Midventricular obstructive hypertrophic cardiomyopathy (MOHCM) is a rare variant of hypertrophic cardiomyopathy. Apical dilatation and myocardial infarction can be complicated without significant coronary artery disease. We report a case of apical dilatation in a patient with MOHCM without atherosclerotic coronary artery disease. A 76-year-old woman was admitted for recent cerebral infarction and consulted to cardiologist for abnormal electrocardiographic findings. She had been suffering from exertional dyspnea (NYHA II) for about four years. Two dimentional-echocardiography revealed midventricular obstructive hypertrophy with an apical dilatation and paradoxical jet flow from the apical aneurysm to the left ventricular outflow tract during early diastole. Cardiac catheterization demonstrated dyskinesia in the apical wall with midventricular obstruction and a peak-to-peak intraventricular pressure gradient of 110 mmHg during pull-back from the apical high-pressure chamber to the subaortic low-pressure chamber in the left ventricle. Coronary angiograms showed no significant stenotic lesion of the coronary arteries. She was prescribed oral beta-adrenergic antagonist to decrease the intraventricular pressure gradient.
Aged ; Aneurysm* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Cerebral Infarction ; Coronary Artery Disease ; Coronary Vessels ; Diastole ; Dilatation* ; Dyskinesias ; Dyspnea ; Electrocardiography ; Female ; Heart Ventricles ; Humans ; Hypertrophy ; Myocardial Infarction ; Ventricular Pressure

BACKGROUND AND OBJECTIVES : The transradial approach has been increasingly used as an alternative to conventional transfemoral intervention. However, there is little data on the efficacy of transradial coronary intervention (TRI) in left main coronary arterial (LMCA) disease. The purpose of this study was to evaluate the feasibility of TRI in selective patients undergoing percutaneous coronary intervention (PCI) for LMCA disease. SUBJECTS AND METHODS : Between Jan 2003 and May 2005, 83 patients with LMCA stenosis were treated with PCI. Of these, 40 selected patients having undergone TRI were included in this study. RESULTS : The patients included 30 males and 10 females, with a mean age of 61+/-12 years. There were 28 cases (70%) involving coronary arteries other than the LMCA and 24 cases (60%) with bifurcation lesion involvement. In 28 cases (70%), a 6 Fr sized guiding catheter was used. No case required crossover from TRI to TFI due to procedural failure. During hospitalization, 2 patients who underwent primary PCI in the setting of STEMI died, but there were no other clinical events. CONCLUSION : In selected patients with LMCA disease, TRI can be a feasible and safe approach for PCI.
Angioplasty, Balloon, Coronary ; Catheters ; Constriction, Pathologic ; Coronary Disease ; Coronary Vessels ; Female ; Hospitalization ; Humans ; Male ; Percutaneous Coronary Intervention ; Radial Artery

PURPOSE: The goal of this study was to investigate the utility of DNA vaccines encoding Ebola virus glycoprotein (GP) as a vaccine type for the production of GP-specific hybridomas and antibodies. MATERIALS AND METHODS: DNA vaccines were constructed to express Ebola virus GP. Mice were injected with GP DNA vaccines and their splenocytes were used for hybridoma production. Enzyme-linked immunosorbent assays (ELISAs), limiting dilution subcloning, antibody purification methods, and Western blot assays were used to select GP-specific hybridomas and purify monoclonal antibodies (MAbs) from the hybridoma cells. RESULTS: Twelve hybridomas, the cell supernatants of which displayed GP-binding activity, were selected by ELISA. When purified MAbs from 12 hybridomas were tested for their reactivity to GP, 11 MAbs, except for 1 MAb (from the A6-9 hybridoma) displaying an IgG2a type, were identified as IgM isotypes. Those 11 MAbs failed to recognize GP. However, the MAb from A6-9 recognized the mucin-like region of GP and remained reactive to the antigen at the lowest tested concentration (1.95 ng/mL). This result suggests that IgM-secreting hybridomas are predominantly generated by DNA vaccination. However, boosting with GP resulted in greater production of IgG-secreting hybridomas than GP DNA vaccination alone. CONCLUSION: DNA vaccination may preferentially generate IgM-secreting hybridomas, but boosting with the protein antigen can reverse this propensity. Thus, this protein boosting approach may have implications for the production of IgG-specific hybridomas in the context of the DNA vaccination platform. In addition, the purified monoclonal IgG antibodies may be useful as therapeutic antibodies for controlling Ebola virus infection.
Animals ; Antibodies ; Antibodies, Monoclonal ; Antibody Formation ; Blotting, Western ; Clinical Coding* ; DNA* ; Ebolavirus* ; Enzyme-Linked Immunosorbent Assay ; Glycoproteins* ; Hemorrhagic Fever, Ebola ; Hybridomas* ; Immunization* ; Immunoglobulin G ; Immunoglobulin M ; Mice ; Vaccination ; Vaccines, DNA*

Fitz-Hugh-Curtis syndrome has been described as perihepatitis associated with pelvic inflammatory disease (PID). It is classically seen in premenopausal young women who have right upper quadrant pain, usually but not always accompanied by symptoms of PID, and is frequently confused with biliary tract disease. However, the syndrome has rarely been reported in males. The predominant symptom is right upper quadrant pain, but PID may not be present in male patients. Here, we report a case of Fitz-Hugh-Curtis syndrome in a young male patient, which was diagnosed by serological tests and computed tomography. Fitz-Hugh-Curtis syndrome should be considered as a possible cause of pain in the right upper quadrant in male patients, although such a case is very rare.
Biliary Tract Diseases ; Female ; Humans ; Male* ; Pelvic Inflammatory Disease ; Serologic Tests

Background: Accurate measurement of the lower limb alignment is one of the most crucial factors in advanced knee osteoarthritis patients scheduled for surgery. Recently, EOS biplanar stereoradiography with three-dimensional reconstruction was developed. The purpose of this study was to compare radiographic parameters between conventional scanography and EOS in patients with advanced knee osteoarthritis who need surgical treatment. Methods: A total of 52 consecutive patients (104 knees) with bilateral knee osteoarthritis of advanced stage (Kellgren-Lawrence [KL] grade 3 or 4) were retrospectively reviewed. We measured the hip-knee-ankle angle (HKA) on conventional scanograms. In EOS, we measured HKA, hip-knee-shaft angle, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle. To evaluate sagittal and axial plane alignment, knee flexion angle (KFA), and knee joint rotation (KJR) were also measured. Results: Ninety knees were KL grade 4, and 14 knees were grade 3. The average HKA was 10.14° ± 6.16° on conventional scanograms and 11.26° ± 6.21° in EOS. HKA was greater in EOS than on conventional scanograms, and the difference (1.12°; range, −1.07° to 3.22°) was statistically significant (p < 0.001). Significant correlations were observed on the difference in HKA and mechanical medial proximal tibial angle (r = –0.198, p = 0.044), KFA (r = 0.193, p = 0.049), and KJR (r = 0.290, p = 0.003). In multivariable linear regression analysis, the difference in HKA had significant relationship with KFA (β = 0.286, p = 0.003) and KJR (β = 0.363, p < 0.001). Conclusions HKA measured on conventional scanograms and in EOS differed significantly and the difference had a significant correlations with KFA, KJR, and medial proximal tibial angle. Surgeons can consider these results before orthopedic surgery in patients who have advanced knee osteoarthritis.

We report a case of closure of the coronary artery fistula with polytetrafluoroethylene (PTFE)-covered stent at the proximal left anterior descending artery along with simultaneous stenting at the stenosed middle segment of the left anterior descending artery. The successful experience proved that this kind of stent is a feasible and safe supplement to catheter-based devices in treating coronary artery fistula, although further evaluation is needed.
Angioplasty, Balloon, Coronary ; Arteries* ; Coronary Vessels* ; Fistula* ; Polytetrafluoroethylene ; Stents* ; Vascular Fistula

We report a rare case of esophageal intramural pseudodiverticulosis (EIPD) associated with esophageal web in a 67-year-old man presenting with dysphagia. EIPD is characterized by multiple tiny flask-shaped outpouchings of the mucosa that extend into the muscular layer on esophagography. EIPD commonly presents with stricture and less commonly with esophageal web. Although etiologies of both EIPD and esophageal web are unclear, a chronic inflammatory condition has been proposed. Treatment of EIPD is usually directed at the associated conditions rather than at the pseudodiverticulosis itself. In our case, dysphagial was successfully relieved by endoscopic dilatation with incision methods for the esophageal web.
Aged ; Constriction, Pathologic ; Deglutition Disorders ; Dilatation ; Humans ; Mucous Membrane

A paradoxical response is not uncommon in non-HIV-infected patients, particularly those with extra-pulmonary tuberculosis. It is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion during anti-tuberculosis therapy. The paradoxical response has been attributed to host immunologic reactions, such as a delayed hypersensitivity or a response to mycobacterial antigens. In most reports of paradoxical response, these responses occurred in the same location as a previous lesion. In this patient with pulmonary tuberculosis, cervical lymph node enlargement occurred as a paradoxical response after the completion of anti-tuberculosis treatment. Although the new lesion developed in another location, it could be considered as a paradoxical response based on the negative culture result of acid fast bacilli from the new lesion and drug sensitivity result from initial bronchoalveolar lavage specimen. Therefore we were able to decide on the termination of unnecessary anti-tuberculous treatment. Based on our case, we can conclude that paradoxical response can occur after the termination of anti-tuberculosis therapy even in new site.
Bronchoalveolar Lavage ; Diagnosis ; Humans ; Hypersensitivity, Delayed ; Lymph Nodes* ; Tuberculosis ; Tuberculosis, Pulmonary*

Monoballismus-monochorea is abnormal neurologic sign characterized by continuous, involuntary and irregular movement involving one extremity. Hyperglycemic ballism-chorea is predominantly observed in older type 2 diabetic patients and non-ketotic hyperglycemia, and is associated with contralateral striatal hyperintensities (i.e., putamen and caudate) on both brain CT and MRI. Movement disorders as the initial symptoms of diabetes mellitus are rare, especially in ketotic hyperglycemia. Here, we report one of these rare manifestations of transient monoballismus with during an episode of ketotic hyperglycemia without contralateral striatal abnormal findings on brain MRI in newly diagnosed diabetes mellitus.
Brain ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Dyskinesias ; Extremities ; Humans ; Hyperglycemia* ; Ketosis ; Magnetic Resonance Imaging ; Movement Disorders ; Neurologic Manifestations ; Putamen

BACKGROUND: Recently, Citrobacter freundii bacteremia outbreak in a neonatal intensive care unit has attracted public attention in Korea. However, Citrobacter bacteremia is uncommon and usually occurs in patients with underlying diseases such as malignancy and hepatobiliary diseases. Increase in resistance and emerging of multidrug resistance among Citrobacter species have gradually been reported. The aim of this study was to investigate the clinical characteristics and outcome of C. freundii and non-freundii bacteremia and antimicrobial susceptibility trends. MATERIALS AND METHODS: We reviewed the medical records of patients with Citrobacter bacteremia at St. Mary's Hospital, from 2007 to 2017. RESULTS: A total of 43 patients with a median age of 72 (24-93) years was identified and 90.7% of them had comorbidities. Twenty-nine (67.4%) patients had C. freundii bacteremia while 14 had non-freundii bacteremia (six of C. braakii, five of C. koseri, two of C. amalonaticus and one of C. youngae). A total of 26 (51.2%) patients had community-acquired infection and intra-abdominal infection including hepatobiliary tract was the most common portal of entry (24/43, 55.8%). Moreover, hepatobiliary tract was the leading primary site of nosocomial infection (9/17, 52.9%). Polymicrobial bacteremia was observed in 21 (48.8%) patients. The percentages of Citrobacter species susceptible to ampicillin, amikacin, aztreonam, cefazolin, cefoxitin, cefotaxime, cefepime, piperacillin-tazobactam, ciprofloxacin, and imipenem were 9.5%, 97.6%, 73.8%, 9.5%, 14.3%, 71.4%, 92.9%, 83.3%, 83.3% and 100%, respectively. The resistance rate did not increase during the study period. Of 39 patients treated with antibiotics, 36 (92.3%) received appropriate empirical antibiotics. Overall mortality was 18.6%. High Charlson comorbidity index and Pitt bacteremia score were significant risk factors for death in univariate analysis and showed trends in the multivariate analysis. No significant difference in clinical features and antimicrobial susceptibility rate was observed between C. freundii and non-freundii bacteremia. CONCLUSION Citrobacter bacteremia was predominant in the elderly with comorbidities, while no pediatric case was observed. Hepatobiliary tract is the leading primary focus of bacteremia both in community-acquired and nosocomial infection. The rate of susceptibility to antibiotics has not changed in the last 11 years.