PURPOSE: Acute cardiac ischemia under the age of 45 years is uncommon. This study was to evaluate the prevalence of various risk factors, the angiographic characteristics, and the prognosis in young patients with acute cardiac ischemia compared with that in older patients. METHODS: A review was retrospectively done of 554 patients with acute cardiac ischemia from January 2002 to December 2002. The patients were divided into two groups: patients under 45 years old (75 patients) and patients over 45 years old (479 patients). The clinical features which were compared between the two groups were demographic features, risk factors (cigarette smoking, history of hypertension and diabetes, hypercholesterolemia, hypertriglyceridemia, and family history of ischemic cardiac disease), coronary angiographic findings, and prognosis. RESULTS: The incidence of acute cardiac ischemia in patients under 45 years old was 13.5% (75/554). Three clinical risk factors, a history of cigarette smoking, a positive family history coronary artery disease, and hypertriglyceridemia, were significantly more prevalent in the young patients. Angiographically, normal or minimal coronary obstructions were more frequently found in the young patients, and significant coronary obstructions were more frequently found in the older patients. However the incidences of single-vessel disease and multi-vessel disease between young patients and older patients were not different. Young patients with acute cardiac ischemia do not have a more favorable prognosis than older patients. CONCLUSION: Acute cardiac ischemia is found in young patients with less extensive disease, but young patients do not have a more favorable prognosis than older patients.
Coronary Artery Disease ; Humans ; Hypercholesterolemia ; Hypertension ; Hypertriglyceridemia ; Incidence ; Ischemia* ; Middle Aged ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking ; Young Adult*

PURPOSE: The most significant advance in treatment of acute myocardial infarction is reperfusion therapy with fibrinolytics and percutaneous coronary intervention (PCI). The aim of this study was to assess the efficacy of reperfusion and the clinical outcomes of patients with acute myocardial infarction (AMI) who underwent fibrinolytic therapy. METHODS: A retrospective chart review was done for 226 patients with acute myocardial infarction who met the criteria for fibrinolytic therapy. We compared the thrombolysisin-myocardia-infarction (TIMI) flow in angiography of the infarct-related artery and the clinical outcomes between patients with and without fibrinolytic therapy. Also we analyzed the effects of fibrinolytics in various treatment modalities. The clinical outcomes included the 30-day mortality, repeat AMI/unstable angina, and coronary artery bypass graft (CABG). RESULTS: Angiography after fibrinolytic therapy revealed TIMI grades 0/1, 2, or 3 flow in 15.1%, 21.4%, and 63.5% of vessels, respectively, but in patients without fibrinolytic therapy those percent were 35.0%, 26.0%, and 39.0%, respectively. A significantly increased mortality was seen in patients with lower TIMI grade flow (11.1%, 0%, and 0.8% with TIMI grade 0/1, 2 and 3, respectively, p =0.001). The 30-day mortality were significantly lower in patients with fibrinolytic therapy than in patients without fibrinolytic therapy, particularly in patients with TIMI grade 0-2 flow. There was no significant difference in the 30-day mortality and the clinical outcomes among patients with fibrinolytic therapy, emergency PCI, and delayed PCI. CONCLUSION: Fibrinolytic therapy improved the TIMI flow in angiography and reduced the 30-day mortality.
Angiography ; Arteries ; Coronary Artery Bypass ; Coronary Vessels* ; Emergencies ; Humans ; Mortality ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Prognosis* ; Reperfusion* ; Retrospective Studies ; Thrombolytic Therapy* ; Transplants

PURPOSE: The purpose of this study was to investigate the usefulness of a qualitative bedside test for detection of cardiac troponin I (Cardiac STATus(TM)) in evaluating patients with acute chest pain in emergency settings. MATERIAL AND METHODS: In 147 patients who had chest pain without ST-segment elevation on their electrocardiograms, we evaluated the sensitivity and the specificity of the new, rapid, bedside troponin I assay for acute myocardial infarction (AMI) and acute cardiac ischemia (ACI). Patients whose samples were taken at least 4 hours after the onset of pain were selected. RESULTS: Cardiac STATus(TM) was positive in 28 patients (19.0%). Among 31 patients with AMI, Cardiac troponin I was positive in 19 (61.3%) patients. Among 95 patients with ACI, Cardiac STATusT M was positive in 24 patients (25.3%). The results were false positive in 12/31 patients (38.7%) for AMI and in 71/119 patients (59.7%) for ACI. The negative predictive value of the Cardiac STATus(TM) was 90.5% for AMI and 65.0% for ACI. During the 30 days of follow-up, there were 4 deaths and 12 cases of non-fatal AMI. Cardiac troponin I proved to be independent predictor of cardiac events. CONCLUSION: In contrast to its excellent specificity (0.92), the sensitivity (0.61) of the Cardiac STATus(TM) assay was poor. Thus, we conclude that this test is not highly sensitive for early detection of myocardial-cell injury. Negative test results were associated with low risk, but did not allow safe discharge of patients with chest pain from the emergency setting. Positive results of Cardiac STATus(TM) were associated with unfavorable outcomes.
Chest Pain* ; Electrocardiography ; Emergencies* ; Follow-Up Studies ; Humans ; Ischemia* ; Myocardial Infarction ; Sensitivity and Specificity ; Thorax* ; Troponin I

Systemic lupus erythematosus frequently has thoracic involvement among connective tissue diseases. One of the pleuropulmonary manifestations is diffuse interstitial lung disease including nonspecific interstitial pneumonia(NSIP). NSIP if a newly classified disease among interstitial lung diseases. Systemic lupus erythematosus has a better prognosis than usual interstitial peumonia(UIP) and responds well to steroids. In this report, a 34 year-old woman who complained of a dry cough, and exertional dyspnea for 2 months is described. The chest X-ray showed fine reticular opacities and a mild honeycomb appearance in both basal lungs. High resolution computed tomography(HRCT) showed bilateral patchy areas of ground-glass attenuation and a mild honeycomb appearance in the subpleural of both the lower and the middle portion of the lung fields. An open lung biopsy showed prominent lymphocytic interstitial inflammation and fibrosis with small are as with a honeycomb appearance. This case was diagnosed as NSIP associated with systemic lupus erythematosus and was managed with oral steroids. Here we report a case of nonspecific interstitial pneumonia associated with systemic lupus erythematosus confirmed by HRCT and an open lung biopsy with a review of the relevant literature.
Biopsy ; Connective Tissue Diseases ; Cough ; Dyspnea ; Female ; Fibrosis ; Humans ; Inflammation ; Lung ; Lung Diseases, Interstitial* ; Lupus Erythematosus, Systemic* ; Prognosis ; Steroids ; Thorax

Benign metastasizing leiomyoma usually occurs in women and is associated with a past hysterectomy in 80% of the cases, which is a rare entity. The patient was a 39-year-old woman who complained of cough and sputum. She underwent hysterectomy beacuse of benign leiomyoma ten years age. Chest X-ray showed nodular lesion in the left lung field. Chest CT showed a 3cm sized round well defined mass at left hilum with mild indentation of segmental bronchi of left upper lobe and a small tiny nodule in right lower lung field. Nodular lesion of left upper lobe was resected by thoracotomy.Pathological evaluation showed benign spindle-like cells having nuclei without cytotic atypia similar to those of benign leiomyoma. Immunohistochemical stainings for desmin and smooth muscle actin were positive. Therefore these nodules are considered as benign metastasizing leiomyoma from a uterine leiomyoma. We report this case with the review of literature.
Actins ; Adult ; Bronchi ; Cough ; Desmin ; Female ; Humans ; Hysterectomy ; Leiomyoma* ; Lung* ; Muscle, Smooth ; Sputum ; Thorax ; Tomography, X-Ray Computed

BACKGROUND: Survivin belongs to the inhibitor of apoptosis family, and it has recently been found to be expressed in most solid tumors. Therefore, its expression is suggested to have prognostic significance. However, no data are available concerning the significance of survivin for the carcinogenesis of bladder cancer. METHODS: In order to induce urothelial tumor in the rat urinary bladder, 0.05% N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) was administered to male Sprague-Dawley rats for 30 weeks. We used immunohistochemistry to investigate the expressions of survivin, HSP90, Bcl-2 and Bax in rat bladder carcinogenesis. RESULTS: Urothelial cell hyperplasia, papilloma, non-invasive urothelial carcinoma and invasive urothelial carcinoma appeared at 5, 10, 20 and 30 weeks, respectively. The expressions of survivin and HSP90 increased sequentially from normal mucosa, hyperplasia, papilloma, non-invasive urothelial carcinoma to invasive urothelial carcinoma. The expressions of Bcl-2 and Bax did not increase, however the number of cases with more than 1 of Bcl-2/Bax expression ratio increased sequentially during the progression of urothelial lesion. The expression of survivin showed a statistically significant correlation with the expression of HSP90 and the Bcl-2/Bax expression ratio. CONCLUSIONS: Our findings suggest that survivin may be involved in the carcinogenesis of rat bladder and its expression is correlated with the expression of HSP90 and the Bcl-2/Bax expression ratio.
Animals ; Apoptosis ; bcl-2-Associated X Protein* ; Butylhydroxybutylnitrosamine ; Carcinogenesis* ; Humans ; Hyperplasia ; Immunohistochemistry ; Male ; Mucous Membrane ; Papilloma ; Rats* ; Rats, Sprague-Dawley ; Urinary Bladder Neoplasms ; Urinary Bladder*

BACKGROUND: In the severe community-acquired pneumonia, it has been known that the immune status is occasionally suppressed. This study was performed to identify the immunologic markers related with the prognostic factors in severe community-acquired pneumonia. METHODS: 23 patients with severe community-acquired pneumonia were involved in this study, and divided into survivor (16) and nonsurvivor (7) groups. In this study, the medical history, laboratory tests(complete blood counts, routine chemistry profile, immunoglobulins, complements, lymphocyte subsets, cytokines, sputum and blood culture, urine analysis), and chest radiographs were scrutinized. RESULTS: 1) Both groups had lymphopenia(total lymphocyte count 995.6±505.7/mm2 in the survivor and 624.0±287.6/mm2 in the nonsurvivor group). 2) The T-lymphocyte count of the nonsurvivor group(295.9±203.0/mm2) was lower than the survivor group(723.6±406.5/mm2) (p<0.05). 3) The total serum protein(albumin) was 6.0±1.0(2.7±0.7) g/dl in the survivor and 5.2±1.5(2.3±0.8)g/dl in the nonsurvivor group. The BUN of the noncurvivor group(41.7±30.0mg/dl) was higher than that of the survivor group(18.9±9.8mg/dl)(p<0.05). The creatinine concentration was higher in the nonsurvivor group(1.8±1.0mg/dl) than that in the survivor group(1.0±0.3mg/dl)(p<0.05). 4) The immunoglobulin G level was higher in the survivor group (1433.0±729.5mg/dl) than in the nonsurvivor group(849.1±373.1mg/dl)(p<0.05). 5) The complement C3 level was 108.0±37.9mg/dl in the survivor group and 88.0±32.1mg/dl in the nonsurvivor group. 6) A cytokine study showed an insignificant differenne in both groups. 7) Chronic liver disease, DM, and COPD were major underlying diseases in both groups. CONCLUSION: These results suggest that decreased a T-lymphocyte count and immunoglobulin G level, and an increased BUN and creatinine level may be associated with the poor prognosis of severe community-acquired pneumonia.
Biomarkers ; Chemistry ; Complement C3 ; Complement System Proteins ; Creatinine ; Cytokines ; Humans ; Immunoglobulin G ; Immunoglobulins ; Immunologic Factors* ; Liver Diseases ; Lymphocyte Count ; Lymphocyte Subsets ; Pneumonia* ; Prognosis* ; Prospective Studies* ; Pulmonary Disease, Chronic Obstructive ; Radiography, Thoracic ; Sputum ; Survivors ; T-Lymphocytes

Nodular pulmonary amyloidosis is one of the rare manifestation of amyloid disease. It is known to be caused by anyloid L fibrils in the majority of case. We experienced an unusual case of a forty-one year-old woman who was presented with multiple nodular lesion on the chest X-ray. CT-guided core needle bilpsy, performed on the lesion, showed apple green birefringes, when stained Congo red and examined under polarized light. Ultrastructurally, there are randomly oriented, forming densed networks, and consists of fine, 7.5 to 10nm diameter, rigid, non-branching filaments of various lengths in electron-microscopic finding. We report a case of primary diffuse nodular pulmonary amyloidosis only localized in the lung, which was confirmed by CT guided core needle biopsy.
Amyloid ; Amyloidosis* ; Biopsy, Large-Core Needle ; Congo Red ; Female ; Humans ; Lung* ; Needles ; Thorax

PURPOSE: Acute traumatic subdural hematoma (SDH) increases after severe traumatic brain injury (TBI) and leads to high mortality. The time to operation is a correctable prognostic factor in TBI, but the timing of hematoma evacuation still remains controversial. We assessed the correlation between operative timing and mortality in traumatic acute SDH. METHODS: We conducted a retrospective study over an 8-year period in 163 surgical patients with acute traumatic SDH. Information was obtained about demographic, clinical, and radiological findings, surgical management, and mortality at discharge. RESULTS: Overall, 85 patients (52.1%) died, and 47 patients (28.8%) showed good recovery. The patients who underwent earlier surgery were more likely to have severe head injury. The time to operation in patients that died was shorter than patients with good recovery. The mean time for evacuation [Ed-Is this the same as time to surgery, or is this specifically when the hematoma was removed? Please clarify.] was 351.7+/-220.5 minutes in patients who died and 395.5+/-363.3 minutes in patients with good recovery. Patients undergoing surgery within 4 hours of injury had a mortality rate of 54.4% versus 50.9% receiving surgery after 4 hours. But the risk ratio for time spent to surgery increased until 240 minutes and then decreased. Logistic regression on patients with 240 minutes until surgery showed that the probability of death increased with time to surgery. CONCLUSION: Patients who undergo surgery within 180 minutes after injury have a lower probability of death than those with delayed surgery.
Brain Injuries ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural ; Hematoma, Subdural, Acute ; Humans ; Logistic Models ; Odds Ratio ; Retrospective Studies

OBJECTIVE: To evaluate the clinical indications and incidence of emergency peripartum hysterectomy by dermographic characteristics by a retrospective review based on hospital data of 98 patients over 8 years. METHODS: We reviewed their medical records of the 98 cases of peripartum hysterectomy among 50,338 deliveries, from January. 1992 to December. 1999, at St Mary, Kang Nam St Mary, and Holy Family hospital of Catholic University. RESULTS: The total incidence of peripartum hysterectomy was 98/50,338 (0.19%), Cesarean hysterectomy was performed in 96 of 22,561 Cesarean sections (0.43%) and in 2 of 27,777 vaginal deliveries (0.01%). The higher the age, the higher incidence of peripartum hysterectomy was noted and the most common indication for hysterectomy was abnormal adherent placentation (45.48%) followed by uterine atony (39.80%). During peripartum hysterectomy, patients were transfused with mean 10.04 pints. Although one maternal death occurred, maternal morbidity remained high (51.02%), including postoperative febrile condition in 15 (15.3%), intraoperative urologic injury in 11 patients (11.2%). CONCLUSION: There is a strong association between advancing age and incidence of peripartum hysterectomy. The data identify abnormal adherent placentation as the primary cause for peripartum hysterectomy and then considering the mean volume of blood loss more than 10 pints of blood should be prepared before emergency hysterectomy.
Cesarean Section ; Emergencies* ; Female ; Humans ; Hysterectomy* ; Incidence ; Maternal Death ; Medical Records ; Peripartum Period* ; Placentation ; Pregnancy ; Retrospective Studies ; Uterine Inertia