Congenitally corrected transposition of the great arteries is a rate congenital heart disease. In this discase, there is discordance between both the atria and ventricles and the ventricles and great vessels. The anatomic left ventricle lies on the rightside and is connected to the pulmonic trunk, whereas the anatomic right ventricles lies on the left side and functions as the systemic ventricle. Most patients have associated another cardiac anomalies and conduction disturbance.Less commonly, ventricular extrasystoles, paroxismal supraventricular tachycardia, WPW preexitaion and atrial fibrillation may be obserced. We report an adult case of congenitally corrected transposition of great arteries associated with paroxysmal atrial fibrillation and heart failure.
Adult* ; Arteries* ; Atrial Fibrillation* ; Chymopapain ; Heart Defects, Congenital ; Heart Failure* ; Heart Ventricles ; Heart* ; Humans ; Tachycardia, Supraventricular ; Transposition of Great Vessels ; Ventricular Premature Complexes

No abstract available.
Hypothyroidism* ; Myasthenia Gravis*

Repeated surgery of the lumbar spine after lumbar discectomy was not uncommon. Total 817 cases of lumbar disorders were carried out surgical intervention in author's clinic from Jan. 1993. to May 1997. Among them, 82 cases were reoperated cases after lumbar disc surgery. The causes, methods and outcome of reoperation were reviewed. The most common causes of reoperation was epidural adhesion, and the most frequent method of reoperation was the interbody fusion with adhesiotomy. Epidural fibrosis was the major problem and must be studied forward for preventing reoperaion.
Diskectomy ; Fibrosis ; Reoperation* ; Spine

Eosinophilic gastroenteritis is a rare clinicopathologic entity of an unknown etiology with a variety of digestive symptoms. The clinical features depend on the site of eosinophilic infiltration and affected layer of intestinal wall. Diagnostic criteria include demonstration of eosinophilic infiltration of the affected bowel wall, lack of evidence extra-intestinal disease, and exclusion of various disorders that could mimic similar conditions. We experienced a 54-year-old man with 6 months history of severe intermittent abdominal colic associated with malnutrition and weight loss. Abdominal computed tomography showed mass like lesion at terminal ileum, which caused partial small bowel obstruction. So, we carried out laparotomy, and then segmental resection and ileo-ascending colostomy were done because of small bowel obstrucion. We diagnosed the case as transmural type of eosinophilic gastroenteritis. We report this case with a brief review of the literatures.
Colic ; Colostomy ; Eosinophils* ; Gastroenteritis* ; Humans ; Ileum ; Laparotomy ; Malnutrition ; Middle Aged ; Weight Loss

The gastrointestinal rnanifestations associated with antiphospholipid antibodies include Budd-Chiari syndroame, hepatic infarction, portal hypertension, pancreatitis, intestinal infarction, perforation, bleeding and ulceration. A 40-year old man, without prior thrombotic event, presented with severe abdominal pain for 3 days and septic shock. Multiple mesenteric venous thrombosis and colonic congestion were suggested by abdominal CT and angiography. Gastroendoscopy revealed esophageal varix and congestive gastropathy. Laboratory tests disclosed postive antiphospholipid antibodies, anti-HCV antibodies, HCV-PCR, prolonged PT, aPTT, thrombocytopenia and had no evidences of SLE and other connective tissue diseases. He was diagnosed as mutiple mesenteric thrombosis and portal hypertension associated with antiphospholipid antibodies in hepatitis C virus infection. He was improved with the antibiotics and intravenous vasopressors. He have had no other thrombotic events until one year after discharge.
Abdominal Pain ; Adult ; Angiography ; Anti-Bacterial Agents ; Antibodies, Antiphospholipid ; Colon ; Connective Tissue Diseases ; Esophageal and Gastric Varices ; Estrogens, Conjugated (USP) ; Hemorrhage ; Hepacivirus ; Hepatitis C Antibodies ; Hepatitis C* ; Hepatitis* ; Humans ; Hypertension* ; Hypertension, Portal ; Infarction ; Pancreatitis ; Shock, Septic ; Thrombocytopenia ; Thrombosis* ; Tomography, X-Ray Computed ; Ulcer ; Venous Thrombosis

Familial isolated primary hyperparathyroidism(FIPH) is associated with multiple endocrine neoplasia type 1 (MEN1) syndrome, primary hyperparathyroidism accompanied by jaw-tumor syndrome, and familial hypocalciuric hypercalcemia. FIPH may be an early stage of MEN1 or an allelic variant of MEN1. Thymic carcinoid tumor is a rare tumor in MEN1 syndrome. Here, the authors report the case of a 40-year-old man diagnosed with recurrent thymic carcinoid tumor and FIPH. Both the patient and his elder sister had been previously diagnosed to have FIPH with a novel frameshift mutation in the MEN1 gene. Initially, the patient underwent thymectomy because of an incidental finding of a mediastinal mass in his chest X-ray, and had remained asymptomatic over the following 4 years. Pancreas computed tomography conducted to evaluate MEN1 syndrome revealed anterior and middle mediastinal masses, and resultantly, massive mass excision was performed. Histological findings disclosed atypical carcinoids with infiltrative margins. In view of the thymic carcinoid tumor relapse that occurred in this patient, the authors recommend that regular pancreas and pituitary imaging studies be conducted for FIPH associated with a MEN1 gene mutation.
Adult ; Carcinoid Tumor* ; Frameshift Mutation ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Incidental Findings ; Multiple Endocrine Neoplasia Type 1 ; Pancreas ; Recurrence ; Siblings ; Thorax ; Thymectomy

Abdominal wall endometriosis secondary to cesarean section is very rare condition, being reported in less than 0.5% of patients undergoing cesarean section. Moreover, parenchymal pulmonary endometriosis is a rare gynecologic problem, characterized by cyclic hemoptysis. We experienced 38 years old female patient who had had cyclically appearing painful abdominal wall mass after cesarean section pathologically proven endometriosis and 33 year-old female patient with recurrent catamenial hemoptysis localized with CT scanning, and then treated with GnRH agonist. So, we present two cases with a brief review of literatures.
Abdominal Wall ; Adult ; Cesarean Section* ; Cicatrix* ; Endometriosis* ; Female ; Gonadotropin-Releasing Hormone ; Hemoptysis ; Humans ; Pregnancy ; Tomography, X-Ray Computed

BACKGROUND: In latent type of hypertrophic obstructive cardiomyopathy, there is no pressure gradient at rest in left ventricular outflow tract(LVOT), but it develops with provocation. Dobutamine increase myocardial contractility and may inducce outflow tract obstruction. To evaluate the usefulness of dobutamine induced outflow tract obstruction as a provocation test, nine patients with latent obstructive cardiomyopathy were studied. METHOD: 680 cases of dobutamine stress echocardiography were reviewed. Nine patients developed late peaking outflow velocity pattern in response to dobutamine infusion(inducible group). Ten patients developed early peaking velocity pattern were included as control group. Left ventricular dimension, outflow tract diameter were measured, and pattern of septal hypertrophy was classified. Changes of peak velocity and acceleration time/ejection time ratio (AT/ET) were measured at rest and peak dose dobutamine. RESULTS: The peak outflow velocity at rest was not different in both groups(1.49±0.45, 1.18±0.11m/sec). Peak velocity and AT/ET ratio were significantly increased in inducible group(4.2±0.9m/sec, 0.66±0.17), but no significant changes were noted in control group. Patients with inducible group had greater septal thickness, smaller outflow tract diameter and greater prevalence of septal bulge morphology. CONCLUSION: These results suggest that dobutamine stress Doppler echocardiography could be a useful provocation test to diagnosis of latent obstructive cardiogyopathy.
Acceleration ; Cardiomyopathies ; Cardiomyopathy, Hypertrophic ; Diagnosis ; Dobutamine ; Echocardiography, Doppler ; Echocardiography, Stress ; Humans ; Hypertrophy ; Methods ; Prevalence

OBJECTIVE: This study is to investigate whether Positron Emission Tomography (PET) is useful for determining pathologic complete response in patients with ovarian carcinoma who had a clinical complete response after primary treatment. METHODS: FDG-PET scans were performed in 10 patients with advanced ovarian cancer (4 patients with stage IIC, 6 patients with IIIC), who showed complete response with cytoreductive surgery and 6 cycles of post-operative adjuvant Cisplatin-based combination chemotherapy. FDG-PET scan was obtained with GE Advance Scanner, beginning at 50 minutes after injection of 370-555 MBq (10-15 mCi) of 18F FDG. Uptakes exceeding 3.5 SUV (Standardized Uptake Value) or larger than surrounding tissue were determined as a positive findings. Second-look laparotomy was undertaken within median 4 days after FDG-PET scanning. RESULTS: The mean age of the patients was 45 years and serous cystadenocarcinoma was most common histologic type. None showed active lesion in pelvis or abdomen with FDG-PET scan (SUV: >3.5 kg/ml), however, 5 patients (50%) showed residual tumors on multiple biopsy during second look operation. One patient showed positive lesion in lung on FDG-PET scan, which was confirmed to have metastatic lesion. CONCLUSION: FDG-PET scan is not useful for detection of small ovarian cancer lesions in pelvis and abdomen and cannot substitute for second-look operation to determine pathologic complete response.
Abdomen ; Biopsy ; Cystadenocarcinoma, Serous ; Drug Therapy, Combination ; Humans ; Laparotomy ; Lung ; Neoplasm, Residual ; Ovarian Neoplasms* ; Pelvis ; Positron-Emission Tomography

BACKGROUND/AIMS: Patient-controlled sedation (PCS) allows the patients to titrate the dosages of sedative drug according to their needs. The objective of this study was to compare the safety and the efficacy of nurse-administered propofol sedation (NAPS) with those of PCS. METHODS: Eighty one patients were randomly assigned to two groups. All patients received meperidine 25 mg and propofol 40 mg as an initial dose for sedation. Patients in PCS group were subsequently infused with propofol 15 mg over 80 seconds through infusion pump whenever they required. Patients in NAPS group were injected with 10~20 mg propofol by nurse with supervision by endoscopist. The dosage of propofol, cardiopulmonary parameters, procedure time, sedation score, pain score, the patients' and endoscopists' satisfaction scores were assessed. RESULTS: With regard to blood pressure, pulse rate and oxygen saturation, serious complications were not observed. Especially, there was no significant difference of mean total dose between two groups (NAPS group and PCS group received 76.7+/-24.7 mg and 82.5+/-26.6 mg respectively). Pain score was higher in woman than in man (p=0.03). CONCLUSIONS: 1.2~1.5 mg/kg of propofol with small dose of opioid during colonoscopy was effective and safe. NAPS was more practical and useful method of sedation than PCS during colonoscopy.
Blood Pressure ; Colonoscopy* ; Female ; Heart Rate ; Humans ; Infusion Pumps ; Meperidine ; Organization and Administration ; Oxygen ; Propofol*