Pseudomonas scleral abscess is characterized by acute onset and rapid progression to scleral perforation, and has a subsequent risk of endophthalmitis. After control of infection with appropriate antibiotics, graft surgery should be performed for reinforcing the defected sclera. We performed a scleral homograft on the eye with large necrotic sclera caused by Pseudomonas aeruginosa infection after pterygium excisIon. And the results were remarkably good.
Abscess* ; Allografts* ; Anti-Bacterial Agents ; Endophthalmitis ; Pseudomonas ; Pseudomonas aeruginosa ; Pterygium* ; Sclera ; Transplants

Pheochromocytoma is a tumor which secretes catecholamine and produces remarkable hemodynamic changes during the perioperative period. It is reported that in cases where a patient with undiagnosed pheochromocytoma is operated on, the mortality rate can reach 25% to 50%. The subject in this study was a 55-year-old female patient who was diagnosed having a retroperitoneal mass which looked like a neurogenic tumor. During the manipulation, serious hypertension and tachycardia were developed. The authors at that time suspected a pheochromocytoma, interrupted the operation, and after insertion of arterial line and sodium nitroprusside infusion, the rest of the operation was restarted. After the extirpation of the tumor, as the patient suffered serious hypotension, the concentration of the inhalation agent was reduced, ephedrine was injected, the proper amount of fluid and blood were administered, and, as a result, the operation was carried out safely, and postoperative course was unremarkable.
Ephedrine ; Female ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Inhalation ; Middle Aged ; Mortality ; Nitroprusside ; Perioperative Period ; Pheochromocytoma* ; Tachycardia ; Vascular Access Devices

Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.
Adenoma ; Classification ; Incidence ; Japan ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms*

Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach.
Adenoma ; Classification ; Incidence ; Japan ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms*

BACKGROUND/AIMS: The ballooning time in endoscopic papillary large balloon dilation (EPLBD) remains controversial. The aim of this study was to evaluate the significance of the ballooning time comparing an immediate balloon deflation method with a conventional ballooning time of > 45 seconds. METHODS: Between January 2010 and December 2010, 126 patients with bile duct stones treated with EPLBD and endoscopic sphincterotomy were divided according to the ballooning time: the immediate deflation group (n=56) and the conventional inflation group (ballooning time 45s to < 60s) (n=70). RESULTS: The overall success rate and the success rate of the first attempt of ERCP (endoscopic retrograde cholangio-pancreatography) were 96.4% (54/56) and 80.4% (45/56) in the immediate group and 97.1% (68/70) and 77.1% (54/70) in the conventional inflation group. There were no statistically significant differences in the overall success and the first attempt of ERCP success rate (p=0.99, p=0.66). The frequency of mechanical lithotripsy was 0% in the immediate deflation group and 7.1% in the conventional inflation group (p=0.065). Complications occurred in 3.6% (2/56) patients in the immediate deflation group and 8.6% (4/70) patients in the conventional inflation group (p=0.298). CONCLUSIONS: The ballooning time in EPLBD does not affect the outcomes of the treatment for bile duct stones. And the feasibility of the immediate deflation method in EPLBD is acceptable.
Bile Ducts* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Humans ; Inflation, Economic ; Lithotripsy ; Sphincterotomy, Endoscopic

BACKGROUND AND OBJECTIVES: Carotid artery stenting has evolved as a potential alternative to carotid endarterectomy in patients (pts) with significant carotid artery stenosis. We evaluated the feasibility and long-term outcome of carotid artery stenting in selected pts at high surgical risk. MATERIALS AND METHODS: Between May, 1996 and September 1998 we performed carotid artery stenting at 35 lesions in 25 pts. There were 23 males and 2 fe-males. Mean age was 63.2+/-6.6 (range 54 - 77). Eight four percent (21/25) of the pts had significant coronary artery disease. Sixty four percent (16/25) of the pts had significant peripheral artery lesions. Sixty percent (15/25) of the pts had neurologic symptoms or non-disabling stroke. We used Wallstent in 32 lesions and Palmaz stent in 3 lesions. Carotid stenting was undertaken in 33 internal carotid, 1 common carotid and 1 external carotid lesions. Bil-ateral carotid stenting was undertaken in forty percent (10/25) of the pts. RESULTS: Carotid stenting was successful in all lesions. One patient died due to massive cerebral hemorrhage 3 days after carotid stenting, who had und-erwent stenting as a rescue procedure for failed endarterectomy. One major stroke developed during procedure with partial recovery. For the combined endpoint of strokes and death within 30 days of procedure, the incidence was 8% and 5.7% in terms of pts and procedures, respectively. On follow-up (12+/-7 months), we found neither neurologic complications nor death. Angiographic and/or duplex sonography which were performed at 5.5 month in all (18) eligible pts with 24 lesions revealed no evidence of stent deformity or restenosis ( 50% of diameter stenosis). Mean angiographic stenosis was 20% on follow-up angiography. CONCLUSION: Carotid artery stenting can be performed with high success and low complication rate in pts with significant carotid artery stenosis especially at high surgical risk. Follow-up clinical outcome of average 12 month was good with low restenosis rate.
Angiography ; Arteries ; Carotid Arteries* ; Carotid Stenosis* ; Cerebral Hemorrhage ; Congenital Abnormalities ; Constriction, Pathologic ; Coronary Artery Disease ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies* ; Humans ; Incidence ; Male ; Neurologic Manifestations ; Stents* ; Stroke

BACKGROUND: Transient myocardial ischemia that is recorded on Holter monitoring after a myocardial infarction is known to be a risk factor of myocardial reinfarction or death. However, it is still uncertain whether transient myocardial ischemia is a cause of ventricular arrhythmias or is simply an indicator of severe coronary artery disease. Therefore, we have studied the relation of ventricular arrhythmias to transient myocardial ischemia detected on Holter monitoring after a myocardial infarction. METHOD: We studied 40 patients with acute myocardial infarction who were performed Holter monitoring, 7 to 14 days after an attack. On Holter monitoring, we analyzed the prevalence, characteristics of transient myocardial ischemia and its relation to ventricular arrhythmias. RESULTS: 1) Among 40 patients(32 men, 8 women, mean age 53+/-13), transient myocardial ischemia was recorded in 13 patients(33%). ST elevation was observed in 2 patients, and ST depression, in 11 patients. Total episodes of transient myocardial ischemia were 65, of which only one episode was accompanied by chest pain, and total daily episodes were 4.8+/-1.4. Total daily duration of transient myocardial ischemia was 61.4+/-15.5 minutes and the duration of each transient myocardial ischemia was 15.8+/-2.1 minutes. 2) There were no significant differences in frequencies of single ventricular premature beast, bigeminy, trigeminy, ventricular couplets, and ventricular tachycardias between two groups with and without transient myocardial ischemia. CONCLUSION: It is concluded that transient myocardial ischemia on Holter monitoring after myocardial infarction is not a cause of ventricular arrhythmias.
Arrhythmias, Cardiac* ; Chest Pain ; Coronary Artery Disease ; Depression ; Electrocardiography, Ambulatory* ; Female ; Humans ; Male ; Myocardial Infarction* ; Myocardial Ischemia* ; Prevalence ; Risk Factors ; Tachycardia, Ventricular

PURPOSE: The purpose of this study is to evaluate the clinical and radiographic results of internal fixation using multiple Kirschner wires (K-wires) for the fifth metatarsal base fracture. MATERIALS AND METHODS: We retrospectively reviewed 14 patients with a displaced fifth metatarsal base fracture. We measured the distance of fracture displacement on the foot oblique radiograph pre- and post-operatively. We evaluated the clinical results using the visual analog pain scale at six weeks and three months postoperatively and the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score at six months postoperatively. RESULTS: In our series, 10 cases were zone I fracture and four cases were zone II fracture. We achieved anatomical reduction and bony union in all of our cases. The average time to bone union was 43 days. The degree of pain around the fifth metatarsal base was significantly decreased after surgery. The average AOFAS score was 95 at six months postoperatively. CONCLUSION: Multiple K-wire fixation is a relatively simple fixation method for displaced fifth metatarsal base fractures. If we place a K-wire into the medial cortex of the fifth metatarsal, we could prevent proximal migration of the K-wire.
Ankle ; Bone Wires* ; Foot ; Humans ; Metatarsal Bones* ; Pain Measurement ; Retrospective Studies

The axillary artery (AA) is often referred to as having three parts, with these divisions based on its location relative to the pectoralis minor muscle. In third part, AA gives off the subscapular (SSA), anterior circumflex humeral, and posterior circumflex humeral arteries (PCHA). However, variations in these arteries were extremely diverse. So, we observed actually some branching patterns of these arteries in this study. METHOD: We studied the pattern of SSA in 128 upper limbs from donated cadavers. RESULT: SSA was originated directly from the third and second parts of AA in 37.5% (48/128) and 4.7% (6/128), respectively. A PCHA made a common trunk with SSA in 25.8% (33/128), and these trunks arose from the third and second parts of AA in 21.1% (27/128) and 4.7% (6/128), respectively. A lateral thoracic artery (LTA) arose from SSA in 12.5% (16/128), and these were originated from the third and second parts of AA in 4.7% (6/128) and 7.8% (10/128), respectively. In 19.5% (25/128) of upper limbs, LTA, SSA, and PCHA have a common trunk, and these arose from the third and second parts of AA in 12.5% (16/128) and 7.0% (9/128), respectively. According to the branching pattern of the SSA, its origin was significantly different.
Arteries* ; Axillary Artery* ; Cadaver ; Methods ; Thoracic Arteries ; Upper Extremity

PURPOSE: Cyclin D1, which is known as a cell regulatory protein in G1-S phase, is overexpressed in 30-90% of breast cancers. Published data on the relationships between cyclin D1 and the established clinicopathologic factors of breast cancer have been controversial, so we investigated the clinical significance of cyclin D1 and its associations with established clinicopathologic factors in 103 primary breast-cancer patients. METHODS: Cyclin D1 overexpression was measured by using immunohistochemical assays, and the results were compared with clinicopathologic factors. RESULTS: Expression of cyclin D1 was detected in 60.2% (62/103) and cyclin D1 was significantly correlated with the estrogen receptor, the progesterone receptor, lymph-node metastasis, histologic grade, and nuclear grade. But there were no associations between cyclin D1 and tumor size, tumor stage, vascular invasion of tumor, DNA ploidy and S phase. CONCLUSION: We found that breast cancer with cyclin D1 overexpression was associated with predictive factors such as the estrogen receptor and the progesterone receptor. Thus, we suggest that aggressive treatment is needed in breast cancer with cyclin D1 overexpression. For cyclin D1 to become a more informative clinical prognostic factor, more prospective studies with large sample sizes are needed.
Breast Neoplasms* ; Breast* ; Cyclin D1* ; Cyclins* ; DNA ; Estrogens ; Humans ; Neoplasm Metastasis ; Ploidies ; Receptors, Progesterone ; S Phase ; Sample Size