A case of congenital mutilocular intrapulmonary bronchogenic cyst which was undifferentiated radiographicallyfrom congenital lobar emphysema, large pneumatocele, or tension pneumothoarax is reported. The cyst occupied about4/5 of left lung fields and displaced the mediastinal structures to right moderately and compressed the remainingleft lungs severely.
Bronchogenic Cyst ; Emphysema ; Lung

Rectovagianl fistula(RVF) is a congenital or acquired communication between the two epithelial-lined surface of the rectum and the vagina. We present our experience with 62 patients with RVF. There were various etiologies and repair methods of rectovaginal fistula. The purpose of this study was to retospectively review the clinical course of the patients we treated and to evaluate the efficacy of various treatment options. The mean age was 40.5 yr, The type of RVF was classified to one of two(simple and complex), according to their location, size and etiology. RVF was developed most commonly after radiotherapy due to cervical cancer(n=17), then after pelvic surgery due to malignancy(n=16), obstetric trauma after episiotomy at delivery(n=7), congenital malformation(n=4), inflammatory bowel disease(n=1), Bechet's disease(n=1), infections such as perianal fistula or abscess(n=2), direct invasion of carcinoma(n=3), after chemotherapy(n=1), and idiopathic(n=6). Three cases of them associated with rectovesicovaginal fistula. Surgical therapeutic option was divided to local repair, abdominal approach and tissue transposition by the type of RVF. Most simple RVFs were repaired with local approach through the vagina or rectum. Most complex RVFs were repaired through abdominal approach or tissue transposition. With an average follow up of 20 months, the treatment results were as follows: completely healed(n=36, 58.1%), persistent symptom(n=6, 9.7%), recurrence after repair(n=5, 8.1%), loss of search or death(n=15, 24.1%). Therefore we assist that the management of RVF depends on size, location, and cause. anal sphincter function and overall health status of the patient. Careful preoperative assessment of the fistula, surrounding tissues, and anal sphincter and exclusion of associated disease are essential. With through evaluation, thoughtful consideration of treatment options, and meticulous operative technique, patient can be assured of an optimal outcome.
Anal Canal ; Episiotomy ; Female ; Fistula ; Follow-Up Studies ; Humans ; Radiotherapy ; Rectovaginal Fistula* ; Rectum ; Recurrence ; Vagina

As is well known, myxoma of the heart is very rare(incidence 0.03%), constituting nearly 50% of all primary cardiac tumors. It is important because it can be abolished by surgical removal but usually fatal if unrecognized or untreated. Recently a wider use of echocardiogram as the screening test of valve lesions can be expected to increase the number of myxomas found preoperatively. We have experienced a case of bilateral atrial myxoma which simulated mitral valvular disease clinically and had typical three cardinal manifestations such as obstructive, embolic and constitutional symptoms. The patients was 39 years old woman. The left atrial myxoma was diagnosed preoperatively by echocardiography and cardiac angiography and the remainder during open heart surgery under the E.C.C. Both of them were removed successfuly and confirmed as typical myxoma microscopically. This is the first case report of bilateral atrial myxoma in Korea to our knowledge.
Adult ; Angiography ; Echocardiography ; Female ; Heart ; Heart Neoplasms ; Humans ; Korea ; Mass Screening ; Myxoma* ; Thoracic Surgery

PURPOSE: The conventional surgical treatment for patients with potentially curable low rectal cancer is abdominoperineal resection. Recently there has been increasing interest in the use of preoperative radiation therapy and sphincter-saving procedure as primary therapy for selected low rectal cancers. We report our institutional experience with this approach. METHODS: From 1995 to 1997, Twelve patients with resectable distal rectal cancer were offered sphincter-saving procedure, excluding the patients whose pretreatment tumor presentation demonstrated fixation to anal sphincter or puborectalis muscle. The distance from the anal verge to the distal tumor margin at initial diagnosis ranged from 1 to 5 cm. Patients received a median 50.4 Gy and chemotherapy Surgery was carried out 4 to 8 weeks after radiation. RESULTS: No patient had toxic reaction that required interruption of chemoradiation. Four patients (33%) had complete pathologic response, but one patient with complete clinical response had residual cancer. Seven patients underwent hand-sewn coloanal anastomosis and five patients transanal excision en bloc. All patients were able to successfully undergo a sphincter-saving procedure. With a mean follow-up of 23 months (range, 6~32), the authors noted no recurrence or complication. Sphincter function was good in 92%. Daily bowel movements was two (range, 1~10). CONCLUSION: Preoperative chemoradiation appears promising in terms of better patient compliance, lesser toxicity, and downstaging tumor, making the sphincter-saving procedure feasible in carefully selected cases. Surgical resection remains essential to confirm and to achieve complete clinical remission. The results of preoperative chemoradiation and sphinctersaving procedure are encouraging, but more experience is needed to determine whether this approach ultimately has similar local control and survival rate compared to standard surgery.
Anal Canal ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Neoplasm, Residual ; Patient Compliance ; Rectal Neoplasms* ; Recurrence ; Survival Rate

OBJECTIVE: Dorsal root entry zone(DREZ) operation has been the most common surgical treatment for paraplegic pain in the past, but the results differ according to the patients. In this study, we attempt to analyze the results from the patients by the different patterns of the pain before the surgery. METHODS: A total of twelve paraplegic patients have undergone a total of thirteen radiofrequency DREZ coagulation procedures between April 1994, and March 2003. The patients were divided depending on patients' subjective description on the character, frequency, and range of pain. RESULTS: The patients were divided into the two groups, postoperatively: improvement of more than 75% of pain was defined as treatment success, and any level less than 75% of improvement was defined as treatment failure. Eight of the ten mechanical pain group cases were regarded as treatment success, and remaining two cases with thermal type of pain as treatment failure. Also, one case with combined pain failed to obtain any favorable outcome. Intermittent pain group (6 of 7 cases), continuous pain group (2 of 6 cases), and localized pain group (7 of 11 cases) showed treatment success, respectively. However, diffuse pain group (1 of 2 cases) resulted in poor outcome. CONCLUSION: Radiofrequency DREZ coagulation is more effective in managing intermittent and/or mechanical pain than continuous and/or thermal pain in the paraplegic patients following spinal cord injury.
Humans ; Spinal Cord Injuries ; Spinal Nerve Roots* ; Treatment Failure

The relationship between infective endocarditis and mycotic aneurysm formation appers clear : In about two to ten percent of patients with infective endocarditis harbor septic intracranial aneurysms. But the pathogenesis, natural course and management of these lesions remains controversial. Aggressive medical treatment of the underlying infected cardiac valve or surgical replacement therapy have significantly reduced the morbidity and mortality rates associated with infective endocarditis. Clinical predictors of mycotic aneurysm, especially neurologic prodromes prior to rupture have been ill-defined since most series contain few patients or include patients with infective aneurysms who have no infective endoarditis. Similarly there has been no consensus regarding the indications and timing of cerebral angiography in patients with infective endocarditis. We have experienced a case of cerebral mycotic aneurysm complicated with subarachnoid hemorrhage due to infective endocarditis in a 29 year-old female patient, who admitted to our hospital because of the pain and paralysis of sudden onset in right forearm, which was diagnosed by echocardiography, brain computed tomography and 4-vessel cerebral angiography. The patient died of sudden rupture of mycotic aneurysm in the 7th hospital day despite intensive medical treatment. We report one case of cerebral mycotic aneurysm with a brief of literature.
Adult ; Aneurysm ; Aneurysm, Infected* ; Brain ; Cerebral Angiography ; Consensus ; Echocardiography ; Endocarditis* ; Female ; Forearm ; Heart Valves ; Humans ; Intracranial Aneurysm ; Mortality ; Paralysis ; Rupture ; Subarachnoid Hemorrhage*

No abstract available.

OBJECTIVE: To evaluate the effects of cardiac rehabilitation (CR) on functional capacity in obese and non-obese patients who have suffered acute myocardial infarction (AMI). METHODS: Overall, 359 patients who have suffered AMI, and were referred for CR after percutaneous coronary intervention from 2010 to 2015 and underwent an exercise tolerance test before and after phase II CR were included in this study. The patients were divided into two groups: obese group with body mass index (BMI) ≥25 kg/m² (n=170; age, 54.32±9.98 years; BMI, 27.52±2.92 kg/m²) and non-obese group with BMI <25 kg/m² (n=189; age, 59.12±11.50 years; BMI 22.86±2.01 kg/m²). The demographic characteristics and cardiopulmonary exercise capacity of all patients were analyzed before and after CR. RESULTS: There were significant changes in resting heart rate (HR(rest)) before and after CR between the obese and non-obese groups (before CR, p=0.028; after CR, p=0.046), but other cardiopulmonary exercise capacity before and after CR was not different between the groups. HR(rest) (p<0.001), maximal metabolic equivalents (METs, p<0.001), total exercise duration (TED, p<0.001), and maximal oxygen consumption (VO(2max), p<0.001) improved significantly in the obese and non-obese groups after CR. No difference in the change in the cardiopulmonary exercise capacity rate was detected between the groups. CONCLUSION: CR may improve functional capacity in patients who suffered AMI regardless of their obesity.
Body Mass Index ; Exercise Test ; Exercise Tolerance ; Heart Rate ; Humans ; Metabolic Equivalent ; Myocardial Infarction* ; Obesity ; Oxygen Consumption ; Percutaneous Coronary Intervention ; Rehabilitation*

BACKGROUND: For the diagnosis of malaria, examination of blood smear slides by light microscopy is used as standard, and commercial kits detecting malarial antibodies and antigens are available, and molecular methods such as polymerase chain reaction (PCR) are used additionally. But, these diagnostic methods can be performed when clinicians request them, so problems of misdiagnosing the patients who are not suspected malaria may be occurred. METHODS: In 42 Korean patients with malaria, the author analyzed the characteristic signals of malaria using granularity (90 degrees depolarized) versus lobularity (90 degrees polarized) graph of Cell-Dyn 4000 (CD4000) automatic hematologic analyzer. And, the author examined the presence of malaria in 421 random samples by CD4000 and Giemsa stain. RESULTS: The usefulness of CD4000 in diagnosing malaria are as follows, 93.0% sensitivity, 99.3% specificity, 93.0% positive-predictive value, and 99.3% negative-predictive value. CONCLUSION: CD4000 automatic hematology analyzer has high diagnostic sensitivity and specificity in diagnosing malaria. Because complete blood count (CBC) is the routine test for most patients, this method has advantage of time and cost effectiveness and can even detect malaria in unsuspected cases.
Antibodies ; Azure Stains ; Blood Cell Count ; Cost-Benefit Analysis ; Diagnosis* ; Hematology* ; Humans ; Malaria* ; Microscopy ; Polymerase Chain Reaction ; Sensitivity and Specificity

The authors present a case of respiration arrest after posterior lumbar interbody fusion. This rare complication occurred because of the tension pneumoperitoneum and pneumomediastinum. We report the pathophysiology and treatments.
Mediastinal Emphysema* ; Pneumoperitoneum* ; Pneumothorax* ; Respiration