To clarify the exact role of endomyocardial biopsy in the diagnosis and monitoring of adriamycin-induced cardiotoxicity and to observe the actual relationship between pathologic changes and cardiac dysfunction, a cross-sectional clinical study was conducted. Echocardiography was used to evaluate cardiac dysfunction in 18 patients who had received chemotherapy including adriamycin(mean dose : 410mg/m2 of B.S.A.) without clinical evidence of congestive heart failure, and in 19 normal controls. Six patients receiving adriamycin underwent 7 transfemoral endomyocardial biopsy procedures, and the specimens were evaluated by light and electron microscopy for evidence of drug-related cardiotoxicity. Indexes of cardiac systolic function obtained by M-mode echocardiography(left ventricular dimension, excursion of interventricular septum and left ventricular posterior wall, shortening fraction and ejection fracton) did not show any statistically significant difference between patients who received adriamycin and normal controls. In transmitral flow-velocity curves recorded by Doppler echocardiography with a 2.25MHz probe, the patients showed less E peak velocity and decreased E/A ratio compared with normal controls, which suggests left ventricular diastolic dysfunction in the patients who received adriamycin. All the specimens of the endomyocardial biopsy showed significant pathologic changes of adriamycin indnced cardiotoxicity which was characterized by myofibrillar loss and vacuolization of the cytoplasm. In 2 specimens, pathologic grade was II, while 5 specimens showed pathologic changes of grade III and further chemotherapy with adriamycine was not done in thse 5 cases. From these results it is suggested that pathologic changes precede the clinical onset of congestive cardiomyopathy in the patients receiving adriamycin and left ventricular diastolic dysfunction occurrs before ejection fraction falls to subnormal levels. We conclude that sequential endomyocardial biopsy is absolutely indicated for exact diagnosis and monitoring of adrinamycin-induced cardiotoxicity to prevent the development of irreversible and often fatal cardiomyopathy.
Biopsy ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cytoplasm ; Diagnosis ; Doxorubicin* ; Drug Therapy ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Humans ; Microscopy, Electron

Clinical study was done on 119 patients with atrial fibrillation in the aspect of underlying diseases, particulary. The results were as follow : 1) In the underlying diseases of atrial finbrillation, rheumatic heart disease, hepertension and ischemic heart disease were common, which occupied 27.8%, 22.7% and and 15.1%, respectly. No apparent underlying disease was found in 21.0%, but in the transient atrial fibrillation, no apparent underlying disease in 42.9%. 2) There were no significant correlations between the ventricular rate, amplitude of f wave and underlying diseases of atrial fibrillation. 3) Complications were found in 29.4% of all cases, such as congestive heart failure(22.7%), embolism(6.7%). Otherwise, atrial fibrillation without underying cardiovascular diseases, congestive heart failure was found only(7.7%).
Atrial Fibrillation* ; Cardiovascular Diseases ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Humans ; Myocardial Ischemia ; Rheumatic Heart Disease

No abstract available.
Pulmonary Alveolar Proteinosis*

The authors have recently experienced a case of conjunctival papilloma which was developed on whole conjunctiva. The 6-year-old girl has soft, pinkish and pedunculated culated growth with delicate finger like processes in the right eye. The processes are scattered all over the mucous membrane of the bulbar and palpebral conjunctiva in considerable numbers. It is probable that many of these pedunculated types are of viral origin and that their spreads are due to contact infection. The papilloma of viral origin has no evidence of distant metastasis or malignant changes. The treatment was performed by electric cauterization with hyfricator and the result has been excellent up to date, 6 months after cauterization.
Cautery ; Child ; Conjunctiva ; Female ; Fingers ; Humans ; Mucous Membrane ; Neoplasm Metastasis ; Papilloma*

Fibrous dysplasia of bone is a relatively rare condition characterized by fibrous tissue replacement of skeleton, usually not disabling, of slow progress, and showing a tendency to become arrested. It may be monostotic (confined to one bone) or Polyostotic (situated in many bones). The etiology of fibrous dysplasia is unkown but it is now believed to be a developmental error in which primitive fibrous tissue proliferates within the bony medulla and encroaches upon the cortex from within. This paper reports the one case of polyostotic fibrous dysplasia. The diagnosis was made by clinical, radiological and histological findings. The review of literatures was made briefly.
Diagnosis ; Fibrous Dysplasia of Bone ; Fibrous Dysplasia, Polyostotic ; Skeleton

Recently limb sparing surgery is accepted as an alternative method in the management of muskuloskeletal tumors of the extremity without undue compromise to the patient s life. But the limb sparing procedure results in large osseous and soft tissue defects. To fill these defect, several options have been used such as tumor prosthesis, temporary spacer with cementation, allograft, and autograft(fresh, autoclaved, low heat treated, and extracorporeal irradiated). To identify the indica- tions ot' individual option, we studied 66 cases of musuloskeletal tumors of extremity which were treated with wide or marginal resection and reconstructive surgery from June, 1990 to June, 1997, in which 48 cases were osteosarcomas, 3 chondrosarcomas, 2 synovial sarcomas. I liposarcoma, 1 giant cell tumor, I malignant lymphoma, and 10 metastatic bone tumors. The location of the lesion were distal femur in 24, proximal tibia in 24, proximal femur in 9, proximal humerus in 6, tibial midshaft in 1. distal radius in 1, and calcaneus in 1. In Enneking stages about primary bone tumors 6 cases were IIA, 42 IIB, and 8 III. We reconstructed the osseous defect with tumor prosthesis in 22 cases, temporary spacer in 9(later, 4 cases was changed to tumor prosthesis for staged operation), allograft in 25, and autograft in 14(low heat treated in 2, irradiated in 12). Total functional result by Enneking system was 71.5% . 80.8% with tumor prosthesis, 50.5% with temporary spacer, 70% with allograft, 75.3% with autograft. Infections were occurred in 18% of the patients treated with tumor prosthesis, 34% with allograft, 0% with temporary spacer or low heated autograft, and 18% with irradiated autograft. Delayed union or nonunion was occurred in l5% of the patients treated with allograft, 40% with autograft. There were 2 cases of metal failure and 2 cases of graft fracture using autograft. In conclusion, we propose that the indication of the tumor prosthesis is for the skeletally matured patient, patient with high-grade malignant tumor, older patients, and patient who have limited life expectancy. The reconstruction with allograft have several advantages for the patients with henign bone tumor and locally aggressive or low-grade malignant tumor. The temporary spacer may be used as staged operations for the skeletally immature patient and patient who have an extreme hone and soft tissue defects after limb sparing operation. The recycling autograft may be applied to the patients at any age with minimal bony involvement of tumor. The low heat treated autograft may be useful in the patients requiring intercalary reconstruction, and the irradiated autograft may he useful in the patients with periarticular involvement.
Allografts ; Autografts ; Calcaneus ; Cementation ; Chondrosarcoma ; Extremities* ; Femur ; Giant Cell Tumors ; Hot Temperature ; Humans ; Humerus ; Life Expectancy ; Liposarcoma ; Lymphoma ; Osteosarcoma ; Prostheses and Implants ; Radius ; Recycling ; Sarcoma, Synovial ; Tibia ; Transplants

To evaluate the effectiveness of transesophageal echocardiography (TEE) for detecting potential intracardiac sources of cerebral emboli. We used both TEE and precordial conventional transthoracic echocardiogyrphy (TEE) in 27 patients with cerebral infarction. Group 1 had no clinical cardiac abnormality. And group 2 had cardiac abnormalities upon clinical examination. In group 1 (N= 18), TEE defined morphologic abnorrnalities in six patients (three with atrial appendage thrombus, two with patent foramen ovale, one with atrial septal aneurysm), whereas precordial echocardiography none. Although both echocardiogrpahic techniques revealed cardiac abnorrnalities in eight patients out of group 2 (N=9) only TEE could disclose left atrial appendage thrombus in six patients. We suggest that patients of cerebral infarction. Without demonstrable causes by conventiona studies including two-dimensional echocardiography. Should undergo TEE with the Valsalva maneuver.
Atrial Appendage ; Cerebral Infarction ; Echocardiography ; Echocardiography, Transesophageal* ; Foramen Ovale, Patent ; Humans ; Infarction* ; Intracranial Embolism ; Thrombosis ; Valsalva Maneuver

The criteria for differentiation of wide QRS tachycardias by electrocardiogram were evaluated in 24 cases of ventricular tachycardia(VT) and 8 cases of supraventricular tachycardia with wide QRS of various causes. There were some differences in Koreans from western countries due to plenity of idiopathic ventricular tachycardias(VTs) and infrequency of VTs by ischemic heart diseases. The characteristics were as follows : 1) Heart rate, QRS duration, QRS axis, distribution of RBBB and LBBB patterns, and QRS configurations of V1 and V6 leads were of limited values for differentiation of wide QRS tachycardias. 2) AV dissociation with or without capture beat and fusion bear was found in 63 % of VTs and very useful for differential diagnosis. Concordance of precordial leads was not frequently noted(2 cases) and and usually favored VT. 3) In LBBB patterns, notching of S wave, interval from Q wave to nadir of S wave greater than or equal to 60 msec, and R wave duration greater than or equal to 30 msec in V1 or V2 lead were present in 60%, 90%, and 29% of VTs respectively. The findings were also noted in accessory pathway conduction of supraventricular tachycardia. 4) Electrical alternans was present in 71% of VTs but also found in accessory pathway conduction of atrial fibrillation.
Atrial Fibrillation ; Axis, Cervical Vertebra ; Diagnosis, Differential* ; Electrocardiography* ; Heart Rate ; Myocardial Ischemia ; Tachycardia* ; Tachycardia, Supraventricular

Myocardial infarction is usually associated with thrombotic occlusion of an artherosclerotic coronary artery. Reperfusion induced by administration of thrombolytic agents may presserve myocardial function and reduce mortality. At a mean of 272 minutes from symtom onset, 7 patients with acute myocardial infarction received recombinant tissue-type Plasminogen Activator. The results are as followings: 1) Reperfusion of the infarct-related artery was observed in all of the 5 patients in whom coronary angiography was performed 19 hour after initiation of drug infusion. Ergonovine challenge test, done in 1 patient who showed normal coronary artery, did not induced coronary spasm. 2) The maximal value of Creatine Kinase and Creatine Kinase-MB(2098+/-2107U/L and 728+/-532U/L, respectively) occured at 7.2+/-4.3 hour, respectively. A nadir value of fibrinogen(42+/-21% of the preinfusion value) occured at 3.1+/-2.0 hour. 3) Major bleeding episodes occured in 3 patients. Major cardiac events were angina followed by percutaneous transluminal coronary angioplasty in 1 patient; cardiogenic shock in 2 patients, one of whom also experienced recurrent ventricular tachycardia;reinfarction in 1 patient, 3 of the 7 patients died.
Angioplasty, Balloon, Coronary ; Arteries ; Coronary Angiography ; Coronary Vessels ; Creatine ; Creatine Kinase ; Ergonovine ; Fibrinolytic Agents ; Hemorrhage ; Humans ; Mortality ; Myocardial Infarction* ; Reperfusion ; Shock, Cardiogenic ; Spasm ; Tissue Plasminogen Activator*

Myocardial infarction is usually associated with thrombotic occlusion of an artherosclerotic coronary artery. Reperfusion induced by administration of thrombolytic agents may presserve myocardial function and reduce mortality. At a mean of 272 minutes from symtom onset, 7 patients with acute myocardial infarction received recombinant tissue-type Plasminogen Activator. The results are as followings: 1) Reperfusion of the infarct-related artery was observed in all of the 5 patients in whom coronary angiography was performed 19 hour after initiation of drug infusion. Ergonovine challenge test, done in 1 patient who showed normal coronary artery, did not induced coronary spasm. 2) The maximal value of Creatine Kinase and Creatine Kinase-MB(2098+/-2107U/L and 728+/-532U/L, respectively) occured at 7.2+/-4.3 hour, respectively. A nadir value of fibrinogen(42+/-21% of the preinfusion value) occured at 3.1+/-2.0 hour. 3) Major bleeding episodes occured in 3 patients. Major cardiac events were angina followed by percutaneous transluminal coronary angioplasty in 1 patient; cardiogenic shock in 2 patients, one of whom also experienced recurrent ventricular tachycardia;reinfarction in 1 patient, 3 of the 7 patients died.
Angioplasty, Balloon, Coronary ; Arteries ; Coronary Angiography ; Coronary Vessels ; Creatine ; Creatine Kinase ; Ergonovine ; Fibrinolytic Agents ; Hemorrhage ; Humans ; Mortality ; Myocardial Infarction* ; Reperfusion ; Shock, Cardiogenic ; Spasm ; Tissue Plasminogen Activator*