PURPOSE: The purpose of this study was to assess the usefulness of MRI in the evaluation of vascular changes of the meningioma. MATERIALS AND METHODS: We retrospectively studied the MRI findings in 20 cases of intracranial meningiomas. The images were assessed for vascular hilum, vascular rim, sinus invasion, and vascular encasement. Cerebral angiograms were obtained in 15 cases and compared with MRI findings. RESULTS: MRI was as accurate as angiography in detection of vascular hilum(MRl=8/20, Anglogram=9/15), vascular rim(MRl=14/20, Angiogram=9/15) and dural sinus invasion(MRl=4/6, Angiogram=5/6). MRI was superior to angiography in detection of vascular encasement(MRl=2/3, Angiogram=0/2) and cavernous sinus invasion(MRI=3/3, Angiogram=0/2). CONCLUSION: MRI is an excellent noninvasive imaging modality in evaluating vascular changes of omas.
Angiography ; Cavernous Sinus ; Magnetic Resonance Imaging* ; Meningioma ; Retrospective Studies

PURPOSE: We reviewed surgical results in a group of women after Raz bladder neck suspension using questionnaire based outcomes analysis. MATERIALS AND METHOD: Of 71 patients who underwent Raz bladder neck suspension 55 had completed the questionnaire. Interviewees mean age was 54 years(range: 41-72 years) and mean observation time was 26.2 months(range: 3-77 months). RESULTS: According to outcomes analysis 39 patients(70.9%) were cured, 4(7.2%) improved, 11(20%) same and 1(1.8%) became worse. Overall improvement was found to be 43 patients(78.2%). 40(72.7%) patients replied 'satisfactory' for the Raz bladder neck suspension. Overall 'success rate' was estimated as 74.5%. No significant statistical correlation was found between success rate of Raz bladder neck suspension and various factors such as patients age, urge incontinence or follow up length. Of the 55 patients 7(12.7%) reported daily pad use. CONCLUSIONS: With these questionnaire based outcome analysis there was an overall success rate of 74.5%. We strongly emphasize the need for standardized questionnaire based outcome analyses for the evaluation of incontience surgery.
Female ; Follow-Up Studies ; Humans ; Neck* ; Surveys and Questionnaires* ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Urge

Jejunal variceal bleeding is less common compared with esophagogastric varices in patients with portal hypertension. However, jejunal variceal bleeding can be fatal without treatment. Treatments include surgery, transjugular intrahepatic porto-systemic shunt (TIPS), endoscopic sclerotherapy, percutaneous coil embolization, and balloon-occluded retrograde transvenous obliteration (BRTO). Percutaneous coil embolization can be considered as an alternative treatment option for those where endoscopic sclerotherapy, surgery, TIPS or BRTO are not possible. Complications of percutaneous coil embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after percutaneous coil embolization for jejunal variceal bleeding. The migrated coil was successfully removed using surgery.
Embolization, Therapeutic ; Esophageal and Gastric Varices* ; Humans ; Hypertension, Portal ; Sclerotherapy ; Varicose Veins

Food-dependent exercise-induced anaphylaxis has been recognized a variant of exercise-induced anaphylaxis charaterised by symptoms occuring on exertion after certain meal. We experienced a patient who developed an anaphylaxis induced by wheat flour made food followed by exercise only in cold temperature. A 22-year-old male patient was presented urticaria, angioedema, dyspnea, and loss of consciousness induced by exercise after ingestion of wheat flour made food only in winter. Skin prick test was negative for wheat or bread but positive for mushroom. By contrast, RAST was positive for wheat and negative for mushroom. In order to confirm the diagnosis exercise challenge test was done. The attack developed after ingestion of wheat flour made food and 10 min of outdoor jogging in temperature about 10 degrees C, but not by indoor treadmill test in temperature about 20 degrees C or ingestion of mushroom. This is the first case of food-dependent exercise-induced anaphylaxis developed only in cold temperature in Korea.
Agaricales ; Anaphylaxis* ; Angioedema ; Bread ; Cold Temperature ; Diagnosis ; Dyspnea ; Eating ; Exercise Test ; Flour ; Humans ; Jogging ; Korea ; Male ; Meals ; Skin ; Triticum ; Unconsciousness ; Urticaria ; Young Adult

PURPOSE: To evaluate the technical feasibility and clinical outcome of bilateral uterine artery embolization (UAE) as a first-line therapeutic option for bleeding uterine arteriovenous malformation (AVM). MATERIALS AND METHODS: Between 2002 and 2012, 19 patients were diagnosed with acquired uterine AVM clinically and through imaging studies. The clinical characteristics, angiographic features, technical success rate of embolization, procedure-related complications, imaging, and clinical follow-up data were assessed. Clinical success was defined as immediate symptomatic resolution with disappearance of vascular abnormality on subsequent imaging studies. RESULTS: A total of 20 bilateral UAE, with or without embolization of extra-uterine feeders, were performed as the first-line treatment. Technical and clinical success rate was 90.0% (18/20) and 89.5% (17/19), respectively. Embolization was incomplete in two patients who had residual extra-uterine fine feeders to the AVM or a procedure-related complication (ruptured uterine artery); the former showed slow regression of the vascular malformation during the observation period, while the latter underwent a successful second bilateral UAE. Immediate clinical success was achieved in the remaining 17 patients after a single session and no recurrence of bleeding was found. Recovery to normal menstrual cycle was seen in all 17 patients with clinical success within one or two months, two of whom subsequently had uneventful intrauterine pregnancies carried to term. CONCLUSION: Bilateral UAE is a safe and effective first-line therapeutic option for the management of bleeding uterine AVMs. However, incomplete embolization due to unembolizable feeders or difficult access into the uterine artery may lead to suboptimal treatment.
Arteriovenous Malformations* ; Female ; Follow-Up Studies ; Hemorrhage* ; Humans ; Menstrual Cycle ; Methods ; Pregnancy ; Recurrence ; Uterine Artery Embolization* ; Uterine Artery* ; Vascular Malformations

Objective: Percutaneous portal vein (PV) stent placement can be an effective treatment for symptoms associated with portal hypertension. This study aimed to evaluate the effect of PV stenting on the overall survival (OS) in patients with malignant PV stenosis. Materials and Methods: Two groups of patients with malignant PV stenosis were compared in this retrospective study involving two institutions. A total of 197 patients who underwent PV stenting between November 2016 and August 2019 were established as the stent group, whereas 29 patients with PV stenosis who were treated conservatively between July 2013 and October 2016 constituted the no-stent group. OS was compared between the two groups before and after propensity score matching (PSM). Risk factors associated with OS were evaluated using the Cox proportional hazards model. Procedureassociated adverse events were also evaluated. Results: The stent group finally included 100 patients (median age, 65 [interquartile range, 58–71] years; 64 male). The nostent group included 22 patients (69 [61–75] years, 13 male). Stent placement was successful in 95% of attempted cases, and the 1- and 2-year stent occlusion–free survival rate was 56% (95% confidence interval, 45%–69%) and 44% (32%–60%), respectively. The median stent occlusion–free survival time was 176 (interquartile range, 70–440) days. OS was significantly longer in the stent group than in the no-stent group (median 294 vs. 87 days, p < 0.001 before PSM, p = 0.011 after PSM).The 1- and 3-year OS rates before PSM were 40% and 11%, respectively, in the stent group. The 1-year OS rate after PSM was 32% and 5% in the stent and no-stent groups, respectively. Anemia requiring transfusion (n = 2) and acute thrombosis necessitating re-stenting (n = 1) occurred in three patients in the stent group within 1 week. Conclusion Percutaneous placement of a PV stent may be effective in improving OS in patients with malignant PV stenosis.

BACKGROUND/AIMS: Cowden's disease is an autosomal dominant hereditary disease characterized by the various hamartomatous and neoplastic lesions of multiple organs. We analyzed gastrointestinal manifestations of 5 cases of Cowden's disease and suggest several findings which are helpful to gastroenterologists for the early diagnosis. METHODS: The clinical characteristics of 5 unrelated patients with Cowden's disease were evaluated. Four patients were male, one patient was female, and their ages at the time diagnosis ranged from 17 to 49 years. All patients had the pathognomonic mucocutaneous lesions and thyroid nodules. RESULTS: In all patients, the esophagus was affected by acanthosis. In 4 patients, the stomach was affected by numerous variable sized polyps. In 4 patients, the duodenum was involved by several polyps. In 4 patients, the entire small bowel and in one patients, only the terminal ileum was affected by numerous polyps. In all patients, the colon, especially the sigmoid colon and rectum, showed numerous variable sized polyps. Family history was positive for stomach cancer in two patients. CONCLUSIONS: Cowden's disease should be considered in patients with esophageal acanthosis among patients with colonic polyposis, although the mucocutaneous lesions, unfamiliar to gastroenterolgists, are pathognomonic criteria for the diagnosis.
Colon ; Colon, Sigmoid ; Diagnosis* ; Duodenum ; Early Diagnosis ; Esophagus ; Female ; Genetic Diseases, Inborn ; Hamartoma Syndrome, Multiple* ; Humans ; Ileum ; Male ; Polyps ; Rectum ; Stomach ; Stomach Neoplasms ; Thyroid Nodule

BACKGROUND AND AIMS: PFD is effectively treated by biofeedback therapy. For the definite diagnosis of PFD, defecography, colon transit time study, balloon expulsion testing, and anorectal manometry are needed. However, these methods are of high cost and cause discomfort to patients. Moreover, definite diagnosis cannot be made by a single test due to a high false positive rate. In general, several symptoms linked with problems in defecating, including excessive straining, the sensation of incomplete evacuation, and applying pressure around the anus or the vagina to facilitate defecation, are known to be frequently associated with PFD. The aim of this study was to evaluate whether specific clinical parameters could differentiate patients with PFD from other constipated patients. METHODS: An organized questionnaire including 47 questions that contained subjective symptoms, past medical history, and eating habits was designed. The questionnaire was distributed to 132 patients who fulfilled Rome II criteria for functional constipation. Digital rectal examination was conducted by a single gastroenterologist. RESULTS: Among 132 patients, 45 patients were categorized as PFD, 26 patients as slow transit constipation (STC) and 17 patients as normal transit constipation. Among specific questions about constipation, hard stool was more frequently noted in patients with STC than PFD (p<0.05), and the frequency of defecation was lower in patients with STC than PFD (p<0.05). However, the symptoms suggesting difficult defecation were not different between the two groups. The percentage of paradoxical contraction by digital rectal examination was not different between the two groups (PFD: 57.1% vs. STC: 48.0%). CONCLUSION: The symptoms and signs suggesting difficult defecation could not differentiate PFD from STC and normal transit constipation, although several parameters were different among the three subgroups. Therefore, anorectal physiologic tests are needed for the diagnosis of PFD.
Anal Canal ; Ataxia* ; Biofeedback, Psychology ; Colon ; Constipation ; Defecation ; Defecography ; Diagnosis ; Digital Rectal Examination ; Eating ; Humans ; Manometry ; Pelvic Floor* ; Sensation ; Time and Motion Studies ; Vagina ; Surveys and Questionnaires

BACKGROUND AND AIMS: PFD is effectively treated by biofeedback therapy. For the definite diagnosis of PFD, defecography, colon transit time study, balloon expulsion testing, and anorectal manometry are needed. However, these methods are of high cost and cause discomfort to patients. Moreover, definite diagnosis cannot be made by a single test due to a high false positive rate. In general, several symptoms linked with problems in defecating, including excessive straining, the sensation of incomplete evacuation, and applying pressure around the anus or the vagina to facilitate defecation, are known to be frequently associated with PFD. The aim of this study was to evaluate whether specific clinical parameters could differentiate patients with PFD from other constipated patients. METHODS: An organized questionnaire including 47 questions that contained subjective symptoms, past medical history, and eating habits was designed. The questionnaire was distributed to 132 patients who fulfilled Rome II criteria for functional constipation. Digital rectal examination was conducted by a single gastroenterologist. RESULTS: Among 132 patients, 45 patients were categorized as PFD, 26 patients as slow transit constipation (STC) and 17 patients as normal transit constipation. Among specific questions about constipation, hard stool was more frequently noted in patients with STC than PFD (p<0.05), and the frequency of defecation was lower in patients with STC than PFD (p<0.05). However, the symptoms suggesting difficult defecation were not different between the two groups. The percentage of paradoxical contraction by digital rectal examination was not different between the two groups (PFD: 57.1% vs. STC: 48.0%). CONCLUSION: The symptoms and signs suggesting difficult defecation could not differentiate PFD from STC and normal transit constipation, although several parameters were different among the three subgroups. Therefore, anorectal physiologic tests are needed for the diagnosis of PFD.
Anal Canal ; Ataxia* ; Biofeedback, Psychology ; Colon ; Constipation ; Defecation ; Defecography ; Diagnosis ; Digital Rectal Examination ; Eating ; Humans ; Manometry ; Pelvic Floor* ; Sensation ; Time and Motion Studies ; Vagina ; Surveys and Questionnaires

BACKGROUND/AIMS: Intestinal tuberculosis can be difficult to diagnose because it may mimic many other intestinal diseases. The aim of this study was to evaluate the diagnostic yield of colonoscopic biopsy and frequency of concomittent extra-intestinal tuberculosis in intestinal tuberculosis. METHODS: The medical records of 225 consecutive patients with intestinal tuberculosis (81 men, 144 women; mean age 40.6 yrs) were analyzed retrospectively. RESULTS: Histological examination of colonoscopic biopsy specimens revealed granulomas in 163 (72.4%) of the 225 patients. However, caseous necrosis was found in only 25 (11.1%) patients, and acid-fast bacilli (AFB) were noted in 39 (17.3%) of the 225 patients. Mycobacterium tuberculosis was isolated from the culture of biopsy specimens in 52 (29.3%) of 177 patients. Eighty-four patients (37.3%) had concomitant extra-intestinal tuberculosis and 67 (29.8%) showed active pulmonary tuberculosis. Histological examination of the biopsy specimens enabled the diagnosis of intestinal tuberculosis by the presence of either caseating granulomas or AFB in 52 (23.1%) patients. Combination of histological examination and Mycobacterium culture established the diagnosis in 87 (38.7%) patients. Before getting the result of Mycobacterium culture, the diagnosis could be made, by either histological examination or the presence of extra-intestinal tuberculosis in 107 (47.6%) patients. Combination of caseating granulomas, AFB staining, Mycobacterium culture, and the presence of extra-intestinal tuberculosis resulted in the diagnosis in 126 (56.0%) patients. CONCLUSIONS: To increase the diagnostic yield, AFB staining and Mycobacterium culture should be routinely performed on biopsy specimens in addition to routine histological examination for caseating granulomas.
Adolescent ; Adult ; Aged ; *Biopsy, Needle ; *Colonoscopy ; English Abstract ; Female ; Humans ; Intestinal Diseases/*diagnosis ; Male ; Middle Aged ; Mycobacterium tuberculosis/isolation & purification ; Tuberculosis, Gastrointestinal/complications/*diagnosis ; Tuberculosis, Pulmonary/complications