Neutrophilic eccrine hidradenitis(NEH) is a self-limited inflammatory dermatosis primarily induced by chemotherapeutic agents. The pathogenesis and possible cause of NEH remain unknown. NEH may represent as a reaction pattern to chemotherapeutic agents or bacterial infection. Also it is developed on palmoplantar areas in healthy children or young adults. In some cases it is developed as a paraneoplastic phenomenon. We report a case of neutrophilic eccrine hidradenitis that developed in a patient suffering from aplastic anemia after or during treatment with cyclosporine, oxymetholone and folic acid.
Anemia, Aplastic ; Bacterial Infections ; Child ; Cyclosporine ; Folic Acid ; Hidradenitis* ; Humans ; Neutrophils* ; Oxymetholone ; Skin Diseases ; Young Adult

BACKGROUND: QT dispersion(QTD=QTmax-QTmin) on the 12 lead ECG has been known to reflect regional variation of ventricular repolarization, and thus a marker of an increased risk of arrhythmia events. Late potential(LP) on signal averagina ECG(SAECG) is independent risk factor of ventricular arrhythmia following acute myocardial infaction(AMI). However, the relation between LP and QTD as indicator of electrophysiologic instability in AMI remains to be determined. METHOD: To determine whether there is a difference in QTD between in parients with AMI during acute phase and in normal control and whether thrombolytic therapy is assiciated with a reduction in QTD, and to determine the relationship between change of QTD and late potential on SAECG, we studied 71 patient with AMI(male 54, female 14, mean age 57yrs) and 23 controls(malw 17, female 6, mean age 58yrs). QT interval was measured on a standard 12 lead ECG in patients with AMI on admission, 2 hours after urokinase IV and 10-14 days post-AMI, and QT dispersion was calculated by difference of maximal and minimal corrected QT interval(QTmax-QTmin). A signal averaged ECG was recorded in 36 patients before discharge and coronary angiogeaphy(CAG) was performed in all patients 10-14 days post-AMI. RESULT: QTD is significantly increased in AMI compared to control(78.7+/-39.5ms vs. 24.6+/-22.3ms, P < 0.01). In patients who received thrombolytic therapy with urokinase, QTD is decreased from 75.0+/-34.4ms to 53.9+/-36.0ms(P < 0.01), whereas there is no significant change in patients who did not received thrombolytic therapy(84.8+/-47.6ms vs. 78.9+/-36.2ms, NS). There in no difference in QTD between patients with positive LP(68.4+/-23.6ms) and those with negative LP(77.8+/-32.1ms) on admission, those with positive LP(66.6+/-27.6ms) and those with negative LP(56.0+/-26.4ms) after 10-14days post-AMI. But magnitude of change of 10-14 days post-AMI QTD in patients with negative LP is larger than those with positive LP(-21.7+/-33.4ms vs. -1.8+/-15.2ms, P=0.06). CONCLUSION: QTD in acute phase of AMI is significantly reduced by the thrombolytic therapy. Patients with negative late potential tent to have greater QTD reduction within 14 days after AMI. These finding suggest that QT dispersion in patients with AMI can be reduced by early recanalization and its reduction is associated with the presence of late potential.
Arrhythmias, Cardiac ; Electrocardiography ; Female ; Humans ; Myocardial Infarction* ; Risk Factors ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator

BACKGROUND: A number of studies in western countries have shown that coronary artery disease(CAD) and younger patients with acute myocardial infarction(AMI) is less extensive but more. closely related to cigarette smoking. However, there are some similarities between the characteristics of the CAD and the risk factors analyzed by age subsets in patients with AMI in Korea. METHODS: Pre-discharge coronary angiograms and risk factors in 194 patients with first AMI(male/female : 154/40,79.4%/20.6%) were analyzed. A comparison was made between the lesion characteristics of the infarct related artery(IRA) and the CAD risk factors. Those under 49 years old (Group I, n=54, male/female : 50/4 : 92.6%/7.4%) and those over 50 years old ( Group II, n=140, male/female : 104/36 : 74.3%/25.7%). RESULTS: There are 54 and 140 patients in groups I and II respectively. 92% of group I and 74.1% of group II were male (p<0.01). At the time of study, more group I patients were smoking cigarettes and drinking alcohol(over 3 times per week 22.6% vs 11.5%, p<0.01) and insignificant stenosis was more common in group I than in group II. In both groups, the most common IRA was the left anterior descending artery and concurrently the anterior wall was the most common morphological type of coronary stenosis of IRA was concentric irregular in group I(27.7%) and eccentric smooth in groupII(31.5%). Although group I had the larger minimal cross sectional area of coronary stenosis(0.97+/-1.16mm2 and 0.54+/-0.80mm2, respectively, p<0.05, reference diameters 2.71+/-0.60mm and 2.66+/-0.67mm, respectively),the coronary lesion was shorter in group I patients(3.39+/-4.06cm and 5.49+/-6.13cm respecitively, p=0.03). CONCLUSION: These findings reveal that coronary atherosclerotic lesions of IRA in patients with AMI in the younger age group are less severe. However, they are more closely related to cigarette smoking and alcohol intake, than cases in the older age group.
Arteries ; Constriction, Pathologic ; Coronary Stenosis ; Coronary Vessels ; Drinking ; Humans ; Korea ; Male ; Middle Aged ; Myocardial Infarction* ; Risk Factors* ; Smoke ; Smoking ; Tobacco Products

BACKGROUND: A number of studies in western countries have shown that coronary artery disease(CAD) and younger patients with acute myocardial infarction(AMI) is less extensive but more. closely related to cigarette smoking. However, there are some similarities between the characteristics of the CAD and the risk factors analyzed by age subsets in patients with AMI in Korea. METHODS: Pre-discharge coronary angiograms and risk factors in 194 patients with first AMI(male/female : 154/40,79.4%/20.6%) were analyzed. A comparison was made between the lesion characteristics of the infarct related artery(IRA) and the CAD risk factors. Those under 49 years old (Group I, n=54, male/female : 50/4 : 92.6%/7.4%) and those over 50 years old ( Group II, n=140, male/female : 104/36 : 74.3%/25.7%). RESULTS: There are 54 and 140 patients in groups I and II respectively. 92% of group I and 74.1% of group II were male (p<0.01). At the time of study, more group I patients were smoking cigarettes and drinking alcohol(over 3 times per week 22.6% vs 11.5%, p<0.01) and insignificant stenosis was more common in group I than in group II. In both groups, the most common IRA was the left anterior descending artery and concurrently the anterior wall was the most common morphological type of coronary stenosis of IRA was concentric irregular in group I(27.7%) and eccentric smooth in groupII(31.5%). Although group I had the larger minimal cross sectional area of coronary stenosis(0.97+/-1.16mm2 and 0.54+/-0.80mm2, respectively, p<0.05, reference diameters 2.71+/-0.60mm and 2.66+/-0.67mm, respectively),the coronary lesion was shorter in group I patients(3.39+/-4.06cm and 5.49+/-6.13cm respecitively, p=0.03). CONCLUSION: These findings reveal that coronary atherosclerotic lesions of IRA in patients with AMI in the younger age group are less severe. However, they are more closely related to cigarette smoking and alcohol intake, than cases in the older age group.
Arteries ; Constriction, Pathologic ; Coronary Stenosis ; Coronary Vessels ; Drinking ; Humans ; Korea ; Male ; Middle Aged ; Myocardial Infarction* ; Risk Factors* ; Smoke ; Smoking ; Tobacco Products

BAKGROUND AND PURPOSES: Spasm of epicardial coronary arteries has been shown to play an important role in the pathogenesis of ischemic heart diseases. Spasm occurs in angiographically normal coronary arteries or arteries with organic atherosclerotic lesion and can result in rest angina, exertional angina or even myocardial angina or even myocardial infarction. However, pathogenetic mechanism of coronary artery spasm still remains unclear. The purpose of present study is to investigate characteristics of pharmacologically induced spasm of epicardial coronary artery in patient with ischemic heart disease with normal coronary angiogram or insignificant coronary artery disease (<25% narrowing), and to determine the relationship of coronary risk factors with coronary artery spasm in these patients group. METHODS: One hundred patients(male 47, female 53, age : 19-75 years) with ischemic heart disease(stable angina, unstable angina, myocardial infarction) who had normal coronary angiogram or angiographically insignificant coronary artery stenosis(<25% narrowing) were included for pharmacological provocation test for coronary artery spasm. Acetylcholine(ACH) and Ergonovine(Erg) were given intracoronarily(IC) in incremental doses(Ach : A1, 20micro, A2 50microg, A3 100microg and Erg : E1 5microg, E2 10microg, E3 25microg) either into coronary artery concordant with ECG leads showing ischemic ST-T changes in exercise ECG and/or 24-hour ambulatory ECG, or otherwise into right coronary artery. Erg provocation test was done after completion of acetylcholine provocation test. Constriction of coronary artery by more than 50% induced by either or both of the drugs were analysed in terms of incidence, degree, location of spasm and relation to risk factors. Coronary vasodilatory reserve function was tested by IC Doppler method for those patients with no spasm of epicardial coronary artery but with chest pain and ST-segment changes during provocation test. Relationship of spasm with various risk factors were investigated. RESULTS: 1) Ach or Erg test were positivie in 50 patients(50%). Among 75 patients who were tested by both drug, both test were positive in 17 patients(22.6%), and negative in 39 patients(52%), and Ach test was positive but Erg test was negative in 15 patients(20%). : The responses of Ach and Erg test were concordant in 75% of patients, the sensitivity and specificity of Ach test with reference to Erg test were 81% and 72%, respectively. 2) The characteristic features of spasm induced by Ach or Erg is focal narrowing in 34 patients and diffuse narrowing in 16 patients. The sites of spasm were LAD(23 cases), RCA(19 cases), LCX(5 cases), and in 3 cases, both LAD and LCX were narrowed. 3) In 50 patients showing no spasm, the typical chest pain or EKG changes was noted in 6 cases(12%). Of 6 patients, coronary vasodilatory reserve was decreased in 4 cases(66.7%). 4) Number of smoker was larger among spasm positive group(42%) than those among spasm negative group(12%)(p<0.01). CONCLUSION: The findings we observed in a limited series of patients suggest that in patients with normal or insignificant coronary angiogram, coronary spasm plays a role in the pathogenesis of broad spectrum of ischemic heart disease and that in patients with no coronary spasm but chest pain and ST-segment changes, coronary vasodilatory reserve is impaired, causing angina pectoris. Smoking may be one of the risk factors for coronary arterial spasm.
Acetylcholine ; Angina Pectoris ; Angina, Unstable ; Arteries ; Chest Pain ; Constriction ; Coronary Artery Disease ; Coronary Vessels ; Electrocardiography ; Female ; Heart ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Ischemia* ; Risk Factors* ; Sensitivity and Specificity ; Smoke ; Smoking ; Spasm

BAKGROUND AND PURPOSES: Spasm of epicardial coronary arteries has been shown to play an important role in the pathogenesis of ischemic heart diseases. Spasm occurs in angiographically normal coronary arteries or arteries with organic atherosclerotic lesion and can result in rest angina, exertional angina or even myocardial angina or even myocardial infarction. However, pathogenetic mechanism of coronary artery spasm still remains unclear. The purpose of present study is to investigate characteristics of pharmacologically induced spasm of epicardial coronary artery in patient with ischemic heart disease with normal coronary angiogram or insignificant coronary artery disease (<25% narrowing), and to determine the relationship of coronary risk factors with coronary artery spasm in these patients group. METHODS: One hundred patients(male 47, female 53, age : 19-75 years) with ischemic heart disease(stable angina, unstable angina, myocardial infarction) who had normal coronary angiogram or angiographically insignificant coronary artery stenosis(<25% narrowing) were included for pharmacological provocation test for coronary artery spasm. Acetylcholine(ACH) and Ergonovine(Erg) were given intracoronarily(IC) in incremental doses(Ach : A1, 20micro, A2 50microg, A3 100microg and Erg : E1 5microg, E2 10microg, E3 25microg) either into coronary artery concordant with ECG leads showing ischemic ST-T changes in exercise ECG and/or 24-hour ambulatory ECG, or otherwise into right coronary artery. Erg provocation test was done after completion of acetylcholine provocation test. Constriction of coronary artery by more than 50% induced by either or both of the drugs were analysed in terms of incidence, degree, location of spasm and relation to risk factors. Coronary vasodilatory reserve function was tested by IC Doppler method for those patients with no spasm of epicardial coronary artery but with chest pain and ST-segment changes during provocation test. Relationship of spasm with various risk factors were investigated. RESULTS: 1) Ach or Erg test were positivie in 50 patients(50%). Among 75 patients who were tested by both drug, both test were positive in 17 patients(22.6%), and negative in 39 patients(52%), and Ach test was positive but Erg test was negative in 15 patients(20%). : The responses of Ach and Erg test were concordant in 75% of patients, the sensitivity and specificity of Ach test with reference to Erg test were 81% and 72%, respectively. 2) The characteristic features of spasm induced by Ach or Erg is focal narrowing in 34 patients and diffuse narrowing in 16 patients. The sites of spasm were LAD(23 cases), RCA(19 cases), LCX(5 cases), and in 3 cases, both LAD and LCX were narrowed. 3) In 50 patients showing no spasm, the typical chest pain or EKG changes was noted in 6 cases(12%). Of 6 patients, coronary vasodilatory reserve was decreased in 4 cases(66.7%). 4) Number of smoker was larger among spasm positive group(42%) than those among spasm negative group(12%)(p<0.01). CONCLUSION: The findings we observed in a limited series of patients suggest that in patients with normal or insignificant coronary angiogram, coronary spasm plays a role in the pathogenesis of broad spectrum of ischemic heart disease and that in patients with no coronary spasm but chest pain and ST-segment changes, coronary vasodilatory reserve is impaired, causing angina pectoris. Smoking may be one of the risk factors for coronary arterial spasm.
Acetylcholine ; Angina Pectoris ; Angina, Unstable ; Arteries ; Chest Pain ; Constriction ; Coronary Artery Disease ; Coronary Vessels ; Electrocardiography ; Female ; Heart ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Ischemia* ; Risk Factors* ; Sensitivity and Specificity ; Smoke ; Smoking ; Spasm

Essential thrombocythemia, a subcategory of chronic myeloproliferative disorder, is characterized by absolute thrombocytosis due to excessive clonal proliferation of platelets, hyperaggregability of platelets and increased incidence of thrombosis and hemorrhage. Essential thrombocythemia may cause frequent vascular thrombosis, but it can be a rare cause of acute ischemic heart diseases such as acute myocardial infarction without atherosclerosis, unstable angina and angina pectoris. We report a case of essential thrombocythemia complicated by acute myocardial infarction. A patient with a previous history of vascular thrombotic complications (such as transient ischemic attack and deep vein thrombosis) was managed with 2.8 million units of intravenous urokinase, antiplatelet agent, ACEI, antianginal medications and hydroxyurea. There were clinically remarkable improvements and no further episodes of thrombotic ischemic vascular complications, including acute myocardial infarction.
Angina Pectoris ; Angina, Unstable ; Atherosclerosis ; Hemorrhage ; Humans ; Hydroxyurea ; Incidence ; Ischemic Attack, Transient ; Myeloproliferative Disorders ; Myocardial Infarction* ; Myocardial Ischemia ; Thrombocythemia, Essential* ; Thrombocytosis ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins

BACKGROUND: Although recent studies have demonstrated that infusion of L-arginine reduces myocardial necrotic area during prolonged ischemia, its effects on transient postischemic myocardial dysfunction(myocardial stunning) and microvascular dyfunction(vascular stunning) are not well known. To investigate whether intravenous administration of L-arginine, physiological nitric oxide(NO) precursor, during reperfusion would attenuate postischemic myocardial dysfunction and microvascular dysfunction, 15 open-chest dogs were studied. METHODS: In 15 pentobarbital anesthesized open-chest dogs, left circumflex coronary artery was occluded for 20 minutes and was followed by a reperfusion for 60 minutes. L-Arginine(30mg/kg)(L-arginine group, n=8) or saline(control group, n=7) was given intravenously by a bolus 1 minute before reperfusion and was followed by a continuous infusion(10mg/kg/min) for 30 minutes during reperfusion. Before coronary occlusion and 60 minutes after reperfusion, coronary blood flow(CBF) and coronary vascular resistance(CVR) wre measured after intracoronary injection of each of acetylcholine(0.01/kg) and adenosine(1.5/kg), and reactive hyperemia with coronary occlusion(RH20) for 20 seconds was measured. Myocardial segment thickening in the area of ischemia-reperfusion was measured using 2D-echocardiography. The echocardiographic images were digitized and analyzed by cardiac image analyzer. RESULTS: The results obtained 60 minutes after reperfusion were as follows. 1) CBF was decreased by 41% in L-arginine group vs 30.1% in control group(p < 0.05) and CVR was increased by 83.9% in L-arginine group vs 19.3% in control group after 60 minutes of reperfusion, compared with pre-occlusion baseline values. 2) Percent change of CBF was decreased in control group(acetylcholine by 25.8%, adenosine by 29.2%, RH20 by 39.8%), while it was increased in L-arginine group(acetylcholine by 60%, adenosine by 22%, RH20 by 26.7%). Percent change of CVR was increased in control group(acetylcholine by 10.5%, adenosine by 6.9%, RH20 by 21%), but it was decreased in L-arginine group(acetylcholine by 10%, adenosine by 6.6%, RH20 by 1.6%). Increase of CBF and decrease of CVR were significant on acetylcholine and RH20 between control group and L-arginine group. 3) Fraction of myocardial segment thickening was significantly decreased in L-arginine group(by 80%) compared with control group(by 61.7%, p < 0.05). CONCLUSIONS: The finding that L-arginine depressed post-ischemic myocardial contractil function suggests that systemic infusion of L-arginine has unfavorable effect on myocardial stunning. In contrast, the finding that L-arginine improved CBF and CVR with acetylcholine and adenosine and reactive hyperemia indicates that L-arginine may exert a beneficial effect on vascular stunning. These results suggest that L-arginine may have independent effects on myocardial stunning and vascular stunning.
Acetylcholine ; Adenosine ; Administration, Intravenous ; Animals ; Arginine* ; Coronary Occlusion ; Coronary Vessels ; Dogs* ; Echocardiography ; Hyperemia ; Ischemia ; Myocardial Reperfusion ; Myocardial Stunning ; Nitric Oxide ; Pentobarbital ; Reperfusion

PURPOSE: To compare the effectiveness of a trochanter stabilizing plate with a dynamic hip screw, with using a dynamic hip screw only in the treatment of an unstable intertrochanteric fracture of elderly patients. MATERIALS AND METHODS: From January 2000 to December 2004, 70 patients, who were treated surgically for unstable intertrochanteric fractures, were evaluated. The patient s age were above 65 years and the T-score <-3.0 and they were followed up for more than 6 months. The patient were divided into two groups. One group was treated with DHS only (Group 1, 38 cases), and the other was treated with DHS and TSP (Group 2, 32 cases). The two groups were compared clinically and radiologically. RESULTS: There was no difference in the prevalence of lag screw sliding. However, there were significant differences in the extent of sliding between the two groups, (an average of 8.8 mm p<0.05). There was a significant difference between two groups in the extent of lateralization of the great trochanter, (An average of 6.0 mm p<0.05). However, there was no difference in the leg length between two groups (p>0.05), but the postoperative functional loss of the hip joint was significantly lower in the group 2 (p<0.05), who required additional surgery due to reduction loss or metal failure. CONCLUSION: Although it is a relatively simple technique, the use of DHS with TSP is more effective for the buttress effect on proximal fragment and additional fixation of great trochanter than just DHS only. It decreases the excessive slippage of the lag screw, lateral displacement of the greater trochanter and postoperative functional loss of the hip joint. Therefore, it may be a useful treatment for unstable or comminuted intertrochanteric fractures in elderly patients with osteoporosis.
Aged ; Femur* ; Hip Fractures* ; Hip Joint ; Hip* ; Humans ; Leg ; Osteoporosis ; Prevalence

Pseudomyxoma peritonei is a benign mucin producing tumor of the peritoneum which is usually diagnosed using a laparotomy. It is uncommon to find a case of pseudomyxoma peritonei which has been diagnosed using a peritoneoscopy in Korea; there are only two cases reported in the literature. We recently experienced a case of pseudomyxoma peritonei in a 61 year old woman who manifested a typical case using a peritoneoscopy. Thick, jelly-like materials were adherent to polypoid nodular masses of the parietal peritoneum, which originated from the mucinous cystadenocarcinoma of an ovary. In this report we discuss the case with relevant review of the literature.
Cystadenocarcinoma, Mucinous ; Female ; Humans ; Korea ; Laparoscopes ; Laparoscopy ; Laparotomy ; Middle Aged ; Mucins ; Ovary ; Peritoneum ; Pseudomyxoma Peritonei*