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

BACKGROUND/AIMS: We compared the accuracy in the diagnosis of hepatic masses such as hepatocellular carcinoma (HCC), metastasis and hemangioma using enhancing pattern alone with using additional findings, and determined whether the additional findings could improve the diagnostic accuracy. METHODS/MATERIALS: Triphasic spiral CT images were retrospectively analyzed in 83 cases of hepatic lesions,' 40 HCC, 21 metastases, and 22 hemangiomas. Three observers made the diagnosis first by the enhancement pattern of the mass alone, and then, by the whole information. The diagnosis of a lesion was considered correct if the lesion was correctly categorized by at least two observers. Diagnostic accuracies of two sessions were compared with McNemar test. RESULTS: Using enhancing patterns alone, 31/40 HCC (78%), 8/21 metastases (38%), 21/22 hemangiomas (95%) were correctly diagnosed. The frequency of correct diagnosis was significantly improved when all images with additional findings were used: 36/40 (90%) HCC, 20/21 (95%) metastases, 22/22 (100%) hemangiomas (P=0.00006). Metastasis showed most prominent and statistically significant improvement in the diagnostic accuracy (P=0.0004). The number of correct diagnoses for HCC increased without statistical significance (P=0.17). However, the images with additional findings did not significantly contribute to the diagnosis of hemangiomas. The additional finidngs those led to correct diagnosis of metastases were multiple mass (7 cases), coexistence of primary malignancy (6 cases), and metastasis to other organ (1 case). The findings of liver cirrhosis were helpful to diagnose HCC correctly in 5 cases. CONCLUSION: The enhancing pattems of tumors were important in the diagnosis of hepatic masses in spiral CT. However, the additional finidngs were also helpful for the diagnosis of hepatic masses especially for the masses with atypical enhancement pattern. In metastases, the additional findings such as multiple masses or detection of primary malignant focus were useful to diagnose correctly.
Carcinoma, Hepatocellular ; Diagnosis ; Hemangioma ; Liver Cirrhosis ; Liver Neoplasms ; Neoplasm Metastasis ; Retrospective Studies ; Tomography, Spiral Computed*

PURPOSE: To report the change of pupil sizes according to age and illuminance in the normal Korean population. METHODS: Normal Koreans outpatients who never had a history of ophthalmic disease were examined. The patients consisted of 320 eyes of 160 patients, which were classified into 8 age decades (teenage to 80's) with 40 eyes in each age group. The vertical and horizontal pupil size and area under 4 different illuminances (3,500, 1,200, 500, 5 lux) were measured using the Colvard pupillometer(R) (OASIS Medical, Glendora, CA, USA). RESULTS: The pupil size was significantly decreased as the age increased under each illuminance. The pupil area measured after dark adaptation was 47.30 mm2 in the teenage group, 43.32 mm2 in the 20's group, 41.94 mm2 in the 30's group, 40.98 mm2 in the 40's group, 40.61 mm2 in the 50's group, 38.60 mm2 in the 60's group, 37.78 mm2 in the 70's group and 35.45 mm2 in the 80's group. The decrease in pupil area was statistically significant. CONCLUSIONS: In the normal Korean population, a significant decrease in pupil size and area was observed with aging. The present study results provide good basic data for cataract and presbyopia refractive surgery.
Aging ; Cataract ; Dark Adaptation ; Eye ; Humans ; Outpatients ; Presbyopia ; Pupil ; Refractive Surgical Procedures

BACKGROUND: Previous studies indicated that there was important correlation between early patency of infarct-related artery, preservation of ventricular function, and improved survival after thrombolytic therapy for acute myocardial infarction. An increased infusion rate of rt-PA has been shown to result in faster thrombolysis and a high patency rate of occluded vessel in myocardial infarction. Therefore, we evaluated the effect of simplified triple bolus injection of rt-PA on early patency of infarct-related artery and evaluated safety and efficacy of triple bolus injection. METHOD: Patients with acute myocardial infarction presenting up to 6 hour from the onset of chest pain were recruited for the study. Aspring(100-200mg) was given immediately. Total dose for 1.5mg/kg of rt-PA(minimum 75mg, maximum 100mg) was administered as triple bolus intravenous injections. The half of total dose was injected initially, the quarter of total dose was injected at 10 minutes after 1st injection and the remainder was injected at 40 minutes after 1st injection. Five thousand units of heparin was given and 1,000-1,500unit/hr was given continuously. Coronary angiogram was performed at 60 minutes and 7-10 days after the first bolus injection. RESULTS: At 60 minutes, eleven of fourteen patients (78.6%) showed TMI grade-3 of patency in infarct-related coronary artery. There were two patients of hemorrhagic complications. One patient developed cerebellar hemorrhage at third day after rt-PA injection, and the other developed bleeding at femoral sheath site. There was no in-hospital mortality and reinfarction. CONCLUSION: In patients with acute myocardial infarction, the simplified triple bolus injection of rt-PA is associated with high early patency(TMI grade-3) in infarct-related coronary artery, with low risk of major bleeding comlications comparable to other studies.
Arteries ; Chest Pain ; Coronary Vessels ; Hemorrhage ; Heparin ; Hospital Mortality ; Humans ; Injections, Intravenous ; Myocardial Infarction* ; Thrombolytic Therapy ; Tissue Plasminogen Activator* ; Ventricular Function

BACKGROUND: Recently authentic human growth hormone(hGH) has produced in the E coli K-12, W3110 by recombinant DNA tecbnology in Korea In this paper, the clinical efficacy and immunogenicity of this GH was shdied in 38 children with growth hormone deficiency during therapy of 1 year. METHODS: The subjects of this study were aged 4.9-13.9 years, diagnosed by failure of plasma GH to respond to insulin-induced hypoglycemia, arginine and/or L-dopa loading and height below -2 standard deviation of mean for their chronological age. Each patient received GH 0.5-0.7IU/kg/week subcutaneously in 6-7 divided doses. During treatment, vital signs, height, body weight and bone age were checked every 3 months. Complete blood count, urinalysis, blood chemistry and thyroid hormone were checked before and every 6 months. The measurement of serum IGF-1 level and antibody against hGH were performed before and every 6 months during therapy of I year. RESULT: The height velocities significantly increased from 3.3 +/- 1.5cm/year to 10.1 +/- 2.5 and 9.0 +/- 1.8cm/year at 6 and 12 months of therapy, respectively. The height standard deviation score for chronological age were significantly improved from -2.141.50 to -1.74 +/- 1.43 and -1.54 +/- 1.38 at 6 and 12 months of therapy with increasing ratio of bone age to chronological age from 0.72 +/- 0.15 at pretreatment to 0.76 +/- 0.15 at 6 month, 0.79 +/- 0.16 at 12 month of therapy. The plasma IGF-1 level significantly increased during treatment. One of 36 patients(2.8%) showed positive antibody against hGH after 1 year of treatment. During therapy of 1 year, unwanted and remarkable clinical side effect were not observed in all subjects. CONCLUSION: These results indicate that this E. coli derived authentic recombinant growth hormone is very effective in stimulating linear growth in children with growth hormone deficiency.
Arginine ; Blood Cell Count ; Body Height ; Chemistry ; Child* ; DNA, Recombinant ; Escherichia coli ; Growth Hormone* ; Human Growth Hormone ; Humans* ; Hypoglycemia ; Insulin-Like Growth Factor I ; Korea ; Levodopa ; Plasma ; Thyroid Gland ; Urinalysis ; Vital Signs

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: Percutaneous intervention has become an established technique in the treatment of peripheral arterial obstructive disease. This study was performed to evaluate the procedural success and long-term outcome of percutaneous intervention of the superficial femoral artery (SFA), and to determine the factors that influence the long-term outcome. SUBJECTS AND MEHTODS: Eighty-eight consecutive lesions, in 76 subjects (mean age 65) with chronic lower limb ischemia and SFA obstruction, diagnosed with angiography were included in this study. The angiographic success was defined as residual stenosis <30% and the clinical success as an improvement by at least one clinical category. The clinical patency was defined as an absence of symptom recurrence and target lesion revascularization during the follow up period. The predictors of the outcome were also determined. RESULTS: Balloon angioplasty only was performed in 39 lesions and thrombolysis only in 2, whereas stenting was performed in 47 lesions. Seventy four of the 88 attempts (84%) at recanalization were angiographically successful, while 73 (83%) experienced clinical improvement. The twelve month patency was 67%. Critical ischemia (versus intermittent claudication)(relative risk 4.2, p=0.020) and renal failure (relative risk 4.1, p=0.016) were independent negative predictors of the patency. CONCLUSION: Percutaneous intervention of the SFA yielded a high procedural success rate, with an acceptable long-term outcome. Symptoms of critical ischemia and renal failure were predictive of a low long-term patency.
Angiography ; Angioplasty ; Angioplasty, Balloon ; Arterial Occlusive Diseases ; Constriction, Pathologic ; Femoral Artery* ; Follow-Up Studies ; Ischemia ; Lower Extremity ; Outcome Assessment (Health Care) ; Recurrence ; Renal Insufficiency ; Stents

PURPOSE: To analyze factors influencing clinical results after microfracture surgery in patients with osteoarthritic knee. MATERIALS AND METHODS: After microfracture surgery, in sixty-six patients with sixty-eight knees having full thickness chondral defect by arthroscopic evaluation, clinical results were evaluated with Baumgartner's nine-point scale during the follow-up of 1 year 4 months (range, 1-2 years 5 months). Results were analyzed according to age, the degree of preoperative varus and the existence of flexion contracture. RESULTS: Sixty-three knees showed excellent or good results at clinical evaluation. According to age, a significant difference was observed about 65 years old (p<0.05). The patients without flexion contracture and with less varus change had better clinical results, as did patients whose medial deviation of mechanical axis was less than 75% (p<0.05). CONCLUSION: Better clinical results, after microfracture surgery, were obtained in patients who were under the age of 65, with less than 75% of medial deviation of the mechanical axis on standing AP radiogram and no flexion contracture.
Aged ; Axis, Cervical Vertebra ; Contracture ; Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis

PURPOSE: To evaluate the effectiveness and safety of endoluminal bifurcated stent graft for the treatment of AAA. MATERIALS AND METHODS: Between August 1997 and August 1998, 20 patients with AAA underwent treatment involving the use of a bifurcated stent graft. Fourteen in whom the aneurysm involved only bifurcation and six patients in whom the common iliac arteries were involved. For one patient, a stent with a short proximal neck measuring 12 mm was used. The stent graft was inserted by means of a unilateral surgical femoral arteriotomy. After the procedure, follow up involving CT and aortography was performed between month 3 and month 12. RESULTS: The primary success rate with the first trial was 79 percent (15 of 19 patients), and the overall success rate was 84 percent; one perigraft leak was successfully corrected. In one case, technical failure occurred due to a tortuous iliac vessel and spasm. Procedure-related complications occurred in 16% of patients (3 of 19), one of whom died due to acute renal failure following a contrast overdose. CONCLUSION: Endovascular treatment of infrarenal AAA by means of a bifurcated stent graft was effective and safe. In particular, if the proximal neck measured more than 1cm, any AAA could be treated using bifurcated stent graft. Further investigation of the outcome and complications arising during long-term follow-up are needed, however.
Acute Kidney Injury ; Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortography ; Blood Vessel Prosthesis* ; Endoleak ; Follow-Up Studies ; Humans ; Iliac Artery ; Neck ; Spasm ; Stents*

Wilson's disease is a treatable autosomal recessive inherited disorder of copper metabolism due to mutation of the copper transporting gene. The basic strategy of treatment is to reduce the amount of copper in the liver and other tissues by administering both a low copper diet and copper-chelating agents. D-penicillamine is the first choice as a copper-chelating agent. Some serious side effects could occur in 3~5% of all patients following D-penicillamine therapy. We report a 19 year-old male with Wilson's disease who developed nephrotic syndrome 6 months after the initiation of D-penicillamine therapy. Prednisolone was administered to control nephrotic syndrome and D-penicillamine was switched to trientine. Urinary remission was achieved within a week and maintained thereafter. Nephrotic syndrome was proven to be MCNS by kidney biopsy.
Biopsy ; Copper ; Diet ; Hepatolenticular Degeneration* ; Humans ; Kidney ; Liver ; Male ; Metabolism ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Penicillamine* ; Prednisolone ; Trientine ; Young Adult