PURPOSE: To report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi. CASE SUMMARY: A 53-year-old female complained of pain and secretion in her right eye, which started 6 weeks before her visit. She applied steroid ointment, which was received from the dermatologist, to her eyelid 7 days prior to her visit but this treatment worsened her symptoms. At the initial visit, the visual acuity of the right eye was light perception, and purulent secretions were observed. Using a slit lamp, severe conjunctival hyperemia, hypopyon, and a ring-shaped central corneal ulcer were observed. The anterior chamber and fundus were not observed due to corneal lesions but ultrasonography showed no intraocular inflammation. Infectious keratitis was suspected and cultured by corneal scraping. During the incubation period, 0.5% moxifloxacin, 2% voriconazole, and 1% cyclopentolate were administered. A total of 400 mg of moxifloxacin and 100 mg of doxycycline were given orally. In the primary culture, Pseudomonas aeruginosa and Acinetobacter baumannii were identified so 5% ceftazidime, which was sensitive for the antibiotic susceptibility results was further instilled. Thereafter, the keratitis improved but the keratitis again worsened while maintaining the topical treatment. A secondary culture was positive for Ochrobactrum anthropi. Treatment with 1.4% gentamicin, which was sensitive for the antibiotic susceptibility test was added and the keratitis improved. A conjunctival flap was performed because of the increased risk of perforation. CONCLUSIONS: We report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi for the first time in the Republic of Korea.
Acinetobacter baumannii ; Acinetobacter ; Anterior Chamber ; Ceftazidime ; Corneal Ulcer ; Cyclopentolate ; Doxycycline ; Eyelids ; Female ; Gentamicins ; Humans ; Hyperemia ; Inflammation ; Keratitis ; Middle Aged ; Ochrobactrum anthropi ; Ochrobactrum ; Pseudomonas aeruginosa ; Pseudomonas ; Republic of Korea ; Slit Lamp ; Ultrasonography ; Visual Acuity ; Voriconazole

BACKGROUND/AIMS: Consistently defining disease activity remains a critical challenge in the follow-up of patients with Crohn's disease (CD). We investigated the potential applicability of abdominal ultrasonography with color Doppler (USCD) analysis for the detection of morphological alterations and inflammatory activity in CD. METHODS: Forty-three patients with CD ileitis/ileocolitis were evaluated using USCD analysis with measurements obtained on the terminal ileum and right colon. Sonographic parameters included wall thickening, stricture, hyperemia, presence of intra-abdominal mass, and fistulas. Patients were evaluated for the clinical activity (Harvey-Bradshaw Index [HBI]), fecal calprotectin (FC) and C-reactive protein (CRP). The USCD performance was assessed using magnetic resonance enterography (MRE) as a criterion standard. RESULTS: Most measurements obtained with USCD matched the data generated with MRE; however, the agreement improved in clinically active patients where sensitivity, positive predictive value, and accuracy were >80%, considering wall thickening and hyperemia. Complications such as intestinal wall thickening, stricture formation, and hyperemia, were detected in the USCD analysis with moderate agreement with MRE. The best agreement with the USCD analysis was obtained in regard to FC, where the sensitivity, positive predictive value, and accuracy were >70%. The overall performance of USCD was superior to that of HBI, FC and CRP levels, particularly when considering thickening, stricture, and hyperemia parameters. CONCLUSIONS: USCD represents a practical noninvasive and low-cost tool for evaluating patients with ileal or ileocolonic disease, particularly in clinically active CD. Therefore, USCD might become a useful asset in the follow-up of patients with CD.
C-Reactive Protein ; Colon ; Constriction, Pathologic ; Crohn Disease ; Fistula ; Follow-Up Studies ; Humans ; Hyperemia ; Ileitis ; Ileum ; Leukocyte L1 Antigen Complex ; Magnetic Resonance Imaging ; Ultrasonography ; Ultrasonography, Doppler, Color

PURPOSE: The purpose of this study was to evaluate the ultrasonographic findings of secondary appendicitis (SA) and to discuss the differential findings compared with primary appendicitis. METHODS: In this study, we analyzed the ultrasonographic findings of 94 patients under 15 years old of age treated at our institution from May 2005 to May 2014 who had bowel inflammation and an inflamed appendix with a maximal outer diameter >6 mm that improved with nonsurgical treatment (the SA group). Ninety-nine patients with pathologically proven acute appendicitis (the primary appendicitis [PA] group) from June 2013 to May 2014 and 44 patients with pathologically negative appendectomy results from May 2005 to May 2014 were also included to compare the ultrasonographic features of these conditions. A retrospective review of the ultrasonographic findings was performed by two radiologists. The clinical and laboratory findings were also reviewed. The results were statically analyzed using analysis of variance, the Pearson chi-square test, and the two-tailed Fisher exact test. RESULTS: Compared with PA, cases of SA had a smaller diameter (9.8 mm vs. 6.6 mm, P < 0.001), and were less likely to show periappendiceal fat inflammation (98% vs. 6%, P < 0.001) or an appendicolith (34% vs. 11%, P < 0.001). SA showed mural hyperemia on color Doppler ultrasonography as frequently as PA (P=0.887). CONCLUSION: The ultrasonographic features of SA included an increased diameter compared to a healthy appendix and the same level of hyperemia as in PA. However, the diameter was commonly in the equivocal range (mean diameter, 6.6 mm), and periappendiceal fat inflammation was rarely present in SA.
Appendectomy ; Appendicitis* ; Appendix ; Humans ; Hyperemia ; Inflammation ; Pediatrics ; Retrospective Studies ; Ultrasonography* ; Ultrasonography, Doppler, Color

PURPOSE: To assess the feasibility and effectiveness of transperineal ultrasonography (TPUS) for the evaluation of perianal Crohn disease (PCD) in pediatric patients. METHODS: Between September 2010 and August 2013, 64 TPUS examinations were performed in 43 patients (34 males and 9 females; mean age+/-standard deviation, 13.3+/-2.4 years; age range, 6 to 17 years) to evaluate PCD. The pain severity, location, and activity of perianal fistula, the presence of an abscess, and anal canal hyperemia were retrospectively evaluated. Spearman rank correlation analysis was performed to assess the relationship between the severity of the pain and the fistula activity, the presence of an abscess, and anal canal hyperemia. RESULTS: All examinations were successfully performed. Thirty-nine examinations (60.9%) were performed without any pain experienced by the patient, 19 examinations (29.7%) with mild pain, five examinations (7.8%) with moderate pain, and one examination (1.6%) with severe pain. The pain severity was correlated with the fistula activity (P<0.01). An anterior fistula location was more common than a posterior location. Active fistulas and abscesses were identified during 30 examinations (46.9%) and 12 examinations (18.8%), respectively. Anal canal hyperemia was identified in 31 examinations (48.4%). CONCLUSION: TPUS with a color Doppler study is useful for visualizing a perianal fistula or abscess and for assessing its inflammatory activity in pediatric Crohn patients.
Abscess* ; Anal Canal ; Crohn Disease* ; Female ; Fistula* ; Humans ; Hyperemia ; Male ; Pediatrics ; Perineum ; Retrospective Studies ; Ultrasonography*

PURPOSE: To reconstruct the midface, local flaps such as nasolabial flaps have been frequently used. These local flaps, however, have the shortcomings of requiring a secondary operation or limitations in the movement of the flap. Thus, new methods have been developed. This paper reports a case wherein the basal cell carcinoma on the cheek was resected and the skin and soft tissue defect was successfully treated using a facial artery perforator flap. METHODS: A 68-year-old female consulted the authors on the basal cell carcinoma that developed on her cheek. The mass was fully resected and revealed a 2.3 x 2.3 cm defective region. Using a Doppler ultrasonography, the facial artery path was traced, and using a loupe magnification, the facial artery perforator flap was elevated and the defective region was covered with the flap. RESULTS: The flap developed early venous congestion, but it disappeared without any treatment. Six months after the surgery, the patient was satisfied with the postoperative result. CONCLUSION: The facial artery perforator flap has a thin pedicle. It offers a big arc of the rotation that allows free movement and one-stage operation. These strengths make the method useful for the reconstruction of the midface among other procedures.
Aged ; Arteries ; Carcinoma, Basal Cell ; Cheek ; Female ; Humans ; Hyperemia ; Perforator Flap ; Skin ; Ultrasonography, Doppler

Living donor liver transplantation is now widely accepted as a therapeutic option for adult patients suffering with various end-stage liver diseases. The major concerns for use of a right lobe (RL) graft have focused on the safety for the donor and the necessity for including the middle hepatic vein (MHV) into the graft to avoid congestion of the right anterior segment. There are 5 types of RL grafts (simple RL, modified RL, modified extended RL, extended RL with V4b preservation and extended RL), and the selection is usually determined after consideration of the graft size to the recipient, the availability of a vessel graft, the amount of hepatic venous congestion and the reconstruction technique. Various kinds of vessel grafts have been used in practice: 1) greater saphenous vein, paraumbilical vein, portal vein and internal jugular vein from the recipient, 2) various veins and arteries from the deceased donors and 3) bovine pericardium and synthetic vessels. Interposition of a vessel graft is the basic principle for MHV reconstruction. Triphasic liver computed tomography and Doppler ultrasonography are the most useful tools for posttransplant follow-up. When outflow obstruction occurs at the interposed vessel grafts that replace the MHV trunk, then radiological intervention with metallic stent insertion seems to be a feasible and reliable treatment modality. At Asan Medical Center, 200 cases of adult living donor liver transplantation using a modified RL graft revealed a > 90% 2-week patency rate regardless of the types of vessel grafts. In conclusion, it is recommended to make the MHV reconstruction resemble the original configuration of the donor's MHV trunk according to the hemodynamic principles.
Adult ; Arteries ; Chungcheongnam-do* ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Hemodynamics ; Hepatic Veins* ; Humans ; Hyperemia ; Jugular Veins ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors* ; Pericardium ; Portal Vein ; Saphenous Vein ; Stents ; Tissue Donors ; Transplants* ; Ultrasonography, Doppler ; Veins

BACKGROUND AND OBJECTIVES: The purposes of this study were to provide evidence of any correlation between the endothelial dysfunction and the extent of coronary atherosclerosis, and the relationship between the endothelial function and individual atherosclerosis risk factors in patients with significant coronary artery stenosis. SUBJECTS AND METHODS: The endothelial function was measured by hyperemia induced brachial artery dilation, using high resolution ultrasound, in 284 consecutive patients (mean age 59 years, men: 176) having undergone coronary angiography. The subjects were divided into four groups according to the number of coronary arteries narrowed by more than 50%; 0 (n=88), 1 (n=98), 2 (n=54) and 3 (n=44). The endothelial functions were compared to see if significant coronary artery disease was present, according to the groups and the presence of individual atherosclerosis risk factors. RESULTS: There were no significant differences in the endothelial dysfunction between the narrowed and normal coronary artery groups (4.66+/-2.45% vs. 4.43+/-1.53% p>0.05) or between the four groups. The endothelial function in patients with significant coronary artery stenosis (n=196) was significantly lower when coupled with hypertension (n=84, 2.99+/-2.4% vs. 4.20+/-2.4%, p<0.05), diabetes (n=44, 4.07+/-2.7% vs. 4.84+/-2.5%, p<0.05) and hypercholesterolemia (n=82, 4.26+/-1.9% vs. 4.95+/-2.7%, p<0.05), but not with smoking. CONCLUSION: The endothelial function showed no difference according to the extent of coronary atherosclerosis. Risk factors of atherosclerosis, such as hypertension, diabetes mellitus and hypercholesterolemia, can deteriorate the endothelial function further, even in the patients with significant coronary artery stenosis.
Atherosclerosis ; Brachial Artery ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels ; Diabetes Mellitus ; Endothelium, Vascular ; Humans ; Hypercholesterolemia ; Hyperemia ; Hyperlipidemias ; Hypertension ; Male ; Risk Factors ; Smoke ; Smoking ; Ultrasonography

In the past, most hepatolithiasis had been brown pigment stones in Korea. However, stones with high cholesterol content are found with increasing frequency. Abdominal ultrasonography is superior to CT for detection of cholesterol hepatolithiasis. The characteristic gross morphology of pure cholesterol hepatolithiasis shown by cholangioscopy is diagnostic. An effective medical management consists of stone removal by percutaneous transhepatic cholangioscopy and ursodeoxycholic acid for the prevention of recurrence. We here report a case of primary pure cholesterol hepatolithiasis with a review of the literature. A 29-year-old woman presented with right upper quadrant pain. Abdominal ultrasonography showed right intrahepatic duct stones. A cholangioscopy revealed typical cholesterol stones, mucosal hyperemia, and mild narrowing in stone-bearing intrahepatic duct. Cholangioscopic stone removal via the percutaneous transhepatic route was successfully performed. To prevent recurrence, ursodeoxycholic acid was administered.
Adult ; Cholesterol* ; Female ; Humans ; Hyperemia ; Korea ; Recurrence ; Ultrasonography ; Ursodeoxycholic Acid

BACKGROUND AND OBJECTIVE: Fractional flow reserve (FFR) has emerged as an easily obtainable, and accurate, lesion-specific parameters for the physiological evaluation of coronary artery stenosis. However, the effects of the lesion length and eccentricity on the FFR remain unclear. Therefore, the relationship between the lesion length and eccentricity to the FFR, and the lesion length to the degree of stenosis were studied to see if there was any significant influence on the trans-stenotic pressure gradients and the FFR. SUBJECTS AND METHODS: Intravascular ultrasound (IVUS) was performed and the FFR measured in 19 lesions, ranging from 80 to 90% in area stenosis (AST), using a pressure wire. The eccentric index at the most stenotic site, and the length of the coronary stenosis lesion, above 50 and 70% of the AST, at the most stenotic site were obtained using IVUS. The FFR was defined by the ratio of distal mean coronary pressure (Pd) to that of the aortic mean pressure (Pa) under hyperemia. RESULTS: The FFR showed no correlation with the eccentricity or the length of the stenosis lesions when they were more than 50% of the AST (p>0.05). However, the FFR showed a significant correlation with the length of the most stenotic lesions (r=-0.79, p<0.001) and the lesions with an AST of more than 70% (r=-0.47, p<0.05). The hyperemic pressure gradient across the lesion showed a significant correlation with the length of the lesion, but only to those with the most severe portion of stenosis (r=0.64, p=0.003). CONCLUSION: In the functional evaluation of coronary stenosis, the length of the most stenotic lesions, as well as the cross sectional area and minimal lumen area at the most stenotic lesion, should be considered, as this study has shown that the length of the most severe stenotic lesion could influence the FFR and trans-stenotic pressure gradients.
Constriction, Pathologic ; Coronary Stenosis ; Hyperemia ; Ultrasonography ; Ultrasonography, Interventional

BACKGROUND: Intravascular ultrasound (IVUS) is one of the golden standards for the assessment of optimal angioplasty. Pressure-derived myocardial fractional flow reserve (FFRmyo) is a lesion-specific functional index of epicardial conduit and may be particularly useful for the assessment of optimal coronary angioplasty. The purpose of this study was to assess IVUS parameters and FFRmyo after successful angioplasty on coronary angiogram and compare them between balloon and stent group. METHODS: The study population consisted of 28 patients who underwent revascularization (14 cases of balloon angioplasty only, 14 cases of angioplasty with stent) from Jan. 1999 to Aug. 2000 at Inha University Hospital. After successful angioplasty on coronary angiogram, we measured minimal luminal diameter (MLD), minimal luminal area (MLA), lesion area stenosis (l-AST) and reference area stenosis (r-AST) with IVUS imaging. And we calculated FFRmyo from the ratio of mean coronary pressure distal to the stenosis (Pd) to the aortic mean pressure (Pa) during maximum coronary hyperemia (Pd/Pa). RESULTS: There was significant difference of MLD (2.2+/-0.4 vs 2.6+/-0.3), MLA (4.4+/-1.1 vs 6.4+/-1.7), r-AST (43.7+/-9.2 vs 29.8+/-9.4) and FFRmyo (0.89+/-0.07 vs 0.93+/-0.03) between balloon and stent group. All IVUS parameters (MLD, MLA, r-AST) are well correlated with FFRmyo after angioplasty (r=0.52, p<0.05, r=0.48, p<0.05 and r=-0.72, p<0.05 respectively). By multiple regression analysis, r-AST showed the best correlation with FFRmyo among IVUS parameters. CONCLUSION: Coronary angioplasty with stent showed more favorable MLD, MLA, r-AST and FFRmyo than balloon angioplasty. FFRmyo may be seemed to be alternative to IVUS for estimating the result of coronary angioplasty.
Angioplasty* ; Angioplasty, Balloon ; Constriction, Pathologic ; Fractional Flow Reserve, Myocardial ; Humans ; Hyperemia ; Phenobarbital ; Stents ; Ultrasonography*