Salivary duct lithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. It most commonly involves submandibular gland (80 to 90%) and less frequently parotid (10 to 20%). The authors report 2 cases of parotid sialolithiasis. The first case involved a 46-year-old male patient complaining of the left parotid area pain and swelling, and presenting with a salivary calculus in the left parotid duct. When the patient was diagnosed, he refused surgical removal. The second case involved a 41-year-old male patient complaining of the right parotid area pain and swelling, and presenting with a salivary calculus in the right parotid duct. The sialolith was surgically removed under general anesthesia. In this paper, we also reviewed a series of concepts related to the etiology, diagnosis and treatment of sialolithiasis.
Adult ; Anesthesia, General ; Diagnosis ; Dilatation, Pathologic ; Humans ; Lithiasis ; Male ; Middle Aged ; Parotid Diseases ; Salivary Calculi ; Salivary Duct Calculi ; Salivary Ducts ; Salivary Gland Calculi* ; Salivary Glands ; Submandibular Gland

ABSTRACT: The present study was designed to investigate the possibility of restoring the testicular steroidogenic ability of the aged Brown Norway rats by administering luteinizing hormone (LH) and thyroxine (Thy). Rats of 3, 6, 12 months (M) of age (n = 8 per group) and four groups of 18 month old rats (n = 8 per group) were used. Eighteen month old rats were implanted subdermally with Alzet mini osmotic pumps containing saline (control), luteinizing hormone (LH, 24 microgram/day), thyroxine (Thy, 5 microgram/day) and LH and Thy (LH +Thy, 24 microgramday and 5 microgram/day), respectively for four weeks (i.e testing was done at 19 months). The results showed that the testis volume was unchanged among all treatment groups. The number of Leydig cell per testis was not significantly different among all treatment groups. The average volume of a Leydig cell was significantly decreased at 12 months, and a further reduction was observed at 19 months (saline-treated); values for 19 month LH-and-LH +Thy-treated rats were not significantly lower than those at 3 and 6 months of age. Testosterone secretory capacity per testis and per Leydig cell in vitro were significantly reduced concomitantly with age advancement from 6 to 19 months (saline-treated) of age. These values of LH-and Thy-treated 19 month old rats were similar to those at 12 months. LH +Thy-treated rats were equally capable to 3 and 6 month old rats in producing testicular testosterone in vitro in response to LH. Serum testosterone was unchanged from 3 M to 12 M rats but was reduced in 19M control rats. Both LH and Thy significantly raised these values above the 19M control levels, but they were still lower than the 3 M through 12 M levels. Additionally, LH +Thy significantly raised the serum testosterone levels to those of 12M rats, but these values were significantly lower than those of 3 M and 6 M rats. In summary, the present study demonstrated that the exogenous supplementation of LH and Thy was effective in restoring the steroidogenic potential of the aged Leydig cells; the most effective treatment was LH +Thy, which upgraded the capacity of aged testes to those of 3 and 6 months.
Animals ; Humans ; Infant ; Leydig Cells* ; Lutein* ; Luteinizing Hormone ; Male ; Norway* ; Rats* ; Testis ; Testosterone ; Thyroid Gland* ; Thyroid Hormones* ; Thyroxine

BACKGROUND: In hypertrophic cardiomyopathy(HCM), which is known as genetic disease, severity and location of left ventricular hypertrophy(LVH) is variable. So we investigated additional modify role of angintensin-I converting enzyme(ACE) gene, which is known to be implicated in cardiac hypertrophy. ACE genotypes and degree of hypertrophy were determined in each subject. METHOD: 172 patients(37 HCM, 26 normotenisve LVH, 19 hypertenisve LVH, 79 normal control) were included in this study. Left ventricular mass index(LVMI) was calculated from electrocardiogram by Rautaharju equation, and LVH was defined as LVMI is above 131g/m2 in male or above 110g/m2 in female. In HCM group, extent of left ventricular hypertrophy was also assessed by Wigle's method. DNA was extracted from peripheral blood and ACE I/D polymorphism was confirmed by PCR method. RESULTS: Frequency of D/D genotype is significantly higher in normotensive LVH group(0.231) and in HCM group(0.243) than normal control group(0.076)(Fisher's exact test, p<0.05). There was no significant difference in genotype frequency between other groups. The mean LVMI(g/m2) and Wigle's LVH score was significantly higher in DD than II and ID(259.8+/-156.4g/m2 vs 176.6+/-56.2g/m2, p<0.05, t-test, 7.82+/-2.4 vs 5.35+/-1.9, p<0.05, Mann-Whitney test). LVMI and LVH score also exhibited increasing tendency toward II, ID DD genotypes. CONCLUSION: D allele of ACE gene contribute to the development of cardiac hypertrophy in HCM as well as normotensive LVH.
Alleles ; Cardiomegaly ; DNA ; Electrocardiography ; Female ; Genotype ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male ; Polymerase Chain Reaction

BACKGROUND: In hypertrophic cardiomyopathy(HCM), which is known as genetic disease, severity and location of left ventricular hypertrophy(LVH) is variable. So we investigated additional modify role of angintensin-I converting enzyme(ACE) gene, which is known to be implicated in cardiac hypertrophy. ACE genotypes and degree of hypertrophy were determined in each subject. METHOD: 172 patients(37 HCM, 26 normotenisve LVH, 19 hypertenisve LVH, 79 normal control) were included in this study. Left ventricular mass index(LVMI) was calculated from electrocardiogram by Rautaharju equation, and LVH was defined as LVMI is above 131g/m2 in male or above 110g/m2 in female. In HCM group, extent of left ventricular hypertrophy was also assessed by Wigle's method. DNA was extracted from peripheral blood and ACE I/D polymorphism was confirmed by PCR method. RESULTS: Frequency of D/D genotype is significantly higher in normotensive LVH group(0.231) and in HCM group(0.243) than normal control group(0.076)(Fisher's exact test, p<0.05). There was no significant difference in genotype frequency between other groups. The mean LVMI(g/m2) and Wigle's LVH score was significantly higher in DD than II and ID(259.8+/-156.4g/m2 vs 176.6+/-56.2g/m2, p<0.05, t-test, 7.82+/-2.4 vs 5.35+/-1.9, p<0.05, Mann-Whitney test). LVMI and LVH score also exhibited increasing tendency toward II, ID DD genotypes. CONCLUSION: D allele of ACE gene contribute to the development of cardiac hypertrophy in HCM as well as normotensive LVH.
Alleles ; Cardiomegaly ; DNA ; Electrocardiography ; Female ; Genotype ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male ; Polymerase Chain Reaction

BACKGROUND: Antibradycardia pacemaker is one of the treatment modalities for bradyarrhythmia. We present the clinical results of 440 implantations of permanent pacemaker between August 1984 and December 1997 at Department of Internal Medicine in Seoul National University Hospital. METHOD: We investigated the indication of permanent pacing, the pacing modes, the complications of permanent pacing, and the chronic pacing threshold. RESULT: The study was comprised of 440 patients (M/F : 179/261, mean age : 59+/-12 years, 58+/-14 years, respectively). Indications of the primary pacemaker implantations were sinus node dysfun-ction in 53% and atrioventricular conduction disorders in 47%. Twelve percent of total pacemaker procedures were pulse-generator replacements. Pacing modes were VVI in 59.1%, VVIR in 10.2%, DDD in 30.2%, and others in 0.5%. Complications developed in 21 cases (4.8%) during long-term follow-up. They included 8 cases of pacing failure due to increased pacing threshold, 2 cases of early power depletion, 2 cases of lead dislodgement, 6 cases of lead fracture, 3 cases of skin erosion, 3 cases of hematoma, 3 cases of infection, and 1 case of skeletal muscle stimulation. Chronic pacing thresholds at pacing width of 0.5 msec were 1.9+/-0.4 V for the epicardial ventricular leads (n=11), 1.3+/-0.5 V for the endocardial ventricular leads (n=36), and 1.1+/-0.2 V for the atrial leads (n=4) after 7 to 10 years of implantation. CONCLUSION: Sinus node dysfunction was the more common indication than atrioventricular block for the antibradycardia pacemaker implantation. Long-term follow-up of the pacemaker patients would be very useful to detect the pacing system abnormalities and to maximize the battery longevity by adjustment of pacing output according to the level of chronic pacing threshold.
Atrioventricular Block ; Bradycardia ; Dichlorodiphenyldichloroethane ; Follow-Up Studies* ; Hematoma ; Humans ; Internal Medicine ; Longevity ; Muscle, Skeletal ; Seoul ; Sick Sinus Syndrome ; Sinoatrial Node ; Skin

BACKGROUND: Antibradycardia pacemaker is one of the treatment modalities for bradyarrhythmia. We present the clinical results of 440 implantations of permanent pacemaker between August 1984 and December 1997 at Department of Internal Medicine in Seoul National University Hospital. METHOD: We investigated the indication of permanent pacing, the pacing modes, the complications of permanent pacing, and the chronic pacing threshold. RESULT: The study was comprised of 440 patients (M/F : 179/261, mean age : 59+/-12 years, 58+/-14 years, respectively). Indications of the primary pacemaker implantations were sinus node dysfun-ction in 53% and atrioventricular conduction disorders in 47%. Twelve percent of total pacemaker procedures were pulse-generator replacements. Pacing modes were VVI in 59.1%, VVIR in 10.2%, DDD in 30.2%, and others in 0.5%. Complications developed in 21 cases (4.8%) during long-term follow-up. They included 8 cases of pacing failure due to increased pacing threshold, 2 cases of early power depletion, 2 cases of lead dislodgement, 6 cases of lead fracture, 3 cases of skin erosion, 3 cases of hematoma, 3 cases of infection, and 1 case of skeletal muscle stimulation. Chronic pacing thresholds at pacing width of 0.5 msec were 1.9+/-0.4 V for the epicardial ventricular leads (n=11), 1.3+/-0.5 V for the endocardial ventricular leads (n=36), and 1.1+/-0.2 V for the atrial leads (n=4) after 7 to 10 years of implantation. CONCLUSION: Sinus node dysfunction was the more common indication than atrioventricular block for the antibradycardia pacemaker implantation. Long-term follow-up of the pacemaker patients would be very useful to detect the pacing system abnormalities and to maximize the battery longevity by adjustment of pacing output according to the level of chronic pacing threshold.
Atrioventricular Block ; Bradycardia ; Dichlorodiphenyldichloroethane ; Follow-Up Studies* ; Hematoma ; Humans ; Internal Medicine ; Longevity ; Muscle, Skeletal ; Seoul ; Sick Sinus Syndrome ; Sinoatrial Node ; Skin

We report a case of successful ventricular pacing via the coronary sinus in a 34 year-old female patient admitted because of repetitive dizziness and syncope. She had rheumatic valvular disease with mitral valve replacement 14 years earlyer. and the mitral, aortic and tricuspid valves were subsequently replaced with prosthetic mechanical valves 4 years ago. Two years after the triple valve replacement, complete AV block developed with the symptoms of dizziness and syncope. A permanent pacemaker was implanted epicardially. Six months later the epicardial lead was replaced because of increased pacing threshold. A year later the epicardial lead had to be replaced because of increased threshold and capture failure to pace. To avoid further thoracotomy, a 'Medtronic 2188' electrode was implanted in the posterior left ventricular vein via the coronary sinus. Pacing threshold was 1.2 volt/0.4 msec. Five days later, the pacing threshold increased to 3.0 volt/0.4 msec. Prednisolone had been given for 10 months. The new system has been functioning well and the pacing threshold was 1.0 volt/0.4 msec at 11 months after implantation. Ventricular pacing via the coronary sinus can be an alternative to the epicardial pacemaker system in patient whose tricuspid valve have been replaced with mechanical prosthetic valve.
Adult ; Atrioventricular Block ; Coronary Sinus* ; Dizziness ; Electrodes ; Female ; Humans ; Mitral Valve ; Prednisolone ; Syncope ; Thoracotomy ; Tricuspid Valve ; Veins

We report a case of successful ventricular pacing via the coronary sinus in a 34 year-old female patient admitted because of repetitive dizziness and syncope. She had rheumatic valvular disease with mitral valve replacement 14 years earlyer. and the mitral, aortic and tricuspid valves were subsequently replaced with prosthetic mechanical valves 4 years ago. Two years after the triple valve replacement, complete AV block developed with the symptoms of dizziness and syncope. A permanent pacemaker was implanted epicardially. Six months later the epicardial lead was replaced because of increased pacing threshold. A year later the epicardial lead had to be replaced because of increased threshold and capture failure to pace. To avoid further thoracotomy, a 'Medtronic 2188' electrode was implanted in the posterior left ventricular vein via the coronary sinus. Pacing threshold was 1.2 volt/0.4 msec. Five days later, the pacing threshold increased to 3.0 volt/0.4 msec. Prednisolone had been given for 10 months. The new system has been functioning well and the pacing threshold was 1.0 volt/0.4 msec at 11 months after implantation. Ventricular pacing via the coronary sinus can be an alternative to the epicardial pacemaker system in patient whose tricuspid valve have been replaced with mechanical prosthetic valve.
Adult ; Atrioventricular Block ; Coronary Sinus* ; Dizziness ; Electrodes ; Female ; Humans ; Mitral Valve ; Prednisolone ; Syncope ; Thoracotomy ; Tricuspid Valve ; Veins

OBJECTIVE: In order to evaluate the prevalence of cytomegalovirus infection to terminally failing heart, cytomegaloviral DNA was detected in the explanted hearts of transplantation recipients. METHODS: DNA extractions were performed from explanted failing hearts(N=22) and normal hearts (N=5) and polymerase chain reactions(PCRs) were done for detection of late gene sequence coded pp150 phosphoprotein. The products were confirmed with electrophoresis on 1% agarose gel. In order to improve the sensitivity of detection in cytomegaloviral genome, nested PCRs were executed with the primers designed for the original 607 bp products. RESULTS: All patients had IgG anti-cytomegalovirus antibody and did not have IgM anti-cytomegalovirus antibody. Cytomegaloviral genomes in myocardium were detected by polymerase chain reaction. The 607bp products by PCRs were found in both explanted failing hearts(3 cases/22, 13.5%) and normal hearts(1 case/5, 20.0%). In nested PCRs, 186bp products were found in both failing hearts(LV 4/22, LA 3/20, RV 5/22, HA 0/17) and normal hearts(LV 2/5, LA 1/4, RV 1/5, RA 2/5). There was no significant change in the presence of cytomegaloviral DNA between failing and normal hearts. Total positivity of cytomegaloviral genome in explanted hearts was 44.4% according to nested PCR results. CONCLUSION: Cytomegalovirus was rarely observed in explanted hearts of terminal heart failure and nested PCR could enhance the sensitivity of cytomegaloviral genome detection. But cytomegalovirus might have no direct causal relationship in the development of terminal heart failure.
Cardiomyopathy, Dilated ; Cytomegalovirus Infections* ; Cytomegalovirus* ; DNA ; Electrophoresis ; Genome ; Heart Failure ; Heart* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Myocardium ; Polymerase Chain Reaction ; Prevalence* ; Sepharose

BACKGROUND/AIMS: Minimal hepatic encephalopthy in patients with clinically asymptomatic chronic progressive liver disease may have adverse effects on daily activity. We evaluated the differences in the cognitive function of patients with chronic hepatitis and liver cirrhosis group according to the Child-Pugh classification. METHODS: We enrolled 61 consecutive chronic liver disease patients. We used the following study instruments: visual continuous performance test, a spatial memory test, the Wisconsin card-sorting test chosen from Neuroscan and STIM system (Study of the Usefulness of Computerized Neuropsychological Test, Neurosoft company, New York, NY, USA), a global-local processing test and an electroencephalogram (EEG). RESULTS: A significant correlation was found between neurologic abnormalities and the degree of liver disease. The result of the neuropsychological test and the EEG showed that cognitive function decreased according to the severity of chronic liver disease, especially in liver cirrhosis. Cirrhotic patients, especially in Child-Pugh C group, exhibited selective deficits in complex attention and fine motor skills as well as visual spatial perception, with preservation of memory. CONCLUSIONS: The STIM and EEG are simple, subjective and reproducible methods and may be used as early detection methods of minimal hepatic encephalopthy.
Adult ; Chronic Disease ; Cognition ; *Electroencephalography ; Female ; Hepatic Encephalopathy/*diagnosis/etiology ; Hepatitis, Viral, Human/complications ; Humans ; Liver Cirrhosis/complications ; Male ; Middle Aged ; *Neuropsychological Tests