BACKGROUND: It is well known that intracoronary thrombolysis during the early period of acute myocardial infarction leads to the limitation of myocardial necrosis, preserves left ventricular function, and improves survivals. The recanalization rate of intracoronary rrokinase infusion into infarct-related coronary artery was known as 62-94 percents in previos studies. The various factors influence the outcome of intracoronary thrombolysis, including total dose of urokinase, time from onsrt of chest pain to thrombolysis. The purpose of this study was to evaluate whether the occlusion site morphology influences recanalization rates of intracoronary thrombolysis. METHODS: We evaluated infarct-related coronary artery morphology of 56 acute mycardial infarction patients who performed intracoronary thrombolytic therapy within 6-12 hours after the onset of acute myocardial infarction. Intracoronary urokinase infusion was performed at a rate of 25000 IU/minute. The presence of calcification, collaterals, side branches and the stump site morphologies(thrombus type, pencil type, cutting type) were identified on magnified 35mm cine frames. RESULTS: Reperfusion was successed in 34 patients and failed in 22 patients. There were no statistically significant difference in the pressure of calcification, collaterals, and side branches between success and failure groups. Intracoronary thrombus was identified in 21 percent of success group, but not in failure group. The reperfusion rates according to stump site morphology were 76% in thrombus type, 58% in cutting type, and 42% in pencil type(p<0.05). CONCLUSION: Our study indicates the presence of intracoronary thrombus and the morphology of thrombus type is more effective in intracoronary thrombolysis in acute myocardial infarction. The identification of types of the coronary obstruction will be helpful for the selection of intracoronary thrombolysis in acute myocardial infarction patients. And the results suggest that the difference of stump composition show different stump morphologies.
Chest Pain ; Coronary Vessels* ; Humans ; Infarction ; Myocardial Infarction* ; Necrosis ; Reperfusion ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Ventricular Function, Left

Carcinoma of the breast can produce cutaneous metastases which sbow highly diversified clinical pictures. The cutaneous metastases produce four definite clinical types: inflammatory carcinoma, telangiectatic carcinoma, nodular carcinoma, and carcinoma, en cuirasse. We present a case of 78-year-old nulliparous woman who had several painful dark purplish colored zosteriform papulovesicular eruptions, suggestive of herpes zoster, on the right breast, right axilla, scapular area, and upper arm for three month. Two month later, well dermacated linearly arranged erysipeloid eruptions appeared around the previous skin lesions and the right chest wall. Histopathological findings showed metastatic ductal carcinoma with massive vascular permeation but the primary focus was undetermined.
Female ; Humans ; Neoplasm Metastasis

We report a case of congenital giant pigmented nevus with malignant melanoma of brain in a 14-year-old male patient. He had giant pigmented nevus on the back and neck, and multiple satellite lesions over the whole body since birth. One year prior to visit to our hospital, the patient suffered from various neurologie symptoms including headache, nausea, vomiting, seizure and right side motor weakness. Flistologic findings of skin lesions were benign nevocytic nevi. Computed tomogram of brain demonstrated increased densities in the both fronto-parietal leptameninges and brain parenchyme. Histologic findings of brain parenchyme by stereotaxic long needle biopsy showed the infiltration of melanin containing atypical melanocytes. There was no evidence of malignant melanoma at other organs. All of these findings suggested that origin of malignant melanoma of brain parenchyme was leptomeninges rather than skin.
Adolescent ; Biopsy, Needle ; Brain* ; Headache ; Humans ; Male ; Melanins ; Melanocytes ; Melanoma* ; Nausea ; Neck ; Nevus ; Nevus, Pigmented* ; Parturition ; Seizures ; Skin ; Vomiting

Candidiasis is the most common fungal infection complicating the course of patients with hematologic malignant neoplasms. Although widespread organ involvement is characteristic of disseminated candidiasis, reports of skin are rare. Reports describing typical clinical and histopathological finding of cutaneous lesions are very important since it may enable a diagnosis of disseminated candidiasis to be made and thus antifungal therapy can be initiated earlier. A 50-year-old housewife was admitted with a 5-month history of fatigue and easy bruising. She was diagnosed as ha.ving acute myelocytic leukemia and treatment was begun with daunorubicin and cytosin, arabinoside. Eight days after the start of chemotherapy, she developed a fever and generalized tender well demacated erythematous to purplish papulonodular eruption. A biopsy specimen from the skin lesion showed perivascular mononuclear cell infiltration and spore and pseudohypae v,rere found within the dermis and subcutis in PAS stain. Cultures of one skin biopsy specimen and one of four blood sarnples grew Candida tropicalis. The patient was treated with intravenous amphotericin B for disseminated candidiasis. On the tenth day of antifun gal therapy, she developed cardiopulmonary arrest and died.
Amphotericin B ; Biopsy ; Candida tropicalis ; Candidiasis* ; Daunorubicin ; Dermis ; Diagnosis ; Drug Therapy ; Fatigue ; Fever ; Heart Arrest ; Humans ; Leukemia, Myeloid, Acute ; Middle Aged ; Skin Manifestations* ; Skin* ; Spores

No abstract available.
Mitral Valve Insufficiency*

This study was designed to investigate the effects of 8-week resistance exercise by using dumbell on the body composition, serum hormone profiles and feeding patterns in young and healthy female students with over 30% of body fat, aged 22 years in Masan, Korea. The subjects were all six, performed successfully the entire exercise-program. Anthropometry, serum lipid and neurohormone profiles of subjects were analyzed at 0, 4 and 8 weeks after exercise. And also their food and nutrient intakes were self-reported by 3-day record and food frequency questionnaire. Triceps skinfoldthickness of the subject students significantly reduced after the exercise to 46% less than before (p < 0.002). The serum concentrations of leptin, insulin and catecholamine appeared to decrease steadily, but not significantly. Total protein in serum increased significantly (p < 0.05), and Na (p < 0.005), K (p < 0.001) and Fe (p < 0.058) concentrations increased remarkably within the normal range. The 8-week resistance exercise tended to induce fiber consumption (p < 0.089) of subject students and changed the P/M/S ratio changed into the desirable way from 0.8 : 1 : 1 to 1 : 1 : 1, and that of n- 6/n-3 PUFA from 11 : 1 to 6 : 1. After taking exercise, the intake frequency of cookies (p < 0.058) and raymeun (p < 0.085) decreased, but finally this feeding pattern returned to the way as before even though at marginal significance. Consequently the resistance exercise may induce the desirable changes of body fat and improve serum lipid profiles and feeding patterns in young obese females.
Adipose Tissue ; Anthropometry ; Body Composition* ; Feeding Behavior* ; Female* ; Humans ; Insulin ; Korea ; Leptin ; Reference Values ; Surveys and Questionnaires

We analyzed the mRNA expression patterns of major potassium channel genes to determine the mechanism of hypokalemia in familial hypokalemic periodic paralysis. We used quantitative RT-PCR to examine the mRNA levels of both inward (KCNJ2, KCNJ6, and KCNJ14) and delayed rectifi er (KCNQ1 and KCNA2) potassium channel genes in skeletal muscle cells from both normal and patient groups, prior to and after exposure to 4 mM and 50 mM potassium buffers. Quantitative RT-PCR analysis revealed no changes in the mRNA levels of these genes in normal and patient cells on exposure to 4 mM potassium buffer. However, after exposure to 50 mM potassium buffer, which was used to induce depolarization, normal cells showed a signifi cant decrease in KCNJ2, KCNJ6, and KCNJ14 expression, but no change in KCNQ1 and KCNA2 expression. In contrast, patient cells showed no change in KCNJ2 and KCNJ6 expression, but an increase in KCNJ14 expression. Furthermore, KCNQ1 and KCNA2 showed decreased expression. We found that the expression levels of both inward and delayed rectifi er potassium channel genes in patient cells differ from those in normal cells. Altered potassium channel gene expression in patient cells may suggest a possible mechanism for hypokalemia in familial hypokalemic periodic paralysis.

BACKGROUND: Recently, a lower incidence of late potentials has been reported in patients with acute myocardial infarction after successful thrombolysis when compared with conventionally treated patients. In another recent study, however, no significant effect of thrombolytic therapy on any abnormal signal average electrocardiography was found at 13 days after acute myocardial infarction. The present study was designed to determine the prognostic significance of the signal average electrocardiography and to evaluate the possible value of this technique as a noninvasive tool for monitoring of coronary occlusion and reperfusion. METHODS: Signal averaging was performed by using a signal average electrocardiography with bidirectional filterings before coronary artery occlusion, at 5 minutes after coronary occlusion and on reperfusion in 20 cats. Three of them died due to malignant ventricular arrhythmia during reperfusion. In all cats, approximately 250 beats were averaged. All data were analysed at filter frequency 25 to 250Hz, 40 to 250Hz and 80 to 250Hz. The following quantitative high resolutional electrocardiographic variables were calculated by computer : 1) filtered total QRS duration, 2) duration of HFLA(high frequency low amplitude) signals under 40uV, 3) RMS voltage of terminal 40ms, 4) mean Voltage of terminal 40ms, 5) average noise voltage. RESULTS: At the filter frequency of 40 to 250Hz and 80 to 250Hz, the filtered QRS duration and duration of HFLA signals 40uV were significantly prolonged at 5 minutes after coronary artery occlusion than before coronary occlusion(p<0.01). At the filter frequency of 40 to 250Hz and 80 to 250Hz, the RMS voltage(terminal 40ms) and mean voltage(terminal 40ms) were significantly prolonged at 5 minutes after coronary artery occlusion than before coronary occlusion(p<0.01, p<0.01 respectively). At the filter frequency of 80 to 250Hz, the filtered QRS duration and at the filter frequency of 25-250Hz, the duration of HFLA signals at 40uV were significantly shortened during reperfusion than at 5 minutes after coronary artery occlusion(p<0.01, p<0.05 respectively). At the filter frequency of 40 to 250Hz and 80 to 250Hz, the RMS voltage(terminal 40ms) and mean Voltage(terminal 40ms) were significantly shortened during reperfusion than at 5 minutes after coronary artery occlusion(p<0.01, p<0.01 respectively). There was no significant change of the filtered QRS duration, duration of HFLA signals 40uV,RMS voltage(terminal 40ms) and mean Voltage(terminal 40ms) after reperfusion compared with those of control at the filter frequency of 25 to 250Hz, 40 to 250Hz and 80 to 250Hz respectively. CONCLUSION: These results suggest that the signal average electrocardiography could be a valuable tool for monitoring the state of coronary artery occlusion and reperfusion.
Animals ; Arrhythmias, Cardiac ; Cats* ; Coronary Occlusion ; Coronary Vessels* ; Electrocardiography* ; Humans ; Incidence ; Myocardial Infarction ; Noise ; Reperfusion* ; Thrombolytic Therapy

A 45 year old man was admitted for further examination of an abnormal shadow of the right posterior mediastinum. The patient suffered from dysesthesia in the right thoracic wall of dermatome T7. CT scan and MRI revealed that two separate tumors had developed in the right paravertebral area linked to the vertebral canal via an intervertebral foramina. One-stage removal of the tumors were performed safely through the right posterolateral thoracotomy following the resection of the rib head and vertebral pedicle. The tumors were confirmed as histologically neurilemomas. The postoperative course was uneventful.
Head ; Humans ; Magnetic Resonance Imaging ; Mediastinal Neoplasms ; Mediastinum* ; Middle Aged ; Neurilemmoma ; Paresthesia ; Ribs ; Thoracic Wall ; Thoracotomy ; Tomography, X-Ray Computed

BACKGROUND: Primary cardiac tumors are extremely rare. The most common type are benign myxomas, and these are almost completely curable with early surgery. Malignant tumors, however, such as sarcomas, are difficult to remove surgically, and their prognosis is known to be poor. In this study, data on patients who had undergone surgical treatment of cardiac tumor in the authors' hospital were collected and analyzed. MATERIAL AND METHOD: The subjects included 28 patients who had undergone surgical treatment of cardiac tumor from August 1993 to December 2008. Their medical records were reviewed and retrospectively analyzed. RESULT: The patients were aged from 20 to 76 years (mean age: 54.2+/-15.6), and 11 were male (39%) and 17 female (61%). Fifteen of them (54%) underwent emergency surgery to improve heart failure symptoms. The most common preoperative symptom was dyspnea (15 cases, 54%). Preoperative echocardiography was performed on all the patients. The average size of the tumor as measured during the operation was 7.0+/-6.9 cm (the average length of the long axis was 2~40 cm), and the sites of tumor attachment were the interatrial septum (18 cases, 64%), the left atrium (9 cases, 32%), the mitral valve annulus (2 cases, 7%), and the left ventricle (2 cases, 7%). The operation was performed with an incision through both atria in all the patients, and a complete excision was made in 25 cases (89%). According to the biopsy results, there were 4 cases of sarcoma (14%), 1 case of lipoma (4%), and 23 cases of myxoma (82%). The three cases in which the tumors were not completely excised were sarcomas. No operative deaths occurred after the operations. Outpatient follow-up was possible for 24 cases (86%), with a mean follow-up period of 46.8+/-42.7 months. Late death occurred in 3 of the 24 patients; each of these patients had sarcomas. Of these patients, the first had undergone two repeat surgeries, the second had metastatic sites removed, and the last had only chemotherapy. The average recurrence time was 12.7+/-10.8 months, and the average metastasis time was 20.5+/-16.8 months. CONCLUSION: Most cardiac tumors are benign myxomas. In principle, they should be surgically treated because they can create risks such as embolism, and can be radically treated when surgically removed. In most cases, however, malignant sarcomas are already considerably advanced with severe infiltration into the neighboring tissues at the time of diagnosis. The surgical removal of malignant sarcomas is known to be difficult because of the advanced stage and degree of infiltration. We suggest that excision of the removable portion of the tumor sites to alleviate symptoms such as heart failure can improve quality of life.
Aged ; Axis, Cervical Vertebra ; Biopsy ; Dyspnea ; Echocardiography ; Embolism ; Emergencies ; Female ; Follow-Up Studies ; Heart Atria ; Heart Failure ; Heart Neoplasms ; Heart Ventricles ; Humans ; Lipoma ; Male ; Medical Records ; Mitral Valve ; Myxoma ; Neoplasm Metastasis ; Outpatients ; Prognosis ; Quality of Life ; Recurrence ; Retrospective Studies ; Sarcoma