Aniskiasis is caused by the accidental infestation of human by larvae of marine mammals found in saltwater fish and squid. The clinical picture may be severe enough to stimulate an acute surgical abdomen. More commonly, colicky pain, diffuse abdominal tenderness, nausea, vomiting, fever, and leukocytosis are seen. Gastroscopically, 2-to 4-cm larvae can be seen penetrating the mucosa. More characteristically, the larvae burrow into the mucosa of the stomach. Here they produce eosinophilic granulomatous tumors with edema, thickening, and induration which may be mistaken for gastric canceer. The pathalogic changes are thought to be the result of a hypersensitivity reaction. We report a case of chronic gastric anisakiasis, which was diagnosed as submucosal tumor with massive bleeding.
Abdomen ; Anisakiasis* ; Abdominal Pain ; Decapodiformes ; Edema ; Eosinophils ; Fever ; Hemorrhage* ; Humans ; Hypersensitivity ; Larva ; Leukocytosis ; Mammals ; Mucous Membrane ; Nausea ; Stomach ; Vomiting

BACKGROUND: The effective ventricular function during ejection and filling is likely to depend on the coordinated action of the longitudinally and circumferentially orientated myocardial fibers and the function of these longitudinal fibers has not been extensively studied. METHODS: The role of longitudinally and circumferentially orientated fibers in left ventricular wall motion was evaluated by M-mode echocardiograms of the mitral ring(whose motion reflect long axis change) and the standard minor axis(left ventricular posterior wall), simultaneous recordings of phonocardiograms and electrocardiograms on the paper (speed 100mm/sec), in 24 healty individuals, 17 patients with mitral stenosis, 11 patients with open mitral commissurotomy and 17 mitral valve replaced patients. RESULTS: In the controls long axis shortening significantly preceded minor axis shortening (phase difference between two axes : 20+/-3 msec, mean+/-SEM) during early systole, indicating left ventricle become more spherical. This phase difference was also observed in the patients with mitral stenosis and in those with open mitral commissurotomy. In patients with mitral valve replacement(MVR) whose papillary muscles had been sectioned, the onset of long axis shortening was more delayed during early systole than that of short axis(-33+/-6msec) and the end of shortening was also prolonged to early diastole more than that of normal controls (54+/-3 msec vs 90+/-8 msec, mean+/-SEM, p<0.01 by t-test). CONCLUSION: We observed the time relations between long and short axis motion in normal controls. It can be concluded that the reversed time relation in patients with MVR is one of the important factors which may effect negatively on ventricular function and long-term prognosis, thus the surgical procedures to preserve papillary annular continuity should be considered in patients with mitral valvular disease. And the controlled, prospective, clinical trials with homogenous groups of patients are needed to evaluate the potential benefits of papillary annular continuity in preserving atrio-ventricular interaction in patients undergoing mitral valvular surgery.
Axis, Cervical Vertebra* ; Diastole ; Echocardiography ; Electrocardiography ; Heart Valve Diseases* ; Heart Ventricles ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Papillary Muscles ; Prognosis ; Systole ; Ventricular Function

The development of cutaneous sarcoidosis as a paradoxical adverse event of tumor necrosis factor alpha (TNF-α) blockers has been reported in the literature; however, an erythrodermic form of cutaneous sarcoidosis during anti-TNF-α therapy has not yet been reported. Herein, we report the first case of an erythrodermic form of cutaneous sarcoidosis during anti-TNF-α therapy and review previous studies of cutaneous sarcoidosis. A 6-year-old Korean girl who had been suffering from juvenile rheumatoid arthritis presented with generalized erythematous skin eruption involving more than about 90% of her body surface area. After 14 months of etanercept treatment, the new erythematous skin eruption had developed and progressed into generalized erythroderma. Exclusion of suspected co-medication had been performed based on medication history. She had no other systemic symptoms, and ophthalmologic and neurologic examinations were normal. Histopathologic findings of the skin lesion revealed diffuse non-caseating granulomatous infiltrates composed of epithelioid histiocytes with sparse lymphocytes involving the entire dermis. Periodic-acid-Schiff and acid-fast stains were negative, and acid-fast bacilli was not detected by polymerase chain reaction of the skin biopsy. Based on clinicopathologic findings, she was diagnosed with etanercept-induced sarcoidal granuloma. After discontinuation of the suspected agent, the lesions spontaneously disappeared.
Arthritis, Juvenile* ; Biopsy ; Body Surface Area ; Child ; Coloring Agents ; Dermatitis, Exfoliative ; Dermis ; Etanercept ; Female ; Granuloma ; Histiocytes ; Humans ; Lymphocytes ; Neurologic Examination ; Polymerase Chain Reaction ; Sarcoidosis* ; Skin ; Tumor Necrosis Factor-alpha*

The development of cutaneous sarcoidosis as a paradoxical adverse event of tumor necrosis factor alpha (TNF-α) blockers has been reported in the literature; however, an erythrodermic form of cutaneous sarcoidosis during anti-TNF-α therapy has not yet been reported. Herein, we report the first case of an erythrodermic form of cutaneous sarcoidosis during anti-TNF-α therapy and review previous studies of cutaneous sarcoidosis. A 6-year-old Korean girl who had been suffering from juvenile rheumatoid arthritis presented with generalized erythematous skin eruption involving more than about 90% of her body surface area. After 14 months of etanercept treatment, the new erythematous skin eruption had developed and progressed into generalized erythroderma. Exclusion of suspected co-medication had been performed based on medication history. She had no other systemic symptoms, and ophthalmologic and neurologic examinations were normal. Histopathologic findings of the skin lesion revealed diffuse non-caseating granulomatous infiltrates composed of epithelioid histiocytes with sparse lymphocytes involving the entire dermis. Periodic-acid-Schiff and acid-fast stains were negative, and acid-fast bacilli was not detected by polymerase chain reaction of the skin biopsy. Based on clinicopathologic findings, she was diagnosed with etanercept-induced sarcoidal granuloma. After discontinuation of the suspected agent, the lesions spontaneously disappeared.
Arthritis, Juvenile* ; Biopsy ; Body Surface Area ; Child ; Coloring Agents ; Dermatitis, Exfoliative ; Dermis ; Etanercept ; Female ; Granuloma ; Histiocytes ; Humans ; Lymphocytes ; Neurologic Examination ; Polymerase Chain Reaction ; Sarcoidosis* ; Skin ; Tumor Necrosis Factor-alpha*

The ocular manifestations of leukemia include leukemic infiltration in optic nerve, retina, choroid, iris, ciliary body and anterior chamber, as well as retinal vascular change and hemorrhage due to systemic hemodynamic abnormalities.Occasionaly, subhyaloid hemorrhage involving the macula may cause acute loss of central visual acuity. We observed dense bilateral macular subhyaloid hemorrhage in 19-year-old man who had been diagnosed to have acute myeloid leukemia.Trans pars plana vitrectomy was performed in his both eyes, resulting in improvement of vision.
Anterior Chamber ; Choroid ; Ciliary Body ; Hemodynamics ; Hemorrhage* ; Humans ; Iris ; Leukemia ; Leukemia, Myeloid, Acute* ; Leukemic Infiltration ; Optic Nerve ; Retina ; Retinaldehyde ; Visual Acuity ; Vitrectomy ; Young Adult

Referred pain is not localized to the site of its cause, but referred to an area that may be an adjacent distant from such a site. With respect to this, there is the possibility of misdiagnosis in the treatment of referred pain patient. We experienced a case of a 31-years-old male patient complaining of right shoulder pain, which subsided after a bursa injection. The patient revisited our clinic after 3 weeks complaining not only of right shoulder pain, but also of right upper quadrant pain and fever. He was diagnosed as having a liver abscess by an imaging study.
Diagnostic Errors ; Fever ; Humans ; Liver Abscess* ; Liver* ; Male ; Pain, Referred ; Shoulder Pain* ; Shoulder*

OBJECTIVES: To evaluate the effects of sperm motility stimulants on the hyperactivation (HA), acrosomal reaction (AR) and sperm penetration assay (SPA) in fresh and frozen-thawed spermatozoa from fertile men. METHODS: We treated the semen samples obtained from 20 normospermic men (fresh semens from 10 and cryopreserved ones from 10) with pentoxiphylline (PF) and 2-deoxyadenosine (2-DXA) to evaluate the change of the patterns of motility using the computerized motility analyzer. The semen samples treated with motility stimulants were incubated in the medium with calcium ionophore A23187 for the examination of the proportion of acrosome lost spermatozoa. Finally we performed SPA in both groups for the evaluation of fertilizing capacity after stimulant treatments. RESULTS: In both fresh and cryopreserved semen samples, the addition of PF and 2-DXA significantly altered the patterns of motility (ALH, VCL, HA) known to have association with sperm quality without increasing the number of sperms with progressive motility and velocity. A23187 induced AR was also augmented by the treatment with PF and 2-DZA. Although the treatment with PF did not increase the mean rates of egg penetration significantly, in selected cases in the cryopreserved semen group, the improvement of the motility pattern was impressive. CONCLUSION: PF and 2-DXA can improve the quality of sperm function in both fresh and frozen-thawed semen from normal fertile men and may increase the sperm penetration rate of zona-free hamster eggs in selected samples of the frozen-thawed semen. The results suggest that PF and 2-DXA pretreatment can be used in the clinical practice for intrauterine insemination (IUI) program with frozen-thawed sperms as well as with samples from men with abnormal semen parameters. In addition, it may be a cost- effective therapy to try IUI combined with such a pretreatment for the couples planned to enter into the ART program.
Acrosome ; Acrosome Reaction ; Animals ; Calcimycin ; Calcium ; Cricetinae ; Eggs ; Family Characteristics ; Fertilization in Vitro* ; Humans ; Insemination ; Male ; Ovum ; Semen ; Sperm Motility* ; Sperm-Ovum Interactions ; Spermatozoa*

OBJECTIVE: Hemifacial spasm (HFS) is considered as a reversible pathophysiological condition mainly induced by continuous vascular compression of the facial nerve root exit zone (REZ) at the cerebellopontine angle. As an offending vessel, vertebrobasilar artery tends to compress much more heavily than others. The authors analyzed HFS caused by vertebrobasilar artery and described the relationships between microsurgical findings and clinical courses. METHODS: Out of 1,798 cases treated with microvascular decompression (MVD) from Jan. 1980 to Dec. 2004, the causative vessels were either vertebral artery or basilar artery in 87 patients. Seventy-nine patients were enrolled in this study. Preoperatively, computed tomography (CT) or brain magnetic resonance (MR) imaging with 3-dimentional short range MR technique was performed and CT was checked immediately or 2-3 days after anesthetic recovery. The authors retrospectively analyzed the clinical features, the compression patterns of the vessels at the time of surgery and treatment outcomes. RESULTS: There were 47 were male and 32 female patients. HFS developed on the left side in 52 cases and on the right side in 27. The mean age of onset was 52.3 years (range 19-60) and the mean duration of symptoms was 10.7 years. Many patients (39 cases; 49.1%) had past history of hypertension. HFS caused only by the vertebral artery was 8 cases although most of the other cases were caused by vertebral artery (VA) in combination with its branching arteries. Most frequently, the VA and the posterior inferior cerebellar artery (PICA) were the simultaneous causative blood vessels comprising 32 cases (40.5%), and in 27 cases (34.2%) the VA and the anterior inferior cerebellar artery (AICA) were the offenders. Facial symptoms disappeared in 61 cases (77.2%) immediately after the operation and 68 cases (86.1%) showed good outcome after 6 months. Surgical outcome just after the operation was poor in whom the perforators arose from the offending vessels concurrently (p<0.05). CONCLUSION: In case where the vertebral artery is a cause of HFS, commonly branching arteries associated with main arterial compression on facial REZ requires more definite treatment for proper decompression because of its relatively poor results compared to the condition caused by other vascular compressive origins.
Age of Onset ; Arteries ; Basilar Artery ; Blood Vessels ; Brain ; Cerebellopontine Angle ; Criminals ; Decompression ; Facial Nerve ; Female ; Glycosaminoglycans ; Hemifacial Spasm ; Humans ; Hypertension ; Magnetic Resonance Spectroscopy ; Male ; Microvascular Decompression Surgery ; Retrospective Studies ; Vertebral Artery

Brugada syndrome describes a subgroup of patients at risk of ventricular fibrillation, but with no evidence of an underlying structural heart disease associated with an ECG pattern of right bundle branch block and a ST segment elevation in the right precordial leads (V1 to V3). This syndrome is familial with an autosomal dominant mode of transmission, and may be considerably more common in Southeast Asia. It is associated with a significant risk of ventricular tachyarrhythmias and sudden death, which is not effectively prevented by anti-arrhythmic drug therapy. We experienced such a case under general anesthesia for a hemi-colectomy, in a 32-year-old male patient diagnosed as having Brugada syndrome by characteristic ECG findings without untoward cardiovascular events.
Adult ; Anesthesia, General ; Asia, Southeastern ; Brugada Syndrome* ; Bundle-Branch Block ; Death, Sudden ; Drug Therapy ; Electrocardiography ; Heart Diseases ; Humans ; Male ; Tachycardia ; Ventricular Fibrillation

Brugada syndrome describes a subgroup of patients at risk of ventricular fibrillation, but with no evidence of an underlying structural heart disease associated with an ECG pattern of right bundle branch block and a ST segment elevation in the right precordial leads (V1 to V3). This syndrome is familial with an autosomal dominant mode of transmission, and may be considerably more common in Southeast Asia. It is associated with a significant risk of ventricular tachyarrhythmias and sudden death, which is not effectively prevented by anti-arrhythmic drug therapy. We experienced such a case under general anesthesia for a hemi-colectomy, in a 32-year-old male patient diagnosed as having Brugada syndrome by characteristic ECG findings without untoward cardiovascular events.
Adult ; Anesthesia, General ; Asia, Southeastern ; Brugada Syndrome* ; Bundle-Branch Block ; Death, Sudden ; Drug Therapy ; Electrocardiography ; Heart Diseases ; Humans ; Male ; Tachycardia ; Ventricular Fibrillation