BACKGROUND: Congenital aortic stenosis in children is characterized by "excessive" left ventricular hypertrophy with reduced left ventricular systolic wall stress that allows for supernormal ejection performance. We hypothesized that left ventricular wall stress was decreased immediately after surgical correction of pure congenital aortic stenosis. Also measuring postoperative left ventricular wall stress was a useful noninvasive measurement that allowed direct assessment for oxygen consumption of myocardium than measuring the peak systolic pressure gradient between ascending aorta and left ventricle for the assessment of surgical results. MATERIAL AND METHOD: Between September 1993 and August 1999, 8 patients with isolated congenital aortic stenosis who underwent surgical correction at Yonsei cardiovascular center were evaluated. There were 6 male and 2 female patients ranging in age from 2 to 11 years(mean age, 10 years). Combined Hemodynamic-Ultrasonic method was used for studying left ventricular wall stress. We compared the wall stress peak systolic pressure gradient and ejection fraction preoperatively and postoperatively. RESULT: After surgical correction peak aortic gradient fell from 58.4+/-17.6, to 23.7+/-17.7 mmHg(p=0.018) and left ventricular ejection fraction decreased but it is not statistically significant. In the consideration of some factors that influence left ventricular end-systolic wall stress excluding one patient who underwent reoperation for restenosis of left ventricular outflow tract left ventricular end-systolic pressure and left ventricular end-systolic dimension were fell from 170.6+/-24.3 to 143.7+/-27.1 mmHg and from 1.78+/-0.4 to 1.76+/-0.4 cm respectively and left ventricular posterior wall thickness was increased from 1.10+/-0.2, to 1.27+/-0.3cm but it was not statistically singificant whereas left ventricular end-systolic wall stress fell from 79.2+/-24.9 to 57.1+/-27.6 kdynes/cm2(p=0.018) in 7 patients. For one patient who underwent reoperation peak aortic gradient fell from 83.0 to 59.7 mmHg whereas left ventricular end-systolic wall stress increased from 67.2 to 97.0 kdynes/cm2 The intervals did not change significnatly. CONCLUSION: We believe that probably some factors that are related to left ventricular geometry influenced the decreased left ventricular wall stress immediately after surgical correction of isolated congenital aortic stenosis. Left ventricular wall stress is a noninvasive measurement and can allow for more direct assesment than measuring peak aortic gradient particularly in consideration of the stress and oxygen consumption of the myocardium therefore we can conclude it is a useful measurement for postoperative assessment of congenital aortic stenosis.
Aorta ; Aortic Valve Stenosis* ; Blood Pressure ; Child ; Equidae ; Female ; Follow-Up Studies* ; Heart Ventricles ; Humans ; Hypertrophy, Left Ventricular ; Male ; Myocardium ; Oxygen Consumption ; Reoperation ; Stroke Volume

PURPOSE: To compare the fluorescein angiographic findings of nonarteritic anterior ischemic optic neuropathy (NA-AION) and optic neuritis. METHODS: The present study included 41 patients (41 eyes), who were diagnosed with NA-AION or optic neuritis and underwent fluorescein angiography in our clinic. The clinical profiles of patients, characteristics of optic disc head and hemorrhage, and visual field findings were analyzed retrospectively. The onset and filling time, perfusion time of retinal artery, optic disc, and peripapillary choroid were evaluated quantitatively. RESULTS: Patients with NA-AION showed statistically significant delay in both the onset time, filling time and perfusion time of the optic disc and peripapillary choroid compared with patients with optic neuritis (p < 0.05). There was no significant difference in the dye leakage of the peripapillary areas between the 2 groups (p = 0.324). CONCLUSIONS: In the present study, the results of fluorescein filling were significantly different between the NA-AION group and the optic neuritis group. The results may help determine the therapeutic plan and to differentiate between the 2 disease entities, especially in cases of overlapping clinical features.
Choroid ; Fluorescein ; Fluorescein Angiography ; Head ; Hemorrhage ; Humans ; Optic Neuritis ; Optic Neuropathy, Ischemic ; Perfusion ; Retinal Artery ; Retrospective Studies ; Visual Fields

PURPOSE: To report a case of fungal keratitis 3 days after intracorneal ring segment (ICRS) implantation for keratoconus. CASE SUMMARY: A 65-year-old woman was referred to our clinic with refractory infectious keratitis in her left eye 3 days after ICRS insertion for keratoconus. Slit lamp examinations revealed infiltrates around the incision site with cellular reaction in the anterior chamber after the ICRS had been removed. Corneal scrapings were obtained for staining and cultures, and intensive topical antibiotics were administered. Initial microscopy and cultures were negative. Despite the use of intensive topical antibiotics, there was no improvement. Hyphae were isolated from additional corneal scrapings. The patient's symptoms and corneal findings improved following administration of topical amphotericin B and oral itraconazole. CONCLUSIONS: Infectious keratitis after ICRS implantation is an uncommon but sight-threatening complication. Fungal keratitis should also be considered if infectious keratitis after ICRS is unresponsive to antibiotics.
Aged ; Amphotericin B ; Anterior Chamber ; Anti-Bacterial Agents ; Eye ; Female ; Humans ; Hyphae ; Keratitis ; Keratoconus ; Microscopy

PURPOSE: To report a case of severe vaso-occlusive retinopathy with significant decrease of bilateral visual acuity as the first manifestation associated with systemic lupus erythematosus (SLE). CASE SUMMARY: A 23-year-old man was referred to our clinic with bilateral visual impairment of hand motion (HH). Fundus examination revealed severe retinal hemorrhage, cotton-wool patch, occlusive retinal vasculitis with vascular engorgement, and diffuse retinal edema in both eyes. Because of a malar rash on both cheeks, generalized edema was observed on initial examination with hypertension, azotemia, anemia, and thrombocytopenia, The patient was diagnosed with SLE, strongly positive to antinuclear antibody (ANA), and received an intravitreal injection of Bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) in the left eye in addition to hemodialysis, transfusion, systemic corticosteroid and immunosuppressant treatment due to lupus nephritis. Eighteen months later, the retinal edema, cotton-wool patch and hemorrhage resolved, leaving epiretinal membrane without traction in his left eye and diffuse degeneration of the right eye. Final visual acuity was HM in the right eye and 20/100 in the left eye. CONCLUSIONS: Vaso-occlusive retinopathy in SLE can result in permanent visual impairment. In a patient with a high possibility of SLE retinopathy, a periodic fundus examination and intensive management of systemic disease should be considered.
Anemia ; Antibodies, Antinuclear ; Antibodies, Monoclonal, Humanized ; Azotemia ; Cheek ; Edema ; Epiretinal Membrane ; Exanthema ; Eye ; Hand ; Hemorrhage ; Humans ; Hypertension ; Intravitreal Injections ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Papilledema ; Renal Dialysis ; Retinal Hemorrhage ; Retinal Vasculitis ; San Francisco ; Thrombocytopenia ; Traction ; Vision Disorders ; Visual Acuity ; Bevacizumab

No abstract available.
Aged* ; Humans ; Intestinal Volvulus* ; Vomiting*

No abstract available.
Colitis, Ulcerative* ; Pyoderma Gangrenosum* ; Pyoderma* ; Ulcer*

We experienced five cases of solitary fibrous tumor; two in the pleura, two in the orbital soft tissue, and one in the lung parenchyma. Three patients were male, and the age of the patients ranged from 38 to 71 years (mean age: 53.6). Grossly, the masses were well circumscribed and had varying sizes from 2.5 to 30.0 cm. The cut surfaces were grayish-yellow firm with focal variegated hemorrhage, necrosis, cystic change, and myxoid area. Microscopically, these were characterized by a haphazard proliferation of spindle cells or polygonal cells separated by variable amounts of hyalinized collagen and showed a prominent vascular channels reminiscent of hemangiopericytoma in foci. Immunoperoxidase stains showed a strong reactivity for CD34, and were weakly positive for vimentin. Electron microscopical examination revealed features of fibroblast; spindle to round tumor cells were arranged in groups and surrounded by collagen. Nucleoli were seldom prominent. The cytoplasm contained many microfilaments and a moderate number of cisternae of rough endoplasmic reticulum.
Actin Cytoskeleton ; Collagen ; Coloring Agents ; Cytoplasm ; Endoplasmic Reticulum, Rough ; Fibroblasts ; Hemangiopericytoma ; Hemorrhage ; Humans ; Hyalin ; Lung ; Male ; Necrosis ; Orbit ; Pleura ; Solitary Fibrous Tumors* ; Vimentin

BACKGROUND/AIMS: Ten-day sequential therapy has been evaluated as the first line therapy for Helicobacter pylori eradication but studies on sequential therapy as a second line therapy is lacking. The aim of this study was to compare the efficacy of 10-day sequential therapy and quadruple therapy as second line treatment for H. pylori eradication after failure of standard triple therapy. METHODS: Patients who did not respond to standard triple therapy for H. pylori eradication were assigned to either 10-day sequential or bismuth based quadruple therapy as second line treatment from January 2009 to December 2014 at Yeungnam University Medical Center. Post treatment H. pylori status was determined by rapid urease test, giemsa staining, or 13C-urea breath test. Eradication rate and side effects of both therapies were compared. RESULTS: A total of 158 H. pylori infected patients were included and 70 patients were treated by bismuth based quadruple therapy and 88 patients by 10-day sequential therapy. Age and sex were not significantly different between the two groups. Eradication rate was 84.3% (59/70) in quadruple group and 56.8% (50/88) in sequential group. Side effects occurred significantly higher in quadruple group than sequential group (27.1% vs. 11.4%, p=0.011). CONCLUSIONS: For second line H. pylori eradication after failure of standard triple therapy, bismuth based quadruple therapy showed significantly higher H. pylori eradication rate than 10-day sequential therapy. Further prospective studies are needed to evaluate the efficacy of 10-day sequential therapy as a second line H. pylori eradication treatment.
Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/adverse effects/pharmacology/*therapeutic use ; Bismuth/adverse effects/pharmacology/*therapeutic use ; Diarrhea/etiology ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy ; Helicobacter pylori/drug effects ; Humans ; Male ; Middle Aged ; Proton Pump Inhibitors/adverse effects/pharmacology/therapeutic use ; Retrospective Studies ; Risk Factors ; Taste Disorders/etiology ; Treatment Outcome ; Young Adult

Carcinoids are slow growing neuroendocrine tumors (NET) originating in the enterochromaffin cells of the gastrointestinal tract. In previous studies, rectal NET comprised only about 1% of all anorectal neoplasms; however, the incidence of rectal NET has shown a recent increase. Typically, rectal NET presents as a single subepithelial nodule, and multicentricity of rectal NETs is rare, with reported incidence of 2-4.5%. Due to the rarity of multiple rectal NETs, there is no consensus or guidelines for treatment of multiple rectal NETs. However, NETs of the rectum that are less than 10 mm in diameter and do not infiltrate the muscularis propria, without distant metastasis, can be removed by endoscopy, as with solitary rectal NET. We encountered five cases of multiple rectal NETs which were treated successfully by endoscopy.
Adult ; Aged ; Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors/*diagnosis/pathology/surgery ; Positron-Emission Tomography ; Rectal Neoplasms/*diagnosis/pathology/surgery ; Sigmoidoscopy ; Tomography, X-Ray Computed

Hyperplastic polyps are the most common histological findings among benign gastric polyps. The characteristics of gastric hyperplastic polyps are usually subclinical, small, sessile form, and solitary lesions occurring in the antrum. With increasing size, they can present with dyspepsia, nausea, melena or iron deficiency anemia due to chronic blood loss. Especially polyps with size exceeding 2 cm is defined as a giant gastric polyp and comprises 2% of gastric hyperplastic polyps. However, massive upper gastrointestinal bleeding caused by gastric hyperplastic polyps is rare. Here, we report a case of a 64-year-old male patient with massive bleeding caused by a giant gastric polyp which needed urgent endoscopic hemostasis and was confirmed as a hyperplastic polyp. According to our experience, physicians should be aware that gastric hyperplastic polyp might result in massive upper gastrointestinal bleeding.
Anemia, Iron-Deficiency ; Dyspepsia ; Hemorrhage* ; Hemostasis, Endoscopic ; Humans ; Male ; Melena ; Middle Aged ; Nausea ; Polyps* ; Stomach