Acute arterial occlusion of the extremity may result from obstruction of an artery by embolism or by thrombosis in situ. This results in the sudden cessation of blood flow to an extremity. So immediate managements are required to prevent propagation of the clot and to restore blood flow to the ischemic extremity promptly. We report a case of a acute arterial occlusion which was developed during prolonged fasting. A 59-year-old male was transferred due to severe ischemic pain, coldness and loss of pulse in left lower extremity during fast. The arteriogram shows a complete obstruction of external iliac artery and non-visualization of femoral artery and popliteotibial artery in the left lower extremity. Selective intra-arterial urokinase thrombolytic therapy and percutaneous transluminal angioplasty resulted in recannulation of obstructed artery and relief of symptoms.
Angioplasty ; Arteries ; Embolism ; Extremities ; Fasting* ; Femoral Artery ; Humans ; Iliac Artery ; Lower Extremity* ; Male ; Middle Aged ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator

Bleeding from esophageal or gastric varix is the most critical and life-threatening complication of portal hypertension and the most common cause of deaths in the patients with cirrhosis. In the management of variceal bleeding, the various therapeutic interventions including operation and nonoperative procedure were tried, but neither of management was successfully achieved. Between February 1992 and November 1994, we performed endoscopic injection sclerotherapy(EIS) in 35 cirrhotic patients who had recently bled from esophageal varices and had a past history of esophageal variceal bleeding in Chonbuk National Univesity Hospital. Among 35 patients, 32 were male and 3 were female. The underlying severity of liver disease was graded A, B or C according to modification of Child-Pugh classification. EIS was repeated every 1 week until the esophageal varices had been complete obliterated and removed. To investigate the effects of esophageal varix eradication by EIS on combined peri- cardial varix, endoscopic examinations were performed both before procedure and after complete EIS sessions and this study was performed to examine a changes of combined pericardial varices after EIS procedure for the treatment of esophageal varices bleeding secondary to portal hypertesion. We reviewed medical records and compared changes or sizes of pericardial varices before and after EIS procedure. Mean follow up peiod was 61 days. Total number of 162 EIS for variceal eradication were performed. Mean session for eradication of esophageal varices was 4.6 per person, mean amount of injected sclerosant was 8.3cc(1-18cc), mean duration of EIS was 39 days, and mean follow up was 62 days after complete EIS procedure. In total 162 EIS procedure, complications associated with EIS including substernal discomfort 53.7%(n=87), substernal chest pain 45.7%(n=74), fever 4.9%(n=8), dysphagia 14.2%(n=23) and pleural effusion 3.1%(n=5), were transient and not required specific management. During the follow-up period, complete disapperance of pericardial varix or reduction of size was appeared in l8 cases(51.4%) among total 35 patients. No significant changes of variceal size before and after procedure were l6 cases(45.7%) and only 1 case(2.9%) was more aggravated. So, these results suggest that EIS procedure of esophageal varix on pericardial varix seems either to improve or to maintain the severity of the pericardial gastric varix without aggravation.
Cause of Death ; Chest Pain ; Classification ; Deglutition Disorders ; Esophageal and Gastric Varices* ; Ethanolamine* ; Female ; Fever ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal ; Jeollabuk-do ; Liver Diseases ; Male ; Medical Records ; Oleic Acid* ; Pleural Effusion ; Sclerotherapy* ; Varicose Veins

Bleeding from esophageal or gastric varix is the most critical and life-threatening complication of portal hypertension and the most common cause of deaths in the patients with cirrhosis. In the management of variceal bleeding, the various therapeutic interventions including operation and nonoperative procedure were tried, but neither of management was successfully achieved. Between February 1992 and November 1994, we performed endoscopic injection sclerotherapy(EIS) in 35 cirrhotic patients who had recently bled from esophageal varices and had a past history of esophageal variceal bleeding in Chonbuk National Univesity Hospital. Among 35 patients, 32 were male and 3 were female. The underlying severity of liver disease was graded A, B or C according to modification of Child-Pugh classification. EIS was repeated every 1 week until the esophageal varices had been complete obliterated and removed. To investigate the effects of esophageal varix eradication by EIS on combined peri- cardial varix, endoscopic examinations were performed both before procedure and after complete EIS sessions and this study was performed to examine a changes of combined pericardial varices after EIS procedure for the treatment of esophageal varices bleeding secondary to portal hypertesion. We reviewed medical records and compared changes or sizes of pericardial varices before and after EIS procedure. Mean follow up peiod was 61 days. Total number of 162 EIS for variceal eradication were performed. Mean session for eradication of esophageal varices was 4.6 per person, mean amount of injected sclerosant was 8.3cc(1-18cc), mean duration of EIS was 39 days, and mean follow up was 62 days after complete EIS procedure. In total 162 EIS procedure, complications associated with EIS including substernal discomfort 53.7%(n=87), substernal chest pain 45.7%(n=74), fever 4.9%(n=8), dysphagia 14.2%(n=23) and pleural effusion 3.1%(n=5), were transient and not required specific management. During the follow-up period, complete disapperance of pericardial varix or reduction of size was appeared in l8 cases(51.4%) among total 35 patients. No significant changes of variceal size before and after procedure were l6 cases(45.7%) and only 1 case(2.9%) was more aggravated. So, these results suggest that EIS procedure of esophageal varix on pericardial varix seems either to improve or to maintain the severity of the pericardial gastric varix without aggravation.
Cause of Death ; Chest Pain ; Classification ; Deglutition Disorders ; Esophageal and Gastric Varices* ; Ethanolamine* ; Female ; Fever ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal ; Jeollabuk-do ; Liver Diseases ; Male ; Medical Records ; Oleic Acid* ; Pleural Effusion ; Sclerotherapy* ; Varicose Veins

Spinal tuberculosis is curable disease, and early diagnosis is mandatory for early treatment. We reviewedconventional radiographies and CT from Histopathologically confirmed 30 cases of spinal tuberculosis, and comparedthese findings with radiologic findings from 2 cases of pyogenic spondylitis and 4 cases of meastasis. The resultswere as follows: 1. The frequnet site of involvement were thoracolumbar juntion and low lumbar vertebrae, and themost frequent type is multisegmented subligamentous type (93.3%). 2. CT was not of great use in the diferentaldiagnosis of the tuberculosis. Dominant CT findings of tuberculous spondylitis were anterior vertebral bodydestruction, paravertebral soft-tissue mass and thick walled abscess formation occasionally containingcalcification and disc space narrowing, in the setting of an indolent or relatively benign course. 3. CT is thebest modality for imaging the extent and anatomy of the destructive process, the degree of canal encroachment, andthe change of adjacent vital structure. So CT was particularily useful in pre-operative planing of debridement andstabilization surgery. 4. The most common causes of neurologic manifestations in tuberculous spondylitis were thecompression of spinal cord by sequestrated bony fragments and disc material, granulation tissue or abscess in thespinal canal.
Abscess ; Debridement ; Early Diagnosis ; Granulation Tissue ; Lumbar Vertebrae ; Neurologic Manifestations ; Spinal Cord ; Spondylitis ; Tuberculosis ; Tuberculosis, Spinal

BACKGROUND: Neointimal hyperplasia, as the most important mechanism of restenosis after intracoronary artery stenting, its severity is closely correlated with the degree of local inflammatory reaction initiated by vasular injury during stenting procedure. So, we proceeded this study to determine whether inflammatory markers such as CD11b/CD18 (Mac-1) adehsion molecules of neutrophils, sICAM-1 (soluble intercellular adhesion molecule-1), ESR, and CRP increase or not in the peripheral circulation after coronary artery stenting, and whether there is any association between these findings and the degree of later restenosis. METHOD: 32 patients (chronic stable angina 4, unstable angina 17, acute myocardial infarction 11) underwent single vessel coronary artery stenting were enrolled in our study. Blood samples were obtained from peripheral vein just before coronary artery stenting and 48 hours thereafter. The degrees of CD11b/CD18 expression on the surface of neutrophils were analyzed by flow cytometry with monoclonal antibodies, and sICAM-1 by ELISA method. At each times, ESR and CRP were also measured. Follow-up coronary artery angiography was performed with QCA analysis at least 6 months later. We compared the each 48 hours values with the baseline (just before procedure) values. Percentage increments (as a ratio 48 hours values to baseline) of CD11b/CD18 expression, sICAM-1, ESR, and CRP levels were also compared with the results of follow-up QCA analysis. RESULTS: Restenosis (diameter stenosis > or = 50%) occurred in 6 patients (19%) at follow up angiography. 48 hours values of CD11b/CD18 expression, sICAM-1, ESR, and CRP were significantly elevated from the baseline values (each p values, CD11b : < 0.0001, CD18 : 0.01, sICAM-1 : < 0.0001, ESR : 0.005, and CRP : 0.001). The percentage increments of CD11b/CD18 expression were more elevated in restenosis group than nonrestenosis group (CD11b : 341+/-215%/74+/-95%, CD18 : 84+/-60%/17+/-37%, each p < 0.001, 0.001). There was some positive correlation between the percentage increments in the expression of CD11b and the late loss index at the follow up angiography (r=.43, p<0.05). CONCLUSIONS: Through this study, we found that the activation of neutrophils was occurred, and that sICAM-1 level was increased after coronary artery stenting in the peripheral blood. There was some correlations between the degree of CD11b expression on the surface of neutrophils and the severity of late lumen loss of inserted stents. The measurements of increased neutrophil adhesion molecules of CD11b/CD18 levels at 48hrs after coronary stenting may have a value as the predictor of subsequent late restenosis.
Angina, Stable ; Angina, Unstable ; Angiography ; Antibodies, Monoclonal ; Arteries ; Constriction, Pathologic ; Coronary Vessels* ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Follow-Up Studies ; Humans ; Hyperplasia ; Myocardial Infarction ; Neutrophils* ; Stents* ; Veins

BACKGROUND AND OBJECTIVES: Stiffening of the aorta is a potential risk factor for increased cardiovascular morbidity and mortality. Increased aortic stiffness can be associated with an increased left ventricular (LV) mass and diastolic dysfunction. The aim of the study was to evaluate the relationship of the aortic stiffness to the LV hypertrophy (LVH) and diastolic dysfunction. SUBJECTS AND METHODS: A total of 188 consecutive patients, without overt cardiovascular disease or symptoms, were included. The LV mass and diastolic filling patterns were assessed. The aortic strain and distensibility were indirectly obtained from the aortic diameters, using echocardiography and blood pressure measurements. RESULTS: Of the 188 patients (92 males, 54+/-14 years old), hypertension was found in 57 and diabetes in 29, with both found in 32 patients. The aortic strain (3.77+/-2.42 vs. 5.13+/-4.27, p<0.001) and distensibility (0.11+/-0.09 vs. 0.22+/-0.21, p<0.001) were significantly lower, but the LV mass index (112.5+/-39.2 vs. 87.8+/-19.0 gm/m2, p<0.001) higher, in the hypertensive compared to normotensive patients. Also, the aortic strain (3.07+/-2.42 vs. 5.18+/-4.01, p<0.001) and distensibility (0.10+/-0.12 vs. 0.21+/-0.20, p<0.001) were lower in patients with LVH. The E/E' ratio was higher in the hypertensive patients (10.9+/-5.0 vs. 8.1+/-3.1, p<0.001) and in those with LVH (10.8+/-5.6 vs. 8.4+/-3.2, p<0.001). In a multivariate analysis, the parameters closely related with aortic strain were age (standardized coefficient beta=-0.240, p=0.001), LV mass index (beta=-0.158, p=0.025) and IVRT (beta=-0.155, p=0.035). The parameters significantly related with aortic distensibility were age (beta=-0.344, p<0.001) and LV mass index (beta=-0.224, p=0.001). CONCLUSION: Increased aortic stiffness is associated with an increased LV mass and diastolic abnormality.
Aorta ; Blood Pressure ; Cardiovascular Diseases ; Echocardiography ; Humans ; Hypertension ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male ; Mortality ; Multivariate Analysis ; Risk Factors ; Vascular Stiffness*

OBJECTIVE: The purposes of this study were to clarify the roles of personality characteristics and general psychopathology, including depression and hypochondriasis, in individuals with eating disorders, and to test a continuum hypothesis of eating disorders. METHODS: Using a multi-stage questionnaire sampling method including area sampling, proportionated stratified sampling, and quota sampling, we surveyed 3,062 subjects(1249 males and 1813 females) from a target of 4,400 Korean adults over the age of 18 in a nationwide area(9 ku's, 10 middle or small cities, and 17 kun's). We used the questionnaire which consisted of three parts:general information, scales for eating traits, and scales for personality characteristics and other general psychopathology. RESULTS: Psychoticism was the only personality characteristics which had a significant relationship with various eating traits including 'eating habits'(r=-0.3195), 'the Eating Attitudes Test'(EAT, r=0.3657), and 'preference for vegetables and fish, and dislike for sweet,tasting foods'(r=-0.2740). Lie scale also had a significant relationship with 'preference for snacks and instant foods'(r=-0.2117). These results were consistent in examining the relationships across genders. In female, there was a significant relationship between 'preference for the traditional Korean foods' and 'psychoticism'(r=-0.2103) in addtion to above relationships. However, there were no significant relationships between any of the eating traits and other psychopathology. Relative to the relationship between personality characteristics and general psychopathology, there were significant correlations between 'depression' and 'interoversion-extraversion'(r=-0.2174), 'depression' and 'neuroticism'(r=0.4510>, and 'hypochondriasis' and 'neuroticism'(r=0.3432). These correlations in female was the same as those of the total group, while among males, 'depression' was significantly correlated with all four personality characteristics, and 'hypochondriasis' was significantly correlated with 'interoversion-extraversion'(r=-0.2265) and 'neuroticism'(r=0.3762). CONCLUSION: These results suggest that psychoticism is the only personaltiy characteristics related to eating-specific psychopathology, while general psychopathology, such as depression and hypochondriasis is not related to eating pathology but may influence eating disorders by their interaction with other personality characteristics, such as interoversion-extraversion and neuroticism. Considering the results of previous studies in the patients with eating disorders and high risk groups, which are similar with our results in the general population, our results support a continuum hypothesis of eating disorders. Our results also suggest that gender differences in the pathology of eating disorders are the result not of difference in eating-specific pathology itself but through difference in influences of concurrent general psychopathology, such as depression and hypochondriasis.
Adult ; Depression ; Feeding and Eating Disorders ; Eating* ; Female ; Humans ; Hypochondriasis ; Male ; Pathology ; Psychopathology* ; Surveys and Questionnaires ; Snacks ; Vegetables ; Weights and Measures

It is often possible to diagnose a pheochromocytoma only when a disastrous cardiac complication like a hypertensive crisis, episodes of unexpected left ventricular failure, myocarditis, arrhythmias, myocardial infarction and sudden death appears secondarily. We revealed that a patient who had been treated with a reversible left ventricular systolic dysfunction with cardiogenic indeed had a pheochromocytoma. Upon initial admission, a 35 years old man had upper respiratory tract infection and abdominal discomfort. Blood pressure was 140/90 mmHg and EKG showed transiently paroxysmal supraventricular tachycardia. Eight hours after admission, he appeared to be in cardiogenic shock. Echocardiography showed extensive global hypokinesia with severe left ventricular systolic dysfunction. Following conservative management he progressively recovered normal cardiac function although we did not discern the etiology of the left ventricular systolic dysfunction. He was readmitted six months later due to episodic headache and high blood pressure. Fortunately, due to the history of reversible left ventricular systolic dysfunction with cardiogenic shock, we were able to quickly assess him as having a pheochromocytoma. The laboratory data and radiological findings were compatible with this tumor, which was subsequently successfully removed through surgery. We suggest that the diagnosis of pheochromocytoma should be considered in young patients presenting with acute heart failure of non-specific origin.
Adult ; Arrhythmias, Cardiac ; Blood Pressure ; Death, Sudden ; Diagnosis ; Echocardiography ; Electrocardiography ; Headache ; Heart Failure ; Humans ; Hypertension ; Hypokinesia ; Myocardial Infarction ; Myocarditis ; Pheochromocytoma* ; Respiratory Tract Infections ; Shock ; Shock, Cardiogenic* ; Tachycardia, Supraventricular

BACKGROUND: There have been a lot of methods that prevent catatrophic airway fires during laser surgery, but none of them can protect endotracheal tube cuff exposed directly to laser beam. This study was performed to know the preventive effect of viscous lidocaine-filled cuffs on laser-induced combustion, and to know how long we can maintain positive pressure ventilation if laser beam broke out cuff perforation. METHODS: Transparent acrylic trachea attached to artificaial lung was intubated with 8.0 ID polyvinylchloride endotracheal tube. Cuff was filled with 8ml of saline or saline and viscous lidocaine mixture with 2:1 or 4:1 ratio. Positive pressure ventilation with air in tidal volume of 500 ml was begun. The laser output was set to 10 watt/sec in the continuous mode with beam diameter of 1 mm. Laser beam was directed perpendicularly at the part of the cuff protruding between endotracheal tube shaft and acrylic trachea, and laser emission was continued until the cuff was perforated or combusted. RESULTS: There was no case of laser-induced fires. After the perforation of cuff, the tidal volume was slowly decreased in 2:1 mixture of saline and viscous lidocaine filled cuff compared to others (P<0.05). CONCLUSION: 2:1 mixture of saline and viscous lidocaine may be used as an efficient inflating material of endotracheal tube cuffs on laser airway surgery.
Fires* ; Laser Therapy ; Lidocaine ; Lung ; Polyvinyl Chloride* ; Polyvinyls* ; Positive-Pressure Respiration ; Tidal Volume* ; Trachea

Bronchogenic cysts are rare congenital anomalies that arise early in gestation from abnormal budding of the developing respiratory system. Mediastinal bronchogenic cysts account for 10-15 percent of all primary mediastinal masses; 63.7 percent of patients are symptomatic. Common symptoms are fever, chest pain, cough, dyspnea, and dysphagia. Gastrointestinal symptoms except dysphagia are rare. It can be life threatening with compression, infection, hemorrhage, or rupture. Symptoms and signs of compression are more frequent in infants and children than in adults. It may be asymptomatic, or cough, infection, and hemoptysis may be observed. Complete excision is recommended. We report a case of bronchogenic cyst misdiagnosed as chronic gastritis with nausea and epigastric pain for a year.
Adult ; Bronchogenic Cyst* ; Chest Pain ; Child ; Cough ; Deglutition Disorders ; Dyspnea ; Fever ; Gastritis ; Hemoptysis ; Hemorrhage ; Humans ; Infant ; Nausea* ; Pregnancy ; Respiratory System ; Rupture