Interocular Difference of Axial Length, Anterior Chamber Depth, Keratometry, Corneal Astigmatism According to Axial Length

Purpose@#To investigate the interocular difference of axial length (AL), mean keratometry (K), corneal astigmatism and anterior chamber depth (ACD) according to AL without history of ocular surgery. @*Methods@#This study was performed on 16,411 patients (32,825 eyes) who were measured AL, K, corneal astigmatism and ACD by IOL Master® from April 2007 to September 2016, excluding patients with missing values and extreme values in AL. After, patients were divided into four groups based on AL; AL < 24 mm, 24 mm ≤ AL < 26 mm, 26 mm ≤ AL < 28 mm, AL ≥ 28 mm, we investigated which variables were associated according to AL. To compensate for age and sex, 1:1:1:1 random matching was performed for age and sex. @*Results@#The longer the average AL of both eyes, the greater the difference between the AL, ACD and mean corneal K of both eyes. The longer AL group had the deeper ACD, the flatter mean corneal K, the higher corneal astigmatism. The older age group had the more shallow ACD, the steeper mean corneal K, lower corneal astigmatism. @*Conclusions@#Ophthalmologists have to be careful in setting fellow eye as control in treating or studying patients with long AL or axial myopia. Because, the longer the average AL of both eyes, the greater the difference between the AL, the ACD and the mean corneal K of both eyes.

Case of a Metastatic Solitary Fibrous Tumor Presenting as Gastrointestinal Bleeding / 대한내과학회지

Metastatic cancers of the stomach are rare. Metastatic diseases of the stomach can occur with melanoma and other primary tumors of the breast, lung, ovary, liver, colon, and testis; however, breast cancer is the most common. Other rare malignant tumors that can involve the stomach include Kaposi's sarcoma, myenteric schwannoma, glomus tumor, small cell carcinoma, and parietal cell carcinoma. On the other hand, solitary fibrous tumors of the pleura are rare soft tissue sarcomas, and most are benign; however, 13 to 36% may be malignant. Metastases may occur in extrathoracic sites, such as the liver, central nervous system, spleen, adrenal gland, and bone. We herein report a case of a 75-year-old man with previously diagnosed brain and liver metastases. He developed a stomach metastasis from a malignant solitary fibrous tumor and presented with gastrointestinal bleeding symptoms.

A Case of Portal Vein Thrombosis by Protein C and S Deficiency Completely Recanalized by Anticoagulation Therapy / 전남의대학술지

Portal vein thrombosis (PVT) is a rare form of venous thrombosis that affects the hepatic portal vein flow, which can lead to portal hypertension. Treatment of PVT includes anticoagulants, thrombolysis, insertion of shunts, bypass surgery, and liver transplantation. Single anticoagulation therapy is not regarded as a curative treatment but can be associated with a reduction in new thrombotic episodes. We experienced a case of acute total occlusion of PVT provoked by protein C and S deficiency syndrome. PVT was completely recanalized with oral anticoagulant therapy following low molecular weight heparin therapy.

A Case of Portal Vein Thrombosis by Protein C and S Deficiency Completely Recanalized by Anticoagulation Therapy / 전남의대학술지

Portal vein thrombosis (PVT) is a rare form of venous thrombosis that affects the hepatic portal vein flow, which can lead to portal hypertension. Treatment of PVT includes anticoagulants, thrombolysis, insertion of shunts, bypass surgery, and liver transplantation. Single anticoagulation therapy is not regarded as a curative treatment but can be associated with a reduction in new thrombotic episodes. We experienced a case of acute total occlusion of PVT provoked by protein C and S deficiency syndrome. PVT was completely recanalized with oral anticoagulant therapy following low molecular weight heparin therapy.

A Case of Ampullary Adenomyoma Associated with Dilatations of Pancreatic and Biliary Ducts / 대한소화기내시경학회지

Adenomyoma is a nonneoplastic lesion that can be found anywhere in the gastrointestinal tract, but it's rarely found in the ampulla of Vater. To the best of our knowledge, it is a benign lesion, but most cases are misdiagnosed as carcinoma or adenoma by a preoperative endoscopic or radiologic procedure, and this leads to unnecessarily extensive surgical resection. We report here on a case of ampulla of Vater adenomyoma that resulted in biliary and pancreatic duct dilatation. The tumor was diagnosed by endoscopic papillectomy.

Multiple Coronary Artery-Left Ventricular Microfistulae in a Patient with Apical Hypertrophic Cardiomyopathy: A Demonstration by Transthoracic Color Doppler Echocardiography

Among the congenital coronary artery fistulae, multiple coronary artery microfistulae arising from the left and right coronary artery and emptying into the left ventricle are very rare and little is known of their anatomic and clinical features, especially in apical hypertrophic cardiomyopathy. A 67-year- old woman was referred for the evaluation of chest pain at exertion, and shortness of breath. Electrocardiographic and echocardiographic findings were typical of apical hypertrophic cardiomyopathy. Coronary arteriography showed normal epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left and right coronary arteries. Transthoracic color Doppler echocardiography, using a high frequency transducer with a low Nyquist limit, demonstrated multiple coronary artery-left ventricular microfistulae just beneath the apical impulse window.

A Case of Multiple Coronary Artery-Left Ventricular Microfistulae Demonstrated by Transthoracic Doppler Echocardiography

Of the congenital coronary artery fistulae, the multiple coronary artery microfistulae, arising from the left and right coronary artery emptying into the left ventricle, are very rare. Little is known about their anatomic and clinical features, especially in apical hypertrophic cardiomyopathy. The clinical findings are heterogeneous, but include, in most cases, a history of typical or atypical angina pectoris. A 67 year old woman was referred for evaluation of chest pain on exertion, and a shortness of breath. The electrocardiographic and echocardiographic findings were typical of apical hypertrophic cardiomyopathy. Coronary arteriography showed normal epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left and right coronary arteries. Transthoracic Doppler echocardiography, using a high frequency transducer, with a low Nyquist limit, demonstrated multiple coronary artery-left ventricular microfistulae just beneath the apical impulse window.

Analysis of the Left Ventricular Contractile Reserve Using End-systolic Pressure-Volume Relation (ESPVR) in Idiopathic Dilated Cardiomyopathy: Its Correlation with Pathologic Findings

BACKGROUND: Left ventricular (LV) end-systolic pressure volume relation (ESPVR) is considered as a load independent contractile index. However, its application in human beings has been limited by the difficulty in the accurate real time measurement of the LV volume changes. With introduction of the echocardiographic automatated edge detection method, on-line generation of multiple LV pressure volume-loops has become possible to assess ESPVR. This study was performed to investigate the correlation of the degree of myocardial damages with myocardial contractility and contractile reserve assessed by ESPVR as a surrogate of contractility index. METHODS: Studies were attempted in ten patients with idiopathic dilated cardiomyopathy. Baseline two-dimensional and Doppler echocardiography, cardiac catheterization for hemodynamic assessment and endomyocardial biopsy were performed. Generation of multiple LV pressure-volume loops during occlusion and release of the inferior vena cava by a balloon catheter was performed using the volume signals from the echocardiographic automatated edge detection method and the pressure signals from a 5F fluid-filled lumen catheter. ESPVR was measured at the baseline and after 3 minutes of dobutamin infusion (10 microgram/Kg/min). RESULTS: No correlation was observed between the degree of myocyte hypertrophy change or interstitial fibrosis and the two-dimensional echocardiographic or hemodynamic data. However, restrictive LV filling pattern was more common in the patients with severe degree of myocyte hypertrophy change. Myocardial contractility and contractile reserve were also significantly reduced in this patient group. The degree of interstitial fibrosis did not affect myocardial contractility or contractile reserve in this particular patient group. CONCLUSION: Assessment of ESPVR using the echocardiographic automatated edge detection method was feasible in the patients with idiopathic dilated cardiomyopathy. The degree of myocardial hypertrophy change was prominent in the patients with reduced contractility and contractile reserve.

Primary Intracardiac Hemangioma: 1 case / 대한흉부외과학회지

Intracardiac hemangiomas are very rare primary cardiac tumor and there have been at least 37 reports of surgically resected cardiac hemangiomas. Most cardiac hemangiomas are asymptomatic. In symptomatic patients, symptoms are related to the location of tumor and outflow tract obstruction or obstruction of inferior and/or superior vena cava. Sudden death may occur due to conduction disturbances. The principle of treatment is surgical resection, and the prognosis is dependent upon the size, location and multiplicity of the tumor. A 40 year old man was admitted due to chest contusion and was found to have an intracardiac mass during echocardiographic examination. The mass was successfully removed and pathologic examination showed benign hemangioma. The patient was recovered uneventfully in postoperative period and was followed up for 1 year without evidence of recurrence.

Comparision of thr Efficacy of Propafenone and Flecainide in Patients with Atrial Fibrillation

BACKGROUND: Atrial fibrillation is one of the most common cardiac arrhythmias which has been recieved relatively little attention until recently.Despite the variety of treatment modalities including drugs,surgery,catheter ablation and devices,the overall treatment of atrial fibrillation is not always satisfactory.Phalmacotherapy is still the most commonly used treatment through the unfavorable side effects of antiarrhythmic drugs are problematic.The purpose of this study is to compare the efficacy of class Ic antiarrhythmic drugs,propafenone versus flecainide. METHODS: We treated one hundred eighteen patients with atrial fibrillation by class Ic antiarrhythmic drugs,propafenone or flecainide with/without DC cardioversion to convert to and maintain the sinus rythm. We compared the clinical findings,drug efficacy,side sffects of drugs between two groups. RESULTS: 30 patients were treated by propafenne and 88 patients by flecainide.21 and 60 patients in each group were lone atrial fibrillation,14 and 49 patients were paroxysmal atrial fibrillation.Mean duration of drug administration were 360.9,339.4 days,respectively.The convesion rate to sinus rhythm by drugs was 25.0% in propafenone group and 30.7% in flecainide group(p=NS).The 300 days-manitenance rates of sinus rhythm after conversion by drugs or DC cardioversion were 63,3%,70.4%(p=NS)respectively. The side effects of drugs were dizziness,nausia and vomitting in both group and 1st degree AV block,transient sinus node dysfunction and decreased visual acuity in flecainde group.The drugs were discontinued in 11(37.7%) and 26(29.5%) patients in each group due to recurrence of atrial fibrillation or side effects of drugs. CONCLUSION: This study suggests that propafenone and flecainide are comparably effective in maintaining sinus rhythm in atrial fibrillation patients.Futher prospective and large study is required to confirm this findings.

Isolated Left Coronary Ostial Stenosis in Korea

BACKGROUND: We studied clinical and angiographic findings of 16 Korean patients who had isolated laft coronary ostial steonsis and compared them with those of the patients with non-ostial left main stenosis. The aim of this study is to find the characteristics of the patients with isolated left voronary ostial stenosis. METHODS: Medical records and coronary angiograms were reviewed. We divided the patients with left main stenosis into four groups by lesion location and associated lesion. Clinical and angiographic findings of each group were compared. RESULTS: Twenty four patients(0.15%) had left coronary ostial stenosis and among them sixteen patients(0.1) had an isolated lesion. Their mean age was 48 years and 62% were female. Only 6 patients had coronary risk factors. Two patients were diagnosed as having Takayasu's srteritis. At treadmill exercise test, 7 out of 11 patients lhowed positive results at stage I. Eight patients had undergone surgical treatment. Comoared with the patients who had non-ostial left main stenosis, left ostial group showed lower mean age, female preponderance and lower incidence of coronary risk factors. There was no difference in the results of treadmill exercise test and hemodynamic parameters. CONCLUSION: Isolated left coronary ostial stenosis in Korea also predominantly occured in young female patients who had less risk factors as previous reports. But the incidence of this lesion and nonatherosclerotic origin seemed to be higher. And most of the patients with the left coronary ostial stenosis had isolated ostial stenosis.

Isolated Left Coronary Ostial Stenosis in Korea

BACKGROUND: We studied clinical and angiographic findings of 16 Korean patients who had isolated laft coronary ostial steonsis and compared them with those of the patients with non-ostial left main stenosis. The aim of this study is to find the characteristics of the patients with isolated left voronary ostial stenosis. METHODS: Medical records and coronary angiograms were reviewed. We divided the patients with left main stenosis into four groups by lesion location and associated lesion. Clinical and angiographic findings of each group were compared. RESULTS: Twenty four patients(0.15%) had left coronary ostial stenosis and among them sixteen patients(0.1) had an isolated lesion. Their mean age was 48 years and 62% were female. Only 6 patients had coronary risk factors. Two patients were diagnosed as having Takayasu's srteritis. At treadmill exercise test, 7 out of 11 patients lhowed positive results at stage I. Eight patients had undergone surgical treatment. Comoared with the patients who had non-ostial left main stenosis, left ostial group showed lower mean age, female preponderance and lower incidence of coronary risk factors. There was no difference in the results of treadmill exercise test and hemodynamic parameters. CONCLUSION: Isolated left coronary ostial stenosis in Korea also predominantly occured in young female patients who had less risk factors as previous reports. But the incidence of this lesion and nonatherosclerotic origin seemed to be higher. And most of the patients with the left coronary ostial stenosis had isolated ostial stenosis.

Peripheral Vascular Disease in Patients with Significant Coronary Artery Disease

BACKGROUND: Although it is known that patients wth peripheral vascular disease are at high risk for coronary arterial disease, however, it has not been determined that patients with coronary artery disease(CAD) correlates with peripheral vascular disease(PVD). This study was designed to determine the prevalence and clinical characteristics of peripheral vascular disease(PVD) in patients with coronary artery disease(CAD). METHODS: A total of one hundred seventy-eight patients with CAD confirmed by coronary angiogram(145 male, age 58.5+/-10.1) were included in this study from February 1992 to May 1994. Coronary and peripheral angiograms were performed in all patients and the patients were divided into two groups; patients with PVD dand patients without PVD. Clinical characteristics were compared between two groups. RESULTS: Peripheral vascular disease was present in 49 patients(27.5%) among 178 CAD patients. The mean age of patients with PVD was significantly older than that of patients without PVD. The hypertension was statistically significant difference between two groups(P<0.05). There were no major differences in the number of risk factors or number of stenotic coronary arteries in patients with and without PVD. CONCLUSION: The prevalence of PVD in patients with CAD was high and it is reasonable to state that most common risk factors for coronary and peripheral atherosclerosis were age, hypertension and obesity.

Morphological Characteristics of Hypertrophic Cardiomyopathy in Korean : Echocardiographic Study

BACKGROUND: Patients with hypertrophic cardiomyopathy(HCMP) may present a wide spectrum of clinical and morphological manifestations. There was little literature regarding clinical and morphological features of HCMP in Korea. METHODS: 1) Study population : Among 18, 183 patients who unerwent echocardiography from June 1990 to Qctober 1993 at Yonsei cardiovascular center Echocardiography laboratory, 65 patients with HCMP were enrolled to study population. All patients with HCMP have at least onesegment of left ventricular wall measuring 17mm or more in thickness at end diastole. 2) Two dimensional echocardiography : All standard views were performed and recorded with Super VHS video tape. All records were reviewed and the maximal wall thickness was measured at video monitor by aid of electronic caliper of our echocardiographic machine. 3) Dopple echocardiography : Peak velocity of E and A wave and deceleration time were measured. The intracavitary peak systolic pressure gradient was also measured using continous wave Doppler at the site of abnomal mosaic pattern in color flow interrogation. RESULTS: 1) Mean age of the patients was 50+/-15 ranging from 11 to 84 and the sex ratio was 2.3:1(male:female). 2) The type 3(involving all segments except inferior wall) was the most frequently observed in Korean(47%). 3) The mid anterior septum was the most frequently involved segment(71%) and the non-obstructive type was perdominant(78%). 4) There was 17 cases of apical HCMP and 4 cases of mid ventricular obstructive type. 5) There was no significant correlation between symptoms and dynamic obstruction. 6) The EA ratio had statistically significant difference between obstructive and non-obstructive groups probably due to mitral regurgitation. CONCLUSION: The type 3 was the most frequent type of HCMP in Korean and the non-obstructive type was more frequently observed than obstructive type. Among the all left ventricular segments, the mid anterior septum was most frequently involved.

Coronary and Left Ventricular Angiographic Findings of Patients with Acute Myocardial Infarction

BACKGROUND: Results of recent studies have suggested that the extent and severity of coronary artery disease and the degree of left ventricular dysfunction are two major factors influencing survival in patients with acute myocardial infarction. Although non-invasive modalities including exercise stress electrocardiography, echocardiography and nuclear cardiologic techniques can predict the prognosis of patients with acute myocardial infarction to an extent, coronary angiography is still the best modality for exact evaluation of the severity and the extent of coronary artery disease. METHODS: A review was done from January, 1985, to August, 1993, on 631 patients with acute myocardial infarction who underwent coronary angiography with or without left ventricular angiography within 30 days after onset of acute myocardial infarction at Yonsei University Severance Hospital. RESULTS: 1) The mean age of the 631 patients was 55.2 years(23-82 years). Five hundred thirty three(84.5%) were males and 98(15.5%) were females. The prevalences of coronary artery disease were high in the 5th decade in males and in the 6th decade in females. 2) The major risk factors were cigarette smoking(69.6%), hypertension(34.9%), diabetes mellitus(18.9%), and hypercholesterolemia(12.3%). Cigarette smoking was statistically more frequent in males and hypertension was more frequent in female. 3) Of the 631 patients studied, 570 patients(90.3%) had Q wave myocardial infarction and 61 patients(9.7%) had a non-Q wave myocardial infarction. 33 patients(5.2%) had a history of previous myocardial infarction. 4) The coronary angiogram showed 25 patients(4.0%) had normal coronary anatomy and 29 patients(4.6%) had minimal coronary vessel lesions. Lesions greater than 50% were confined to one major artery in 309 patients(49.0%), whereas two-and three-vessel disease were found in 179(28.3%) and 83(13.1%) patients respectively. 5) The normal or minimal lesion coronary anatomy and one-vessel disease were significantly frequent in patients under 40 years of age. However, multi-vessel disease was significantly more frequent in patients over 40 years of age. 6) The patients who had a history of cigarette smoking often had more normal or minimal lesion coronary anatomy, one vessel disease and less multi-vessel disease, compared with those without a history of cigarette smoking. The patients with hypertension had more multi-vessel disease and less normal or minimal lesion coronary anatomy, one vessel disease. The patients with diabetes mellitus had less one vessel disease and more multi-vessel disease. 7) According to the site of infarction, anterior myocardial infarction was associated with more prevalence in normal or minimal lesion coronary anatomy, one vessel disease, inferior myocardial infarction was associated with more prevalence in multi-vessel disease. 8) The infarct related artery was the left anterior descending artery in 5.3.7%, the right coronary artery in 35.9%, the left circumflex artery in 10.3%. Additionally, there was one case of anterior myocardial infarction associated with the left main coronary artery occlusion. 9) With the passage of time, there was a decrease of total occlusion in all cases whether thrombolytic therapy was administered or not. The patients with thrombolytic therapy had a lower total occlusion rate of infarct related artery compared with those without thrombolytic therapy. 10) The left ventricular ejection fraction was higher in the patients with non-Q wave infarction than in those with Q wave infarction. The left ventricular ejection fraction was higher in the patients with thrombolytic therapy in comparison with those who did not receive thrombolytic therapy. CONCLUSION: The coronary angiographic findings of patients with acute myocardial infarction showed higher prevalence of one vessel disease, and more frequent onset of myocardial infarct under 40 years of age with normal or minimal lesion coronary anatomy. Thrombolytic therapy administered to patients with acute myocardial infarction resulted in the beneficial effects of decreased total occlusion rate of the infarct related artery and improved left ventricular function.

Acute myocardial infarction in the young adults

A review was done on 631 patients with acute myocardial infarction who underwent coronary angiography within 30 days after onset of myocardial infarction at Yonsei University Severance Hospital from January, 1985, to August, 1993. The incidence of acute myocardial infarction in patients under 40 years of age was 10.3% (65/631). Acute myocardial infarction below the fourth decades was the predominant disease of men. Risk factor analysis revealed a history of cigarette smoking and hypercholesterolemia were more frequently found in the young patients, but a history of hypertension and diabetes were more frequently found in the elderly patients. Angiographically, the incidence of one vessel disease and normal or minimal lesion coronary anatomy were more frequent in the young patients and incidence of multi-vessel disease were more frequent in the elderly patients. Of the 65 patients under 40 with acute myocardial infarction, the patients with multi-vessel disease tended to have a history of diabetes mellitus in comparison with those with normal coronary anatomy or one vessel disease.

Coronary Angiographic Predictors for Immediate Results of Percutaneous Transluminal Coronary Angioplasty

Certain angiographic patterns outlining the morphologic characteristics of vessels and defining the lesion-specific characteristics have recently been shown to greatly influence the likelihood of a successful dilation. In 1988, ACC/AHA Subcommitte on percutaneous transluminal coronary angioplasty proposed the lesion-specific classification as a guide for estimating the likelihood of a successful procedure as well as the the likelihood of developing abrupt vessel closure. To determine the lesion-specific predictors for successful dilation and complications after percutaneous transluminal coronary angioplasty, nine angiographic charateristics of 200 lesions in 164 patients who underwent coronary angiplasty between May, 1983 and September, 1989 were analyzed. 1) Successful dilation, defined as a reduction in stenosis diameter to less than 50% without acute myocardial infarction or emergency coronary artery bypass graft, occurred in 175 of 212 lesions(82.5%). 2) Successful dilation occurred in 13 of 15 type A lesions(86.6%), 148 of 178 type B lesions(83.1%) and 3 of 7 type C lesions(42.8%)(p<0.05 for A or B vs C). 3) Acute closure syndrome occurred in none of type A lesions, 6 of type B lesions(3.4%), 2 of type C lesions(28.5%)(p<0.005 for A or B vs C). 4) multivariate analysis showed that lesion-specific characteristic predictors for successful dilation were length of lesion(p<0.05) and accessibility(p<0.05) ; for ischemic events were major branch involvement(p<0.05) and eccentricity(p<0.05); for acute closure syndrome were accessibility(p<0.05) and eccentricity(p<0.05). 5) Procedural predictors for ischemic events were coronary artery dissection(p<0.01), post-PTCA diameter stenosis(p<0.05) and balloon/artery diameter ratio(p<0.01) ; For acute closure syndrome was coronary artery dissection(p<0.005). In this analysis, we found that angiographic lesion-specific characteristics related very importantly to procedural success and were able to define three major independent lesionspecific risk factors whose presence beforehand decreased the likelihood of successful dilation and increased the likelihood of acute closure. In the absence of any of these risk factors, the risk of acute closure is very small. Thus, identification of these factors and their associate risk should improve patients selection and better define the role of coronary angioplasty in the management fo patients with coronary artery disease.