Congenital diaphragmatic eventration is an abnormal elevation of the diaphragm as a result of developmental failure of muscular fibers during the fetal period. Mediastinal shift to the contralateral side may cause significant compression of the affected chest contents resulting in compromised pulmonary function especially when bilaterally involved. The differentiation between congenital diaphragmatic eventration and diaphragmatic hemia is very difficult but eventration has a better perinatal outcome compared to diaphragmatic hernia. We report a case of congenital diaphragmatic eventration on left side with good perinatal outcome after plication in which the initial prenatal diagnosis of diaphragmatic hernia was made by prenatal ultrasonography.
Diaphragm ; Diaphragmatic Eventration* ; Hernia, Diaphragmatic* ; Prenatal Diagnosis ; Thorax ; Ultrasonography ; Ultrasonography, Prenatal

This rare venous congenital anomaly has been diagnosed preoperatively in a 35-year-old female with complaint of the right flank pain. Herein a case of retrocaval ureter is presented with brief review of literatures.
Adult ; Female ; Flank Pain ; Humans ; Retrocaval Ureter*

The computerized image analysis is a useful tool for the quantitative assessment of histopathologic findings. In contrast to the usual microscopic examination by pathologists, the computerization should be accompanied with the standardization process of the image. We developed an algorithm to standardize images and to determine the optimal gray level threshold, using a myocardial fibrosis model. Sirius red staining was more convenient for the image analysis than Masson's trichrome staining because of a better contrast with the surrounding structures. To get an optimal measurement, light intensity was standardized at each of the fibrosis, myocardium and background. In this study, the most promising method to determine the degree of fibrosis was that of revising the background without tissue to a gray level of 200, obtaining a green component of the color image, revising the myocardial fiber to 163, and defining a partial ratio as fibrosis index when the gray level threshold was 120. These threshold levels and parameters were determined after drawing the binarization index curves according to the change of the gray level threshold and by the morphological examination of the actual binarization figures overlaid to the original color image. Through these processes we could get a consistent result on the myocardial fibrosis and we expect a similar principle applies when we analyze color images in the histopathologic quantitation by computerized image analysis.
Fibrosis* ; Myocardium

No abstract available.
Animals ; Embryonic Structures* ; Female ; Follicular Fluid* ; Humans* ; Mice*

The authors identified a patient with typical seasonal affective disorder, characterized by recurrent depression in the winter with remission in the spring or summer. Many studies reported that bright light therapy was effective in seasonal affective disorder, but the mechanism of bright light therapy and the therapeutic parameters of light therapy including intensity, duration, timing are still debated. We treated the patient with morning light treatment using 2500lux light box, the clinical symptoms in this case were improved. The authors suggest that seasonal affective disorder can be effectively treated with morning light treatment.
Depression ; Humans ; Phototherapy ; Seasonal Affective Disorder ; Seasons*

No abstract available.
Pancreatic Neoplasms* ; Pancreatitis*

Aggregatibacter aphrophilus is a facultatively anaerobic gram-negative coccobacillus or bacillus that grows with no dependence on X factor and variable requirement for V factor. The organism is normal flora in the human oral cavity and upper respiratory tract and, rarely, causes invasive infections such as bacteremia, endocarditis, brain abscess, or osteomyelitis. We report a case of septic peripheral embolism in left leg from A. aphrophilus endocarditis. A 49-year-old man with known hypertension presented with acute muscle pain in the left leg. On physical examination, a regular heartbeat with a pansystolic murmur was heard. There were decreased pulses in the left popliteal and dorsalis pedis arteries and coldness of the left foot, although sensory and motor functions were intact. Angiography revealed an embolus in a branch of the left femoral artery. He underwent emergency embolectomy, and gram-negative bacilli grew in the embolus cultures. The same microorganism was isolated in two pairs of blood culturs and subsequently identified as A. aphrophilus. Transthoracic echocardiography revealed mitral regurgitation and multiple vegetations on the mitral valve. The patient was treated with a third-generation cephalosporin for 4 weeks and mitral valve replacement in view of the diagnosis of infective endocarditis and septic peripheral embolism.
Angiography ; Arteries ; Bacillus ; Bacteremia ; Brain Abscess ; Cold Temperature ; Echocardiography ; Embolectomy ; Embolism ; Embolism and Thrombosis ; Emergencies ; Endocarditis ; Femoral Artery ; Foot ; Humans ; Hypertension ; Leg ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Mouth ; Muscles ; Osteomyelitis ; Physical Examination ; Respiratory System

Duodenal varices bleed less commonly than gastro-esophageal varices in patients with portal hypertension. However, if there is no stigmata of recent esophageal or gastric variceal bleeding, clinicians should suspect the presence of an extra gastro-esophageal site of variceal bleeding. Duodenal variceal bleeding can be difficult to diagnose and treat. Therefore, the bleeding may be life threatening in most cases and has a poor prognosis. We experienced a case of variceal bleeding that developed in a patient with far advanced pancreatic cancer after placement of a self- expanding metal stent into a strictured bile duct via the peroral and transpapillary route. The patient had a duodenal varix near the major papilla and the bleeding was treated with an injection of Histoacryl(R). We thought the bleeding of the periampullary varix resulted from injury due to exposure to the free end of the alloy wires in the distal portion of the inserted biliary metal stent.
Alloys ; Bile Ducts ; Christianity ; Hemorrhage ; Humans ; Hypertension, Portal ; Pancreatic Neoplasms ; Prognosis ; Stents ; Varicose Veins

Purpose: We sought to provide a new classification system for Duane retraction syndrome (DRS) according to type and angle of strabismus during primary gaze and to analyze the clinical features of each DRS type. Methods: The medical records of 65 DRS patients who visited the department of pediatric ophthalmology at Seoul National University Children's Hospital between 2010 and 2017 were retrospectively analyzed. Patients whose angle of exotropia at primary gaze exceeded 3 prism diopters (PDs) were classified as “Exo-Duane,” those whose angle of strabismus at primary gaze did not exceed 3 PDs were classified as “Ortho-Duane,” and those whose angle of esotropia at primary gaze exceeded 3 PDs were classified as “Eso-Duane.” Results: Among 65 DRS patients, Ortho-Duane was the most common (53.8%) type, followed by Eso-Duane (33.8%) and Exo-Duane (12.3%). The mean age at diagnosis was significantly higher in the Exo-Duane group than the Ortho-Duane or Eso-Duane group (p = 0.003 and p < 0.001, respectively). A predominance of left eye involvement was observed in the Ortho-Duane (62.9%) and Eso-Duane (90.9%) groups. The frequencies of upshoot, downshoot, fissure narrowing, and globe retraction were not significantly different among the subgroups. Head-turn was more frequent in Eso-Duane patients than in Exo-Duane or Ortho-Duane patients (p = 0.001 and p < 0.001, respectively). Myopia accounted for the most common refractive error among Exo-Duane patients (71.4%), while hyperopia was found more often in both Ortho-Duane (64.7%) and Eso-Duane (85.0%) patients. The majority of patients showed gross stereoacuity (93.1%), and a large proportion had good stereoacuity (Exo-Duane 60.0%, Ortho-Duane 81.3%, Eso-Duane 87.5%). Conclusions Our newly proposed classification of DRS according to type and angle of strabismus at primary gaze was practically useful and showed potential for use as an objective guideline in the clinical setting.

The torsion of appendix testis is the second most common disease of the acute scrotal diseases in frequency. Despite recent development of diagnostic equipments, its differential diagnosis is often difficult and its treatment is controversial. We reviewed retrospectively 19 cases who were diagnosed to have torsion of appendix testis during recent 6 years. The mean age was 11.3 years. Five cases who had blue dot sign and tender mass on upper pole of testis, and one of 9 who had been examined with scrotal ultrasonography were diagnosed to have torsion of appendix testis, but other clinical finding and laboratory findings were not contributable to its diagnosis. Nine of 14 cases who were diagnosed by surgical exploration were consistent with the preoperative impression. Mean duration of scrotal pain were 1.3 days in surgical treatment group and were 3.6 days in conservative treatment group. The pathognomonic sign of torsion of appendix testis was seen only in a few cases. The diagnostic accuracy of torsion of appendix testis before exploration was low. The scrotal pain was relieved relatively more rapidly in surgical treatment group. So, we think that surgery was more desirable in diagnosis and treatment of torsion of appendix testis.
Appendix* ; Diagnosis ; Diagnosis, Differential ; Diagnostic Equipment ; Retrospective Studies ; Scrotum* ; Testis* ; Ultrasonography