BACKGROUND:Rotational atherectomy has been developed for several years. It is a useful tool in complex coronary lesion morphologies such as diffuse, calcific, ostial and angulated lesion. We report initial experience of the rotational atherectomy in complex coronary artery morphology. METHODS: We included 64 patients who was treated with rotational atherectomy since July 1997 to February 1999. Mean age was 56+/-9 years with 47 male patients. Clinical diagnosis was 12 acute myocardial infarction, 49 unstable angina, and 3 stable angina. Rotational atherectomy was done by transfemoral or transradial approach with adjunctive ballooning and/or stenting in all patients. RESULTS: Ninty-one percent of the treated lesions showed complex lesion morphologies (B2/C lesion) with 43 left anterior descending artery and 19 right coronary artery. Rotational atherectomy was done in 37 de novo lesion (58%) and 27 (42%) restenosis patients. Transradial approach was done in 33 patients (52%). Mean maximal burr size was 1.68 mm and mean burr to reference artery ratio was 0.63. Rotastenting were done in 58% of the patients with higher post-procedure minimal lumen diameter, % diameter stenosis and net gain than rotablator with adjunctive balloon angioplasty. Overall procedural success was 94% (62/64). Complications were one non-Q infarction, one coronary artery perforation, two slow flow, and one guidewire fracture. None of the patients showed inhospital mortality or 30 day cardiac event (death, emergency CABG, Q-infarction, or re-intervention). CONCLUSION: Rotational atherectomy is a useful technique with high success rate without showing major cardiac events during inhospital period and within 30 days.
Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Atherectomy ; Atherectomy, Coronary* ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Emergencies ; Hospital Mortality ; Humans ; Infarction ; Male ; Myocardial Infarction ; Stents

Malaria is a protozoan disease transmitted by the bite of infected mosquitoes. During acute and chronic malarial infection, altered splenic structure and function produce asymptomatic enlargement or com plications such as hematoma formation, rupture, hypersplenism, or cyst formation. Spontaneous splenic rupture occurs during acute infection, usually during the primary attack. However, rupture occurring in chronic malarial splenomegaly is seldom spontaneous; obvious trauma is almost always the precipitating event. Recently, conservative therapy has been applied in all cases of malarial splenic rupture. Surgical therapy should be reserved for patients with severe rupture or for those with continued or recurrent bleeding. We report the case of a recently treated 25-year-old male who had acute malaria complicated by fever and by severe abdominal pain, tenderness, and distension, a condition that may result in splenic rupture. At operation, the spleen was slightly enlarged and multiple tearing was found in the lateral surface of the capsule. A splenectomy was preformed.
Abdominal Pain ; Adult ; Culicidae ; Fever ; Hematoma ; Hemorrhage ; Humans ; Hypersplenism ; Malaria ; Male ; Rupture ; Rupture, Spontaneous* ; Spleen* ; Splenectomy ; Splenic Rupture ; Splenomegaly

Malaria is a protozoan disease transmitted by the bite of infected mosquitoes. During acute and chronic malarial infection, altered splenic structure and function produce asymptomatic enlargement or com plications such as hematoma formation, rupture, hypersplenism, or cyst formation. Spontaneous splenic rupture occurs during acute infection, usually during the primary attack. However, rupture occurring in chronic malarial splenomegaly is seldom spontaneous; obvious trauma is almost always the precipitating event. Recently, conservative therapy has been applied in all cases of malarial splenic rupture. Surgical therapy should be reserved for patients with severe rupture or for those with continued or recurrent bleeding. We report the case of a recently treated 25-year-old male who had acute malaria complicated by fever and by severe abdominal pain, tenderness, and distension, a condition that may result in splenic rupture. At operation, the spleen was slightly enlarged and multiple tearing was found in the lateral surface of the capsule. A splenectomy was preformed.
Abdominal Pain ; Adult ; Culicidae ; Fever ; Hematoma ; Hemorrhage ; Humans ; Hypersplenism ; Malaria ; Male ; Rupture ; Rupture, Spontaneous* ; Spleen* ; Splenectomy ; Splenic Rupture ; Splenomegaly

Although there are many controversies about clear-cut guidelines for blood transfusion, blood transfusions are critically important and essential in many emergency cases involving trauma to abdominal organs. However, occasionally there are certain situations in which blood transfusions cannot be made, despite clear indications for urgent blood transfusion based on clinical and laboratory findings. One is the case in which the patient refuses to receive a blood transfusion for reasons based on religious beliefs. We present a case of successful perioperative management without blood transfusion in a patient, a Jehovah's Witness, with a massive hemoperitoneum due to an injury caused by a motor vehicle accident.
Blood Transfusion* ; Emergencies ; Hemoperitoneum* ; Humans ; Motor Vehicles ; Religion

PURPOSE: Increasing evidence suggests that Randalls plaque contributes to the pathogenesis of urinary stone formation. The purpose of our study is to compare the incidence of the abnormal metabolic stone risk factors between the calcium stone former with papillary calcification and the calcium stone former without papillary calcification on unenhanced spiral computed tomography (CT). MATERIALS AND METHODS: A series of patients with calcium stones (n=49) underwent unenhanced spiral CT and complete metabolic evaluation after they consumed a random diet for 1 month after stone removal. Of the 49 patients, 38 patients showed papillary calcification on unenhanced spiral CT and 11 patients did not. Their blood was evaluated by using a multichannel analysis sequential multichannel autoanalyzer (SMA)-20 and PTH tests. The 24-hour urinary constituents were assayed for calcium, oxalate, citrate, total volume, phosphorus and sodium. We compared the incidence of abnormal metabolic risk factors between the two groups. Statistical analysis was performed by chi-square tests. RESULTS: The incidences of hyperuricemia were 27.3% in the patients without papillary calcification and 31.6% in the patients with papillary calcification. The incidences of hypernatriuria were 18.2% versus 42.1%, the incidences of hypercalciuria were 36.4% versus 26.3%, the incidences of hyperuricosuria were 18.2% versus 18.4%, the incidences of hyperoxaluria were zero versus 28.9%, and the incidences of hypocitraturia were 45.5% versus 44.7%, respectively. The difference between the two groups was statistically significant only for hyperoxaluria (p=0.043). CONCLUSIONS: Hyperoxaluria is the only metabolic risk factor that more frequently occurred in the patients with papillary calcification. Our date suggest that hyperoxaluria may be an important factor in the pathogenesis of papillary calcification.
Calcium ; Citric Acid ; Diet ; Humans ; Hypercalciuria ; Hyperoxaluria ; Hyperuricemia ; Incidence ; Phosphorus ; Risk Factors* ; Sodium ; Tomography, Spiral Computed* ; Urinary Calculi

PURPOSE: To report a case of long anterior lens zonule and pigment dispersion syndrome. CASE SUMMARY: A 67-year-old female visited our clinic with complaint of visual disturbance in the left eye. She had no history of nyctalopia. Visual acuity was 0.6 in the right eye and 0.4 in the left eye. Intraocular pressure was 12 mm Hg in the right eye and 16 mm Hg in the left eye. Nuclear sclerosis was observed in the left lens. There was no pseudoexfoliative material observed. In the left eye, long anterior zonules with brown pigmented lens striae were spotted irregularly in every direction of the anterior lens. On gonioscopy, the angle was open, and dense, uniform, trabecular meshwork pigmentations were observed at the interior 120 degrees. On fundus examination, cup-to-disc ratio was 0.4 in the right eye, 0.3 in the left eye, and multiple hard exudates were observed in both retinas. Axial length was 22.03 mm in the right eye and 21.84 in the left eye. Anterior chamber depth was 2.71 mm in the right eye and 2.47 mm in the left eye. Defects in the retinal nerve fiber or visual field examination were not observed and pigment dispersion syndrome was diagnosed. The patient showed no significant change at the 9-month follow-up. CONCLUSIONS: We diagnosed atypical pigment dispersion syndrome associated with long anterior zonules and pigmented lens striae. Late onset retinal degeneration should be ruled out with chromosomal analysis if patients show nyctalopia, retinal pigment epithelium atrophy, or family history.
Aged ; Anterior Chamber ; Atrophy ; Exudates and Transudates ; Female ; Follow-Up Studies ; Gonioscopy ; Humans ; Intraocular Pressure ; Nerve Fibers ; Night Blindness ; Pigmentation ; Retina ; Retinal Degeneration ; Retinal Pigment Epithelium ; Retinaldehyde ; Sclerosis ; Trabecular Meshwork ; Visual Acuity ; Visual Fields

BACKGROUND: Several studies have reported that muscle strength and bone mineral density have a significant positive correlation and most previous literature on muscle strength and bone mineral density examined their association. To evaluate the association between grip strength and radius bone mineral density, more precise PQCT was used rather than SPA or DEXA. METHODS: The study was performed from June to August 1999 in Pundang community with 154 postmenopausal women who undertaken osteoporosis screening program who participated in this study. Bone mineral density was measured at the radius using PQCT (peripheral quantitive computed tomograpy). Grip and pinch strength were measured in both the dominant and nondominant hands using a dyanometer. Other data were obtained from the questionnaire. RESULTS: Grip and pinch strength of the dominant hands were significantly higher than the nondominant hands. There was no significant difference in bone mineral density by exercise and fracture history. Age-adjusted partial correlation analysis indicated a significant positive correlation of radius BMD with dominant hands grip strength. Significant positive correlations also were found between radius BMD and pinch strength. CONCLUSION: Subjects with stronger grip strength had a low BMD. There was a significant positive correlationship between bone mineral density and dominant hand grip strength. especially with the more positive association of cortical BMD with forearm circumference. The data suggest that grip strength is a weak predictor of radius bone mineral density and provide a feasible way of predicting it.
Bone Density* ; Female ; Forearm ; Hand ; Hand Strength* ; Humans ; Mass Screening ; Muscle Strength ; Osteoporosis ; Pinch Strength ; Radius* ; Surveys and Questionnaires

PURPOSE: To evaluate the biometric conditions causing increased disparity in the calculation of intraocular lens (IOL) power between the Hoffer Q and SRK/T formulas. METHODS: A prospective comparative study was conducted on 365 uneventful, cataract surgeries performed at a tertiary care center by one surgeon. The IOL power was calculated using both the Hoffer Q and SRK/T formulas with A-scan biometry. For a selected IOL power, the expected disparity between the 2 formulas (EDF) was measured and the EDF value was used to categorize the cases. The resultant error associated with each formula was determined at postoperative 6 weeks. KAL was defined as the product of mean corneal power (K) and axial length (AL). Postoperative errors of both formulas were calculated and their association with preoperative biometry measurements analyzed. RESULTS: In 17.8% of the cases, the EDF was larger than 0.4 D, possibly leading to different IOL diopter recommendations. The EDF value and the product of corneal curvature and axial length were significantly correlated (R2 = 0.855, p < 0.001). Multiple regression analysis of causative preoperative biometric factors on the postoperative formula errors showed that astigmatism, anterior chamber depth (ACD), and lens thickness (LT) were significantly associated with Hoffer Q error and SRK/T error. CONCLUSIONS: Overall, both formulas performed very well when recommending the correct IOL power. The cause of disparity between the predicted refraction for the 2 formulas was more associated with KAL than K or AL alone. Astigmatism, ACD, and LT were the causative factors for the postoperative errors in both formulas.
Anterior Chamber ; Astigmatism ; Biometry ; Cataract ; Lenses, Intraocular ; Prospective Studies ; Tertiary Care Centers

Colorectal cancer is the third most common malignant neoplasm worldwide and the fourth most common cancer in Korea. Recently, incidence of colorectal cancer is increasing steadily. Because of advances in diagnostic tools, such as colonofiberoscopy, early detection of colorectal cancers is available. The survival rates of colorectal cancer is increasing due to early detection and advances in adjuvant therapy, such as chemotherapy and radiotherapy. The clinical analysis was made on 475 patients with colorectal cancer who have been admitted and operated at the Department of Surgery, Chonnam University Hospital, from January, 1987 to December, 1996. The results were as follows: 1) The peak age group was in the sixth(29.7%) and seventh decade(29.7%) followed by the fifth decade(17.3%) of life. The male: female ratio was 1.1:1. 2) The annual incidence was increased steadily, but since 1994, plateau in incidence has occurred. 3) The most common site was the rectum(62.7%). 4) Common symptoms and signs were anal bleeding(40.1%) and abdominal pain (28.1%). According to site, anal bleeding was the most common complaint in the rectum and left sided colon and abdominal pain was in other colons and cecum. 5) The most common stage by TNM staging system was stage II (38.7%). 6) Most cases of colorectal cancer were adenocarcinoma(97.7%), well differentiated lobular adenocarcinoma(55.6%) in which was the most common histopathologic type. 7) Preoperative circulating CEA(carcinoembryonic antigen) level was checked in 396 patients(83.4%). CEA was less than 10.0 ng/ml in 295 cases(74.5%) and more than 10.0 ng/ml in 101 cases(25.6%). 8) DNA ploidy was checked in 197 cases(41.5%). There ware aneuploid in 102 cases, diploid in 95 cases. 9) Curative surgery were performed in most cases. The most common surgical procedure was low anterior resection(35.4%). 10) Postoperative complications were developed in 63 patients(13.3%). The most common complication was wound infection in 12 cases(19.0%). 11) The overall 5-year survival rate for patients with colorectal cancer was 55.9%. The difference of 5-year survival rate between diploidy and aneuploidy of DNA content was not significant statically(p=0.97). But, patients of preoperative serum CEA level over 10 ng/ml had a low survival rate compared with those under 10 ng/ml(p=0.0002). And also those of tumor size over 3 cm had a low survival rate compared with those under 3 cm(p=0.002).
Abdominal Pain ; Aneuploidy ; Cecum ; Colon ; Colorectal Neoplasms* ; Diploidy ; DNA ; Drug Therapy ; Female ; Hemorrhage ; Humans ; Incidence ; Jeollanam-do ; Korea ; Male ; Neoplasm Staging ; Ploidies ; Postoperative Complications ; Radiotherapy ; Rectum ; Survival Rate ; Wound Infection

Undifferentiated(embryonal) sarcoma of the liver developing predominantly in the late childhood is extremely rare in malignant hepatic tumors. It has been described by a variety of terms such as malignant mesenchymoma, embryonal sarcoma, fibromyxosarcoma, embryonal rhabdomyosarcoma or primary sarcoma of the liver. The tumor usually presents a huge mass containing solid and sometimes cystic components, and is cmposed of large stellate and spindle cells in an abundant myxoid matrix. The treatment of choice is surgical resection with or without adjuvant chemotherapy and/or radiotherapy, but the prognosis of this disease has been reported extremly poor. We experienced a case of undifferentiated(embryonal) sarcoma of the liver recently which was confirmed by pathological examinations in a 18-year-old boy. He visited our hospital for examination of the progressive growing RUQ abdominal mass detected incidentally. On physical examination, a firm, non-tender, hard, fixed, huge, abdominal mass was palpated in the right upper quadrant of abdomen. Abdominal ultrasonography, computerized tomography and magnetic resonance imaging showed a 10x15cm sized mass confined to the left lobe of the liver, and it was hypovascular mass on angiography. We performed left lobectomy including the tumor and it was confirmed as undifferentiated (embryonal) sarcoma of the liver by pathologic examination. We herein report this case including histologic, electronmicroscopic and flow cytometric results with the review of literatures.
Abdomen ; Adolescent ; Angiography ; Chemotherapy, Adjuvant ; Humans ; Liver* ; Magnetic Resonance Imaging ; Male ; Mesenchymoma ; Physical Examination ; Prognosis ; Radiotherapy ; Rhabdomyosarcoma, Embryonal ; Sarcoma* ; Ultrasonography