No abstract available.
Syringoma

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

The congenital ball-and-socket ankle joint is a rare condition and is associated with congenital shortening of the lower extrimity and various skeletal abnormalities of the foot. This disease entity was reported in the German literature by Politzer in 1931 and in the English literature by Lamb in 1958. Several series have been reported since, suggesting that the condition may not be as rare as generally thought. This case is, to our knowledge, the first reported in this country.
Ankle Joint ; Ankle ; Foot

We report a case of ciliated hepatic foregut cyst which was incidentally found in a 64 year-old man. The cyst, 6 cm in diameter, was unilocular, solitary and was located in the medial segment of left lobe, just below the Glisson's capsule. Microscopically, the cyst wall consisted of 4 layers; pseudostratified ciliated columnar epithelium, subepithelial loose connective tissue, smooth muscle bundles and an outermost fibrous capsule. Although cartilage or subepithelial sero-mucous glands were absent, the morphologic features of the cyst correspond with those of an incomplete form of brochogenic cyst.
Cysts

PURPOSE: To report a case of episcleral cartilaginous single tissue choristoma attached to pterygium with literature review. METHODS: A-65-year old woman had a pterygium. we found hard and movable mass attached to pterygium over medial rectus muscle when we excised pterygium. Excisional biopsy was done. RESULTS: This mass was confirmed as episcleral cartilaginous single tissue choristoma.
Biopsy ; Choristoma* ; Female ; Humans ; Pterygium

PURPOSE: The purpose was to evaluate the procedure-related complications of the TIPS and its clinical significance. MATERIALS AND METHODS: The materials consisted of 52 patients who had 57 TIPS procedures for the management of variceal bleeding due to portal hypertension. To detect the occurrence of complications during transhepatic needle puncture(from hepatic vein to the portal vein), contrast material was injected with the withdrawl of the puncture needle. RESULTS: Procedure-related complications occurred in 28 patients (54%) among 52 patients. The corn lications were biliary tree puncture(15 cases), transperitoneal puncture(14 cases), stent malposition(3 cases) stent migration(1 case), hepatic arteries puncture(1 case), splenic vein perforation(1 case), and paroxysmal tricular tachycardia(1 case). Three patients had acute stent thrombosis with rebleeding immediately after procedure. The procedure was repeated in two patients. One patient was expired due to rebleeding. CONCLUSION: The procedure related complications were clinically insignificant in most instances, when stent thrombosis or proxysmal ventricular tachycardia was developed.
Biliary Tract ; Esophageal and Gastric Varices ; Hepatic Artery ; Hepatic Veins ; Humans ; Hypertension, Portal ; Needles ; Portasystemic Shunt, Surgical* ; Punctures ; Splenic Vein ; Stents ; Tachycardia, Ventricular ; Thrombosis ; Zea mays

No abstract available.

BACKGROUND: Qunatitation of blood flow within the cardiac chambers has been tried using digitally recorded velocity information of color Doppler flow mapping (CDFM). However, the accuracy of CDFM has not been systematically assessed. The purpose of the study was to test the accuracy of digitally recorded velocity information obtained through CDFM. Method: Using the American Society of Echocardiography flow phantom, an in vitro steady flow experiment was performed. Eight different flow fields through the phantom (84, 139, 172, 192, 232, 237, 244, 436 mL/sec) were imaged by CDFM using Hewlett Packard Sonos 2500 and all data were stored in the magneto-optical disc. Multiple aliases were visible and 7 different Nyquist limits (17, 23, 27, 37, 42, 53, 58 cm/sec) were used for recording. A fully automatic computer algorithm was used to unwrap the aliases and to convert the CDFM to digital velocity. Among 9 consecutive values at each pixel along the centerline of the phantom, median value was chosen as a representative value, which was compared to the actual value. RESULTS: In the slow velocity region, CDFM tends to overestimate the true velocity, whereas in the fast velocity region, it underestimates. At the aliasing point of 2 times Nyquist limit, there is a marked turbulence and estimation of velocity is impossible;fter aliasing, velocity information of CDFM is totally unreliable. Velocity estimation of CDFM is the most accurate at the velocity region of the Nyquist limit and shows reasonable accuracy between 0.5 x Nyquist limit and 1.5 x Nyquist limit with the error of estimation less than 15%. Conclusion: Velocity information of CDFM is accurate in the limited region and is dependent on the Nyquist limit of each measurement;this can be explained by the effect of wall filter. Baseline-shift of CDFM should be limited to the region between 0.5 x Nyquist limit and 1.5 x Nyquist limit for accurate quantitation using velocity information of CDFM.
Echocardiography

Running for a long distance in runners with exercise-induced hypertension (EIH) increases high blood pressure (BP) which causes myocardial burden, inducing elevation of cardiac markers. It is assumed to be associated with endothelial dysfunction, but has not been studied so far. The purpose of this study is to exam the responses of anti-inflammatory, inflammatory, and endothelial regulation factors to 100 km ultra-marathon of athletes who have EIH. For this study, we obtain and analysis interleukin-6, tumor necrosis factor-α, interleukin-10 (IL-10), monocyte chemoattractant protein-1, creatine kinase and nitric oxide (NO) from 100 km ultra-marathoners before and right after the 100 km race. There were 40 volunteers who had ever won the 100 km marathon race before more than one time. They had the graded exercise test with measurement of BP for assessing EIH. Among them, eight athletes were categorized to normal control group (NCG) and 10 athletes were assessed by EIH group (EIHG). The graded exercise test with treadmill was performed for the maximal strenuous exercise and BP. EIH was diagnosed as <140/90 mm Hg in normal and ≥210 mm Hg in maximal exercise. Marathoners including EIHG (n=10) and NCG (n=8) participated in the race and blood extracted from them before the race and right after the race. As results, EIHG had lower IL-10 than NCG during resting states and after the 100 km race EIHG had significantly lower NO concentration than NCG. Therefore, the NO in the endothelial is inhibited during strenuous endurance exercise, resulting in vasoconstriction with increasing the BP.
Athletes* ; Cardiovascular Diseases ; Chemokine CCL2 ; Continental Population Groups ; Creatine Kinase ; Cytokines ; Exercise Test ; Humans ; Hypertension* ; Interleukin-10 ; Interleukin-6 ; Necrosis ; Nitric Oxide ; Running* ; Vasoconstriction ; Volunteers