In complication of infective endocaditis splenomegaly and splenic infarction are not uncommon but splenic rupture is very rare. We report a case of splenic rupture complicated by infective endocarditis in 1 71-yr-old man who had been suffered from rheumatic heart disease (aortic regurgitation and stenosis and mitral regurgitation). The patient was admitted to mild fever and generalized weakness for 20 days. Diagnosis of infective endocarditis due to Staphylococcus epidermidis was made by clinical manifestaions and blood culture study.On 34th day of admissionthe patient suddenly displayed the symptoms and signs of massive intraperitoneal hemorrhage. Splenic rupture was revealed by paracentesis and radiologic studies. Rupture of spleen is an uncommon and usually fatal complication of infective endocarditis. Therefore early diagnosis and prompt treatment must be performed.
Constriction, Pathologic ; Diagnosis ; Early Diagnosis ; Endocarditis* ; Fever ; Hemorrhage ; Humans ; Paracentesis ; Rheumatic Heart Disease ; Rupture ; Spleen ; Splenic Infarction ; Splenic Rupture* ; Splenomegaly ; Staphylococcus epidermidis

Purpose: To evaluate risk factors predisposing to intraocular lens (IOL) dislocation after cataract surgery. Methods: The medical and surgical records of patients diagnosed with IOL dislocation between January 2011 and December 2021 after undergoing extracapsular cataract extraction, phacoemulsification, and phacoemulsification with pars plana vitrectomy at Hallym University Sacred Heart Hospital were reviewed retrospectively. Preoperative factors (ocular parameters and demographics) and intra-operative factors (surgery time, surgeon, and intra-operative complications) were compared according to early, late, and bilateral dislocation. Results: In 68 patents and 71 eyes, the average age at the diagnosis of dislocation was 63.3 years, and there were more males (77.5%) than females. Possible major factors predisposing to IOL dislocation were high myopia (9 eyes), retinal detachment (8 eyes), neodymium-doped yttrium aluminum garnet capsulotomy (6 eyes), and normal tension glaucoma (6 eyes). The rate of out-of-the bag dislocation was higher in early dislocation than in late. Early dislocation had a significantly older age, longer surgery time, and higher intraoperative complication rate during cataract surgery than did late dislocation. There was no difference in surgery time for late dislocated eyes compared to non-dislocated eyes. There was no difference in the incidence of dislocation between phacoemulsification and phacoemulsification with pars plana vitrectomy; there were seven eyes with prior vitrectomy only, with late dislocation. Of the seven patients with bilateral IOL dislocation, one had retinitis pigmentosa, two had retinal detachment, and one had high myopia. Bilateral dislocation patients were significantly younger at the time of cataract surgery, compared to unilateral dislocation patients. Conclusions Early dislocation was associated with long surgery time and intraoperative complications, while late dislocation had no significant correlation with surgery-related factors. A history of vitrectomy and combined vitrectomy with cataract surgery seemed to be associated with late dislocation, but this association was not significant.

In order to investigate the efficacy and safety of oral fosinopril, a new phosphorus containing angiotensin converting enzyme inhibitor, a single dose of 10 to 20mg was administered in 23 hypertensive patients with diastotic blood pressure above 95mmHg and all other anti-hypertensive agents were not administered during 4 weeks of study. Blood pressure and heart rate were measured on the 2nd and 4th week of therapy. The complete blood count with platelet count, blood chemistry by SMA-12 and serum electrolytes were performed at the begining and 4th week of therapy. The urinalysis and electrocardiography were performed at the beginning and 4th week of therapy. Any kinds of side effects were actively questioned by the examining physicians. The following results were obtained : 1) At the beginning and 4th weeks of therapy, the average systolic and diastolic pressure were 170.0+/-17.6/101.6+/-6.1mmHg, 142.7+/-15.1/87.3+/-6.7mmHg respectively. The systolic and diastolic blood pressure were declined statistically significantly(p<0.05) throughout the period of treatment and diastolic blood pressure of all subjects except 3 patients(86%) was maintained below 90mmHg after 4th week of treatment. 2) There was no significant change in the pulse rate before and after therapy. 3) There were no significant changes in blood chemistry, serum electrolytes, hematologic findings, urinalysis and electrocardiographic findigns. 4) side effect were developed in 5 patients(23%) with dry cough, 3 patients(13%) with headache and 2 patients with facial edema but side effects were mostly mild in nature without potenitally serious episodes. These results suggested that antihypertensive therapy with onec-daily fosinopril was effective and well tolerated in essential hypertensive patients.
Antihypertensive Agents ; Blood Cell Count ; Blood Pressure ; Chemistry ; Cough ; Edema ; Electrocardiography ; Electrolytes ; Fosinopril* ; Headache ; Heart Rate ; Humans ; Hypertension ; Peptidyl-Dipeptidase A ; Phosphorus ; Platelet Count ; Urinalysis

No abstract available.
Abscess* ; Eosinophils* ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Transplants*

BACKGROUND AND OBJECTIVES: We studied the correlation between radiologically identified bony osteitis and prognosis of the functional endoscopic sinus surgery in chronic rhinosinusitis patients. SUBJECTS AND METHOD: A retrospective review of medical records were carried out on 77 patients who had been diagnosed as chronic paranasal sinusitis and undergone endoscopic sinus surgery from 2002 through 2003 at our institution. Computed tomography scans were used for grading according to the Lund-Mackay radiologic grading system and diagnosis the pansinusitis coexistence. Medical records were used for grading according to the Lund-Mackay surgical grading system and for follow-up observation and age. Statistical analysis was done for correlation between radiologically identified indices and post-operative prognosis. RESULTS: The study revealed that radiologically identified bony osteitis need a longer post-operative medical management period and also found that if pansinusitis coexist with osteitis, poorer outcome would be accompanied. CONCLUSION: This study provides further evidence that radiologically identified bony osteitis and pansinusitis may act as poor prognostic factors.
Diagnosis ; Follow-Up Studies ; Humans ; Medical Records ; Osteitis* ; Prognosis* ; Retrospective Studies ; Sinusitis ; Tomography, X-Ray Computed

Intravenous leiomyomatosis is a rare benign smooth muscle tumor arising from uterine muscle or vascular wall. The disease grows into pelvic venous channel, and can extend to inferior vena cava, and, in exceptional cases, right side of the heart. A case of intravenous leiomyomatosis is presented with a brief review of literatures. A 42-year-old woman presented with one month history of vague right lower quadrant pain and leg swelling. Six years before admission, she had undergone total abdominal hysterectomy for leiomyoma of the uterus and excision of recurred mass and right salpingo-oophorectomy 32 months ago. During the follow-up, right adnexa mass was detected and the size grew progressively, so transferred to our hospital. CT scan and venograpy revealed out the large pelvic cavity mass and intravenous extension to right common iliac vein, bifurcation of IVC. Preoperative tumor embolization followed by resection of recurred pelvic tumor, removal of intravenous tumor via internal iliac vein venotomy and left salpingo-oophorectomy were done. After the operation, the symptoms were relieved and the patient resumed her normal activity.
Adult ; Animals ; Female ; Follow-Up Studies ; Heart ; Humans ; Hysterectomy ; Iliac Vein ; Leg ; Leiomyoma ; Leiomyomatosis ; Mice ; Myometrium ; Smooth Muscle Tumor ; Tomography, X-Ray Computed ; Uterus ; Vena Cava, Inferior

Interrupted aortic arch may be defined as a discontinuity of the aortic arch. This uncommon anomaly was first described by Steidele in 1778 and was later classified into 3 types by Celoria and Patton. We experienced the case of a 25-year-old male with an interrupted aortic arch(Type B) which was well supplied by collateral circulations. Ligation of collateral supplies and a Y-graft replacement from ascending aorta to descending thoracic aorta and left subclavian artery was done. Postoperative aortogram revealed no collateral circulations and good continuity of the aorta without narrowing of the anatomic site. During the period of 2-month follow up, the patient was able to lead a relatively active life.
Adult ; Aorta ; Aorta, Thoracic ; Collateral Circulation ; Equipment and Supplies ; Follow-Up Studies ; Humans ; Ligation ; Male ; Subclavian Artery

PURPOSE: This is a trial attempting to show that the addition of mycophenolate mofetil (MMF) can reduce toxicity without impacting efficacy in patients undergoing adult living donor liver transplantation (LDLT) who experience adverse events on tacrolimus (Tac). METHODS: Between February 1999 and December 2002, 47 cases of adult LDLT were administered Tac as a first-line immunosuppressive agents. Patients were categorized to a Tac Group (Tac+steroid; n=24) or a Tac/MMF Group (Tac+steroid+MMF; n=23). RESULTS: The actuarial 2-year patient survival rate was similar in the two groups (91.3% vs. 87.0%, P=0.591), and the 2-year rejection-free survival rate was also comparable (95.2% vs. 90.0%, P=0.672). In 14 patients with nephrotoxicity, mean creatinine levels decreased significantly from 1.80+/-0.24 mg/dL to 1.31+/-0.30 (P=0.001) within 3 months of adding of MMF. Of two patients with neurotoxicity, the clinical symptoms of one patient improved after adding MMF. In 7 patients with a lower therapeutic level, the mean Tac doses could be reduced from 6.4+/-4.0 mg at study entry to 2.4+/-1.4 mg 12 months after adding MMF. CONCLUSION: The addition of MMF to Tac is a potent immunosuppressive agent to reduce the Tac-induced toxicity, and which does not increase the risk of allograft rejection in LDLT.
Adult* ; Allografts ; Creatinine ; Humans ; Immunosuppressive Agents ; Liver Transplantation ; Liver* ; Living Donors* ; Survival Rate ; Tacrolimus* ; Transplantation*

BACKGROUND: Previous studies indicated that a recently approved synthetic HMG-CoA reductase inhibitor, atorvastatin, reduces LDL cholesterol and triglyceride. To assess the efficacy on the level of serum LDL cholesterol and other lipoprotein fractions and its safety, we investigated 59 patients for lipid and side effect profile. METHOD: In patients with hypercholesterolemia, who showed 12-hours fasting serum LDL cholesterol>145 mg/dl and <250 mg/dl and triglyceride levels<400 mg/dl were enrolled to diet therapy for 4 weeks. After 4 weeks of diet therapy, serum lipid profile were reevaluated and patients with LDL cholesterol > or =130 mg/dl were assigned to receive 10 mg dose of atorvastatin once daily for 4weeks. After 4 weeks of drug therapy, serum lipid profile were rechecked, if showed LDL cholesterol level> or =130 mg/dl, assigned to receive 20 mg dose of atorvastatin once daily until 8 weeks. RESULTS: Of the 59 patients were assigned to receive atorvastatin therapy, 52 patients completed the study. Among lipid profiles, total cholesterol, triglyceride, LDL-cholesterol and apolipoprotein B levels showed significant reduction with mean reduction rate of 28%, 13%, 38%, 32% respectively after 4 weeks and 31%, 13%, 41% and 34% respectively after 8 weeks. HDL-Cholesterol and lipoprotein (a) level did not show significant change after 8 weeks of therapy. Nine patients had mild adverse events, such as elevated ALT, epigastric pain, insomnia, thumb pain. postural hypotension, palpitation and constipation. Only three patients of fifty-nine withdrew from the study due to adverse events related to drug treatment. CONCLUSION: The atorvastatin was highly effective and generally well tolerated with an acceptable safety profile in patients with primary hypercholestelemia.
Apolipoproteins ; Cholesterol ; Cholesterol, LDL ; Constipation ; Diet Therapy ; Drug Therapy ; Fasting ; Humans ; Hypercholesterolemia* ; Hypotension, Orthostatic ; Lipoprotein(a) ; Lipoproteins ; Oxidoreductases ; Sleep Initiation and Maintenance Disorders ; Thumb ; Triglycerides ; Atorvastatin Calcium

OBJECTIVE: The present study was performed to investigate the efficiency of partial laser assisted hatching (p-LAH; lased 1/2 ZP width from ZP edge) on hatching of mouse blastocysts. METHODS: We used non-contact 1.48 micrometer diode laser (MTM, Switzland) to create a precise hole on zona pellucida. 2-cell embryos were collected from the mouse (ICR) oviduct at 48 hours after hCG administration. Collected 2-cell embryos were cultured in the P-1 medium supplemented with 0.4% BSA. For experiments, embryos at 8-cell stage were used after 20~22 hours in culture. After conventional (c-LAH) or partial laser assisted hatching, the embryos were further cultured in P-1 medium supplemented with 0.4% BSA for 3 days. To compare efficiency of complete and partial laser assisted hatching, hatching rate, hatching time and blastocyst diameter and zona pellucida thickness at hatching time were investigated. Embryos were examined every 12 hours. Blastocyst diameter and zona pellucida thickness at hatching time were measured with an ocular micrometer. RESULTS: Hatching rates of p-LAH group (84.2%) was significantly higher than that of control group (39.3%), but there was no difference between the p-LAH (84.2%) and c-LAH (91.2%). p-LAH group was hatched 12 hours earlier than control group, but hatched 12 hours later than c-LAH group. The diameter of blastocyst at hatching time of p-LAH group (113.1+/-6.4 micrometer) was smaller than that of control group (122.2+/-5.0 micrometer), but larger than that of c-LAH group (102.2+/-2.7 micrometer). Zona pellucida thickness at hatching time of p-LAH group (6.4+/-0.9 micrometer) was thicker than that of control group (4.5+/-1.5 micrometer), but thinner than that of c-LAH group (10.0+/-0.8 micrometer). CONCLUSION: These results suggest that p-LAH may maintains the cell arrangement of early embryos to ensure successful development and prevent precocious hatching of blastocyst when compare to c-LAH and conventional (acidic tyrode) AH. Thus, p-LAH may provide a valuable and effective AH technique for human ART program.
Animals ; Blastocyst ; Embryonic Structures* ; Humans ; Lasers, Semiconductor ; Mice* ; Oviducts ; Zona Pellucida