This report concerns a male patient suffered from refractory dysphagia after subarachnoid hemorrhage. A 49-year-old man admitted with severe headache followed by mental change. Imaging studies revealed that subarachnoid hemorrhage was located in basal cistern, and demonstrated ruptured vertebral dissecting aneurysm. After operation, the patient recovered well except severe dysphagia. Initial VFSS showed aspiration in fluid trial, penetration in semisolid bolus, and large amount of pharyngeal residue with poor relaxation of upper esophageal sphincter. For about 5 months, his symptom and several follow-up VFSS findings did not show marked improvement by various treatments. On magnetic resonance imaging for further evaluation of his brain lesion, an old infarction in right lateral side of medulla was found. He kept dysphagia rehabilitation more than one year, and his symptom improved to the level of oral feeding at last.
Aneurysm, Dissecting ; Brain ; Deglutition Disorders ; Esophageal Sphincter, Upper ; Follow-Up Studies ; Headache ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Relaxation ; Subarachnoid Hemorrhage

A 30-year-old man visited the emergency room for chest pain, dyspnea and fever. Despite increased serum cardiac enzymes, ST segment elevation and inferior wall akinesis in electrocardiography and echocardiography, no atherosclerosis was evident in the coronary angiography. However, radionuclide myocardial perfusion image at day 2 showed a persistent perfusion defect in the left ventricular (LV) inferior wall. At day 3, prominent myocardial edema and severe LV systolic dysfunction developed with signs of heart failure. In this case, fulminant myocarditis seemed to originate from the right coronary artery territory and simulated a ST segment elevation myocardial infarction without coronary artery obstruction. The pathogenesis of the localized perfusion defect was unlcear.
Atherosclerosis ; Chest Pain ; Coronary Angiography ; Coronary Vasospasm ; Coronary Vessels ; Dyspnea ; Echocardiography ; Edema ; Electrocardiography ; Emergencies ; Fever ; Heart Failure ; Ischemia ; Myocardial Infarction ; Myocarditis ; Perfusion

Surgery is the primary treatment for adenocarcinoma originating from the esophagogastric junction. However, many physicians attempt various endoscopic treatments for the cases of early adenocarcinoma and high-grade dysplasia of esophagogastric junction in order to avoid the high risk of complications associated with surgical resection. Recently, there is an increasing tendency to use endoscopic mucosal resection for the management of early esophageal cancer due to low morbidity and mortality rates. We report here on a case of early adenocarcinoma at esophagogastric junction successfully treated with endoscopic mucosal resection.
Adenocarcinoma ; Endoscopy ; Esophageal Neoplasms ; Esophagogastric Junction

A healthy 35-year-old man who was scheduled for closed reduction of nasal bone fracture developed atrial fibrillation during induction of general anesthesia after intravenous glycopyrrolate injection. During emergence of general anesthesia, atrial fibrillation was suddenly changed to paroxysmal supraventricular tachycardia with 200 beat per minute and lasted for about 10 seconds. Because blood pressure was stable, esmolol was used to reduce ventricular response. At recovery room, ventricular response reduction about 55 beat per minute was observed after intravenous injection of verapamil 5 mg. Thereafter, the rhythm was returned to normal sinus rhythm with bradycardia.
Anesthesia, General ; Atrial Fibrillation ; Blood Pressure ; Bradycardia ; Glycopyrrolate ; Injections, Intravenous ; Nasal Bone ; Propanolamines ; Recovery Room ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular ; Verapamil

Gastrointestinal stromal tumors (GISTs) are common mesenchymal tumors that arise in the wall of the gastrointestinal tract. We report a case of obscure gastrointestinal bleeding due to a GIST of the jejunum successfully documented by videocapsule endoscopy (VCE) and single-balloon enteroscopy (SBE). A 36-year-old man with hematochezia was referred for further evaluation of no evidence of bleeding focus on esophagogastroduodenoscopy and colonoscopy. A VCE showed a suspicious ulcerative hyperemic mass that located in about 1 hour apart from duodenal second portion. SBE revealed a nonbleeding 4x2 cm mass with an ulcer at the proximal jejunum. The patient underwent laparoscopic resection without complication. Histological examination revealed a well circumscribed, dumbbell-shaped firm mass comprised of spindle cells. Immunohistochemical staining for CD 117 was diffusely positive, whereas staining for S-100, CD 34 and MIB-1 was all negative. It was confirmed to be a low-grade GIST at the proximal jejunum.
Capsule Endoscopy ; Colonoscopy ; Endoscopy ; Endoscopy, Digestive System ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Jejunum ; Ulcer

Double primary cancers are two independently developed cancers in an individual. There have been some reports on double primary cancer since Billroth reported it for the first time in 1879. Double primary cancer of the stomach and esophagus has been revealed a very low incidence worldwide. The incidence of an esophageal cancer with another primary cancer is reported to be 9.5~27%, but double primary cancers in the esophagus and stomach have been rarely reported to our knowledge. In this study, we present here a case of double primary esophageal and stomach cancer in a 66-year-old man because of progressive dysphagia.
Deglutition Disorders ; Esophageal Neoplasms ; Esophagus ; Incidence ; Stomach ; Stomach Neoplasms

OBJECTIVES: To evaluate the treatment failure (TF) rate of leiomyoma after uterine artery embolization (UAE) for uterine leiomyomas in cases of the presence of anastomoses between the ovarian arteries (OA) and uterine arteries (UA). METHODS: The results of 163 consecutive UAE for uterine fibroid were reviewed. Mean patient age was 42.8 years (range, 25 to 57 years). TF was evaluated according to the anastomoses between OA and UA on pre-embolization angiography. Magnetic resonance images (MRIs) were obtained at 1~6 months or 12 months after UAE. MRIs were gadolinium (Gd)-enhanced images and/or T2-weighted images. MRIs exhibited focal enhancement portion on fibroid and evaluated the TF rate of the leiomyoma in patients of presence of anastomoses between OA and UA. RESULTS: Fifty six patients had anastomoses between UA and OA on pre-embolization angiography (56/163, 34.4%). Angiographic subtypes were type Ia (n=19), type Ib (n=16), type II (n=11) and type III (n=10). Of all patients, 10 patients showed the focal enhancements of the leiomyomas on follow-up enhanced MRIs (10/163, 6.1%). Three treatments failed in patients demonstrated type Ia (3/19, 15,8%). One had type Ib (1/16, 6.3%). Other 6 had no anastomoses. There was no TF rate difference between patients with communication (4/56, 7.1%) and without communication (6/107, 5.7%). However, TF rate in patients with type Ia communication (15.8%) was higher than that without communication (5.7%; P<0.05). CONCLUSION: Type Ia utero-ovarian anastomoses communication could be a contraindication for embolization treatment for leiomyoma.
Angiography ; Arteries ; Follow-Up Studies ; Gadolinium ; Humans ; Leiomyoma ; Magnetic Resonance Spectroscopy ; Treatment Failure ; Uterine Artery ; Uterine Artery Embolization

OBJECTIVES: There are 3 subtypes of natriuretic peptide (NP) receptors: type A natriuretic peptide receptor (NPRA), NPRB, and NPRC. The NPRA gene polymorphism, consisting of substition of methionine (ATG) to isoleucine (ATC) at nucleotide 1023 (M341I) of exon 3 was revealed to be associated with increased risk for essential hypertension (EH) in Japanese people. The purpose of this study is to investigate association between EH and the M341I polymorphism in the NPRA gene in Korea. METHODS: Eighty patients in whom type B natriuretic peptide (BNP) was measured were enrolled in this study. 66 patients had EH and 14 patients did not. The polymorphism of M341I was evaluated by multiplex genotyping polymerase chain reaction and by sequencing analysis. RESULTS: The overall distribution of alleles was not significantly different between the control and EH groups. However, the C/C homozygous genotype was found only in the EH group. In the EH group, patient carrying the C/C homozygous genotype had the trend of having higher systolic and diastolic BP levels regardless of the previous treatment, even though other laboratory markers including BNP levels had no significant differences according to the genotypes. CONCLUSION: This would be meaningful for the first identification of the M341I polymorphism in the NPRA gene and for the first suggestion of association of the EH with it in Korea.
Alleles ; Asian Continental Ancestry Group ; Exons ; Genotype ; Humans ; Hypertension ; Isoleucine ; Korea ; Lifting ; Methionine ; Natriuretic Peptide, Brain ; Polymerase Chain Reaction ; Receptors, Peptide ; Biomarkers

OBJECTIVES: Patients receiving hemodialysis have been shown to be carnitine deficient due to many causes. Tissues, especially the skeletal muscle and myocardium, require carnitine for the production of energy. This study was performed to find out the effects of L-carnitine supplementation on muscular symptoms and cardiac functions in dialysis patients. METHODS: Among 72 hemodialysis patients, 40 patients who showed decreased free carnitine levels were selected to receive L-carnitine intravenously after each hemodialysis session for 6 months. Before and after supplementation, echocardiography, various neurologic examinations and questionnaires were obtained. RESULTS: After carnitine treatment for 6 months (1~1.5 g per every hemodialysis session), the blood level of carnitine was increased more than 10 times (19.04+/-7.12 micromol/L vs. 267.24+/-69.94 micromol/L, P<0.001). The left ventricular ejection fraction was improved in the patients who have less than 60% of ejection fraction (56.45+/-2.53% vs. 60.44+/-6.29%, P=0.03) after carnitine treatment. The neurological symptom score and isometric muscle power (pinch power) were improved, but the total neuropathy score, activities of daily living scale and grip power were not changed after carnitine supplementation on dialysis patients. CONCLUSION: Regular L-carnitine supplementation on hemodialysis patients can improve their left ventricular ejection fraction and some parts of functionality.
Activities of Daily Living ; Carnitine ; Dialysis ; Echocardiography ; Hand Strength ; Humans ; Muscle, Skeletal ; Muscles ; Myocardium ; Neurologic Examination ; Renal Dialysis ; Stroke Volume ; Surveys and Questionnaires

OBJECTIVES: Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block. METHODS: Bupivacaine (0.5%) 9 mg with fentanyl 10 microg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine. RESULTS: Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn't influence on the onset and level of sensory block and didn't reduce the incidence of hypotension. But onset of hypotension was delayed. CONCLUSION: Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.
Anesthesia ; Anesthesia, Spinal ; Blood Pressure ; Bupivacaine ; Cesarean Section ; Ephedrine ; Female ; Fentanyl ; Heart Rate ; Hypotension ; Incidence ; Injections, Spinal ; Pregnancy ; Subarachnoid Space