Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.
Angioplasty, Balloon ; Aspirin ; Coronary Vessels* ; Dilatation ; Dilatation, Pathologic ; Humans ; Liver Cirrhosis* ; Liver* ; Myocardial Infarction* ; Platelet Aggregation Inhibitors ; Prognosis ; Stents ; Thrombosis*

The emergence of new technologies, especially digital transformation, influences the entire society, including the medical aspects. Therefore, the concept of digital hospital has been emerging. Here we present the Yongin Severance Hospital, which has developed various novel solutions to serve as foundations for the establishment of a digitally innovative hospital. Further strategies have also been provided to implement consistent and long-term planning.

Multiple simultaneous cranial neuropathies occur rarely in diabetes patients. In general, diabetic cranial neuropathy presents in an isolated form and frequently involves oculomotor or facial nerves. We report a 73-year-old man with known type 2 diabetes mellitus who presented with severe dizziness, diplopia and third, fourth and sixth nerve ophthalmoplegia of both eyes. Radiological, laboratory and ophthalmic work-up including magnetic resonance imaging and angiography (MRI and MRA) revealed no specific tumor, aneurysm, or inflammation findings, except for a previous cerebral infarction and atherosclerotic changes in the internal carotid and vertebral arteries. After strict blood glucose control, the multiple cranial nerve palsies spontaneously resolved in 12 weeks. We report the case with a review of the literature.
Abducens Nerve* ; Aged ; Aneurysm ; Angiography ; Blood Glucose ; Cerebral Infarction ; Cranial Nerve Diseases ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diabetic Neuropathies* ; Diplopia ; Dizziness ; Facial Nerve ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Ophthalmoplegia ; Vertebral Artery

BACKGROUND/AIMS: Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat and a commonly encountered clinical condition. We aim to evaluate the prevalence of gastroesophageal reflux disease (GERD) and to determine the parameters for predicting the response to treatment with proton pump inhibitor (PPI) using wireless pH monitoring in patients with globus sense. METHODS: We retrospectively reviewed the medical records of 37 patients with atypical GERD symptoms. A total of 27 patients with dominant globus sense were enrolled. Endoscopic examination and 48-hour wireless esophageal pH monitoring were performed, and the patients underwent a therapeutic trial of full dose PPIs daily over a period of 4 weeks. RESULTS: Both typical and atypical GERD symptoms co-existed in 14 patients (51.9%, 14/27). According to ROME III criteria, 19 patients (70.4%, 19/27) were diagnosed as GERD. Twelve patients (44.4%, 12/27) were PPI responders. A significant difference in the frequency of symptom index (+) or symptom associated probability (+) was observed between the PPI responder group and the non-responder group (p<0.01). CONCLUSIONS: In patients with globus sense, 70.4% were diagnosed with GERD. Symptom index/symptom associated probability in wireless ambulatory pH monitoring was a good objective parameter for PPI responder.
Adult ; Aged ; Case-Control Studies ; Endoscopy, Digestive System ; Esophageal pH Monitoring ; Female ; Gastroesophageal Reflux/*diagnosis/drug therapy/pathology ; Humans ; Male ; Manometry ; Middle Aged ; Proton Pump Inhibitors/therapeutic use ; Retrospective Studies ; Severity of Illness Index ; Wireless Technology

OBJECTIVE: Distal posterior cerebral artery(PCA) aneurysms requiring the problematic surgical approaches are rarely encountered. With the development of endovascular treatment, distal PCA aneurysms tend to be treated by endovascular method rather than surgery. We report our experience of distal PCA aneurysms, which were managed mainly by endovascular treatment. METHODS: During the last 5 years, there were five patients harboring distal PCA aneurysms(0.7% among a total 656 intracranial aneurysms). Four patients presented with subarachnoid hemorrhage, while one presented with ipsilateral facial hypesthesia. Four of them were treated by endovascular(Guglielmi detachable coil: GDC) embolization and one was treated by surgical clipping after failure of GDC embolization. RESULTS: Complete obliteration with parent artery encroachment was confirmed in 2 cases. There was one occipital lobe infarction and it resulted in the homonymous quadrantanopsia. In the other case, cerebral infarction did not develop. Incomplete coil embolization was inevitably performed to avoid parent artery occlusion in another two cases. CONCLUSION: Even with the obliteration of the parent artery, distal PCA aneurysms could be treated by use of GDC effectively. Adequate collateral supply to the distal arterial territory seems to contribute to it. Further study needs to be performed to verify this hypothesis.
Aneurysm ; Arteries ; Cerebral Infarction ; Embolization, Therapeutic ; Hemianopsia ; Humans ; Hypesthesia ; Infarction ; Intracranial Aneurysm* ; Occipital Lobe ; Parents ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery* ; Subarachnoid Hemorrhage ; Surgical Instruments

PURPOSE: Bleaching agents containing sodium hypochlorite are widely used at home to bleach laundry and to disinfect hard surfaces. A retrospective study, with a literature review, was conducted to focus attention on the clinical outcome after accidental or intentional ingestion of sodium hypochlorite. METHODS: The medical records of 67 patients presented to the Inha University emergency department for sodium hypochlorite ingestion between June 1996 and July 2003 were retrospectively examined. RESULTS: The Mean volume of the bleach in the 56 patients who ingested the bleach in a suicide attempt was significantly larger than that of the 11 patients with accidental ingestion (P=0.001). Nausea and vomiting was present in 79% of the patients. The volume of ingestion in patients with vomiting was significantly larger than that in patients without vomiting (P=0.001). Patients with epigastric pain ingested larger volumes of bleach compared to patients without the pain (P=0.01). Endoscopic examinations were performed in seven patient, and normal findings were seen in three patients. Grade 1 caustic injury was observed in two patients, and Grade 2 injuries in the rest. CONCLUSION: The solution of the sodium hypochlorite may cause mild symptoms and seems to be safe after ingestion. However, careful evaluation with endoscopy and hospital admission should be considered if there are symptoms or signs suggesting caustic injury of the esophagus and/or stomach or if the ingested volume is large.
Bleaching Agents ; Caustics ; Eating ; Emergency Service, Hospital ; Endoscopy ; Esophagus ; Family Characteristics* ; Humans ; Medical Records ; Nausea ; Poisons ; Retrospective Studies* ; Sodium Hypochlorite* ; Sodium* ; Stomach ; Suicide ; Vomiting

Early repolarization is a common electrocardiographic (ECG) feature found in young adults, men and athletes, and has been considered to be a benign feature for the last several decades. But recent studies suggest that early repolarization may be related to idiopathic ventricular fibrillation and sudden cardiac death. We report a young man, 35 years old, who had life threatening ventricular fibrillation and sudden cardiac arrest. He was evaluated for cardiac causes of ventricular fibrillation. There was no explanation other than that his ECG showed an early repolarization pattern so we treated him with implantable cardioverter defibrillator. Thus, we suggest that early repolarization may be related with life threatening ventricular arrhythmia.
Arrhythmias, Cardiac ; Athletes ; Death, Sudden, Cardiac ; Defibrillators ; Electrocardiography ; Humans ; Male ; Ventricular Fibrillation* ; Young Adult

Brain-MR studies are sensitive to intracranial ischemia and vascular flow. However, brain MR study for brain death is clinically limited because keeping the ventilation is difficult during study. In our hospital, three 'brain death patients' brain-MR studies were performed under the anesthetic Mapleson's circuit-F system. Three patients' clinical states were not changed after the studies. We confirmed that brain herniation, absent intracranial flow void, no intracranial contrast enhancement, poor gray/white matter differentiation, and prominent nasal enhancement findings. The value of brain-MR study for brain death may be possible.
Brain ; Brain Death ; Ischemia ; Ventilation

PURPOSE: To assess the estimate prevalence and risk factors for age-related maculopathy (ARM) in Seoul, Korea. PATIENTS AND METHODS: We examined 9,530 subjects with, 40 years of age or older between January 2006 and December 2006 in Seoul, Korea. Subjects underwent fundus photography, clinical examinations (including blood analyses), and completed detailed questionnaires. Fundus images were graded according to definitions from the Wisconsin Age-Related Maculopathy Grading System. RESULTS: ARM was present in 235 subjects, corresponding to an estimate prevalence of 2.46%. Hepatitis B infection (positive status for HBsAg and HBcAb), serum triglyceride levels and high density lipoprotein levels remained as significant risk factors after age-adjustment. Multivariate analyses showed that the prevalence of ARM was significantly higher in older subjects [odds ratio (OR) 1.134; 95% CI 1.114-1.154] and those who were seropositive for hepatitis B surface antigen (OR 2.566; 95% CI 1.519-4.335). CONCLUSION: The estimated prevalence of ARM was 2.46%. Age and hepatitis B infection may increase the risk of ARM.
Adult ; Age Factors ; Aged ; Female ; Hepatitis B/complications ; Humans ; Korea/epidemiology ; Lipoproteins, HDL/blood ; Macular Degeneration/blood/*epidemiology/etiology ; Male ; Middle Aged ; Risk Factors ; Triglycerides/blood