Spontaneous Rupture of the Right Gastroepiploic Artery Immediately after Gastroscopy

Idiopathic spontaneous intraperitoneal hemorrhage is both rare and potentially fatal. The incidence of gastroepiploic artery rupture, especially a non-aneurysmal rupture, is extremely low. We report the case of an elderly woman who was mistakenly diagnosed with procedure-related bleeding after gastroscopy. A 0.3 cm polyp was identified and removed during the procedure. The patient later developed shock due to which gastroscopy was repeated; however, no unusual findings were observed. Therefore, abdominopelvic computerized tomography was performed and gastroepiploic artery rupture was detected. Transcatheter arterial embolization was immediately performed without laparotomy, without any complications. The bleeding was controlled, and the patient was discharged after embolization. It is important to acknowledge the possibility of spontaneous rupture of the visceral arteries in elderly individuals with hypertension or atherosclerosis, especially in the event of sudden abdominal pain or shock immediately after an endoscopic procedure. This is the first case report of idiopathic spontaneous rupture of the right gastroepiploic artery successfully managed by transcatheter arterial embolization in South Korea.

Spontaneous Rupture of the Right Gastroepiploic Artery Immediately after Gastroscopy

Idiopathic spontaneous intraperitoneal hemorrhage is both rare and potentially fatal. The incidence of gastroepiploic artery rupture, especially a non-aneurysmal rupture, is extremely low. We report the case of an elderly woman who was mistakenly diagnosed with procedure-related bleeding after gastroscopy. A 0.3 cm polyp was identified and removed during the procedure. The patient later developed shock due to which gastroscopy was repeated; however, no unusual findings were observed. Therefore, abdominopelvic computerized tomography was performed and gastroepiploic artery rupture was detected. Transcatheter arterial embolization was immediately performed without laparotomy, without any complications. The bleeding was controlled, and the patient was discharged after embolization. It is important to acknowledge the possibility of spontaneous rupture of the visceral arteries in elderly individuals with hypertension or atherosclerosis, especially in the event of sudden abdominal pain or shock immediately after an endoscopic procedure. This is the first case report of idiopathic spontaneous rupture of the right gastroepiploic artery successfully managed by transcatheter arterial embolization in South Korea.

Infuence of Metabolic Syndrome on Hearing Outcome in Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (S-SNHL) has been reported to be associated with hypertension, diabetes mellitus, hyperlipidemia, and stroke in previous studies. The purpose of this study was to confrm whether metabolic syndrome (MS) infuences the hearing outcome of S-SNHL in the Korean population. SUBJECTS AND METHOD: We prospectively investigated the clinical variables of 231 cases of S-SNHL from 2010 March to 2014 February. MS was defned according to the National Cholesterol Education Program Adult Treatment Panel III with Asian modifcations. We analyzed and compared the basic and clinical characteristics, the thresholds of pure tone audiometry (PTA), and the hearing outcomes of patients with MS (MS group) and without MS (NMS group). RESULTS: There were no signifcant differences in the basic characteristics and initial hearing thresholds between the MS and NMS groups; on the other hand, there were signifcant differences in all of the clinical values of MS between the two groups. The average thresholds of final PTA for the MS and NMS groups were 52.9±30.9 dB and 40.5±27.2 dB, respectively, with meaningful diversity (p < 0.01). According to Siegel's criteria, the recovery rate of the NMS group (95/159, 59.7%) was signifcantly higher than those of the MS group (29/72, 40.3%). The proportion of recovery within 5 days after starting the treatment was signifcantly higher of the NMS group (37/95, 39.0%) than those of the MS group (4/29, 13.8%) (p < 0.01). CONCLUSION: The hearing outcome of the NMS group was signifcantly better than those of the MS group.

The Effect of Protective Socks with Functional Insoles on Plantar Foot Pressure in Diabetes Patients

PURPOSE: The most common cause of plantar ulceration is an excessive plantar pressure in patients with peripheral neuropathy. Foot orthosis and therapeutic footwear have been used to decrease the plantar pressure and prevent the plantar ulceration in in diabetes patients. We investigated whether protective sock with functional insoles reduce plantar pressure while walking in 17 diabetes patients. METHODS: An in-shoe measurement device was used to measure the peak plantar pressure while walking. Peak plantar pressure data were collected while walking under two conditions: 1) wearing diabetic sock and 2) wearing the protective sock with functional insoles. Each subject walked 3 times in 10-m corridor under three conditions, and data were collected in 3 steps in the middle of corridor with in right and left feet, respectively. Pared t-test was used to compare the peak plantar pressures in three plantar areas under these two conditions. RESULTS: The protective sock with functional insoles significantly reduced the peak plantar pressure on the lateral rearfoot, but significantly increased the peak plantar pressure on the middle forefoot, and medial midfoot (p 0.05). CONCLUSION: The protective sock with functional insoles reduced plantar pressures in the rearfoot and supported the medial longitudinal arch. However, it is necessary to change the position of metatarsal pad in the insole design of forefoot area to prevent diabetic foot ulceration.

The Comparison of Short-Term Therapeutic Effects of Acute Low-Tone Sensorineural Hearing Loss according to Steroid Capacity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute low-tone sensorineural hearing loss refers to a condition wherein thresholds increase only at low frequencies in pure-tone audiometry. Systemic steroid treatment is commonly used for acute low-tone sensorineural hearing loss without vertigo, but there has been no established treatment in most clinical researches. The purpose of this study is to compare and analyze the short-term effects of high- and half-dose oral steroid therapy on patients suffering from acute low-tone sensorineural hearing loss without vertigo. SUBJECTS AND METHOD: Forty-six patients diagnosed with acute low-tone sensorineural hearing loss were divided into two groups and treated with high-dose (24 patients) and half-dose (22 patients) steroids, respectively. A retrospective analysis was conducted on their medical records. RESULTS: There were no significant differences between the two groups in any of the following: age, sex ratio, duration of symptoms before treatment, pure-tone hearing thresholds, low frequency hearing thresholds and speech intelligibility. However, both groups showed significant differences in hearing thresholds before and after treatment. In addition, no significant difference was noted in the recovery and recurrence rate between the two groups. CONCLUSION: According to the results of this study, there is no difference in treatment effect between the high- and half-dose groups. Therefore, half-dose steroids may be used as a treatment option for acute low tone sensorineural hearing loss.

Clinical Features and Prognosis of Henoch-Schönlein Purpura in Children and Adults: A 13-Year Retrospective Study at a Single Centre

PURPOSE: To investigate differences in clinical features, blood/urinary findings, and prognosis in different age groups of patients with Henoch-Schönlein purpura (HSP). METHODS: A total of 469 patients with HSP were analyzed retrospectively from June 2003 to February 2016. We classified patients into child or adult groups based on their age. RESULTS: The adult group had more patients with anemia (child vs. adult; 7.5% vs. 16.4%), and higher immunoglobulin A (IgA) (30.0% vs. 50.0%) levels, C-reactive protein (34.2% vs. 54.0%) and uric acid (3.1% vs. 12.1%) levels than the child group. The child group was highly positive for Mycoplasma pneumoniae immunoglobulin M (IgM) (34.4%). More patients in the child group presented with high levels of antistreptolysin O (24.7% vs. 2.9%) and high C4 (11.5% vs. 4.2%). Low C3 (1.1% vs. 10.2%) levels, and renal involvement with gross hematuria (8.6% vs. 21.5%), nonnephrotic proteinuria (1.1% vs. 11.2%), and nephrotic syndrome (1.1% vs. 6.0%) were common in the adult group. Adults also had poorer renal outcomes [persistent hematuria/proteinuria (10.5% vs. 32.8%), and chronic kidney disease (0% vs. 11.2%)] than the child group. Risk factors for renal involvement such as older age and higher level of uric acid were only found in the child group. The risk factors for poor renal outcome were nephrotic syndrome in the child group and gross hematuria in the adult group. CONCLUSION: In this study, child and adult groups presented with different clinical manifestations of HSP. We found that risk factors for renal involvement included age and high uric acid level in the child group. Moreover, nephrotic syndrome in the child group and gross hematuria in the adult group increased the risk of poor renal outcome.

Clinical Features and Prognosis of Henoch-Schönlein Purpura in Children and Adults: A 13-Year Retrospective Study at a Single Centre

PURPOSE: To investigate differences in clinical features, blood/urinary findings, and prognosis in different age groups of patients with Henoch-Schönlein purpura (HSP). METHODS: A total of 469 patients with HSP were analyzed retrospectively from June 2003 to February 2016. We classified patients into child or adult groups based on their age. RESULTS: The adult group had more patients with anemia (child vs. adult; 7.5% vs. 16.4%), and higher immunoglobulin A (IgA) (30.0% vs. 50.0%) levels, C-reactive protein (34.2% vs. 54.0%) and uric acid (3.1% vs. 12.1%) levels than the child group. The child group was highly positive for Mycoplasma pneumoniae immunoglobulin M (IgM) (34.4%). More patients in the child group presented with high levels of antistreptolysin O (24.7% vs. 2.9%) and high C4 (11.5% vs. 4.2%). Low C3 (1.1% vs. 10.2%) levels, and renal involvement with gross hematuria (8.6% vs. 21.5%), nonnephrotic proteinuria (1.1% vs. 11.2%), and nephrotic syndrome (1.1% vs. 6.0%) were common in the adult group. Adults also had poorer renal outcomes [persistent hematuria/proteinuria (10.5% vs. 32.8%), and chronic kidney disease (0% vs. 11.2%)] than the child group. Risk factors for renal involvement such as older age and higher level of uric acid were only found in the child group. The risk factors for poor renal outcome were nephrotic syndrome in the child group and gross hematuria in the adult group. CONCLUSION: In this study, child and adult groups presented with different clinical manifestations of HSP. We found that risk factors for renal involvement included age and high uric acid level in the child group. Moreover, nephrotic syndrome in the child group and gross hematuria in the adult group increased the risk of poor renal outcome.

The relationship between pregnancy rate and suppression of luteinizing hormone in IVF-ET program / 대한산부인과학회지

OBJECTIVE: To investigate the effect of profound LH suppression in the late follicular phase during controlled ovarian hyperstimulation (COH) on pregnancy rate. METHODS: Data were collected by retrospective analysis. A total of 172 cycles of oocytes retrieval for IVF after COH with GnRH agonist-down regulation and hMG/FSH were included from January 1999 to July 2002. Serum LH, FSH, estradiol and progesterone concentrations were measured on the day 3 of the preceding cycle and LH concentration was measured on the day of hCG administration. Based on LH concentrations (mIU/mL) on the day of hCG administration, cycles are classfied to two groups (group 1: LH>0.7 mIU/mL, group 2: LH

Effects of Back-belt on Electromyographic Activities and Angle of Lower Back and Extremity during Lifting / 대한산업의학회지

OBJECTIVES: The purpose of this study was to examine the electromyographic activities of the erector spinae muscle of the back and the rectus femoris muscle of the thigh, and to measure the angles of the spinal and knee flexions in order to determine the effect of wearing a back belt. METHODS: Fifteen healthy males participated in the study. Surface electromyography was used to measure the level of muscle activities at the two muscle groups. The Simi system, utilizing two-dimensional analysis of movement, was used to examine the range of motion of the back and low extremity. RESULTS: Firstly, the angle of the spinal flexion was significantly less in the back-belt-wearing group than in the control, and that of the knee flexion was significantly increased in the back-belt-wearing group. Secondly, there was no significant change in the electromyographic signals of the erector spinae muscle of the back and the rectus femoris muscle of the thigh. CONCLUSIONS: The use of back belts helps workers to correct their posture when lifting boxes. It can therefore protect workers from acute back injuries.

Clinical Manifestations and Treatment Outcomes of Pulmonary Aspergilloma

BACKGROUND: Pulmonary aspergilloma usually results from the ingrowth of colonized Aspergillus from a damaged bronchial tree, a pulmonary cyst, or from the cavities of patients with underlying lung diseases. In the present study, we analyzed the clinical features, diagnostic methods, and managements of 36 patients with pulmonary aspergilloma. METHODS: Thirty-six patients were diagnosed as having pulmonary aspergilloma at Chung-Ang University Hospital between February 1988 and February 2000. Their medical records were reviewed retrospectively. RESULTS: The age of patients (median +/- SD) was 53.3 +/- 11.8 years, the male to female ratio was 2.36: 1, and the most frequent symptom was hemoptysis, which occurred in 24 patients (65%). The most common underlying disease was pulmonary tuberculosis (81%), and the upper lobes of both lungs were the most frequently involved sites. Nine patients received a chest CT in the prone position and seven of these showed a movable fungus ball. Eleven patients were positive for the precipitin antibody to A. fumigatus. Twenty patients underwent surgical resection, and post-operative complications were reported in seven cases. The post-operative mortality was 5.6% (2/36). CONCLUSION: Pulmonary aspergilloma usually develops in the patients with underlying lung diseases. Resectional lung surgery is considered the mainstay of therapy for pulmonary aspergilloma. However, this operation is associated with significant complications and death in some cases. Therefore, it is necessary to develop reasonable criteria for selection of candidates for such surgery.

Clinical investigation of pulmonary aspergilloma / 대한내과학회지

BACKGROUND: Pulmonary aspergilloma usually results from the ingrowth of the colonized Aspergillus in the damaged bronchial tree, pulmonary cyst, or cavities of patients with underlying lung diseases. We analyzed the clinical features, diagnostic methods, and managements of 36 patients with pulmonary aspergilloma. METHODS: From February 1988 to February 2000, medical records of 36 patients who were diagnosed as pulmonary aspergilloma at Chung Ang university hospital were reviewed retrospectively. RESULTS: The mean age (mean+/-SD) was 53.3+/-11.8 years, The male to female ratio was 2.36:1. The most frequent symptom was hemoptysis which occured in 24 patients (65%). The most common underlying disease was pulmonary tuberculosis (81%). The upper lobe was most commonly involved area. In 9 patients, chest CT was taken with prone position and 7 of them showed movability of the fungus ball. Eleven patients showed positive test for precipitin antibody of Aspergillus species. As for the treatment, 20 patients underwent surgical resection. Post-operative complications were reported in 7 cases. The post-operative mortality was 5.6% (2/36). CONCLUSION: Pulmonary aspergillomas usually develop in patients with underlying respiratory diseases. Resectional lung surgery is considered to be the mainstay of therapy for pulmonary aspergilloma. However, operation is associated with significant complication rate and even deaths. Therefore, it is necessary to develop a reasonable criteria for the selection of suitable candidates with aspergilloma for the surgery.

A Case of Lymphangioleiomyomatosis with Renal Angiomyolipoma / 결핵

Recently we have experienced one case of pulmonary lymphangioleiomymatosis(LAM). A 49 year-old woman visited the outpatient department complaining of longstanding dyspnea, which was aggravated by exercise. Although the chest PA film showed nothing more than a slight increase in interstitial marking, a lung HRCT revealed multiple cystic lesions of a similar size that were scattered through out the whole field in both lungs. An abdominal CT detected an angiomyolipoma located in the midbody of the left kidney. Video-assisted thoracic surgery(VATS) was performed for the pathologic diagnosis. On gross examination of the biopsy lung, a pulmonary LAM was confirmed by a finding of smooth muscle proliferation in the interstitum of the lung. After the final diagnosis, oral medroxyprogesterone was prescribed and she is presently in a stable condition.

Bleeding from a Tuberculous Gastric Ulcer in a Hemodialysis Patient / 대한신장학회잡지

The incidence of Tuberculosis among the patients with end-stage renal disease(ESRD) has increased up to 16 times of that in the general population. The impairment of the cellular immunity in the ESRD patients may have a role in the pathogenesis. Extrapulmonary tuberculous manifestations such as lymph node, peritoneum, and pleura involvement are more frequent in the ESRD patients than in the general population. However, there has been no case of upper gastrointestinal(UGI) bleeding as a result of a gastric tuberculosis in the ESRD patient on hemodialysis. Here we report an unusual case of a hemodialysis patient with UGI bleeding secondary to a tuberculous gastric ulcer. A 31-year-old female on hemodialysis was admitted with melena. Endoscopy revealed a benign gastric ulcer with a visible bleeding vessel at the base, located in the anterior wall of the antrum. An exploratory laparotomy showed multiple, round, small and yellow nodules on the visceral peritoneum as well as a 1-cm sized gastric ulcer. After gastric resection, a histological examination including peritoneal nodules demonstrated chronic granulomatous inflamation with caseous necrosis and giant cells. The patient has been on antituberculosis medication and followed up in the outpatient department without any event for 8 months.

Usefulness of the Portable Cystometer

OBJECTIVE: To evaluate the usefulness of a newly devised portable cystometer to measure the pressure of bladder in a low cost and easier accessability. METHOD: This study was performed in 47 patients with a conventional instrumental cystometer (Jupiter 8000, Wiest) and the newly devised portable cystometer. In the supine position, we measured the maximal intravesical pressure, abdominal pressure and bladder volume with the portable cystometer just after the measurement of the maximal detrusor pressure and bladder volume with the conventional instrumental cystometer. Paired t-test was utilized to analyze and compare the result. RESULTS: 1) There was no significant difference in the average maximal detrusor pressures measured by maximal intravesical pressures minus abdominal pressures, which were 38.32 20.97 cmH2O by the conventional instrumental cystometer and 40.02 20.70 cmH2O by the portable cystometer (p>0.05). 2) There was no significant difference in the average bladder volumes at maximal detrusor pressure, which were 302.13 83.92 cc by the conventional instrumental cystometer and 314.04 94.17 cc by the portable cystometer (p>0.05). CONCLUSION: We conclude that there is no significant difference between the conventional instrumental cystometer and the portable cystometer in the measurement of detrusor pressure and bladder volume. We believe this portable cystometer would be a useful tool to evaluate the function of bladder in a low cost and easier accessability.

Urethral Stent as a Part of Management of the Neurogenic Bladder in Spinal Cord Injury: Two cases report

In spinal cord injury, various options exist for the management of the neurogenic bladder. For the management of neurogenic bladder, urethral stent was placed under a cystoscopic guidance as one day procedure. Urethral stents were inserted in a T12 spinal cord injured patient who had recurrent urinary tract infections and a vesicoureteral reflux (VUR) and a T3 spinal cord injured patient who had a detrusor-sphincter dyssynergia. In the first case, recurrent urinary tract infection and VUR were resolved after the stenting. In the second case, urethral stent was removed because of the failure of continuous drainage. Because of its easily reversible nature, the urethral stent can be adopted for use in pateints as an option of neurogenic bladder management.

Choroidal Effesuion After Trabeculetomy in Glaucoma with Sturge-Weber Syndrome

The authors experienced a case of choroidal expansion which occurred after trabeculectomy in glaucoma with Sturge-Weber syndrome. She had right facial nevus flammeus and prominent episcleral vessels. Intraocular pressure was measured to be 45mmHg(OD). Gonioscopy showed wide open angle. Fundus examination revealed tortous retinal vessels and glaucomatous optic atrophy. We performed trabeculectomy and mitomycin-C soaking. There were no serious intraoperative complications. Choroidal expansion and detachment occurred at entire peripheral fundus postoperatively. It disappeared when intraocular pressure was maintained high(24-36mmHg), but recurred when intraocular pressure maintaned low(15-20mmHg). Indocyanine green angiography revealed chroidal hemangioma at posterior pole of fundus.

Choroidal Effesuion After Trabeculetomy in Glaucoma with Sturge-Weber Syndrome

The authors experienced a case of choroidal expansion which occurred after trabeculectomy in glaucoma with Sturge-Weber syndrome. She had right facial nevus flammeus and prominent episcleral vessels. Intraocular pressure was measured to be 45mmHg(OD). Gonioscopy showed wide open angle. Fundus examination revealed tortous retinal vessels and glaucomatous optic atrophy. We performed trabeculectomy and mitomycin-C soaking. There were no serious intraoperative complications. Choroidal expansion and detachment occurred at entire peripheral fundus postoperatively. It disappeared when intraocular pressure was maintained high(24-36mmHg), but recurred when intraocular pressure maintaned low(15-20mmHg). Indocyanine green angiography revealed chroidal hemangioma at posterior pole of fundus.

Experimental Study for Rabbit Corneal Epithelial Toxicity of MMC

We studied the biological effects of Mitomycin C(MMC) in cellular metabolic activity and cytotoxicity on the corneal epithelial cell in rabbit that is clinically used according to MMC concentrations and exposure time. The concentration of MMC were 0.01%, 0.02%, 0.04%, 0.06%, 0.1%, and exposure time were 5, 10, and 30 minutes. MTT assay (3-I4,5-Dimethy-lthiazol-2-ylI-2,5-diphenyltetrazolium bromide) and transmission electromicroscopic examination were performed to access the metabolic activity of corneal cell, toxicity of corneal epithelial cell, and cellular morphology. In calorimetric assay, the higher the concentration of MMC and longer the duration of exposure time, the cellular metabolic activity was decreased. Also the toxicity of corneal epithelial cell was increased in a concentration and time dependent manner. The metabolic activity of corneal cell were inhibited by 50% at least over MMC 0.04% for 30 minutes exposure time. The LD50 at 5 minutes exposure was MMC 0.057%. In histologic finding, the higher the concentration of MMC, the change of cellular structure such as loss of microvilli, enlargement of rough endoplasmic reticulum or mitochondria, damage of nuclear membrane were more appeared. To obtain the efficacy of MMC for inhibition of cellular proliferation, we think that further experimental and clinical studies should be need to assess the safe concentration and exposure time of MMC to the corneal toxicity.

Clinical analysis of Superior Oblique Plication Procedure

The purpose of this study is to evaluate retrospectively the surgical results and complications in the patients with unilateral superior oblique palsy using superior oblique plication(SO plication) only or SO plication combined with inferior oblique weakening. Among 22 patients with unilateral superior oblique palsy, there were 13 patients(59.1%) in type III, 5 patients(22.7%) in type IV, 2 patients(9.1%) in type II and 2 patients(9.1%) in type V according to Knapps classification. The mean amount of hypertropia was 18 prism diopters(PD) and 18 of 22 patients(81.8%) showed abnormal head posture(AHP). Nineteen patients (86.4%) showed horizontal strabismus and exotropia was most common. The methods of oblique and vertical rectus operation were SO plication, SO plication combined with inferior oblique weakening, combined with resection of inferior rectus, and combined with recession of contralateral inferior rectus, inferior oblique weakening, and superior rectus weakening. We performed corrective surgery on the patients with horizontal deviation more than 14 PD. Postoperatively the mean amount of hypertropia was 2.6PD. In 7 patients with superior oblique plication only the mean amount of correction in plication was 8.4PD, and hypertropia was corrected 1.2PD per mm. Thirteen of 18 patients(72.2%) with AHP and 15 of 19 patients (78.9%) with horizontal strabismus were corrected after operation. Postoperative complications were residual hypertropia in 7 patients(31.8%) and Brown syndrome in one. We conclude that plication of the superior oblique may be one of the effective procedures for correction of superior oblique palsy and possible its complications may be postoperative undercorrection and Brown syndrom.

The Role of Preoperative Indirect Ophthalmoscopy Under General Anesthesia for Diagnosis of Torsional Strabismus

The purpose of this study is to evaluate the status of fundus torsion in 48 patients with unilateral inferior oblique overaction(IOOA) and the results were compared with that in 182 patients who showed normal inferior oblique function by an indirect ophthalmoscope under general anesthesia before strabismic surgery. In 48 eyes with unilateral IOOA, 35 eyes(72.9%) showed extorsion in the same eye. We could also find extorsion in 9 normal fellow eyes(18.7%). Among 182 horizontal strabismic patients(364 eyes) with normal inferior oblique function, there were 23 eyes(6.3%) of extorsion and 1 eye (0.3%) of intorsion. We compared the degree of extorsion with that of IOOA in 48 patients with unilateral IOOA: a mild extorsion were observed in 2 of 10 eyes with IOOA+1. A mild and moderate extorsion were observed in 13(72.2%) and 3 (16.7%) of 18 eyes with IOOA+2, respectively. A mild and moderate extorsion were observed in 9(45%) and 8(40%) of 20 eyes with IOOA+3 respectively. These findings showed that the greater IOOA produces the greater extorsion(p<0.01). On our results the fundus indirect ophthamoscopy before strabismic surgery seems to be helpful in the diagnosis of cyclotorsion.