There was no significant difference in morbidity and mortality between those that received simultaneous operation for coronary artery disease and peripheral vascular disease versus those that received coronary artery bypass graft alone. Simultaneous operation is also cost effective. A 46 year-old patient with resting chest pain and intermittent claudication was diagnosed as unstable angina and Leriche's syndrome. We performed simultaneous revascularization for coronary artery stenosis with internal mammary artery and right gastroepiploic artery and a bifurcated vascular graft interposition between in the aorta, left common iliac and right femoral arteries for Leriche's syndrome. The postoperative coronary angiogram and aortogram revealed a good patency of the arterial conduits and vascular graft. He has been followed for 12 months without any problem.
Angina, Unstable ; Aorta ; Chest Pain ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Femoral Artery ; Gastroepiploic Artery ; Humans ; Intermittent Claudication ; Leriche Syndrome ; Mammary Arteries ; Middle Aged ; Mortality ; Peripheral Vascular Diseases* ; Transplants

Bilateral popliteal artery entrapment syndrome is a rare vascular disease, which leads to ischemic claudication as a result of disturbance to the blood flow from the abnormal relationship of the popliteal artery to the gastrocnemius muscle, a fibrous band or the popliteus muscle in the young male population. A 58-years-old male patient, complaining of ischemic claudication, coldness and 3rd toe gangrene of left leg of 1 month's duration was admitted to our institution. His left ankle-brachial index was decreased; therefore, a femoral artery angiography was performed, which revealed a total occlusion below the distal superficial femoral artery of the left leg. An EKG revealed atrial fibrillation, suggestive of a thromboembolism of the popliteal artery due to atrial fibrillation; therefore, Urokinase thrombolysis was attempted. After the Urokinase thrombolysis, popliteal artery entrapment syndrome was diagnosed, with MRI then performed for an anatomical diagnosis. The popliteal artery entrapment was type I, where the popliteal artery was displaced medial to the Gastrocnemius head. After complete removal of the popliteal artery aneurysm, interposition was performed with a contra lateral greater saphenous vein graft. A mild right popliteal artery aneurysm still remained, but surgery was not performed. Currently, the patent is surviving, without complications. Herein, the good results obtained for the surgical treatment of a severely affected leg, and the conservative treatment of a mildly affected leg, are reported.
Aneurysm ; Angiography ; Ankle Brachial Index ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Diagnosis ; Electrocardiography ; Femoral Artery ; Gangrene ; Head ; Humans ; Leg ; Magnetic Resonance Imaging ; Male ; Muscle, Skeletal ; Peripheral Vascular Diseases ; Popliteal Artery* ; Saphenous Vein ; Thromboembolism ; Toes ; Transplants ; Urokinase-Type Plasminogen Activator ; Vascular Diseases

OBJECTIVE: Few studies on the clinical spectrum of automated pressure-controlled discography (APCD)-defined positive discs have been reported to date. Thus, the present study was undertaken to analyze clinical parameters critical for diagnosis of discogenic pain and to correlate imaging findings with intradiscal pressures and pain responses in patients with APCD-positive discs. METHODS: Twenty-three patients who showed APCD-positive discs were selected for analysis. CT discogram findings and the degrees of nuclear degeneration seen on MRI were analyzed in comparison to changes of intradiscal pressure that provoked pain responses; and clinical pain patterns and dynamic factors were evaluated in relation to pain provocation. RESULTS: Low back pain (LBP), usually centralized, with diffuse leg pain was the most frequently reported pattern of pain in these patients. Overall, LBP was most commonly induced by sitting posture, however, standing was highly correlated with L5/S1 disc lesions (p < 0.01). MRI abnormalities were statistically correlated with grading of CT discogram results (p < 0.05); with most pain response observed in CT discogram Grades 3 and 4. Pain-provoking pressure was not statistically correlated with MRI grading. However, it was higher in Grade 3 than Grade 4. CONCLUSION: APCD-positive discs were demonstrated in patients reporting centralized low back pain with diffuse leg pain, aggravated by sitting and standing. MRI was helpful to assess the degree of nuclear degeneration, yet it could not guarantee exact localization of the painful discs. APCD was considered to be more useful than conventional discography for diagnosis of discogenic pain.
Humans ; Intervertebral Disc ; Leg ; Low Back Pain ; Posture

Lemierre syndrome is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. The usual etiologic agent is Fusobacterium necrophorum. Lemierre syndrome was a common disease with a high mortality rate in the pre-antibiotic era. Since the advent of antibiotics and their widespread use for the treatment of pharyngeal infections, there has been a substantial decrease in the incidence of this malady and it has become a "forgotten disease". Prompt diagnosis and antibiotic therapy for Lemierre syndrome is essential to avoid morbidity and mortality. We describe here a case of Lemierre syndrome with multiple septic pulmonary emboli.
Anti-Bacterial Agents ; Diagnosis ; Fusobacterium necrophorum ; Incidence ; Jugular Veins ; Lemierre Syndrome* ; Mortality ; Pharynx ; Pulmonary Embolism* ; Thrombophlebitis

This study was undertaken to develop species-specific forward and universal reverse PCR primers for the detection of Streptococcus sobrinus. These primers target the variable regions of the 16S ribosomal RNA coding gene (rDNA) and their specificity was tested against 10 strains of S. sobrinus strains and 20 different species of oral bacteria using serial dilutions of the purified genomic DNA of S.sobrinus ATCC 33478T . Our data show that species-specific amplicons were obtained from all the S. sobrinus strains tested but not from other species. Both direct and nested PCR could detect as little as 400 pg and 4 fg of genomic DNA from S. sobrinus ATCC 33478T , respectively. This result suggests that these PCR primers are highly specific and sensitive and applicable to the detection of S. sobrinus.
Bacteria ; Clinical Coding ; Collodion ; DNA ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S ; Sensitivity and Specificity ; Streptococcus ; Streptococcus sobrinus

Inflammation has recently been implicated in cancer formation and progression. As tissue transglutaminase (TG2) has been associated with both inflammatory signaling and tumor cell behavior, we propose that TG2 may be an important link inducing interleukin-6 (IL-6)-mediated cancer cell aggressiveness, including cancer stem cell-like characteristics and distant hematogenous metastasis. We evaluated the effect of differential TG2 and IL-6 expression on in vivo distant metastasis of human ovarian cancer cells. IL-6 production in human ovarian cancer cells was dependent on their TG2 expression levels. The size and efficiency of tumor sphere formation were correlated with TG2 expression levels and were dependent on TG2-mediated IL-6 secretion in human ovarian cancer cells. Primary tumor growth and propagation in the peritoneum and distant hematogenous metastasis into the liver and lung were also dependent on TG2 and downstream IL-6 expression levels in human ovarian cancer cells. In this report, we provide evidence that TG2 is an important link in IL-6-mediated tumor cell aggressiveness, and that TG2 and downstream IL-6 could be important mediators of distant hematogenous metastasis of human ovarian cancer cells. Intervention specific to TG2 and/or downstream IL-6 in ovarian cancer cells could provide a promising means to control tumor metastasis.
Axis, Cervical Vertebra* ; Humans* ; Inflammation ; Interleukin-6 ; Liver ; Lung ; Neoplasm Metastasis* ; Ovarian Neoplasms* ; Peritoneum

Idiopathic hypereosinophilic syndrome is a rare systemic, leukoproliferative disorder characterized by eosinophil- mediated tissue injury causing multiple organ failure, including the heart. Cardiac involvement occurs in more than 75% of patients with hypereosinophilic syndrome. Cardiac manifestations include subendocardial fibrosis, thrombus leading to peripheral emboli, restrictive cardiomyopathy, and valvular dysfunction. It is more common in men than in women (9:1), and trends to present between the ages of 20 and 50 years. Presentation in childhood is unusual. We report for the first time a case of a 58-year-old man with idiopathic hypereosinophilic syndrome manifested by prosthetic aortic valve dysfunction that was successfully treated by steroid and hydroxyurea therapy after surgical valvular replacement.
Aortic Valve* ; Cardiomyopathy, Restrictive ; Female ; Fibrosis ; Heart ; Humans ; Hydroxyurea ; Hypereosinophilic Syndrome* ; Male ; Middle Aged ; Multiple Organ Failure ; Thrombosis

Congenital defects of the sternum are rare development anomalies. They result form the failure of the lateral sternal bars to fuse. This malformation may be associated with other ventral midline fusion defects and ectopia cordis. A complete sternal cleft is the rarest form and less than 10 cases have been reported in the medical literature. Here were report a 3-day-old boy with complete sternal cleft without other malformations, who underwent primary surgical repair. Surgical correction of complete sternal cleft should be performed in neonatal period whether the infant if symptomatic or not because it is usually simple, able to achieve good result and primary repair is usually feasible at this period.
Congenital Abnormalities ; Ectopia Cordis ; Humans ; Infant ; Male ; Sternum

The growth or rebleeding of the spontaneous ICH is catastrophic so that prevention of them is critical in management. We reviewed 233 cases of spontaneous ICH from Jan. 1990 to Dec. 1994 to evaluate the factors associated with the hematoma enlargement. The relationship among the admission time from hematoma onset, the systolic BP at admission, hemostatic parameter, liver dysfunction with rebleeding incidence were assessed. Also, hematoma shape, density, site, volume, and operation tiem from hematoma onset were evaluated. Hematoma growth was oserved at 26 patients(11.6%). Incidence of rebleeding was significantly associated in patients with shorter admission time from hematoma onset, high systoic BP at admission, inhomogenous, irregular-shaped hematoma at CT and liver dysfunction. The incidence of hematoma growth was higher in the early operation group but there was no significant relationship in statistic analysis. Patients admitted within 6 hours of hematoma onset, with irregular-shaped, inhomogenous hematoma on CT, and liver dysfunction should be observed closely for the enlargement of hematoma. The operation time might be delayed at least 6 hours after hematoma onset.
Cerebral Hemorrhage* ; Hematoma ; Humans ; Incidence ; Liver Diseases

No abstract available.
Endocardial Cushion Defects* ; Endocardial Cushions* ; Ultrasonics*