Résumé
Thrombi within the aortic arch are rare, and are generally detected after cerebral, visceral, or peripheral embolization. Although the indications for treatment remain controversial, there is increasing interest in the etiopathogenesis of this rare clinical entity and the development of appropriate diagnostic and therapeutic approaches. We report a case in which a thrombus was detected in the proximal aortic arch on echocardiography and computed tomography angiography as the origin of upperextremity ischemia. This pedunculated thrombus was attached to the atherosclerotic aortic wall and was removed surgically.
Sujets)
Angiographie , Aorte thoracique , Échocardiographie , Ischémie , ThromboseRésumé
Thrombi within the aortic arch are rare, and are generally detected after cerebral, visceral, or peripheral embolization. Although the indications for treatment remain controversial, there is increasing interest in the etiopathogenesis of this rare clinical entity and the development of appropriate diagnostic and therapeutic approaches. We report a case in which a thrombus was detected in the proximal aortic arch on echocardiography and computed tomography angiography as the origin of upperextremity ischemia. This pedunculated thrombus was attached to the atherosclerotic aortic wall and was removed surgically.
Sujets)
Angiographie , Aorte thoracique , Échocardiographie , Ischémie , ThromboseRésumé
Stent migration from the delivery balloon catheter is a rare but serious complication during percutaneous coronary intervention, particularly when a part of the stent stretches into the aorta. We report an unusual case of stent migration treated with a combination of a gooseneck snare and rotablation. A part of the stent was overstretched and unrolled into the aorta and the rest of the stent remained implanted in the coronary artery. The stent was captured with a gooseneck snare but could not be retrieved because it was connected to a stent remnant implanted in the coronary artery. The stent strut was cut with rotablation, and the stent was successfully removed through the femoral sheath.
Sujets)
Angioplastie coronaire par ballonnet , Aorte , Athérectomie coronarienne , Cathéters , Vaisseaux coronaires , Intervention coronarienne percutanée , Protéines SNARE , EndoprothèsesRésumé
Purple urine bag syndrome (PUBS) is a rare condition, in which the patient has a purple-colored urine tubes or bags following urinary catheterization for hours to months. It is usually associated with elderly females, prolonged urinary catheterization, some bacterial infections that produce sulphatase/phosphatase, chronic debilitated state, and chronic constipation. We present a case report of this rare phenomenon occurring in a 73-year-old woman.
Sujets)
Sujet âgé , Femelle , Humains , Infections bactériennes , Constipation , Cathétérisme urinaire , Cathéters urinairesRésumé
Amiodarone is one of the most commonly prescribed antiarrhythmic drug for almost all atrial or ventricular arrythmias. Amiodarone-induced pulmonary toxicity (APT) was first described in 1980 and has potentially serious side effects that are believed to develop in 5% of patients. In general, APT occurs only when high amiodarone doses are used for a long time. However, during short-term therapy of amiodarone, APT is rarely reported. In this report, we describe a case of amiodarone-induced pulmonary toxicity after a short course of amiodarone therapy for atrial fibrillation.
Sujets)
Humains , Amiodarone , Troubles du rythme cardiaque , Fibrillation auriculaire , DimapritRésumé
PURPOSE: The aim of this study was to determine the advantage of adequate PTGBD in acute complicated cholecystitis patients. METHODS: We performed a retrospective review of a collected database from September 2001 to July 2008. Acute cholecystitis with gangrene or perforation was defined as acute complicated cholecystitis. A PTGBD was performed for these patients immediately after the diagnosis using US or CT and then a tubogram was performed after 5~7 days. After evaluating the gallbladder (GB) and common bile duct (CBD) with a tubogram, we removed the drainage tube and the patients underwent a LC after readmission. RESULTS: Three hundred seventy four of the 893 patients who were diagnosed with acute cholecystitis underwent PTGBD. While 19 (3.2%) of the total acute cholecystitis patients were converted to open cholecystectomy due to severe inflammation, 14 (3.7%) of the acute complicated patients were converted to open cholecystectomy. In 79 patients, the pre-operative tubogram showed the presence of CBD stone and so ERCP was performed. There were no post-operative deaths. CONCLUSION: PTBGD in acute complicated cholecystitis patients allows the early relief of acute cholecystitis symptoms. This allows sufficient evaluation and treatment for CBD during the PTGBD state. Furthermore, this decreases the mortality and morbidity in the high-risk patients due to sufficient evaluation and management of the underlying critical disease, which allows elective cholecystectomy when the patients is in better condition for surgery. Therefore, PTGBD can be useful for acute complicated cholecystitis.
Sujets)
Humains , Cholangiopancréatographie rétrograde endoscopique , Cholécystectomie , Cholécystectomie laparoscopique , Cholécystite , Cholécystite aigüe , Conduit cholédoque , Drainage , Vésicule biliaire , Gangrène , Imidazoles , Inflammation , Composés nitrés , Études rétrospectivesRésumé
BACKGROUND: Recently, there has been an increase in acute poisonings in the elderly, which may be associated with attempts at suicide. The purpose of this study was to compare and analyze the clinical aspects and outcomes of acute poisonings in aged individuals with those of younger individuals. METHODS: We performed a retrospective analysis of 207 patients seen in the emergency department (ED) with acute poisoning from January 2009 to December 2010. Two groups were created, >65 years and 65 group and 0.3% in the 65 years than in those <65 years. As motive for suicide, health problem was cited more often in the older group (p=0.000). The older group had fewer interviews with psychiatrists and were more often diagnosed with depressive disorder (p=0.010, p=0.041, respectively). PSS and mortality were higher in the older group (p=0.002, p=0.010, respectively). CONCLUSION: A better understanding for the cause of poisonings and the poisonous substance used in the aged population is needed. And because of the more serious effects of acute poisonings to the elderly patient, they should readily receive regular comprehensive care including psychiatric care.
Sujets)
Sujet âgé , Humains , Trouble dépressif , Urgences , Hospitalisation , Unités de soins intensifs , Troubles mentaux , Psychiatrie , Études rétrospectives , SuicideRésumé
BACKGROUND AND OBJECTIVES: The maze procedure is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). We compared the left atrial mechanical function (LAMF) of patients whose rhythm was converted to SR after maze procedure with that of patients whose rhythm was not converted to SR and determined if preoperative left atrial volume index (LAVI) and immediate postoperative LAMF could predict conversion of AF to SR. SUBJECTS AND METHODS: We prospectively evaluated 80 patients with AF treated with the maze procedure between March 2005 and February 2007. LAMF was assessed by looking at left atrial ejection volume (LAEV) and ejection fraction (LAEF) during echocardiography before, 2 weeks after, and 6 months after the procedure. RESULTS: Of the 80 enrolled patients, 71 were converted to SR after the maze procedure (SR group), and 9 were not converted to SR (AF group). There were no significant differences in age, sex, hypertension, diabetes mellitus, renal failure, stroke, thyroid dysfunction, or smoking history between the groups. Pre-operative LAVI (p=0.010) was a predictor of conversion of AF to SR. LAEF gradually increased in the SR group during follow-up, but not in the AF group. CONCLUSION: LAMF recovered in the SR group after the maze procedure, irrespective of clinical presentation and initial LAMF. Preoperative LAVI predicted SR conversion.
Sujets)
Humains , Fibrillation auriculaire , Fonction auriculaire gauche , Diabète , Échocardiographie , Études de suivi , Hypertension artérielle , Valve atrioventriculaire gauche , Études prospectives , Insuffisance rénale , Fumée , Fumer , Accident vasculaire cérébral , Chirurgie thoracique , Glande thyroideRésumé
BACKGROUND AND OBJECTIVES: Echocardiographic evaluation of the long axis left ventricle (LV) function has been reported to be useful for understanding heart failure in those patients with a preserved ejection fraction (EF). The global and segmental peak LV systolic longitudinal strain (PSLS), as determined by the 2D speckle tracking method, may be related with the conventional diastolic parameters. We sought to determine whether the PSLS could reveal LV systolic dysfunction in those patients who have a normal EF and diastolic dysfunction. SUBJECTS AND METHODS: A total of 168 patients who underwent a routine echocardiographic examination were evaluated. Echocardiographic evaluations were performed and the patients were grouped according to the grade of their diastolic dysfunction. The global and segmental PSLS were analyzed off-line. RESULTS: Measurements of the LV PSLS were successfully obtained in 83% of the patients. The mid and basal PSLS values were significantly lower in the patients with grade I and II diastolic dysfunction (-17.5+/-2.0% and -17.5+/-2.3%, respectively) versus the normal healthy controls (-20.6+/-1.9%, p<0.001). The mid and basal PSLS values were found to be well related to the early diastolic mitral annular velocity (r=0.510, p<0.001) and the left atrial volume index (r=-0.422, p<0.001). CONCLUSION: The systolic LV long-axis function, as determined by 2D strain and especially in the mid and basal LV segments, is reduced in the patients with diastolic dysfunction in spite of their normal LV EF.
Sujets)
Humains , Axis , Diastole , Échocardiographie , Défaillance cardiaque , Ventricules cardiaques , Entorses et foulures , Systole , AthlétismeRésumé
Ruptured dissecting aneurysm of the vertebral artery requires a rapid treatment because of the high rate of fatal early rebleeding. Stent-assisted coil embolization has been introduced as an effective procedure for both aneurysmal occlusion and parent artery preservation. We report a case of successful urgent treatment of ruptured dissecting aneurysm using a self-expandable, intracranial stent (Neuroform(R)) and a coated coil (HydroCoil(R)).
Sujets)
Humains , Anévrysme , , Artères , Embolisation thérapeutique , Parents , Endoprothèses , Artère vertébraleRésumé
A 40-year-old Korean man presented with painful swelling and tenderness of both ankle joints as well as the plantar surfaces of both feet, along with inflammatory back pain, and a purulent discharge from the urethral orifice. The patient also complained of sicca-like symptoms including dry eyes and dry mouth. An immunological analysis revealed a high titer of rheumatoid factor, positive results for antinuclear antibody and anti-Ro antibody, and a positive result for HLA-B27. An antibody titer for Chlamydia was also significantly increased. Positive results of the Schirmer's test and for keratoconjunctivitis sicca were confirmed by an ophthalmologist. These clinical manifestations were compatible with Chlamydia-induced reactive arthritis (ReA) accompanied by Sjogren's syndrome (SS). This is the first report of the combination of these two distinct disease entities in the Korean population.
Sujets)
Mâle , Humains , Adulte , Syndrome de Gougerot-Sjögren/complications , Chlamydia trachomatis , Infections à Chlamydia/complications , Arthrite réactionnelle/complications , Anticorps antinucléaires/sangRésumé
PURPOSE: To prospectively evaluate the accuracy of sonography for diagnosis of cubital tunnel syndrome (CUTS) confirmed by electrodiagnostic study. ATERIALS and METHODS: From February 2004 to March 2005, we prospectively analyzed 24 elbows in 19 patients (8 women, 11 men; mean age, 49.2 years; range 23-65 years) with cubital tunnel syndrome, including 5 bilateral cases. Diagnoses of CUTS were confirmed by both clinical symptom and electrodiagnostic study. Sonographic findings of 20 asymptomatic cases served as controls. In sonographic examination, the cross sectional area of the ulnar nerve was measured at the inlet (at the level of medial epicondyle) and outlet (at the level of convergence of flexor carpi ulnaris tendons) of the cubital tunnel. The shape and echogenicity of the ulnar nerve were also evaluated, as were possible causes of entrapment. The accuracy of using ultrasonographic cross sectional area to diagnose CUTS was evaluated with receiver operating characteristic (ROC) analysis. RESULTS: The cross sectional area of the ulnar nerve at the inlet and outlet levels in CUTS patients was increased much more than in the asymptomatic cases. Decreased echogenicity and distortion of normal parallel echotexture of the ulnar nerve were observed in all CUTS patients. At the inlet level, the area under the ROC curve (AUC) was 0.816, and the ideal cut-off value for CUTS diagnosis was 0.08 cm2 with a sensitivity of 58.3%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 66.7%. At the distal outlet level, the AUC was 0.785, and the cut-off value was 0.06 cm2 with a sensitivity of 79.2%, specificity of 70%, PPV of 76%, and NPV of 73.7%. When the summation value of inlet and outlet cross sectional areas was used, the AUC was 0.853, and cut-off value was 0.14 cm2 with a sensitivity of 70.8%, specificity of 85%, PPV of 85%, and NPV of 70.8%. CONCLUSION: Measurement of the cross sectional area of the ulnar nerve at the inlet and outlet of the cubital tunnel can aid in the sonographic diagnosis of cubital tunnel syndrome by more objectively determining the increase in cross sectional area.
Sujets)
Femelle , Humains , Mâle , Aire sous la courbe , Baies (géographie) , Syndrome du tunnel ulnaire au coude , Diagnostic , Coude , Nerfs périphériques , Études prospectives , Courbe ROC , Sensibilité et spécificité , Nerf ulnaire , ÉchographieRésumé
BACKGROUND/AIMS: Protein induced by vitamin K absence or antagonist-II (PIVKA-II), also known as des-carboxyprothrombin (DCP), can be used as an alternative tool to alpha-fetoprotein (AFP) for surveillance of hepatocellular carcinoma (HCC). The aims of the present study were to compare PIVKA-II levels between the patients with HCC and patients with non-HCC chronic liver disease, to evaluate the correlation of PIVKA-II and AFP in HCC patients, and finally to estimate the optimal cut-off value for PIVKA-II for the diagnosis of HCC with using the receiver operating characteristic (ROC) curve. METHODS: A total of 227 consecutive patients with HCC (n=42) or chronic liver disease (n=185) were enrolled in this study. HCC was diagnosed histologically or by imaging such as computed tomography, magnetic resonance imaging or angiography. The serum PIVKA-II and AFP levels were measured by electrochemiluminoimmunoassay with using the Haicatch PIVKA-II kit and by immunoradiometric assay, respectively. RESULTS: The PIVKA-II level in the HCC patients was significantly higher than the non-HCC chronic liver disease patients (903.0+/-1156.7 vs. 111.7+/-211.0 mAU/ mL, respectively, P<0.01). PIVKA-II and AFP showed a statistical correlation in HCC patients (r=0.46, P<0.01). The sensitivity and specificity of PIVKA-II for the diagnosis of HCC were 66.7% and 74.1%, respectively, and when tasted together with AFP, the sensitivity was increased by 85.7%. For the ROC curve of PIVKA-II in HCC patients, the specificity of a 250 mAU/mL level of PIVKA-II was 95%. CONCLUSIONS: PIVKA-II was as useful surveillance tool for differentiating HCC from chronic liver disease, and a PIVKA-II value of 250 mAU/ mL was proposed as a significant cut-off value for diagnosis of hepatocellular carcinoma.
Sujets)
Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Marqueurs biologiques/sang , Carcinome hépatocellulaire/diagnostic , Tumeurs du foie/diagnostic , Valeur prédictive des tests , Précurseurs de protéines/sang , Prothrombine , Courbe ROC , Marqueurs biologiques tumoraux/sang , Alphafoetoprotéines/analyseRésumé
Sarcoidosis is a rare systemic disorder with unknown cause that is characterized pathologically by non-caseating granuloma. The lung and mediastinal lymph nodes are almost always involved, and most patients experience acute or insidious respiratory symptom. Because sarcoidosis is an interstitial lung disorder involving the alveoli and bronchioles, the most common radiological finding is a reticularnodular lesion with lymphatic distribution. However, cavitation is quite rare. Sarcoidosis is also a major cause of hepatic granuloma in Western countries, accounting for 12% to 30% of cases. In most patients, the course of hepatic sarcoidosis is benign. However, chronic intrahepatic cholestasis or portal hypertension may develop in some patients. We report a case of sarcoidosis with cavitation and hepatic involvement.
Sujets)
Humains , Bronchioles , Cholestase intrahépatique , Granulome , Hypertension portale , Poumon , Noeuds lymphatiques , SarcoïdoseRésumé
Behcet's disease (BD) is a chronic inflammatory disease, involving several organs. It is well known that there are the marked regional differences in the disease expression of BD. In case of the vascular involvement in BD, the frequency rate has been described in 25~30% among the patients from the MiddLe East, whereas it has been noted in 5~15% in our country. In general, BD associated with large vessel lesions is named vasculo-BD. On the other hand, the cardiac involvement in BD has rarely been reported in the literature. Ebstein anomaly is a kind of malformation that is characterized by a downward displacement of the tricuspid valve into the right ventricle. We reported a 54-year-old male patient with vasculo-BD who had inferior vena cava obstruction and Ebstein anomaly. The association of Ebstein anomaly with vasculo-BD is considered to be coincidental. To the best of our knowledge, this is the first case of Ebstein anomaly associated with BD.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Maladie d'Ebstein , Main , Ventricules cardiaques , Moyen Orient , Valve atrioventriculaire droite , Veine cave inférieureRésumé
PURPOSE: The purpose of this study was to compare the findings on high-resolution CT (HRCT) of the chest with those on video-assisted thoracoscopy for the detection of bullae in patients who had undergone an operation for spontaneous pneumothorax, and we also wished to evaluate the relationship between the characteristics of bullae on HRCT and development of spontaneous pneumothorax. MATERIALS AND METHODS: Fifty patients with spontaneous pneumothorax who had undergone both HRCT of the chest and video-assisted thoracoscopic surgery were included in the study. Spontaneous pneumothoraces were classified as either primary or secondary pneumothorax, and as initial or recurrent pneumothorax. The HRCT scans were obtained with 1 mm slice thickness and a 5 mm scan interval. Two radiologists retrospectively compared the HRCT findings of the chest with those findings on video-assisted thoracoscopy for the detection of bullae, and they evaluated the value of HRCT for diagnosing bullae. In addition, we assessed the size and number of bullae in these patients, and we also evaluated the relationship between those findings of bullae and the development of spontaneous pneumothorax. RESULTS: Bullae were detected in 40 patients by using video-assisted thoracoscopy, and HRCT showed bullae in 38 of these patients. Bullae were not identified with video-assisted thoracoscopy in the remaining ten patients, and among these ten patients, bullae were not demonstrated by HRCT in eight of them. Therefore, the sensitivity and specificity of HRCT for the detection of bullae were 95% (38/40) and 80% (8/10), respectively. The average size of the bullae of the affected hemithorax and the contralateral un-affected hemithorax was 1.97 cm+/-2.30 and 1.24 cm+/-1.46, respectively. Pneumothorax was more frequently observed in the hemithorax with larger bullae (p0.05). The average size of bullae in patients with secondary pneumothorax and those bullae of patients with primary pneumothorax was 4.44 cm+/-4.06 and 1.42 cm+/-1.26, respectively. The bullae were significantly larger in the patients with secondary pneumothorax than in those patients with primary pneumothorax (p0.05). CONCLUSION:HRCT of the chest would be a useful modality for detecting the bullae of those patients with spontaneous pneumothorax. The development of spontaneous pneumothorax is associated with the size of bullae rather than the number of bullae.
Sujets)
Humains , Pneumothorax , Études rétrospectives , Sensibilité et spécificité , Chirurgie thoracique vidéoassistée , Thoracoscopie , ThoraxRésumé
The so-called racemose cysticercosis, a rare variety of neurocysticercosis occurring in ventricles or basal cisterns, is characterized by abnormal growth of cystic membranes with degeneration of Taenia solium heads (scolex). Although lesions of this type are known to follow a progressive course even after ventricular shunting, there are limitations of case series treated with antiparasitic drugs, and the optimal duration of the treatment is not yet known. We report a case of relapsed racemose cysticercosis in the Sylvian fissure, who has been successfully treated with albendazole and adjunct corticosteroid for 4 weeks. The patient had been previously treated with praziquantel and ventriculoperitoneal shunt, and maintained on the anticonvulsant drug for one year, but returned to the hospital due to seizure recurrence. The patient has been well in seizure-free state for the follow-up 2 years after albendazole therapy. The subarachnoid racemose cysticercosis seems to respond well to treatment of corticosteroid along with prolonged albendazole.
Sujets)
Humains , Albendazole , Antiparasitaires , Cysticercose , Études de suivi , Tête , Membranes , Neurocysticercose , Praziquantel , Récidive , Crises épileptiques , Taenia solium , Dérivation ventriculopéritonéaleRésumé
The so-called racemose cysticercosis, a rare variety of neurocysticercosis occurring in ventricles or basal cisterns, is characterized by abnormal growth of cystic membranes with degeneration of Taenia solium heads (scolex). Although lesions of this type are known to follow a progressive course even after ventricular shunting, there are limitations of case series treated with antiparasitic drugs, and the optimal duration of the treatment is not yet known. We report a case of relapsed racemose cysticercosis in the Sylvian fissure, who has been successfully treated with albendazole and adjunct corticosteroid for 4 weeks. The patient had been previously treated with praziquantel and ventriculoperitoneal shunt, and maintained on the anticonvulsant drug for one year, but returned to the hospital due to seizure recurrence. The patient has been well in seizure-free state for the follow-up 2 years after albendazole therapy. The subarachnoid racemose cysticercosis seems to respond well to treatment of corticosteroid along with prolonged albendazole.
Sujets)
Humains , Albendazole , Antiparasitaires , Cysticercose , Études de suivi , Tête , Membranes , Neurocysticercose , Praziquantel , Récidive , Crises épileptiques , Taenia solium , Dérivation ventriculopéritonéaleRésumé
Generalized myalgia and muscle tenderness are relatively common during exacerbations in patients with systemic lupus erythematosus (lupus), and inflammatory myositis involving the proximal muscles occurs in 5~11% of patients during the course of the disease. However, patients with overlap syndrome of lupus and idiopathic inflammatory myopathy have been not that frequent. We described 2 patients with overlap syndrome of these two diseases. Patient 1 was a 27-year-old female patient concurrently having lupus and dermatomyositis. She manifested the characteristic skin rash for dermatomyositis such as heliotrope rash. Patient 2 was a 32-year-old female patient concurrently having lupus and polymyositis, in whom the disease-specific autoantibodies for lupus or idiopathic inflammatory myopathy such as anti-ds DNA antibody, anti-Sm antibody and anti-Jo-1 antibody were positive.
Sujets)
Adulte , Femelle , Humains , Autoanticorps , Dermatomyosite , ADN , Exanthème , Lupus érythémateux disséminé , Muscles , Myalgie , Myosite , PolymyositeRésumé
The radiographic appearance of a unilateral hyperlucent lung is related to various conditions, the accurate radiographic interpretation of which requires a structured approach as well as an awareness of the spectrum of these entities. Firstly, it is important to determine whether a hyperlucent hemithorax is associated with artifacts resulting from rotation of the patient, grid cutoff, or the heel effect. The second step is to determine whether or not a hyperlucent lung is abnormal. Lung that is in fact normal may appear hyperlucent because of diffusely increased opacity of the opposite hemithorax. Thirdly, thoracic wall and soft tissue abnormalities such as mastectomy or Poland syndrome may cause hyperlucency. Lastly, abnormalities of lung parenchyma may result in hyperlucency. Lung abnormalities can be divided into two groups: a) obstructive or compensatory hyperinflation; and b) reduced vascular perfusion of the lung due to congenital or acquired vascular abnormalities. In this article, we describe and illustrate the imaging spectrum of these causes and outline a structured approach to accurate radiographic interpretation.