large B-cell lymphoma of the seminal vesicle is an extremely rare disorder, with only two cases reported in the English literature. Here, we present imaging findings of a case of primary diffuse large B-cell lymphoma of the seminal vesicle. On transrectal ultrasonography, the mass presented as a 3.0-cm-sized heterogeneous, hypoechoic lesion in the right seminal vesicle. Computed tomography (CT) revealed a mass with rim-like enhancement in the right seminal vesicle. On magnetic resonance imaging (MRI), the tumor showed iso-signal intensity on T1-weighted images and heterogeneously intermediate-high signal intensity on T2-weighted images. The tumor showed rim-like and progressive enhancement with non-enhancing portion on dynamic scanning. Diffusion restriction was observed in the mass. On fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) imaging, a high standardized uptake value (maxSUV, 23.5) by the tumor was noted exclusively in the right seminal vesicle.
B-Lymphocytes* ; Diffusion ; Electrons ; Lymphoma ; Lymphoma, B-Cell* ; Magnetic Resonance Imaging ; Multidetector Computed Tomography ; Positron-Emission Tomography ; Seminal Vesicles* ; Ultrasonography

BACKGROUND: The goal of this study is to evaluate the differences of the rate and the ratio of heart rate changes, which is well known to reflect the vagal reactivation, after peak exercise between ischemic heart disease and normal during treadmill exercise test. Additionally R-wave amplitude changes are evaluated to have the discriminal power between ischemic heart disease and normal. METHODS: We have studied 253 human (196 control, 57 patients) who took the symptom-limited exercise test using Marquette case 8000 model. The 57 patients who showed the positive result by exercise test have confirmed by coronary angiography. The rate of heart rate changes was defined as the absolute difference of the heart rate subtracted by the just-previous stage heart rate. The ratio of heart rate changes was defined as the percentile of the rate of heart rate changes comparing to the just-previous stage heart rate. The changes of R-wave amplitude at lead V5 and aVF were obtained by the subtraction of R-wave amplitude at the peak exercise stage from that at the standing rest stage respectively. Additively heart rate recovery was defined as the rate of heart rate change which was obtained at 1 minute later after peak exercise. RESULTS: In patients and control, the resting heart rate were 70 +/- 13 bpm and 69 +/- 11 bpm (p>0.05), and the peak heart rate were 136 +/- 22 bpm and 155 +/- 18 bpm respectively (p<0.001). The rate of heart rate changes in patients group were significantly lower than that in control at 1 minute, 3 minute, and 5 minute respectively (p<0.001, p=0.008, p=0.002). The ratio of heart rate changes in patients group were also significantly lower than that in control at 1 minute, 3 minute, and 5 minute respectively (p=0.017, p=0.027, p=0.002). With comparing both groups, the incidences of ventricular ectopy were not different during exercise and recovery stages, and the difference in the changes of R-wave amplitude at lead V5 and aVF were not observed respectively. CONCLUSION: The rate and ratio of heart rate changes are significantly lower in iscemic heart disease than in normal, and these are resulted from the depression of vagal reactivation. These findings are supplemental to make a diagnosis and a arrhythmic risk stratification of ischemic heart disease.
Coronary Angiography ; Depression ; Diagnosis ; Exercise Test ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Incidence ; Myocardial Ischemia*

Villous adenomas of the stomach are rare, although they more frequently occur in the colon and rectum. Clinical symptoms are similar to gastric polyps, but acute or chronic bleeding with anemia occurs frequently. The size of tumors varies between 4 and 6 cm, and the malignant potential is greater when the tumor is larger. Complete resection with surgery or endoscopic resection is the treatment of choice. Endoscopic findings revealed a dome-like or pedunculated appearance. Microscopically, the tumor was composed of long fronds and papillations covered by columnar epithelia with a reduced number of goblet cells. We report a case of polyps with chronic intermittent and acute bleeding for 6 months, which was alleviated by endoscopic mucosal resection and was confirmed as a villous adenoma.
Adenoma ; Adenoma, Villous ; Anemia ; Colon ; Gastrointestinal Hemorrhage ; Goblet Cells ; Hemorrhage ; Polyps ; Rectum ; Stomach

Pulmonary aspergilloma usually arises in preexisting lung cavities characterized by recurrent hemoptysis. Although surgical resection of the aspergilloma is the best treatment, most patients are poor candidates for surgery because of far-advanced underlying pulmonary disease. On the other hand, pulmonary actinomycosis is a chronic, indolent bacterial infection and follows aspiration of oropharyngeal material. Bronchiectasis and obstructive lung disease are often associated underlying conditions. We report a case of pulmonary aspergilloma in bronchogenic cyst associated with an actinomycosis in 21-year-old woman treated by thoracoscopic surgery with a review of literature.
Actinomycosis* ; Bacterial Infections ; Bronchiectasis ; Bronchogenic Cyst* ; Female ; Hand ; Hemoptysis ; Humans ; Lung ; Lung Diseases ; Lung Diseases, Obstructive ; Thoracoscopy ; Young Adult

BACKGROUND: Measuring urine albumin in diabetic patients is an important screening test to identify those individuals at high risk for cardiovascular disease and the progression of kidney disease. Recently, spot urine albumin-to-creatinine ratio (ACR) has replaced 24 hour-collected urine albumin excretion rate (AER) as a screening test for microalbuminuria given its comparative simplicity. The purpose of the current study was to evaluate the degree of correlation between AER and ACR in the normal, microalbuminuric and macroalbuminuric ranges, and to identify the lower limits of ACR for both genders. METHODS: A total of 310 type 2 diabetics admitted to one center were enrolled in the present study. Following the collection of a spot urine sample, urine was collected for 24 hours and albumin content was measured in both specimens. RESULTS: Mean patient age was 60.2 years. A total of 25.4% had microalbuminuria and 15.8% had macroalbuminuria. The data revealed a strongly positive correlation between AER and ACR across all ranges of albuminuria (R = 0.8). The cut-off value of ACR for 30 mg/day of AER by the regression equation was 24 microgram/mg for men, 42 microgram/mg for women and 31.2 microgram/mg for all patients. The diagnostic performance expressed as the area under the curve (AUC) was 0.938 (95% CI, 0.911-0.965) for ACR. ACR revealed a sensitivity of 84% and specificity of 84%, when a cut-off value of 31.2 microgram/mg was employed. CONCLUSION: ACR was highly correlated with AER, particularly in the range of microalbuminuria. The gender combined cut-off value of ACR in type 2 diabetic patients was determined to be 31.2 microg/mg However, additional studies of large outpatient populations, as opposed to the inpatient population used in the present study, are required to confirm the utility of this value.
Albuminuria ; Cardiovascular Diseases ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Female ; Humans ; Inpatients ; Kidney Diseases ; Male ; Mass Screening ; Outpatients ; Sensitivity and Specificity

OBJECTIVE: The purpose of this study is to investigate the incidence of lymph node metastasis in early endometrial cancer patients and to evaluate preoperative clinicopathological factors predicting lymph node metastasis. METHODS: We identified 142 patients with endometrial cancer between January 2000 and February 2013. All patients demonstrated endometrioid adenocarcinoma with grade 1 or 2 on preoperative endometrial biopsy. Preoperative magnetic resonance imaging showed that tumors were confined to the uterine corpus with superficial myometrial invasion (less than 50%), and there were no lymph nodes enlargements. All patients had complete staging procedures and were surgically staged according to the 2009 FIGO (International Federation of Gynecology and Obstetrics) staging system. Clinical and pathological data were obtained from medical records and statistically analyzed. RESULTS: Of the 142 patients, 127 patients (89.4%) presented with stage 1A, 8 (5.6%) with stage IB, 3 (2.1%) with stage II, and 4 (2.8%) with stage III disease. Three patients (2.1%) had lymph node metastasis-2 IIIC1 and 1 IIIC2 disease. Age, preoperative tumor grade, and myometrial invasion less than 50% on preoperative MRI were not associated with lymph node metastasis. A high preoperative serum CA-125 level (>35 IU/mL) was a statistically significant factor for predicting lymph node metastasis on univariate and multivariate analyses. Lymph node metastasis was only found in patients with preoperative grade 2 tumors or a high serum CA-125 level. CONCLUSION: Preoperative tumor grade and serum CA-125 level can predict lymph node metastasis in apparent early endometrial cancer patients.
Biopsy ; Carcinoma, Endometrioid ; Endometrial Neoplasms* ; Female ; Gynecology ; Humans ; Incidence ; Lymph Nodes* ; Magnetic Resonance Imaging ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis*

OBJECTIVE: To examine using surface electromyography whether stair climbing with abdominal hollowing (AH) is better at facilitating local trunk muscle activity than stair climbing without AH. METHODS: Twenty healthy men with no history of low back pain participated in the study. Surface electrodes were attached to the multifidus (MF), lumbar erector spinae, thoracic erector spinae, transverse abdominus - internal oblique abdominals (TrA-IO), external oblique abdominals (EO), and the rectus abdominis. Amplitudes of electromyographic signals were measured during stair climbing. Study participants performed maximal voluntary contractions (MVC) for each muscle in various positions to normalize the surface electromyography data. RESULTS: AH during stair climbing resulted in significant increases in normalized MVCs in both MFs and TrA-IOs (p<0.05). Local trunk muscle/global trunk muscle ratios were higher during stair climbing with AH as compared with stair climbing without AH. Especially, right TrA-IO/EO and left TrA-IO/EO were significantly increased (p<0.05). CONCLUSION: Stair climbing with AH activates local trunk stabilizing muscles better than stair climbing without AH. The findings suggest that AH during stair climbing contributes to trunk muscle activation and trunk stabilization.
Cross-Sectional Studies* ; Electrodes ; Electromyography ; Humans ; Low Back Pain ; Male ; Muscles* ; Paraspinal Muscles ; Rectus Abdominis

PURPOSE: We describe a 54-year-old woman with systemic lupus erythematosus (SLE) who suddenly presented with chorea and had positive antiphospholipid antibodies. F-18 FDG PET showed abnormally increased glucose metabolism in bilateral putamen and primary motor cotex. Tc-99m ECD SPECT also showed abnormally increased regional cerebral blood flow in bilateral putamen. She was treated with corticosteroid and aspirin after which the symptoms improved. Four months later, follow up F-18 FDG PET showed improvement with resolution of hypermetabolism in bilateral putamen. This case suggests that striatal hypermetabolism is associated with chorea in SLE.
Antibodies, Antiphospholipid ; Aspirin ; Chorea* ; Female ; Follow-Up Studies ; Glucose ; Humans ; Lupus Erythematosus, Systemic* ; Metabolism ; Middle Aged ; Putamen ; Tomography, Emission-Computed, Single-Photon