BACKGROUND/AIMS: Conventional colonoscopy is limited in some patients with several causes, such as fixed angulation, extensive loop or adhesion. Therefore, small-caliber scopes are considered alternatives to unsuccessful conventional colonoscopy. The aim of this study is to evaluate the usefulness of gastroscope in patients with unsuccessful colonoscopy. METHODS: From May 2008 to April 2009, a total of 2,548 colonoscopies were performed in Wonkwang University Hospital. The gastroscope was used subsequently when conventional colonoscopy failed. RESULTS: There were 27 cases (1.06%) of unsuccessful colonoscopy. The causes of failure were assessed as fixed angulation of the sigmoid colon (59.2%, 16/27), excessive looping (14.8%, 4/27), stricture (14.8%, 4/27), sigmoid diverticulosis (7.4%, 2/27), and adhesion of transverse colon (3.7%, 1/27). The average time of intubation to cecum with the gastroscope was 7 minutes and 28 seconds (range, 2 to 20 minutes). With the gastroscope, 77.8% (21/27) were intubated to the cecum. The pain score of gastroscope was reduced, as compared with that of conventional colonoscopy (4.95 vs. 5.94, P<0.001). CONCLUSIONS: Gastroscope would be a useful alternative tool in patients with unsuccessful colonoscopy.
Cecum ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Constriction, Pathologic ; Diverticulum ; Gastroscopes ; Humans ; Intubation

BACKGROUND/AIMS: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS. METHODS: We included 277 patients who were admitted for ACS between January and December 2006. We measured NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a median of 559 days for cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS. RESULTS: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30), followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87;HR 1.99, 95% CI 1.18-3.37, respectively), but not the baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67). CONCLUSIONS: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in isolation.
Acute Coronary Syndrome ; Biomarkers ; C-Reactive Protein ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Peptide Fragments ; Prognosis ; Troponin ; Troponin I

Inferior sinus venosus type atrial septal defect (ASD) is a rare congenital cardiac deformity that occurs between the inferior vena cava and right atrium. Inferior sinus venosus defect is difficult to diagnose through transthoracic echocardiography because of its location which is infero-posterior to the fossa ovalis. Increasing pulmonary arterial pressure and pulmonary vascular resistance in patients with sinus venosus defect usually occur earlier than other types of ASD. We report a case of 19-year-old man who presented exertional dyspnea due to inferior sinus venous type ASD with mild pulmonary hypertension. In this case, we found clues from slight diastolic flattening of interventricular septum and shortened acceleration time of right ventricular outflow tract on initial transthoracic echocardiography, leading right heart catheterization and transesophageal echocardiography to reveal this rare type of ASD.
Acceleration ; Arterial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Congenital Abnormalities ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal ; Heart Atria ; Heart Septal Defects, Atrial ; Humans ; Hypertension, Pulmonary ; Vascular Resistance ; Vena Cava, Inferior ; Young Adult

BACKGROUND AND OBJECTIVES: The purpose of the current study was to assess left atrial (LA) physiology in relation to associations between LA volume change and regional tissue velocities and strains, and to extend this information to patients with mitral stenosis (MS) or mitral regurgitation (MR). SUBJECTS AND METHODS: Twenty-two healthy persons, 22 patients with moderate-to-severe MS, and 22 patients with moderate-to-severe MR were studied. Tissue velocities, strains, and time-volume curves of the LA were acquired using tissue Doppler imaging and 3-dimensional echocardiography. RESULTS: In healthy controls, the maximal LA volume was negatively correlated with the posterior wall longitudinal systolic strain (r=-0.45, p=0.03). The time-to-maximal LA volume was positively correlated with the time-to-posterior wall longitudinal peak strain (r=0.46, p=0.03) and the time-to-circumferential peak strain (r=0.59, p=0.004). The LA active emptying fraction (LAactEF) was positively correlated with the posterior wall longitudinal peak systolic and late diastolic tissue velocities. In patients with MS, the maximal LA volume was negatively correlated with the posterior wall radial peak systolic velocity and the longitudinal late diastolic velocity. In patients with MS, the LAactEF had an additional positive correlation with the anterior wall longitudinal and circumferential systolic velocities, whereas the patients with MR had an additional positive correlation between the LAactEF and the lateral wall longitudinal peak strain as compared with the healthy cantrols. CONCLUSION: LA longitudinal and circumferential deformations are more related than radial deformation to determining LA volume and function. The LA of patients with MS revealed a greater pathologic physiology than those of patients with MR.
Echocardiography ; Heart Atria ; Heart Valve Diseases ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Sprains and Strains

Malignant fibrous histiocytoma (MFH) is a soft-tissue sarcoma that usually occurs in middle-aged or elderly patients, has a similar male-to-female ratio, and rarely develops in the retroperitoneum, especially in the psoas muscles. The lower extremity is the most common site of origin, followed by upper extremity, the trunk, and the retroperitoneum. Primary retroperitoneal involvement of a malignant fibrous histiocytoma is often diagnosed at an advanced stage as it has no specific symptoms. Primary retroperitoneal involvement of a malignant fibrous histiocytoma is very rare and there is no case report of MFH in the psoas muscle in Korea, as introduced here.
Aged ; Histiocytoma, Malignant Fibrous* ; Humans ; Korea ; Lower Extremity ; Psoas Muscles* ; Sarcoma ; Upper Extremity

PURPOSE: We wanted to investigate the efficacy and safety of the immunotherapeutic Uro-Vaxom for treating uncomplicated recurrent cystitis in female patients only. MATERIALS AND METHODS: Adult female patients were enrolled in this multicenter, open-label study if they had acute cystitis at the enrollment visit and positive results on urine culture (> or =10(3)CFU/ml). The patients were treated for 3 months with one capsule daily of Uro-Vaxom after antibiotic therapy, and they were observed for another 3 months. The primary efficacy criteria were the cystitis recurrence rates over 6 months, the distribution of cystitis and the proportion of patients with cystitis. RESULTS: A total of 50 patients were evaluated. During the 6-month trial, the number of cystitis recurrences was significantly reduced in comparison with the 6-month pretrial period (on the average 0.64 as compared to 3.0 recurrences, respectively p<0.001). The incidences of frequency, urgency and dysuria remained low until the end of the trial. Uro-Vaxom was well tolerated: side-effects were mentioned by 8% of the 50 patients, and there was no case leading to treatment withdrawal. CONCLUSIONS: Uro-Vaxom significantly reduced the incidence of cystitis during the 6 months of this study, including the 3 months of treatment. These results demonstrate that Uro-Vaxom is a valuable agent for prophylaxis of recurrent cystitis.
Adult ; Cystitis* ; Dysuria ; Escherichia coli ; Female ; Humans ; Incidence ; Recurrence

PURPOSE: We evaluated the treatment efficacy including survival and recurrence, and factors associated with recurrence in osteosarcoma patients treated with preoperative chemotherapy, surgery, and adjuvant chemotherapy. MATERIALS AND METHODS: Forty nine patients with osteosarcoma were treated with preoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion for 3 cycles, followed by surgery. According to the pathologic response, if tumor was necrotized more than 90%, the same adjuvant chemotherapy was reintroduced for 3 cycles, and if the response was not enough, then the salvage regimen was introduced. Plain chest film and chest CT scan were taken monthly and every 3 months, respectively. When tumor recurred, the metastasectomy was performed whenever possible. RESULTS: Forty three patients were evaluable with amedian follow up of 53 months. Five-year disease-free and overallsurvival rate was 47.0% and 66.9%, respectively. The recurrence was observed in 22 patients (51.2%) with median time of 12.5 months. Baseline alkaline phosphatase (ALP) was the only significant factor for recurrence (p=0.03) and the patients with the possibility of metastasectomy recurrence showed higher post-relapse survival compared to other treatment modalities (26 momths vs 5~12 months). CONCLUSION: These results indicates that pre- and postoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion showed comparable treatment efficacy and acceptable toxicities.
Alkaline Phosphatase ; Chemotherapy, Adjuvant ; Cisplatin ; Doxorubicin ; Drug Therapy* ; Extremities* ; Follow-Up Studies ; Humans ; Metastasectomy ; Osteosarcoma* ; Recurrence ; Thorax ; Tomography, X-Ray Computed ; Treatment Outcome

No abstract available.
Heart* ; Thoracic Surgery*

The incidence of oligodendroglioma in pediatric age is less than 1%, and about 90% of them are located supratentorially. The authors are reporting a case of oligodendroglioma at the cerebellar vermis in a 14 years old boy which was cured by surgical resection and shunt procedure.
Adolescent ; Child* ; Humans ; Incidence ; Male ; Oligodendroglioma*

We report a case of leiomyosarcoma of the spermatic cord with the review of literatures. To our knowledge, this is the first case to be reported in Korea.
Korea ; Leiomyosarcoma* ; Spermatic Cord*