Eosinophilic colitis is a chronic inflammatory bowel condition of unknown etiology and a rare subtype of eosinophilic gastrointestinal diseases. It is characterized by gastrointestinal symptoms and increased eosinophil numbers in the intestinal mucosa and absence of other potential causes of gastrointestinal eosinophilia. The clinical presentation is varied and depends on the involved layer of the large intestine. There are no confirmatory laboratory tests, and the morphologic evaluation of biopsies or surgical specimens is required to confirm the diagnosis. A 65-year-old man presented with an 8 day duration of bloody diarrhea and lower abdominal pain. The patient was diagnosed with eosinophilic colitis by histopathological evaluation of biopsies and was further categorized as a nonatopic variant associated with non-IgE-mediated reaction. The patient was successfully treated with systemic corticosteroid for 2 weeks. On follow-up after 9 months, the patient remained well without relapse or new lesions.
Abdominal Pain ; Aged ; Biopsy ; Colitis ; Diarrhea ; Eosinophilia ; Eosinophils ; Follow-Up Studies ; Gastrointestinal Diseases ; Humans ; Intestinal Mucosa ; Intestine, Large ; Recurrence

OBJECTIVE: To evaluate the influences of age and height on pulmonary function in cervical spinal cord injury patients and to suggest the reference value of Pulmonary Function Test (PFT) with respect to each level of injury. METHOD: One hundred eighteen subjects with complete cervical spinal cord injury underwent PFT. Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1) were measured and percentages of normal predictive values were also calculated. RESULTS: Age, height and injury level were determinants of FVC and FEV1. But only injury level affected the percen-tages of FVC and FEV1 predictive values. The mean FVC of C4, C5, C6, C7, C8 tetraplegic subjects were 1.78 L, 2.00 L, 2.20 L, 2.74 L, 2.94 L respectively. The mean FEV1 of C4, C5, C6, C7, C8 tetraplegic subjects were 1.64 L, 1.83 L, 2.08 L, 2.59 L, 2.74 L respectively. CONCLUSION: Age and height should be considered when interpreting PFT of tetraplegic patients. The reference values suggested would help to evaluate the severity of pulmonary function loss in complete cervical spinal cord injury patients.
Forced Expiratory Volume ; Humans ; Male ; Quadriplegia ; Reference Values ; Respiratory Function Tests ; Spinal Cord Injuries ; Spinal Cord* ; Vital Capacity

Targetoid hemosiderotic nevus (THN) is a rare variant of melanocytic nevus, characterized by a sudden development of a targetoid ecchymotic halo around a pre-existing nevus. THN clinically raises concern for malignant transformation due to its abrupt change in color and size. THN should be distinguished from other diseases showing a peripheral halo, including targetoid hemosiderotic hemangioma, halo nevus, and Meyerson nevus. Dermoscopy can help clinicians to differentiate THN from these diseases. The typical dermoscopic features of THN are known to be divided into two distinctive areas: the central melanocytic area and the peripheral ecchymotic area. In our case, dermoscopy revealed a novel bull’s eye pattern composed of a central area with characteristic features of benign melanocytic nevus, an intermediated white circular ring, and a peripheral milky red area. When a sudden change occurs in a pre-existing nodule showing targetoid features, dermoscopy should be considered before conducting a biopsy or surgical intervention.

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

The cardiovascular manifestations of hyperthyroidism are sinus tachycardia, paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, atrioventricular block, bundle branch block, angina pectoris, heart failure, and cardiomyopathy. Though complete atrioventricular block is rare, it is important to recognize it in clinical practice because of the possibility of cardiac arrest. We experienced a 47-year-old female patient who had hyperthyroidism with complete atrioventricular block and developed cardiac arrest despite the initiation of an antithyroid drug. We could resuscitate successfully and inserted a temporary pacemaker, but eventually a permanent pacemaker was needed to prevent the recurrence of cardiac arrest. We report a rare case of complete atrioventricular block and cardiac arrest associated with hyperthyroidism with the review of references.
Angina Pectoris ; Atrial Fibrillation ; Atrial Flutter ; Atrioventricular Block* ; Bundle-Branch Block ; Cardiomyopathies ; Female ; Heart Arrest* ; Heart Failure ; Humans ; Hyperthyroidism* ; Middle Aged ; Recurrence ; Tachycardia, Sinus ; Tachycardia, Supraventricular

PURPOSE: Determination of medical intractability is primarily essential for planning a surgical treatment of epolepsy. Questions regarding intractability include the optimum duration of adequate antiepileptic drug (AED) treatment and the tolerable seizure frequency. Unfortunately, thereis no established guideline for determination of medical intractability in terms of the duration or the tolerability of AED resistance. In temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS), a Well-Known surgically remediable epileptic syndrome, the inverstigation of relationship between short-term and long-term AED response may help us finding a way to solve the above questions. METHODS: From 2 epilepsy centers, 86 patients with TLE demonstrating MTS on MRI were evaluated. All of them were on AED treatment for at least 2 years. We investigated seizure free rate for 1st 1 year, for next 1 year and that for two years. We compared seizure number of 1st 1 year with that of 2nd 1 year and analyzed corrdlation coefficiency between seizure numbers of the two periods. Paired-t-test and Pearson correlation test were performed for statistical analysis. RESULTS: Two year terminal remission rate was 3.5%. Remission rate for the 1st 1 year was 4.7% Whereas in the 2nd 1 year it rose to 16.3%. Mean seizure number of 1st one year was 34.9 and that of next one year was 27.0. Mean paired differences between seizure numbers of the two periods was 7.95(95% dcnfidence interval:1.82-14.09) Which was statistically significant(p=0.012). Pearson correlation coefficiendy was 0.815 between seizure numbers fo the two periods. CONCLUSION: In TLE with MTS, seizure free outcome was very poor. However, seizurw-free rate rose and seizure number declined as AED treatment duration was prolonged for 2 years. Weizure munber of 1st year may predict that of 2nd year. To establish an appropriate index time for considering medical intractability, further studies on longer-term outcone by AED treatment duration was porlonged for 2 years. Seizure munber of 1st year further studies on longer-term outcome by AED treatment should be recommended in addition to studies on adequate tolerability of AED resistance.
Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Magnetic Resonance Imaging ; Sclerosis* ; Seizures* ; Temporal Lobe*

BACKGROUND/AIMS: This study evaluated the efficacy of endoscopic treatment in a bile leak that occurred through various causes. METHODS: The medical records of 35 patients (mean age 55.4 years; male/female 25/10), who were diagnosed with a bile leak by endoscopic retrograde cholangiopancreatography in Yeungnam University Hospital from January 1998 to January 2006, were reviewed. RESULTS: The most common cause of the bile leak was an open cholecystectomy (n=13, 37.1%) followed by a laparoscopic cholecystectomy (n=10, 28.6%), trauma (n=2, 5.7%), transarterial chemoembolization (n=3, 8.6%), spontaneous (n=3, 8.6%), and a hepatic resection (n=4, 11.4%). Thirty-four patients were treated endoscopically by the insertion of a plastic stent with/without a sphincterotomy (70.6%, 24/34), a nasobiliary drainage (11.8%, 4/34), or a sphincterotomy alone (17.6%, 6/34). Of these 34 patients, 30 were cured by the endoscopic treatment, 2 patients died from liver failure despite the use of nasobiliary drainage and 2 patients did not improve after endoscopic treatment. One patient underwent surgery without endoscopic treatment because of a transsection of the common bile duct. With the exception of the two who died from liver failure, the overall cure rate of endoscopic treatment was 90.9% (30/33). There were no complications associated with the endoscopic treatment. CONCLUSIONS: Endoscopic treatment for a bile leak is safe and effective regardless of the cause.
Bile* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Drainage ; Humans ; Liver Failure ; Medical Records ; Plastics ; Stents

Neurilemmoma, also refired to as Schwannoma, neurinoma and perineural fibroblastoma, is well capsulated solitary tumor of Schwann cell origin. The most common sites for benign solitary neurilemmoma are the extremities or the head and neck region. In the retroperitoneum, they are commonly seen in the presacral region. It is incidentally detected and confirmed by pathologic findings. We report a case of retroperitoneal neurilemmoma arising from adjacent to kidney, in 49 years old man.
Extremities ; Head ; Humans ; Kidney* ; Middle Aged ; Neck ; Neurilemmoma*

PURPOSE: We evaluated the differences between radiologically measured size and pathologic size of renal tumors. MATERIALS AND METHODS: The data from 171 patients who underwent radical or partial nephrectomy for a renal tumor at Ajou University Hospital were reviewed. Radiologic tumor size, which was defined as the largest diameter on a computed tomographic scan, was compared with pathologic tumor size, which was defined as the largest diameter on gross pathologic examination. RESULTS: Mean radiologic size was significantly larger than mean pathologic size for all tumors (p=0.019). When stratified according to radiologic size range, mean radiologic size was significantly larger than mean pathologic size for tumors <4 cm (p=0.003), but there was no significant difference between the sizes for tumors 4-7 cm and >7 cm. When classified according to histologic subtype, mean radiologic size was significantly larger than mean pathologic size only in clear cell renal cell carcinomas (p=0.002). When classified according to tumor location, mean radiologic size was significantly larger than mean pathologic size in endophytic tumors (p=0.043) but not in exophytic tumors. When endophytic tumors were stratified according to radiologic size range, there was a significant difference between the mean radiologic and pathologic sizes for tumors <4 cm (p=0.001) but not for tumors 4-7 cm (p=0.073) and >7 cm (p=0.603). CONCLUSIONS: Our results suggest that in planning a nephron-sparing surgery for renal tumors, especially for endophytic tumors of less than 4 cm, the tumor size measured on a computed tomography scan should be readjusted to get a more precise estimate of the tumor size.
Carcinoma, Renal Cell ; Humans ; Kidney ; Nephrectomy

BACKGROUND AND OBJECTIVES: Renin-angiotensin system (RAS) inhibitors are likely to reduce the development of atrial fibrillation (AF) by preventing atrial fibrosis. We attempted to assess the relevance of strain echocardiography for quantitative assessment of the left atrial (LA) status in AF, its modification by RAS inhibitors and changes of biochemical markers during cardiac remodeling in AF. SUBJECTS AND METHODS: Strain echocardiography is performed 2 times (baseline and 12 month) in 60 patients with AF (RAS inhibitors-used group: 30, non-used group: 30). In an apical 4-chamber view, the regional analysis consisted of placing the region of interest cursor at the basal segments of the septal and lateral wall of LA. Mean peak systolic and early diastolic strain/rate are measured with LA end-systolic antero-posterior, longitudinal and transverse dimensions. RESULTS: Six patients of RAS inhibitors-used group (group A, 20%) and three patients of non-used group (group B, 10%) were converted to normal sinus rhythm during the study. LA size, E wave velocity, E/E', strain parameters showed no significant differences between groups at the baseline. There were no significant differences in LA size and E wave velocity between groups at the 12 months, however, peak systolic strain/rate were significantly higher in group A (36.71+/-13.63% and 2.98+/-0.59s(-1), p<0.05, respectively) than group B (27.21+/-10.49% and 2.21+/-0.47s(-1)). In addition, peak early diastolic strain/rate were significantly higher in group A (-1.89+/-3.30% and -2.32 +/-0.77s-1 p<0.05, respectively) than group B (-0.83+/-2.79% and -1.77+/-0.25s(-1)). There were no significant differences in C-reactive protein (CRP) and B-type natriuretic peptide (BNP) at the baseline, but BNP were significantly reduced in group A (822.9+/-798.3 pg/mL, p<0.05) than group B (1481.9+/-209.97 pg/mL) at the 12-month follow-up. CONCLUSION: The increased values of atrial peak systolic and diastolic strain/rate after treatment with RAS inhibitors revealed that passive stretching and shortening of LA wall might improve in some patients with AF even before LA size change possibly because of reduced atrial fibrosis and increased compliance. Our results indicated that strain echocardiography provides clinically useful information of LA function and remodeling and treatment with RAS inhibitors appears to preserve LA reservoir function in AF patients without visible LA structural change.
Atrial Fibrillation ; Atrial Function, Left ; Biomarkers ; C-Reactive Protein ; Compliance ; Echocardiography ; Fibrosis ; Humans ; Muscle Stretching Exercises ; Natriuretic Peptide, Brain ; Prospective Studies ; Renin-Angiotensin System ; Sprains and Strains