The hypokalemic periodic paralysis is characterized by intermittent falccid paralysis of extremities with spontaneous recovery. It is rarely accompanied by cardiac arrhythmia, especially fatal ventricular tachycardia or torsades de pointes. We observed a 29 year old man, who had suffered from intermittent periodic paralysis and fatal ventricular tachyarrhythmia. He had the first episode of muscle weakness in his low grade of elementary school, which lasted for 20 -30 hours. Similar episodes of muscle weakness occurred 1 -7 times per year, especially after carbohydrate rich food. On admission to emergency room, his chief complaints were generalized weakness and chest tightness, serum potassium level was 1.6mEq/l, and four extremities showed Grade 0 motor weakness. His electrocardiography(ECG) showed Atrioventricular dissociation due to sinus tachycardia and accelerated junctional rhythm, intraventricular conduction distrubance. During intravenous potassium administration, ECG showed sustained ventricular tachycardia and cardiovascular collapse occurred. So we carried out resuscitation and cardioversion. After resuscitation, he recovered from cardovascular collapse and ECG showed sinus tachycardia. But during continuous monitoring ECG showed torsades de pointes with cardiovascular collapse. We carried out resuscitation and defibrillation repeatedly. Serum potassium level was 1.7 - 1.8mEq/L at that time. After successful resuscitation, ECG showed sinus rhythm, and his mental status was fully recovered. After he admitted to intensive care unit, paralytic attack and cardiac arrhythmia did not occurred any more. Serum potassium level was maintained between 3.9 -6.1lmEq/L during his hospital days. He was fully recovered but could not take any medications(e.g. acetazolamide, potassium supplying agent and antiarrhythmic drugs) due to severe gastrointestinal disturbances. During the 30 months of postdischarge period, he experienced three mild paralysis attacks, but they were not accompanied by chest tightness, palpitation or syncope.
Acetazolamide ; Adult ; Arrhythmias, Cardiac* ; Electric Countershock ; Electrocardiography ; Emergency Service, Hospital ; Extremities ; Heart Block ; Humans ; Hypokalemia ; Hypokalemic Periodic Paralysis* ; Intensive Care Units ; Muscle Weakness ; Paralysis ; Potassium ; Resuscitation ; Syncope ; Tachycardia ; Tachycardia, Sinus ; Tachycardia, Ventricular ; Thorax ; Torsades de Pointes

BACKGROUND: Cardiac tamponade is associated with the expiratory increase and the expira-tory decrease in left ventricular filling flow. With Doppler echocardiography, we analyzed the respiratory variations of mitral and tricuspid inflows, and pulmonary and hepatic venous flows in patients with cardiac tamponade. METHODS: Respiratory hemodynamic changes in mitral and tricuspid inflows and pulmonary and hepatic venous flows were evaluated using Doppler echocardiography in 13 patients (6 men and 7 women; mean age 51+/-13 years) with large pericardial effusion and clinical cardiac tamponade, and compared the results with those of 11 control subjects (3 men and 8 women, mean age 53+/-13 years). Doppler examination was repeated after pericardiocentesis in 6 patients. RESULTS: Peak velocity of early diastolic mitral inflow (E velocity) decreased during inspiration compared with expiratory increase; the mean percentage change was 40%. Peak velocity of late diastolic mitral inflow (A velocity) decreased 13% during inspiration. E/A ratio decreased 31% during inspiration. Deceleration time (DT) and isovolumic relaxation time (IVRT) increased by 26% and 44%, respectively, during inspiration. But respiratory variations of tricuspid inflow were opposite to those of mitral inflow. Tricuspid E velocity increased during inspiration and decre-ased during expiration. The mean percentage change was 123%, which was larger than thte 40% of mitral inflow. The most characteristic findings of pulmonary venous flow during respiration were the expiratory increases of peak diastolic velocity (DV) and diastolic time-velocity integral (D-TVI). The mean percentage changes of peak systolic velocity (SV), DV and D-TVI during respiration were 27%, 45% and 53% respectively. In contrast, the SV and DV of hepatic venous flow increased during inspiration and decreased during expiration. The respiratory variations of peak systolic reverse flow velocity (SR) and peak diastolic reverse flow velocity (DR) were opposite to those of SV and DV. DR notably increased during expiration, and the mean percentage change was 61%. The ratio of RFI (Inspiratory reverse flow integral) to FFI (forward flow integral) of the tamponade group was 270%. The mean percentage changes of each parameters decreased after pericardiocentesis. CONCLUSION: Patients with cardiac tamponade showed inspiratory increases of diastolic tri-cuspid filling flow and hepatic forward flow. Expiratory increases included diastolic mitral filling flow, pulmonary venous systolic and diastolic flow, and hepatic venous reverse flow. Such res-piratory variations decreased after pericardiocentesis.
Cardiac Tamponade* ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Female ; Hemodynamics ; Humans ; Male ; Pericardial Effusion ; Pericardiocentesis ; Relaxation ; Respiration

OBJECTIVE: To investigate whether synovial fluid adenosine deaminase activity is useful in the differential diagnosis of joint swelling and in estimating the disease activity. METHOD: Adenosine deaminase activity was determined in the synovial fluid taken from patients with rheumatoid arthritis (n=21), osteoarthritis (n=ll), ankylosing spondylitis (n=3), and gouty arthritis (n=2). This enzyme activity was compared with the laboratory indices (ESR, CRP) in the blood and the other parameters in the synovial fluid. RESULT: More increased adenosine deaminase activity was found in the synovial fluid taken from patients with rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis, as compared with that of osteoarthritis patients. Synovial fluid ADA activity was significantly corelated with the WBC count in the synovial fluid, but there was no statistical corelation between other synovial parameters and adenosine deaminase activity. CONCLUSION: Adenosine deaminase activity is useful in the differential diagnosis of joint swelling between inflammatory joint disease and osteoarthritis, but not useful in estimating the disease activity.
Adenosine Deaminase ; Adenosine* ; Arthritis, Gouty* ; Arthritis, Rheumatoid* ; Diagnosis, Differential ; Humans ; Joint Diseases ; Joints ; Osteoarthritis* ; Spondylitis, Ankylosing* ; Synovial Fluid*

PURPOSE: To investigate levels of serum homocysteine in patients with pseudoexfoliation syndrome and the association between serum homocysteine levels and risk of coronary heart disease. METHODS: From March 2013 to September 2013, 37 patients with pseudoexfoliation syndrome and 59 age-matched patients (control group) were enrolled in this prospective study. Serum homocysteine levels were compared between the 2 groups. We compared the estimated 10-year risk of coronary heart disease based on Framingham risk score between the 2 groups. Additionally, we analyzed correlations between risk of coronary heart disease and serum homocysteine levels. RESULTS: The mean homocysteine level of patients with pseudoexfoliation syndrome was significantly higher than the control group (13.3 ± 6.8 µmol/L vs. 10.0 ± 5.2 µmol/L, p = 0.009). The rate of high risk defined as a 10-year coronary heart disease risk >20% in the patients with pseudoexfoliation syndrome was significantly higher than in the control group (21.4% vs. 4.4%, p = 0.048). Correlation between serum homocysteine levels and estimated 10-year risk of coronary heart disease was statistically significant (r = 0.578, p < 0.001). CONCLUSIONS: Hyperhomocysteinemia and high risk of coronary heart disease were observed in patients with pseudoexfoliation syndrome. Therefore, we suggest efforts to prevent coronary heart disease in pseudoexfoliation syndrome patients with hyperhomocysteinemia are necessary.
Coronary Disease* ; Exfoliation Syndrome* ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Prospective Studies

PURPOSE: The purpose of this study was to determine the efficacy of sonography in the evaluation of normal pseudocapsular morphology and the detection of complications after total hip arthroplasty. MATERIALS AND METHODS: Between Janvary 1997 and June 2000, 47 patients [35 men and 12 women aged 24 to 84 (mean, 61) years] using real-time linear-array, convex US units with 3.5-MHz and 10-MHz transducers. Normal capsular morphology in 30 with total hip replacements, who had been asymptomatic for at least one year, was studied, and the prosthetic joint infection demonstrated in six of 17 who had experienced was confirmed at surgery or by US-guided aspiration. RESULTS: Sonograms indicated that a normal pseudocapsule lay straight over the neck of the prosthesis or was slightly convex toward the neck, and that the mean bone-to-pseudocapsule distance was 2.9 mm. However, in the 11 symptomatic patients in whom no evidence of infection was revealed by cultures, th mean distance was 4.7 mm; in the remaining six patients, whose joints were infected (a condition strongly suggested by the presence of extracapsular fluid), the mean distance was 5.5 mm, with no significant difference between the two groups. CONCLUSION: Sonography can be used to evaluate normal caspular morphology after total hip replacement and to diagnose infection around hip prostheses. In all patients in whom sonography revealed the presence of extra-articular fiuid, infection had occurred.
Arthroplasty, Replacement, Hip* ; Female ; Hip Prosthesis ; Humans ; Joints ; Male ; Neck ; Prostheses and Implants ; Transducers ; Ultrasonography*

PURPOSE: To measure the normal size of the styloid process using 3D (three-dimensional) reconstruction CT. MATERIALS AND METHODS: We retrospectively analyzed 3D reconstruction images obtained after coronal and axial CT scanning of the temporal bone or neck of 115 patients. The length and shape of both sides of the styloid process, the location of its tip, and calcification of the stylohyoid ligament were retrospectively analysed. RESULTS: The mean length of the styloid process was 26.6 (+/-7.9)mm on the right side, and 26.4(+/-8.3)mm on the left, a statistically insignificant difference (p=0.694). Its mean length was 26.2 (+/-8.5)mm in men and 26.7 (+/-7.2)mm in women, a statically in significant difference (p=0.733). As for variation with age, mean length tended to increase until the third decade, but not beyond. Segmental type (104/230, 45.2%) and fragmental type (73/230, 31.7%) were more commonly seen in shape of styloid process, and tapering tip of styloid process (156/230, 67.9%) is more commonly seen than clubbing tip of it (74/230, 32.1%). The process was angulated in six cases (2.6%); its tip was more frequently located between the internal and external carotid artery (211 cases, 91.7%) than more medially (19 cases, 8.3%). In the former location, the length of the process was 26.2(+/- 7.2)mm, and in the latter, 37.0(+/-6.0)mm. The difference was statistically significant (p=0.000). Calcification had occurred in 33 cases (14.3%). CONCLUSION: The length of a normal styloid process was 18-32 mm. There were no statistically significant differences between its two sides, or between the sexes. Length tended to increase until the third decade, but not beyond. Predominantly the tip was located between the internal and external carotid artery, though the process was longer when its tip was located medially.
Carotid Artery, External ; Female ; Humans ; Ligaments ; Male ; Neck ; Retrospective Studies ; Temporal Bone ; Tomography, X-Ray Computed

Facial asymmetry can be classified into the rolling-dominant type (R-type), translation-dominant type (T-type), yawing-dominant type (Y-type), and atypical type (A-type) based on the distorted skeletal components that cause canting, translation, and yawing of the maxilla and/or mandible. Each facial asymmetry type represents dentoalveolar compensations in three dimensions that correspond to the main skeletal discrepancies. To obtain sufficient surgical correction, it is necessary to analyze the main skeletal discrepancies contributing to the facial asymmetry and then the skeletal-dental relationships in the maxilla and mandible separately. Particularly in cases of facial asymmetry accompanied by mandibular yawing, it is not simple to establish pre-surgical goals of tooth movement since chin deviation and posterior gonial prominence can be either aggravated or compromised according to the direction of mandibular yawing. Thus, strategic dentoalveolar decompensations targeting the real basal skeletal discrepancies should be performed during presurgical orthodontic treatment to allow for sufficient skeletal correction with stability. In this report, we document targeted decompensation of two asymmetry patients focusing on more complicated yaw-dependent types than others: Y-type and A-type. This may suggest a clinical guideline on the targeted decompensation in patient with different types of facial asymmetries.
Chin ; Facial Asymmetry* ; Humans ; Mandible ; Maxilla ; Orthognathic Surgery ; Tooth Movement

Moyamoya disease (MMD) is a cerebrovascular disorder characterized by bilateral stenosis or occlusion of the terminal portions of the internal carotid arteries. MMD is also accompanied by typical net-like collateral vessels in the basal ganglia. Although the etiology of MMD remains unknown, hereditary, immunogenic, and hemodynamic factors have been implicated as underlying mechanisms of MMD. Here, the authors report on one patient with a rare combination of Graves' disease-associated thyrotoxicosis, myasthenia gravis, and MMD, where cerebrovascular ischemic events occurred during a thyrotoxic state.
Basal Ganglia ; Brain Ischemia ; Carotid Artery, Internal ; Cerebrovascular Disorders ; Constriction, Pathologic ; Graves Disease ; Hemodynamics ; Humans ; Moyamoya Disease ; Myasthenia Gravis ; Thyrotoxicosis

OBJECTIVE: Longstanding hypertension lead to left ventricular diastolic dysfunction with a development of a left atrial enlargement (LAE) which may result in vulnerability to atrial fibrillation (AF). Paroxysmal AF is usually unrevealed in the acute period of ischemic stroke, but is crucial for anticoagulation to prevent recurrent stroke. This study was aimed to investigate the frequency of LAE and the predictors of paroxysmal AF during the hospitalization of acute ischemic stroke. METHODS: A total 1,643 consecutive patients with acute ischemic stroke were registered in between January 2005 and December 2014. The subjects who had AF before index stroke or at admission were excluded. The clinical and echocardiographic findings of all patients were reviewed. Paroxysmal AF were detected on electrocardiography of Holter monitoring during hospitalization. LAE were defined as LA diameter larger than 44 mm in echocardiography. We compared the frequency of LAE between the patients with or without AF. Logistic regression analysis were performed to determine the echocardiographic parameters for prediction of paroxysmal AF. RESULTS: The mean age was 67.3 and the male was 55.6%. AF were detected in 123 (11.4%) of LAE(-) group but were detected in 102 (49.0%) in LAE(+) group. In logistic regression analysis, LAE significantly predicted for newly detected AF during hospitalization after adjusting covariates (odds ratio, 5.698; 95% confidence interval, 3.799-8.546; P<0.001). CONCLUSION: LAE was an independent predictor for AF during hospitalization in patients with acute ischemic stroke. Prolonged electrocardiography monitoring should be meticulously indicated for acute ischemic stroke with LAE to detect paroxysmal AF.
Atrial Fibrillation* ; Atrial Function, Left ; Echocardiography* ; Electrocardiography ; Electrocardiography, Ambulatory ; Hospitalization ; Humans ; Hypertension ; Logistic Models ; Male ; Stroke*

Cardiac myxoma is the most common benign cardiac tumor and it presents various clinical symptoms and signs. Although two-thirds of patients have abnormal electrocardiographic findings, atrial flutter or conduction abnormalities are known to be rare. We report on a case of a large left atrial myxoma which was diagnosed by trans-thoracic, trans-esophageal echocardiography, chest computerized tomography, and histological examination. The myxoma was presented as atrial flutter in a 41-year old man who was complaining palpitation and dyspnea on exertion. After surgical excision of the mass, atrial flutter converted to normal sinus rhythm. We report this case with review of literatures on left atrial myxoma associated with arrhythmia.
Arrhythmias, Cardiac ; Atrial Flutter ; Dyspnea ; Echocardiography ; Electrocardiography ; Heart Neoplasms ; Humans ; Myxoma ; Thorax