BACKGROUND AND OBJECTIVES: The combination of platelet glycoprotein IIb/IIIa inhibitors and a low dose thrombolytic agent may produce early Thrombolysis In Myocardial Infarction (TIMI) 3 flow and a high rate of ST elevation resolution in an ST elevation acute myocardial infarction (STEMI). The clinical effect of tirofiban combined with low dose alteplase, prior to primary percutaneous coronary intervention (PCI) in STEMI, were evaluated on the ST elevation resolution, TIMI flow and 30-day clinical outcomes. SUBJECTS AND METHODS: Following aspirin, clopidogrel and standard heparin, 45 patients with STEMI were randomized into 2 groups; tirofiban administration (Group I; n=23, 64+/-10 years; 15 male) or combined administration of tirofiban with 40 mg alteplase prior to primary PCI (Group II; n=22, 59+/-11 years; 19 male). The pre- and post-interventional TIMI flow grades, ST elevation resolution and bleeding complications were compared between the two groups. The major adverse cardiac events (MACE) were compared between the two groups during 30-days of clinical follow-up. RESULTS: Group II had a higher pre-interventional TIMI flow (TIMI flow> or =2: 34.8% vs. 90.9%, p<0.0001) and rate of ST elevation resolution (49.0+/-27.8% vs. 66.6+/-27.2%, p=0.045) than Group I. A major bleeding complication developed in 1 (5.0%) Group II patient, and minor bleeding complications developed 1 patient from each group (Group I; 9.5% vs. Group II; 10%, p=0.959). CONCLUSION: Combined administration of tirofiban with alteplase prior to primary PCI leads to a higher TIMI flow and more frequent ST elevation resolution, without bleeding complications, compared to a single administration of tirofiban.
Angioplasty ; Aspirin ; Blood Platelets ; Electrocardiography ; Follow-Up Studies ; Glycoproteins ; Hemorrhage ; Heparin ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Thrombolytic Therapy ; Tissue Plasminogen Activator*

Pseudolymphoma or lymphoid hyperplasia is a rare clinicopathologic disease which occurs in a variety of sites including the skin, orbit, salivary glands, gastrointestinal tract, lung, and other organs. Lymphoid hyperplasia of the gastrointestinal tract can be categorized into four clinicopathologic groups: focal lymphoid hyperplasia of the stomach, focal lymphoid hyperplasia of the small intestine, focal lymphoid hyperplasia of the rectum, and nodular lymphoid hyperplasia of the gastrointestinal tract. We experienced two cases of nodular lymphoid hyperplasia of the small intestine with hypogammaglobulinemia (IgA deficiency) and without hypogammaglobulinemia presented with epigastric discomfort. Esophagogastroduodenoscopy and small bowel series showed 0.2~.5 cm sized small, numerous Yamada-I or Yamada-II polypoid lesions from the duodenal bulb to the terminal ileum in two cases. Histologic finding of the duodenal bulb showed small round mature lymphocyte infiltration and reactive follicle with germinal center in two cases. We report two cases with a brief reviews of literature.
Agammaglobulinemia ; Endoscopy, Digestive System ; Gastrointestinal Tract ; Germinal Center ; Hyperplasia* ; Ileum ; Intestine, Small ; Lung ; Lymphocytes ; Orbit ; Pseudolymphoma ; Rectum ; Salivary Glands ; Skin ; Stomach

BACKGROUND: Sedation with propofol during esophagogastroduodenoscopy (EGD) has been increased. However, the use of propofol during EGD may have significant side effects such as hypoxemia and hypotension. We studied the dose of propofol for adequate sedation without side effects during EGD. METHODS: From June to August 2003, 46 healthy persons who visited St. Carollo hospital health management center for diagnostic EGD were enrolled for this study. Twenty four persons (Group A) were given a initial loading dose of propofol 60 mg (in person below 60 kg by body weight) and 80 mg (in person above 60 kg by body weight). Twenty two persons (Group B) were given a initial loading dose of propofol 80 mg and 100 mg at the same way. Additional dose of propofol which was injected once a minute until adequate sedation by 20 mg and maintenance dose during EGD were compared between two groups. Respiration rate, pulse rate, blood pressure, arterial oxygen saturation and ejection fraction of left ventricle were monitored. RESULTS: There were no significant differences between two groups in monitored parameters. Persons in group B were given significantly lower additional dose (p<0.001) and maintenance dose (p<0.05) of propofol. However total amount of propofol during EGD was not significantly different between two groups. CONCLUSION: In relatively young (under 60 years of age) and healthy persons without significant medical problem, 80 mg and 100 mg of propofol (in person below 60 kg and above 60 kg by body weight) as initial loading dose of propofol during EGD are more clinically relevant than 60 mg and 80 mg of propofol (in person below 60 kg and above 60 kg by body weight).
Anoxia ; Arterial Pressure ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Heart Rate ; Heart Ventricles ; Humans ; Hypotension ; Oxygen ; Propofol* ; Respiratory Rate

BACKGROUND AND OBJECTIVES: Myocardial ruptures, including: ventricular free wall rupture (VFWR) and ventricular septal rupture (VSR), after acute myocardial infarction (AMI), are fatal complications. Recently, ubiquitous use of echocardiographs, and other imaging techniques, allows us to diagnose these complications in the antemortem period. Thus, this study retrospectively evaluated the clinical characteristics of patients with myocardial ruptures following AMI. SUBJECTS AND METHODS: 620 patients that had had AMIs, between January 1999 and June 2001, were analysed for the purpose of this study. Myocardial ruptures were diagnosed from their clinical symptoms, echocardiographs, and pericardiocenteses or cardiac catheterizations. The clinical characteristics of the patients with myocardial ruptures (n=15) were compared to those patients with myocardial infarction, without rupture (n=397), from their Q waves. RESULTS: The patients with myocardial ruptures were older than those without (67+/-9.7 years vs 60+/-11.7 years, p<0.05), and ruptures were more frequent in women (66.7% vs 25.2%, p<0.001). The frequency of systemic hypertension, DM, and the distribution of infarction sites were similar in both groups. Also, clinical characteristics between patients with VFWR, and those with VSR, were similar. Of the patients with VFWR (n=8), 7 suddenly died, and 1 was alive directly following surgery. Of the patients with VSR (n=7), 4 died. CONCLUSION: Myocardial rupture is a fatal complication of AMI, which is more frequent in women, and the patients with ruptures, in our study, were older than those without.
Cardiac Catheterization ; Cardiac Catheters ; Female ; Heart Rupture ; Humans ; Hypertension ; Infarction ; Myocardial Infarction* ; Pericardiocentesis ; Retrospective Studies ; Rupture* ; Ventricular Septal Rupture

PURPOSE: In some patients with an implantable cardioverter defibrillator (ICD), multiple episodes of electrical storm (ES) can occur. We assessed the prevalence, features, and predictors of ES in patients with ICD. MATERIALS AND METHODS: Eighty-five patients with an ICD were analyzed. ES was defined as the occurrence of two or more ventricular tachyarrhythmias within 24 hours. RESULTS: Twenty-six patients experienced at least one ES episode, and 16 patients experienced two or more ES episodes. The first ES occurred 209 +/- 277 days after ICD implantation. In most ES cases, the index arrhythmia was ventricular tachycardia (65%). There were no obvious etiologic factors at the onset of most ES episodes (57%). More patients with a structurally normal heart (p = 0.043) or ventricular fibrillation (VF) as the index arrhythmia (p = 0.017) were in the ES-free group. Kaplan-Meier estimates and a log-rank test showed that patients with nonischemic dilated cardiomyopathy (DCMP) (log-rank test, p = 0.016) or with left ventricular ejection fraction < 35% (p = 0.032) were more likely to experience ES, and that patients with VF (p = 0.047) were less affected by ES. Cox proportional hazard regression analysis showed that nonischemic DCMP correlated with a greater probability of ES (hazard ratio, 3.71; 95% confidence interval, 1.16-11.85; p = 0.027). CONCLUSION: ES is a common and recurrent event in patients with an ICD. Nonischemic DCMP is an independent predictor of ES. Patients with VF or with a structurally normal heart are less likely to experience ES.
Adult ; Aged ; Defibrillators, Implantable/*adverse effects ; Female ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular/*diagnosis/etiology ; Ventricular Fibrillation/*diagnosis/etiology

Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as 'pinch-off syndrome'. 'Pinch-off syndrome' refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter.
Back Pain ; Catheters ; Central Venous Catheters ; Clavicle ; Drug Therapy ; Female ; Fractures, Spontaneous ; Heart Atria ; Humans ; Lung Neoplasms* ; Lung* ; Middle Aged ; Pulmonary Artery ; Radiography, Thoracic ; Ribs ; Thrombosis ; Vascular Access Devices

Recently, intra-Muscular Stimulation (IMS) therapy is being increasingly used for musculoskeletal pain. This procedure is generally regarded as a safe procedure for the general public. Some cases of iatrogenic pneumothorax caused by acupuncture have been reported in the medical literature. However, a case of an IMS therapy associated pneumothorax has not reported. We experienced two cases of iatrogenic pneumothorax after IMS therapy. A 62 year-old man received IMS therapy on the right shoulder due to posterior neck pain. After IMS therapy, acute dyspnea and chest discomfort developed. The other patient was a 74 year-old woman who also received IMS therapy. This patient experienced a nonproductive cough and acute dyspnea after the treatment. As the popularity of this form of alternative medicine increases, we might expect to see more cases of iatrogenic pneumothorax. Physicians should be aware of the adverse events associated with IMS therapy.
Acupuncture ; Aged ; Complementary Therapies ; Cough ; Dyspnea ; Female ; Humans ; Middle Aged ; Musculoskeletal Pain ; Neck Pain ; Pneumothorax* ; Shoulder ; Thorax

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disorder characterized by a nonneoplastic proliferation of distinctive histiocyte cells within lymph node sinuses and lymphatics in extranodal sites. SHML occurs worldwide and is primarily a disease of childhood and early adulthood. A 26-yr-old man presented with painless palpable lymph node in cervical area. Radiographic studies revealed pleural effusion with lymphadenopathy and calcification in mediastinum. The cervical lymph node biopsy showed dilated sinuses filled with histiocytes with clear cytoplasm. The cells stained positive with CD68 and S-100. These cytologic and immunohistochemical findings were considered consistent with the diagnosis of SHML.
Adult ; Antigens, CD/metabolism ; Antigens, Differentiation, Myelomonocytic/metabolism ; Histiocytes/pathology ; Histiocytosis, Sinus/*diagnosis/metabolism/pathology ; Humans ; Lymph Nodes/pathology ; Male ; Neck ; Pleural Effusion/*radiography ; S100 Proteins/metabolism ; Tomography, X-Ray Computed

Paragonimiasis is a parasitic infection that occurs following the ingestion of infectious Paragonimus metacercariae, which occurs as a result of eating raw or undercooked freshwater crabs or crayfish. Pulmonary paragonimiasis is the most common clinical manifestation of this infection. Human paragonimiasis occurs sporadically. We experienced a case of pulmonary paragonimiasis in a 35-year-old woman with left lower chest pain. The patient had hypereosinophilia and a pleural effusion. The diagnosis was confirmed by positive ELISA (Enzyme-linked immunosorbent assay) that detected Paragonimiasis westermani antibody in the serum. We treated the patient with praziquantel for two days at a daily dosage of 75 mg/kg. Left pleuritic pain and pleural effusion improved after treatment. However, similar symptoms and pleural effusion developed recurrently for the first 3 courses of treatment with praziquantel. Upon the fourth round of treatment, the patient made a full recovery.
Adult ; Astacoidea ; Chest Pain ; Eating ; Enzyme-Linked Immunosorbent Assay ; Female ; Fresh Water ; Humans ; Metacercariae ; Paragonimiasis ; Paragonimus ; Pleural Effusion ; Praziquantel ; Recurrence

BACKGROUND: Tei index is a Doppler-derived index of combined systolic and diastolic myocardial performance proposed to be a promising noninvasive measurement of overall cardiac function, calculated as the sum of isovolumic contraction (ICT) and isovolumic relaxation times (IRT) divided by ejection time (ET). This study aimed to investigate the effect of changes in preload on Tei index. SUBJECTS AND METHOD: The study population was 10 patients with chronic renal failure who are on regular hemodialysis (HD). They were 3 men and 7 women with a mean age of 45.3+/-12.4 years old. The complete 2-dimensional and Doppler echocardiography including recordings of mitral inflow and left ventricular outflow were performed using HP SONOS 1500 equipment before and after HD. Body weight was measured using electric scale before and after HD. Blood pressure and pulse rate were measured by an automated cuff measurement every 1 hour throughout HD. Hematocrit was monitored noninvasively and continuously using the Crit-Line instrument (In-Line Diagnostics, Riverdale, UT, USA) during HD. RESULTS: There were no significant changes in systolic and diastolic blood pressure, RR interval, left ventricular end-diastolic and end-systolic dimension, left atrial dimension, and left ventricular ejection fraction during HD. The mean body weight loss during HD was 2.1+/-0.65 kg. The percentage of reduction of body weight was 4.1+/-1.56%. Changes in total blood volume at the end of HD were compared with that of baseline -11.79+/-5.51%. The percent change in total blood volume during the HD correlated significantly with the amount of change in body weight (r=0.678, p<0.05) and percent change in body weight (r=0.835, p<0.01), respectively. ICT before HD and at the end of HD were 39+/-13.0, 42+/-24.1 msec (p=NS). IRT before HD and at the end of HD were 76+/-29.1, 95+/-28.5 msec (p<0.01) and , ET before HD and at the end of HD were 317+/-18.1, 289+/-9.0 msec (p<0.01), respectively. Tei index before HD was 0.36+/-0.10, and the index at the end of HD were 0.47+/-0.13 (p<0.001). CONCLUSION: When there is a change in preload during a short period, it seems that the effect of change in preload should be considered when using Tei index to assess ventricular function.
Blood Pressure ; Blood Volume ; Body Weight ; Echocardiography, Doppler ; Female ; Heart Rate ; Hematocrit ; Humans ; Kidney Failure, Chronic ; Male ; Relaxation ; Renal Dialysis ; Stroke Volume ; Ventricular Function