The appendiceal mucocele is very rare disease of 0.2% incidence. About 24% of patients are asymptomatic and symptomatic patients present with pain in the right lower quadrant of abdomen in 64%, plapable maas in the right lower quadrant of abdomen in 50%, and rarely, melena, hematochezia, anemia, diarrhea, malaise, and abdominal distension. The gastrointestinal bleeding may be presented in the patient with intussusception, but the massive bleeding is generally absent. We report a case of appendiceal mucocele accompanying with gastrointestinal bleeding and review of literature.
Abdomen ; Anemia ; Diarrhea ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Incidence ; Intussusception ; Melena ; Mucocele* ; Rare Diseases

Malignant esophago-bronchial fistula is an incurable and distressing condition. The passage of swallowed saliva and solid or liquid food into the bronchial tree causes coqghing and frequent pulmonary infection and collapse. Most patients are unfit for major surgery, but intubation offers a quick, simple and effective treatment with improved length and quality of life. However, intubation with simple esophageal tubes are liable to result in failure to occlude the fistela, migration of the tube, erosion, and in the case of latex tubes, disintegration. To overcome these problems, the fistula is intubated perorally with a prosthesis surrounded by a foam rubber cuff contained ia silicone sheath, in which vacuum can be created. This cuffed prosthesis is the most satisfactory design for the treatment of malignant esophago-bronchial fistula with effiective and gentle occlusion of the fistula without risk of pressure necrosis. We experienced a case of the endoscopic treatment with a cuffed prosthesis for malignant esophago-bronchial fistula. So we report this case with brief review of the previous literatures.
Bronchial Fistula* ; Esophageal Neoplasms ; Fistula ; Humans ; Intubation ; Latex ; Necrosis ; Prostheses and Implants* ; Quality of Life ; Rubber ; Saliva ; Silicones ; Vacuum

PURPOSE: To evaluate the effectiveness of pelvic arterial embolization (PAE) for intractable postpartum hemorrhage (PPH) after hysterectomy. MATERIALS AND METHODS: From March 2011 to December 2017, 14 patients who received PAE for PPH that persisted after total abdominal hysterectomy were included (mean age, 33.6 years; range, 26–37 years). The delivery type, cause of PPH, and angiographic findings were investigated. The technical and clinical success rates and clinical outcomes were evaluated. RESULTS: Of 14 patients, 8 patients (57%) had positive angiographic findings for bleeding; contrast extravasation (n = 6), and pseudoaneurysm (n = 2). Remnant uterine artery (UA) was the most common bleeding focus (n = 4), followed by vaginal artery (n = 2), left lateral sacral artery (n = 1), and left internal pudendal artery (n = 1). Technical and clinical success rates were 100% and 93% (13/14), respectively. In 1 patient, bleeding was not controlled after initial selective embolization and the entire anterior divisions of both internal iliac arteries were embolized with gelfoam. CONCLUSION PAE for persistent PPH after hysterectomy is a safe and effective treatment. Remnant UA was the most common bleeding site and all patients recovered without any significant sequelae after embolization.

BACKGROUND: It has been suggested that the sympathetic nervous system might play an important role in the development of coronary artery spasm. Recently, advances have made possible the imaging of the cardiac adrenergic nervous system with metaiodobenzylguanidine (MIBG) labeled with iodine-123. The purpose of this study was to assess the presence and location of abnormal sympathetic innervation by iodine-123-metaiodobenzylguanidine single-photon emission computed tomography (SPECT) and to evaluate the clinical efficacy of iodine-123-MIBG SPECT as a noninvasive screening test in patients with coronary artery spasm. METHOD: Coronary arteriography and provocative test with intravenous administration of ergonovine maleate were performed in 26 patients (21 men, 5 women, mean age 49.1+/-9.3, range: 26-59) who were suspected of having a coronary artery spasm. The subjects were divided into 2 groups ; Group 1 comparised of 18 patients subjects to the positive provocative test, Group 2 comparised of 8 patients subjects to the negative provocative test. Four healthy subjects served as control. All patients also underwent iodine-123-MIBG SPECT for the evaluation of cardiac sympathetic integrity. The SPECT findings were qualitatively evaluated by two experienced physicians who were blind to the clinical data. RESULTS: Abnormal sympathetic nervous innervation using iodine-123-MIBG SPECT was observed either as a reduced uptake or defect pattern in the perfused areas in 13 of the 18 vessels of ergonovine induced vasospasm. Normal sympathetic innervation as evidenced by normal iodine-123-MIBG uptake was noted in all of the 60 segments of normal vessel territories. Reduced uptake of iodine-123-MIBG was not detected in the perfused areas of five vasospasm-induced vessels (perfusion territory of LAD in 2 and the RCA in 3 patients). The sensitivity and specificity of iodine-123-MIBG for detection coronary artery spasm were 72.2% (95% confidence interval [CI] 55% to 89%) and 100%, respectively. The positive predictive value and negative predictive value were 100% and 92.3% (95% CI 91% to 93%), respectively. CONCLUSION: Iodine-123-MIBG SPECT is a feasible method to noninvasively evaluate and localize the territories of coronary arteries with spasms. Invasive diagnostic coronary arteriography with ergonovine provocation test may be unnecessary for the diagnosis of coronary artery spasm in patients with typical resting pain, negative exercise test or normal thallium perfusion scan, but abnormal iodine-123-MIBG SPECT.
Administration, Intravenous ; Angiography ; Coronary Vessels* ; Diagnosis* ; Ergonovine ; Exercise Test ; Female ; Humans ; Male ; Mass Screening* ; Myocardial Perfusion Imaging* ; Nervous System ; Neurons* ; Perfusion ; Sensitivity and Specificity ; Spasm* ; Sympathetic Nervous System ; Thallium ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

Lowe syndrome is a rare genetic disease that appears to cause various clinical symptoms involving the eye, nervous system, and kidney. While a mutation of the OCRL1 gene is known to be responsible for this syndrome, the exact pathophysiology remains unclear. Various multi-organ symptoms are characteristic of Lowe syndrome, but skin lesions have rarely been described. Recently, mechanisms for the association of Lowe syndrome and skin lesions have been proposed. We report this case of Lowe syndrome involving multiple epidermal cysts on the scalp in a 6-year-old male child.
Child ; Epidermal Cyst ; Eye ; Humans ; Kidney ; Male ; Nervous System ; Oculocerebrorenal Syndrome ; Scalp ; Skin

PURPOSE: Chronic prostatitis (CP) does not yet have a universally successful therapy. Alternative treatments including thermotherapy have been adopted in the multimodal management of pain and voiding dysfunction. We retrospectively analyzed the therapeutic efficacy of bipolar radiofrequency thermotherapy for patients who were unsatisfied with conventional medication for CP. MATERIALS AND METHODS: A retrospective study between October 2009 and September 2010 of 26 patients who were under 50 years old and diagnosed with CP (National Institutes of Health [NIH]-category III) was performed. Twenty patients were diagnosed with inflammatory CP (NIH-category IIIa) and the rest with noninflammatory CP (NIH-category IIIb). We used the Tempro system at an intraprostatic temperature of 55degrees C for 50 minutes with a medium heating rate. All patients also completed the NIH-Chronic Prostatitis Symptom Index (CPSI) before and after treatment. RESULTS: In the patients diagnosed with CP, the mean serum prostate-specific antigen (PSA) level was 0.9+/-0.3 ng/ml, the prostate volume was 27.1+/-5.5 g, and the average score for all 3 domains on the NIH-CPSI significantly decreased. The total scores decreased from 19.8+/-7.1 to 11.1+/-7.0, the pain domain decreased from 8.6+/-3.1 to 4.8+/-3.1, the voiding symptom domain decreased from 5.1+/-1.8 to 2.9+/-1.8, and the effect on the quality of life decreased from 6.1+/-2.2 to 3.4+/-2.2 (p<0.05). CONCLUSIONS: Bipolar radiofrequency thermotherapy for patients with CP intractable to conventional medication can provide significant improvement in the NIH-CPSI. Large, randomized controlled trials will also be required to confirm the efficacy of this therapy.
Academies and Institutes ; Heating ; Hot Temperature ; Humans ; Hyperthermia, Induced ; Prostate ; Prostate-Specific Antigen ; Prostatitis ; Quality of Life ; Retrospective Studies

Recently the incidence of colonic disease increases in Korea. Because a large proportion of polyps and cancer occur in the rectosigmoid colon, fecal occult blood test and sigmoidoscopy have been used widely in screening test. (continue...)
Colon* ; Colonic Diseases ; Colonic Neoplasms ; Colonoscopy ; Incidence ; Korea ; Mass Screening ; Occult Blood ; Polyps ; Sigmoidoscopy

STUDY DESIGN: Multi institution, double blind, random sample. OBJECTIVES: We conducted a comparative study with Aceclofenac Tab, which is widely used in the clinical field in order to observe the Pelubiprofen Tab's clinical efficiency in patients with back pain. SUMMARY OF LITERATURE REVIEW: Among the numerous literatures regarding the chronic back pain, there is are few studies with Pelubiprofen Tab's clinical efficiency. MATERIALS AND METHODS: We computed an experimental model through a case control study, practiced from January, 2010 to January, 2011, and thereby, 298 back pain patients were selected. This study was conducted through a multi institution, double blind, and random sample. We compared the experimental and control groups' clinical efficiency that was estimated by VAS after 28 days of medication. Also, we compared the treatment efficiency of both drugs by using a variation of Oswestry Disability Index (ODI) and Physician's Global assessment, with a total usage of relief medicine. Also, the side effect and clinical pathologic result were tested. Statistical analysis was done with three different methods, Safety method, ITT (Intent-To-Treat), and PP (Per Protocol). Logistic regression model was used, and this result was compared by a Chi-square or Fisher's Exact test. RESULTS: Comparing the VAS of both groups, VAS decreased with statistical significance. Both groups didn't show a significant difference in VAS (p=0.6764). As the decrement of the total dosage of relief medicine, the decrease in the control group was rather higher, but the difference didn't show any statistical significance (p=0.9955). The experimental group was not inferior than that of the control group in ODI and PGA variation. Analyzing the side effect, both groups didn't show any significant difference (p=0.9843). CONCLUSIONS: As a result of the clinical trial, Pelubiprofen Tab. applied to back pain patients was not inferior to that of aceclofenac Tab., in terms of efficiency, and didn't show any significant difference in safety.
Back Pain ; Case-Control Studies ; Diclofenac ; Humans ; Logistic Models ; Models, Theoretical ; Phenylpropionates ; Prostaglandins A

PURPOSE: The standard treatment for aortic aneurysms is surgical replacement with a prosthetic graft. Currently there is great interest in endoluminal intervention for treatment of aortic aneurysm. The purpose of this study was to evaluate the safety and effectiveness of endoluminally placed Stent-graft for the treatment of aortic aneurysms. MATERIALS AND METHODS: Transluminal endovascular Stent-graft placements were attempted in 9 patients with infra-renal aortic aneurysms(n=6), thoracic aortic aneurysm(n=l), and aortic dissection(n=2). The endovascular Stent-grafts were custom-designed for each patient and were constructed of self-expandable modified Gianturco Stents covered with polytetrafluroethylene. The Stent-grafts were introduced through a 16-18 french sheath and expanded to 17-30mm in diameter. The endovascular therapy was performed using a common femoral artery cutdown with local anesthesia. RESULTS: The endovascular Stent-graft deployment was achieved in 7 of 9 patients. Two cases failed deployment of the Stent-graft due to lilac artery stenosis and tortousity. There were complete thrombosis of the thoracic and infra-renal aortic aneurysm surround the Stent-graft in 3 patients, and persistent leak with partial thrombosis in 2. Two patients with aortic dissection were successfully treated by obliteration of entry tears. There were no major complication associated with Stent-graft placement. CONCLUSION: These preliminary results show that transluminal endovascular Stent-grafts offer great promise and good results. Further investigation is needed to establish its long-term safety and efficacy.
Anesthesia, Local ; Aortic Aneurysm ; Arteries ; Constriction, Pathologic ; Femoral Artery ; Humans ; Stents ; Thrombosis ; Transplants

With the technical development of ultrasonically guided punture of the gallbladder, percutaneous transhepatic cholecystoscopy(PTCCS) was first performed in 1981 by Inui et al. and Ichikawa et al. This procedure useful for preoperative, accurate diagnosis of carcinoma and nonsurgical treatment of high-risk patients with gallbladder stones. PTCCS-lithotripsy(PTCCS-L) is one of the non-surgical treatment modalities for gallbladder stones, and is a safe, reliable and technically easy therapeutic procedure through improvement in PTCCS-L manipulation and the development of new devices for this technique. PTCCS-L is performed when the patients with gallbladder stones cannot be operated on because of the risk of complications, such as renal failure, congestive heart failure etc. In this report, we present the proeedures of PTCCS-L for the the nonoperative treatment of gallbladder stones in the patient with cholangitis and cholecystitis because of common bile duct stone and gallbladder stones. Since a sinus tract of about 5 mm in diameter was needed to pass an endoscope, the sinus tract of percutaneous cholecystostomy was dilated immediately upto 18 French in diameter in a single step following percutaneous cholecystostomy itself, using a dilator set containing 10, 14, 16 and 18 French dilators and 18 French sheath. And then PTCCS-L with electrohydraulic lithotripter was successfully performed with a complete removal of gallbladder stones. There- after endoscopic sphincterotomy and mechanical lithotripsy was successfully done for the removal of common bile duct stone. There has been no recurrence of gall stones for up to 1 year.
Cholangitis ; Cholecystitis ; Cholecystostomy ; Common Bile Duct ; Diagnosis ; Endoscopes ; Gallbladder* ; Gallstones ; Heart Failure ; Humans ; Lithotripsy ; Recurrence ; Renal Insufficiency ; Sphincterotomy, Endoscopic