The characterisitic finding of hypertrophic cardiomyopathy is left ventricular hypertrophy without dilated chamber. Echocardiographic studies of patients with pheochromocytoma in the past have revealed both dilated and hypertrophic cardiomyopathies, as well as obstruction of the left ventricular outflow tract. We report this case because we experienced a pheochromocytoma patient who had reversible hypertrophic cardiomyopathy which might be related with circulating catecholamine level.
Cardiomyopathy, Hypertrophic* ; Echocardiography ; Humans ; Hypertrophy, Left Ventricular ; Pheochromocytoma*

Anti-thrombin III deficiency is known as a disease of autosomal dominant trait and relatively common, but in Korea, exact incidence and mortality is not known, In general, Anti-thrombin III deficiency is expressed to venous thromboembolism like deep vein thrombosis or pulmonary embolism. But, arterial embolism is very rare. We experienced a case of Antithrombin III deficiency expressed as myocardial infarction of inferior wall by huge thrombosis in the mid and distal right coronary artery.
Antithrombin III Deficiency ; Coronary Vessels ; Embolism ; Incidence ; Korea ; Mortality ; Myocardial Infarction* ; Pulmonary Embolism ; Thrombosis ; Venous Thromboembolism ; Venous Thrombosis

The first case report of granular cell tumor was by Abrikossoff in 1926, the tumor has been named with more than 20 different synonyms. It is found usually in the tongue, oral cavity, and the skin. It occurs rarely in the esophagus. Esophageal granular cell tumor is a benign lesion which can be diagnosed by endoscopic biopsy. Large symptomatic lesion can be removed by polypectomy. A 29-year-old female visited our hospital for intermittent epigastric pain and anterior chest discomfort. Endoscopy showed a 0.6 *0.4 cm whitish yellow nodule in the mid-esophagus, 25 cm from the incisor teeth. Endoscopic polypectomy was performed with "O"-type rubber band for endoscopic variceal ligation(EVL). A case of esophageal granular cell tumor conformed by S-100 protein stain is reported with the review of literature.
Adult ; Biopsy ; Endoscopy ; Esophagus* ; Female ; Granular Cell Tumor* ; Humans ; Incisor ; Mouth ; Rubber ; S100 Proteins ; Skin ; Thorax ; Tongue ; Tooth

The authors have inverstigated the hypothesis that ischemic injury could be attenuated by xanthine oxidase inhibitor(Allopurinol) and superoxide dismutase(SOD). This study used rat MAC model. Each animal was assigned to four groups which was composed with control group, allopurinol pretreated group(50mg/kg. I.P single). SOD pretreated group(16,000 I.U/kg I.V q 15min for 4hours) and combined pretreatment group. Oxygen derived free radicals have been implicated in various pathological conditions including ischemia. Xanthine oxidase serve as a source of oxidizing agents such as superoxide radical and hydrogen peroxide. The superoxide flux in normal cells appears to have necessitated the development of SOD, which scavenges the superoxide by dismutation. Infarcted area was measured by computerized morphometric analysis after triphenyl tetrazolium chloride staining, infarcted area was reduced in SOD treated group(p=0.005) and SOD, allopurinol combined group(P=0.035). Brain edema was measured by gravimetric method. And it was reduced in Allopurinol treated group(P=0.001) and SOD allopurinol combined group (P<0.001). Thus it was revealed that ischemic injury might be reduced by either decrease of production or increase of scavenger and the combination of two should be more efficious.
Allopurinol* ; Animals ; Brain Edema* ; Cerebral Infarction* ; Free Radicals ; Hydrogen Peroxide ; Ischemia ; Oxidants ; Oxygen ; Rats ; Superoxide Dismutase* ; Superoxides* ; Xanthine Oxidase

The author has performed the experimental study to define the validity of the constant infusion technique used in determining the outflow resistance(Ro) of cerebrospinal fluid(CSF). The reduced formula of the constant infusion technique in clinical setting assume that the initial resing Ro and the post-infusion equilibrium Ro are equal, which means that the Ro value is constant regardless of CSF pressure or infusion rate. Although this assumption allows such measurement to be simply and readily applicable in clinical situation, these two Ro values are practically different. So the effect such assumption on calculated Ro data has been investigated. Using 2 different methods Ro was measured simultaneously on each of 20 adult cats;one method was clinically using reduced formula(RoFc) and the other derived from the data of CSF formation rate which was calculated by modified Masserman's method(RoFm). Constant infusion was performed with varying state of infusion(0.01 to 0.2 m/min). Mean values of resting CSF pressure and superior sagittal sinus pressure were 8.8+/-2.9 mmHg and 5.7+/-1.2 mmHg respectively. Mean calculated rate of CSF formation of integrative modifiying Massereman method was 0.0183+/-0.003 ml/min. The maximum Ro was achieved between the rate of infusion of 0.02 and 0.03 ml/min achieved between the range of CSF pressure of 14 and 18 mmHg. Either in level of low CSF pressure or in rate of low infusion, RoFc showed remarkable higher values than RoFm. But this difference did not distinguished in the higher range of CSF pressure or infusion rate. The minmum and maxmum value of RoFc differed the more and RoFm, the less. These findings suggest that in order to obtain more accurate Ro data with constant infusion technique, it must be corrected in low range of CSF pressure or the rate of infusion should be increased several times as that of CSF formation at the risk of possibility of induction of a pressure wave.
Adult ; Cerebrospinal Fluid* ; Humans ; Superior Sagittal Sinus

The authors dersibe two cases of moyamoya-like disease associated with intracranial aneurysm. Moyamoya like disease, rare variant of moyamoya disease, has a normal unilateral caroted system. There are only few cases reported in the world literature of moyamoya-like disease associated with intracranial aneurysm. The radiological fearures and the management of these cases are discussed.
Intracranial Aneurysm* ; Moyamoya Disease ; Rare Diseases

BACKGROUND: Uncomplicated myocardial infarction is often the harbinger of future cardiac events such as unstable angina pectoris,recurrent myocardial infarction or death. The feasibility and safety of exercise testing performed soon after myocardial infarction have been established but the prognostic value of exercise test after myocardial infarction remain inconclusive. The object of this study is to determine whether exercise test results can be utilized to predict of future cardiac events after uncomplicated myocardial infarction. METHODS: The study group comprised 149 patients with an uncomplicated myocradial infarction. A low level exercise test was performed before discharge from the hospital 8 to 10 days after myocardial infarction. The exercise thst results was considered positive if there was new > or =1mm horizontal or downsloping ST segment depression at 0.08 sec after the J point compared with baseline. The patients were followed for the development of new cardiac events. RESULTS: 1) The exercise test after acute myocardial infarction was performed in 149 patients without complication. The mean duration of exercise test was 14 min(range 1-20 min) and the mean work-load(Metabolic equivalents) was 3.7+/-1.1 METs. 2) 37 patients had ST-segment depression, 13 had ST-segment elevation and 27 had an inadequate blood pressure response to exercise. During the exercise, there were angina in 5 patients, dyspnea in 17 and no symptom in 127 patients. 3) During the follow-up period(1 to 75 month, mean 27.4 month), 29 patients experienced post-myocardial infarction angina, 1 had recurrent myocardial infarction, 4 had revascularization therapy(PTCA 2, CABG 2),5 had ischemic cardiomyopathy and 5 died a cardiac death. 4) The patients with cardiac events such as cardiac death, myocardial infarction and post MI angina had a significantly shorter exercise duration(13.1+/-4.0 and 14.6+/-2.7min, p<0.05), lower exercise tolerance(3.5+/-1.0 and 3.9+/-1.0 METs, p<0.05) and lower peak heart rate(117 +/- and 126+/-5, p<0.05). 5) The ST-segment depression, lower exercise tolerance(<3.0 METs) and history of hypertension were associated significantly with cardiac events(p<0.05) but ST-segment elevation, inadequate blood pressure response to exercise, the use of thrombolytic agents and non-Q wave infarction did not predict future cardiac events. Conclusions: The exercise test after acute myocardial infarction is safe and of limited value for predicting patients at risk of cardiac events in the follow-up period. The ST-segment depression and lower exercise tolerance(<3.0 METs) can predict cardiac events and the prognosis of the patients of this group can be improved with aggressive management and careful follow-up.
Angina, Unstable ; Blood Pressure ; Cardiomyopathies ; Death ; Depression ; Dyspnea ; Exercise Test* ; Fibrinolytic Agents ; Follow-Up Studies ; Heart ; Humans ; Hypertension ; Infarction ; Myocardial Infarction* ; Prognosis

PURPOSE: The aim of this study was to assess the involvement of several organs patients with Marfan syndrome in Korea. Also the clinical features in childhood patients with Marfan syndrome were assessed. METHODS: Thirty-eight cases of Marfan syndrome were enrolled in this study. Clinical evaluations of the musculoskeletal, cardiovascular and occular system were performed in all cases. RESULTS: The musculoskeletal system was involved in 32 cases (84.2%) and occular system in 24 cases (63.1%). Cardiovascular abnormalities were found in 19 cases (50.0%) at initial evaluation. Family history was involved in 21 cases (55.2%). Ectopia lentis was found in 17 cases (70.8%). Severe myopia and iris abnormalities were also present in 14 cases (58.2%). The ascending aorta was dilated in 13 cases (34.2%). Emergency operation was performed in 3 cases (7.9%) because of a dissecting aorta. Mitral regurgitation and prolapse were found in 29 cases (76.4%) and other valve insufficiency was accompainied in 5 cases (13.1%). Of the 38 cases, 29 patients (79.3%) were less than 15 years of age and their major manifestations were occular problems in 23 cases (79.3%), and family history in 17 cases (58.6%). In one infant, severe heart failure was the predominant clinical feature. CONCLUSION: The clinical features of Korean patients with Marfan syndrome were summarized in this report. Heart failure was the main manifestaton in infantile Marfan syndrome. Early treatment with beta-blocker and valvular replacement can prevent fatality, i.e. aortic dissection, in this disease, concern and management should be advocated in the early detection of Marfan syndrome.
Aorta ; Cardiovascular Abnormalities ; Ectopia Lentis ; Emergencies ; Heart Failure ; Humans ; Infant ; Iris ; Korea ; Marfan Syndrome* ; Mitral Valve Insufficiency ; Musculoskeletal System ; Myopia ; Prolapse

Legionella species are causative agents of both community-acquired and nosocomial pneumonia. The spectrum of disease ranges from asymptomatic infection to serious disease and two specific syndromes are identified, i.e., Legionnaires' disease and Pontiac fever. Legionnaires' disease tends to occur in patients with underlying illnesses, so Legionella pneumonia should be included in the differential diagnosis of severe community-acquired pneumonia, especially in immunocompromised patients. Herein we report a case of community- acquired Legionnaires' disease in a patient with renal transplantation. A 63-year old man was admitted because of fever, chills, and dyspnea. Thirteen years ago, he had undergone kidney transplantation and he had received immu-nosuppressive agents, including deflazacort and cyclosporin A. On physical examination crackles were heard in the middle area of the right lung and the chest radiograph showed multifocal patchy consolidations on both lung fields. Serologic tests for Legionella pneumophila antibody, urinary antigen assay for L. pneumophila serogroup 1, and polymerase chain reaction for Legionella DNA fragments (5S rRNA, IPC, mip target sequence) were positive. The patient was treated with roxithromycin for twenty eight days and recovered without complication.
Asymptomatic Infections ; Chills ; Cyclosporine ; Diagnosis, Differential ; DNA ; Dyspnea ; Fever ; Humans ; Immunocompromised Host ; Kidney Transplantation ; Legionella ; Legionella pneumophila ; Legionnaires' Disease* ; Lung ; Middle Aged ; Physical Examination ; Pneumonia ; Polymerase Chain Reaction ; Radiography, Thoracic ; Respiratory Sounds ; Roxithromycin ; Serologic Tests ; Transplantation*

Background: This study aimed to evaluate whether fluvoxamine reduces clinical deterioration in adult patients with mild to moderate coronavirus disease 2019 (COVID-19), and to identify risk factors for clinical deterioration in patients admitted to a community treatment center (CTC). Materials and Methods: A randomized, placebo-controlled trial was conducted in a CTC, in Seoul, Korea from January 15, 2021, to February 19, 2021. Symptomatic adult patients with positive results of severe acute respiratory syndrome coronavirus 2 real timepolymerase chain reaction within 3 days of randomization were assigned at random to receive 100 mg of fluvoxamine or placebo twice daily for 10 days. The primary outcome was clinical deterioration defined by any of the following criteria: oxygen requirement to keep oxygen saturation over 94.0%, aggravation of pneumonia with dyspnea, or World Health Organization clinical progression scale 4 or greater. Results: Of 52 randomized participants [median (interquartile range) age, 53.5 (43.3 - 60.0) years; 31 (60.0%) men], 44 (85.0%) completed the trial. Clinical deterioration occurred in 2 of 26 patients in each group (P >0.99). There were no serious adverse events in either group. Clinical deterioration occurred in 15 (6.0%) of 271 patients admitted to the CTC, and all of them were transferred to a hospital. In multivariate analysis, age between 55 and 64, fever and pneumonia at admission were independent risk factors for clinical deterioration. Conclusion In this study of adult patients with symptomatic COVID-19 who were admitted to the CTC, there was no significant differences in clinical deterioration between patients treated with fluvoxamine and placebo (ClinicalTrials.gov Identifier: NCT04711863).