PURPOSE: To demonstrate the clinical usefulness of ultrasonography for detecting esophageal varices. MATERIALS AND METHODS: In 20 cases of esophaged varix, the authors analysed the transabdominal ultrasono-graphicfindings of the esophagogastric junction and compared mural thickness, the anteroposterior diameter of theesophagus, and the echogenic nature of the esophageal mucosal layer with those of 78 normal patients. RESULTS:The anterior and posterior mural thickeness of normal esophagus was 2.2 +/-0.7 and 2.4 +/-0.8mm re-spectively, butfor variceal esophagus, the corresponding readings were 5.9 +/-1.3 and 5.2 +/-1.3mm respective-ly. Theanteroposterior diameter of normal esophagus was 7.9 +/-2.1mm and that of variceal esophagus was 1 4 . 0 +/-1.8mm.There was a stastically significant difference (p<0.01) in mural thickness and anteroposterior diameter of theesophagus between a normal and variceal patient with regard to change of echogenic nature at the esphagogastricjunction. Normal esophageal mucosa showed a thin and uniform echogenic line, but for variceal mucosa, theechogenic pattern was irregular, tortuous and thick. CONCLUSION: The athors believe that transabdominal US ishelpful for detecting esophageal varices in patients with liver cirrhosis and UGI bleeding. Important clinicallyuseful sonographic findings in diagnosing e-sophageal varix are as follows: 1) mural thickness more than 6mm; 2)anteroposterior diameter of the esopha-gus of more than 15mm; 3) irregular, tortuous and thickened echogenicmucosa.
Esophageal and Gastric Varices* ; Esophagogastric Junction ; Esophagus ; Hemorrhage ; Humans ; Liver Cirrhosis ; Mucous Membrane ; Reading ; Ultrasonography ; Varicose Veins

Endovascular aortic repair (EVAR) was relatively safe, and became a widely performed procedure. If aortic dissection (AD) occurred in patient with previous EVAR, it could cause fatal complications like endograft collapse. Surgical treatment was limited in this situation for comorbidities and complex anatomies. Here we report a rare case of acute type B AD developed following trans-radial coronary intervention in a patient with previous EVAR of abdominal aortic aneurysm, which was treated with thoracic EVAR.
Aneurysm ; Aorta ; Aortic Aneurysm, Abdominal* ; Comorbidity ; Endovascular Procedures ; Humans

No abstract available.
Carotid Arteries ; Stents

PURPOSE: Coronary artery spasm (CAS) and diabetes mellitus (DM) are implicated in endothelial dysfunction, and insulin resistance (IR) is a major etiological cause of type 2 DM. However, the association between CAS and IR in non-diabetic individuals has not been elucidated. The aim of the present study was to evaluate the impact of IR on CAS in patients without DM. MATERIALS AND METHODS: A total of 330 eligible patients without DM and coronary artery disease who underwent acetylcholine (Ach) provocation test were enrolled in this study. Inclusion criteria included both hemoglobin A1c < 6.0% and fasting glucose level < 110 mg/dL without type 2 DM. Patients were divided into quartile groups according the level of homeostasis model assessment of insulin resistance (HOMA-IR): 1Q (n=82; HOMA-IR < 1.35), 2Q (n=82; 1.35≤HOMA-IR < 1.93), 3Q (n=83; 1.93≤HOMA-IR < 2.73), and 4Q (n=83; HOMA-IR≥2.73). RESULTS: In the present study, the higher HOMA-IR group (3Q and 4Q) was older and had higher body mass index, fasting blood glucose, serum insulin, hemoglobin A1c, total cholesterol, and triglyceride levels than the lower HOMA-IR group (1Q). Also, poor IR (3Q and 4Q) was considerably associated with frequent CAS. Compared with Q1, the hazard ratios for Q3 and Q4 were 3.55 (95% CI: 1.79–7.03, p < 0.001) and 2.12 (95% CI: 1.07–4.21, p=0.031), respectively, after adjustment of baseline risk confounders. Also, diffuse spasm and accompanying chest pain during Ach test were more strongly associated with IR patients with CAS. CONCLUSION: HOMA-IR was significantly negatively correlated with reference diameter measured after nitroglycerin and significantly positively correlated with diffuse spasm and chest pain.
Acetylcholine ; Blood Glucose ; Body Mass Index ; Chest Pain ; Cholesterol ; Coronary Artery Disease ; Coronary Vessels* ; Diabetes Mellitus ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin Resistance* ; Insulin* ; Nitroglycerin ; Spasm* ; Triglycerides

We report herein the optical coherence tomography (OCT) and stent boost imaging guided bioresorbable vascular scaffold (BVS) implantation for right coronary artery (RCA) chronic total occlusion (CTO) lesion. The gold standard for evaluating BVS expansion after percutaneous coronary intervention is OCT. However, stent boost imaging is a new technique that improves fluoroscopy-based assessments of stent overlapping, and the present case shows clinical usefulness of OCT and stent boost imaging guided ‘overlapping’ BVS implantation via antegrade approach for a typical RCA CTO lesion.
Coronary Vessels ; Percutaneous Coronary Intervention ; Stents* ; Tomography, Optical Coherence*

This animal experimental study reports one case of hybrid transvaginal natural orifice transluminal endoscopic surgery (NOTES) for nephrectomy. We performed a nephrectomy through a transvaginal access and 2 additional 5 mm trocars in the abdomen by using the keyhole technique. The specimen was removed through the vaginal tract. The total procedure time was 102 minutes. There were no intraoperative complications.
Abdomen ; Animal Experimentation ; Chimera ; Gastroscopy ; Intraoperative Complications ; Laparoscopy ; Natural Orifice Endoscopic Surgery ; Nephrectomy ; Surgical Instruments ; Vagina

Cushing's syndrome associated with nodular adrenal glands will be divided into four main categories: adrenal adenoma, adrenal carcinoma, primary pigmented nodular adrenal dysplasia (PPNAD) and macronodular adrenal hyperplasia(MAH). The term macronodular adrenal hyperplasia is restricted to the presence of multiple nodules visible to the naked eye, ranging in size from 0.5 to 7.0 cm. We report a case of Cushings syndrome caused by bilateral macronodular adrenal hyperplasia (MAH). A 45-year-old man presented with Cushingoid features, hypertension and diabetes mellitus. Urine free cortisol was 449.9 mmol/day(27-276) and were not suppressed after administration of low-dose and high-dose dexamethasone. Plasma ACTH was very low(1.87 pmol/L(18)) and was not stimulated by administration of ovine CRH. In abdominal CT, both adrenal glands were markedly enlarged and nodular in appearance. Pituitary MRI showed no abnormal finding. Bilateral adrenalectomy was done. Histologic examination revealed multiple nodules and internodular hyperplasia. This case and other reports suggested that because of variable biochemical, radiologic and pathologic findings, macronodular adrenal hyperplasia represents a heterogeneous group of patients with varying degrees of adrenal autonomy.
Adenoma ; Adrenal Glands ; Adrenalectomy ; Adrenocorticotropic Hormone ; Cushing Syndrome ; Dexamethasone ; Diabetes Mellitus ; Humans ; Hydrocortisone ; Hyperplasia ; Hypertension ; Magnetic Resonance Imaging ; Middle Aged ; Plasma ; Tomography, X-Ray Computed