Transesophageal echocardiogram (TEE) was performed in the 86 normal persons using a UM9 of ATL with a 3.5 MHZ transducer in the Heart Center of Dong-A University Hospital during March-September 1990. 1) The transesophageal basal short axis views in the normal were seen in the Fig. 2~6. The Fig. 2 showed 3 aortic valve cusps, Fig. 3 the left coronary artery, Fig. 4 the right pulmonary artery bifurcated from the main pulmonary artery, Fig. 5 3 major vessels of superior vena cava, aorta and pulmonary artery and Fig. 6 the Left atrial appendage. 2) The transesophageal 4-chamber views in the normal were seen in Fig. 7~10. The Fig. 7 showed the left ventricular outflow tract, Fig. 8 right and left atrium and ventricle, Fig. 9 the atrial septum containing the membrane of fossa ovalis and Fig. 10 right atrium and ventricle. 3) The transesophageal transgastric short axis view in the normal was seen in Fig. 11. Fig. 11 showed the transverse image of LV and RV. 4) The transesophageal ascending aorta image was observed in Fig. 3. descending aorta image in Fig. 12 and the transesophageal aortic arch image in Fig. 14. 5) From the transesophageal 4 chamber view the septum-lateral wall dimension of the left ventricle was 5.0cm and the dimension between the apex and the closed mitral valve 6.3cm. The medial-lateral dimension of the left atrial appendage was 3.0cm and the superior-inferior dimension 4.1cm. The dimension of the descending aorta was 2.7cm and the ascending aorta 3.0cm.
Aorta ; Aorta, Thoracic ; Aortic Valve ; Atrial Appendage ; Atrial Septum ; Axis, Cervical Vertebra ; Coronary Vessels ; Echocardiography, Transesophageal ; Heart ; Heart Atria ; Heart Ventricles ; Humans ; Membranes ; Mitral Valve ; Pulmonary Artery ; Transducers ; Vena Cava, Superior

No abstract available.
Breast Neoplasms* ; Breast* ; Estrogens*

A 64-year-old man was treated with sunitinib as a first-line therapy for metastatic renal cell carcinoma. He was given oral sunitinib in cycles of 50 mg once daily for 2 weeks followed by a week off. During the 5th week of treatment right upper quadrant pain developed, but this resolved spontaneously during the 6th week (off treatment). However, on the 8th week of treatment, he was admitted to hospital because the acute right upper quadrant pain recurred with nausea, vomiting, and fever. Acute acalculous cholecystitis was then diagnosed by ultrasonography and CT. In addition, his laboratory findings indicated disseminated intravascular coagulation. Accordingly, sunitinib therapy was discontinued and broad-spectrum antibiotics initiated. He subsequently recovered after emergent percutaneous cholecystostomy. His Naranjo Adverse Drug Reaction Probability Scale score was 7, indicaing a probable association of the event with sunitinib. Suspicion of sunitinib-related acute cholecystitis is required, because, although uncommon, it can be life-threatening.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Carcinoma, Renal Cell ; Cholecystitis, Acute ; Cholecystostomy ; Disseminated Intravascular Coagulation ; Drug-Related Side Effects and Adverse Reactions ; Fever ; Humans ; Middle Aged ; Nausea ; Ultrasonography ; Vomiting

Pancreatic arteriovenous malformation (PAVM) is very rare anomaly. It occurs most commonly in the pancreatic head portion and gastrointestinal bleeding is the most common symptom. The management of PAVM is rather complex, with complete treatment usually accomplished by a total extirpation of the affected organ or at least its involved portion. We report the clinical presentation and management of 64 year-old male patient with PAVM, which was developed in pancreatic tail portion with sudden abdominal pain. Pancreatic computed tomography and magnetic resonance cholangiopancreatography were consistent with a vascular formation on pancreatic tail portion and simultaneously revealed with pseudocysts beside it. A subsequent superior mesenteric artery angiographic findings depicted PAVM on pancreatic tail portion. The patient underwent laparoscopic distal pancreatectomy and splenectomy and had a favorable outcome.
Abdominal Pain ; Arteriovenous Malformations* ; Cholangiopancreatography, Magnetic Resonance ; Head ; Hemorrhage ; Humans ; Male ; Mesenteric Artery, Superior ; Pancreas ; Pancreatectomy ; Splenectomy ; Tail

Congenital cysts of the gallbladder are extremely rare, hence only a few ciliated foregut cysts of gallbladder have been reported. We report a case of a 20-year-old woman presenting with mild right upper quadrant abdominal discomfort, with normal levels of serum bilirubin and liver function tests. Abdominal ultrasonography revealed a well-defined cystic mass measured about 2 cm attached to the neck of gallbladder, with internal echogenic debris suggesting a complicated cyst, such as a hemorrhagic cyst. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed similar findings. Laparoscopic cholecystectomy showed a slightly distended gallbladder. The size of cyst on the neck was 1.6x1.2 cm, and it contained mucosa lined by ciliated pseudostratified columnar epithelium and underlying smooth muscle layers. Histopathology identified a ciliated foregut cyst of gallbladder.
Abdomen/diagnostic imaging ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy, Laparoscopic ; Cysts/diagnostic imaging/pathology/surgery ; Female ; Gallbladder/pathology/surgery ; Gallbladder Diseases/*diagnosis ; Humans ; Tomography, X-Ray Computed ; Ultrasonography ; Young Adult

Autoimmune pancreatitis (AIP) occurs in two forms. Type 1 AIP is an IgG4-related systemic fibro-inflammatory disease. Type 2 AIP is not associated with altered levels of IgG4, and involves only the pancreas. Here, we report a case of type 2 AIP manifesting as acute pancreatitis in a 20-year-old male with ulcerative colitis. The patient was definitely diagnosed with type 2 AIP based on typical pancreatic imaging, supportive histology, history of ulcerative colitis, and steroid responsiveness.
Colitis, Ulcerative* ; Humans ; Immunoglobulin G ; Male ; Pancreas ; Pancreatitis* ; Ulcer* ; Young Adult

Among metastatic pancreatic tumors, malignant melanomas are rare. Here, we report a very rare case of a malignant melanoma that involved only the pancreas and liver, and was difficult to differentiate from a neuroendocrine tumor of the pancreas with a liver metastasis. A 65-year-old- male with no history of a malignant melanoma exhibited hypervascular hepatic and pancreatic tumors on computed tomography and contrast-enhanced endoscopic ultrasonography. He lacked lesions of the skin, eye, and gastrointestinal tract on physical examination, upper endoscopy, and a whole-body positron emission tomography-computed tomography scan; these sites are common primary sites of malignant melanoma. Finally, endoscopic ultrasound-guided pancreatic core biopsy and percutaneous ultrasonography-guided liver biopsy confirmed malignant melanoma of the pancreas and liver.
Biopsy ; Electrons ; Endoscopy ; Endosonography ; Gastrointestinal Tract ; Humans ; Liver ; Male ; Melanoma ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Pancreas ; Pancreatic Neoplasms ; Physical Examination ; Skin

Among metastatic pancreatic tumors, malignant melanomas are rare. Here, we report a very rare case of a malignant melanoma that involved only the pancreas and liver, and was difficult to differentiate from a neuroendocrine tumor of the pancreas with a liver metastasis. A 65-year-old- male with no history of a malignant melanoma exhibited hypervascular hepatic and pancreatic tumors on computed tomography and contrast-enhanced endoscopic ultrasonography. He lacked lesions of the skin, eye, and gastrointestinal tract on physical examination, upper endoscopy, and a whole-body positron emission tomography-computed tomography scan; these sites are common primary sites of malignant melanoma. Finally, endoscopic ultrasound-guided pancreatic core biopsy and percutaneous ultrasonography-guided liver biopsy confirmed malignant melanoma of the pancreas and liver.

In upper gastrointestinal endoscopy, intravenous anesthesia is commonly used due to its safety and improvement in patient's satisfaction and comfort. The aim of this approach is to improve the condition for endoscopy. Although the risks of sedation are reported to be very low with sufficient monitoring, we still have few risks that cannot be overlooked including aspiration pneumonia. There have been two reported cases of aspiration pneumonia after endoscopic submucosal dissection. However, to our knowledge, there has been no reports about aspiration pneumonia developing after endoscopy for a young healthy female. So, we report a first case of unexpected aspiration pneumonia after endoscopy.
Anesthesia, Intravenous ; Endoscopy ; Endoscopy, Gastrointestinal* ; Female ; Humans ; Pneumonia, Aspiration*

The incidence of acute cholecystitis complicating endoscopic retrograde Cholangiopancreatography (ERCP) is rarely reported at 0.2% but is usually associated with a cystic duct obstruction caused by gallstones, gallbladder polyps, or cancer. However, acute cholecystitis with a gallbladder perforation after ERCP without a history of cystic duct obstruction can develop very rarely and has not yet been reported in Korea. We report a case of acute cholecystitis with gallbladder perforation and aggravation of a pancreatic pseudocyst after diagnostic ERCP in a man with a pancreatic cystic lesion. He has been successfully cured using only percutaneous transhepatic gallbladder drainage and antibiotics with no surgery.
Anti-Bacterial Agents ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis, Acute ; Cystic Duct ; Drainage ; Gallbladder ; Gallstones ; Incidence ; Korea ; Pancreatic Cyst ; Pancreatic Pseudocyst ; Polyps