Congenital coronary arteriovenous fistula is a rare condition which is an abnormal communication of the coronary artery with the right ventricle, right atrium, left atrium or left ventricle. Coronary artery aneurysm is an uncommon disease which is defined as coronary dilatation which exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. In young ages, symptoms are unusual, but significant symptoms and complications such as congestive heart failure, subacute bacterial endocarditis, coronary steal syndrome, aneurysm formation, rupture, and pulmonary hypertension may appear among the older age group. We report a case of giant aneurysm of a congenital coronary arteriovenous fistula between left co-ronary artery and right ventricular outflow tract with significant left to right shunt confirmed in a 84-year old female with a brief review of literature.
Aged, 80 and over ; Aneurysm* ; Arteries ; Arteriovenous Fistula* ; Coronary Aneurysm ; Coronary Vessels* ; Dilatation ; Endocarditis, Subacute Bacterial ; Female ; Heart Atria ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension, Pulmonary ; Rupture

No abstract available.
Aged* ; Humans

This study investigated the patterns of alcohol disorder comorbidity with other psychiatric disorders, using Korean nationwide epidemiological data. By two-stage cluster sampling, 5,176 adult household residents of Korea were interviewed using the Korean version of the Diagnostic Interview Schedule. Psychiatric disorders strongly associated with alcohol disorders were, other drug abuse or dependence, major depression, simple phobia, antisocial personality disorder, tobacco dependence, and pathological gambling. Male alcoholics had a tendency to begin with tobacco dependence, and some male pathological gamblers first had alcohol disorders. The presence of comorbid psychiatric disorders was associated with a more severe form and the later onset of alcohol disorders, and associated with help-seeking for alcohol abuse/dependence.
Adolescent ; Adult ; Age of Onset ; Aged ; Alcohol-Induced Disorders/*epidemiology/physiopathology/psychology ; Alcoholism/*epidemiology/physiopathology/psychology ; Cluster Analysis ; Comorbidity ; Female ; Humans ; Interviews as Topic ; Male ; Mental Disorders/*epidemiology/physiopathology ; Middle Aged ; Patient Acceptance of Health Care ; Time Factors

In this study, we examined rabbit gastric ulcer models that can serve as more clinically relevant models. Two types of ulcer model were studied: acetic acid-induced ulcers (AAU) and mucosal resection-induced ulcers (MRU). For AAU, rabbit gastric mucosa was exposed by median laparotomy and treated with bottled acetic acid. MRU was examined as a model for endoscopic mucosal resection (EMR). Normal saline was injected into the submucosal layer and the swollen mucosa was resected with scissors. Endoscopic mucosal resection (EMR) is frequently performed for treatment of early gastric cancers. This procedure inevitably leads to ulcers and bleeding. Bleeding control is the major concern in endoscopic mucosectomy, and some endoscopic hemostatic agents are currently under clinical and preclinical studies. MRU was developed as a model for these induced ulcers and the evaluation of the healing process. The clinical relevancy of those models was compared with that of rat models. Progressive healing was observed for 7 days based on histology. Rabbit models demonstrate round, deep ulcers with clear margins and well-defined healing stages that were difficult to define in rat models.
Acetic Acid ; Animals ; Gastric Mucosa ; Hemorrhage ; Laparotomy ; Mucous Membrane ; Rats ; Stomach Neoplasms ; Stomach Ulcer ; Ulcer

PURPOSE: To report brain metastasis of hepatocellular carcinoma presenting as homonymous hemianopia. CASE SUMMARY: A 51-year-old female with a history of hepatectomy and diagnosis of hepatocellular carcinoma (HCC) 19 months earlier was referred to our neuro-ophthalmology clinic for evaluation due to headache and decreased visual acuity over the past several months. Best visual acuity was 20/20, and the results of all other aspects of our examination were normal except Humphrey automatic perimetry, which showed complete left homonymous hemianopia. Brain magnetic resonance imaging showed a large mass in the right occipital lobe. Craniotomy and removal of tumor were performed. HCC was confirmed by histopathologic examination. CONCLUSIONS: Metastasis of hepatocellular carcinoma to the occipital lobe is extremely rare but can present as homonymous hemianopia. Therefore, clinicians should be aware of this when examining a patient with a history of HCC.
Brain ; Brain Neoplasms ; Carcinoma, Hepatocellular* ; Craniotomy ; Diagnosis ; Female ; Headache ; Hemianopsia* ; Hepatectomy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Occipital Lobe* ; Visual Acuity ; Visual Field Tests

The selective targeting of an integrin alphavbeta3 receptor using radioligands may enable the assessment of angiogenesis and integrin alphavbeta3 receptor status in tumors. The aim of this research was to label a peptidomimetic integrin alphavbeta3 antagonist (PIA) with 99mTc(CO)3 and to test its receptor targeting properties in nude mice bearing receptor-positive tumors. PIA was reacted with tris-succinimidyl aminotriacetate (TSAT) (20 mM) as a PIA per TSAT. The product, PIA-aminodiacetic acid (ADA), was radiolabeled with [99mTc(CO)3(H2O)3](+1), and purified sequentially on a Sep-Pak C-18 cartridge followed by a Sep-Pak QMA anion exchange cartridge. Using gradient C-18 reverse-phase HPLC, the radiochemical purity of 99mTc(CO)3-ADA-PIA (retention time, 10.5 min) was confirmed to be > 95%. Biodistribution analysis was performed in nude mice (n = 5 per time point) bearing receptor-positive M21 human melanoma xenografts. The mice were administered 99mTc(CO)3-ADA-PIA intravenously. The animals were euthanized at 0.33, 1, and 2 hr after injection for the biodistribution study. A separate group of mice were also co-injected with 200 microg of PIA and euthanized at 1 hr to quantify tumor uptake. 99mTc(CO)3-ADA-PIA was stable in phosphate buffer for 21 hr, but at 3 and 6 hr, 7.9 and 11.5% of the radioactivity was lost as histidine, respectively. In tumor bearing mice, 99mTc(CO)3-ADA-PIA accumulated rapidly in a receptor-positive tumor with a peak uptake at 20 min, and rapid clearance from blood occurring primarily through the hepatobiliary system. At 20 min, the tumor-to-blood ratio was 1.8. At 1 hr, the tumor uptake was 0.47% injected dose (ID)/g, but decreased to 0.12% ID/g when co-injected with an excess amount of PIA, indicating that accumulation was receptor mediated. These results demonstrate successful 99mTc labeling of a peptidomimetic integrin antagonist that accumulated in a tumor via receptor-specific binding. However, tumor uptake was very low because of low blood concentrations that likely resulted from rapid uptake of the agent into the hepatobiliary system. This study suggests that for 99mTc(CO)3-ADA-PIA to be useful as a tumor detection agent, it will be necessary to improve receptor binding affinity and increase the hydrophilicity of the product to minimize rapid hepatobiliary uptake.
Animals ; Chromatography, High Pressure Liquid ; Histidine ; Humans ; Hydrophobic and Hydrophilic Interactions ; Integrin alphaVbeta3 ; Melanoma ; Mice ; Mice, Nude ; Radioactivity ; Succinimides ; Transplantation, Heterologous ; Ursidae

About 5% of all malignancies involve the oral cavity. Metastatic cancers to the oral cavity from distant sites are very rare, and only a few cases have been reported in the clinical literature. The most common tumors that metastasize to the oral cavity originate in the breast, lung, and kidney. We recently experienced a patient who had a non-small cell lung cancer that metastasized to the gingiva. The patient was 56-year-old man. The disease status was a progressive condition, although the patient had received third-line chemotherapy. The patient had multiple bony metastases including vertebral bodies, femurs, and clivus as well as the gingival metastasis. The gingival tumor was histopathologically diagnosed as a poorly differentiated adenocarcinoma. The metastatic gingival tumor had the same pathology as the primary lung cancer.
Adenocarcinoma ; Breast ; Carcinoma, Non-Small-Cell Lung* ; Cranial Fossa, Posterior ; Drug Therapy ; Femur ; Gingiva* ; Humans ; Kidney ; Lung ; Lung Neoplasms ; Middle Aged ; Mouth ; Neoplasm Metastasis ; Pathology

OBJECTIVES: The aims of this study were 1) to estimate prevalence rates of drinkers, two subtypes of drinkers-drinkers without dependence and drinkers with probable alcohol dependence(AD) using CAGE, and 2) to find out the correlates of sociodemographic variables and drinking patterns of the drinkers with probable AD by comparing those of the drinkers without dependence, 3) to analyse risk factors for the drinkers with probable AD. METHODS: Using data from face-to-face interviews conducted during 1995, we investigated the prevalence and characteristics of two subtypes of drinkers in a national probability sample of 1,695 drinkers 20 years of age and older. We defined drinkers with CAGE scores 2 and over as drinkers with probable AD, and scores less than 1 as drinkers without dependence. The comparisons of sociodemographic characteristics and drinking patterns between two subtypes of drinkers were examined through chi-square test using weighted data. Statistical analysis including multiple logistic regression analysis were done for each sex, respectively. Because of the large number of coefficients estimated, Bonferroni's method was used to compute p values. RESULTS: The results were as follows: 1) Prevalence of the drinkers was 33.7% in the total sample. Prevalence rate of male and female drinker were 26.3% and 7.40%, respectively. Prevalence of the drinkers with probable AD was 10.9%. For males the prevalence of the drinkers with probable AD was 9.99% and for females 0.94%. 2) According to sociodemographic variables between drinkers without dependence and drinkers with probable AD, males drinkers with probable AD were older, less educated, more depressive, married marital status and were more likely to have occupations of service section than male drinkers without dependence. Female drinkers with probable AD were less educated, more depressive and had less monthly income than drinkers without dependence. 3) As for the drinking patterns, male drinkers with probable AD drank more frequently, had more drinks, had more trying to quit drinking and preferred Soju. Female drinkers with probable AD drank more frequently, had more drinks, were more trying to quit drinking, too. 4) Multiple logistic regression analysis showed that the risk factors for male drinkers with probable AD were lower education(< or =6 years) and depressive symptoms. For females, depressive symptoms and lower education(< or =6 years) were strongly indicative of risk factors though not reaching the statistical significance. CONCLUSIONS: Prevalence of the drinkers with probable AD was 10.9%, and male to female ratio was 10.6:1, which was lower than previous results. Depressive symptoms and lower education proved to be strong predictors for alcohol dependence. This suggest that early detection and treatment of depression and public education for the lower education group should be important.
Adult* ; Alcoholism* ; Depression ; Drinking ; Education ; Female ; Humans ; Logistic Models ; Male ; Marital Status ; Occupations ; Prevalence ; Risk Factors* ; Sampling Studies*

OBJECTIVES: The aim of the study was to develop a North Korean version of the Composite International Diagnostic Interview (NK-CIDI) and to evaluate the reliability and validity of NK-CIDI. METHODS: Subjects were 100 North Korean defectors, aged 18 to 65, who were recruited in a center for defectors in the National Medical Center or who were on an education curriculum in the defector settlement support center. NK-CIDI was developed based on the Korean version of CIDI considering the sociocultural background of North Korea. Inter-rater reliability, test/retest reliability, and validity of NK-CIDI were evaluated and kappa value was calculated. RESULTS: Different vocabularies and awkward expressions were adjusted, and additional explanations were supplemented for difficult phases. The target for development of NK-CIDI was early defectors who entered South Korea less than 3 months ago. Inter-rater reliability (n=30, kappa value 0.35-1.00), test/retest reliability (n=30, kappa value 0-0.86), and diagnostic validity (n=100, kappa value -0.02-0.42) were evaluated. CONCLUSION: Compared to the general population, defectors experience more psychiatric issues, and a standardized tool for diagnosis is needed. In this study, NK-CIDI was developed and the results suggest that reliability is acceptable but validity needs further verification. NK-CIDI could be utilized in future epidemiologic studies.
Curriculum ; Democratic People's Republic of Korea ; Diagnosis ; Education ; Epidemiology ; Korea ; Mental Disorders ; Reproducibility of Results ; Vocabulary

Gastric volvulus is an uncommon condition which is difficult to diagnose and treat. It designates abnormal rotation of the stomach along its longitudinal (organoaxial) or transverse (mesenteroaxial) axis. When the rotation exceeds 180 degrees, gastric obstruction or strangulation may occur. The classical presentation of acute gastric volvulus is the triad of severe epigastric pain, vomiting followed by retching without the ability to vomit, and difficulty or inability to pass a nasogastric tube. Delay in diagnosis and treatment of gastric volvulus can lead to fatal complications such as gastric ischemia, perforation, and hemorrhage. Gastric volvulus is a true emergency which should be treated immediately either surgically or by upper endoscopy. We report a case of an acute incarcerated gastric volvulus due to a left-sided diaphragmatic hernia in an adult male patient, which was treated successfully by operation.
Acute Disease ; Hernia, Diaphragmatic/*complications ; Humans ; Male ; Middle Aged ; Stomach Volvulus/diagnosis/*etiology