BACKGROUND AND OBJECTIVES: For patients with bilateral carotid artery stenosis, simultaneous bilateral carotid endarterectomy is rarely performed due to a higher perioperative risk for death and strokes. We assessed the immediate and long-term outcomes of simultaneous bilateral carotid stenting (SBCS) for internal carotid stenosis in patients at high surgical risk. MATERIALS AND METHODS: We analyzed 10 patients who underwent SBCS for de novo stenoses of both internal carotid arteries (ICA). Included were those who had 60% to 99% stenosis of extracranial ICAs irrespective of neurologic symptoms and had more than 2 risk factors of Mayo grade III (medical risks) or IV (neurologic risks). RESULTS: The patients had a mean age of 67+/-7 years. Technical success was achieved in all lesions. The mean percent diameter stenosis was reduced from 79+/-13% to 8+/-8%. A total of 21 Wallstents were deployed at 20 lesions. One patient had a minor stroke just after the procedure which was completely resolved with local injection of urokinase. There were no deaths, major strokes or myocardial infarctions during the 30 day follow-up. Six months imaging studies were available on all 9 eligible patients with 18 lesions by duplex sonography and angiography. Late clinical follow-up at a mean of 15.1+/-8.1 months revealed no occurrence of neurologic event or death. CONCLUSION: SBCS is feasible, safe and effective to treat bilateral de novo ICA stenoses in patients at high surgical risk. The procedure, however, is investigational and more experience is required to define its role in the treatment of this patient population.
Angiography ; Carotid Artery, Internal* ; Carotid Stenosis* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Neurologic Manifestations ; Risk Factors ; Stents* ; Stroke ; Urokinase-Type Plasminogen Activator

BACKGROUND AND OBJECTIVES: he patients with atrial septal defect generally have no symptoms in the childhood, and have nonspecific symptoms such as dyspnea on exertion, fatigue, and palpitation even in the late period of adult. Thus delayed diagnosis for whom surgical correction was undoubtedly needed remains to be resolved. Accordingly, the simple and noninvasive method such as electrocardiography in patients with atrial septal defect having the nonspecific symptoms or having no symptoms warrants to be developed. This study was performed to see whether the crochetage pattern on R wave in inferior limb leads is effective for the electrocardiographic diagnosis of atrial septal defect and relates to the magnitude of left to right shunt. METHODS: Our subjects were 129 patients diagnosed as the atrial septal defect by the echocardiography and cardiac catheterization from January 1992 to June 1998. We selected 57 persons, as control group, who showed the normal findings under the echocardiography and also showed the incomplete right bundle branch block on the electrocardiography. We compared the frequency of the crochetage pattern in inferior limb leads between the two groups. Also we compared the frequency of the crochetage pattern before operation and after operation according to the quantity of the left to right shunt in the operated 40 patients with atrial septal defect. RESULTS: ) The crochetage pattern was observed in 61.2% in patients with atrial septal defect and its frequency was greater than that of the control group (38.6%, p=0.005). 2) The crochetage pattern was disappeared by the operation in 16/29 patients (55.2%, p=0.001). 3) The frequency of disappearance of the crochetage pattern after operation differed significantly according to shunt severity: 72.2% for a Qp/Qs> or =3.0 group, 18.2% for a Qp/Qs<3.0 group (p=0.015). CONCLUSION: The crochetage pattern on R wave in inferior limb leads was helpful to the electrocardiographic diagnosis of the atrial septal defect. The disappearance of the crochetage pattern after operation was correlated with shunt severity.
Adult ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Delayed Diagnosis ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography* ; Extremities* ; Fatigue ; Heart Septal Defects, Atrial* ; Humans

BACKGROUND AND OBJECTIVES: Spontaneous progression of severe congestive heart failure is structurally characterized by cellular degeneration and multiple foci of myocardial cell death. The cardiac troponin I (cTnI), one of the subunits of the troponin regulatory complex, binds to actin and inhibits interaction between actin and myosin. cTnI is uniquely expressed in the adult human myocardium, and an increase in its circulating levels is highly indicative of myocardial injury. In this study, we addressed the usefulness of cTnI as a sensitive and specific molecular marker for severity in patients with congestive heart failure. MethodscTnI, creatinin kinase-MB (CK-MB), and myoglobin were assessed in 59 patients with severe congestive heart failure diagnosed by the echo-cardiography and gated equilibrium blood pool heart scan. Also we assesed cTnI, creatinin kinase-MB (CK-MB), and myoglobin in 25 persons without cardiac disease in echocardiography. RESULTS: 1) The cTnI con-centration was 89.6+/-69.3 pg/mL in patients with congestive heart failure and its level was greater than that of the control group (22.4+/-17.1, p=0.001). 2) The cTnI level differed significantly according to left ventricular ejection fraction (EF), 117.3+/-73.8 pg/mL in patients with EF\<40% (28 patients), 66.3+/-44.5 pg/mL in patients with EF> or =40% (31 patients), 22.4+/-17.1 pg/mL in the control group (25 persons) (p=0.001). CONCLUSION: cTnI was useful as a specific and sensitive serum molecular marker in patients of congestive heart failure. And its level reflected the severity of congestive heart failure.
Actins ; Adult ; Cell Death ; Echocardiography ; Equidae ; Estrogens, Conjugated (USP)* ; Heart ; Heart Diseases ; Heart Failure* ; Humans ; Myocardium ; Myoglobin ; Myosins ; Stroke Volume ; Troponin I* ; Troponin*

PURPOSE: Althoughpancreas injury is rare in abdominal trauma,it posesa challengeto the surgeon because its clinicalfeaturesare not prominentand the presence of main duct injurycannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. METHODS: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosedas having pancreas injury by using an explo-laparotomy. Patients successfully treated bynon-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. RESULTS: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34)). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases). Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due tomassive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively,three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. CONCLUSION: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverseoutcomes.
Head ; Hemorrhage ; Humans ; Male ; Neck ; Necrosis ; Pancreas ; Pancreatectomy ; Shock, Septic ; Wounds, Nonpenetrating

PURPOSE: Clinical features of Pancreatic Neuroendocrine Tumors (PETs) vary according to the hormone secreted and to the heredity of the tumors. Malignant PETs are common among nonfunctioning PETs (NFTs) whereas the majority of functioning PETs (FTs) are benign. Our goal was to determine the clinical features and prognosis of PETs stratified by the WHO classification scheme and AJCC-UICC 7TH TNM staging. METHODS: We selected for study 30 patients with PETs, including one case of nesidiolastosis, who presented at our clinic between April 1992 and June 2010. Clinicopathological features were studied retrospectively. PETs were classified as benign, uncertain malignant, well differentiated carcinoma, or poorly differentiated carcinomas by the WHO classification. For statistical analysis, Student's t-test, the Chi-square test, and the Kaplan-Meier method were utilized. RESULTS: Nine cases were FTs and twenty one cases were NFTs. The average size of the FTs was smaller than that of the NFTs (1.71 vs 4.33, p=0.04). The head of the pancreas was most commonly involved (33.3% of FTs; 47.6% of NFTs) but the locations of the tumors were not different. Insulinoma was the most common (66.7%, 6/9) among FTs. The incidence of malignant tumors was 33.3% and 55.0% among, respectively, FTs and NFTs. The 5-year disease-free survival rate of patients with benign PETs (FTs and NFTs), and of patients with functioning well-differentiated carcinomas was 100%. However, the 5-year disease-free survival rates of patients with nonfunctioning well- and poorly-differentiated carcinomas were 66.7% and 0%. CONCLUSION: Among patients with Pancreatic Neuroendocrine Tumors, malignant tumors are more common among NFTs than FTs. Poorly-differentiated carcinomas have a worse prognosis while all FTs regardless of their WHO classification fail to show any disease recurrence.
Disease-Free Survival ; Head ; Heredity ; Humans ; Incidence ; Insulinoma ; Neoplasm Staging ; Neuroendocrine Tumors ; Pancreas ; Prognosis ; Recurrence ; Retrospective Studies

The case of enteric fever and bowel perforation caused by nontyphoidal Salmonella spp. is extremely rare. We report a case of a 28-year-old man who suffered from enteric fever with complicated a small bowel perforation, which is a known complication of S. typhi and S. paratyphi infections. The culprit later proved to be nontyphoidal group D Salmonella spp. in our case.
Adult ; Humans ; Salmonella* ; Typhoid Fever*

The case of enteric fever and bowel perforation caused by nontyphoidal Salmonella spp. is extremely rare. We report a case of a 28-year-old man who suffered from enteric fever with complicated a small bowel perforation, which is a known complication of S. typhi and S. paratyphi infections. The culprit later proved to be nontyphoidal group D Salmonella spp. in our case.
Adult ; Humans ; Salmonella* ; Typhoid Fever*

BACKGROUND AND OBJECTIVES: The pathologic Q wave was once considered to be a sign of transmural myocardial infarction (MI), but the exact meaning of the pathologic Q wave remains to be elucidated. To evaluate the meaning of the pathologic Q wave using magnetic resonance imaging (MRI) investigations, which has recently emerged as a state-of-the-art diagnostic modality within cardiology. SUBJECTS AND METHODS: Thirty eight consecutive patients with acute myocardial infarction were enrolled in this study. MRI and coronary angiography were performed in all patients during their admission. A 32 segment model was used to analyze the MRI findings. Just before MRI, the electrocardiograms of all the patients were checked and the presence of the pathologic Q wave evaluated. The ischemic territories in each patient were quantified by the number of dysfunctional segments. Myocardial necrosis was determined by the area of delayed hyperenhancement in contrast enhanced MRI, and the myocardial necrosis index per segment was defined as the ratio of the hyperenhanced area to that of the entire segment. The total necrosis index was defined as the sum of all the myocardial necrosis indices in a patient, and the average necrosis index of dysfunctional segment (ANI) was calculated from the total necrosis index/number of dysfunctional segments in a patient. The transmurality of infarction was also assessed. RESULTS: Of all 38 patients, 26 showed a pathologic Q wave on ECG (Group A), whereas the other 12 did not (Group B). The number of dysfunctional segments, total necrosis index and frequency of transmural infarction (defined by infarct transmurality> or = 75% of wall thickness) were no different between the two groups. The infarct transmurality over 25 or 50% and ANI were significantly different between the two groups. In a multivariate analysis, an infarct transmurality over 50% and ANI were significant factors in determining the presence of a pathologic Q wave. CONCLUSION: By an in vivo analysis of myocardial necrosis, as determined by MRI in acute myocardial infarction, an infarct transmurality over 50% and average necrosis index of dysfunctional segments (ANI) might be significant factors in the genesis of a pathologic Q wave.
Cardiology ; Coronary Angiography ; Electrocardiography ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Myocardial Infarction* ; Necrosis

BACKGROUND: In this study, we retrospectively analyzed the outcomes of aortic valvuloplasty in pediatric age. MATERIAL AND METHOD: Between January 1993 and March 2004, 35 patients underwent aortic valvuloplasty for aortic stenosis (AS) or aortic regurgitation (AR). The mean age was 81.1+/-61.5 (1~223) months. The mean follow up was 50.8+/-30.2 (3~121) months. Nine patients had AS, 21 had AR, and 6 had AS and AR. Valve morphology was tricuspid in 24 patients, bicuspid in 9, quadricuspid in 1, and unicuspid in 1. The mean peak pressure gradients of AS were 72.0+/-33.0 mmHg, and the mean grades of AR were 3.1+/-0.9. RESULT: There was one late mortality without early mortality. After operation, AS improved with mean peak pressure gradients of 23.5+/-21.0 mmHg (p<0.05), and AR improved with mean grades of 1.9+/-0.8 (p<0.05). At mean follow up of 35.0+/-23.0 months, AS maintained with mean peak pressure gradients of 31.5+/-24.0 mmHg, but AR progressed with mean grades of 2.8+/-1.3 (p<0.05). Reoperation was required in 6 patients 38.3+/-21.8 months after the original operation. The actuarial figures for freedom from reoperation at 2, 5 and 8 years were 96.9+/-3.1%, 79.5+/-5.5%, and 56.8+/-11.4%, respectively. Age at operation, presence of AS, preoperative severity of AS or AR, and morphology of aortic valve were not significant risk factors for reoperation, and improvement of AS or AR. CONCLUSION: Aortic valvuloplasty showed good immediate postoperative valve function. Aortic valvuloplasty offers children many years with tolerable valve function and allows to postpone aortic valve replacement or Ross procedure in pediatric patients.
Aortic Valve ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Bicuspid ; Child ; Follow-Up Studies ; Freedom ; Humans ; Mortality ; Reoperation ; Retrospective Studies ; Risk Factors

Primary cardiac malignancy is very rare. Angiosarcoma is the most frequent malignant cardiac tumor and associated with a very unfavourable outcome. We report the case of an cardiac angiosarcoma complicated with cardiac tamponade revealed by echocardiography with pericardiocentesis and confirmed histopathologically in a 25 years old man.
Adult ; Cardiac Tamponade* ; Echocardiography ; Heart Neoplasms ; Hemangiosarcoma* ; Humans ; Pericardiocentesis