Cases of acute myocardial infarction (AMI) that occur during pregnancy or postpartum are rarely reported. Ergot derivatives are known to induce the spasmodic contraction of coronary arteries. Administration of ergot derivatives can cause AMI, even in normal healthy people. In several reported cases, ergot derivatives triggered severe AMI during the postpartum period. Here, we report the case of a forty-year-old woman who was successfully impregnated by artificial fertilization and died after treatment with ergot derivatives. The autopsy revealed AMI with severe coronary atherosclerosis. This is the first case that reports aggravation of pre-existent severe coronary atherosclerosis after postpartum infusion of ergot derivtives.
Pregnancy ; *Postpartum Period ; Myocardial Infarction/*chemically induced/diagnosis/pathology ; Maternal Age ; Humans ; Female ; Ergot Alkaloids/*adverse effects ; Coronary Arteriosclerosis/chemically induced/diagnosis/pathology ; Adult

Post-traumatic pisotriquetral osteoarthritis is an unusual condition and its diagnosis is not easy to make. This disease must be distinguished from other conditions that cause ulnar side wrist pain. We experienced a case of post-traumatic pisotriquetral osteoarthritis treated by pisiformectomy.
Diagnosis ; Osteoarthritis* ; Wrist

No abstract available.
Bone Marrow* ; Chimerism* ; Hematologic Neoplasms* ; Recurrence*

OBJECTIVE: To identify the risk factors for secondary lymphedema after breast cancer surgery. Lymphedema, a sequelae of breast cancer therapy, changes functional abilities and may affect a patient's psychosocial adjustment and overall quality of life. It is generally underreported and undertreated. METHOD: Six hundred two patients who had undergone breast cancer surgery between January 2000 and December 2005 were examined. The circumferences of the upper extremities were measured and lymphedema was defined as difference of greater than 2cm between the affected and normal arms. The effects of age, body mass index, diabetes, hypertension, side of tumor, sugery method, radiotherapy, chemotherapy, TNM stage, involvement of axillary lymph nodes, menopausal state and laboratory findings on the development lymphedema were investigated and analyzed by t-test, chi-square test and multiple logistic regression analysis. RESULTS: 121 out of 602 patients had lymphedema. Those patients with lymphedema had a higher body mass index. Univariate analysis indicated an increased occurrence of lymphedema due to those with body mass index, radiotherapy, T2 stage, N3 stage and axillary lymph node invasion. Multivariate analysis revealed that body mass index and radiotherapy were independently associated factors for lymphedema after breast cancer surgery. CONCLUSION: The patients who had radiotherapy or BMI greater than 25 must be considered as potential candidates to have lymphedema after breast cancer surgery. Therefore, these patients should be informed during the follow-up period about this morbidity, the preventive measure, and the treatment.
Arm ; Body Mass Index ; Breast ; Breast Neoplasms ; Humans ; Hypertension ; Logistic Models ; Lymph Nodes ; Lymphedema ; Multivariate Analysis ; Quality of Life ; Risk Factors ; Upper Extremity

OBJECTIVE: To determine risk factors of orthostatic hypotension in ischemic stroke patients. METHOD: In 98 ischemic stroke patients, blood pressure and heart rate were measured after resting in the supine position for 10 minutes and again after standing for one minute. Presence of orthostatic hypotension was correlated with age, gender, body mass index, laboratory findings, diabetes mellitus, anti-hypertensive use, side of involved hemisphere, smoking and K-MBI (Korean Modified Barthel Index). RESULTS: 30 out of 98 patients had orthostatic hypotension. Those patients with orthostatic hypotension were older in age and had a higher average blood pressure, heart rate and plasma creatinine. On the other hand, body mass index, K-MBI and serum sodium levels were lower in the orthostatic hypotension group. Multivariate analysis revealed that age, body mass index, anti-hypertensive use and smoking were independently associated with orthostatic hypotension. CONCLUSION: Old age, low BMI, anti-hypertensive use, smoking were risk factors of orthostatic hypotension in the ischemic stroke patients. Patients in the higher risk categories should receive regular monitoring of blood pressure in order to detect orthostatic hypotension and prevent its complications.
Blood Pressure ; Body Mass Index ; Creatinine ; Diabetes Mellitus ; Hand ; Heart Rate ; Humans ; Hypotension, Orthostatic* ; Multivariate Analysis ; Plasma ; Risk Factors* ; Smoke ; Smoking ; Sodium ; Stroke* ; Supine Position

BACKGROUND: Slim patients or those with large breasts may be ineligible for breast reconstruction with an abdominal flap, as the volume of the flap may be insufficient. This study aimed to establish that abdominal tissue–based breast reconstruction can be well suited for Korean patients, despite their thin body habitus. METHODS: A total of 252 patients who underwent postmastectomy breast reconstruction with an abdominal flap from October 2006 to May 2013 were retrospectively reviewed. The patients' age and body mass index were analyzed, and a correlation analysis was performed between the weight of the mastectomy specimen and that of the initial abdominal flap. RESULTS: The average weights of the mastectomy specimen and initial abdominal flap were 451.03 g and 644.95 g, respectively. The ratio of the weight of the mastectomy specimen to that of the initial flap was 0.71±0.23. There was a strong positive linear relationship between the weight of the mastectomy specimen and that of the initial flap (Pearson correlation coefficient, 0.728). Thirty nulliparous patients had a final-to-initial flap weight ratio of 0.66±0.11. The 25 patients who underwent a contralateral procedure had a ratio of 0.96±0.30. The adjusted ratio of the final flap weight to the initial flap weight was 0.66±0.12. CONCLUSIONS: Breast weight had a strong positive relationship with abdominal flap weight in Koreans. Abdominal flaps provided sufficient soft tissue for breast reconstruction in most Korean patients, including nulliparous patients. However, when the mastectomy weight is estimated to be >700 g, a contralateral reduction procedure may be considered.
Body Mass Index ; Breast* ; Female ; Free Tissue Flaps ; Humans ; Korea ; Mammaplasty* ; Mastectomy* ; Retrospective Studies ; Weights and Measures

Gastrocolocutaneous fistula is a rare complication of the percutaneous endoscopic gastrostomy (PEG) procedure. Typical symptoms usually occur in the first few months. We recently encountered 2 patients with 8- and 33-month asymptomatic periods. A 74-year-old man presented with watery diarrhea for 1 month. He had undergone PEG 9 months earlier. During workup, an upper endoscopy and abdominal CT scan revealed the migration of the feeding tube into the transverse colon. He was discharged with a nasogastric tube after treatment. A 77-year-old man presented with sudden loosening of his PEG tube with a duration over 3 days. He had undergone PEG procedure three times until that time. During workup, a gastrocolocutaneous fistula was diagnosed. However, when previous studies were reviewed, an abdominal CT scan, which was done 6 months ago before the third PEG, showed the fistula already existed at that time, suggesting that it was created about 33 months earlier when he underwent the second PEG procedure. The patient died of pneumonia aggravation despite conservative treatment. Both a high index of suspicion and the careful inspection of the upper endoscopy are very important for early diagnosis regardless of symptoms.
Aged ; Colon, Transverse ; Diarrhea ; Early Diagnosis ; Endoscopy ; Fistula* ; Gastrostomy* ; Humans ; Pneumonia ; Tomography, X-Ray Computed

Intravesical bacillus Calmette-Guérin (BCG) immunotherapy is a common treatment modality for bladder cancer after transurethral resection of a bladder tumor. This therapy is generally safe, and development of a prostatic abscess with a prostatorectal fistula after intravesical BCG immunotherapy is a very rare complication. This finding was incidentally obtained by the authors, who examined a patient with colonoscopy for evaluation of abdominal pain. The patient was successfully treated with antitubercular drugs. To the authors’ knowledge, this is the first report of a patient with a tuberculous prostatic abscess with prostatorectal fistula after BCG immunotherapy in South Korea.
Abdominal Pain ; Abscess* ; Antitubercular Agents ; Bacillus* ; Colonoscopy ; Fistula* ; Humans ; Immunotherapy* ; Korea ; Mycobacterium bovis ; Prostate ; Tuberculosis ; Urinary Bladder Neoplasms

Adipsic hypernatremia is a rare disorder of hypothalamic osmoreceptor dysfunction for thirst. It is frequently associated with a deficiency in antidiuretic hormone (ADH) release. We report the first case in Korea of adipsic hypernatremia combined with subnormal ADH response to osmotic stimuli without any demonstrable structural lesion. A 69-year-old woman was admitted to the hospital with general weakness. In a hypernatremic hyperosmolar state, she denied thirst and did not drink spontaneously. Her plasma ADH level was markedly subnormal but she had no large volume of dilute urine. Investigation of osmoregulation by infusion of hypertonic saline revealed adipsia and an absolute deficiency in antidiuretic hormone release, despite a serum osmolarity in excess of 321 mOsmol/kg. There was no structural lesion of the hypothalamus and no abnormal finding in hypothalamic-pituitary function. After diagnosis, she was treated successfully with intentional water intake alone.
Aged ; Female ; Humans ; Hypernatremia ; Hypothalamus ; Korea ; Osmolar Concentration ; Plasma ; Thirst ; Water-Electrolyte Balance

PURPOSE: To assess the clinical outcomes of radiotherapy (RT) using two-dimensional (2D) and three-dimensional conformal RT (3D-CRT) for patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma to evaluate the effectiveness of involved field RT with moderate-dose and to evaluate the benefit of 3D-CRT comparing with 2D-RT. MATERIALS AND METHODS: Between July 2003 and March 2015, 33 patients with stage IE and IIE gastric MALT lymphoma received RT were analyzed. Of 33 patients, 17 patients (51.5%) were Helicobacter pylori (HP) negative and 16 patients (48.5%) were HP positive but refractory to HP eradication (HPE). The 2D-RT (n = 14) and 3D-CRT (n = 19) were performed and total dose was 30.6 Gy/17 fractions. Of 11 patients who RT planning data were available, dose-volumetric parameters between 2D-RT and 3D-CRT plans was compared. RESULTS: All patients reached complete remission (CR) eventually and median time to CR was 3 months (range, 1 to 15 months). No local relapse occurred and one patient died with second primary malignancy. Tumor response, survival, and toxicity were not significantly different between 2D-RT and 3D-CRT (p > 0.05, each). In analysis for dose-volumetric parameters, D(max) and CI for PTV were significantly lower in 3D-CRT plans than 2D-RT plans (p < 0.05, each) and D(mean) and V₁₅ for right kidney and D(mean) for left kidney were significantly lower in 3D-CRT than 2D-RT (p < 0.05, each). CONCLUSION: Our data suggested that involved field RT with moderate-dose for gastric MALT lymphoma could be promising and 3D-CRT could be considered to improve the target coverage and reduce radiation dose to the both kidneys.
Helicobacter pylori ; Humans ; Kidney ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Radiotherapy ; Recurrence ; Stomach