Variant angina is a syndrome of cyclical chest pain at rest caused by vasospasm and associated with ST-segment elevation. Most of these cases are induced by the provocation with ergonovine or acetylcholine, and mechanical irritation of coronary artery by catheter, but spontaneous migrating spasm in right coronary artery is very rare. We report a fifty one year old male patient presenting as a variant angina due to spontaneous migrating spasm in right coronary artery during diagnostic coronary angiogram. The spasm was relieved spontaneously or by the administration of intracoronary nitroglycerin. No chest pain was documented after medication with calcium-channel blocker and nitrates on 6 month clinical follow-up. This paper presents our experience with a patient presenting with migrating coronay vasospasm of right coronary artery.
Acetylcholine ; Catheters ; Chest Pain ; Coronary Vasospasm ; Coronary Vessels ; Ergonovine ; Follow-Up Studies ; Humans ; Male ; Nitrates ; Nitroglycerin ; Spasm

Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease of unknown etiology characterized by accumulation of calcium phosphate in the submucosa of large airways and benign proliferation of bone and cartilage resulting in nodular formation. We report a case of tracheobronchopathia osteochondroplastica diagnosed by Endobronchial ultrasonography in a 56-year-old man. Chest Computed Tomography revealed thickening of tracheal and bronchial wall, and multiple nodules through whole trachea. Endobronchial ultrasonography showed numerous submucosal nodules with hetero-echogenecity in the third and fourth layers. Histopathological examination revealed nonspecific bronchitis with squamous metaplasia and metaplastic ossification. We confirmed tracheobronchopathia osteochondroplastica. The patient's symptoms were successfully treated with antibiotics and oxygen supplyment. endobronchial ultrasonography can helpful diagnosis in tracheobronchopathia osteochondroplastica.
Anti-Bacterial Agents ; Bronchitis ; Calcium ; Calcium Phosphates ; Cartilage ; Humans ; Metaplasia ; Middle Aged ; Osteochondrodysplasias ; Oxygen ; Thorax ; Trachea ; Tracheal Diseases

Eosinophilic gastroenteritis is a relatively uncommondisease of unknown etiology and pathogensis. It is characterized by massive tissue eosinophilia, that can involve any layers of the gastrointestinal tract wall. The gastrointestinal signs and symptoms usually reflect the layer which is most severly affected. Eosinophilic gastroenteritis can be rarely accompanied by extraintestinal involvement. We report a case of a 19-year-old male with repeated epigastric and low abdominal pain. An abdominal computed tomography showed diffused wall thickeningof esophagus, small bowel and bladder with ascites. Esosinophilic infiltration was shown by multiple biopsies of the esophagus, duodenum on esophagogastroduodenoscopy and peritoneal fluid analysis. The patient was diagnosed with eosinophilic gastroenteritis, accompanied by esosinophilic ascites and cystitis and was treated with corticosteroid and ketotifen. Abdominal pain was improved dramatically.
Abdominal Pain ; Ascites ; Ascitic Fluid ; Biopsy ; Cystitis ; Duodenum ; Endoscopy, Digestive System ; Enteritis ; Eosinophilia ; Eosinophils ; Esophagus ; Gastritis ; Gastroenteritis ; Gastrointestinal Tract ; Humans ; Ketotifen ; Male ; Urinary Bladder ; Young Adult

Invasive fungal sinusitis is a rare, severe disease, most commonly presenting in immunocompromised patients who have impaired neutrophil function or who have received long term immunosuppressive therapy. The gold standard for treatment has been wide surgical debridement, intravenous administration of antifungal agents such as amphotericin B (AMB), and correction of the underlying immunocompromised state. A 51-year-old female was admitted to our hospital with fever and headache who had received renal transplantation 14 years ago in the other hospital. Paranasal sinus CT scan revealed hyperplasia and soft tissue density of the left maxillary sinus. Histological examination of the fungus ball and edematous mucosa of the left maxillary sinus revealed suspicious invasion of Aspergillus in the mucosa. Clinical improvement occurred after a combination of surgery and post-operative systemic antifungal therapy with voriconazole. We think that voriconazole as initial treatment may be initiated for invasive sinonasal aspergillosis, if the infection is known to be due to Aspergillus species.
Administration, Intravenous ; Amphotericin B ; Antifungal Agents ; Aspergillosis ; Aspergillus ; Debridement ; Female ; Fever ; Fungi ; Headache ; Humans ; Hyperplasia ; Immunocompromised Host ; Kidney ; Kidney Transplantation ; Maxillary Sinus ; Middle Aged ; Mucous Membrane ; Neutrophils ; Paranasal Sinuses ; Pyrimidines ; Sinusitis ; Triazoles

Among the Acetylcholinesterase inhibitors as used for Alzheimer's disease treatment, Galantamine has been recently developed and widely used owing to proven its clinical efficacy and safety. However, it has reported that prolonged QT interval, which can lead to ventricular arrythimias such as Torsade de points, has developed in Galantamine-treated patients. A 74-year-old female Alzheimer's patient been treated with galantamine for 8 months visited the hospital complaining about frequent dizziness. ECG monitor was performed promptly, it was informed that the prolonged QTc interval was increased 450 ms to 486 ms. So, we made her stop taking the galantamine, and after that QTc interval has normalized to 406 ms. In this article, we reported the first case on prolonged QT interval associated with galantamine in Korea.
Aged ; Alzheimer Disease ; Cholinesterase Inhibitors ; Dizziness ; Electrocardiography ; Female ; Galantamine ; Humans ; Korea ; Organothiophosphorus Compounds

A 84-year-old woman visited by back and pubic pain. Abdominal CT showed 10cm sized abdominal mass with calcified component. At bone scan, multiple bone absorption was seen. T2 weighted MRI revealed heterogeneous high signal mass on pubis. Aspiration cytology reported only blood and exudate without malignant cells. Other 88-year-woman visited by systemic arthralgia and dysbasia. Abdominal CT revealed pubic bone fracture, surrounded by soft tissue, and relatively low density on lumbar spine. Bone scan showed increased absorption at multiple bone and joints. Enhanced chest CT revealed only consolidation, no malignant component was seen. Aspiration cytology reported degenerative bone tissue without malignant cell. At these cases, mass like lesion was looked like malignant tumors, but final diagnosis was insufficiency fractures. Aware these cases, we emphasize avoid misunderstanding for malignancy, may read to unnecessary and excessive evaluation before making the correct diagnosis, at insufficiency fracture.
Absorption ; Aged, 80 and over ; Arthralgia ; Bone and Bones ; Exudates and Transudates ; Female ; Fractures, Stress ; Humans ; Joints ; Pubic Bone ; Spine ; Thorax

A 12-year-old girl with nephrotic syndrome was admitted to Kosin University Gospel Hospital because of progressive generalized edema and weight gain for the last one month. From the eighth day of admission, she developed headache and generalized tonic seizures. Magnetic resonance imaging (MRI) of the brain showed multiple T2-high signal intensity lesions in the bilateral posterior parieto-occipital cortex and subcortical white matter. The convulsions responded to anticonvulsant and antihypertensive drugs but recurred again until she developed massive diuresis and became normotensive. Follow-up brain MRI 5 days later showed complete resolution of the previous abnormal lesions. The cause of Posterior Reversible Encephalopathy Syndrome (PRES) in our case remains unclear. Blood pressure has been only moderately elevated when the patient became symptomatic. Here, we report a case of minimal change nephrotic syndrome complicated by PRES with a literature review.
Antihypertensive Agents ; Blood Pressure ; Brain ; Child ; Diuresis ; Edema ; Follow-Up Studies ; Headache ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Seizures ; Weight Gain

OBJECTIVES: The aim of this study is to evaluate the short-term results and complications of treating the intertrochanteric fracture with bipolar hemiarthroplasty (BHA) in elderly population. METHODS: We retrospectively reviewed 31 unstable intertrochanteric fracture patients who were treated with BHA between January 2007 and August 2009 in older populations more than 65 years old. The 6 males and 25 females had a mean age of 79.8 years (range: 66-88) and a mean follow-up of 36.3 months (range: 24-55). We analyzed the radiological outcomes, functional recovery grade, using Jensen's social function score and Harris hip score (HHS), and complications. RESULTS: The average operation time and blood loss was 148.9 min (range, 110-215 min) and 455.2 mL (range, 200-1200 mL). Mean preoperative and postoperative hemoglobin (Hb) was 10.9 g/dL (range, 8.6-13.4 g/dL) and 10.5 g/dL (range, 5.1-14.1 g/dL) respectively. Average 1.3 pints of blood transfusion was performed. Ambulation with (or without) crutch was possible at mean 6.8 days postoperatively. The stability and alignment indices were adequate in all cases at final follow-up. On clinical results, the average HHS score, was changed from 79.7 points (range, 44-100) preoperatively to 73.0 points (range, 46-92) postoperatively, and the preoperative and postoperative Jensen's score was 1.8 (range, 1-3) and 2.1 (range, 1-4) respectively. CONCLUSIONS: The BHA is an acceptable alternative for unstable intertrochanteric fractures in older population.
Aged ; Blood Transfusion ; Butylated Hydroxyanisole ; Female ; Femur ; Follow-Up Studies ; Hemiarthroplasty ; Hemoglobins ; Hip ; Hip Fractures ; Humans ; Male ; Retrospective Studies ; Walking

OBJECTIVES: Many investigators have recommended adequate resection margin and lymphadenectomy for radical curative resection. The aim of this study is to evaluate clinical characteristics of positive resection margin (proximal or distal) of postgastrectomy in advanced gastric cancer. METHODS: We studied 17 patients with gastric cancer who were diagnosed positive resection margin by intraoperative frozen biopsy or permanent biopsy report from January 2005 to December 2007, retrospectively. Surgical margin monitored by endoscopy. RESULTS: Distal gastrectomy was performed in 13 patients and total gastrectomy in 4. Gastrectomy with combined resection including splenectomy was performed in 3, distal pancreatectomy in 2, transverse colon segmental resection in 1, and cholecystectomy in 2. Positive Proximal margin was found in 12, positive distal margin in 3, and both in 2. Palliative chemotherapy was performed in 8 patients. Postoperative follow up endoscopy was established in only 8 patients. Malignant results from endoscopic biopsy in gastroenteric or esophagoenteric anastomotic line were proven in 2 patients during follow up. 9 patients were not performed follow-up endoscopy. Among total 17 patients, 2 patients are alive. Fifteen patients died of aggravation of disease in 13 and postoperative complication in 2. CONCLUSIONS: Although positive surgical margin in far advanced gastric cancer were found, it can consider that does not further resection to obtain microscopic clear anastomotic margin.
Adenocarcinoma ; Biopsy ; Cholecystectomy ; Colon, Transverse ; Endoscopy ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Node Excision ; Pancreatectomy ; Postoperative Complications ; Research Personnel ; Retrospective Studies ; Splenectomy ; Stomach ; Stomach Neoplasms

OBJECTIVES: The purpose of this study is to compare newly developed assay for identification of ENA antibody, Phadia EliA ENA with Euroimmun line immunoassay by analyzing the degree of agreement and the individual antibodies between two methods. METHODS: A total of 82 patient samples were used. Indirect immunofluorescence assay using Hep-2 cell was performed to screen the antinuclear antibody (ANA). Euroimmun line immunoassay (LIA) and Phadia EliA ENA assay were tested to identify the antibodies against extractable nuclear antigens (ENAs). Kappa statistics was used to evaluate the degree of agreement. RESULTS: Mean age of patients was 41.0 (8-79), and the M:F ratio was 21:61. ANA was positive in 74 samples, and negative were 8 samples. Kappa analysis of the 82 tested samples showed a moderate strength of agreement (kappa = 0.521, P = 0.000). There were differences in the order of identified individual antibodies between two methods (Ro > La = RNP > Centromere > Sm > Scl-70 in Phadia EliA ENA, Ro > RNP > Sm>La > Scl-70 > Centromere=Jo-1 in Euroimmun LIA). Ro antibody was most frequently identified in Phadia EliA ENA negative-Euroimmun LIA positive specimens (Ro > RNP = Jo-1 > La = Sm = Centromere > Scl-70). CONCLUSIONS: A moderate strength of agreement was observed between the Phadia EliA ENA and the Euroimmun LIA. There seemed to be a significant difference in the ratio of individual antibodies, especially in the anti-Ro and Sm antibodies.
Antibodies ; Antibodies, Antinuclear ; Antigens, Nuclear ; Centromere ; Fluorescent Antibody Technique, Indirect ; Humans ; Immunoassay