Management of unstable angina has evolved progressively. Although coronary angioplasty has recently shown to be relatively safe and effective treatment strategy for unstable angina, aute occlusion due to intracoronary thrombus accumulation during or immediately after coronary angioplasty remains to be one of the most common serious complication of this procedure. Intracoronary urokinase has been used to treat flow-limiting intracoronary thrombus accumulation that complicated initial successful percutaneous transluminal coronary angioplasty(PTCA) in unstable angina patient, which made the patient stablilzed. Thus in patient with flow-limiting intracoronary thrombus accumulation complicating PTCA, intracoronary urokinase proved to be highly effective in restoring vessel patency and preventing acute myocardial infarction. We report a case of successful revascularization with intracoronary infusion of urokinase in patient with intracoronary thrombus accumulation that complicated PTCA.
Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary* ; Humans ; Myocardial Infarction ; Thrombosis ; Urokinase-Type Plasminogen Activator

Monoclonal gammopathy occurs in one-third of the patients with mucosa-associated lymphoid tissue lymphoma (MALT lymphoma). However, monoclonal gammopathy has been rarely reported in Korea. Paraprotenemia accompanying MALT lymphoma is strongly correlated with involvement of the bone marrow, and this involvement leads to the progression of the disease. Here, we present a case of a 66-yr-old man diagnosed with IgM monoclonal gammopathy and stage IV extranodal marginal zone lymphoma of the small intestine, with the involvement of the bone marrow.
Aged ; Antineoplastic Agents/therapeutic use ; Bone Marrow/pathology ; Drug Therapy, Combination ; Electrophoresis, Polyacrylamide Gel ; Humans ; Immunoglobulin M/analysis ; Intestinal Neoplasms/complications/drug therapy/*pathology ; Lymphatic Metastasis ; Lymphoma, B-Cell, Marginal Zone/complications/drug therapy/*pathology ; Male ; Neoplasm Staging ; Paraproteinemias/blood/complications/*pathology ; Positron-Emission Tomography ; Tomography, X-Ray Computed

No abstract available.
Echocardiography ; Myocardial Infarction*

BACKGROUND/AIMS: Propofol sedation is increasingly being used when performing upper gastrointestinal endoscopy because of its rapid onset and good recovery profile. For achieving safe sedation during endoscopy, close monitoring of the vital signs is necessary because of the sedation's potentially serious adverse effects. There are only a few studies on the induction of sedation with using propofol for endoscopy in Korea. The present study was undertaken to evaluate the adequate initial injected dose of propofol for achieving safe and effective sedation when performing upper gastrointestinal endoscopy in Koreans. METHODS: From March 2008 to July 2008, 150 subjects who visited Kwangju Christian Hospital were randomized into 3 groups. An initial bolus dose of 0.5 mg/kg, 1.0 mg/kg and 1.5 mg/kg of propofol was allocated to groups A, B and C, respectively. The effectiveness and safety profiles of each injected dose of propofol were prospectively assessed by measuring various parameters of the vital signs and the adverse events. RESULTS: Group C had a significantly shorter induction time and the patients in group C did not require additional injections of propofol without increasing adverse events, as compared to that of the other 2 groups. CONCLUSIONS: 1.5 mg/kg of propofol was found to be more appropriate than 0.5 mg/kg or 1.0 mg/kg of propofol as the initial injected dose for induction of sedation during performance of upper gastrointestinal endoscopy in Koreans.
Endoscopy ; Endoscopy, Gastrointestinal ; Humans ; Korea ; Propofol ; Prospective Studies ; Vital Signs

PURPOSE: This study was conducted to evaluate the technical feasibility and safety of robotic extended lateral pelvic lymph node dissection (LPLD) in patients with advanced low rectal cancer. METHODS: A review of a prospectively-collected database at Kyungpook National University Medical Center from January 2011 to November revealed a series of 8 consecutive robotic LPLD cases with a preoperative diagnosis of lateral node metastasis. Data regarding patient demographics, operating time, perioperative blood loss, surgical morbidity, lateral lymph node status, and functional outcome were analyzed. RESULTS: In all eight patients, the procedures were completed without conversion to open surgery. The mean operative time of extended pelvic node dissection was 38 minutes (range, 20 to 51 minutes), the mean number of lateral lymph nodes harvested was 4.1 (range, 1 to 13), and 3 patients (38%) were found to have lymph node metastases. Postoperative mortality and morbidity were 0% and 25%, respectively, but, there was no LPLD-related morbidity. The mean hospital stay was 7.5 days (range, 5 to 12 days). CONCLUSION: Robotic LPLD is safe and feasible, with the advantage of being a minimally invasive approach. Further large-scale studies comparing robotic and conventional surgery with long-term follow-up evaluation are needed to confirm these findings.
Academic Medical Centers ; Blood Loss, Surgical ; Conversion to Open Surgery ; Demography ; Humans ; Imidazoles ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Nitro Compounds ; Operative Time ; Rectal Neoplasms

The maxillary anterior teeth play an important role in esthetics. The esthetic of maxillary anterior teeth is closely related to tooth morphology and also harmony with gingiva. Precise diagnosis and treatment plan are essential to satisfy patient's demand, and sometimes surrounding soft tissue management is involved to achieve the goal. Gingivectomy can be considered as one method to make esthetic restoration possible. As well as esthetics, function has to be considered in maxillary anterior teeth restoration. Definitive cast of abutment and diagnostic cast waxed up labially were superimposed with model scanner, so can provide former comfortable occlusion. This case report demonstrates functional and esthetic improvements of two patients through gingivectomy and the data of superimposed image of casts.
Diagnosis ; Esthetics ; Gingiva ; Gingivectomy ; Humans ; Methods ; Tooth

PURPOSE: Rectovaginal fistula (RVF) after low anterior resection for rectal cancer is a type of anastomotic leakage. The aim of this study was to find out the difference of leakage, according to RVF presence or absence and to identify the optimal strategy for RVF. METHODS: All female patients who underwent low anterior resection with colorectal anastomosis or coloanal anastomosis (n = 950) were retrospectively analyzed. Patients' demographics and perioperative outcomes were analyzed between the RVF group and leakage without the RVF (nRVF) group. We performed 4 types of procedures—primary repair, diverting stoma, redo coloanal anastomosis (RCA), and conservative procedure—to treat RVF, and calculated the success rates of each type of procedure. RESULTS: The leakage occurred in 47 patients (4.9%). Among them, 18 patients (1.9%) underwent an RVF and 29 (3.0%) underwent nRVF. The RVF group received more perioperative radiotherapy (27.8% vs. 3.4%, P < 0.015) and occurred late onset after surgery (181.3 ± 176.4 days vs. 23.2 ± 53.6 days, P < 0.001) more than did the nRVF group. In multivariate analysis for the risk factor of the RVF group, the RVF group was statistically associated with less than 5 cm of anastomosis more than was the no-leakage group. A total of 35 procedures were performed in 18 patients with RVF for treatment. RCA showed satisfactory success rates (85.7%, n = 6) and, primary repair (transanal or transvaginal) showed acceptable success rate (33.3%, n = 8). CONCLUSION: After low anterior resection for rectal cancer, RVF was strongly correlated with a lower level of primary tumor location. Among the patients who underwent leakages, receipt of perioperative radiotherapy was significantly high in the RVF group than that of the nRVF group. Additionally, this study suggests that RCA might be considered another successful treatment strategy for RVF.
Anastomotic Leak ; Colectomy ; Demography ; Female ; Humans ; Multivariate Analysis ; Radiotherapy ; Rectal Neoplasms ; Rectovaginal Fistula ; Retrospective Studies ; Risk Factors

PURPOSE: Although the overall survival and recurrence rates after open or laparoscopic surgery for colorectal cancer are similar, the potential oncological benefits of laparoscopic surgery have not been established. This study compared the effects of the two surgical approaches (open and laparoscopic) on the intraoperative inferior mesenteric vein (IMV) carcinoembryonic antigen (CEA) levels in patients who were undergoing open or laparoscopic surgery for sigmoid colon and rectal cancer. METHODS: Between December 2005 and July 2008, a total of 37 patients were enrolled in this study. Twenty one patients underwent open surgery and 16 patients were operated on laparoscopically. The baseline peripheral CEA level was measured preoperatively. The IMV blood was taken before and after mobilization of the cancer-bearing bowel segment and the CEA levels in the two groups were compared. RESULTS: The baseline CEA levels in the peripheral vein were similar in the two groups. After mobilization, the overall CEA level was elevated. The median pre-mobilization CEA levels of the open and laparoscopic group were 2.3 (range: 1.2~3.7) ng/ml and 1.5 (range: 1.0~2.6) ng/ml, respectively. Hence, the degree of CEA elevation after mobilization was significantly higher in the open surgery group compared with that of the laparoscopic approach (4.2 vs. 1.6, respectively, p=0.004). CONCLUSION: The CEA levels measured from the IMV after mobilization were elevated to a lesser degree after laparoscopic mobilization of the cancer-bearing bowel segment, as compared with that of open surgery. However, the long term oncological effects need to be examined by conducting longer, larger scale studies.
Carcinoembryonic Antigen ; Colon, Sigmoid ; Colorectal Neoplasms ; Humans ; Laparoscopy ; Mesenteric Veins ; Recurrence ; Veins

Primary lymphoma of the small intestine is commonly diagnosed after serious complications, such as bowel perforation and bleeding. It results from vague symptoms and the lack of routine screening programs due to low prevalence. Ileal intubation can be used for screening and diagnosis of various small intestinal diseases. However, the value of routine terminal ileum intubation during colonoscopy remains controversial because of its low diagnostic yield. In Korea, there has been no report of asymptomatic primary lymphoma of the small intestine discovered through ileal intubation during colonoscopy. Thus, we report a case of asymptomatic primary lymphoma of the small intestine diagnosed incidentally through terminal ileum intubation during screening colonoscopy, and we review the literature on small intestinal lymphoma and the value of routine ileal intubation.
Colonoscopy* ; Diagnosis ; Endoscopy ; Hemorrhage ; Ileum ; Intestinal Diseases ; Intestine, Small ; Intubation* ; Korea ; Lymphoma* ; Mass Screening* ; Prevalence

PURPOSE: Treatment of patients with para-aortic lymph node metastasis from colorectal cancer is controversial. The goal of this study was to investigate the technical feasibility of laparoscopic intrarenal para-aortic lymph node dissection in patients with colorectal cancer and clinically suspected para-aortic lymph node dissection. METHODS: The inclusion criteria for the laparoscopic approach were patients with infrarenal para-aortic lymph node metastasis from colorectal cancer. Patients who had any other distant metastatic lesion or metachronous para-aortic lymph node metastasis were excluded from this study. Perioperative outcomes and survival outcomes were analyzed. RESULTS: Between November 2004 and October 2013, 40 patients underwent laparoscopic para-aortic lymph node dissection. The mean operating time was 192.3 +/- 68.8 minutes (range, 100-400 minutes) and the mean estimated blood loss was 65.6 +/- 52.6 mL (range, 20-210 mL). No patient required open conversion. The postoperative complication rate was 15.0%. Sixteen patients (40.0%) had pathologically positive lymph nodes. In patients with metastatic para-aortic lymph nodes, the 3-year overall survival rate and disease-free survival rate were 65.7% and 40.2%, respectively. CONCLUSION: The results of our study suggest that a laparoscopic approach for patients with colorectal cancer with metastatic para-aortic lymph nodes can be a reasonable option for selected patients.
Colorectal Neoplasms* ; Disease-Free Survival ; Humans ; Laparoscopy ; Lymph Node Excision* ; Lymph Nodes* ; Neoplasm Metastasis ; Postoperative Complications ; Survival Rate